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1.
Phytomedicine ; 80: 153365, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33126168

RESUMO

BACKGROUND: Medical adherence is often higher in clinical trials than in real world practice. The aim of this study was to investigate the effects of traditional Chinese medicine (TCM) on medical adherence to hormonal therapy (HT) and survival outcome in ER (+) breast cancer patients in Taiwan. SUBJECTS AND METHODS: Using a nationwide longitudinal population-based database, we enrolled patients with newly diagnosed ER-positive breast cancer who had received HT, and followed for up to 5 years (N = 872). Medication adherence in terms of medication possession ratios (MPR) and patient outcome were evaluated with or without TCM exposure. We applied logistic regression and Cox proportional hazards (PH) analysis to identify factors, including TCM exposure, associated with adherence to HT and mortality. RESULTS: MPR to HT in general decreased over the 5-year period post breast cancer diagnosis. Both TCM and MPR to HT ≥ 80% were significantly associated with reduced risk of breast cancer-associated mortality. Subgroup analysis revealed that TCM annual visits ≥ 3 times with CHP prescription 1~90 days per year affected mortality reduction most significantly (HR: 0.26; 95% CI = 0.08-0.83; p < 0.05) compared to other TCM use. In contrast, using TCM (either short-term or long-term) was not associated with MPR in HT. CONCLUSIONS: Our results supported the potential advantage of TCM on breast cancer-associated mortality, whereas TCM use does not compromise medical adherence to HT. This study offers important insights in integrative therapy for HT in patients with estrogen receptor (+) breast cancer.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/psicologia , Adesão à Medicação/psicologia , Medicina Tradicional Chinesa/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Humanos , Adesão à Medicação/estatística & dados numéricos , Medicina Tradicional Chinesa/estatística & dados numéricos , Pessoa de Meia-Idade , Receptores Estrogênicos/metabolismo , Estudos Retrospectivos , Taiwan , Resultado do Tratamento , Adulto Jovem
2.
Rev Saude Publica ; 54: 118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237173

RESUMO

OBJECTIVE: To examine the HIV care cascade among trans women and travestis in São Paulo - Brazil, the most populous city in South America. METHODS: Using data from a cross-sectional study carried out between November 2016 and May 2017 in the city of São Paulo (Divas Research). Respondent driven sampling (RDS) was used to recruit 386 transgender women and travestis who participated in a HIV risk survey and were tested for HIV. The cascade was defined as HIV prevalence, HIV diagnosed, Antiretroviral (ART) Prescription, and currently on ART. A multiple analysis model was conducted to identify the association between sociodemographics and the cascade gaps. RESULTS: Of the trans women living with HIV, 80.9% were already diagnosed, 76.6% of them had been prescribed, of which 90.3% were currently on treatment. Those who were registered in care had a higher rate of ART (aPR 2.06; 95%CI 1.09-3.88). Trans women between 31-40 years old (aPR 1.65; 95%CI 1.09-2.50) and those older than 40 (aPR 1.59; 95%CI 1.04-2.43) had higher prevalence of ART. CONCLUSIONS: Our data suggest an increase in the testing and treatment policy implementation among trans women in the city of São Paulo, although gaps have been found in the linkage to care. However, young trans women and those not registered in health care service may benefit from efforts to engage this part of the population in care to improve HIV treatment and care outcomes.


Assuntos
Antirretrovirais/uso terapêutico , Continuidade da Assistência ao Paciente , Infecções por HIV/tratamento farmacológico , Qualidade de Vida/psicologia , Estigma Social , Pessoas Transgênero , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Adesão à Medicação/psicologia , Estudos Soroepidemiológicos , Marginalização Social/psicologia , Pessoas Transgênero/estatística & dados numéricos
3.
AIDS Patient Care STDS ; 34(11): 491-497, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33147084

RESUMO

There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Depressão/complicações , Depressão/psicologia , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Isolamento Social/psicologia , Estigma Social , Adulto , Depressão/epidemiologia , Discriminação Psicológica , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Autoimagem , Autoeficácia , Apoio Social , Estereotipagem , Estados Unidos/epidemiologia
4.
AIDS Patient Care STDS ; 34(11): 484-490, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33147086

RESUMO

The stigmatization of HIV infection impedes every step along the HIV continuum of care, particularly care engagement and retention. The differential effects of various sources of stigma on retention in HIV care have been the subject of limited research. We examined the accumulation of HIV stigma experiences over 1 year in relationship to treatment retention among 251 men and women marginally engaged in HIV care in the southeastern United States. Results showed that cumulative stigma experiences predicted poorer retention in care, with greater stigma experiences related to less consistency in attending scheduled medical appointments. HIV stigma originating from family members and acts of overt discrimination were the most frequently experienced sources of stigma and were most closely associated with disengagement from HIV care. In addition, analyses by gender indicated that retention in care for men was impacted by stigma to a greater extent than among women. These findings reaffirm the importance of HIV stigma as a barrier to HIV care and provide new directions for interventions to mitigate the negative effects of stigma on patients who are not fully engaged in HIV care. Clinical trials registration NCT104180280.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Retenção nos Cuidados/estatística & dados numéricos , Estigma Social , Estereotipagem , Adulto , Feminino , Infecções por HIV/epidemiologia , Disparidades em Assistência à Saúde , Humanos , Masculino , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Saúde da População Rural , População Rural , Sudeste dos Estados Unidos , Carga Viral
5.
PLoS One ; 15(11): e0241857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33152010

RESUMO

BACKGROUND: Organ transplantation is the most effective treatment for patients with end-stage organ failure. It has been actively carried out all over the world. Recently, eHealth interventions have been applied to organ transplant patients. This systematic review and meta-analysis aimed to evaluate the effects of eHealth interventions for improving medication adherence in organ transplant patients as compared to usual or conventional care alone. METHODS: We searched MEDLINE via PubMed, Excerpta Media dataBASE (EMBASE), the Cochrane Register Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and six domestic Korean databases to identify randomized controlled trials (RCTs) published up to April 17, 2020. Two reviewers independently selected relevant studies and extracted data. The quality and bias of the identified studies were assessed. To estimate the effect size, a meta-analysis of the studies was performed using the Cochrane Collaboration software Review Manager 5.3. PRISMA guidelines were followed. When statistical heterogeneity was greater than 80%, narrative synthesis was performed. RESULTS: Of the 1,847 articles identified, seven RCTs with a total of 759 participants met the inclusion criteria. The risk of bias assessment showed that the blinding of participants and personnel was high. In six studies, medication adherence (effect size = -0.18-1.30) and knowledge scores were not significantly different between those receiving eHealth interventions and the controls. CONCLUSIONS: Our findings suggest that eHealth interventions were similar to standard care or advanced care for improving medication adherence, and they faired equally well for improving medication knowledge. Therefore, eHealth interventions can be used for medication adherence of organ transplant patients. More research is needed to provide well-designed eHealth intervention to improve the medication adherence and knowledge of organ transplant patients. PROTOCOL REGISTRATION NUMBER: CRD42017067145 16/05/2017.


Assuntos
Intervenção Baseada em Internet/tendências , Adesão à Medicação/psicologia , Telemedicina/métodos , Humanos , Transplante de Órgãos/métodos , Qualidade de Vida
6.
PLoS One ; 15(11): e0242491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33201934

RESUMO

We formulate a sex-structured deterministic model to study the effects of varying HIV testing rates, condom use rates and ART adherence rates among Adolescent Girls and Young Women (AGYW) and, Adolescent Boys and Young Men (ABYM) populations in Kenya. Attitudes influencing the Kenyan youth HIV/AIDS control measures both positively and negatively were considered. Using the 2012 Kenya AIDS Indicator Survey (KAIS) microdata we constructed our model, which we fitted to the UNAIDS-Kenya youth prevalence estimates to understand factors influencing Kenyan youth HIV/AIDS prevalence trends. While highly efficacious combination control approach significantly reduces HIV/AIDS prevalence rates among the youth, the disease remains endemic provided infected unaware sexual interactions persist. Disproportional gender-wise attitudes towards HIV/AIDS control measures play a key role in reducing the Kenyan youth HIV/AIDS prevalence trends. The female youth HIV/AIDS prevalence trend seems to be directly linked to increased male infectivity with decreased female infectivity while the male youth prevalence trend seems to be directly associated with increased female infectivity and reduced male infectivity.


Assuntos
Infecções por HIV/epidemiologia , Adesão à Medicação/psicologia , Cooperação do Paciente/psicologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Atitude Frente a Saúde , Criança , Feminino , HIV/patogenicidade , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Adesão à Medicação/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Prevalência , Fatores de Risco , Sexo Seguro/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
7.
Seizure ; 83: 208-215, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33227659

RESUMO

OBJECTIVES: Anti-seizure medication (ASM) non-adherence contributes to treatment gap and increases mortality and morbidity associated with epilepsy. Beliefs about medications are considered better predictors of ASM non-adherence than clinico-demographic factors. We aimed to look into ASM non-adherence rates among adults with epilepsy (AWE), identify the contributing barriers and determine whether medication beliefs were more powerful predictors than clinico-demographic factors. METHODS: This was a cross-sectional study of AWE receiving ASMs. Participants (n = 304) were assessed by validated questionnaires, for non-adherence (8-item Morisky Medication Adherence Scale) and perceptions of ASMs (Beliefs about Medicines Questionnaire) along with clinico-demographic details. RESULTS: Our group with high literacy and low-income had a high non-adherence rate (55 %) despite having positive beliefs (Mean necessity-concern differential [NCD] = 2.86). Among the beliefs, ASM non-adherence was significantly associated with ASM-concern (t = 4.23, p < 0.001) and NCD (t = -4.11, p < 0.001). Stepwise multiple linear regression analysis showed that non-adherence was significantly associated with per-capita income (ß -0.215, p < 0.001), ASM side effects (ß 0.177, p = 0.001), high seizure frequency (ß 0.167, p = 0.002), ASM availability (ß -0.151, p = 0.004), ASM costs (ß -0.134, p = 0.013 and NCD (ß -0.184, p = 0.001). NCD accounted for 2.9 % of the variance in non-adherence whereas the other clinico-demographic variables together accounted for 14.6 %. CONCLUSION: We describe a paradigm shift in AWE with high non-adherence to ASMs, wherein clinico-demographic variables emerge as better predictors of non-adherence than beliefs. High literacy facilitates the perception of need for ASMs whereas costs and side effects hamper adherence.


Assuntos
Custos e Análise de Custo/economia , Epilepsia/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/psicologia , Adulto , Custos e Análise de Custo/métodos , Estudos Transversais , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
BMC Infect Dis ; 20(1): 874, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33228562

RESUMO

BACKGROUND: Pakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH). METHODS: Adults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire. RESULTS: Post-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001). CONCLUSIONS: The findings support the improvement in ART adherence and HIV management. TRIAL REGISTRATION: The trial is registered with Australian New Zealand Clinical Trials Registry ( ACTRN12618001882213 ). Registered 20 November 2018.


Assuntos
Antirretrovirais/uso terapêutico , Aconselhamento/métodos , Infecções por HIV/tratamento farmacológico , HIV/imunologia , Adesão à Medicação/psicologia , Farmacêuticos/psicologia , Adulto , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Fatores de Risco , Autorrelato , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
9.
BMC Public Health ; 20(1): 1598, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33097028

RESUMO

INTRODUCTION: Globally, India has the third largest population of people living with HIV (PLHIV) and the second highest number of COVID-19 cases. Anxiety is associated with antiretroviral therapy (ART) nonadherence. It is crucial to understand the burden of anxiety and its sources among Asian Indian PLHIV during the COVID pandemic, but data are limited. METHODS: During the first month of government mandated lockdown, we administered an anxiety assessment via telephone among PLHIV registered for care at a publicly funded antiretroviral therapy (ART) center in Pune, India. Generalized anxiety was defined as GAD-7 score ≥ 10. Sociodemographic and clinical variables were compared by anxiety status (GAD-7 score ≥ 10 vs GAD-7 score < 10). Qualitative responses to an open-ended question about causes of concern were evaluated using thematic analysis. RESULTS: Among 167 PLHIV, median age was 44 years (IQR 40-50); the majority were cisgender women (60%) and had a monthly family income < 200 USD (81%). Prior history of tuberculosis and other comorbidities were observed in 38 and 27%, respectively. Overall, prevalence of generalized anxiety was 25% (n = 41). PLHIV with GAD-7 score ≥ 10 had fewer remaining doses of ART than those with lower GAD-7 scores (p = 0.05). Thematic analysis indicated that concerns were both health related and unrelated, and stated temporally. Present concerns were often also projected as future concerns. CONCLUSIONS: The burden of anxiety was high during COVID lockdown in our population of socioeconomically disadvantaged PLHIV in Pune and appeared to be influenced by concerns about ART availability. The burden of anxiety among PLHIV will likely increase with the worsening pandemic in India, as sources of anxiety are expected to persist. We recommend the regular use of short screening tools for anxiety to monitor and triage patients as an extension of current HIV services.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por HIV/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Antirretrovirais/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Questionário de Saúde do Paciente , Pneumonia Viral/prevenção & controle , Pobreza , Prevalência
10.
JAMA Netw Open ; 3(10): e2019429, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33034639

RESUMO

Importance: Financial incentives can improve medication adherence and cardiovascular disease risk, but the optimal design to promote sustained adherence after incentives are discontinued is unknown. Objective: To determine whether 6-month interventions involving different financial incentives to encourage statin adherence reduce low-density lipoprotein cholesterol (LDL-C) levels from baseline to 12 months. Design, Setting, and Participants: This 4-group, randomized clinical trial was conducted from August 2013 to July 2018 among several large US insurer or employer populations and the University of Pennsylvania Health System. The study population included adults with elevated risk of cardiovascular disease, suboptimal LDL-C control, and evidence of imperfect adherence to statin medication. Data analysis was performed from July 2017 to June 2019. Interventions: The interventions lasted 6 months during which all participants received daily medication reminders and an electronic pill bottle. Statin adherence was measured by opening the bottle. For participants randomized to the 3 intervention groups, adherence was rewarded with financial incentives. The sweepstakes group involved incentives for daily adherence. In the deadline sweepstakes group, incentives were reduced if participants were adherent only after a reminder. The sweepstakes plus deposit contract group split incentives between daily adherence and a monthly deposit reduced for each day of nonadherence. Main Outcomes and Measures: The primary outcome was change in LDL-C level from baseline to 12 months. Results: Among 805 participants randomized (199 in the simple daily sweepstakes group, 204 in the deadline sweepstakes group, 201 in the sweepstakes plus deposit contract group, and 201 in the control group), the mean (SD) age was 58.5 (10.3) years; 519 participants (64.5%) were women, 514 (63.9%) had diabetes, and 273 (33.9%) had cardiovascular disease. The mean (SD) baseline LDL-C level was 143.2 (42.5) mg/dL. Measured adherence at 6 months (defined as the proportion of 180 days with electronic pill bottle opening) in the control group (0.69; 95% CI, 0.66-0.72) was lower than that in the simple sweepstakes group (0.84; 95% CI, 0.81-0.87), the deadline sweepstakes group (0.86; 95% CI, 0.83-0.89), and the sweepstakes plus deposit contract group (0.87; 95% CI, 0.84-0.90) (P < .001 for each incentive group vs control). LDL-C levels were measured for 636 participants at 12 months. Mean LDL-C level reductions from baseline to 12 months were 33.6 mg/dL (95% CI, 28.4-38.8 mg/dL) in the control group, 32.4 mg/dL (95% CI, 27.3-37.6 mg/dL) in the sweepstakes group, 33.2 mg/dL (95% CI, 28.1-38.3 mg/dL) in the deadline sweepstakes group, and 36.5 mg/dL (95% CI, 31.3-41.7 mg/dL) in the sweepstakes plus deposit contract group (adjusted P > .99 for each incentive group vs control). Conclusions and Relevance: Compared with the control group, different financial incentives improved measured statin adherence but not LDL-C levels. This result points to the importance of directly measuring health outcomes, rather than simply adherence, in trials aimed at improving health behaviors. Trial Registration: ClinicalTrials.gov Identifier: NCT01798784.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Participação do Paciente/economia , Reembolso de Incentivo/estatística & dados numéricos , Recompensa , Adulto , Anticolesterolemiantes/uso terapêutico , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Motivação , Participação do Paciente/psicologia , Fatores de Tempo
11.
Cochrane Database Syst Rev ; 10: CD008312, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33089492

RESUMO

BACKGROUND: Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials (RCTs) and quasi-RCTs to assist people with adherence to antiepileptic medication. This is an update of a Cochrane review first published in 2011, and last updated in 2017. OBJECTIVES: To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. SEARCH METHODS: For the latest update, we searched the following databases on 18 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE, CINAHL Plus and PsycINFO. CRS Web includes RCTs or quasi-RCTs from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. We also searched the reference lists of relevant articles. SELECTION CRITERIA: RCTs and quasi-RCTs of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. DATA COLLECTION AND ANALYSIS: All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed a quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to GRADE. The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. MAIN RESULTS: We included 20 studies reporting data on 2832 participants. Thirteen studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one recruited pediatric patients aged between 1 month to 15 years, one study targeted caregivers of children with epilepsy, one targeted adolescents and caregivers, and two studies targeted families of children with epilepsy. We identified three ongoing studies. Follow-up time was generally short in most studies, ranging from 1 to 12 months. The studies examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All but three studies compared treatment with usual care or 'no intervention'. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy had mixed success (moderate-certainty evidence). Behavioural interventions such as the use of intensive reminders provided more favourable effects on adherence (moderate-certainty evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-certainty evidence). Eleven studies described seizure frequency or seizure severity or both, with four of them, reporting improved adherence and decreased seizure frequency in the intervention groups (moderate-certainty evidence). Findings related to self-efficacy and quality of life were mixed, with no clear pattern across types of intervention. AUTHORS' CONCLUSIONS: Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results, however, we need more reliable evidence on their efficacy, derived from carefully-designed RCTs before we can draw a firm conclusion. None of the newly included studies have provided additional information that would lead to significant changes in our conclusions.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Adesão à Medicação/psicologia , Adulto , Viés , Criança , Análise Custo-Benefício , Epilepsia/psicologia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia
12.
Medicine (Baltimore) ; 99(35): e21606, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871876

RESUMO

The increasing availability of antiretroviral therapy (ART) worldwide is yet to result in decreasing HIV-related mortality among adolescents (10-19 years old) living with HIV (ALHIV) in part because of poor adherence. the poor adherence might itself be due to high level of depression. We assess the prevalence of depressive symptomatology and it's associated with adherence among ALHIV receiving ART care in Brazzaville and Pointe Noire, Republic of Congo (RoC).Adolescents aged 10 to 19 years, on antiretroviral therapy (ART), followed in the two Ambulatory Treatment Centers (ATC) in Brazzaville and Pointe Noire, RoC were included in this cross-sectional study. From April 19 to July 9, 2018, participants were administered face to face interviews using a standardized questionnaire that included the nine-item Patient Health Questionnaire (PHQ-9). Participants who reported failing to take their ART more than twice in the 7 days preceding the interview were classified as non-adherent. Bivariate and multivariable log-binomial models were used to estimate the prevalence ratio (PR) and 95% confidence interval (95%CI) assessing the strength of association between predictors and presence of depressive symptoms (PHQ-9 score ≥9).Overall, 135 adolescents represented 50% of ALHIV in active care at the 2 clinics were interviewed. Of those, 67 (50%) were male, 81 (60%) were 15 to 19 years old, 124 (95%) had been perinatally infected, and 71 (53%) knew their HIV status. Depressive symptoms were present in 52 (39%) participants and 78 (58%) were adherent. In univariate analyses, the prevalence of depressive symptoms was relative higher among participants who were not adherent compared to those who were (73% vs 33%; PR: 2.20 [95%CI: 1.42-3.41]). In multivariate analysis, after adjustment for report of been sexually active, alcohol drinking, age category (10-14 and 15-19), not in school, loss of both parents, the association between depression and adherence was strengthened (PR: 2.06 [95%CI: 1.23-3.45]).The prevalence of depressive symptoms in adolescents living with HIV is high and was strongly associated with poor adherence even after adjustment of potential confounders. Efforts to scale-up access to screening and management of depression among ALHIV in sub-Saharan is needed for them to realize the full of ART.


Assuntos
Antirretrovirais/uso terapêutico , Depressão/epidemiologia , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Adolescente , Instituições de Assistência Ambulatorial , Estudos de Casos e Controles , Criança , Congo/epidemiologia , Estudos Transversais , Depressão/psicologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Adesão à Medicação/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Assistência Perinatal/tendências , Prevalência , Inquéritos e Questionários , Adulto Jovem
13.
Pflege ; 33(5): 319-328, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996864

RESUMO

The process of medication self-management: a model revision based on a qualitative secondary analysis Abstract. Background: For safe and effective use of medication, specific skills are required which are inherent in the concept of medication self-management. In order to provide adequate counseling, it is important for registered nurses, physicians and pharmacists to know how medication self-management works in everyday life for the people affected. This process was presented in 2013 in a first conceptual model by Bailey et al. Aim: The purpose of this study was to enhance the empirical foundation of the existing model and to gain an in-depth theoretical understanding of the process of medication self-management. METHOD: A qualitative secondary analysis was conducted based on data from a semi-standardized survey (n = 395) of people in Austria, who regularly take medicine. The data were analysed according to the structuring content analysis. RESULTS: The extended model shows a new kind of logic. While the steps "fill", "take", "monitor" and "react" are always conducted one after the other, "integrate" and "maintain" form components that are mutually dependent and start after successfully completing the first four steps. "Understand" is a component that influences all steps. The whole process is influenced by personal, socio-economic, disease and medication-related factors, by supportive systems and by the overall health care system. CONCLUSIONS: Based on the present study, the drug self-management process is a complex, multi-layered and iterative one. In the context of counselling, it is important to focus on "understanding" at every step.


Assuntos
Adesão à Medicação/psicologia , Autogestão/psicologia , Áustria , Humanos , Modelos Psicológicos , Pesquisa Qualitativa
14.
Geriatr Gerontol Int ; 20(11): 1079-1084, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32896089

RESUMO

AIM: Adherence to medication is important in older patients with non-communicable diseases, and there is a need to investigate various interventions to enhance adherence in our Indian setting. This pilot randomized controlled trial aimed at testing the effectiveness of systematic education and behavioral intervention in enhancing medication adherence among older adults. METHODS: It was a single center, open label, parallel arm, randomized controlled trial carried out among older (age >60 years) inpatients of general medicine wards diagnosed with select non-communicable diseases, such as diabetes, hypertension, dyslipidemia and coronary artery disease. Participants were randomized either to receive the usual standard of care or the intervention that comprises of systematic education, patient diary to mark daily medicine intake and periodic telephone reminders. Barriers to medication adherence were identified and interventions were tailored according to the identified barriers over a 6-month follow-up period. The primary end-points were change in the reported pill count (RPC) within groups and between groups at the third and sixth month. RESULTS: The RPC in control and intervention arms at the thrid month were 78.20% and 91.88% (P = 0.007), whereas at 6 months they were 68.64% and 83.08% (P = 0.003), respectively. Similarly, change in RPC in intervention arm between baseline and the third month (mean difference 24.08%, P = 0.001), and between baseline and the sixth month (mean difference 15.280%, P = 0.006) were statistically significant. However, the RPC between the third and sixth month showed a significant decline (mean difference 8.8%, P = 0.016). CONCLUSION: In this pilot study, we prove that behavioral interventions have improved medication adherence among older adults, and it is feasible to carry out such studies among older adults in India. Geriatr Gerontol Int 2020; 20: 1079-1084.


Assuntos
Terapia Comportamental/métodos , Adesão à Medicação/psicologia , Doenças não Transmissíveis/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Índia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sistemas de Alerta , Projetos de Pesquisa , Telefone
15.
Psychiatry Res ; 292: 113346, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32750572

RESUMO

This 6 month randomized control trial investigated whether a novel text-messaging program impacted targeted clinical outcomes in patients with schizophrenia and schizoaffective disorder (SAD). Forty patients were enrolled and completed baseline, 3-month and 6-month assessments. The intervention group received daily symptom check-in text messages, plus, a medication reminder or, inspirational quote text. The control group had treatment as usual. At 6 months the Positive and Negative Syndrome Scale mean positive score was significantly lower and injectable medication compliance was significantly higher in the intervention group. Recovery scores were significantly higher at 3 months. Results suggest that this program may benefit individuals with schizophrenia/SAD who use text messaging. Further investigation in a larger sample appears warranted.


Assuntos
Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Prevenção Secundária/métodos , Envio de Mensagens de Texto , Adulto , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Projetos Piloto , Transtornos Psicóticos/psicologia , Psicologia do Esquizofrênico , Prevenção Secundária/tendências , Envio de Mensagens de Texto/tendências
16.
Ann Emerg Med ; 76(6): 739-750, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32854965

RESUMO

STUDY OBJECTIVE: We determine whether an emergency department (ED)-initiated fall-prevention intervention can reduce subsequent fall-related and all-cause ED visits and hospitalizations in older adults. METHODS: The Geriatric Acute and Post-acute Fall Prevention intervention was a randomized controlled trial conducted from January 2018 to October 2019. Participants at 2 urban academic EDs were randomly assigned (1:1) to an intervention or usual care arm. Intervention participants received a brief, tailored, structured, pharmacy and physical therapy consultation in the ED, with automated communication of the recommendations to their primary care physicians. RESULTS: Of 284 study-eligible participants, 110 noninstitutionalized older adults (≥65 years) with a recent fall consented to participate; median age was 81 years, 67% were women, 94% were white, and 16.3% had cognitive impairment. Compared with usual care participants (n=55), intervention participants (n=55) were half as likely to experience a subsequent ED visit (adjusted incidence rate ratio 0.47 [95% CI 0.29 to 0.74]) and one third as likely to have fall-related ED visits (adjusted incidence rate ratio 0.34 [95% CI 0.15 to 0.76]) within 6 months. Intervention participants experienced half the rate of all hospitalizations (adjusted incidence rate ratio 0.57 [95% CI 0.31 to 1.04]), but confidence intervals were wide. There was no difference in fall-related hospitalizations between groups (adjusted incidence rate ratio 0.99 [95% CI 0.31 to 3.27]). Self-reported adherence to pharmacy and physical therapy recommendations was moderate; 73% of pharmacy recommendations were adhered to and 68% of physical therapy recommendations were followed. CONCLUSION: Geriatric Acute and Post-acute Fall Prevention, a postfall, in-ED, multidisciplinary intervention with pharmacists and physical therapists, reduced 6-month ED encounters in 2 urban EDs. The intervention could provide a model of care to other health care systems aiming to reduce costly and burdensome fall-related events in older adults.


Assuntos
Acidentes por Quedas/prevenção & controle , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfunção Cognitiva/epidemiologia , Assistência à Saúde/economia , Feminino , Avaliação Geriátrica/métodos , Hospitalização , Humanos , Masculino , Adesão à Medicação/psicologia , Modalidades de Fisioterapia/normas , Encaminhamento e Consulta/estatística & dados numéricos
17.
AIDS Educ Prev ; 32(3): 243-259, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32749879

RESUMO

Qualitative data were collected from 34 Indonesian female sex workers to understand their engagement with HIV treatment. Influences that enhanced treatment initiation and adherence included women's desires to stay healthy to continue working to provide for families; awareness of the biomedical benefits of treatment; support from bosses, outreach workers, and peer support groups; and flexible, nonjudgmental HIV service provision. Influences inhibiting treatment initiation and adherence included concerns about unwanted disclosure in the workplace and side effects of medication on women's capacity to earn money through sex work; geographical location of services; discrimination and confidentiality concerns in HIV care services. To improve HIV treatment initiation and adherence among Indonesian female sex workers, future responses should explore health promotion messages that engage with women's family and livelihood obligations; increased funding for community-based peer outreach workers; community-based treatment initiation and supply; and advocacy in work environments to secure support for treatment initiatives.


Assuntos
Família , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Profissionais do Sexo/psicologia , Estigma Social , Apoio Social , Adulto , Cidades , Confidencialidade , Revelação , Discriminação Psicológica , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Indonésia/epidemiologia , Grupo Associado , Pesquisa Qualitativa , Trabalho Sexual , Adulto Jovem
18.
Niger J Clin Pract ; 23(8): 1033-1038, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788477

RESUMO

Background: Inhaler corticosteroids (ICS) are the most commonly used antiinflammatory drugs in the treatment of asthma. Although systemic adverse effects are minimal, patients hesitate to use ICS for a long time because of corticophobia. There is no study evaluating corticophobia via Likert-type appendix among the asthmatic patients. Aim: In this study, it was aimed to evaluate the fears and beliefs about ICS in asthmatic patients. Subjects and Methods: Between December 2017 and January 2018, 150 stable asthmatic patients were included in the study. Demographic data (age, education, smoking history, etc.) and asthma-related data (pulmonary function test, drug use) were recorded. The appendix of TOPICOP study applied to the patients with asthma which was composed of 10 questions (five questions about fear of ICS and five questions about beliefs of ICS). Results: The rate of ICS maintain in stable asthmatic patients was found to be 66.6%. According to the survey results, 68% of the patients believed that ICS may lead to weight gain, 52% believed that ICS may lead to infection, 73% believed that ICS may pass into bloodstream, and 67.3% believed that ICS may damage the lungs. It was also found that 90.7% needed to be informed about ICS and 67.3% wanted to cut the ICS drug as soon as possible. Conclusion: We found that treatment adherence may increase, if physicians allocate more time to asthma patients to inform about ICS beneficial effects at the initiating of ICS treatment and control visits.


Assuntos
Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Medo , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/psicologia , Transtornos Fóbicos/psicologia , Administração por Inalação , Corticosteroides/efeitos adversos , Adulto , Antiasmáticos/efeitos adversos , Asma/psicologia , Feminino , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Transtornos Fóbicos/epidemiologia , Transtornos Fóbicos/etiologia , Inquéritos e Questionários
19.
PLoS One ; 15(8): e0238321, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853261

RESUMO

BACKGROUND: Psychological treatments improve depressive symptoms in people living with HIV/AIDS (PLWHA). Adaptation of treatments should be based on explanatory models of depression and other elements within the given context. AIM: This study aimed to examine explanatory models of depression and acceptable approaches for implementation of group IPT in Northwest Ethiopia. METHODS: Qualitative data were collected from April to May 2019 from case managers, adherence supporters and service users using focus group discussion and analysed thematically. RESULTS: PLWHA attributed depression to psychosocial problems, spiritual factors and biological factors. Depression had several impacts at individual and family level. Group-based interpersonal therapy (IPT) was acceptable if provided by trained peer counselors. CONCLUSION: The current study findings informed how to conduct feasibility and acceptability trials of group IPT in the HIV population in Ethiopia.


Assuntos
Adaptação Psicológica/fisiologia , Infecções por HIV/psicologia , Adolescente , Adulto , Depressão/psicologia , Etiópia , Feminino , Grupos Focais , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Psicoterapia de Grupo/métodos , Pesquisa Qualitativa , Organização Mundial da Saúde , Adulto Jovem
20.
PLoS One ; 15(8): e0237781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857798

RESUMO

BACKGROUND: Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH). METHODS: A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association. RESULTS: Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). ß blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5). CONCLUSION: Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Antagonistas Adrenérgicos beta/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/farmacocinética , Estudos Transversais , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
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