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1.
BMC Ophthalmol ; 21(1): 325, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493240

RESUMO

BACKGROUND: Designing educational interventions tailored to the needs of Contact Lens Wearers (CLWs) are important and necessary. The present study aimed to determine the information needs of CLWs to educate and provide information to them to increase their knowledge and reduce complications and non-compliance behaviors. METHODS: A qualitative approach was applied and semi-structured interviews were conducted in three contact lenses (CL) clinics in Iran among all their practitioners and 24 purposively selected patients. Data were analyzed using the Lundman and Graneheim conventional content analysis. RESULTS: The qualitative analysis revealed knowledge and skill themes as two main categories. The knowledge category includes five subcategories of basic information for the CLWs, acquaintance with the CL, caring for CL, hygiene and vigilance of CL, and challenges of using CL. The skill category consists of two subcategories, including handling/insertion and removal of the CL, and stabilization of learned information. Moreover, 36 sub-subcategories emerged from these seven subcategories that reflected the information needs of CLWs. CONCLUSIONS: A clear understanding of CLWs' information needs can help to design and develop appropriate educational approaches to overcome training barriers such as physicians' time constraints and high workload. Moreover, it can help deal with CLWs' insufficient knowledge and provide the required information simply and practically with the possibility of enough repetition.


Assuntos
Lentes de Contato , Escolaridade , Humanos , Higiene , Cooperação do Paciente , Pesquisa Qualitativa
2.
Medicine (Baltimore) ; 100(36): e27172, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516512

RESUMO

ABSTRACT: The aim of this study was to explore the compliance of epilepsy patients in the Phenobarbital Epilepsy Management Project in a rural area of China and its influencing factors, so as to provide the basis for further strategies.A retrospective study researching on the compliance of epilepsy patients in the Phenobarbital Epilepsy Management Project of Rural China was conducted. The Nan County, Hunan Province as a typical rural China was selected as the study site. We collected the compliance and other relative factors from 2017 to 2019 though the Phenobarbital Epilepsy Management Project data system.The good compliance patients in the Phenobarbital Epilepsy Management Project in a rural area of China were 98.99% (393/397); only 4 cases had poor compliance. The factors affecting the compliance of epilepsy patients were "adverse reactions of digestive tract symptoms," "how the patient felt physically, mentally, or working and learning ability during this period," and "the ratio of the attack to the previous one."The rate of good compliance among the epilepsy patients in the Phenobarbital Epilepsy Management Project in a rural area of China was high. More attention to education, patients' psychology, and the curative effect of family members may improve the compliance of patients with epilepsy further.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Fenobarbital/uso terapêutico , Adolescente , Adulto , Anticonvulsivantes/administração & dosagem , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fenobarbital/administração & dosagem , Estudos Retrospectivos , População Rural , Adulto Jovem
3.
Ann Palliat Med ; 10(8): 8737-8745, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488363

RESUMO

BACKGROUND: The purpose of this study was to analyze the effect of the meticulous nursing model on the treatment compliance and quality of life of patients with upper gastrointestinal bleeding (UGIB). METHODS: A total of 108 UGIB patients treated in Linyi Central Hospital from October 2018 to October 2019 were selected as the study subjects, and were randomly divided into a research group and reference group, with 54 cases in each group. The reference group received conventional nursing while the research group received meticulous nursing on this basis to compare the clinical intervention effect and the impact on quality of life in the 2 groups of patients. RESULTS: The Generic Quality of Life Inventory-74 (GQOLI-74) scores in the 2 groups of patients after intervention were significantly higher than those before intervention (P<0.001), and the score of the research group after intervention was significantly higher than that of the reference group (P<0.001). The Stanford Acute Stress Reaction Questionnaire (SASRQ) scores of the patients presented a trend opposite to GQOLI-74 (P<0.001). The number of fully satisfied cases in the research group was significantly higher than that in the reference group (P<0.05), while the number of dissatisfied cases was significantly lower than that in the reference group (P<0.05). The self-rating anxiety scale (SAS) scores in the 2 groups of patients after intervention were significantly lower than those before intervention (P<0.001), and the score of the research group after intervention was significantly lower than that of the reference group (P<0.001). The total clinical effective rate and treatment compliance of the research group were significantly higher than those of the reference group (P<0.05). CONCLUSIONS: The meticulous nursing model can effectively improve the quality of life of UGIB patients, reduce the psychological stress response, and improve clinical treatment compliance and nursing satisfaction with a definite effect, making it worthy of promotion and application. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048735.


Assuntos
Hemorragia Gastrointestinal , Qualidade de Vida , Humanos , Modelos de Enfermagem , Cooperação do Paciente , Resultado do Tratamento
4.
Prog Orthod ; 22(1): 25, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34514529

RESUMO

BACKGROUND: Apps have been shown to be an effective tool in changing patients' behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published. OBJECTIVES: 1. To evaluate the quality of these apps aiming to change behaviour. 2. To assess BCTs used in patient focused orthodontic apps. METHODS: The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors. RESULTS: BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly 'prompts/cues', and 'information about health consequences'. All apps were shown to be of moderate quality (range 3.1-3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent. CONCLUSIONS: The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients' compliance with treatment.


Assuntos
Aplicativos Móveis , Terapia Comportamental , Humanos , Cooperação do Paciente , Reprodutibilidade dos Testes
5.
Front Public Health ; 9: 716814, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422754

RESUMO

Regardless of the advocacies made by the media and numerous organizations about the need for preventing the spread of COVID-19, there still exists a gap as far as compliance to regular implementation of the preventive mechanisms within communities is concerned. The purpose of the present study was, therefore, to examine compliance to personal protective behavioral recommendations to contain the spread of COVID-19 among urban residents engaged in the informal economic activities in Wolaita Sodo town, Southern Ethiopia. A cross-sectional study design was used where quantitative data were collected through the survey research method. Three hundred and eighty-four participants of the urban-based informal economy were randomly selected and contacted in their own natural settings with an interviewer-administered questionnaire. Data were inserted into SPSS software for analysis that involved both descriptive and inferential statistics, including frequency and percentage distributions, binomial and multinomial logistic regressions. The results of the research indicated that only 35.4% of the respondents regularly wore a mask. In addition, 54.9% of the survey participants disclosed that they do not clean their hands with disinfectants after touching objects under circumstances where they cannot get access to water and soap. Moreover, the most commonly reported reason of respondents for non-compliance to regular wearing of a mask has been its inconvenience or discomfort (62.8%), followed by the need to appear indifferent because most people around them do not wear a mask (25.2%). Furthermore, experiences of the respondents of regularly wearing a mask are significantly associated with regular attendance of the media regarding the preventive mechanisms of COVID-19 (OR = 0.224; P < 0.001; 95%C.I: 0.109-0.460), knowledge of someone ever infected by COVID-19 (OR = 0.402; P < 0.05; 95%C.I: 0.190-0.851), the belief that COVID-19 causes a severe illness (OR = 0.444; P < 0.05; 95%C.I: 0.201-0.980), and perception of the likelihood of dying as a result of infection by COVID-19 (OR = 0.374; P < 0.01; 95% C.I: 0.197-0.711). The authors have found a low level of compliance to the recommended safety measures, especially wearing of masks. It is, therefore, important that continued efforts of raising awareness should be done by all the concerned bodies. Above all, urban safety net programs that aim at keeping such social groups at home, at least during the critical wave of the pandemic, should also be strengthened.


Assuntos
COVID-19 , Comportamentos Relacionados com a Saúde , Cooperação do Paciente/estatística & dados numéricos , COVID-19/prevenção & controle , Estudos Transversais , Surtos de Doenças , Etiópia/epidemiologia , Humanos
7.
BMC Med Inform Decis Mak ; 21(1): 236, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362359

RESUMO

BACKGROUND: Advanced analytics, such as artificial intelligence (AI), increasingly gain relevance in medicine. However, patients' responses to the involvement of AI in the care process remains largely unclear. The study aims to explore whether individuals were more likely to follow a recommendation when a physician used AI in the diagnostic process considering a highly (vs. less) severe disease compared to when the physician did not use AI or when AI fully replaced the physician. METHODS: Participants from the USA (n = 452) were randomly assigned to a hypothetical scenario where they imagined that they received a treatment recommendation after a skin cancer diagnosis (high vs. low severity) from a physician, a physician using AI, or an automated AI tool. They then indicated their intention to follow the recommendation. Regression analyses were used to test hypotheses. Beta coefficients (ß) describe the nature and strength of relationships between predictors and outcome variables; confidence intervals [CI] excluding zero indicate significant mediation effects. RESULTS: The total effects reveal the inferiority of automated AI (ß = .47, p = .001 vs. physician; ß = .49, p = .001 vs. physician using AI). Two pathways increase intention to follow the recommendation. When a physician performs the assessment (vs. automated AI), the perception that the physician is real and present (a concept called social presence) is high, which increases intention to follow the recommendation (ß = .22, 95% CI [.09; 0.39]). When AI performs the assessment (vs. physician only), perceived innovativeness of the method is high, which increases intention to follow the recommendation (ß = .15, 95% CI [- .28; - .04]). When physicians use AI, social presence does not decrease and perceived innovativeness increases. CONCLUSION: Pairing AI with a physician in medical diagnosis and treatment in a hypothetical scenario using topical therapy and oral medication as treatment recommendations leads to a higher intention to follow the recommendation than AI on its own. The findings might help develop practice guidelines for cases where AI involvement benefits outweigh risks, such as using AI in pathology and radiology, to enable augmented human intelligence and inform physicians about diagnoses and treatments.


Assuntos
Medicina , Médicos , Inteligência Artificial , Humanos , Inteligência , Cooperação do Paciente
8.
J Prev Med Public Health ; 54(4): 221-229, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34370934

RESUMO

OBJECTIVES: The Indonesian government issued large-scale social restrictions (called Pembatasan Sosial Berskala Besar, or PSBB) at the beginning of the coronavirus disease 2019 (COVID-19) pandemic to control the spread of COVID-19 in Jakarta, Bogor, Depok, Tangerang, and Bekasi (Greater Jakarta). Public compliance poses a challenge when implementing large-scale social restrictions, and various factors have contributed to public non-compliance with the regulation. This study aimed to determine the degree of non-compliance and identify the factors that contributed to public non-compliance with the PSBB in Greater Jakarta, Indonesia. METHODS: This was a quantitative study with a cross-sectional design. A total of 839 residents of Greater Jakarta participated in this study. Data were collected online using a Google Form, and convenience sampling was undertaken. Univariate and multivariate analyses were performed to explore the relationships between public non-compliance with the PSBB regulation and socio-demographic variables, respondents' opinion of the PSBB, and social capital. RESULTS: A total of 22.6% of subjects reported participating in activities that did not comply with the PSBB. The variables that most affected non-compliance with the PSBB were age, gender, income, opinion of the PSBB, and social capital. CONCLUSIONS: Strengthening social capital and providing information about COVID-19 prevention measures, such as washing one's hands with soap, wearing masks properly, and maintaining social distancing, is essential. Robust public understanding will foster trust and cooperation with regard to COVID-19 prevention efforts and provide a basis for mutual agreement regarding rules/penalties.


Assuntos
COVID-19/prevenção & controle , Cooperação do Paciente , Distanciamento Físico , Fatores Socioeconômicos , Adolescente , Adulto , Estudos Transversais , Higiene das Mãos , Humanos , Indonésia , Internet , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
9.
Health Qual Life Outcomes ; 19(1): 204, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429115

RESUMO

BACKGROUND: We aimed to investigate the determinants of Health-related quality of life (HRQOL) in Iranian patients with celiac disease (CD) using the structural equation modeling (SEM). METHODS: In the present cross-sectional study, a total of 170 adult patients with CD were recruited. The information regarding adherence to diet, symptom severity, and HRQOL were collected using the celiac disease adherence test (CDAT), gastrointestinal symptom rating scale (GSRS), and SF-36 questionnaire respectively. Association between various studied variables and HRQOL was assessed using SEM. The standardized regression weights were used to assess total, direct and indirect effects. The model fit indices were used to assess the "goodness of fit" between the hypothesized models. RESULTS: The mean age of participants was 37.57 ± 9.59 years. The results of SEM indicated that the overall fit of our model was acceptable. Adherence to the diet, GSRS score, occupation, and education level was significantly related to PCS of SF-36; and adherence to the diet, GSRS score, and education level were significantly correlated with MCS of SF-36. The analysis of indirect associations indicated that only adherence to diet indirectly via GSRS score was significantly associated with PCS and MCS of SF-36. CONCLUSION: In adult patients with celiac disease, HRQOL was associated with age, education, adherence to GFD, and GSRS score. Additionally, occupation and disease duration were associated with HRQOL only in women and men respectively.


Assuntos
Doença Celíaca/psicologia , Cooperação do Paciente/psicologia , Qualidade de Vida/psicologia , Adulto , Doença Celíaca/epidemiologia , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade
10.
Artigo em Inglês | MEDLINE | ID: mdl-34348541

RESUMO

Background: Although noninvasive ventilation (NIV) improves survival and quality of life (QOL) in ALS, use of NIV is suboptimal. Objective: To determine compliance with "early" NIV initiation, requisite for the feasibility of a large study of early NIV initiation, and examine factors impacting compliance. Methods: Seventy-three ALS participants with forced vital capacities (FVC) >50% were enrolled. Participants with FVC over 80% (Group 1) were initiated on NIV early (FVC between 80 and 85%). Participants with FVC between 50 and 80% (Group 2) started NIV at FVC between 50 and 55%. Symptom surveys, QOL scores, and NIV compliance (machine download documenting use ≥4 hours/night >60% of time) were collected following NIV initiation. Results: 53.6% of Group 1 and 50% of Group 2 were compliant 28 days following NIV initiation, with increased compliance over time. Participants who were unmarried, had lower income, lower educational attainment, or limited caregiver availability were less likely to be compliant. Bothersome symptoms in non-compliant participants included facial air pressure, frequent arousals with difficulty returning to sleep, and claustrophobia. Both compliant and noncompliant participants felt improved QOL with NIV; improvement was significantly greater in compliant participants. Conclusions: These data suggest ALS patients can comply with NIV early in their disease, and potentially benefit as evidenced by improved QOL scores, supporting both feasibility and need for a study comparing early versus late NIV initiation. Moreover, modifiable symptoms were identified that could be optimized to improve compliance. Further studies are needed to determine the impact of "early" intervention on survival and QOL.


Assuntos
Esclerose Amiotrófica Lateral , Ventilação não Invasiva , Insuficiência Respiratória , Esclerose Amiotrófica Lateral/terapia , Humanos , Cooperação do Paciente , Qualidade de Vida , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Capacidade Vital
11.
Nutrients ; 13(8)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34444908

RESUMO

Unhealthy behaviours, including diet and physical activity, coupled with genetic predisposition, drive type 2 diabetes (T2D) occurrence and severity; the present review aims to summarise the most recent nutritional approaches in T2D, outlining unmet needs. Guidelines consistently suggest reducing energy intake to counteract the obesity epidemic, frequently resulting in sarcopenic obesity, a condition associated with poorer metabolic control and cardiovascular disease. Various dietary approaches have been proposed with largely similar results, with a preference for the Mediterranean diet and the best practice being the diet that patients feel confident of maintaining in the long term based on individual preferences. Patient adherence is indeed the pivotal factor for weight loss and long-term maintenance, requiring intensive lifestyle intervention. The consumption of nutritional supplements continues to increase even if international societies do not support their systematic use. Inositols and vitamin D supplementation, as well as micronutrients (zinc, chromium, magnesium) and pre/probiotics, result in modest improvement in insulin sensitivity, but their use is not systematically suggested. To reach the desired goals, patients should be actively involved in the collaborative development of a personalised meal plan associated with habitual physical activity, aiming at normal body weight and metabolic control.


Assuntos
Restrição Calórica/métodos , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos/métodos , Suplementos Nutricionais , Terapia Nutricional/tendências , Dieta Mediterrânea , Exercício Físico , Humanos , Cooperação do Paciente
12.
Nutrients ; 13(8)2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34444884

RESUMO

BACKGROUND: The relationship between the quality of the diet and the adherence to the Mediterranean diet with the presence of persistent or recurrent depressive symptoms have been described. The objective of this study is to analyze the relationship between adherence to the Mediterranean diet and the intake of specific foods in primary care patients aged 45 to 75, having subclinical or major depression. The study also specifically analyzes this relationship in individuals suffering from chronic diseases. METHODS: A cross-sectional descriptive study was conducted. 3062 subjects met the inclusion criteria from the EIRA study. Sociodemographic variables, clinical morbidity, depression symptomatology (PHQ-9) and adherence to Mediterranean diet (MEDAS) were collected. RESULTS: Being female, younger, with a higher BMI, consuming more than 1 serving of red meat a day and drinking more than one carbonated or sugary drink daily, not consuming 3 servings of nuts a week and not eating 2 vegetables cooked in olive oil a week are predictors of having higher depressive symptomatology. CONCLUSIONS: Assessing the type of diet of patients presenting depressive symptoms and promoting adherence to a healthy diet is important, especially in patients with chronic diseases. However, depression is a very complex issue and the relationship between nutrition and depression must be further examined.


Assuntos
Depressão/dietoterapia , Dieta Saudável/estatística & dados numéricos , Dieta Mediterrânea/psicologia , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Estudos Transversais , Depressão/psicologia , Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34360060

RESUMO

Attempts to optimize monitoring of brace adherence prescribed to adolescents with idiopathic scoliosis (IS) have generally relied on sensors. Sensors, however, are intrusive and do not allow the assessment of psychological and physical consequences of brace use that might underlie poor adherence. Mobile applications have emerged as alternatives to monitor brace compliance. However, the feasibility and utility of these app-based systems to assess key psychological and physical domains associated with non-adherence remain unexplored. This feasibility study aims to test the usability, acceptability, and clinical utility of an app-based system that monitors brace use and related psychological and physical factors. Forty adolescents with IS daily respond to the app for 90 days. The patient responses may generate clinical alarms (e.g., brace non-adherence, discomfort, or distress) that will be sent daily to the medical team. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will include brace adherence, the number of side effects reported, number and type of clinical alarms, stress, quality of life, perceived health status, and mood. If accepted by patients and clinicians, apps may allow rapid detection and response to undesired events in adolescents undergoing brace treatment.


Assuntos
Escoliose , Telemedicina , Adolescente , Braquetes , Estudos de Viabilidade , Humanos , Cooperação do Paciente , Qualidade de Vida , Escoliose/terapia
14.
Front Public Health ; 9: 693409, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34336773

RESUMO

Background: Adherence to therapy is one of the most important elements during the therapeutic process ensuring the predefined therapeutic outcomes. The aim is to analyze the need and importance of treatment adherence guideline for acromegaly patients and the possibilities for its development and implementation in Bulgaria. Methods: A set of methods was applied: (1) a literature review in the electronic database for identification of articles and guidelines related to adherence and acromegaly; (2) analysis of Bulgarian legislative documents; (3) a pilot study for assessment of the level of treatment adherence among hospitalized Bulgarian acromegaly patients in 2018; (4) a plan for development and implementation of specific guideline was created entitled BULMEDACRO - BULgarian guideline for MEdication aDherence assessment and improvement in ACROmegaly. Results: No specific guidelines for evaluation, monitoring, reporting and/or improving adherence in acromegaly patients has been found in the literature. Requirements for regular assessment of the level of adherence, application of appropriate methods for improvement and monitoring are not sufficiently formulated and mandatory. The pilot study confirmed that therapy adherence among Bulgarian patients with acromegaly is relatively high as almost 90% of patients report that they strictly comply with their prescribed treatment regimen. It is necessary, however, a specific guideline focused on the methods for assessment and improvement of adherence, in order to ensure monitoring and follow-up of acromegaly patients. Conclusions: Patients with acromegaly should be the focus of specially designed national programs, initiatives and/or guidelines for regular evaluation and improvement of the adherence level. Despite the difficulties and the lack of an adequate legal basis, successive steps initiated by different stakeholder are needed.


Assuntos
Acromegalia , Acromegalia/diagnóstico , Bulgária/epidemiologia , Protocolos Clínicos , Humanos , Cooperação do Paciente , Projetos Piloto
15.
PLoS One ; 16(8): e0256495, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34411185

RESUMO

Social distancing measures implemented by governments worldwide during the COVID-19 pandemic have proven an effective intervention to control the transmission of SARS-CoV-2. There is a growing literature on predictors of adherence behaviours to social distancing measures, however, there are no comprehensive insights into the nature and types of non-adherence behaviours. To address this gap in the literature, we studied non-adherence in terms of counts of infringements and people's accounts on their behaviours in a sample of North London residents. We focused on the following social distancing rules: keeping 2 mts. distancing, meeting family and friends, and going out for non-essential reasons. A mixed-methods explanatory sequential design was used comprising an online survey (May 1-31, 2020) followed by semi-structured in-depth interviews held with a purposive sample of survey respondents (August 5 -September 21, 2020). A negative binomial regression model (quantitative) and Framework Analysis (qualitative) were undertaken.681 individuals completed the survey, and 30 individuals were interviewed. We integrated survey and interview findings following three levels of the Social Ecological model: individual, interpersonal and community levels. We identified non-adherence behaviours as unintentional (barriers beyond individual's control) and intentional (deliberate decision). Unintentional adherence was reported by interviewees as, lack of controllability in keeping 2 mts. distancing, environmental constraints, social responsibility towards the community and feeling low risk. Intentional non-adherence was statistically associated with and reported as lack of trust in Government, support from friends, and lack of knowledge about rules. In addition, interviewees reported individual risk assessment and decision making on the extent to following the rules, and perceived lack of adherence in the local area. Our findings indicate that unintentional and intentional non-adherence should be improved by Government partnerships with local communities to build trust in social distancing measures; tailored messaging to young adults emphasising the need of protecting others whilst clarifying the risk of transmission; and ensuring COVID-secured environments by working with environmental health officers.


Assuntos
COVID-19/prevenção & controle , Intenção , Pandemias/prevenção & controle , Cooperação do Paciente , Distanciamento Físico , SARS-CoV-2 , Adulto , Idoso , COVID-19/psicologia , Estudos Transversais , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Teóricos
16.
J Clin Sleep Med ; 17(8): 1563-1569, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34313215

RESUMO

STUDY OBJECTIVES: To explore the association of continuous positive airway pressure (CPAP) adherence with clinical outcomes in patients with type 2 diabetes and obstructive sleep apnea in a real-world setting. METHODS: This was a retrospective study of patients with type 2 diabetes diagnosed with obstructive sleep apnea between 2010 and 2017. CPAP adherence (usage for ≥ 4 h/night for ≥ 70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate, hemoglobin A1c, systolic and diastolic blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes. RESULTS: Of the 1,295 patients, 260 (20.7%) were CPAP adherent, 318 (24.5%) were CPAP nonadherent, and 717 (55.3%) had insufficient data. The follow-up period was, on average, 2.5 (1.7) years. Compared to those who were CPAP nonadherent, those who were adherent had a significantly lower systolic blood pressure (ß = -1.95 mm Hg, P = .001) and diastolic blood pressure (ß = -2.33 mm Hg, P < .0001). Among the patients who were CPAP adherent, a 17% greater CPAP adherence was associated with a 2 mm Hg lower systolic blood pressure. Lipids, hemoglobin A1c, estimated glomerular filtration rate, and incident cardiovascular/peripheral vascular/cerebrovascular events were not different between the 2 groups. CONCLUSIONS: Achieving CPAP adherence in patients with type 2 diabetes and obstructive sleep apnea was associated with significantly lower blood pressure. Greater CPAP use within patients who were adherent was associated with lower systolic blood pressure. CITATION: Sheth U, Monson RS, Prasad B, et al. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. J Clin Sleep Med. 2021;17(8):1563-1569.


Assuntos
Diabetes Mellitus Tipo 2 , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Diabetes Mellitus Tipo 2/complicações , Humanos , Cooperação do Paciente , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia
17.
Semin Nephrol ; 41(3): 262-271, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34330366

RESUMO

When providing care, nephrologists are subject to various ethical duties. Beyond the Hippocratic notion of doing no harm, nephrologists also have duties to respect their patients' autonomy and dignity, to meet their patients' care goals in the least invasive way, to act impartially, and, ultimately, to do what is (clinically) beneficial for their patients. Juggling these often-conflicting duties can be challenging at the best of times, but can prove especially difficult when patients are not fully adherent to treatment. When a patient's nonadherence begins to cause harm to themselves and/or others, it may be questioned whether discontinuation of care is appropriate. We discuss how nephrologists can meet their ethical duties when faced with nonadherence in patients undergoing hemodialysis, including episodic extreme agitation, poor renal diet, missed hemodialysis sessions, and emergency presentations brought on by nonadherence. Furthermore, we consider the impact of cognitive impairment and provider-family conflict when making care decisions in a nonadherence context, as well as how the coronavirus disease 2019 pandemic might affect responses to nonadherence. Suggestions are provided for ethically informed responses, prioritizing a patient-narrative approach that is attentive to patients' values and preferences, multidisciplinarity, and the use of behavioral contracts and/or technology where appropriate.


Assuntos
Nefrologistas/ética , Cooperação do Paciente , Diálise Renal/ética , Adulto , Idoso , Tomada de Decisões/ética , Feminino , Humanos , Masculino , Assistência Centrada no Paciente , Autonomia Pessoal
18.
Int J Chron Obstruct Pulmon Dis ; 16: 2001-2021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262270

RESUMO

Background: Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as comorbidities, resulting in higher rates of exacerbations, hospitalizations, and worse clinical outcomes. Objective: This systematic review provided a synthesis of studies about the relationships between anxiety, depression, and adherence in people affected by COPD. Methods: English language publications were searched in the PUBMED, SCOPUS, PsycInfo, Web of Science, PsycArticles, and Cochrane Library databases from December 2020 to March 2021, following PRISMA guidelines. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. Results: A total of 34 studies (23 quantitative and 2 qualitative studies, 9 reviews) were included. The relationship between depression and treatment adherence was significant and negative. Adherence to both rehabilitation, psychological, and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization. Moreover, depressed patients compliant with an antidepressant were more likely to adherent to COPD maintenance inhalers. On the other hand, the associations between anxiety and adherence were poorly investigated and high heterogeneity characterized the studies, leading to a weak and variable relationship as well as too few interventions. Conclusion: The systematic review highlights the variability in estimates of the relationship between depression, anxiety, and treatment adherence in COPD. It could be explained by methodological differences across the included studies. This suggests that standardization is critical to improving the precision of the estimates. Recommendations for future research include attention to causal inferences, an exploration of mechanisms to explain the relationships between both anxiety and depression and adherence in COPD, and a comprehensive, systematic approach.


Assuntos
Depressão , Doença Pulmonar Obstrutiva Crônica , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Transtornos de Ansiedade , Depressão/diagnóstico , Depressão/tratamento farmacológico , Depressão/epidemiologia , Humanos , Cooperação do Paciente , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia
19.
Emerg Med Pract ; 23(7): 1-24, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34196515

RESUMO

As highly active antiretroviral therapies have advanced, HIV patients who are treatment-adherent can achieve undetectable viral loads, virtual elimination of opportunistic infection, improved quality of life, and normal life expectancy. This issue focuses on emergency department management of HIV patients both with successful disease suppression from long-term therapy as well as the patient with low CD4 counts in the context of lack of engagement with care, nonadherence, or undiagnosed disease. Optimal emergency department management of patients with HIV also includes identifying and treating undiagnosed patients, helping to re-establish care for those who have been lost to followup, and preventing new HIV infections with pre-exposure and postexposure prophylaxis.


Assuntos
Serviço Hospitalar de Emergência , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Adulto , Contagem de Linfócito CD4 , Humanos , Cooperação do Paciente , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição
20.
Sleep Med ; 84: 352-355, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242925

RESUMO

OBJECTIVES: Adherence to Continuous Positive Airway Pressure (CPAP) in children can be challenging. Advancements in CPAP technology have potential to influence adherence. The aim of this study was to compare adherence rates of children with obstructive sleep apnoea (OSA) initiated on autotitrating CPAP (APAP) with remote modem monitoring compared to a cohort started on fixed pressure CPAP alone. METHODS: Children aged over 3 years starting APAP at our centre between February 2017 and February 2020 were included. Therapy data was obtained for the initial 90 days. Data was compared to a cohort of children started on CPAP between July 2004 and September 2008. RESULTS: A total of 61 patients with a median age of 14.3 years formed the APAP group, and were significantly older than the CPAP group who had a median age of 8.6 years (p = 0.02). Co-morbid conditions were present in 51% compared with 69% in the earlier cohort (p = 0.11). No significant difference was found in any adherence parameters between the groups. The value closest to achieving a significant difference was hours used per day used, with an median of 5.2 h in the CPAP group compared with 7.0 h in the APAP group (p = 0.07). Two-way ANOVA including age group (above or below 13 years) showed that both age group and treatment group (CPAP vs APAP) were significantly associated with a difference in adherence (F = 4.41, p = 0.006), with mean hours used on days used being highest in the APAP group aged under 13 years. However no significant interaction was found between age and treatment group. CONCLUSION: Despite the convenience for patients with outpatient initiation and ability to achieve optimal pressures quickly and remotely, our results show no improvement in adherence using APAP with remote monitoring, with the possible exception of children aged under 13 years. A large randomized controlled trial would be required to confirm these findings.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Cooperação do Paciente , Polissonografia , Apneia Obstrutiva do Sono/terapia
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