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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 596-610, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184787

RESUMO

Introducción: El número de enfermos de diabetes tipo 2 está creciendo de forma alarmante. Este aumento está causando problemas personales, familiares, sociales, económicos y políticos. El objetivo de este artículo es revisar los efectos secundarios de los tratamientos, complicaciones que experimentan los pacientes y prácticas para mejorar la gestión de esta enfermedad desde el punto de vista de la vivencia del individuo y de la gestión de la atención sanitaria. Material y métodos: Se realizó una revisión narrativa de los estudios sobre la diabetes tipo 2 publicados en inglés y en español indexados en PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection y Google Académico. Se identificaron 1.118 artículos, de los cuales 42 se referían a los objetivos de la revisión y cumplían los criterios de inclusión. Resultados: Los efectos secundarios y complicaciones que experimentan los pacientes y la percepción de recibir escasa información repercuten en una falta de adherencia al tratamiento. Esto implica una disminución de la salud de los pacientes y un aumento de los costes sanitarios. Las propuestas de los estudios revisados encaminan las acciones para mejorar la adherencia al tratamiento y así mejorar la calidad de vida del paciente, disminuir los efectos secundarios, la mortalidad y, por tanto, los costes asociados a esta enfermedad a través de: 1) tener un acceso a la atención médica rápido y fácil, 2) una educación de calidad y 3) permitir que el paciente participe en las decisiones de su tratamiento y autogestione su enfermedad para realizar los mínimos cambios en su estilo de vida


Introduction: There is an alarming increase in the number of patients with type 2 diabetes mellitus. This increase is causing personal, family, social, economic, and political problems. The aim of this article is to review the side effects of treatments, the complications suffered by patients, and the practices to improve management of this disease from the viewpoint of the experience of patients and health care management. Material and methods: A narrative review was conducted of studies on type 2 diabetes mellitus published in English and Spanish indexed in PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection, and Google academic. A total of 1,118 articles were found, 42 of which referred to the objectives of the review and met the inclusion criteria. Results: The side effects and complications experienced by patients and their perception that they do not receive adequate information, together with poor satisfaction, lead to non-adherence to treatment, which impairs patient health and increases health care costs. The proposals in the reviewed studies guide the actions to improve treatment adherence and, thus, quality of life of patients, to decrease side effects and mortality and, therefore, the costs associated to type 2 diabetes mellitus through: 1) quick and easy access to medical care, 2) quality health education, and 3) participation of patients in the decisions about their treatment and in self-management of their disease to make minimum changes in their lifestyles


Assuntos
Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Assistência à Saúde/organização & administração , Qualidade de Vida/psicologia , Cooperação e Adesão ao Tratamento , Análise Qualitativa , Satisfação do Paciente , Diabetes Mellitus Tipo 2/complicações , Relações Médico-Paciente
2.
Acta otorrinolaringol. esp ; 70(6): 336-341, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184878

RESUMO

Antecedentes y objetivo: El riesgo de meningitis bacteriana aumenta en los pacientes con implante coclear. Por ello, se indica la vacunación antineumocócica, antigripal y frente a Haemophilus influenzae tipo b en este grupo. El objetivo del presente estudio es conocer el cumplimiento del calendario vacunal en los pacientes implantados en un hospital de referencia. Materiales y métodos: Se incluyeron los pacientes con implante coclear intervenidos entre 2005 y 2015. Se evaluaron las coberturas vacunales frente a gripe estacional, Haemophilus influenzae tipo b, neumococo conjugada de 13 serotipos y neumococo polisacárida de 23 serotipos. Se dividió la muestra en 2 grupos por edad (< 14 años y ≥ 14 años). Se realizó un análisis univariante y bivariante. Resultados: De los 153 pacientes estudiados (28,01% 0-13 años y 71,9% ≥ 14), solo 2 (5,71%) tuvieron un 100% de adherencia al calendario vacunal, mientras que el 65,71% registró un cumplimiento del 50% o menor. Globalmente, la cobertura de vacunación frente a la pauta secuencial de neumococo fue del 48,57%. La población pediátrica superó el 90% de cobertura para la vacuna frente a Haemophilus influenzae tipo b y neumococo conjugada de 13 serotipos, mientras que en los mayores de 14 años apenas superó el 50%. La cobertura frente a gripe estacional fue inferior al 40%. Se obtuvo una correlación inversa entre la edad y el cumplimiento, aunque no estadísticamente significativa. Conclusiones. Las coberturas de vacunación en los pacientes con implante coclear evaluados son más bajas de lo esperado. Se propone la colaboración estrecha entre los servicios de Otorrinolaringología y las Unidades de Vacunas como principal estrategia para la mejora


Background and objective: The risk of bacterial meningitis increases in cochlear implant patients. Therefore, pneumococcal, influenza and Haemophilus influenzae type b vaccination is indicated in this group. The aim of this study was to determine compliance with the vaccination calendar in patients implanted in a referral hospital. Materials and methods: Patients with cochlear implant operated between 2005 and 2015 were included. Vaccine coverage for seasonal influenza, Haemophilus influenzae type b and pneumococcal conjugate 13-serotypes and pneumococcal polysaccharide 23-serotypes was evaluated. The sample was divided into 2 age groups (< 14 years and ≥ 14 years). A univariate and bivariate analysis was performed. Results: Of the 153 patients studied (28.01% 0-13 years old and 71.9% ≥ 14), only 2 (5.71%) had 100% adherence to the vaccination schedule, while 65.71% had compliance of 50% or less. Overall, vaccination coverage against the sequential pneumococcal pattern was 48.57%. The paediatric population exceeded 90% coverage for the vaccine against Haemophilus influenzae type b and pneumococcal conjugate 13-serotypes while in those over 14 years of age it barely exceeded 50%. Influenza coverage was less than 40%. An inverse correlation was obtained between age and compliance, although not statistically significant. Conclusions: Vaccination coverage in patients with cochlear implant is lower than expected. Close collaboration between Otolaryngology departments and the Vaccination Units is proposed as the main strategy for improvement


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Cobertura Vacinal , Implantes Cocleares , Vacinas Pneumocócicas , Cooperação do Paciente , Cooperação e Adesão ao Tratamento , Meningite/imunologia , Meningite/prevenção & controle , Estudos Transversais , Vacinação Obrigatória
3.
ABCS health sci ; 44(3): 213-216, 20 dez 2019.
Artigo em Inglês, Português | LILACS | ID: biblio-1047758

RESUMO

INTRODUÇÃO: Este estudo relata possíveis fatores para a recorrência de infarto agudo do miocárdio de um paciente atendido em unidade coronariana sob a perspectiva familiar. RELATO DE CASO: Trata-se de um estudo descritivo, com abordagem qualitativa, do tipo relato de caso. Os dados foram coletados através de uma entrevista piloto semiestruturada, realizada com um familiar de uma paciente que se encontrava internada na unidade coronariana com recorrência de Infarto Agudo do Miocárdio (IAM). O familiar relatou que a intensa atividade física realizada pela paciente, o consumo excessivo de álcool e a não adesão ao tratamento medicamentoso contribuíram para o segundo quadro de IAM. A familiar mencionou que as orientações recebidas durante a alta foram somente em torno dos medicamentos prescritos, destacando a ausência de orientações acerca das alterações no estilo de vida, em especial à equipe de enfermagem. CONCLUSÃO: O presente relato revelou que as orientações durante a alta não estão sendo efetivas na prevenção da recorrência de IAM e ressalta a necessidade de repensar o papel dos profissionais de enfermagem em relação às orientações prestadas, como forma de facilitar a adesão do paciente ao tratamento medicamentoso e às mudanças no estilo de vida.


INTRODUCTION: This study reports the possible factors for the recurrence of acute myocardial infarction of a patient attended in the coronary care unit in the perspective of relatives. CASE REPORT: This is a descriptive study, with qualitative approach, of the case report type. The data were collected through a semi-structured pilot interview, conducted with a member of the patient family, who was hospitalized in the coronary care unit with the recurrence of Acute Myocardial Infarction (AMI). The relative reported that the intense physical activity performed by the patient, the excessive consumption of alcohol and non-adherence to drug therapy, have contributed to the second event of AMI. The same mentioned that the guidance received during the high, were only around for medicines prescribed, highlighting the absence of guidance about the changes in life style and the realization of the same by health care professionals, in particular nursing staff. CONCLUSION: The present report revealed that the guidelines during the high are not being effective in the prevention of the recurrence of AMI, and highlights the need to rethink the role of professional nursing in relation to the guidelines provided, as a way of facilitating the patient's adherence to medication treatment and changes in lifestyle.


Assuntos
Humanos , Feminino , Idoso , Relatos de Casos , Família , Prevenção de Doenças , Relações Familiares , Cooperação e Adesão ao Tratamento , Promoção da Saúde , Infarto do Miocárdio
4.
Prensa méd. argent ; 105(11): 800-809, dic2019. graf, tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1049807

RESUMO

Introduction: Discharging with personal satisfaction is one of the main problems in hospitalization, when the patient leaves the hospital sooner than the doctor's advice. This will exacerbate the disease and increase the risk of hospital re-admittance. In this regard, more attention should be given to children because they are not able to understand the above meaning or participate in decision making. Materials and Methods: In this descriptive cross-sectional study, all children who were discharged due to personal satisfaction from the hospital were included. The 4-page checklist for the various causes of "leaving the hospital despite medical advice" was divided into three sections: Causes related to the patient's own issues, causes related to the hospital medical staff and the causes of the hospital situation, and a page of demographical variables included gender, age and history of hospitalization and ward of hospitalization. Results: A total of 310 cases (7.4%) were discharged with personal satisfaction of their parents. The most important factor linked to discharge with personal satisfaction was the poor economic condition of parents. In terms of factors related to the medical staff, the lack of proper handling of the nurse and then the doctor were the most important factors for discharge. Conclusion: It seems that economic issues are the most important factor in the discharge of children with parental consent of parents. On the other hand, factors such as unacceptable and unpopular behavior of nurses and doctors play crucial role in this phenomenon. Parents who are under intense psychological stress due to economic problems and child illness can be at risk of developing this phenomenon if they are not mentally supported by health staffs


Assuntos
Humanos , Criança , Alta do Paciente , Pobreza/economia , Epidemiologia Descritiva , Estudos Transversais/estatística & dados numéricos , Satisfação do Paciente , Impactos na Saúde/efeitos adversos , Consentimento dos Pais , Cooperação e Adesão ao Tratamento , Hospitalização
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 563-570, nov. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184379

RESUMO

Objetivo: Evaluar en el paciente diabético anciano la probabilidad de mejorar la fragilidad tras realizar ejercicios de fuerza con una banda elástica y ejercicio aeróbico. Métodos: Estudio prospectivo de pacientes diabéticos mayores de 70 años, con Barthel > 80 puntos y Global Deterioration Scale-Functional Assessment Staging < 3 puntos. Se recomendaron ejercicios de fuerza con una banda elástica 3 días a la semana y caminar 30 min al día 5 días a la semana. Se revisó la adherencia a los ejercicios mediante la pregunta de Haynes-Sacket. En el momento basal y a los 6 meses se evaluaron la fragilidad según los criterios de Fried y la capacidad funcional mediante el Short Physical Performance Battery. Resultados: Un total de 44 pacientes completaron los 6 meses de seguimiento. Se produjo falta de adherencia a los ejercicios aeróbicos en el 38,6% de los casos y a los ejercicios con bandas elásticas en el 47,7%. La prevalencia de fragilidad disminuyó del 34,1% inicial al 25% a los 6 meses (p = 0,043), y el porcentaje de sujetos con una limitación funcional moderada-grave se redujo del 26,2 al 21,4% (p = 0,007). La adherencia a los ejercicios aeróbicos (p = 0,034) y la ausencia de cardiopatía isquémica coronaria (p = 0,043) predispusieron a mejorar la fragilidad. Conclusiones: Realizar durante 6 meses ejercicios de fuerza con una banda elástica y ejercicio aeróbico reduce la prevalencia de fragilidad en pacientes diabéticos ancianos. La probabilidad de mejorar la fragilidad disminuye en caso de cardiopatía isquémica coronaria y aumenta con la adherencia a los ejercicios aeróbicos


Aim: To evaluate in the elderly diabetic patient the probability of improving the frailty after performing strength exercises with an elastic band and aerobic exercise. Methods: Prospective study of diabetic patients older than 70 years, with Barthel > 80 points and Global Deterioration Scale -Functional Assessment Staging < 3 points. Strength exercises with an elastic band 3 days a week and walk 30 min a day 5 days a week were recommended. Adherence to the exercises was assessed using the Haynes-Sacket test. Frailty was assessed by the Fried criteria and functional capacity by the Short Physical Performance Battery at baseline and at 6 months. Results: 44 patients completed 6 months of follow-up. There was non-adherence to aerobic exercises in 38.6% of cases and to exercises with elastic bands in 47.7%. The prevalence of frailty decreased from an initial 34.1% to 25% at 6 months (p = 0.043) and the percentage of patients with a moderate-severe functional limitation was reduced from 26.2% to 21.4% (p = 0.007). Adherence to aerobic exercises (p = 0.034) and absence of coronary ischemic heart disease (p = 0.043) predisposed to improve frailty. Conclusions: Performing 6-month strength exercises with an elastic band and aerobic exercise reduces the prevalence of frailty in elderly diabetic patients. The probability of improving frailty decreases in case of coronary ischemic heart disease and increases with adherence to aerobic exercises


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Exercício/fisiologia , Força Muscular/fisiologia , Idoso Fragilizado , Debilidade Muscular/terapia , Terapia por Exercício , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Estudos Prospectivos , Cooperação e Adesão ao Tratamento
6.
Aten. prim. (Barc., Ed. impr.) ; 51(9): 529-535, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185929

RESUMO

Objetivos: Examinar las diferencias de género sobre determinados factores de protección (FP: aceptación y resiliencia), factores de vulnerabilidad (FV: ira, depresión y ansiedad), la adherencia al tratamiento y calidad de vida (CV) en pacientes cardiovasculares; y estudiar las relaciones de estos factores con la adherencia y CV en mujeres y hombres separadamente. Diseño: Observacional y transversal. Emplazamiento: Dos Centros de Atención Primaria de Gran Canaria. Participantes: Participaron 198 pacientes cardiovasculares (91 hombres y 107 mujeres). Mediciones principales: La aceptación se midió con la escala ICQ; la resiliencia, con la escala CD-RISC; la depresión, con el PHQ-9; la ansiedad, con la escala HADS; la ira interiorizada y exteriorizada, mediante el STAXI-2; la CV, con el cuestionario SF-36; y la adherencia, con una escala autoinformada. Resultados: Las mujeres, en comparación con los hombres, presentaron mayor ansiedad (IC 95%: 6,3 a 7,9) y adherencia a la reducción de tabaco (IC 95%: 9,4 a 10,0) y alcohol (IC 95%: 9,6 a 10,1), y menor ira exteriorizada (IC 95%: 8,9 a 10,0), CV mental (IC 95%: 47,0 a 51,3) y adherencia a la medicación (IC 95%: 22,2 a 23,3). La aceptación se asoció con mejor adherencia solo en las mujeres. En los hombres hubo más FV relacionados con una peor adherencia. En ambos grupos la ansiedad tuvo un impacto negativo sobre la adherencia, y la CV se asoció positivamente con los FP y negativamente con FV. Conclusiones: Se constatan las diferencias de género sobre CV, algunos FV y la adherencia; y el papel beneficioso de la aceptación en las mujeres


Objectives: To examine gender differences on specific protective factors (PF: acceptance and resilience), vulnerability factors (VF: anger, depression, and anxiety; adherence to treatment and quality of life (QoL) in cardiovascular patients, as well as to study separately the relationships of these factors with adherence and QoL in females and males. Design: Observational and cross-sectional. Setting: Two Primary Care Centres in Gran Canaria. Participants: One hundred and ninety-eight cardiovascular patients (91 males and 107 females) participated. Main measurements: Acceptance was assessed by the ICQ scale; resilience by the CD-RISC; depression by the PHQ-9; anxiety by the HADS; Anger-In and Anger-Out by the STAXI-2; QoL by the SF-36; and adherence by a self-reported scale. Results: Females exhibited higher anxiety (95% CI: 6.3-7.9) and adherence to reducing smoking (95% CI: 9.4-10.0) and drinking (95% CI: 9.6-10.1), and lower Anger-Out (95% CI: 8.9-10.0), mental QoL (95% CI: 47.0-51.3) and adherence to medication (95% CI: 22.2-23.3) compared to males. Acceptance was associated with better adherence only in women. There were more VF related to worse adherence in males. Anxiety had a negative impact on adherence, and QoL was positively associated with PF, and negatively with VF in both groups. Conclusions: Gender differences in QoL, some VF, and adherence are observed, in addition to the beneficial role of Acceptance in women


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Gênero e Saúde , Populações Vulneráveis , Qualidade de Vida , Cooperação e Adesão ao Tratamento , Doenças Cardiovasculares/terapia , Epidemiologia Descritiva , Inquéritos e Questionários , Análise de Variância
7.
Rev Saude Publica ; 53: 95, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644773

RESUMO

OBJECTIVE: To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS: A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS: The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS: Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Mães/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Sífilis Congênita/terapia , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Fatores de Risco , Fatores Socioeconômicos , Sífilis Congênita/epidemiologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
8.
Rev Assoc Med Bras (1992) ; 65(9): 1151-1155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618329

RESUMO

This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.


Assuntos
Cirurgia Bariátrica , Desnutrição Proteico-Calórica/complicações , Infecções Estreptocócicas/complicações , Adulto , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/terapia , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Nutrição Parenteral , Complicações Pós-Operatórias , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/etiologia , Desnutrição Aguda Grave/terapia , Cooperação e Adesão ao Tratamento
9.
Invest. educ. enferm ; 37(3): [E02], 15 Octubre 2019. Tab 1, Tab 2, Tab 3
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1023469

RESUMO

Objective. To determine the factors associated with adherence to the therapeutic regime in patients with hypertension and type 2 diabetes mellitus cared for in primary care centers. Methods. This was an analytical cross-sectional study, conducted with 500 patients from two institutions in Bucaramanga (Colombia). Adherence to the therapeutic regime was measured with the label of Nursing outcomes "Treatment Behavior: Illness or Injury" and the instrument "Factors that influence on adherence to pharmacological and non-pharmacological treatments" by Ortiz Suárez was used. Results. Factors affecting negatively adherence to the therapeutic regime were: belonging to the subsidized regime, never being able to read written information about the management of their disease, and never receiving information about benefits of the medications ordered by the physician. On the contrary, positive influence was noted by referring "never" to the following statements, which impacted positively on adherence: the diverse occupations you have in and out of the house hinder your following the treatment; when your symptoms improve, do you interrupt the treatment? previously, have you had difficulties in complying with your treatment and believe there are difficult-to-change customs about foods and exercises? Conclusion. Two socioeconomic factors and one related with the health system and staff affected negatively on adherence to the therapeutic regime, while four factors related with the therapy favored it. The factors identified could be used in the design of nursing interventions to improve adherence in this population.


Objetivo. Determinar los factores asociados a la adherencia al régimen terapéutico en pacientes con hipertensión y diabetes mellitus tipo 2 en centros de atención primaria. Métodos. Estudio de corte transversal analítico, realizado en 500 pacientes de dos instituciones de Bucaramanga (Colombia). La adherencia al régimen terapéutico se midió con la etiqueta de Resultados de Enfermería "Conducta terapéutica: enfermedad o lesión" y se empleó el instrumento "Factores que influyen en la adherencia a tratamientos farmacológicos y no farmacológicos" de Bonilla. Resultados. Los factores que afectaron negativamente la adherencia al régimen terapéutico fueron: pertenecer al régimen subsidiado, nunca poder leer información escrita sobre el manejo de su enfermedad y nunca recibir información sobre beneficios de los medicamentos ordenados por el médico. Por el contrario, influyeron positivamente referir "nunca" a las siguientes afirmaciones, que impactaron positivamente la adherencia: las diversas ocupaciones que tiene dentro y fuera del hogar le dificultan seguir el tratamiento; cuando mejoran sus síntomas, ¿usted suspende el tratamiento?; anteriormente, ¿ha presentado dificultades para cumplir su tratamiento y cree que hay costumbres sobre alimentos y ejercicios difíciles de cambiar?. Conclusión. Dos factores socioeconómicos y uno relacionado con el sistema y equipo de salud afectaron negativamente la adherencia al régimen terapéutico, mientras que cuatro factores relacionados con la terapia la favorecieron. Los factores identificados podrían ser utilizados en el diseño de intervenciones para mejorar la adherencia en esta población.


Objetivo. Determinar os fatores associados à aderência ao regime terapêutico em pacientes com hipertensão e diabetes mellitus tipo 2 atendidos nos centros de atenção primária. Métodos. Estudo de corte transversal analítico, realizado em 500 pacientes de duas instituições de Bucaramanga (Colômbia). A aderência ao regime terapêutico foi medida com a etiqueta de Resultados de Enfermagem "Conduta terapêutica: doença ou lesão" e se empregou o instrumento "Fatores que influem na aderência a tratamentos farmacológicos e não farmacológicos" de Ortiz Suárez. Resultados. Os fatores que afetaram negativamente a aderência ao regime terapêutico foram: pertencer ao regime subsidiado, nunca poder ler a informação escrita sobre o manejo da sua doença e nunca receber informação sobre benefícios dos medicamentos ordenados pelo médico. Pelo contrário, influíram positivamente referir "nunca" às seguintes afirmações, impacto positivamente a aderência: as diversidades ocupações que tem dentro e fora do lar lhe dificultam seguir o tratamento; quando melhoram seus sintomas, você suspende o tratamento; anteriormente há apresentado dificuldades para cumprir seu tratamento e acredita que há costumes sobre alimentos e exercícios difíceis de mudar. Conclusão. Dois fatores socioeconômicos e um relacionado com o sistema e equipamento de saúde, afetaram negativamente a aderência ao regime terapêutico, enquanto que quatro fatores relacionados com a terapia a favoreceram. Os fatores identificados poderiam ser utilizados no desenho de intervenções de enfermagem para melhorar a aderência nesta população.


Assuntos
Humanos , Estudos Transversais , Fatores de Risco , Diabetes Mellitus Tipo 2 , Cooperação e Adesão ao Tratamento , Hipertensão
10.
Invest. educ. enferm ; 37(3): [E09], 15 Octubre 2019. Tab 1, Tab 2
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1023498

RESUMO

Objective. To determine the validity and reliability of the Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH), Spanish version, designed by Chunhua Ma et al. Methods. This study was carried out in the city of Ibagué (Colombia) and the test validation determined validity (face, content, and construct) and reliability. Face and content validity were conducted through expert judgment, using Fleiss' Kappa Coefficient statistical tests and modified Lawshe's content validity index. The construct validity and the reliability test had the participation of 220 people with diagnosis of primary hypertension. Reliability was calculated through Cronbach's alpha statistical test. Results. In the face validity, the instrument reported a Fleiss' Kappa index was 0.68 in comprehension, 0.76 in clarity, and 0.64 in accuracy, interpreted as a substantial agreement. The content validity index was satisfactory with 0.91; el exploratory factor analysis reported six factors with a total variance explained of 54%. Cronbach's alpha for the total scale was 0.74. Conclusion. The Spanish version of the TAQPH is a valid and reliable scale to evaluate adherence to treatment in patients with primary hypertension.


Objetivo: Determinar la validez y confiabilidad del cuestionario para medir la adherencia al tratamiento en pacientes con hipertensión arterial (Treatment Adherence Questionnaire for Patients with Hypertension - TAQPH), versión en español, diseñado por Chunhua Ma et al. Métodos. Estudio de validación de pruebas realizado en la ciudad de Ibagué (Colombia) en el que se determinó la validez (facial, de contenido y de constructo) y la confiabilidad. La validez facial y de contenido se efectuó mediante el juicio de expertos, utilizando las pruebas estadísticas de Coeficiente Kappa de Fleiss e índice de Lawshe modificado. En la validez de constructo y prueba de confiabilidad participaron 220 personas con diagnóstico de hipertensión arterial. La confiabilidad se calculó mediante la prueba estadística de alfa de Cronbach. Resultados. En la validez facial, el instrumento reportó un índice de Kappa de Fleiss de 0.68 en comprensión, 0.76 en claridad y 0.64 en precisión, interpretado como un acuerdo sustancial. El índice de validez de contenido fue satisfactorio con 0.91. El análisis factorial exploratorio reportó seis factores con una varianza total explicada de 54%. El alfa de Cronbach fue de 0.74 para la escala total. Conclusión. La versión en español del TAQPH es una escala válida y confiable para la evaluación de la adherencia al tratamiento en pacientes con hipertensión arterial.


Objetivo: Determinar a validez e confiabilidade do questionário para medir a aderência ao tratamento em pacientes com hipertensão arterial (Treatment Adherence Questionnaire for Patients with Hypertension - TAQPH), versão em espanhol, desenhado por Chunhua Ma et al. Métodos. Estudo de validação de provas que se realizou na cidade de Ibagué (Colômbia) no qual se determinou a validez (facial, de conteúdo e de construto) e a confiabilidade. A validez facial e de conteúdo se efetuou mediante o juízo de especialistas, utilizando as provas estatísticas de Coeficiente Kappa de Fleiss e índice de Lawshe modificado. Na validez de construto e prova de confiabilidade participaram 220 pessoas com diagnóstico de hipertensão arterial. A confiabilidade se calculou mediante a prova estatística de alfa de Cronbach. Resultados. Na validez facial, o instrumento reportou um índice de Kappa de Fleiss de 0.68 em compreensão, 0.76 em claridade e 0.64 em precisão, interpretado como um acordo substancial. O índice de validez de conteúdo foi satisfatório com 0.91, a análise fatorial exploratório reportou seis fatores com uma variação total explicada de 54%. O alfa de Cronbach foi de 0.74 para a escala total. Conclusão. A versão em espanhol de TAQPH é uma escala válida e confiável para a avaliação da aderência ao tratamento em pacientes com hipertensão arterial.


Assuntos
Humanos , Psicometria , Inquéritos e Questionários , Estudos de Validação , Hipertensão Essencial , Cooperação e Adesão ao Tratamento
11.
Nutr. hosp ; 36(5): 1116-1122, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184635

RESUMO

Introducción: la dieta mediterránea (DM) se relaciona con un buen estado de salud. Existen diferentes propuestas validadas de índices para evaluar la adherencia al patrón dietético mediterráneo. Objetivos: la finalidad del estudio fue evaluar la clasificación de la población adulta de la Comunitat Valenciana según su adecuación a la DM, utilizando dos índices validados y analizar el grado de concordancia entre ellos. Métodos: estudio metodológico sobre la concordancia de clasificación de una población a través de dos instrumentos de medición de la adhesión a la DM, sobre una muestra representativa de 2.728 individuos adultos de la Comunitat Valenciana. Datos obtenidos de la Encuesta de Nutrición de la Comunitat Valenciana 2010-2011. La adhesión se determinó mediante "Puntuación Modificada de Dieta Mediterránea" y "Cribado de Adherencia de Dieta Mediterránea". La población se clasificó en adhesión baja, media o alta según cada índice. Se realizó un análisis estadístico para variables cualitativas y cuantitativas. Se evaluó la concordancia de los índices por la prueba Kappa. Resultados: en ambos índices, el mayor porcentaje (41% y 71%, respectivamente) de población se situó en una adhesión media a la DM. Entre ambos índices el valor del índice kappa fue de 0,169, para hombres de 0,163 y para mujeres de 0,174. Por grupos de edad: 0,158 para los de 16-24 años, 0,139 para 25-44 años, 0,185 para 45-64 años y, 0,161 para mayores de 64 años. Conclusiones: los dos índices testados mostraron entre si un grado de acuerdo pobre y clasificaron de forma diferente a una misma población


Background: the Mediterranean diet (MD) has been related to a good state of health. There are different index to evaluate the adherence to Mediterranean dietary pattern. Objective: the purpose of the study was to evaluate the classification of the adult population of the Comunitat Valenciana according to their suitability to the MD using two validated indexes, and analyze the degree of agreement between them. Methods: methodological study of the concordance of classification of a population through two instruments for measuring adherence to MD, of a representative sample of 2,728 adult of the Comunitat Valenciana. Data obtained from Encuesta de Nutrición de la Comunitat Valenciana 2010-2011. The adhesion was determined by "Puntuación Modificada de Dieta Mediterránea" and "Cribado de Adherencia de Dieta Mediterránea". The population was classified as low, medium or high according to each index. A statistical analysis was performed for qualitative and quantitative variables. The concordance of the indexes was evaluated by the Kappa test. Results: in both indexes, the highest percentage (41% and 71%, respectively) of the population was in medium adherence to MD. Between both indexes, the value of the kappa index was 0.169, for men 0.163 and for women 0.174. By age groups: 0.158 for those aged 16-24 years, 0.139 for 25-44 years, 0.185 for 45-64 years, and 0.161 for those over 64 years. Conclusions: the two indexes tested showed a degree of poor agreement and classified the same population differently


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cooperação e Adesão ao Tratamento , Dieta Mediterrânea , Estado Nutricional , Consumo de Alimentos , Indicadores Básicos de Saúde , Inquéritos e Questionários , Análise de Variância
13.
AIDS Behav ; 23(Suppl 3): 287-295, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31520241

RESUMO

Test and Rapid Response Treatment (TRRT) linkage programs have demonstrated improved HIV suppression rates. This paper describes the design and implementation of the Miami TRRT initiative and its clinical impact. Assisted by a dedicated care navigator, patients receiving a reactive HIV rapid test at the Florida Department of Health STD Clinic were offered same-day HIV care at the University of Miami/Jackson Memorial Medical Center Adult HIV Outpatient Clinic. Patient retention and labs were tracked for 12 months. Of the 2337 individuals tested, 46 had a reactive HIV test; 41 (89%) consented to participate. For the 36 patients in continued care for a year, 33 (91.7%) achieved virological suppression (< 200 copies/mL) within 70 days of their reactive HIV rapid test; at 12 months, 35 (97.2%) remained suppressed, and mean CD4 T cell counts increased from 452 ± 266 to 597 ± 322 cells/mm3. The Miami TRRT initiative demonstrated that immediate linkage to care is feasible and improves retention and suppression in a public/academic medical center in the U.S. South.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Programas de Rastreamento/métodos , Navegação de Pacientes , Cooperação e Adesão ao Tratamento/psicologia , Centros Médicos Acadêmicos , Adulto , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Continuidade da Assistência ao Paciente , Feminino , Florida , Infecções por HIV/virologia , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento , Carga Viral
14.
PLoS Negl Trop Dis ; 13(9): e0007714, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31490925

RESUMO

BACKGROUND: Although leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Using individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25-1.97) and Northeast (OR = 1.44; 95%CI 1.17-1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01-1.69), no income (OR = 1.41; 95%CI 1.07-1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13-1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28-1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10-1.66). CONCLUSIONS: The findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Fatores Socioeconômicos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Brasil/epidemiologia , Estudos de Coortes , Quimioterapia Combinada/estatística & dados numéricos , Grupos Étnicos , Feminino , Geografia , Humanos , Hanseníase/epidemiologia , Masculino
15.
Artigo em Inglês | MEDLINE | ID: mdl-31510102

RESUMO

High costs are an important reason patients postpone dental visits, which can lead to serious medical consequences. However, little is known about the determinants of postponing visits due to financial constraints longitudinally. Thus, the purpose of this study was to examine the determinants of postponing dental visits due to costs in older adults in Germany longitudinally. Data from wave 5 and 6 of the Survey of Health, Ageing, and Retirement in Europe was used. The occurrence of postponed dental visits due to costs in the last 12 months served as the outcome measure. Socioeconomic and health-related explanatory variables were included. Conditional fixed effects logistic regression models were used (n = 362). Regressions showed that the likelihood of postponing dental visits due to costs increased with lower age, less chronic disease, and lower income. The outcome measure was neither associated with marital status nor self-rated health. Identifying the factors associated with postponed dental visits due to costs might help to mitigate this challenge. In the long term, this might help to maintain the well-being of older individuals.


Assuntos
Serviços de Saúde Bucal/economia , Cooperação e Adesão ao Tratamento , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aposentadoria , Fatores Socioeconômicos , Inquéritos e Questionários
16.
Gastroenterol. hepatol. (Ed. impr.) ; 42(7): 423-428, ago.-sept. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183828

RESUMO

Introducción: Adherence to guidelines on the periendoscopic management of antiplatelet therapy (APT) has not been analyzed in detail. Our aim was to assess adherence to guidelines in patients referred to our Endoscopy Unit on a case-by-case basis, describing in detail the detected deviations and identifying areas of improvement. Patients and methods: Cross-sectional study of outpatients consecutively scheduled for an unsedated upper or lower gastrointestinal endoscopy between January and June 2015. Patients on anticoagulant therapy were excluded. Results: 675 patients were evaluated, including 91 (13.5%) patients on APT [upper GI endoscopy 25 (27.5%), lower GI endoscopy 66 (72.5%)]. Contrary to the clinical guidelines, aspirin was discontinued in 25 of the 77 patients previously prescribed the drug (32.5%) but this modification was patient's own decision in 11 cases. Most of the apparent deviations in the management of clopidogrel and dual antiplatelet therapy (DAPT) were not true non-adherence cases. The Primary Care physician modified an APT prescribed by another physician in 8 of 9 cases (88.9%), always in cases with aspirin. No relationship was found between the endoscopic procedure's predicted risk of bleeding or the patient's thrombotic risk and modification of therapy. Discussion: In many patients, the peri-procedural management of APT goes against current guidelines, but some of these inconsistencies cannot be considered true deviations from practice. Identified areas for improvement are increasing patient awareness about APT, disseminating the guidelines in Primary Care, and underscoring the significance of thrombotic risk related to APT withdrawal


Introducción: El cumplimiento de las guías clínicas sobre el manejo periendoscópico del tratamiento antiagregante plaquetario (TAP) no se ha analizado con detalle. Nuestro objetivo fue analizar caso por caso el cumplimiento de las guías en los pacientes que acuden a nuestra Unidad de Endoscopia, describiendo con detalle las desviaciones detectadas e identificando áreas de mejora. Pacientes y métodos: Estudio transversal sobre pacientes consecutivos programados para gastroscopia o colonoscopia realizadas sin sedación entre enero y junio de 2015. Se excluyeron los pacientes en tratamiento anticoagulante. Resultados: Se evaluaron 675 pacientes de los que se incluyeron 91 (13,5%) por estar en tratamiento con antiagregante plaquetario (gastroscopias 25 [27,5%], colonoscopias 66 [72,5%]). La aspirina se interrumpió contrariamente a las guías clínicas en 25 de los 77 pacientes que la llevaban (32,5%), pero esta modificación fue una decisión del propio paciente en 11 casos. Muchas de las aparentes desviaciones en el manejo del clopidogrel y del tratamiento antiagregante plaquetario doble (TAPD) no eran verdaderos casos de no cumplimiento. El médico de Atención Primaria modificó el TAP prescrito por otro especialista en 8 de 9 casos (88,9%), siempre en casos de aspirina. No se encontró relación entre el riesgo de sangrado del procedimiento endoscópico o el riesgo de trombosis del paciente y la modificación del tratamiento. Discusión: En una proporción significativa de pacientes el manejo periprocedimiento del TAP va en contra de las guías clínicas, pero algunas de estas desviaciones no pueden considerarse verdaderos incumplimientos. Áreas de mejora son aumentar la información al paciente sobre el TAP, extender la diseminación de las guías a atención primaria y resaltar la importancia del riesgo trombótico relacionado con la suspensión del TAP


Assuntos
Humanos , Inibidores da Agregação de Plaquetas/uso terapêutico , Cooperação e Adesão ao Tratamento , Endoscopia/métodos , Gastroscopia , Estudos Prospectivos , Estudos Transversais , Clopidogrel/uso terapêutico , Estatísticas não Paramétricas
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 417-424, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182861

RESUMO

Antecedentes y objetivo: La dieta mediterránea (DM) tradicional se asocia a un menor riesgo de padecer numerosos cánceres. Sin embargo, pocos estudios han analizado la relación de la DM con el riesgo de padecer cáncer de cabeza y cuello (CCyC). Se lleva a cabo un estudio de casos y controles en el que se compara la adherencia a la DM en pacientes diagnosticados de CCyC y población sana. Pacientes y método: Mediante el cuestionario Mediterranean Diet Adherence Screener (MEDAS), de 14 ítems, empleado en el estudio PREDIMED, se evalúa el nivel de adherencia a la DM tanto en casos obtenidos de pacientes diagnosticados de CCyC en el hospital 12de Octubre de Madrid, como en controles obtenidos de población sana de un centro de salud del Área, estratificando dicha adherencia en función de la puntuación: baja (≤7puntos), media (8-9puntos) y alta (≥10puntos). Se calcula el odds ratio (OR) para desarrollar CCyC en base a diferentes factores. Resultados: Se analiza una muestra de 168 individuos: 100 controles y 68 casos. El hábito tabáquico (OR: 2,98 [IC95%: 1,44-6,12]; p=0,003) y el consumo de alcohol (OR: 2,72 [IC95%: 1,39-5,33]; p=0,003) demuestran ser factores de riesgo para desarrollar CCyC. Sin embargo, la adherencia media-alta a la DM se asocia a menor riesgo de CCyC (OR: 0,48 [IC95%: 0,20-1,07]; p=0,052). Conclusiones: La adherencia media-alta a la DM se asocia a menor riesgo para desarrollar CCyC


Background and objective: The traditional Mediterranean diet (MD) is associated to a lower risk of suffering multiple tumors. However, few studies have analyzed the relationship between MD and the risk of developing head and neck cancer (HNC). A case-control study comparing adherence to MD was conducted in patients diagnosed with HNC and healthy population. Patients and methods: The level of adherence to MD was assessed using the 14-item MEDAS (Mediterranean Diet Adherence Screener) questionnaire, used in the PREDIMED study, in patients diagnosed with HNC at 12de Octubre Hospital in Madrid (cases) and in healthy subjects enrolled in a nearby primary health care center (controls). Adherence was stratified based on the score as low (≤7points), medium (8-9points), and high (≥10points). The odds ratio (OR) for developing HNC was estimated based on different factors. Results: A sample of 168 subjects (100 controls and 68 cases) was analyzed. Smoking (OR, 2.98 [95%CI: 1.44-6.12]; P=.003) and alcohol consumption (OR, 2.72 [95%CI: 1.39-5.33], P=.003) were strongly associated to HNC. However, medium-high adherence to MD was associated to a lower risk of developing HNC (OR, 0.48 [95%CI: 0.20-1.07], P=.052). Conclusions: Consistent medium-high adherence to MD contributes to decrease the risk of developing HNC


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dieta Mediterrânea , Neoplasias de Cabeça e Pescoço/dietoterapia , Fatores de Risco , Cooperação e Adesão ao Tratamento , Estudos de Casos e Controles , Inquéritos e Questionários , Fumar Tabaco/efeitos adversos , Alcoolismo/complicações , Análise Estatística , Intervalos de Confiança
19.
Surgery ; 166(4): 691-697, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31402128

RESUMO

BACKGROUND: Care pathways facilitate standardized, evidence-based treatment to improve outcomes and value of care. Care pathways consist of multiple nodes representing decision points. Few studies investigate care pathway compliance. We demonstrate nodal care pathway analysis by reviewing compliance with our institutional multidisciplinary, evidence-based care pathways on the treatment of thyroid nodule to generate strategies to increase care pathway adherence and value of care. METHODS: Patients undergoing workup and treatment of structural thyroid disease between January 2018 and June 2018 were included in a retrospective analysis of enterprise-wide compliance with the following 3 care pathway nodes: (1) laboratory testing: only patients with abnormal results from thyroid-stimulating hormone testing should have T3/T4 measured. (2) imaging: neck computed tomography, magnetic resonance imaging, and positron emission tomography ordered for the workup of nodules were reviewed to determine clinical appropriateness. (3) operative treatment: the first 200 thyroid resections conducted in 2018 were reviewed to determine whether the indication and extent of the operation complied with the care pathway. Medicare fee schedules were used for financial calculations. RESULTS: Care pathway nonadherence occurred in 48% of the thyroid-stimulating hormone studies and 38% of the imaging studies obtained, with annual costs exceeding $120,000. Substantial care pathway nonadherence occurred in 3% of nodule-related operations. CONCLUSION: Care pathway nodal analysis can identify areas of care pathway nonadherence. Nodal analysis should be considered for care pathway maintenance and generation of strategies of quality improvement.


Assuntos
Procedimentos Clínicos , Doenças da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia/métodos , Cooperação e Adesão ao Tratamento , Centros Médicos Acadêmicos , Adulto , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Doenças da Glândula Tireoide/patologia , Doenças da Glândula Tireoide/cirurgia , Testes de Função Tireóidea , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X/métodos
20.
AIDS Behav ; 23(11): 3140-3151, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410618

RESUMO

We developed and piloted a video-based intervention targeting HIV-positive pregnant women to optimize antiretroviral therapy (ART) retention and adherence by providing a VITAL Start (Video-intervention to Inspire Treatment Adherence for Life) before ART. VITAL Start (VS) was grounded in behavior-determinant models and developed through an iterative multi-stakeholder process. Of 306 pregnant women eligible for ART, 160 were randomized to standard of care (SOC), 146 to VS and followed for one-month. Of those assigned to VS, 100% completed video-viewing; 96.5% reported they would recommend VS. Of 11 health workers interviewed, 82% preferred VS over SOC; 91% found VS more time-efficient. Compared to SOC, VS group had greater change in HIV/ART knowledge (p < 0.01), trend towards being more likely to start ART (p = 0.07), and better self-reported adherence (p = 0.02). There were no significant group differences in 1-month retention and pharmacy pill count. VITAL Start was highly acceptable, feasible, with promising benefits to ART adherence.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Aconselhamento/métodos , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adesão à Medicação/psicologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Gestantes/psicologia , Adulto , Feminino , Infecções por HIV/psicologia , Pessoal de Saúde , Humanos , Malaui/epidemiologia , Gravidez , Autorrelato , Cooperação e Adesão ao Tratamento , Gravação em Vídeo
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