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1.
Einstein (Sao Paulo) ; 18: eAO4723, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851224

RESUMO

OBJECTIVE: To identify interventions aimed to improve adherence to medical and non-medical antihypertensive and antidiabetic therapy. METHODS: Scientometric study conducted in February and March 2018, based on data collected on PubMed ® and SciELO databases, using the following search terms: "interventions to improve adherence to diabetes therapy", "interventions to improve adherence to hypertension therapy" and "interventions to improve adherence to therapy for hypertension and diabetes". RESULTS: A total of 95 articles were selected. Scientific production increased as of 2009, with a higher number of studies published between 2015 and 2017. Most interventions described in literature were aimed at diabetic patients (46.31%). Face-to-face interventions were more common (46.31%), followed by telephone-based (31.58%) and digital (26.31%) interventions. North America stood out as the continent with the highest number of publications (68.42%), followed by Europe (14.74%). Most studies (63.16%) were based on a single type of intervention. CONCLUSION: Traditional intervention methods were more widely used to promote adherence to antihypertensive and antidiabetic therapy; digital technology emerged as a trend in interventions aimed to improve hypertension and diabetes-related health behaviors.


Assuntos
Bibliometria , Diabetes Mellitus/terapia , Hipertensão/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Fatores de Tempo , Resultado do Tratamento
2.
Int J Med Inform ; 134: 104039, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31865054

RESUMO

BACKGROUND: Although mobile app-delivered physical activity (PA) interventions have the potential to promote exercise, poor adherence to these apps is a common issue impeding their effectiveness. Gaining insights into the factors that influence PA app adherence is an important priority for app developers and intervention designers. OBJECTIVE: The objective of this study is to perform a literature review to synthesize the factors influencing PA app adherence and to identify directions for future research in this area. METHODS: A scoping review of prior research was conducted to uncover the factors influencing PA app adherence. Seven online journal databases were searched for relevant articles published from January 1, 2014, to December 31, 2018. The initial search identified 5,572 articles. After a screening and eligibility check based on inclusion criteria, 24 articles were finally selected. The definition of PA app adherence in this review could be categorized along four dimensions derived from previous studies: i.e., frequency of PA app usage, intention/motivation to sustain use of the PA app, degree of function use within the PA app, and the duration of PA app usage. RESULTS: Of the 24 included studies (both qualitative and quantitative), 12 studies were conducted in the U.S. The methods and study designs varied considerably, with the study durations ranging from 2 weeks to 24 months. The synthesized evidence indicates that 89 distinct factors influenced PA app adherence, and these could be classified into three categories: Personal Factors (n = 28), Technology Features (n = 53), and Contextual Factors (n = 8). Nine more detailed sub-categories were also compiled. Factors in sub-categories, such as psychological factors, health-related factors and predefined goals, are essential for physical activity behavior change experts to implement interventions. Factors in technology features, including PA tracking, PA goal setting and customization of exercise, are specifically useful for PA app developers or PA intervention designers. Overall, evidence of causal factors was limited. Only 5 of the 24 articles explored causal factors that affect PA app adherence. Furthermore, longitudinal studies with long durations were also limited. CONCLUSIONS: Uncovering the factors influencing PA app adherence is critical as it can expand our current knowledge and provide guidance for app-delivered PA interventions, as well as the design of PA apps. This scoping review identified and categorized factors that influence PA app adherence in prior studies. Based on the evidence synthesized, users are paying more attention to the "playfulness" and personalized features of PA apps, in addition to basic functional requirements. Also, app glitches are the most common factors found to negatively influence app adherence. Several important directions for future research are highlighted in this review, especially the design of studies to explore causality.


Assuntos
Exercício/psicologia , Aplicativos Móveis/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Humanos , Motivação , Atividade Motora , Fatores de Tempo
3.
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
4.
Reprod Biol Endocrinol ; 17(1): 73, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477128

RESUMO

BACKGROUND: Mediterranean diet (MediDiet) had been reported to be beneficial to human health. However the relationship between diet pattern and outcomes of in vitro fertilization (IVF) treatment was scarcely researched. This study was aimed to explore the correlation between MediDiet pattern of infertile women and their clinical outcomes of IVF cycles. METHODS: An observational prospective cohort study was conducted in the reproductive center from September 2016 to December 2017. Seven hundred infertile women about to undergo IVF treatment were asked to conduct a questionnaire survey. Patients were assigned to higher MediDiet adherence group or lower MediDiet adherence group according to their Mediterranean diet scores. Laboratory parameters and clinical outcomes were compared and those were different between groups were further analyzed for their relationship with MediDiet adherence. RESULTS: A total of 590 women were finally included in the study. According to MediDiet scores, 228 participants were categorized as higher MediDiet adherence group and 362 others as lower MediDiet adherence group. No significant differences were found in baseline characteristics between groups. Higher MediDiet adherence group showed larger number of embryos available (8.40 ± 5.26 vs 7.40 ± 4.71, P = 0.028). Clinical pregnancy rate and implantation rate were similar between the two groups. In further correlation tests and multivariate linear regression analysis, number of fertilized oocytes and embryo yield were positively correlated to MediDiet adherence of participants. CONCLUSION: Infertile women with greater adherence to Mediterranean diet pattern were likely to obtain more embryos available in IVF cycle.


Assuntos
Dieta Mediterrânea , Embrião de Mamíferos/metabolismo , Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Adulto , Feminino , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/estatística & dados numéricos
5.
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
6.
Rev. clín. esp. (Ed. impr.) ; 219(6): 285-292, ago.-sept. 2019.
Artigo em Espanhol | IBECS | ID: ibc-186569

RESUMO

Objetivo: Analizar la calidad de vida, la adherencia y la percepción del grado de satisfacción del tratamiento con dabigatrán frente a antagonistas de vitamina K (AVK) en pacientes con fibrilación auricular no valvular (FANV) atendidos en consultas de cardiología en España. Métodos: Estudio observacional, comparativo, prospectivo y multicéntrico en pacientes con FANV atendidos en Cardiología, que iniciaron tratamiento con dabigatrán o AVK en el mes previo a la visita basal. El seguimiento fue de 6 meses. Se analizaron la calidad de vida mediante el cuestionario validado AF-QoL 18 (0: mínimo; 100: máximo), la adherencia mediante el test de Morisky-Green y la percepción del cardiólogo mediante un cuestionario específico (0: completamente insatisfecho; 10: totalmente satisfecho). Resultados: Se analizó a 1.015 pacientes (73,3+/- 9,4 años; 57% varones; CHA2DS2VASc: 3,4+/- 1,5; HAS-BLED: 1,5+/- 1,0), tratados con dabigatrán (74,7%) o con AVK (25,3%). Las puntuaciones totales de calidad de vida se mantuvieron constantes durante el seguimiento (47,9+/- 23,5 basalmente vs. 48,6+/- 24,4 a los 6 meses; p=NS), pero superiores a los 6 meses en el grupo de dabigatrán (50,6+/- 24,7 vs. 42,8+/- 22,5; p<0,001). La adherencia al tratamiento fue elevada durante el estudio, pero superior con dabigatrán a los 6 meses (89,2% vs. 81,1%; p=0,001). Existió una mejor percepción del cardiólogo sobre la satisfacción de los pacientes tratados con dabigatrán a los 6 meses (9,0+/-1,2 vs. 6,6+/-2,2; p<0,001). Conclusiones: En pacientes con FANV y alto riesgo tromboembólico atendidos en consultas de Cardiología, tanto la adherencia como la satisfacción y la calidad de vida fueron superiores en los pacientes tratados con dabigatrán que con AVK


Objective: To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. Methods: We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). Results: We analysed 1015 patients (mean age, 73.3+/-9.4 years; 57% men; CHA2DS2VASc, 3.4+/-1.5; HAS-BLED, 1.5+/-1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9+/-23.5 and 48.6+/-24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6+/-24.7 vs. 42.8+/-22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0+/-1.2 vs. 6.6+/-2.2; P<.001). Conclusions: For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Dabigatrana/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Tromboembolia/prevenção & controle , Anticoagulantes/uso terapêutico , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Satisfação do Paciente/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Estudos Prospectivos
8.
Rev Lat Am Enfermagem ; 27: e3159, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432915

RESUMO

OBJECTIVE: to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality of patients with heart failure. METHOD: randomized clinical trial without blinding, including 201 patients diagnosed with heart failure admitted to the emergency room, who were randomized in Control Group and Intervention Group. Intervention was carried out with specific discharge guidance in the Intervention Group, who were contacted for solving doubts via phone calls after 7 and 30 days, and the adherence to treatment was evaluated after 90 days with the Morisky test, the Brief Medical Questionnaire and the non-drug adherence test in both groups. The Generalized Estimating Equations Model was used (p<0.05%). RESULTS: One-hundred and one patients were randomly sorted in the Control Group and in the Intervention Group, their average age being 62.6±15.2. The Intervention Group had higher drug and non-drug therapeutic adherence compared to the Control Group (p<0.001) and there were lower re-hospitalization and death rates in the Intervention Group after 90 days. CONCLUSION: discharge guidance with telephone follow-up was effective and resulted in greater therapeutic adherence, as well as in decrease of re-hospitalization and death rates in patients with heart failure. Clinical Trial Registration (REBEC): RBR- 37n859.


Assuntos
Insuficiência Cardíaca/terapia , Alta do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Telefone/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Idoso , Brasil , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo
9.
BMC Public Health ; 19(1): 950, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307455

RESUMO

BACKGROUND: Despite advancement in Prevention of Mother to Child Transmission (PMTCT) services, the rate of MTCT of HIV in sub-Saharan Africa is still high. This is partly due to low retention of HIV positive mothers in HIV care. We sought to determine the level of retention and the factors associated with retention among HIV positive pregnant and breastfeeding mothers following accreditation of an antiretroviral therapy (ART) clinic to offer full time ART services in one of the lower health facilities in rural Western Uganda. METHODS: This study was a mixed methods study conducted in 5 health centres in rural Western Uganda from 10th April to 10th May 2017. A total of 132 retained and non-retained HIV positive pregnant and breastfeeding mothers were recruited. A Mother was categorized as retained if she had not missed her ART appointments at antenatal or postnatal clinic for ≥3 consecutive months. Questionnaires were administered and four focus group discussions were held. We used descriptive statistics to understand characteristics of mothers and their levels of retention. Thematic analysis was used to analyze qualitative data. RESULTS: About a third (35.6%) of the mothers were aged 18-24 with a median age of 26 (IQR 23, minimum age of 16 and maximum age of 39). More than half, 73 (55.3%) of all mothers were in HIV care for 3-24 months and about 116(87.9%) of all mothers were retained in HIV care. This was an improvement from 53% reported in 2015. We found lack of formal education, lack of disclosure of HIV status to the spouse, perceived lack of confidentiality and self stigmatization as factors hindering retention. The desire to have an HIV free baby, fear of death and opportunistic infections, support from significant others and community groups were factors associated with retention. CONCLUSIONS: We observed improved retention in lower health centres and to achieve 100% retention, we recommend interventions such as sensitizing HIV positive mothers on disclosure of HIV status to spouse, maintaining confidentiality of client information at the clinic, support to girl child education and formation of community support groups. TRIAL REGISTRATION: This study was retrospectively registered with the Uganda National Council for Science and Technology (UNCST), registration receipt number 10961 on the 9th March, 2018.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Mães/psicologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Serviços de Saúde Rural/organização & administração , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Grupos Focais , Humanos , Lactente , Recém-Nascido , Mães/estatística & dados numéricos , Gravidez , Uganda , Adulto Jovem
10.
Nurs Res ; 68(5): 383-389, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283717

RESUMO

BACKGROUND: Adherence to rehabilitation is beneficial to patients with hip fracture. However, the relationships between different levels of adherence and postoperative recovery among older adults after hip fracture have not been addressed thoroughly in the literature. OBJECTIVES: The aims of this study were to explore the trajectories of adherence to home-based rehabilitation during the 12-month period after hospital discharge and to examine the effects of adhering to prescribed home-based rehabilitation on postoperative recovery of physical functions. METHODS: We employed a secondary data analysis, and 88 hip-fractured older adults with diabetes were recruited. The Chinese Barthel Index was used to measure daily physical functions, a goniometer was used to measure range of motion, and the MicroFET2 dynamometer was used to measure muscle power. Adherence was measured as the rate of adherence to the suggested frequency of home-based rehabilitation activities. RESULTS: Adherence to home-based rehabilitation decreased over time. The high-adherence group was more likely to recover prefracture physical functions than was the low-adherence group, and the high-adherence group had better self-care abilities, greater range of motion for ankle extension, and higher muscular strength on both adduction and abduction than did the low-adherence group. DISCUSSION: The results of our study suggest that patients adhere to more than 50% of prescribed rehabilitation. Future studies should continue to explore interventions to enhance rehabilitation adherence after hospital discharge.


Assuntos
Diabetes Mellitus/epidemiologia , Fraturas do Quadril/reabilitação , Serviços de Assistência Domiciliar/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Resultado do Tratamento
11.
Eur J Oncol Nurs ; 40: 111-119, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31229200

RESUMO

PURPOSE: The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer. METHODS: The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress, masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12. RESULTS: Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44-357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22-12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was -0.36 (95% CI: -0.44 to -0.28) greater in the experimental than in the active control group. CONCLUSIONS: The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.


Assuntos
Neoplasias Bucais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Consulta Remota , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Trismo/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Mandíbula/fisiopatologia , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Diabetes Metab Syndr ; 13(3): 2025-2031, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235131

RESUMO

The objective of this study was to assess the affordability effect of diabetic medicine on patient's treatment adherence among patients aged 18 and above who sought treatment at IH diabetic clinic. The source of data was primary which was collected by the researcher from IH. The independent variable was considered as affordability of the diabetic medicine and adherence was the dependent variable in this study. Findings showed that Sex, marital status, education level, estimated monthly income were significantly associated with treatment adherence at the bivariate level. The objectives of the study were looking at the affordability effect of diabetic medicine and awareness among the patients. It was found out that there is a statistically significant relationship between the two variables. Basing on the findings of the study, it is recommended that more sensitization should be put in place to help patients be informed about their health, to be educated and also made aware of how to take good care of themselves especially on the side of females as well as be trained on how to have a strong financial base as this can help improve on affordability of medicine.


Assuntos
Custos e Análise de Custo/economia , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Gastos em Saúde , Cooperação do Paciente/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores Socioeconômicos , Uganda/epidemiologia , Adulto Jovem
13.
Rech Soins Infirm ; (136): 28-42, 2019 03.
Artigo em Francês | MEDLINE | ID: mdl-31210498

RESUMO

INTRODUCTION: Diabetes mellitus is a major public health problem. ContextBackground: Educational programs have been shown to be effective demonstrated their effectiveness in improving diabetes control. In Lebanon, no action has been taken to date. OBJECTIVE: The objective is to evaluate the effects of a that an educational intervention has on the therapeutic adherence of patients with type 2 diabetes on therapeutic adherence. METHOD: An experimental design was used. The sample was composed of comprised 136 patients with type 2 diabetes. They were randomized and assigned to either an experimental group, who received a nursing intervention including that involved two education sessions followed by five telephone calls within two months of the procedure, or a and in control group. Measurements were taken before the nursing intervention and three months later. RESULTS: Compared to the control group, the experimental group demonstrated a significant improvement in the level of self-efficacy levels, self-care behaviors (general diet, specific diet, physical exercise and glycemic monitoring), the application of implementing the recommendations (diet and foot care), and HbA1c levels. DISCUSSION: The results were consistent with the studies reviewed. CONCLUSION: Nursing education improves health behaviors, enhances self-efficacy, and promotes adherence in patients with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/enfermagem , Relações Enfermeiro-Paciente , Educação de Pacientes como Assunto , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Humanos , Líbano , Pesquisa em Avaliação de Enfermagem , Autocuidado/psicologia , Autoeficácia
14.
Asia Pac J Public Health ; 31(4): 296-305, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31104477

RESUMO

Low adherence to leprosy treatment is the main challenge in Indonesia. This is a quasi-experimental observational study in a real setting of a leprosy control program in Indonesia. The study is aimed at evaluating an e-leprosy framework in increasing the rate of on-time attendance at primary health care and on-time completion of treatment of leprosy patients. This study has implemented an e-leprosy framework for primary health care at Pekalongan District. The intervention was conducted for 19 months to observe a 1-episode long-term treatment of leprosy patients. The study collected data of 391 registered patients from June 2012 to March 2016. Based on the inclusion and exclusion criteria, this study selected 188 patients. The SMS (short message service) reminders proved to be effective in increasing on-time completion and on-time attendance rates by 21% and 14.6%, respectively. There is a trend for late collections of the drugs at the 3rd, 8th, and 11th multidrug therapy drug collections.


Assuntos
Hanseníase/tratamento farmacológico , Atenção Primária à Saúde/organização & administração , Mensagem de Texto , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto , Criança , Feminino , Humanos , Indonésia , Masculino , Avaliação de Programas e Projetos de Saúde
15.
JMIR Mhealth Uhealth ; 7(4): e12652, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30938681

RESUMO

BACKGROUND: South Africa provides free antiretroviral therapy for almost 5 million people living with HIV, but only 71% of the eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade. OBJECTIVE: SmartLink is a health app for Android smartphones providing HIV-related laboratory results, information, support, and appointment reminders to engage and link patients to care. This study aimed to evaluate the ability of SmartLink to improve linkage to care for HIV-positive smartphone owners. METHODS: This study was a multisite randomized controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received the standard of care (referral alone). Linkage to care was confirmed by an HIV-related blood test reported on the National Health Laboratory Service database between 2 weeks and 8 months after initiation. RESULTS: A total of 345 participants were recruited into the study; 64.9% (224/345) of the participants were female and 44.1% (152/345) were aged less than 30 years. In addition, 46.7% (161/345) were employed full time, 95.9% (331/345) had at least secondary school education, and 35.9% (124/345) were from Zimbabwe. Linkage to care between 2 weeks and 8 months was 48.6% (88/181) in the intervention arm versus 45.1% (74/164) in the control (P=.52) and increased to 64.1% (116/181) and 61.0% (100/164) (P=.55), respectively, after the initial 8-month period. Moreover, youth aged 18 to 30-years showed a statistically significant 20% increase in linkage to care for the intervention group. CONCLUSIONS: Youth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW).


Assuntos
Infecções por HIV/terapia , Retenção nos Cuidados/normas , Smartphone/instrumentação , Adolescente , Adulto , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Aplicativos Móveis/normas , Aplicativos Móveis/estatística & dados numéricos , Retenção nos Cuidados/estatística & dados numéricos , Smartphone/estatística & dados numéricos , África do Sul , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Zimbábue
16.
Immunol Allergy Clin North Am ; 39(2): 233-242, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954173

RESUMO

Treatment nonadherence in young children with asthma involves multiple factors and should be viewed within an ecological framework. Few interventions have targeted multiple bidirectional factors, however, and little research has examined which interventions may be most appropriate for young children. Additional research is needed to identify essential intervention components, and to determine how to sustain such interventions in at-risk communities. Pediatric psychologists, with training in psychosocial intervention, screening, and primary prevention models, may be uniquely equipped to partner with communities and medical settings to develop and sustain targeted interventions for young children with asthma.


Assuntos
Asma/terapia , Autogestão , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Asma/epidemiologia , Controle Comportamental , Criança , Pré-Escolar , Assistência à Saúde , Humanos , Modelos Econométricos , Monitorização Fisiológica , Educação de Pacientes como Assunto , Estados Unidos/epidemiologia
17.
JMIR Mhealth Uhealth ; 7(4): e11989, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31012858

RESUMO

BACKGROUND: Surgical cancer patients often have deteriorated physical activity (PA), which in turn, contributes to poor outcomes and early recurrence of cancer. Mobile health (mHealth) platforms are progressively used for monitoring clinical conditions in medical subjects. Despite prevalent enthusiasm for the use of mHealth, limited studies have applied these platforms to surgical patients who are in much need of care because of acutely significant loss of physical function during the postoperative period. OBJECTIVE: The aim of our study was to determine the feasibility and clinical value of using 1 wearable device connected with the mHealth platform to record PA among patients with gastric cancer (GC) who had undergone gastrectomy. METHODS: We enrolled surgical GC patients during their inpatient stay and trained them to use the app and wearable device, enabling them to automatically monitor their walking steps. The patients continued to transmit data until postoperative day 28. The primary aim of this study was to validate the feasibility of this system, which was defined as the proportion of participants using each element of the system (wearing the device and uploading step counts) for at least 70% of the 28-day study. "Definitely feasible," "possibly feasible," and "not feasible" were defined as ≥70%, 50%-69%, and <50% of participants meeting the criteria, respectively. Moreover, the secondary aim was to evaluate the clinical value of measuring walking steps by examining whether they were associated with early discharge (length of hospital stay <9 days). RESULTS: We enrolled 43 GC inpatients for the analysis. The weekly submission rate at the first, second, third, and fourth week was 100%, 93%, 91%, and 86%, respectively. The overall daily submission rate was 95.5% (1150 days, with 43 subjects submitting data for 28 days). These data showed that this system met the definition of "definitely feasible." Of the 54 missed transmission days, 6 occurred in week 2, 12 occurred in week 3, and 36 occurred in week 4. The primary reason for not sending data was that patients or caregivers forgot to charge the wearable devices (>90%). Furthermore, we used a multivariable-adjusted model to predict early discharge, which demonstrated that every 1000-step increment of walking on postoperative day 5 was associated with early discharge (odds ratio 2.72, 95% CI 1.17-6.32; P=.02). CONCLUSIONS: Incorporating the use of mobile phone apps with wearable devices to record PA in patients of postoperative GC was feasible in patients undergoing gastrectomy in this study. With the support of the mHealth platform, this app offers seamless tracing of patients' recovery with a little extra burden and turns subjective PA into an objective, measurable parameter.


Assuntos
Exercício/psicologia , Aplicativos Móveis/normas , Monitorização Fisiológica/instrumentação , Neoplasias Gástricas/reabilitação , Idoso , Deambulação Precoce/instrumentação , Deambulação Precoce/métodos , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Neoplasias Gástricas/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Dispositivos Eletrônicos Vestíveis/normas , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos
18.
Int J Behav Nutr Phys Act ; 16(1): 34, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999896

RESUMO

BACKGROUND: The World Health Organization's 'Global Recommendations on Physical Activity for Health' state that adults should engage in regular moderate-to-vigorous intensity aerobic physical activity (MVPA; e.g. walking, running, cycling) and muscle-strengthening activity (MSA; e.g. strength/resistance training). However, assessment of both MVPA and MSA is rare in physical activity surveillance. The aim of this study is to describe the prevalence, correlates and chronic health conditions associated with meeting the combined MVPA-MSA guidelines among a population representative sample of U.S. adults. METHODS: In this cross-sectional study, data were drawn from the U.S. 2015 Behavioral Risk Factor Surveillance System. During telephone interviews, MVPA and MSA were assessed using validated questionnaires. We calculated the proportions meeting both the global MVPA and MSA physical activity guidelines (MVPA ≥150 min/week and MSA ≥2 sessions/week). Poisson regressions with a robust error variance were used to assess: (i) prevalence ratios (PR) for meeting both guidelines across sociodemographic factors (e.g. age, sex, education, income, race/ethnicity); and (ii) PRs of 12 common chronic health conditions (e.g. diabetes, coronary heart disease, hypertension, depression) across different categories of physical activity guideline adherence (met neither [reference]; MSA only; MVPA only; met both). RESULTS: Among 383,928 adults (aged 18-80 years), 23.5% (95% CI: 20.1, 20.6%) met the combined MVPA-MSA guidelines. Those with poorer self-rated health, older adults, women, lower education/income and current smokers were less likely to meet the combined guidelines. After adjustment for covariates (e.g. age, self-rated health, income, smoking) compared with meeting neither guidelines, MSA only and MVPA only, meeting the combined MVPA-MSA guidelines was associated with the lowest PRs for all health conditions (APR range: 0.44-0.76), and the clustering of ≥6 chronic health conditions (APR = 0.33; 95% CI: 0.31-0.35). CONCLUSIONS: Eight out of ten U.S. adults do not meet the global physical activity guidelines. This study supports the need for comprehensive health promotion strategies to increase the uptake and adherence of MVPA-MSA among U.S. adults. Large-scale interventions should target specific population sub-groups including older adults, women, those with poorer health and lower education/income.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Exercício/fisiologia , Treinamento de Resistência/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
19.
Psychol Trauma ; 11(7): 767-774, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30973252

RESUMO

OBJECTIVE: Few studies have investigated determinants of trauma-informed care (TIC) in vulnerable youth populations. The purpose of the present study was to investigate factors associated with initiation, completion, and selection of type of TIC treatment among a sample of 128 treatment-seeking youth who experienced crime or violence. METHOD: This retrospective medical record review study used data collected through routine clinical care at an outpatient, no-cost community mental health clinic. RESULTS: We found that 69.5% of treatment-seeking youth (n = 89) initiated treatment, defined as attending at least 1 TIC session. Among youth who initiated treatment, 61.8% (n = 55) completed a TIC treatment. Predisposing and need characteristics were not significantly associated with initiating or completing treatment in adjusted models. Youth assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) were more likely to complete treatment compared with those assigned to child-centered therapy (CCT) approaches (odds ratio [OR] = 4.48, 95% CI [1.35, 14.91], p = .014). Logistic regression analyses suggested therapists were less likely to select TF-CBT for children with higher externalizing symptoms (OR = 0.92, 95% CI [0.85, 0.99], p = .035). CONCLUSIONS: Findings suggest among youth who called in for treatment, many successfully initiated treatment, and of those who initiated, most completed treatment. Empirically supported treatments such as TF-CBT may further promote treatment completion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Psicoterapia Centrada na Pessoa/estatística & dados numéricos , Trauma Psicológico/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos
20.
JMIR Mhealth Uhealth ; 7(4): e11720, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30964436

RESUMO

BACKGROUND: Ensuring treatment adherence is important for the internal validity of clinical trials. In intervention studies where touch points decrease over time, there is even more of an adherence challenge. Trials with multiple cohorts offer an opportunity to innovate on ways to increase treatment adherence without compromising the integrity of the study design, and previous cohorts can serve as historical controls. Electronically delivered nudges offer low-cost opportunities to increase treatment adherence. OBJECTIVE: This study aimed to evaluate the effectiveness of electronic messages (e-messages) on treatment adherence to the last cohort of a parent weight loss intervention during the second half of a year-long trial, when intervention checkpoint frequency decreases. Treatment adherence is measured by intervention class attendance and adherence to the intervention diet. METHODS: All participants in the last cohort (cohort 5, n=128) of a large randomized weight loss study were offered an e-message intervention to improve participant adherence during the last 6 months of a 1-year weight loss program. Overall, 3 to 4 electronic weekly messages asked participants about intervention diet adherence. A propensity score model was estimated using 97 participants who opted to receive e-messages and 31 who declined in cohort 5 and used to pair match cohort 5 e-message participants to a historical control group from cohorts 1 to 4. Moreover, 88 participants had complete data, yielding 176 participants in the final analyses. After matching, intervention and matched control groups were compared on (1) proportion of class attendance between the 6 and 12 month study endpoints, (2) diet adherence, as measured by total carbohydrate grams for low-carbohydrate (LC) and total fat grams for low-fat (LF) diets at 12 months, and (3) weight change from 6 to 12 months. The dose-response relationship between the proportion of text messages responded to and the 3 outcomes was also investigated. RESULTS: Compared with matched controls, receiving e-messages had no effect on (1) treatment adherence; class attendance after 6 months +4.6% (95% CI -4.43 to 13.68, P=.31), (2) adherence; LC -2.5 g carbohydrate, 95% CI -29.9 to 24.8, P=.85; LF +6.2 g fat, 95% CI -4.1 to 17.0, P=.26); or on (3) the secondary outcome of weight change in the last 6 months; +0.3 kg (95% CI -1.0 to 1.5, P=.68). There was a positive significant response correlation between the percentage of messages to which participants responded and class attendance (r=.45, P<.001). CONCLUSIONS: Although this e-message intervention did not improve treatment adherence, future studies can learn from this pilot and may incorporate more variety in the prompts and more interaction to promote more effective user engagement. Uniquely, this study demonstrated the potential for innovating within a multicohort trial using propensity score-matched historical control subjects. TRIAL REGISTRATION: ClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2016.12.021.


Assuntos
Mensagem de Texto/normas , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Estudos de Coortes , Feminino , Grupos Focais/métodos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Sistemas de Alerta/instrumentação , Sistemas de Alerta/normas , Sistemas de Alerta/estatística & dados numéricos , Inquéritos e Questionários , Mensagem de Texto/instrumentação , Mensagem de Texto/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos
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