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1.
Lancet HIV ; 8(2): e106-e113, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33539757

RESUMO

Ending the AIDS epidemic by 2030 will require addressing stigma more systematically and at a larger scale than current efforts. Existing global evidence shows that stigma is a barrier to achieving each of the 90-90-90 targets; it undermines HIV testing, linkage to care, treatment adherence, and viral load suppression. However, findings from both research studies and programmatic experience have helped to inform the growing body of knowledge regarding how to reduce stigma, leading to key principles for HIV stigma reduction. These principles include immediately addressing actionable drivers of stigma, centring groups affected by stigma at the core of the response, and engaging opinion leaders and building partnerships between affected groups and opinion leaders. Although there is still room to strengthen research on stigma measurement and reduction, in particular for intersectional stigma, the proliferation of evidence over the past several decades on how to measure and address stigma provides a solid foundation for immediate and comprehensive action.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Síndrome de Imunodeficiência Adquirida/psicologia , Epidemias/prevenção & controle , Medo/psicologia , Estigma Social , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/virologia , Fármacos Anti-HIV/uso terapêutico , Feminino , HIV/efeitos dos fármacos , HIV/crescimento & desenvolvimento , HIV/patogenicidade , Humanos , Masculino , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Isolamento Social/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Carga Viral/efeitos dos fármacos
2.
Transl Psychiatry ; 11(1): 75, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500389

RESUMO

The impact of the COVID-19 pandemic on clinically stable older patients with psychiatric disorders is unclear. This study examined the prevalence of depressive and anxiety symptoms, and their associations with quality of life (QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. This was a multicenter, cross-sectional study. Depressive and anxiety symptoms, insomnia, pain, and QOL were assessed with standardized instruments. A total of 1063 patients were included. The prevalence of depressive and anxiety symptoms, and combined depressive and anxiety symptoms were 62.3% (95%CI = 59.4-65.2%), 52.4% (95%CI = 49.3-55.4%), and 45.9% (95%CI = 42.9-48.9%), respectively. Patients with depressive and anxiety symptoms had significantly lower QOL than those without (P < 0.01). Binary logistic regression analyses revealed that having depressive symptoms was positively associated with more severe insomnia (OR = 1.29, P < 0.01) and pain (OR = 1.14, P < 0.01), and was negatively associated with other psychiatric diagnoses (except for major depressive disorder, schizophrenia, and organic mental disorder; OR = 0.50, P < 0.01), while having anxiety symptoms was positively associated with severe physical diseases (OR = 1.57, P = 0.02), poor adherence to treatment (OR = 1.50, P < 0.01), and more severe insomnia (OR = 1.15, P < 0.01) and pain (OR = 1.11, P < 0.01). Having combined depression and anxiety symptoms was positively associated with poor adherence to treatment (OR = 1.42, P = 0.02) and more severe insomnia (OR = 1.19, P < 0.01) and pain (OR = 1.15, P < 0.01), and was negatively associated with the diagnosis of schizophrenia (OR = 0.50, P = 0.04) and others (OR = 0.53, P < 0.01). Depressive and anxiety symptoms were common in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Considering the negative impact of these symptoms on QOL, regular screening and appropriate treatment are recommended for this population.


Assuntos
Transtornos Mentais/epidemiologia , Dor/epidemiologia , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Idoso , China/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença
3.
Curr Probl Cardiol ; 46(4): 100737, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33412349

RESUMO

BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.


Assuntos
Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Diabetes Mellitus/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/psicologia , Dieta/estatística & dados numéricos , Dislipidemias/epidemiologia , Dislipidemias/psicologia , Ingestão de Alimentos , Exercício Físico/psicologia , Feminino , Frutas , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , América Latina/epidemiologia , Masculino , Saúde Mental , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Verduras
4.
Esc. Anna Nery Rev. Enferm ; 25(2): e20200213, 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1142953

RESUMO

RESUMO Objetivo Analisar a associação entre a adesão ao tratamento anti-hipertensivo e a ocorrência de Síndrome Metabólica em pacientes hipertensos de uma unidade de atenção primária à saúde. Método Estudo analítico com corte transversal realizado com 306 pacientes hipertensos de uma Unidade de Atenção Primária à Saúde localizada na cidade de Fortaleza-CE. Resultados Dos participantes do estudo 74,2% eram do sexo feminino, média 61,8 ± 11,9 anos e dentro da faixa etária de 54 a 69, 77,1% raça/cor parda, 60,8% com nível fundamental incompleto ou completo e 70,6% com renda familiar entre 1 e 2 salários mínimos. Dos hipertensos avaliados, 41,5% apresentaram Síndrome Metabólica e 76,5% apresentava aderência parcial ao tratamento anti-hipertensivo. Na avaliação estatística da associação entre as variáveis foi verificado não existir (p = 0,149 e p = 0,642). Os valores referentes à adesão ao tratamento anti-hipertensivo eram iguais, tanto nos pacientes com Síndrome Metabólica como dos que não apresentavam essa condição. Conclusão e implicações para a prática A adesão terapêutica anti-hipertensiva alta e parcial foi prevalente. A frequência de Síndrome Metabólica entre os hipertensos em estudo foi elevada. Portanto, medidas de prevenção para doenças cardiovasculares e alcance das metas terapêuticas devem ser implementas continuamente. Um desafio a ser superado pelos profissionais e serviços de saúde.


RESUMEN Objetivo Analizar la asociación entre la adherencia al tratamiento antihipertensivo y la aparición del síndrome metabólico en pacientes hipertensos en una unidad de atención primaria de salud. Método Estudio analítico con corte transversal realizado con 306 pacientes hipertensos de una Unidad de Atención Primaria de Salud ubicada en la ciudad de Fortaleza-CE. Resultados De los participantes en el estudio, el 74,2% eran mujeres, con una media de 61,8 ± 11,9 años y dentro del grupo de edad de 54 a 69, 77,1% raza / color marrón, 60,8% con nivel fundamental incompleto o completo y 70.6% con ingresos familiares entre 1 y 2 salarios mínimos. De los pacientes hipertensos evaluados, el 41.5% tenía síndrome metabólico y el 76.5% tenía adherencia parcial al tratamiento antihipertensivo. En la evaluación estadística de la asociación entre las variables, se encontró que no existía (p = 0,149 e p = 0,642). Los valores con respecto a la adherencia al tratamiento antihipertensivo fueron los mismos, tanto en pacientes con síndrome metabólico como en aquellos que no tenían esta condición. Conclusiones e implicaciones para la práctica La adherencia a la terapia antihipertensiva alta y parcial fue prevalente. La frecuencia del síndrome metabólico entre los pacientes hipertensos en estudio fue elevada. Por lo tanto, las medidas preventivas para las enfermedades cardiovasculares y el logro de objetivos terapéuticos deben implementarse continuamente. Un desafío a superar por los profesionales y servicios de salud.


ABSTRACT Objective To analyze the association between adherence to antihypertensive treatment and the occurrence of Metabolic Syndrome in hypertensive patients in a primary health care unit. Method Analytical cross-sectional study carried out with 306 hypertensive patients from a Primary Health Care Unit located in the city of Fortaleza-CE. Results Of the study participants, 74.2% were female, mean 61.8 ± 11.9 years old and within the age group of 54 to 69, 77.1% race / brown color, 60.8% with incomplete fundamental level or complete and 70.6% with family income between 1 and 2 minimum wages. Of the evaluated hypertensive patients, 41.5% had Metabolic Syndrome and 76.5% had partial adherence to antihypertensive treatment. In the statistical evaluation of the association between the variables, it was verified that it did not exist (p = 0,149 e p = 0,642). The values regarding adherence to antihypertensive treatment were the same, both in patients with Metabolic Syndrome and in those who did not have this condition. Conclusions and implications for practice High and partial antihypertensive therapy adherence was prevalent. The frequency of Metabolic Syndrome among hypertensive patients under study was high. Therefore, preventive measures for cardiovascular diseases and achievement of therapeutic goals must be implemented continuously. A challenge to be overcome by health professionals and services.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Síndrome Metabólica , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Fatores de Risco , Hipertensão/tratamento farmacológico
5.
Diabetes Res Clin Pract ; 172: 108629, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33347898

RESUMO

AIMS: The aim of this study was to develop a Diabetes Mellitus Treatment Adherence Scale (DMTAS) to fill the gap in the internationally accepted comprehensive scale. METHODS: An initial item pool for the Diabetes Mellitus Treatment Adherence Scale (DMTAS) was generated based on a review of the literature and an open-ended interview. An expert group screened this initial item pool using an item-level content validity index. Then, pilot testing with 116 participants was conducted. After removing redundant and cross-loading items by exploratory factor analysis, 630 subjects were recruited to evaluate the reliability and validity of DMTAS. Analyses included internal consistency, test-retest reliability, split-half reliability, construct validity, convergent validity, and discriminant validity analysis. RESULTS: The final DMTAS consisted of 19 items and six dimensions. The results of the exploratory factor analysis indicated that the variances of each factor explained were 23.07%, 12.28%, 9.50%, 8.25%, 7.85%, and 5.80%, and all six factors explained 66.75% of the variance in the 19 items. The items' factor loadings were all above 0.6. The results of the confirmatory factor analysis indicated that adequate fit indices (χ2 value to degrees of freedom = 3.62; root mean square error of approximation = 0.06; goodness-of-fit index = 0.92) were achieved. The Cronbach's alpha coefficient was 0.79, test-retest reliability was 0.73, and split-half reliability was 0.75. CONCLUSIONS: The DMTAS showed good validity and reliability to measure the out-of-hospital treatment adherence in patients with diabetes mellitus.


Assuntos
Diabetes Mellitus/terapia , Psicometria/métodos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários , Estudos de Validação como Assunto
8.
J Med Internet Res ; 22(10): e22596, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32936776

RESUMO

BACKGROUND: Risk and crisis communication plays an essential role in public health emergency responses. The COVID-19 pandemic has triggered spontaneous and intensive media attention, which has affected people's adoption of personal preventive measures and their mental health. OBJECTIVE: The aim of this study was to investigate the associations between exposure to COVID-19-specific information and mental health (depression and sleep quality) and self-reported compliance with personal preventive measures (face mask wearing and hand sanitizing). We also tested whether these associations were moderated by thoughtful consideration of the veracity of the information to which people were exposed. METHODS: A cross-sectional, closed web-based survey was conducted among a sample of 3035 factory workers at the beginning of work resumption following the COVID-19 outbreak in Shenzhen, China. A stratified two-stage cluster sampling design was used for recruitment. Multivariate linear and logistic regression models were used for the analyses. RESULTS: The prevalence of probable moderate-to-severe depression was 170/3035 (5.6%), while that of good or excellent sleep quality was 2110/3035 (69.5%). The prevalence of self-reported consistent face mask wearing in public places was 2903/3035 (95.7%), while that of sanitizing hands every time after returning from public spaces or touching public installations was 2151/3035 (70.9%). Of the 3035 respondents, 1013 to 1638 (33.3% to 54.0%) reported >1 hour of daily exposure to COVID-19-specific information through web-based media and television. After controlling for significant background variables, higher information exposure via television and via newspapers and magazines was associated with better sleep quality and higher compliance with hand sanitizing. Higher exposure via unofficial web-based media was associated with higher compliance with hand sanitizing but was also associated with higher depressive symptoms. In contrast, higher exposure through face-to-face communication was associated with higher depressive symptoms, worse sleep quality, and lower compliance with hand sanitizing. Exposure to information about positive outcomes for patients with COVID-19, development of vaccines and effective treatments, and heroic stories about frontline health care workers were associated with both better mental health and higher compliance with preventive measures. Higher overall information exposure was associated with higher depressive symptoms among participants who were less likely to carefully consider the veracity of the information to which they were exposed; it was also associated with better sleep quality among people who reported more thoughtful consideration of information veracity. CONCLUSIONS: This study provides empirical evidence of how the amount, sources, and contents of information to which people were exposed influenced their mental health and compliance with personal preventive measures at the initial phase of work resumption in China. Thoughtful consideration of information quality was found to play an important moderating role. Our findings may inform strategic risk communication by government and public health authorities during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Desinfecção das Mãos , Comportamentos de Risco à Saúde , Saúde Mental/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Inquéritos e Questionários , Adolescente , Adulto , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Surtos de Doenças , Feminino , Humanos , Masculino , Pneumonia Viral/epidemiologia , Autorrelato , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto Jovem
9.
Niger J Clin Pract ; 23(9): 1305-1311, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913172

RESUMO

Objective: The aim of this study was to investigate the effects of the cardiology patients' illness perception on their medication adherence will guide in the development of training and consultancy strategies. Material and Method: The study was conducted with 110 patients who were followed up in the cardiology clinics of a university hospital. The study included patients over the age of 18 years, who agreed to participate in the study and were diagnosed with a cardiovascular disease at least six months before. The data were collected using a patient information form questioning the subjects such as the patients' age, gender, marital status and economic condition, the Illness Perception Questionnaire and the Morisky Medication Adherence Scale. Results: The results showed that 72.7% (n=80) of the group had forgotten to take their medicine, 38.2% (n=42) had a trouble remembering to take their medicine, 29.1% (n=32) stopped taking their medicine when they felt good and 32.7% (n=36) stopped taking their medicine because they sometimes felt bad after taking their medicine. It was determined that there was no statistically significant correlation between Morisky Medication Adherence Scale scores and Illness Perception Questionnaire subscale scores (P >0.05). It was determined that there was a statistically significant difference between the educational backgrounds, in terms of the personal control subscale mean scores (P=0.003; P<0.01). Conclusion: Patients try to explain their disease in the light of their personal experiences, knowledge, values, beliefs, and needs. Illness perception which is among the most important factors providing treatment adherence is an important factor affecting many areas from the person's psychological adaptation to the course of disease. Illness perception and treatment adherence are affected by educational level.


Assuntos
Doenças Cardiovasculares/terapia , Conhecimentos, Atitudes e Prática em Saúde , Percepção , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Doenças Cardiovasculares/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia , Adulto Jovem
10.
Rev Saude Publica ; 54: 80, 2020.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32813868

RESUMO

OBJECTIVE To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41-0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57-0.83). CONCLUSIONS The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.


Assuntos
Fidelidade a Diretrizes , Falência Renal Crônica/terapia , Insuficiência Renal Crônica/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/epidemiologia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Peru/epidemiologia , Avaliação de Programas e Projetos de Saúde , Diálise Renal , Terapia de Substituição Renal , Fatores de Risco , Análise de Sobrevida
11.
Public Health ; 186: 52-56, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32771661

RESUMO

OBJECTIVES: Lockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19-related lockdown on service utilisation and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties. STUDY DESIGN: The design of this study is a retrospective cross-sectional study. METHODS: All patients who visited the mental health outpatient service in the months of February and March in the years 2017-2020 were included in the study. To compare service utilisation before and after the lockdown, the number of patients who visited the mental health outpatient service for psychiatric interview were recorded. Follow-up adherence was calculated as the percentage of patients who visited in February and subsequently attended a follow-up visit in March of the same year. RESULTS: The number of patients who visited the outpatient service between February 2017 and February 2020 was continuously increasing. In March 2020, fewer patients visited the service for psychiatric interview, in line with the introduction of lockdown measures. In addition, the number of the patients who visited in February 2020 and returned for their follow-up visits in March 2020 declined from approximately 30% over the same months in 2017-2019 to 17.53% in March 2020. CONCLUSIONS: The lockdown-related reduction in numbers of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.


Assuntos
Infecções por Coronavirus/prevenção & controle , Emigrantes e Imigrantes/psicologia , Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pobreza , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Pessoas em Situação de Rua/psicologia , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Refugiados/psicologia , Refugiados/estatística & dados numéricos , Estudos Retrospectivos , Populações Vulneráveis , Adulto Jovem
12.
Rev. cuba. med. trop ; 72(2): e499, mayo.-ago. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149910

RESUMO

Introducción: La no adherencia terapéutica a los antirretovirales es una de las causas de la progresión rápida a sida en individuos seropositivos. Objetivo: Identificar los factores asociados a la no adherencia terapéutica a los antirretrovirales, en personas que conviven con VIH/sida. Métodos: Se realizó una investigación analítica de corte transversal en 153 pacientes de 18 y más años de edad, con diagnóstico de VIH/sida, del Policlínico Marcios Manduley, municipio Centro Habana, en el año 2018. La fuente de información fueron las historias clínicas individuales y familiares, y se aplicó un cuestionario estructurado para complementar la información requerida. Para establecer relación entre variables se utilizó la prueba de chi cuadrado ((2) con significación estadística, p= 0,05, y se identificaron variables cuyos coeficientes fueron significativamente diferentes de 0 (p< 0,05) La causalidad fue determinada mediante el cálculo de odss ratio (OR). Resultados: Se encontró asociación estadística y constituyeron factores de riesgo de mala adherencia terapéutica: la baja escolaridad, el vínculo de pareja no estable, la disfunción familiar, el tiempo bajo tratamiento mayor de 5 años y la presencia de reacciones adversa. Conclusiones: El estudio permitió identificar las principales variables asociadas con la mala adherencia terapéutica en estos pacientes, lo que aporta evidencia científica para un adecuado control de la enfermedad(AU)


Introduction: Non-adherence to antiretroviral therapy is one of the causes of the fast progression to AIDS among seropositive individuals. Objective: Identify the factors associated with non-adherence to antiretroviral therapy among people living with HIV / AIDS. Methods: An analytical cross-sectional study was conducted of 153 HIV / AIDS patients aged 18 years and over from Marcios Manduley polyclinic, municipality of Centro Habana, in the year 2018. Data were obtained from individual and family medical records, and a structured questionnaire was applied to complement the information required. The relationship between the variables was determined with the chi-square test ((2) with a statistical significance of p= 0.05, and variables were identified whose coefficients were significantly different from 0 (p< 0.05). Causality was determined by odds ratio (OR) estimation. Results: A statistical association was found, as well as the following risk factors for poor adherence to therapy: low educational level, frequent change of sexual partner, dysfunctional family, therapy duration longer than 5 years and adverse reactions. Conclusions: The study made it possible to identify the main variables associated to poor adherence to therapy among these patients, contributing scientific evidence for an appropriate control of the disease(AU)


Assuntos
Cooperação e Adesão ao Tratamento/estatística & dados numéricos
13.
Am J Public Health ; 110(S2): S251-S257, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663093

RESUMO

Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.


Assuntos
Habitação , Obesidade Pediátrica/prevenção & controle , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Criança , Depressão , Feminino , Abastecimento de Alimentos , Humanos , Masculino , Massachusetts , Pais/psicologia , Fatores Socioeconômicos , Estresse Psicológico
14.
Gastroenterol. hepatol. (Ed. impr.) ; 43(6): 285-292, jun.-jul. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193510

RESUMO

La tasa de no adherencia al tratamiento médico en la enfermedad inflamatoria intestinal (EII) está en torno al 50%, empeorando así los resultados de los tratamientos, la morbilidad y el coste. OBJETIVOS: Determinar mediante una encuesta online entre gastroenterólogos con especial dedicación a la EII el conocimiento sobre la adherencia al tratamiento de sus pacientes y los métodos utilizados para mejorarla. MÉTODOS: Desde la secretaría técnica de GETECCU se envió un correo a los socios con un enlace a la encuesta a través de un sistema online. RESULTADOS: Se invitó a 760 socios. Se obtuvieron 184 encuestas (28,5%). El 68% de los encuestados tenía publicaciones sobre EII indexadas, solo el 13% eran sobre adherencia. A pesar de que casi el 99% consideraban la adherencia como muy importante/importante, el 25% de los médicos no la medía. Pese a que el 100% consideraba que mejorar la adherencia implicaría un mejor pronóstico, el 47% no utilizaba sistemas para mejorarla. Los factores asociados con la medición y mejora de la adherencia fueron: hospital universitario (81,4%), que el paciente recibiera tratamiento combinado con tiopurínicos y biológicos (44,6%), médico de sexo femenino (63,1%), dedicar ≥ 6 h semanalmente a la EII (71,6%), que el médico tenga publicaciones indexadas sobre EII (68,5%) y sobre adherencia en EII (12,5%) y que el médico considere la adherencia importante o muy importante (98,9%). CONCLUSIONES: Aunque el conocimiento sobre la relevancia de la adherencia al tratamiento médico en EII está generalizado, entre los gastroenterólogos con dedicación especial a la EII que fueron encuestados casi la mitad no utiliza ningún sistema objetivo para cuantificarla. Se debe hacer un esfuerzo para cuantificar y mejorar la adherencia al tratamiento de estos pacientes


The rate of non-adherence to medical treatment in inflammatory bowel disease (IBD) is around 50%, with the consequent negative impact on treatment results, morbidity and cost. OBJECTIVES: To determine through an online survey among gastroenterologists with special dedication to IBD, their knowledge about the adherence to treatment of their patients and the methods used to improve it. METHODS: An email was sent to gastroenterologists from the technical office of the Crohn's disease and ulcerative colitis Spanish working group (GETECCU), with a link to the online survey. RESULTS: 760 physicians were invited. One hundred eighty-four surveys were obtained (28.5%). A total of 68% of respondents had indexed IBD publications, 13% of which were on adherence. Although almost 99% considered adherence as very important/important, 25% of physicians did not assess it. Even though 100% considered that improving adherence would imply a better prognosis, 47% did not use any system to improve it. The factors associated with the assessment and improvement of adherence were: university hospital (81.4%), combined treatment with thiopurines and biological drugs (44.6%), physician gender (female) (63.1%), dedicating ≥ 6 hours weekly to IBD (71.6%), previous published indexed papers on IBD (68.5%) and on adherence in IBD (12.5%), and considering adherence as important/very important (98.9%). CONCLUSIONS: Although knowledge about the relevance of adherence to medical treatment in IBD is widespread, among the gastroenterologists with special dedication to IBD who were surveyed, almost half do not use any objective system to quantify it. An effort must be made to quantify and improve adherence to the treatment of these patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Doenças Inflamatórias Intestinais/epidemiologia , Resultado do Tratamento , Doenças Inflamatórias Intestinais/economia , Inquéritos e Questionários
15.
Enferm. glob ; 19(59): 286-297, jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198891

RESUMO

OBJETIVO: Investigar las tasas de suspensión y motivos de cancelación de las cirugías electivas en un hospital en Rio Grande do Norte. MÉTODOS: Estudio descriptivo, retrospectivo, cuantitativo, con análisis documental de los registros archivados en el sistema informatizado MV de la unidad del Centro quirúrgico del Hospital Universitario Onofre Lopes, en el período de abril de 2015 a abril de 2016. RESULTADOS: De las 8.622 (100%) cirugías programadas para el período investigado, el 74,2% fueron realizadas y el 25,8% canceladas. Entre las cirugías canceladas (2.227), la mayoría de las cancelaciones se hicieron por cirugía general (37,5%) y urología (21,6%). Los principales motivos de cancelación se introdujeron en las categorías relacionadas con la organización de la unidad (34,4%); relacionados con recursos humanos (27,1%); relacionados al paciente (6,5%); relacionado con materiales y equipamientos (6,2%), sin justificación (5,5%) y cirugía condicional (0,3%). CONCLUSIONES: Este estudio se torna relevante, pues permitió identificar las causas de cancelaciones de cirugías electivas en un hospital de la red pública, contribuyendo para mejorar la actuación profesional frente a la problemática, siendo posible reducir la cantidad de suspensiones, considerando que la mayoría de los motivos de cancelación son prevenibles


OBJECTIVE: To investigate the suspension rates and reasons for cancellation of elective surgery in a teaching hospital in Rio Grande do Norte. METHODS: A descriptive, retrospective, quantitative study, with documentary analysis of the records filed in the computerized system of the Surgical Center unit of Onofre Lopes University Hospital, from April 2015 to April 2016. RESULTS: Of the 8.622 (100%) scheduled surgeries for the surveyed period, 74.2% were performed and 25.8% canceled. Among the canceled surgeries (2.227), most cancellations were made by General Surgery (37.5%) and Urology (21.6%). The main reasons for cancellations were included in the categories related to the following aspects: unit's organization (34.4%); related to human resources (27.1%); patient-related (6.5%); related to materials and equipment (6.2%), without justification (5.5%) and conditional surgery (0.3%). CONCLUSIONS: The study identified the cancellations causes of elective surgeries in a teaching hospital, contributing to the improvement of professional performance. This may contribute to reduce the number of suspensions, considering that most reasons for cancellation are prevenTable


OBJETIVO: Investigar as taxas de suspensão e motivos de cancelamento de cirurgias eletivas em um hospital escola do Rio Grande do Norte. MÉTODOS: Estudo descritivo, retrospectivo, quantitativo, com análise documental dos registros arquivados no sistema informatizado da unidade do Centro Cirúrgico do Hospital Universitário Onofre Lopes, no período de abril de 2015 a abril de 2016. RESULTADOS: Das 8.622 (100%) cirurgias programadas para o período pesquisado, 74,2% foram realizadas e 25,8% canceladas. Dentre as cirurgias canceladas (2.227), a maioria dos cancelamentos foram feitos pela cirurgia geral (37,5%) e urologia (21,6%). Os principais motivos de cancelamentos foram inseridos nas categorias relacionados à organização da unidade (34,4%); relacionados a recursos humanos (27,1%); relacionados ao paciente (6,5%); relacionado a materiais e equipamentos (6,2%), sem justificativa (5,5%) e cirurgia condicional (0,3%). CONCLUSÕES: O estudo permitiu identificar as causas de cancelamentos de cirurgias eletivas em um hospital escola, contribuindo para melhoria da atuação profissional frente a problemática, sendo possível reduzir a quantidade de suspensões, considerando que a maioria dos motivos de cancelamento são preveníeis


Assuntos
Humanos , Suspensão de Tratamento/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Recusa do Médico a Tratar/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Estudos Retrospectivos , Hospitais de Ensino/estatística & dados numéricos
16.
An Real Acad Farm ; 86(2): 125-131, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193548

RESUMO

El objetivo de esta investigación fue la determinación de la adherencia terapéutica en pacientes con enfermedades crónicas del club de adultos mayores de un centro de atención primaria de Riobamba - Ecuador, para lo cual participaron 25 pacientes previo consentimiento informado. Se empleó método subjetivo indirecto, basado en cuestionario dirigido a determinar características sociodemográficas de los pacientes, grado de adherencia terapéutica a través del test de Morisky Green y posibles factores influyentes en la adherencia, consideraron las 4 principales dimensiones establecidas por la OMS. Para análisis de resultados se utilizó SPSS-PC 24.5 Windows y niveles de significancia de 0,05 %. Los resultados mostraron un predominio de género femenino (80 %), un promedio de edad de 70,2 años y un grado de instrucción primaria en un 60 % de los pacientes. Se identificó que un 56 % de los pacientes padecían al menos dos enfermedades crónicas, resultando la hipertensión arterial la más prevalente (84 %); y un 64 % de ellos se administraban 2 a 3 medicamentos diarios. Se determinó que el 64 % de los adultos mayores eran in adherentes con el esquema terapéutico prescrito, encontrando que los factores socioeconómicos incidieron de manera totalitaria sobre los pacientes en estudio. Los factores relacionados con el equipo de salud, la terapia y los inherentes al paciente, incidieron en la adherencia terapéutica en menor proporción. La insuficiencia económica para costear los medicamentos y las dietas de elevado costo prescritas, resultó ser la variable con mayor impacto en la in adherencia terapéutica, encontrando relación directa con el grado de instrucción primaria que tenían mayoritariamente los pacientes en estudio. Además, todas las variables reportadas en el estudio como causas de la in adherencia al tratamiento exigen direccionar acciones orientadas a afianzar un sistema sanitario basado en la promoción y prevención de salud, a fin de aumentar la calidad de vida de los pacientes


The objective of this investigation was the determination of therapeutic adherence in patients with chronic diseases of the club of older adults of a primary care center in Riobamba-Ecuador, for which 25 patients participated with prior informed consent. An indirect subjective method was used, based on a questionnaire aimed at determining the sociodemographic characteristics of the patients, degree of therapeutic adherence through the Morisky Green test and possible influencing factors on adherence, considered the 4 main dimensions established by the WHO.SPSS-PC 24.5 for Windows and significance levels of 0.05 % were used for results analysis. The results showed a predominance of female gender (80 %), an average age of 70.2 years and a degree of primary education in 60 % of the patients. It was identified that 56 % of the patients suffered from at least two chronic diseases, with hypertension being the most prevalent (84 %); and 64 % of them administered 2 to 3 medications daily. It was determined that 64 % of older adults were in adherent with the prescribed therapeutic scheme, finding that socioeconomic factors had a total impact on the study patients. Factors related to the health team, therapy, and those inherent to the patient, influenced therapeutic adherence in a lesser proportion. The economic insufficiency to pay for the medications and the high-cost diets prescribed, turned out to be the variable with the greatest impact on therapeutic non-adherence, finding a direct relationship with the degree of primary education that the study patients had mostly. In addition, all the variables reported in the study as causes of non-adherence to treatment require directing actions aimed at strengthening a health system based on health promotion and prevention, in order to increase the quality of life of patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Crônica/tratamento farmacológico , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Fatores Socioeconômicos , Equador
17.
Rev. chil. enferm. respir ; 36(2): 100-108, jun. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1138541

RESUMO

INTRODUCCIÓN: La resistencia antibiótica y una inadecuada adherencia terapéutica son fenómenos que favorecen la proliferación de la tuberculosis. Los cambios sociodemográficos nos desafían a conocer la realidad actual de la enfermedad a través de antecedentes que nos permitan contextualizar un nuevo escenario. OBJETIVO: Caracterizar el perfil biopsicosocial del paciente con tuberculosis y su relación con la adherencia terapéutica. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, correlacional. Muestra de 90 pacientes tratados en 35 Centros de Salud Familiar de los Servicios de Salud de Iquique, Metropolitano Norte, Concepción y Reloncaví. RESULTADOS: los componentes biopsicosociales como edad, antecedentes de enfermedad mental, autoestima, situación sentimental, pertenencia a grupos de riesgo, alcoholismo, drogadicción y situación de calle presentaron una relación estadísticamente significación con la adherencia terapéutica. CONCLUSIONES: La caracterización biopsicosocial del paciente con tuberculosis visibiliza nuevos factores relacionados con la adherencia que deben ser considerados para una atención interdisciplinaria.


BACKGROUND: Antibiotic resistance and inadequate therapeutic adherence are phenomena that promote the proliferation of tuberculosis. Sociodemographic changes challenge us to know the real situation of the disease and allows us to contextualize a new scenario. OBJECTIVE: To characterize the biopsychosocial profile of the patient with tuberculosis and its relationship to therapeutic adherence. MATERIAL AND METHOD: Descriptive, cross-sectional, correlational study. Sample of 90 patients treated at 35 Family Health Centers from the following Chilean Public Health Services: Iquique, Metropolitan northern (Santiago), Concepción and Reloncaví. RESULTS: Biopsychosocial components such as age, history of mental illness, self-esteem, sentimental status, belonging to risk groups, alcoholism, drug addiction and homeless situation presented a statistically significant relationship with therapeutic adherence. CONCLUSIONS: The biopsychosocial characterization of the TB patient evidence a new adherence-related factors that should be considered for interdisciplinary care.


Assuntos
Humanos , Masculino , Feminino , Adulto , Tuberculose/psicologia , Tuberculose/tratamento farmacológico , Adesão à Medicação/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Autoimagem , Fatores Socioeconômicos , Grupos de Risco , Pessoas em Situação de Rua , Chile , Saúde da Família , Estudos Transversais , Inquéritos e Questionários , Transtornos Relacionados ao Uso de Substâncias/psicologia , Farmacorresistência Bacteriana , Alcoolismo/psicologia , Adesão à Medicação/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Correlação de Dados , Antituberculosos/uso terapêutico
18.
Medicine (Baltimore) ; 99(20): e20236, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443358

RESUMO

Patients lost to follow-up (LTFU) over the human immunodeficiency virus (HIV) cascade have poor clinical outcomes and contribute to onward HIV transmission. We assessed true care outcomes and factors associated with successful reengagement in patients LTFU in southern Mozambique.Newly diagnosed HIV-positive adults were consecutively recruited in the Manhiça District. Patients LTFU within 12 months after HIV diagnosis were visited at home from June 2015 to July 2016 and interviewed for ascertainment of outcomes and reasons for LTFU. Factors associated with reengagement in care within 90 days after the home visit were analyzed by Cox proportional hazards model.Among 1122 newly HIV-diagnosed adults, 691 (61.6%) were identified as LTFU. Of those, 557 (80.6%) were approached at their homes and 321 (57.6%) found at home. Over 50% had died or migrated, 10% had been misclassified as LTFU, and 252 (78.5%) were interviewed. Following the visit, 79 (31.3%) reengaged in care. Having registered in care and a shorter time between LTFU and visit were associated with reengagement in multivariate analyses: adjusted hazards ratio of 3.54 [95% confidence interval (CI): 1.81-6.92; P < .001] and 0.93 (95% CI: 0.87-1.00; P = .045), respectively. The most frequently reported barriers were the lack of trust in the HIV-diagnosis, the perception of being in good health, and fear of being badly treated by health personnel and differed by type of LTFU.Estimates of LTFU in rural areas of sub-Saharan Africa are likely to be overestimated in the absence of active tracing strategies. Home visits are resource-intensive but useful strategies for reengagement for at least one-third of LTFU patients when applied in the context of differentiated care for those LTFU individuals who had already enrolled in HIV care at some point.


Assuntos
Infecções por HIV/terapia , Perda de Seguimento , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Antirretrovirais/uso terapêutico , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Infecções por HIV/psicologia , Humanos , Masculino , Moçambique , Estudos Prospectivos , População Rural/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos
19.
Sci Rep ; 10(1): 8110, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32415231

RESUMO

The aim of this study is to present a robot-assisted therapy protocol for children with ASD based on the current state-of-the-art in both ASD intervention research and robotics research, and critically evaluate its adherence and acceptability based on child as well as parent ratings. The robot-assisted therapy was designed based on motivational components of Pivotal Response Treatment (PRT), a highly promising and feasible intervention focused at training "pivotal" (key) areas such as motivation for social interaction and self-initiations, with the goal of establishing collateral gains in untargeted areas of functioning and development, affected by autism spectrum disorders. Overall, children (3-8 y) could adhere to the robot-assisted therapy protocol (Mean percentage of treatment adherence 85.5%), showed positive affect ratings after therapy sessions (positive in 86.6% of sessions) and high robot likability scores (high in 79.4% of sessions). Positive likability ratings were mainly given by school-aged children (H(1) = 7.91, p = .005) and related to the movements, speech and game scenarios of the robot. Parent ratings on the added value of the robot were mainly positive (Mean of 84.8 on 0-100 scale), while lower parent ratings were related to inflexibility of robot behaviour.


Assuntos
Transtorno do Espectro Autista/terapia , Terapia Comportamental , Protocolos Clínicos/normas , Relações Interpessoais , Pais/psicologia , Robótica/instrumentação , Robótica/métodos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Transtorno do Espectro Autista/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Relações Pais-Filho
20.
Artigo em Inglês | MEDLINE | ID: mdl-32370202

RESUMO

The purpose of this study was to define if Outcomes Expectations for Exercise (OEE) and Decisional Balance (DB) scales predict adherence to guided exercise programs and associate with the improvement in physical performance in the dialysis population. Participants (n = 40; age 63.6 ± 12.5 years) completed OEE and DB questionnaires before randomization to the experimental group (n = 20) and control group (n = 20) of a two-phased exercise program-the experimental group received eight weeks of supervised functional exercise and exercise counseling (1st phase) before commencing eight weeks of home-based exercise on non-dialysis days (2nd phase). Both groups performed intradialytic cycling on dialysis days during both study phases. Patients with above-median OEE and DB scores (>3.15 and >1.3, respectively) expressed significantly better adherence to intradialytic cycling (89% vs. 76%, 89% vs. 77%, respectively, p < 0.05). Experimental group patients with an above-median OEE (but not DB) score had significantly better adherence to supervised and home-based functional exercise (93% vs. 81% and 85% vs. 60%, respectively, p < 0.05). Baseline DB score predicted the final result in the hand-grip test and 6-min walk test. Low OEE and, to a lesser degree, low DB questionnaire scores associate with inferior adherence to dialysis bundled and home-based exercise programs and may help define patient subsets in need of intensified motivational input by exercise caregivers.


Assuntos
Motivação , Diálise Renal , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Exercício Físico , Terapia por Exercício , Humanos , Masculino , Inquéritos e Questionários , Resultado do Tratamento
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