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2.
PLoS One ; 15(10): e0240411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044990

RESUMO

BACKGROUND: Tobacco Cessation on Prescription (TCP) is a new intervention that is being evaluated in socioeconomically disadvantaged areas in Swedish primary health care (PHC). Patients' perceptions of TCP are important to understand as this may have implications for the acceptability and adherence to treatment and explain cessation outcomes. Patients' general experiences of tobacco cessation are also important to explore to improve cessation support in this setting. AIM: To explore experiences of tobacco cessation and TCP among patients in Swedish PHC focusing on socioeconomically disadvantaged areas. METHODS: Inductive content analysis of transcripts from eight semi-structured interviews with patients recruited from the intervention group in a randomized controlled trial evaluating the effectiveness of TCP in socioeconomically disadvantaged areas in PHC in Stockholm. RESULTS: Two themes were identified: needing individualized support to quit, taking differences in patients' experiences of tobacco use and cessation into account, acknowledging individual factors such as impact of health and wellbeing on tobacco use and differing attitudes towards tobacco and cessation and needing a supportive environment to facilitate tobacco cessation, taking contextual factors like professional support from the health care system, the importance of the social environment and supportive societal structures into account. Regarding TCP, the prescription form was perceived as useful for providers but did not appear to have a direct impact on tobacco cessation from the informants' perspective. However, individualized counseling from a tobacco cessation specialist, an empathetic approach in the treatment and long-term follow-up was considered important. CONCLUSION: A holistic approach may be needed in cessation treatment, combined with interventions outside the health care system, to facilitate tobacco cessation among patients in socioeconomically disadvantaged areas in Swedish PHC. The TCP prescription form may be helpful for PHC providers but counseling and follow-up appear to be the most important components of TCP for patients in this setting.


Assuntos
Abandono do Uso de Tabaco/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Populações Vulneráveis/psicologia , Adulto , Idoso , Aconselhamento , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Prescrições , Atenção Primária à Saúde , Suécia
3.
Aust N Z J Public Health ; 44(6): 451-456, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33044774

RESUMO

OBJECTIVE: To better understand the impact of alcohol consumption on the clinical management of chronic diseases in a regional general practice setting. METHODS: A retrospective chart audit was undertaken of individual patient records at two large group general practices in Townsville, a regional Australian city. Three common indicator chronic diseases were selected that have clear management guidelines for general practice: type 2 diabetes; chronic obstructive pulmonary disease; and chronic kidney disease. The audits were analysed using SPSS software to examine the association between alcohol consumption on acquisition of clinical management targets and primary disease intermediate outcomes (haemoglobin A1c fraction; per cent of normal forced expiratory volume at one second; and estimated glomerular filtration rate). RESULTS: A total of 457 records were audited. Higher-risk alcohol consumption is associated with reduced ability of patients to reach management targets (F[3,453]=3.68; p=0.012) and decreased standardised primary disease outcome (F[3,403]=2.86; p=0.037). CONCLUSION: Higher-risk alcohol consumption is associated with reduced attainment of chronic disease management targets and worse chronic disease outcomes. Implications for public health: Alcohol consumption should be assessed frequently in people with chronic disease, especially when there is difficulty acquiring management targets or worsening of disease outcomes without a clear explanation. Better education about the potential associations between alcohol use and chronic disease would benefit those managing these complex conditions, both clinicians and patients.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Doença Crônica , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia
4.
Aust N Z J Public Health ; 44(6): 457-461, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33044787

RESUMO

OBJECTIVE: To understand the impact of alcohol consumption on the health utilisation of people with chronic diseases. METHODS: A retrospective chart audit was undertaken in two primary care settings in a regional Australian city. Three indicator conditions were selected: type 2 diabetes, chronic obstructive pulmonary disease and chronic kidney disease. The audits were analysed to examine the impact of alcohol consumption on primary care and hospital-based health utilisation. RESULTS: A total of 457 records were audited. Alcohol consumption decreased engagement in the primary care setting, with fewer visits, prescriptions and lower primary care costs. There was a U-shaped association between alcohol consumption and hospital attendance rates and costs. Admission rates were unchanged but a decrease in length of stay was observed in non-smokers in the highest alcohol consumption category. CONCLUSION: Excess alcohol consumption decreases engagement in primary care and results in increased emergency department attendance, but not admissions to hospital. In those who are admitted to hospital, alcohol is associated with a decreased length of stay. Implications for public health: Alcohol consumption should be considered as a potential cause of decreased engagement in primary care. Follow-up and recall of patients may reduce shifting of care to the hospital environment.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Diabetes Mellitus Tipo 2/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Austrália , Doença Crônica , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos
5.
Nursing (Säo Paulo) ; 23(269): 4683-4694, out.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145366

RESUMO

Objetivos: Conhecer as vivências de usuários de um Centro de Atenção Psicossocial de álcool e de drogas em Minas Gerais. Método: Pesquisa exploratória, descritiva e de abordagem qualitativa. A amostra foi composta por 18 participantes determinada pela técnica de saturação. A coleta de dados foi realizada por entrevista semiestruturada com questões norteadoras, gravadas, transcritas, e por meio da técnica de análise de conteúdo, resultou em quatro categorias. Resultado: A maior dificuldade em aderir ao tratamento é o rompimento dos vínculos familiares e as fragilidades sociais. O acolhimento interfere na adesão e abandono do tratamento. Relatam ainda a falta de estrutura do ambiente coletivo e de atividades recreativas. Conclusão: Tem-se como ponto facilitador para adesão ao tratamento o acolhimento, a escuta ativa e a família. Como incipiente tem-se a infraestrutura física do local, as atividades de lazer e as oficinas terapêuticas.(AU)


Objectives: To know the experiences of users of a Psychosocial Care Center for alcohol and drugs in Minas Gerais. Method: This is an exploratory, descriptive and qualitative approach. The sample was composed by 18 participants determined by the saturation technique. The data collection was done through a semi-structured interview with four guiding questions, recorded, transcribed, and through the technique of content analysis, resulted in four categories. Results: Revealed that the greatest difficulty in adhering to treatment is the disruption of family ties correlated with social difficulties such as social exclusion and street dwelling. For most, the way in which the host occurs interferes with adherence and abandonment of treatment. They also report the lack of structure of the collective environment and recreational activities. Conclusion: Users reported as a facilitator for adherence to treatment, welcoming, active listening of professionals and the family as an essential support. It has as incipient the infrastructure of the establishment, the leisure activities and the therapeutic workshops.(AU)


Objetivos: Conocer las experiencias de los usuarios de un Centro de Atención Psicosocial para el consumo de alcohol y drogas en Minas Gerais. Método: Este es un enfoque exploratorio, descriptivo y cualitativo. La muestra estuvo compuesta por 18 participantes determinados por la técnica de saturación. La recolección de datos se realizó a través de una entrevista semiestructurada con cuatro preguntas de guía, grabadas, transcritas y mediante la técnica de análisis de contenido, que dio como resultado cuatro categorías. Resultados: Reveló que la mayor dificultad para adherirse al tratamiento es la interrupción de los lazos familiares relacionados con dificultades sociales como la exclusión social y la vivienda en la calle. Para la mayoría, la forma en que se produce el huésped interfiere con la adherencia y el abandono del tratamiento. También denuncian la falta de estructura del entorno colectivo y las actividades recreativas. Conclusión: Los usuarios informaron como facilitadores de la adherencia al tratamiento, la bienvenida y la escucha activa de los profesionales y la familia como un apoyo esencial. Tiene como incipiente la infraestructura del establecimiento, las actividades de ocio y los talleres terapéuticos.(AU)


Assuntos
Humanos , Enfermagem Psiquiátrica , Saúde Mental , Usuários de Drogas , Serviços de Saúde Mental , Acolhimento , Cooperação e Adesão ao Tratamento/psicologia
6.
Psychooncology ; 29(10): 1445-1451, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32915468

RESUMO

OBJECTIVE: Given the reported increased rates of physical morbidity and higher mortality rates among people with severe mental illness (SMI) (schizophrenia and severe mood disorders), with a life expectancy shorter of 15-20 years with respect to the general population, the aim of this paper was to call attention to the problem of cancer in SMI. METHODS: We conducted a narrative review of the most significant papers published in the areas of cancer screening, incidence, mortality and palliative care in SMI. RESULTS: Data from the literature confirm disparities in screening (eg, mammography; pap-smear test; colorectal cancer screening) and prevention (eg, clinical breast examination; smoking cessation). The incidence of cancer was found to be variable with a portion of the studies reporting a higher prevalence while others a similar or a lower prevalence of cancer compared to the general population. A lower percentage of patients with SMI received proper cancer treatment resulting in survival after cancer diagnosis significantly worse than people without SMI. Likewise, end-of-life care has been shown to be lacking with poorer levels of physical, psychological and spiritual care. CONCLUSIONS: The problems of stigma and discrimination, poorer dignity, poorer health behavior, lack of integration in health-care services for people with SMI needs to be addressed and solved in cancer care. Psycho-oncology has a very specific and mandatory role in integrating the recommendation of the World Health Organization to improve the links between oncology and mental health settings for more specific psycho-oncology programs addressed for this vulnerable segment of the population.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Transtornos Mentais/complicações , Neoplasias/diagnóstico , Neoplasias/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Neoplasias/psicologia , Cuidados Paliativos , Cooperação e Adesão ao Tratamento/psicologia
7.
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
8.
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
9.
Afr J AIDS Res ; 19(2): 135-146, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32780677

RESUMO

Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere.


Assuntos
Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Masculino , Mães , Gravidez , Pesquisa Qualitativa , População Rural , Participação dos Interessados , Uganda/epidemiologia , População Urbana
10.
Psychiatry Res ; 290: 113140, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32512354

RESUMO

The present study examined the factor structure of the Hungarian version of the Medication Adherence Rating Scale (MARS) and analyzed its association with socio-demographics, insight, internalized stigma, and the experience of loss and grief as a result of the mental illness diagnosis, using confirmatory factor analysis (CFA) with a series of one covariates at a time. Mentally ill patients (N=200) completed self-report questionnaires. CFA supported the original three-factor structure although one item was moved from its original factor to another. Lower insight, higher internalized stigma, loss, and grief were significant predictors of lower treatment adherence. Lower adherence was found to be significantly associated with lower quality of life. No difference in adherence was found between different diagnostic groups, which stresses the need to examine non-adherence in the wider spectrum of mental diagnosis. The study also stresses the importance of patients' subjective experience in promoting better adherence, and raises the need to address the experience of stigma but also of less studied experiences, such as patients' feelings of loss and grief. Integrating these experiences in intervention programs might have meaningful implications for the improvement of treatment adherence and patients' quality of life.


Assuntos
Pesar , Solidão/psicologia , Transtornos Mentais/psicologia , Pessoas Mentalmente Doentes/psicologia , Qualidade de Vida/psicologia , Estigma Social , Cooperação e Adesão ao Tratamento/psicologia , Adaptação Psicológica , Adulto , Escalas de Graduação Psiquiátrica Breve , Análise Fatorial , Feminino , Humanos , Controle Interno-Externo , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
Nurs Res ; 69(5): 404-411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520763

RESUMO

BACKGROUND: The 5-year survival for Black women with breast cancer in the United States is lower than White women for stage-matched disease. Our past and ongoing work and that of others suggest that symptom incidence, cancer-related distress, and ineffective communication contribute to racial disparity in dose reduction and early therapy termination. Although race is perhaps the most studied social determinant of health, it is clear that race alone does not account for all disparities. OBJECTIVES: The aim of the study was to present a study protocol of Black and White women prescribed breast cancer chemotherapy. The aims are to (1) examine and compare chemotherapy received/prescribed over time and in total; (2a) examine and compare symptom incidence, distress, and management and clinical encounter, including patient-centeredness of care and management experience over time and (2b) correlate symptom incidence, distress, and management experience to Aim 1; and (3) explore the effects of social determinants of health, including age, income, education, zip code, and lifetime stress exposure, on Aims 1, 2a, and 2b. METHODS: A longitudinal, repeated-measures (up to 18 time points), comparative, mixed-methods design is employed with 179 White and 179 Black women from 10 sites in Western Pennsylvania and Northeast Ohio over the course of chemotherapy and for 2 years following completion of therapy. RESULTS: The study began in January 2018, with estimated complete data collection by late 2023. DISCUSSION: This study is among the first to explore the mechanistic process for racial disparity in dosage and delay across the breast cancer chemotherapy course. It will be an important contribution to the explanatory model for breast cancer treatment disparity and may advance potential mitigation strategies for racial survival disparity.


Assuntos
Afro-Americanos/psicologia , Neoplasias da Mama/tratamento farmacológico , Protocolos Clínicos , Tratamento Farmacológico/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Afro-Americanos/etnologia , Neoplasias da Mama/psicologia , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Ohio/epidemiologia , Ohio/etnologia , Pennsylvania/epidemiologia , Pennsylvania/etnologia
12.
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
13.
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
15.
Sangyo Eiseigaku Zasshi ; 62(6): 261-270, 2020 Nov 25.
Artigo em Japonês | MEDLINE | ID: mdl-32404581

RESUMO

OBJECTIVE: To examine Japanese workers' acceptance and perceptions of the work-treatment balance system proposed by the Japanese Government. METHODS: A questionnaire survey was conducted among 120,000 Japanese workers. Participants were asked about their acceptance of the work-treatment balance system and their attitudes toward disclosing health problems and seeking support in the workplace. RESULTS: Only 7% and 27% of participants accepted the work-treatment balance system and a consultation desk for employees having difficulties at the workplace, respectively. The proportion of those who preferred not to disclose a health problem in the workplace (31%) exceeded those who preferred to do so (15%). Multiple logistic regression analysis indicated that acceptance of the work-treatment balance system and a consultation desk at the workplace was significantly associated with attitudes toward disclosing health problems. Those who worked in smaller workplaces (less than 300 employees) and were employed in sales/customer service, manufacturing, and driving/delivery were significantly less likely to indicate a willingness to disclose a health problem in the workplace. CONCLUSION: Most workers have little understanding of the work-treatment balance system. Further knowledge of the work-treatment balance system must be promoted by both the Government and companies.


Assuntos
Emprego/psicologia , Promoção da Saúde , Saúde do Trabalhador , Sistemas de Apoio Psicossocial , Cooperação e Adesão ao Tratamento/psicologia , Local de Trabalho , Adulto , Atitude Frente a Saúde , Comportamento , Revelação , Feminino , Órgãos Governamentais , Humanos , Indústrias , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
Medicina (Kaunas) ; 56(4)2020 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-32260408

RESUMO

BACKGROUND: The prevalence of gluten-related disorders (GRD) and adherence to a gluten-free diet (GFD) remains unknown in Brazilian population and there is no published information on the scientific literature about the proportion of Brazilians that were diagnosed with a gluten-related disorder. Thus, the aim of this work was to estimate the prevalence of GRDs and adherence to a GFD by self-report in adult Brazilian population. MATERIALS AND METHODS: A questionnaire-based cross-sectional study was conducted in two Brazilian cities. RESULTS: The response rate was 93.2% (1630/1749). The self-reported prevalence rates were (95% CI): adverse reactions to gluten 10.06% (8.64-11.62); gluten sensitivity 2.33% (1.65-3.18); physician-diagnosed celiac disease 0.3% (0.09-0.71); non-celiac gluten sensitivity 1.71% (1.14-2.47); wheat allergy 0.79% (0.42-1.36); adherence to gluten-free diet 7.48% (6.25-8.87); gluten avoiders 15.21% (13.5-17.05). Among those who were following a GFD (n = 122), 65.6% (n = 80) of them reported that they did not develop symptoms after wheat/gluten ingestion and 50% (n = 61) were following the diet without medical/dietitian advice. The main motivation for following a GFD in the self-reported and non-self-reported gluten sensitivity groups were the symptoms triggered after wheat/gluten ingestion (86.8%) and weight control (57.1%), respectively. CONCLUSIONS: Implementation of programs to increase awareness about GRDs among healthcare professionals and giving scientifically sound information to the general population about the risks and benefits for following a GFD are desirable actions in Brazil. The results also add to the growing body of evidence for highlighting the under-diagnosis of GRD and the trend for following a GFD in Latin America.


Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten/métodos , Adulto , Brasil/epidemiologia , Doença Celíaca/complicações , Doença Celíaca/epidemiologia , Dieta Livre de Glúten/estatística & dados numéricos , Feminino , Humanos , Masculino , Razão de Chances , Prevalência , Autorrelato , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia
17.
Medicina (Kaunas) ; 56(4)2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32283681

RESUMO

Background and Objectives: Obesity in children and adolescents results in a number of serious health-related consequences necessitating early treatment. Support from family members and family-focused lifestyle interventions can improve effectiveness of the treatment. The aim of the study was to assess the effects of parental characteristics and family-based dietary habits on the adherence and success of a body mass reduction program in children with obesity included in a lifestyle intervention program after 1 year. Materials and Methods: The program included dietetic, psychosocial, and endocrine counseling given to individuals either alone or in groups and was conducted by a multidisciplinary team (consisting of endocrinologists, nurses, psychologists, social counselors, dietitians, and physiotherapists). A total of 113 children aged 10-17 years (mean age 12.9 ± 2.0; 60 girls, 53 boys) were included in the program. After 1 year of participation, the rate of adherence and success were assessed. The effect of the participants' general characteristics, including anthropometric data, as well as parental characteristics (marital status, employment, education, body mass index (BMI), duration of breastfeeding) and the circumstances of meal consumption (eating at home or outside, fast food consumption), was analyzed. Results: The most important factors predicting body mass reduction success were baseline BMI (p < 0.0001) and waist-hip ratio (WHR) (p = 0.04), but they did not predict body mass reduction adherence. Conclusions: The meal consumption habits and support from family members may be among the determinants of adherence to a body mass reduction program for preadolescents and adolescents with obesity. However, the results of the presented study suggested that baseline BMI and WHR are the most important determinants of the body mass reduction success.


Assuntos
Pais/psicologia , Obesidade Pediátrica/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Programas de Redução de Peso/normas , Adolescente , Índice de Massa Corporal , Criança , Croácia , Feminino , Humanos , Masculino , Relações Pais-Filho , Obesidade Pediátrica/fisiopatologia , Cooperação e Adesão ao Tratamento/psicologia , Programas de Redução de Peso/métodos
18.
Medicina (Kaunas) ; 56(4)2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32295226

RESUMO

Background and Objectives: Rheumatoid arthritis (RA) is a severe autoimmune disease characterized by chronic inflammation of the joints accompanied by the progressive deformation and destruction of cartilage and joint bones. This study aims to gain insight into the outcomes related to adherence in patients with rheumatoid arthritis. Predicting the medication adherence in RA patients is a key point to improve the treatment outcome. Materials and Methods: A number of 119 Romanian patients with RA were included and divided into two groups: first group included 79 patients treated with conventional therapy and second group included 40 patients treated with biologic therapy. A CQR-9 (compliance questionnaire rheumatology with nine items) and PDSQ (psychiatric diagnostic screening questionnaire) were performed to assess correlations between medication adherence, patient sociodemographic variables, 11 psychiatric scales (major depressive disorder, posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, psychosis, agoraphobia, social phobia, drug abuse/dependence, generalized anxiety disorder, somatization disorder, hypochondriasis) and lifestyle (bulimia, alcohol intake). Results: Whilst modelling factors associated with adherence, it was found that women and patients with higher education are more adherent. From the psychiatric indicators, only major depressive disorder and post-traumatic stress disorder were found to be positively correlated with therapeutic adherence. None of the assessed lifestyle factors influenced the adherence of RA patients. Conclusion: The knowledge of factors that impact on treatment adherence can be useful for clinicians to guide patient-centred care.


Assuntos
Artrite Reumatoide/psicologia , Artrite Reumatoide/terapia , Estilo de Vida , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Idoso , Artrite Reumatoide/epidemiologia , Estudos Transversais , Demografia/métodos , Demografia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Romênia/epidemiologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(17): e19769, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332617

RESUMO

INTRODUCTION: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. METHODS/DESIGN: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). DISCUSSION: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).


Assuntos
Anti-Hipertensivos/normas , Determinação da Pressão Arterial/normas , Hipertensão/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial/métodos , Restrição Calórica/métodos , Análise por Conglomerados , Dieta Hipossódica/métodos , Exercício Físico/fisiologia , Feminino , Humanos , Hipertensão/psicologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autogestão/métodos , Autogestão/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Resultado do Tratamento
20.
BMC Public Health ; 20(1): 454, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252703

RESUMO

BACKGROUND: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and inadequate health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. METHODS: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. Thematic analysis using a mixed deductive/inductive thematic approach was used. RESULTS: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient's TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients not following their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. CONCLUSIONS: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care.


Assuntos
Antituberculosos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Cooperação e Adesão ao Tratamento/psicologia , Tuberculose/psicologia , Adulto , Medo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Relações Médico-Paciente , Médicos/psicologia , Pesquisa Qualitativa , Estigma Social , Apoio Social , África do Sul/epidemiologia , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia
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