¿Cómo llega el paciente asmático al servicio de emergencias? Datos del estudio multicéntrico SABINA EMERGENCIAS / How Does the Asthmatic Patient Arrive at the Emergency Department? Data from the SABINA EMERGENCIAS Multicenter Study

Introducción: Los objetivos del control del asma son prevenir la aparición de síntomas y reducir el riesgo de exacerbaciones y mortalidad mediante educación médica, técnica inhalatoria, adherencia a medicación controladora e indicación de planes de acción (PA); pero los pacientes enfrentan exacerbaciones de diversa gravedad. Objetivos: El objetivo principal del estudio SABINA EMERGENCIAS fue describir la forma en que los pacientes concurren al servicio de emergencias (SE), considerando la frecuencia y uso de medicación de rescate. Objetivos secundarios: consultas al SE; uso de corticoides sistémicos (CS), agonistas beta-2 de acción corta (SABA) y tratamiento controlador; disponibilidad de PA. Material y Métodos: Estudio transversal, observacional, descriptivo, en cuatro hospitales del área metropolitana de Buenos Aires en adultos con asma. Resultados: n=323 (edad: 43,7±16,8 años; mujeres: 66,6%): 61,3% no eran seguidos por especialistas; 90,1% utilizaron SABA como rescate (mediana:10 inhalaciones; rango 0-100) la semana previa; 75,9% tuvieron ≥1 consulta al SE el año previo (mediana:2 [0-100]); 29,4% habían sido hospitalizados; 59,1% recibieron ≥1 ciclo de CS; mediana de consumo de SABA: 3 envases/año (0-23); 51,7% habían utilizado ≥3 envases; 30% no empleaban tratamiento de mantenimiento (23% usaba SABA); 75,9% no efectuaban terapia regular de mantenimiento; 77,1% no contaban con PA. Conclusión: Una reducida proporción de pacientes asmáticos que concurren al SE son seguidos por médicos especialistas, con alto consumo y elevada frecuencia de aplicación de SABA como rescate y baja adherencia al tratamiento de mantenimiento. Se remarca la necesidad de optimizar el manejo, con énfasis en la derivación al especialista, adherencia al tratamiento y prescripción de PA.

Introduction: The objectives of asthma control are to prevent the onset of symptoms and reduce the risk of exacerbations and mortality through medical education, inhaler technique, adherence to controller medication and indication of action plans (AP); but patients experience exacerbations of varying severity. Objective: The main objective of the SABINA EMERGENCIAS study was to describe how patients attend the emergency department (ED), considering the frequency and use of rescue medication. Secondary objectives: ED visits; use of systemic corticosteroids (SC), short-acting beta-2 agonists (SABA) and controller therapy; availability of AP. Methods: Cross-sectional, observational, descriptive study in 4 hospitals in the metropolitan area of Buenos Aires in adults with asthma. Results: n=323 (age:43.7±16.8 years; women:66.6%): 61.3% were not followed by specialists; 90.1% used SABA as rescue medication (median:10 puffs; range 0-100) the previous week; 75.9% had ≥1 visit to the ES the previous year (median: 2 [0-100]); 29.4% had been hospitalized; 59.1% received ≥1 cycle of CS; median SABA consumption: 3 cannisters/year (0-23); 51.7% had used ≥3 cannisters; 30% did not use maintenance therapy (23% used SABA); 75.9% did not perform regular maintenance therapy; 77.1% did not have an AP. Conclusion: A small proportion of asthmatic patients attending the ES are followed by specialist physicians, with high consumption and high frequency of SABA application as rescue medication and low adherence to maintenance treatment. The need to optimize management is highlighted, with emphasis on referral to specialists, adherence to treatment and prescription of APs.

Enfermedad de Chagas: prevalencia de infección por Trypanosoma cruzi en pacientes de un hospital polivalente / Chagas disease: prevalence of Trypanosoma cruzi infection in patients of a general hospital

La enfermedad de Chagas afecta a más de 7 millones de personas a nivel mundial, la mayoría de en América Latina. En la Argentina se calcula existen 2 millones de infectados. Objetivos: Determinar la prevalencia de infec-ción por Trypanosoma cruzi en pacientes que se atienden en un servicio de infectología de adultos y caracterizar dicha población. Población: pacientes seguidos con diag-nóstico de infección por Trypanosoma cruzi, realizado por serología, considerando infección en aquellos con al menos dos de tres técnicas positivas (HAI/ELISA/IFI) de una misma muestra. Se obtuvieron los datos de mane-ra retrospectiva de 90 historias clínicas. Resultados: La prevalencia de infección fue del 3%; de ellos, 50% eran argentinos. El 85,5% eran mujeres, en rango etario entre 31-45 años. El nivel educativo fue bajo. El diagnóstico se realizó en contexto de embarazo en 53%. Predominó la presentación Chagas crónico sin patología evidente (62%). El 94,5% cumplía criterio de tratamiento; lo reci-bió el 39%. Conclusiones: La prevalencia se asemeja a la publicada por otros autores. Predominó la nacionalidad argentina, en mujeres de edad fértil con diagnóstico en contexto de embarazo. Un gran porcentaje se encontraba en fase clínica sin lesión de órgano blanco, algo previsible dadas las características epidemiológicas del grupo. Casi la totalidad de ellos con criterio de recibir tratamiento, aunque menos de la mitad lo recibió. Esto puede deberse a la dificultad para realizar el seguimiento luego del diag-nóstico. Enfatizamos la importancia de concientizar a los pacientes sobre adherir a la consulta con la posibilidad de cura con tratamiento oportuno

Chagas disease affects more than 7 million people world-wide, the majority in Latin America. In Argentina it is es-timated that there are 2 million infected. Objectives: De-termine the prevalence of Trypanosoma cruzi infection in patients treated in an adult infectious disease service and characterize said population. Population: patients fol-lowed with a diagnosis of Trypanosoma cruzi infection, made by serology, considering infection in those with at least 2 of 3 positive techniques (HAI/ELISA/IFI) from the same sample. Data were obtained retrospectively from 90 medical records. Results: The prevalence of infection was 3%, of which 50% were Argentine. 85.5% were women in the age range between 31-45 years. The educational level was low. The diagnosis was made in the context of pregnancy in 53%. Chronic Chagas clinical presentation without obvious pathology predominated (62%). 94.5% with treatment criteria, 39% received it. Conclusions: The prevalence is similar to that published by other authors. Argentine nationality predominated in women of child-bearing age diagnosed in the context of pregnancy. A large percentage was in the clinical phase without target organ injury, something predictable given the epidemio-logical characteristics of the group. Almost all of them were eligible for treatment, although less than half re-ceived it. This may be due to the difficulty in following up after diagnosis. We emphasize the importance of raising patients' awareness about adhering to the consultation with the possibility of cure with timely treatment

Predictive Role of Resilience and Hope on Adherence to Treatment in Hemodialysis Patients / Papel predictivo de la resiliencia y la esperanza en la adherencia al tratamiento en pacientes en hemodiálisis / Papel preditivo da resiliência e da esperança na adesão ao tratamento em pacientes em hemodiálise

Objective. To determine the predictive role of resilience and hope on adherence to treatment in hemodialysis patients hospitalized in two hospitals affiliated to Shiraz University of Medical Sciences (Shiraz, Iran). Methods. This is a descriptive-analytical study that was conducted in 2021-2022 on 120 patients treated in hemodialysis sections in Namazi and Shahid Faqihi teaching hospitals. Sampling was conducted using a stratified random method. Demographic information questionnaires, Connor and Davidson's resilience, Snyder's hope and adherence to kidney patients' treatment questionnaires were used to collect the data. Results. The finds showed that the levels of resilience, hope, and adherence to treatment had hight level. More specifically, it was indicated that the mean and standard deviation for the total resilience score, the hope variable, and adherence to total treatment was 75.45±14.34, 40.43±3.66, and 80.12±18.20, respectively; which have maximum possible scores of 100, 48 and 100. Thus, it can be said that no correlation was observed between resilience and adherence to treatment variables (p>0.05); hope variable and adherence to treatment (p>0.05), and adherence to treatment with hope and resilience variables (p>0.05). However, hope and resilience variables showed a direct and weak correlation with each other (r=0.36, p<0.05); that is, patients who had more hope indicated better resilience as well. Conclusion. Although in this study we found that the resilience and hope variables were not able to predict the treatment adherence, hope and resilience indicated a direct and weak correlation. It is recommended that nurses should pay more attention to hope and resilience of hemodialysis patients in order to promote their health.

Objetivo. Determinar el papel predictivo de la resiliencia y la esperanza en la adherencia al tratamiento en pacientes en hemodiálisis internados en dos hospitales afiliados a la Universidad de Ciencias Médicas de Shiraz (Shiraz, Irán). Métodos. Se trata de un estudio descriptivo-analítico que se realizó en 2021-2022 con la participación de 120 pacientes tratados en secciones de hemodiálisis en los hospitales docentes Namazi y Shahid Faqihi. El muestreo se realizó mediante un método aleatorio estratificado. Para la recogida de datos se utilizaron datos demográficos y las escalas de resiliencia de Connor y Davidson, de esperanza de Snyder y de adherencia al tratamiento de pacientes renales. Resultados. Los hallazgos mostraron que los niveles de resiliencia, esperanza y adherencia al tratamiento se encontraban en niveles altos. Más concretamente, se indicó que la media y la desviación estándar para la puntuación total de resiliencia, la variable esperanza y la adherencia al tratamiento total fueron 75.45±14.34, 40,43±3.66 y 80.12±18.20, respectivamente; las cuales tienen como puntajes máximos posibles 100, 48 y 100. No se observó correlación entre las variables: resiliencia y adherencia al tratamiento (p>0.05), esperanza y la adherencia al tratamiento (p>0.05), y adherencia al tratamiento y las variables esperanza y resiliencia (p>0.05). Sin embargo, las variables esperanza y resiliencia mostraron una correlación directa y débil entre sí (r=0.36, p<0.05); es decir, los pacientes que tenían más esperanza indicaron también mejor resiliencia. Conclusión. Aunque en este estudio encontramos que las variables resiliencia y esperanza no fueron capaces de predecir la adherencia al tratamiento, la esperanza y la resiliencia indicaron una correlación directa y débil. Se recomienda que el personal de enfermería preste más atención a la esperanza y la resiliencia de los pacientes en hemodiálisis para promover su salud.

Objetivo. Determinar o papel preditivo da resiliência e da esperança na adesão ao tratamento em pacientes em hemodiálise internados em dois hospitais afiliados à Universidade de Ciências Médicas de Shiraz (Shiraz, Irã). Métodos. Trata-se de um estudo descritivo-analítico realizado em 2021-2022 com a participação de 120 pacientes atendidos nas seções de hemodiálise dos hospitais universitários Namazi e Shahid Faqihi. A amostragem foi realizada por método aleatório estratificado. Para a coleta de dados foram utilizados dados demográficos e as escalas de resiliência de Connor e Davidson, escalas de esperança de Snyder e adesão ao tratamento de pacientes renais. Resultados As descobertas mostraram que os níveis de resiliência, esperança e adesão ao tratamento estavam em níveis elevados. Mais especificamente, foi indicado que a média e o desvio padrão do escore de resiliência total, da variável esperança e da adesão total ao tratamento foram 75.45±14.34, 40.43±3.66 e 80.12±18.20, respectivamente; que possuem as pontuações máximas possíveis de 100, 48 e 100. Não foi observada correlação entre as variáveis: resiliência e adesão ao tratamento (p>0.05), esperança e adesão ao tratamento (p>0.05), e adesão ao tratamento e esperança e variáveis de resiliência (p>0.05). Contudo, as variáveis esperança e resiliência apresentaram correlação direta e fraca entre si (r=0.36, p<0.05); Ou seja, os pacientes mais esperançosos também indicaram melhor resiliência. Conclusão. Embora neste estudo tenhamos constatado que as variáveis resiliência e esperança não foram capazes de predizer a adesão ao tratamento, a esperança e a resiliência indicaram uma correlação direta e fraca. Recomenda-se que a equipe de enfermagem preste mais atenção à esperança e à resiliência dos pacientes em hemodiálise para promover sua saúde.

Transición en enfermedades inflamatorias intestinales: de la pediatría a la adultez / Transition in inflammatory bowel diseases: from childhood to adulthood

El 25% de los pacientes con Enfermedades Inflamatorias Intestinales (EII) se diagnostican antes de los 20 años. En la mayor parte de los centros del país se lleva a cabo la "transferencia" del paciente desde un centro de atención pediátrico a uno de adultos. La "transición" es un criterio de calidad con beneficios en el control de la EII reduciendo el número de recaídas, de hospitalizaciones y de cirugías. Por tal motivo hemos desarrollado un Programa Interdisciplinario de Transición entre dos hospitales de referencia nacional e internacional en EII. Materiales y métodos: Entre 1/2021 y 12/ 2022 se incorporaron 24 pacientes que ingresaron en 3 fases: Fase 1 Pacientes entre 14 y 16 años asistidos en el Hospital Garrahan (HG) con un abordaje interdisciplinario. Fase 2. A partir de los 17 años se realizaron 2 (dos) encuentros en el HG en conjunto con gastroenterólogos de adultos evaluando adherencia y autonomía y la Fase 3 llevada a cabo en el Hospital B. Udaondo (HBU) sólo con el equipo de adultos luego de 6 meses de realizada la transferencia evaluando adherencia al tratamiento, consultas a emergencias, internación y/o cirugías Resultados: Al inicio del Programa el 66% de los pacientes presentaban una actividad moderada a severa vs el 8% al finalizar la fase 3. Luego de la transferencia el 12,5% necesito ingreso a guardia e internación y un 8% tratamiento quirúrgico. El 83% de los pacientes continúan en seguimiento luego de 6 meses de haber sido transferidos (AU)

Twenty-five percent of patients with inflammatory bowel diseases (IBD) are diagnosed before the age of 20 years. In most centers in the country, the "transfer" of the patient from a pediatric to an adult care center is done. However, "transition" is a quality criterion with benefits in the control of IBD by reducing the number of relapses, hospitalizations, and surgeries. For this reason, we developed an Interdisciplinary Transition Program between two national and international reference hospitals in IBD. Materials and Methods: Between January 2021 and December 2022, we incorporated 24 patients into a three-phase program. Phase 1 involved patients between 14 and 16 years of age seen at Garrahan Hospital (HG) with an interdisciplinary approach. Phase 2 began from 17 years of age, with two meetings held at HG involving adult gastroenterologists to evaluate adherence and autonomy. Phase 3 was conducted at Hospital B. Udaondo (HBU) only with the adult team, six months after the transfer, evaluating adherence to treatment, emergency consultations, hospitalizations, and/or surgeries. Results: At the beginning of the program, 66% of the patients presented with moderate to severe disease activity, compared to 8% at the end of Phase 3. After the transfer, 12.5% of the patients required emergency department visits and hospitalization, and 8% required surgical treatment. Eighty-three percent of the patients continue in the program and are still being followed up six months after the transfer (AU)

Factores de riesgo asociados a mala adherencia en adolescentes trasplantados hepáticos en transición / Risk factors associated with poor adherence in adolescent liver transplant recipients in transition

Cada vez más pacientes trasplantados hepáticos durante la edad pediátrica alcanzan la adultez debido al aumento en las tasas de sobrevida a largo plazo, por lo que requieren continuar su atención en un centro de adultos. Este pasaje entre centros se asocia con peores resultados clínicos y mayor mala adherencia, debido al momento de vulnerabilidad que representa este momento en la atención médica y por el mismo momento vital atravesado por el paciente adolescente. La mayoría de los centros de trasplantes establecieron programas de transición para mejorar estos resultados. Para que estos programas sean efectivos, deben conocerse las barreras y los facilitadores de adherencia tanto en el paciente como en su entorno. El objetivo de este trabajo es reconocer estos factores de riesgo y su relación con mala adherencia y resultados clínicos, y realizar un seguimiento a corto plazo de los pacientes transferidos a un centro de atención de adultos. Para esto, se realizó una encuesta pre y post derivación a una cohorte de pacientes adolescentes del Hospital Garrahan. Para medir mala adherencia se utilizaron métodos objetivos y subjetivos, cada uno de los cuales correlacionó con distintos factores de riesgo, como presencia de violencia, consumo de sustancias y déficit educativo. Como conclusión, medir la mala adherencia es complejo debido a que su origen es multifactorial. Al parecer, combinar cuestionarios validados con entrevistas no estructuradas es la estrategia más efectiva para detectar mala adherencia en la consulta médica. Luego, las variables psicosociales están cobrando cada vez más relevancia y deben ser consideradas en los programas de transición de los servicios de trasplante si se quiere lograr un seguimiento a largo plazo exitoso (AU)

An increasing number of pediatric liver transplant patients reach adulthood due to the increase in long-term survival rates, and therefore require continued care in an adult center. This transition between centers is associated with worse clinical outcomes and poorer adherence, due to the vulnerability that this moment in medical care represents and the same vital moment that the adolescent patient goes through. Most transplant centers have established Transition Programs to improve these outcomes. For these programs to be effective, the barriers and facilitators of adherence in both the patient and their environment should be known. The aim of this study was to identify these risk factors and their relationship with poor adherence and clinical outcomes, and to perform a short-term follow-up of patients transferred to an adult care center. For this purpose, a pre- and post-referral survey was conducted on a cohort of adolescent patients from the Garrahan Hospital. Objective and subjective methods were used to measure poor adherence, each of which correlated with different risk factors, such as the presence of violence, substance use, and educational deficits. In conclusion, measuring poor adherence is complex because its origin is multifactorial. Combining validated questionnaires with unstructured interviews seems to be the most effective strategy for detecting poor adherence in the medical consultation. Therefore, psychosocial variables are becoming increasingly relevant and should be considered in the Transition Programs of transplantation services if a successful longterm follow-up is to be achieved (AU)

Transición a la medicina del adulto en sobrevivientes de un trasplante alogénico de células progenitoras hematopoyéticas / Transition to adult medicine in survivors of allogeneic hematopoietic stem cell transplantation

Los sobrevivientes de un trasplante alogénico de células progenitoras hematopoyéticas (TACPH) pediátrico presentan alto riesgo de padecer problemas de salud. Debido a esta vulnerabilidad, la continuidad del cuidado impacta en su pronóstico y la transición a la medicina del adulto (TMA) es un proceso clave. Objetivo: Evaluar el proceso actual de TMA de los receptores de TACPH en nuestro hospital. Métodos: Diseño: observacional retrospectivo y prospectivo. Población: todos los pacientes (p) que realizaron su TMA desde enero/2022 a marzo/2023. Instrumentos: entrevista personal; material escrito; resumen de historia clínica; escalas TRAQ 5.0 (transición), PedsQL 4.0 (CVRS) y Lansky (funcionalidad); elección de estrategias de seguimiento según complejidad y requerimientos; contacto con profesionales de adultos; entrevista telefónica luego de 6 meses posTMA; red conformada. Resultados: 36p completaron la TAM (33 presencial, 3 virtual). Edad m19 años (m6 años de seguimiento), 70% del interior del país, 58% TACPH por enfermedad maligna, 64% TACPH familiar. A la TMA: antecedente EICHc 50%, segunda enfermedad maligna 2%, compromiso órganos 75% (m2/p, r0-8, mayormente endocrinológicas, oculares y neurológicas), 94% Lansky ≥80 (r50-100), PedsQL m82 (27% ≤75), TRAQ m3.4 (r1.7- 4.8). Derivación: todos los p cubrían sus necesidades (30% en centros de alta complejidad o expertos en THA) pero 3p debieron readecuar las estrategias, 5p presentaban complicaciones en actividad o necesidad de pronta resolución. Contacto posterior: 30/33p continuaban seguimiento, 3p pudieron retomarlo, 9p nuevas complicaciones/tratamientos. Red: 20 profesionales/instituciones. Conclusiones: Se refuerza la necesidad y utilidad de un proceso de TMA tanto formal como personalizado según necesidades individuales de los pacientes con TACPH (AU)

Pediatric allogeneic hematopoietic stem cell transplant (HSCT) survivors are at high risk for health problems. Because of this vulnerability, continuity of care impacts their prognosis and transition to adult medicine (TAM) is a key process. Objective: To evaluate the current process of TAM of HSCT recipients in our hospital. Methods: A retrospective and prospective observational study was conducted. The population included all patients (p) who underwent TAM from January 2022 to March 2023. Instruments used included personal interviews, written materials, medical history summaries, the TRAQ 5.0 (transition), PedsQL 4.0 (HRQoL), and Lansky (functionality) scales. Follow-up strategies were chosen according to complexity and requirements, with contact established with adult professionals and a telephone interview conducted six months post-TAM in an established network network. Results: 36p completed TAM (33 face-to-face, 3 online). Mean age was 19 years (with a mean of 6 years of follow-up); 70% were from the provinces of the country, 58% underwent HSCT due to malignant disease, 64% had familial HSCT. At TAM: 50% had a history of GVHD, 2% had a second malignant disease, and 75% had organ involvement (mean of 2 per patient, ranging from 0 to 8, mostly endocrinological, ocular, and neurological), 94% had Lansky ≥80 (range, 50-100), mean PedsQL was 82 (27% ≤75), mean TRAQ was 3.4 (range, 1.7-4.8). Referral needs were met for all patients (30% in tertiary-level centers or with experts in allogeneic HSCT), although 3 patients had to readjust strategies, and 5 had complications requiring prompt resolution. In subsequent contact, 30 out of 33 patients continued follow-up, 3 resumed it, and 9 experienced new complications or treatments. The network included 20 healthcare providers/institutions. Conclusions: This study reinforces the need for and usefulness of a formal and personalized TAM process according to the individual needs of patients with HSCT (AU)

Adherencia de pacientes de alto riesgo heredo-familiar de cáncer de mama a "Programa de Vigilancia Activa": experiencia de la Clínica de Alto Riesgo de Cáncer de Mama del Centro Mamario del Hospital Universitario Austral / Adherence of patients with high hereditary-familial risk of breast cancer to the "Active Surveillance Program": experience of the High Risk Breast Cancer Clinic of the Breast Center of the Austral University Hospital

Introducción: Las mujeres con predisposición genética-familiar presentan un riesgo más elevado de desarrollar cáncer de mama. La vigilancia es una de las estrategias más efectivas para ofrecer a este subgrupo de mujeres, sin embargo la adherencia a la misma puede ser dificultosa. Objetivo: Analizar la adherencia de las pacientes con Alto Riesgo Heredo-Familiar (ARHF) al programa específico de "Seguimiento de pacientes de Alto Riesgo" del Hospital Universitario Austral. Material y método: Se revisaron de forma retrospectiva datos de 104 mujeres sanas con ARHF que ingresaron al programa de vigilancia: "Seguimiento de pacientes de Alto Riesgo" del Hospital Universitario Austral en el período comprendido entre junio de 2016 a febrero de 2022. Resultados: La adherencia al programa fue total en 38 pacientes (36,54%) y parcial en 42 (40,38%). Se observó falta de adherencia en 24 pacientes (23,07%). La causa más prevalente fue la incomodidad al realizar la resonancia (54,16%). Analizando la adherencia según el año de ingreso al programa se observa una caída significativa a partir del 3er año de seguimiento y solo 48,98% completaron la sexta ronda. Conclusiones: La falta de adherencia observada fue significativa. Los datos demostrados apuntan a una necesidad de continuar desarrollando estrategias que faciliten el seguimiento(AU)

Introduction: Women with a genetic-familial predisposition have a higher risk of developing breast cancer. Surveillance is one of the most effective strategies to offer this subgroup of women, however adherence to it can be difficult. Objetive: To analize the adherence of patients with High Risk of Familial-Hereditary (HRFH) breast cancer to a specific program: "Follow-up in High Risk patients" of the Austral University Hospital. Material and method: Data from 104 women with HRFH who were admitted to the surveillance program: "Follow-up in High Risk patients" of the Austral University Hospital in the period from june 2016 to february 2022 were retrospectively reviewed. Results: Adherence to the program was complete in 38 patients (36,54%) and partial in 42 (40,38%). 24 (23,07%) patients had lack of adherence. The most prevalent cause was discomfort when performing the resonance (54,16%). When we analyze adherence according to the year of admission to the program, a significant drop is observed from de 3rd year of follow-up and only 48,98% completed round six. Conclusions: The observed lack of adherence was significant. The demonstrated data points to a need to continue developing strategies that facilitate monitoring(AU)

Adolescencia, adherencia y transición: Experiencia de un centro de trasplante renal pediátrico / Adolescence, adherence, and transition: Experience from a pediatric renal transplant center

Con el advenimiento de nuevas técnicas quirúrgicas y medicaciones inmunosupresoras la sobrevida de los niños trasplantados mejoró, llegando a la adultez. La continuidad de su tratamiento requiere un proceso planificado que permita su tránsito a un sistema de salud orientado al adulto. El objeto de este trabajo es mostrar la transición a centros de adultos en una cohorte de pacientes trasplantados renales en el Hospital Garrahan, describir sus características clínicas y demográficas, su evolución, y oportunidades de mejora implementadas. Debido a cambios médicos y su abordaje desde la interdisciplina, se dividió a la población en tres periodos: era 1 (1988-1999), era 2 (2000-2009), y era 3 (2010- 2023). En la era 1, 179 adolescentes continuaron su atención médica en un centro de adultos, 212 en la era 2 y 201 en la era 3. En la era 1 el seguimiento estaba coordinado por el nefrólogo de cabecera y eran consultados los servicios de Urología, Servicio Social y Salud Mental. En la era 2, se fortaleció el trabajo en interdisciplina y aún más a partir del 2011. Surgieron centros de trasplante de adultos que recibían adolescentes y médicos dedicados a ellos en forma preferencial. En la actualidad la transición comienza a los 12 años y progresa hasta los 18. El modelo implementado es la transición directa, entre el nefrólogo pediatra y el de adultos, con varias consultas secuenciales en ambos centros. Si bien la sobrevida del paciente e injerto mejoraron, el rechazo, asociado a no adherencia, es una asignatura por mejorar (AU)

With the advent of new surgical techniques and immunosuppressive medications, the survival of transplanted children has improved, allowing them to reach adulthood. The continuity of their treatment requires a planned process that facilitates their transition to an adult-oriented healthcare system. The aim of this study was to examine the transition to adult centers in a cohort of renal transplant patients at Garrahan Hospital, describing their clinical and demographic characteristics, their evolution, and the improvement opportunities implemented. Based on medical changes and the interdisciplinary approach, the population was divided into three periods: era 1 (1988- 1999), era 2 (2000-2009), and era 3 (2010-2023). In era 1, 179 adolescents continued their medical care in an adult center, 212 in era 2, and 201 in era 3. In era 1, follow-up was coordinated by the attending nephrologist with consultations from Urology, Social Services, and Mental Health Services. In era 2, interdisciplinary work was strengthened, and even more so since 2011. Adult transplant centers were created to receive adolescents with physicians dedicated to their care on a preferential basis. Currently, the transition begins at 12 years of age and progresses up to 18. The implemented model involves direct transition between the pediatric nephrologist and the adult nephrologist, with several sequential consultations in both centers. Although patient and graft survival have improved, rejection associated with non-adherence remains an area for improvement

Impacto de la identificación de síntomas depresivos en un programa de rehabilitación cardiovascular / Impact of the identification of depressive symptoms in a cardiovascular rehabilitation program

Introducción. La evidencia muestra una relación bidireccional entre la depresión y la enfermedad coronaria. La identificación de síntomas depresivos en la consulta de rehabilitación cardiovascular (RCV) puede ser un indicador valioso. Materiales y métodos. Aquellos pacientes que presentaron síntomas depresivos (autorreportados) fueron remitidos al servicio de Salud Mental (SM), y posteriormente se compararon con un grupo de pacientes sin estos síntomas y se evaluó su impacto en variables cardiovasculares. Resultados. Se evaluaron 60 pacientes. Se observó una adherencia del 86,44% (n=51). 13 pacientes fueron remitidos al área de HM (edad media 67,08 años; DE 6,09). Hemos analizado el impacto que puede representar este trastorno, tanto en la recuperación física como en la percepción de calidad de vida. Conclusiones. Los efectos positivos de la derivación a MH complementan los beneficios de la RCV. La mejora emocional del individuo también favorece la adherencia y el cumplimiento del tratamiento rehabilitador

Introduction. Evidence shows a bidirectional relationship between depression and coronary heart disease. The identification of depressive symptoms in the cardiovascular rehabilitation (CVR) consultation can be a valuable indicator. Materials and methods. Those patients who presented depressive symptoms (self-reported) were referred to the Mental Health (MH) service, and were subsequently compared with a group of patients without these symptoms, and their impact on cardiovascular variables was evaluated. Results. 60 patients were evaluated. An adherence of 86.44% (n=51) was observed. 13 patients were referred to the MH area (mean age 67.08 years; SD 6.09). We have analyzed the impact that this disorder can represent, both on physical recovery and on the perception of quality of life. Conclusions. The positive effects of referral to MH complement the benefits of CVR. The individual's emotional improvement also favors adherence and compliance with rehabilitation treatment

Asthma patients' and physicians' perspectives on the burden and management of asthma: Post-hoc analysis of APPaRENT 1 and 2 to assess predictors of treatment adherence.

INTRODUCTION: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns. METHODS: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence. RESULTS: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting ß2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines. CONCLUSIONS: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.

Beyond Therapeutic Adherence: Alternative Pathways for Understanding Medical Treatment in Type 1 Diabetes Mellitus.

Given the psychosocial and economic costs of behaviors of patients who seem not to benefit from the medications, technologies, and medical therapies available for chronic diseases such as Type 1 Diabetes Mellitus, therapeutic adherence has been identified as one of the main focuses in the intervention. This paper presents contributions from semiotic cultural clinical psychology for understanding problems associated with the implementation of medical treatment in patients with Type 1 Diabetes Mellitus to explore psychological dimensions not yet reported in depth. A narrative review of 24 scientific articles published between 2012 and 2023 is carried out. The information is produced through thematic analysis, and the results are presented in three themes: 1. illness characteristics, 2. adherence and associated concepts, and 3. modes of intervention. It concludes with the development of a two-axis proposal for understanding the experience of patients that privileges psychological aspects involved in the disease and its treatment, considering the approach to the goals of treatment as dynamic and fluctuating rather than as final states.

Aplicación de un modelo farmacocinético poblacional para el seguimiento de pacientes en tratamiento con dolutegravir: estudio piloto / Application of a Population Pharmacokinetic Model for the Monitoring of Patients Undergoing Treatment with Dolutegravir: pilot study / Aplicação de modelo farmacocinético populacional para acompanhamento de pacientes tratados com dolutegravir: estudo piloto

Introducción: a pesar de los avances en tratamiento antirretroviral, existe la posibilidad de que personas que viven con el virus de la inmunodeficiencia humana (VIH) experimenten falla terapéutica vinculada a múltiples factores que impactan en la respuesta al fármaco. Objetivos: evaluar la utilidad de aplicar un modelo farmacocinético en pacientes con diagnóstico de VIH en tratamiento con dolutegravir para el análisis de las concentraciones plasmáticas experimentales. Adicionalmente, se pretende identificar potenciales interacciones farmacológicas, evaluar adherencia y fallo terapéutico. Material y método: se realizó un estudio piloto transversal y observacional en pacientes VIH tratados con dolutegravir que incluyó la dosificación de la concentración plasmática, evaluación de adherencia mediante el cuestionario simplificado de adherencia a la medicación (SMAQ) y retiro de medicación. Se utilizó un modelo poblacional referenciado en la bibliografía para la predicción de concentraciones de dolutegravir en cada paciente y se compararon con las concentraciones experimentales. Resultados: fueron incluidos en el estudio 21 pacientes. Al cotejar las concentraciones plasmáticas experimentales con la simulación farmacocinética se encontraron diferencias para 12 pacientes, las cuales se explican por posibles interacciones farmacológicas, mala adherencia u otros factores que afectan la farmacocinética. Se detectó 38% de no adherencia de acuerdo con SMAQ y 23% de acuerdo con el retiro de medicación. Conclusiones: se expone el rol potencial de los modelos farmacocinéticos para la interpretación de concentraciones plasmáticas y se genera la necesidad de avanzar en este tipo de estudios para el establecimiento de rango terapéutico y aplicabilidad clínica.

Introduction: Despite advances in antiretroviral treatment, there is a possibility that people living with HIV may experience treatment failure linked to multiple factors that impact drug response. Objective: To evaluate the usefulness of applying a pharmacokinetic model in patients diagnosed with HIV undergoing treatment with dolutegravir for the analysis of experimental plasma concentrations. Additionally, the aim is to identify potential drug interactions, assess adherence, and therapeutic failure. Method: A cross-sectional, observational pilot study was conducted in HIV patients treated with dolutegravir, which included plasma concentration dosing, assessment of adherence using the Simplified Medication Adherence Questionnaire (SMAQ), and medication withdrawal. A population-based model referenced in the literature was used to predict dolutegravir concentrations in each patient and these were compared with experimental concentrations. Results: Twenty-one patients were included in the study. When comparing experimental plasma concentrations with pharmacokinetic simulation, differences were found for 12 patients, which can be explained by possible drug interactions, poor adherence, or other factors affecting pharmacokinetics. Non-adherence was detected in 38% according to the SMAQ and 23% according to medication withdrawal. Conclusions: The potential role of pharmacokinetic models in the interpretation of plasma concentrations is highlighted, emphasizing the need to advance in this type of studies to establish therapeutic ranges and clinical applicability.

Introdução: Apesar dos avanços no tratamento antirretroviral, existe a possibilidade de que pessoas que vivem com HIV experimentem falha terapêutica ligada a múltiplos fatores que impactam na resposta ao medicamento. Objetivos: Avaliar a utilidade da aplicação de um modelo farmacocinético em pacientes com diagnóstico de HIV em tratamento com dolutegravir para análise de concentrações plasmáticas experimentais. Além disso, pretende-se identificar potenciais interações medicamentosas, avaliar a adesão e a falha terapêutica. Método: Um estudo piloto observacional transversal foi conduzido em pacientes HIV tratados com dolutegravir que incluiu dosagem de concentração plasmática, avaliação de adesão usando o questionário simplificado de adesão à medicação (SMAQ) e retirada da medicação. Um modelo populacional referenciado na literatura foi utilizado para prever as concentrações de dolutegravir em cada paciente e compará-las com as concentrações experimentais. Resultados: 21 pacientes foram incluídos no estudo. Ao comparar as concentrações plasmáticas experimentais com a simulação farmacocinética, foram encontradas diferenças em 12 pacientes, que são explicadas por possíveis interações medicamentosas, má adesão ou outros fatores que afetam a farmacocinética. Foram detectadas 38% de não adesão segundo o SMAQ e 23% segundo retirada da medicação. Conclusões: Fica exposto o papel potencial dos modelos farmacocinéticos para a interpretação das concentrações plasmáticas e gera-se a necessidade de avançar neste tipo de estudos para estabelecer a faixa terapêutica e a aplicabilidade clínica.

HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City.

Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI)  = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.

Educação em saúde para pessoas vivendo com HIV em supressão virológica parcial: pesquisa convergente assistencial / Health education for people living with HIV in partial virologic suppression: convergent care researchEducación sanitaria para personas que viven con VIH en supresión virológica parcial: investigación convergente asistencialLilian Caroline Souza1ORCID: 0000-0002-6559-1855Andressa Midori Sakai1ORCID: 0000-0002-0974-1943Ieda Harumi Higarashi2ORCID: 0000-0002-4205-6841Flávia Meneguetti Pieri1ORCID: 0000-0003-1239-2550Juliana Helena Montezeli1ORCID: 0000-0003-4522-9426Gilselena Kerbauy1ORCID: 0000-0002-1737-42821Universidade Estadual de Londrina. Londrina, Paraná, Brasil. 2Universidade Estadual de Maringá. Maringá, Paraná, Brasil.Autor correspondente:Gilselena KerbauyE-mail:gilselena@uel.brResumo Objetivo: Analisar o processo de implementação de educação em saúde às pessoas vivendo com HIV (PVHIV) em supressão viral parcial com vistas ao resgate da adesão à terapia antirretroviral. Métodos: Pesquisa Convergente Assistencial realizada com 13 pessoas infectadas pelo HIV, com supressão viral parcial. Por meio das etapas de concepção, instrumentação, perscrutação e análise, identificaram-se os motivos de falhas no tratamento, implementou-se educação em saúde e analisou-se o processo com entrevistas e análise de conteúdo. O processo educativo ocorreu com apoio de tecnologia educacional: Material Educativo sobre HIV (INPI: BR 10 2020 003765 0). Resultados: As falhas no tratamento deram-se pelos seguintes motivos: efeitos colaterais, preconceito, problemas familiares, dificuldade no acesso ao serviço de saúde e esquecimento. Das falas após intervenção, emergiram três categorias: 1 -O despertar para a importância do uso correto da terapia antirretroviral; 2 -Sentimentos advindos do processo educativo; 3 -O conhecimento e superação de estigmas sociais. Conclusão: A tecnologia educacional, somada à escolha de uma pesquisa participativa como método, proporcionou aprendizado para todos os envolvidos, sendo possível perceber a importância do fortalecimento do vínculo ensino-serviço, da utilização do diálogo no contextoda coletividade e da convergência investigativa para a prática assistencial.Descritores:Enfermagem; HIV; Síndrome de Imunodeficiência Adquirida; Cooperação e Adesão ao Tratamento. Educação em Saúde.Como citareste artigo: SouzaLC, SakaiAM, HigarashiIH, PieriFM, MontezeliJH, KerbauyG. Educação em saúde para pessoas vivendo com HIV em supressão virológica parcial: pesquisa convergente assistencial.Rev. enferm. UFPI. [internet] 2024 [citado em: dia mês abreviado ano];13:e4249. DOI: 10.26694/reufpi.v13i1.4249O que se sabe?Os usos de tecnologias educacionais possibilitam experiências positivas para PVHIV, contribuem para melhoria do vínculo entre profissionais e PVHIV e proporcionam acesso as informações e reflexões a certa da doença. O que o estudo adiciona?Os resultados do estudo destacam o impacto positivo da tecnologia educativa no despertar da consciência, na adesão ao tratamento e no enfrentamento dos desafios emocionais e sociais relacionados ao HIV. Isso pode ter consequências importantes para a melhoria da qualidade de vida e do cuidado prestado às PVHIV.

Objetivo: Analisar o processo de implementação de educação em saúde às pessoas vivendo com HIV (PVHIV) em supressão viral parcial com vistas ao resgate da adesão à terapia antirretroviral. Métodos: Pesquisa Convergente Assistencial realizada com 13 pessoas infectadas pelo HIV, com supressão viral parcial. Por meio das etapas de concepção, instrumentação, perscrutação e análise, identificaram-se os motivos de falhas no tratamento, implementou-se educação em saúde e analisou-se o processo com entrevistas e análise de conteúdo. O processo educativo ocorreu com apoio de tecnologia educacional: Material Educativo sobre HIV (INPI: BR 10 2020 003765 0). Resultados: As falhas no tratamento deram-se pelos seguintes motivos: efeitos colaterais, preconceito, problemas familiares, dificuldade no acesso ao serviço de saúde e esquecimento. Das falas após intervenção, emergiram três categorias: 1 -O despertar para a importância do uso correto da terapia antirretroviral; 2 -Sentimentos advindos do processo educativo; 3 -O conhecimento e superação de estigmas sociais. Conclusão: A tecnologia educacional, somada à escolha de uma pesquisa participativa como método, proporcionou aprendizado para todos os envolvidos, sendo possível perceber a importância do fortalecimento do vínculo ensino-serviço, da utilização do diálogo no contextoda coletividade e da convergência investigativa para a prática assistencial

Objective:To analyze the process of implementing health education for people living with HIV in partial viral suppression with a view to rescuing adherence to antiretroviral therapy. Methods:Convergent Care Research carried out with 13 HIV-infected people, with partial viral suppression. Through the stages of conception, instrumentation, scrutiny and analysis, the reasons for treatment failures were identified, health education was implemented and the process was analyzed with interviews and content analysis. The educational process took place with the support of educational technology: Educational Material on HIV (INPI: BR 10 2020 003765 0). Results:Treatment failures were due to the following reasons: side effects, prejudice, family problems, difficulty in accessing the health service and forgetfulness. Three categories emerged from the speeches after the intervention: 1-Awakening to the importanceof the correct use of antiretroviral therapy; 2-Feelings arising from the educational process; 3-Knowledge and overcoming social stigmas. Conclusion:Educational technology, added to the choice of participatory research as a method, provided learning for all involved, making it possible to perceive the importance of strengthening the teaching-service bond, the use of dialogue in the context of collectivity and investigative convergence for care practice

Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda.

OBJECTIVE: To examine the preliminary impact of group cognitive behavioral therapy and multiple family group-based family strengthening to address HIV stigma and improve the mental health functioning of adolescents living with HIV in Uganda. STUDY DESIGN: We analyzed data from the Suubi4Stigma study, a 2-year pilot randomized clinical trial that recruited adolescents living with HIV (10-14 years) and their caregivers (n = 89 dyads), from 9 health clinics. We fitted separate three-level mixed-effects linear regression models to test the effect of the interventions on adolescent outcomes at 3 and 6 months post intervention initiation. RESULTS: The average age was 12.2 years and 56% of participants were females. Participants in the multiple family group-based family strengthening intervention reported lower levels of internalized stigma (mean difference = -0.008, 95% CI = -0.015, -0.001, P = .025) and depressive symptoms at 3 months (mean difference = -0.34, 95% CI = -0.53, -0.14, P < .001), compared with usual care. On the other hand, participants in the group cognitive behavioral therapy intervention reported lower levels of anticipated stigma at 3 months (mean difference = -0.039, 95% CI = -0.072, -0.006), P = .013) and improved self-concept at 6 months follow-up (mean difference = 0.04, 95% CI = 0.01, 0.01, P = .025). CONCLUSION: Outcome trends from this pilot study provide compelling evidence to support testing the efficacy of these group-based interventions on a larger scale. TRIAL REGISTRATION: The study is registered in the Clinical trials.gov database (Identifier #: NCT04528732).

A Novel Digital Educational Strategy Improves Treatment Adherence and Quality of Life in Patients with Multiple Myeloma.

Multiple myeloma, the second most common hematologic malignancy worldwide, is an aggressive disease with high morbidity and mortality rates. Although myeloma remains incurable, new treatments have improved patients' life expectancy and quality of life. However, as these therapies are administered for prolonged and often indefinite periods, their success depends on high treatment adherence and significant patient engagement. This study aimed to evaluate the impact of a novel digital educational strategy on treatment adherence, quality of life, and the development of complications in patients with newly diagnosed myeloma. To this end, a two-arm, randomized, prospective, double-blind study was conducted to compare the conventional educational approach alone or combined with the novel digital strategy. This strategy was based on some principles of the Persuasive Systems Design model and incorporated the educational recommendations of patients and caregivers. Compared to the control group that only received information through the conventional educational approach, patients randomized to the digital strategy showed significantly higher treatment adherence and quality of life, associated with increased functionality and rapid reincorporation into daily routines. The digital strategy empowered patients and caregivers to understand the disease and therapeutic options and helped patients recall treatment information and implement healthy lifestyle habits. These results support that patient-targeted educational strategies can positively influence treatment adherence and thus improve their quality of life.

Estratégias educativas em saúde para pessoas vivendo com HIV: revisão de escopo / Estrategias educativas en salud para personas que viven con el VIH: revisión de alcance / Health educational strategies for people living with HIV: scoping review

Resumo Objetivo Mapear a produção científica sobre as estratégias educativas e os conteúdos abordados na educação de pessoas vivendo com HIV. Métodos Esta é uma revisão de escopo em que a seleção dos artigos foi realizada em abril de 2021 e atualizada em outubro de 2022 em dez fontes de dados; a revisão seguiu os pressupostos estabelecidos pelo Joanna Briggs Institute e o checklist dos Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Os resultados foram analisados descritivamente e sintetizados em um quadro. Resultados Foram selecionados 17 estudos com publicação predominante em 2017; Estados Unidos da América e Brasil foram os países com a maior quantidade de produções. A maioria dos estudos buscou avaliar o impacto e a eficácia das estratégias e desenvolver ou validar instrumentos de educação em saúde e atividades de prevenção. Em relação ao conteúdo abordado pelas estratégias, foram formadas cinco categorias: orientação inicial sobre HIV/AIDS, cuidados gerais, vida saudável, saúde sexual e suporte emocional. As estratégias educativas que se destacaram em relação à maior adesão dos pacientes ao tratamento estão relacionadas com o desenvolvimento de sistemas, programas e multimídia. As cartilhas promoveram empoderamento e autonomia de pessoas vivendo com HIV. Conclusão Foram mapeadas as principais estratégias educativas, com destaque para cartilhas, material impresso, recursos multimídia, sistemas, formulários e oficinas/workshops, abordando orientação inicial sobre HIV/AIDS, tratamento farmacológico, cuidados gerais, vida saudável, saúde sexual e suportes social e emocional.

Resumen Objetivo Mapear la producción científica sobre las estrategias educativas y los contenidos abordados en la educación de personas que viven con el VIH. Métodos Esta es una revisión de alcance, cuya selección de artículos se realizó en abril de 2021 y se actualizó en octubre de 2022 en diez fuentes de datos. La revisión siguió las premisas establecidas por el Joanna Briggs Institute y la checklist de los Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Los resultados fueron analizados descriptivamente y sintetizados en un cuadro. Resultados Se seleccionaron 17 estudios con publicación predominante en 2017. Estados Unidos de América y Brasil fueron los países con mayor cantidad de producciones. La mayoría de los estudios buscó evaluar el impacto y la eficacia de las estrategias y elaborar o validar instrumentos de educación para la salud y actividades de prevención. Con relación al contenido abordado por las estrategias, se formaron cinco categorías: instrucciones iniciales sobre VIH/SIDA, cuidados generales, vida saludable, salud sexual y apoyo emocional. Las estrategias educativas que se destacaron con relación a una mayor adhesión de los pacientes al tratamiento están relacionadas con el desarrollo de sistemas, programas y multimedia. Las cartillas promovieron empoderamiento y autonomía de personas que viven con el VIH. Conclusión Se mapearon las principales estrategias educativas, con énfasis en cartillas, material impreso, recursos multimedia, sistemas, formularios y talleres/workshops, que abordaron instrucciones iniciales sobre VIH/SIDA, tratamiento farmacológico, cuidados generales, vida saludable, salud sexual y apoyo social y emocional. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Abstract Objective To map the scientific production on educational strategies and the content covered in the education of people living with HIV. Methods This is a scoping review in which the selection of articles was carried out in April 2021 and updated in October 2022 in ten data sources; the review followed the assumptions established by the Joanna Briggs Institute and the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The results were descriptively analyzed and summarized in a chart. Results A total of 17 studies were selected, predominantly published in 2017; The USA and Brazil were the countries with the largest number of productions. Most studies sought to evaluate the impact and effectiveness of strategies and develop or validate health education instruments and prevention activities. Concerning the content covered by the strategies, five categories were formed: initial guidance on HIV/AIDS, general care, healthy living, sexual health, and emotional support. The educational strategies that stood out concerning greater patient adherence to treatment are related to the development of systems, programs, and multimedia. The booklets promoted empowerment and autonomy for people living with HIV. Conclusion The main educational strategies were mapped, with emphasis on booklets, printed material, multimedia resources, systems, forms, and workshops, covering initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Factors associated with medication non-adherence among patients with heart failure / Fatores associados à não adesão ao tratamento farmacológico de pacientes com insuficiência cardíaca / Factores asociados a la no adhesión al tratamiento farmacológico de pacientes con insuficiencia cardíaca

Abstract Objective: to identify the factors contributing to medication non-adherence among patients with heart failure. Method: cross-sectional and analytical study using the Medida de Adesão ao Tratamento [Treatment Adherence Measure] scale to assess medication non-adherence. Independent variables were collected using the European Heart Failure Self-care Behavior Scale and an instrument developed by the authors based on a previous study. Statistical tests were implemented to analyze data with p≤0.05 statistical significance. Results: the sample comprised 340 patients, with 9.4% considered non-adherent. The multiple analysis results showed that one unit increase in an individual's self-care score led to an 8% increase in the prevalence of non-adherence; patients with a family income above three times the minimum wage presented a prevalence of non-adherence equal to 3.5% of the prevalence of those with up to one times the minimum wage; individuals consuming alcohol or with depression presented 3.49 and 3.69 times higher prevalence of non-adherence, respectively, than individuals not presenting such history. Conclusion: medication non-adherence was associated with self-care, family income, depression, and alcohol consumption.

Resumo Objetivo: identificar os fatores que contribuem para a não adesão ao tratamento farmacológico de pacientes com insuficiência cardíaca. Método: estudo transversal e analítico que utilizou a escala de Medida de Adesão ao Tratamento para avaliar a não adesão ao tratamento farmacológico. Variáveis independentes foram coletadas utilizando-se a European Heart Failure Self-care Behavior Scale e um instrumento elaborado pelos autores, baseado em estudo anterior. Foram utilizados testes estatísticos para análise dos dados, sendo considerados significativos os valores de p≤0,05. Resultados: a amostra foi composta por 340 pacientes. Desses, 9,4% foram classificados como não aderentes. Os resultados da análise múltipla mostraram que o aumento de uma unidade no escore de autocuidado leva a um aumento de 8% na prevalência de não adesão do indivíduo; pacientes com renda familiar superior a três salários mínimos têm prevalência de não adesão ao tratamento igual a 3,5% da prevalência entre aqueles com até um salário mínimo; indivíduos que ingerem bebida alcoólica e sofrem de depressão têm prevalências de não adesão 3,49 e 3,69 vezes maiores, respectivamente, do que aqueles que não têm tais antecedentes. Conclusão: a não adesão ao tratamento farmacológico relacionou-se com comportamento de autocuidado, renda familiar, depressão e ingestão de bebida alcoólica.

Resumen Objetivo: identificar los factores que contribuyen para la no adhesión al tratamiento farmacológico de pacientes con insuficiencia cardíaca. Método: estudio transversal y analítico que utilizó la escala de Medida de Adhesión al Tratamiento para evaluar la no adhesión al tratamiento farmacológico. Las variables independientes fueron recolectadas utilizando la European Heart Failure Self-care Behavior Scale y un instrumento elaborado por los autores, basado en estudio anterior. Fueron utilizadas pruebas estadísticas para el análisis de los datos, siendo considerados significativos los valores de p≤0,05. Resultados: la muestra estuvo compuesta por 340 pacientes; de esos, 9,4% fueron clasificados como no adherentes. Los resultados del análisis múltiple mostraron que el aumento de una unidad en el puntaje de autocuidado lleva a un aumento de 8% en la prevalencia de la no adhesión del individuo; pacientes con renta familiar superior a tres salarios mínimos tienen prevalencia de no adhesión al tratamiento igual a 3,5% de aquellos que reciben hasta un salario mínimo; individuos que ingieren bebida alcohólica y sufren de depresión, tienen prevalencias de no adhesión de 3,49 y 3,69 veces mayores, respectivamente, que aquellos que no tienen esos antecedentes. Conclusión: la no adhesión al tratamiento farmacológico se relacionó con comportamientos de autocuidado, renta familiar, depresión e ingestión de bebida alcohólica.

(Des)compassos do trabalho psicológico no acompanhamento familiar no CRAS / (Dis)order of the psychological work within family care at CRAS / (Des)compás del trabajo psicológico en el seguimiento familiar en el Centro de Referencia de Asistencia Social (CRAS)

Esta pesquisa teve como objetivo investigar as perspectivas dos psicólogos dos Centros de Referência da Assistência Social (CRAS) que compõem a equipe de Proteção e Atenção Integral à Família (PAIF) a respeito do seu trabalho no Acompanhamento Familiar oferecido para famílias com membros com transtornos mentais. Oito psicólogos que atuavam nos CRAS de um município no interior de Minas Gerais participaram do estudo. O instrumento utilizado foi um roteiro de entrevista semiestruturada, com a subsequente análise de conteúdo temática. As categorias temáticas foram analisadas à luz da literatura específica da área. De maneira geral, os resultados indicaram que os psicólogos se sentem despreparados para o exercício de sua função no CRAS, uma vez que a formação específica e continuada em Psicologia não ofereceu subsídios adequados para o conhecimento da atuação no campo da Assistência Social. A natureza (psico)terapêutica do trabalho é discutida, assim como a necessidade de formações continuadas para a atuação. Ressalta-se a necessidade de mais pesquisas que abordem a formação em Psicologia e suas relações com a Assistência Social, bem como os impactos desse despreparo na prática dos profissionais, de maneira a fomentar maior satisfação pessoal/profissional e, consequentemente, aprimorar a assistência oferecida à comunidade.(AU)

This study aims to investigate the views of psychologists who worked at Social Assistance Reference Centers (CRAS) associated with the Comprehensive Family Care Program (PAIF) on their work with the aforementioned program. Overall, eight psychologists who worked at CRAS units in small municipalities in Minas Gerais for at least one year participated in this research. The instrument used was a semi-structured interview script, and the data were analyzed under the content analysis (thematic) method. Thematic categories were analyzed based on the specific literature. Results indicate that the psychologists generally felt unprepared to work at CRAS since their degree in Psychology provided inadequate knowledge to deal with Social Assistance issues. This study discusses the (psycho)therapeutic nature of their practice and the need for ongoing training for their proper performance. This study highlights the need for further research that addresses the links between education in Psychology and Social Assistance and the impacts of said unpreparedness on the performance of those professionals. Such research might provide more professional/personal satisfaction and, in turn, improve the quality of the offered service.(AU)

Este estudio tuvo la intención de conocer las perspectivas de los psicólogos de los Centros de Referencia de Asistencia Social (CRAS) que forman parte de los equipos del Protección y Atención Integral a la Familia (PAIF) acerca del seguimiento de familias con miembros portadores de trastornos mentales. Ocho psicólogos que actuaban en los CRAS de un municipio del interior del estado de Minas Gerais (Brasil) participaron en el estudio. El instrumento utilizado fue un guion de entrevistas semiestructuradas; y, para análisis de datos, se utilizó el análisis de contenido temático. Las categorías temáticas se analizaron a la luz de la literatura específica del campo. De modo general, los resultados indicaron que los psicólogos no se sienten preparados para desempeñar la función en el CRAS, puesto que la formación en Psicología no ofreció conocimientos adecuados para actuar en el campo de la asistencia social. Se discuten la naturaleza (psico)terapéutica del trabajo y la necesidad de formación continua para esta actuación. Se destaca la necesidad de más investigaciones que tratan de la formación en Psicología y sus relaciones con la asistencia social, y los impactos de esta falta de preparo en la práctica de los profesionales, de modo a promover una satisfacción personal/profesional y, consecuentemente, optimizar la asistencia ofrecida a la comunidad.(AU)

Câncer materno: a compreensão da criança e suas representações / Maternal cancer: the child's understanding and its representations / Cáncer materno: comprensión del niño y sus representaciones

O câncer é uma doença crônico-degenerativa, que tem como uma de suas principais características a capacidade de invadir tecidos e órgãos do corpo, favorecendo o crescimento desordenado de células. É uma doença que impacta fortemente a pessoa enferma e todos à sua volta, incluindo sua família e seus amigos. A partir desse cenário, este trabalho visou compreender a visão da criança e o impacto emocional sofrido diante do diagnóstico de câncer da mãe. Buscou-se avaliar, a partir de ferramentas lúdicas e do desenho-estória, o entendimento da criança em relação ao processo de adoecimento materno, tomando como base o referencial psicanalítico para reconhecer como ela lidou com a situação. Participaram desta pesquisa uma mulher de 39 anos com diagnóstico de câncer em remissão e seu filho de 9 anos. Os resultados demonstraram que o adoecimento materno causou impactos emocionais significativos e assustadores para o infante, gerando fantasias irreais relacionadas ao câncer e a si próprio. Dessa forma, considera-se de fundamental importância o cuidado estendido aos familiares do indivíduo doente, a fim de que se tenha um olhar a todos que sofrem diante desse contexto.(AU)

Cancer is a chronic-degenerative disease that has as one of its main characteristics the ability to invade tissues and organs of the body, favoring the disordered cell growth. It is a disease that strongly impacts the sick person and everyone around them, including their family and friends. Based on this scenario, this work aimed to understand the child's view and the emotional impact suffered in the face of the mother's cancer diagnosis. It sought to evaluate, with ludic tools and drawing history, the child's understanding about the mother's illness process, based on the psychoanalytic framework to recognize how they deal with the situation. A 39-year-old woman diagnosed with cancer, in remission, and her 9-year-old son participated in this research. The results showed that the maternal illness caused significant and frightening emotional impacts for the infant, creating unrealistic fantasies related to cancer and to himself. Thus, the care extended to the sick individual's family and to the relatives is considered of fundamental importance, to give a complete care for all those who suffer in this context.(AU)

El cáncer es una enfermedad crónico-degenerativa, que tiene como una de sus principales características la capacidad de invadir tejidos y órganos, favoreciendo un crecimiento desordenado de las células. Enfermedades como esta impactan fuertemente a la persona que está enferma y a todos los que la rodean, incluidos familiares y amigos. Considerando esta situación, este estudio tuvo como objetivo comprender la percepción de un niño y el impacto emocional que sufrió ante el diagnóstico del cáncer vivido por su madre. Se pretendió evaluar, utilizando herramientas lúdicas y de dibujo-cuento, la comprensión del niño al proceso de enfermedad materna, buscando reconocer cómo el niño manejó este proceso a partir del referencial teórico psicoanalítico. En esta investigación participaron una mujer de 39 años diagnosticada de cáncer en remisión y su hijo de 9 años. Los resultados mostraron que los impactos emocionales de la enfermedad materna fueron significativos y aterradores para el infante, generando fantasías irreales relacionadas con el cáncer y él mismo. De esta forma, el cuidado extendido a la familia del individuo que está enfrentando esta enfermedad es importante para promover una atención integral a quienes la padecen en este contexto.(AU)