Adherence to Therapy in Chronic Obstructive Pulmonary Disease: A Systematic Review.

Adherence to therapy plays a key role in treatment optimization and clinical outcome in patients with chronic obstructive pulmonary disease (COPD). The adherence to inhaled medications is poor, ranging from 20% to 60%. In this study we searched Medline and PubMed literature regarding factors that could have an impact on therapy adherence in COPD patients, using the key words "COPD" or "chronic obstructive pulmonary disease" and "adherence". The search was limited to the English language article published between January 2013 and December 2019. Review papers, study protocols, and meta-analyses were excluded. The final material included 25 articles. The evaluation was performed using the Cochrane Review Manager guidelines. The 25 articles represented 29 countries from 5 continents. We assessed adherence to therapy and the impact of selected factors on the adherence in 27,660 COPD patients (60.9% of whom were male, mean age 64 years). The factors affecting adherence were broken down into three categories: sociodemographic, clinical, and psychological. There were two standardized instruments used in the analyzed studies: Test of Adherence to Inhalers (TAI) and self-reported Morisky Medication Adherence Scale (MMAS-8). We found that 46.3% of patients had a moderately good level of adherence to inhaled therapy (TAI range around 50 points), while 41.6% of patients had a high level of adherence to oral therapy. The nature of non-adherence was in most cases inadvertent rather than an erratic or deliberate demeanor (48.5% vs. 38.9% vs. 42.4%, respectively). We conclude that standardized instruments enable the prediction of adherence to therapy and should be used in clinical practice. The assessment of adherence is essential for undertaking interventions to counteract plausible non-adherence. Collaboration between an educator and a psychologist is required to evaluate the patient's motivation and to ensure his comprehension of treatment prescribed.

Quality of life in children with acute lymphoblastic leukaemia.

INTRODUCTION: Acute lymphoblastic leukaemia (ALL) is one of the most common neoplasms in children, that is. 3,000 new cases are diagnosed in the USA each year. The assessment of the quality of life (QoL) by the patient is the important indicator of the effects of treatment by the means of physical, psychical and social functioning. AIM: The aim of the study was to evaluate the QoL of children treated for ALL and the stress levels of their parents. Additionally, the impact of the most common symptoms on perceived QoL was analysed. MATERIAL AND METHODS: Seventy-four patients with ALL (mean age 9.03) were enrolled in the study. The questionnaire of Paediatric Quality of Life (PedsQL) and the medical records as the source of the socio-clinical data were applied in this study. RESULTS: In QoL assessment, the social functioning reached the highest score (67.57 ± 21.33), and physical functioning - the lowest score (51.1 ± 25.59). The analysis of the symptoms showed that the most intensive were stress (7.19 ± 2.71), fatigue and weakness (5.19 ± 2.76). In Spearman's rank correlation analysis the depressed mood, fatigue and weakness were significant negative predictors influencing QoL in all the domains of PedsQoL. In the linear regression analysis only the depressed mood was the significant independent determinant of the decreased QoL in the majority of the domains of PedsQoL, respectively: the general QoL (ß = -0.314; p = 0.002); psychosocial functioning (ß = -3.44; p < 0.01); role functioning (ß = -3.18; p = 0.004); social functioning (ß = -3.5; p = 0.007) and emotional functioning (ß = -3.012; p = 0.002). CONCLUSIONS: Quality of life of children with ALL is decreased and of the lowest value in the range of physical health. The factors negatively influencing the QoL are depressed mood, fatigue and weakness. The significant independent determinant of the decreased QoL is children's depressed mood.

Quality of Foot Care Among Patients With Diabetes: A Study Using a Polish Version of the Diabetes Foot Disease and Foot Care Questionnaire.

Diabetic foot syndrome is a common, yet serious complication of diabetes, affecting 4% to 10% of patients with diabetes. Polish Diabetes Association guidelines emphasize the need for prevention among patients with diabetes; a key role is played by consistent education on foot care and ulceration prevention. The Diabetes Foot Disease and Foot Care Questionnaire (DFDFC-Q) is the only research instrument available for comprehensive assessment of foot self-care. The study purposes were to explore the quality of foot care among patients with diabetes and to evaluate the psychometric properties of the Polish version of the DFDFC-Q in adult patients with diabetes. The study included 180 patients (112 females and 68 males, mean age 62 ± 14.1 years) with clinically confirmed diabetes mellitus and was performed between January 2017 and May 2018. The questionnaire was translated into Polis, and evaluated by using Cronbach's α coefficient. Of the 180 patients, 39.7% demonstrated good quality of self-care, 44.7% demonstrated moderate quality, and 15.6% demonstrated low quality. Mean score in the group was 22 ± 4.18 points. Scale reliability as measured by Cronbach's α was 0.672. One hundred thirteen (62.78%) patients inspected their feet daily. Many patients wore improper footwear: flip-flops (69.44%) or sandals (58.89%). The aspect most commonly omitted in diabetes education was inspection of the soles of one's feet using a mirror (17.7%). We found that 16.1% of patients visited a podologist in the past year. Comparative analysis demonstrated that a good-quality foot self-care was associated with high school education (p = .008), not having a partner (p = .046), and adhering to dietary recommendations (p = .014). In the linear regression model, independent predictors of better foot self-care included high school and vocational education (ß = 7.439, p = .001 and ß = 5.539, p = .014, respectively), marital status (divorced and single: ß = 3.496, p = .025, widowed: ß = 3.466, p = .048), professional inactivity (retirees: ß = 7.679, p = .001; disability pensioners: ß = 3.522, p = .049; unemployed: ß = 4.631, p = .017), and adhering to a diet (ß = 5.065, p = .001). An independent negative predictor (i.e., one associated with lower scores in the questionnaire) was male sex (ß = -2.853, p = .024). The Polish version of the DFDFC-Q has moderate psychometric properties, but because of the lack of other available instruments for foot self-care assessment, it can be used in the population of Polish diabetic patients. Better quality of foot self-care is determined by high school education, marital status (not having a partner), and adhering to dietary treatment recommendations.

The influence of selected psychological variables on quality of life of chronically dialysed patients.

BACKGROUND: The impact of illness acceptance in assessment of health-related quality (HRQoL) between chronic diseases remains unclear. Depression and anxiety reduce HRQoL and worsen prognosis. We describe the relationship between illness acceptance, anxiety and depression, and HRQoL in chronic dialysis patients. MATERIAL: The study included 105 patients with chronic kidney disease (mean age 65.8 years), treated with chronic dialysis. Three validated instruments were used, including the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey (SF-36). For statistical analysis, Student's t-test and Pearson's r correlation coefficient were carried out. RESULTS: Spearman's rho correlation analyses were carried out on the patients' quality of life (PCS and MCS), and their anxiety, depression and illness acceptance scores. The results showed acceptance of illness to be positively correlated with quality of life in terms of PCS (rho = 0.43) and MCS (rho = 0.36), and depression and anxiety to be negatively correlated with quality of life in both domains (PCS: rho = -0.39 and rho = -0.56, respectively; MCS: rho = -0.56 and rho = -0.78, respectively). The multiple-factor analysis for anxiety, depression and acceptance of illness showed acceptance of illness to be a significant independent determinant of higher quality of life in the PCS (ß = 1.580; p < 0.000) and MCS (ß = 1.980; p < 0.000) domains. The analysis also showed anxiety to be a significant independent determinant of lower quality of life in the MCS domain (ß = -0.432; p = 0.041), while depression was found to be a significant independent determinant of lower scores in both the PCS (ß = -3.557; p < 0.00) and the MCS (ß = -1.257; p < 0.00) domains. CONCLUSION: Acceptance of illness significantly affects HRQoL in dialysis patients - higher acceptance scores result in higher quality-of-life scores. Symptoms of depression and anxiety also significantly affect HRQoL in dialysis patients - a higher intensity of symptoms lead to lower quality-of-life scores.

The role of education in type 2 diabetes treatment.

Diabetes mellitus is a major and growing medical problem, affecting patients of all ages worldwide. Diabetes education is an important component of diabetes treatment. The goals of diabetes education include not only providing knowledge and skills, but also changing the patient's behavior, increasing their motivation to comply with therapeutic recommendations, improving their quality of life, establishing a partnership within the treatment process, preparing the patient for self-care, increasing their awareness of cardiovascular risk factors, and increasing their psychological resilience. The education process is affected by a number of factors, primarily the patient's psychological and socio-economic characteristics, as well as educator-related variables. Benefits of diabetes education are mainly observed in terms of patient self-care and metabolic control of diabetes.