Beliefs related to adherence to oral antidiabetic treatment according to the Theory of Planned Behavior

OBJECTIVE:

to identify salient behavioral, normative, control and self-efficacy beliefs related to the behavior of adherence to oral antidiabetic agents, using the Theory of Planned Behavior.

METHOD:

cross-sectional, exploratory study with 17 diabetic patients in chronic use of oral antidiabetic medication and in outpatient follow-up. Individual interviews were recorded, transcribed and content-analyzed using pre-established categories.

RESULTS:

behavioral beliefs concerning advantages and disadvantages of adhering to medication emerged, such as the possibility of avoiding complications from diabetes, preventing or delaying the use of insulin, and a perception of side effects. The children of patients and physicians are seen as important social references who influence medication adherence. The factors that facilitate adherence include access to free-of-cost medication and taking medications associated with temporal markers. On the other hand, a complex therapeutic regimen was considered a factor that hinders adherence. Understanding how to use medication and forgetfulness impact the perception of patients regarding their ability to adhere to oral antidiabetic agents.

CONCLUSION:

medication adherence is a complex behavior permeated by behavioral, normative, control and self-efficacy beliefs that should be taken into account when assessing determinants of behavior.     

老年冠心病患者危险因素和冠脉造影分析

目的探讨老年冠心病患者的危险因素，冠状动脉病变特点与中青年的区别。方法对34例住院的老年（年龄≥65岁）、27例中青年（年龄〈65岁）冠心病患者的临床和冠状动脉造影资料进行回顾性的分析和比较。结果老年冠心病患者高血压、糖尿病、空腹血糖明显高于中青年患者（P〈0．05）；冠状动脉造影阳性率明显高于中青年组（P〈0．05）；双支、多支病变明是显高于中青年组（P〈0．05）；中重度病变明显高于中青年组（P〈0、05）；但吸烟、饮酒、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）显著低于中青年患者（P〈0．05）。结论高血压、糖尿病、空腹血糖异常是老年冠心病患者的危险因素；老年冠心病患者的冠脉病变以双支、多支、中重度病变多见。     

Quality of life,clinical characteristics and treatment adherence of people living with HIV/AIDS

OBJECTIVES:

to assess the quality of life of people living with HIV/AIDS and verify its association with clinical characteristics and treatment adherence.

METHOD:

cross-sectional study conducted in a hospital in the state of Paraíba, Brazil. A questionnaire was used to collect socio-demographic and clinical data. The quality of life scale proposed by the World Health Organization and a questionnaire to measure treatment adherence were used.

RESULTS:

of the 314 interviewees, 190 (60.5%) were male, aged 43 years on average, 121 (38.5%) had attended up to five years of schooling, 108 (34.4%) received up to two times the minimum wage, and 112 (35.7%) were on sick leave. In regard to clinical variables, individuals with an undetectable viral load scored higher in all the domains concerning quality of life, with statistically significant differences in three domains. Regarding treatment adherence, 235 (73.8%) presented poor adherence and those who strictly adhered to treatment obtained better scores in quality of life. The results show that quality of life is better among individuals adherent to ART. Supporting people to adhere to the antiretroviral treatment should be a persistent task of healthcare workers and other people participating in the treatment, such as family members and friends.     

Medication adherence and quality of life among the elderly with diabetic retinopathy

OBJECTIVE:

to investigate the factors related to medication adherence and its relation to Health- Related Quality of Life (HRQoL) in elderly people with diabetic retinopathy.

METHOD:

one hundred (n=100) elderly outpatients with diabetic retinopathy taking antihypertensives and/or oral antidiabetics/insulin were interviewed. Adherence was evaluated by the adherence proportion and its association with the care taken in administrating medications and by the Morisky Scale. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was used to evaluate HRQoL.

RESULTS:

most (58%) reported the use of 80% or more of the prescribed dose and care in utilizing the medication. The item "stopping the drug when experiencing an adverse event", from the Morisky Scale, explained 12.8% and 13.5% of the variability of adherence proportion to antihypertensives and oral antidiabetics/insulin, respectively.

CONCLUSION:

there was better HRQoL in the Color Vision, Driving and Social Functioning domains of the NEI VFQ-25. Individuals with lower scores on the NEI VFQ-25 and higher scores on the Morisky Scale presented greater chance to be nonadherent to the pharmacological treatment of diabetes and hypertension.     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.     

家庭医生签约服务对农村冠心病患者服药依从性影响研究

目的了解山东省农村地区冠心病患者服药依从现状,探讨以家庭医生签约服务为主的农村地区冠心病患者服药依从性的影响因素。方法于2018年分层抽取了山东省3个地级市,采用随机数字表抽取各个村的居民进行问卷调查,该研究共纳入其中的冠心病患者350例。结果350例冠心病患者中,74.57%患者服药依从性差;76.15%未签约患者服药依从性差,72.17%签约患者服药依从性差。家庭医生签约服务对冠心病患者服药依从性的影响无统计学意义(P>0.05);多因素Logistic回归分析显示:男性(OR=1.803,95%CI=1.071~3.036)、大龄(OR=1.039,95%CI=1.006~1.073)、低EQ-5D健康指数(OR=0.111,95%CI=0.025~0.495)冠心病患者的服药依从性相对较好。结论山东省农村冠心病患者服药依从性较低,未见家庭医生签约服务对其有影响。     

Systemic Arterial Hypertension in the Emergency Service: medication adherence and understanding of this disease

Objective:

to identify the epidemiological profile of hypertension patients, how much they understand about the disease and the rate of adherence to treatment by these patients who had been hospitalized in the Brazilian emergency service.

Methods:

this cross-sectional study was performed with 116 patients, both male and female and aged over 18 years, who had been hospitalized in the Emergency Service of a University Hospital between March and June, 2013. The studied variables were data referring to socio-demographics, comorbidities, physical activity and knowledge regarding the disease. Patient adherence to treatment and the identification of the barriers were respectively evaluated using the Morisky test and the Brief Medication Questionnaire.

Results:

most of the patients involved in this study were women (55%), with white skin color (55%), married (51%), retirees or pensioners (64%) and with a low educational level (58%). Adherence to treatment, in most cases (55%), was moderate and the most prevalent adherence barrier was recall (67%). When medication was acquired at no cost to the patient, there was greater adherence to treatment.

Conclusion:

this study''s patients had a moderate understanding about the disease. The high correlation between the number of drugs used and the recall barrier suggests that monotherapy is an option that can facilitate treatment adherence and reduce how often the patients forget to take their medication.     

经皮冠状动脉介入治疗对冠心病患者术后焦虑和抑郁影响的研究

目的 评价经皮冠状动脉介入治疗对冠心病患者术后焦虑和抑郁影响。方法 600例冠心病患者根据是否在冠状动脉造影时接受支架植入术治疗分为支架组（n = 400）和非支架组（n = 200）,400例支架组患者根据术后是否接受心理干预治疗进一步随机分成干预组（n = 200）和非干预组（n = 200）。患者入院后1 d、PCI治疗后1 d、出院时分别采用焦虑自我量表和抑郁自我量表进行焦虑和抑郁评分,比较不同时间患者焦虑和抑郁评分。结果 3组患者平均年龄、性别构成、血红蛋白含量、总胆固醇含量、甘油三酯含量、低密度脂蛋白胆固醇含量和高密度脂蛋白胆固醇含量差异均无统计学意义（均P > 0.05）,具有可比性。入院后1 d,3组冠心病患者焦虑和抑郁评分差异均无统计学意义（均P > 0.05）;PCI治疗后 1 d,干预组和非干预组冠心病患者焦虑和抑郁评分均显著高于非支架组（均P < 0.05）,干预组和非干预组冠心病患者焦虑（t = 11.21,P < 0.01;t = 9.96,P < 0.01）和抑郁评分（t = 8.56,P < 0.01;t = 6.73,P < 0.01）均显著高于入院后1 d。出院时,3组冠心病患者焦虑和抑郁评分差异均有统计学意义（均P < 0.05）,干预组和非干预组冠心病患者出院时焦虑（t = 21.57,P < 0.01;t = 15.77,P < 0.01）和抑郁评分（t = 24.33,P < 0.01;t = 15.01,P < 0.01）均显著低于PCI治疗后 1 d,干预组焦虑和抑郁评分均显著低于非干预组（均P < 0.05）。结论 PCI治疗会加重冠心病患者术后焦虑和抑郁状态,而心理干预治疗可减轻焦虑和抑郁状态。     

核素心肌灌注断层显像诊断冠心病的临床应用

目的评估核素心肌灌注断层显像在冠心病（CAD）临床诊断中的价值。方法对30例冠心病和可疑冠心病患者进行^99m锝-甲氧基异丁基异晴（^99mTc-MIBI）心肌灌注断层显像，同时采用半定量方法分析患者左心室心肌血流灌注情况，其中15例患者行冠状动脉造影术（CAG）。结果心肌灌注断层显像冠心病和可疑冠心病患者检查的阳性率为46．7％。结论。^99mTc-MIBI心肌灌注断层显像是安全、无创伤、方便及费用低的检查方法，临床联合应用对冠心病的诊断、治疗和预后判断有重要的价值。     

Quality of life of men with AIDS and the model of social determinants of health

OBJECTIVE:

to analyze the quality of life (QoL) of men with AIDS from the perspective of the model of social determinants of health (MSDH).

METHOD:

cross-sectional study conducted in an outpatient infectious diseases clinic from a Brazilian university hospital over the course of one year with a sample of 138 patients. A form based on the MSDH was used to collect sociodemographic data addressing individual, proximal, intermediate determinants and the influence of social networks together with an instrument used to assess the QoL of people with HIV/AIDS. The project was approved by the Institutional Review Board (Protocol No. 040.06.12).

RESULTS:

according to MSDH, most men with AIDS were between 30 and 49 years old (68.1%), mixed race (59.4%), heterosexual (46.4%), single (64.5%), Catholic (68.8%), had a bachelor''s degree (39.2%), had no children (61.6%), and had a formal job (71.0%). The perception of QoL in the physical, level of independence, environment, and spirituality domains was intermediate, while QoL was perceived to be superior in the domains of psychological and social relationship. A perception of lower QoL was presented by homosexual (p=0.037) and married men (p=0.077), and those with income below one times the minimum wage (p=0.042). A perception of greater QoL was presented by those without a religion (p=0.005), living with a partner (p=0.049), and those who had a formal job (p=0.045).

CONCLUSION:

social determinants influence the QoL of men with AIDS.     

The meaning of pharmacological treatment for schizophrenic patients

OBJECTIVE:

to understand the meaning of medication therapy for schizophrenic patients and formulate a theoretical model about the study phenomenon.

METHOD:

a qualitative approach was employed, using Symbolic Interactionism as the theoretical and Grounded Theory as the methodological framework. The research was developed between 2008 and 2010 at three community mental health services in the interior of the State of São Paulo - Brazil. Thirty-six patients and thirty-six family members were selected through theoretical sampling. The data were mainly collected through open interviews and observation and simultaneously analyzed through open, axial and selective coding.

RESULTS:

the meaning of the pharmacotherapy is centered on the phenomenon "Living with a help that bothers", which expresses the patients'' ambivalence towards the medication and determines their decision making. The insight, access, limitations for self-administration of the drugs and interactions with family members and the health team influenced the patient''s medication-related behavior.

CONCLUSION:

the theory presented in this study provides a comprehensive, contextualized, motivational and dynamic understanding of the relation the patient experiences and indicates potentials and barriers to follow the medication treatment.     

冠心病患者康复护理研究进展

冠心病或缺血性心脏病,由于心脏动脉斑块的形成,导致心肌血流量减少,是最常见的心血管疾病,包括稳定型心绞痛、不稳定型心绞痛、心肌梗死和心源性猝死.常见的症状是胸痛或不适,可能蔓延到肩部、手臂、背部和颈部.近年来我国患有冠心病的人数较多,常发于年龄＞40岁的男性群体,并且受到社会压力、不健康生活习惯及遗传等因素影响,导致该...     

Quality of nursing care and satisfaction of patients attended at a teaching hospital

Objectives

assess the quality of nursing care, the patients'' satisfaction and the correlation between both.

Method

cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman''s correlation coefficients.

Results

among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables.

Conclusion

Despite the quality deficit, the patients'' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients'' expectations.     

Conjugal violence in the perspective of "Family Health Strategy" professionals: a public health problem and the need to provide care for the women

Objective

to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy.

Methods

research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications.

Results

the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care.

Conclusions

the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence.     

经皮冠状动脉介入术后冠心病患者健康促进行为与健康信念的相关性研究

目的 探讨冠心病经皮冠状动脉介入术后患者健康促进行为与健康信念的相关性,为指导患者形成正确的健康信念和健康促进行为提供依据。方法 以2015年6月至2016年6月在海南省中医院行PCI手术的所有患者为调查对象,应用一般情况调查表、改良健康促进生活方式量表Ⅱ（HPLPⅡ）及健康信念量表对患者术后健康促进行为及健康信念状况进行调查。分析健康促进行为与健康信念的影响因素及相关性。结果 共对104例成功行PCI手术的冠心病患者进行调查,其中男性70例,女性34例,平均（55.72 ± 13.69）岁,病程平均（78.64 ± 31.57）个月,BMI平均为（27.67 ± 3.46）。多元线性回归分析结果显示：性别与文化程度是影响PCI术后患者健康信念的主要因素（β=7.165、4.856,P<0.05或P<0.01）;文化程度、家庭人均月收入、BMI是影响PCI术后患者健康促进行为的主要因素（β=5.114、3.625、8.160,均P<0.05）。PCI术后冠心病患者健康促进行为与健康信念呈正相关（r=0.216）;感知到严重性评分与自我实现、运动锻炼得分呈负相关（r=-0.213、-0.236）,感知健康行为益处评分与健康促进行为得分及自我实现、营养、压力管理3个维护评分呈正相关（r=0.238、0.246、0.279）,健康动力与健康促进行为总分及各维度评分呈正相关（r=0.358、0.374、0.326、0.204、0.304、0.318、0.301）。结论 健康信念与PCI术后冠心病患者的健康促进行为具有一定的相关性,感知健康行为益处越大,维护健康动力越强,其健康促进行为水平就越高。