美沙酮维持治疗依从性与社会支持相关性分析

目的了解美沙酮维持治疗依从性与社会支持的关系,为建立提高美沙酮维持治疗依从性的社会支持系统提供科学依据。方法采用Morisky服药依从性问卷和肖水源社会支持评定量表（SSRS）,调查分析美沙酮维持治疗依从性与社会支持的关系。结果246例受治者中,27．64％有忘记服药的经历,2．85％不重视服药,24．80％自觉症状改善后停药,12．60％出现副作用后停药,53．66％的受治者在治疗期间偶尔间断或经常间断服药;不同美沙酮维持治疗依从性对象的社会支持得分比较,是否忘记服药、美沙酮治疗间断情形之间的主观支持得分和社会支持总分差异有统计学意义（P〈O．05）。结论美沙酮维持治疗者的依从性较差;良好的社会支持特别是主观社会支持可提高美沙酮受治者依从性。     

心脏永久性起搏器植入患者门诊随访依从性分析

目的：分析心脏永久性起搏器植入患者门诊随访依从性的现状、影响因素及探讨提高随访依从性的方法。方法：回顾性分析2006-01至2013-01在我院住院植入心脏永久性起搏器的患者817例,对术后1年内的门诊随访情况进行依从性评判,并分析其影响因素。实际随访790例（96.70%）,1年内未进行门诊随访者入电话随访组（n=350例）,至少进行过1次门诊随访者入门诊随访组（n=440例）。结果：研究对象中,失访26例,失访率3.18%;非起搏器相关死亡1例,实际随访790例,实际随访率96.7%,其中门诊随访者440例（55.70％）,电话随访者350例（44.30％）。两组在文化程度、医疗费用、居住地、对心律失常的了解、固定陪护人员方面的差异有统计学意义（P<0.05）。高中以上文化程度、医疗费用可报销、本地居住、对心律失常知识了解、有固定陪护人员的患者门诊随访率高。1年内总体并发症发生率1.8%,均未造成严重后果。随访时进行优化参数设置者占59.5%。结论：心脏永久性起搏器植入患者门诊随访率较低。影响因素较多,包括文化程度、医保制度、居住地、对心律失常的认知程度、有无陪护人员。     

Long-term adherence to nasal continuous positive airway pressure therapy by hypertensive patients with preexisting sleep apnea

Background and objectiveAlthough positive screening for and treatment of obstructive sleep apnea (OSA) have been recommended for patients with cardiovascular problems, patient adherence to nasal continuous positive airway pressure (CPAP) therapy primarily for a cardiovascular concern is unknown. Therefore, this study aimed to determine the adherence to CPAP therapy by hypertensive patients with OSA after a screening test performed regardless of OSA-related symptoms.Subjects and methodsCPAP therapy was administered to 194 of the 1365 hypertensive patients who underwent the screening. The monthly dropout from CPAP therapy and the adequate use level (4 h every night, 70% days in a month) were assessed using the Kaplan–Meier analysis over a 3-year follow-up period.ResultsOf the patients, 106 (55%) refused or abandoned the therapy by the end of the follow-up period (adherence, 45%). An adequate use level was maintained by 76 patients (39%). Most of the patients’ background characteristics, including age, sex, Epworth sleepiness scale scores, and parameters obtained on polysomnography, were not related to adherence or adequate use level. The good-compliance level on the first visit after CPAP therapy introduction was most strongly related to adherence (95% CI, 0.05–0.32; p < 0.001) and adequate use level (95% CI, 0.06–0.33; p < 0.05). Fourth quartile of apnea hypopnea index value (greater than 67/h) was also related to adherence (95% CI, 0.21–0.98; p < 0.02) and adequate use level (95% CI, 0.19–0.88; p < 0.05).ConclusionsThe adherence and use level in this population may not be satisfactory but are comparable with those in previous sleep center reports treating symptomatic OSA patients. Thus, the present results would encourage hypertensive patients to undergo positive screening for OSA, regardless of OSA-related symptoms. However, an outcomes study with the same cohort is needed.     

Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin

Objectives

to verify the face validity, criterion-related validity and the reliability of two distinct forms of presentation of the instrument Measurement of Adherence to Treatment, one being for ascertaining the adherence to the use of oral antidiabetics and the other for adherence to the use of insulin, as well as to assess differences in adherence between these two modes of drug therapy.

Method

a methodological study undertaken with 90 adults with Type 2 Diabetes Mellitus. The criterion-related validity was verified using the Receiver Operating Characteristic curves; and for the reliability, the researchers calculated the Cronbach alpha coefficient, the item-total correlation, and the Pearson correlation coefficient.

Results

the oral antidiabetics and the other showed sensitivity of 0.84, specificity of 0.35 and a Cronbach correlation coefficient of 0.84. For the adherence to the use of insulin, the values found were, respectively, 0.60, 0.21 and 0.68. A statistically significant difference was found between the final scores of the two forms of the instrument, indicating greater adherence to the use of insulin than to oral antidiabetics.

Conclusion

it is concluded that the two forms of the Measurement of Adherence to Treatment instrument are reliable and should be used to evaluate adherence to drug treatment among people with diabetes mellitus.