O presente estudo foi desenvolvido com o objetivo de identificar fatores determinantes da não adesão ao tratamento dos hipertensos em município do interior de Goiás. Trata-se de um estudo de corte transversal, descritivo e de abordagem quantitativa. A coleta de dados compreendeu o período de novembro de 2012 a abril de 2013 e foi dividida em duas fases. Na primeira, buscamos os pacientes hipertensos cadastrados no SISHIPERDIA e no SIAB de cada USF do município e identificamos se permaneciam na área de abrangência da USF. Na segunda, os pacientes foram entrevistados utilizando-se um questionário que contemplou a caracterização sociodemográfica e socioeconômica, tratamento não- medicamentoso e medicamentoso. Participaram 138 pacientes hipertensos, sendo 65,9% do sexo feminino, com média de idade de 60,5 anos (DP=11,32), 71% com a escolaridade primeiro grau incompleto e renda individual de 1 a 2 salários mínimos. Em relação à ocupação, 39,9% eram aposentados e 21,7% eram do lar. Entre os fatores que contribuem para a não adesão ao tratamento 70,3% dos pacientes referiram aspectos pessoais. Foram classificados como aderentes ao tratamento não farmacológico 15,9% dos participantes e 21% seguir corretamente o tratamento farmacológico. Diante dos dados, percebemos que ainda é preciso desenvolver novas pesquisas na atenção primária, com vistas de conhecer os fatores da não adesão ao tratamento da hipertensão, e destacamos a necessidade de elaboração e execução de projetos com ações multiprofissionais que busquem estimular a adesão ao tratamento dos hipertensos assistidos no município estudado / The present study was developed with the aim of identifying determinants of non- adherence to treatment of hypertensive people in a city in the interior of Goiás. This is a cross-sectional, descriptive, quantitative study. Data collection was done from November 2012 to April 2013 and was divided into two phases. Initially, we sought for hypertensive patients registered in the SISHIPERDIA and SIAB in each municipality\'s USF and identified if they remained in the area covered by the USF. Secondly, patients were interviewed using a questionnaire that included the sociodemographic and socioeconomic characteristics, non- medicated and medicated treatment. A number of 138 hypertensive patients participated of this study, 65.9% were female, with a mean age of 60.5 years old (SD = 11.32), 71% with incomplete primary school education and individual income 1-2 minimum wages. Regarding occupation 39.9% were retired and 21.7% were housewives. Among the factors that contributed to non-adherence to treatment 70.3% of patients reported private affairs. Adherent participants in non-pharmacological treatment were 15,9% and 21% were reported as correctly following the pharmacological treatment. Based on the data, we realized that we still need to develop new researches in primary care, aiming to know the factors of non-adherence to hypertension treatment, and highlight the need for development and implementation of multidisciplinary projects with actions that seek to encourage adherence to treatment of hypertensive care in the city of the study

by Tong Lai Wah, Christina. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 101-112). / Abstracts in English and Chinese. / Title Page --- p.i / Authorization Page --- p.ii / Signature Page --- p.iii / Acknowledgements --- p.iv / Table of Contents --- p.v-viii / List of Figures --- p.ix / List of Tables --- p.x / List of Append --- p.ix xi / Title Page --- p.xii / Abstract --- p.xiii / Chapter 1 --- Introduction --- p.14-15 / Chapter 2 --- Literature Review --- p.16-24 / Chapter 2.1 --- Introduction / Chapter 2.2 --- End-stage renal disease / Chapter 2.3 --- Continuous ambulatory peritoneal dialysis / Chapter 2.4 --- Patient participation / Chapter 2.4.1 --- Definition of participation / Chapter 2.4.2 --- Benefits of participation / Chapter 2.4.3 --- Problems of patient participation / Chapter 2.4.4 --- Application of patient participation / Chapter 2.5 --- Conclusion / Chapter 3 --- Methodology --- p.25-43 / Chapter 3.1 --- Introduction / Chapter 3.2 --- Overview of grounded theory / Chapter 3.3 --- Procedures / Chapter 3.3.1 --- Data generation / Chapter - --- Sampling / Chapter - --- Data gathering / Chapter - --- Data recording / Chapter 3.3.2 --- Data analysis / Chapter - --- Open coding / Chapter - --- Constant comparative analysis / Chapter - --- Categorization / Chapter - --- Axial coding / Chapter - --- Theoretical sensitivity / Chapter - --- Memoing / Chapter 3.3.3 --- Theory construction / Chapter - --- Core category / Chapter 3.4 --- Method application / Chapter 3.4.1 --- Data collection / Chapter - --- Sampling / Chapter - --- Interview / Chapter - --- Recording / Chapter 3.4.2 --- Data analysis / Chapter - --- Open coding / Chapter - --- Constant comparative analysis / Chapter - --- Categorization and Axial coding / Chapter - --- Theoretical sensitivity / Chapter - --- Memoing / Chapter 3.4.3 --- Theoretical construction / Chapter - --- Concept formation / Chapter - --- Concept development / Chapter 3.5 --- Credibility & Trustworthiness / Chapter 3.6 --- Conclusion / Chapter 4 --- Findings --- p.44-72 / Chapter 4.1 --- Introduction / Chapter 4.2 --- Core category: Integrative Restructuring / Chapter 4.3 --- Emotional Labour / Chapter 4.3.1 --- Entering the active zone / Chapter (a) --- Conditions to go into active zone / Chapter (b) --- Outcomes of emotional labour / Chapter (c) --- Strategies used for emotional labour / Chapter - --- Letting go of emotions / Chapter - --- Aligning cognitive consistency / Chapter - --- Maximizing ego / Chapter - --- Locating self / Chapter - --- Boosting power / Chapter i. --- Active control / Chapter ii. --- Building positive expectancies / Chapter iii. --- Covariance to positive expectancies / Chapter 4.3.2 --- Retreating into comfort zone / Chapter (a) --- Contexts of comfort zone / Chapter (b) --- Conditions to build comfort zone / Chapter (c) --- Strategies used within comfort zone / Chapter - --- Defending / Chapter - --- Relinquishing / Chapter - --- Anchoring / Chapter 4.3.3 --- Migrating between the two zones / Chapter (a) --- Conditions to initiate the move / Chapter (b) --- Covariance to the movement / Chapter (c) --- Strategies to make progress / Chapter 4.4 --- Conclusion / Chapter 5 --- Discussion --- p.73-92 / Chapter 5.1 --- Introduction / Chapter 5.2 --- Theoretical framework / Chapter 5.3 --- Core category: Integrative Restructuring / Chapter 5.4 --- Variables affecting the move to active zone / Chapter 5.4.1 --- Preparations / Chapter 5.4.2 --- Support / Chapter (a) --- Source of support / Chapter (b) --- Context of support / Chapter (c) --- Effects of support / Chapter (i) --- Effects upon support-seekers / Chapter (ii) --- Supporter's reaction to support-giving relationship / Chapter 5.4.3 --- Commitment / Chapter (a) --- Perception of the situation / Chapter (b) --- Cultural influences / Chapter 5.4.4 --- Control / Chapter 5.5 --- Conclusion / Chapter 6 --- Concluding Chapter --- p.93-100 / Chapter 6.1 --- Limitations / Chapter 6.2 --- Implications / Chapter 6.2.1 --- Practice / Chapter 6.2.2 --- Research / Chapter 6.2.3 --- Teaching / Chapter 6.2.4 --- Policy Making / Chapter 6.2.5 --- Summary / Chapter 6.3 --- Future research / Chapter 6.4 --- Reflections upon the study / Chapter 6.5 --- Conclusion / References --- p.101-112

This dissertation uses three types of routinely collected data from HIV care and treatment facilities in sub-Saharan Africa to investigate the association between the availability of adherence support and active outreach services on patient non-retention, loss to follow-up, and measured death after ART initiation. Following a literature review summarizing the state of knowledge concerning the influence of programmatic services on patient retention in care and survival, these relationships are first examined in an aggregate analysis of over 232,000 patients at 349 HIV care and treatment facilities initiating ART between January 2004 and December 2008. Key findings are that several adherence support and outreach services are associated with reduced rates of non-retention, loss to follow-up, and death. Specifically, facilities offering three or more adherence support services, written educational materials promoting ART adherence, one-on-one or group adherence counseling sessions, reminder tools, and food rations to promote ART adherence were associated with reduced non-retention and loss to follow-up, while facilities offering on-site support groups for HIV+ patients, peer educators, provision of reminder tools, and food rations to promote ART adherence were associated with reduced death rates. In sub-analyses investigating six- and 12-month retention after ART initiation, facilities offering three or more separate adherence support services, routine review of medication pickup and/or dedicated ART pharmacists, and active patient outreach to trace patients missing visits had lower non-retention. Taken together, this analysis provides evidence that program-level services found efficacious in experimental settings are also effective in operational settings. Next, a sub-analysis is conducted among facilities also providing electronic patient-level data to investigate similarities and differences in the association between adherence support and outreach services and patient non-retention, loss to follow-up, and measured death using aggregate vs. patient-level estimates of these outcomes, and to assess whether adjustment for patient-level differences between facilities change these measures of association. In multivariate analyses, clinics offering active patient outreach had lower rates of non-retention in both the ART cohort analysis and the patient-level analysis, and clinics offering food rations to promote ART adherence were associated with a lower risk of ascertained death in both the facility-level and patient-level analyses, but this association was diminished after adjustment for patient-level covariates. In contrast, various adherence counseling or support services were associated with lower non-retention in the ART cohort analyses but not in the patient-level data analyses. When compared with the results in the first paper, fewer associations were observed, suggesting either that the countries with patient-level databases are not representative of the entire range of HIV care and treatment facilities assessed in the first paper, and/or the specific facilities with electronic databases are more similar to each other than they are to facilities without electronic databases. Finally, the dissertation concludes with an investigation into the relationship between loss to follow-up and measured death. For this analysis, estimates of the death probability among patients lost to follow-up are created under varying assumptions (either assuming that the death probability among those lost to follow-up is equivalent to the death probability within various strata of covariates, or assuming that the probability of death is greater among patients lost to follow-up). Key findings from this analysis are that ratio comparisons of death rates between facilities offering different services are robust to changes in the death probability if patients lost to follow-up are assumed to have a similar probability of death, conditioned on covariates, as those not lost to follow-up, but that associations between facility services and death rates are masked under the scenario where the facility service is associated with loss to follow-up and the death probability is assumed to be higher, conditioned on covariates, then the death probability among patients not lost to follow-up.

末期腎衰竭乃是一種慢性並且會持續惡化的疾病，現時唯一的治療方案便是腎功能替代療法。在香港，一般新發現患有末期腎衰竭的病人，將會被安排進行持續性家居腹膜透析。接受持續性家居腹膜透析的病人均需遵照以下四項治療性方案(包括限制膳食和流質食物，服用處方葯物，及跟從腹膜透析的指引)，以減慢病程的惡化。以往有關病人遵照治療性方案的研究，大多側重於使用血液透析的病人及醫護專業人仕的評估。本研究的目的乃是從現正進行持續性家居腹膜透析的病人的觀點，去明白及解釋病人遵照治療性方案的模式。 / 此硏究採用混合方法硏究設計，並分兩期進行。在第一期的調查，173位病人自我評估其遵照治療性方案中四個環節的程度。調查結果顯示:參加對葯物及腹膜透析的遵照程度，比限制膳食和流質食物的遵照程度為高。再者，男性、較年青、或進行了透析治療一至三年的參加者，自覺其遵照程度比其他參加者為低。此調查結果將指導第二期硏究的最大變化採樣，方法是跟據參加者自我報告其遵照治療性方案的程度分為跟從及不跟從兩組，硏究採用立意取樣方法去選取36位不同性別、年齡、及透析年歷的參加者作第二期硏究的面談。整合第一期的調查及第二期的面談結果後，硏究為參加者遵照治療性方案的模式提供了解釋。 / 結果顯示參加者的遵照模式乃是一個浮動過程，此過程可分為三個階段: 起初的遵照模式、隨後的遵照模式、及長期的遵照模式。在起初的遵照模式階段，參加者嘗試嚴謹地遵照各項治療性方案，但體會到這是不能持久的。在進行了透析二至六個月後，參加進入隨後的遵照模式，透過試驗、監察及不斷的調校，參加者學會選擇性地去遵照某些治療性方案。當參加者接受透析三至五年後，他們開始進入長期的遵照模式，在這階段，參加者已能將自行修改了的治療性方案融入日常的生活當中。 / 參加者遵照治療性方案的浮動過程，乃是受其「抱怨失去自主及常規」和「嘗試挽回自主及常規」所驅使。此浮動情況在每個階段都會發生。除了透析年歷，影響參加者遵照治療性方案的決定性因素乃是其家人及醫護專業人仕的支持。參加並認為醫護專業人仕非常強調其需絶對遵照所有治療性方案，反眏現行以治療為本的照料模式。 / 此硏究在理論及臨床上皆有貢獻。在理論方面，此乃首個硏究確立接受持續性家居腹膜透析的病人，在遵照治療性方案的浮動過程中出現的三個階段。在臨床上，此三個階段的確立可作為策劃護理方案的參照，以幫助病人順利過渡各個階段。硏究的結果亦倡導醫療模式的轉變，即由以治療作主導的模式轉變為以病人為本的照料模式，授權病人在末期腎衰竭的治療過程中參與自我料理。 / End-stage renal disease (ESRD) is a chronic, progressive and debilitating illness with renal replacement therapy (RRT) as the only treatment modality. In Hong Kong, patients newly diagnosed with ESRD who require RRT are generally started on continuous ambulatory peritoneal dialysis (CAPD). Patients receiving CAPD are required to adhere to a renal therapeutic regimen comprising four components (dietary and fluid restrictions, and medication and dialysis prescriptions) to decelerate disease progression. Studies on patients' adherence have mainly focused on those undergoing haemodialysis and are generally from healthcare professionals' perspectives. The aim of this study was to understand and explain adherence from the perspectives of patients undergoing CAPD. / The study employed a mixed-methods design and was conducted in two phases. In phase I, a survey was conducted to examine 173 patients' self-reported adherence to the four components of the therapeutic regimen. Results showed that participants were more adherent to dialysis and medication prescriptions than to fluid and dietary restrictions. Moreover, participants who were male, younger or had received dialysis for 1 to 3 years rated themselves as more non-adherent than other participants. These findings guided the maximum variation sampling of 36 purposively recruited participants of different genders, ages, and duration of dialysis from the adherent and non-adherent groups for the phase II interview. The survey and interview data were merged in the interpretation of findings to provide an understanding of participants' adherence. / Findings indicate that participants' adherence was a dynamic process with three stages: initial adherence, subsequent adherence and long-term adherence. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2 to 6 months of dialysis, participants entered the stage of subsequent adherence. Through experimenting, monitoring and making continuous adjustments, they learned to adopt selective adherence. The stage of long-term adherence commenced after participants had received dialysis for more than 3 to 5 years. At this stage, they were able to assimilate the modified therapeutic regimen into everyday life. / The dynamic process of adherence was driven by "grieving for the loss of autonomy and normality" and "attempting to regain autonomy and normality". The process was dynamic as there were fluctuations at each stage of the participants' adherence. In addition to the duration of dialysis, the major determinant influencing the participants' adherence was the support provided by family members and healthcare professionals. Moreover, participants perceived that the focus of care provision was on strict adherence to all components of the therapeutic regimen, reflecting a biomedical model of care. / This study has theoretical and clinical significance. Theoretically, this is the first study that identified three stages in the dynamic process of adherence among patients undergoing CAPD. Clinically, with reference to each stage identified, nursing interventions can be developed to help patients achieve a smooth transition throughout all the stages. The findings also call for a paradigm shift from the biomedical model of care to patient-centred care, so as to empower patients to engage in self-management of their ESRD. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Lam, Lai Wah. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / LIST OF TABLES --- p.xv / LIST OF FIGURES --- p.xvi / LIST OF ABBREVIATIONS --- p.xvii / LIST OF APPENDICES --- p.xviii / Chapter CHAPTER ONE --- INTRODUCTION / Introduction --- p.1 / ESRD and its management in the Hong Kong context --- p.2 / The research problem --- p.3 / Aim of the study --- p.6 / Overview of the thesis --- p.6 / Chapter CHAPTER TWO --- LITERATURE REVIEW / Introduction --- p.7 / Literature search strategies --- p.7 / The concept of adherence --- p.8 / Theoretical models used to understand adherence --- p.14 / Health belief model --- p.14 / Locus of control --- p.16 / Self-efficacy --- p.19 / Transtheoretical model --- p.22 / Measurement of adherence --- p.24 / Prevalence of adherence --- p.27 / Patients undergoing HD --- p.28 / Patients undergoing PD --- p.31 / Factors influencing patients’ adherence --- p.34 / Demographic and clinical characteristics --- p.34 / Social support --- p.37 / Knowledge about adherence --- p.39 / Chinese culture --- p.43 / Exploring adherence from patients’ perspectives --- p.47 / Adherence among patients undergoing dialysis in Hong Kong --- p.51 / An introduction to the concept of self-management --- p.52 / Summary --- p.53 / Chapter CHAPTER THREE --- METHODOLOGY / Introduction --- p.56 / Aim --- p.56 / Objectives --- p.56 / Operational definitions --- p.57 / Research design --- p.57 / The paradigm of mixed methods research --- p.58 / Justification for using a mixed methods design --- p.60 / Application of the mixed methods design --- p.61 / Phase I study --- p.67 / Sampling --- p.67 / Setting --- p.67 / Sampling method and sample size --- p.67 / Data collection method --- p.68 / Instrument --- p.68 / Data collection procedures --- p.70 / Data analysis --- p.70 / Pilot Study --- p.71 / Validity and reliability --- p.72 / Phase II study --- p.74 / Sampling --- p.74 / Sample size --- p.74 / Sampling method --- p.75 / Data collection method --- p.80 / Semi-structured interview --- p.80 / Development of the interview guide --- p.81 / Data collection procedures --- p.82 / Making contact with participants --- p.82 / The interviewing process --- p.83 / Data analysis --- p.87 / Pilot study --- p.89 / Rigour of the study --- p.91 / Credibility --- p.91 / Dependability --- p.95 / Confirmability --- p.95 / Transferability --- p.95 / Ethical considerations --- p.96 / Summary --- p.98 / Chapter CHAPTER FOUR --- FINDINGS OF THE PHASE I STUDY / Introduction --- p.99 / Results --- p.99 / Participants --- p.99 / Demographic and clinical characteristics of the participants --- p.100 / Overall adherence to the therapeutic regimen --- p.103 / Number of days non-adherent to the therapeutic regimen --- p.103 / Degree of deviation from the therapeutic regimen --- p.104 / Adherence in relation to demographic and clinical variables --- p.106 / Summary --- p.109 / Chapter CHAPTER FIVE --- FINDINGS OF THE PHASE II STUDY / Introduction --- p.110 / Demographic and clinical characteristics of the participants --- p.110 / Major categories and subcategories identified --- p.115 / Perceptions of adherence --- p.117 / Meaning of adherence --- p.117 / Perceived needs to adhere --- p.118 / Perceived levels of adherence --- p.120 / The process of adherence --- p.123 / Initial adherence --- p.124 / Practising two major types of adherence --- p.124 / Striving to live with strict adherence --- p.124 / Doing what I am told --- p.124 / Trying my best --- p.125 / Exercising self-control --- p.127 / Adopting partial adherence --- p.128 / Recognizing limitations of current types of adherence --- p.129 / Sacrificing freedom for strict adherence --- p.129 / Social restriction --- p.129 / Having nothing to eat --- p.132 / Paying the price of inadequate adherence --- p.133 / Physiological complications --- p.134 / Need for additional treatment --- p.136 / Harsh comments from healthcare professionals --- p.137 / Realizing the need for changes in adherence --- p.139 / Rationalising an easy-going approach to adherence --- p.139 / Seeing the need for stricter adherence --- p.144 / Subsequent adherence --- p.146 / Experimenting with an easy-going approach to adherence --- p.147 / Allowing some slippage --- p.147 / Monitoring indicators of adherence --- p.148 / Making continuous adjustments --- p.149 / Adopting selective adherence --- p.153 / Long-term adherence --- p.158 / Factors influencing the process of living with adherence --- p.159 / Support --- p.159 / Family members --- p.159 / Healthcare professionals --- p.163 / Hope for the future --- p.165 / Situational factors --- p.168 / Dinning out --- p.169 / Employment --- p.171 / Summary --- p.173 / Chapter CHAPTER SIX --- DISCUSSION / Introduction --- p.177 / The dynamic process of adherence --- p.179 / Initial adherence --- p.182 / Following instructions --- p.182 / Grieving for the loss of autonomy and normality --- p.184 / Social restriction --- p.185 / Unmet nutritional and psychosocial needs --- p.187 / Subsequent adherence --- p.193 / Experimenting with an easy-going approach to adherence --- p.193 / Attempting to regain autonomy and normality --- p.198 / Dialysis --- p.199 / Medication --- p.201 / Fluid --- p.204 / Diet --- p.205 / Long-term adherence --- p.209 / Support as a major determinant of adherence --- p.212 / Family --- p.213 / Healthcare professionals --- p.216 / Biomedical model of care --- p.221 / Disease-oriented perspective --- p.222 / One-way paternalistic communication --- p.228 / Summary --- p.232 / Chapter CHAPTER SEVEN --- CONCLUSIONS / Introduction --- p.235 / Limitations of the study --- p.235 / Implications --- p.237 / Implications for clinical practice --- p.237 / Initial stage --- p.237 / Provision of timely appropriate support --- p.238 / Psychological support --- p.238 / On-site support --- p.239 / Adjustment of the CAPD training content --- p.240 / Empowering patients for self-management of their ESRD --- p.241 / Subsequent stage --- p.244 / Long-term stage --- p.245 / Implications for administration --- p.246 / Implications for nursing education --- p.247 / Recommendations for further research --- p.249 / Conclusions --- p.252 / REFERENCES --- p.254

Estudo descritivo transversal que teve como objetivos caracterizar os usuários dos serviços de saúde com diabetes mellitus que apresentaram não adesão ao tratamento segundo variáveis sociodemográficas, clínicas e terapêuticas, e relacionar a não adesão e as variáveis sexo, idade, anos de estudo, tempo de diagnóstico, hemoglobina glicada, colesterol total, triglicerídeos, colesterol lipoproteína de alta densidade e colesterol lipoproteína de baixa densidade. Os dados foram provenientes da base de dados de um estudo seccional conduzido, em 2010, em 17 Unidades de Saúde da Família do município de Passos, Minas Gerais. A amostra foi constituída por 417 pacientes com diabetes mellitus tipo 2 que apresentaram não adesão ao tratamento. Para análise, utilizou-se estatística descritiva e o Teste Exato de Fisher. Para a quantificação das associações utilizou-se a regressão logística, com o cálculo do Odds ratio bruto. Os resultados mostraram que houve predomínio de mulheres, média de 62,4 anos, 4,2 anos de estudo e 2,6 salários mínimos. A maioria tinha tempo de diagnóstico inferior a dez anos, excesso de peso, obesidade abdominal, valores elevados de pressão arterial sistólica. As complicações e comorbidades mais referidas foram retinopatia e a hipertensão arterial, respectivamente. Os antidiabéticos orais mais utilizados foram as biguanidas e as sulfonilureias. O consumo de gordura saturada, fibra alimentar e fracionamento das refeições diárias não estavam de acordo com os parâmetros recomendados. O nível de atividade física foi considerado moderadamente ativo e muito ativo para maioria dos usuários. Ao adotar o nível de significância de 5%, no qual valores de p menores que 0,05 foram considerados significativos, não houve diferença estatisticamente significativa entre não adesão e as variáveis estudadas. Entretanto, aqueles com tempo de estudo igual ou inferior a oito anos tiveram maior chance de não aderir ao plano alimentar; os com valores de hemoglobina glicada maiores que 6,5% tiveram maior chance de não aderir ao tratamento medicamentoso, e os com valores de colesterol total igual ou superior a 200 mg/dl, ao plano alimentar. Espera- se que os resultados possam contribuir para o diagnóstico situacional dos usuários com diabetes das 17 Unidades de Saúde da Família investigadas e para a busca de estratégias inovadoras no enfrentamento das fragilidades em relação a não adesão aos três pilares do tratamento em diabetes. Essa avaliação pode também constituir em um instrumento valioso de mensuração contínua do impacto das intervenções implementadas. / Descriptive transversal study aimed to characterize the patient with diabetes mellitus that had no treatment adherence according to socio-demographic variables, clinical and therapeutic, and relate to nonadherence and the variables sex, age, years of study, time of diagnosis, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. The data were from a base sectional study conducted in 2010 in 17 family health units of the municipality of Passos, Minas Gerais. The sample consisted of 417 patients with type 2 diabetes mellitus who have nonadherence to treatment. For analysis, we used descriptive statistics and the Fisher exact Test. For the quantification of logistic regression was employed, with the calculation of the Odds ratio. The results showed that there was a predominance of women, average of 62.4 years, 2.6 years of study and 4.2 minimum wages. Most had diagnostic time less than ten years, overweight, abdominal obesity, high systolic blood pressure values. The most reported complications and comorbidities were hypertension. The complication and comorbidity more reported was hypertension and retinopathy, respectively. The most commonly used oral antidiabetics were the biguanidas and the sulfonilureias. The consumption of saturated fat, dietary fiber and fractionation of daily meals were not according to the recommended parameters. The level of physical activity was considered moderately active and very active for most patients. By adopting the significance level of 5%, in which p values less than 0.05 were considered significant, not statistically significant difference was found between nonadherence and the variables studied. However, those with study time equal to or less than the eight years had a higher chance of not joining the food plan; the glycated hemoglobin values greater than 6.5% had a higher chance of not adhering to drug treatment, and the total cholesterol values equal to or greater than 200 mg/dl, the eating plan. It is expected that the results contribute to the situational diagnosis of the patients with diabetes of 17 family health units investigated and to the search for innovative strategies in confronting the weaknesses in relation to nonadherence to the three pillars of diabetes treatment. This evaluation can also be a valuable tool for measuring the impact of interventions implemented.

Thesis (M.PH.) --University of Limpopo, 2012 / Objectives: To determine the level of adherence of people who are on ARVs and to determine the influence of HIV and AIDS stigma and family support on adherence and non-adherence to antiretrovirals. Methods: A descriptive cross sectional study involving 175 HIV/AIDS adult patients attending Siloam hospital was conducted. These patients were on ARV drugs. They were investigated for the level of adherence and the influence of HIV and AIDS stigma and family support on adherence and non-adherence to antiretrovirals. Data were collected from respondents through self-administered questionnaires which were distributed to 175 randomly selected participants. The key variables were demographic information and social support and disclosure, current use of ARVs and personal experience of living with HIV/AIDS. Data were analyzed using descriptive statistics, numerical summaries, tables, graphs, ANOVA, Pearson chi-square test and statistical package for social sciences (SPSS). Results: Forty comma eight percent (40,8%) of the respondents on ARVs were males and 28, 8 % females aged between 23-35 years; 23, 9% males and 40, 4% females ranged between 36-45 years; 35, 2% males and 30, 8% were 46 years old and above. The most commonly cited reasons for missing doses were: Social grant, forgetting, side effects and stigma. The most cited reasons for taking medication were: respondents wanted to feel better; to increase the CD4 count; and they feared death. The majority of the adhering participants, 68, 9% and 55, 8% of the non- adhering group never experienced negative reactions from their families after disclosure. There was no significant difference between the adhering and the non adhering group (P =0.250). A substantial number of ARV users of the adhering group 92, 2% participants disclosed that they were receiving support which included emotional/psychological support, financial support, physical care support as well as reminders to ensure that they took their medications on time. There was no significant difference between the adhering and the non adhering group on the general satisfaction with the overall support they received from their family (p= 0.976). Conclusion: Patients have a range of reasons for failing to adhere to their antiretroviral therapy and reasons for adhering. Support can improve adherence to therapy and patients can only receive support if they revealed their HIV positive status. It was recommended that the community should be sensitised about the availability of treatment and the importance of adherence Keywords: Adherence, antiretrovirals, HIV/AIDS, stigma and family support

Orientador: Renato Herman Sundfeld / Coorientador: Lucas Silveira Machado / Banca: Ticiane Cestari Fagundes Tozzi / Banca: Leandro Azambuja Reichert / Resumo: Este estudo prospectivo, randomizado e paralelo analisou a alteração de cor, sensibilidade dental, grau de cooperação e satisfação de voluntários quando submetidos ao clareamento dental com peróxido de carbamida a 10%, empregado durante 21 dias por 2, 4 e 8 horas/dia. O tempo preciso do uso diário das moldeiras/produto clareador foi mensurado por meio de um microssensor TheraMon (Sales Agency Gschladt, Hargelsberhg, Áustria). Sessenta e seis voluntários, de ambos os gêneros, com idades entre 18 e 22 anos foram selecionados e distribuídos aleatoriamente em três grupos de estudo (n = 22), os quais receberam as informações sobre a presença do microssensor em suas moldeiras. O fator estudado foi o tempo de uso das moldeiras em três níveis: 2 (GI), 4 (GII) e 8 (GIII) hrs/dia. Para a análise clínica, as variáveis de resposta foram: grau de cooperação diária dos voluntários de acordo com o tempo de uso diário das moldeiras; grau de satisfação dos voluntários com o clareamento dental; eficácia do clareamento dental nos incisivos e caninos superiores e inferiores pelo método visual (Vita Classical) e digital (Vita Easyshade), assim como o grau de sensibilidade dental que foi avaliado com método analógico-visual. Os voluntários foram avaliados no período inicial (baseline), aos 7, 14 e 21 dias após o início do tratamento clareador e 14 dias após apenas para as observações da cor, sensibilidade e grau de satisfação. Os dados foram analisados com aplicação do teste ANOVA e pelo post test... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This prospective, randomized, parallel study analyzed the color change, tooth sensitivity, degrees of cooperation, and satisfaction of volunteers when submitted to at home dental bleaching with 10% carbamide peroxide (Opalescence -Ultradent Products, Inc. South Jordan, USA) for 21 consecutive days for 2, 4 and 8 hours/day. The wear time of acetate trays/dental bleaching was measured through a TheraMon microsensor (TheraMon® microelectronic system; Sales AgencyGschladt, Hargelsberhg, Austria). Sixty six volunteers, both sexes, with ages ranging from 18 to 22 years were selected and randonly distributed into 3 study groups (n=22). The volunters received information about presence of the microsensor in their trays. The fator studied was the wear time of the trays in three levels: during 2 (GI), 4 (GII) and 8 (GIII) hours/day. For the clinical analysis the response variables were: the degree of daily cooperation of the volunteers as the wear time/daily of the trays, microelectrically collected by micro sensor TheraMon®; the degree of satisfaction of volunteers with dental bleaching; the effectiveness of dental bleaching in the upper and lower incisors and canines teeth, by the visual method (Vita Classical) and digital (Vita Easyshade) and dental sensitivity was evaluated by the volunteers with a scale visual analog method on a scale of 0 to 10. The volunteers were evaluated at baseline period, at one, two and three weeks after the beginning of the bleaching treatment, and again ... (Complete abstract click electronic access below) / Mestre

Thesis (B.Sc. (Hons.)) - University of Queensland, 2006. / Includes bibliography.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 93-102).

Idag finns vetenskaplig evidens för att livsstilsförändringar kan sänka blodtrycket hos patienter med hypertoni. Rekommendationer vid behandling av hypertoni är i första hand hälsosamma livsstilsförändringar. Syftet var att belysa faktorer som påverkade patienters följsamhet till livsstilsförändringar vid hypertoni. Metoden som användes var en litteraturstudie. Databearbetning gjordes utifrån 15 vetenskapliga artiklar. Artiklarnas vetenskapliga kvalitet granskades. Därefter analyserades artiklarnas resultatdel och bearbetades för att finna faktorer som kunde påverka patientens följsamhet till livsstilsråd. Fyra kategorier framkom; patientens kunskap och inställning till sin hypertoni, behandlingsprogram och uppföljning, vårdpersonalens kunskap och bemötande samt sociodemografiska och kliniska faktorer. Resultatet visade vikten av att ge råd om livsstilsförändringar till varje patient utifrån den enskildes situation. Vid information är det viktigt att personalen har aktuell kunskap och kan delge den på ett motiverande sätt. För att minska antalet individer med hypertoni bör hälso- och sjukvården i större utsträckning prioritera hälsopromotivt arbete. Utbildning och stöd till personalen krävs för att kunna följa de senaste rekommendationerna som finns för hälsosamma livsstilsval. Studien visar hur betydelsefullt det är för patienter att få utbildning och stöd för att göra positiva livsstilsförändringar. / Today there is evidence based science which shows that lifestyle changes can reduce blood pressure in patients with hypertension. Recommendations for treatment of hypertension are healthy lifestyle changes. The aim was to examine factors that affect patient’s adherence to lifestyle changes when they got hypertension. The method was a literature study.  Data processing was made of 15 science journals. The science qualities of the journals were examined. After that the results in the journals were analyzed to find factors which could affect patient’s adherence to lifestyle changes. Four categories became clear; patient’s knowledge and adjustment to their hypertension, treatment program and follow-up, healthcare personnel’s knowledge and attitude and socio-demographic and clinical factors. The result showed that it is important that right information about lifestyle changes is given from the patient’s own situation. When information is given it is important that personnel have the latest knowledge and can give it in a motivated way. To decrease the number of individuals with hypertension and following diseases, healthcare services should prioritize health promotion. The personnel should receive education and support to be able to follow the latest recommendations there are for healthy lifestyle choices. Education and support is important for patients in their choice of making positive lifestyle changes.