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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
61

An Analysis of California Drug Courts: Why Drug Treatment Programs Should Have Teeth

Tuttle, Kimberly 01 January 2019 (has links)
Since the passing of Proposition 47 in California in 2014, drug court programs across the state have invariably undergone changes. In my thesis, I evaluate the drug court programs of three counties in Southern California: Orange County, Los Angeles County, and Riverside County. Through a qualitative analysis of the drug court programs in these counties, via interviews, data collection, and courtroom observation, I provide insight into the functionality of each county's program, as well as an analysis of the effects of Proposition 47. This paper aims to address the key factors involved in maintaining a functional and successful drug court system.
62

Priklausomybės ligų kaip socialino reiškinio valdymo galimybės / Possibilities of management of drug addiction as social phenomenon

Jasilionis, Rolandas 16 June 2009 (has links)
Darbo tikslas – išanalizuoti narkomanijos kaip socialinės problemos valdymo galimybes. Uždaviniai: 1. Ištirti priklausomybės nuo narkotikų atsiradimo prielaidas ir aplinkybes, siekiant nustatyti pagrindines socialinės rizikos zonas. 2. Identifikuoti psichoaktyvių medžiagų vartojimo sukeliamas problemas. 3. Nustatyti esmines prielaidas efektyviam narkomanijos kaip socialinio reiškinio valdymui. Tyrimo metodika: anketinė anoniminė Priklausomybės ligų centrų, žalos mažinimo programose dalyvaujančių pacientų apklausa (n = 114). Rezultatų statistinė analizė atlikta naudojant SPSS 17.0. Rezultatai: 78 proc. respondentų turi vidurinį išsilavinimą ir 74 proc. niekur nedirba. 53 proc. respondentų per mėnesį jie uždirba iki 1000 Lt. 42 proc. respondentų mėnesio pajamos yra nuo 1000 iki 2000 Lt. 12 proc. respondentų buvo atleisti iš darbo dėl narkotikų vartojimo. 34 proc. respondentų yra nevedę ir 28 proc. išsiskyrę. 76 proc. respondentų šeimų pajamos yra mažesnės nei 2000 Lt per mėn. Dauguma respondentų šeimų (86 proc.) žino apie narkotikų problemą ir 73 proc. šeimų padeda su ja kovoti. 80 proc. respondentų jaučia neigiamą narkotikų vartojimo poveikį šeimai. 47 proc. respondentų narkotikų pirmą kartą pabandė būdami iki 19 metų amžiaus, 44 proc. būdami 20-29 metų amžiaus. 30 proc. respondentų reguliariai vartoti pradėjo būdami iki 19 metų amžiaus, 54 proc. būdami nuo 20 iki 29 metų amžiaus. Vartojimo priežastys pasiskirstė sekančiai: 33 proc. pabandė dėl smalsumo, 17 proc. prikalbino... [toliau žr. visą tekstą] / Aim of the study: Analysis of the management possibilities of drug addiction as social problem Objectives: 1. Research of drug addiction coming consumption and factors and to identify the main social risk areas. 2. To identify problems determined by use of psychoactive substances. 3. To ascertain the fundamental consumptions of management of drug addiction as social phenomenon. Methods: The anonym questionnaire research at the Dependency disease center among Harm reduction program participants (n=114). The statistical analysis of the results was carried out exploitive SPSS 17.0. Results: 78% of respondents have secondary education and 74% are unemployed. 53% of respondents salary is till 1000 Lt per month, 42% respondents salary is from 1000 till 2000 Lt. per month. 12% of respondents was dismissed from job because of use of drugs. 34% of respondents are single and 28% divorced. 76% of respondent’s family income is lower than 2000 Lt per month. Most families (86%) know about addiction problem and are helping (73%) to fight against addiction, therefore 80% of respondents fell negative addiction influence to families members. 47% of respondents first time used drugs when they was till 19 years old, 44% when was from 20 till 29 years old. 30% of respondents started regularly use drugs when they was till 19 years old, 54% when was from 20 till 29 years old. The reason of drug use distributed as follows: 33% tried because of curiosity, 17% friend persuade, 15% wanted forget... [to full text]
63

Otimização da degradação da tetraciclina utilizando a fotocatálise heterogênea com ZnO como catalisador / Optimization of degradation of the tetracycline using the heterogeneous phtocatalysis with ZnO catalyst

Davis, Rafael 13 December 2013 (has links)
Made available in DSpace on 2017-07-10T18:08:02Z (GMT). No. of bitstreams: 1 Rafael Davis.pdf: 3104669 bytes, checksum: 32c13b5a2c3fed5feb5e59355e3dbbf9 (MD5) Previous issue date: 2013-12-13 / The aim of this work was to determine the optimal conditions for the degradation of the TC, using the heterogeneous phtocatalysis with ZnO catalyst. Preliminary experiments were conducted to evaluate to efficiency of heterogeneous photocatalysis in the degradation of TC. The degradation was carried out using standard solutions of TC 30 mg L 1. The photocatalytic experiments by using a set of high-pressure mercury lamps as artificial UV irradiation source were performed in laboratory scale. As reactor operational parameters to be optimized by a 33 full factorial experimental design: hydrogen peroxide and zinc oxide as well as the initial solution pH were chosen as variables, keeping constant a reaction time of 60 min. The concentration of TC was determined by UV-Vis spectrophotometry and HPLC. Mineralization and toxicity of the treated solution by photocatalytic process were evaluated based on the total organic carbon (TOC) and antibacterial activity. Second-degree models for the degradation of TC were proposed to model the photocatalytic experiments to obtain optimum values of the reactor operating parameters. Second-degree models were also validated by ANOVA. Predicted yields showed good validation with experimental yields. The hydrogen peroxide did not influence significantly the range studied by factorial experimental design. Was necessary to perform photocatalytic experiments at lower concentrations for hydrogen peroxide. The values of the optimized reactor operational parameters were 6, 2 g L-1 and 175 mg L-1 for initial pH, oxide zinc and hydrogen peroxide concentrations, respectively, for photocatalyses heterogeneous process. Based on this optimized experimental conditions, almost 100% of TC degraded. The TOC and antibacterial activity were determined of treated solutions in optimal conditions. Only 46% of the TOC was mineralized, the remainder as intermediate molecules not presented antibacterial activity, not providing risk to the environment. / O objetivo deste trabalho é determinar as condições ótimas para a degradação da TC, utilizando a fotocatálise heterogênea com o óxido de zinco (ZnO) como catalisador. Foram realizados experimentos preliminares para avaliar a eficiência da fotocatálise heterogênea na degradação da TC. A degradação da TC foi realizada a partir de soluções padrão com a concentração de 30 mg L-1 de TC. Os experimentos foram realizados em reatores de escala laboratorial utilizando fonte de irradiação UV artificial (lâmpada de vapor de mercúrio 125 W). Os parâmetros operacionais do reator: pH inicial, concentrações de ZnO e H2O2, foram otimizados baseados na redução da concentração da TC, a partir de um planejamento fatorial 33 completo com o tempo de irradiação constante em 60 minutos. A concentração da TC foi acompanhada por espectrofotometria UV-Vis e cromatografia líquida de alta eficiência (CLAE). A mineralização da TC e a possível toxicidade do composto degradado pelo processo fotocatalítico foram avaliadas baseadas no carbono orgânico total e na análise de atividade antibacteriana. Para auxiliar na obtenção das condições ótimas dos parâmetros operacionais do reator no processo fotocatalítico as respostas experimentais para a concentração da TC foram ajustados por um modelo previsto de segunda ordem, o qual apresentou uma boa modelagem dos dados, validado pela ANOVA. Como no PEC o H2O2 não influenciou significativamente devido a faixa estudada estar acima do necessário, foi verificado a influência de cada POR em concentrações menores das estudadas no planejamento, para o H2O2 a concentração mínima foi de 100 mg L-1. Os valores ótimos operacionais do reator na degradação da TC utilizando a fotocatálise heterogênea foram: pH 6, [ZnO] 2 g L-1 e [H2O2] 175 mg L-1. Nessas condições, a degradação total da tetraciclina foi alcançada após um período de 60 minutos de reação. Com a solução degradada nessas condições, foi determinado o carbono orgânico total (COT) e realizada uma análise para verificar a atividade antibacteriana onde concluiu que embora apenas 46% do COT tenha sido mineralizado, o restante na forma de moléculas intermediárias da reação, não oferece riscos biológicos aos ecossistemas, pois não apresenta atividade antibacteriana.
64

Factors affecting compliance with anti-hypertensive drug treatment and required lifestyle modifications among hypertensive patients on Praslin island

Edo, Thomas Akpan 06 1900 (has links)
Various studies on compliance with anti-hypertensive medications and appropriate lifestyle modifications have been conducted worldwide but studies specific to the Island of Praslin are lacking. The purpose of this quantitative, descriptive-correlational study was to describe factors that affected compliance with hypertension medications and lifestyle modification strategies in a sample of 102 hypertensive persons. The comprehensive version of the Health Belief Model served as the conceptual framework directing the study. The researcher investigated whether there were any significant relationships between compliance and the Health Belief Model variables. Data was collected by means of structured interviews and document analysis, involving an interview schedule and a checklist. All respondents were diagnosed hypertension patients registered at either of the two public health centres on the Island of Praslin. Individual perception of the benefits and risks of hypertension treatment as well as cues to action were found to be significant determinants of compliance behaviour. The study highlighted the need for improved health education and follow-up measures to strengthen patients’ perceptions about the benefits of treatment and compliance. / Public Health / M.A. (Public Health)
65

A qualitative analysis of the communication process between HIV-positive patients and medical staff : a study at Stanger Regional Hospital's antiretroviral therapy clinic

Moola, Sabihah 07 1900 (has links)
Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)
66

Avaliação da taxa de dispensação de isoniazida utilizada no tratamento preventivo de tuberculose em serviço especializado em HIV/aids / Evaluation of withdrawal of isoniazid for preventive treatment of tuberculosis in HIV/aids outpatient clinic

Santana, Claudinei Alves 30 June 2014 (has links)
INTRODUÇÃO: A Tuberculose (TB) e a Síndrome da Imunodeficiência Adquirida (AIDS) são, individualmente, grandes ameaças à saúde pública. As epidemias de AIDS e TB são sinérgicas e criaram uma crise de grandes proporções e desafios para o manejo clínico dos doentes, serviços de saúde e órgãos governamentais. A infecção pelo Vírus da Imunodeficiência Humana (HIV) é um dos principais fatores de risco para TB. O tratamento de pacientes com HIV ou aids e TB requer o uso concomitante de medicamentos tuberculostáticos e antirretrovirais, e as dificuldades a serem superadas incluem alto número de comprimidos, adesão aos tratamentos, interações medicamentosas com possibilidade de sobreposição de efeitos tóxicos e síndrome de reconstituição imune inflamatória. Uma forma de prevenção da TB é o Tratamento Preventivo com Isoniazida (TPI) nos pacientes com Infecção Latente por Mycobacterium tuberculosis (ILMTb), para os quais taxas de adesão de 80% ou mais são adequadas. A baixa adesão ao TPI diminui a sua efetividade. Neste cenário, avaliar a adesão ao TPI é de grande importância. O Serviço de Farmácia pode ser um instrumento altamente eficiente para realizar esta avaliação, através do acompanhamento das taxas de dispensação de isoniazida (INH) prescrita como TPI. OBJETIVO: Avaliar a taxa de adesão ao TPI em sujeitos com HIV ou aids e ILMTb, através da dispensação de INH. MÉTODO: Foram incluídos sujeitos que apresentaram prescrição do medicamento INH no período de 01/07/2008 a 30/06/2011 na farmácia do Serviço de Extensão ao Atendimento de Pacientes HIV/Aids da Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (SEAP HIV/Aids). As informações sobre sexo, idade, acompanhamento médico, uso de antirretrovirais, doenças concomitantes, intercorrências, datas de início e término do TPI foram obtidas do prontuário e informações sobre prescrição e dispensação de INH foram obtidas do Sistema de Informações de Gerenciamento Hospitalar (SIGH). RESULTADOS: Foram incluídos na análise 161 sujeitos, 78,9% (127) do sexo masculino, com idade média de 46 anos, 84,5% (136) deles acompanhados por médicos assistentes, 92,5% (149) utilizavam drogas antirretrovirais, 77,6% (125) apresentavam doenças concomitantes e 12,4% (20) sofreram intercorrências durante o TPI. Observou-se aumento transitório de enzimas hepáticas que não justificava a suspensão do TPI. A taxa de adesão foi de 96%. A prescrição eletrônica da INH nem sempre acompanhou, temporalmente, as datas, registradas em prontuário, de início e fim do TPI. A análise de concomitância entre início e fim do TPI e a prescrição de INH foi realizada para 90% (146) dos sujeitos para os quais estas informações eram disponíveis. Para 8,7% (14) dos sujeitos a prescrição eletrônica foi posterior à data de início de TPI; para 56,2% (82) dos sujeitos a prescrição de INH ultrapassou a data de término do TPI no prontuário e para 17,1% (25) dos sujeitos a prescrição de INH foi encerrada antes do término do TPI no prontuário. Não foram observadas associações estatísticas significativas entre o desfecho e as variáveis de interesse. CONCLUSÃO: Adesão é um comportamento complexo, assim como sua avaliação. Identificamos elevada taxa de adesão ao TPI entre sujeitos que vivem com HIV/aids; a frequência de hepatotoxicidade foi baixa e, quando ocorreu, transitória. Salientamos o descompasso entre o projeto terapêutico de TPI, registrado em prontuário, e a sua concretização, através da prescrição da INH. A prescrição eletrônica é um instrumento concebido para elevar a qualidade e agilizar a assistência; entretanto, pode expor o paciente a prescrição inadequada. Para evitá-lo devem ser adotadas medidas de segurança que, sem dificultar a prescrição, possam aprimorá-la constantemente, conforme os protocolos de tratamento disponíveis e os conhecimentos atualizados / BACKGROUND: Tuberculosis (TB) and Acquired Immunodeficiency Syndrome (AIDS) are major threats to public health. The Aids and TB epidemics are synergistic, bring great challenges for the clinical management of patients, health services and governments. Infection with Human Immunodeficiency Virus (HIV) is a major risk for TB. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs administered concomitantly. These patients are defied by the high number of tablets, adherence, drugs interactions, overlapping toxicities and immune reconstitution inflammatory syndrome. The isoniazid preventive therapy (IPT) is recommended to reduce the risk of TB in HIV/aids patients with Mycobacterium tuberculosis Latent Infection (MTbLI). Adherence rates of 80% or more are adequate. Low adherence to the IPT reduces its effectiveness. Assessing adherence to the IPT is of great importance in this setting, and the withdrawal of INH from the pharmacy can be used for this purpose. OBJECTIVE: To evaluate the adherence to the IPT in subjects with HIV/Aids and MTbLI, followed at Serviço de Extensão ao Atendimento de Pacientes HIV/ Aids (SEAP HIV/Aids), an HIV/aids outpatient clinic, through the withdrawal of INH from the pharmacy. METHODS: subjects with HIV/Aids and MTbLI who had a prescription of INH for IPT from 01/07/2008 to 30/06/2011 were included. Information about sex, age, medical conditions, antiretrovirals, comorbidities, IPT period, intercurrences during the IPT and withdrawal of INH from the pharmacy were retrieved from the medical files and the system of information and hospital management (SIGH). RESULTS: 161 subjects were included in the study, 78,9% (127) of them males, with a mean age of 46 years, 84,5 % (136) of them assisted by infectologists, 92,5% ( 149) taking antiretrovirals, 77,6% (125) with comorbidities and 12,4% (20) with intercurrences during the IPT; a low and transient increase of liver enzymes that not led to discontinuation of the IPT was observed. The adherence rate was 96%. The evaluation of concordance between the periods of ITP and prescription of INH was performed for 90% (146) of subjects for whom this information was available. The electronic prescription of INH was not coincident with the period of IPT registered in medical files for most subjects. To 8,7% (14) of the subjects the electronic prescription was made after the beginning of IPT, for 56,2% (82) of the subjects the prescription of INH exceeded the date of completion of the IPT and for 17,1% (25) of the subjects the prescription of INH ended before the end of the IPT registered in medical files. No statistically significant associations between the outcome and the variables of interest were observed. CONCLUSION: Adherence is a complex behavior, as well as their evaluation. We found a high adherence rate to IPT among HIV/Aids subjects with MTbLI, with a low and transient grade of hepatotoxicity. Although the electronic prescription is an instrument designed to improve the quality of the health care, it can expose patients to inappropriate prescription. To avoid this, security measures should be adopted, in order to improve it constantly, according to the protocols of treatment available and updated knowledge, without hampering medical prescription
67

Factors affecting compliance with anti-hypertensive drug treatment and required lifestyle modifications among hypertensive patients on Praslin island

Edo, Thomas Akpan 06 1900 (has links)
Various studies on compliance with anti-hypertensive medications and appropriate lifestyle modifications have been conducted worldwide but studies specific to the Island of Praslin are lacking. The purpose of this quantitative, descriptive-correlational study was to describe factors that affected compliance with hypertension medications and lifestyle modification strategies in a sample of 102 hypertensive persons. The comprehensive version of the Health Belief Model served as the conceptual framework directing the study. The researcher investigated whether there were any significant relationships between compliance and the Health Belief Model variables. Data was collected by means of structured interviews and document analysis, involving an interview schedule and a checklist. All respondents were diagnosed hypertension patients registered at either of the two public health centres on the Island of Praslin. Individual perception of the benefits and risks of hypertension treatment as well as cues to action were found to be significant determinants of compliance behaviour. The study highlighted the need for improved health education and follow-up measures to strengthen patients’ perceptions about the benefits of treatment and compliance. / Public Health / M.A. (Public Health)
68

A qualitative analysis of the communication process between HIV-positive patients and medical staff : a study at Stanger Regional Hospital's antiretroviral therapy clinic

Moola, Sabihah 07 1900 (has links)
Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)
69

Avaliação da taxa de dispensação de isoniazida utilizada no tratamento preventivo de tuberculose em serviço especializado em HIV/aids / Evaluation of withdrawal of isoniazid for preventive treatment of tuberculosis in HIV/aids outpatient clinic

Claudinei Alves Santana 30 June 2014 (has links)
INTRODUÇÃO: A Tuberculose (TB) e a Síndrome da Imunodeficiência Adquirida (AIDS) são, individualmente, grandes ameaças à saúde pública. As epidemias de AIDS e TB são sinérgicas e criaram uma crise de grandes proporções e desafios para o manejo clínico dos doentes, serviços de saúde e órgãos governamentais. A infecção pelo Vírus da Imunodeficiência Humana (HIV) é um dos principais fatores de risco para TB. O tratamento de pacientes com HIV ou aids e TB requer o uso concomitante de medicamentos tuberculostáticos e antirretrovirais, e as dificuldades a serem superadas incluem alto número de comprimidos, adesão aos tratamentos, interações medicamentosas com possibilidade de sobreposição de efeitos tóxicos e síndrome de reconstituição imune inflamatória. Uma forma de prevenção da TB é o Tratamento Preventivo com Isoniazida (TPI) nos pacientes com Infecção Latente por Mycobacterium tuberculosis (ILMTb), para os quais taxas de adesão de 80% ou mais são adequadas. A baixa adesão ao TPI diminui a sua efetividade. Neste cenário, avaliar a adesão ao TPI é de grande importância. O Serviço de Farmácia pode ser um instrumento altamente eficiente para realizar esta avaliação, através do acompanhamento das taxas de dispensação de isoniazida (INH) prescrita como TPI. OBJETIVO: Avaliar a taxa de adesão ao TPI em sujeitos com HIV ou aids e ILMTb, através da dispensação de INH. MÉTODO: Foram incluídos sujeitos que apresentaram prescrição do medicamento INH no período de 01/07/2008 a 30/06/2011 na farmácia do Serviço de Extensão ao Atendimento de Pacientes HIV/Aids da Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (SEAP HIV/Aids). As informações sobre sexo, idade, acompanhamento médico, uso de antirretrovirais, doenças concomitantes, intercorrências, datas de início e término do TPI foram obtidas do prontuário e informações sobre prescrição e dispensação de INH foram obtidas do Sistema de Informações de Gerenciamento Hospitalar (SIGH). RESULTADOS: Foram incluídos na análise 161 sujeitos, 78,9% (127) do sexo masculino, com idade média de 46 anos, 84,5% (136) deles acompanhados por médicos assistentes, 92,5% (149) utilizavam drogas antirretrovirais, 77,6% (125) apresentavam doenças concomitantes e 12,4% (20) sofreram intercorrências durante o TPI. Observou-se aumento transitório de enzimas hepáticas que não justificava a suspensão do TPI. A taxa de adesão foi de 96%. A prescrição eletrônica da INH nem sempre acompanhou, temporalmente, as datas, registradas em prontuário, de início e fim do TPI. A análise de concomitância entre início e fim do TPI e a prescrição de INH foi realizada para 90% (146) dos sujeitos para os quais estas informações eram disponíveis. Para 8,7% (14) dos sujeitos a prescrição eletrônica foi posterior à data de início de TPI; para 56,2% (82) dos sujeitos a prescrição de INH ultrapassou a data de término do TPI no prontuário e para 17,1% (25) dos sujeitos a prescrição de INH foi encerrada antes do término do TPI no prontuário. Não foram observadas associações estatísticas significativas entre o desfecho e as variáveis de interesse. CONCLUSÃO: Adesão é um comportamento complexo, assim como sua avaliação. Identificamos elevada taxa de adesão ao TPI entre sujeitos que vivem com HIV/aids; a frequência de hepatotoxicidade foi baixa e, quando ocorreu, transitória. Salientamos o descompasso entre o projeto terapêutico de TPI, registrado em prontuário, e a sua concretização, através da prescrição da INH. A prescrição eletrônica é um instrumento concebido para elevar a qualidade e agilizar a assistência; entretanto, pode expor o paciente a prescrição inadequada. Para evitá-lo devem ser adotadas medidas de segurança que, sem dificultar a prescrição, possam aprimorá-la constantemente, conforme os protocolos de tratamento disponíveis e os conhecimentos atualizados / BACKGROUND: Tuberculosis (TB) and Acquired Immunodeficiency Syndrome (AIDS) are major threats to public health. The Aids and TB epidemics are synergistic, bring great challenges for the clinical management of patients, health services and governments. Infection with Human Immunodeficiency Virus (HIV) is a major risk for TB. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs administered concomitantly. These patients are defied by the high number of tablets, adherence, drugs interactions, overlapping toxicities and immune reconstitution inflammatory syndrome. The isoniazid preventive therapy (IPT) is recommended to reduce the risk of TB in HIV/aids patients with Mycobacterium tuberculosis Latent Infection (MTbLI). Adherence rates of 80% or more are adequate. Low adherence to the IPT reduces its effectiveness. Assessing adherence to the IPT is of great importance in this setting, and the withdrawal of INH from the pharmacy can be used for this purpose. OBJECTIVE: To evaluate the adherence to the IPT in subjects with HIV/Aids and MTbLI, followed at Serviço de Extensão ao Atendimento de Pacientes HIV/ Aids (SEAP HIV/Aids), an HIV/aids outpatient clinic, through the withdrawal of INH from the pharmacy. METHODS: subjects with HIV/Aids and MTbLI who had a prescription of INH for IPT from 01/07/2008 to 30/06/2011 were included. Information about sex, age, medical conditions, antiretrovirals, comorbidities, IPT period, intercurrences during the IPT and withdrawal of INH from the pharmacy were retrieved from the medical files and the system of information and hospital management (SIGH). RESULTS: 161 subjects were included in the study, 78,9% (127) of them males, with a mean age of 46 years, 84,5 % (136) of them assisted by infectologists, 92,5% ( 149) taking antiretrovirals, 77,6% (125) with comorbidities and 12,4% (20) with intercurrences during the IPT; a low and transient increase of liver enzymes that not led to discontinuation of the IPT was observed. The adherence rate was 96%. The evaluation of concordance between the periods of ITP and prescription of INH was performed for 90% (146) of subjects for whom this information was available. The electronic prescription of INH was not coincident with the period of IPT registered in medical files for most subjects. To 8,7% (14) of the subjects the electronic prescription was made after the beginning of IPT, for 56,2% (82) of the subjects the prescription of INH exceeded the date of completion of the IPT and for 17,1% (25) of the subjects the prescription of INH ended before the end of the IPT registered in medical files. No statistically significant associations between the outcome and the variables of interest were observed. CONCLUSION: Adherence is a complex behavior, as well as their evaluation. We found a high adherence rate to IPT among HIV/Aids subjects with MTbLI, with a low and transient grade of hepatotoxicity. Although the electronic prescription is an instrument designed to improve the quality of the health care, it can expose patients to inappropriate prescription. To avoid this, security measures should be adopted, in order to improve it constantly, according to the protocols of treatment available and updated knowledge, without hampering medical prescription
70

Respostas cardiovasculares associadas ao intervalo interséries de exercício resistido em mulheres hipertensas sob controle farmacológico / Cardiovascular responses associated with rest interval in the resistance exercise in hypertensive women treated pharmacological

Pereira, Gilene de Jesus 29 January 2016 (has links)
Resistance exercise (RE) is indicated as a complement to aerobic exercise program to control high blood pressure. However, it is known that during RE may occur peak pressure and increased risk of cardiovascular events in hypertensive individuals. It is known that the exercise intensity, exercise volume and muscle fatigue potentiate these effects. The effects of blood pressure control and the rest time between sets have not yet been investigated. The objective of this study was to verify, in hypertensive women undergoing resistance exercise, the effects of blood pressure control and the rest time between sets (30s, 60s and 90s) the responses of systolic blood pressure (SBP) and diastolic (DBP), heart rate (HR) and double product (DP). The study included nineteen hypertensive women, mean age 58.5 ± 5.2 years and BMI 29.4 ± 4.9 kg / m2, were divided into groups: controlled (n=6), decompensated (n=8) and untreated (n=5). The subjects were submitted to the 1RM test in the leg extension and held three training sessions resistance (3x12 to 60% of 1RM knee extension). Each session was performed with different rest interval (30, 60 and 90 seconds). It used 2-way ANOVA for repeated measures with post test Tukey, establishing a significance level of p<0.05. In the control group, there was no significant difference between exercise and rest to PAD, FC and DP in any of the intervals (p>0.05), while SBP was higher than the rest, when the rest interval was 30 seconds (p=0,0204). In uncontrolled and untreated groups, there was an increase in all the variables, compared to the rest (p<0.05) independent of the rest interval. Pressure peaks reached during the exercise, in the controlled group (SBP: 171.3 ± 14 and DBP: 99.5 ± 11mmHg) were similar as compare to uncontrolled groups (216.1 ± 11 and DBP: 132.5 ± 16 mmHg) and untreated (216.8 ± 21 and DBP: 133.6 ± 13mmHg). Thus, if the hypertensive framework is not controlled, the cardiovascular stress significantly increases during the RE and the pharmacological control is shown to be effective in reducing the effort during the practice of RE. Therefore, the control condition of the hypertensive frame is more important than the rest interval for influencing the cardiovascular responses during the RE. Thus, we can suggest that effective control of the PA, through pharmacological treatment can reduce the risk of pressure peak during the practice of resistance exercise. / O exercício resistido (ER) é indicado como complemento aos programas de exercícios aeróbios para controle da hipertensão arterial. Porém, sabe-se que durante o ER pode ocorrer pico pressórico e risco aumentado de evento cardiovascular em indivíduos hipertensos. Sabe-se que a intensidade de esforço, volume de exercício e fadiga muscular potencializam tais efeitos. Os efeitos do controle da pressão arterial e do tempo de descanso interséries ainda não foram investigados. Assim, o objetivo desse estudo foi verificar, em mulheres hipertensas submetidas ao exercício resistido, os efeitos do controle da pressão arterial e do tempo de descanso interséries (30s, 60s e 90s) nas respostas de pressão arterial sistólica (PAS) e diastólica (PAD), frequência cardíaca (FC) e duplo produto (DP). Participaram do estudo dezenove mulheres hipertensas, com idade média de 58,5±5,2 anos e IMC, 29,4±4,9 Kg/m2. Foram divididas em grupos: controlado (n=6), descompensado (n=8) e não tratado (n=5). Os sujeitos foram submetidos a um teste de uma repetição máxima (1RM), na cadeira extensora e realizaram três sessões de exercício resistido (3x12 a 60% de 1RM de extensão de joelhos). Cada sessão foi realizada com um intervalo interséries diferente (30, 60 e 90 segundos). Foi utilizado ANOVA de 2 vias para medidas repetidas, com pós teste de Tukey, estabelecendo nível de significância de p<0,05. No grupo controlado, não houve diferença significativa entre exercício e repouso de PAD, FC e DP em nenhum dos intervalos (p>0,05), enquanto a PAS foi maior que o repouso, quando o intervalo interséries foi de 30s (p= 0,0204). Nos grupos descompensado e não tratado, houve elevação de todas as variáveis, comparadas ao repouso (p<0,05) independente do tempo de descanso. Picos pressóricos atingidos durante o exercício, no grupo controlado (PAS: 171,3±14 e PAD: 99,5± 11mmHg) foram semelhantes aos picos atingidos pelos grupos descompensado (216,1±11 e PAD: 132,5±16mmHg) e não tratado (216,8±21 e PAD: 133,6±13 mmHg). Dessa forma, é possível afirmar que se o quadro hipertensivo não está controlado, o esforço cardiovascular aumenta significativamente durante o ER e o controle farmacológico mostra-se efetivo para diminuir esse esforço durante a prática do ER. Portanto, a condição de controle do quadro hipertensivo é mais importante do que o intervalo interséries para influenciar as respostas cardiovasculares ao ER. Assim, podemos sugerir que o efetivo controle da PA, através do tratamento farmacológico pode diminuir o risco de pico pressórico durante a prática do exercício resistido.

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