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Made available in DSpace on 2014-06-11T19:29:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T18:39:19Z : No. of bitstreams: 1 duarte_mtc_me_botfm.pdf: 367548 bytes, checksum: 0bc9456e76ceee8e0aa601ea2566a701 (MD5) / Objetivou-se, com este trabalho, identificar o abandono do seguimento médico em uma coorte de pacientes inscritos, em 1995, no atendimento ao hipertenso do Centro de Saúde-Escola (CSE) de Botucatu, no período de 1995 a 1999, e analisar os motivos de abandono do tratamento da hipertensão arterial relatados por esses pacientes. Estudaram-se 192 pacientes hipertensos, que compõem a coorte, tendo sido identificados, nesta, três grupos: grupo abandono (GAB), composto por 89 pacientes; grupo abandono-aderente (GAB/AD), composto por 41 pacientes, e grupo aderente (GAD), composto por 62 pacientes. A taxa de abandono observada foi de 46,4% e a de aderência de 53,6%. Os grupos foram caracterizados segundo as variáveis: sociodemográficas, relacionadas ao seguimento e tratamento no serviço de saúde, e doenças crônicas associadas. Na segunda parte do estudo, foram entrevistados 50 pacientes do GAB. A análise temática de conteúdo foi a técnica utilizada para tratamento das respostas dos entrevistados. A pesquisa indicou que a taxa de abandono do seguimento médico no CSE não pode ser generalizada como taxa de abandono de seguimento médico ou, ainda, como de abandono do tratamento da hipertensão, uma vez que se observou que mais da metade dos pacientes entrevistados estavam em acompanhamento médico para tratamento da hipertensão arterial em outros serviços de saúde e relataram diversas formas de cumprimento do tratamento medicamentoso e não-medicamentoso. Os motivos para o abandono do tratamento da hipertensão — considerando em separado os seus componentes... / The aim of this research is to identify the hypertension treatment dropout in a cohort assisted at a School Health Center (SHC), in Botucatu, from 1995 to 1999. This cohort (192 patients) was divided in to three groups: Dropout group – DG – (89 patients), dropout-compliant group – DCG – (41 patients) and compliant group – CG – (62 patients). The dropout rate was 46,4% and the compliance rate was 53,6%. The groups were studied according to these variables: socio-demographic, health service treatment and follow-up and chronic diseases comorbidity. Fifty DG patients were interviewed. Their answer were analyzed by content analysis. As more than half of the patients interviewed were being assisted at other health services the dropout rate at the SHC can not be considered as a treatment dropout. The causes of dropout - patient related problems, lack of symptons, better or normal arterial pressure, alcohol consumption – were the same if one considers each dropout component (medical treatment, changes in life style and health services follow-up) separetely. The lack of information about the medication and its side effects can be regarded as the main dropout causes of medical treatment. Moreover, it was observed that some health service features played an important rule in medical follow-up dropout.

Consumer health information technologies (CHITs) are emerging as promising tools for delivering healthcare services and facilitating patient self-management of chronic diseases; however, the use of the CHITs is largely constrained by usability problems and unclear evidence on the effectiveness of the technologies. The ergonomics research team of The University of Hong Kong developed a patient-centered computerized self-monitoring system that appeared to be useful and easy to use; with the system, this thesis focuses on the examination of the short-term impacts of the technology on patient outcomes for diabetic and hypertensive patients. The self-monitoring technology was designed using user-centered approaches and relevant human factors principles. Iterative usability evaluations were conducted to assess and improve the usability of the technology with 97 chronically ill patients. Also, using data from a larger randomized controlled trial (RCT) of technology-based disease self-management to improve patients’ outcomes, this thesis compared the short-term effects of the use of a computerized self-monitoring system to usual care using 63 patients with type 2 diabetes and hypertension for four weeks. Thirty-three patients were randomized into intervention group, whose disease care was supported by the self-monitoring system, while 30 patients into control group, who continued with their usual care. A pretest-posttest repeated measures design was employed to determine the effects of the technology on clinical, psychosocial, behavioral, usage, and technology perception outcomes over time. Measurements were obtained at baseline, and after 2 and 4 weeks. The iterative usability studies improved and verified the usability of the self-monitoring system for chronically ill patients. Results from the RCT showed that after four weeks, there were significant decreases in systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.001), self-efficacy for managing chronic disease (p = 0.001), and adherence to treatment (p = 0.001) in the intervention group compared with the control group. Significant differences in favor of intervention group after four weeks were also documented for changes of several quality of life subscales (i.e., general health (p = 0.010), role physical (p = 0.001), role emotional (p = 0.002), bodily pain (p = 0.050), and physical component summary score (p = 0.005)), and perceived ease of use (p = 0.007). No significant difference was found between groups for fasting blood glucose (p = 0.687), perceived usefulness (p = 0.661), frequency of self-monitoring of blood pressure (p = 0.230) and self-monitoring of blood glucose (p = 0.993), and several other quality of life subscales over time. The usability evaluation presented in this thesis report demonstrated that the method was effective and efficient in identifying potential usability problems at the early stage of system development for CHITs. The findings from the RCT indicated that the use of the human factored-engineered self-monitoring technology had short-term effectiveness in improving blood pressure control, self-efficacy for managing chronic disease, adherence to treatment, and quality of life for patients with type 2 diabetes and hypertension. A human factored-engineered self-management technology appears to be an effective tool in patient self-management of chronic diseases. / published_or_final_version / Industrial and Manufacturing Systems Engineering / Doctoral / Doctor of Philosophy

D.Litt. et Phil. / The condition known as hypertensive encephalopathy has thrust high blood pressure as a factor in cognitive dysfunction into the limelight. The present study seeks to explore this phenomenon, the allied considerations of adrenergic activation and blockade (as induced by the class of anti-hypertensives termed beta-adrenergic antagonists) and their relationship with attention and memory. The main impetus for the thesis derives from the disparate results of studies into the functioning of attention and memory processes in both medicated and unmedicated hypertensives, despite consistent outcomes having emerged from animal studies. An integrative, explanatory psychophysiological model 1s consequently developed to help illuminate this scientific terrain. The study constitutes an analysis of the course and pathogenesis of hypertension, with a specific emphasis on factors that maintain the disease as well as those that serve to lessen its adverse health effects. The association between hypertension and sympathetic nervous system activation receives much attention together with relevant personality and behavioural variables. It is discussed how sympathetic nervous system activation and the failure of certain negative feedback mechanisms relate to hypertension as well as memory consolidation. The disparate study outcomes and explanations regarding the connection between adrenergic activation and memory are traced to certain paradigmatic roots. These include the computer analogy of mental functioning, Cartesian dualist notions and the case of 'HM'. In contrast to, notably, the Cartesian dualist notions, it is shown that body and brain are a necessary unity for memory formation. This unity is explicated through an analysis of baroreceptor function as an example of a 'simple' cybernetic system involved in maintaining regulated cerebral blood flow.

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Resumo: Objetivou-se, com este trabalho, identificar o abandono do seguimento médico em uma coorte de pacientes inscritos, em 1995, no atendimento ao hipertenso do Centro de Saúde-Escola (CSE) de Botucatu, no período de 1995 a 1999, e analisar os motivos de abandono do tratamento da hipertensão arterial relatados por esses pacientes. Estudaram-se 192 pacientes hipertensos, que compõem a coorte, tendo sido identificados, nesta, três grupos: grupo abandono (GAB), composto por 89 pacientes; grupo abandono-aderente (GAB/AD), composto por 41 pacientes, e grupo aderente (GAD), composto por 62 pacientes. A taxa de abandono observada foi de 46,4% e a de aderência de 53,6%. Os grupos foram caracterizados segundo as variáveis: sociodemográficas, relacionadas ao seguimento e tratamento no serviço de saúde, e doenças crônicas associadas. Na segunda parte do estudo, foram entrevistados 50 pacientes do GAB. A análise temática de conteúdo foi a técnica utilizada para tratamento das respostas dos entrevistados. A pesquisa indicou que a taxa de abandono do seguimento médico no CSE não pode ser generalizada como taxa de abandono de seguimento médico ou, ainda, como de abandono do tratamento da hipertensão, uma vez que se observou que mais da metade dos pacientes entrevistados estavam em acompanhamento médico para tratamento da hipertensão arterial em outros serviços de saúde e relataram diversas formas de cumprimento do tratamento medicamentoso e não-medicamentoso. Os motivos para o abandono do tratamento da hipertensão - considerando em separado os seus componentes... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this research is to identify the hypertension treatment dropout in a cohort assisted at a School Health Center (SHC), in Botucatu, from 1995 to 1999. This cohort (192 patients) was divided in to three groups: Dropout group - DG - (89 patients), dropout-compliant group - DCG - (41 patients) and compliant group - CG - (62 patients). The dropout rate was 46,4% and the compliance rate was 53,6%. The groups were studied according to these variables: socio-demographic, health service treatment and follow-up and chronic diseases comorbidity. Fifty DG patients were interviewed. Their answer were analyzed by content analysis. As more than half of the patients interviewed were being assisted at other health services the dropout rate at the SHC can not be considered as a treatment dropout. The causes of dropout - patient related problems, lack of symptons, better or normal arterial pressure, alcohol consumption - were the same if one considers each dropout component (medical treatment, changes in life style and health services follow-up) separetely. The lack of information about the medication and its side effects can be regarded as the main dropout causes of medical treatment. Moreover, it was observed that some health service features played an important rule in medical follow-up dropout. / Orientador: Massako Iyda / Coorientador: Ana Teresa de Abreu Ramos Cerqueira / Mestre

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / The identification of patients with arterial hypertension, and the attitudes and practices related to individual cases of the condition, are fundamental to its control and to the prevention of associated complications. The dyslipidemia and hypertension are common and powerful risk factors for cardiovascular disease (CVD) and often coexist in the same individual. The diuretics and beta blockers affect the lipid profile and they can act synergistically, with dyslipidemia and hypertension, in terms of increased risk for CVD. We investigated the influence of hypertension and its treatment on circulating lipids. One hundred and sixty-nine individuals with aged between 32-87 years were studied. According to the results the population was predominantly women (72,6%), and the subjects had a mean blood pressure of 144,23  14,86 (mean  SD) for systolic pressure, and 90,45  9,91 for diastolic pressure. Hydrochlorothiazide (HCTZ), captopril (CPT) and propranolol (PPL) were the most prescribed drugs. Monotherapy was used in 33,53% of the patients, and CPT was the most prescribed drug. In association therapy (66,47%) the most used drug was HCTZ, specially in prescriptions associated to CPT. Propranolol was used proportionally more by women (p=0,01) and verapamil more by men (p=0,009), and the control of hypertension was significantly (p=0,04) more frequent in individuals being treated with monotherapy than in the subjects being treated with combination therapy. Patients taking HCTZ had significant effects in theirs lipid serum concentrations while that ones taking CPT and/or PPL have no expressive effects. The main associations which lead to lipid serum alterations were HCTZ+CPT and HCTZ+PPL. Theses results suggest that any therapy with includes HCTZ as an hypertensive drug, must be associated to a lipid monitoring process / A identificaÃÃo de pacientes com hipertensÃo arterial, as atitudes e as prÃticas face aos casos individuais sÃo determinantes para o controle da doenÃa e prevenÃÃo e para prevenÃÃo das complicaÃÃes associadas. Dislipidemia e hipertensÃo sÃo comuns e poderosos fatores de risco para doenÃas cardiovasculares e freqÃentemente coexistem num mesmo indivÃduo. Os diurÃticos e beta bloqueadores elevam o perfil lipÃdico e podem agir sinergicamente, com dislipidemia e hipertensÃo, na elevaÃÃo dos riscos para doenÃas cardÃacas. NÃs investigamos a influÃncia da hipertensÃo e seu tratamento sobre os lipÃdios circulantes. Foram estudados 169 indivÃduos, com idades entre 32 â 87 anos. De acordo com os resultados obtidos, a maioria da populaÃÃo foi composta por mulheres (72,6%), e a mÃdia de pressÃo era 144,23  14,86 (mÃdia  DP) para pressÃo sistÃlica e 90,45  9,91 para pressÃo diastÃlica. Hidroclorotiazida (HCTZ), captopril (CPT) e propranolol (PPL) foram as drogas mais prescritas. Monoterapia foi utilizada por 33,53% dos pacientes, e captopril foi a droga mais prescrita. Em associaÃÃo (66,47%) a droga mais prescrita foi HCTZ, principalmente associada com CPT. Propranolol foi predominantemente utilizada no sexo feminino (p= 0,01) e verapamil no sexo masculino (p=0,009), sendo que o controle da hipertensÃo foi significativamente (p=0,04) mais freqÃente nos indivÃduos tratados com monoterapia do que naqueles em uso de associaÃÃo. Pacientes em uso de hidroclorotiazida tiveram efeitos significantes sobre as concentraÃÃes sÃricas de lipÃdios, enquanto aqueles em uso de CPT e/ou PPL nÃo apresentaram efeitos expressivos. As principais associaÃÃes que elevaram lipÃdeos sÃricos foram HCTZ+CPT e HCTZ+PPL. Estes resultados sugerem que quando a terapÃutica antihipertensiva envolver o uso de HCTZ, a monitorizaÃÃo do perfil lipÃdico se faz necessÃria.

The use of controlled release dosage forms has increased significantly in recent years as they result in increased patient compliance and higher therapeutic efficiency. This research focused on the development of a once daily dosage form that could be used for the treatment of hypertension. Both a separate sustained release dosage of metoprolol tartrate and a combination dosage form that included both an immediate release hydrochlorothiazide and a sustained release metoprolol component, were developed and evaluated. A matrix tablet, consisting of an ethylcellulose ranulation of metoprolol tartrate compressed into a hydrophilic hydroxypropyl methylcellulose polymer matrix, effectively sustained metoprolol release over a 22-hour experimental period. A multiparticulate combination dosage form that consisted of six coated mini matrix tablets of metoprolol and a powder blend of hydrochlorothiazide packed into a gelatin capsule, displayed zero order release kinetics for metoprolol release over 22 hours (r2=0.9946). The release of hydrochlorothiazide was found to be comparable to that of a commercially available product tested. Differential Scanning Calorimetry was used to identify possible incompatibilities between MPTA and excipients initially, and long term stability testing was used to assess to behaviour of the dosage form. Dissolution testing of the dosage forms was performed using USP Apparatus III, which was found to be more discriminating between the batches assessed. Dissolution curves were evaluated for similarity and difference using f1 and f2 fit factors. Samples were analyzed using a high performance liquid chromatographic method that was developed and validated for the simultaneous determination of the compounds of interest. Various factors influencing drug release from the developed dosage forms were assessed and recommendations for further optimization of the formulation are made. Factors evaluated included the quantity of granulating fluid, matrix polymer content, drug load and process variables, including drying time and compression force. The influence of various coating levels on drug release was assessed and none of the levels assessed were found to adequately retarded drug release over a 22-hour period. Combinations of tablets coated to different levels allowed for the successful development of a sustained release metoprolol component, which could be included into the combination dosage form.

Male (8) and female (22) Essential Hypertensives (130/85 mm Hg or above) were randomized into a nonspecific treatment or an experimental treatment utilizing eight relaxation strategies. Both groups had eight training sessions which consisted of baseline blood pressures (BP), 15 minute relaxation tapes, and post-relaxation BP's. Subjects were instructed to use their tapes three times between sessions. Five BP readings were taken at the one and two month follow-ups. It was hypothesized that the experimentals would have greater within and across session decreases in BP, and that the differences would be maintained during a no treatment follow-up. Eleven experimentals and 8 controls were on medication. Mean medication compliance percentages were 99.9 and 99.6 while mean relaxation compliance percentages were 95.2 and 115.2 for experimentals and controls respectively. Efficacy was checked at each training session on a seven-point scale and group means were 6.5 and 5.4 for experimentals verses controls. Within session decreases in BP were compared with t tests and no significant differences (p < .05) were present for the eight training sessions with systolic (SBP) or diastolic (DBP). Across session changes were compared with ANCOVA and no significant differences (p < .05) were present for the eight training or two follow-up sessions for SBP or DBP. In summary, the experimentals showed within and across session decreases in BP consistent with prior research, but the effect was not significantly better than "sitting quietly". It was concluded that nonspecific treatments must be included in BP research on effectiveness of treatments. A final conclusion was that both groups did show clinically useful decreases in BP which were maintained at follow-up and the effectiveness of noninvasive treatments for Essential Hypertension was demonstrated.