No description available.

Introduction: Currently there are approximately 1.2 million people in the United States living with HIV and it is estimated that 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression on substance use and medication adherence specifically among HIV-positive adult Georgians receiving medical care for HIV. Methods: Secondary data with a probability sample of 608 HIV-positive adults who took part in the 2009-2012 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analysis and multivariate logistic regression models were conducted to assess relationships between depression with current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design and were performed using SAS 9.2 (Cary, NC). Results: Among HIV-positive adults in Georgia, approximately 9.2% met the criteria for major depression; 15.2% of women and 6.9% of men had major depression. Heterosexual adults also had a higher percentage of major depression (11.9%) compared to adults who identified as bisexual (8.3%) or homosexual (6.1%). Major depression was also highest among young adults (17.1%) and adults with high school diploma or GED (13.0%). Major depression was associated with a greater odds of current cigarette smoking (3.04; 95% CI: 1.48, 6.23); injection drug use (5.62; 95% CI: 0.96, 32.81), and other non-injection drug use (2.17; 95% CI: 1.10, 4.25), after adjusting for sociodemographic variables. Major depression was also associated with a greater odds of ART medication non-adherence, 2.52 (95% CI: 1.20, 5.28), after adjusting for gender. Conclusion: As previously found in the general population, we found significant associations between depression and smoking and other non-injection drug use among HIV-positive adults. Major depression was also associated with a greater odds of ART medication non-adherence, which is also consistent with the literature. Because HIV-positive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population.

Objective: To evaluate the level of agreement between two self-reported medication adherence scales and prescription refill records in older adults. Design: Cross-sectional study Setting: Imperial Plaza; a retirement community located in Richmond, Virginia. Participants: 32 independent-living older adults, taking anti-hypertensive medications and filling their prescriptions at on-site Plaza Professional Pharmacy were recruited in the study. Methods: Participants’ 6 months refill records were obtained and Medication Possession Ration (MPR) was calculated. Participants were interviewed using Morisky Medication Adherence Scale (MMAS) & Brief Medication Questionnaire (BMQ). Kappa statistics was used to evaluate the level of agreement. Results: Poor level of agreement was found between refill records and MMAS (k=-0.004), refill records and BMQ belief screen (k=-0.09), regimen screen (k=-0.09), and recall screen (k =-0.004). Strong agreement was found between MMAS and BMQ regimen screen (k=0.79) and recall screen (k=0.87) respectively. Conclusion: Self-reported measure of adherence exhibited poor agreement with prescription refill records.

Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado com 48 portadores de hipertensão arterial sistêmica (HAS), internados em alas de internação e UTI cardiológica de um hospital privado do interior paulista, realizado no período de julho a setembro de 2009, tendo por objetivo avaliar os fatores que interferem na adesão à terapêutica. Para coleta de dados, foram utilizados três instrumentos: um relacionado aos dados sociodemográficos, clínicos e relacionados à terapêutica medicamentosa; o Teste de Medida de Adesão ao Tratamento (MAT) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliação da Atitude Frente à Tomada de Remédio (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0 e MedCalc 10.2, e os dados foram considerados significativos quando o nível de significância foi p<0,05 e IC 95%. Os sujeitos possuíam idade entre 19 e 90 anos, com mediana de 70,5 anos, 79,2% eram do sexo masculino, 70,8%, casados, 64,6%, aposentados, 35,4% possuíam ensino médio completo, seguidos por 25% com ensino superior completo, a renda familiar variou de R$900,00 a R$30.000,00, com mediana de R$4.000,00, o número de indivíduos que utilizam a renda familiar variou de 1 a 6, 29,2% eram obesos, 93,8% apresentaram relação cintura-quadril (RCQ) alterada, 35,4% apresentaram valores de pressão arterial (PA) acima de 140X90mmHg, 35,4% faziam uso de diurético, 27,1%, de betabloqueador, 25%, de bloqueador de canais de cálcio, 29,2%, de inibidor da enzima conversora de angiotensina (ECA), 35,4%, de bloqueador do receptor da angiotensina 1 (AT1) e 66,7% utilizam apenas um medicamento para controle da PA. O tempo de diagnóstico da HAS variou de 1 a 40 anos, com mediana de 10 anos. As principais comorbidades encontradas foram: cardiopatias (52,1%), dislipidemia (45,8%) e diabetes mellitus (35,4%). Quando avaliados pelo MAT, 44 (91,7%) apresentaram adesão ao tratamento; pelo IAAFTR 34 (70,8%) mostraram atitude positiva frente à tomada de remédio. Entre aqueles que apresentaram adesão pelo MAT, 33 (75%) também apresentaram atitude positiva frente à tomada de remédio. Não houve diferença estatisticamente significante para idade, sexo, estado civil, ocupação, escolaridade, IMC, RCQ e complicações clínicas, quando aplicados o MAT e o IAAFTR. A prevalência de adesão foi maior entre os indivíduos que acreditavam que sua PA estava controlada (p=0,041), os que não necessitaram de mudanças em sua rotina de vida após o diagnóstico da HAS (p=0,007) e os que nunca recusaram um medicamento prescrito para controle da PA (p<0,001). Diante desse contexto, permanece o desafio quanto à necessidade dos profissionais de saúde buscarem a diminuição das barreiras que interferem na adesão ao tratamento da HAS, favorecendo-a e mostrando seus benefícios, adotando assim uma visão holística do portador de HAS. / This descriptive, quantitative and cross-sectional study was carried out with 48 patients with systemic high blood pressure (SHBP), hospitalized in a cardiologic ICU (Intensive Care Unit) of a private hospital in the interior of the state of São Paulo, between July and September 2009 and aimed to assess the factors that interfere in the adherence to treatment. Three instruments were used for data collection: one related to socioeconomic and clinical data and data related to medication therapy; the Test of Treatment Adherence Measure (TAM) to evaluate the adherence to medication treatment and the Instrument of Evaluation of Attitude regarding Medication Intake (IAAFTR). Statistical tests were carried out using the software Statistica 8.0 and MedCalc 10.2, and data were considered significant for a level of significance p<0.05 and Confidence Interval (CI) 95%. Subjects were aged 19 to 90 years, with median of age of 70.5 years, 79.2% were male, 70.8% married, 64.6% retired, 35.4% had completed high school, followed by 25% with complete higher education, family monthly income varied from R$900.00 (Brazilian reais) to R$30,000.00 (Brazilian reais), with median of R$4,000.00 (Brazilian reais), the number of individuals living with this income varied from 1 to 6, 29.2% were obese, 93.8% presented altered waist-hip ratio (WHR), 35.4% presented values of arterial pressure (AP) above 140X90mmHg, 35.4% used diuretic agents, 27.1% beta-Blockers, 25% blocker of calcium channels, 29.2% Angiotensin-Converting Enzyme Inhibitors (ACE), 35.4% Angiotensin Type 1 Receptor Blockers (AT1) and 66.7% used only one medication for blood pressure control. The time of diagnosis of SHBP varied from 1 to 40 years, with median of 10 years. The main comorbidities were heart diseases (52.1%), dyslipidemias (45.8%) and diabetes mellitus (35.4%). When assessed by TAM, 44 (91.7%) presented adherence to treatment; by IAAFTR 34 (70.8%) showed positive attitude regarding medication intake. Among the ones who presented adherence by TAM, 33 (75%) also presented positive attitude regarding medication intake. There was no statistically significant difference for age, gender, marital status, occupation, schooling, BMI, WHR and clinical complications, for administration of TAM and IAAFTR. The prevalence of adherence was higher among individuals who believed their BP was controlled (p=0.041), the ones who did not need changes in their daily life after the diagnosis of SHBP (p=0.007) and the ones who never refused a prescribed medication for BP control (p<0.001). In this context, remains the challenge of health professionals to decrease the barriers that interfere in the adherence to SHBP treatment, favoring adherence, showing its benefits and thus adopting a holistic view of patients with SHBP.

Pesquisa descritiva e qualiquantitativa que resgatou representações sociais de profissionais de saúde e pacientes referentes ao modo de comunicação do diagnóstico da tuberculose e adesão ao tratamento. O trabalho buscou analisar o conteúdo discursivo baseado nas discussões sobre Conscientização desenvolvidas por Paulo Freire. Realizou-se entrevista semi-estruturada com 39 profissionais envolvidos com a entrevista inicial de diagnóstico e 34 pacientes adultos em tratamento da tuberculose em 22 unidades de saúde da região Sul/São Paulo. Questionados sobre a entrevista inicial de diagnóstico, os pacientes entendem este momento de modo amplo, para além da consulta onde receberam a notícia oficial. Entretanto, para profissionais, o momento da notícia é bem delimitado e revela que o diagnóstico possui um caráter tecnológico. Questionados sobre o modo de dar a notícia de sorte a incentivar o paciente a se tratar, uma das categorias expressadas pelos pacientes traz a importância de se discutir tudo aquilo que envolve a doença, contexto e vida do paciente. Em contrapartida, profissionais se importam com o conteúdo a ser informado, mantendo o caráter tecnológico da informação. Questionados sobre os modos de dar a notícia que podem desmotivar o paciente a se tratar, pacientes e profissionais trazem a importância do entendimento do tratamento (aspecto cognitivo) e do respeito e vínculo (aspecto psíquico ou afetivo) para não haver desistência. Com relação ao tratamento parecer complicado quando explicado durante a notícia (aspecto comportamental) pacientes e profissionais discordam desta opção. Algumas ideias centrais destes dois grupos concordam que o tratamento é complicado e isso pode fazer o paciente desistir. Segundo Paulo Freire, toda ação educativa deve ser precedida de reflexão sobre o homem e o meio de vida para que não se torne pré-fabricada e inoperante. Por isso ampliar as discussões sobre o que envolve a doença, contexto e vida do paciente pode contribuir para um entendimento mais completo da situação. Apesar do tratamento da tuberculose ser complicado e, portanto, desmotivante, promover o entendimento do paciente, respeitá-lo e construir um vínculo podem contribuir para a adesão, na visão de pacientes e de profissionais de saúde / Descriptive and qualitative-quantitative research that rescued social respresentations of health professionals and patients in relation to mode of communication of tuberculosis diagnosis and treatment adherence. The study aimed to analyze the discursive content based on discussions about Conscientization developed by Paulo Freire. Semi-structured interviews were performed with 39 professionals involved with the initial diagnostic interview and 34 adult patients in 22 health units in South Region, Sao Paulo. Asked about initial diagnostic interview, patients understand this point broadly, far beyond the consultation where they received the official news. However, for professionals, the moment of the news is well defined and reveals that the diagnosis has a technological character. Asked how to break the news so as to encourage the patient to treatment, one of the categories expressed by patients brings the importance of discussing everything that involves the disease, context and patients life. In contrast, professionals care about the content to be informed, keeping the technological character of the information. Asked about ways to break the news that might discourage the patient to treatment, patients and professionals bring the importance of understanding about treatment (cognitive aspect) and respect and bond (psychic or affective aspect) so as to avoid abandonment. Regarding the fact that the treatment seems complicated when explained in the news (behavioral aspect), both patients and professionals oppose to this option. Some central ideas of these two groups agree that treatment is complicated and can make patient to give it up. According to Paulo Freire, all educational activity must be preceded by reflection on the human being and the lifestyle so that it does not turn out prefabricated and inoperative. Therefore, expanding the discussions on what involves the disease, context and patients life can contribute to a more complete understanding of the situation. Although the treatment of tuberculosis is complicated, and therefore disappointing, to promote the understanding of the patient, to respect him and to build a bond with him can contribute to the adherence, both in patients and health professionals point of view

Trata-se de um estudo observacional transversal, com o objetivo avaliar a adesão aos agentes antidiabéticos orais de pessoas com Diabetes mellitus com o uso do Brief Medication Questionnaire. O estudo foi realizado no Centro de Saúde Escola Prof. Dr. Joel Domingos Machado. Participaram do estudo 60 pacientes que participavam do Programa de Apoio Telefônico em Diabetes mellitus e utilizavam o agente antidiabético oral no seu tratamento. A coleta de dados foi realizada de maio a outubro de 2013, e o trabalho foi aprovado pelo Comitê de Ética e Pesquisa em Humanos da Escola de Enfermagem de Ribeirão Preto, parecer número: 324.098. Para a coleta de dados foi utilizado um questionário contendo variáveis sociodemográficas e clínicas, e o Brief Medication Questionnaire. Para análise, utilizou-se estatística descritiva, Teste Exato de Fisher e a quantificação desta associação foi mensurada por meio de modelos de regressão logística. Os resultados mostraram que os pacientes tinham de 31 a 87 anos, com predomínio do sexo feminino (58,3%), a maioria era casada (75,0%), 53,3% eram aposentados e média de estudo era de 6,7 anos. Para as variáveis clínicas: o tempo de diagnóstico mais prevalente foi de 11 a 20 anos e entre as comorbidades referidas a hipertensão arterial sistêmica foi presente em 75,0% dos participantes, 40,6% apresentaram hipertensão arterial sistêmica grau I, 35,0% apresentaram obesidade grau 1, em relação à circunferência abdominal, 72,0% dos homens tem valores elevados de circunferência abdominal, em contrapartida 94,3% das mulheres também apresentam valores elevados de circunferência abdominal. Quanto aos valores da glicemia em jejum, 55,0% dos participantes apresentam valores maiores que 130 mg/dl. Em relação à hemoglobina glicada, 75,0% participantes estavam com valores alterados sendo que 33 são adultos com valores maiores que 7% e 12 idosos com valores maiores que 8%. Em relação aos outros exames laboratoriais, observa-se predomínio de 10,0% dos participantes apresentam valores menores de 60 mg/dl de HDL-C, 31,7% valores alto de triglicerídeos e 21,7% apresentavam valores limítrofes de colesterol total. Em relação aos agentes antidiabéticos orais, mostrou-se predomínio do uso da classe das biguanidas, com destaque para a metformina sendo utilizada por 80,0% participantes. Em relação à mensuração geral do BMQ, mostrou-se que 25,0% dos participantes aderem plenamente e 21,7% apresentam provável adesão ao uso de agentes antidiabéticos orais. Para os três domínios, observou-se que o Domínio Regime apresentou 81,7% de adesão, o Domínio Crença 55,0% de adesão e o Domínio Recordação 35,0% de adesão. Não houve relação estatística entre a adesão e as variáveis sociodemográficas e clínicas. No entanto, a importância deste estudo foi apresentar achados em Diabetes mellitus com uma nova ferramenta para mensuração da adesão ao tratamento medicamentoso. Os achados apresentam outros aspectos como crença e recordação do que apenas o uso do medicamento que podem subsidiar estudos de intervenção com proposta de melhorar a adesão ao tratamento medicamento oral em Diabetes mellitus / This is a cross-sectional study aimed to assess the adherence to oral antidiabetic agents in people with diabetes mellitus using the Brief Medication Questionnaire. The study was conducted at the School Health Center Prof. Dr. Joel Domingos Machado. The study included 60 patients participating in the Telephone Support Program for Diabetes mellitus who used the oral antidiabetic in its treatment. Data collection was conducted from May to October 2013, and the study was approved by the Ethics Committee of Human Research of the Nursing School of Ribeirão Preto, opinion number: 324 098. To collect data, a questionnaire containing sociodemographic and clinical variables was used, and the Brief Medication Questionnaire. For analysis, we used descriptive statistics, Fisher\'s Exact Test and quantify of this association was measured by means of logistic regression models. The results showed that the patients were 31-87 years old, with a predominance of females (58,3%), most were married (75,0%), 53,3% were retired, and the study average was 6,7 years. For clinical variables: the most prevalent diagnosis time was 11-20 years and among these referred comorbidities the hypertension was present in 75,0% of participants, 40,6% had grade hypertension I, 35,0% had grade obesity 1, compared to waist circumference, 72,0% of men have high values of waist circumference, and 94,3% of women also exhibit high values of waist circumference . On the values of unfed glycemia, 55,0% participants had higher values than 130 mg/dl. In relation to glycosylated hemoglobin, 75,0% participants were with altered values 33 adults with larger values than 7% and 12 elderly patients with values greater than 8%. In relation to other laboratory tests, it is observed predominance of 10,0% participants presented lower values of 60 mg/dl of HDL - C, 31,7% high triglyceride levels and 21,7% had borderline the values of total cholesterol. Regarding oral antidiabetic agents, it has proved predominance of the use of the biguanide class, especially metformin being used by 80,0% participants. Regarding the overall measurement of BMQ, it was shown that 25,0% of participants fully adhere and 21,7% are likely accession to the use of oral antidiabetic agents. For all three areas, it was observed that the Scheme Domain presented 81,7% adherence, Belief Domain 55,0% adherence and Remembrance Domain 35,0% adherence. There was no statistical relationship between adherence and sociodemographic and clinical variables. However, the importance of this study was to present findings in diabetes mellitus with a new tool to measure the drug treatment adherence. The findings show other aspects such as belief and recall than just the medication use that can aid intervention studies proposed to improve adherence to oral drug treatment in diabetes mellitus

Asthma is the most common long-term condition in children in the United Kingdom (UK). Asthma-related hospitalisations and mortality are disproportionally higher in the UK, compared with other European countries, however the reasons for this disparity remain unclear. A putative explanation is that that prevalence of suboptimal asthma control in children in the UK is higher than in continental Europe. If this is indeed correct, then the drivers of suboptimal control, such as poor adherence to therapy resulting from poor understanding of the role of preventer medication (inhaled corticosteroids (ICS)) in UK children would be of significant clinical interest. Therefore, in this thesis, I sought to first identify the levels of asthma control and medication adherence in a non-random sample of London secondary school children. Then, I used focus groups to further highlight the barriers to good medication adherence, and generate insights into potential solutions. To achieve these aims, I developed and implemented an online questionnaire to be delivered in schools, which included the validated Asthma Control Test (ACT). Methods: This thesis is divided into three main sections. The first and second sections include original data from an observational research study, which collected data about asthma control, from 24 London secondary schools between December 2014 and March 2016. The aim of the first section was to assess current levels of asthma control and medication adherence among children with asthma in London secondary schools. Data were collected using an online questionnaire, which included the validated ACT to measure asthma control, as well as additional questions about knowledge, healthcare use, medication use, school attendance, lifestyle and emotion and behaviour, using the validated Me and My School (M&MS) questionnaire. The second section of this thesis includes data generated from six focus groups, conducted in four London secondary schools with 56 students. In order to generate data to inform future interventions, discussions focused on the barriers to medication adherence among teenagers, and how these barriers could be addressed. The third section comprises a systematic review of school-based self-management interventions for children with asthma. The review uses a mixed-methods approach, and includes both quantitative and qualitative study data. A process evaluation is also included, to identify intervention elements that are associated with implementation success. Results: 766 children with asthma from 24 schools were surveyed. Almost half of the students (45.7%; n = 350) had poor asthma control by ACT score. Adherence with asthma medication was low, regardless of asthma control (56.2% self-reported forgetting to use their ICS "preventer" inhaler; 29% self-reported not using their SABA "reliever" inhaler when they needed it, at least some of the time). Health care involvement was relatively high, with at least one unplanned GP visit, due to asthma in the previous four weeks, reported by 28.1% of students; at least one unplanned hospital visit was self-reported by 15.7% of students; and at least one unplanned school nurse visit due to asthma was self-reported by 16% of students. At least one whole school absence was reported by 20.9% of students. Unplanned medical care and school absences were higher among children with poor asthma control, according to the ACT. Themes from focus groups suggested that social stigma, fear of embarrassment, forgetfulness, and incorrect attitudes towards medication were all contributory factors to poor medication adherence. Communications with healthcare professionals were also identified as key unmet needs of teenagers with asthma. The findings from the meta-analyses, included in the systematic review of school-based self-management interventions, showed that such interventions were effective in improving several outcomes, largely related to healthcare use. These included hospitalisations, emergency department (ED) visits, and health-related quality of life. There was no evidence that school-based interventions improved school absences, experiences of day and night time symptoms, or the use of medication. The findings from the analysis of the process evaluation studies showed that a theoretical framework is important in the development of a successful intervention. Conclusions: First, in a large non-random sample of secondary school children with asthma, the proportion of children with suboptimal control is worryingly high, and this is associated with general poor adherence to prescribed therapy asthma. Second, focus groups identified practical and social barriers to good adherence, that should be addressed in future studies. Third, previous studies suggest that school based interventions are effective in reducing incidences of unplanned and urgent healthcare use. The systematic review included studies that included relatively hard-to-reach populations, suggesting that such interventions may be effective across diverse populations, including those considered hard-to-reach. The findings in this thesis informed the development of a school-based self-management intervention, to be piloted in London secondary schools, and an NIHR-funded global research group award on improving asthma control in African children.

Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado entre 75 portadores de hipertensão arterial (HA) seguidos no ambulatório de um hospital-escola de nível terciário, no interior paulista, realizado no período de setembro de 2008 a abril de 2009, tendo por objetivo avaliar a adesão ao tratamento. Para a coleta de dados foram utilizados três instrumentos: um relativo a dados sociodemográficos, da doença e do tratamento; o Teste de Morisky e Green (TMG) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliar Atitudes Frente à Tomada de Remédios (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0, e os resultados foram considerados significativos quando o nível de significância foi (p <0,05). Os sujeitos possuíam idade média de 61,5 ±10,36 anos, 52,0% eram do sexo feminino, 85,3% brancos, 70,7% casados, 48,0% aposentados e 24,0% do lar, 65,3% possuíam ensino fundamental incompleto, média de 3,08 ±1,99 filho, 94,7% residiam com outros membros da família, 81,3% informaram renda familiar entre um e três salários mínimos; 48,0% apresentaram valores de pressão arterial (PA) maiores que 140X90mmHg, 48,0% eram obesos, 80,6% dos homens e 94,9% das mulheres apresentaram circunferência da cintura com valores alterados. A média do tempo de diagnóstico da hipertensão arterial sistêmica (HAS) foi de 15,57 ±9,61 anos. As principais comorbidades identificadas foram: diabetes mellitus (54,3%) e dislipidemia (46,6%). A média dos medicamentos utilizados foi de 5,1 comprimidos/dia, sendo os mais comumente utilizados os hipoglicemiantes (58,7%) e os antiagregantes plaquetários (54,8%). A média de medicamentos usados para o tratamento da HA foi de 3 comprimidos/dia, sendo que os diuréticos foram os mais usados (84,0%). Quando avaliados pelo TMG, 21 (28,0%) apresentaram adesão ao tratamento; pela utilização do IAAFTR 37 (49,3%) mostraram atitudes positivas frente à tomada dos medicamentos. Entre aqueles que apresentaram adesão pelo TMG, 16 (76,2%) também apresentaram atitudes positivas quando avaliados pelo IAAFTR. A prevalência de controle da PA foi maior para os que tiveram adesão (66,7%) e para aqueles com atitudes positivas (64,9%). Houve significância estatística para o sexo e atitude frente à tomada dos medicamentos em relação ao controle da PA. Os valores de PA foram menores para os que tiveram adesão pelo TMG e que apresentaram atitudes positivas quanto à tomada dos medicamentos (p <0,05). Em relação aos fatores de risco para a HAS, 64,0% não praticavam exercício físico; 9,3% eram fumantes; 17,3% faziam uso de bebida alcoólica e 54,7% diziam ser estressados; 96,0% citaram antecedentes familiares para doenças cardiovasculares. Diante deste contexto permanece um desafio quanto à necessidade de revisão das medidas educativas instituídas no sentido de possibilitar alternativas que possam melhorar, na prática, a adesão dos portadores de HA ao tratamento medicamentoso, o controle da PA e a mudança nos fatores de risco para a HAS. / It is a cross-section descriptive study of quantitative approach, carried out with 75 hypertensive outpatients of tertiary level, in upstate São Paulo, carried out from September 2008 to April 2009, aiming to evaluate adherence to the treatment. Three questionnaires were used to collect the data: one about socio-demographic data regarding the disease and the treatment; the Morisky-Green Test, to assess the adherence to the drug-based treatment and the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The statistical tests were applied by means of the software Statistica 8.0, and the results were considered significant whenever the significance level was (p<0.05). The subjects average age was 61.5 ±10.36 years, 52.0% were women, 85.3% Caucasians, 70.7% married, 48.0% retired and 24.0% housewives, 65.3% did not finish primary education, they had on average 3.08 ±1.99 children, 94.7% lived with other family members, 81.3% stated that their familly income was between one and three minimum wages; 48.0% had blood pressure readings above 140X90 mmHg, 48.0% were overweight, 80.6% of the men and 94.9% of the women had unhealthily large waist circumferences. Average hypertension diagnosis time (HT) was 15.57 ±9.61 years. The most important comorbities identifed were: diabetes mellitus (54.3%) e dyslipidemia (46.6%). The average of the medications used was 5.1 pills/day, and the most commonly used drugs were hypoglycemiants (58.7%) and platelet antiaggregant (54.8%). The average of the medications used for the treatment of HT was 3 pills/day, and the diuretics were the most used ones (84.0%). When evaluated with the Morisky-Green test, 21 (28.0%) showed adherence to the treatment, by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines, 37 (49.3%) showed positive attitudes towards the taking the medicines. Those that showed adherence through the Morisky-Green test also showed positive attitudes when evaluated by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The prevalence of control of the blood pressure was higher for those who had adherence (66.7%) and for those with positive attitudes (64.9%). Gender and attitude towards taking medicines had statistical significance to the control of blood pressure. Blood pressure readings were lower in hypertensives that had adherence according to the Morisky- Green test and that had positive attitudes toward taking the medicines (p<0.05). Regarding the risk factors for HT, 64.0% did not practice physical exercise; 9.3% were smokers; 17.3% drank alcoholic drinks and 54.7% reported being stressed; 96% cited family antecedents of cardiovascular disease. In face of this context, there remains the challenge of reviewing the current educative measures to enable alternatives that may improve, in practice, the adherence of hypertensives to the drug-based treatment, the control of blood pressure and the change in the risk factors for HT.

Pesquisa descritiva e qualiquantitativa que resgatou representações sociais de profissionais de saúde e pacientes referentes ao modo de comunicação do diagnóstico da tuberculose e adesão ao tratamento. O trabalho buscou analisar o conteúdo discursivo baseado nas discussões sobre Conscientização desenvolvidas por Paulo Freire. Realizou-se entrevista semi-estruturada com 39 profissionais envolvidos com a entrevista inicial de diagnóstico e 34 pacientes adultos em tratamento da tuberculose em 22 unidades de saúde da região Sul/São Paulo. Questionados sobre a entrevista inicial de diagnóstico, os pacientes entendem este momento de modo amplo, para além da consulta onde receberam a notícia oficial. Entretanto, para profissionais, o momento da notícia é bem delimitado e revela que o diagnóstico possui um caráter tecnológico. Questionados sobre o modo de dar a notícia de sorte a incentivar o paciente a se tratar, uma das categorias expressadas pelos pacientes traz a importância de se discutir tudo aquilo que envolve a doença, contexto e vida do paciente. Em contrapartida, profissionais se importam com o conteúdo a ser informado, mantendo o caráter tecnológico da informação. Questionados sobre os modos de dar a notícia que podem desmotivar o paciente a se tratar, pacientes e profissionais trazem a importância do entendimento do tratamento (aspecto cognitivo) e do respeito e vínculo (aspecto psíquico ou afetivo) para não haver desistência. Com relação ao tratamento parecer complicado quando explicado durante a notícia (aspecto comportamental) pacientes e profissionais discordam desta opção. Algumas ideias centrais destes dois grupos concordam que o tratamento é complicado e isso pode fazer o paciente desistir. Segundo Paulo Freire, toda ação educativa deve ser precedida de reflexão sobre o homem e o meio de vida para que não se torne pré-fabricada e inoperante. Por isso ampliar as discussões sobre o que envolve a doença, contexto e vida do paciente pode contribuir para um entendimento mais completo da situação. Apesar do tratamento da tuberculose ser complicado e, portanto, desmotivante, promover o entendimento do paciente, respeitá-lo e construir um vínculo podem contribuir para a adesão, na visão de pacientes e de profissionais de saúde / Descriptive and qualitative-quantitative research that rescued social respresentations of health professionals and patients in relation to mode of communication of tuberculosis diagnosis and treatment adherence. The study aimed to analyze the discursive content based on discussions about Conscientization developed by Paulo Freire. Semi-structured interviews were performed with 39 professionals involved with the initial diagnostic interview and 34 adult patients in 22 health units in South Region, Sao Paulo. Asked about initial diagnostic interview, patients understand this point broadly, far beyond the consultation where they received the official news. However, for professionals, the moment of the news is well defined and reveals that the diagnosis has a technological character. Asked how to break the news so as to encourage the patient to treatment, one of the categories expressed by patients brings the importance of discussing everything that involves the disease, context and patients life. In contrast, professionals care about the content to be informed, keeping the technological character of the information. Asked about ways to break the news that might discourage the patient to treatment, patients and professionals bring the importance of understanding about treatment (cognitive aspect) and respect and bond (psychic or affective aspect) so as to avoid abandonment. Regarding the fact that the treatment seems complicated when explained in the news (behavioral aspect), both patients and professionals oppose to this option. Some central ideas of these two groups agree that treatment is complicated and can make patient to give it up. According to Paulo Freire, all educational activity must be preceded by reflection on the human being and the lifestyle so that it does not turn out prefabricated and inoperative. Therefore, expanding the discussions on what involves the disease, context and patients life can contribute to a more complete understanding of the situation. Although the treatment of tuberculosis is complicated, and therefore disappointing, to promote the understanding of the patient, to respect him and to build a bond with him can contribute to the adherence, both in patients and health professionals point of view

A adesão ao tratamento ocorre quando o conselho médico ou de saúde coincide com o comportamento do indivíduo, ao uso de medicamentos, cumprimento da dieta e mudanças no estilo de vida, não sendo, portanto, um ato não passivo do paciente. Em pacientes com hipertensão arterial sistêmica a adesão ao tratamento pode ser definida como o grau de cumprimento das medidas terapêuticas indicadas, sejam elas medicamentosas ou não, com o objetivo de manter a pressão arterial em níveis pressóricos normais. A não adesão em pacientes com doenças crônicas em tratamento a longo prazo em países desenvolvidos é em média de 50%, revelando a importância de serem avaliados os motivos que levam a esse comportamento. O estudo teve como objetivo avaliar a não adesão em idosos hipertensos de uma unidade pública de saúde de Ribeirão Preto - SP. Trata-se de um estudo de corte transversal, desenvolvido com uma amostra de 196 pessoas. A coleta de dados ocorreu entre agosto de 2014 até junho de 2015, após aprovação do Comitê de Ética em Pesquisa. Para essa etapa foram utilizados os instrumentos Brief Medication Questionnaire, Medical Outcomes Studies 36-item Short Form Survey, Escore de Risco Global e Escore de Risco pelo Tempo de Vida. Após a coleta dos dados, as entrevistas foram codificadas, os dados foram tabulados e foi realizada a análise estatística descritiva e de correlação. Como resultado, constatou-se que houve predomínio de mulheres, com idade média de 69,4 anos, casados/união estável, não moravam sozinhos, com 1,85 pessoas na casa em média, de cor branca, com ensino fundamental incompleto, renda de até dois salários mínimos e aposentados/pensionistas, atendidos pelo SUS. Apresentaram hábitos de vida razoáveis, sem predomínio de consumo de bebidas alcoólicas, tabagismo, uso excessivo de sal e sedentarismo. A mais frequente comorbidade associada à HAS foi a dislipidemia. Foi observado elevado predomínio de fatores de risco cardiovasculares como obesidade abdominal, obesidade geral, comorbidades, razão de lipídeos e fatores agravantes como proteína c reativa ultrassensível, microalbuminúria e síndrome metabólica. A maioria da amostra foi classificada como sendo portador de risco cardiovascular alto após estratificação do risco. A percepção da qualidade de vida relacionada à saúde foi considerada baixa na maioria principalmente devido a limitações emocionais. A não adesão esteve presente em quase metade dos idosos, relacionada principalmente à complexidade da farmacoterapia e dificuldade em lembrar sobre o uso de seus medicamentos. Não foi observada correlação entre a não adesão e as variáveis estudadas. Conclui-se que o comportamento de não adesão observado não esteve relacionada às variáveis estudadas nessa amostra e que são necessárias intervenções urgentes para reduzir o risco cardiovascular e prevenir doenças cardiovasculares e mortalidade, bem como melhora da percepção da qualidade de vida relacionada à saúde. / Adherence to treatment is when medical or health advice corresponds with the individual\'s behavior, the use of medication, diet compliance and changes in lifestyle. Therefore, it is a non-passive act of the patient. In patients with systemic arterial hypertension, adherence to treatment can be defined as the degree of compliance with therapeutic measures, whether medicinal or not, in order to maintain blood pressure in normal blood pressure levels. In developed countries, non adherence rate is about a half in patients with chronic diseases in long-term treatment, showing the importance of the evaluation of the reasons for this behavior. This study aimed to assess non adherence among elderly hypertenses in a public health unit of Ribeirão Preto-SP. This is a cross-sectional study, conducted with a sample of 196 people. Data collection took place from August 2014 untill June 2015, after approval by the Research Ethics Commitee. For this step, we used the instruments Brief Medication Questionnaire, Medical Outcomes Studies 36-item Short Form Survey, Global Risk Score and Lifetime Risk Escore. After data collection, the interviewers were codified, data were tabulated for the descriptive and correlation statistical analysis. We found out that there was predominance of women, mean age of 69.4 years, married individuals, and most of them lived with other people (mean 1.85), white individuals, with incomplete Elementary School, income of two minimum wage at least, retired and using public health system. We identified individuals with fair health habits, without predominance of alcohol, tabacco and salt use. A minority claimed physical inactivity. Dyslipidemia were the most frequent comorbidity associated with SAH. We observed a high presence of risk factors for cardiovascular diseases such as abdominal and general obesity, comorbidities, lipids rates, ultra-sensitive c-reactive protein, microalbuminuria and metabolic syndrome. The sample showed a very high presence of elevated cardiovascular risk after risk escore calculation. The perception of health related quality of life was considered low in most, mainly due to emotional limitations. Non adherence was present in almost half of the elderly and was mostly related to the complexity of pharmacotherapy and the difficulty to remember about the use of their drugs. No correlation was observed between non adherence and the variables studied in this sample. We strongly advice that interventions are made to reduce cardiovascular risk and prevent cardiovascular disease and mortality, and to improve mental health status.