The purpose of this study was to investigate the relationship between health insurance status and diabetes management (in terms of medication adherence and physical activity levels) in Black adults based on socioeconomic factors. Data were harvested from the Sample Adult Questionnaires of the National Health Interview Survey (NHIS) between the years of 2010 and 2016. The survey questions that were collected included information about the participants' income, education level, insurance status, diabetes diagnosis, medication therapy and physical activity levels. This study employed the most recent version of the Statistical Package for Social Sciences (SPSS) software. The association between diabetes management and socioeconomic factors were analyzed using chi-square analysis. It was hypothesized that Black adults who were uninsured, lower income, and less-educated would report lower adherence to medication and lower physical activity participation when compared to their insured, higher income, and higher-educated counterparts. However, there was no statistically significant relationship between health insurance status and diabetes management in people of different socioeconomic status. Too few people met the weekly recommendations for moderate exercise thus chi-square outcomes for physical activity were invalid. This study will be beneficial for future research as it has provided more generalizable information on this topic due to the use of a national dataset. This study also highlighted the importance of adequate physical activity interventions for this population and can be used for further research on Black adults with diabetes.

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Objectives: Adherence to psychotropic medication is poor among individuals with bipolar disorder (BD). To understand treatment experiences and associated adherence among these individuals, we developed a novel construct of Clinical Net Benefit (CNB) using psychiatric symptoms, adverse effects and overall functioning assessments. We tested whether adherence differed across classes of CNB, whether individuals transitioned between classes over time, and whether these transitions were differentially associated with adherence. Methods: Data come from individuals aged 18+ during five years of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB. Latent transition analysis determined probabilities of transitioning between classes over time. Adherence was defined as taking 75%+ of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics. Results: Five classes of CNB were identified during the first two years (high, moderately high, moderate, moderately low, low), and four classes (removing moderately high) during the last three years. Adherence did not differ across classes or time points. Medication regimens differed by class; those with higher CNB taking fewer medications had lower odds of adherence while those with lower CNB taking more medications had higher odds of adherence compared with monotherapy. Probability of transitioning from higher to lower CNB, and lower to higher CNB was greatest over time. Conclusions: CNB is heterogeneous in individuals treated for BD, and movement between classes is not uncommon. Understanding why individuals adhere despite suboptimal CNB may provide novel insights into aspects influencing adherence.

Introducción: La atención farmacéutica mejora la adherencia del paciente al tratamiento, por lo que es necesario que el farmacéutico cuente con instrumentos para evaluarla y mejorarla mediante su intervención en el seguimiento farmacoterapéutico (SFT). Objetivos: Evaluar el impacto de la intervención farmacéutica en la mejora de la adherencia de los pacientes con virus de la inmunodefi ciencia humana (VIH) y sida, e identifi car los factores que infl uyen en ella y que pueden ser modifi cados por la intervención farmacéutica en el SFT. Métodos: Se realizó SFT durante 23 meses a 52 pacientes mayores de 18 años de edad, con tratamiento antirretroviral durante más de 3 meses, que dieron su consentimiento informado. La adherencia se evaluó con el CEAT-VIH (cuestionario para evaluar la adhesión al tratamiento antirretroviral) al inicio y al fi nal de 6 meses de SFT. Resultados: La puntuación total del CEAT-VIH (p <0,05; intervalo de confi anza del 95%), el cumplimiento del tratamiento (p <0,001) y la percepción del paciente respecto a su enfermedad y tratamiento antirretroviral (p <0,001) incrementaron signifi cativamente su valor. La educación al paciente para incrementar la adherencia al tratamiento (46%) fue la intervención farmacéutica más frecuente. Conclusiones: Se demuestra que la intervención del farmacéutico, mediante el SFT, mejora la adherencia al tratamiento antirretroviral. El farmacéutico mejoró los aspectos de cumplimiento y percepción del paciente sobre su tratamiento y enfermedad. Los farmacéuticos pueden utilizar el CEAT-VIH como instrumento para evaluar la adherencia en la práctica del SFT. / Introduction: Pharmaceutical care improves medication adherence that is why is important that the pharmacist uses instruments to evaluate and improves it through pharmaceutical intervention at pharmaceutical care. Objective: To evaluate the impact of the pharmaceutical intervention in the improvement of the medication adherence of the patients with HIV and AIDS, and to identify the factors that infl uence on medication adherence and which one could be modifi ed by the pharmaceutical intervention during pharmaceutical care. Methods: Pharmacotherapeutic follow-up was realized for 23 months to 52 patients, older than 18 years, with antiretroviral treatment for up to three months, consent informed was obtained from patients. Medication adherence was evaluated with CEAT-HIV (questionnaire to evaluate the adhesion to the antiretroviral treatment) at the beginning and at the end of the study (6 months). Results: The fi nal score from CEAT-HIV (p <0.05; 95% IC), treatment compliance (p <0.001) and patient’s beliefs to the disease and antiretroviral treatment (p <0.001) improved signifi cantly with the pharmaceutical intervention. The more frequent pharmaceutical intervention was education to the patient to increment the adherence to the treatment (46%). Conclusion: These results demonstrate that the pharmacists’ intervention through pharmacotherapeutic follow-up improves the adherence to the antiretroviral treatment. The pharmacist was able to improve aspects of compliance and patient’s beliefs about the treatment and disease. The pharmacist could utilize CEAT-VIH as an instrument to evaluate the adherence in HIV/AIDS patients.

Objetivos: Este trabalho teve como objetivo determinar a prevalência e os fatores associados às alterações neurocognitivas em uma coorte de pacientes portadores do HIV-1 vinda do Banco de Sangue do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC-FMUSP, com alto nível de adesão aos antirretrovirais e baixa prevalência de doenças oportunistas associadas ao vírus. Metodologia: A prevalência de alterações neurocognitivas associadas ao HIV (HAND) foi avaliada através de uma bateria neuropsicológica estruturada composta por 8 instrumentos, possibilitando uma abrangência maior em relação a quantidade de funções cognitivas superiores avaliadas e maior precisão na detecção das alterações. Resultados: A amostra foi composta por 54 pacientes e a análise dos dados mostrou elevada prevalência de HAND na amostra analisada (60%), independente do controle imunológico e virológico, com maior presença da forma assintomática (ANI), porém o resultado da forma leve (MND) também foi significativo, sendo próximo à porcentagem dos pacientes com a forma assintomática. Conclusão: Os resultados do estudo refletiram o cenário nacional e internacional mostrando a alta prevalência das alterações cognitivas associadas ao HIV, alertando os profissionais de saúde para a importância de identificação, diagnóstico e acompanhamento adequado desses pacientes. Os dados também mostraram a importância da presença do profissional da área de psicologia na equipe de saúde, oferecendo ao paciente o desenvolvimento de estratégias de atendimento mais específicas e eficazes / The main goal of this study was to determine the prevalence and factors associated with neurocognitive disorders in a cohort of 54 patients with HIV-1 from the Blood Bank of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC- FMUSP with high adherence to antiretroviral therapy and low prevalence of opportunistic diseases associated with the virus. Methods: The prevalence of HIV associated neurocognitive disorders (HAND) was evaluated through a structured neuropsychological battery of 8 tests, increasing the coverage of superior cognitive functions being evaluated and greater precision in the detection of cognitive alterations. Results: Data analysis showed a high prevalence of HAND in the population under analysis (60%), irrespective of the immunological and virologic control, with a greater presence of the asymptomatic form (ANI), but the occurrence of the mild form (MND) was also significant, being close to the percentage of patients with the asymptomatic form. Conclusion: The result of the study reflected the national and international scenario showing high prevalence of HIV associated neurocognitive disorders, alerting health professionals to the importance of identification, diagnosis and adequate follow-up of these patients. The data also showed the importance of the presence of the psychologist in the health team, offering to the patient more specific and effective care strategies

Introdução: As evidências mostram que com o tratamento da infecção crônica pelo vírus da hepatite B (VHB) conseguimos suprimir a carga viral, a qual deve ser mantida o mais baixo possível. Entre os fatores ligados diretamente ao sucesso terapêutico, encontra-se a adesão ao tratamento. Diversos instrumentos de avaliação da adesão estão disponíveis, porém não existe nenhum validado para uso na hepatite B crônica. Esse estudo incluiu a adaptação do CEAT-VIH (Remor, 2002) para pacientes portadores de hepatite B crônica, avaliou a confiabilidade e as evidências de validade do questionário adaptado (denominado CEAT-VHB). Métodos: Trata-se de um estudo transversal e foram avaliados 183 pacientes com diagnóstico de infecção crônica pelo VHB, em tratamento há pelo menos três meses com adefovir, entecavir, lamivudina e/ou tenofovir. Foram coletadas informações sócio-demográficas e aplicados o questionário adaptado (\"Questionário para avaliação da adesão ao tratamento antiviral em pacientes portadores de hepatite B crônica\", CEAT-VHB) e o Teste de Morisky. A carga viral de VHB foi compilada diretamente do prontuário. A avaliação da confiabilidade (consistência interna) do CEAT-VHB foi testada por meio do valor de alfa de Cronbach. As evidências de validade do questionário adaptado foram estabelecidas através das validades de critério e constructo. As validades de critério e do constructo do tipo convergente do instrumento proposto foram testadas pelas correlações das medidas obtidas com os resultados do Teste de Morisky e do nível de carga viral plasmática de VHB. Resultados: O CEAT-VHB mostrou-se com boa aceitabilidade no formato de entrevista estruturada dirigida. A confiabilidade do CEAT-VHB demonstrou uma consistência interna adequada no escore global do questionário (alfa de Cronbach = 0,734). Foi evidenciada correlação negativa boa (r = -,615; p < 0,001) do domínio \"grau de cumprimento ao tratamento antiviral\" com o Teste de Morisky e correlação negativa moderada (r = -,417; p < 0,001) do domínio \"variáveis para não adesão\" com o nível de carga viral plasmática de VHB. Na capacidade discriminativa do constructo, os pacientes foram estratificados em função do desfecho clínico (carga viral de VHB detectável ou indetectável), que demonstrou diferença estatisticamente significativa (p < 0,001). Por meio da curva ROC, foi possível calcular a sensibilidade e especificidade do CEAT-VHB. Como vimos na capacidade discriminativa do constructo, que escores maiores ou iguais a 80 detectam adesão ao tratamento, necessário para a predição de uma carga viral de VHB indetectável, fixamos como ponto de corte da curva ROC o valor 80,50. Assim, encontramos um valor de sensibilidade de 81,43% e especificidade de 67,26%. Ainda, o CEAT-VHB identificou 43,2% (79) dos pacientes em não adesão ao tratamento antiviral. Conclusões: O CEAT-VHB é um instrumento de boa confiabilidade, com validade e capacidade discriminativa adequada para medir o grau de adesão ao tratamento antiviral, e predizer o desfecho clínico do paciente (carga viral de VHB detectável ou indetectável), além de ser uma ferramenta diagnóstica útil na prática clínica, para uso na língua portuguesa / Background: Evidence shows that chronic infection treatment for hepatitis B virus (HBV) can suppress the viral load, which should be as low as possible. Treatment adherence is among the factors directly linked to therapeutic success. Several adherence assessment instruments are available, but there is not one validated yet for use in chronic hepatitis B. This study included the adaptation of CEAT-VIH (Remor, 2002) for chronic hepatitis B patients; it evaluated the reliability and validity evidence of the adapted questionnaire (named CEAT-VHB). Methods: This is a cross-sectional study that evaluated 183 patients with chronic HBV infection in treatment for at least three months with adefovir, entecavir, lamivudine and / or tenofovir. Socio-demographic information was collected and patients answered the adapted questionnaire (\"Assessment of adherence to antiviral therapy questionnaire for chronic hepatitis B patients\", CEAT-VHB) and Morisky test. The HBV viral load was compiled directly from medical records. The evaluation of reliability (internal consistency) for CEAT-VHB was tested through Cronbach\'s alpha value. Evidence of validity of the adapted questionnaire was established through the criterion and construct validities. The criterion validity and construct type convergent were tested by correlation of measurements obtained with the results of the Morisky test and HBV viral load level. Results: The CEAT-VHB was shown with good acceptance in the form of structured interview addressed. The CEAT-VHB reliability showed good internal consistency in the overall score of the questionnaire (Cronbach\'s alpha = 0.734). Negative and significant correlation was good (r = -.615, p < 0.001) of the domain \"degree of compliance to antiviral therapy\" with the Morisky test and moderate negative correlation (r = -.417, p < 0.001) of the domain \"variables for non- adherence\" with HBV viral load level. In the construct discriminative capacity, the patients were stratified according to clinical outcome (detectable or undetectable HBV viral load), which demonstrated a statistically significant difference (p < 0.001). The ROC curve was used to calculate sensitivity and specificity of the CEAT-VHB. As seen in construct discriminative capacity, which scores greater than or equal to 80 detect treatment adherence, necessary for the prediction of an undetectable HBV viral load, it was set the cut-off value of 80.50. Thus, it was find a value of 81.43% for sensitivity and specificity of 67.26%. The CEAT-VHB identified 43.2% (79) patients in non-adherence for antiviral treatment. Conclusions: The CEAT-VHB is an instrument of good reliability, with validity and discrimination adequate to measure the degree of adherence to antiviral therapy, and predict the clinical outcome of patients (detectable or undetectable HBV viral load), besides being a useful diagnostic tool in clinical practice, for use in Portuguese

Varfarina é o anticoagulante oral prescrito com maior frequência, no entanto há difi-culdades em seu manejo na prática clínica. Embora tenha eficácia bem estabelecida é considerado um medicamento potencialmente perigoso, que está associado a erros de medicação fatais na atenção primária à saúde. Para garantir a segurança do paciente, seu uso requer o monitoramento dos níveis de anticoagulação, sendo importante a ade-são ao tratamento e a informação dos pacientes quanto aos cuidados durante o trata-mento. O objetivo do presente estudo foi verificar o nível de informações dos pacien-tes quanto à prescrição, o nível de informações prestadas pela equipe de saúde aos pa-cientes, a adesão ao tratamento e os níveis de controle da anticoagulação através do valor do Coeficiente Internacional Normatizado (INR). Foi realizado estudo transver-sal, a partir de uma coorte prospectiva, com 60 pacientes atendidos na atenção primá-ria à saúde no município de Ijuí, utilizando-se questionário para verificar o nível de informação prestada aos pacientes pela equipe de sáude, a Escala de Adesão Terapêu-tica de Morisky de Oito Itens para verificar a adesão, e o exame do tempo de protrom-bina para verificar o valor INR. De acordo com os critérios adotados, verificou-se um nível insuficiente de informações prestada pela equipe de saúde, baixa adesão ao tra-tamento, com a maioria dos pacientes fora do intervalo terapêutico adequado. Verifica-se a necessidade de melhoria da qualidade das informações prestadas aos usuários, incentivo da adesão ao tratamento e melhor monitoramento da anticoagulação visando à segurança do paciente. / Warfarin is the oral anticoagulant most frequently prescribed, although is difficult handling warfarin in clinical practice. It’s has a well-established efficacy, but is con-sidered a potentially dangerous drug, and in primary health care is associated with fatal medication errors. To ensure patient safety, its use requires requires anticoagulation levels monitoring ,, so medication adherence and care information’s about anticoagula-tion therapy are important. The aim of this study was to verify the information level about the prescription, information level provided by the health care team, medication adherence and anticoagulation control levels by the International Normalized Ratio (INR) value. A cross-sectional study, from a prospective cohort, was realized with 60 patients seen in primary health care in Ijuí city, a questionnaire was use to check the information level to the patients by the health team, Eight Item Morisky Medication Adherence Scale was use to verify adherence, and prothrombin time exam was use to check the INR value. According to the criteria adopted, was observed insufficient in-formation level provided by health care team, poor adherence to treatment and most patients was out of the therapeutic range. It’s necessary improve the quality of infor-mation provided to the patients, promote medication adherence and improve the anti-coagulation monitoring for patient safety in the treatment.

Introdução: A adesão ao tratamento da hepatite B crônica na vida real tem sido pouco estudada em todo o mundo. Neste estudo, foram avaliados os desfechos virológicos e de adesão ao tratamento antiviral de longo prazo em pacientes monoinfectados com hepatite B crônica. Métodos: Trata-se de um estudo prospectivo de coorte com pacientes portadores de hepatite B crônica (n = 183), tratados com adefovir, entecavir, lamivudina e / ou tenofovir, realizado em um centro de referência terciário brasileiro. A adesão ao tratamento foi avaliada por um questionário validado, denominado CEAT-HBV, em três momentos (2010/2011, 2013/2014 e 2014/2015). As variantes de resistência às drogas para hepatite B e a farmacocinética de um único ponto foram determinadas por sequenciamento e cromatografia líquida com espectrômetro de massa em tandem, respectivamente. Resultados: CEAT-HBV identificou 79/183 (43%) pacientes em não-adesão ao tratamento antiviral e entre esses, 53/79 (67%) tinham maior frequência de HBV DNA positiva. Porém, 38% (70/183) tiveram carga viral positiva sugerindo não resposta ao tratamento. As mais frequentes variantes de resistência aos antivirais foram M204I/V (78%), L180M (59%), L80I (15%), V173L (7%) e Q215H (6%). As principais causas associadas com a ausência de resposta ao tratamento antiviral foram variantes de resistência às drogas (39%), variantes de resistência às drogas e não adesão (23%), não adesão (13%), duração de tratamento insuficiente (10%), e indeterminada (16%). A farmacocinética de dose única indicou 48% (31/65) de não adesão ao antiviral. Dois anos depois da primeira avaliação, o CEAT-HBV indicou que 101/143 (71%) pacientes estavam em adesão ao tratamento, baseado na análise da população per-protocol. Entretanto, 21% (40/183) dos pacientes não puderam ser avaliados e foram excluídos. As principais razões para exclusão foram óbito (20/183), 11 dos 20 óbitos causados pelo carcinoma hepatocelular, perda de seguimento (16/183) e outras (4/183). Todos os participantes receberam nesse momento uma cartilha para orientação do tratamento. A terceira avaliação do CEAT-HBV (2014/2015) mostrou que 112/135 (83%) pacientes estavam em adesão ao tratamento (população per-protocol) e 8/143 (6%) foram excluídos. Desfechos de longo prazo mostraram que a taxa de adesão baseado no CEAT-HBV continua a aumentar após 4 anos (p < 0,001). Conclusões: Nossos dados realçam a importância do monitoramento da avaliação de adesão à terapia para hepatite B crônica. Desfechos de adesão de longo prazo podem ser dinâmicos e é possível aumentar a taxa de migração para o grupo com adesão/HBV DNA negativa / Background: Chronic hepatitis B (CHB) real-life treatment adherence has been poorly studied worldwide. In this study, it was evaluated long term virological and adherence outcomes regarding antiviral treatment in monoinfected CHB patients. Methods: A prospective cohort study with CHB patients (n=183) treated with adefovir, entecavir, lamivudine and / or tenofovir was performed in a Brazilian reference tertiary center. Treatment adherence was evaluated by a validate questionnaire named CEAT-HBV within three year-periods (2010/2011, 2013/2014 and 2014/2015). HBV drug resistance variants and single-dose pharmacokinetics were determined by sequencing and LC-MS/MS, respectively. Results: CEAT-HBV identified 79/183 (43%) patients with non-adherence to antiviral treatment and among them, 53/79 (67%) were more frequently viral load positive. However, 38% (70/183) had positive viral loads suggesting treatment non-response. Most frequent antiviral resistance variants were M204I/V (78%), L180M (59%), L80I (15%), V173L (7%) and Q215H (6%). The main causes associated with nonresponse to antiviral treatment were drug resistance variants (39%), drug resistance variants and nonadherence together (23%), non-adherence (13%), insufficient treatment duration (10%), and undetermined (16%). Single-dose pharmacokinetics indicated 48% (31/65) antiviral non-adherence. Two years after the first assessment, the CEATHBV indicated that 101/143 (71%) patients were adhered treatment, on basis of an analysis of the per-protocol population. However, 21% (40/183) of the patients could not be evaluated and were excluded. The main reasons for exclusion were death (20/183), 11 out 20 deaths due to hepatocellular carcinoma, loss to follow up (16/183) and others (4/183). HBV booklet was used for medical education. The third CEAT-HBV assessment (2014/2015) showed that 112/135 (83%) patients were on treatment adherence (per-protocol population) and 8/143 (6%) were excluded. Longterm evaluation showed that adherence rate based on CEAT-HBV continue to increase after 4-years (p < 0.001). Conclusions: Our data highlights the importance of CHB therapy adherence assessment monitoring. Long-term adherence outcomes may be dynamic and it is possible to increase the migration rate to adherence/HBV DNA negative group