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)

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)

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

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)

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)

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

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.

This dissertation attempts to explain why cross-national variation exists in government approaches to dealing with illegal drugs. As other scholars have shown, several domestic and international political factors do account for some of this variance. However less is known of the effect that bureaucratic dominance and political institutions may have on drug policy. This research argues that bureaucrats define problems in ways that make their services the best possible solution to policymakers. Mediating the ability of bureaucrats to influence drug policy outcomes are political institutions. Certain institutional structures foster a competitive policymaking environment while others foster a more cooperative policymaking environment. In the former of these, law enforcement approaches to the drug problem are often retained as the status quo because competition between policy actors prevents consideration of alternatives. In the latter environment however, prevention, treatment, and harm reduction approaches to the drug problem are developed because cooperation between policymakers allows other actors. namely public health bureaucrats.to influence drug policy decision making. To test this argument, I constructed an original dataset that includes over 4,000 observations of drug policy in 101 democracies. Institutional data on intergovernmental relations, regime type, political bargaining, electoral design, and cameralism were regressed on 6 different drug policy indices: law enforcement, deterrence-based prevention, abstinence-based treatment, educationbased prevention, substitution-based treatment, and harm reduction. While controlling for government resource capacity, severity of the drug problem, international pressure, and political ideology, I found that institutions explain a portion of the variance in drug policy outcomes. Providing in-depth information about these phenomena is a large amount of field data I collected while interviewing 155 politicians, bureaucrats, interest group leaders, and service providers. Respondents from all four of the case countries examined in this research.including United States, Canada, Austria, and Netherlands.report that bureaucrats play a major role in the formation of drug policy. Which bureaucrats have the most influence on policymakers is largely a function of domestic political conditions, international political factors, and political institutions.

Queer-identified women in Canada and elsewhere are underserved as a community with regard to the provision of support for drug use related problems. In order to provide much needed inclusive support services, researchers, policy makers and treatment providers must recognize and act on the interface of oppression with substance use in populations of queer women. The homophobia and heterosexism endemic to our society is an issue that necessitates the exploration, development, and inclusion of responsive policies and services for queer women who seek - or desire to seek - support for problematic substance use. This research study explores the support needs of queer-identified women who experience difficulties as a result of drug use. Through qualitative, interview-based research, my inquiry examines responses to the question: What are the support needs of women who are impacted by the confluence of heteronormativity and problematic drug use? Data are derived from nine, semi-structured in-depth interviews with women in the Vancouver Island and Lower Mainland areas of British Columbia. The methodological framework incorporates a critical feminist approach. A thematic analysis technique was utilized to analyse the interviews, with data categorized into three primary themes of discrimination, resistance, and support. Findings indicate that queer women require distinct support services for problematic substance use issues in an effort to redress systemic heteronormativity.