Background: Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control. Methods: In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ≧18 years completed a standardized assessment including a laboratory screening, questionnaires, and diagnostic measures. Subsequent to baseline (t0), patients were tracked over a period of 12 months (t1). Depression was assessed according to DSM-IV and ICD-10 criteria. Glycemic control was determined by levels of glycosylated hemoglobin (HbA1c); a level of ≧7% was judged as unsatisfactory. Regression analyses were performed to analyze the prospective relationship between depression, medication adherence, diabetes-related health behavior, and HbA1c. Results: Patients with depression at t0 revealed increased rates of medication nonadherence (adjusted OR: 2.67; CI: 1.38–5.15) at t1. Depression (adjusted regression coefficient: β = 0.96; p = 0.001) and subthreshold depression (β = 1.01; p < 0.001) at t0 also predicted increased problems with diabetes-related health behavior at t1. Adjusted ORs for poor glycemic control (HbA1c ≧7%) at t1 were also increased for patients with baseline depression (2.01; CI: 1.10–3.69). However, problems with medication adherence as well as problems with diabetes-related health behavior at t0 did not predict poor glycemic control at t1. Conclusions: In a prospective representative study of patients with type 2 diabetes, baseline depression predicted problems with medication adherence, problems with health-related behaviors, and unsatisfactory glycemic control at follow-up.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-30T11:38:09Z No. of bitstreams: 1 elisadeoliveiramarsicano.pdf: 1820352 bytes, checksum: fc21554f216954440f19500eb4bf4483 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-07-05T16:33:03Z (GMT) No. of bitstreams: 1 elisadeoliveiramarsicano.pdf: 1820352 bytes, checksum: fc21554f216954440f19500eb4bf4483 (MD5) / Made available in DSpace on 2016-07-05T16:33:03Z (GMT). No. of bitstreams: 1 elisadeoliveiramarsicano.pdf: 1820352 bytes, checksum: fc21554f216954440f19500eb4bf4483 (MD5) Previous issue date: 2012-08-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Doença Renal Crônica (DRC) constitui hoje um importante problema médico e de saúde pública. O transplante renal é, atualmente, a melhor opção terapêutica para o paciente com DRC, tanto do ponto de vista médico, quanto social ou econômico. Para proporcionar maior segurança terapêutica e controle de complicações clínicas e cirúrgicas existem estratégias que são fundamentais. Uma questão considerada relevante é a não aderência (NA) ao uso das medicações e ao tratamento proposto. A aderência é definida como o grau de concordância entre o comportamento de um paciente em relação às orientações do médico e/ou de outro profissional da saúde. É um fenômeno multidimensional que envolve fatores determinados por questões socioeconômicas, pelo sistema de saúde, pelos profissionais de saúde, por fatores relacionados à terapia e ao paciente. Para o diagnóstico da NA podemos utilizar métodos diretos e indiretos. Este estudo teve como objetivos adaptar e validar para a população de transplantados brasileiros o instrumento The Basel AssessmentofAdherencewithImunossupressiveMedicationScale (BAASIS), utilizando uma amostra de transplantados renais atendidos no ambulatório do Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia da Universidade Federal de Juiz de Fora (Niepen), determinar a frequência de NA na população estudada, avaliada através do emprego três métodos diagnósticos e avaliar a associação entre os fatores de risco e a presença de NA. Trata-se de um estudo transversal onde foram analisados 100 pacientes transplantados renais com mais de um ano de transplante em acompanhamento ambulatorial no Niepen. A adaptação cultural foi realizada utilizando o protocolo de Guillemin (i.e. tradução, retrotradução, análise por comitê de especialistas e pré-teste). Para verificação das propriedades psicométricas foram aplicados os testes de reprodutibilidadeintra e interobservador, alfa de Cronbach, correlação do BAASIS com a Medida de Aderência ao Tratamento – MAT e análise fatorial. Além de análise univariada e multivariada para os fatores associados a NA. Os pacientes foram classificados em dois grupos: aderentes e não aderentes através da utilização de três métodos diagnósticos (BAASIS, opinião dos profissionais e nível sangúineo dos imunossupressores) e as condições associadas aNA foram coletadas através de um questionário e do prontuário. A média de idade dos pacientes foi de 45±13,5 anos, 65% eram homens e 89% receberam o enxerto de um doador vivo. O instrumento BAASIS foi adaptado transculturalmente para língua portuguesa sem dificuldades. Em relação às propriedades psicométricas, encontramos baixa variância, de 0,007 e 0,003 nos testes de reprodutibilidade intra e interobservador; a correlação com o MAT foi de 0,65; cargas fatoriais aceitáveisdas três primeiras questões do BAASIS (r=0,76; r=0,80, and r=0,68), e alfa de Cronbach de 0,7. 51% dos pacientes foram considerados não aderentes utilizando-se três métodos para avaliar a aderência ao tratamento imunossupressor. As variáveis relacionadas com a NA foram: residir a mais de 100 km do centro transplantador (54,9 vs. 38,8%, p<0,07), renda familiar maior que 5 salários mínimos (21,6 vs. 4%, p<0,009), e ter acesso a exames por seguro de saúde (35,3% vs. 18,4%,p<0,01). No modelo de regressão logística apenas renda familiar maior que cinco salários foi fator de risco para NA (OR 5,0 IC:1,01 - 25,14; p<0,04). Os resultados demonstraram que a BAASIS apresenta boas propriedades psicométricas, e este estudo viabliza o seu uso na prática clínica e em pesquisas sobre aderência em TxR. Nesta amostra, as variáveis associadas com a NA foram relacionadas às condições socioeconômicas: morar distante do centro transplantador, melhor renda familiar e ter acesso a exames por seguro de saúde. Ressaltamos que este é o primeiro estudo brasileiro com metodologia adequada sobre fatores de risco e frequência de NA no pós TxR. / Chronic Kidney Disease (CKD) is now an important medical and public health problem. Kidney transplantation is currently the best therapeutic option for patients with CKD, both from the medical, the social or economic´s points of view. To promote safety and therapeutic control of clinical and surgical complications, some strategies are fundamental. An issue that is considered very important is nonadherence (NA) to the use of medications and the proposed treatment. Adherence is defined as the degree of agreement between the behavior of a patient in relation to the advice of the physician and/or other healthcare professional. It is a multidimensional phenomenon that involves factors determined by socio-economic issues, the health system, health professionals, factors related to therapy and to the patient. For the diagnosis of NA we can apply direct and indirect methods. This study aimed to validate to the Brazilian transplant population the instrument “The Basel Assessment of Medication Adherence with Imunossupressive Scale” (BAASIS), using a sample of renal transplant patients, form the outpatient clinic of the NúcleoInterdisciplinar de Estudos e PesquisasemNefrologia da Universidade Federal de Juiz de Fora (Niepen),to assess the frequencyof NAin the studied population, evaluatedby employingthree diagnostic methodsand to evaluate theassociation betweenrisk factorsand the presence ofNA. This is a cross-sectional study of 100 renal transplant recipients with more than one year of transplant, followed as an outpatient at Niepen. The BAASIS (English version) was transculturally adapted and psychometric properties were assessed. Transcultural adaptation was performed using the Guillemin protocol (i.e. translation, back translation, analysis by an expert committee, and pre-testing). Psychometric testing included intra and inter observer reproducibility,Cronbach’salpha,correlation between BAASIS and Measure of Adherence to Treatment and factorial analysis. In alsounivariate and multivariate analyzes for factors associated with NA. Patients were classified into two groups: adherent and non-adherent using three diagnostic methods (The BAASIS, the professionals' opinion and imunossupressivesblood levels) and the conditions associated with NA were collected from a questionnaire and medical files. The mean age of patients was 45 ± 13.5 years, 65% were men and 89% received a graft from a living donor. On testing the psychometric properties of reliability, intra-observer reproducibility showed a variance of 0.007, with inter-observer reproducibility having a variance of 0.003, suggesting preciseness was achieved. For Validity, in construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r=0.76; r=0.80, and r=0.68). For criterion validity, the adapted BAASIS was correlated with another self-reporting instrument – Measure of Adherence to Treatment (MAT) and showed good congruence/correlation (r=0.65). Cronbach's alpha was0.7. 51% of patients were considered nonadherente using three methods to assess adherence to immunosuppressive treatment. Variables related to NA were: living more than 100 km from the transplant center (54.9 vs. 38.8%, p<0.07), family income higher than five minimum wages (21.6 vs. 4%, p<0.009), and access to lab tests from health insurance (35.3% vs. 18.4%, p<0.01). In the logistic regression model only low family income higher than five minimum wages was a risk factor for NA (OR 5.0 CI: 1.01 to 25.14, p<0.04). The results showed the BAASIS has good psychrometric properties and this study enables its use in clinical practice and in researches on adherence in kidney transplant. In this sample, the variables associated with NA were related to socioeconomic conditions: living far from the transplant center, better income and having access to private health insurance. We emphasize that this is the first Brazilian study, with appropriate methodology, on risk factors and frequency of NA post kidney transplantation.

No description available.

Le port d’un corset orthopédique de 20 à 23 heures par jour est reconnu comme efficace pour prévenir la progression de la courbe chez les adolescents atteints de scoliose idiopathique, mais il engendre des conséquences biopsychosociales importantes qui perturbent leur quotidien et qui contribuent à un problème de non-adhésion au corset généralisé. En effet, le temps de port réel observé est d’environ 12 heures par jour. Il n’existe aucune intervention dans la littérature qui vise à améliorer l’adhésion au corset pour cette population spécifique. Le but de ce mémoire était de concevoir un modèle interprofessionnel d’interventions de soutien à l’adhésion au traitement par corset chez les patients atteints de scoliose idiopathique. Pour répondre à ce but, nous avons effectué des entrevues individuelles auprès de neuf professionnels d’expertises variées afin de comprendre leurs perspectives et leurs stratégies potentielles pour soutenir les patients vers une meilleure adhésion au corset. Les entrevues ont été enregistrées, transcrites et codées. Nous avons procédé à l’analyse thématique des verbatim et conçu le modèle d’intervention résultant. Lors des entrevues, les participants ont relevé des barrières à l’adhésion au corset et au soutien professionnel ainsi que des stratégies fonctionnelles, éducatives, motivationnelles, psychologiques et interprofessionnelles pour répondre à ces barrières. Le modèle a été validé par un panel d’experts cliniques. Le modèle d’intervention Interprofessionnel en Soutien à l’Adhésion (IPSA) au traitement par corset est structuré en trois paliers (préparation au corset, ateliers de groupe et consultation individuelle) et nous estimons qu’il a un grand potentiel d’implantation en clinique de scoliose. / Wearing a spinal brace between 20 to 23 hours a day is recognized as effective to prevent curve progression in adolescents with idiopathic scoliosis, but it generates important biopsychosocial consequences that disturb patients’ daily activities and that contribute to the generalized problem of brace nonadherence. Indeed, the observed time spent in-brace is approximately 12 hours a day. A thorough review of the literature could not yield any intervention to enhance brace adherence for this specific population. The purpose of this master’s thesis is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with idiopathic scoliosis. To fulfill this purpose, we have conducted individual interviews with 9 professionals of various expertise in order to understand their perspectives and their potential strategies to support patients towards better brace adherence. The interviews were audiotaped, transcribed and coded. We proceeded to a thematic analysis of the interview transcripts, which resulted in the intervention model. During the interviews, participants mentioned adherence barriers to brace treatment and professional support barriers as well as functional, educational, motivational, psychological and interprofessional teamwork strategies for answering these issues. The model was reviewed by an expert panel of clinicians. The Interprofessional Adherence Support intervention model (IPAS) to brace treatment is three-tiered to provide different levels of intensity of support to patients (brace preparation, group workshops and one-on-one consultations) and has great potential for implementation in clinical practice.

Made available in DSpace on 2011-05-04T12:42:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Os objetivos dessa tese foram: Descrever os determinantes de acesso aserviços de saúde por idosos em uma perspectiva de gênero; Determinar a prevalência e os fatores associados à não utilização de mamografia pela população feminina; Identificar os motivos para nunca ter realizado exame mamográfico e os fatores predisponentes, habilitadores e reforçadores associados com cada categoria de motivo, identificando o papel das características contextuais nesse processo. Foram elegíveis para estudo indivíduos com 60 ou mais anos de idade, residentes no município de Juiz de Fora que compareceram a um posto de vacinação do município no período da Campanha Nacional de Vacinação Contra Gripe de 2006. Os principais resultados mostraram perfil social e de saúde similar ao descrito para a população brasileira, Pior auto-avaliação da saúde, maior proporção de morbidade, mais uso de medicação e maior proporção e freqüência deconsultas médicas entre as mulheres. Foi observada prevalência de não utilização de mamografia de 27,9 por cento nessa população, associada à idade avançada, à baixa escolaridade, à ausência de relação conjugal e à não realização de consultas com ginecologista e de exame de Papanicolaou. As principais razões apontadas pelas mulheres para nunca terem se submetido ao exame mamográfico foram Não acha necessário fazer mamografia; Não ter recebido recomendação médica para fazer mamografia e Afetos negativos. / The objectives of this study were: To describe the determinants of access to health services for older people in a gender perspective; to determine the prevalence and the factors associated with non-use of mammography by women; to identify the reasons for never having been submitted to mammography and the predisposing, enablers and reinforcing factors associated to each category of reasons, and to identify the role of contextual characteristics in this process. Subjects with 60 or more years old, living in Juiz de For a and who attended a vaccination station in the city during the National Immunization Campaign Against Influenza of 2006 were eligible for study. The main results showed social and health profiles similar to that described for the Brazilian population. Women had poorer self-rated health, higher proportion of morbidity and use of medication and a higher proportion and frequency of medical visits compared to men. The prevalence of non-use of mammography in this population was 27,9%, and advanced age, poor education, lack of marital relationship, lack of Pap smear and no consultations with gynecologists were associated to a higher risk of non-use. The main reasons why women have never undergone mammography were "Having no need of a mammogram", "Not having received medical advice to have a mammogram" and “Having negative affects in relation to mammograms”.

Made available in DSpace on 2011-05-04T12:42:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Os medicamentos são um instrumento terapêutico importante no cuidado à saúde do idoso. No entanto, devido a motivos financeiros, estima-se que um quarto dos indivíduos deste grupo populacional subutiliza os tratamentos prescritos. A subutilização é uma forma de não adesão, que ocorre quando o indivíduo não faz uso dos medicamentos prescritos ou reduz as doses ou a freqüência de uso, comportamento que pode levar a hospitalizações, incapacidades e morte. Os objetivos deste trabalho foram estimar a prevalência e identificar a influência defatores sócio-demográficos, econômicos, relativos à saúde, à percepção de capital social e ao sistema de saúde na subutilização por motivos financeiros entre idosos residentes em duas comunidades localizadas no Estado de Minas Gerais, Brasil (Região Metropolitana de Belo Horizonte - RMBH e Bambuí). A prevalência da subutilização para indivíduos acima de 60 anos, residentes na Região Metropolitana de Belo Horizonte, foi de 12,9 por cento, estando independentemente associada à filiação a plano privado de saúde, à freqüência com que o profissional de saúde esclareceu sobre a saúde / tratamento, à auto-avaliação de saúde, ao número de condições crônicas, à percepção de coesão ao bairro de moradia e ao número de contatos sociais. Já para o subgrupo de mulheres acima de 70 anos, a prevalência da subutilização foi de 11,4 por cento para aquelas que residem na RMBH e de 5,4 por cento para as residentes da cidade de Bambuí. Os fatores independentemente associados à subutilização na RMBH foram a autoavaliação de saúde, a capacidade funcional e a percepção de ajuda. Em Bambuí, os fatores independentemente associados à subutilização foram a percepção de coesão ao bairro de moradia e a percepção do ambiente físico. Os resultados evidenciam uma situação de risco para indivíduos em piores condições de saúde e confirmam a importância dos aspectos sócio-econômicos para a subutilização pormotivos financeiros. Além disso, indicam também que a determinação dessa subutilização está ligada à qualidade da comunicação médico-paciente e ao contexto social no qual o indivíduo está inserido, sendo este último aspecto especialmente relevante para as mulheres idosas. / Cost-related medication nonadherence (CRN) is an important and recognized issue for older people. Recent studies have documented that up to one-quarter of seniors reported underusing prescription medicines due to financial barriers. This behavior, which includes unfilled prescriptions, reduced frequency or lowered dosage of prescription medicines, is associated with increased risk of declining health and higher rates of hospitalization in the elderly population. The aim of this study was to estimate the prevalence of cost-related medication nonadherence and to evaluate the associations between CRN with socio-demographic and economic status, health related characteristics and perceived social capital and health system characteristics among elderly individuals residing in two communities located in Minas Gerais State, Brazil (Greater Metropolitan Belo Horizonte and Bambuí). The prevalence of CRN among elderly individuals (age ≥ 60) was 12.9%. Health plan coverage, frequencies of physician-patient dialogue about health/treatment, self-rated health, multiple comorbidities, perception of attachment to the neighbourhood and social contacts were the variables most strongly related to CRN. For elderly women (age ≥ 70) residing in the GMBH, the prevalence of CRN was 11.4% and for those residing in Bambuí, this rate was 5.4%. Among GMBH residents in poor or very poor health status, any ADL limitation and no perception of help had the strongest effect on the likelihood of CRN. In contrasting, a high perception of attachment to the neighborhood and a high perception of physical environment significantly decreased the likelihood of CRN among Bambuí residents. Our results suggest that the pronounced risk of cost-related underuse among elderly in poor health is especially worrisome. Additionally, our results also suggest adherence problems within this population are due to a communication gap between seniors and physicians in respect to treatment and to the lack of health plan coverage. Social capital explains to some extent adherence problems within this population, especially for older women.