Bakgrund: Diabetes är sjukdom som kan leda till sänkt livskvalitet och lidande för personen som drabbats men även till höga kostnader för samhället. Behandlingen kan bestå av en kombination av läkemedel och livsstilsförändringar, där sjuksköterskan stödjer vårdtagarna genom att undervisa och främja deras empowerment. Forskning visar att det är vanligt förekommande att personer med diabetes har låg följsamhet till sin behandling vilket kan leda till sämre blodsockerkontroll samt ökad risk för diabetesrelaterade komplikationer. Syfte: Syftet var att beskriva faktorer som påverkar följsamheten till behandling vid diabetes typ 2. Metod: En litteraturöversikt där tolv kvantitativa artiklar sammanställdes. Resultat: Högre ålder verkar vara en faktor som främjar följsamheten medan lägre ålder innebär lägre följsamhet. Vårdtagarens uppfattning om sjukdomen och behandlingen visade sig också påverka följsamheten. Personens förmåga att ta läkemedel påverkade följsamheten, där minnesproblematik framstår som ledande orsak till låg följsamhet. Socialt stöd och delaktighet i behandlingen samt patientundervisning är andra faktorer som främjar följsamheten. Slutsats: Litteraturstudien visar på faktorer som sjuksköterskan kan uppmärksamma för att identifiera personer som har risk för låg följsamhet och tidigt sätta in åtgärder. Undervisning och stöd är omvårdnadsåtgärder som skulle kunna påverka vårdtagarnas följsamhet positivt. / Background: Diabetes means lower quality of life amongst the ones that suffer from the disease and it also means high costs for society. The treatment consists of a combination of drugs and lifestyle changes where the nurse supports the patient by providing patient education and promoting empowerment. Research has shown that diabetes patients have a low adherence to treatment which may lead to poorer glucose control and an increased risk of diabetesrelated complications. Purpose: The purpose was to describe factors that contributes to non-adherence in persons that are treated for diabetes type 2. Method: A literature review where twelve quantitative articles where analyzed. Results: Older age seems to be a factor that contributes to adherence while younger age seems to predict non-adherence. The persons view and understanding of the disease and treatment seems to influence the adherence. The ability to take medication seems to be important, with memory problems as a leading cause for non-adherence. Social support, patient participation and patient education are other factors that promotes adherence. Conclusion: This literature review shows factors that can be used by the nurse to identify persons in risk of non-compliance and thereby take action early. The nurse’s measures, such as education and support, may have a positive impact on adherence to treatment.

Bakgrund: Sveriges befolkning blir allt äldre och behovet av vård och omsorg ökar, vilket kan leda till ökad risk för vårdskador, onödiga väntetider och annat som leder till ökade kostnader. Tidigare forskning har visat på att e-hälsa kan användas för att minska denna risk. Syfte: Syftet var att undersöka effekten av e-hälsa för äldre personer. Metod: En litteraturöversikt med adherence som teoretisk utgångspunkt har genomförts. 16 stycken artiklar med kvantitativ design har analyserats. Resultat: Resultatet visade på förbättrad hälsa och kognitiv förmåga, ökad delaktighet och kvalitet i vården samt minskade antal sjukhusvistelser och dödsfall. Slutsats: Resultatet kan bero på den ökade tillgängligheten och kostnadseffektiviteten samt att upplevelsen av e-hälsa var positiv. Därför bör information om e-hälsa spridas, och det bör användas och anpassas för äldre personer inom samtliga delar och nivåer av vården; under alla vårdutbildningar, på sjukhus och vårdcentraler, inom kommuner och regioner samt nationellt såväl som internationellt. / Background: The Swedish population is getting older and the need for care is increasing, which can lead to increased risk of health care injuries, unnecessary waiting times and other things that lead to increased costs. Earlier research has shown that e-health can be used to reduce this risk. Aim: The aim was to study the effect of e-health on elderly people. Method: A literature review with the term adherence as a theoretical starting point was conducted. 16 articles with quantitative design have been analyzed. Result: The result showed improved health and cognitive ability, increased participation and quality of care as well as reduced number of hospital stays and deaths. Conclusion: This result may be due to increased accessibility and cost-effectiveness and that the experience of e-health was positive. Therefore, information about e-health should be spread, and it should be used and adapted for elderly people in all parts and levels of care; during all health care educations, at hospitals and health centres, within municipalities and regions and both nationally and internationally.

Charles University, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Author: Eliška Voříšková Supervisor: PharmDr. Kateřina Malá, Ph.D. Consultant: Mgr. Barbora Košťálová Title of thesis: CONSENSUS OF CZECH TERMINOLOGY IN THE FIELD OF MEDICATION ADHERENCE BACKGROUND: The terminology of medication adherence has undergone a vast change over the last 50 years. As individual terms have not become established, they are often misused and interchanged between each other. The aim of this work was to analyze the Czech literature and to establish a consensus in the field of terminology of medication adherence using Delphi round survey. METHODS: For Czech language, a search of literature released before January 6th, 2021 in databases Solen, ProLékaře.cz, BMČ and PubMed was reviewed. There were 122 articles published between 1998-2020, themed on the medication adherence. Based on the review, a questionnaire for three-round Delphi survey was created as well as a list of panelists invited in the survey. The survey was online, anonymous and contained questions about translation of 7 terms and their definitions established by the English document so-called ABC Taxonomy. RESULTS: In the 1st round of the Delphi survey, 106 panelists were contacted, 46 of whom responded. A consensus on...

BACKGROUND: Adherence to TB treatment and therefore treatment success could be improved using digital adherence technology. OBJECTIVE: To evaluate the effectiveness of a medication event reminder monitor system (MERM) on treatment success and treatment adherence in patients with drug-susceptible pulmonary TB in Perú. METHODS: This was an experimental, randomised, open-label, controlled study conducted among patients in the second phase of TB treatment. The intervention group received their medications through MERM with the support of a treatment monitor, whereas the control group used the usual strategy. Participants were followed until they completed the 54 doses of the second phase of treatment. RESULTS: The study included 53 patients in each group; four in the intervention group withdrew from the study. Treatment success was significantly more frequent in the MERM group (RR 1.15, 95% CI 1.02–1.30; P = 0.0322). There was no significant difference in the adherence outcomes; however, the percentage of patients who missed at least one dose and patients with more than 10% of total doses missed were lower in the intervention group. CONCLUSION: The use of MERM in the second phase of treatment showed a significant improvement in the treatment success rate in patients with drug-susceptible pulmonary TB. / National Institutes of Health / Revisión por pares

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Mycobacterium tuberculosis is responsible for nearly three million human deaths every year. Understanding the mechanisms and bacterial factors responsible for M. tuberculosis' ability to cause disease in humans is critical for the development of improved treatment strategies. Using negative staining and transmission electron microscopy it was discovered that mycobacteria, including the human pathogen M. tuberculosis, produce fine surface structures known as pili. Mass spectroscopy analysis demonstrated that purified pili from M. tuberculosis are comprised of protein subunits encoded by the predicted M. tuberculosis H37Rv ORF designated Rv3312A. These pili termed M. tuberculosis pili, Mtp, are highly aggregative 2-5 nm diameter fibers and are recognized by IgG antibodies contained within TB patient sera. These results indicate that Mtp are produced during human infection. Mtp bind to the extracellualr matrix protein laminin in vitro suggesting that Mtp are a newly identified adherence factor for M. tuberculosis.A second pili morphotype that appeared as rope-like bundles were observed for M. tuberculosis and it was found that the M. tuberculosis chromosome contains a type IVB pili gene cluster. The M. tuberculosis type IV pili belong to the Flp sub-family of type IVB pili. RT-PCR analysis reveals that flp is expressed by M. tuberculosis and IF microscopy with Flp-specific antibodies shows the Flp protein is secreted from the bacteria. Evidence presented herein also demonstrates that an Flp-derived peptide is capable of polymerizing into pili-like fibers in vitro over a pH range of 4.5-7.5. Further studies show that the M. tuberculosis type IV pili are encoded by a novel 5-kb genomic island that contains the flp prepilin and putative biogenesis genes. The flp genomic island is characterized by an increased G+C content of 70% (the mean G+C content of the M. tuberculosis chromosome is 65%) and is flanked by multiple direct repeats. The identification of type IV pili in M. tuberculosis is the first report of any classical virulence factor for the bacillus and the genetic characteristics of the locus strongly suggest this chromosomal region was horizontally acquired.

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Magister Public Health - MPH / Background: Over the past decade, South Africa has scaled-up its antiretroviral treatment (ART) programme in an effort to control the HIV epidemic. Interventions to support the rollout of ART include task shifting ART initiation to nurses at primary health care level and ensuring HIV adherence counselling at every visit by lay counsellors. Furthermore, community-based outreach teams work at the community level to follow up on patients and ensure that patients remain in care and are adhering to ART. Despite all these efforts, poor adherence to ART remains a pertinent problem. In 2016, the national adherence to ART rate among adult patients was estimated at 35% compared to 39% in Pule Sefatsa clinic in Mangaung district, Free-state Province. Aim: The aim of the study was to explore the factors that influence poor adherence to ART among patients receiving ART at Pule Sefatsa primary health care clinic in Mangaung district, South Africa. Methodology: A descriptive qualitative research approach was used. Two focus group discussions were conducted with health workers and community caregivers and 16 in-depth interviews were conducted with ART patients who are in care and those who had defaulted on their treatment. Audio recorded data obtained from these sources were transcribed verbatim and prepared for analysis. Thematic analysis was used for data analysis and the results were classified under various categories. Findings: Adherence to ART in Pule Sefatsa clinic was found to be influenced by medical related factors, socio-economic factors, health system factors and individual factors. The medical-related factor was the side effects of the medication. The socio-economic factors were stigma and discrimination, lack of family support, poverty and food insecurity. Health system factors that hindered adherence to ART were medication stock-outs, long waiting times and poor service delivery. The final group of barriers to ART adherence was related to the individuals using ART and these include patients forgetting to take treatment and feeling depressed.

After 25 years of existence, the Human Immuno-deficiency Virus (HIV) has become a global challenge. Yearly, about 3 million people in the sub Saharan region become infected with the disease each year, while 2 million die of the disease. The young, sexually active and those in the economically active group are mostly affected although other categories are also affected. Over the years efforts have been made to turn HIV infection from a death sentence to a manageable chronic disease through the use of antiretro viral treatment (ART). Despite the fact that this treatment is a life-long commitment with adherence being crucial to its effectiveness, some patients still default. This research study sought to identify the characteristics of HIV positive patients who are lost to follow up after the initiation of antiretroviral treatment over a 2-year period (2007-2008). A tick sheet was used to collect data from all the files of patients lost to follow up and 20 variables were tested. The conclusion reached is that age, sex, distance of residence to the ART site and economic capability contribute to ‘lost to follow-up’.