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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

A comparative post-secondary follow-up study of students served through general education and through special education

Diehm, Kendra Lea Williams 02 June 2009 (has links)
This study examines the preparation during high school and post-secondary outcomes of students with disabilities. High school preparation consists of activities in which students participated during high school. Post-secondary outcomes relate to the current status of students following high school graduation in relation to the four major outcomes areas: (a) post-secondary education, (b) employment, (c) independent living, and (d) recreation and leisure. The target population included all students graduating from one school district in a mid-sized city in Texas. A stratified random sample of 228 students both with and without disabilities was selected. Post-secondary follow-up surveys, consisting of one survey administered prior to graduation and one survey administered six-months following graduation, were given to the participants. The response rate for the initial exit survey was 82.9% while the response rate for a post-school survey was 61.4%. Differences between groups were analyzed using loglinear analyses based upon educational setting, disability category, gender, ethnicity, and socio-economic status. In addition, a sub-study was completed to determine the level of agreement among students and teachers on a post-secondary readiness skill inventory. The findings indicated that differences among groups did exist in terms of both high school preparation and post-secondary outcomes. In terms of high school preparation, the participation among various groups produced few results that were significantly different. Statistically significant results occurred only with respect to extracurricular activity participation by educational setting and socio-economic status. Post-secondary outcome results produced more statistically significant findings than high school preparation. The variable of educational setting produced statistically significant post-secondary outcomes in the three areas of employment, post-secondary education, and recreation and leisure. Ethnicity was the next largest determinant to influence post-secondary outcomes, and statistically significant results were found for both post-secondary education and independent living. Socio-economic status produced statistically significant results for employment outcomes. The variable of gender produced no results that reached statistical significance. The last findings provided an analysis of the agreement between students and teachers in terms of a post-secondary readiness skill inventory. Overall students and teachers demonstrated a high level of congruency in which similar responses were indicated within 95% of the items.
2

A comparative post-secondary follow-up study of students served through general education and through special education

Diehm, Kendra Lea Williams 02 June 2009 (has links)
This study examines the preparation during high school and post-secondary outcomes of students with disabilities. High school preparation consists of activities in which students participated during high school. Post-secondary outcomes relate to the current status of students following high school graduation in relation to the four major outcomes areas: (a) post-secondary education, (b) employment, (c) independent living, and (d) recreation and leisure. The target population included all students graduating from one school district in a mid-sized city in Texas. A stratified random sample of 228 students both with and without disabilities was selected. Post-secondary follow-up surveys, consisting of one survey administered prior to graduation and one survey administered six-months following graduation, were given to the participants. The response rate for the initial exit survey was 82.9% while the response rate for a post-school survey was 61.4%. Differences between groups were analyzed using loglinear analyses based upon educational setting, disability category, gender, ethnicity, and socio-economic status. In addition, a sub-study was completed to determine the level of agreement among students and teachers on a post-secondary readiness skill inventory. The findings indicated that differences among groups did exist in terms of both high school preparation and post-secondary outcomes. In terms of high school preparation, the participation among various groups produced few results that were significantly different. Statistically significant results occurred only with respect to extracurricular activity participation by educational setting and socio-economic status. Post-secondary outcome results produced more statistically significant findings than high school preparation. The variable of educational setting produced statistically significant post-secondary outcomes in the three areas of employment, post-secondary education, and recreation and leisure. Ethnicity was the next largest determinant to influence post-secondary outcomes, and statistically significant results were found for both post-secondary education and independent living. Socio-economic status produced statistically significant results for employment outcomes. The variable of gender produced no results that reached statistical significance. The last findings provided an analysis of the agreement between students and teachers in terms of a post-secondary readiness skill inventory. Overall students and teachers demonstrated a high level of congruency in which similar responses were indicated within 95% of the items.
3

The Present Status of an Early Infantile Autism First Reported in Japan Thirty Years Ago

SUGIYAMA, TOSHIRO, WAKABAYASHI, SHINICHIRO 03 1900 (has links)
No description available.
4

The association between single-parent family background and physical morbidity, mortality, and criminal behaviour in adulthood

Sauvola, A. (Anu) 27 March 2001 (has links)
Abstract The proportion of single-parent families has increased in the last few decades world-wide, mostly due to high divorce rates. Also in Finland growing numbers of children spend part of their childhood in single-parent families. The aim of this study was to investigate in a longitudinal perspective, the possible long-term effects of the childhood family structure on psychological, physical and criminal outcomes of an offspring during adulthood. A large, prospectively collected general population birth cohort (n= 11 017), the Northern Finland 1966 Birth Cohort, was used as a study population. This database provided the information on childhood family structure of cohort members with additional information of sociodemographic factors of the family and of the child. Information concerning physical and psychiatric illnesses were gathered from the Finnish Hospital Discharge Register (FHDR). Death certificates and the information from national crime registers were also obtained. Females with a single-parent family background were more commonly hospital-treated (61.3 % vs. 56.7 %) for any physical condition than females with a two-parent family background. For males such difference in overall physical illness was not found. Both females and males from single-parent families had more commonly been hospital-treated for some diagnoses in the ICD-category of "injury and poisoning" than had other cohort members. Furthermore, females from single-parent families had also more commonly been treated due to pregnancy-related conditions such as induced abortions. During the follow-up time (16 to 28 years of age) 117 (90 males, 27 females) cohort members had died. Males with single-parent family background exhibited an increased mortality risk, especially due to suicides (OR=2.5, 95% CI 1.1-5.8, adjusted for psychiatric hospital diagnosis, parental social class). Criminality was more common among both males and females from single-parent families compared with other cohort members. The results showed that the risk of violent offending and recidivism was increased up to 8-fold if the cohort male member had been born and raised in a single-mother family over most of his childhood. Parental divorce also doubled the risk for both violent and recidivistic offending. Non-violent offences among males were associated only with parental death and divorce. Furthermore, drunk driving was more common among both males and females with single-parent background. Males who were born into single-mother families were at the highest risk of drunk driving offences in adulthood (OR=2.4, 95% CI 1.4-4.2, adjusted for maternal age, psychiatric hospital diagnosis, parental social class). In this study it was shown that young adults with single-parent families in childhood experienced a more stressful pathway from late adolescence to adulthood. However, most of the offspring of single-parent families did well during the follow-up time. Strategies to promote the well-being of children and adolescents in single-parent families are of prime importance for preventive health care.
5

Impacto de uma intervenção educativa na qualidade de vida relacionada à saúde de pacientes com insuficiência cardíaca: estudo quase experimental / Impact of an educational intervention on the health-related quality of life of patients with heart failure: quasi-experimental study

Pelegrino, Viviane Martinelli 29 September 2015 (has links)
Introdução. As internações ou readmissões hospitalares de indivíduos com descompensação da Insuficência Cardíaca (IC) são decorrentes de vários fatores, entre eles a não adesão ao tratamento. Objetivo. Avaliar o impacto de uma intervenção educativa voltada para o autocuidado de pacientes com IC considerando a QVRS, adesão ao tratamento e o relato de sinais e sintomas três meses após a alta hospitalar. Método. Estudo quase experimental de série consecutiva com alocação de pacientes internados com IC descompensada para dois grupos, intervenção (GI) e controle (GC). A intervenção constou de orientações individuais sobre a IC e folheto educativo na internação, e reforço das orientações por telefonema um mês após a alta hospitalar (GI). O GC recebeu o cuidado usual. O desfecho principal foi a qualidade de vida relacionada à saúde (QVRS) avaliada pelo Minnesota Living with Heart Failure Questionnaire (MLHFQ) e os secundários foram a adesão farmacológica avaliada pela Medida de Adesão aos Tratamentos (MAT), adesão não farmacológica e sinais e sintomas da IC. Para a análise estatística utilizou-se de análise descritiva, teste t de Student para amostras independentes, Qui-quadrado ou Exato de Fisher para as variáveis categóricas, teste de correlação de Pearson e análise de regressão. O nível de significância foi de 0,05. Resultados. Em relação à QVRS, três meses após a alta, não houve diferença estatisticamente significante para as medidas do MLHFQ total (p=0,19), físico (p=0,20) e emocional (p=0,51). Na análise de regressão \"forward\" foram inseridas no modelo, uma a uma, idade, QVRS, depressão e senso de coerência (avaliadas na internação). O coeficiente de grupo mostrou que os participantes do GI tinham, em média, 5,2 pontos a menos (menor impacto da doença/maior QVRS) do que os do GC, mas sem significância estatística. Essse modelo explicou, apenas, 7% da variância da QVRS aos três meses após a alta. Houve alta percentagem de participantes em ambos os grupos que relataram adesão farmacológica na hospitalização e três meses após a alta hospitalar (mais de 70% inicial e 80% no seguimento) (p=0,45). Na avaliação da adesão não farmacológica, três após meses a alta hospitalar, o controle de peso foi relatado em maior número pelos participantes do GI (p=0,007). A realização de atividade física foi o item menos citado, não havendo diferenças entre os grupos. Quanto ao número de sinais e sintomas relatado após três meses da alta, embora os valores apresentados não tenham diferença estatisticamente significante, notamos que há uma proporção maior de indivíduos no GI do que no GC que não teve qualquer sintoma ou teve apenas um ou dois sintomas. Portanto, a intervenção, se melhorada, é promissora para a adesão medicamentosa. Conclusão. Três meses após a alta hospitalar, os participantes com IC que receberam uma intervenção educativa reforçada por contato telefônico não apresentaram melhores avaliações na QVRS e na adesão farmacológica do que os indivíduos que receberam o cuidado usual. Idade dos participantes e as medidas da QVRS, depressão e senso de coerência, obtidas durante a internação, explicaram apenas 7% da variância da medida de QVRS aos três meses após a alta / Introduction. The hospitalizations and hospital readmissions of individuals with decompensated heart failure (HF) are due to several factors, including non-adherence to treatment. Objective. To assess the impact of an educational intervention focused on the self care of patients with HF, considering the health-related quality of life (HRQoL), adherence to treatment and the report of signs and symptoms three months after hospital discharge. Method. A quasi-experimental study of consecutive series in which patients with decompensated HF were divided into two groups, namely: intervention (IG) and control (CG). The intervention consisted of individual guidance on HF and an educational brochure handed upon admission, with strengthening of guidelines by telephone calls a month after hospital discharge (IG). The CG received the usual care. The primary outcome was the health-related quality of life (HRQoL) assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcomes were the pharmacological adherence assessed by the Medida de Adesão ao Tratamento (MAT), the non-pharmacological adherence, and signs and symptoms of HF. In the statistical analysis, we used descriptive analysis, the Student\'s t-test for independent samples, the chi-square or Fisher\'s exact test for categorical variables, the Pearson correlation test and regression analysis. The significance level was 0.05. Results. Regarding the HRQoL at three months after discharge, there was no statistically significant difference for the measurements of total MLHFQ (p = 0.19), physical (p = 0.20) and emotional (p = 0.51). In the forward regression analysis, were inserted into the model: age, HRQoL, depression and sense of coherence (assessed on admission). The group coefficient showed that on average, participants of the IG had 5.2 points less (less impact of the disease/higher HRQoL) than the CG, but without statistical significance. This model explained only 7% of the HRQoL variance at three months after discharge. A high percentage of participants in both groups have reported pharmacological adherence during hospitalization and three months after hospital discharge (over 70% initially and 80% at follow-up) (p = 0.45). In the evaluation of non-pharmacological adherence three months after discharge, weight control was reported in greater number by participants of the IG (p = 0.007). The practice of physical activity was the least mentioned item, with no differences between groups. Regarding the number of signs and symptoms at three months after discharge, although the values presented by the IG and CG did not have statistically significant differences, we found a greater proportion of subjects in the IG than in the CG who had no symptoms or had only a symptom or two. Therefore, with improvements, the intervention is promising for medication adherence. Conclusion. Three months after hospital discharge, the participants with HF who received an educational intervention strengthened by telephone did not show better ratings of HRQoL and pharmacological adherence than individuals who received usual care. The age of participants and measurements of HRQoL, depression and sense of coherence obtained during hospitalization, explained only 7% of the variance of HRQoL measurement at three months after discharge
6

Qualidade de vida relacionada à saúde e adesão ao tratamento de indivíduos em uso de anticoagulação oral: avaliação dos seis primeiros meses de tratamento / Health-related quality of life and its adherence to treatment of individuals in use of oral anticoagulation: evaluation of the first six months of treatment

Carvalho, Ariana Rodrigues da Silva 02 June 2010 (has links)
Estudo descritivo, correlacional, de delineamento longitudinal, com 78 pacientes que iniciaram anticoagulante oral (ACO) entre abril de 2008 a junho de 2009 em três serviços de saúde de um município do oeste do Paraná. Os objetivos foram avaliar a adesão medicamentosa e comparar a qualidade de vida relacionada à saúde (QVRS) e o estado global de saúde no início e com seis meses de tratamento. Os dados foram coletados por entrevistas individuais com instrumentos específicos para adesão farmacológica (Medida de Adesão ao Tratamento), QVRS (Medical Outomes Survey Short form - SF-36; Duke Anticoagulation Satisfaction Scale DASS), todos validados para o uso no Brasil, e o estado global de saúde (Escala Visual analógica EVA). Foram realizados testes de comparação de médias (Teste t de Student pareado e para amostras independentes), de correlação (coeficiente de correlação de Pearson) e de regressão linear múltipla. O nível de significância foi 0,05. Entre os sujeitos, 53,8% eram mulheres, com idade média de 56,8 anos, casados (71,8%), com baixa escolaridade e 48,7% não desempenhavam atividades remuneradas. As principais indicações para o uso do ACO foram fibrilação atrial (34,6%) e prótese cardíaca mecânica (26,9%) e o ACO mais usado foi a varfarina sódica (91%). Os resultados apontaram que após seis meses, apenas dois participantes foram classificados como não aderentes ao tratamento com ACO e que, no geral, houve melhora na QVRS avaliada por ambos os instrumentos. A avaliação pelo SF-36 mostrou que as diferenças entre os oito domínios foram estatisticamente significantes, exceto para saúde mental. Entretanto, as comparações das médias dos domínios do DASS foram estatisticamente significantes apenas para os domínios Impacto psicológico negativo e Impacto psicológico positivo. O estado global de saúde avaliado pela EVA apresentou valores médios que aumentaram da primeira para segunda avaliação, de 74 para 83, respectivamente, em um intervalo possível de zero a 100. Considerando como variável resposta a medida do DASS total, um modelo de regressão linear multivariada composto pelas variáveis idade, escolaridade, número de medicamentos em uso, indicação para o ACO, dosagem semanal do ACO, Saúde mental (domínio do SF-36), Vitalidade (domínio do SF-36) e intervalo terapêutico explicaram 39,3% da variância da medida da QVRS. Neste modelo, as variáveis com maiores valores de coeficiente beta () e estatisticamente significantes foram: idade (= - 0,317; p=0,017), número de medicamentos usados pelo indivíduo (= -0,353; p=0,005) e saúde mental (= -0,364; p=0,032). Um segundo modelo de regressão linear multivariada foi feito tendo como variável resposta a medida do estado global de saúde. As variáveis explanatórias foram: escolaridade, número de medicamentos em uso, Vitalidade, Saúde mental, Aspectos emocionais e intervalo terapêutico que explicaram 40,4% da variância desta medida. Os resultados obtidos podem subsidiar a prática dos profissionais da saúde na prevenção de fatores que possam afetar à adesão ao medicamento e a qualidade de vida dos usuários de ACO. / A descriptive, correlational design of longitudinal, with 78 patients who initiated oral anticoagulant taking (OAC) within the months of April, 2008 and June, 2009 in three health care services from a municipality of the state of Parana. The aims of this study were to evaluate the medication adherence and compare the health-related quality of life (HRQL) and the global health status in its beginning and within six months of treatment. The datas were all collected through individual interviews making use of specific instruments for pharmacological adherence (Means of Adherence to Treatment), QVRS (Medical Outcomes Survey Short form - SF-36; Duke Anticoagulation Satisfaction Scale DASS), which ones are validated to use in Brazil, and the global health status (Visual Analog Scale VAS).Comparison of average tests were applied (Students test t for paired and independent samples), of correlation (Pearsons correlation test) and of multiple linear regression. The significance level was set at 0,05. Among the subjects, 53,8% were women, at the average age of 56.8, married (71.8%), with low education and 48,7% did not performed any paid job. The main indications to the use of OAC were atrial fibrillation (34,6%) and mechanical cardiac prosthesis (26,9%) and the most used OAC was the warfarin sodium (91%). The results pointed out that after six months, only two participants were classified as not-adherent to treatment with OAC and that, by and large, there was improvement in the HRQL evaluated by both instruments. The evaluation with SF-36 showed that the differences among the eight domains were statistically significant, except for mental health. However, the average comparisons of domains of the DASS were statistically significant only to the negative psychological impact and positive psychological impact domains.The global health status evaluated by VAS presented average score increase from the first to the second evaluation, from 74 to 83, respectively, in a possible interval from zero to 100. Considering it as a variable response to the measurement of the total DASS, a model of linear regression multivariate made up by age variables, education, number of chemicals in use, indication to the OAC, weekly dose of OAC, mental health (domain of SF-36), Vitality (domain of SF-36) and interval therapy explained 39,3% of the variability of the measurement of HRQL. In this model, the variables with higher beta () coefficient scores and statistically significant, were: age (= -0,317; p=0,017), number of chemicals taken by the individual (= -0,353; p=0,005) and mental health (= -0,364; p=0,032).A second model of linear multivariate regression was done, taking into account as a variable response to the measurement of global state of health. The explanatory variables were: education, number of chemicals in use, Vitality, Mental health, Emotional functioning and interval therapy explained 40,4% of the variability of this measurement. The results obtained may subside the practice of healthcare professionals in the prevention of factors that may affect the adherence to the medication and the health-related quality of life of OAC users.
7

A Study of Drop-out Students Who Failed to Respond to the Follow-up Study of Former High School Students of Logan, Utah

Herrod, J. T., Jr. 01 May 1958 (has links)
Dresher reported that today there is an increased and growing interest among the lay population as well as among educators in the appreciation of the drop-out problem of the public schools of the United States. Some educators believe that one of the most important issues facing education today is the problem of determining ways by which the high school pupil might be encouraged to finish his secondary trainings.
8

Response shift in health-related quality of life in older men: The Manitoba follow-up study

Alshammari, Maryam 03 September 2015 (has links)
Problem: Older adults may change their view on what is important to their health-related quality of life (HRQOL). They may alter their opinion about areas relevant to HRQOL (reconceptualization), or how important these areas are to them (reprioritization), and this can be referred to as response shift (RS). Overtime, changes in HRQOL may be imprecise (underestimated or overestimated) if RS occurs. Providing detailed information about RS in the older adult population will have many implications for health professionals, family members, caregivers, policy makers, and researchers. The purpose was to explore RS in HRQOL in community-dwelling older men. Methods: Data from the Manitoba Follow-up Study (MFUS) was used as 360 older men returned the Successful Aging Questionnaire in each of five years (2007-2011). The participants identified the importance of 15 items, which reflect the physical (2 items), mental (5 items), and social domains (8 items) of HRQOL. Descriptive analysis was performed using SPSS21. An individualized method was used to identify different aspects of RS at group and individual levels, as well as the item level. Predictors of RS were also identified using logistic regression in a one-year period. Results: Mean age of participants was 89.7 years (SD 2.9) in 2011. Across 15 items over a one-year period, RS varied from a low of 9.3% for the ‘being mentally aware’ item to 39.3% for the ‘having goals/making plans’ item. Because we were examining RS of 15 items, it was very uncommon to find older men with no RS on all items. Only 27 out of 360 older men (7.5%) provided the same response on all the items they answered at both times (2010-2011). The average of the percent of people showing RS over 15 items, across four time periods, within three domains, was 24.4%. Reprioritization was more common in physical and mental domains, respectively, whereas reconceptualization was seen mainly in the social domain. Further, most of those who showed reprioritization, showed a decrease in importance, while most of those who showed reconceptualization, dropped a concept. Older men who were older, married, living independently, and recently did not participate in activities, were more likely to show RS in certain items. Older men with lower self-rated health were less likely to show RS. Conclusions: Data from the MFUS presents an opportunity to assess RS by using an individualized method that is simple to conduct and interpret in research and clinical settings. This method provides extensive demonstration of RS including magnitude, timing, type, direction, and predictors. RS should be considered an important part of aging, when planning resources and individualizing interventions for the older adult population. Future studies should design a method that evaluates RS individually, similar to our method. / October 2015
9

Impacto de uma intervenção educativa na qualidade de vida relacionada à saúde de pacientes com insuficiência cardíaca: estudo quase experimental / Impact of an educational intervention on the health-related quality of life of patients with heart failure: quasi-experimental study

Viviane Martinelli Pelegrino 29 September 2015 (has links)
Introdução. As internações ou readmissões hospitalares de indivíduos com descompensação da Insuficência Cardíaca (IC) são decorrentes de vários fatores, entre eles a não adesão ao tratamento. Objetivo. Avaliar o impacto de uma intervenção educativa voltada para o autocuidado de pacientes com IC considerando a QVRS, adesão ao tratamento e o relato de sinais e sintomas três meses após a alta hospitalar. Método. Estudo quase experimental de série consecutiva com alocação de pacientes internados com IC descompensada para dois grupos, intervenção (GI) e controle (GC). A intervenção constou de orientações individuais sobre a IC e folheto educativo na internação, e reforço das orientações por telefonema um mês após a alta hospitalar (GI). O GC recebeu o cuidado usual. O desfecho principal foi a qualidade de vida relacionada à saúde (QVRS) avaliada pelo Minnesota Living with Heart Failure Questionnaire (MLHFQ) e os secundários foram a adesão farmacológica avaliada pela Medida de Adesão aos Tratamentos (MAT), adesão não farmacológica e sinais e sintomas da IC. Para a análise estatística utilizou-se de análise descritiva, teste t de Student para amostras independentes, Qui-quadrado ou Exato de Fisher para as variáveis categóricas, teste de correlação de Pearson e análise de regressão. O nível de significância foi de 0,05. Resultados. Em relação à QVRS, três meses após a alta, não houve diferença estatisticamente significante para as medidas do MLHFQ total (p=0,19), físico (p=0,20) e emocional (p=0,51). Na análise de regressão \"forward\" foram inseridas no modelo, uma a uma, idade, QVRS, depressão e senso de coerência (avaliadas na internação). O coeficiente de grupo mostrou que os participantes do GI tinham, em média, 5,2 pontos a menos (menor impacto da doença/maior QVRS) do que os do GC, mas sem significância estatística. Essse modelo explicou, apenas, 7% da variância da QVRS aos três meses após a alta. Houve alta percentagem de participantes em ambos os grupos que relataram adesão farmacológica na hospitalização e três meses após a alta hospitalar (mais de 70% inicial e 80% no seguimento) (p=0,45). Na avaliação da adesão não farmacológica, três após meses a alta hospitalar, o controle de peso foi relatado em maior número pelos participantes do GI (p=0,007). A realização de atividade física foi o item menos citado, não havendo diferenças entre os grupos. Quanto ao número de sinais e sintomas relatado após três meses da alta, embora os valores apresentados não tenham diferença estatisticamente significante, notamos que há uma proporção maior de indivíduos no GI do que no GC que não teve qualquer sintoma ou teve apenas um ou dois sintomas. Portanto, a intervenção, se melhorada, é promissora para a adesão medicamentosa. Conclusão. Três meses após a alta hospitalar, os participantes com IC que receberam uma intervenção educativa reforçada por contato telefônico não apresentaram melhores avaliações na QVRS e na adesão farmacológica do que os indivíduos que receberam o cuidado usual. Idade dos participantes e as medidas da QVRS, depressão e senso de coerência, obtidas durante a internação, explicaram apenas 7% da variância da medida de QVRS aos três meses após a alta / Introduction. The hospitalizations and hospital readmissions of individuals with decompensated heart failure (HF) are due to several factors, including non-adherence to treatment. Objective. To assess the impact of an educational intervention focused on the self care of patients with HF, considering the health-related quality of life (HRQoL), adherence to treatment and the report of signs and symptoms three months after hospital discharge. Method. A quasi-experimental study of consecutive series in which patients with decompensated HF were divided into two groups, namely: intervention (IG) and control (CG). The intervention consisted of individual guidance on HF and an educational brochure handed upon admission, with strengthening of guidelines by telephone calls a month after hospital discharge (IG). The CG received the usual care. The primary outcome was the health-related quality of life (HRQoL) assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcomes were the pharmacological adherence assessed by the Medida de Adesão ao Tratamento (MAT), the non-pharmacological adherence, and signs and symptoms of HF. In the statistical analysis, we used descriptive analysis, the Student\'s t-test for independent samples, the chi-square or Fisher\'s exact test for categorical variables, the Pearson correlation test and regression analysis. The significance level was 0.05. Results. Regarding the HRQoL at three months after discharge, there was no statistically significant difference for the measurements of total MLHFQ (p = 0.19), physical (p = 0.20) and emotional (p = 0.51). In the forward regression analysis, were inserted into the model: age, HRQoL, depression and sense of coherence (assessed on admission). The group coefficient showed that on average, participants of the IG had 5.2 points less (less impact of the disease/higher HRQoL) than the CG, but without statistical significance. This model explained only 7% of the HRQoL variance at three months after discharge. A high percentage of participants in both groups have reported pharmacological adherence during hospitalization and three months after hospital discharge (over 70% initially and 80% at follow-up) (p = 0.45). In the evaluation of non-pharmacological adherence three months after discharge, weight control was reported in greater number by participants of the IG (p = 0.007). The practice of physical activity was the least mentioned item, with no differences between groups. Regarding the number of signs and symptoms at three months after discharge, although the values presented by the IG and CG did not have statistically significant differences, we found a greater proportion of subjects in the IG than in the CG who had no symptoms or had only a symptom or two. Therefore, with improvements, the intervention is promising for medication adherence. Conclusion. Three months after hospital discharge, the participants with HF who received an educational intervention strengthened by telephone did not show better ratings of HRQoL and pharmacological adherence than individuals who received usual care. The age of participants and measurements of HRQoL, depression and sense of coherence obtained during hospitalization, explained only 7% of the variance of HRQoL measurement at three months after discharge
10

Qualidade de vida relacionada à saúde e adesão ao tratamento de indivíduos em uso de anticoagulação oral: avaliação dos seis primeiros meses de tratamento / Health-related quality of life and its adherence to treatment of individuals in use of oral anticoagulation: evaluation of the first six months of treatment

Ariana Rodrigues da Silva Carvalho 02 June 2010 (has links)
Estudo descritivo, correlacional, de delineamento longitudinal, com 78 pacientes que iniciaram anticoagulante oral (ACO) entre abril de 2008 a junho de 2009 em três serviços de saúde de um município do oeste do Paraná. Os objetivos foram avaliar a adesão medicamentosa e comparar a qualidade de vida relacionada à saúde (QVRS) e o estado global de saúde no início e com seis meses de tratamento. Os dados foram coletados por entrevistas individuais com instrumentos específicos para adesão farmacológica (Medida de Adesão ao Tratamento), QVRS (Medical Outomes Survey Short form - SF-36; Duke Anticoagulation Satisfaction Scale DASS), todos validados para o uso no Brasil, e o estado global de saúde (Escala Visual analógica EVA). Foram realizados testes de comparação de médias (Teste t de Student pareado e para amostras independentes), de correlação (coeficiente de correlação de Pearson) e de regressão linear múltipla. O nível de significância foi 0,05. Entre os sujeitos, 53,8% eram mulheres, com idade média de 56,8 anos, casados (71,8%), com baixa escolaridade e 48,7% não desempenhavam atividades remuneradas. As principais indicações para o uso do ACO foram fibrilação atrial (34,6%) e prótese cardíaca mecânica (26,9%) e o ACO mais usado foi a varfarina sódica (91%). Os resultados apontaram que após seis meses, apenas dois participantes foram classificados como não aderentes ao tratamento com ACO e que, no geral, houve melhora na QVRS avaliada por ambos os instrumentos. A avaliação pelo SF-36 mostrou que as diferenças entre os oito domínios foram estatisticamente significantes, exceto para saúde mental. Entretanto, as comparações das médias dos domínios do DASS foram estatisticamente significantes apenas para os domínios Impacto psicológico negativo e Impacto psicológico positivo. O estado global de saúde avaliado pela EVA apresentou valores médios que aumentaram da primeira para segunda avaliação, de 74 para 83, respectivamente, em um intervalo possível de zero a 100. Considerando como variável resposta a medida do DASS total, um modelo de regressão linear multivariada composto pelas variáveis idade, escolaridade, número de medicamentos em uso, indicação para o ACO, dosagem semanal do ACO, Saúde mental (domínio do SF-36), Vitalidade (domínio do SF-36) e intervalo terapêutico explicaram 39,3% da variância da medida da QVRS. Neste modelo, as variáveis com maiores valores de coeficiente beta () e estatisticamente significantes foram: idade (= - 0,317; p=0,017), número de medicamentos usados pelo indivíduo (= -0,353; p=0,005) e saúde mental (= -0,364; p=0,032). Um segundo modelo de regressão linear multivariada foi feito tendo como variável resposta a medida do estado global de saúde. As variáveis explanatórias foram: escolaridade, número de medicamentos em uso, Vitalidade, Saúde mental, Aspectos emocionais e intervalo terapêutico que explicaram 40,4% da variância desta medida. Os resultados obtidos podem subsidiar a prática dos profissionais da saúde na prevenção de fatores que possam afetar à adesão ao medicamento e a qualidade de vida dos usuários de ACO. / A descriptive, correlational design of longitudinal, with 78 patients who initiated oral anticoagulant taking (OAC) within the months of April, 2008 and June, 2009 in three health care services from a municipality of the state of Parana. The aims of this study were to evaluate the medication adherence and compare the health-related quality of life (HRQL) and the global health status in its beginning and within six months of treatment. The datas were all collected through individual interviews making use of specific instruments for pharmacological adherence (Means of Adherence to Treatment), QVRS (Medical Outcomes Survey Short form - SF-36; Duke Anticoagulation Satisfaction Scale DASS), which ones are validated to use in Brazil, and the global health status (Visual Analog Scale VAS).Comparison of average tests were applied (Students test t for paired and independent samples), of correlation (Pearsons correlation test) and of multiple linear regression. The significance level was set at 0,05. Among the subjects, 53,8% were women, at the average age of 56.8, married (71.8%), with low education and 48,7% did not performed any paid job. The main indications to the use of OAC were atrial fibrillation (34,6%) and mechanical cardiac prosthesis (26,9%) and the most used OAC was the warfarin sodium (91%). The results pointed out that after six months, only two participants were classified as not-adherent to treatment with OAC and that, by and large, there was improvement in the HRQL evaluated by both instruments. The evaluation with SF-36 showed that the differences among the eight domains were statistically significant, except for mental health. However, the average comparisons of domains of the DASS were statistically significant only to the negative psychological impact and positive psychological impact domains.The global health status evaluated by VAS presented average score increase from the first to the second evaluation, from 74 to 83, respectively, in a possible interval from zero to 100. Considering it as a variable response to the measurement of the total DASS, a model of linear regression multivariate made up by age variables, education, number of chemicals in use, indication to the OAC, weekly dose of OAC, mental health (domain of SF-36), Vitality (domain of SF-36) and interval therapy explained 39,3% of the variability of the measurement of HRQL. In this model, the variables with higher beta () coefficient scores and statistically significant, were: age (= -0,317; p=0,017), number of chemicals taken by the individual (= -0,353; p=0,005) and mental health (= -0,364; p=0,032).A second model of linear multivariate regression was done, taking into account as a variable response to the measurement of global state of health. The explanatory variables were: education, number of chemicals in use, Vitality, Mental health, Emotional functioning and interval therapy explained 40,4% of the variability of this measurement. The results obtained may subside the practice of healthcare professionals in the prevention of factors that may affect the adherence to the medication and the health-related quality of life of OAC users.

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