Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado com 48 portadores de hipertensão arterial sistêmica (HAS), internados em alas de internação e UTI cardiológica de um hospital privado do interior paulista, realizado no período de julho a setembro de 2009, tendo por objetivo avaliar os fatores que interferem na adesão à terapêutica. Para coleta de dados, foram utilizados três instrumentos: um relacionado aos dados sociodemográficos, clínicos e relacionados à terapêutica medicamentosa; o Teste de Medida de Adesão ao Tratamento (MAT) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliação da Atitude Frente à Tomada de Remédio (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0 e MedCalc 10.2, e os dados foram considerados significativos quando o nível de significância foi p<0,05 e IC 95%. Os sujeitos possuíam idade entre 19 e 90 anos, com mediana de 70,5 anos, 79,2% eram do sexo masculino, 70,8%, casados, 64,6%, aposentados, 35,4% possuíam ensino médio completo, seguidos por 25% com ensino superior completo, a renda familiar variou de R$900,00 a R$30.000,00, com mediana de R$4.000,00, o número de indivíduos que utilizam a renda familiar variou de 1 a 6, 29,2% eram obesos, 93,8% apresentaram relação cintura-quadril (RCQ) alterada, 35,4% apresentaram valores de pressão arterial (PA) acima de 140X90mmHg, 35,4% faziam uso de diurético, 27,1%, de betabloqueador, 25%, de bloqueador de canais de cálcio, 29,2%, de inibidor da enzima conversora de angiotensina (ECA), 35,4%, de bloqueador do receptor da angiotensina 1 (AT1) e 66,7% utilizam apenas um medicamento para controle da PA. O tempo de diagnóstico da HAS variou de 1 a 40 anos, com mediana de 10 anos. As principais comorbidades encontradas foram: cardiopatias (52,1%), dislipidemia (45,8%) e diabetes mellitus (35,4%). Quando avaliados pelo MAT, 44 (91,7%) apresentaram adesão ao tratamento; pelo IAAFTR 34 (70,8%) mostraram atitude positiva frente à tomada de remédio. Entre aqueles que apresentaram adesão pelo MAT, 33 (75%) também apresentaram atitude positiva frente à tomada de remédio. Não houve diferença estatisticamente significante para idade, sexo, estado civil, ocupação, escolaridade, IMC, RCQ e complicações clínicas, quando aplicados o MAT e o IAAFTR. A prevalência de adesão foi maior entre os indivíduos que acreditavam que sua PA estava controlada (p=0,041), os que não necessitaram de mudanças em sua rotina de vida após o diagnóstico da HAS (p=0,007) e os que nunca recusaram um medicamento prescrito para controle da PA (p<0,001). Diante desse contexto, permanece o desafio quanto à necessidade dos profissionais de saúde buscarem a diminuição das barreiras que interferem na adesão ao tratamento da HAS, favorecendo-a e mostrando seus benefícios, adotando assim uma visão holística do portador de HAS. / This descriptive, quantitative and cross-sectional study was carried out with 48 patients with systemic high blood pressure (SHBP), hospitalized in a cardiologic ICU (Intensive Care Unit) of a private hospital in the interior of the state of São Paulo, between July and September 2009 and aimed to assess the factors that interfere in the adherence to treatment. Three instruments were used for data collection: one related to socioeconomic and clinical data and data related to medication therapy; the Test of Treatment Adherence Measure (TAM) to evaluate the adherence to medication treatment and the Instrument of Evaluation of Attitude regarding Medication Intake (IAAFTR). Statistical tests were carried out using the software Statistica 8.0 and MedCalc 10.2, and data were considered significant for a level of significance p<0.05 and Confidence Interval (CI) 95%. Subjects were aged 19 to 90 years, with median of age of 70.5 years, 79.2% were male, 70.8% married, 64.6% retired, 35.4% had completed high school, followed by 25% with complete higher education, family monthly income varied from R$900.00 (Brazilian reais) to R$30,000.00 (Brazilian reais), with median of R$4,000.00 (Brazilian reais), the number of individuals living with this income varied from 1 to 6, 29.2% were obese, 93.8% presented altered waist-hip ratio (WHR), 35.4% presented values of arterial pressure (AP) above 140X90mmHg, 35.4% used diuretic agents, 27.1% beta-Blockers, 25% blocker of calcium channels, 29.2% Angiotensin-Converting Enzyme Inhibitors (ACE), 35.4% Angiotensin Type 1 Receptor Blockers (AT1) and 66.7% used only one medication for blood pressure control. The time of diagnosis of SHBP varied from 1 to 40 years, with median of 10 years. The main comorbidities were heart diseases (52.1%), dyslipidemias (45.8%) and diabetes mellitus (35.4%). When assessed by TAM, 44 (91.7%) presented adherence to treatment; by IAAFTR 34 (70.8%) showed positive attitude regarding medication intake. Among the ones who presented adherence by TAM, 33 (75%) also presented positive attitude regarding medication intake. There was no statistically significant difference for age, gender, marital status, occupation, schooling, BMI, WHR and clinical complications, for administration of TAM and IAAFTR. The prevalence of adherence was higher among individuals who believed their BP was controlled (p=0.041), the ones who did not need changes in their daily life after the diagnosis of SHBP (p=0.007) and the ones who never refused a prescribed medication for BP control (p<0.001). In this context, remains the challenge of health professionals to decrease the barriers that interfere in the adherence to SHBP treatment, favoring adherence, showing its benefits and thus adopting a holistic view of patients with SHBP.

As novas drogas para tratamento do HIV/aids mudaram a história da doença, diminuindo a morbimortalidade e possibilitando um tratamento seguro e tolerável ao portador. Entretanto, para se alcançar os benefícios do tratamento é necessário o uso correto e diário dos medicamentos gerando um novo desafio: a adesão a TARV. A interação do paciente com a equipe multiprofissional tem sido associada ao aumento crescente da adesão. A inserção do farmacêutico nesta equipe é relativamente recente e tem potencial de impactar positivamente na adesão. Neste contexto, este trabalho teve como objetivo avaliar o impacto de intervenções farmacêuticas na adesão ao tratamento antirretroviral em pacientes com HIV/aids. Para alcançar os nossos objetivos foi realizado um estudo de intervenção (pesquisa-ação), prospectivo com análise quali e quantitativa. Foram convidados a participar do estudo os pacientes que já estavam em uso de TARV há pelo menos 12 meses antes do inicio do estudo e que apresentavam história de má adesão (grupo 1) e pacientes que iriam começar a TARV no momento de sua inclusão no estudo (grupo 2). A adesão foi avaliada por meio de questionários estruturados, pelos exames laboratoriais de contagem da carga viral e contagem do linfócito TCD4, e do histórico de retiradas dos medicamentos. O acompanhamento farmacêutico aconteceu por um período de 12 meses onde foram enviadas mensagens de texto SMS (torpedos) para os pacientes com objetivos de lembra-los da consulta com o farmacêutico e da retirada da TARV. Foram convidados a participar do estudo 120 pacientes, sendo que 95 concluíram o acompanhamento farmacêutico. Deste total, 63 pacientes pertenciam ao grupo 1 e 32 pertenciam ao grupo 2. Após 12 meses de seguimento farmacêutico, entre os 63 pacientes que já estavam em tratamento, houve aumento do percentual de boa adesão de 16% para 57%, com aumento do CD4+, e aumento do percentual de pessoas (de 21% para 52%) com carga viral indetectável. Para o grupo que iniciava a TARV pela primeira vez, 69% teve boa adesão e 91% teve queda significativa da carga viral após 12 meses de acompanhamento. Diante destes resultados, é possível concluir que ha uma tendência no aumento da adesão quando a equipe multiprofissional conta com um farmacêutico que atua de forma clínica junto ao paciente. / Antiretroviral therapy (ART) has changed the history of HIV/aids, reducing morbi-mortality and providing a safe and tolerable treatment. However, to achieve all the benefits from the treatment its expected a correct and daily use of medicines, which means the challenge of adherence to ART. Its known that an effective interaction between patient and the multidisciplinary team is linked to good treatment adherence. The insertion of a clinical pharmacist in this team is recent and it has the potential to positively impact in adherence and HIV control. This study aimed to assess pharmaceutical interventions on adherence to ART in HIV/aids patients. We designed an interventional and prospective study, including qualitative and quantitative analysis. Patients with poor history of adherence to ART, detected by the multiprofessional team (Group 1) were included. These patients should have been using ART at least 12 months before their entrance in the study. In the other group we invited people with recent HIV diagnosis and with ART prescription for the first time (Group 2). Adherence was assessed through structured questionnaires, laboratory exams of viral load count and CD4+ lymphocyte count, and by withdrawal of medicines. The pharmaceutical monitoring had been done during 12 months, in which text messages (SMS messages) were sent for patients to remind them about the pharmacist and medical appointments as well as the withdrawal of ART. An amount of 120 patients were invited to participate in the study, and 95 completed the pharmaceutical monitoring. Of this total, 63 patients belonged to Group 1 and 32 belonged to Group 2. After 12 months of pharmaceutical monitoring, among group 1 (63 patients) there was an increase in the percentage of adherence from 16% to 57%, an increase of CD4+ (median of 199 to 301cel/mm3) and an important raise in the percentage of people with undetectable viral load (from 21% to 52%). For Group 2 that started ART for the first time, 69% had a good adherence and 91% had a significant drop in viral load, after 12 months of follow-up. Based on these results, we can conclude that adherence and HIV control increases significantly when the multidisciplinary team has a pharmacist who works close to the patient and the healthcare team.

Pesquisa descritiva e qualiquantitativa que resgatou representações sociais de profissionais de saúde e pacientes referentes ao modo de comunicação do diagnóstico da tuberculose e adesão ao tratamento. O trabalho buscou analisar o conteúdo discursivo baseado nas discussões sobre Conscientização desenvolvidas por Paulo Freire. Realizou-se entrevista semi-estruturada com 39 profissionais envolvidos com a entrevista inicial de diagnóstico e 34 pacientes adultos em tratamento da tuberculose em 22 unidades de saúde da região Sul/São Paulo. Questionados sobre a entrevista inicial de diagnóstico, os pacientes entendem este momento de modo amplo, para além da consulta onde receberam a notícia oficial. Entretanto, para profissionais, o momento da notícia é bem delimitado e revela que o diagnóstico possui um caráter tecnológico. Questionados sobre o modo de dar a notícia de sorte a incentivar o paciente a se tratar, uma das categorias expressadas pelos pacientes traz a importância de se discutir tudo aquilo que envolve a doença, contexto e vida do paciente. Em contrapartida, profissionais se importam com o conteúdo a ser informado, mantendo o caráter tecnológico da informação. Questionados sobre os modos de dar a notícia que podem desmotivar o paciente a se tratar, pacientes e profissionais trazem a importância do entendimento do tratamento (aspecto cognitivo) e do respeito e vínculo (aspecto psíquico ou afetivo) para não haver desistência. Com relação ao tratamento parecer complicado quando explicado durante a notícia (aspecto comportamental) pacientes e profissionais discordam desta opção. Algumas ideias centrais destes dois grupos concordam que o tratamento é complicado e isso pode fazer o paciente desistir. Segundo Paulo Freire, toda ação educativa deve ser precedida de reflexão sobre o homem e o meio de vida para que não se torne pré-fabricada e inoperante. Por isso ampliar as discussões sobre o que envolve a doença, contexto e vida do paciente pode contribuir para um entendimento mais completo da situação. Apesar do tratamento da tuberculose ser complicado e, portanto, desmotivante, promover o entendimento do paciente, respeitá-lo e construir um vínculo podem contribuir para a adesão, na visão de pacientes e de profissionais de saúde / Descriptive and qualitative-quantitative research that rescued social respresentations of health professionals and patients in relation to mode of communication of tuberculosis diagnosis and treatment adherence. The study aimed to analyze the discursive content based on discussions about Conscientization developed by Paulo Freire. Semi-structured interviews were performed with 39 professionals involved with the initial diagnostic interview and 34 adult patients in 22 health units in South Region, Sao Paulo. Asked about initial diagnostic interview, patients understand this point broadly, far beyond the consultation where they received the official news. However, for professionals, the moment of the news is well defined and reveals that the diagnosis has a technological character. Asked how to break the news so as to encourage the patient to treatment, one of the categories expressed by patients brings the importance of discussing everything that involves the disease, context and patients life. In contrast, professionals care about the content to be informed, keeping the technological character of the information. Asked about ways to break the news that might discourage the patient to treatment, patients and professionals bring the importance of understanding about treatment (cognitive aspect) and respect and bond (psychic or affective aspect) so as to avoid abandonment. Regarding the fact that the treatment seems complicated when explained in the news (behavioral aspect), both patients and professionals oppose to this option. Some central ideas of these two groups agree that treatment is complicated and can make patient to give it up. According to Paulo Freire, all educational activity must be preceded by reflection on the human being and the lifestyle so that it does not turn out prefabricated and inoperative. Therefore, expanding the discussions on what involves the disease, context and patients life can contribute to a more complete understanding of the situation. Although the treatment of tuberculosis is complicated, and therefore disappointing, to promote the understanding of the patient, to respect him and to build a bond with him can contribute to the adherence, both in patients and health professionals point of view

Trata-se de um estudo observacional transversal, com o objetivo avaliar a adesão aos agentes antidiabéticos orais de pessoas com Diabetes mellitus com o uso do Brief Medication Questionnaire. O estudo foi realizado no Centro de Saúde Escola Prof. Dr. Joel Domingos Machado. Participaram do estudo 60 pacientes que participavam do Programa de Apoio Telefônico em Diabetes mellitus e utilizavam o agente antidiabético oral no seu tratamento. A coleta de dados foi realizada de maio a outubro de 2013, e o trabalho foi aprovado pelo Comitê de Ética e Pesquisa em Humanos da Escola de Enfermagem de Ribeirão Preto, parecer número: 324.098. Para a coleta de dados foi utilizado um questionário contendo variáveis sociodemográficas e clínicas, e o Brief Medication Questionnaire. Para análise, utilizou-se estatística descritiva, Teste Exato de Fisher e a quantificação desta associação foi mensurada por meio de modelos de regressão logística. Os resultados mostraram que os pacientes tinham de 31 a 87 anos, com predomínio do sexo feminino (58,3%), a maioria era casada (75,0%), 53,3% eram aposentados e média de estudo era de 6,7 anos. Para as variáveis clínicas: o tempo de diagnóstico mais prevalente foi de 11 a 20 anos e entre as comorbidades referidas a hipertensão arterial sistêmica foi presente em 75,0% dos participantes, 40,6% apresentaram hipertensão arterial sistêmica grau I, 35,0% apresentaram obesidade grau 1, em relação à circunferência abdominal, 72,0% dos homens tem valores elevados de circunferência abdominal, em contrapartida 94,3% das mulheres também apresentam valores elevados de circunferência abdominal. Quanto aos valores da glicemia em jejum, 55,0% dos participantes apresentam valores maiores que 130 mg/dl. Em relação à hemoglobina glicada, 75,0% participantes estavam com valores alterados sendo que 33 são adultos com valores maiores que 7% e 12 idosos com valores maiores que 8%. Em relação aos outros exames laboratoriais, observa-se predomínio de 10,0% dos participantes apresentam valores menores de 60 mg/dl de HDL-C, 31,7% valores alto de triglicerídeos e 21,7% apresentavam valores limítrofes de colesterol total. Em relação aos agentes antidiabéticos orais, mostrou-se predomínio do uso da classe das biguanidas, com destaque para a metformina sendo utilizada por 80,0% participantes. Em relação à mensuração geral do BMQ, mostrou-se que 25,0% dos participantes aderem plenamente e 21,7% apresentam provável adesão ao uso de agentes antidiabéticos orais. Para os três domínios, observou-se que o Domínio Regime apresentou 81,7% de adesão, o Domínio Crença 55,0% de adesão e o Domínio Recordação 35,0% de adesão. Não houve relação estatística entre a adesão e as variáveis sociodemográficas e clínicas. No entanto, a importância deste estudo foi apresentar achados em Diabetes mellitus com uma nova ferramenta para mensuração da adesão ao tratamento medicamentoso. Os achados apresentam outros aspectos como crença e recordação do que apenas o uso do medicamento que podem subsidiar estudos de intervenção com proposta de melhorar a adesão ao tratamento medicamento oral em Diabetes mellitus / This is a cross-sectional study aimed to assess the adherence to oral antidiabetic agents in people with diabetes mellitus using the Brief Medication Questionnaire. The study was conducted at the School Health Center Prof. Dr. Joel Domingos Machado. The study included 60 patients participating in the Telephone Support Program for Diabetes mellitus who used the oral antidiabetic in its treatment. Data collection was conducted from May to October 2013, and the study was approved by the Ethics Committee of Human Research of the Nursing School of Ribeirão Preto, opinion number: 324 098. To collect data, a questionnaire containing sociodemographic and clinical variables was used, and the Brief Medication Questionnaire. For analysis, we used descriptive statistics, Fisher\'s Exact Test and quantify of this association was measured by means of logistic regression models. The results showed that the patients were 31-87 years old, with a predominance of females (58,3%), most were married (75,0%), 53,3% were retired, and the study average was 6,7 years. For clinical variables: the most prevalent diagnosis time was 11-20 years and among these referred comorbidities the hypertension was present in 75,0% of participants, 40,6% had grade hypertension I, 35,0% had grade obesity 1, compared to waist circumference, 72,0% of men have high values of waist circumference, and 94,3% of women also exhibit high values of waist circumference . On the values of unfed glycemia, 55,0% participants had higher values than 130 mg/dl. In relation to glycosylated hemoglobin, 75,0% participants were with altered values 33 adults with larger values than 7% and 12 elderly patients with values greater than 8%. In relation to other laboratory tests, it is observed predominance of 10,0% participants presented lower values of 60 mg/dl of HDL - C, 31,7% high triglyceride levels and 21,7% had borderline the values of total cholesterol. Regarding oral antidiabetic agents, it has proved predominance of the use of the biguanide class, especially metformin being used by 80,0% participants. Regarding the overall measurement of BMQ, it was shown that 25,0% of participants fully adhere and 21,7% are likely accession to the use of oral antidiabetic agents. For all three areas, it was observed that the Scheme Domain presented 81,7% adherence, Belief Domain 55,0% adherence and Remembrance Domain 35,0% adherence. There was no statistical relationship between adherence and sociodemographic and clinical variables. However, the importance of this study was to present findings in diabetes mellitus with a new tool to measure the drug treatment adherence. The findings show other aspects such as belief and recall than just the medication use that can aid intervention studies proposed to improve adherence to oral drug treatment in diabetes mellitus

L’évolution des propriétés d’adhérence dépend de la nature de l’adhésion entre le mortier et son support, mais également des conditions environnementales auxquelles l’ouvrage est exposé. Les mortiers de façade sont intrinsèquement soumis au séchage. Ce phénomène tend a priori à réduire la résistance du lien entre les matériaux par la limitation du développement de l’adhésion et par la création de contraintes de traction et de cisaillement.Ces dernières peuvent conduire à la fissuration voire à la désolidarisation du mortier.L’objectif de cette thèse est de comprendre les phénomènes initiateurs de cette fissuration et d’évaluer son impact sur l’adhérence. Le couplage entre hydratation et séchage, le dosage en éther de cellulose et la rugosité du support sont les principaux paramètres étudiés. Les dispositifs expérimentaux développés au cours de ces travaux mises en place révèlent que ces trois paramètres influencent significativement la fissuration des mortiers. Aucun lien clair n’a cependant pu être mis en évidence entre fissuration et adhérence. / The quality of adherence between a coating mortar and its substrate, such as building front wall, depends on environmental conditions. Especially, the restraint of the drying shrinkage of the mortar by the substrate usually results in tensile stresses. This could lead to cracking or even debonding. The main objective of the present PhD dissertation is to study the cracking phenomenon due to restrained drying shrinkage and its impact on the failure of the mortar/substrate system. The interaction between cement hydration and drying, the content of cellulose ether (used as chemical admixture) and the substrate roughness are the main studied parameters. For this purpose, several original experimental devices were developed. In particular, cracking was investigated with digital image correlation. The three studied parameters appeared to influence significantly the adherence and cracking. However, no clear relation between cracking and adherence could be emphasized.

Asthma is the most common long-term condition in children in the United Kingdom (UK). Asthma-related hospitalisations and mortality are disproportionally higher in the UK, compared with other European countries, however the reasons for this disparity remain unclear. A putative explanation is that that prevalence of suboptimal asthma control in children in the UK is higher than in continental Europe. If this is indeed correct, then the drivers of suboptimal control, such as poor adherence to therapy resulting from poor understanding of the role of preventer medication (inhaled corticosteroids (ICS)) in UK children would be of significant clinical interest. Therefore, in this thesis, I sought to first identify the levels of asthma control and medication adherence in a non-random sample of London secondary school children. Then, I used focus groups to further highlight the barriers to good medication adherence, and generate insights into potential solutions. To achieve these aims, I developed and implemented an online questionnaire to be delivered in schools, which included the validated Asthma Control Test (ACT). Methods: This thesis is divided into three main sections. The first and second sections include original data from an observational research study, which collected data about asthma control, from 24 London secondary schools between December 2014 and March 2016. The aim of the first section was to assess current levels of asthma control and medication adherence among children with asthma in London secondary schools. Data were collected using an online questionnaire, which included the validated ACT to measure asthma control, as well as additional questions about knowledge, healthcare use, medication use, school attendance, lifestyle and emotion and behaviour, using the validated Me and My School (M&MS) questionnaire. The second section of this thesis includes data generated from six focus groups, conducted in four London secondary schools with 56 students. In order to generate data to inform future interventions, discussions focused on the barriers to medication adherence among teenagers, and how these barriers could be addressed. The third section comprises a systematic review of school-based self-management interventions for children with asthma. The review uses a mixed-methods approach, and includes both quantitative and qualitative study data. A process evaluation is also included, to identify intervention elements that are associated with implementation success. Results: 766 children with asthma from 24 schools were surveyed. Almost half of the students (45.7%; n = 350) had poor asthma control by ACT score. Adherence with asthma medication was low, regardless of asthma control (56.2% self-reported forgetting to use their ICS "preventer" inhaler; 29% self-reported not using their SABA "reliever" inhaler when they needed it, at least some of the time). Health care involvement was relatively high, with at least one unplanned GP visit, due to asthma in the previous four weeks, reported by 28.1% of students; at least one unplanned hospital visit was self-reported by 15.7% of students; and at least one unplanned school nurse visit due to asthma was self-reported by 16% of students. At least one whole school absence was reported by 20.9% of students. Unplanned medical care and school absences were higher among children with poor asthma control, according to the ACT. Themes from focus groups suggested that social stigma, fear of embarrassment, forgetfulness, and incorrect attitudes towards medication were all contributory factors to poor medication adherence. Communications with healthcare professionals were also identified as key unmet needs of teenagers with asthma. The findings from the meta-analyses, included in the systematic review of school-based self-management interventions, showed that such interventions were effective in improving several outcomes, largely related to healthcare use. These included hospitalisations, emergency department (ED) visits, and health-related quality of life. There was no evidence that school-based interventions improved school absences, experiences of day and night time symptoms, or the use of medication. The findings from the analysis of the process evaluation studies showed that a theoretical framework is important in the development of a successful intervention. Conclusions: First, in a large non-random sample of secondary school children with asthma, the proportion of children with suboptimal control is worryingly high, and this is associated with general poor adherence to prescribed therapy asthma. Second, focus groups identified practical and social barriers to good adherence, that should be addressed in future studies. Third, previous studies suggest that school based interventions are effective in reducing incidences of unplanned and urgent healthcare use. The systematic review included studies that included relatively hard-to-reach populations, suggesting that such interventions may be effective across diverse populations, including those considered hard-to-reach. The findings in this thesis informed the development of a school-based self-management intervention, to be piloted in London secondary schools, and an NIHR-funded global research group award on improving asthma control in African children.

Glaukom är än kronisk sjukdom i synnerven som medför synfältsdefekter, oftast i samband med förhöjt ögontryck. I västvärlden är glaukom den näst vanligaste orsaken till blindhet. Det uppskattas att mer än 60 miljoner människor i hela världen har glaukom och antalet väntas stiga till nästan 80 miljoner år 2020. Även om det finns flera orsaker till glaukom så finns det bara en orsak som kan behandlas, ögontrycket, som ska sänkas med hjälp av ögondroppar. För att kunna bromsa försämringen i patientens sjukdom så krävs det god medverkan av patienten, som noggrant behöver följa läkarens ordination. Trots allvarliga konsekvenser för synen finns det många brister i följsamheten. Syftet med denna uppsats är därför att beskriva faktorer som patienter med glaukom upplever påverkar deras följsamhet till den medicinska terapin. Som metod valdes en litteraturstudie. Åtta kvalitativa primärkällor valdes från databaserna PubMed och Cinahl. Resultatet presenterar fyra huvudteman, Att ha förståelse för sin sjukdomssituation, Att kombinera medicineringen med livet, Individuella förutsättningar och Att ha tillgång till vårdens resurser med tillhörande subteman. Det framkommer i studien att stor vikt ligger på information om sjukdomen och behandlingen. Kunskap om tilltagande försämring trots symtomfrihet samt vilka biverkningar medicineringen kan ge är en förutsättning för att patienten ska följa sin ordinerade terapi. Dessutom måste behandlingen kunna kombineras med patientens vardag för att möjliggöra för patienten att droppa regelbundet. Denna studie visar att flera faktorer ligger hos patienten själv men att även vårdpersonalen har möjlighet att påverka patientens följsamhet positivt. / Program: Fristående kurs

A AIDS é uma manifestação clínica avançada da infecção pelo vírus da imunodeficiência humana (HIV), tendo se tornado um dos maiores problemas de saúde pública do mundo devido ao aumento do número de casos, alto custo da terapêutica, seqüelas físicas e emocionais e aos altos índices de mortalidade. Com o advento da terapia antiretroviral, a sobrevida destas pessoas aumentou e, desta forma, esta doença tem sido considerada uma condição crônica. Crianças que adquiriram o HIV na infância, seja por transmissão vertical ou outros meios, chegam à fase da adolescência, enfrentando conflitos característicos deste momento, os quais se agravam quando aliados a uma condição crônica incurável, como a AIDS, na qual é necessário acompanhamento periódico de saúde, com consultas médicas e uso de medicamentos diários. O presente estudo é de natureza descritivo-exploratória, com análise qualitativa dos dados. Tem por objetivo compreender o processo de adesão dos adolescentes com HIV/AIDS ao tratamento e identificar as causas que podem levar à não adesão. Foram selecionados nove adolescentes, com idades entre 12 a 18 anos, em seguimento na Unidade Especializada de Tratamento de Doenças Infecciosas, de um hospital escola do interior do estado de São Paulo, em uso de terapia antiretroviral, que adquiriram o HIV na infância¸ bem como os responsáveis por estes adolescentes. A coleta de dados foi realizada mediante entrevistas. Na análise, os dados foram organizados em torno de dois temas centrais - o viver com HIV/AIDS e a adesão ao tratamento medicamentoso. Ao conhecermos a experiência destes adolescentes e seus cuidadores, observamos as dificuldades por eles enfrentadas diante de uma doença que traz estigma e discriminação e tais dificuldades podem influenciar na adesão medicamentosa destas pessoas. Observamos que os adolescentes procuram viver e sentirem-se normais, como seus pares, entretanto, na sociedade ainda existe preconceito em relação ao HIV/AIDS, o que os levam a vivenciarem o dilema de revelar ou não o status sorológico e, muitas vezes, quando o revelam ou este é descoberto, sofrem com o estigma e discriminação. Seus cuidadores permanecem almejando a cura e relatam terem medo de perder os adolescentes, por já terem vivenciado situações semelhantes com outros familiares. Os adolescentes sonham com um futuro, incluindo casamento e filhos. Mencionam dificuldades com a terapêutica medicamentosa, seja pelo sabor desagradável dos medicamentos ou pela lembrança da doença. Os adolescentes mencionaram também a importância e os benefícios dos antiretrovirais, salientando que a finalidade dos mesmos é evitar outras doenças e contribuir para a cura do HIV/AIDS. Os resultados do estudo possibilitaram identificar aspectos que necessitam de intervenção por parte da equipe de saúde, objetivando obter-se uma melhor adesão dos adolescentes ao tratamento. / AIDS is an advanced clinical manifestation of infection by the human immunodeficiency virus (HIV), it has become one of worlds major public health problems due to the increase in the number of cases, high costs of treatment, physical and emotional sequelae and high mortality rates. The arrival of the antiretroviral therapy has increased the patients survival, hence, this disease is currently considered a chronic condition. People who have acquired HIV in childhood, through vertical transmission or other means, get to adolescence and start to face the conflicts characteristic of this moment of life. These conflicts worsen when associate to an incurable chronic condition, as AIDS, in which is necessary periodic health follow, with medical appointments and daily use of drugs, what is permeated by stigma and discrimination. It is a descriptive-exploratory study, with qualitative methodological approach, which aimed to understand the adherence process of adolescents with HIV/AIDS to treatment, and identify the causes that can lead to non-adherence. The subjects were nine adolescents, aged between 12 and 18 years old, in use of antiretroviral therapy, who acquired HIV during childhood and are under follow-up at the Infectious Diseases Specialized Treatment Unity of a university hospital in the interior of São Paulo state, as well as the ones responsible for the adolescents. The data collection was carried out through semi-structured interview with the adolescents and non-structured interview with the ones responsible for them. In the analysis, the data were organized around two central themes living with HIV/AIDS and adherence to medication therapy. While describing the adolescents and their caregivers experience, we observe the difficulties faced by them when facing a disease that brings so much stigma and discrimination, and in which way this can influence in the medication adherence of these people. The study showed us the adolescents try to live and feel normal, as other people of their age. However, there is still much prejudice in society in relation to HIV/AIDS, what makes them live the dilemma of revealing or not their serologic status and, many times, when they reveal or it is found out by the school, neighbors and family, they suffer with the discrimination and stigma inherent to the disease. Their caregivers still long for cure and mention fear of losing the adolescents, as they have been through similar situations before. The adolescents dream of a future, including marriage and children. These facts influence in the adherence to treatment and the difficulty in taking medications, for the unpleasant taste, the memory of the disease or for thinking that it can lead them to death, as if it was the solution for their problems. The adolescents know the importance and benefits of antiretrovirals, verbalizing that their purpose is to avoid diseases and contribute to healing. These facts can be explained by the vulnerability of the period of life they are going through - adolescence, and for the fact that it still is an incurable disease. The results of the study enabled the identification of aspects which need intervention, aiming a better adherence to treatment.

Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado entre 75 portadores de hipertensão arterial (HA) seguidos no ambulatório de um hospital-escola de nível terciário, no interior paulista, realizado no período de setembro de 2008 a abril de 2009, tendo por objetivo avaliar a adesão ao tratamento. Para a coleta de dados foram utilizados três instrumentos: um relativo a dados sociodemográficos, da doença e do tratamento; o Teste de Morisky e Green (TMG) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliar Atitudes Frente à Tomada de Remédios (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0, e os resultados foram considerados significativos quando o nível de significância foi (p <0,05). Os sujeitos possuíam idade média de 61,5 ±10,36 anos, 52,0% eram do sexo feminino, 85,3% brancos, 70,7% casados, 48,0% aposentados e 24,0% do lar, 65,3% possuíam ensino fundamental incompleto, média de 3,08 ±1,99 filho, 94,7% residiam com outros membros da família, 81,3% informaram renda familiar entre um e três salários mínimos; 48,0% apresentaram valores de pressão arterial (PA) maiores que 140X90mmHg, 48,0% eram obesos, 80,6% dos homens e 94,9% das mulheres apresentaram circunferência da cintura com valores alterados. A média do tempo de diagnóstico da hipertensão arterial sistêmica (HAS) foi de 15,57 ±9,61 anos. As principais comorbidades identificadas foram: diabetes mellitus (54,3%) e dislipidemia (46,6%). A média dos medicamentos utilizados foi de 5,1 comprimidos/dia, sendo os mais comumente utilizados os hipoglicemiantes (58,7%) e os antiagregantes plaquetários (54,8%). A média de medicamentos usados para o tratamento da HA foi de 3 comprimidos/dia, sendo que os diuréticos foram os mais usados (84,0%). Quando avaliados pelo TMG, 21 (28,0%) apresentaram adesão ao tratamento; pela utilização do IAAFTR 37 (49,3%) mostraram atitudes positivas frente à tomada dos medicamentos. Entre aqueles que apresentaram adesão pelo TMG, 16 (76,2%) também apresentaram atitudes positivas quando avaliados pelo IAAFTR. A prevalência de controle da PA foi maior para os que tiveram adesão (66,7%) e para aqueles com atitudes positivas (64,9%). Houve significância estatística para o sexo e atitude frente à tomada dos medicamentos em relação ao controle da PA. Os valores de PA foram menores para os que tiveram adesão pelo TMG e que apresentaram atitudes positivas quanto à tomada dos medicamentos (p <0,05). Em relação aos fatores de risco para a HAS, 64,0% não praticavam exercício físico; 9,3% eram fumantes; 17,3% faziam uso de bebida alcoólica e 54,7% diziam ser estressados; 96,0% citaram antecedentes familiares para doenças cardiovasculares. Diante deste contexto permanece um desafio quanto à necessidade de revisão das medidas educativas instituídas no sentido de possibilitar alternativas que possam melhorar, na prática, a adesão dos portadores de HA ao tratamento medicamentoso, o controle da PA e a mudança nos fatores de risco para a HAS. / It is a cross-section descriptive study of quantitative approach, carried out with 75 hypertensive outpatients of tertiary level, in upstate São Paulo, carried out from September 2008 to April 2009, aiming to evaluate adherence to the treatment. Three questionnaires were used to collect the data: one about socio-demographic data regarding the disease and the treatment; the Morisky-Green Test, to assess the adherence to the drug-based treatment and the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The statistical tests were applied by means of the software Statistica 8.0, and the results were considered significant whenever the significance level was (p<0.05). The subjects average age was 61.5 ±10.36 years, 52.0% were women, 85.3% Caucasians, 70.7% married, 48.0% retired and 24.0% housewives, 65.3% did not finish primary education, they had on average 3.08 ±1.99 children, 94.7% lived with other family members, 81.3% stated that their familly income was between one and three minimum wages; 48.0% had blood pressure readings above 140X90 mmHg, 48.0% were overweight, 80.6% of the men and 94.9% of the women had unhealthily large waist circumferences. Average hypertension diagnosis time (HT) was 15.57 ±9.61 years. The most important comorbities identifed were: diabetes mellitus (54.3%) e dyslipidemia (46.6%). The average of the medications used was 5.1 pills/day, and the most commonly used drugs were hypoglycemiants (58.7%) and platelet antiaggregant (54.8%). The average of the medications used for the treatment of HT was 3 pills/day, and the diuretics were the most used ones (84.0%). When evaluated with the Morisky-Green test, 21 (28.0%) showed adherence to the treatment, by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines, 37 (49.3%) showed positive attitudes towards the taking the medicines. Those that showed adherence through the Morisky-Green test also showed positive attitudes when evaluated by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The prevalence of control of the blood pressure was higher for those who had adherence (66.7%) and for those with positive attitudes (64.9%). Gender and attitude towards taking medicines had statistical significance to the control of blood pressure. Blood pressure readings were lower in hypertensives that had adherence according to the Morisky- Green test and that had positive attitudes toward taking the medicines (p<0.05). Regarding the risk factors for HT, 64.0% did not practice physical exercise; 9.3% were smokers; 17.3% drank alcoholic drinks and 54.7% reported being stressed; 96% cited family antecedents of cardiovascular disease. In face of this context, there remains the challenge of reviewing the current educative measures to enable alternatives that may improve, in practice, the adherence of hypertensives to the drug-based treatment, the control of blood pressure and the change in the risk factors for HT.

L'assemblage de matériaux par collage pour l'aéronautique est une solution à laquelle les industriels pensent depuis longtemps pour alléger les structures. Cependant, les adhésifs développés de nos jours ne sont pas suffisamment performants pour remplacer les méthodes traditionnelles (rivetage, boulonnage, etc..). Notamment, la température de service limite la performance d'un joint adhésif. Pour élargir l'opérabilité d'un assemblage collé, la première solution proposée a consisté à utiliser deux adhésifs dans un même joint : c'est le concept du joint multi-adhésif. Plus récemment, plusieurs travaux de recherche ont fait évoluer ce concept en utilisant un joint adhésif avec des propriétés variables discontinues le long de la surface encollée. Le présent manuscrit propose une nouvelle évolution de ce concept, où cette fois-ci la variation de propriétés est continue le long du joint adhésif : on parlera de concept de joint adhésif aux propriétés graduées (JAPG). L’idée du concept du JAPG réside dans la possibilité de diffusion de copolymères au sein d’une résine époxyde-amine, créant ainsi un gradient de concentration en copolymères, et donc un gradient de propriétés le long du joint. Suite à l’optimisation de la mise en œuvre de ce type de joint, le cœur du travail s’est articulé autour de la définition de méthodes de caractérisation d’assemblages collés sensibles à la modularité des propriétés d’adhérence induites par ces adhésifs hybrides. Plus précisément la puissance d’adhérence a été quantifiée lors de la phase d’encollage dans laquelle l’adhésif est sous forme de gel, puis lorsque l’adhésif est rigide au sein de la structure collée en service. Les tests choisis sont un test de tack à poinçon plat et un test de clivage en coin. Cette volonté de suivre l’évolution de l’adhérence durant toute la transformation de l’état physique de l’adhésif s’explique par la nécessité de maitriser la compétition entre forces de cohésion internes à l’adhésif qui prédominent quand l’adhésif est rigide et forces d’adhésion qui se créent lors de la mise en contact de l’adhésif avec le substrat. Les tests mécaniques sélectionnés et adaptés se sont finalement révélés être des outils sensibles et fiables pour caractériser l'adhérence d'un JAPG. Cette étude a montré qu’un tel joint possède des propriétés d’adhérence supérieures à celles de ses contreparties mono-adhésives de par la distribution hétérogène des copolymères dans le joint. / Bonded assemblies are a solution for which the aeronautical industry is looking forward to lighten airplanes since a long time. However, adhesives used nowadays are not equivalent to traditional methods, performance-wise. Particularly, in life temperature is one of the parameters that limit the performance of adhesive joints. A first attempt to solve this problem saw the birth of the multi adhesive joint, where two adhesive are used in the same joint. Recently, several works proposed an evolution of this concept, where the properties are changed gradually along the joint. This thesis moves one step forward by proposing yet another evolution. We designed an adhesive joint where the properties are continually graded over the joint: an adhesive joint with a gradient of properties (AJGP). Continuous grading is obtained by designing an adhesive joint with two adhesives. One of those is obtained from a classical epoxy-amine system. The other adhesive is made with the same epoxy-amine matrix, with the addition of amphiphilic tribloc copolymers. The latter is a nanostructured adhesive, which exhibit higher toughness than the former. When those adhesives are placed in the same joint, an interdiffusion phenomenon occurs. This allows copolymers diffusion along the joint. This work is split in two complementary research axis: first, a AJGP joint is designed and realized, to be tested either during bonding or in-life. Second, experimental tests are used to assess fracture toughness of the AJGP joint, with the challenge in mind to be able to detect an adherence variation along the joint. We chose a probe tack test and two wedge tests (cleavage test and driven wedge test) as mechanical tests. Those mechanical tests proved useful to assess adherence properties of an AJGP, which exhibits higher properties than its mono-adhesives counterpart