• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 41
  • 30
  • 3
  • 3
  • 2
  • 1
  • 1
  • Tagged with
  • 91
  • 91
  • 28
  • 27
  • 26
  • 26
  • 20
  • 18
  • 16
  • 13
  • 11
  • 11
  • 10
  • 9
  • 9
  • 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.
31

Efeitos de uma intervenção cognitivo comportamental em grupo para pacientes hipertensos atendidos em serviços de atenção primária de Ribeirão Preto/SP / Effects of a Cognitive Behavioral Intervention for Hypertensive Outpatients of Primary Care Services in Ribeirão Preto/SP.

Ana Cristina Zordan Rani 17 February 2012 (has links)
As doenças cardiovasculares (DCVs) lideram o ranking de causas de mortes em países desenvolvidos, produzindo custos socioeconômicos elevados. Dentre os fatores de risco para as DCVs, a hipertensão arterial sistêmica (HAS) surge como uma das principais causas para seu desenvolvimento. Estima-se que, no Brasil, a prevalência da HAS em adultos ultrapasse os 30%, o que a torna um grave problema de saúde pública, sendo seu controle uma das áreas prioritárias de atendimento dos Serviços de Atenção Primária à Saúde. Pelo fato da HAS possuir evolução silenciosa e lenta, os pacientes muitas vezes negligenciam sua condição deixando de seguir o tratamento proposto. Além disso, fatores psicológicos como depressão, ansiedade e estresse podem interferir, tanto no surgimento da HAS como na adesão ao tratamento. A falta de adesão à terapêutica, seja ela medicamentosa ou não, torna-se um problema para os profissionais de saúde. Diversos estudos mostram a importância de intervenções psicológicas para a implantação de mudanças e manutenção de comportamentos que interferem no controle da HAS. O objetivo deste trabalho foi avaliar o efeito de uma intervenção cognitivo comportamental sobre a pressão arterial (PA), as variáveis psicológicas, o índice de massa corporal (IMC), o comportamento alimentar e a atividade física de hipertensos atendidos em Serviços de Atenção Primária da cidade de Ribeirão Preto/SP. Participaram deste estudo 84 pacientes que foram avaliados utilizando-se entrevista semi-estruturada, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Depressão de Beck (BDI) e Inventário de Ansiedade de Beck (BAI). Os pacientes foram submetidos a uma avaliação inicial e uma avaliação final, para que posteriormente os dados das duas avaliações pudessem ser comparados. Entre uma avaliação e outra os pacientes foram divididos em dois grupos: Grupo de Terapia Cognitivo Comportamental (GTCC) e Grupo de Orientação (GO). Vinte e dois pacientes frequentaram os grupos propostos, sendo 11 do GTCC e 11 do GO, enquanto 62 não participaram de quaisquer grupos. Os resultados mostraram que não houve diferença estatística significante entre o GTCC e o GO, o que pode estar relacionado ao baixo número de participantes. Quanto às características sócio demográficas (n=84) observou-se que a maioria era do sexo feminino (76,2%), com idade superior a 50 anos, com companheiro (60,7%), com nível de escolaridade até o ensino fundamental completo (53,6%), sem emprego ou aposentados (60,7%) e com renda familiar superior a três salários mínimos (62,0%). Observou-se ainda que a maioria apresentava IMC acima da taxa de normalidade (75,0%) e não praticava atividade física (64,3%). Tinham sua PA controlada 54,8% dos sujeitos e 94% faziam uso de medicação. Quanto aos fatores psicológicos, 53,6% apresentavam sintomas de estresse, 20,2% obtiveram pontuação do BDI que indicava sintomas de transtorno depressivo e 23,8% apresentavam sintomas ansiosos. Considerando-se a baixa frequência de participação nos grupos buscou-se também avaliar a não adesão ao tratamento proposto. Comparando-se os participantes que aderiram aos grupos (n=22) com aqueles que não aderiram (n=62) observou-se diferença estatística significante quanto ao sexo, estado civil, escolaridade, renda familiar, diabetes melittus, conhecimento da PA, conhecimento da PA tida como normal e presença de estresse. No Grupo Adesão houve predomínio de participantes do sexo feminino (95,5%), sendo que a maioria não possuía companheiro (59,1%), tinha nível de escolaridade elevado (72,7%) e possuía renda familiar superior a três salários mínimos (77,3%). No que se refere ao conhecimento e manejo da HAS, no Grupo Adesão, 100% dos participantes conheciam a sua PA após os encontros grupais. Quanto à presença de estresse, houve diminuição de 59,1% para 31,8% entre aqueles indivíduos que aderiram ao tratamento proposto. Os dados indicaram que as mulheres procuram mais os serviços de saúde e que o nível de escolaridade e a renda familiar elevados podem favorecer a adesão ao tratamento. A análise qualitativa dos motivos para a não adesão mostrou que a \"falta de tempo\" foi o principal motivo que dificultou a presenças dos pacientes nos grupos. De maneira geral, os participantes do estudo acreditaram que o \"desinteresse com a própria saúde\" foi o principal fator que interferiu na adesão aos grupos. As principais sugestões dos pacientes para melhorar a adesão estão relacionadas a mudanças na estrutura dos grupos. Os dados deste estudo podem ter sido comprometidos pelo baixo número de participantes nos grupos; o GTCC não favoreceu mais mudanças comportamentais do que o GO, o que indica que uma intervenção tão elaborada pode não ter uma boa relação custo benefício. Variáveis que não foram controladas podem ter favorecido as mudanças observadas no GO. Como alternativa para aumentar a adesão aos grupos pode-se propor telefonemas semanais aos pacientes, folhetos informativos, atenção da equipe multidisciplinar, auxílio da instituição de saúde na divulgação dos encontros e mudança do nome do grupo. Contudo, para a adequação desta intervenção cognitivo comportamental, novos estudos precisam ser realizados com amostras compostas por um maior número de sujeitos. / Cardiovascular diseases (CVDs) lead the ranking of causes of death in developed countries, producing high socioeconomic costs. Among the risk factors for cardiovascular diseases, hypertension has emerged as a major reason for their development. It is estimated that in Brazil, the prevalence of hypertension in adults exceeds 30% which makes it a serious public health problem, being its control a priority area in Primary Health Care. Because hypertension has silent and slow evolution, patients often neglect their treatment. In addition, psychological factors like depression, anxiety and stress can interfere with the onset of hypertension and treatment adherence. The nonadherence to drug therapy or other kinds of therapies becomes a problem for health professionals. Several studies shown the importance of psychological interventions for the implementation of changes and maintenance of behaviors that interfere with control of hypertension. The objectives of this study were to evaluate the effect of a cognitive behavioral intervention on blood pressure (BP), psychological variables, body mass index, physical activity and feeding behavior of hypertensive patients in primary care services of the city Ribeirão Preto/SP. The study included 84 patients, which were assessed using a semi-structured interview, Lipp\'s Inventory of Stress Symptoms in Adults (ISSL), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). They were submitted to an initial assessment and a final evaluation so that data from the two moments could be compared. Between assessments the outpatients were divided into two groups: Cognitive Behavioral Therapy Group (CBTG) and Orientation Group (OG), 22 of them adhered to treatment, 11 of the CBTG and 11 of the OG, while 62 did not adhere. The results showed no statistically significant difference between the CBTG and OG which may be related to the low number of participants. With regard to sociodemographic data (n = 84) it was observed that the majority were female (76.2%), older than 50 years, with a partner (60.7%), with an elementary level of education (53.6%), unemployed or retired (60.7%) and family income above three minimum wages (62.0%). It was also observed that the majority had body mass index above the normal rate (75.0%) and physical inactivity (64.3%). They had their blood pressure controlled and 54.8% and 94.0% of the subjects were using medication. As for psychological factors, 53.6% had symptoms of stress, 20.2% had BDI scores indicating symptoms of depressive disorder and 23.8% had anxiety symptoms. Considering the low adherence in groups it was also assessed the nonadherence to the proposed treatment. Comparing the participants who joined the groups (n = 22) with those who did not adhere (n = 62) it were observed significant differences regarding sexgender, marital status, education, family income, diabetes mellitus, knowledge of blood pressure, knowledge of blood pressure regarded as normal and the presence of stress. In the group where adherence treatment was observed, it was verified a predominance of female participants (95.5%), and that most had no partner (59.1%), had higher education (72.7%) and had a family income above three minimum wages (77.3%). With regard to knowledge and management of hypertension in the group that adhered to treatment, 100% of the participants knew their blood pressure after the group meetings. Regarding the presence of stress, it decreased from 59.1% to 31.8% among those individuals who have joined the proposed treatment. The data indicated that more women seek health services and the education level and family income levels may promote adherence to treatment. Qualitative analysis of the reasons for nonadherence showed that \"lack of time\" was the main reason that hindered the participation of patients in groups. Overall, the study participants believed that the \"indifference regarding their own health\" was the main factor that interfered with adherence to the groups. The main suggestions to improve patients\' adherence are related to changes in the structure of the groups. Data from this study may have been compromised by the low number of participants in the groups. The CBTG did not favor more behavioral changes than the OG, which indicates that such elaborated intervention may not have a cost-effective relation. Variables that were not controlled may have favored the changes observed in OG. As an alternative to increasing adherence to groups it can be proposed weeklytelephone calls to patients, newsletters, multidisciplinary care team, assisting of the health institution in order to promote the meetings and group name change. However, for the adequacy of cognitive behavioral intervention, further studies are needed with samples composed of a greater number of subjects.
32

Apoio social, adesão ao tratamento e controle metabólico de pessoas com Diabetes Mellitus tipo 2 / Social support, treatment adherence and metabolic control of people with type 2 diabetes mellitus.

Lilian Cristiane Gomes Villas Boas 08 July 2009 (has links)
Trata-se de um estudo seccional, de abordagem quantitativa, cujo objetivo geral foi analisar a relação entre o apoio social percebido, a adesão às atividades de autocuidado, a adesão ao tratamento medicamentoso e o controle metabólico de pessoas com diabetes mellitus tipo 2. Como objetivos específicos, pretendeu-se caracterizar a amostra segundo características sociodemográficas, clínicas, hábitos de vida e controle metabólico; avaliar a percepção das pessoas com diabetes mellitus tipo 2 frente ao apoio social; avaliar a adesão ao autocuidado e ao tratamento medicamentoso das pessoas com diabetes mellitus tipo 2. O estudo foi desenvolvido em unidade ambulatorial, no período de maio a novembro de 2008. Mediante os critérios de inclusão e exclusão, a amostra ficou constituída por 162 pessoas; para a coleta dos dados, foram utilizados o Inventário da Rede de Suporte Social, o Questionário das Atividades de Autocuidado com a Diabetes e a Medida de Adesão aos Tratamentos. Resultados: 94 (58%) participantes eram do sexo feminino, a média de idade foi de 59,39 (DP=8,02) anos, 114 (70,4%) eram casados, 67 (41,4%) aposentados ou pensionistas, 129 (79,6%) procedentes de Ribeirão Preto e/ou região, média de escolaridade de 5,36 (DP=3,90) anos de estudo e uma média de renda familiar mensal de 1.325,65 (DP=1.122,72) reais. O tempo de diagnóstico foi, em média, 14,8 (DP=7,72) anos; 88 (54,3%) eram obesos e 58 (35,8%) com sobrepeso; a prática de atividade física (regular ou esporadicamente), o tabagismo e o consumo de bebida alcoólica foram referidos, respectivamente por 55,5%, 6,2% e 19,8% dos participantes. Entre as complicações/comorbidades, as de maiores frequências foram as dislipidemias e a hipertensão arterial sistêmica; 104 (64,2%) participantes estavam em terapia combinada de insulina e antidiabéticos orais; 143 (88,3%) apresentaram hemoglobina glicada maior ou igual a 7% (média=9,1%; DP=1,82); médias da pressão arterial sistólica 140 mmHg (DP=22,4) e da diastólica 78 mmHg (DP=11,84); da circunferência abdominal para o sexo masculino 106,4 cm (DP=12,87) e feminino 106 cm (DP=13,87); colesterol total 182 mg/dl (DP=47,7); HDL 42 mg/dl (DP=9,3) e triglicérides 215 mg/dl (DP=237,3). Observou-se elevada percepção de apoio social, e a principal fonte foi a dos familiares, seguidos pelos profissionais de saúde. A adesão ao autocuidado foi baixa em 69,1% dos participantes e alta para o tratamento medicamentoso (95,7%). Para um p<0,05, o apoio social teve correlação direta com a idade (0,20), adesão ao autocuidado (0,21) e adesão medicamentosa (0,18); e inversamente com a escolaridade (-0,24). A adesão ao autocuidado correlacionou-se diretamente com a adesão medicamentosa (0,22), e inversamente com a escolaridade (-0,18); a adesão medicamentosa correlacionou-se diretamente com a adesão ao autocuidado (0,22), com a frequência diária de aplicação de insulina (0,18) e frequência diária de tomada do antidiabético oral (0,27). Conclusões: os dados sugerem que a escolaridade é uma variável que deve ser considerada na educação em diabetes mellitus e pode ser uma barreira para o autocuidado, enquanto o apoio social poderá ser útil para se obter a adesão ao tratamento e ao autocuidado. / The general aim of this cross-sectional quantitative study was to analyze the relationship among perceived social support, adherence to self-care activities, adherence to medication and metabolic control of people with type 2 diabetes mellitus. The specific aims were to characterize the sample according to sociodemographic and clinical characteristics, life habits and metabolic control; to evaluate the perception of people with type 2 diabetes mellitus regarding social support; and to evaluate their adherence to self-care and medication. The study was developed at an outpatient clinic, between May and November 2008. The sample consisted of 162 patients, after applying the exclusion and inclusion criteria. The Social Support Network Inventory, the Diabetes Self-Care Activities Questionnaire and the Treatment Adherence Measure were used for data collection. Results: 94 (58%) participants were female, average age was 59.39 (SD=8.02) years, 114 (70.4%) subjects were married, 67 (41.4%) were retired or pensioners and 129 (79.6%) were from the city of Ribeirão Preto or its surrounds. The average educational level was 5.36 (SD=3.90) years of school and the average monthly family income was 1,325.65 (DP=1,122.72) reais. The average time of diagnosis was 14.8 (SD=7.72) years; 88 (54.3%) participants were obese and 58 (35.8%) overweight. Subjects mentioned practicing physical activities (55.5%, regularly or sporadically), smoking (6.2%) and consuming alcoholic drinks (19.8%). Most frequent complications/comorbidities were dyslipidemia and systemic high blood pressure; 104 (64.2%) participants were being treated with oral antidiabetic therapy in combination with insulin and 143 (88.3%) presented glycated hemoglobin higher or equal to 7% (average=9.1%; SD=1.82). The average systolic blood pressure was 140 mmHg (SD=22.4) and diastolic blood pressure was 78 mmHg (SD=11.84); male average abdominal circumference was 106.4 cm (SD=12.87) and female was 106 cm (SD=13.87). Total cholesterol was 182 mg/dl (SD=47.7); HDL 42 mg/dl (SD=9.3) and triglycerides 215 mg/dl (SD=237.3). High perception of social support was observed, the main source was family members, followed by health professionals. Adherence to self-care was low in 69.1% of the participants, while adherence to medication was high (95.7%). For p0.05, social support had direct correlation with age (0.20), adherence to self-care (0.21) and adherence to medication (0.18); and inverse correlation with educational level (-0.24). Adherence to self-care was directly correlated to adherence to medication (0.22) and inversely correlated to educational level (-0.18); adherence to medication was directly correlated with adherence to selfcare (0.22), with daily frequency of insulin injection (0.18) and daily frequency of oral antidiabetic therapy (0.27). Conclusions: data suggest the educational level is a variable that should be considered in education in diabetes mellitus and can be a barrier to self-care, while social support can be useful to achieve adherence to treatment and self-care.
33

The impact of depression on treatment adherence and cardiorespiratory fitness in cardiac rehabilitation

Ho, Sheau-Yan 01 January 2017 (has links)
Major depression and coronary heart disease are two strongly linked, major causes of death and disability. After an acute coronary event, many patients are referred to cardiac rehabilitation (CR), a medically supervised exercise intervention and lifestyle training program. Depression may partially account for poor CR adherence and resulting cardiovascular problems in patients with a history of heart disease; however, underlying mechanisms through which depression impacts cardiac functioning are not well understood. The current project tests a theoretical model in which CR adherence (i.e., number of CR sessions attended) mediates the relation between baseline depression and cardiorespiratory fitness after CR. A community sample of 858 older adults initiating CR after hospitalization for a coronary event completed a symptom-limited exercise stress test before and after the 12-week program. Cardiorespiratory fitness was measured via VO2max, peak MET, and total duration of the stress test. Depression was measured at baseline using the Patient Health Questionnaire Depression Scale. CR adherence did not mediate the relation between baseline depression scores and fitness outcomes. Path analyses revealed that higher baseline depression severity predicted lower likelihood of CR completion (i.e., completion of all 36 sessions, or fewer if limited by insurance or terminated early for good prognosis) in the full sample. Higher levels of depression predicted poorer CR adherence in a subsample of 74 patients with moderate to severe depression. These findings lend support to depression as a predictor of treatment nonadherence in CR. Screening for depression in the context of coronary heart disease and implementing evidence-based depression interventions in secondary prevention settings can help alleviate a massive public health burden.
34

Falta de adherencia en la terapia física en pacientes con dolor y transtornos músculo esqueléticos: incidencia y factores de riesgo

Coello Talavera, Diana, Rojas Motta, Noelia Fernanda 01 July 2015 (has links)
Fundamento y objetivo. Conocer la incidencia y factores de riesgo asociados con la falta de adherencia al tratamiento fisioterapéutico en pacientes con dolor y trastornos músculo esqueléticos que asisten a una clínica docente en Lima, Perú. Materiales y métodos. Estudio de cohorte retrospectivo, incluyó a todos los pacientes nuevos atendidos por dolor y trastornos músculo esqueléticos en periodo 2012-2014. Se midió la falta de adherencia (asistencia menor a las 8 sesiones indicadas) y factores demográficos. Se calculó los riesgos relativos crudos y ajustados (RRa). Resultados. Se incluyó 549 pacientes, 68,3% fueron mujeres, 37,2% tuvieron 60 o más años, las lesiones más frecuentes se ubicaron en miembro inferior (34,2%) y dorso lumbar (24,6%). Se encontró una incidencia de falta de adherencia de 56,4% (IC95%: 52,2 a 60,7%) y estuvo asociada con residir lejos de la clínica (RRa: 1,34; IC95%: 1,16 a 1,57) y tener menos de 40 años (RRa: 1,27; IC95%:1,04 a 1,54). Conclusión. Existe una alta incidencia de falta de adherencia al tratamiento fisioterapéutico relacionado con la distancia y edad de los pacientes, por lo que se deben buscar estrategias para aumentar la adherencia. / Objective. To determine the incidence and risk factors to the non-adherence to physiotherapy treatment in patients with pain and musculoskeletal disorders attending a Teaching Clinic in Lima, Peru. Material and Methods. Retrospective cohort study, it included all new patients seen by pain and skeletal muscle disorders in period 2012-2014. Non adherence was measure (less than 8 sessions attended) and demographic factors. We calculated crude and adjusted relative risk (aRR). Results. We included 549 patients,: 68,3% women, 37,2% had 60 or more years , the most frequent injuries were located on the legs (34,2%) and lumbar (24,6%). We found an incidence of non-adherence of 56,4% (95% CI: 52,2 to 60,7%) and was associated to reside away from the clinic (aRR:1,34; 95%CI: 1,16 to 1,57) and less than 40 years (aRR: 1,27; 95%CI:1,04 to 1,54). Conclusion. There is a high incidence of non-adherence to physiotherapy related to distance and age of patients, so it must find strategies to increase adherence.
35

An assessment of food security interventions for people living with HIV/AIDS on antiretroviral treatment at household Llvel in the Khomas Region, Namibia

Magazi, Shirley January 2008 (has links)
Magister Public Health - MPH / In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia. / South Africa
36

The influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District, South Africa

Musvipwa, Faith Mary 20 September 2019 (has links)
PhD (Sociology) / Department of Sociology / The purpose of the study was to investigate the influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District. This qualitative study used an explorative design to envisage the aim. A cross-sectional snowball sample was used to draw a sample of 9 participants from the 4 municipalities of Vhembe District. The data collection methods were; in-depth interviews, focus group discussions and key informants’ interviews. The 3 data collection techniques ensured triangulation for more complete and well-validated outcomes of the study. The researcher used the Van Manen method to analyse data. Contrary to popular belief that THPs promote non-adherence among people living with HIV/AIDS (PLWHA), the study found out that the majority of Traditional Healing Practitioners (THPs) encourage and positively influence PLWHA to adhere to anti-retroviral treatment. Apart from a minority of participants who claimed to cure HIV/AIDS, the majority acknowledged and admitted that traditional healing practices do not cure HIV/AIDS but it only heals opportunistic infections. As a result, the majority of THPs influences PLWHA to adhere to anti-retroviral therapy (ART). However, the positive influence of THPs is challenged by individual and social-cultural factors that are beyond THPs’ control which influence treatment adherence such as; traditional and cultural beliefs, side effects of ARVs, nurses’ attitude, inconveniences, lack of transport, personal choices, lack of trust in ARVs and fear of loss of the Disability Grant. It is on this backdrop that study findings prompted devising of a model and a 5 phase support program for intervention. / NRF
37

Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women

Cutimanco-Pacheco, V., Arriola-Montenegro, J., Mezones-Holguin, E., Niño-Garcia, R., Bonifacio-Morales, N., Lucchetti-Rodríguez, A., Ticona-Chávez, E., Blümel, J. E., Pérez-López, F. R., Chedraui, P. 03 May 2020 (has links)
Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection. Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR). Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39–2.29; PR: 1.76, 95% CI: 1.38–2.23; and PR: 2.07, 95% CI: 1.64–2.61, respectively) and the adjusted model. Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women. / Revisión por pares
38

Connecting Patient Centered Care for Chronic Conditions to School-based Clinics through Telehealth: the Asthma Free Schools Program

Dunfee, Madeline N. 12 September 2017 (has links)
No description available.
39

The Effects of a Brief Motivational Enhancement Targeting Parents of Adolescent Substance Users

Baum, David E., Baum 15 August 2016 (has links)
No description available.
40

Efetividade de intervenções para o manejo da adesão ao tratamento para pacientes adultos submetidos ao transplante cardíaco: uma revisão sistemática / The effectiveness of interventions to manage treatment adherence of adult patients undergoing heart transplant: a systematic review.

Marcelino, César Augusto Guimarães 10 July 2013 (has links)
Introdução: A falta de adesão ao tratamento é fator limitante para o sucesso dos transplantes de coração, pois contribui para o aumento da morbidade e mortalidade, reduz a qualidade de vida e aumenta os custos referentes ao uso de serviços de saúde. Objetivo: Sintetizar as melhores evidências sobre as intervenções para o manejo da adesão ao tratamento farmacológico e não farmacológico no transplante cardíaco. Método: Revisão sistemática de literatura por meio de busca de estudos publicados e não publicados nas seguintes bases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science e banco de Teses da Capes. Foram critérios de inclusão: estudos clínicos com pacientes adultos depois de transplante cardíaco, que tivessem testado o impacto de qualquer intervenção na adesão ao tratamento, avaliada objetivamente ou por auto-relato, usando instrumentos válidos e confiáveis, comparada ao cuidado usual. A qualidade metodológica dos estudos elegíveis foi realizada por dois revisores independentes e as discordâncias foram resolvidas por consenso. Os resultados foram integrados de forma narrativa. Resultados: Foram identificadas 2.519 citações potencialmente relevantes. Excluídos 1.336 por repetição, restaram 1.183 citações que tiveram seus resumos lidos e, após a aplicação de critérios de inclusão, restaram sete publicações para análise da qualidade metodológica. Quatro estudos foram excluídos e os principais motivos foram a falta de avaliação de intervenção (dois estudos), estudo teórico (um estudo) e a adesão ao tratamento não ter sido o foco da intervenção estudada (um estudo). Um dos estudos mantidos não detectou diferença entre intervenção educativa realizada em laboratório de ensino comparada a cuidado usual; outro estudo também não detectou diferença entre uma intervenção multifacetada, composta por oficinas interativas, oferecida pela internet comparada a cuidado usual; e o terceiro detectou impacto positivo da diminuição na dose diária do imunossupressor, de duas vezes ao dia para uma vez. Com relação ao método, dois estudos utilizaram ensaio clínico controlado não randomizado e um foi descritivo / observacional. Conclusões: As evidências disponíveis para orientar decisões sobre intervenções para controlar a adesão do paciente submetido ao transplante de coração ainda são escassas. A realização de ensaios clínicos randomizados, com alta qualidade metodológica, é fundamental para fornecer evidencias mais robustas sobre o manejo da adesão no transplante cardíaco. / Introduction: Treatment adherence failure is a limiting factor for effective heart transplants, as it contributes with increased morbidity and mortality and a reduced quality of life in addition to increasing health service costs. Objective: To synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart transplant patients. Method: Systematic literature review by searching published and unpublished studies on the following databases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science and the Capes Thesis database. The inclusion criteria were: clinical studies with adult heart transplant patients, which tested the impact of any intervention over treatment adherence, evaluated objectively or through self-reports, using validated and reliable instruments, compared to common care. Two independent raters assessed the methodological quality of the eligible studies and any disagreements were solved by consensus. The results were integrated in a narrative form. Results: A total of 2.519 potentially relevant statements were identified. Of the total, 1.336 were repeated, and, therefore, excluded. The abstracts of the remaining 1.183 statements were read and, after considering the inclusion criteria, seven publications were analyzed in terms of their methodological quality. Four studies were excluded mainly because they did not present an evaluation of the intervention (two studies), one was a theoretical study, and one study was not center the investigation on treatment adherence. On of the selected studies did not find any difference between the educational intervention performed in a teaching laboratory compared to common care; another study also did not find any difference between one multiple intervention, comprised of online interactive workshops, compared to common care; and the third study found a positive impact from reducing the immunosuppressant dose from twice to once a day. Regarding the method, there were two non-randomized clinical trials and one descriptive/observational study. Conclusions: The current best evidence to guide decisions regarding interventions to manage treatment adherence of heart transplant patients remain scant. Randomized clinical trials with high methodological rigor are key to obtain more robust evidence regarding treatment adherence management in heart transplants.

Page generated in 0.1179 seconds