Características realcionadas à compreensão do tratamento entre pacientes iniciando a terapia anti-retroviral no Brasil

Exportado OPUSMade available in DSpace on 2019-08-12T08:34:13Z (GMT). No. of bitstreams: 1 tese_maria_das_gracas_braga_ceccato.pdf: 1718124 bytes, checksum: f83a6d0cb06d2198241ae695b83965da (MD5) Previous issue date: 7Objetivo: O objetivo deste estudo foi avaliar a compreensão de informações relativas a medicamentos prescritos, entre pacientes em início de tratamento anti-retroviral, e determinar fatores associados à esta compreensão. Está constituído por três artigos. O primeiro apresenta uma revisão da literatura sobre o tema. O segundo desenvolve um escore para determinar o nível de compreensão sobre a terapia anti-retroviral (TARV). O terceiro avalia os fatores associados com o nível de compreensão dessa terapia. Metodologia: Para a revisão bibliográfica dos estudos publicados sobre compreensão daprescrição médica pelo paciente foi pesquisada a base bibliográfica MEDLINE_PubMed. Realizou-se um estudo transversal no qual os pacientes de dois serviços públicos de referência para o tratamento do HIV/aids (Belo Horizonte, Brasil) foram entrevistados depois de iniciara TARV. Foram coletadas informações sobre as características do paciente, do tratamento prescrito e dos profissionais de saúde provedores da atenção. O escore da compreensão dos medicamentos prescritos foi obtido utilizando-se modelo de traço latente estimado pela Teoria de Resposta ao Item (TRI), após análise de concordância entre a resposta do paciente e a informação contida na presricão. Realizou-se análise de regressão linear hierárquica para obter a compreensão global dos medicamentos, considerando cada classe de medicamentos(nível 1) e o indivíduo (nível 2), como também para avaliar os fatores associados a esse nível de compreensão. Resultados: Os estudos revisados são suficientes para justificar a importância da compreensão da prescrição médica pelo paciente e da necessidade de se medir esse grau de compreensão. Dos 406 pacientes avaliados, 37,9% não atingiram um nível mínimo de compreensão do tratamento. Com uma idade média de 35 anos (DP=10), a maioria dos participantes era do sexo masculino (56%), de etnia afro-americana (77%) e com umaescolaridade < 8 anos (53%). O item com maior nível de dificuldade foi precaução de uso. O item dose foi o que mais diferenciou os pacientes quanto à compreensão da TARV. O modelo de regressão mostrou que 52,25% da variabilidade da compreensão era explicada pelo indivíduo. As variáveis associadas com um menor nível de compreensão (p<0,05) foram menor escolaridade (< 8 anos), o desconhecimento da duração da TARV, a gravidade clínica,a informação médica inadequada, a incapacidade de entender a informação farmacêutica, o número diário de comprimidos e o esquema de TARV prescrito. Conclusão: Observou-se alta proporção de pacientes sem um nível mínimo de compreensão da TARV, o que pode indicar um alto risco potencial de não-adesão à terapia. Há uma alta variabilidade individual na compreensão da informação sobre a TARV. No entanto, existem características do paciente (educação e gravidade clínica), do tratamento (número diário de comprimidos, esquema TARV prescrito) e dos profissionais de saúde (informações médicas e farmacêuticas) que se mostraram associadas com o grau de compreensão. Deveriam serpriorizadas, no processo de atenção, estratégias de comunicação que reforcem a assimilação da informação sobre a TARV, especialmente para aqueles pacientes que apresentam um baixo nível de compreensão do tratamento.Objective: The aim of this study was to evaluate the level of understanding regarding information on medications prescribed among patients initiating anti-retroviral therapy (ARVT), and to determine factors associated with this level of understanding. It is composed of three articles. The first presents a review of the literature on the subject. The second develops a score to determine the level of understanding on ARVT. The third evaluates the factors associated with the level of understanding of this therapy. Methods: For the literature review of published studies on understanding the patient's prescription was the basis searched MEDLINE-PubMed literature. There was cross-sectionalanalysis in which patients of two HIV/AIDS public referral (Belo Horizonte, Brazil) were interviewed after initiating ART. Information on variables related to the characteristics of the patient, the treatment prescribed and the health care professional were collected.The score of patients understanding regarding the medications prescribed was obtained using a latent trait model estimated by the Item Response Theory (IRT), based on the concordance between each patient answer and written prescription. Hierarchical linear regression was used to assesspatients global understanding of ARVT, considering each class of drugs (level 1) and the individual (level 2), also to assess the factors associated with this level of understanding. Results: Of 406 patients evaluated, 37.9% had not reached a minimum level of understanding of the treatment. With a mean age of 35 ± 10 years, most participants were males (56%), afroamerican ethnicity (77%) and had had < 8 years of education (53%). The item with highest level of difficulty was precaution of use. The item dosage was the one which mostly differentiated understanding of ARVT. The model showed 52.25% of the variability of the understanding was explained by the individual. Variables associated (p<0.05) with lowest ART understanding were lower education (< 8 years), lack of knowledge about treatment duration, clinical severity, inadequacy of medical information, little understanding ofpharmacist information, daily number of tablets and ARVT regimen prescribed. Conclusions: The review of studies was enough to justify the importance of the understanding the prescription for the patient and the need to measure the degree of understanding A high proportion of patients with minimum level of ARVT understanding was observed, which can indicate a high potential risk for non-adherence to the therapy. There is a high individual variability in the understanding of information regarding ARVT regimen prescribed. However, there are factors related to the characteristics to the patient (education, clinical severity), to the treatment (daily number of tablets, ARVT regimen prescribed) and tothe healthcare professionals (medical and pharmacist information) associated with the understanding degree. Strategies for reinforcement of information about ARVT should be prioritized among patients with a low level of understanding

Characteristics of tuberculosis in the state of Minas Gerais, Brazil: 2002-2009

OBJECTIVE: To analyze the profile of tuberculosis cases reported between 2002 and 2009 in the state of Minas Gerais, Brazil, according to sociodemographic, clinical, and laboratory characteristics, as well as to comorbidities and mortality. METHODS: This was a descriptive, epidemiological study based on data obtained from the Brazilian Case Registry Database and the Brazilian Mortality Database for the 2002-2009 period. RESULTS: There were 47,285 reported cases of tuberculosis, corresponding to a mean incidence of 22.3/100,000 population. The individuals diagnosed with tuberculosis were predominantly in the 20- to 49-year age bracket and male (62.4% and 67.0%, respectively). Individuals with a low level of education accounted for 18.5% of the cases. New cases, cases of recurrence, and cases of retreatment accounted for 83.7%, 5.7%, 5.7%, respectively. The rates of cure and treatment noncompliance were 66.2% and 11.2%, respectively; multidrug-resistant tuberculosis was identified in 0.2% of the cases; and the mortality rate was 12.9%. The directly observed treatment, short-course (DOTS) strategy was applied in 21.8% of the cases. Sputum smear microscopy and culture were performed in only 73.9% and 12.9% of the cases, respectively. Chest X-rays were performed in 90.5% of the cases. Pulmonary tuberculosis was the predominant form (in 83.9%). Comorbidity with alcoholism, HIV infection, and diabetes mellitus were identified in 17.2%, 8.3%, and 3.8%, respectively. CONCLUSIONS: During the study period, the numbers of new cases, cases of treatment noncompliance, and deaths were high, comorbidities were common, and there was a failure to perform adequately basic tests for the diagnosis of tuberculosis. Multidisciplinary approaches, expanded use of the DOTS strategy, better knowledge of the distribution of tuberculosis, and improvements in the databases are needed in order to achieve better control of the disease in the state of Minas Gerais

Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis

To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search and 14 additional articles were identified through hand searching. Forty-eight articles (11,432 participants) from 42 studies (38 RCTs and four cohorts) met the inclusion criteria. Meta-analysis results revealed the following: (i) tacrolimus was associated with an increased risk for diabetes and lower risk of dyslipidemia, compared to cyclosporine; (ii) mycophenolate mofetil (MMF) was associated with increased risk for total infections, abdominal pain, diarrhea and vomiting, compared with azathioprine; (iii) sirolimus was associated with higher risk of anemia, diabetes, dyslipidemia, lymphoceles and withdrawal compared to tacrolimus or cyclosporine, and cyclosporine was associated with an increased risk of CMV infection; (iv) the combination of CNI with antimetabolites was associated with more adverse events than CNI alone; (v) TOR-I was related to more adverse events than MMF. The data observed in this meta-analysis are similar to those describe by others authors; thus, the choice of treatment must be made by the clinical staff based on specific patient characteristics