Association between the morisky medication adherence scale and medication complexity and patient prescription knowledge in primary health care

The aim of the study was to check the association of the Morisky Medication Adherence Scale with the prescription complexity and with the patient’s level of knowledge about the prescription. A cross-sectional study was conducted by means of an interview and analysis of the prescription received by patients selected at Family Health Strategy Units. A Poisson regression model with robust variance was used to describe the association between the variables. Low adherence was significantly associated with highly complex prescriptions: Prevalence Ratio (PR) = 1.53; 95 % Confidence Interval (CI) = 1.28-1.82, in comparison with low and moderate complexity. Low adherence was also significantly associated with very low levels of knowledge: regarding the highest level (third tertile), the first and second tertiles had PR = 4.44; 95 % CI = 3.26-6.06 and PR = 3.22; 95 % CI = 2.33-4.47, respectively. The Morisky scale is useful to measure low adherence, with the advantage of being an easily understood instrument, which can be quickly administered, presenting simple interpretation and applicationColegio de Farmacéuticos de la Provincia de Buenos Aire

Association between the morisky medication adherence scale and medication complexity and patient prescription knowledge in primary health care

The aim of the study was to check the association of the Morisky Medication Adherence Scale with the prescription complexity and with the patient’s level of knowledge about the prescription. A cross-sectional study was conducted by means of an interview and analysis of the prescription received by patients selected at Family Health Strategy Units. A Poisson regression model with robust variance was used to describe the association between the variables. Low adherence was significantly associated with highly complex prescriptions: Prevalence Ratio (PR) = 1.53; 95 % Confidence Interval (CI) = 1.28-1.82, in comparison with low and moderate complexity. Low adherence was also significantly associated with very low levels of knowledge: regarding the highest level (third tertile), the first and second tertiles had PR = 4.44; 95 % CI = 3.26-6.06 and PR = 3.22; 95 % CI = 2.33-4.47, respectively. The Morisky scale is useful to measure low adherence, with the advantage of being an easily understood instrument, which can be quickly administered, presenting simple interpretation and applicationColegio de Farmacéuticos de la Provincia de Buenos Aire

Eventos marcadores associados à adesão ao tratamento para HIV/aids em um estudo de coorte

OBJETIVO: Analisar como eventos clínicos e sociais podem impactar na adesão ao tratamento antirretroviral para o HIV. MÉTODOS: Trata-se de um estudo de coorte histórica com 528 pacientes que realizaram o tratamento para o HIV em um serviço de assistência especializada em Alvorada, RS. Foram analisadas 3429 consultas executadas entre os anos de 2004 e 2017. Para cada consulta, foram coletados dados de características do tratamento e do quadro clínico dos pacientes. A adesão, aferida pelo autorrelato dos pacientes, foi o desfecho do estudo. O modelo de regressão logística via equações de estimação generalizadas foi utilizado para estimação das associações. RESULTADOS: 67,8% dos pacientes analisados possuem até 8 anos de estudos e 24,8% têm histórico de uso de crack e/ou cocaína. Entre os homens, estar assintomático [razão de chances (RC) = 1,43; IC95% 1,05–1,93], possuir mais de 8 anos de estudo (RC = 2,32; IC95% 1,27–4,23) e nunca ter usado crack (RC = 2,35; IC95% 1,20–4,57) estiveram associados à adesão. Para as mulheres, possuir mais de 24 anos (RC = 1,82; IC95% 1,09–3,02), nunca ter usado cocaína (RC = 2,54; IC95% 1,32–4,88) e estar em gestação (RC = 3,28; IC95% 1,83–5,89) aumentaram as chances de adesão. CONCLUSÕES: Além de características sociodemográficas definidas, eventos pontuais que podem ocorrer na trajetória de pacientes em tratamentos longos, como início de uma nova gestação e não apresentar sintomas, podem impactar nas chances de adesão dos pacientes ao tratamento.OBJECTIVE: To analyze how clinical and social events may impact adherence to antiretroviral treatment for HIV. METHODS: This is a historical cohort study with 528 patients who underwent treatment for HIV in a specialized care service in Alvorada, RS. A total of 3429 queries executed between the years 2004 and 2017 were analyzed. For each visit, data on treatment characteristics and the patients' clinical picture were collected. Adherence, as measured by patients' self-report, was the endpoint of the study. The logistic regression model via generalized estimating equations was used for estimating the associations. RESULTS: 67.8% of the patients analyzed have up to 8 years of education and 24.8% have a history of crack and/or cocaine use. Among men, being asymptomatic [odds ratio (OR) = 1.43; 95%CI 1.05-1.93], having more than 8 years of education (OR= 2.32; 95%CI 1.27-4.23), and never having used crack (RC = 2.35; 95%CI 1.20-4.57) were associated with adherence. For women, being older than 24 years (CR = 1.82; 95%CI 1.09-3.02), never having used cocaine (CR = 2.54; 95%CI 1.32-4.88) and being pregnant (RC = 3.28; 95%CI 1.83-5.89) increased the odds of adherence. CONCLUSIONS: In addition to defined sociodemographic characteristics, one-off events that may occur in the trajectory of patients on long treatment, such as starting a new pregnancy and not having symptoms, can impact patients' chances of treatment adherence

Conocimiento y práctica de atención a pacientes politraumatizados en el personal de enfermería de la unidad de Emergencias del Hospital Cayetano Heredia – Lima 2023

La presente investigación presenta como objetivo general determinar cuál es la relación entre el conocimiento y práctica de atención a pacientes politraumatizados en el personal de enfermería de la unidad de emergencias del Hospital Cayetano Heredia – Lima 2023. Fue un estudio de diseño no experimental, transversal y nivel correlacional con el método hipotético – deductivo; la población y muestra se conformó por 60 licenciadas (os) de enfermería que laboran en el servicio de emergencia del Hospital Cayetano Heredia en el año 2023; se usó el cuestionario de conocimiento de atención sobre paciente politraumatizado diseñado y validado en la realidad peruana por la Lic. Carranza en el año 2019, y la lista de cotejo de práctica de atención sobre paciente politraumatizado diseñado y validado en la realidad peruana por las Lic. Neri Maquera y Yeshira Vidal en el año 2019. Los resultados indicaron en 58.3% un nivel alto de conocimiento, seguido por el nivel regular en 35% y nivel bajo en 6.7%, por otro lado, la práctica es adecuada en 73.3% e inadecuadas en 26.7% de los profesionales de enfermería. Se concluye que existe una correlación positiva, moderada y significativa al obtener Rho=0.552 y p=0.000<0.05 entre el conocimiento y práctica de atención al paciente politraumatizado en el personal de enfermería de la unidad de emergencias del Hospital Cayetano Heredia – Lima 2023

Adherence to dietary recommendations for preschoolers: clinical trial with teenage mothers

OBJETIVO Avaliar o efeito de intervenção alimentar educativa oferecida, no primeiro ano de vida da criança, a mães adolescentes e avós maternas, no cumprimento das recomendações alimentares aos quatro a sete anos. MÉTODOS Ensaio clínico randomizado iniciado em 2006, em Porto Alegre, RS, envolvendo 323 mães adolescentes e avós maternas, quando em coabitação. A intervenção consistiu em seis sessões de aconselhamento sobre aleitamento materno e alimentação complementar saudável. A primeira sessão ocorreu na maternidade e as demais, nos domicílios das mães aos sete, 15, 30, 60 e 120 dias de vida da criança. As informações sobre alimentação da criança foram obtidas mensalmente nos primeiros seis meses de vida, a cada dois meses no segundo semestre, e aos quatro a sete anos, por meio de questionário de frequência alimentar. Para avaliar a adequação do consumo alimentar às recomendações do Ministério da Saúde, elaborou-se um sistema de escore que refletisse o cumprimento dos Dez Passos Para Uma Alimentação Saudável Para Crianças de 2 a 10 Anos. As médias dos escores dos grupos intervenção e controle foram comparadas por meio do teste t. RESULTADOS Houve baixa adesão às recomendações sobre alimentação infantil na população estudada, sem diferença no cumprimento dos passos entre os grupos. O escore relativo ao cumprimento dos passos foi semelhante nos dois grupos (9,6 [DP = 1,63] e 9,3 [DP = 1,60] nos grupos intervenção e controle, respectivamente) e não houve influência da coabitação com a avó materna. CONCLUSÕES Intervenção alimentar educativa nos primeiros quatro meses de vida da criança para mães adolescentes e avós maternas não teve efeito no cumprimento das recomendações alimentares aos quatro a sete anos de vida.OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child’s life. The information about the child’s diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test. RESULTS Low adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found. CONCLUSIONS Educational dietary intervention in the first four months of the child’s life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child’s life

Information Management in Multicenter Studies: the Brazilian Longitudinal Study for Adult Health

Information management in large multicenter studies requires a specialized approach. The Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil - Brazilian Longitudinal Study for Adult Health) has created a Datacenter to enter and manage its data system. The aim of this paper is to describe the steps involved, including the information entry, transmission and management methods. A web system was developed in order to allow, in a safe and confidential way, online data entry, checking and editing, as well as the incorporation of data collected on paper. Additionally, a Picture Archiving and Communication System was implemented and customized for echocardiography and retinography. It stores the images received from the Investigation Centers and makes them available at the Reading Centers. Finally, data extraction and cleaning processes were developed to create databases in formats that enable analyses in multiple statistical packages.A gerência da informação em estudos multicêntricos de grande porte requer uma abordagem especializada. O Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) criou um Centro de Dados para delinear e gerenciar seu sistema de dados. O objetivo do artigo foi descrever os passos envolvidos, incluindo os métodos de entrada, transmissão e gerência de informações. Foi desenvolvido um sistema web que permitiu, de forma segura e confidencial, a entrada online, verificação e edição, bem como incorporação de dados coletados em papel. Além disso, foi implantado e personalizado um sistema de armazenamento e comunicação de imagens (Picture Arquiving and Communication System) para ecocardiografia e retinografia que armazena as imagens recebidas dos Centros de Investigação e as torna acessíveis nos Centros de Leitura. Finalmente, foram desenvolvidos processos de extração e limpeza de dados para criação de bases de dados em formatos que permitam análises em múltiplos pacotes estatísticos

Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study

OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechanical ventilation. The mortality rate was 51%. The mean age (± standard deviation) was 57±18 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22.6±8.3. The variables independently associated with mortality were (i) conditions present at the beginning of mechanical ventilation, age (hazard ratio: 1.01;

Indoor-outdoor relationships of airborne nanoparticles, BC and VOCs at rural and urban preschools

Health risks caused by exposure to black carbon (BC) and nanoparticles (NP) are well studied, although no standard currently exists for them worldwide. Exposure to children may lead to serious health effects due to their increased vulnerability and longer time spend inside the classrooms, making it important to assess the factors that affect air quality in preschools. Thus, this work aims to evaluate indoor-outdoor (I/O) relationships of NPs in the 10–420 nm range, BC and volatile organic compounds (VOCs) at rural and urban preschools (aged 3–5 years) between May 2016 and July 2017. Factorial analysis was applied to identify the possible emission sources. Prior communalities were estimated by the squared multiple correlations with all other variables. We used the varimax rotation method and the criterion for factor selection was the number of eigenvalues greater than one. Results indicate that BC and NP were 4- and 3.2-times higher in urban outdoor caused by traffic emissions, respectively. Highest concentrations occurred during rush hours and during the pickup time of children. In urban school, BC was directly related to accumulation mode (N49-205), while in the rural area, BC was related to local traffic and particles from pulp industries in the regional background. Nucleation mode (N11-36) was related to traffic emissions in urban school, while in the rural school was related with secondary formation of particles. Mean I/O ratios of BC and NP in the urban (0.54; 0.51) and rural (0.71; 0.91) schools, respectively, suggested that their higher concentrations occurred in outdoors. VOCs were higher indoor in urban (I/O = 1.97) and rural (I/O = 2.22) sites, indicating these pollutants are generated inside, regardless of urban or rural sites. These findings suggest the necessity of improving ventilation and commuting styles to lower the exposure of children to air pollutants in and around school environments

Low birth weight and markers of inflammation and endothelial activation in adulthood: The ARIC study

To investigate the hypothesis that intrauterine growth restriction might produce a longstanding pro-inflammatory tendency, we investigated the association of low birth weight with blood levels of markers of inflammation and endothelial activation in middle-aged adults

Optimizing strategies to identify high risk of developing type 2 diabetes

IntroductionThe success of diabetes prevention based on early treatment depends on high-quality screening. This study compared the diagnostic properties of currently recommended screening strategies against alternative score-based rules to identify those at high risk of developing diabetes.MethodsThe study used data from ELSA-Brasil, a contemporary cohort followed up for a mean (standard deviation) of 7.4 (0.54) years, to develop risk functions with logistic regression to predict incident diabetes based on socioeconomic, lifestyle, clinical, and laboratory variables. We compared the predictive capacity of these functions against traditional pre-diabetes cutoffs of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), and glycated hemoglobin (HbA1c) alone or combined with recommended screening questionnaires.ResultsPresenting FPG &gt; 100 mg/dl predicted 76.6% of future cases of diabetes in the cohort at the cost of labeling 40.6% of the sample as high risk. If FPG testing was performed only in those with a positive American Diabetes Association (ADA) questionnaire, labeling was reduced to 12.2%, but only 33% of future cases were identified. Scores using continuously expressed clinical and laboratory variables produced a better balance between detecting more cases and labeling fewer false positives. They consistently outperformed strategies based on categorical cutoffs. For example, a score composed of both clinical and laboratory data, calibrated to detect a risk of future diabetes ≥20%, predicted 54% of future diabetes cases, labeled only 15.3% as high risk, and, compared to the FPG ≥ 100 mg/dl strategy, nearly doubled the probability of future diabetes among screen positives.DiscussionCurrently recommended screening strategies are inferior to alternatives based on continuous clinical and laboratory variables