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Objectives: to evaluate factors associated with adherence to drug therapy in hypertensive patients in a Primary Care Unit. Methods: a descriptive, exploratory study, applying the assessment of adherence and Self-reported Medication Adherence Measure in 54 patients of the Adult Health Program. For categorical variables, the chi-square test or Fisher exact test were used; for the numeric, the Mann-Whitney or Kruskal- Wallis test were used; and for correlation the correlation coefficient of Spearman was used. Results: patients had a mean age of 61.4 (± 12.5) years, 51.8% women and 48.1% men, mean schooling was 4.3 (± 3.5) years, 59% were employed, 35.1% performed blood pressure control only for medical consultation and/or nursing, 61.1% were non-adherent to medication treatment despite showing high favourability behavior accession. Men and those who did not follow dietary recommendations were more careless when taking medications; those who worked out of their home forgot to take the medication more often; smokers and those who frequently ingest alcohol were behaviors less favorable to adhesion. Conclusions: factors associated with nonadherence were gender and healthy habits. Thus, the major challenge for health professionals is to implement measures that actually change the behavior of adhesion. The development of an intervention based on reflection, respect for the autonomy and individuality of the patient may help to improve adherence. [ABSTRACT FROM AUTHOR]

Periodontal disease is an infectious-inflammatory disease caused by the presence of bacteria in the dental biofilm, leading in many cases to tooth loss. The objective of this work is to report a clinical case of generalized periodontal disease. Female patient, sought the Dental Clinic of the University of Passo Fundo, complaining that her upper dental arch was increasingly "crooked" and felt a little "mobility"., being diagnosed with stage II periodontitis, due to the pandemic, the patient was only able to return to the Dental Clinic after 5 months, when new exams were carried out, with an increase in the probing depth reaching 7mm in some sites, having a new diagnosis periodontal disease, periodontitis stage III of the disease. The patient's treatment plan consisted of adapting the oral environment, through oral hygiene guidance, prophylaxis, supragingival and subgingival scaling. After 6 months of follow-up, it can be noted that the proposed treatment it was not satisfactory, because, after doing a new periogram, there was no regression of the disease. as for oral hygiene, the patient did not cooperate with the treatment and the installation of orthodontic appliances was not recommended. Periodontal maintenance along with the patient's cooperation is essential to achieve successful periodontal treatment, but in the following case report there was no success in periodontal therapy, and the patient's lack of cooperation could be one of the reasons. [ABSTRACT FROM AUTHOR]

Objective: To identify the factors associated with selfcare of chronic cardiopulmonary diseases. Methods: An integrative literature review with the purpose of synthesizing the evidence produced on the topic. The search was performed using the descriptors: Selfcare, self management, heart disease, lung disease and patient cooperation, from the Scielo, Pubmed, PEDro, Lilacs and Capes databases, published between the year 2013 to 2020, in Portuguese, English and Spanish. 46 studies were included after analyzing and selecting the content of the articles. Results: Better selfcare was seen in patients with greater knowledge of the disease, more comorbidities, symptom monitoring, employment relationship, social support, motivation, belief in treatment, spirituality, educational strategies and educational interventions that were culturally appropriate. A worse selfcare was associated with a higher body mass index, black race, living alone, anxiety and depression, and lack of empathy with the team. Conclusion: The selfmanagement process is complex and involves several determinants that can influence it, understanding these factors is necessary in order to have parameters for effective interventions and even to identify groups at risk for less selfcare. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to perform an objective videotaped evaluation of the difficulties of eyedrop instillation and daily tasks in patients with advanced glaucoma with visual impairment. Methods: A prospective observational study was performed in advanced glaucoma patients with visual impairment, during 5 months. Patients completed a survey (with demographic questions, quality of life, compliance and eyedrop instillation) with interview and video recording in specific daily tasks (eyedrop instillation, climbing stairs, walking in a crowded room and in an irregular floor). Ophthalmologic evaluation was performed and its results registered in a form. Correlation was searched between limitation in quality of life, tasks' performance and visual fields. Results: 25 patients were included, corresponding to 12h of videotaping. All patients reported being capable of self-instilling eyedrops. 68% of them reported no difficulty instilling the eye drops at home, however 20% of the patients were unable to instill a drop in the eye in the objective evaluation. 72% of the patients stated never touching the eye with the bottle but 40% touched the ocular surface with the bottle. There was a moderate difficulty in the other tasks, with some patients exhibiting proprioceptive mechanisms of adaptation to impaired vision. There was a tendency of correlation between limitation in tasks and visual field defects, but no statistically significant. Conclusion: Patients with advanced glaucoma and visual impairment have marked difficulty in eye drop instillation and daily tasks, with a poor awareness of their inabilities. Some patients have proprioceptive adaptations that allow them to perform better than expected in tasks. [ABSTRACT FROM AUTHOR]

Objectives: Describe ocular findings and its correlation with systemic diseases in Down Syndrome (DS) pediatric patients. Methods: Quantitative and cross-sectional study of prevalence with children aged from 0 to 25 years. Standard ophthalmic examinations performed: visual acuity, slit lamp biomicroscopy, ocular motility, static refraction and indirect ophthalmoscopy. Ocular findings were associated with comorbidities available in pediatric records of patients in FURB Down Syndrome Outpatient clinic, in which they have regular follow-up. Results: A total of 76 patients were evaluated (33 males and 43 females). Of these, 72 patients (94.73%) had ocular abnormalities. Refractive errors were the most prevalent (94.73%), followed by alterations in indirect ophthalmoscopy (40.8%), biomicroscopy (15.8%), ocular motility (15.8%) and epiphora (9.2%). From the refractive changes 13.15% had myopia; 76.31% had hypermetropia and 47.36% had astigmatism. Sytemic abnormalities were observed in 73 children. The most prevalent was thyroid diseases presented in 65.79%, followed by heart disease 61.84%, gastrointestinal disease (15.79%); abdominal hernias (14.4%); respiratory changes (14.4%); genitourinary alterations (10.53%); musculoskeletal alterations (10.53%) and epilepsy (3.95%). There was statically significant association between the presence of myopia and hypothyroidism (p = 0.01); astigmatism and heart diseases (p = 0.003); and astigmatism and genitourinary alterations (p = 0.001). Conclusion: There was a high prevalence of ophthalmologic abnormalities in this study of children with Down Syndrome. Associations between myopia and hypothyroidism, astigmatism and heart diseases, and astigmatism and genitourinary disorders were found. More studies and increase of the sample are necessary to confirm the associations of ophthalmologic abnormalities with most common systemic diseases in this population. [ABSTRACT FROM AUTHOR]

Introduction: chest physiotherapy, airway clearance techniques, and physical exercise are associated with better outcomes in cystic fibrosis, but adherence to these recommendations remains a challenge. Objective: to assess adherence to chest physiotherapy, airway clearance techniques, and physical exercise by children and adolescents with cystic fibrosis and analyze the factors related to adherence. Methods: retrospective study of children and adolescents with cystic fibrosis from a pediatric referral center in Brazil. Data were collected from electronic records of the multidisciplinary team responsible for caring for these patients at the referral center. Results: the sample included all 83 patients registered at the referral center, with a mean age of 7.88 ± 4.88 years. Among them, 28.9% did not have weekly chest physiotherapy, 66.3% did not practice physical exercise regularly, and only 38.6% practiced airway clearance techniques from 6 to 7 times a week. Higher adherence to airway clearance techniques was associated with higher mean age (p<0.01) and correlated with FEV1 (r=-0.39; p=0.03), FEF25-75% (r =-0.36; p=0.02), FEV1/FVC (r =-0.43; p=0.01) and lower mean Shwachman-Kulczycki Score (r=-0.34; p<0.01). Higher physical exercise adherence was associated with a higher mean age (p<0.01). Individuals using public financing of physiotherapy services had a lower Shwachman-Kulczycki Score (p=0.02) than those using non-public services. The metropolitan region had a higher percentage of individuals using nonpublic services than other regions (p<0.01). Conclusion: adherence to chest physiotherapy, airway clearance techniques and physical exercise was lower than recommendations. Airway clearance techniques and physical exercise adherence increased with age, and airway clearance techniques adherence was associated with the high severity of disease. These results suggest that patients only increase adherence when they get older and the disease worsens, highlighting the need for strategies to increase adherence early. [ABSTRACT FROM AUTHOR]

Non-adherence to medication was first noted over 2000 years ago and remains a challenge; the issue continues to generate intense debate. A surge in research in this area has helped to elucidate the extent, causes and consequences of patient non-adherence. However, how do we elucidate the extent of adherence without understanding its concept? What is the difference between the terms used in research in this field, such as compliance, adherence, concordance and persistence? A mapping of the existing literature on adherence to medication was conducted in order to answer this and other questions. This narrative review was conducted with no time limit, by searching MEDLINE/PubMed and Scielo databases. Health science descriptors (DeCS) were applied (Medication Adherence; Patient Compliance; Surveys and Questionnaires and Terminology); MESH terms (drug therapy, medication adherence, medication therapy management, patient compliance, terminology); and other terms. Although there is a vast literature on the concept of adherence to medication, no standard consensus is established. The terms compliance, adherence and concordance have been misused as interchangeable terms for adherence to medication. Some authors categorize non-adherence into intentional and unintentional; repeated or sporadic, and primary or secondary. Adherence is a complex multifactorial behavior influenced by several factors, which are often controversial and inconsistent in publications. Although there is a rich and promising universe in the field of medication adherence, there is a lot of complexity and contradiction as well. Everything that is related to adherence is somewhat fragmented and controversial, which makes it difficult to analyze its process as a whole. [ABSTRACT FROM AUTHOR]

This article describes a clinical case of a 20-year-old patient with an extremely severe Class III malocclusion. Compensatory orthodontics was not possible, so surgical preparation for Orthognathic Surgery was chosen. Pre-surgical orthodontic alignment and leveling were performed, followed by the Orthognathic Surgery. The case was finalized with a significant improvement in profile, facial aesthetics, and dental appearance. The descriptors include Orthognathic Surgery, Angle Class III malocclusion, and Corrective Orthodontics. [Extracted from the article]

Background: Chronic kidney disease presents itself as a public health problem because of its prevalence, the costs involved in treatment and the high rate of morbidity and mortality. Objective: To evaluate non-adherence to the therapeutic regimen of hemodialysis patients and associated factors. Method: A cross-sectional study with patients undergoing hemodialysis at a University Hospital and two private clinics agreed to the Unified Health System. Standards for non-adherence to the hemodialysis regimen were based on indicators established by The Dialysis Outcomes and Practice Patterns Study: water restrictions, dietary, drug regimen, and hemodialysis therapy. Non-compliance in at least one aspect of treatment was considered non-adherence to therapy. Results: Individuals younger than 60 years were more likely to be non-adherent to water restriction, dietary and drug regimens, and therapy. Anuric patients were more likely to be non-adherent to water restriction and therapy. Individuals with hypoalbuminemia and hypohemoglobinemia were more likely not to adhere to water restriction, while patients who self-declared themselves to be non-whites had a higher chance of not adhering to therapy. No explanatory variables of adherence to hemodialysis therapy remained significant in the final logistic regression model. Conclusion: Non-conformity related to treatment aspects can result in increased hospitalization and health expenses, worsening of clinical status, greater intercurrences in treatment and increase in mortality rate. [ABSTRACT FROM AUTHOR]

Hope is considered a primary concern to the seriously ill patient, mainly at the end phase of diseases. The concepts of hope are reviewed, as well as its meaning in quality of life preservation, in patient collaboration and in decision-making about treatment. An emphasis is made on the relation between hope and the kind and amount of information, the moment and the way the bad news should be released. At last medical postures are suggested as the key so generate and support hope, taking in account the balance between autonomy and beneficence. [ABSTRACT FROM AUTHOR]

Background: In older adults is common to identify changes in body balance and gait pattern, requiring the use of walking aids to maintain safe mobility. Despite the benefits of these devices, some people do not comply with their use. Objective: To explore older adults' perspectives regarding the factors associated with non-compliance to walking aids. Methodology: A qualitative, descriptive exploratory study was carried out. Semi-structured interviews were conducted with 11 older adult users of a Day Care Unit from a Private Institution of Social Solidarity in the region of Lisbon and Tagus Valley. Content analysis was performed to analyse data. The consolidated criteria for reporting qualitative research (COREQ) checklist was applied to this study. Results: The factors associated with non-compliance to walking aids encompass four categories: social context, the symbolism of the device, involvement of health professionals, and low critical judgment. Conclusion: There are different factors associated with non-compliance to walking aids. It is necessary to structure intervention programs that allow the elimination or reduction of the effect of these factors to increase older adults' compliance. [ABSTRACT FROM AUTHOR]

Objective: to describe the perception of people with arterial hypertension of the aspects that facilitate and hinder treatment adherence. Method: descriptive qualitative study developed with 16 people met in Nursing consultations. Interviews were conducted with a semi-structured guide and the content analysis technique was used. Data were collected between January and August 2017. Results: having willpower, family and multidisciplinary support, knowledge about the pathology and forms of prevention and fear of death facilitated adherence; on the other hand, little knowledge, laziness, lack of urban infrastructure and climatic conditions, habit of consuming unhealthy foods, alcoholic beverages and tobacco, cost of treatment and forgetfulness of taking the medication hindered adherence. Conclusion: the treatment of hypertension causes changes in the dynamics of life, being essential to have willpower, family and professional support, in addition to overcoming unhealthy habits. [ABSTRACT FROM AUTHOR]

Objective: To assess clinicians’ knowledge about pulmonary rehabilitation, and identify the barriers faced when referring patients with health insurance to pulmonary rehabilitation. Methods: This was a survey-based cross-sectional study conducted in 2019, at a private reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: internal medicine, geriatrics, cardiology, pulmonology or thoracic surgery. Results: We collected 72 responses, and 99% of participants recognized chronic obstructive pulmonary disease as a potential indication for pulmonary rehabilitation; less often (75%), they listed interstitial lung disease, bronchiectasis and pulmonary hypertension. Most participants (67%) incorrectly associated pulmonary rehabilitation with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended pulmonary rehabilitation only to patients on supplemental oxygen and 14% prescribed only home physical therapy, patterns more commonly seen among non-respiratory physicians. The three most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to pulmonary rehabilitation center (63%) and lack of social support (29%). Conclusion: Financial, logistic and social constraints pose challenges to pulmonary rehabilitation enrollment, even for patients with premium healthcare insurance. Moreover, physician knowledge gaps may be an additional barrier to pulmonary rehabilitation referral and adherence. Providing continued medical education, incorporating automatic reminders in electronic medical records, and using telerehabilitation tools may improve pulmonary rehabilitation referral, adherence, and ultimately, patient care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the degree of adherence to physiotherapeutic treatment in adolescents with Cystic Fibrosis (CF) followed up in a multidisciplinary program. Method: Observational cross-sectional study with 14 patients from the multidisciplinary CF outpatient clinic from May 2016 to October 2016. A questionnaire was used to determine the adherence of physiotherapy. Together with the adhesion of the drug alpha dornase, analyzed by the Morisky-Green Test and the severity of the disease was evaluated by applying the Shwachman-Kulczycki Score. Results: Patients' ages ranged from a mean of 15.14 years, of which 8 (57.1%) were male. According to the degree of adhesion, 5 (35,7%) were classified with low adhesion, 4 (28,7%) with moderate adhesion and 5 (35,7%) with high adhesion. The Shwachman-Kulczycki score was classified as excellent in 6 (48.8%), good 4 (28.5%), mild 3 (21.4%), moderate 1 (7.1%), severe (0%). In the present study, no correlation was observed between the adherence of physiotherapy and the severity score, and also with the use of the alphadornase medication. Conclusion: Satisfactory (moderate to high) adherence to respiratory physiotherapy was observed in 64.3% of the CF adolescents investigated. However, a balance between low adherence and high adherence (35.7%) for this treatment was noted. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the adherence to clinical glaucoma treatment in patients that benefit from the Brazilian National Glaucoma Program and receive antiglaucomatous eye drops free of charge. Methods: This cross-sectional study included 255 patients that benefit from the Brazilian National Glaucoma Program (BNGP) and were assisted at the Altino Ventura Foundation (FAV), Pernambuco state, Brazil. The Morisky's Adhesion Scale (MAS) was used to evaluate adhesion profile to treatment. Patients with a Morisky's Adhesion score = 6 was considered adherent to treatment. The analyzed variables included sex, educational level, distance from home to the treatment center, number of eye drops used, time since the glaucoma diagnosis, patients' subjective classification of their quality of vision, and prevalence of other comorbidities. Results: A total of 255 patients [167 (65.4%) females] were included in this study with a mean age was 65.9 ± 13.8 years (range, 11-99 years). Adherence to clinical glaucoma treatment was seen in 155 patients (60.8%). Worse adherence to treatment was observed in female patients (p=0.034), with low education level (p=0.046), who presented other comorbidities (p=0.048), living in remote areas (p=0.038), judged their vision as satisfactory (p=0.046), and who were recently diagnosed with glaucoma (p=0.001). Conclusion: 40% of patients who benefited from the Brazilian National Glaucoma Program were not compliant to treatment. Low adhesion rate was mostly seen in female patients, socially vulnerable, living in remote areas, recently diagnosed with glaucoma, using fewer eyedrops, presenting other comorbidities, and in those that considering themselves of having a satisfactory vision. [ABSTRACT FROM AUTHOR]

Objective: Identify tele-monitoring strategies for patients with heart failure who collaborate for adherence when it comes to treatment. Material and Method: Integrative review of the literature carried out in the databases CINAHL, PubMed, Scielo and LILACS. The elaboration of the problem was guided by the PICO strategy that gave rise to the following question: "What are the tele-monitoring strategies for patients with heart failure that contribute to their adherence to treatment?". Results: Sixteen articles met the criteria defined by the study and, therefore, participated in the analysis of this review. Conclusion: Tele-monitoring allows the monitoring of a larger number of patients, contributing to the control of signs and symptoms of heart failure. Also, It favors the optimization of pharmacological and non-pharmacological treatments, reducing rates of rehospitalization and mortality. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the level of self-referenced treatment adherence (TA) and its association with clinical and sociodemographic variables in patients with cystic fibrosis assisted at a reference center, as well as compare the level of self-referenced TA with that presumed by the multidisciplinary team. Methods: This is a cross-sectional study that included children and adolescents aged between 0-20 years with cystic fibrosis. Adolescents older than 14 years or their guardians, when younger than 14 years old, were interviewed using a standardized questionnaire. Professionals from the multidisciplinary clinic Filled out another form with their impressions of the patients' TA. Clinical and laboratory data were obtained in the medical records. The TA was considered satisfactory if the total adherence index (TAI) was equal or higher than 80%. Results: 53 patients were included with a median age of 112 months. The mean TAI was 83.2%. The mean TAIs for dornase alfa, pancreatic enzymes, continued use of inhaled tobramycin, vitamins supplements, nutritional supplements and dietary orientation was respectively: 86.1; 96.6; 78.6; 88.1; 51.8 and 78%. Children younger than 14 years presented better TA (p=0.021). The correlation between the self-referenced TA and the one presumed by the multidisciplinary team ranged from 0,117 to 0.402, being higher for Psychology and Nutrition professionals. Conclusions: The TAI was high particularly among children younger than 14 years. There was a positive correlation between the self-referenced TA and the one presumed by the Psychology (p=0.032) and the nutrition (p=0.012) professionals. [ABSTRACT FROM AUTHOR]

Adhesion level to medicinal treatment by adults diagnosed with hypertension is identified by a descriptive and transversal study involving 213 people diagnosed with hypertension and participating in arterial hypertension campaign in a town in the hinterland of the state of São Paulo, Brazil. Data were collected by half-structured interviews and by Morisky & Green questionnaire. Most participants (84%) failed to adhere to medicinal treatment, with females complying most with adhesion. Adhesion impairments comprised difficulties in changes in lifestyle, irregular visits to the doctor´s and medicine timetable. Adhesion to medicine treatment is a complex and multifactor process that needs special attention by the multiprofessional health team to increase adhesion rates and life quality of patients. [ABSTRACT FROM AUTHOR]

Objective: To develop a questionnaire that allows the early detection of patients at risk for poor adherence to medical and non-medical treatment in children and adolescents with chronic rheumatic diseases. Methods: The Pediatric Rheumatology Adherence Questionnaire (PRAQ) was applied in recently diagnosed patients within a period of one to four months after confirmation of the rheumatic disease. After six months, the patients' adherence to the medical and nonmedical treatment was assessed. An internal consistency analysis was conducted to eliminate redundant questions in the PRAQ. Results: A total of 33 patients were included in the pilot study. Six months after the PRAQ had been applied, poor global adherence was observed in seven (21.2%) patients and poor adherence to medical treatment in eight (24.2%) patients. No correlation was observed between the PRAQ scores and the percentages of adherence, as well as the stratification for each index, except for a tendency to a correlation between socioeconomic index and poor adherence to medical treatment (p=0.08). A new PRAQ questionnaire with 25 of the 46 original questions was generated as a result of the reliability analysis. Conclusions: The usefulness of this questionnaire in clinical practice should be still evaluated. Due to the importance of a tool for the early detection of rheumatic patients at risk of poor adherence to treatment, the new PRAQ questionnaire should be reviewed and applied in a larger study to better define its validity and reliability. [ABSTRACT FROM AUTHOR]

Objective. To assess the impact of efforts to reduce visual impairment by detecting and treating refractive errors (REs) among schoolchildren in two urban areas of Chile. Methods. In 2013, in the communities of Concepción and La Florida, we conducted a multicenter, multistage-sampling, cross-sectional study employing methods used by the Refractive Error Study in Children (RESC) survey. Best-corrected visual acuity was assessed using pinhole, with and without glasses. The coverage for correcting visual impairment due to refractive error was estimated. Results. We examined 5 412 schoolchildren, in the communities of Concepción (n = 3 049) and La Florida (n = 2 363). Uncorrected visual acuity (VA) of > 0.63 in at least one eye was found in 4 721 children (87.23%; 95% confidence interval (CI): 86.58%--88.30%). Of the remaining children, 1 017 of them (18.79%; 95% CI: 17.78%--19.80%) had a VA of < 0.5 in at least one eye. Of the 691 children with uncorrected visual impairment with both eyes open (12.77%; 95% CI: 11.9%--13.64%), 476 of them (8.76%; 95% CI: 8.03%--9.49%) achieved normal vision using best possible correction, and with 271 of the 476 (56.93%) having a normal presenting VA in the better eye. Conclusions. We found an increased coverage of services for RE-associated visual impairment and an increased percentage of children wearing glasses as compared to values reported for La Florida in an article published in 2000. The National Board of School Aid and Scholarships (JUNAEB) in Chile is achieving better results in its schoolchildren eye care program. [ABSTRACT FROM AUTHOR]

Introduction and objective: Hypertension and diabetes mellitus as public health problems are evidenced by the high prevalence, socioeconomic impact and difficulties in the treatment adherence. The objective of this research was to investigate the adherence to pharmacological and non pharmacological treatment for the users of the Unified Health System, hospitalized due complications because of the failure of the control of these diseases. Materials and methods: It is a descriptive study with a quantitative approach. We used the structured interview as instrument with 11 people. Results: Of these, 10 were using medicines at home, 4 reported to forget to take them. Concerning the nonpharmacological treatment, 3 followed diet with dietary restrictions, 10 were considered by themselves physically active and 1 practiced exercises regularly. Discussion and conclusion: The results indicate the need of looking at the pacient as an entire part, identifying factors that lead to a non-adherence to the available treatment and promoting strategies to improve the adherence to them. [ABSTRACT FROM AUTHOR]

Objective: adherence to treatment by patients with venous ulcers (VU) and how it that adherence is associated with sociodemographic characteristics and features of health and care. Materials and methods: This is an analytical, cross-sectional study of 101 patients with venous ulcers. Two instruments were used: a questionnaire designed to characterize sociodemographic aspects, health and care, and the Multidimensional Therapeutic Adherence Scale. Results: The poorest adhesion to treatment was found with respect to compression therapy. The study identified an association between the domain of a healthy lifestyle and marital status, and between the domain of neurovascular surveillance and age range, marital status, profession and alcoholism. Associations also were found between the dimensions of adherence and the characteristics of care: adherence to compression therapy, guidance on the use of compression therapy, guidance on regular exercises, and who applies treatment outside the primary care units. Conclusions: There is greater difficulty in adhering to treatment in terms of compression therapy. The assistance given is associated with adherence to compression therapy, guidance on the use of compression therapy and guidance on exercises to be performed regularly. [ABSTRACT FROM AUTHOR]

Ulcerative colitis (UC) is an idiopathic disease with chronic inflammation of the intestine, which predominantly affects the mucous layer of the colon and proximal portions. The course of the disease goes through periods of activity and remission, with a minority showing constant activity. The severity of the seizures and response to treatment are variable and difficult to predict. The aim of this study was to report the case of a patient with ulcerative colitis and the outcome of nonadherence to treatment. This is a descriptive study carried out at a General Hospital in the interior of Bahia, using subjective methods, imaging tests and surgical procedures, which shows that the patient is suffering from anemia, malnutrition and an inflammatory process (sepsis) probably aggravated by lack Adherence to the initial treatment of disease discovery. It is possible to reflect on the importance of the multidisciplinary relationship in adherence to treatment. Educational strategies can optimize adherence to treatment. Intervention studies are necessary to establish the impact of these measures in order to provide a greater benefit in the improvement of these patients avoiding more serious complications and hospitalizations. [ABSTRACT FROM AUTHOR]

Objective: To determine adherence to glaucoma eye drops in patients from Glaucoma Project (Ministry of Health) by Morisky scale of 8 items. Methods: We conducted a cross-sectional study through a questionnaire applied to 237 patients diagnosed with glaucoma regularly enrolled in the Glaucoma Project at Institutode Olhos de Maceio, adapting the Morisky scale, already validated in Portuguese, for eyedrops. The variables were adherence to antiglaucoma eyedrops, age, sex, race, glaucoma diagnosis time, eyedrops number used, systemic diseases, education, subjective vision (categorized in bad, reasonable or good) and the factors correlated with poor adherence. Statistical analysis between variables was performed with the statistical test Chi-square test for categorical variables and test Mann- Whitney test for continuous outcomes, considering a 5% significance level. Results: The rate of adherence to the glaucoma drops was 54%. The age and number of drops (p = 0.02 and 0,03 respectively), and quality of vision (p<0,001) were statistically significant for the inappropriate use of the therapy and the most common reason both adherent group as the non-adherent was forgetfulness (23% and 76,15% respectively). Conclusion: Using the Morisky scale adapted to antiglaucoma eyedrops the adherence was 54%. [ABSTRACT FROM AUTHOR]

This study was developed to identify determinant factors of non-adherence in the treatment of hypertensive individuals in a Brazilian municipality. This cross-sectional and descriptive study with a quantitative approach was conducted from November 2012 to April 2013. A total of 138 hypertensive patients participated, 65.9% were female, aged 60.5 years old (SD=11.32) on average, 71% had incomplete primary/middle school and an individual income of 1 to 2 times the minimum wage. In regard to occupation, 39.9% were retired and 21.7% were homemakers. Among the factors contributing to nonadherence to treatment, 70.3% reported personal reasons. Adherence was at 15.9% for nonpharmacological treatment and 21% for pharmacological treatment. We verified the need for new studies within the primary health care sphere conducted with hypertensive patients and also the need for multidisciplinary actions intended to encourage treatment adherence among hypertensive patients cared for in the municipality under study. [ABSTRACT FROM AUTHOR]

Objective: To carry out a synthesis of the concept of adherence and describe the methods used to measure it. Methodology: Review article. A search, selection and review of original and secondary articles published between 2004 and 2013, written in English or Spanish in different databases including Scielo, Pubmed, Cinahl, Science@direct and Ovidsp which were was carried out. Results: A total of 53 articles were selected, 13 of which defined the concept and classification of methods; 32 were research studies that used indirect methods, 17 combined direct and indirect methods and one study used a direct method. Conclusions: The use of different concepts defining adherence, without a consensus was evident. Also, different techniques were used for measurement being the most widely used indirect methods, followed by the combination of direct and indirect methods. [ABSTRACT FROM AUTHOR]

Public health currently faces a major challenge: reducing the dropout rates for tuberculosis treatment. Therefore, knowledge of the factors associated with dropout becomes necessary to change this reality. This study aimed to describe, from evidence available in the literature, the main factors associated with abandonment of tuberculosis treatment. This is an integrative review of 14 articles published between 2005-2014 in the LILACS and SciELO databases. As a result, it was found that the factors associated with noncompliance with treatment fortuberculosis could be related to the patient and their lifestyle, as well as health services and therapy. In conclusion, this study is of paramount importance to the people, professionals, and managers, as it provides information about the factors related to the abandonment of treatment and, therefore, planning of strategies to reduce dropout rates. [ABSTRACT FROM AUTHOR]

Motivation and education in mouth health are basic tools to prevent periodontal diseases. Current study assesses patients' cooperation level at the Periodontal Clinic of the Dentistry Course of the Universidade Federal do Maranhão during Basic Periodontal Therapy (BPT). Sounding depth (PS), gum recession (RG), level of clinical insertion, dental mobility, furca involvement, plaque index (IP) and gum blooding index (ISG) of six adult were assessed clinically at three phases: baseline, T1 and T2. The patients were diagnosed with regard to their periodontal condition and answered a questionnaire on the impact on routine and life quality during the last six months, using Oral Health Impact Profile (OHIP-14). Data underwent statistical analysis and patients were classified according to their cooperation level, namely, collaborators (75%), irregular collaborators (12.5%) and non-collaborators (12.5%). No significant differences existed in collaborators' PS and NIC during the three phases. ISG decreased when compared to baseline. IP mean of collaborating patients showed a slight decrease when compared to that of irregular collaborators. Since no significant score impact existed in OHIP-14 assessment, there was a good perception by patients with regard to mouth health quality. Collaborating patients had a weak impact with regard to periodontal disease in the two phases (T1 and T2). Main diagnoses were gingivitis plus biofilm gum (38.46%) and local advanced chronic periodontitis (30.76%). Results show that most patients collaborated with BPT, with a stable or advanced periodontal condition in periodontal health. [ABSTRACT FROM AUTHOR]

Context: since the mid-2000s, the services marketing literature proposes Service-Dominant Logic as an innovative strategic vision, based on the creation of greater value with - rather than for - the consumer. This paper seeks to explore their applicability to the health service. Methodology: by reviewing and discussing the theoretical of the specificity of the health service on the premises of the Service-Dominant Logic it has been demonstrated that: a) what its main characteristic elements are, b) how the co-creation of value is achieved in the scope of this service. Results: The credence nature, its critical character and its social dimension characterize the health service. With this reality, the co-creation of value in health care is obtained from the active participation of a patient becoming more informed and understanding of the complex balances of the doctor-patient relationship. [ABSTRACT FROM AUTHOR]

The control of diabetes mellitus and the prevention of complications involve knowledge and implementation of self-care tasks by the patient. This study aims to assess compliance with treatment and knowledge about the disease, as well as to correlate these variables with demographic and clinical characteristics. This is a cross-sectional study conducted with 35 patients of the nutrition ambulatory of a hospital center. For data collection, medical records were assessed and interviews using questionnaires were conducted. Statistical analyzes were performed using SPSS 17.0 software. We found high overweight index, partial knowledge about the disease and differences between the means of various types of adhesion to self-care activities. Factors such as age and gender showed exert influence of self-care behavior. The predominant characteristics found in the analyzed group are described in literature as associated factors to difficulties in developing appropriate care actions and greater predisposition to complications. The awareness about the importance of achieving a balanced diet and the practice of other self-care activities in diabetes mellitus can act as a tool in the prevention of complications and promotion of quality of life. [ABSTRACT FROM AUTHOR]

Introduction: The combination of several medications to control diseases in chronic patients is very common. However, medication adherence is variable, and associated factors differ. Besides, there is no uniform data on this subject. Methods: Cross-sectional study in an outpatient Internal Medicine Service of a tertiary care hospital, with patients ≥ 18 years old with two or more chronic diseases, aimed at assessing medication adherence using the Morisky Medication Adherence Scale. Factors associated with adherence were assessed by Poisson regression. The control of hypertension, diabetes and dyslipidemia was assessed. Results: A total of 170 patients (mean age 65±9.8 years), 61 of them men (36%), was included. Sixty-seven patients had up to 4 years of study, and 56 patients reported a monthly income of less than a thousand Brazilian reais. The average number of comorbidities was 4±1.14. Hypertension was the most prevalent disease (96.5%), followed by type 2 diabetes mellitus (67%). Each patient used 7.5 ± 2.5 medications. The control rate of the most prevalent chronic diseases was: hypertension 72% (95% CI 65-79%), diabetes mellitus 53% (95% CI 42-63%), and dyslipidemia 51% (95% CI 41-61%). The prevalence of medium and high adherence was 43%. The factors independently associated with medication adherence were physical exercise (PR = 1.63; 95%CI: 1.09-2.44; p= 0.017) and age (PR= 1.02; 95%CI: 1.00-1.03; p= 0.032). Conclusion: Less than half of the chronic clinical patients adheres to the prescription. It is necessary to establish new strategies for patients to benefit from prescription medication. [ABSTRACT FROM AUTHOR]

Objective: To describe the difficulties encountered in the telephone follow-up for the practice of self-care behaviors related to adherence to non-pharmacological treatment in patients with heart failure (HF). Methodology: Descriptive study i n which 31 patients with HF of a hospital in Medellin, Colombia, in 2011 participated.7 per month telephone follow-up sessions for patients were conducted. Each session (30-45 minutes) difficulties with adherence to 9 self-care behaviors were assessed. All participants received nursing education according to their individual needs. Results: All patients had difficulties in practicing some self-care activities related to non-adherence to drug therapy, 83.9% of them for 5 or more activities. The behaviors that were more difficult were: measuring urine and weight control (100% each), control of salt intake (96.7%) and fluid restriction (93.5%). Conclusion: With the help of telephone follow-up education given by health personnel was identified as the main difficulty in regards to the adherence to non-pharmacological treatment in patients with HF. Individual issues were important in the control of salt intake, decreased daily activities and the reduction of alcohol consumption and cigarette. For weight control the most reported aspect was of social nature. [ABSTRACT FROM AUTHOR]

The aim of this review is to discuss in a clear and accessible way the key concepts for the understanding and management of non-adherence to pharmacological treatment, in the Brazilian context. To this end, a search was conducted among scientific articles published in Scopus, Scielo and PubMed. Papers were selected and analyzed by independent reviewers, following the stages of an integrative review involving qualitative interpretation of records. Various terms are used currently to define the degree of correspondence between a patient's behavior and the medical advice received. Non-adherence is determined by multiple dimensions and represents an important predictor of adverse clinical outcomes, such as increased mortality, hospitalization and health care cost. Living conditions related to socioeconomic factors, characteristics of the health system and health care professionals in relation to the patient, the disease and its treatment can all play a part in non-adherence, which may be intentional or unintentional. It can be measured by direct, indirect or mixed methods, according to the type of enquiry. The development of professional practices and routines in the health services, capable of identifying non-adherence, tracing its individual causes and building intervention and support strategies, is basic to the management of this situation and improvement of the services provided and patients' quality of life. [ABSTRACT FROM AUTHOR]

Objective: To characterize the factors that interfere in drug treatment compliance in a group of individuals with arterial hypertension. Methods: A non-experimental descriptive study that analyzed a sample of 80 patients diagnosed with arterial hypertension, who underwent medical treatment and were admitted to a university hospital during the period from March to May 2009. To collect data, the Instrument for Evaluation of Attitudes Regarding Taking Medication was applied. Results: In the studied population, 45.1% had sufficient degree of compliance to drug therapy. Individuals with controlled blood pressure, females, white, single, married or widowed, retired, aged between 40 and 59 years, and those aged above 80 years were the interviewees who answered positively regarding compliance and follow-up of drug therapy. Conclusion: Despite the fact that the number of factors that facilitate the process of compliance to drug treatment is greater than the number of complicating factors, we found that more than half of the patients surveyed had an insufficient degree of compliance with drug treatment for high blood pressure, which demonstrates the need to develop studies aimed to identify these factors and their contribution to the promotion of patient autonomy, acceptance, awareness and adaptation regarding their illness. [ABSTRACT FROM AUTHOR]

Objective: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. Methods: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. Results: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and P<0.001), respectively; the adhesion to the treatment, measured and compared between the groups, was significantly higher in the intervention group (P=0.001). Conclusion: the strategy of home visits to patients who were recently hospitalized with decompensated heart failure was effective in improving the outcomes assessed and its implementation deserves to be considered in Brazil aiming at avoiding unplanned hospitalizations. NCT-01213862 [ABSTRACT FROM AUTHOR]

Introduction: In the female population, adherence to specialist clinical treatment for psychoactive substance dependence has peculiar characteristics in terms of therapeutic approaches available to addicts in general. A smaller number of women seek specialist treatment in comparison with men. Traditionally, most health care services specializing in chemical dependence provide similar therapies to both men or women, including the use of mixed-sex groups at some facilities. Objective: To discuss the views or psychological meanings attributed by women with substance use disorders to phenomena associated with adherence to treatment at a specialist university outpatient clinic. Methods: The qualitative-clinical method was used, i.e., an approach characterized by the typically qualitative focus of human sciences adapted to health care settings. The semi-structured interview technique with open questions was used for data collection, combined with observation of the women interviewed. Data were processed using qualitative content analysis. Results: Three categories of treatment outcomes emerged: 1) significant motivations to seek and follow the treatment proposed; 2) symbolic meanings attributed to the drug; 3) psychological representations of lack of motivation to explain difficulties adhering to treatment. Conclusions: Our findings suggest that the motivations of addicted women to seek treatment vary, but highlight the fact that the substance used becomes perceived as something that causes significant losses and hinders the proper exercise of women's role in family and social contexts. A warm welcoming is considered essential for a patient to adhere to treatment, offsetting the strong physical pleasure associated with psychoactive substance use. [ABSTRACT FROM AUTHOR]

This study analyzed the limitations and strengths of the Directly Observed Treatment Short-Course (DOTS) for tuberculosis from the perspective of patients and healthcare providers in a Technical Health Supervision unit in the city of São Paulo, SP, Brazil. Four patients and 17 healthcare providers from nine Primary Care Units were interviewed from April to June 2006, after signing free and informed consent forms. The reports were decoded according to the speech analysis technique. The Theory of the Social Determination of the Health-Disease Process was adopted as the theoretical framework. The strengths were: establishment of bonds between healthcare providers and patients and the introduction of incentives, which promotes treatment adherence. Limitations included: restricted involvement of DOTS' healthcare providers and reconciling patients' working hours with supervision. Treatment adherence goes beyond the biological sphere and healthcare providers should acknowledge patients' needs that go beyond the supervision of medication taken. [ABSTRACT FROM AUTHOR]

This cross-sectional and quantitative study aimed to analyze the relationship among social support, adherence to non-pharmacological (diet and physical exercise) and pharmacological treatments (insulin and/or oral anti-diabetic medication) and clinical and metabolic control of 162 type 2 diabetes mellitus patients. Data were collected through instruments validated for Brazil. Social support was directly correlated with treatment adherence. Adherence to non- pharmacological treatment was inversely correlated with body mass index, and medication adherence was inversely correlated with diastolic blood pressure. There were no associations between social support and clinical and metabolic control variables. Findings indicate that social support can be useful to achieve treatment adherence. Studies with other designs should be developed to broaden the analysis of relations between social support and other variables. [ABSTRACT FROM AUTHOR]

Adhesion to antiretroviral treatment for Aids patients must be approached from a multi-factor and particular viewpoint, considering sociocultural aspects, built meanings and subjects' autonomy. This qualitative study aims to explore elements and narrative forms developed by patients so as to promote adhesion. In-depth interviews with nine Aids patients who had good adhesion, as well as clinical and laboratorial response to treatment, were conducted. The analysis of speeches identified the contexts and narrative discourses that helped these people face the illness and its repercussions, and that influenced on adhesion. It was noticed that the timing of adhesion in narratives was not chronological and the justification/explanation for dealing with infection, disease and prejudice acquired therapeutical dimension. The protagonist's role in life and illness histories became a central element while facing disruptions arisen from illness and influenced on adhesion incorporation in a therapeutical perspective. [ABSTRACT FROM AUTHOR]

The present study aimed to understand patients' experience with osteoporosis treatment. The methodological and theoretical frameworks were, respectively, the Grounded Theory and Symbolic Interactionism. The research subjects were 12 patients monitored in a specialized outpatient unit. The obtained statements were transcribed and analyzed, leading to a synthesis of the described themes. From the analysis process, two phenomena emerged: "self-evaluating health conditions according to the disease signs" and "making a decision about the treatment targeting at well-being". The realignment and the inter-relationship of the components belonging to these phenomena (themes, categories, and subcategories) allowed to identify the core category: "self-managing osteoporosis treatment for well-being recovery mediated by the (in)visibility of the disease signs". Furthermore, it allowed for the design of a theoretical model concerning the process used by the player in his cyclic movement of the experience, between adherence to and relaxation from the osteoporosis treatment. [ABSTRACT FROM AUTHOR]

The greatest challenge posed by Systemic Hypertension (SH) is related to patients' compliance with treatment. Thus, this study aimed to determine attendance of these patients to medical appointments and the percentage of adherence to medication and non-medication regimens, and also identify the main reasons hypertensive patients report for non-adherence. This is a descriptive study with 68 hypertensive patients (64.71% women with average age of 63.9 years) at a teaching outpatient clinic. The instruments used for data collection were: multiprofesional team care report form, the Morisky-Green test and telephone interview. The results show that 61.76% attended the medical consultations, 86.76% did not comply with the medication regimen and 85.29% did not comply with the non-medication regimen, reporting at least one non-healthy life habit. The emotional factor was the most reported (69.12%) among patients' reasons for non-adherence to treatment. The study can support interventions in care delivery to patients with systemic hypertension, with a view to improving their level of adherence and quality of life. [ABSTRACT FROM AUTHOR]