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Introduction. The objective of the following review was to characterize adherence to antiretroviral treatment in adult patients with HIV-AIDS, in the dimensions of degree of adherence and risk factors. Methodology. This evidence review was carried out using several studies that have been published in the last 10 years in any country worldwide; the information search was carried out in the SciELO, PubMed, LILACS and Dialnet databases. Results. A total of 227 articles were identified; of which, 211 publications were excluded for not meeting the eligibility criteria and finally the studies that were included in this research were 14. Discussion. Lack of adherence to antiretroviral treatment is a latent problem that was highlighted in the scientific evidence analysed and from the different studies that were collected, it was found that more than half of the patients were adherent; while in others, the complete opposite occurred and in relation to the risk factors associated with non-adherence, the following were identified: factors related to the therapeutic regimen (occurrence of adverse reactions; presence of comorbidities; longer time under treatment), factors related to the individual (stress, depression, stigma, forgetfulness, consumption of psychoactive substances and alcohol, academic grade, male sex and younger age) and factors related to the social situation (lack of family social support)., Introducción. El objetivo de la siguiente revisión fue caracterizar la adherencia al tratamiento antirretroviral en pacientes adultos con VIH-SIDA en las dimensiones de grado de adherencia y factores de riesgo. Metodología. La presente revisión de la evidencia se llevó a cabo utilizando varios estudios que se hubieran publicado en los últimos 10 años en cualquier país a nivel mundial; la búsqueda de información se hizo en las bases de datos SciELO, PubMed, LILACS y Dialnet. Resultados. Se identificaron un total de 227 artículos; de los cuales, se excluyeron 211 publicaciones por no cumplir con los criterios de elegibilidad y finalmente los estudios que se incluyeron en esta investigación, fueron 14. Discusión. La falta de adherencia al tratamiento antirretroviral es un problema latente que se puso de manifiesto en la evidencia científica analizada y a partir de los diferentes estudios que fueron recabados, se encontró que más de la mitad de los pacientes si fueron adherentes; mientras que en otros, ocurrió totalmente lo contrario y en relación a los factores de riesgo asociados a la falta de adherencia, se identificaron los siguientes: factores relacionados con el régimen terapéutico (aparición de reacciones adversas; presencia de comorbilidades; mayor tiempo bajo tratamiento), relacionados con el individuo (estrés, depresión, estigma, olvido, consumo de sustancias psicoactivas y alcohol, grado académico, sexo masculino y menor edad) y relacionados con la situación social (falta de apoyo social familiar).

O comportamento de adesão ao tratamento antirretroviral configura-se como importante barreira para o cuidado adequado em saúde. O objetivo desse estudo foi caracterizar as pessoas que vivem com HIV/aids (PVHA) e apresentam comportamentos adaptativos frente ao tratamento, e comparar as variáveis de controle desses comportamentos. Trata-se de um estudo do tipo descritivo transversal. Foram avaliados pacientes ambulatoriais em tratamento antirretroviral que apresentaram, há mais de 12 meses, carga viral indetectável e CD4 ? 500 células/mm3. Para a coleta de dados utilizou-se: questionário sociodemográfico, entrevista semiestruturada, WHOQOL-bref e Escala Transversal de Sintomas. Foram realizadas análises quantitativa e qualitativa dos dados. Dos 36 participantes, predominaram pessoas do sexo masculino, com baixa escolaridade e baixo nível socioeconômico. A maioria identificou duas ou mais fontes de suporte social e não apresentou sintomas psiquiátricos graves. Verificou-se adequada percepção de qualidade de vida geral e satisfação com a saúde. Também foi encontrada associação estatisticamente significativa entre saúde mental e qualidade de vida. A maioria relatou não ter dificuldade com o tratamento medicamentoso e elencou motivação relacionada à qualidade de vida, suporte social e espiritualidade. Dentre as principais dicas oferecidas, destacou-se a persistência no tratamento, a busca por informações adequadas e o suporte social. Conclui-se que a adesão ao tratamento antirretroviral consiste em um processo colaborativo e de corresponsabilidade no cuidado em saúde. A adaptação psicológica ao HIV/aids associada à satisfação com o suporte social disponível e a presença da espiritualidade estimulam a adesão e manutenção do tratamento e fortalecem o enfrentamento das PVHA., Adherence to antiretroviral treatment is an important barrier to adequate health care. The objective of this study was to characterize people living with HIV/AIDS (PLWHA) and exhibit adaptive behaviors in response to treatment, and to compare the control variables for these behaviors. This is a cross-sectional descriptive study. Outpatients on antiretroviral treatment who had, for more than 12 months, an undetectable viral load and CD4 ? 500 cells/mm3 were evaluated. For data collection, the following were used: sociodemographic questionnaire, semi-structured interview, WHOQOL-bref and Cross-sectional Symptom Scale. Quantitative and qualitative analyzes of the data were carried out. Of the 36 participants, the majority were male, with low education and low socioeconomic status. The majority identified two or more sources of social support and did not present severe psychiatric symptoms. There was an adequate perception of general quality of life and satisfaction with health. A statistically significant association was also found between mental health and quality of life. The majority reported having no difficulty with drug treatment and listed motivation related to quality of life, social support and spirituality. Among the main tips offered, persistence in treatment, the search for adequate information and social support stood out. It is concluded that adherence to antiretroviral treatment consists of a collaborative process and co-responsibility in health care. Psychological adaptation to HIV/AIDS associated with satisfaction with available social support and the presence of spirituality encourage adherence and maintenance of treatment and strengthen PLWHA's ability to cope., La adherencia al tratamiento antirretroviral es una barrera importante para una atención sanitaria adecuada. El objetivo de este estudio fue caracterizar a las personas que viven con VIH/SIDA (PVVS) y exhiben conductas adaptativas en respuesta al tratamiento, y comparar las variables de control de estas conductas. Se trata de un estudio descriptivo transversal. Se evaluaron pacientes ambulatorios en tratamiento antirretroviral que presentaron, durante más de 12 meses, carga viral indetectable y CD4 ? 500 células/mm3. Para la recolección de datos se utilizó: cuestionario sociodemográfico, entrevista semiestructurada, WHOQOL-bref y Escala Transversal de Síntomas. Se llevaron a cabo análisis cuantitativos y cualitativos de los datos. De los 36 participantes, la mayoría eran hombres, con baja educación y bajo nivel socioeconómico. La mayoría identificó dos o más fuentes de apoyo social y no presentó síntomas psiquiátricos graves. Hubo una percepción adecuada de la calidad de vida general y la satisfacción con la salud. También se encontró una asociación estadísticamente significativa entre la salud mental y la calidad de vida. La mayoría refirió no tener dificultades con el tratamiento farmacológico y enumeró motivaciones relacionadas con la calidad de vida, el apoyo social y la espiritualidad. Entre los principales consejos ofrecidos se destacaron la perseverancia en el tratamiento, la búsqueda de información adecuada y el apoyo social. Se concluye que la adherencia al tratamiento antirretroviral consiste en un proceso colaborativo y corresponsable en la atención de salud. La adaptación psicológica al VIH/SIDA asociada con la satisfacción con el apoyo social disponible y la presencia de espiritualidad fomentan la adherencia y el mantenimiento del tratamiento y fortalecen la capacidad de las PVVS para afrontarlo.&nbsp

O comportamento de adesão ao tratamento antirretroviral configura-se como importante barreira para o cuidado adequado em saúde. O objetivo desse estudo foi caracterizar as pessoas que vivem com HIV/aids (PVHA) e apresentam comportamentos adaptativos frente ao tratamento, e comparar as variáveis de controle desses comportamentos. Trata-se de um estudo do tipo descritivo transversal. Foram avaliados pacientes ambulatoriais em tratamento antirretroviral que apresentaram, há mais de 12 meses, carga viral indetectável e CD4 ? 500 células/mm3. Para a coleta de dados utilizou-se: questionário sociodemográfico, entrevista semiestruturada, WHOQOL-bref e Escala Transversal de Sintomas. Foram realizadas análises quantitativa e qualitativa dos dados. Dos 36 participantes, predominaram pessoas do sexo masculino, com baixa escolaridade e baixo nível socioeconômico. A maioria identificou duas ou mais fontes de suporte social e não apresentou sintomas psiquiátricos graves. Verificou-se adequada percepção de qualidade de vida geral e satisfação com a saúde. Também foi encontrada associação estatisticamente significativa entre saúde mental e qualidade de vida. A maioria relatou não ter dificuldade com o tratamento medicamentoso e elencou motivação relacionada à qualidade de vida, suporte social e espiritualidade. Dentre as principais dicas oferecidas, destacou-se a persistência no tratamento, a busca por informações adequadas e o suporte social. Conclui-se que a adesão ao tratamento antirretroviral consiste em um processo colaborativo e de corresponsabilidade no cuidado em saúde. A adaptação psicológica ao HIV/aids associada à satisfação com o suporte social disponível e a presença da espiritualidade estimulam a adesão e manutenção do tratamento e fortalecem o enfrentamento das PVHA., Adherence to antiretroviral treatment is an important barrier to adequate health care. The objective of this study was to characterize people living with HIV/AIDS (PLWHA) and exhibit adaptive behaviors in response to treatment, and to compare the control variables for these behaviors. This is a cross-sectional descriptive study. Outpatients on antiretroviral treatment who had, for more than 12 months, an undetectable viral load and CD4 ? 500 cells/mm3 were evaluated. For data collection, the following were used: sociodemographic questionnaire, semi-structured interview, WHOQOL-bref and Cross-sectional Symptom Scale. Quantitative and qualitative analyzes of the data were carried out. Of the 36 participants, the majority were male, with low education and low socioeconomic status. The majority identified two or more sources of social support and did not present severe psychiatric symptoms. There was an adequate perception of general quality of life and satisfaction with health. A statistically significant association was also found between mental health and quality of life. The majority reported having no difficulty with drug treatment and listed motivation related to quality of life, social support and spirituality. Among the main tips offered, persistence in treatment, the search for adequate information and social support stood out. It is concluded that adherence to antiretroviral treatment consists of a collaborative process and co-responsibility in health care. Psychological adaptation to HIV/AIDS associated with satisfaction with available social support and the presence of spirituality encourage adherence and maintenance of treatment and strengthen PLWHA's ability to cope., La adherencia al tratamiento antirretroviral es una barrera importante para una atención sanitaria adecuada. El objetivo de este estudio fue caracterizar a las personas que viven con VIH/SIDA (PVVS) y exhiben conductas adaptativas en respuesta al tratamiento, y comparar las variables de control de estas conductas. Se trata de un estudio descriptivo transversal. Se evaluaron pacientes ambulatorios en tratamiento antirretroviral que presentaron, durante más de 12 meses, carga viral indetectable y CD4 ? 500 células/mm3. Para la recolección de datos se utilizó: cuestionario sociodemográfico, entrevista semiestructurada, WHOQOL-bref y Escala Transversal de Síntomas. Se llevaron a cabo análisis cuantitativos y cualitativos de los datos. De los 36 participantes, la mayoría eran hombres, con baja educación y bajo nivel socioeconómico. La mayoría identificó dos o más fuentes de apoyo social y no presentó síntomas psiquiátricos graves. Hubo una percepción adecuada de la calidad de vida general y la satisfacción con la salud. También se encontró una asociación estadísticamente significativa entre la salud mental y la calidad de vida. La mayoría refirió no tener dificultades con el tratamiento farmacológico y enumeró motivaciones relacionadas con la calidad de vida, el apoyo social y la espiritualidad. Entre los principales consejos ofrecidos se destacaron la perseverancia en el tratamiento, la búsqueda de información adecuada y el apoyo social. Se concluye que la adherencia al tratamiento antirretroviral consiste en un proceso colaborativo y corresponsable en la atención de salud. La adaptación psicológica al VIH/SIDA asociada con la satisfacción con el apoyo social disponible y la presencia de espiritualidad fomentan la adherencia y el mantenimiento del tratamiento y fortalecen la capacidad de las PVVS para afrontarlo.&nbsp

Background: Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. Objective: This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents—a silent digital expert, a communicative digital expert, and a digital companion (DC). Methods: We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. Results: Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. Conclusions: Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.

Introduction: Human Immunodeficiency Virus (HIV) infection is a chronic disease and constitutes one of the most serious public health problems worldwide, due to its constant and continuous spread. Treatment has currently substantially modified the evolution of the disease with a decrease in opportunistic infections, as well as improving the quality and life expectancy for infected people. Highly Active Antiretroviral Therapy (HAART) has made it possible to begin to talk about HIV infection as a chronic disease that is not necessarily fatal. The success of treatment is related to adherence to medications, so identifying the factors that influence adherence is essential to predict the success or failure of treatment and avoid complications, morbidity and mortality of patients. Material and Methods: The study design is observational, descriptive, cross-sectional, applied to a universe of 153 patients, who were receiving antiretroviral treatment at HGZ No. 3, Tuxtepec, Oaxaca, with prior informed consent, the modified Morisky-Green-Levine test was applied, as well as the survey of determining factors of therapeutic compliance. Results: Of a total of 153 patients, 118 met the selection criteria, to which the questionnaire was applied. Once the data was obtained, it was concluded that adherence to antiretroviral treatment is related to external and patient-specific factors. Conclusions: The factors that are associated with adherence to antiretroviral treatment are related to health services, family support, information about the disease and treatment. Factors such as depression and discrimination play an important role and are essential for long-term adherence to antiretroviral treatment., Introducción: La infección por Virus de la Inmunodeficiencia Humana (VIH) es una enfermedad crónica y constituye uno de los problemas de salud pública más graves a nivel mundial, debido a su propagación constante y continua. El tratamiento actualmente ha modificado sustancialmente la evolución de la enfermedad con la disminución de infecciones oportunistas, así como mejorando la calidad y esperanza de vida para las personas infectadas. La Terapia Antirretroviral de Gran Actividad (TARGA), ha hecho posible comenzar a hablar de la infección por VIH como una enfermedad crónica no necesariamente fatal. El éxito del tratamiento está relacionado con la adherencia a los medicamentos por lo que identificar los factores que influyen en el apego es fundamental para predecir el éxito o fracaso del tratamiento y evitar complicaciones, morbilidad y mortalidad de los pacientes. Material y Métodos: El diseño de estudio es observacional, descriptivo, transversal, aplicado a un universo de 153 pacientes, que recibían tratamiento antirretroviral en el HGZ No. 3, Tuxtepec, Oaxaca, previo consentimiento informado, se les aplicó el test de Morisky-Green-Levine modificado, así como la encuesta de factores determinantes de cumplimiento terapéutico. Resultados: De un total de 153 pacientes, 118 cumplieron con los criterios de selección, a los que se aplicó el cuestionario, una vez obtenidos los datos se concluyó que la adherencia al tratamiento antirretroviral si está relacionada a factores externos y propios del paciente. Conclusiones: Los factores que se asocian a el apego al tratamiento antirretroviral, se encuentran relacionados a los servicios de salud, el apoyo familiar, la información de la enfermedad y tratamiento. Factores como la depresión y la discriminación, juegan un papel importante y son fundamentales para que exista un apego al tratamiento antirretroviral a largo plazo.

Background: Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication. Aim: to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication. Methods: A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life. Results: In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy. Conclusion: Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness

Background: Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication. Aim: to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication. Methods: A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life. Results: In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy. Conclusion: Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness

The general objective of the research was to identify the factors that influence adherence to treatment in patients with tuberculosis: Integrative review. An integrative review was carried out, which was characterized by the scientific inquiry on a particular subject based on the review of existing knowledge. The approach adopted was the one proposed by PRISMA, which was based on 27 items to determine the validity of the articles to be used in the development of the review, some of these are: eligibility criteria, sources of information, data extraction process, certainty of the evidence, among others. It is concluded that, the integrative review allowed to know that adherence to tuberculosis treatment is an issue that continues to be relevant for health personnel. Its prevalence is strongly anchored in resource-poor countries, and it is in these areas that it affects more severely., El objetivo general de la investigación fue identificar los factores que influyen en la adherencia al tratamiento de pacientes con tuberculosis: Revisión integrativa. Se realizó una revisión integrativa, la cual se caracterizó por la indagación científica sobre una materia en particular a partir de la revisión del conocimiento existente. El enfoque adoptado fue el propuesto por PRISMA, el cual se basó en 27 ítems para determinar la validez de los artículos a utilizar en el desarrollo de la revisión, algunos de estos son: criterios de elegibilidad, fuentes de información, proceso de extracción de datos, certeza de la evidencia, entre otros. Se concluye que, la revisión integrativa permitió conocer que la adherencia al tratamiento de la tuberculosis es un tema que continúa siendo relevante para el personal sanitario. Su prevalencia está fuertemente anclada en países de escasos recursos, y es en estas zonas en las que afecta más gravemente.

The study aimed to analyze the psychometric properties of validity and reliability of “Escala de Adherencia Terapéutica basada en comportamientos explícitos” in patients with kidney disease. Method: The research was instrumental, with a sample of 245 patients with kidney disease, between men and women, whose ages ranged from 16 to 65 years. Results: The reliability obtained through the alpha, ordinal and omega coefficient, values greater than .70 considered acceptable. In addition, a confirmatory factorial analysis was performed where adequate fit indices were found for an oblique three-factor model with 13 items (X2 =158.432, gl=62, CFI=.955, TLI=.943, SMRM=.075, RMSEA =.080 and WRMR=1.007). Conclusions: The instrument presents evidence of validity and reliability based on the structure of the construct for the study sample., El estudio propone como objetivo establecer las propiedades psicométricas de validez y confiabilidad de la «Escala de Adherencia Terapéutica basada en comportamientos explícitos» en pacientes con insuficiencia renal crónica. Método de estudio. Una investigación instrumental, con una muestra de 245 pacientes diagnosticados de insuficiencia renal, entre varones y mujeres, en edades comprendidas de 16 a 65 años. Hallazgos. La confiabilidad obtenida, a través del coeficiente alfa, ordinal y omega con valores mayores a .70, es considerada aceptable. Además, se realizó un análisis factorial confirmatorio, habiéndose encontrado adecuados índices de ajuste para un modelo oblicuo de tres factores con 13 ítems (X2 =158.432, gl=62, CFI=.955, TLI=.943, SMRM=.075, RMSEA=.080 y WRMR=1.00). Conclusiones. La Escala de Adherencia Terapéutica basada en comportamientos explícitos, en los casos de insuficiencia renal crónica, presenta evidencias de validez y confiabilidad a partir de la estructura del constructo para la muestra estudiada.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation. Besides its irreversibility, COPD is a treatable condition, and patients would strongly benefit from being adherent to their treatments. However, almost half of them are non-adherent, and, according to several recent studies, the way the patient perceives the disease might influence this variable. Aim: This systematic review provided a synthesis of studies about the relationships between illness perceptions (IP), cognitions, beliefs, and adherence in COPD. Methods: English language publications were searched in PubMed, Medline, Scopus, ResearchGate, PsycINFO, and Cochrane Library databases from November 2022 to February 2023, following PRISMA guidelines. The reference lists of eligible studies were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. Results: A total of 14 studies were included. Adherence to treatment in COPD is confirmed to be low, using both self-report questionnaires and objective assessment systems. Most studies concluded that COPD is perceived as a moderate threat destined to last forever, even if many participants referred to little disease knowledge. This perception did not change between adherent and nonadherent groups. Those who considered more necessary to take their medicines and had a caregiver were more adherent and less concerned about their future. On the other side, forgetfulness, lack of trust in medications, and difficulties in understanding how to take them were perceived as the main causes of non-adherence. Other predictors of non-adherence, like depression, low self-efficacy, and severity of disease were confirmed. Conclusion: The systematic review highlights the variability of the relationship between IP, cognitions and beliefs, and COPD treatment adherence. A new level of awareness of the relationship bet

Diabetes mellitus (DM) generates a heavy socioeconomic burden, and to address it, it is necessary to investigate its possible conditioning factors to achieve effective control, prevention, and treatment., La diabetes mellitus (DM) genera una pesada carga socioeconómica, y para su abordaje es necesario indagar sobre sus posibles condicionantes para lograr su control, prevención y tratamiento efectivo.

Hypertension is a chronic non-communicable pathology. It refers to a multifactorial state, which depends on genetic / epigenetic, environmental and social aspects. Non-adherence to treatment is linked to several factors. Objectives: to assess the scientific literature on the main factors reported by hypertensive patients for non-adherence to blood pressure treatment. Material and Methods: This is an integrative literature review. The Virtual Health Library (VHL), Academic Google and Scielo databases were used, based on the descriptors: “hypertension” and “adherence to treatment” and “primary health care”, including articles published in the last few 5 years in full version. Results and Discussion: 188 articles were found, from which ten were selected that met the objectives of this work. It was observed that the main factors of low adherence to treatment are individual, socioeconomic, and elements related to the health network are also highlighted. Conclusions: Primary Care comprises the place of first contact for patients and where they have access to coordinated, comprehensive and longitudinal care. In this sense, it is necessary to create links to better understand them, mainly through multidisciplinary health education actions., La hipertensión es una patología crónica no transmisible. Se refiere a un estado multifactorial, que depende de aspectos genéticos / epigenéticos, ambientales y sociales. La no adherencia al tratamiento está relacionada con varios factores. Objetivos: evaluar la literatura científica sobre los principales factores reportados por los pacientes hipertensos por la no adherencia al tratamiento de la presión arterial. Material y métodos: Esta es una revisión integradora de la literatura. Se utilizaron las bases de datos biblioteca virtual en salud (BVS), Google Académico y Scielo, con base en los descriptores: "hipertensión" y "adherencia al tratamiento" y "atención primaria de salud", incluyendo artículos publicados en los últimos 5 años en versión completa. Resultados y Discusión: Se encontraron 188 artículos, de los cuales se seleccionaron diez que cumplieron con los objetivos de este trabajo. Se observó que los principales factores de baja adherencia al tratamiento son individuales, socioeconómicos, y también se destacan elementos relacionados con la red de salud. Conclusiones: La Atención Primaria comprende el lugar de primer contacto de los pacientes y donde tienen acceso a una atención coordinada, integral y longitudinal. En este sentido, es necesario crear vínculos para comprenderlos mejor, principalmente a través de acciones multidisciplinarias de educación para la salud., Hipertensão Arterial é uma patologia crônica não transmissível. Refere-se a um estado multifatorial, o qual depende de aspectos genéticos/epigenéticos, ambientais e sociais. A não adesão ao tratamento está ligada a diversos fatores. Objetivos: avaliar na literatura científica os principais fatores assinalados por pacientes hipertensos para não adesão ao tratamento da pressão arterial. Material e Métodos: Trata-se de uma revisão integrativa da literatura. Utilizaram-se as bases de dados Biblioteca Virtual em Saúde (BVS), Google Acadêmico e Scielo, a partir dos descritores: “hipertensão arterial” and “adesão ao tratamento” and “atenção primária à saúde”, sendo incluídos os artigos publicados nos últimos 5 anos em versão integral. Resultados e Discussão: Foram encontrados 188 artigos, dos quais, selecionaram-se dez que atendiam aos objetivos deste trabalho. Observou-se que os principais fatores de baixa adesão ao tratamento são de caráter individual, socioeconômico, destacando-se também elementos relacionados a rede de saúde. Conclusões: A Atenção Primária compreende o local de primeiro contato dos pacientes e onde possuem acesso ao cuidado coordenado, integral e longitudinal. Nesse sentido, faz se necessário a criação de vínculos para melhor entendê-los, principalmente, por meio de ações multiprofissionais de educação em saúde.

Hypertension is a chronic non-communicable pathology. It refers to a multifactorial state, which depends on genetic / epigenetic, environmental and social aspects. Non-adherence to treatment is linked to several factors. Objectives: to assess the scientific literature on the main factors reported by hypertensive patients for non-adherence to blood pressure treatment. Material and Methods: This is an integrative literature review. The Virtual Health Library (VHL), Academic Google and Scielo databases were used, based on the descriptors: “hypertension” and “adherence to treatment” and “primary health care”, including articles published in the last few 5 years in full version. Results and Discussion: 188 articles were found, from which ten were selected that met the objectives of this work. It was observed that the main factors of low adherence to treatment are individual, socioeconomic, and elements related to the health network are also highlighted. Conclusions: Primary Care comprises the place of first contact for patients and where they have access to coordinated, comprehensive and longitudinal care. In this sense, it is necessary to create links to better understand them, mainly through multidisciplinary health education actions., La hipertensión es una patología crónica no transmisible. Se refiere a un estado multifactorial, que depende de aspectos genéticos / epigenéticos, ambientales y sociales. La no adherencia al tratamiento está relacionada con varios factores. Objetivos: evaluar la literatura científica sobre los principales factores reportados por los pacientes hipertensos por la no adherencia al tratamiento de la presión arterial. Material y métodos: Esta es una revisión integradora de la literatura. Se utilizaron las bases de datos biblioteca virtual en salud (BVS), Google Académico y Scielo, con base en los descriptores: "hipertensión" y "adherencia al tratamiento" y "atención primaria de salud", incluyendo artículos publicados en los últimos 5 años en versión completa. Resultados y Discusión: Se encontraron 188 artículos, de los cuales se seleccionaron diez que cumplieron con los objetivos de este trabajo. Se observó que los principales factores de baja adherencia al tratamiento son individuales, socioeconómicos, y también se destacan elementos relacionados con la red de salud. Conclusiones: La Atención Primaria comprende el lugar de primer contacto de los pacientes y donde tienen acceso a una atención coordinada, integral y longitudinal. En este sentido, es necesario crear vínculos para comprenderlos mejor, principalmente a través de acciones multidisciplinarias de educación para la salud., Hipertensão Arterial é uma patologia crônica não transmissível. Refere-se a um estado multifatorial, o qual depende de aspectos genéticos/epigenéticos, ambientais e sociais. A não adesão ao tratamento está ligada a diversos fatores. Objetivos: avaliar na literatura científica os principais fatores assinalados por pacientes hipertensos para não adesão ao tratamento da pressão arterial. Material e Métodos: Trata-se de uma revisão integrativa da literatura. Utilizaram-se as bases de dados Biblioteca Virtual em Saúde (BVS), Google Acadêmico e Scielo, a partir dos descritores: “hipertensão arterial” and “adesão ao tratamento” and “atenção primária à saúde”, sendo incluídos os artigos publicados nos últimos 5 anos em versão integral. Resultados e Discussão: Foram encontrados 188 artigos, dos quais, selecionaram-se dez que atendiam aos objetivos deste trabalho. Observou-se que os principais fatores de baixa adesão ao tratamento são de caráter individual, socioeconômico, destacando-se também elementos relacionados a rede de saúde. Conclusões: A Atenção Primária compreende o local de primeiro contato dos pacientes e onde possuem acesso ao cuidado coordenado, integral e longitudinal. Nesse sentido, faz se necessário a criação de vínculos para melhor entendê-los, principalmente, por meio de ações multiprofissionais de educação em saúde.

Objetivo: Relacionar la carga de trabajo del paciente crónico independiente con la adherencia terapéutica. Método: Estudio analítico observacional de tipo transversal. La muestra consta de 390 pacientes de la Zona Básica de Salud de Mogán (Gran Canaria), seleccionados de forma sistemática según cumplieran el criterio de paciente crónico mayor de 50 años con enfermedad cardiovascular establecida incluyéndose diagnósticos de Infarto Agudo de Miocardio, Fibrilación Auricular e Insuficiencia cardíaca (IAM, FA e IC). Enfermedad Pulmonar Obstructiva Crónica (EPOC) y enfermedad neurológica con los diagnósticos de ICTUS y Parkinson. Se utilizó el cuestionario “Treatment Burden Questionnarie” (TBQ) para cuantificar la carga de trabajo, y la Escala de Adherencia al Tratamiento de Morisky (MMAS-8) para la adherencia. Resultados: El 40,5% de la muestra presenta una carga moderada y adherencia moderada (38,2%)-baja (35,4%). La baja-moderada ad-herencia se asoció con una puntuación elevada del TBQ (puntuación media de 64,8 puntos). Los grupos de enfermedades que mayor carga tienen son las neurológicas (puntuación media TBQ 74,73 puntos), EPOC (puntuación media TBQ de 69,08 puntos), y, por último, las enfermedades cardiovasculares (puntuación media TBQ de 64,47 puntos). Existe una asociación estadísticamente significativa entre la carga de trabajo y la adherencia terapéutica x2= 68,343 p <0,000. Conclusiones: Los pacientes crónicos con mayor carga de trabajo presentan una menor adherencia terapéutica., Aim: To relate the treatment burden of the independent chronic patient to adherence to treatment. Method: Cross-sectional observational analytical study. The sample consisted of 390 patients from the Basic Health Area of Mogán (Gran Canaria) systematically selected according to the criteria of chronic patient over 50 years of age with established cardiovascular disease including diagnoses of Acute Myocardial Infarction, Atrial Fibrillation and Heart Failure (AMI, AF and HF). Chronic Obstructive Pulmonary Disease (COPD) and neurological disease with the diagnoses of stroke and Parkinson's disease. The Treatment Burden Questionnaire (TBQ) was used to quantify workload, and the Morisky Treatment Adherence Scale (MMAS-8) was used for adherence. Results: 40.5% of the sample had moderate burden and moderate (38.2%)-low (35.4%) adherence. Low-moderate treatment adherence was associated with a high TBQ score (mean score 64.8 points). The disease groups with the highest burden were neurological diseases (mean TBQ score 74.73 points), COPD (mean TBQ score 69.08 points), and finally cardiovascular diseases (mean TBQ score 64.47 points). There is a statistically significant association between workload and adherence x2= 68.343 p<0.000. Conclusions: Chronic patients with higher workload present lower therapeutic adherence., Objectivo: Relacionar a carga de trabalho do paciente crónico independente com a aderência ao tratamento. Método: Estudo analítico observacional transversal. A amostra consistiu em 390 pacientes da Área de Saúde Básica de Mogán (Gran Canaria), sistematicamente seleccionados de acordo com os critérios de paciente crónico com mais de 50 anos de idade com doença cardiovascular estabelecida, incluindo diagnósticos de Infarto Agudo do Miocárdio, Fibrilação Atrial e Insuficiência Cardíaca (IAM, FA e IC). Doença Pulmonar Obstrutiva Crónica (DPOC) e doença neurológica com o diagnóstico de AVC e doença de Parkinson. O Questionário de Carga de Tratamento (TBQ) foi utilizado para quantificar a carga de trabalho, e a Escala de Adesão ao Tratamento Morisky (MMAS-8) foi utilizada para a aderência. Resultados: 40,5% da amostra teve carga moderada e aderência moderada (38,2%)-baixa (35,4%). A adesão ao tratamento com baixa moderação foi associada a uma pontuação elevada de TBQ (pontuação média de 64,8 pontos). Os grupos de doenças com maior carga são as doenças neurológicas (nota média TBQ de 74,73 pontos), DPOC (nota média TBQ de 69,08 pontos), e finalmente as doenças cardiovasculares (nota média TBQ de 64,47 pontos). Existe uma associação estatisticamente significativa entre carga de trabalho e aderência x2= 68.343 p<0.000. Conclusões: Os doentes crónicos com maior carga de trabalho têm menor aderência terapêutica.

Introduction Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it. Purpose of Review The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients? Methods A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship. Results As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet). Conclusion The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well.

Introduction: aging is a concern that occupies public policies in all countries of the world. Objective: to analyze the adherence, use of medications and health status in the elderly of the municipality of Acacías (Colombia). Methodology: descriptive study, non-probabilistic discretionary sampling, n = 96 older adults. Results: 64.6% of older adults consume medications; 62.9% are not adherent to pharmacological treatment, there is a significant correlation through the MCC (Mini Cognitive Examination), 46.2% of them suffer some type of cognitive deterioration. Conclusions: there is a correlation between non-adherence with cognitive status and family support., Introdução: o envelhecimento é uma preocupação que ocupa políticas públicas em todos os países do mundo. Objetivo: analisar a adesão, o uso de medicamentos e o estado de saúde dos idosos do município de Acacías (Colômbia). Metodologia: estudo descritivo, amostragem não probabilística discricionária, n = 96 idosos. Resultados: 64,6% dos idosos consomem medicamentos; 62,9% não aderem ao tratamento farmacológico, existe uma correlação significativa através do MEC (mini exame cognitivo), 46,2% deles sofrem de algum tipo de deterioração cognitiva. Conclusões: há correlação entre a não adesão com o estado cognitivo e o suporte familiar., Introdução O processo da velhice compreende vários estágios que são acompanhados por algumas mudanças fisiológicas e biológicas que os idosos experimentam ao longo de suas vidas aumentando muito o risco de sofrer múltiplas doenças crônicas e também aumentando a probabilidade de que o idoso adquira status de polifarmácia devido à ausência de avaliação geriátrica em idosos. Objetivo: analisar a adesão, uso de medicamentos e estado de saúde em idosos do município de Acacías-Colômbia. Metodologia Estudo descritivo, amostragem discricionária não probabilística, n = 96 idosos. Resultados 64,6% dos idosos consomem medicação, 62,9% não aderem ao tratamento farmacológico, há uma correlação significativa através do MEC (Mini Cognitive Examination), onde 46,2% deles sofrem algum tipo de deterioração cognitiva . Conclusões Existe uma correlação entre a não adesão com o status cognitivo e o apoio familiar.

High blood pressure is a chronic disease; One difficulty in controlling it is non-attendance to hypertension programs, even though the Pan American Health Organization encourages the development of public health policies and projects to prevent high blood pressure, as well as supporting projects that facilitate the provision of drugs. necessary for their care and prevention. That is why, through a descriptive cross-sectional study, information is collected on the factors that intervene in the non-attendance to control in an arterial hypertension program in a State Social Enterprise north of the department of Cauca-Colombia, with a population of 810 patients; Obtaining a sample of 260 people, additionally, a non-response proportion (20%) was applied, reaching a total of 312 participants. Among the results, 72.1% were women, 35.3% were between 61-70 years old. As non-attendance factors, the following were found: 30.8% forgetfulness, insufficient appointment reminders used by the institution, 52.6% and more than 80% feel satisfied with the care provided by health personnel. Concluding, that it is necessary to reorient the programs considering gender characteristics and strengthen strategies that bring the programs closer to the population., La hipertensión arterial es una enfermedad crónica; una dificultad para su control es la inasistencia a los programas de hipertensión, aun cuando la Organización Panamericana de la Salud, fomenta el desarrollo de políticas y proyectos de salud pública para prevenir la hipertensión arterial, así como también apoya proyectos que faciliten la provisión de medicamentos necesarios para su cuidado y prevención. Es por ello, que a través de un estudio descriptivo de corte transversal, se recolecta información sobre los factores que intervienen en la no asistencia al control en un programa de hipertensión arterial en una Empresa Social del Estado al norte del departamento del Cauca-Colombia, con una población de 810 pacientes; obteniendo una muestra de 260 personas, adicionalmente, se aplicó una proporción de no respuesta (20%), alcanzando un total de 312 participantes. Entre los resultados, el 72,1% eran mujeres, 35,3% tenían entre 61-70 años. Como factores de inasistencia se encontraron: Olvido 30,8%, insuficiencia en los recordatorios de citas que utiliza la institución 52,6% y más del 80% se sienten satisfechos con la atención brindada por el personal de salud. Concluyendo, que es necesario reorientar los programas considerando características de género y fortalecer estrategias que acerquen los programas a la población.

Patients with systemic lupus erythematosus (SLE) with kidney involvement run a high risk of end-stage kidney disease—reaching levels as high as 10% at 10 years—that is partially explained by nonadherence. As with many other chronic diseases, nonadherence to treatment is the rule and perfect adherence the exception. Thus, a Canadian study assessing primary nonadherence in various conditions found that as many as 31% of the 37,506 first prescriptions were never collected from the pharmacy within 9 months. [...]

High blood pressure is a chronic disease; One difficulty in controlling it is non-attendance to hypertension programs, even though the Pan American Health Organization encourages the development of public health policies and projects to prevent high blood pressure, as well as supporting projects that facilitate the provision of drugs. necessary for their care and prevention. That is why, through a descriptive cross-sectional study, information is collected on the factors that intervene in the non-attendance to control in an arterial hypertension program in a State Social Enterprise north of the department of Cauca-Colombia, with a population of 810 patients; Obtaining a sample of 260 people, additionally, a non-response proportion (20%) was applied, reaching a total of 312 participants. Among the results, 72.1% were women, 35.3% were between 61-70 years old. As non-attendance factors, the following were found: 30.8% forgetfulness, insufficient appointment reminders used by the institution, 52.6% and more than 80% feel satisfied with the care provided by health personnel. Concluding, that it is necessary to reorient the programs considering gender characteristics and strengthen strategies that bring the programs closer to the population., La hipertensión arterial es una enfermedad crónica; una dificultad para su control es la inasistencia a los programas de hipertensión, aun cuando la Organización Panamericana de la Salud, fomenta el desarrollo de políticas y proyectos de salud pública para prevenir la hipertensión arterial, así como también apoya proyectos que faciliten la provisión de medicamentos necesarios para su cuidado y prevención. Es por ello, que a través de un estudio descriptivo de corte transversal, se recolecta información sobre los factores que intervienen en la no asistencia al control en un programa de hipertensión arterial en una Empresa Social del Estado al norte del departamento del Cauca-Colombia, con una población de 810 pacientes; obteniendo una muestra de 260 personas, adicionalmente, se aplicó una proporción de no respuesta (20%), alcanzando un total de 312 participantes. Entre los resultados, el 72,1% eran mujeres, 35,3% tenían entre 61-70 años. Como factores de inasistencia se encontraron: Olvido 30,8%, insuficiencia en los recordatorios de citas que utiliza la institución 52,6% y más del 80% se sienten satisfechos con la atención brindada por el personal de salud. Concluyendo, que es necesario reorientar los programas considerando características de género y fortalecer estrategias que acerquen los programas a la población.

From a biopsychosocial perspective, the aim of the study was to determine which diabetes model presents thebest fi t to the data: one in which treatment adherence predicts depression, or one in which depression predictstreatment adherence, considering in both cases social support, coping strategies, and sex. This was assessed via acausal cross-sectional design with a sample of 278 patients, with an average age of 59 years. Measures included theThree-dimensional Depression Questionnaire, Diabetics’ Lifestyle Instrument, Coping Strategies Questionnaire,and Social Network and Support Scale. Structural equation modeling showed a similar fi t for indexes from bothmodels; therefore, it can be stated that these models present an acceptable fi t to the data. Being a woman, less avoidancestrategy, greater support networks, and less treatment adherence, produces less depression. These results willallow researchers to design psychological interventions to increase treatment adherence, and to prevent depression., Desde una aproximación biopsicosocial, se pretendió determinar el modelo en diabetes que presentaun mayor ajuste a los datos: aquel donde la adherencia al tratamiento predice la depresión o aquelen que la depresión es el predictor de la adherencia. Se consideraron, en ambos, el apoyo social, lasestrategias de afrontamiento y el sexo. Se utilizó un diseño transeccional-causal en 278 pacientes conun promedio de 59 años. Se empleó el Cuestionario Tridimensional de la Depresión, el Instrumentopara Medir el Estilo de Vida en Diabéticos, Cuestionario de Estrategias de Afrontamiento y la Escalade Social Network and Support. Al evaluar los modelos de ecuaciones estructurales, se obtuvieronlas mismas medidas de bondad de ajuste, con relaciones similares entre variables, por lo que ambosmodelos poseen un ajuste aceptable. Ser mujer, poseer menor estrategia de evitación, presentar mayorred de apoyo, tener menor adherencia al tratamiento, conlleva a una menor depresión. Los resultadospueden servir de base para diseñar intervenciones psicológicas para aumentar la adherencia yevitar la depresión.

Introduction: The antihypertensive treatment in patients with 20 or more years old requires strict controls in order to maintain their healthy life span. Objective: To assess the therapeutic adherence in patients with hypertension from the Family doctor’s office No. 4, linked to the Policlínico Universitario “Joaquín de Agüero y Agüero”, in Camagüey. Method: An observational, descriptive, cross-sectional study during the period from October 2020 to February 2021 was conducted. In the research 98 patients with 20 or more years old were recruited to work with. Patients with difficulties in their blood pressure control due to the noncompliance with the treatment. Variables assesed were as follow: age, sex, stage of hypertension, adherence to treatment using the Morisky-Green-Levine test, drugs used, and non-adherence factors. The information gathered was processed via SPSS statistic 25.0. Results: Patients with 60 years old (46.9%), males (58.1%), and clasified as stage 2 hypertension (51%) were predominant. Also, were predominant patients with partial therapeutic adherence (68.3%) (asper the Morisky-Green-Levine test outcomes), and patients whitch used three types of drugs to treat the illness (46.9%). The most common factors found were lack of drugs to treat the hypertension (86.7%) and the inadequate diet (77.5%). Conclusions: Non-adherence to treatment in hypertensive patients expose them to adquire any cardiovascular complication, aspect whitch affect patients themselve, family, and the society., Introdução: A medicação anti-hipertensiva em pacientes com mais de 20 anos exige um controle rigoroso, o que garante uma manutenção adequada do estado de saúde desse grupo populacional. Objetivo: analisar a adesão terapêutica em pacientes com hipertensão arterial no Consultório Médico de Família nº 4, pertencente à Policlínica Universitária “Joaquín de Agüero y Agüero”, do município de Camagüey. Método: Estudo observacional, transversal, descritivo, de outubro de 2020 a fevereiro de 2021. Trabalhamos com 98 pacientes com idade igual ou superior a 20 anos, com dificuldade de controle da pressão arterial devido à não adesão ao tratamento. As variáveis foram mensuradas: idade, sexo, grau de hipertensão, adesão ao tratamento pelo teste de Morisky-Green-Levine, quantidade de medicamentos utilizados e fatores de não adesão. As informações foram processadas por meio do pacote estatístico SPSS 25.0. Resultados: Houve predomínio dos maiores de 60 anos (46,9%), 58,1% do sexo masculino, classificados como grupo II de hipertensão arterial (51%). Predominaram pacientes com adesão terapêutica parcial (68,3%) pelo teste de Morisky-Green-Levine e com uso de três medicamentos para tratamento da doença (46,9%). Dentre os fatores mais frequentes, predominou a dificuldade de obtenção do medicamento (86,7%) e da dieta alimentar (77,5%). Conclusões: A não adesão terapêutica em hipertensos os expõe ao aparecimento de complicações cardiovasculares, com as repercussões que isso acarreta para o indivíduo, a família e a sociedade., Introducción: La medicación antihipertensiva de pacientes mayores de 20 años amerita un riguroso control, que garantice un adecuado mantenimiento del estado de salud de dicho grupo poblacional. Objetivo: Analizar la adherencia terapéutica en los pacientes con hipertensión arterial del Consultorio del Médico de Familia No. 4, perteneciente al Policlínico Universitario “Joaquín de Agüero y Agüero”, del municipio Camagüey. Método: Estudio observacional, descriptivo de corte transversal durante el periodo de octubre de 2020 a febrero de 2021. Se trabajó con los 98 pacientes de 20 y más años de edad, con dificultad en su control de la tensión arterial debido al incumplimiento de su tratamiento. Se midieron las variables: edad, sexo, grado de hipertensión, adherencia al tratamiento a través del test de Morisky-Green-Levine, cantidad de fármacos utilizados y los factores de la no adherencia. La información se procesó a través del paquete estadístico SPSS 25.0. Resultados: Existió un predominio de los mayores de 60 años (46,9 %), del sexo masculino en un 58,1 %, clasificados como grupo II de la hipertensión arterial (51 %). Predominaron los pacientes con una adherencia parcial terapéutica (68,3 %) según el test de Morisky-Green-Levine y con la utilización de tres fármacos como tratamiento de la enfermedad (46,9 %). Dentro de los factores más frecuentes predominaron la dificultad con la obtención del medicamento (86,7 %) y la realización de la dieta (77,5 %). Conclusiones: La no adherencia terapéutica en los pacientes hipertensos los expone a la aparición de complicaciones cardiovasculares, con la repercusión que conlleva para el individuo, la familia y la sociedad.

Objective: To determine the association between knowledge about Diabetes Mellitus and adherence to treatment in patients of the Jorge Reátegui Piura Hospital 2019. Methods: Study carried out in 236 patients from the Jorge Reátegui - Piura Hospital, who attended the endocrinology office during 2019. Adherence and level of knowledge were evaluated through questionnaires: Morisky Green-8 test (high, medium or low adherence) and Test Diabetes Knowledge Questionnaire 24 (adequate and inadequate). Multinomial logistic regression was applied between the variables, in SPSS v.25. Results: Inadequate knowledge predominated (68.2%); over the adequate (31.8%). Adherence was low (38.6%); medium (31.4%) and high (30.0%). An association was found between knowledge and adherence to treatment (p = 0.001). Also, between educational level (p = 0.002) and origin (p = 0.037). If the patient does not present studies, it is associated with low adherence OR 6,244 [CI (2,113 -18,449), p = 0.001], or mean OR 3,724 [CI (1,207 -11,492), p = 0.022]. In addition, if the patient presents primary, it is associated with low adherence OR 5,591 [CI (1,766 -17,703), p = 0.003]. Likewise, if the patient comes from a rural area OR 5,923 [IC (1,596 -21,979), p = 0.008], or marginal urban OR 4,431 [IC (1,274 -15,411), p = 0.019] associated with low adherence. An association was found between inadequate knowledge and low adherence OR 3,451 [CI (1,748 -6,814), p = 0.000], or mean OR 2,625 [CI (1,313 -5,247), p = 0.006]. Conclusion: There is an association between knowledge about diabetes and adherence; inadequate knowledge predisposes to a higher risk of low or medium adherence. Likewise, certain sociodemographic factors such as the degree of education and the origin., Objetivo: Determinar la asociación entre conocimientos sobre Diabetes Mellitus y adherencia al tratamiento en pacientes del Hospital Jorge Reátegui Piura 2019. Métodos: Estudio realizado en 236 pacientes del Hospital Jorge Reátegui – Piura, que acudieron a consultorio de endocrinología durante 2019. La adherencia y nivel de conocimientos, se evaluaron a través de cuestionarios: Test Morisky Green-8 (adherencia alta, media o baja) y Test Diabetes Knowledge Questionnaire 24 (adecuado e inadecuado). Se aplicó regresión logística multinomial entre las variables, en SPSS v.25. Resultados: Predominó el conocimiento inadecuado (68,2%); sobre el adecuado (31,8%). La adherencia fue baja (38,6%); media (31,4%) y alta (30,0%). Se halló asociación entre conocimientos y adherencia al tratamiento (p=0,001). También, entre grado de instrucción (p=0,002) y procedencia (p=0,037). Si el paciente no presenta estudios, se asocia a una adherencia baja OR 6,244 [IC (2,113 -18,449), p=0,001], o media OR 3,724 [IC (1,207 -11,492), p=0,022]. Además, si el paciente presenta primaria, se asocia a adherencia baja OR 5,591 [IC (1,766 -17,703), p=0,003]. Así mismo, si el paciente procede de una zona rural OR 5,923 [IC (1,596 -21,979), p=0,008], o urbano marginal OR 4,431 [IC (1,274 -15,411), p=0,019] asocia a una adherencia baja. Se evidenció asociación entre conocimiento inadecuado y adherencia baja OR 3,451 [IC (1,748 -6,814), p=0,000], o media OR 2,625 [IC (1,313 -5,247), p=0,006]. Conclusión: Existe asociación entre conocimientos sobre diabetes y adherencia; un inadecuado conocimiento predispone a mayor riesgo de adherencia baja o media. Así mismo, ciertos factores sociodemográficos como el grado de instrucción y la procedencia.

From a biopsychosocial perspective, the aim of the study was to determine which diabetes model presents thebest fi t to the data: one in which treatment adherence predicts depression, or one in which depression predictstreatment adherence, considering in both cases social support, coping strategies, and sex. This was assessed via acausal cross-sectional design with a sample of 278 patients, with an average age of 59 years. Measures included theThree-dimensional Depression Questionnaire, Diabetics’ Lifestyle Instrument, Coping Strategies Questionnaire,and Social Network and Support Scale. Structural equation modeling showed a similar fi t for indexes from bothmodels; therefore, it can be stated that these models present an acceptable fi t to the data. Being a woman, less avoidancestrategy, greater support networks, and less treatment adherence, produces less depression. These results willallow researchers to design psychological interventions to increase treatment adherence, and to prevent depression., Desde una aproximación biopsicosocial, se pretendió determinar el modelo en diabetes que presentaun mayor ajuste a los datos: aquel donde la adherencia al tratamiento predice la depresión o aquelen que la depresión es el predictor de la adherencia. Se consideraron, en ambos, el apoyo social, lasestrategias de afrontamiento y el sexo. Se utilizó un diseño transeccional-causal en 278 pacientes conun promedio de 59 años. Se empleó el Cuestionario Tridimensional de la Depresión, el Instrumentopara Medir el Estilo de Vida en Diabéticos, Cuestionario de Estrategias de Afrontamiento y la Escalade Social Network and Support. Al evaluar los modelos de ecuaciones estructurales, se obtuvieronlas mismas medidas de bondad de ajuste, con relaciones similares entre variables, por lo que ambosmodelos poseen un ajuste aceptable. Ser mujer, poseer menor estrategia de evitación, presentar mayorred de apoyo, tener menor adherencia al tratamiento, conlleva a una menor depresión. Los resultadospueden servir de base para diseñar intervenciones psicológicas para aumentar la adherencia yevitar la depresión.

High blood pressure is a chronic disease; One difficulty in controlling it is non-attendance to hypertension programs, even though the Pan American Health Organization encourages the development of public health policies and projects to prevent high blood pressure, as well as supporting projects that facilitate the provision of drugs. necessary for their care and prevention. That is why, through a descriptive cross-sectional study, information is collected on the factors that intervene in the non-attendance to control in an arterial hypertension program in a State Social Enterprise north of the department of Cauca-Colombia, with a population of 810 patients; Obtaining a sample of 260 people, additionally, a non-response proportion (20%) was applied, reaching a total of 312 participants. Among the results, 72.1% were women, 35.3% were between 61-70 years old. As non-attendance factors, the following were found: 30.8% forgetfulness, insufficient appointment reminders used by the institution, 52.6% and more than 80% feel satisfied with the care provided by health personnel. Concluding, that it is necessary to reorient the programs considering gender characteristics and strengthen strategies that bring the programs closer to the population., La hipertensión arterial es una enfermedad crónica; una dificultad para su control es la inasistencia a los programas de hipertensión, aun cuando la Organización Panamericana de la Salud, fomenta el desarrollo de políticas y proyectos de salud pública para prevenir la hipertensión arterial, así como también apoya proyectos que faciliten la provisión de medicamentos necesarios para su cuidado y prevención. Es por ello, que a través de un estudio descriptivo de corte transversal, se recolecta información sobre los factores que intervienen en la no asistencia al control en un programa de hipertensión arterial en una Empresa Social del Estado al norte del departamento del Cauca-Colombia, con una población de 810 pacientes; obteniendo una muestra de 260 personas, adicionalmente, se aplicó una proporción de no respuesta (20%), alcanzando un total de 312 participantes. Entre los resultados, el 72,1% eran mujeres, 35,3% tenían entre 61-70 años. Como factores de inasistencia se encontraron: Olvido 30,8%, insuficiencia en los recordatorios de citas que utiliza la institución 52,6% y más del 80% se sienten satisfechos con la atención brindada por el personal de salud. Concluyendo, que es necesario reorientar los programas considerando características de género y fortalecer estrategias que acerquen los programas a la población.

Aims: The study aimed to assess the impact of self-care on adherence to treatment in patients diagnosed with type 2 diabetes and effect of complex interaction of social, lifestyle, economic, environmental and behavioural. Methods: The study was carried out between June 2018 and May 2019 on 324 patients (162 females, 162 males) with type 2 diabetes. To measure the levels of self-care, the Self-Care of Diabetes Index (SCODI) questionnaire was used. Adherence to treatment was assessed with the Adherence in Chronic Diseases Scale (ACDS). Results: The highest scores of health behaviour were on the subscale of adherence with the mean value of 68.37, and the lowest results on the subscale of blood sugar self-monitoring, with the mean of 56.05. We found that low adherence to treatment was present in 52.47% of respondents, the moderate level in 39.20%, while only 8.33% of patients showed the high level. There were significant positive correlations between the ACDS and SCODI subscales (p < 0.05): self-care maintenance (0.436), self-care management (0.413), self-care monitoring (0.384), and self-care confidence (0.453). Conclusions: Self-care affects on adherence in patients with type 2 diabetes. The higher self-efficacy in each of the areas of functioning, the higher the level of adherence to treatment. We found that demographic variables such as female sex, education and employment status can influence self-care in managing chronic illnesses such as type 2 diabetes.

El objetivo de este artículo es describir y analizar los enfoques teóricos de enfermería que han sido utilizados para la investigación sobre adherencia al tratamiento en personas con enfermedades cardiovasculares. Para ello, se realiza una revisión integrativa descriptiva entre los años 2005 - 2018 en el que se incluyen 27 artículos originales, de revisión, tesis de maestría y doctorado en enfermería teniendo en cuenta los descriptores adherencia al tratamiento, teorías de enfermería y salud cardiovascular. Como resultado, se identificaron 4 teorías de enfermería que más se han trabajado con relación a la adherencia al tratamiento: Teoría del Proceso de Enfermería Deliberativa, Teoría de la Autoeficacia, Teoría de Autocuidado y Teoría del autocuidado en Falla Cardíaca; evidenciando en la literatura predominio de estudios descriptivos, metodológicos y de intervención utilizando estos enfoques teóricos. Se puede concluir que los marcos teóricos de enfermería han permitido el avance investigativo en la adherencia de esta población, sin embargo, con la evolución del conocimiento se requiere explorar otros enfoques teóricos situacionales o derivados de la práctica., The aim of this article is to describe and analyze the theoretical approaches to nursing that have been used for research on adherence to treatment in people with cardiovascular diseases. For this, a descriptive integrative review is carried out between the years 2005 - 2018 in which 27 original articles are included, review, master's thesis and doctorate in nursing taking into account the descriptors adherence to treatment, nursing theories and cardiovascular health. As a result, 4 nursing theories that have been worked on in relation to adherence to treatment were identified: Deliberative Nursing Process Theory, Theory of Self-efficacy, Theory of Self-Care and Theory of Self-Care in Cardiac Failure; evidencing in literature the predominance of descriptive, methodological and intervention studies using these theoretical approaches. It can be concluded that the theoretical frameworks of nursing have allowed the investigative advance in the adherence of this population, however, with the evolution of knowledge it is required to explore other situational theoretical approaches or derived from the practice., O objetivo deste artigo é descrever e analisar as abordagens teóricas em enfermagem que vêm sendo utilizadas para pesquisas sobre adesão ao tratamento em pessoas com doenças cardiovasculares. 2018, que inclui 27 artigos originais, artigos de revisão, teses de mestrado e doutorado em enfermagem, considerando descritores de adesão ao tratamento, teorias de enfermagem e saúde cardiovascular - para isso, uma revisão integrativa descritiva a partir de 2005 é realizada. Como resultado, foram identificados 4 teorias de enfermagem que têm trabalhado mais sobre adesão ao tratamento: Teoria Deliberativo do Processo de Enfermagem, a teoria da auto-eficácia, teoria da auto-cuidado e auto-cuidado Teoria na Insuficiência Cardíaca; evidenciando na literatura a predominância de estudos descritivos, metodológicos e de intervenção utilizando essas abordagens teóricas. Podese concluir que os referenciais teóricos da enfermagem permitiram o avanço investigativo na adesão dessa população, porém, com a evolução do conhecimento, é necessário explorar outras abordagens teóricas situacionais ou derivadas da prática.

The incidence of overweight and obesity in Mexico persists, as well as failure in addressing it, contrary to the official-medical discourse that attempts to regulate it. In many individuals the difficulty to adhere to a weight control treatment persists, beyond their will and their material and social resources to achieve it. In such cases, it is possible to assume that there is an unconscious dimension that disrupts the individuals’ lives and affects the way they usually operate. Such cases can be tackled with the psychoanalytic device, tackling as well the psychic complications present in those individuals for whom it becomes difficult to adhere to their weight control treatment and which are beyond the scope of official proposals to address them, such as the Mexican Official Regulation NOM-008-SSA3-2017. It is about listening to the individual, acknowledging their singularity, to what happens to them, not only regarding the difficulties they expe-rience in managing their weight or their weight itself, but also their lives; their own words are the privileged means to do so., La incidencia del sobrepeso y la obesidad en México perdura, así como el fracaso en su atención, contrariando al discurso médico-oficial que pretende regularlo. En muchos pacientes la dificultad de serguir un tratamiento para el control de peso persiste, por encima de su voluntad y de sus recursos materiales y sociales para lograrlo; en casos así, es posible suponer que existe una dimensión inconsciente que trastoca la vida de los sujetos e incide en sus modos de funcionamiento. De estos casos puede encargarse el dispositivo psicoanalítico, de las complicaciones psíquicas que presentan los sujetos a los que se les vuelve complicado apegarse a su tratamiento para el control de su peso y escapan al alcance de las propuestas oficiales para atenderlas, como La Norma Oficial Mexicana NOM-008-SSA3-2017. Se trata de escuchar al sujeto, de dar lugar a su singularidad, a lo que le ocurre, no solo con las dificultades que experimenta en su control de peso, o con su peso, sino en su vida; su palabra es el medio privilegiado para hacerlo.

Aim: To test the hypothetical model of adherence to treatment among patients with coronary disease after percutaneous coronary intervention. Design: A descriptive, explanatory, cross‐sectional survey. Methods: The study was conducted in 2013 with 416 patients in five hospitals in Finland. The adherence of patients with chronic disease instrument, the adherence visual analogue scale, the social support for people with coronary heart disease instrument, the EuroQoL five‐dimensional scale and EuroQoL visual analogue scale were used. The data were analysed using descriptive statistic. The hypothetical model was tested using structural equation modelling. Results: The hypothetical model explained 30% of perceived adherence to treatment. Structural equation modelling confirmed that motivation, support from physicians and next of kin had direct associations with adherence. Indirectly, informational support, results of care, perceived health, anxiety and depression were associated with adherence. The background variables associated with adherence were gender, relationship, physical activity, consumption of vegetables and consumption of alcohol.

Introduction: The main problem presented by patients with DM2 is the lack of adherence to medical treatments (WHO, 2004) since it is complex and requires changes in lifestyle and health habits. Objective: analyze the relationship between self-efficacy, social support, and threat perception to treatment adherence. Method: The design was transectional correlational with a non-probabilistic convenience sampling of 166 participants with DM2 who attended for medical attention at the Ministry of Health and ISSSTE of Michoacán. Instruments were administered to evaluate Self-efficacy to Treatment in DM2, Social Support in DM2, the subscales of severity and perceived susceptibility of the ECS-DM2 / PG and the adherence scale to the treatment of DM2. Results: By dividing the sample by levels of threat perception, a clear mediating role of perception of susceptibility and severity can be observed in the rest of the variables under study. Maintaining treatment adherence and glycosylated hemoglobin as dependent variables, multiple linear regression analyzes were performed using the stepwise method to identify the joint effect of the independent variables. The highest levels of prediction, both for treatment adherence and for glycosylated hemoglobin levels, are in the group with medium levels of susceptibility, where 46 % of the variance of treatment adherence is explained based on the sole independent variable of perceived social support. For glycosylated hemoglobin levels, the prediction of 33 % of the variance in the middle group is given by the factors of hygiene, self-care, and diet as components of treatment adherence. Discussion or Conclusion: According to the results obtained, it seems that the relationship between the perceived threat and adherence is not linear. It appears to be observed that perceived threat may produce a tendency to abandon by not following medical indications, when the patient perceives a very high level of susceptibility and severity, as we, Resumen Introducción: El principal problema de los pacientes con Diabetes Mellitus Tipo 2 (DM2) es la falta de adherencia a los tratamientos médicos (OMS, 2004). Estos son complejos y exigen realizar modificaciones en el estilo de vida y hábitos de salud. Por esto, el objetivo de esta investigación fue analizar la relación entre autoeficacia, apoyo social para la adherencia al tratamiento y la hemoglobina glucosilada, en función del nivel de percepción de amenaza en pacientes con DM2. Método: El diseño fue transeccional correlacional con un muestreo no probabilístico por conveniencia, con 166 participantes con DM2 que acuden a atención médica en la Secretaría de Salud y el ISSSTE en Michoacán, México. Se aplicaron instrumentos para evaluar Autoeficacia al Tratamiento en DM2, Apoyo Social en la DM2, las subescalas de severidad y de susceptibilidad percibida de la ECS-DM2/PG y la Escala de adherencia al tratamiento de la DM2. Resultados: Al dividir la muestra por niveles de percepción de amenaza se puede observar un claro papel mediador de la percepción de susceptibilidad y severidad en el resto de las variables bajo estudio. Manteniendo como variables dependientes la adherencia al tratamiento y la hemoglobina glucosilada, se realizaron análisis de regresión lineal múltiple con el método por pasos para identificar el efecto conjunto de las variables independientes. Los niveles más altos de predicción, tanto para la adherencia al tratamiento como para los niveles de hemoglobina glucosilada se ubican en el grupo con niveles medios de susceptibilidad, donde el 46 % de la varianza de la adherencia al tratamiento se explica con base en la única variable independiente apoyo social percibido. Para los niveles de hemoglobina glucosilada, la predicción de un 33 % de la varianza en el grupo medio está dado por los factores higiene, autocuidado y dieta como componentes de la adherencia al tratamiento. Discusión o Conclusión: Los resultados obtenidos parecen señalar que la relaci

Pharmacological treatment recommended by guidelines for very high-risk patients with established cardiovascular disease (CVD) includes lipid-lowering drugs, antihypertensive agents and antiplatelet therapy. Depending on the associated comorbidities, this baseline regimen has to be complemented with other drugs. Therefore, the number of pills to be taken is usually high and adherence to these multiple pill therapeutic regimens and long-Term persistence on treatment is low, being the main factor for insufficient control of cardiovascular risk factors. The CNIC (Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Ciencia e Innovación, España) polypill is the only polypill containing low-dose aspirin approved by the EMA and marketed in Europe, and has demonstrated to improve adherence. For this reason, guidelines recommend its use for secondary prevention of CVD, and also for primary prevention of cardiovascular events in patients with multiple cardiovascular risk factors and advanced atherosclerotic process at high risk of thrombosis and low risk of bleeding. This article pretends to simplify the steps that clinicians may follow to switch from any baseline regimen to the polypill with the use of several algorithms and tables showing the equivalent effective daily doses of different angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins to facilitate switching, as well as the steps to be followed depending of the initial levels of BP and LDL-cholesterol values to achieve BP and lipid control with the association to the polypill of other BP-lowering or lipid-lowering drugs whenever needed.

Introduction: The main problem presented by patients with DM2 is the lack of adherence to medical treatments (WHO, 2004) since it is complex and requires changes in lifestyle and health habits. Objective: analyze the relationship between self-efficacy, social support, and threat perception to treatment adherence. Method: The design was transectional correlational with a non-probabilistic convenience sampling of 166 participants with DM2 who attended for medical attention at the Ministry of Health and ISSSTE of Michoacán. Instruments were administered to evaluate Self-efficacy to Treatment in DM2, Social Support in DM2, the subscales of severity and perceived susceptibility of the ECS-DM2 / PG and the adherence scale to the treatment of DM2. Results: By dividing the sample by levels of threat perception, a clear mediating role of perception of susceptibility and severity can be observed in the rest of the variables under study. Maintaining treatment adherence and glycosylated hemoglobin as dependent variables, multiple linear regression analyzes were performed using the stepwise method to identify the joint effect of the independent variables. The highest levels of prediction, both for treatment adherence and for glycosylated hemoglobin levels, are in the group with medium levels of susceptibility, where 46 % of the variance of treatment adherence is explained based on the sole independent variable of perceived social support. For glycosylated hemoglobin levels, the prediction of 33 % of the variance in the middle group is given by the factors of hygiene, self-care, and diet as components of treatment adherence. Discussion or Conclusion: According to the results obtained, it seems that the relationship between the perceived threat and adherence is not linear. It appears to be observed that perceived threat may produce a tendency to abandon by not following medical indications, when the patient perceives a very high level of susceptibility and severity, as we, Resumen Introducción: El principal problema de los pacientes con Diabetes Mellitus Tipo 2 (DM2) es la falta de adherencia a los tratamientos médicos (OMS, 2004). Estos son complejos y exigen realizar modificaciones en el estilo de vida y hábitos de salud. Por esto, el objetivo de esta investigación fue analizar la relación entre autoeficacia, apoyo social para la adherencia al tratamiento y la hemoglobina glucosilada, en función del nivel de percepción de amenaza en pacientes con DM2. Método: El diseño fue transeccional correlacional con un muestreo no probabilístico por conveniencia, con 166 participantes con DM2 que acuden a atención médica en la Secretaría de Salud y el ISSSTE en Michoacán, México. Se aplicaron instrumentos para evaluar Autoeficacia al Tratamiento en DM2, Apoyo Social en la DM2, las subescalas de severidad y de susceptibilidad percibida de la ECS-DM2/PG y la Escala de adherencia al tratamiento de la DM2. Resultados: Al dividir la muestra por niveles de percepción de amenaza se puede observar un claro papel mediador de la percepción de susceptibilidad y severidad en el resto de las variables bajo estudio. Manteniendo como variables dependientes la adherencia al tratamiento y la hemoglobina glucosilada, se realizaron análisis de regresión lineal múltiple con el método por pasos para identificar el efecto conjunto de las variables independientes. Los niveles más altos de predicción, tanto para la adherencia al tratamiento como para los niveles de hemoglobina glucosilada se ubican en el grupo con niveles medios de susceptibilidad, donde el 46 % de la varianza de la adherencia al tratamiento se explica con base en la única variable independiente apoyo social percibido. Para los niveles de hemoglobina glucosilada, la predicción de un 33 % de la varianza en el grupo medio está dado por los factores higiene, autocuidado y dieta como componentes de la adherencia al tratamiento. Discusión o Conclusión: Los resultados obtenidos parecen señalar que la relaci

Introduction: The main problem presented by patients with DM2 is the lack of adherence to medical treatments (WHO, 2004) since it is complex and requires changes in lifestyle and health habits. Objective: analyze the relationship between self-efficacy, social support, and threat perception to treatment adherence. Method: The design was transectional correlational with a non-probabilistic convenience sampling of 166 participants with DM2 who attended for medical attention at the Ministry of Health and ISSSTE of Michoacán. Instruments were administered to evaluate Self-efficacy to Treatment in DM2, Social Support in DM2, the subscales of severity and perceived susceptibility of the ECS-DM2 / PG and the adherence scale to the treatment of DM2. Results: By dividing the sample by levels of threat perception, a clear mediating role of perception of susceptibility and severity can be observed in the rest of the variables under study. Maintaining treatment adherence and glycosylated hemoglobin as dependent variables, multiple linear regression analyzes were performed using the stepwise method to identify the joint effect of the independent variables. The highest levels of prediction, both for treatment adherence and for glycosylated hemoglobin levels, are in the group with medium levels of susceptibility, where 46 % of the variance of treatment adherence is explained based on the sole independent variable of perceived social support. For glycosylated hemoglobin levels, the prediction of 33 % of the variance in the middle group is given by the factors of hygiene, self-care, and diet as components of treatment adherence. Discussion or Conclusion: According to the results obtained, it seems that the relationship between the perceived threat and adherence is not linear. It appears to be observed that perceived threat may produce a tendency to abandon by not following medical indications, when the patient perceives a very high level of susceptibility and severity, as we, Resumen Introducción: El principal problema de los pacientes con Diabetes Mellitus Tipo 2 (DM2) es la falta de adherencia a los tratamientos médicos (OMS, 2004). Estos son complejos y exigen realizar modificaciones en el estilo de vida y hábitos de salud. Por esto, el objetivo de esta investigación fue analizar la relación entre autoeficacia, apoyo social para la adherencia al tratamiento y la hemoglobina glucosilada, en función del nivel de percepción de amenaza en pacientes con DM2. Método: El diseño fue transeccional correlacional con un muestreo no probabilístico por conveniencia, con 166 participantes con DM2 que acuden a atención médica en la Secretaría de Salud y el ISSSTE en Michoacán, México. Se aplicaron instrumentos para evaluar Autoeficacia al Tratamiento en DM2, Apoyo Social en la DM2, las subescalas de severidad y de susceptibilidad percibida de la ECS-DM2/PG y la Escala de adherencia al tratamiento de la DM2. Resultados: Al dividir la muestra por niveles de percepción de amenaza se puede observar un claro papel mediador de la percepción de susceptibilidad y severidad en el resto de las variables bajo estudio. Manteniendo como variables dependientes la adherencia al tratamiento y la hemoglobina glucosilada, se realizaron análisis de regresión lineal múltiple con el método por pasos para identificar el efecto conjunto de las variables independientes. Los niveles más altos de predicción, tanto para la adherencia al tratamiento como para los niveles de hemoglobina glucosilada se ubican en el grupo con niveles medios de susceptibilidad, donde el 46 % de la varianza de la adherencia al tratamiento se explica con base en la única variable independiente apoyo social percibido. Para los niveles de hemoglobina glucosilada, la predicción de un 33 % de la varianza en el grupo medio está dado por los factores higiene, autocuidado y dieta como componentes de la adherencia al tratamiento. Discusión o Conclusión: Los resultados obtenidos parecen señalar que la relaci

El objetivo de este artículo es describir y analizar los enfoques teóricos de enfermería que han sido utilizados para la investigación sobre adherencia al tratamiento en personas con enfermedades cardiovasculares. Para ello, se realiza una revisión integrativa descriptiva entre los años 2005 - 2018 en el que se incluyen 27 artículos originales, de revisión, tesis de maestría y doctorado en enfermería teniendo en cuenta los descriptores adherencia al tratamiento, teorías de enfermería y salud cardiovascular. Como resultado, se identificaron 4 teorías de enfermería que más se han trabajado con relación a la adherencia al tratamiento: Teoría del Proceso de Enfermería Deliberativa, Teoría de la Autoeficacia, Teoría de Autocuidado y Teoría del autocuidado en Falla Cardíaca; evidenciando en la literatura predominio de estudios descriptivos, metodológicos y de intervención utilizando estos enfoques teóricos. Se puede concluir que los marcos teóricos de enfermería han permitido el avance investigativo en la adherencia de esta población, sin embargo, con la evolución del conocimiento se requiere explorar otros enfoques teóricos situacionales o derivados de la práctica., The aim of this article is to describe and analyze the theoretical approaches to nursing that have been used for research on adherence to treatment in people with cardiovascular diseases. For this, a descriptive integrative review is carried out between the years 2005 - 2018 in which 27 original articles are included, review, master's thesis and doctorate in nursing taking into account the descriptors adherence to treatment, nursing theories and cardiovascular health. As a result, 4 nursing theories that have been worked on in relation to adherence to treatment were identified: Deliberative Nursing Process Theory, Theory of Self-efficacy, Theory of Self-Care and Theory of Self-Care in Cardiac Failure; evidencing in literature the predominance of descriptive, methodological and intervention studies using these theoretical approaches. It can be concluded that the theoretical frameworks of nursing have allowed the investigative advance in the adherence of this population, however, with the evolution of knowledge it is required to explore other situational theoretical approaches or derived from the practice., O objetivo deste artigo é descrever e analisar as abordagens teóricas em enfermagem que vêm sendo utilizadas para pesquisas sobre adesão ao tratamento em pessoas com doenças cardiovasculares. 2018, que inclui 27 artigos originais, artigos de revisão, teses de mestrado e doutorado em enfermagem, considerando descritores de adesão ao tratamento, teorias de enfermagem e saúde cardiovascular - para isso, uma revisão integrativa descritiva a partir de 2005 é realizada. Como resultado, foram identificados 4 teorias de enfermagem que têm trabalhado mais sobre adesão ao tratamento: Teoria Deliberativo do Processo de Enfermagem, a teoria da auto-eficácia, teoria da auto-cuidado e auto-cuidado Teoria na Insuficiência Cardíaca; evidenciando na literatura a predominância de estudos descritivos, metodológicos e de intervenção utilizando essas abordagens teóricas. Podese concluir que os referenciais teóricos da enfermagem permitiram o avanço investigativo na adesão dessa população, porém, com a evolução do conhecimento, é necessário explorar outras abordagens teóricas situacionais ou derivadas da prática.

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative, and narrative) and argues that determining the specific aspect of autonomy affected is the first step toward protecting or promoting (and respecting) patient autonomy. These different manifestations of autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions, and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people's capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence in many patients with chronic ailments (where adherence is defined as being the extent to which a patient's behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive, and narrative capacities and taking appropriate action based on the results may help increase adherence rates.

Objetivo: Determinar la confiabilidad y validez de la versión en español de la escala para medir la contribución del cuidador al autocuidado del paciente con falla cardiaca (CC-SCHFI). Metodología: Estudio metodológico, con abordaje cuantitativo; que incluyó pruebas psicométricas, aplicadas a cuidadores familiares de personas con insuficiencia cardiaca. Se siguieron las recomendaciones metodológicas de la International Test Commission para la adaptación cultural de la prueba traducción – retrotraducción, adecuación semántica, validez facial y de contenido, confiabilidad mediante la consistencia interna y validez de constructo). Resultados: Se obtuvo un acuerdo entre expertos según el Kappa de Fleiss de 0,44 en la dimensión de relevancia, 0,41 en la dimensión de pertinente y una validez de contenido por método normalizado de CVI de 0,68. La consistencia interna del instrumento resultó óptima con un coeficiente de Alpha de Cronbach = 0,950. La exploración del constructo arrojó una estructura de 6 componentes. Conclusiones: Se obtuvo una escala en español disponible para abordar el fenómeno de la contribución del cuidador al autocuidado del paciente con falla cardiaca, con un análisis factorial que mostró que los ítems del instrumento tienden a agruparse en dos dominios (de mantenimiento y gestión del autocuidado) y no tres, como lo propone el instrumento original., Objective: To determine the reliability and validity of the Spanish version of the scale to measure the caregiver's contribution to self-care of patients with heart failure (CC-SCHFI). Methodology: Methodological study, with quantitative approach; which included psychometric tests, applied to family caregivers of people with heart failure. The methodological recommendations of the International Test Commission were followed for the cultural adaptation of the translation-back-translation test, semantic adequacy, facial and content validity, reliability through internal consistency and construct validity). Results: An agreement was reached between experts according to the Fleiss Kappa of 0.44 in the relevance dimension, 0.41 in the relevant dimension and a content validity by standardized CVI method of 0.68. The internal consistency of the instrument was optimal with a Cronbach's Alpha coefficient = 0.950. The exploration of the construct yielded a structure of 6 components. Conclusions: A Spanish scale was available to address the phenomenon of the caregiver's contribution to the self-care of patients with heart failure, with a factorial analysis that showed that the items of the instrument tend to be grouped into two domains (maintenance and management of self-care) and not three, as proposed by the original instrument., Objetivo: Determinar a confiabilidade e a validade da versão em espanhol da escala para medir a contribuição do cuidador ao autocuidado de pacientes com insuficiência cardíaca (CC-SCHFI). Metodologia: Estudo metodológico, com abordagem quantitativa; que incluiu testes psicométricos, aplicados a familiares cuidadores de pessoas com insuficiência cardíaca. As recomendações metodológicas da International Test Commission foram seguidas para a adaptação cultural do teste (tradução-retroversão, adequação semântica, validade facial e de conteúdo, confiabilidade por consistência interna e validade de constructo). Resultados: Houve concordância entre os especialistas segundo o Fleiss Kappa de 0,44 na dimensão de relevância, 0,41 na dimensão relevante e validade de conteúdo pelo método CVI padronizado de 0,68. A consistência interna do instrumento foi ótima com um coeficiente alfa de Cronbach = 0,950. A exploração do construto produziu uma estrutura de 6 componentes. Conclusões: Foi disponibilizada uma escala de espanhol para abordar o fenômeno da contribuição do cuidador para o autocuidado de pacientes com insuficiência cardíaca, com uma análise fatorial que mostrou que os itens do instrumento tendem a ser agrupados em dois domínios (manutenção e manejo dos pacientes). autocuidado) e não três, como proposto pelo instrumento original.

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative, and narrative) and argues that determining the specific aspect of autonomy affected is the first step toward protecting or promoting (and respecting) patient autonomy. These different manifestations of autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions, and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people's capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence in many patients with chronic ailments (where adherence is defined as being the extent to which a patient's behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive, and narrative capacities and taking appropriate action based on the results may help increase adherence rates.

Objetive: to determine the association between adherence to the diet and nutritional education in patients with dialysis treatment. Material and Methods: Cross-sectional descriptive study in patients with Chronic Kidney Disease on dialysis treatment ≥6 months, who have previously received nutritional education. The State of Nutrition was evaluated by means of the Subjective Global Assessment (SGA), skinfolds (tricipital and subescapular), dry weight and height (according to the parameters established by the International Society for Advances of Kinanthropometry); nutritional knowledge and adherence through the Knowledge and Adherence to The Therapeutic Regimen Survey; quality of life through the KDQOL-SF ™ instrument. Results: 85 patients were included, 46 (54%) men and 39 (46%) women with an average age of 42 ± 17 years and a mean time with dialysis treatment 3 ± 1.96 years. 58% of the patients did not have adherence to the diet. However, 89% of patients adhered to the sodium restriction recommendation, while 59% adhered to fluid intake. According to the VGS, 58% of the patients presented mild/moderate malnutrition, however, 71% had average fat according to the sum of the skinfolds and 67% presented a normal nutritional status determined by Body Mass Index (BMI). Conclusions: no significant difference in adherence to dietary treatment was observed in those patients who have nutritional knowledge compared to those who do not., Objetivo: determinar la asociación entre el apego a la dieta y la educación nutricional en los pacientes con tratamiento de diálisis. Material y métodos: estudio transversal en pacientes con enfermedad renal crónica (ERC) en tratamiento de diálisis ≥6 meses, que han recibido educación nutricional previamente. Se evaluó el estado de nutrición mediante la Valoración Global Subjetiva (VGS), toma de pliegues cutáneos (tricipital y subescapular), peso seco y estatura (de acuerdo con los parámetros establecidos por la International Society for Advances of Kinanthropometry); los conocimientos nutricionales y su adherencia mediante la Encuesta de Conocimientos y Adherencia al Régimen Terapéutico, y la calidad de vida mediante el instrumento KDQOL-SF™. Resultados: se incluyeron 85 pacientes, 46 (54%) hombres y 39 (46%) mujeres con una edad media de 42 ±17 años y un tiempo medio en diálisis de 3 ± 1.96 años. El 58% de los pacientes no presentó apego al régimen dietético. Sin embargo, el 89% de los pacientes se apegaron a la recomendación de la restricción de sodio, mientras que el 59% se adhirió al consumo de líquidos. De acuerdo con la VGS, el 58% de los pacientes presentaron desnutrición leve/moderada; no obstante, el 71% tuvieron grasa promedio según la sumatoria de pliegues y el 67% presentó un estado de nutrición normal determinado por el de Índice de Masa Corporal (IMC). Conclusiones: no se observó diferencia significativa en la adherencia al tratamiento dietético en aquellos pacientes que tienen conocimientos nutricionales respecto a los que no los tienen.

Background: The electronic prescription has meant an evolution in the quality of health care, but it has a series of deficiencies that compromise the adherence to treatments. The objective of this work was to collect and group these limitations and propose the changes that could solve them. Methods: During 2017 and 2018, through dispensing and pharmacotherapeutic monitoring activities, incidents related to the electronic prescription were collected in a pharmacy in Santander and their causes were identified. A survey was conducted and sent to the Information Centers of the Medicines of the rest of the regions to know if the same problems were shared and the resulting data were treated by frequency distribution. Results: We detected 1,500 incidents related to the way of access to the treatment and its activation period, with the availability of the medication when the patient requested it and those in which the assessment of the problem by the doctor was essential. The survey data showed that in 100% of the CCAA the patient must return to the doctor when there is an incidence, because there is no protocol to solve it from the pharmacy. Conclusions: These incidents compromise the adherence to treatments and the health of patients. To avoid them, we propose the elimination of the password that is necessary to access the treatment, the establishment of a minimum period of 30 days for its activation, the creation of protocols so that the pharmacist can solve problems and perform dispensations in special circumstances, and finally, the optimization of the communication between pharmacist and doctor., Fundamentos: La receta electrónica ha supuesto una evolución en la calidad de la asistencia sanitaria, pero presenta una serie de deficiencias que comprometen la adherencia a los tratamientos. El objetivo de este trabajo fue recopilar y agrupar estas limitaciones y proponer cambios que podrían resolverlas. Sujeto y métodos: Durante los años 2017 y 2018, a través de las actividades de dispensación y seguimiento farmacoterapéutico, se recogieron en una farmacia de Santander las incidencias relacionadas con la dispensación de recetas electrónicas y se identificaron sus causas. Se realizó una encuesta que se envió a los Centros de Información de los Medicamentos del resto de comunidades autónomas para conocer si se compartían los mismos problemas y se trataron los datos resultantes mediante distribución de frecuencias. Resultados: Se detectaron 1.500 incidencias relacionadas con el modo de acceso al tratamiento y su periodo de activación, con la disponibilidad de la medicación cuando el paciente lo solicitaba y aquellas en las que era indispensable la valoración del problema por parte del médico. Los datos de la encuesta mostraron que en el 100% de las comunidades autónomas el paciente debía volver al centro de salud para solucionar estas incidencias, al no existir ningún protocolo para resolverlas desde la farmacia. Conclusiones: Estas incidencias comprometen la adherencia a los tratamientos y la salud de los pacientes. Para evitarlas, proponemos la eliminación del número de orden que es necesario para acceder al tratamiento, la instauración de un período mínimo de 30 días para su activación, la creación de protocolos para que el farmacéutico pueda solucionar problemas y realizar dispensaciones en circunstancias especiales, y por último, la optimización de la comunicación entre farmacéutico y médico.

Heart disease is the most prevalent and with the highest mortality in the world and in Colombia. Despite the fact that cardiac rehabilitation has proven to be effective in secondary prevention, its effectiveness is limited because of the poor patients‘ adherence to treatment, especially in the outpatient phase, when they do not have any direct supervision from health professionals, which conditions a deterioration of their health and quality of life. In this study, by means of focus groups, facilitating factors and barriers for selfmanagement of the disease and other categories associated with the development of adherence are identified from the actors‘ perspective (patients, family members and professionals with skill in cardiac rehabilitation). These findings are discussed together with contributions from various areas of knowledge, and guidelines are proposed to develop intervention proposals that improve therapeutic adherence, an interdisciplinary view being necessary for increasing it., La enfermedad cardiaca es la de mayor prevalencia y mortalidad en el mundo y en Colombia. Pese a que la rehabilitación cardiaca ha probado su eficacia en la prevención secundaria, su efectividad es limitada por la baja adherencia de los pacientes al tratamiento, especialmente en la fase extrahospitalaria, cuando no tienen supervisión directa de los profesionales de la salud, lo que condiciona deterioro de su salud y la calidad de vida. En este estudio, mediante grupos focales se identifican desde la perspectiva de los actores (pacientes, familiares y profesionales expertos en rehabilitación cardiaca) factores facilitadores y barreras para la autogestión de la enfermedad y otras categorías asociadas con el desarrollo de la adherencia. Estos hallazgos se discuten junto con contribuciones de diversas áreas del conocimiento y se proponen pautas para elaborar propuestas de intervención que mejoren la adherencia terapéutica, para cuyo incremento es necesaria una mirada interdisciplinar.

Objective: To assess whether knowledge about Diabetes Mellitus (DM), family functionality and depression are associated with Therapeutic Adherence in adults with type 2 DM. Methods: Analytical study of cross section. It was carried out in the diabetes program of CAP-UNHEVAL of Hospital II Essalud. Participants: patients with type 2 DM. Interventions: According to the inclusion and exclusion criteria. Validated collection instruments were used, interviewed for two months. The descriptive analysis was carried out; for inferential analysis: Chi2 test with 95% significance. The statistical package SPSS and Microsoft Excel was used. Results. The average age: 61.95 years, most frequent diseases: dyslipidemia (23.8%) and hypertension (43.6%). Knowledge about DM2 was not acceptable (86%), 95.9% with poor family function and 90.2% with depression were obtained. Variables associated with poor adherence to diabetic treatment were: family dysfunction [p = 0.00; RP = 26.18; CI: 95% (8.71 - 78.64)], unacceptable knowledge on DM2 [p = 0.00; RP= 23.57; 95% CI (8.54-65.06)] and depression [p = 0.00; RP= 6.81; 95% CI (3.00 - 15.45)]. Conclusions: Poor adherence to treatment is influenced by family dysfunction, poor knowledge about diabetes and depression., Objetivo: Evaluar si el conocimiento sobre Diabetes Mellitus (DM), la funcionalidad familiar y la depresión están asociados a la Adherencia Terapéutica en adultos con DM tipo 2. Métodos: Estudio analítico de corte transversal. Se realizó en el programa de diabetes del CAP-UNHEVAL del Hospital II Essalud. Participantes: pacientes con DM tipo 2. Intervenciones: Según los criterios de inclusión y exclusión. Se utilizó instrumentos de recolección validados, se entrevistó durante dos meses. Se realizó el análisis descriptivo; para el análisis inferencial: prueba Chi2 con significancia del 95%. Se empleó el paquete estadístico SPSS y Microsoft Excel. Resultados. La edad promedio: 61,95 años, enfermedades más frecuentes: dislipidemia (23,8%) e HTA (43,6%). El conocimiento sobre DM2 fue no aceptable (86%), se obtuvo un 95,9% con una mala función familiar y un 90,2% de depresión. Variables asociadas a la mala adherencia del tratamiento diabético fueron: disfunción familiar [p=0,00; OR=26.18; IC: 95% (8,71 – 78,64)], conocimiento no aceptable sobre DM2 [p=0,00; OR=23.57; IC 95% (8,54 – 65,06)] y depresión [p=0,00; OR=6.81; IC 95% (3,00 – 15,45)]. Conclusiones: La mala adherencia al tratamiento está influenciada por la disfunción familiar, el pobre conocimiento sobre la diabetes y la depresión.

Objetivo: Determinar la confiabilidad y validez de la versión en español de la escala para medir la contribución del cuidador al autocuidado del paciente con falla cardiaca (CC-SCHFI). Metodología: Estudio metodológico, con abordaje cuantitativo; que incluyó pruebas psicométricas, aplicadas a cuidadores familiares de personas con insuficiencia cardiaca. Se siguieron las recomendaciones metodológicas de la International Test Commission para la adaptación cultural de la prueba traducción – retrotraducción, adecuación semántica, validez facial y de contenido, confiabilidad mediante la consistencia interna y validez de constructo). Resultados: Se obtuvo un acuerdo entre expertos según el Kappa de Fleiss de 0,44 en la dimensión de relevancia, 0,41 en la dimensión de pertinente y una validez de contenido por método normalizado de CVI de 0,68. La consistencia interna del instrumento resultó óptima con un coeficiente de Alpha de Cronbach = 0,950. La exploración del constructo arrojó una estructura de 6 componentes. Conclusiones: Se obtuvo una escala en español disponible para abordar el fenómeno de la contribución del cuidador al autocuidado del paciente con falla cardiaca, con un análisis factorial que mostró que los ítems del instrumento tienden a agruparse en dos dominios (de mantenimiento y gestión del autocuidado) y no tres, como lo propone el instrumento original., Objective: To determine the reliability and validity of the Spanish version of the scale to measure the caregiver's contribution to self-care of patients with heart failure (CC-SCHFI). Methodology: Methodological study, with quantitative approach; which included psychometric tests, applied to family caregivers of people with heart failure. The methodological recommendations of the International Test Commission were followed for the cultural adaptation of the translation-back-translation test, semantic adequacy, facial and content validity, reliability through internal consistency and construct validity). Results: An agreement was reached between experts according to the Fleiss Kappa of 0.44 in the relevance dimension, 0.41 in the relevant dimension and a content validity by standardized CVI method of 0.68. The internal consistency of the instrument was optimal with a Cronbach's Alpha coefficient = 0.950. The exploration of the construct yielded a structure of 6 components. Conclusions: A Spanish scale was available to address the phenomenon of the caregiver's contribution to the self-care of patients with heart failure, with a factorial analysis that showed that the items of the instrument tend to be grouped into two domains (maintenance and management of self-care) and not three, as proposed by the original instrument., Objetivo: Determinar a confiabilidade e a validade da versão em espanhol da escala para medir a contribuição do cuidador ao autocuidado de pacientes com insuficiência cardíaca (CC-SCHFI). Metodologia: Estudo metodológico, com abordagem quantitativa; que incluiu testes psicométricos, aplicados a familiares cuidadores de pessoas com insuficiência cardíaca. As recomendações metodológicas da International Test Commission foram seguidas para a adaptação cultural do teste (tradução-retroversão, adequação semântica, validade facial e de conteúdo, confiabilidade por consistência interna e validade de constructo). Resultados: Houve concordância entre os especialistas segundo o Fleiss Kappa de 0,44 na dimensão de relevância, 0,41 na dimensão relevante e validade de conteúdo pelo método CVI padronizado de 0,68. A consistência interna do instrumento foi ótima com um coeficiente alfa de Cronbach = 0,950. A exploração do construto produziu uma estrutura de 6 componentes. Conclusões: Foi disponibilizada uma escala de espanhol para abordar o fenômeno da contribuição do cuidador para o autocuidado de pacientes com insuficiência cardíaca, com uma análise fatorial que mostrou que os itens do instrumento tendem a ser agrupados em dois domínios (manutenção e manejo dos pacientes). autocuidado) e não três, como proposto pelo instrumento original.

In recent years, several studies have advocated the need to expand the concept of patient autonomy beyond the capacity to deliberate and make decisions regarding a specific medical intervention or treatment (decision-making or decisional autonomy). Arguing along the same lines, this paper proposes a multidimensional concept of patient autonomy (decisional, executive, functional, informative, and narrative) and argues that determining the specific aspect of autonomy affected is the first step toward protecting or promoting (and respecting) patient autonomy. These different manifestations of autonomy are not mutually dependent; there may be patients who have problems in one dimension, while at the same time being fully autonomous in others. Nevertheless, a close interaction has been observed between the various dimensions, and indeed, a phenomenological analysis shows that damage to or a reduction in one aspect of people's capacity for self-government generally affects other aspects of their autonomy, which in turn disrupts their identity and the way in which they see themselves and are seen by others. In this paper, I shall examine some of these interactions and show how they may lie at the heart of the problem of poor treatment adherence in many patients with chronic ailments (where adherence is defined as being the extent to which a patient's behavior over time coincides with the recommendations made by and agreed with their health professional). One example given is that of psoriasis, a chronic skin disease with a very poor adherence record. In Spain, it is calculated that 85% of patients diagnosed with mild to moderate psoriasis fail to comply properly with their treatment, and figures from other parts of the world are similar. Although there are many possible causes for non-adherence among psoriasis patients, assessing their decisional, executive, and narrative capacities and taking appropriate action based on the results may help increase adherence rates.

Objetive: to determine the association between adherence to the diet and nutritional education in patients with dialysis treatment. Material and Methods: Cross-sectional descriptive study in patients with Chronic Kidney Disease on dialysis treatment ≥6 months, who have previously received nutritional education. The State of Nutrition was evaluated by means of the Subjective Global Assessment (SGA), skinfolds (tricipital and subescapular), dry weight and height (according to the parameters established by the International Society for Advances of Kinanthropometry); nutritional knowledge and adherence through the Knowledge and Adherence to The Therapeutic Regimen Survey; quality of life through the KDQOL-SF ™ instrument. Results: 85 patients were included, 46 (54%) men and 39 (46%) women with an average age of 42 ± 17 years and a mean time with dialysis treatment 3 ± 1.96 years. 58% of the patients did not have adherence to the diet. However, 89% of patients adhered to the sodium restriction recommendation, while 59% adhered to fluid intake. According to the VGS, 58% of the patients presented mild/moderate malnutrition, however, 71% had average fat according to the sum of the skinfolds and 67% presented a normal nutritional status determined by Body Mass Index (BMI). Conclusions: no significant difference in adherence to dietary treatment was observed in those patients who have nutritional knowledge compared to those who do not., Objetivo: determinar la asociación entre el apego a la dieta y la educación nutricional en los pacientes con tratamiento de diálisis. Material y métodos: estudio transversal en pacientes con enfermedad renal crónica (ERC) en tratamiento de diálisis ≥6 meses, que han recibido educación nutricional previamente. Se evaluó el estado de nutrición mediante la Valoración Global Subjetiva (VGS), toma de pliegues cutáneos (tricipital y subescapular), peso seco y estatura (de acuerdo con los parámetros establecidos por la International Society for Advances of Kinanthropometry); los conocimientos nutricionales y su adherencia mediante la Encuesta de Conocimientos y Adherencia al Régimen Terapéutico, y la calidad de vida mediante el instrumento KDQOL-SF™. Resultados: se incluyeron 85 pacientes, 46 (54%) hombres y 39 (46%) mujeres con una edad media de 42 ±17 años y un tiempo medio en diálisis de 3 ± 1.96 años. El 58% de los pacientes no presentó apego al régimen dietético. Sin embargo, el 89% de los pacientes se apegaron a la recomendación de la restricción de sodio, mientras que el 59% se adhirió al consumo de líquidos. De acuerdo con la VGS, el 58% de los pacientes presentaron desnutrición leve/moderada; no obstante, el 71% tuvieron grasa promedio según la sumatoria de pliegues y el 67% presentó un estado de nutrición normal determinado por el de Índice de Masa Corporal (IMC). Conclusiones: no se observó diferencia significativa en la adherencia al tratamiento dietético en aquellos pacientes que tienen conocimientos nutricionales respecto a los que no los tienen.

The main task of the general practitioner is managing patients with the effects of ischemic stroke. The improvement of patients adherence to treatment in a significant way contributes to successful secondary prevention of ischemic stroke. Adherence to treatment can be determined through various questionnaires, including Morissky-Green. Currently, the adherence to a long-term drug therapy remains insufficient.

Adherence to treatment has been an institutional process after a diagnosis that involves self-care and family support aimed at rehabilitation or treatment, which in the best case involves the social and occupational reintegration of the patient. In this sense, the objective of this work is to analyze the expectations of adherence to HIV treatment, considering psychological, subjective and cognitive factors. A non-experimental study was carried out with a non-probabilistic selection of 258 students from a public university in central Mexico. However, the results show that there is a direct and indirect relationship between the rules regarding accession. Such findings are discussed in light of the assumption that adherence is a factor determined by personal variables., La adhesión al tratamiento ha sido un proceso institucional posterior a un diagnóstico que supone un autocuidado y un soporte familiar orientado a la rehabilitación o al tratamiento que, en el mejor de los casos, implica la reinserción social y laboral del paciente. En tal sentido, el objetivo del presente trabajo es analizar las expectativas de adhesión al tratamiento del Virus de Inmunodeficiencia Humana (VIH), considerando factores psicológicos, subjetivos y cognitivos. Se llevó a cabo un estudio no experimental con una selección no probabilística de 258 estudiantes de una universidad pública del centro de México. Sin embargo, los resultados mues- tran que existe una relación directa e indirecta entre las normas con respecto a la adhesión. Tales hallazgos se discuten a la luz del supuesto de que la adhesión es un factor determinado por variables personales.

Adherence to treatment has been an institutional process after a diagnosis that involves self-care and family support aimed at rehabilitation or treatment, which in the best case involves the social and occupational reintegration of the patient. In this sense, the objective of this work is to analyze the expectations of adherence to HIV treatment, considering psychological, subjective and cognitive factors. A non-experimental study was carried out with a non-probabilistic selection of 258 students from a public university in central Mexico. However, the results show that there is a direct and indirect relationship between the rules regarding accession. Such findings are discussed in light of the assumption that adherence is a factor determined by personal variables., La adhesión al tratamiento ha sido un proceso institucional posterior a un diagnóstico que supone un autocuidado y un soporte familiar orientado a la rehabilitación o al tratamiento que, en el mejor de los casos, implica la reinserción social y laboral del paciente. En tal sentido, el objetivo del presente trabajo es analizar las expectativas de adhesión al tratamiento del Virus de Inmunodeficiencia Humana (VIH), considerando factores psicológicos, subjetivos y cognitivos. Se llevó a cabo un estudio no experimental con una selección no probabilística de 258 estudiantes de una universidad pública del centro de México. Sin embargo, los resultados mues- tran que existe una relación directa e indirecta entre las normas con respecto a la adhesión. Tales hallazgos se discuten a la luz del supuesto de que la adhesión es un factor determinado por variables personales.

[Resumen] Introducción: La polimedicación se entiende como el hecho de tomar más medicamentos de los clínicamente apropiados. La adherencia a los medicamentos es compleja y un comportamiento dinámico que ha sido vinculado a muchos aspectos, como el estado socioeconómico, el equipo de salud y el sistema de salud. Los profesionales deben adquirir la habilidad de ayudar a su paciente a poder hablar de sus problemas y a encontrar la forma de solucionarlos, por ello se necesita disponer de un marco conceptual que intente explicar cómo se puede intervenir. Estos son conscientes del alto potencial que tienen sus intervenciones, por lo que están asumiendo un papel más importante en las actividades de promoción y prevención, así como en la gestión y el seguimiento de los pacientes crónicos. Objetivo general: Indagar sobre la experiencia en comunicación de los profesionales de enfermería en la adherencia al tratamiento en pacientes polimedicados. Objetivos específicos:  Identificar estrategias de comunicación en la experiencia de los enfermeros.  Identificar las barreras de comunicación que dificultan la relación enfermera-paciente.  Conocer cómo afecta una mejora de la comunicación en la adherencia al tratamiento en pacientes polimedicados.  Conocer la importancia de la comunicación con el paciente. Metodología: Estudio de carácter cualitativo basado en la fenomenología según Van Manen. La población de estudio serán enfermeros que atienden a pacientes polimedicados en centros de salud de la Gerencia de Gestión Integrada de Ferrol (XXIF). Se usará un muestreo teórico e intencionado y se llevarán a cabo entrevistas semiestructuradas., [Resumo] Introdución: A polimedicación se entende coma o feito de tomar máis medicación da clinicamente apropiada. A adherencia a medicación é complexa e un comportamento dinámico que vinculase a moitos aspectos, coma o estado socioeconómico, equipo de saúde e o sistema de saúde. Os profesionais deben adquirir a habilidade de axudar o seu paciente a poder falar dos seus problemas e a atopar a forma de solucionalos, por isto necesitase dispoñer dun marco conceptual que intente explicar a forma na que se pode intervir. Estes son conscientes do alto potencial que teñen as súas intervencións, polo que están asumindo un papel máis importante nas actividades de promoción e prevención, así como na xestión e o seguimento dos pacientes crónicos. Obxectivo xeneral: Indagar sobre a experiencia en comunicación dos profesionais de enfermería na adherencia o tratamento en pacientes polimedicados. Obxectivos específicos:  Identificar estratexias de comunicación na experiencia dos enfermeros.  Identificar as barreiras de comunicación que dificultan a relación enfermera-paciente.  Coñecer cómo afecta unha mellora da comunicación na adherencia o tratamento en pacientes polimedicados.  Coñecer a importancia da comunicación có paciente. Metodoloxía: Estudo de carácter cualitativo baseado na fenomenoloxía segundo Van Manen. A poboación do estudo serán enfermeiras que atenden a pacientes polimedicados nos centros de saúde da Xerencia de Xestión Integrada de Ferrol (XXIF). Usarase un móstreo teórico e intencionado e se levarán a cabo entrevistas semiestructuradas., [Abstract] Introduction: Polypharmacy is understood as taking more drugs than clinically appropriate. Adherence to medications is complex and a dynamic behavior that has been linked to many aspects, such as socioeconomic status, health team and health system. Professionals must acquire the ability to help their patient so they can talk about problems and how to solve them, therefore, you need to have a conceptual framework that tries to explain how you can intervene. These are known for the high potential of their interventions, so they are aware of their most important role in the promotion and prevention activities, as well as in the management and monitoring of chronic patients. General objetive: Inquire about the communication experience of nursing professionals in adherence to treatment in polymedicated patients. Specific objetives:  Identify communication strategies in the experience of nurses.  Identify communication barriers that hinder the nurse-patient relationship.  Know how an improvement in communication affects adherence to treatment in polymedicated patients.  Know the importance of communication with the patient. Methodology: Qualitative study based on the phenomenology according to Van Manen. The population of the health centers that receive attention in the health centers of the Management of Integrated Management of Ferrol (XXIF). A theoretical and intended marker is used and semi-structured interviews are carried out.

[Resumen] Introducción: La Enfermedad Pulmonar Obstructiva Crónica es una patología caracterizada por la presencia de síntomas respiratorios y limitación del flujo aéreo persistente, cuyo principal factor de riesgo es el tabaquismo. Constituye un gran reto de salud pública, ya que es una causa importante de morbilidad crónica y mortalidad en todo el mundo. Es la cuarta causa de muerte, pero se prevé que llegue a ser la tercera en el año 2020. Existen algunos estudios que demuestran la baja adherencia a la medicación inhalada en los pacientes con EPOC. Se ha demostrado que una buena adherencia está asociada con un menor riesgo de exacerbaciones graves y muertes, una disminución de ingresos hospitalarios y menores costes para el sistema sanitario. Hay escasos estudios sobre intervenciones para mejorar la adherencia. Es necesario el diseño e implantación en nuestro sistema sanitario de una intervención de educación sanitaria desde el ámbito de Atención Primaria, que se centre en el autocuidado, el conocimiento de la enfermedad, la cronicidad y el correcto manejo del tratamiento. Objetivos principales: diseñar y evaluar la eficacia de una intervención de enfermería que suponga un aumento en la adherencia al tratamiento en pacientes con EPOC y, por tanto, una mejora en la calidad de vida y un enlentecimiento de la progresión de la enfermedad. Metodología: estudio epidemiológico de tipo cuantitativo, con un diseño cuasi-experimental de tipo antes-después, analítico, prospectivo y longitudinal. Para la recogida de datos y obtención de resultados se utilizarán cuestionarios validados, que cubrirán los pacientes antes y después de la intervención., [Resumo] Introdución: A Enfermidade Pulmonar Obstructiva Crónica é una patoloxía caracterizada pola presenza de síntomas respiratorios e limitacións persistentes no fluxo de aire, cuxo principal factor de risco é o tabaquismo. Constitúe un gran reto de saúde pública, xa que é una causa importante de morbilidade e mortalidade en todo o mundo. É a cuarta causa de morte, pero se prevé que chegue a ser a terceira en 2020. Existen algúns estudos que demostran a baixa adherencia á medicación inhalada en pacientes con EPOC. Demostrouse que una boa adherencia está asociada cun menor risco de exacerbacións graves e mortes, una diminución de ingresos hospitalarios e menores custos para o sistema sanitario. Hai escasos estudos sobre intervencións para mellorar á adherencia. É necesario o deseño e implementación no noso sistema sanitario dunha intervención de educación sanitaria dende o ámbito de Atención Primaria, que se centre no autocuidado, o coñecemento da enfermidade, a cronicidade e o correcto manexo do tratamento. Obxectivos principais: deseñar e evaluar a eficacia dunha intervención de enfermaría que supoña un aumento na adherencia ao tratamento en pacientes con EPOC e, polo tanto, una mellora na calidade de vida e un enlentecemento da progresión da enfermidade. Metodoloxía: estudo epidemiolóxico de tipo cuantitativo, cun deseño cuasi-experimental de tipo antes-después, analítico, prospectivo e lonxitudinal. Para a recollida de datos e obtención de resultados, utilizaranse cuestionarios validados, que cubrirán os pacientes antes e despois da intervención., [Abstract] Introduction: Chronic Obstructive Pulmonary Disease is a pathology characterized by the presence of respiratory symptoms and the persistent limitation of air flow, whose main risk factor is smoking. Moreover, it constitutes a great public health issue, since it is an important cause of chronic morbidity and mortality throughout the world. It is the fourth most common cause of death, but it is believed to become the third in 2020. There are some studies that demonstrate the low adherence to inhaled medicine in patients with COPD. It has been shown that good adherence is associated with a lower risk of severe exacerbations and deaths, a decrease in hospital admissions and lower costs for the health system. There are few studies on interventions to improve adherence. The design and implementation in our health system of a health education intervention from the Primary Care area – which focuses on self-care, knowledge of the disease, chronicity and treatment of work – is necessary. Primary objectives: the design and evaluation of the efficacy of an infirmary intervention that supposes an increase in the adherence to work in patients with COPD and, therefore, an improvement in the quality of life and a slowdown in the progression of the disease. Methodology: epidemiological study of quantitative type, with a quasi-experimental design of before-after, analytical, prospective and longitudinal type. Validated questionnaires would be used to collect data and obtain results, which patients would have to cover before and after the intervention.

To develop a conceptual framework of adherence to treatment among Thai people living with tuberculosis, a grounded theory approach was used. A purposive sample of 20 Thai people living with tuberculosis, aged from 23 to 85years, was interviewed. From the participants' perspective, a core category of social belonging was highlighted, with three categories of conditions connected: personal barriers, personal resilience, and social facilitation. Personal barriers encompassed fear of stigma, concealing the illness, and lack of knowledge and motivation to complete the treatment regime. Personal resilience encompassed positive thinking and self-awareness. Social facilitation encompassed the ease of access to health services, continuity in the health service's ability to choose a directly-observed therapy observer, and social support. This study contributes a deeper understanding of the perspective of Thai people living with tuberculosis with regards to adherence to tuberculosis treatment. It might improve how local healthcare workers provide tuberculosis care, and inspire them to tailor care to people living with tuberculosis in a local community to increase personal resilience and reduce stigma.

To evaluate psychotropic drug use in undocumented migrants and natives in the same conditions of poverty. We studied drug dispensation by a nongovernmental organization during the year 2014. Drugs were identified according to the Anatomical Chemical Therapeutic classification and their quantity was measured in defined daily doses (DDD). We determined the percentage of patients taking at least one medicine with psychotropic activity in relation to the total number of patients receiving medicines of any class. We also calculated the individual DDD for psychoactive drugs. The percentage of natives receiving this type of medicine is significantly higher than that of undocumented migrants. Individual DDDs for each class of psychotropic drug are comparable in Italians and undocumented migrants and, among the latter, no difference was found in relation to ethnicity. Our findings describe for the first time the use of psychotropic medicines by undocumented migrants. On this basis, we hypothesize that poverty is more important than migration and ethnicity in generating the need for this type of pharmacological treatment. Both natives and undocumented migrants show poor adherence to treatment. This situation should be considered when programming health interventions in this field for the very poor and undocumented migrants