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Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03–3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.

Background: Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods: The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 20192021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings: Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a high level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation: Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative A Healthy Diet for a Healthy Life. (c) 2022 The Author(s)

Heart sounds convey important information regarding potential heart diseases. Currently, heart sound classification attracts many researchers from the fields of telemedicine, digital signal processing, and machine learning—among others—mainly to identify cardiac pathology as quickly as possible. This article proposes chaogram as a new transform to convert heart sound signals to colour images. In the proposed approach, the output image is, therefore, the projection of the reconstructed phase space representation of the phonocardiogram (PCG) signal on three coordinate planes. This has two major benefits: (1) it makes possible to apply deep convolutional neural networks to heart sounds and (2) it is also possible to employ a transfer learning scheme by converting a heart sound signal to an image. The performance of the proposed approach was verified on the PhysioNet dataset. Due to the imbalanced data on this dataset, it is common to assess the results quality using the average of sensitivity and specificity, which is known as score, instead of accuracy. In this study, the best results were achieved using the InceptionV3 model, which achieved a score of 88.06%.

Background: Although different methods for the evaluation of energy intake (EI) misreport have been described, it is unclear which one is the most appropriate. Aim: To assess the performance of these methods in the prevalence of EI misreports and accuracy of nutrient intake estimates. Methods: Reports of 3,639 adults from the Portuguese National Food, Nutrition and Physical Activity Survey 20152016 were classified using univariate (Willett; interquartile range) and multivariate (Goldberg; predicted total energy expenditure [pTEE], testing different standard deviations [SD]) methods. Self-reported intakes were compared to their respective estimates by urinary excretion in a sub-sample of 80. The effect of the exclusion of misreporters on nutrient estimates was assessed by the differences in linear regression coefficients between plausible and total sample. Results: The highest prevalence of EI misreport was observed using pTEE 1SD (63.9%). Differences in the associations between nutrient self-reported intake and estimated intake using urinary biomarkers were verified with misreporters exclusion by pTEE 1SD method (ß-protein = 0.209; 95% CI = 0.0740.529; ß-potassium = 0.276; 95% CI = 0.0600.560) and Goldberg 2SD (ß-protein = 0.080; 95% CI = 0.0250.235; ß-potassium = 0.106; 95% CI = 0.0480.246). Conclusions: Multivariate methods lead to a higher prevalence of misreports and larger differences in nutrient estimates. The application of the pTEE 1SD and Goldberg 2SD methods resulted in more accurate nutrient estimates.

Made available in DSpace on 2022-04-28T19:46:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Image registration is a commonly task in medical image analysis. Therefore, a significant number of algorithms have been developed to perform rigid and non-rigid image registration. Particularly, the free-form deformation algorithm is frequently used to carry out non-rigid registration task; however, it is a computationally very intensive algorithm. In this work, we describe an approach based on profiling data to identify potential parts of this algorithm for which parallel implementations can be developed. The proposed approach assesses the efficient of the algorithm by applying performance analysis techniques commonly available in traditional computer operating systems. Hence, this article provides guidelines to support researchers working on medical image processing and analysis to achieve real-time non-rigid image registration applications using common computing systems. According to our experimental findings, significant speedups can be accomplished by parallelizing sequential snippets, i.e., code regions that are executed more than once. For the selected costly functions previously identified in the studied free-form deformation algorithm, the developed parallelization decreased the runtime by up to seven times relatively to the related single thread based implementation. The implementations were developed based on the Open Multi-Processing application programming interface. In conclusion, this study confirms that based on the call graph visualization and detected performance bottlenecks, one can easily find and evaluate snippets which are potential optimization targets in addition to throughput in memory accesses. CNPq National Scientific and Technological Development Council Research Group PIXEL - UNEMAT Programa Doutoral em Engenharia Informática Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial Faculdade de Engenharia Universidade do Porto Departamento de Ciências da Computação Faculdade de Ciências Universidade Estadual Paulista-UNESP Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial Departamento de Engenharia Mecânica Faculdade de Engenharia Universidade do Porto Departamento de Ciências da Computação Faculdade de Ciências Universidade Estadual Paulista-UNESP

Classification and analysis of surface EMG (sEMG) signals have been of particular interest due to their numerous applications in the biomedical field. They can be used for the diagnosis of neuromuscular diseases, kinesiological studies, and human-machine interaction. However, these signals are difficult to process due to their noisy nature. To overcome this problem, a hybrid of wavelet with ensemble empirical mode decomposition pre-processing technique called WD-EEMD is proposed for classifying lower limb activities based on sEMG signals in healthy and knee abnormal subjects. First, Wavelet De-noising is used for filtering out white Gaussian Noise (WGN) and unwanted signals (contribution of other muscle signals). Next, an Ensemble Empirical Mode Decomposition is used for filtering out power line interference (PLI) and baseline wandering (BW) noises, followed by extraction of a total of nine time-domain features. Finally, the performance parameters of the Linear Discriminant Analysis (LDA) classifier are calculated with a 3-fold cross-validation technique. This study involves 11 healthy and 11 individuals with a knee abnormality for three different activities: walking, flexion of the leg up (standing), and leg extension from sitting position (sitting). Different pre-processing techniques similar to that of WD-EEMD were compared. It was observed that the proposed method achieves an average classification accuracy of 90.69% and 97.45% for healthy subjects and knee abnormal subjects, respectively.

According to the World Alzheimer Report 2015, 46 million people are living with dementia in the world. The diagnosis of diseases helps doctors treating patients better. One of the signs of diseases is related to white matter, grey matter and cerebrospinal fluid. Therefore, the automatic segmentation of three tissues in brain imaging especially from magnetic resonance imaging (MRI) plays an important role in medical analysis. In this research, we proposed an effective approach to segment automatically these tissues in three-dimensional (3D) brain MRI. First, a deep learning model is used to segment the sure and unsure regions. In the unsure region, another deep learning model is used to classify each pixel. In the experiments, an adaptive U-net model is used to segment the sure and unsure regions, and the Local Convolutional Neural Network (CNN) model with multiple inputs is used to classify each pixel only in the unsure region. Our method was evaluated with a real image database, Internet Brain Segmentation Repository database, with 18 persons (IBSR 18) (https://www.nitrc.org/projects/ibsr) and compared with state of art methods being the results very promising.

Increasing evidence supports a role for local fat depots in cancer outcomes. Despite the robust positive association of obesity with renal cell carcinoma (RCCa) diagnosis, increased adiposity is inversely related to RCCa oncological outcomes. Here, we sought to ascertain whether imagiologically assessed local fat depots associate with RCCa progression and survival and account for this apparent paradox. A retrospective cohort of renal carcinoma patients elective for nephrectomy (n = 137) were included. Beyond baseline clinicopathological characteristics, computed tomography (CT)-scans at the level of renal hilum evaluated areas and densities of different adipose tissue depots (perirenal, subcutaneous, visceral) and skeletal muscle (erector spinae, psoas and quadratus lumborum muscles) were analyzed. Univariate and multivariable Cox proportional hazards models were estimated following empirical analysis using stepwise Cox regression. Age, visceral adipose tissue (VAT) area and body mass index (BMI) predicted tumour-sided perirenal fat area (R2 = 0.584), which presented upregulated UCP1 expression by 27-fold (P = 0.026) and smaller adipocyte areas, compared with subcutaneous depot. Multivariate analyses revealed that increased area of perirenal adipose tissue (PRAT) on the contralateral and tumour side associate with improved progression-free survival (HR = 0.3, 95CI = 0.1–0.8, P = 0.019) and overall survival (HR = 0.3, 95CI = 0.1–0.7, P = 0.009). PRAT measurements using CT, might become a possible tool, well correlated with other measures of obesity such as VAT and BMI, that will improve determination of obesity and contribute to assess the risk for disease progression and mortality in renal cancer patients. Present data supports the obesity paradox in RCCa, assumed that larger PRAT areas seem to protect from disease progression and death.

Introduction: Bariatric surgery is considered the most effective obesity treatment. Obese patients have a high prevalence of eating disorders. Objectives: Evaluate the occurrence of eating disorders and eating patterns in candidates for bariatric surgery and associate eating disorders with sociodemographic and clinical characteristics. Methods: A retrospective study was conducted using electronic charts of candidates for bariatric surgery. Data were collected on sex, age, marital status, schooling, occupation, non-communicable diseases, body mass index (BMI), eating disorders, and eating patterns. Results: Among the 281 patients evaluated, eating disorders were detected in 26.7%; 10.3% had binge eating disorder, 6.6% had bulimia nervosa, and 5.3% had the night-eating syndrome. The specific eating patterns were overeating (46.6%), binge eating during periods of stress (9.3%), eating sweets (4%), and snaking (1.3%). BMI ranged from 35.38 to 59.03 kg/m² (mean: 44.37 ± 5.89). All individuals (100%) had systemic arterial hypertension, and 23.3% had type 2 diabetes mellitus or dyslipidemia. Conclusions: The frequency of eating disorders was low in the sample studied, the most common of which was binge eating disorder. Non-communicable diseases were associated with eating disorders. Among the eating patterns observed, the most frequent was overeating.

Parkinson’s disease (PD) is the most common form of Parkinsonism, which is a group of neurological disorders with PD-like motor impairments. The disease affects over 6 million people worldwide and is characterized by motor and non-motor symptoms. The affected person has trouble in controlling movements, which may affect simple daily-life tasks, such as typing on a computer. We propose the application of a modified SqueezeNet convolutional neural network (CNN) for detecting PD based on the subject’s key-typing patterns. First, the data are pre-processed using data standardization and the Synthetic Minority Oversampling Technique (SMOTE), and then a Continuous Wavelet Transformation is applied to generate spectrograms used for training and testing a modified SqueezeNet model. The modified SqueezeNet model achieved an accuracy of 90%, representing a noticeable improvement in comparison to other approaches.

Exercise in a hot and humid environment may endanger athlete’s health and affect physical performance. This systematic review aimed to examine whether internal administration of ice, cold beverages or menthol solutions may be beneficial for physical performance when exercising in different environmental conditions and sports backgrounds. A systematic search was performed in PubMed, Web of Science, Scopus and SPORTDiscus databases, from inception to April 2022, to identify studies meeting the following inclusion criteria: healthy male and female physically active individuals or athletes (aged ≥18 years); an intervention consisting in the internal administration (i.e., ingestion or mouth rinse) of ice slush, ice slurry or crushed ice and/or cold beverages and/or menthol solutions before and/or during exercise; a randomized crossover design with a control or placebo condition; the report of at least one physical performance outcome; and to be written in English. Our search retrieved 2,714 articles in total; after selection, 43 studies were considered, including 472 participants, 408 men and 64 women, aged 18-42 years, with a VO2max ranging from 46.2 to 67.2 mL⋅kg–1⋅min–1. Average ambient temperature and relative humidity during the exercise tasks were 32.4 ± 3.5°C (ranging from 22°C to 38°C) and 50.8 ± 13.4% (varying from 20.0% to 80.0%), respectively. Across the 43 studies, 7 exclusively included a menthol solution mouth rinse, 30 exclusively involved ice slurry/ice slush/crushed ice/cold beverages intake, and 6 examined both the effect of thermal and non-thermal internal techniques in the same protocol. Rinsing a menthol solution (0.01%) improved physical performance during continuous endurance exercise in the heat. Conversely, the ingestion of ice or cold beverages did not seem to consistently increase performance, being more likely to improve performance in continuous endurance trials, especially when consumed during exercises. Co-administration of menthol with or within ice beverages seems to exert a synergistic effect by improving physical performance. Even in environmental conditions that are not extreme, internal cooling strategies may have an ergogenic effect. Further studies exploring both intermittent and outdoor exercise protocols, involving elite male and female athletes and performed under not extreme environmental conditions are warranted.Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268197], identifier [CRD42021268197].

In ultrasound tomography, cross-sectional images represent the spatial distribution of the physical parameters of a target of interest, which can be obtained based on scattered ultrasound measurements. These measurements can be obtained from dense datasets collected at different transmitter and receiver locations, and using multiple frequencies. The Born approximation method, which provides a simple linear relationship between the objective function and the scattering field, has been adopted to resolve the inverse scattering problem. The distorted Born iterative method (DBIM), which utilizes the first-order Born approximation, is a productive diffraction tomography scheme. In this article, the range of interpolation applications is extended at the multilayer level, taking into account the advantages of integrating this multilayer level with multiple frequencies for the DBIM. Specifically, we consider: (a) a multi-resolution technique, i.e., a multi-step interpolation for the DBIM: MR-DBIM, with the advantage that the normalized absolute error is reduced by 18.67% and 37.21% in comparison with one-step interpolation DBIM and typical DBIM, respectively; (b) the integration of multi-resolution and multi-frequency techniques with the DBIM: MR-MF-DBIM, which is applied to image targets with high sound contrast in a strongly scattering medium. Relative to MR-DBIM, this integration offers a 44.01% reduction in the normalized absolute error.

As contínuas alterações demográficas colocam-nos perante uma população cada vez mais envelhecida e com necessidades crescentes de cuidados alimentares, tanto numa ótica de cuidados de saúde, como de fornecimento de refeições, necessidade frequentemente suprida por serviços de alimentação coletiva. A qualidade nutricional e alimentar da oferta assume-se como um determinante major na saúde e satisfação dos idosos, sendo o plano de ementas uma das mais importantes ferramentas de gestão na área. Para que seja promovida uma oferta alimentar adequada, é essencial a existência de orientações que a balizem e que sejam alvo de atualização e melhoria contínua. A envolvência de nutricionistas no processo possibilita a revisão por pares e uma maior adaptação à realidade, permitindo obter ferramentas que auxiliem na tomada de decisão e na sustentação do trabalho desenvolvido. O presente estudo tem como objetivo explorar a perceção e os contributos de nutricionistas sobre o documento “Proposta de Ferramenta de Avaliação Qualitativa de Ementas destinadas a Idosos”, visando uma proposta de atualização. Foi adotada uma metodologia qualitativa através da realização de grupos focais a partir de uma amostra por conveniência, constituída por 38 nutricionistas. Os resultados sugerem que, apesar de ser considerada útil, a ferramenta carece de atualização para uma maior adaptação à faixa etária e à realidade prática. Da análise de critérios específicos, os participantes identificam vários de difícil cumprimento (ex. oferta equitativa de métodos de confeção, não repetição de fruta, oferta de oleaginosas, refeições de ovo e de massa ou arroz integral), partilhando os motivos para tal. Sugerem ainda a necessidade de inclusão de critérios para alimentação de textura modificada e refletem acerca de possíveis melhorias na própria dinâmica de aplicação da ferramenta. Em suma, a discussão promovida deixa importantes contributos para uma possível atualização da ferramenta, numa ótica de maior ajuste à faixa etária e de inclusão de critérios sobre tópicos emergentes. Continuous demographic changes confront us with an increasingly elderly population with growing needs for nutritional care, both from a health care perspective and from meals’ provision, which is often supplied by food services. The nutritional and food quality is a major determinant of the seniors’ health and satisfaction, and the menu is one of the most important management tools. To promote an adequate food offer, it is essential to have guidelines, that must be updated and continuously improved. The involvement of nutritionists in this process enables peer review and greater adaptation to reality, allowing to obtain tools that help in the decision-making process and sustain the developed work. This work aims to explore the perceptions and contributions of nutritionists on the document “Proposta de Ferramenta de Avaliação Qualitativa de Ementas destinadas a Idosos”, with a view to an update proposal. A qualitative methodology was adopted by conducting focus groups with a convenience sample of 38 nutritionists. Results suggest that, although the tool is considered useful, it needs to be updated to better adapt to the targeted age group and to the practical context. From the analysis of specific criteria, participants identify difficulties to comply with some of them (e.g. equitable offering of cooking methods, non-repetition of fruit, offering of oilseeds, egg based meals and whole wheat pasta or wholegrain rice), sharing the reasons why. They also suggest the need to include criteria for texture modified foods and they reflect on possible improvements in the tool application. In conclusion, the discussion promoted breeds important contributions for a possible update of the tool, in a perspective of greater adjustment to the age group it is destined to and inclusion of criteria on emerging topics. info:eu-repo/semantics/publishedVersion

Introdução: No âmbito da conclusão do Mestrado Integrado em Medicina debrucei-me sobre o legado de Francisco Carneiro Chaves (1936-2009), um prestigiado Professor Universitário, Médico e Investigador destacando-se em Luanda e Portugal. Material e Métodos: Consultei a informação integrada nos inúmeros documentos e diplomas facultados pela esposa, complementando com entrevistas realizadas a personalidades ligadas ao seu percurso profissional. Resultados: Licenciou-se na Faculdade de Medicina da Universidade de Lisboa em 1961, diferenciou-se na área da Gastroenterologia em 1965, finalizando a sua graduação em medicina interna em 1969. Destacou-se como Docente e Diretor do Serviço de Medicina II no Hospital Universitário de Luanda. No regresso a Portugal, integra o corpo docente da Faculdade de Medicina do Porto, dedicando-se à regência de disciplinas da área da medicina e chefia do Serviço de Medicina II. Desempenhou cargos de excelência como Presidente do Conselho Regional de Luanda da Ordem dos Médicos, Presidente do Núcleo de Hepatologia, Presidente da Sociedade Portuguesa de Gastroenterologia, Presidente da Comissão de Ética da Sociedade Portuguesa de Gastroenterologia, Governador para Portugal do American College of Gastroenterology, destacando-se como Presidente do Colégio de Especialidade de Gastroenterologia. Discussão: Percurso profissional marcado pelo ensino, investigação e prática clínica. Referência na sua área de especialização, descreveu um interesse particular pela hepatologia, contribuindo para a sua subespecialidade. O ensino pré e pós-graduado, a organização e o exercício da medicina interna motivaram a sua reflexão e intervenção. Conclusão: Reconhecida capacidade técnica, de organização e de chefia. Demonstrou um empenho ímpar, distinguindo-se dos demais pelo notável profissionalismo e ética profissional. Introduction: As part of the conclusion of the Integrated Master in Medicine, I focused on the legacy of Francisco Carneiro Chaves (1936-2009), a prestigious University Professor, Doctor and Researcher that stood out in Luanda and Portugal. Material and Methods: The wife of Francisco Carneiro Chaves provided numerous documents and diplomas. The information from these documents was complemented with interviews with personalities linked to his professional path. Results: He graduated from the Faculty of Medicine of the University of Lisbon in 1961, distinguished himself in the field of Gastroenterology in 1965, finishing his degree in internal medicine in 1969. He distinguished himself as Professor and Director of the Department of Medicine II at the University of Luanda. When returning to Portugal, he joinedof the Faculty of Medicine of Oporto, as a Professor, dedicating himself to teaching disciplines in the area of medicine and heading the Department of Medicine II. He has held positions of excellence as President of the Medical Association of the Luanda's Regional Council, President of the Hepatology Nucleus, President of the Portuguese Society of Gastroenterology, President of the Ethics Committee of the Portuguese Society of Gastroenterology, Governor for Portugal of the American College of Gastroenterology, highlighting himself as President of the Specialty College of Gastroenterology. Discussion: Professional path marked by teaching, research and clinical practice. A reference in his area of specialization, he showed a particular interest in hepatology, contributing to his subspecialty. The pre and post-graduate education, the organization and practice of internal medicine motivated his reflection and intervention. Conclusion: Recognized technical, organizational and leadership skills. He demonstrated an unparalleled commitment, distinguishing himself from the others for his remarkable professionalism and professional ethics.

As estatinas são uma das principais ferramentas farmacológicas em prevenção de doenã cardiovascular. No entanto, a adesão à terapêutica é baixa, limitando a sua efectividade. A não adesão às estatinas é um importante e modificável fator de risco cardiovascular. Esta revisão tem como objetivo identificar todos os fatores relacionados com o paciente na adesão às estatinas. Métodos: Pesquisamos as bases de dados PubMed e Scopus com a seguinte query ("statins" OR "Hydroxymethylglutaryl-CoA Reductase Inhibitors") AND ("medication adherence" OR "compliance" OR "persistence" OR "discontinuation"), e sistematicamente revimos todos os artigos originais que mediram adesão às estatinas e seus determinantes na dimensão do paciente. Resultados: Dos 3388 registos identificados, 50 foram incluídos para síntese qualitativa. Incluídos nos fatores do paciente foram as suas características psicométricas, crenças, atitudes, expectativas, comportamentos e experiências. Das características psicométricas, conscienciosidade, abilidade cognitiva, auto-eficácia, auto-regulação, aversão ao risco, e um locus de controlo em outros poderosos, aumentaram a adesão. A crença no papel da dislipidemia como causa de doença cardiovascular, a perceção de risco cardiovascular, a crença na necessidade, efectividade, e segurança das estatinas, bem como a expectativa de seu uso a longo prazo, aumentaram a adesão. Quando a toma estava associada com uma rotina diária, os pacientes perderam menos doses. A adesão prévia a estatinas ou outros medicamentos são fortes determinantes da adesão à atual medicação. Pacientes com alta adesão participam em mais programas de prevenção secundária e têm menos acidentes. Pacientes que usam a internet para pesquisar informação relativa a estatinas, são menos aderentes. Sentimentos de incerteza ou confusão relativamente à informação sobre estatinas aumentam a não-adesão. Pacientes que confiam no seu médico, e sentem que este tem informação adequada para responder às suas questões, são mais aderentes. Conclusão: Identificamos vários fatores da dimensão do paciente com impacto na adesão às estatinas. Estes são comuns e modificáveis. Este trabalho apoia o clínico na identificação do paciente não-aderente. Serve também como guia para compreender e melhorar a não-adesão. Purpose : Statins are one of the main tools in cardiovascular disease prevention, yet, long-term adherence is low, severely limiting its effectiveness. Non-adherence to statins is a crucial modifiable cardiovascular risk factor. This review aims to identify all patient factors in adherence to statins. Patients and Methods : We searched PubMed and Scopus databases using the query ("statins" OR "Hydroxymethylglutaryl-CoA Reductase Inhibitors") AND ("medication adherence" OR "compliance" OR "persistence" OR "discontinuation"), and systematically reviewed all original studies which measured adherence to statins and its determinants in the patient dimension. Results : Of the 3388 reports identified, 50 were included for qualitative synthesis. Included as patient-related factors were psychometric traits, health beliefs, attitudes, expectations, behaviors, and experiences of the patient. Of the psychometric characteristics, conscientiousness, cognitive ability, self-efficacy, autonomous self-regulation, risk aversion, and a locus of control in powerful others, all increase adherence. A belief in the causal role of dyslipidemia in cardiovascular disease, the perception of cardiovascular risk, and a belief in statin's necessity, effectiveness, and safety, as well as the expectation of its long-term use, increased adherence. When intake was associated with a daily routine, patients missed fewer doses. Previous adherence to statins and other medications are strong predictors of adherence to current medication. Adherent patients participate more in preventative medicine and have fewer accidents. Patients who use the internet to research statins are less adherent. Feeling uncertain or confused by the information on statins, either from the media or their physician, increased discontinuation rates. Those who trusted their physician and felt they had adequate knowledge to answer their questions, were more adherent. Conclusion : We have identified several patient factors in non-adherence to statins which are both prevalent and modifiable. This work helps the clinician identify and understand the non-adherent patient, as well as provide guidance for its improvement.