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Recchi AF, Azambuja RSD, Alves LS, Maltz M, Jardim JJ. Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial. J Dent 2024:105099. [PMID: 38797489 DOI: 10.1016/j.jdent.2024.105099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. METHODS Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50% of the dentin thickness). Teeth were submitted to SCRSD (n=76) or SW (n=76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). RESULTS The follow-up period ranged from 6 to 18 months (mean±SD 16.3±3.4 months). Patients' ages ranged from 9 to 55 years (mean±SD 29±10.5 years). A total of 135 teeth (SCRSD=72; SW=63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4%) and SCRSD (97.9%) (p=0.16). Patients presenting gingivitis (≥20% of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20% of bleeding sites (p=0.03). CONCLUSION This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. CLINICAL SIGNIFICANCE SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.
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Affiliation(s)
- Andrea Fontoura Recchi
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Schultz de Azambuja
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luana Severo Alves
- Department of Restorative Dentistry, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil.
| | - Marisa Maltz
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Juliana Jobim Jardim
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Araújo YB, Teixeira JDS, Oliveira ECD, Sobral GS, Meneguz-Moreno RA, Amaral RG, Santos SL, Andrade LN. Factors associated with adherence to pharmacological treatment in hypertensive patients enrolled in the HIPERDIA program. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i2.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To assess adherence to antihypertensive treatment in patients at a Family Health Strategy (FHS) unit. Methods: quantitative, transversal, and observational study with 131 hypertensive patients registered in the HIPERDIA program of an FHS located in the city of Lagarto, Sergipe, Brazil, through the analysis of medical records and the application of structured questionnaires. The assessment of the degree of adherence was carried out through the Brief Medication Questionnaire. Results: Factors related to poor adherence were illiteracy (PR: 0.61; 95%CI: 0.42 - 0.89), per capita family income < 1 minimum wage (PR: 0.51; 95%CI : 0.33 - 0.78) and high pharmacological complexity (PR: 0.66; 95%CI: 0.45 - 0.97), while only regular physical activity (PR: 2.64; 95%CI: 1.28 - 5.46) and a good quality of life (PR: 1.44; 95%CI: 1.02 - 2.04) remained positively associated with adherence. Conclusion: As these are modifiable factors, the simplification of the therapeutic scheme and the regular practice of physical activity are key points for increasing adherence to the treatment of systemic arterial hypertension in Primary Care.
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Siemer L, Brusse-Keizer MGJ, Postel MG, Ben Allouch S, Sanderman R, Pieterse ME. Adherence to Blended or Face-to-Face Smoking Cessation Treatment and Predictors of Adherence: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17207. [PMID: 32459643 PMCID: PMC7413278 DOI: 10.2196/17207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 12/28/2022] Open
Abstract
Background Blended face-to-face and web-based treatment is a promising way to deliver smoking cessation treatment. Since adherence has been shown to be an indicator of treatment acceptability and a determinant for effectiveness, we explored and compared adherence and predictors of adherence to blended and face-to-face alone smoking cessation treatments with similar content and intensity. Objective The objectives of this study were (1) to compare adherence to a blended smoking cessation treatment with adherence to a face-to-face treatment; (2) to compare adherence within the blended treatment to its face-to-face mode and web mode; and (3) to determine baseline predictors of adherence to both treatments as well as (4) the predictors to both modes of the blended treatment. Methods We calculated the total duration of treatment exposure for patients (N=292) of a Dutch outpatient smoking cessation clinic who were randomly assigned either to the blended smoking cessation treatment (n=130) or to a face-to-face treatment with identical components (n=162). For both treatments (blended and face-to-face) and for the two modes of delivery within the blended treatment (face-to-face vs web mode), adherence levels (ie, treatment time) were compared and the predictors of adherence were identified within 33 demographic, smoking-related, and health-related patient characteristics. Results We found no significant difference in adherence between the blended and the face-to-face treatments. Participants in the blended treatment group spent an average of 246 minutes in treatment (median 106.7% of intended treatment time, IQR 150%-355%) and participants in the face-to-face group spent 238 minutes (median 103.3% of intended treatment time, IQR 150%-330%). Within the blended group, adherence to the face-to-face mode was twice as high as that to the web mode. Participants in the blended group spent an average of 198 minutes (SD 120) in face-to-face mode (152% of the intended treatment time) and 75 minutes (SD 53) in web mode (75% of the intended treatment time). Higher age was the only characteristic consistently found to uniquely predict higher adherence in both the blended and face-to-face groups. For the face-to-face group, more social support for smoking cessation was also predictive of higher adherence. The variability in adherence explained by these predictors was rather low (blended R2=0.049; face-to-face R2=0.076). Within the blended group, living without children predicted higher adherence to the face-to-face mode (R2=0.034), independent of age. Higher adherence to the web mode of the blended treatment was predicted by a combination of an extrinsic motivation to quit, a less negative attitude toward quitting, and less health complaints (R2=0.164). Conclusions This study represents one of the first attempts to thoroughly compare adherence and predictors of adherence of a blended smoking cessation treatment to an equivalent face-to-face treatment. Interestingly, although the overall adherence to both treatments appeared to be high, adherence within the blended treatment was much higher for the face-to-face mode than for the web mode. This supports the idea that in blended treatment, one mode of delivery can compensate for the weaknesses of the other. Higher age was found to be a common predictor of adherence to the treatments. The low variance in adherence predicted by the characteristics examined in this study suggests that other variables such as provider-related health system factors and time-varying patient characteristics should be explored in future research. Trial Registration Netherlands Trial Register NTR5113; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113
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Affiliation(s)
- Lutz Siemer
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, Netherlands.,Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | | | - Marloes G Postel
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Tactus Addiction Treatment, Enschede, Netherlands
| | - Somaya Ben Allouch
- Digital Life Research Group, Amsterdam University of Applied Science, Amsterdam, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Department of Health Psychology, University Medical Center Groningen, Groningen, Netherlands
| | - Marcel E Pieterse
- Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
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Lee RRS, Samsudin MI, Thirumoorthy T, Low LL, Kwan YH. Factors affecting follow-up non-attendance in patients with Type 2 diabetes mellitus and hypertension: a systematic review. Singapore Med J 2019; 60:216-223. [PMID: 31187148 PMCID: PMC6535449 DOI: 10.11622/smedj.2019042] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This is a systematic review of the factors and reasons associated with follow-up non-attendance (FUNA) in patients with Type 2 diabetes mellitus and hypertension in an outpatient setting. We performed a systematic literature search using electronic databases and related keywords with the PRISMA-P checklist, focusing on the factors, types of studies and number of studies that showed a positive, negative or neutral association with FUNA. Data was presented in three categories: patient, disease and medication, and healthcare provider factors. In total, 4,822 articles were reviewed. Among the 24 articles that were relevant to the stated objective, 83 factors were found to be associated with FUNA. A target-board model for FUNA was presented for clinicians to better understand the various aspects contributing to and implications involved in FUNA. Greater awareness and understanding of the multifactorial nature of FUNA and taking a multifaceted approach are important to effectively reduce this problem.
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Affiliation(s)
| | | | | | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
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5
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Siemer L, Brusse-Keizer MG, Postel MG, Ben Allouch S, Patrinopoulos Bougioukas A, Sanderman R, Pieterse ME. Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence. J Med Internet Res 2018; 20:e246. [PMID: 30068503 PMCID: PMC6094087 DOI: 10.2196/jmir.9969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/08/2018] [Indexed: 12/15/2022] Open
Abstract
Background Blended face-to-face and Web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, in this study, we explored adherence to a new blended smoking cessation treatment (BSCT). Objective The objective of our study was to (1) develop an adequate method to measure adherence to BSCT; (2) define an adequate degree of adherence to be used as a threshold for being adherent; (3) estimate adherence to BSCT; and (4) explore the possible predictors of adherence to BSCT. Methods The data of patients (N=75) were analyzed to trace adherence to BSCT delivered at an outpatient smoking cessation clinic. In total, 18 patient activities (eg, using a Web-based smoking diary tool or responding to counselors’ messages) were selected to measure adherence; the degree of adherence per patient was compared with quitting success. The minimum degree of adherence of patients who reported abstinence was examined to define a threshold for the detection of adherent patients. The number of adherent patients was calculated for each of the 18 selected activities; the degree of adherence over the course of the treatment was displayed; and the number of patients who were adherent was analyzed. The relationship between adherence and 33 person-, smoking-, and health-related characteristics was examined. Results The method for measuring adherence was found to be adequate as adherence to BSCT correlated with self-reported abstinence (P=.03). Patients reporting abstinence adhered to at least 61% of BSCT. Adherence declined over the course of the treatment; the percentage of adherent patients per treatment activity ranged from 82% at the start of the treatment to 11%-19% at the final-third of BSCT; applying a 61% threshold, 18% of the patients were classified as adherent. Marital status and social modeling were the best independent predictors of adherence. Patients having a partner had 11-times higher odds of being adherent (OR [odds ratio]=11.3; CI: 1.33-98.99; P=.03). For social modeling, graded from 0 (=partner and friends are not smoking) to 8 (=both partner and nearly all friends are smoking), each unit increase was associated with 28% lower odds of being adherent (OR=0.72; CI: 0.55-0.94; P=.02). Conclusions The current study is the first to explore adherence to a blended face-to-face and Web-based treatment (BSCT) based on a substantial group of patients. It revealed a rather low adherence rate to BSCT. The method for measuring adherence to BSCT could be considered adequate because the expected dose-response relationship between adherence and quitting could be verified. Furthermore, this study revealed that marital status and social modeling were independent predictors of adherence. Trial Registration Netherlands Trial Registry NTR5113; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113 (Archived by WebCite at http://www.webcitation.org/71BAPwER8).
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Affiliation(s)
- Lutz Siemer
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands.,Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands.,Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands.,Tactus Addiction Treatment, Enschede, Netherlands
| | | | - Marloes G Postel
- Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands.,Tactus Addiction Treatment, Enschede, Netherlands
| | - Somaya Ben Allouch
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
| | | | - Robbert Sanderman
- Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marcel E Pieterse
- Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
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6
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Maltz M, Koppe B, Jardim JJ, Alves LS, de Paula LM, Yamaguti PM, Almeida JCF, Moura MS, Mestrinho HD. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clin Oral Investig 2017; 22:1337-1343. [DOI: 10.1007/s00784-017-2221-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
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7
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Sung SF, Lai ECC, Wu DP, Hsieh CY. Previously undiagnosed risk factors and medication nonadherence are prevalent in young adults with first-ever stroke. Pharmacoepidemiol Drug Saf 2017; 26:1458-1464. [PMID: 28691203 DOI: 10.1002/pds.4250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/13/2017] [Accepted: 06/05/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The incidence of stroke and prevalence of traditional vascular risk factors (VRFs) in young adults (age < 55 y) are both increasing. Young patients tend to be unaware of their VRFs and to have lower medication adherence. We examined how age affects the prevalence of previously undiagnosed VRFs and the extent of medication nonadherence among stroke patients. METHODS Using Taiwan's National Health Insurance Research Database, we identified consecutive adult patients with first-ever stroke between 2000 and 2013. Diagnosis of hypertension, diabetes, and hyperlipidemia was ascertained using validated methods. We investigated (1) the proportion of patients who had undiagnosed VRFs within 3 years before stroke and (2) the proportion of nonadherence to medications among patients who had a previously diagnosed VRF. RESULTS Among stroke patients with hypertension (n = 9722), diabetes (n = 4751), and hyperlipidemia (n = 4486), 24.9%, 20.8%, and 55.0%, respectively, had not been diagnosed before stroke, whereas 56.0%, 66.7%, and 32.5%, respectively, had been diagnosed at least 1 year before stroke. The proportions of medication nonadherence were 71.5%, 64.3%, and 88.4% in patients with previously diagnosed hypertension, diabetes, and hyperlipidemia, respectively. In multivariate analysis, younger age was independently associated with undiagnosed hypertension before stroke as well as medication nonadherence in patients with previously diagnosed hypertension or diabetes. CONCLUSIONS Previously undiagnosed hypertension and nonadherence to treatment of hypertension and diabetes were more prevalent in young adult patients with first-ever stroke in Taiwan. Interventions targeting young people to promote early detection and adequate control of VRFs should be encouraged.
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Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Darren Philbert Wu
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
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Teixeira JDF, Goulart MR, Busnello FM, Pellanda LC. Hypertensives' Knowledge About High-Sodium Foods and Their Behavior. Arq Bras Cardiol 2016; 106:404-10. [PMID: 27096524 PMCID: PMC4914005 DOI: 10.5935/abc.20160049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/11/2016] [Indexed: 11/20/2022] Open
Abstract
Background In Brazil, the prevalence of systemic arterial hypertension (SAH) is
approximately 30% of the total population. In 2010, SAH was the cause of
death of about 9.4 million people worldwide. A healthy dietary pattern is
important to maintain proper blood pressure levels and, consequently,
disease control. Objectives To describe the knowledge and practices of hypertensive patients cared for at
a public hypertension outpatient clinic, and its relationship with
high-sodium food. Methods We applied a questionnaire to patients with questions related to
sociodemographics, dietary pattern, frequency of ingestion of certain foods,
and knowledge about their own disease. Results We studied 221 patients, 56.1% of whom were women, and 53.8% had only
elementary education. Their mean age was 57.7 ±13.5 years, and 75.6%
of them reported having high blood pressure, and 11.3%, diabetes mellitus.
Regarding dietary pattern, 62% used ready-to-use seasonings, but 94.1%
reported not adding extra salt to their ready meals. Regarding patients'
knowledge about high-sodium foods and SAH, only 8 patients had 100% of right
answers, 37 patients had 73.8%, and 42 patients, 57% of right answers. Conclusion Knowledge about SAH prevention and high-sodium foods was insufficient. Based
on this study's findings, more effective educational strategies targeted at
this population can be developed.
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Affiliation(s)
| | - Maíra Ribas Goulart
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Jiang XJ, Liu ZL, She Q, Ying YH, Huang J, Deng SB, Zhou LY, Ye SQ, Hu R. Blood pressure control rate and associated risk factors in hospitals of different grades in Chongqing, China. Int J Cardiol 2014; 176:800-4. [PMID: 25150470 DOI: 10.1016/j.ijcard.2014.07.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/27/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present article aimed to provide accurate estimate of the control rate of hypertension and the influencing factors in hospitals of different grades in Chongqing. METHODS In this survey, hypertensive outpatients were recruited from 5 tertiary hospitals, 6 secondary hospitals and 5 primary hospitals in 9 districts of Chongqing from November 2011 to May 2012. Outpatients were investigated by clinical interview with BP measurement and questionnaire. Univariate analyses and logistic regression analysis was used to assess the effect of variables on control of hypertension. RESULT A total of 2742 hypertensives were studied, of which 820 were from primary hospitals, 901 from secondary hospitals and 1021 from tertiary hospitals. The total control rate for hypertensive outpatients in Chongqing was 46.0%. The control rate of the primary,secondary and tertiary hospitals were 38.7%、46.7%、51.1%. Multinomial Logistic Regression showed that the control rate was positively correlated with mastery of knowledge of hypertension, normal BMI;whereas it was positively correlated with peasantry,the dissatisfactory with doctor's manner and the distrust to doctor. CONCLUSION Blood pressure control rate of hypertensive outpatients in Chongqing was low.High BMI, peasantry, lack of knowledge of hypertension, doctors' manners, distrust to doctor were the key reasons for low BP control rate.
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Affiliation(s)
- Xiu-Juan Jiang
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhan-Lan Liu
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; The Central Hospital of Xiaogan, China
| | - Qiang She
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue-Hui Ying
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Song-Bai Deng
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Yuan Zhou
- Division of Cardiology, People's Hospital of Santai Country, Sichuan, Province, China
| | - Shi-Quan Ye
- Division of Cardiology, People's Hospital of Santai Country, Sichuan, Province, China
| | - Rong Hu
- Division of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Raymundo ACN, Pierin AMG. Adherence to anti-hypertensive treatment within a chronic disease management
program: A longitudinal, retrospective study. Rev Esc Enferm USP 2014; 48:811-9. [DOI: 10.1590/s0080-6234201400005000006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/28/2014] [Indexed: 11/21/2022] Open
Abstract
Objective This study assessed pharmacological treatment adherence using the Morisky-Green Test and identified related variables. Method A longitudinal and retrospective study examined 283 patients with hypertension (62.5% women, 73.4 [10.9] years old) who were being monitored by a chronic disease management program for 17 months between 2011 and 2012. Nurses performed all the actions of the program, which consisted of advice via telephone and periodic home visits based on the risk stratification of the patients. Results A significant increase in treatment adherence (25.1% vs. 85.5%) and a decrease in blood pressure were observed (p<0.05). Patients with hypertension and chronic renal failure as well as those treated using angiotensin-converting enzyme inhibitors were the most adherent (p<0.05). Patients with hypertension who received angiotensin receptor blockers were less adherent (p<0.05). Conclusions Strategies such as nurse-performed chronic disease management can increase adherence to anti-hypertensive treatment and therefore contribute to the control of blood pressure, minimizing the morbidity profiles of patients with hypertension.
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Pinho NDA, Pierin AMG. Hypertension control in brazilian publications. Arq Bras Cardiol 2013; 101:e65-73. [PMID: 24061761 PMCID: PMC4032316 DOI: 10.5935/abc.20130173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/30/2013] [Accepted: 04/30/2013] [Indexed: 11/20/2022] Open
Abstract
Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used.
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12
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Daniel ACQG, Veiga EV. Factors that interfere the medication compliance in hypertensive patients. EINSTEIN-SAO PAULO 2013; 11:331-7. [PMID: 24136760 PMCID: PMC4878592 DOI: 10.1590/s1679-45082013000300012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 02/05/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize the factors that interfere in drug treatment compliance in a group of individuals with arterial hypertension. METHODS A non-experimental descriptive study that analyzed a sample of 80 patients diagnosed with arterial hypertension, who underwent medical treatment and were admitted to a university hospital during the period from March to May 2009. To collect data, the Instrument for Evaluation of Attitudes Regarding Taking Medication was applied. RESULTS In the studied population, 45.1% had sufficient degree of compliance to drug therapy. Individuals with controlled blood pressure, females, white, single, married or widowed, retired, aged between 40 and 59 years, and those aged above 80 years were the interviewees who answered positively regarding compliance and follow-up of drug therapy. CONCLUSION Despite the fact that the number of factors that facilitate the process of compliance to drug treatment is greater than the number of complicating factors, we found that more than half of the patients surveyed had an insufficient degree of compliance with drug treatment for high blood pressure, which demonstrates the need to develop studies aimed to identify these factors and their contribution to the promotion of patient autonomy, acceptance, awareness and adaptation regarding their illness.
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13
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Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, de Paula LM. Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res 2012. [PMID: 23207420 DOI: 10.1159/000344013] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. METHODS INCLUSION CRITERIA patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. OUTCOMES success was defined as pulp sensitivity to cold test and absence of periapical alterations. RESULTS Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR - 1 pulpitis; SW - 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. CONCLUSION The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.
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Affiliation(s)
- M Maltz
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Maltz M, Garcia R, Jardim J, de Paula L, Yamaguti P, Moura M, Garcia F, Nascimento C, Oliveira A, Mestrinho H. Randomized Trial of Partial vs. Stepwise Caries Removal. J Dent Res 2012; 91:1026-31. [DOI: 10.1177/0022034512460403] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions — partial caries removal (PCR) and stepwise excavation (SW) — with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).
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Affiliation(s)
- M. Maltz
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - R. Garcia
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - J.J. Jardim
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - M.S. Moura
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - F. Garcia
- Brasilia University, Brasilia, DF, Brazil
| | - C. Nascimento
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Santa-Helena ETD, Nemes MIB, Eluf Neto J. [Risk factors associated with non-adherence to anti-hypertensive medication among patients treated in family health care facilities]. CAD SAUDE PUBLICA 2011; 26:2389-98. [PMID: 21243233 DOI: 10.1590/s0102-311x2010001200017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 08/11/2010] [Indexed: 01/13/2023] Open
Abstract
In order to estimate the prevalence of treatment non-adherence and associated factors among individuals with systemic arterial hypertension treated at family health care facilities, a cross-sectional study was performed with 595 patients. The dependent variable non-adherence was measured with a Medication Adherence Questionnaire (MAQ). A hierarchical logistic regression model was used to analyze socioeconomic, health care-related, personal, and treatment-related variables. Prevalence of non-adherence was 53%. Variables associated with non-adherence were: (1) socioeconomic--belonging to economic classes C, D, or E; work market participation in unskilled labor; (2) health care--out-of-pocket payment for medication; more than six months since last physician consultation; and (3) personal and treatment characteristics--previous interruption of treatment; being on treatment for less than three years; and presence of a common mental disorder. The study of determinants of non-adherence articulated in a hierarchical model suggests that social inequalities are either directly associated with non-adherence or mediated by personal and health services factors.
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16
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Duarte MTC, Cyrino AP, Cerqueira ATDAR, Nemes MIB, Iyda M. [Reasons for medical follow-up dropout among patients with arterial hypertension: the patient's perspective]. CIENCIA & SAUDE COLETIVA 2010; 15:2603-10. [PMID: 20802892 DOI: 10.1590/s1413-81232010000500034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 10/30/2008] [Indexed: 11/22/2022] Open
Abstract
Arterial hypertension is a relevant public health problem as it is a risk factor for cardiovascular diseases, the major cause of mortality in Brazil. Low compliance and treatment dropout are among the main obstacles to individual control strategies. This study aimed at assessing the reasons for failure in medical appointment follow-up among a cohort of patients under treatment for four years in a primary care service. Thus, semi-structured interviews were conducted with 50 individuals who had dropped out of medical appointments. Statements were assessed by using thematic content analysis. The reported reasons for dropping out were most frequently related with the healthcare service itself - its organization and structure, and doctor-patient relationship - or treatment at another healthcare service. The reasons related with the patients themselves, such as absence of symptoms, improvement and/or normalization of arterial hypertension, as well as alcohol consumption contributed to the discontinuation of the treatment. To study the reasons for treatment dropout through the patients' eyes showed the abundance and diversity of problems involved.
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Affiliation(s)
- Marli Teresinha Cassamassimo Duarte
- Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. Distrito de Rubião Júnior s/n, Rubião Júnior.18618-970 Botucatu SP.
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17
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Bishop MD, Robinson ME, Light KE. Tobacco use and recovery of gait and balance function in older adults. Arch Phys Med Rehabil 2009; 90:1613-8. [PMID: 19735791 DOI: 10.1016/j.apmr.2009.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 02/26/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the influence of tobacco use status on outcome after an exercise program designed to improve gait and balance. DESIGN Review of clinical database. SETTING Standardized assessment clinic in a tertiary care setting. PARTICIPANTS Patients (N=136, 77.2+/-5.8 y, 3 women) who were attending a Gait and Balance Disorders clinic. INTERVENTIONS Individualized home exercise programs based on findings of an extensive gait and mobility examination. Patients were evaluated every 4 weeks for 12 weeks. MAIN OUTCOME MEASURES Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Medical Outcomes Study 36-item Short Form Health Survey Physical Functioning subscale (SF-36 PF). Differences were assessed preintervention, and separate hierarchical linear regression models were used to examine the unique contribution of tobacco use to changes in each of primary outcome measures. RESULTS Current tobacco users had higher frequencies of chronic obstructive pulmonary disease (P=.009) and depression (0.037). No differences were noted on preintervention measures of the primary outcomes based on tobacco use. Tobacco use explained a significant amount of additional variance in the postintervention score on each of the primary outcomes (BBS, 25.4%; DGI, 8.7%; SF-36 PF, 30.3%) after controlling for preintervention score, depression, and limb strength. Inspection of the adjusted means indicated that the group that had never used tobacco showed greater improvement than the current users for all variables after adjusting for factors used in the regression models. CONCLUSIONS Older adults who never used tobacco showed greater improvement than the current users for all variables after adjusting for factors used in the regression models. Current tobacco users perceived themselves to be more limited by their health after participation in the rehabilitation exercise program.
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Affiliation(s)
- Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
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18
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de Resende SMDFS, Velásquez-Meléndez G. Abdominal adiposity, age, education level and therapy associated with uncontrolled hypertension. J Hum Hypertens 2003; 17:365-6. [PMID: 12756411 DOI: 10.1038/sj.jhh.1001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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