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  1 / 6 MEDLINE  
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[PMID]:29267500
[Au] Autor:Vieira E; Maia HS; Monteiro CB; Carvalho LM; Tonon T; Vanz AP; Schwartz IVD; Ribeiro MG
[Ad] Endereço:Agência Nacional de Saúde Suplementar, Rio de Janeiro, RJ, Brasil.
[Ti] Título:Quality of life and adherence to treatment in early-treated Brazilian phenylketonuria pediatric patients.
[So] Source:Braz J Med Biol Res;51(2):e6709, 2017 Dec 11.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Early dietary treatment of phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, results in normal cognitive development. Although health-related quality of life (HRQoL) of PKU patients has been reported as unaffected in high-income countries, there are scarce data concerning HRQoL and adherence to treatment of PKU children and adolescents from Brazil. The present study compared HRQoL scores in core dimensions of Brazilian early-treated PKU pediatric patients with those of a reference population, and explored possible relationships between adherence to treatment and HRQoL. Early-treated PKU pediatric patient HRQoL was evaluated by self- and parent-proxy reports of the Pediatric Quality of Life Inventory (PedsQL) core scales. Adherence to treatment was evaluated by median Phe levels and percentage of results within the therapeutic target range in two periods. Means for total and core scales scores of PedsQL self- and parent proxy-reports of PKU patients were significantly lower than their respective means for controls. Adequacy of median Phe concentrations and the mean percentage of values in the target range fell substantially from the first year of life to the last year of this study. There was no significant difference in mean total and core scale scores for self- and parent proxy-reports between patients with adequate and those with inadequate median Phe concentrations. The harmful consequences for intellectual capacity caused by poor adherence to dietary treatment could explain the observed decrease in all HRQoL scales, especially in school functioning. Healthcare system and financial difficulties may also have influenced negatively all HRQoL dimensions.
[Mh] Termos MeSH primário: Fenilcetonúrias/dietoterapia
Qualidade de Vida
Cooperação e Adesão ao Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Fatores Etários
Análise de Variância
Brasil
Criança
Feminino
Seres Humanos
Testes de Inteligência
Modelos Lineares
Masculino
Pais
Fenilalanina/sangue
Fenilcetonúrias/psicologia
Procurador
Qualidade de Vida/psicologia
Prevenção Secundária
Autorrelato
Fatores Socioeconômicos
Fatores de Tempo
Cooperação e Adesão ao Tratamento/psicologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
47E5O17Y3R (Phenylalanine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


  2 / 6 MEDLINE  
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[PMID]:28470156
[Au] Autor:Joung J; Kim S
[Ad] Endereço:College of Nursing, Seoul National University, Seoul, Korea.
[Ti] Título:[Effects of a Relapse Prevention Program on Insight, Empowerment and Treatment Adherence in Patients with Schizophrenia].
[So] Source:J Korean Acad Nurs;47(2):188-198, 2017 Apr.
[Is] ISSN:2093-758X
[Cp] País de publicação:Korea (South)
[La] Idioma:kor
[Ab] Resumo:PURPOSE: The purpose of this study was to develop a relapse prevention program (RPP) and examine the effects of the RPP on insight, empowerment, and treatment adherence in patients with schizophrenia. METHODS: A non-equivalent control group pretest-posttest design was used. Participants were 54 inpatients who had a diagnosis of schizophrenia (experimental group: 26, control group: 28). The study was carried out from February 7, 2012 to February 6, 2013. Over a 10-day period prior to discharge each participant in the experimental group received three one-hour sessions of RPP a one-to-one patient-nurse interaction. Data were collected using Assess Unawareness of Mental Disorder (SUMD), Empowerment Scale, and Insight and Treatment Attitude Questionnaire (ITAQ) and analyzed using PASW 18.0 with chi-square test, independent t-test, Mann-Whitney U test, and ANCOVA. RESULTS: The experimental group had a significant increase in insight and treatment adherence compared to the control group. However, there was no significant difference in empowerment between the two groups. CONCLUSION: Findings indicate that the RPP for patients with schizophrenia was effective in improving insight and treatment adherence. A longitudinal study is needed to confirm the persistence of these effects of RPP in patients with schizophrenia.
[Mh] Termos MeSH primário: Poder (Psicologia)
Avaliação de Programas e Projetos de Saúde
Esquizofrenia/prevenção & controle
Cooperação e Adesão ao Tratamento
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Recidiva
Esquizofrenia/diagnóstico
Psicologia do Esquizofrênico
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.4040/jkan.2017.47.2.188


  3 / 6 MEDLINE  
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[PMID]:29321156
[Au] Autor:Wang T; Heianza Y; Sun D; Huang T; Ma W; Rimm EB; Manson JE; Hu FB; Willett WC; Qi L
[Ad] Endereço:Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
[Ti] Título:Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies.
[So] Source:BMJ;360:j5644, 2018 01 10.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate whether improving adherence to healthy dietary patterns interacts with the genetic predisposition to obesity in relation to long term changes in body mass index and body weight. DESIGN: Prospective cohort study. SETTING: Health professionals in the United States. PARTICIPANTS: 8828 women from the Nurses' Health Study and 5218 men from the Health Professionals Follow-up Study. EXPOSURE: Genetic predisposition score was calculated on the basis of 77 variants associated with body mass index. Dietary patterns were assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (AMED). MAIN OUTCOME MEASURES: Five repeated measurements of four year changes in body mass index and body weight over follow-up (1986 to 2006). RESULTS: During a 20 year follow-up, genetic association with change in body mass index was significantly attenuated with increasing adherence to the AHEI-2010 in the Nurses' Health Study (P=0.001 for interaction) and Health Professionals Follow-up Study (P=0.005 for interaction). In the combined cohorts, four year changes in body mass index per 10 risk allele increment were 0.07 (SE 0.02) among participants with decreased AHEI-2010 score and -0.01 (0.02) among those with increased AHEI-2010 score, corresponding to 0.16 (0.05) kg versus -0.02 (0.05) kg weight change every four years (P<0.001 for interaction). Viewed differently, changes in body mass index per 1 SD increment of AHEI-2010 score were -0.12 (0.01), -0.14 (0.01), and -0.18 (0.01) (weight change: -0.35 (0.03), -0.36 (0.04), and -0.50 (0.04) kg) among participants with low, intermediate, and high genetic risk, respectively. Similar interaction was also found for DASH but not for AMED. CONCLUSIONS: These data indicate that improving adherence to healthy dietary patterns could attenuate the genetic association with weight gain. Moreover, the beneficial effect of improved diet quality on weight management was particularly pronounced in people at high genetic risk for obesity.
[Mh] Termos MeSH primário: Dieta/métodos
Dieta Saudável/tendências
Obesidade/genética
Ganho de Peso/genética
[Mh] Termos MeSH secundário: Adulto
Idoso
Índice de Massa Corporal
Dieta/efeitos adversos
Feminino
Seguimentos
Predisposição Genética para Doença/epidemiologia
Predisposição Genética para Doença/genética
Genótipo
Pessoal de Saúde/estatística & dados numéricos
Dieta Saudável/psicologia
Seres Humanos
Masculino
Meia-Idade
Enfermeiras e Enfermeiros/estatística & dados numéricos
Obesidade/epidemiologia
Avaliação de Resultados (Cuidados de Saúde)
Estudos Prospectivos
Cooperação e Adesão ao Tratamento/estatística & dados numéricos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5644


  4 / 6 MEDLINE  
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[PMID]:29229609
[Au] Autor:Desai M; Field N; Grant R; McCormack S
[Ad] Endereço:HIV and STI Department, Public Health England, London NW9 5EQ, UK.
[Ti] Título:Recent advances in pre-exposure prophylaxis for HIV.
[So] Source:BMJ;359:j5011, 2017 12 11.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.
[Mh] Termos MeSH primário: Antirretrovirais/uso terapêutico
Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico
Infecções por HIV/prevenção & controle
HIV/efeitos dos fármacos
Profilaxia Pré-Exposição/métodos
Doenças Sexualmente Transmissíveis/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antirretrovirais/administração & dosagem
Análise Custo-Benefício
Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/administração & dosagem
Feminino
HIV/isolamento & purificação
Infecções por HIV/epidemiologia
Infecções por HIV/virologia
Disparidades em Assistência à Saúde
Homossexualidade Masculina/psicologia
Seres Humanos
Incidência
Masculino
Meia-Idade
Ensaios Clínicos Controlados Aleatórios como Assunto
Assunção de Riscos
Doenças Sexualmente Transmissíveis/tratamento farmacológico
Doenças Sexualmente Transmissíveis/prevenção & controle
Cooperação e Adesão ao Tratamento
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5011


  5 / 6 MEDLINE  
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[PMID]:29321467
[Au] Autor:Miao J; Aboagye DE; Chulpayev B; Liu L; Ishkanian G; Kolanuvada B; Alaie D; Petrillo RL
[Ad] Endereço:Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.
[Ti] Título:Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case.
[So] Source:Am J Case Rep;19:41-46, 2018 Jan 11.
[Is] ISSN:1941-5923
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND Neuromyelitis optica (NMO) is a rare demyelinating disease of the central nervous system; NMO predominantly affects the spinal cord and optic nerves. The diagnosis is based on history, clinical presentation, seropositive NMO-IgG antibody, and notably, exclusion of other diseases. Despite the absence of definitive therapeutic strategies for NMO, methylprednisolone pulse therapy and plasma exchange are used for acute phase treatment, while immunosuppressive agent(s) are recommended to prevent relapses and improve prognosis. Here, we report a repeating relapse NMO case due to lack of regular and maintenance therapy. CASE REPORT A 58-year-old female with chronic NMO presented with a three-day history of new-onset right leg weakness and pain. The patient was diagnosed with NMO three years ago and presented with her fourth attacks. During her initial diagnosis, she was initiated on steroids. One year later, she developed the first relapse and was treated with steroids and rituximab, leading to 1.5-year remission. After the second relapse, steroids and rituximab was still given as maintenance therapy, but was not followed. Thus, the third relapse occurred in five months. During this hospitalization, she received initially high-dose solumedrol (1 g daily for five days) in addition to gabapentin 100 mg (gradually increased to 300 mg) three times a day for muscle spasms. Due to worsening of paresthesia and hemiparesis, it was decided to place her on plasma exchange treatment. After two plasma exchanges, the patient's condition was improved and she regained strength in her lower extremity. She completed five more cycles of plasma exchange, and was then discharged on steroid therapy (prednisone 20 mg daily for 10 days then taper) as maintenance therapy and with follow-up in neurology clinic. CONCLUSIONS Over the span of three years, the patient has had three relapses since her NMO diagnosis where her symptoms have worsened. Steroid therapy alone seemed not insufficient in managing her more recent relapses. Nonadherence to NMO treatment likely increased her risk for recurrence, thus regular and long-term maintenance therapy is imperative to delay the progression and prevent relapse in NMO.
[Mh] Termos MeSH primário: Glucocorticoides/uso terapêutico
Imunossupressores/uso terapêutico
Neuromielite Óptica/diagnóstico
Neuromielite Óptica/terapia
Troca Plasmática
Rituximab/uso terapêutico
Cooperação e Adesão ao Tratamento
[Mh] Termos MeSH secundário: Aminas/uso terapêutico
Analgésicos/uso terapêutico
Autoanticorpos/sangue
Biomarcadores/sangue
Doença Crônica
Ácidos Cicloexanocarboxílicos/uso terapêutico
Feminino
Seres Humanos
Fatores Imunológicos/sangue
Meia-Idade
Neuromielite Óptica/sangue
Troca Plasmática/métodos
Prognóstico
Recidiva
Resultado do Tratamento
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Autoantibodies); 0 (Biomarkers); 0 (Cyclohexanecarboxylic Acids); 0 (Glucocorticoids); 0 (Immunologic Factors); 0 (Immunosuppressive Agents); 4F4X42SYQ6 (Rituximab); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE


  6 / 6 MEDLINE  
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[PMID]:29182641
[Au] Autor:Bor J; Fox MP; Rosen S; Venkataramani A; Tanser F; Pillay D; Bärnighausen T
[Ad] Endereço:Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
[Ti] Título:Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa.
[So] Source:PLoS Med;14(11):e1002463, 2017 Nov.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Loss to follow-up is high among HIV patients not yet receiving antiretroviral therapy (ART). Clinical trials have demonstrated the clinical efficacy of early ART; however, these trials may miss an important real-world consequence of providing ART at diagnosis: its impact on retention in care. METHODS AND FINDINGS: We examined the effect of immediate (versus deferred) ART on retention in care using a regression discontinuity design. The analysis included all patients (N = 11,306) entering clinical HIV care with a first CD4 count between 12 August 2011 and 31 December 2012 in a public-sector HIV care and treatment program in rural South Africa. Patients were assigned to immediate versus deferred ART eligibility, as determined by a CD4 count < 350 cells/µl, per South African national guidelines. Patients referred to pre-ART care were instructed to return every 6 months for CD4 monitoring. Patients initiated on ART were instructed to return at 6 and 12 months post-initiation and annually thereafter for CD4 and viral load monitoring. We assessed retention in HIV care at 12 months, as measured by the presence of a clinic visit, lab test, or ART initiation 6 to 18 months after initial CD4 test. Differences in retention between patients presenting with CD4 counts just above versus just below the 350-cells/µl threshold were estimated using local linear regression models with a data-driven bandwidth and with the algorithm for selecting the bandwidth chosen ex ante. Among patients with CD4 counts close to the 350-cells/µl threshold, having an ART-eligible CD4 count (<350 cells/µl) was associated with higher 12-month retention than not having an ART-eligible CD4 count (50% versus 32%), an intention-to-treat risk difference of 18 percentage points (95% CI 11 to 23; p < 0.001). The decision to start ART was determined by CD4 count for one in four patients (25%) presenting close to the eligibility threshold (95% CI 20% to 31%; p < 0.001). In this subpopulation, having an ART-eligible CD4 count was associated with higher 12-month retention than not having an ART-eligible CD4 count (91% versus 21%), a complier causal risk difference of 70 percentage points (95% CI 42 to 98; p < 0.001). The major limitations of the study are the potential for limited generalizability, the potential for outcome misclassification, and the absence of data on longer-term health outcomes. CONCLUSIONS: Patients who were eligible for immediate ART had dramatically higher retention in HIV care than patients who just missed the CD4-count eligibility cutoff. The clinical and population health benefits of offering immediate ART regardless of CD4 count may be larger than suggested by clinical trials.
[Mh] Termos MeSH primário: Assistência Ambulatorial/utilização
Infecções por HIV/tratamento farmacológico
Cooperação e Adesão ao Tratamento/psicologia
[Mh] Termos MeSH secundário: Adulto
Fármacos Anti-HIV/uso terapêutico
Contagem de Linfócito CD4/classificação
Feminino
Seres Humanos
Masculino
Setor Público
População Rural
África do Sul/epidemiologia
Resultado do Tratamento
Carga Viral/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002463



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