992 resultados para aggregative-like adherence pattern


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Background:Effective interventions to improve medication adherence are usually complex and expensive.Objective:To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD.Method:A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4). The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates.Results:61 patients were randomized to intervention (n = 30) and control (n = 31) groups. The mean age of the patients was 61 years (SD 12.73), 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3). Medication adherence was correlated to intervention (p = 0.04) and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups.Conclusion:The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes.

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Magdeburg, Univ., Fak. für Naturwiss., Diss., 2009

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Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

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Magdeburg, Univ., Fak. für Naturwiss., Diss., 2014

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Otto-von-Guericke-Universität Magdeburg, Fakultät für Naturwissenschaften, Dissertation, 2016

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The plastral spotting variation in the chelid turtle Phrynops hilarii (Duméril & Bibron, 1835) in relation to sex, size, and geographic procedence of individuals was analyzed. States for qualitative characters were analyzed using non-parametric tests. Quantitative characters (shell and scute measurements) were standardized for body size by linear regression against carapace length, and were subjected to principal components analysis and canonical discriminant function analysis. Results suggest that increased plastral spotting is a polymorphic ontogenetic trait in P. hilarii. Neither hatchlings nor juveniles have plastral pattern moderately or heavily pigmented. The simplest pattern, however, may persist without changes in some adults. There are no differences between sexes. The spatial distribution of the plastral pattern is not ordered latitudinally or longitudinally, showing no relationship with gradients of elevation, temperature, or precipitation. This pattern trait lacks of taxonomic significance. The morphometric analysis failed to reveal any character of diagnostic utility in the plastron to support the possibility that these patterns correspond to different sympatric taxa.

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Shell selection by the hermit crab Paguristes tortugae Schmitt, 1933 from Anchieta Island (Brazil) was analyzed using the six most frequently occupied shell species in the field and taking into account the sexual condition of the individuals, the shell size and the shell species. The experiments were conducted under laboratory conditions and the shell species preference was estimated on the basis of the frequency that each species was chosen by the individuals. The preferred shell species and size were determined by regression analysis. The highest correlation coefficients were obtained for the relations between the hermit dimensions and shell dry weight. The ovigerous females preferred shells with larger internal volume: Leucozonia nassa (Gmelin, 1791) and Cerithium atratum (Born, 1778). In the experiment of shell size, males preferred heavier shells whereas females selected the shape characteristics of the shell, such as the aperture and the internal volume, which are probably related to the growth and offspring guarantee, respectively. In general, and independent of sex condition, P. tortugae showed significant selection among all shells utilized. The results suggest that shell selection by P. tortugae involves sexual and reproductive condition preferences.

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We evaluated the gastropod shell utilization pattern of the hermit crab Clibanarius vittatus (Bosc, 1802) at Pescadores Beach in São Vicente, State of São Paulo, Brazil. Specimens were collected monthly from May 2001 through April 2003, in the intertidal zone at low tide. The crabs were weighed and their carapace shield length measured. All gastropod shells were identified and had their shell biometric parameters (total length and aperture length) measured (mm) and weighed (g). A total of 2,344 hermit crabs (644 males, 1,594 females, 45 ovigerous females and 61 individuals in intersex), using 13 species of gastropod shells, were collected. Stramonita haemastoma (Linnaeus, 1767), Cymatium parthenopeum (Von Salis, 1793) and Achatina fulica (Bowdich, 1822) comprised over 98% of all the shells. Male and intersex crabs were significantly larger than the females. This size difference strongly influenced the shell utilization pattern, principally in A. fulica, which has the largest shell size, that was only used by males and intersexual individuals of C. vittatus. Cymatium parthenopeum was the only shell species that showed a high determinant coefficient in all the biometric correlations evaluated. The high abundance of S. haemastoma shells and a strong correlation between crab size and shell aperture length established by a significant determination coefficient, indicated that C. vittatus uses this species as the principal resource for shell occupation at Pescadores Beach.