Search

Objective Studies have been conducted to determine the causal factors and clinical consequences of non-adherence to treatment in systemic lupus erythematosus (SLE). However, no interventions have been performed to increase drug adherence. Our objective was to assess the effectiveness of pharmaceutical care (PC) for drug treatment adherence in lupus nephritis (LN). Methods This was a randomized clinical trial (pragmatic trial) in patients with LN in Rio de Janeiro, Brazil, allocated in two groups: an intervention group (Dader Method for PC) and a control group (institution's usual care). Drug treatment adherence was measured by the combination of five questions normally used in clinical practice. Results A total of 131 patients were randomized, and 122 completed the study, with a mean follow-up of 12.7 months and use of six drugs per day and 10–12 doses per day. Low adherence was observed at baseline (intervention group: 30%; control group: 29%). PC showed 27% effectiveness (95% confidence interval (CI) –6% to 50%) in the intention to treat analysis and 31% (95% CI 0–52%) in per protocol analysis, considering all drugs. As for adherence to specific drugs for SLE, effectiveness of PC was 64% (95% CI 34–80%) with intention-to-treat analysis and 62% (95% CI 32–79%) in per protocol analysis. Conclusions PC was effective for increasing drug treatment adherence in SLE. The detailed account provided by the Dader Method of the difficulties with patients' drug therapy proved invaluable to approach non-adherence.

Summary The characterisation of oral-motor movements and speech of patients with tetanus were investigated to determine the existence of possible signs that are characteristic of this pathology. Thirteen patients clinically diagnosed with tetanus (10 with severe tetanus and three with very severe tetanus) and admitted to an intensive care unit underwent clinical evaluation of oral-motor movements and speech. Statistical analysis indicated significant between-group differences for speech motor functions, suggesting that individuals with very severe tetanus present rigidity as a characteristic interfering in articulatory precision (P = 0·035) and movement rate (P = 0·038). For lip closure, tongue movement, palatal elevation, gag reflex and voice quality, no between-group differences were identified for the specific abnormal characteristics. The observed abnormal results indicate that muscle strength and functional status of the oral-motor system presented by most of the participants of the study did not ensure the necessary integrity for satisfactory performance. The characterisation of the oral myofunctional aspects of patients with tetanus provides medical teams, patients and families with a wider and better description of the clinical situation, giving support to the diagnosis, prognostics and treatment.

Karasek postulated that high job strain, an interaction between high psychological demands and low control at work, increases the risk of ill-health. Objective Systematic review/meta-analysis of the association between job strain and blood pressure (BP). Methods Target studies were published on Pubmed, Lilacs, SciELO, PsycInfo, Embase and Web of Science, until July 2009. Data extraction was conducted independently by 2 of 3 reviewers using a standardised form. Results The search retrieved 1377 studies and 51 fulfilled the eligibility criteria, mostly cross-sectional and conducted in Europe or USA. Most of them applied the job content questionnaire (89.4%) and used the Karasek9s quadrant categories (78.4%). Casual BP was measured in 26 (50%), ambulatory BP monitored in 22 (84.6%), self-measured BP in two (3.8%) and self-reported hypertension in two studies (3.8%). Hypertension was the outcome in 16 studies (30.8%), 9 of them defined by BP>140/90 mm Hg. High strain was associated with high BP/hypertension in 27/51 (52.9%) studies. Meta-analysis could be only performed for nine hypertension studies, for which the association was not confirmed neither for high strain (ORc=1.08, 95% CI 0.98 to 1.19), high psychological demands (ORc=1.08, 95% CI 0.98 to 1.19) nor for high control (ORc=1.02, 95% CI 0.94 to 1.11), with no evidence of publication bias. Conclusion There is weak evidence in favour of the association between job strain and BP/hypertension. Comparisons were hampered by methods heterogeneity, particularly: inclusion criteria, data collection and exposure/outcome definition. Further research should include longitudinal design, low and middle-income countries and female workers, still lacking.