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Background. A lot of brain damage including traumatic brain injuries during war can lead to persistent cognitive disorders and followed impaired functioning in everyday life. The main focus in dealing with such disorders is made on the neuropsychological (cognitive) rehabilitation. Patients psychoeducation aimed to creating an adequate internal picture of the disease and increasing self-awareness of deficits and behavior is considered as the first and the most important step in their rehabilitation process. Yet, to date the theoretical and methodological foundations of psychoeducation are not clear formulated and developed so it makes this stage of the cognitive rehabilitation not much effective. Objective. Review and analysis of the research literature in the fields of clinical psychology and neuropsychology concerning implementation of psychoeducation for neurological patients, as well as discussion of relevant issues in this problematic area. Results. The literature review has shown that “psychoeducation” was first officially recommended for severe mental illnesses and continues to develop in the modern system of psychosocial rehabilitation for psychiatric and psychosomatic patients as a special type of psychosocial intervention in the structure of their treatment and rehabilitation process. Various authors particularly highlight the learning aspect of psychoeducation, associated with the patient's mastery of methods for recognizing the manifestations of his cognitive deficits and behavioral disorders. Conclusions. Psychoeducation should be implemented in the practice of neuropsychological (cognitive) rehabilitation. In order to advance research and practice of psychoeducation for improving the effectiveness of cognitive rehabilitation, it is necessary to develop it as a typical educational process where each stage should be matched with adequate tools and practices. In addition, psychoeducation should be linked to the treatment process and to specific therapeutic and rehabilitation goals.

Background: The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes. Methods: This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC). Results: The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36–4.01) and lower SMI (0.73, 95 % CI 0.55–0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24–6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93–0.98), and higher SMI (0.97, 95 % CI 0.95–0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93–0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01–1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93–0.99). Conclusions: Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC.

Amaç: Çalışmanın amacı hipertansiyon hastalarında tedaviye uyum ve yaşam tarzı değişikliği başarı durumunu ölçmek ve bu durumun kan basıncı kontrolü üzerindeki etkilerini incelemektir. Yöntem: Çalışma, 300 hipertansiyon hastası ile yapıldı. Hastaların boy, kilo, kan basıncı ve bel çevresi ölçümleri, biyokimya ve hemogram sonuçları kaydedildi. Hastalara; tıbbi bilgileri, sosyodemografik özellikleri, yaşam tarzı alışkanlıklarını içeren anket soruları soruldu. Hipertansif Bireylerin Tedaviye Uyum ve Yaşam Değişikliği Başarısını Değerlendirme Ölçeği uygulandı. Bulgular: Hastaların yaş ortalaması 62,41±10,49 yıl idi. Ortanca hipertansiyon süresi 10 yıl saptandı. Katılımcıların %36,7’si üç veya daha fazla antihipertansif ilaç kullanmaktaydı. Katılımcıların %44,7’sinde sistolik kan basıncı ≥140 mmHg, %33’ünde diyastolik kan basıncı ≥90 mmHg olarak ölçüldü. Hastaların %52’si tedaviye rağmen hipertansif olarak bulundu. Vücut kitle indeksine göre hastaların %59,7’si obezdi. Vücut kitle indeksi, kadınlarda 34,14±6,84 kg/m² iken, erkeklerde 30,20±4,76kg/m² idi (p=0,001). Sistolik ve diyastolik kan basıncı yüksek olanlarda vücut kitle indeksi ve bel çevreleri, kan basıncı normal olanlara göre daha yüksekti (p=0,001 ve p=0,001). Hipertansif Bireylerin Tedaviye Uyum ve Yaşam Değişikliği Başarısını Değerlendirme Ölçeğine göre hastaların %81’i uyumluydu. Uyumsuz hastaların %66,7’si, uyumlu hastaların %48,6’sı hipertansifti (p=0,014). Haftada en az 3 gün egzersiz yapan hastalar daha uyumlu bulundu (p=0,007). Uyumlu hasta grubunun obezite oranları daha düşüktü (p=0,047). Sonuç: Çalışmamızda uyum oranı yüksek olarak değerlendirilen hasta grubunun obezite oranı daha düşük saptandı. Aynı grubun kan basıncı kontrollerinin daha iyi olduğu değerlendirildi. Hipertansiyon tedavisinde başarıya ulaşılabilmesi için, hastaların tedaviye uyum ve yaşam tarzı değişikliği konularında eğitilmesi gerekir.

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Introduction. Nowadays, obesity is considered as a chronic metabolic disease that occurs at any age. The relevance of the study is defined by the high prevalence of obese peopleThe objective was a psychological assessment of the level of compliance, emotional state, characteristics of eating behavior and satisfaction with the quality of life in patients with morbid obesity before and after bariatric surgery.Methods and materials. The study included 30 patients with morbid obesity who underwent bariatric surgery aged 26 to 53 years. Psychodiagnostic techniques and clinical scales were used to determine the level of compliance, emotional state and features of eating behavior.Results. The study showed that in patients with morbid obesity after bariatric surgery, the type of eating behavior changed towards stronger compliance to the diet, their emotional state improved but at the same time, satisfaction with the quality of life decreased. 6 months after the bariatric surgery, compliance to medical recommendations in patients decreased. Patients began to violate the prescribed regimen, depreciated the possible consequences and complications, and began to neglect some aspects of treatment and dietary compliance.Conclusion. It is important to pay attention to the creation of preventive programs aimed at informing patients about food composition and caloric value, awareness of habitual behavioral reactions to food stimuli and risk factors for repeated breakdowns.

Introduction. Medical compression stockings are one of the main methods in a conservative strategy for the treatment of chronic vein diseases as well as for adjuvant treatment after superficial venous interventions. however, compliance to this treatment is low.Objective. To evaluate patient satisfaction with medical compression knitwear therapy in a short-term follow-up.Materials and мethods. The study included 150 patients of both sexes aged 42 ± 8.3 years. Endovenous laser obliteration combined with mini-phlebectomy and/or sclerotherapy for varicose veins was performed. All patients after the surgery wore compression stockings of compression class 2 with a recommended wearing period of 14 days. At the control visit at the end of the follow-up period all patients were asked to complete a satisfaction survey with a specially prepared questionnaire including 7 questions.Results and discussion. No significant adverse events and complications related to either the invasive intervention or the compression therapy were observed during the follow-up period. There were no abnormalities such as compression sensations or changes in blood flow under the knitwear. The compression was totally adequate, with no areas of over- and/or under-compression. All respondents felt that the knitwear was well anchored to the leg and no slipping or twisting due to the wide elastic band with droplet silicone. In addition to all of the above, the patients noted that the knitwear offered to them in the study had good tactile properties: it was soft and pleasant to the skin. According to the survey, the average score for all questions was 9.5 (QR 8-10).Conclusion. Elastic compression is an effective and safe means of preventing adverse events, complications and pain in patients after superficial varicose veins surgery. Additional consumer properties of medical compression knitwear can significantly influence patients’ compliance and therefore the effectiveness of treatment.

Background: Diabetes Mellitus is a condition that has a significant effect on the lives of individuals with diabetes and their families. Individuals with DM display emotional reactions and difficulties in adjustment. Aim: The purpose of this study is to examine the relation between family support and compliance to treatment in individuals with diabetes. Methodology: The study population consists of individuals admitted to Balıkesir State Hospital Endocrinology Clinic; while the sample of the study consists of 260 voluntary individuals with diabetes whose conditions satisfied the study criterion. Data gathering forms were Survey Form and Hensarling's Diabetes Family Support Scale. Study data have been gathered from 30 November 2015 to 30 September 2016. Data have been assessed by using Shapiro Wilk's' test, Mann Whitney U test, Kruskal Wallis-H test, Post-Hoc Multiple Comparison test. Results: 95,38% of the individuals with diabetes taking part in the study have stated that they accepted treatment; 93,08% stated they do blood glucose monitoring; 22,69% stated they regularly perform medical nutrition treatment, 28,84% stated they perform regular exercise, 94,23% stated they take medication regularly, 23,46% stated they watch out for foot care and 82,69% stated that they receive family support for treatment and care. There is no statistically meaningful difference between Family Support Scale total score and regular implementation of medical nutrition treatment, foot care, previous training on diabetes and receiving family support for diabetes treatment and care. Conclusion: In terms of Hensarling's Diabetes Family Support Scale sub-dimension support scores, namely empathic, encouraging, facilitator and sharing, there is no statistically significant difference between receiving family support for diabetes treatment and care. [ABSTRACT FROM AUTHOR]

Background: The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes., Methods: This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC)., Results: The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36-4.01) and lower SMI (0.73, 95 % CI 0.55-0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24-6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93-0.98), and higher SMI (0.97, 95 % CI 0.95-0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93-0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01-1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93-0.99)., Conclusions: Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Aim: The reasons such as the fact that individuals with chronic diseases are mostly in the old age and that the diseases lead to changes in physical and psychological fields may bring about an increase of dependence in meeting daily needs. This study aims to determine the relationship between care dependency and compliance to treatment and life satisfaction in individuals with chronic physical diseases. Material and methods: This research designed as a descriptive and relationship-seeking style includes 294 individuals with chronic physical diseases who were hospitalized for internal medicine clinics of a university hospital. After the ethics committee permission, the data were obtained by patient identification form, Care Dependency Scale, Modified Morisky Scale and Life Satisfaction Scale. Results: It was found out that the level of care dependency and motivation and knowledge levels of the individuals were positively weak (p<0.05), and that there was a positive moderate relationship between care dependency and life satisfaction level (p<0.01). In addition, individuals’ life satisfaction and motivation level in drug use account for 23% of the total variance in care dependence. In addition, 23% of the change in individuals’ dependency on care results from life satisfaction and motivation for medication use. Conclusions: As the levels of independence increases in fulfilling the care requirements of individuals with chronic physical disease, their compliance with drug and life satisfaction also tend to increase. Moreover, compliance to treatment and the life satisfaction of individuals are also important determinants in care dependency. [ABSTRACT FROM AUTHOR]

Purpose: Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America. Methods: Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12–18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey. Results: Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001). Conclusions: Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy. [ABSTRACT FROM AUTHOR]

Changing lifestyles reduce the time spent by children on physical activity during the day. The result is an increasing frequency of childhood obesity, which has become one of the most common chronic diseases of childhood. Furthermore, the treatment of obesity in childhood is quite difficult, and the most common problem is non-compliance with obesity treatment. The path that will facilitate the adaptation to treatment comprises nutrition regulation and increased daily physical activity and psychological support. Diet alone leads to a significant reduction in both fat and non-fat body mass. However, adding exercise to dietary therapy improves weight loss by maintaining non-fat body mass. Even though exercise alone has little effect on weight loss, it provides a significant reduction in mortality. Moreover, regular physical exercise is also an important factor in regulating body composition during growth. However, changes in the child's body during growth affect the motor power and performance, so it is necessary to plan the exercise according to the individual characteristics, age and sex of the child. Short-term frequent exercises are more entertaining and more accessible forms of exercise (dancing at home) for children, and enhance compliance with treatment. Starting treatment as soon as possible will also increase behavioral effectiveness and compliance. This paper focuses on the basics of exercise therapy, which is extremely beneficial for both healthy and obese children. [ABSTRACT FROM AUTHOR]

Background: This study was designed as a randomized experimental study to determine the effect of web-based training on anxiety and depression levels in patients who previously underwent myocardial infarction (MI). Methodology: The study was carried out between January and December 2016 with individuals who applied to two hospitals affiliated to the Ministry of Health because of MI. 65 individuals were randomly assigned to the experimental group and the control group separately. Data were collected with Patient Information Form and Hospital Anxiety Depression Scale and Patient Follow-up Form. While patients in the control group received routine patient notification, a web-based distance education program was applied to the experimental group. Both groups were reevaluated after 3 months. Results: The attitude of the individuals included in the study to exhibit health behaviors, and thus their compliance to treatment, was significantly higher in the experimental group compared to the control group (P < 0.001). The mean anxiety and depression scores of the experimental group were 6.74 ± 3.36 and 6.26 ± 3.16, whereas the mean scores of the control group were 9.66 ± 3.85 and 9.28 ± 3.49, respectively. A significant difference was found between the groups (P < 0.001). Similarly, 20% and 52.3% of the experimental group and 49.2% and 81.5% of the control group had anxiety and depression scores above the threshold, respectively. Conclusion: Web-based remote training is effective in decreasing the anxiety and depression levels in individuals who previously underwent MI. Web-based remote training can be recommended as an effective training method in dealing with life-threatening situations. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is one of the top ten chronic diseases in the world and the prevalence of this disease will increase in the future including in Indonesia. Treatment of DM needs collaboration between the patients and the providers to prevent multiorgan complications and increase the compliance to treatment. The correlation among the level of knowledge (K), attitude (A) and practice (P) plays an important role of patients towards compliance to treatment. The objectives of this study was to identify the level of knowledge, attitude and practice of DMT2 patient towards compliance to treatment at a primary care facility. Methods: This study was carried out by using cross sectional descriptive study from August until November 2013 in Public Health Center (Pusat Kesehatan Masyarakat/Puskesmas) Tanjungsari, Sumedang, West Java. There were 49 respondents and the sampling method used was non-probability sampling. The data was collected through face to face interview using questionnaire which consist of 27 questions about knowledge, attitude and practice. The collected data was anayzed using computer and was presented in the form of tables and a figure. Results: This study discovered that 22 patients had moderate knowledge, 17 patients had good knowledge and 10 patients had poor knowledge. As for attitude, there were 32 patients had good attitude and 17 patients had moderate attitude. Whereas, for practice, 44 patients were good and 5 patients were moderate. Conclusions: Majority of respondent had moderate knowledge, good attitude and practices.

Background and Objectives: Arterial hypertension remains an important cause of cardiovascular morbidity and mortality, despite all the progress made in the methods of diagnosis, monitoring of target organs’ damage and treatment. The main cause of the increased prevalence of uncontrolled blood pressure values is the low compliance to antihypertensive treatment. The objective of our study was to assess the compliance to the treatment of patients diagnosed with arterial hypertension and monitored in a primary care office. Materials and Methods: The cross-sectional, retrospective study included 129 patients, 65.89% (85) women, previously diagnosed with arterial hypertension. Data from the medical files were analyzed, as well as the patients’ answers to a survey of 18 questions regarding arterial hypertension, comorbidities, complications, treatment and awareness of the condition. Results: The study included 129 patients, with a mean age of 66 ± 8 years. The majority of patients were overweight, 55.81% (72 patients), and 10.85% (14 patients) had grade I obesity. Most of the patients, 55.81% (72 patients) were diagnosed with grade III hypertension, while 37.98% (49 patients) were diagnosed with grade II hypertension and 6.2% (8 patients) with grade I hypertension. One third of the surveyed patients answered that they follow the recommendations of a low-sodium diet, 21.7% are adherent to treatment, but 56% think that the total cost of the medication is an impediment for their compliance to treatment. The majority, 82.17% (106 patients), of respondents had an affirmative answer to the questions: ‘Do you think it would be easier to take one pill instead of 2, 3 or 4 pills?’ Conclusion: The increased compliance to the antihypertensive treatment and control of blood pressure values are associated with the degree of awareness of arterial hypertension and the consequences if left untreated, emphasizing the role of the general practitioner in counseling for secondary prevention.

Low compliance to a prescribed Coumadin treatment can result in negative health outcomes. In this study we aimed to evaluate risk factors affecting patient compliance to Coumadin. For this purpose, two study phases were performed: Phase 1: a retrospective eight-year follow-up of databases from health care services; and Phase 2: a cross-sectional study with telephone interviews. A Total Compliance Index was constructed using the number of Coumadin purchases (40%), international standardised ratio (INR) tests (40%), and average INR values (20%). Multiple models for the Total Compliance Index were constructed using socio-demographic, treatment-related, and health care utilisation variables, use of drugs, patient-physician relationships and patient's quality of life. 78.5 ± 3.4% of patients in the total population were non-compliant in the retrospective phase of the study, and 53.2% in the second, cross-sectional phase. Total Compliance Index was significantly associated with older age, number of doctor visits, and drugs from group C. We suggest that the Total Compliance Index for other drugs can be utilised as well. [ABSTRACT FROM AUTHOR]

Aim. To study efficacy of a short course of highly active antiretroviral therapy (HAART). Material and methods. Acute HIV infection was verified in 16 infected subjects basing either on seroconversion (by immunoblotting) or a documented negative result 6-12 months before registration of a positive result for HIV antibodies. Results. HAART was given to 12 patients (combivir+nevirapin). The number of CD+ lymphocytes (by median) 1 month after the treatment increased by 185 cells/mcl, 3 months after the treatment - by 215 cells/mcl. After 1-month therapy viral load (median) diminished by 2,02 logl0 copy/ml, after 3 months - by 2,31 logw copy/ml. 71% patients had HIV RNA under 400 copy/ml. Untreated patients showed changes neither in CD4+lymphocytes number nor in viral load. The study continues. Conclusion. HAART is used at the stage of acute infection in the presence of psychic trauma provoked by establishment of HIV-infection diagnosis. Therefore, it is necessary to consult the patients for preparing them for treatment and to maintain compliance.

Background. Despite the chronic and relapsing nature of inflammatory bowel diseases (IBD), at least 30% to 45% of the patients are noncompliant to treatment. IBD patients often seek information about their disease. Aim. To examine the association between information-seeking activity and treatment compliance among IBD patients. To compare information sources and concerns between compliant and noncompliant patients. Methods. We used data from the Swiss IBD cohort study, and from a qualitative survey conducted to assess information sources and concerns. Crude and adjusted odds ratios (OR) for noncompliance were calculated. Differences in the proportions of information sources and concerns were compared between compliant and noncompliant patients. Results. A total of 512 patients were included. About 18% ( n = 99) of patients were reported to be noncompliant to drug treatment and two-thirds ( n = 353) were information seekers. The OR for noncompliance among information seekers was 2.44 (95%CI: 1.34-4.41) after adjustment for confounders and major risk factors. General practitioners were 15.2% more often consulted ( p = 0.019) among compliant patients, as were books and television (+13.1%; p = 0.048), whereas no difference in proportions was observed for sources such as internet or gastroenterologists. Information on tips for disease management were 14.2% more often sought among noncompliant patients ( p = 0.028). No difference was observed for concerns on research and development on IBD or therapies. Conclusion. In Switzerland, IBD patients noncompliant to treatment were more often seeking disease-related information than compliant patients. Daily management of symptoms and disease seemed to be an important concern of those patients. [ABSTRACT FROM AUTHOR]

In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic and clinical characteristics, between patients with different levels of awareness of illness (insight). The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behaviour. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.

Despite the proven efficacy of current strategies for cardiovascular (CV) risk reduction, a considerable gap remains between the risk reductions achieved in clinical trials and those seen in clinical practice. A major reason for this is poor compliance to medication, which has been extensively documented for antihypertensive therapy. Low adherence results in suboptimal blood pressure control, which is associated with adverse CV outcomes and increased treatment costs. Adverse effects of medication are an important cause of diminished adherence. Angiotensin II receptor blockers (ARBs) may offer better long-term tolerability than other classes of antihypertensive agent, and this is likely to be a major factor in the high levels of adherence and persistence seen with these agents. This could have implications for CV protection, as confirmed by the results of recent clinical trials. Thus, ARBs should be considered as an alternative to angiotensin-converting enzyme inhibitors in patients at risk of low adherence. [ABSTRACT FROM AUTHOR]

Introduction Tobacco consumption is a serious public health problem and the principal cause of death worldwide. It is linked to chronic obstructive pulmonary disease (COPD), coronary disease, and various cancers such as lung cancer, which is the most frequent, and cancer of the larynx and other organs. Smoking affects the quality of life of millions of people. Those who live with smokers also become involuntary or passive smokers. It is important to determine the factors that influence initiation and continuation of smoking and the reasons that facilitate or favor smoking cessation. The dependence of cigarette smoking acts as a modulator of the relationship that smokers have with their social environment and on the expression of their feelings. We considered important to study the assertiveness of smokers, which is considered to be the social skill that individuals have to express what they think, feel and opine about respecting their rights and the rights of others as a factor that may influence smoking cessation or continuation of smoking. Objective We undertook this study to determine the levels of assertiveness and the sociodemographic profile of a population of 130 patients who were smokers and who came to the «Clinic against Smoking» located at a tertiary level teaching and research hospital in Mexico City. This was the first attempt for these patients to undergo cognitive behavioral treatment to stop smoking. We sought to determine if there are any significant differences between those patients who smoke and who continue treatment and those patients who abandon treatment. Material and methods Only patients who were active smokers were studied. Of a total of 130 subjects, 65 completed the treatment and 65 abandoned treatment. For each patient, the socioeconomic profile was investigated with regard to gender, age, marital status, education, occupation, and contribution to the family income. The Gambrill and Richey Assertiveness Inventory for the Mexico City population was used. The Fagerström questionnaire was applied for evaluation of nicotine dependence, with a value >6 considered to be positive to qualify as dependence and the Russell reasons for smoking, which include stress reduction, the need to smoke, relaxation, the stimuli to perform activities and manipulation. Results were analyzed by descriptive analysis evaluating the assertiveness profile by probability of assertive response and the degree of discomfort classified as high, medium and low. The level of assertiveness was diagnosed according to the probability of response and the degree of discomfort as indifferent, assertive, nonassertive, average level of assertiveness and anxiety; a group was not classified between the groups mentioned. We used χ² for comparison of the levels of assertiveness between those who completed the treatment and those who did not. Results Of the 130 subjects studied, 65 completed the study satisfactorily and 65 abandoned treatment. Average age of the group of patients was 39.8 years (range: 19-60 years). There were 56.9% (74/130) females and 43.07% (56/130) males. It was determined that 60% of the population lived with a partner (78/130). Of the study population, those reporting a higher educational level (51.5%) (67/130) had a slight predominance over those subjects with either primary or secondary level of education. Of the 130 patients studied with the Fagerström questionnaire, 56.4% were nicotine dependent (73/130) and 47.4% (57/130) were not dependent. According to the Russell questionnaire for reasons for smoking, the most important reasons for smoking were stress reduction in 30.4% (42/130), the need to smoke in 33.1 % (43/130) and for relaxation, with no difference between those who completed treatment and those who abandoned treatment. Stimulation, habit and manipulation were less frequently observed reasons. In general, the population studied presented a low level of assertiveness and a deficit in social behavior without significant differences between those who leave or continue the treatment. Only 20% of all smokers were assertive, 19% were not assertive, 30% were indifferent, 15% had an average level of assertiveness, 5% demonstrated anxiety and 36% of those who had other levels remained in the «unclassified» group. The analysis of reactives demonstrated that the smokers presented a low probability of response in the areas that manifested in the expression of annoyance, anger or disagreement with others, recognizing personal limitations and acting in defense of rights in commercial situations and interactions with neighbors. They demonstrated a greater degree of discomfort in the areas of confrontation, defense of views and resisting pressure from others. Discussion Knowledge of the socioeconomic environment of smokers who desire to stop smoking using cognitive behavioral therapy is important because the environment in which the smoker lives exerts an influence on the success or failure of the attempt to stop smoking. Gender, age, living with a partner, economic status and educational level are factors that may influence adherence to treatment and also influence the tendency to abandon treatment. Nicotine dependence was a determinant factor regarding completion or abandonment of treatment. Stress reduction and searching for and needing relaxation were the most frequently mentioned reasons for smoking. The level of assertiveness does not appear to playa definitive role for treatment success or for abandoning the smoking habit. Only 20% of the smokers were assertive and, of those, only half completed the treatment, with no difference between those who did not complete the treatment. The probability of an assertive response and the degree of discomfort did not show differences in the two groups mentioned, which suggests that assertiveness does not have a great influence on the final results. In general, the population studied had a deficit in social abilities. In the reactive analysis it was found that there is an opposition in the areas of defense of opinions and for resisting pressure from others, for manifesting annoyance, anger or disagreement and in regard to the defense of rights in commercial situations and interaction with others. There were no significant differences observed in between-group comparisons (χ² 0.406). There were also no significant differences between those who are assertive and those who have a low level of assertiveness. These individuals prefer to reduce stress, satisfy their needs and seek relaxation or the stimulation produced by nicotine vs. the effort required to follow smoking cessation treatment, particularly within a social environment where smoking may be an element that eases relationships with others. The observations obtained in this study suggest that assertiveness training specific to the type of smoker who tends to abandon treatment may be appropriate to obtain positive results and contribute not only to avoid abandoning treatment but also to maintaining positive results and to avoid relapses. This training may influence those susceptible subjects to avoid initiating a smoking habit. Conclusion The level of assertiveness is not an important factor to explain the success or failure of a smoking cessation program. Training in assertiveness may be useful to enhance success of treatment to quit smoking. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiological studies have unequivocally shown that hypertension (HT)is a major cardiovascular (CV) risk factor and that a direct linear relationship exists between the severity of the blood pressure (BP) elevation and the occurrence of CV events. [ABSTRACT FROM PUBLISHER]

The aim of this review was to summarize recent findings on patients' adherence and persistence to antihypertensive (AHT) therapy. A literature search was performed using MEDLINE for original studies published in the English language between April 2003 and July 2008. According to selection criteria, the review included 47 papers classified into the following groups: (i) studies assessing overall behaviour towards treatment; (ii) studies differentiating among AHT classes; and (iii) studies comparing specific AHTs. It was not possible to perform a meta-analysis due to the wide variety of study designs, objectives and definitions. However, some strong messages emerged: non-adherent patients have higher blood pressure (BP) values, which lead to a higher risk of cardiovascular events; angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) are the AHTs with the best patient adherence and persistence to treatment; better treatment adherence is observed in patients using fixed versus extemporaneous AHT combinations. Improving BP control is pivotal to reduce cardiovascular events, allowing for a better use of healthcare resources, and good adherence and persistence to treatment are essential for reaching this goal. [ABSTRACT FROM AUTHOR]

Schizophrenia is one of the most important public health problems. It is a common, tragic and devastating mental illness that typically strikes young people when they are maturing into adulthood. Among schizophrenic out-patients, 24–63% of patients are non compliant as they failed to take the correct drug in the correct dosage. Clinical experience had demonstrated the existence of several groups of patients, some who comply with the medical regimen and others who do not adhere to treatment. Some of the factors that had been linked to poor compliance included low socio-economic status, unstable lifestyle, general negative attitudes towards one’s predicament, cognitive strategies and patient’s personal and psychological characteristics. As such, several studies have shown that three personality dimensions are particularly important for understanding schizophrenia which are extraversion, neuroticism and peculiarity. The aim of this study is to search for the possible association between personality traits or cognitive strategies and compliance to treatment in a sample of adult patients with schizophrenia. Eighty-three patients were screened for suitability for inclusion into the study. Patients who fulfilled the following criteria were recruited: aged 18 and more, who received a diagnosis of schizophrenia (Axis I DSM-IV), without severe cognitive impairment, without a diagnosis of personality disorder (Axis II DSM-IV), consulting their psychiatrist for a period of one year after dismissal of their psychiatric ward and having given their written informed consent. The final study sample consisted of 50 out-patients adults, 35 males and 15 females, age 19–59 years. After inclusion, patients were divided into two groups (Compliant–C and Non Compliant–NC) on the basis of their compliance to treatment. Mean age for the two groups is, respectively, 34.59 ± 9.62 and 27.29 ± 7.93. Compliance to treatment was measured by indirect methods such as the impression of the treating psychiatrist, interviewing patients, therapeutic outcome, counting the number of tablets remaining in a patient’s supply and objective criteria such as presence to medical and staff appointments or ending the follow-up. Personality traits were measured by the Rorschach Test, scored and interpreted according to Exner’s Comprehensive System. This psychological measure was selected for its ability to differentiate state and trait personality variables and its sound validity when used in the manner for which it was designed and intended. The selected trait variables in the Rorschach are: P < a + 1, which identifies tendencies to be passive and deferential in social situations; HVI index, which indicates a cautious, distant and mistrustful orientation to people ; EB which shows a cognitive style of decision making; Lambda > 0.99 which identifies a lack of adequate openness to experience and tendencies to view one’s world with an overly narrow focus of attention; and Fr + rF, associated with narcissistic marked tendencies to overvalue personal worth. The selected defense mechanisms in the Rorschach are: the intellectualization index (2AB + Art + Ay) used to keep emotion at a distance and minimize their impact. Denial (MP > MA) defines a predilection for escapist fantasy and prevents the impact of an unpleasant reality. Patients were contacted during their hospitalization period by the medical chief of staff who described the study in details. After they had consented, participants received the Rorschach test, before leaving the hospital. The Rorschach protocols have been scored by two Senior Rorschach practitioners. On the selected variables their scoring agreement percentage was 100%. Rorschach protocols were assigned to the C and NC groups by the end of the scoring process and once the medical team had finished the inclusion into the two groups (C and NC). The two Rorschach practitioners had worked single-blind on the set of Rorschach protocols. Group differences in Rorschach variables at the end of one year of medical follow-up were examined by using the χ2 test. The significance level was set at P < 0.05. Results have shown that the C and NC groups differ significantly on the basis of schizophrenia subtypes. The Paranoid type (295.30) is more frequent in the C group whether the Disorganized type (295.10) is more frequent in the NC group (χ2 = 12.16, P < 0.001). Compliant schizophrenic patients use significantly, more frequently the intellectualization defense mechanism (χ2 = 6.17, P < 0.012). Non compliant patients appear to have significantly more marked narcissistic traits and tendencies to overvalue personal worth (χ2 = 8.79, P < 0,003). These observations support the idea that paranoid delusions, even if persecutory, do not alter pervasively the ability of maintaining genuine relationships with some others, such as the treating psychiatrist, for instance. In Disorganized type patients, the orientation to people is overall disturbed, the interest in the therapeutic alliance more superficial and fragile. Due to narcissistic traits and tendencies to overvalue personal worth, non compliant patients display a sense of grandiosity and entitlement which distort the genuine perception of personal needs and that of their psychological states. Intellectualization acts as cognitive coping strategy aiming to mute the intensity of emotions and safeguard against distress. Shifting emotional experience to a cognitive level allows the schizophrenic patient to acknowledge his needs for medical therapy even if he does not recognize himself as being ill. The research presented here comprises a 1-year prospective study designed to test some associations between personality factors and compliance to treatment. The degree to which schizophrenic patients comply with the advice of health workers depends, among other factors, on their stable personality traits and coping mechanisms. Continued study of the links between personality traits and compliance to treatment in this population as well as regular psychological assessment of these patients may identify which therapeutic approaches are best for which patients. There is increasing interest in the role of psychological mechanisms in compliance behavior formation after the onset of illness and these models may also be useful in thinking about events before onset. [Copyright &y& Elsevier]

(1) Background: Eye drops are the most common route of administration for ophthalmic medications. Administering drops can be a major hurdle for patients, potentially resulting in noncompliance and treatment failure. The purpose of this study is to compare the efficacy and safety of two different aids and the conventional bottle for eye drop instillation; (2) Methods: An interventional crossover study involving standard eye drop bottle, Opticare aid and Autodrop aid. The study included healthy subjects without a history of regular eye drop use; (3) Results: Twenty-six subjects were enrolled. Of those subjects, 96% and 92% were able to assemble the eye drop bottle into the Autodrop and the Opticare aids, respectively. Subjective assessment indicated that Autodrop was significantly easier to assemble than Opticare (95% CI: −1.6802 to −0.1659, p = 0.02). When using either aid, there was no contamination of the bottle tip, which occurred in 46% of subjects when no aid was used (p = 0.0005). Fewer drops were expelled when using the conventional bottle as compared to the aids (p = 0.05 compared to Autodrop, p = 0.1 compared to Opticare); (4) Conclusions: Autodrop and Opticare can assist patients with eye drop placement. These aids completely prevented bottle tip contamination, which was frequently observed when the conventional bottle was used alone. [ABSTRACT FROM AUTHOR]

Sub-optimal adherence to pharmacological therapy is one of the main reasons for poor effectiveness, reducing the patient's quality of life and affecting health-care economics. This study investigated the possibility for a wastewater-based epidemiology approach to assess the overall adherence of a population to some pharmacological therapies in a defined area. We selected specific active ingredients and their main urinary metabolites (biomarkers) according to the best practice protocol available and we measured them for the first time in urban wastewater. We conducted this first case study in Italy, considering the whole country and two Italian regions by sampling for five days six cities from north to south. Liquid chromatography tandem mass spectrometry was used to measure the biomarkers in raw wastewater, developing and validating specific analytical methods. We used concentrations measured in influent wastewater, together with a careful review of the excretion profile of the active ingredients selected, to back-calculate consumption (measured consumptions - MC) which were then compared with consumptions calculated from medical prescriptions (expected consumptions – EC) reported annually by the Italian Medicine Agency. In general there was a rough correlation between MC and EC, with ratios sometimes close to unity and always within a 0.3–3.0 range. Interpretation of the results suffers some biases, which are case-by-case discussed in detail, but inclusion of measurements of the urinary metabolites together with the active ingredients gave a fuller understanding of the results. Unlabelled Image • Adherence to therapy was assessed through a wastewater-based epidemiology approach. • Urinary metabolites and active ingredients were selected as biomarkers. • All biomarkers were found in measurable concentrations in raw wastewater. • Biomarker concentrations in wastewater may reflect their prescription figures. • Urinary metabolites allowed better assessment of the medical adherence. [ABSTRACT FROM AUTHOR]

Background and Objectives: Arterial hypertension remains an important cause of cardiovascular morbidity and mortality, despite all the progress made in the methods of diagnosis, monitoring of target organs' damage and treatment. The main cause of the increased prevalence of uncontrolled blood pressure values is the low compliance to antihypertensive treatment. The objective of our study was to assess the compliance to the treatment of patients diagnosed with arterial hypertension and monitored in a primary care office. Materials and Methods: The cross-sectional, retrospective study included 129 patients, 65.89% (85) women, previously diagnosed with arterial hypertension. Data from the medical files were analyzed, as well as the patients' answers to a survey of 18 questions regarding arterial hypertension, comorbidities, complications, treatment and awareness of the condition. Results: The study included 129 patients, with a mean age of 66 ± 8 years. The majority of patients were overweight, 55.81% (72 patients), and 10.85% (14 patients) had grade I obesity. Most of the patients, 55.81% (72 patients) were diagnosed with grade III hypertension, while 37.98% (49 patients) were diagnosed with grade II hypertension and 6.2% (8 patients) with grade I hypertension. One third of the surveyed patients answered that they follow the recommendations of a low-sodium diet, 21.7% are adherent to treatment, but 56% think that the total cost of the medication is an impediment for their compliance to treatment. The majority, 82.17% (106 patients), of respondents had an affirmative answer to the questions: 'Do you think it would be easier to take one pill instead of 2, 3 or 4 pills?' Conclusion: The increased compliance to the antihypertensive treatment and control of blood pressure values are associated with the degree of awareness of arterial hypertension and the consequences if left untreated, emphasizing the role of the general practitioner in counseling for secondary prevention.

Changing lifestyles reduce the time spent by children on physical activity during the day. The result is an increasing frequency of childhood obesity, which has become one of the most common chronic diseases of childhood. Furthermore, the treatment of obesity in childhood is quite difficult, and the most common problem is non-compliance with obesity treatment. The path that will facilitate the adaptation to treatment comprises nutrition regulation and increased daily physical activity and psychological support. Diet alone leads to a significant reduction in both fat and non-fat body mass. However, adding exercise to dietary therapy improves weight loss by maintaining non-fat body mass. Even though exercise alone has little effect on weight loss, it provides a significant reduction in mortality. Moreover, regular physical exercise is also an important factor in regulating body composition during growth. However, changes in the child's body during growth affect the motor power and performance, so it is necessary to plan the exercise according to the individual characteristics, age and sex of the child. Short-term frequent exercises are more entertaining and more accessible forms of exercise (dancing at home) for children, and enhance compliance with treatment. Starting treatment as soon as possible will also increase behavioral effectiveness and compliance. This paper focuses on the basics of exercise therapy, which is extremely beneficial for both healthy and obese children., Competing Interests: Conflict of Interest: No conflict of interest was declared by the author., (Copyright: © 2020 Turkish Archives of Pediatrics.)

An educational program, consisting in a clear explanation of the technical aspects and use of the adrenaline auto-injection devices (AAD) and in a practical test utilizing a demonstration kit was given to 350 patients from our outpatient clinic. AAD was also distributed to 50 patients formerly followed by another allergy clinic without training. At practical control test, only 10% of the untrained patients where able to correctly use the AAD versus 80% of trained subjects. Since AAD is a life-saving procedure in severe anaphylactic episodes, this attempt to improve the ability of the patient to comply with the procedure can improve the efficacy of the treatment and eventually the patient's health.

In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic, and clinical characteristics, between patients with different levels of awareness of illness (insight). The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behavior. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic, and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.

Patient empowerment is considered to be one of the key factors in improving and maintaining a patient's health status. Patient empowerment in chronic illnesses involves educating the patient after the initial diagnosis and then keeping the patient motivated to adhere to the treatment in the follow up period. The aim of this research is creating an interactive framework to improve adherence to treatment in type 1 diabetic (T1D) patients based on an existing theoretical behavioral change model. The proposed framework learns from the patient's situation based on the patient's adherence to treatment and the patient's personal profile; and then the framework adapts itself to the new situation and creates new strategies to motivate the patient in order to reinforce positive behavior on the part of the patient. Thus, the embedded self-care interactive framework empowers T1D patients in achieving improved health outcomes by adhering to long term treatments.