BackgroundDespite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence.MethodsA cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire.ResultsNon-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73).ConclusionThe results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new questionnaire is presented and may help to evaluate systematically the patients regarding PB adherence in hemodialysis setting.

Background Due to the COVID-19 pandemic, a large portion of oncology consultations have been conducted remotely. The maladaptation or compromise of care could negatively impact oncology patients and their disease management. Objective We aimed to describe the development and implementation process of a web-based, animated patient education tool that supports oncology patients remotely in the context of fewer in-person interactions with health care providers. Methods The platform created presents multilingual oncology care instructions. Animations concerning cancer care and mental health during the COVID-19 pandemic as well as immunotherapy and chemotherapy guides were the major areas of focus and represented 6 final produced video guides. Results The videos were watched 1244 times in a period of 6 months. The most watched animation was the COVID-19 & Oncology guide (viewed 565 times), followed by the video concerning general treatment orientations (viewed 249 times) and the video titled “Chemotherapy” (viewed 205 times). Although viewers were equally distributed among the age groups, most were aged 25 to 34 years (342/1244, 27.5%) and were females (745/1244, 59.9%). Conclusions The implementation of a patient education platform can be designed to prepare patients and their caregivers for their treatment and thus improve outcomes and satisfaction by using a methodical and collaborative approach. Multimedia tools allow a portion of a patient’s care to occur in a home setting, thereby freeing them from the need for hospital resources.

O estudo em questão considera o suicídio um problema de saúde pública, um acontecimento complexo desencadeado pela influência de fatores estressores sobre o indivíduo. O objetivo deste artigo é avaliar o componente social nas mortes por suicídio, pela análise de indicadores socioeconômicos. Trata-se de um estudo do tipo ecológico exploratório que busca a associação entre dez indicadores socioeconômicos e a taxa de suicídio em todas as capitais do país. Os dados utilizados foram obtidos no DATASUS e no Atlas de Desenvolvimento Humano no Brasil do IBGE, referentes ao ano 2000. Os resultados apontam que a taxa de mortalidade por suicídio variou de 0,77 / 100 mil habitantes em Salvador (BA) a 14,04 / 100 mil habitantes em Boa Vista (AC). O sexo masculino apresenta risco relativo 3,7 vezes maior de cometer suicídio do que o feminino. A faixa etária de 15 a 29 anos apresentou menor risco relativo de cometer suicídio, enquanto o maior risco relativo foi encontrado na população com idade igual ou superior a 60 anos. Ambos os indicadores de desigualdade social (Índice de Gini e Índice L de Theil) apresentaram correlação negativa com a taxa de mortalidade por suicídio, com significância estatística (rs = -0,479, p = 0,011 e rs = -0,403, p = 0,037, respectivamente). Concluiu-se que há associação entre os indicadores de desigualdade social e as taxas de suicídio. Nenhum outro indicador socioeconômico apresentou correlação, o que leva a acreditar que a origem e o amadurecimento do pensamento suicida parecem sofrer influência preponderante de fatores biopsicológicos.

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UNSTRUCTURED The recent Coronavirus (COVID-19) pandemic has caused a large portion of oncology consultation to be conducted remotely. Maladaptation or compromises of care resulted could negatively impact oncology patients and their disease management. We herein describe the development and implementation process of an online animated patient education tool that could support patients with reduced in-person interactions with their health care providers. The platform presents multilingual oncology care instructions and infection prevention during COVID adapted to patient’s literacy level, developed through multi-layered interdisciplinary collaboration. It serves to support oncology patient in the growing telemedicine and virtual care environment through strengthening the patient-activation, self-efficacy and emotional well-being.

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Health literacy, culture and language play vital roles in patients’ understanding of health issues. Obstacles are more evident in low- and middle-income countries (LMICs), where inadequate patient education levels are higher and hospital resources are lower. This is a prospective pilot study assessing the feasibility of digital preoperative animations as guides for surgical patients. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Thirty-four patients were included, and 26 patients concluded the intervention (76.5% acceptability rate). Demographic factors seemed to affect the results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. Few studies have evaluated the use of multimedia resources for surgical patients, and no studies assessed the use of animations as digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based approach is proposed to aid the implementation of patient education digital interventions. The use of digital multimedia animations as preoperative guides in LMICs is feasible. It may help improve patient education and promote clinical benefits.

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