Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs.
Health-related quality of life in Spanish women with osteoporosis ABSTRACT OBJECTIVE:To analyze the health-related quality of life in patients with osteoporosis and to compare it with the overall population. METHODS:A cross-sectional descriptive study was carried out with 60 female patients of the rheumatology service at a university hospital, in Spain, from April to October 2003. The Short Form-36 (SF-36) questionnaire was applied in order to obtain demographic data, clinical characteristics and data about lifestyles related to health. Patients were classified in age groups. The statistics tests performed were Chi-square, general linear model, Student's t-test. RESULTS:The interviewees' average age was 65.57 years old (SD: ±9.7 years), and average time interval for diagnosis was 3.4±2.84 years. The best scores were in social functioning (89), emotional aspects (72.2), mental health (63), and vitality (53.7). The lowest scores were in general health (45.1), physical capacity (47.7), pain (52.3) and physical aspects (59.9). The patients' average scores were lower than the general Spanish population's scores in the following dimensions: functional capacity, physical aspects, pain and overall health status. The greatest differences between the average SF-36 scores for patients and for the overall Spanish population were in the age group ranging from 55 to 64 years old. Scores were lower or similar to the general Spanish population in all other dimensions of the questionnaire. No significant associations were found between the dimensions of the SF-36 contemplated in this study and the clinical, demographic and lifestyle data. CONCLUSIONS:The patients presented bad quality of life, particularly with respect to those dimensions that are most relevant with respect to osteoporosis, when compared with the overall Spanish population. The physical dimensions were the ones most affected.
Objectives: To clinically characterize calcifying tendonitis of the shoulder (CT) through a prospective quasi-experimental beforeand-after study, which provides a level of demonstrable evidence to support the decision-making and demonstrate the effectiveness of acetic acid iontophoresis and ultrasound in the treatment of CT. Methods: Prospective, quasi-experimental before-after intervention study was conducted on 44 patients who referred to the rehabilitation department, Santísima Trinidad's General Foundation hospital, Salamanca, from June 2014 to April 2016. Outcome measures: 1) Pain: measured by visual analogical scale (VAS); 2) calcification size: in millimetres, both measured radiologically at the beginning/end of treatment; 3) Intervention: Iontophoresis with 5% acetic acid at 4.7 mA × 10 minutes and continuous ultrasound 1 W/cm 2 /1 MHz × 5 minutes over calcification.Results: Mean age of the subjects was 54.2 years (n = 44), 65.9% female (n = 29), (95% with supraspinatus tendon (n = 38) and 5% with subscapularis (n = 2); 55% had complication in left shoulder (n = 22), 45% in right shoulder (n = 18) and 4.5% bilateral (n = 2). Regarding the occupation, 59.1% had (n = 26) administrative positions and 40.9% manual jobs (n = 18). On personal history: 34.09% were smoker (n = 15), 4.5% had diabetes (n = 2) and calcium intake secondary to osteoporosis was recorded for 2.27% (n = 1) of the subjects. Regarding radiological type: 68.18% formative (n = 30), 38.72% resorptive (n = 14) were observed. Average number of sessions was 19 and 9.01% (n = 4) of the subjects had treatment complications as intolerance/erythema/burn. Average initial pain was 7.7 points (VAS scale), significantly decreased (P = 0.0000) post treatment to 2.2. Initial average size of calcification was 10 mm and significantly decreased (P = 0.0000) post treatment to 3 mm. With respect to the change of calcification: success/cure rate was 56.8% (n = 25), improvement rate was 25% (n = 11); failure rate was 18.2% (n = 8). Conclusions: CT is common in middle-aged working females. It affects supraspinatus tendon. It is associated with smoking. Occupational risk factors are awkward positions and lifting weights. Iontophoresis with 5% acetic acid and ultrasound is a safe, simple and inexpensive technique, capable to reduce pain and calcification, with a recommended degree of scientific evidence (2B).
Background: The study was conducted to: 1) demonstrate the effectiveness of a treatment protocol with Ozone therapy in pain, function, and quality of life in patients with knee osteoarthritis; and 2) apply Ozone as a conservative treatment option with a demonstrable level of scientific evidence. Methods: This prospective quasi-experimental before-after study was conducted on 119 patients with knee osteoarthritis, having Kellgren-Lawrence grade 2 or more, who were referred to hospital of Santa Cristina's University, from January 2012 to April 2016. The protocol consisted of an intra-articular infiltration of a medical mixture of Oxygen-Ozone (95%-5%) 20mL, at a 20ug / mL concentration, during a total number of 4 sessions (once per week). Pain and quality of life were measured by visual analogical scale (VAS) and Western Ontarion and Mc Master Universities Index for osteoarthritis (WOMAC) at the beginning and end of the treatment. Results: The mean age of participants was 66.29 years. The sample was composed of 70.5% Women (n = 84) and 29.5% men (n = 35). The severity of OA according to Kellgren-Lawrence scale was 2.94°. Post-puncture erythema was 8.4% (n = 10). Pain measured by VAS significantly decreased (P < 0.0001) from the score 7.89 to 2.1. The scores of WOMAC-pain, WOMAC-stiffness, and WOMAC-function subscales decreased significantly (P < 0.0001) from 15.9 to 4.4, 3.5 to 0.9, and 49.5 to 17.6, respectively. The WOMAC total score decreased from 68.9 to 22.9 (P < 0.0001). Conclusions: Ozone is a safe medical treatment that can improve significantly pain relief, stiffness, and function in patients with knee osteoarthritis. The study shows a good level of evidence as well as a good grade of recommendation that allows us to consider Ozone as a conservative therapeutic option in the treatment of osteoarthritis of the knee.
Objetivo. Establecer la calidad de vida relacionada con la salud (CVRS) percibida por las personas con discapacidad intelectual en la provincia de (edad media: 35 años; mínima: 16; máxima: 72) . Las puntuaciones máximas obtenidas correspondieron a las dimensiones rol físico y función física (por encima de 85 puntos) y las míni-mas, a salud general y vitalidad (por debajo de 70 puntos). No se observaron diferencias significativas entre los hombres y las mujeres en ninguna de las ocho dimensiones. Las variables independientes edad, ingresos familiares, nivel educacional y necesidad de apoyo presentaron la mayor cantidad de asociaciones independientes con las dimensiones salud general, función física y función social. De los participantes, 41,5% manifestó que su salud percibida era buena. Conclusiones. Los participantes en este estudio percibieron su CVRS como buena, especialmente en las dimensiones rol físico y función física. Se deben diseñar estudios para evaluar la CVRS en personas con diferentes grados de discapacidad intelectual para contribuir a elaborar intervenciones y programas sanitarios y sociales específicos para esta población y para evaluar las intervenciones y los programas en marcha.Personas con discapacidad mental, salud del portador de deficiencia o discapacidad, calidad de vida, España. RESUMEN
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