Aims
To validate a translated and culturally adapted version of the Morisky Medication Adherence Scale for use in Spanish population, and to examine the psychometric properties of this scale in patients with type 2 diabetes mellitus in Spain.
Design
This cross-sectional study was conducted in a single university hospital in Spain. Patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, being treated with anti-diabetic medication were included.
Intervention
We used the Spanish version of the scale to measure treatment adherence.
Principal measurements
three level categorical scale is broken down into low adherence (score of <6), medium adherence (score of 6 to <8) and high adherence (score of 8). To validate the questionnaire, we measured internal consistency through Cronbach's
α
, confirmed construct validity through an exploratory principal component analysis and assessed test–retest reliability.
Results
232 patients met the inclusion criteria. The Cronbach's
α
coefficient was 0.40 (95% CI 0.28–0.52). The exploratory principal component analysis showed three components. The intraclass correlation coefficient was 0.718 (95% CI 0.564–0.823).
Conclusions
the Spanish version of the Morisky Medication Adherence scale showed low internal consistency, the exploratory factor analysis identified three dimensions, and the test–retest reliability was acceptable, therefore, psychometric properties of MMAS-8 are not suitable for measuring medication adherence in type 2 diabetes mellitus patients from Spain.
El objetivo del presente estudio fue realizar una revisión sistemática sobre los efectos de los programas de fuerza utilizados en futbolistas varones pre-adolescentes y adolescentes. Se analizaron un total de veinticinco artículos, en español o en inglés, a raíz de la búsqueda en PubMed, ISI Web of Knowledge y SportDiscus. Se encontró que el entrenamiento pliométrico, seguido del entrenamiento de fuerza-resistencia y el entrenamiento isoinercial, por ese orden, son los comúnmente empleados para el entrenamiento de fuerza en futbolistas pre-adolescentes y adolescentes. Sin embargo, en función del estado madurativo, y del bagaje motriz del jugador, parecen generar diferentes adaptaciones en estos, y por tanto, requieren de una individualización de la carga de entrenamiento en función de su nivel tanto físico, como técnico.
Abstract. The aim of the study was to do a systematic review about the effects of strength programs used in pre-adolescent and adolescent male football players. A total of twenty-five articles, in Spanish or English, were analyzed by searching PubMed, ISI Web of Knowledge and SportDiscus. Plyometric training, followed by strength-resistance training and isoinertial training, in that order, were found to be commonly used for strength training in pre-adolescent and adolescent footballers. However, depending on the maturation state, and the player's motor experience, they seem to generate different adaptations in these, and therefore, require an individualization of the training load depending on their physical and technical level.
IntroductionAdherence to treatment and hypoglycemia awareness are strongly linked to glycemic control and hypoglycemia risk in people with type 2 diabetes mellitus (T2DM). Community pharmacies are suitable facilities to detect these conditions, and should be involved in the strategies to minimize the associated risks and burden.Research design and methodsThis cross-sectional study conducted at community pharmacies across Spain assessed the prevalence of low adherence to antidiabetic treatments, the frequency of impaired hypoglycemia awareness, and their predictive factors. Adherence was measured with the 8-item Morisky Medication Adherence Scale (MMAS-8) and electronic records of dispensed treatments. The Clarke questionnaire was used to assess impaired hypoglycemia awareness. Healthcare counseling provided in the pharmacy was collected.ResultsSeventy-nine pharmacists and 618 subjects with T2DM participated in the study. Mean age in the overall T2DM population was 67 years, being the majority (69%) pensioners. Adherence was high in 41% of participants, medium in 35%, and low in 24% according to the MMAS-8. Impaired hypoglycemia awareness was observed in 25% of participants. Main determinants of low adherence were the level of education, the number of treatments per patient, hypoglycemia awareness, and the type of pharmacy. Predictive factors of impaired hypoglycemia awareness were the level of education, information on diabetes-related complications, adherence levels, and the type of pharmacy. The proportion of participants who had healthcare counseling was 71% in the overall population and 100% in subjects with impaired hypoglycemia awareness and low adherence. Healthcare counseling comprised diabetes education (69%), pharmacotherapeutic assessment (20%), and physician referrals (11%).ConclusionLack of adherence to antidiabetic treatments and impaired hypoglycemia awareness are frequent and correlate in T2DM. Community pharmacies can detect these conditions and should have an active role in the design of strategies to minimize them.
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