Introduction: Tuberculosis is a global health problem. Improving medication adherence is an important attribute concerning the outcome of tuberculosis treatment. This study investigates illness experience of patients ...Introduction: Tuberculosis is a global health problem. Improving medication adherence is an important attribute concerning the outcome of tuberculosis treatment. This study investigates illness experience of patients belonging to a low-income district within Manguinhos catchment area. Narrative studies are able to unfold features concerning patient adherence and co-occurrence of depressive symptoms. Methods: Twenty-three patients under treatment were interviewed using McGill Illness Narrative Interview (MINI-McGILL), besides depression screening with “Self-Report Questionnaire-20” (SRQ-20) and “Beck Depression Inventory” (BDI). Results: Explanatory models disregarded airborne microorganism contagion, known but not considered relevant while bohemian or deviant lifestyle was rather perceived as a causal model. Patients mentioned contiguous events suggesting pneumonia or influenza misdiagnosis before final tuberculosis diagnosis (testing or suspicion). Therapeutic pathways were erratic, suggesting low literacy level and postponed or inadequate diagnosis accuracy. Emergency units or private services usually stood for primary care units considered first choice by planners. Expressions such as “dreadful/shameful disease” or “very heavy illness” acknowledged stigma. Research data detected the importance of social network role, highlighting the family through financial and affective support. Hopelessness and depression were closely related to illness suffering and adversities. The percentage of patients for positive common mental disorder and depression approaches 30%. Conclusion: Tuberculosis remains a stigmatizing disease. Building effective health services networks, comprising treatment facilities, community and family resources are very important to improve medication adherence. Effective tuberculosis management through health teams training seems necessary. Incorporating simple screening instruments for depression assessment might promote well-being and patient adherence.展开更多
AIM To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients. METHODS The study examined the psychological variables ...AIM To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients. METHODS The study examined the psychological variables likely responsible for the non-adherent behavior using a psychological-psychiatric assessment, evaluation of the perception of patients' health status, and an interview regarding the anti-rejection drug therapy assumption. The study included 74 kidney transplant recipients. RESULTS Individuals with a higher level of education and more years since transplantation showed better mental balance. Regarding gender, women appeared to be less adherent to therapy. Further, the years since transplantation adversely affected the proper pharmacological assumption. Adherence to therapy did not significantly change with the mental health index. CONCLUSION The biopsychosocial illness model provides a conceptualframe of reference in which biological, psychological, and social aspects take on the same importance in the adherence to treatment protocols. For effective management, it is necessary to understand the patients' personal experiences, their assumptions about the disease, health status perception, and mood, and to identify any "barriers" that could cause them to become noncompliant.展开更多
文摘Introduction: Tuberculosis is a global health problem. Improving medication adherence is an important attribute concerning the outcome of tuberculosis treatment. This study investigates illness experience of patients belonging to a low-income district within Manguinhos catchment area. Narrative studies are able to unfold features concerning patient adherence and co-occurrence of depressive symptoms. Methods: Twenty-three patients under treatment were interviewed using McGill Illness Narrative Interview (MINI-McGILL), besides depression screening with “Self-Report Questionnaire-20” (SRQ-20) and “Beck Depression Inventory” (BDI). Results: Explanatory models disregarded airborne microorganism contagion, known but not considered relevant while bohemian or deviant lifestyle was rather perceived as a causal model. Patients mentioned contiguous events suggesting pneumonia or influenza misdiagnosis before final tuberculosis diagnosis (testing or suspicion). Therapeutic pathways were erratic, suggesting low literacy level and postponed or inadequate diagnosis accuracy. Emergency units or private services usually stood for primary care units considered first choice by planners. Expressions such as “dreadful/shameful disease” or “very heavy illness” acknowledged stigma. Research data detected the importance of social network role, highlighting the family through financial and affective support. Hopelessness and depression were closely related to illness suffering and adversities. The percentage of patients for positive common mental disorder and depression approaches 30%. Conclusion: Tuberculosis remains a stigmatizing disease. Building effective health services networks, comprising treatment facilities, community and family resources are very important to improve medication adherence. Effective tuberculosis management through health teams training seems necessary. Incorporating simple screening instruments for depression assessment might promote well-being and patient adherence.
文摘AIM To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients. METHODS The study examined the psychological variables likely responsible for the non-adherent behavior using a psychological-psychiatric assessment, evaluation of the perception of patients' health status, and an interview regarding the anti-rejection drug therapy assumption. The study included 74 kidney transplant recipients. RESULTS Individuals with a higher level of education and more years since transplantation showed better mental balance. Regarding gender, women appeared to be less adherent to therapy. Further, the years since transplantation adversely affected the proper pharmacological assumption. Adherence to therapy did not significantly change with the mental health index. CONCLUSION The biopsychosocial illness model provides a conceptualframe of reference in which biological, psychological, and social aspects take on the same importance in the adherence to treatment protocols. For effective management, it is necessary to understand the patients' personal experiences, their assumptions about the disease, health status perception, and mood, and to identify any "barriers" that could cause them to become noncompliant.
