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Canadian Journal of Diabetes Aug 2019Physical exercise is recommended for individuals with type 1 diabetes, yet the effects of exercise on glycemic control are not well established. We evaluated the impact... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Physical exercise is recommended for individuals with type 1 diabetes, yet the effects of exercise on glycemic control are not well established. We evaluated the impact of different modes of exercise on glycemic control in people with type 1 diabetes.
METHODS
In a 3-week randomized crossover trial, 10 adults with type 1 diabetes (4 men and 6 women, aged 33±6 years; duration of diabetes, 18±10 years; glycated hemoglobin level, 7.4%±1%) were assigned to 3 weeks of intervention: aerobic exercise (treadmill at 60% of maximum volume of oxygen utilization), resistance training (8 to 12 repetitions of 5 upper and lower body exercises at 60% to 80% of 1 repetition maximum) or no exercise (control). During each exercise week, participants completed 2 monitored 45 min exercise sessions. For each week of the study, we analyzed participants' insulin pump data, sensor glucose data and meal intake using a custom smart-phone application. The primary outcome was the percentage of time in range (glucose >3.9 mmol/L and ≤10 mmol/L) for the 24 h after each bout of exercise or rest during the control week. The study was registered on ClinicalTrials.gov (NCT:02687893).
RESULTS
Aerobic exercise caused a mean glucose reduction during exercise of 3.94±2.67 mmol/L, whereas the reduction during resistance training was 1.33±1.78 mmol/L (p=0.007). The mean percentage time in range for the 24 h after resistance training was significantly greater than that during the control period (70% vs. 56%, p=0.013) but not after aerobic exercise (60%).
CONCLUSIONS
The results indicate that when various confounders are considered, resistance training could improve glycemic control in this population.
Topics: Adult; Cross-Over Studies; Diabetes Mellitus, Type 1; Exercise; Female; Follow-Up Studies; Humans; Hyperglycemia; Hypoglycemia; Male; Patient Compliance; Prognosis; Resistance Training
PubMed: 30414785
DOI: 10.1016/j.jcjd.2018.08.193 -
Journal of Parkinson's Disease 2020Exercise is increasingly being recognized as a key element in the overall management of persons living with Parkinson's disease (PD) but various (disease-specific)... (Review)
Review
Exercise is increasingly being recognized as a key element in the overall management of persons living with Parkinson's disease (PD) but various (disease-specific) barriers may impede even motivated patients to participate in regular exercise. We aimed to provide a comprehensive review of the various barriers and motivators for exercise in persons with PD. We scrutinized data on compliance-related factors published in cross-sectional studies, randomized controlled trials and reviews. We classified the barriers and motivators to exercise from a patient perspective according to the International Classification of Functioning, Disability and Health. We present an overview of the large range of potential motivators and barriers for exercise in persons with PD. Healthcare professionals should consider a wide and comprehensive range of factors, in order to identify which specific determinants matter most for each individual. Only when persons with PD are adequately motivated in a way that appeals to them and after all person-specific barriers have been tackled, we can begin to expect their long-term adherence to exercise. Such long-term compliance will be essential if exercise is to live up to its expectations, including the hope that prolonged engagement in regular exercise might help to modify the otherwise relentlessly progressive course of PD.
Topics: Attitude to Health; Exercise; Exercise Therapy; Humans; Motivation; Parkinson Disease; Patient Compliance; Self Efficacy
PubMed: 32925106
DOI: 10.3233/JPD-202247 -
Current HIV/AIDS Reports Feb 2020The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic... (Review)
Review
PURPOSE OF REVIEW
The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years.
RECENT FINDINGS
Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART. Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.
Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; China; Continuity of Patient Care; Female; HIV; Humans; Male; National Health Programs; Patient Compliance
PubMed: 31939111
DOI: 10.1007/s11904-019-00478-x -
Investigacion Y Educacion En Enfermeria Sep 2019. To determine the validity and reliability of the Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH), Spanish version, designed by Chunhua Ma et...
OBJECTIVES
. To determine the validity and reliability of the Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH), Spanish version, designed by Chunhua Ma et al.
METHODS
This study was carried out in the city of Ibagué (Colombia) and the test validation determined validity (face, content, and construct) and reliability. Face and content validity were conducted through expert judgment, using Fleiss' Kappa Coefficient statistical tests and modified Lawshe's content validity index. The construct validity and the reliability test had the participation of 220 people with diagnosis of primary hypertension. Reliability was calculated through Cronbach's alpha statistical test.
RESULTS
In the face validity, the instrument reported a Fleiss' Kappa index was 0.68 in comprehension, 0.76 in clarity, and 0.64 in accuracy, interpreted as a substantial agreement. The content validity index was satisfactory with 0.91; el exploratory factor analysis reported six factors with a total variance explained of 54%. Cronbach's alpha for the total scale was 0.74.
CONCLUSIONS
The Spanish version of the TAQPH is a valid and reliable scale to evaluate adherence to treatment in patients with primary hypertension.
Topics: Aged; Aged, 80 and over; Colombia; Female; Humans; Hypertension; Language; Male; Middle Aged; Patient Compliance; Reproducibility of Results; Surveys and Questionnaires
PubMed: 31830407
DOI: 10.17533/udea.iee.v37n3e09 -
Journal of Medical Internet Research Jul 2020Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance... (Randomized Controlled Trial)
Randomized Controlled Trial
The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial.
BACKGROUND
Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied.
OBJECTIVE
This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF).
METHODS
We conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis.
RESULTS
A total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; P=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; P=.005).
CONCLUSIONS
ITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care.
TRIAL REGISTRATION
Australian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691.
Topics: Aged; Chronic Disease; Female; Heart Failure; Humans; Male; Patient Compliance; Remote Consultation; Self-Management; Telemedicine; Treatment Outcome
PubMed: 32673222
DOI: 10.2196/17559 -
BMC Public Health Aug 2020Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore,...
An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension.
BACKGROUND
Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence.
METHODS
We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression.
RESULTS
Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes.
CONCLUSIONS
Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.
Topics: Aged; Diabetes Mellitus, Type 2; Female; Health Knowledge, Attitudes, Practice; Humans; Hypertension; Male; Middle Aged; Patient Compliance; Self Efficacy; Self-Management; Socioeconomic Factors; Surveys and Questionnaires
PubMed: 32787809
DOI: 10.1186/s12889-020-09274-4 -
Investigacion Y Educacion En Enfermeria Sep 2019To determine the factors associated with adherence to the therapeutic regime in patients with hypertension and type 2 diabetes mellitus cared for in primary care centers.
OBJECTIVES
To determine the factors associated with adherence to the therapeutic regime in patients with hypertension and type 2 diabetes mellitus cared for in primary care centers.
METHODS
This was an analytical cross-sectional study, conducted with 500 patients from two institutions in Bucaramanga (Colombia). Adherence to the therapeutic regime was measured with the label of Nursing outcomes "Treatment Behavior: Illness or Injury" and the instrument "Factors that influence on adherence to pharmacological and non-pharmacological treatments" by Ortiz Suárez was used.
RESULTS
Factors affecting negatively adherence to the therapeutic regime were: belonging to the subsidized regime, never being able to read written information about the management of their disease, and never receiving information about benefits of the medications ordered by the physician. On the contrary, positive influence was noted by referring "never" to the following statements, which impacted positively on adherence: the diverse occupations you have in and out of the house hinder your following the treatment; when your symptoms improve, do you interrupt the treatment? previously, have you had difficulties in complying with your treatment and believe there are difficult-to-change customs about foods and exercises?
CONCLUSIONS
Two socioeconomic factors and one related with the health system and staff affected negatively on adherence to the therapeutic regime, while four factors related with the therapy favored it. The factors identified could be used in the design of nursing interventions to improve adherence in this population.
Topics: Aged; Colombia; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Humans; Hypertension; Male; Middle Aged; Patient Compliance; Primary Health Care; Socioeconomic Factors
PubMed: 31830400
DOI: 10.17533/udea.iee.v37n3e02 -
International Journal of Molecular... May 2021Alcohol affects the symptoms, compliance and comorbidities as well as the safety and efficacy of treatments in psoriatic patients. In this review, we aim to summarize... (Review)
Review
Alcohol affects the symptoms, compliance and comorbidities as well as the safety and efficacy of treatments in psoriatic patients. In this review, we aim to summarize and link clinical observations with a molecular background, such as signaling pathways at the cellular level and genetic variations, and to provide an overview of how this knowledge could influence our treatment selection and patient management.
Topics: Animals; Ethanol; Genetic Predisposition to Disease; Humans; Models, Biological; Patient Compliance; Psoriasis; Translational Research, Biomedical
PubMed: 34067223
DOI: 10.3390/ijms22094987 -
Heart Failure Reviews May 2021Even though effective drugs for treating hypertension are available, a great percentage of patients have inadequate control of their blood pressure. Unwanted side... (Review)
Review
Even though effective drugs for treating hypertension are available, a great percentage of patients have inadequate control of their blood pressure. Unwanted side effects and inappropriate oral drug adherence are important factors that contribute to the global problem of uncontrolled hypertension. Vaccination could provide a revolutionary therapy with long-lasting effects, increasing patient compliance and therefore better control of high blood pressure. Nowadays, current immunization approaches against hypertension target renin, angiotensin I, angiotensin II, and angiotensin II type 1 receptor, key elements of the renin-angiotensin system. This article reviews the different vaccination attempts with proteins and peptides against the different molecules of the renin-angiotensin system in the last two decades, safety issues, and other novel prospects biomarkers in hypertension, and summarizes the potential of this immunomodulatory approach in clinical practice.
Topics: Blood Pressure; Humans; Hypertension; Medication Adherence; Renin; Renin-Angiotensin System; Vaccines
PubMed: 32995973
DOI: 10.1007/s10741-020-10033-1 -
Journal of Manipulative and... Feb 2022The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to... (Review)
Review
OBJECTIVE
The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings.
METHODS
Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance.
RESULTS
Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics.
CONCLUSIONS
Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.
Topics: Aged; Humans; Lower Extremity; Orthotic Devices; Patient Compliance; Self-Help Devices
PubMed: 35753880
DOI: 10.1016/j.jmpt.2022.04.003