Página 1 dos resultados de 668 itens digitais encontrados em 0.023 segundos

Análise de domínios reforçados através da combinação MEC/MEF considerando modelos de aderência; Reinforced Domains Analysis throughBEM/FEM Combination Considering Adherence Models

Rocha, Fabio Carlos da
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 02/10/2009 Português
Relevância na Pesquisa
67.367705%
Neste trabalho, uma combinação do Método dos Elementos de Contorno (MEC) com o Método dos Elementos Finitos (MEF) é apresentada para análise bidimensional de sólidos elastostáticos reforçados, sendo considerados modelos de aderência no acoplamento. O elemento de contorno é adotado para modelar o comportamento do domínio, enquanto que o modelo por elementos finitos é utilizado para modelar o enrijecedor. Devido às singularidades nas equações integrais do MEC, estudou-se o erro ocasionado pelos integrandos de ordem e e como conseqüência sugerem-se, neste trabalho, equações mais simples para representar o erro das integrações. Para a formulação do acoplamento, um polinômio do terceiro grau é adotado para aproximar tanto o campo de deslocamento quanto a rotação do enrijecedor, enquanto aproximações lineares são usadas para representar a força de contato entre o domínio e o enrijecedor. Modelos de escorregamento, apresentados, são lineares e governados em função do carregamento escrito em termos das forças de contato e o deslocamento relativo. A partir da combinação entre o MEC e o MEF obtém-se uma matriz retangular contendo duas equações para o MEC e uma para o MEF. O resultado das equações algébricas redundantes é eliminado pela aplicação do procedimento dos mínimos quadrados. Exemplos ilustram o bom ajuste e os melhores resultados proporcionados pelo controle do erro das equações integrais...

Monitoração de modelos físicos reduzidos para investigação do comportamento de estruturas em escala real.; Monitoring reduced physical models to investigate the behavior of real structures.

Ticona Melo, Ladislao Roger
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 04/08/2011 Português
Relevância na Pesquisa
36.79721%
Esta pesquisa apresenta a monitoração de modelos reduzidos para a investigação do comportamento de estruturas. O estudo do comportamento estrutural consistiu basicamente na medição de grandezas físicas de forma experimental, para o qual os modelos físicos reduzidos foram submetidos a múltiplos ensaios em laboratório. Posteriormente, os dados experimentais foram tratados e analisados, para então serem comparados com os resultados dos modelos teóricos, avaliando assim, sua capacidade de simulação. No total foram monitorados três modelos reduzidos, cujas grandezas físicas foram medidas utilizando-se sensores elétricos, tais como: extensômetros, LVDTs e um servoatuador hidráulico, os quais estavam ligados ao sistema de aquisição da National Instrument, controlado por um computador de comando e pelos programas LabView e DynaTester. Um dos modelos construído em alumínio foi utilizado a fim de se estudar o comportamento da ponte do rio Suaçui, assim como calibrar os modelos teóricos em função dos dados experimentais da estrutura real e do modelo reduzido e estabelecer uma relação entre eles. Os outros dois modelos construídos em microconcreto foram utilizados para estudar o comportamento de estruturas na fase não linear e em fratura...

Adesão ao agente antidiabético oral de pessoas com Diabetes mellitus: uso do Brief Medication Questionnaire; Adherence to oral antidiabetic agent in people with diabetes mellitus: use of the Brief Medication Questionnaire

Istilli, Plinio Tadeu
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 10/07/2014 Português
Relevância na Pesquisa
37.19148%
Trata-se de um estudo observacional transversal, com o objetivo avaliar a adesão aos agentes antidiabéticos orais de pessoas com Diabetes mellitus com o uso do Brief Medication Questionnaire. O estudo foi realizado no Centro de Saúde Escola Prof. Dr. Joel Domingos Machado. Participaram do estudo 60 pacientes que participavam do Programa de Apoio Telefônico em Diabetes mellitus e utilizavam o agente antidiabético oral no seu tratamento. A coleta de dados foi realizada de maio a outubro de 2013, e o trabalho foi aprovado pelo Comitê de Ética e Pesquisa em Humanos da Escola de Enfermagem de Ribeirão Preto, parecer número: 324.098. Para a coleta de dados foi utilizado um questionário contendo variáveis sociodemográficas e clínicas, e o Brief Medication Questionnaire. Para análise, utilizou-se estatística descritiva, Teste Exato de Fisher e a quantificação desta associação foi mensurada por meio de modelos de regressão logística. Os resultados mostraram que os pacientes tinham de 31 a 87 anos, com predomínio do sexo feminino (58,3%), a maioria era casada (75,0%), 53,3% eram aposentados e média de estudo era de 6,7 anos. Para as variáveis clínicas: o tempo de diagnóstico mais prevalente foi de 11 a 20 anos e entre as comorbidades referidas a hipertensão arterial sistêmica foi presente em 75...

O desenvolvimento da confiança nas comunidades terapêuticas e o seu impacto na adesão ao tratamento; The development of trust in therapeutic communities and its impact on treatment adherence

Machado, Luís A.; Veloso, Ana Luísa de Oliveira Marques
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
Relevância na Pesquisa
37.043276%
A confiança é reconhecida como um elemento essencial para o estabelecimento da relação terapêutica, com um importante impacto na adesão ao tratamento. No entanto, existem poucos estudos e modelos teóricos que permitam a sua conceptualização e mensuração neste contexto. A presente investigação tem como objectivo estudar o desenvolvimento da confiança nas Comunidades Terapêuticas e o seu impacto na adesão ao tratamento. Foi adoptada uma metodologia mista e participaram nesta investigação, 231 sujeitos distribuídos por nove Comunidades Terapêuticas. Os resultados mostram a existência de dois níveis de confiança (na relação dos residentes com os técnicos e com as instituições) e apresentam-na como um elemento fundamental para o desenvolvimento da relação terapêutica e para a adesão ao tratamento.; Trust is recognized as an essential element for the establishment of therapeutic relationship and has a major impact on treatment adherence. However, there are few studies and theoretical models which allow its conceptualization and measurement within this context. This research aims to study the development of trust in Therapeutic Communities and its impact on treatment adherence. It was adopted a mixed methodology and 231 subjects spread over nine Therapeutic Communities participated of the study. The results show the existence of two levels of trust (with the technical staff and with the institutions) and present it as a key element for developing therapeutic relationship and treatment adherence.

Association of Ongoing Drug and Alcohol Use with Non-Adherence to Antiretroviral Therapy and Higher Risk of AIDS and Death: Results from ACTG 362

COHN, Susan E.; JIANG, Hongyu; MCCUTCHAN, J. Allen; KOLETAR, Susan L.; MURPHY, Robert L.; ROBERTSON, Kevin R.; DESTMAURICE, Annabelle; CURRIER, Judith S.; WILLIAMS, Paige L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2011 Português
Relevância na Pesquisa
27.51591%
Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997–1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR=2.11...

How Qualitative Methods Contribute to Understanding Combination Antiretroviral Therapy Adherence

Sankar, Andrea; Golin, Carol; Simoni, Jane M.; Luborsky, Mark; Pearson, Cynthia
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 01/12/2006 Português
Relevância na Pesquisa
37.135452%
Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods...

Free HIV Antiretroviral Therapy Enhances Adherence among Individuals on Stable Treatment: Implications for Potential Shortfalls in Free Antiretroviral Therapy

Byakika-Tusiime, Jayne; Polley, Eric C.; Oyugi, Jessica H.; Bangsberg, David R.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
27.490942%
Objective: To estimate the population-level causal effect of source of payment for HIV medication on treatment adherence using Marginal Structural Models. Methods: Data were obtained from an observational cohort of 76 HIV-infected individuals with at least 24 weeks of antiretroviral therapy treatment from 2002 to 2007 in Kampala, Uganda. Adherence was the primary outcome and it was measured using the 30-day visual analogue scale. Marginal structural models (MSM) were used to estimate the effect of source of payment for HIV medication on adherence, adjusting for confounding by income, duration on antiretroviral therapy (ART), timing of visit, prior adherence, prior CD4+ T cell count and prior plasma HIV RNA. Traditional association models were also examined and the results compared. Results: Free HIV treatment was associated with a 3.8% improvement in adherence in the marginal structural model, while the traditional statistical models showed a 3.1–3.3% improvement in adherence associated with free HIV treatment. Conclusion: Removing a financial barrier to treatment with ART by providing free HIV treatment appears to significantly improve adherence to antiretroviral therapy. With sufficient information on confounders, MSMs can be used to make robust inferences about causal effects in epidemiologic research.

Improving adherence to antiretroviral treatment in Uganda with a low-resource facility-based intervention

Obua, Celestino; Kayiwa, Joshua; Waako, Paul; Tomson, Göran; Balidawa, Hudson; Chalker, John; Ross-Degnan, Dennis; Wahlstrom, Rolf
Fonte: Co-Action Publishing Publicador: Co-Action Publishing
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
37.2715%
Objective: To assess the effects of facility-based interventions using existing resources to improve overall patient attendance and adherence to antiretroviral therapy (ART) at ART-providing facilities in Uganda. Methods: This was an interventional study which tracked attendance and treatment adherence of two distinct cohorts: experienced patients who had been on treatment for at least 12 months prior to the intervention and patients newly initiated on ART before or during the intervention. The interventions included instituting appointment system, fast-tracking, and giving longer prescriptions to experienced stable patients. Mixed-effects models were used to examine intervention effects on the experienced patients, while Cox proportional hazards models were used to determine the intervention effects on time until newly treated patients experienced gaps in medication availability. Results: In all, 1481 patients’ files were selected for follow-up from six facilities – 720 into the experienced cohort, and 761 into the newly treated cohort. Among patients in the experienced cohort, the interventions were associated with a significant reduction from 24.4 to 20.3% of missed appointments (adjusted odds ratio (AOR): 0.67; 95% confidence interval (CI): 0.59–0.77); a significant decrease from 20.2 to 18.4% in the medication gaps of three or more days (AOR: 0.69; 95% CI: 0.60–0.79); and a significant increase from 4.3 to 9.3% in the proportion of patients receiving more than 30 days of dispensed medication (AOR: 2.35; 95% CI: 1.91–2.89). Among newly treated patients...

Psychosocial Predictors of Non-Adherence and Treatment Failure in a Large Scale Multi-National Trial of Antiretroviral Therapy for HIV: Data from the ACTG A5175/PEARLS Trial

Safren, Steven A.; Biello, Katie B.; Smeaton, Laura; Mimiaga, Matthew J.; Walawander, Ann; Lama, Javier R.; Rana, Aadia; Nyirenda, Mulinda; Kayoyo, Virginia M.; Samaneka, Wadzanai; Joglekar, Anjali; Celentano, David; Martinez, Ana; Remmert, Jocelyn E.; Na
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
37.544343%
Background: PEARLS, a large scale trial of antiretroviral therapy (ART) for HIV (n = 1,571, 9 countries, 4 continents), found that a once-daily protease inhibitor (PI) based regimen (ATV+DDI+FTC), but not a once-daily non-nucleoside reverse transcriptase inhibitor/nucleoside reverse transcriptase inhibitor (NNRTI/NRTI) regimen (EFV+FTC/TDF), had inferior efficacy compared to a standard of care twice-daily NNRTI/NRTI regimen (EFV+3TC/ZDV). The present study examined non-adherence in PEARLS. Methods: Outcomes: non-adherence assessed by pill count and by self-report, and time to treatment failure. Longitudinal predictors: regimen, quality of life (general health perceptions = QOL-health, mental health = QOL-mental health), social support, substance use, binge drinking, and sexual behaviors. “Life-Steps” adherence counseling was provided. Results: In both pill-count and self-report multivariable models, both once-a-day regimens had lower levels of non-adherence than the twice-a-day standard of care regimen; although these associations attenuated with time in the self-report model. In both multivariable models, hard-drug use was associated with non-adherence, living in Africa and better QOL-health were associated with less non-adherence. According to pill-count...

Learning Data-Driven Models of Non-Verbal Behaviors for Building Rapport Using an Intelligent Virtual Agent

Amini, Reza
Fonte: FIU Digital Commons Publicador: FIU Digital Commons
Tipo: Artigo de Revista Científica Formato: application/pdf
Português
Relevância na Pesquisa
36.623938%
There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness. Evidence-based patient-centered Brief Motivational Interviewing (BMI) interven- tions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap...

Tailored expectant management: risk factors for non-adherence

van den Boogaard, N.; Oude Rengerink, K.; Steures, P.; Bossuyt, P.; Hompes, P.; van der Veen, F.; Mol, B.; van der Steeg, J.
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
Relevância na Pesquisa
37.238384%
INTRODUCTION Prediction models for spontaneous pregnancy are useful tools to prevent overtreatment, complications and costs in subfertile couples with a good prognosis. The use of such models and subsequent expectant management in couples with a good prognosis are recommended in the Dutch fertility guidelines, but not fully implemented. In this study, we assess risk factors for non-adherence to tailored expectant management. METHODS Couples with mild male, unexplained and cervical subfertility were included in this multicentre prospective cohort study. If the probability of spontaneous pregnancy within 12 months was ≥40%, expectant management for 6–12 months was advised. Multivariable logistic regression was used to identify patient and clinical characteristics associated with non-adherence to tailored expectant management. RESULTS We included 3021 couples of whom 1130 (38%) had a ≥40% probability of a spontaneous pregnancy. Follow-up was available for 1020 (90%) couples of whom 214 (21%) had started treatment between 6 and 12 months and 153 (15%) within 6 months. A higher female age and a longer duration of subfertility were associated with treatment within 6 months (OR: 1.06, 95% CI: 1.01–1.1; OR: 1.4; 95% CI: 1.1–1.8). A fertility doctor in a clinical team reduced the risk of treatment within 6 months (OR: 0.62; 95% CI: 0.39–0.99). CONCLUSIONS In couples with a favorable prognosis for spontaneous pregnancy...

Adherence to rescreening for colorectal cancer with faecal occult blood testing.

Duncan, Amy Claire
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2012 Português
Relevância na Pesquisa
37.27656%
This thesis aimed to describe and predict adherence to Faecal Occult Blood Test (FOBT) rescreening recommendations in South Australia. Specifically this thesis aimed to determine the relevance of social cognitive variables for explaining variations in rescreening adherence. FOBT screening for colorectal cancer (CRC) is recommended every one to two years for those over the age of 50; reductions in incidence and mortality from CRC are dependent on continued compliance with these guidelines. Whilst there has been substantial research on factors associated with initial screening participation, there has been very little research conducted on how to encourage rescreening adherence (i.e., continued participation in annual or biennial screening offers). The few studies that have examined predictors of rescreening have, to date, limited their exploration to demographic and health systems factors. This thesis aims to determine the relevance of the inclusion of behavioural factors previously associated with initial screening (i.e., social cognitive variables) for explaining rescreening and also to explore potential new predictors of rescreening not previously examined in CRC rescreening research. The thesis used a sequential, mixed-methods research design to address the aims. Three separate studies...

Medical decision-making, adherence and quality of life in people living with HIV/AIDS; Therapieentscheidung, Adhärenz und Lebensqualität von Menschen mit HIV/AIDS

Kremer, Heidemarie
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
Português
Relevância na Pesquisa
37.21199%
Introduction: The purpose of this study is to describe the decision about antiretroviral therapy (ART) from the perspective of people living with HIV/AIDS (PWHA) and to develop models to reduce decisional conflict and to optimize the quality of life in PWHA. Methods: 79 HIV+ people who had been offered ART by their physicians participated. In the qualitative part of this study, interviews on reasons and sources of information for decision-making and patient-physician relationship were evaluated with qualitative content analysis. In the quantitative part of this study, questionnaires examined preferred and perceived role in decision-making (Control Preferences Scale), decisional conflict (Decisional Conflict Scale), adherence and symptoms of HIV/ART (ACTG Adherence Questionnaire), quality of life (HIV/AIDS Targeted Quality of Life), depression (Beck Depression Inventory), perceived stress (Perceived Stress Scale), patient-physician relationship (Doctor-Patient Relationship) and beliefs about medicines (Beliefs about Medicines Questionnaire). Results: Qualitative: Seventy-three percent decided to take ART, and 27% decided not to take ART. Ten criteria were important: Surrogate markers (87%), quality of life (85%), knowledge/beliefs about resistance (66%)...

Adherence in transplantated patients.; Adesão nos doentes transplantados.

Telles-Correia, Diogo; Unidade de Apoio Psiquiátrico ao Transplante, Centro Hepato-Bilio-Pancreático e de Transplantação, Hospital Curry Cabral, Lisboa, Portugal.; Barbosa, António; Mega, Inês; Barroso, Eduardo; Monteiro, Estela
Fonte: Ordem dos Médicos Publicador: Ordem dos Médicos
Tipo: info:eu-repo/semantics/article; article; article; info:eu-repo/semantics/publishedVersion Formato: application/pdf
Publicado em 23/05/2007 Português
Relevância na Pesquisa
27.55357%
There is a lot evidence about the importance adherence in the transplantated patients. Many theoretical models that can me used to predict adherence, the more important are: the communication model of compliance (Ley), the health belief model (Rosenstock, Becker), and the autoregulation model (Leventhal). The authors explore these models and sugest the one wich is more useful in transplantated patients. It is not possible to classify adherence in a monodimensional way, therefore it is useful to consider several catacteristics like timing (early, late, continuous), frequency (occasional, intermittent, persistant, complete), origin (accidental, invulnerable, decisive) and diagnostic certaincy (definite, probable, possible, unlikely). There are many ways to mesure adherence. These can be classified in direct methods (assays of drug concentrations, use of markers incorporated into pills, direct observation of pill taking) and indirect methods (patient self-reports, compliance ratings by doctors). The authors describe the various methods and suggest the ones that best suite transplantated patients. The non-adherence in transplantated patients is very common, it's medium prevalence is 25,28%, and can be influenced by many factors: demographic (age...

Adapatação cultural e avaliação das propriedades de medida da "Self_Efficacy for Appropriate Medication Adherence Scale - SEAMS"; Cultural adaptation and evaluation of measurement of "Self-Efficacy for Appropriate Medication Adherence Scale - SEAMS"

Rafaela Batista dos Santos Pedrosa
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 07/07/2014 Português
Relevância na Pesquisa
37.135452%
Este estudo tem como objetivo disponibilizar uma versão da Self-efficacy for Appropriate Medication Adherence Scale ¿ SEAMS para a cultura brasileira e avaliar suas propriedades de medida quando aplicada em pacientes com doença arterial coronária (DAC) em seguimento ambulatorial.. O processo de adaptação cultural foi realizado de acordo com as etapas propostas na literatura - tradução, síntese, retrotradução, avaliação por comitê de especialistas e pré-teste, seguidos pela avaliação da praticabilidade, aceitabilidade, confiabilidade e validade. Fizeram parte deste estudo 147 pacientes com DAC em uso de medicamentos cardioprotetores e de alívio dos sintomas, em seguimento ambulatorial em hospital universitário do interior do estado de São Paulo. Os dados foram obtidos por meio de entrevista e aplicação de instrumento de caracterização sociodemográfica/clínica e das versões brasileiras da Morisky Self-Reported Measure of Medication Adherence Scale (MMAS-4), da General Perceived Self-Efficacy Scale (GSE) e da SEAMS. A praticabilidade foi avaliada pelo tempo despendido na entrevista e a aceitabilidade pela proporção de pacientes que responderam a todos os itens do instrumento. Foi estimada a confiabilidade no que se refere à consistência interna e estabilidade da medida. A validade de construto foi estimada pela evidência correlacional entre os escores da versão brasileira da SEAMS...

Patient, Physician, and Payment Predictors of Statin Adherence

Chan, David Chimin; Shrank, William H.; Cutler, David M.; Jan, Saira; Fischer, Michael Adam; Liu, Jun; Avorn, Jerry Lewis; Solomon, Daniel Hal; Brookhart, Alan; Choudhry, Niteesh K
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
37.568118%
BACKGROUND: Although many patient, physician, and payment predictors of adherence have been described, knowledge of their relative strength and overall ability to explain adherence is limited. OBJECTIVES: To measure the contributions of patient, physician, and payment predictors in explaining adherence to statins RESEARCH DESIGN: Retrospective cohort study using administrative data SUBJECTS: 14,257 patients insured by Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) who were newly prescribed a statin cholesterol-lowering medication MEASURES: Adherence to statin medication was measured during the year after the initial prescription, based on proportion of days covered (PDC). The impact of patient, physician, and payment predictors of adherence were evaluated using multivariate logistic regression. The explanatory power of these models was evaluated with C statistics, a measure of the goodness of fit. RESULTS: Overall, 36.4% of patients were fully adherent. Older patient age, male gender, lower neighborhood percent black composition, higher median income, and fewer number of emergency department (ED) visits were significant patient predictors of adherence. Having a statin prescribed by a cardiologist, a patient's primary care physician...

Differentiated risk models in portfolio optimization: a comparative analysis of the degree of diversification and performance in the São Paulo Stock Exchange (BOVESPA)

Gartner,Ivan Ricardo
Fonte: Sociedade Brasileira de Pesquisa Operacional Publicador: Sociedade Brasileira de Pesquisa Operacional
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2012 Português
Relevância na Pesquisa
36.79721%
Faced with so many risk modeling alternatives in portfolio optimization, several questions arise regarding their legitimacy, utility and applicability. In particular, a question arises involving the adherence of the alternative models with regard to the basic presupposition of Markowitz's classical model, with regard to the concept of diversification as a means of controlling the relationship between risk and return within a process of optimization. In this context, the aim of this article is to explore the risk-differentiated configurations that entropy can provide, from the point of view of the repercussions that these have on the degree of diversification and on portfolios performance. The reach of this objective requires that a comparative analysis is made between models that include entropy in their formulation and the classic Markowitz model. In order to contribute to this debate, this article proposes that adaptations are made to the models of relative minimum entropy and of maximum entropy, so that these can be applied to investment portfolio optimizations. The comparative analysis was based on performance indicators and on a ratio of the degree of portfolio diversification. The portfolios were formed by considering a sample of fourteen assets that compose the IBOVESPA...

Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital

Bruce,Suliasnaia P.; Acheampong,Franklin; Kretchy,Irene
Fonte: Pharmacy Practice (Granada) Publicador: Pharmacy Practice (Granada)
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/03/2015 Português
Relevância na Pesquisa
37.21199%
Background: The burden of diabetes mellitus, especially Type-2, continues to increase across the world. Medication adherence is considered an integral component in its management. Poor glycemic controls due to medication nonadherence accelerates the development of long-term complications which consequently leads to increased hospitalization and mortality. Objective: This study examined the level of adherence to oral antidiabetic drugs among patients who visited the teaching hospital and explored the probable contributory factors to non-adherence. Methods: A cross-sectional descriptive study using systematic sampling to collect quantitative data was undertaken. Questionnaires were administered to out-patients of the medical department of a teaching hospital in Ghana. Logistic regression was performed with statistical significance determined at p<0.05. Results: A total of 200 diabetic patients participated in the study. Using the Morisky Medication Adherence scale, the level of adherence determined was 38.5%. There were significant correlations between level of adherence and educational level [(OR)=1.508; (CI 0.805- 2.825), P=0.019), and mode of payment [(OR)=1.631; (CI 0.997- 2.669), P=0.05). Conclusion: Adherence in diabetic patients was low among respondents and this can be improved through education...

An economic evaluation of anticipated costs and savings of a behavior change intervention to enhance medication adherence

Wiegand,Phillip N.; Wertheimer,Albert I.
Fonte: Pharmacy Practice (Internet) Publicador: Pharmacy Practice (Internet)
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/06/2008 Português
Relevância na Pesquisa
37.135452%
Medication adherence across disease states is generally poor. Research has focused on various methods to improve medication adherence, but there is little conclusive evidence regarding specific methods efficacy. The Transtheoretical Model for Behavior Change has been used to modify existing addictive behaviors but not in medication adherence specifically. As a behavioral component is inherently related to medication adherence, it is thought that this model may be applicable. Objective: The purpose of this research is to evaluate the costs and savings of implementing a novel behavioral intervention against the cost of poor medication adherence to determine whether further development is realistic. Methods: The basic tools required to administer this intervention were determined through primary literature review and priced by vendors supplying such materials. Diabetes Mellitus Type 2 (DM2) was used as a vehicle to establish the cost of care for long-term complications of a chronic disease. The primary literature provided information regarding the cost of care for DM2 morbidity and outpatient annual drug therapy expenditure. The total cost of the behavioral intervention components and the cost of care for DM2 morbidity were applied to a theoretical cohort of 1000 patients. By dividing this cost across 1000 patients...

Adherence: a review of education, research, practice, and policy in the United States

Rickles,Nathaniel M.; Brown,Todd A.; McGivney,Melissa S.; Snyder,Margie E.; White,Kelsey A.
Fonte: Pharmacy Practice (Internet) Publicador: Pharmacy Practice (Internet)
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/03/2010 Português
Relevância na Pesquisa
37.267043%
Objective: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States. Methods: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals. Results: Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed...