RESUMO
Introduction: High blood pressure is a public health problem worldwide. In Colombia, its prevalence is 25% with a high mortality rate. The psychosocial factors affecting pharmacological adherence among patients have not been sufficiently studied and despite international evidence on their impact, in Colombia, there is a paucity of research on the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence. Objective: To examine the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence in hypertensive patients aged 45 to 70 years old in three Colombian cities between 2015 and 2016. Materials and methods: We conducted a cross-sectional study in a population of hypertensive patients. Data for this study came from the first wave of longitudinal study aimed at examining social factors associated with the control of hypertension in Bogotá, Medellín, and Quibdó. Patients with hypertension were selected randomly from a sample of those participating in the hypertension control program De todo corazón. For the statistical analysis of the data, we used factorial analysis and multivariate regressions. Results: We found a positive association between socioeconomic status and the degree of pharmacological adherence and a negative one with chronic stress. Besides, evidence was found that stress has a negative association with the degree of adherence. Conclusions: The results suggest that stress is not a likely mediator between socioeconomic status and the pharmacological adherence of hypertensive patients in Colombia. Additional studies are required to confirm these relationships with a larger sample.
Introducción. La hipertensión arterial sistémica es un problema de salud pública en el mundo. En Colombia, su prevalencia es del 25 % y la mortalidad es alta. Los factores psicosociales que afectan el cumplimiento del tratamiento farmacológico no han sido estudiados suficientemente. En otros países, se ha estudiado el papel del estrés crónico en la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo. Objetivo. Examinar el papel del estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico, en pacientes hipertensos de 45 a 70 años en el 2015 y el 2016. Materiales y métodos. Se hizo un estudio transversal de una población de pacientes hipertensos. Los datos provienen de la muestra seleccionada para el programa "De todo corazón" en Bogotá, Medellín y Quibdó. El análisis estadístico de los datos se hizo mediante análisis factorial y regresiones multivariadas. Resultados. Los resultados confirmaron una asociación positiva entre la posición socioeconómica y el grado de cumplimiento del tratamiento farmacológico, y una relación negativa entre la primera y el estrés crónico. Además, se evidenció que el estrés tiene una asociación negativa con el grado de cumplimiento. Conclusiones. Los resultados sugieren que el estrés no es un mediador entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo en Colombia. Se requieren estudios adicionales para confirmar estas relaciones con una muestra más amplia.
Assuntos
Hipertensão/psicologia , Cooperação do Paciente/psicologia , Classe Social , Determinantes Sociais da Saúde , Estresse Psicológico/psicologia , Idoso , Colômbia/epidemiologia , Estudos Transversais , Escolaridade , Feminino , Promoção da Saúde , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pobreza , Prevalência , População UrbanaRESUMO
Introducción. La hipertensión arterial sistémica es un problema de salud pública en el mundo. En Colombia, su prevalencia es del 25 % y la mortalidad es alta. Los factores psicosociales que afectan el cumplimiento del tratamiento farmacológico no han sido estudiados suficientemente. En otros países, se ha estudiado el papel del estrés crónico en la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo. Objetivo. Examinar el papel del estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico, en pacientes hipertensos de 45 a 70 años en el 2015 y el 2016. Materiales y métodos. Se hizo un estudio transversal de una población de pacientes hipertensos. Los datos provienen de la muestra seleccionada para el programa "De todo corazón" en Bogotá, Medellín y Quibdó. El análisis estadístico de los datos se hizo mediante análisis factorial y regresiones multivariadas. Resultados. Los resultados confirmaron una asociación positiva entre la posición socioeconómica y el grado de cumplimiento del tratamiento farmacológico, y una relación negativa entre la primera y el estrés crónico. Además, se evidenció que el estrés tiene una asociación negativa con el grado de cumplimiento. Conclusiones. Los resultados sugieren que el estrés no es un mediador entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo en Colombia. Se requieren estudios adicionales para confirmar estas relaciones con una muestra más amplia.
Introduction: High blood pressure is a public health problem worldwide. In Colombia, its prevalence is 25% with a high mortality rate. The psychosocial factors affecting pharmacological adherence among patients have not been sufficiently studied and despite international evidence on their impact, in Colombia, there is a paucity of research on the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence. Objective: To examine the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence in hypertensive patients aged 45 to 70 years old in three Colombian cities between 2015 and 2016. Materials and methods: We conducted a cross-sectional study in a population of hypertensive patients. Data for this study came from the first wave of longitudinal study aimed at examining social factors associated with the control of hypertension in Bogotá, Medellín, and Quibdó. Patients with hypertension were selected randomly from a sample of those participating in the hypertension control program De todo corazón. For the statistical analysis of the data, we used factorial analysis and multivariate regressions. Results: We found a positive association between socioeconomic status and the degree of pharmacological adherence and a negative one with chronic stress. Besides, evidence was found that stress has a negative association with the degree of adherence. Conclusions: The results suggest that stress is not a likely mediator between socioeconomic status and the pharmacological adherence of hypertensive patients in Colombia. Additional studies are required to confirm these relationships with a larger sample.
Assuntos
Estresse Psicológico , Hipertensão , Classe Social , Cooperação do Paciente , Colômbia , Adesão à MedicaçãoAssuntos
Estresse Psicológico , Carta , Adesão à Medicação , Classe Social , Cooperação do Paciente , Colômbia , HipertensãoRESUMO
In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.
Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Cobertura do Seguro/organização & administração , Seguro Saúde , Adulto , Colômbia , Feminino , Humanos , Cobertura do Seguro/economia , Masculino , Pessoa de Meia-IdadeRESUMO
In recent years, interest on researching on antenatal care issues and other health promotion and prevention interventions has increased. However, even though there is a growing interest in publishing about antenatal care use, evidence concerning which, and how socioeconomic conditions influence whether a pregnant woman demands or not antenatal consultations on the assumption that the theoretical access to this service has not entry barriers, is still limited. In order to generate this evidence, a two-stage analysis was performed with data gathered on the Demographic and Health Survey (DHS) carried out by Profamilia in Colombia during 2005. The first stage was run as a logistic regression model showing the marginal effects on the probability of attending the first visit and an ordinary least squares model was performed for the second stage accounting for the absences to antenatal consultations once at least one visit was carried out. It was found that mothers living in the Pacific Ocean region as well as young mothers seem to have a lower probability of attending the first visit but these factors are not related to the number of absences to antenatal consultation once the first visit has been achieved. The effect of health insurance was surprising because of the differing effects that the health insurers showed. Some familiar and personal conditions such as willingness to have the last children and number of previous children, demonstrated to be important in the determination of demand. The effect of mother's educational attainment was proved as important whereas the father's educational achievement was not. This paper provides some elements for policy making in order to increase the demand inducement of antenatal care, as well as stimulating research on demand for specific issues on health.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Colômbia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Econométricos , Gravidez , Classe SocialRESUMO
Introducción: las estadísticas vitales constituyen importantes indicadores en demografía y salud pública. En el casoespecífico del cáncer, la medición de la mortalidad es fundamental para evaluar numerosos aspectos de su epidemiología, fundamental en el diseño de estudios y políticas en cáncer. El instrumento básico de medición de mortalidad lo constituyen los certificados de defunción. se realizó un estudio de corte transversal de todos los certificados de defunción expedidos durante un periodo de 17 semanas en el Instituto Nacional de Cancerología (n=400); se evaluó la precisión de la información contenida en ellos y la relación entre las características de la muerte, del paciente y del médico firmante con el tipo de error cometido. se encontraron grandes frecuencias de error en las variables del certificado: 10,5por ciento de los certificados tuvieron errores en la fecha de nacimiento; 1,5por ciento y 2,3por ciento fueron las frecuencias de error en el nombre y apellidos y en el documento de identificación respectivamente. Se encontró algún error en más del 62por ciento de los certificados en cuanto a la determinación del estado de gravidez. El 31,8por ciento de los certificados tuvieron algún error en las causas de muerte y el 71por ciento tuvieron al menos un error.los certificados de defunción en la institución tienen graves errores de diligenciamiento que deben ser corregidos no sólo por las implicaciones en las estadísticas de mortalidad específica en cáncer en el ámbito distrital y nacional, sino por los graves inconvenientes que se producen para las familias de los fallecidos.
Introduction: Vital statistics are important demographic and public health indicators. On cancer research, these indicators provide a fundamental understanding of the epidemiologic characteristics of the disease. Death certificates constitute a basic tool for assessing mortality; therefore, it is necessary to evaluate how accurate the information provided is, not only because of the statistical data, but because erroneous data may have serious consequences on the families of the deceased. Materials and methods: A cross-sectional evaluation of 400 death certificates was performed over a 17 week period at the Instituto Nacional de Cancerología (National Cancer Institute, Colombia). Accuracy was assessed by comparing every death certificate with the patients admission form, ID and medical record. Results: A wide proportion of errors were found in this study: 10.5% of death certificates reported inaccurate dates of birth whereas 1.5% and 2.3% had mistakes on name and ID respectively. Up to 62% of death certificates failed to determine pregnancy status accurately, 31.8% were found to have some error in the cause of death and 71% had at least one mistaken variable. Conclussions: A high proportion of death certificates at the Instituto Nacional de Cancerología have been found to contain erroneous information. This fact should encourage regional and national entities as well as the institute, to strengthen death certification quality because it could have serious implications on death statistics at a regional and national level, and important consequences to the patients family.