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PURPOSE: Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America. METHODS: Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12-18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey. RESULTS: Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001). CONCLUSIONS: Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.

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Introduction Tobacco consumption is a serious public health problem and the principal cause of death worldwide. It is linked to chronic obstructive pulmonary disease (COPD), coronary disease, and various cancers such as lung cancer, which is the most frequent, and cancer of the larynx and other organs. Smoking affects the quality of life of millions of people. Those who live with smokers also become involuntary or passive smokers. It is important to determine the factors that influence initiation and continuation of smoking and the reasons that facilitate or favor smoking cessation. The dependence of cigarette smoking acts as a modulator of the relationship that smokers have with their social environment and on the expression of their feelings. We considered important to study the assertiveness of smokers, which is considered to be the social skill that individuals have to express what they think, feel and opine about respecting their rights and the rights of others as a factor that may influence smoking cessation or continuation of smoking. Objective We undertook this study to determine the levels of assertiveness and the sociodemographic profile of a population of 130 patients who were smokers and who came to the <

Introducción El tabaquismo es un problema de salud pública, es la principal causa de muerte evitable en el mundo, se vincula a padecimientos -como enfermedad pulmonar obstructiva crónica (EPOC), enfermedad coronaria y diversos cánceres, como el de pulmón, que es el más frecuente, y el de laringe- y afecta la calidad de vida de miles de seres. Los que conviven con el fumador se convierten en <

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Adesão é um comportamento complexo, envolve desde pequenas recusas ao tratamento até o uso inadequado dos serviços de saúde e abandono do tratamento. O presente trabalho é um estudo qualitativo com seis pacientes com transtorno de personalidade borderline sobre adesão ao tratamento, utilizando análise qualitativa em entrevista aberta, questionário psicossocial, classificação diagnóstica pela SCID I e II e acompanhamento clínico. Os resultados mostraram que impulsividade, manipulação, dissociação afetiva, tentativa de suicídio, tendência à regressão e agressividade dificultaram ou impossibilitaram a adesão ao tratamento. Concluímos que os casos que abandonaram o tratamento colocaram a equipe em uma situação de impotência e apelo para estratégias sociais como forma de manejo da situação. É levantada a hipótese de que familiares saudáveis podem ser importantes para a adesão ao tratamento. Nos casos que não abandonaram o acompanhamento, a não-adesão se manifestou como ataques ao vínculo, ataques a melhora, e agressividade voltada à equipe e à instituição.

Compliance is a complex behavior, ranging from minor instances of treatment refusal to the inappropriate use of health services or even treatment abandonment. The study comprises a qualitative analysis of six patients with borderline personality disorder submitted to an open interview, a psychosocial questionnaire, a diagnostic classification through SCDI I and II and a clinical follow-up. Six behaviors made treatment compliance either difficult or impossible: impulsivity, manipulation, affective dissociation, attempted suicide, tendency to regression, and aggression. The participants who abandoned the treatment made the health team impotent, requiring social strategies to manage the situation. We hypothesized that healthy families are of great importance for compliance to treatment. For the cases in which treatment was not abandoned, non-compliance was manifested as attacks against the bonds and against the improvement, and aggression towards the health team and the institution.

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