Objetivo de conocer la relación entre percepción del proceso salud-enfermedad con las demandas de cuidado de la salud enlas comunidades rurales del distrito de Chimbote. La población estuvo conformada por 88 pobladores. Para la recolección dedatos se utilizó la técnica de encuesta. El riesgo relativo (Odd Ratio) y chi cuadrada (x2) se utilizaron para el análisis de relacionesentre percepción y demanda del cuidado. Resultados: La mayoría tiene una percepción biológica del proceso salud-enfermedad(59.1%), seguido de la ecológica (35.2%) e, histórico social (5.7%). Prevalece una demanda de cuidado clínico asistencial (49.9%),autoatención (38.6%) y, lo espiritual 20.5%. La percepción del proceso salud-enfermedad se relaciona significativamente conlas demandas de cuidado de la salud (p=0,0245), y existe 3 veces más riesgo que los pobladores demanden un cuidado clínicoasistencial si la percepción es biológica (OR=3.2). Los pobladores perciben el proceso salud-enfermedad como producto devariables biológicas, ecológicas e histórico sociales, conllevándoles a prácticas de la salud alternativa y la salud tradicional.Descriptores: Salud, Enfermedad, Atención a la Salud, Enfermería en Salud Comunitaria.PERCEPTION OF THE PROCESS HEALTH - DISEASE AND THE DEMANDS OF HEALTH CARE IN THE RURAL COMMUNITIES OF CHIMBOTE -PERU.This motivated to realize the investigation with the aim to know the relation between perception of the process health - diseasewith the demands of care of the health in the rural communities of Chimbote district. The population was shaped by 88 settlers.For the compilation of information the technology of survey was in use. The relative risk (Odd Ratio) and chi squared (x2) theywere in use for the analysis of relations between perception and demand of the care. Results: The majority has a biologicalperception of the process health - disease (59.1 %), followed by the ecological one (35.2 %) and, historically socially (5.7 %). Thereprevails a demand of clinical welfare care (49.9 %), autoattention (38.6 %) and, the spiritual thing 20.5 %. The perception of theprocess health - disease relates significantly to the demands of care of the health (p=0,0245), and there exists 3 times morerisk than the settlers demand a clinical welfare care if the perception is biological (OR=3.2). The settlers perceive the processhealth - disease as product and historical of biological, ecological social variables, carrying them to practices of the alternativehealth and the traditional health.Descriptors: Health, Disease, Health Care, Infirmary in Community Health.PERCEPÇÃO DO PROCESSO SAÚDE-DOENÇA E DEMANDA DE CUIDADOS EM COMUNIDADE RURAIS DE CHIMBOTE-PERUObjetivo: conhecer a relação entre a percepção do processo saúde-doença com as demandas de cuidados de saúde emcomunidades rurais do distrito de Chimbote. Trata-se de uma pesquisa quantitativa que utilizou um survey para a coleta dedados. A população foi composta por 88 moradores. O risco relativo (OddsRatio) e qui-quadrado (x2) foram utilizados paraanalisar as relações entre percepção e demanda de da procura de cuidados. Resultados: A maioria tem uma percepção biológicado processo saúde-doença (59,1%), seguida da ecológica (35,2%) e histórico-social (5,7%). Prevalece uma demanda de cuidadoclínico-assistencial (49,9%), autocuidado (38,6%) e espiritual (20,5%). A percepção do processo saúde-doença se relacionasignificativamente com as demandas de cuidados de saúde (p = 0,0245), existindo 3 vezes maior risco que os moradores exijamum cuidado clínico se sua percepção é biológico (OR = 3.2) .Os moradores percebem o processo saúde-doença como produtode variáveis biológicas, ecológicas e históricas, conduzindo-os a práticas de saúde alternativa e saúde tradicional.Descritores: Saúde, Doença, Cuidados de Saúde, Saúde Comunitária.

BackgroundDespite the growing body of evidence to support the importance of exercise in the management of ankylosing spondylitis (AS), fewer than one-quarter of patients with AS exercise frequently. Several factors could explain it, including the lack of related specific knowledge among many rheumatologists or patient's barriers to exercise. Therefore, we need a broad and multidisciplinary approach in order to design an effective strategy to prescribe and monitor physical exercise in SpA patients.Objectives1) To establish recommendations on exercise for SpA patients; 2) to provide motivational actions and facilitators for an active exercise prescription by rheumatologists; 3) to provide motivational actions and facilitators to improve patients adherence to exercise.MethodsA guided discussion group of rheumatologists with expertise on SpA was organized on issues the rheumatologists considered important when indicating and evaluating the effect of physical exercise in SpA patients, as well as on their current knowledge on this field and potential gaps or needs. The results of a systematic literature review about factors that improve adherence to exercise, the results of two discussion groups of patients (to explore barriers and facilitators to exercise), and the results of a focus group of exercise specialists (to define effective exercises for SpA patients and how messages should be given in order to be more effective) were presented and discussed.ResultsThe following consensus recommendations were drawn out:How to prescribe. SpA patients should be prescribed aerobic exercise of moderate intensity the same as general population and exercise programs similar to the American College of Sports Medicine recommendations, adapted to patients and disease characteristics. Although there is little limitation evidence to support it, it is important to do some type of aerobic exercise at all disease stages. Besides, in cases of ankylosis, forced stretching can be dangerous and are unuseful. Exercises in painful areas should be avoided in phases of activity and postural education must be provided.How to motivate rheumatologists. The following points were proposed: To agree on physical exercise with exercise specialists, to increase knowledge about the evidence based benefits of exercise in SpA and training on exercise. Including all these recommendations in a specifically designed website with a frequently asked questions section, explaining basics of exercise, and examples of the exercises they are prescribing might also help.How to motivate patients: The following points were agreed: to spend more time in daily practice for exercise issues, to provide positive and personalized messages without mentioning directly neither the structural damage of the disease nor depressing information, but being realistic, to explain properly the exercises the patient must not do. It was also argued that patients' associations can be effective promoters.ConclusionsRheumatologists believe that they require more knowledge about exercise in orde...

BackgroundNon-adherence to exercise is not uncommon in spondyloartritis (SpA). The extent to which patients with SPA are adhering to exercise as remains unclear. Understanding patient perceptions about the benefits and barriers to exercise could aid in focusing nonpharmacological strategies to improve outcomes.ObjectivesTo explore barriers and facilitators of patients with SpA to exercise.MethodsTwo discussion groups were organized, both recorded and analyzed using specific software for qualitative analysis of speech. The analysis was developed to identify the factors that influence exercise adherence as well as to describe relationships between them. The results were synthesized as follows 1) Segmentation according to thematic criteria, 2) Categorization according to situations, relationships, opinions, feelings or others, 3) Codification of the different categories and 4) Interpretation of results.ResultsWe found 4 different stages of coping with the exercise or physical activity in SpA: 1) the onset of the disease, in which patients feel scared but receptive; 2) the stabilization phase: important increase of self-confidence and interest in patients' associations and exercise specialists; 3) expert-patient phase: the patient is typically relaxed; 4) disease flares. The following table shows main facilitators and barriers identified.FacilitatorsBarriersKnowledge on physical exercise physician's, physiotherapists and patient)Information about benefits, limits, possibilities, risks, etc.Misunderstanding and inconsistency between messages given by doctors, physiotherapists and specialists in sport.Become aware of positive effectsFear of structural damage and pain worseningPainAccessibility (places and time expenditure)Role of associationsLack of access, expensive or facilities have inconvenient schedulesRegularity/HabitInactivity periods because of holidays or flaresEarly startAbsence of supporting messages and reinforcement by the doctorPositive previous experienceBad previous experiencesIneffectiveness of pharmacotherapyExercise adaptation to patient and disease characteristicsFlaresFatigueDifficulty and intensity of exerciseA good monitor or equipmentA bad monitorSocial aspects of exercise, physical activity and sportBoredom or depressionActive copingComplicated livesIsolation In addition, a series of neutral or discordant factors including stress, time, and exercise at home or paying for exercising were also identified.ConclusionsApart from recognizing that some personal factors should be modified, patients generally demand more knowledge and learning about physical exercise and about the pros and cons of it in the context of their disease. Consistency of messages received and better monitors accompanying them in their disease-and-exercise-coping process are important facilitators to exercise adherence. Patients' associations can disseminate much more information, in addition to support and provide advice to patients based on their prior experience.AcknowledgementsFunded by an unrestricted grant from Merck Sharp...