A personalized and standardized APA is acceptable, effective and safe in patients awaiting LT. It positively influences the index of fitness and quality of life. Its promising impact on the posttransplantation period, duration of hospitalization, and 6-month survival needs to be prospectively evaluated in a large randomized study.

Adesão à terapêutica antirretroviral de pessoas vivendo com HIV/aids em um município do interior paulista Adhesión a la terapia antirretroviral de personas viviendo con VIH/SIDA en un municipio del interior ABSTRACTObjective: To assess adherence to antiretroviral drugs by people living with HIV/AIDS and identify its association with sociodemographic and clinical variables. Methods:Cross-sectional analytical study using a sociodemographic instrument and CEAT-HIV, with data collected in the period from 2014-2015.Results: A 75.0% was identified as having a good/proper adhesion. It was found that individuals between ages 40 and 59 (p = 0.029) and with morethan eight years of formal education (p = 0.043) had a higher level of compliance, as well as those diagnosed with HIV/AIDS for more than 10 years (p = 0.002), CD4 count >350 cells/mm3 (p<0,001) and an undetectable viral load (p=0,025). Conclusion:In this study, a good adhesion between the subjects was identified and it was observed that individuals of older age, higher level of education, delayed diagnosis, high CD4 cell counts and undetectable viral load were associated with higher treatment adherence.Keywords: Medication adherence. Antiretrovirals. HIV. Nursing. Nursing care. RESUMO Objetivo: Avaliar a adesão aos antirretrovirais de pessoas vivendo com o HIV/AIDS e identificar sua associação com variáveis sociodemográficas e clínicas.Métodos: Estudo analítico transversal que utilizou instrumento sociodemográfico e o CEAT-HIV, com dados coletados no período de 2014 a 2015.Resultados: Identificou-se 75,0% com grau de adesão bom/adequado. Verificou-se que os indivíduos com idade entre 40 e 59 anos (p=0,029) e com mais de oito anos de estudo (p=0,043) obtiveram maior grau de adesão, assim como aqueles com diagnóstico de HIV/AIDS há mais de 10 anos (p=0,002), contagem de TCD4 >350 células/mm 3 (p<0,001) e carga viral indetectável (p=0,025). Conclusão:Nesse estudo, identificou-se uma boa adesão entre os sujeitos e observou-se que indivíduos de maior faixa etária, maior grau de escolaridade, maior tempo de diagnóstico, elevada contagem de células TCD4 e carga viral indetectável estiveram associados a uma maior adesão ao tratamento.Palavras-chave: Adesão à medicação. Antirretrovirais. HIV. Enfermagem. Cuidados de enfermagem. RESUMEN Objetivo: Evaluar la adherencia a los medicamentos antirretrovirales para las personas que viven con el VIH/SIDA e identificar su asociación con variables sociodemográficas y clínicas.Métodos: Estudio transversal analítico utilizando instrumento sociodemográfico y CEAT-VIH, con los datos recogidos desde 2014 hasta 2015.Resultados: Se identificó un 75,0% con el grado de buena adherencia/adecuada. Se encontró que los individuos con edades comprendidas entre los 40 y los 59 años (p = 0,029) y más de ocho años de estudio (p = 0,043) tuvieron mayor nivel de cumplimiento, así como las personas diagnosticadas con VIH/SIDA durante más de 10 años (p = 0,002), recuento de CD4> 350 células/mm3 (p <0,001) y la carga viral indetectable (p = 0,025). Concl...

BackgroundIn chronic respiratory failure (CRF), body composition strongly predicts survival. Methods A prospective randomised controlled trial was undertaken in malnourished patients with CRF to evaluate the effects of 3 months of home rehabilitation on body functioning and composition. 122 patients with CRF on long-term oxygen therapy and/or non-invasive ventilation (mean (SD) age 66 (10) years, 91 men) were included from eight respiratory units; 62 were assigned to home health education (controls) and 60 to multimodal nutritional rehabilitation combining health education, oral nutritional supplements, exercise and oral testosterone for 90 days. The primary endpoint was exercise tolerance assessed by the 6-min walking test (6MWT). Secondary endpoints were body composition, quality of life after 3 months and 15-month survival. Results Mean (SD) baseline arterial oxygen tension was 7.7 (1.2) kPa, forced expiratory volume in 1 s 31 (13)% predicted, body mass index (BMI) 21.5 (3.9) kg/m 2 and fat-free mass index (FFMI) 15.5 (2.4) kg/m 2 . The intervention had no significant effect on 6MWT. Improvements (treatment effect) were seen in BMI (+0.56 kg/m 2 , 95% CI 0.18 to 0.95, p¼0.004), FFMI (+0.60 kg/m 2 , 95% CI 0.15 to 1.05, p¼0.01), haemoglobin (+9.1 g/l, 95% CI 2.5 to 15.7, p¼0.008), peak workload (+7.2 W, 95% CI 3.7 to 10.6, p<0.001), quadriceps isometric force (+28.3 N, 95% CI 7.2 to 49.3, p¼0.009), endurance time (+5.9 min, 95% CI 3.1 to 8.8, p<0.001) and, in women, Chronic Respiratory Questionnaire (+16.5 units, 95% CI 5.3 to 27.7, p¼0.006). In a multivariate Cox analysis, only rehabilitation in a per-protocol analysis predicted survival (HR 0.27, 95% CI 0.07 to 0.95, p¼0.042). Conclusions Multimodal nutritional rehabilitation aimed at improving body composition increased exercise tolerance, quality of life in women and survival in compliant patients, supporting its incorporation in the treatment of malnourished patients with CRF. Clinical Trial number NCT00230984.

The aim of this study was to assess the percentage of respiratory disorders and airway obstruction in patients with rheumatoid arthritis by comparing lung function test results between patients with rheumatoid arthritis and control subjects with other rheumatological conditions.A prospective case-control study of respiratory symptoms and lung function abnormalities was performed in a series of 100 patients with rheumatoid arthritis. Eighty eight patients with other rheumatological diseases served as controls. Diagnosis of respiratory disorders was based on clinical, radiological and spirometric findings. Airway obstruction was determined from predicted values. The results were compared using Student's t-test and Chi-squared tests. An explanatory analysis was carried out by linear regression.The number of symptoms, respiratory disorders (including bronchiectasis) and lung function abnormalities was higher in patients with rheumatoid arthritis than in controls. After exclusion of smokers, the proportion of airway obstruction in patients with rheumatoid arthritis was 16% (versus 0% in controls), although the patients with rheumatoid arthritis still had more symptoms and respiratory disorders. The Chi-squared test did not identify any relationship between airway obstruction, duration of rheumatoid arthritis and type of treatment and occurrence of Sjögren's syndrome. In the nonsmokers, different explanatory models for the patients with and without a history of cardiac and respiratory disease emerged from multivariate analysis of indices of obstruction. These models included variables characterizing the severity and course of the rheumatoid arthritis.Respiratory disorders (including bronchiectasis) and airway obstruction are more frequent among patients with rheumatoid arthritis than in rheumatological controls. Although the exact pathophysiology of the link between bronchial obstruction and rheumatoid arthritis is still a matter of debate, explanatory factors for obstruction included variables characterizing the rheumatoid arthritis.