The Effect of an Education Program Based on Illness Perception on the Lifestyle of Patients with Metabolic Syndrome: A Randomized Controlled Clinical Trial

Illness perception, health literacy, self-efficacy, adherence and quality of life in patients with intermittent claudication - a longitudinal cohort study

BACKGROUND

Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

AIM

to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

METHODS

A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

RESULTS

In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy..

CONCLUSION

Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

Effect of Leventhal's self-regulatory intervention on the hypertensive patients' illness perception and lifestyle: a randomized controlled trial

BACKGROUND

The perception of illness may lead to improving the hypertensive patients' lifestyle, but no study was found in this regard. Therefore, this study was conducted to determine the effect of intervention based on Leventhal's self-regulatory model on the illness perception and lifestyle of patients with hypertension.

METHODS

In the present randomized controlled trial study, ninety eligible patients with primary hypertension were randomly assigned to one of the two groups of intervention and control. Patients in the intervention group received five sessions of Leventhal's self-regulatory intervention, each of 60 min and weekly. However the control group received routine care. The outcomes were illness perception and lifestyle of the patients with hypertension. The Revised Illness Perception Questionnaire and the Lifestyle Questionnaire were administered to assess illness perception and lifestyle before the treatment to establish a baseline and subsequently 12 weeks after the intervention. The collected data were analyzed using statistical IMB SPSS software, version 21. Qualitative data were analyzed using Chi-Square test or Fisher's Exact test, and the Independent Sample t- test and Paired Sample t- test were used for analyzing quantitative data.

RESULTS

Leventhal's self-regulatory intervention improved subscales of illness perception (p < 0.05) except for emotional representations and consequences. The global mean scores of the hypertensive patients ̓ lifestyle in the intervention group significantly increased from 102.8 ± 2.3 at the baseline to 112.1 ± 3 post-intervention.

CONCLUSIONS

Interventions based on Leventhal's self-regulatory model could improve the illness perception and lifestyle of patients with hypertension. Trial registration The present randomized controlled trial study was registered on the Iranian Registry of Clinical Trials Website (IRCT); ID: IRCT20141222020401N6 on 8/5/2019.

Illness Perceptions and Medication Nonadherence to Immunosuppressants After Successful Kidney Transplantation: A Cross-Sectional Study

Background: Medication nonadherence to immunosuppressants is a well-known risk factor for suboptimal health outcomes in kidney transplant recipients (KTRs). This study examined the relationship between illness perceptions and medication nonadherence in prevalent Dutch KTRs and whether this relationship depended on post-transplant time.

Methods: Eligible KTRs transplanted in Leiden University Medical Center were invited for this cross-sectional study. The illness perceptions and medication nonadherence were measured via validated questionnaires. Associations between illness perceptions and medication nonadherence were investigated using multivariable logistic regression models.

Results: For the study, 627 participating KTRs were analyzed. 203 (32.4%) KTRs were considered nonadherent to their immunosuppressants with “taking medication more than 2 h from the prescribed dosing time” as the most prevalent nonadherent behaviour (n = 171; 27.3%). Three illness perceptions were significantly associated with medication nonadherence: illness identity (adjusted odds ratio [OR_adj] = 1.07; 95% confidence interval [CI], 1.00–1.14), concern (OR_adj = 1.07; 95%CI,1.00–1.14), and illness coherence (OR_adj = 1.11; 95%CI,1.01–1.22). The relationships between illness perceptions and medication nonadherence did not differ depending on post-transplant time (p-values ranged from 0.48 to 0.96).

Conclusion: Stronger negative illness perceptions are associated with medication nonadherence to immunosuppressants. Targeting negative illness perceptions by means of psychoeducational interventions could optimize medication adherence and consequently improve health outcomes in KTRs.

Influence of the use of atypical antipsychotics in metabolic syndrome

OBJECTIVES

To describe the possible relationship between the use of antipsychotic drugs and the presence of metabolic syndrome. Other objectives are to list the main side effects of antipsychotic treatment, and to determine if there is any pharmacological treatment that can contribute towards counteracting metabolic syndrome.

MATERIAL AND METHOD

A narrative bibliographic review was carried out of the following databases: PubMed, Cochrane, CINAHL, IBECS, LILACS and HealthCare. Preference in the selection process was given to clinical trials and systematic review articles or review articles and some articles that were considered relevant because of their content. The time period was limited to between January 2014 and November 2019. The languages were English and Spanish. Repeated articles and those that were not related to the objectives were rejected. The search criteria were: "antipsychotic AND metabolic syndrome"; "schizophrenia AND metabolic syndrome"; "bipolar disorder AND metabolic syndrome"; "metabolic syndrome AND suicide NOT disorder"; "metabolic syndrome AND prisons"; "metabolic syndrome AND prolactin".

RESULTS

24 articles were selected out of the 510 that were consulted. The relationship between atypical antipsychotics and metabolic syndrome was evident. Other anticholinergic, antidopaminergic effects, extrapyramidal syndromes, neuroleptic malignant syndrome, hypotension, arrhythmias, sedation, hypovitaminosis D, increased prolactin, sexual dysfunction, sleep disturbances, etc. are also highlighted. Pharmacological associations with other drugs were also found.

DISCUSSION

There is a relationship between the use of atypical antipsychotics and weight gain, lipid disorders, glucose and high blood pressure. There are some associated drugs that decrease some symptoms (ranitidine, topiramate, metformin, melatonin, modafinil). Patients taking this type of medication should be monitored and encouraged to lead healthy lifestyles.