Category Archives: Artikel

Suplementasi Probiotik Memperbaiki Gejala Rinitis Alergika pada Anak

Insidens penyakit alergi pada masa kanak-kanak meningkat di seluruh dunia, terutama di negara-negara industri, hal ini kemungkinan disebabkan oleh sistem imun tidak mendapatkan stimulasi yang adekuat pada tahap awal kehidupan. Penyakit alergi dapat menyebabkan ketidakmampuan pada anak-anak, dan dapat menimbulkan penurunan kualitas hidup serta menurunkan efektivitas kerja para orang tua.

Bakteri probiotik dapat memperbaiki keseimbangan mikroba usus, dan dapat mempermudah modulasi respon imun. Terdapat perbedaan komposisi flora usus pada anak-anak yang mengalami alergi dengan yang tidak. Khususnya, jumlah Clostridia dalam flora usus lebih tinggi pada orang yang mengalami alergi, sedangkan jumlah Bifidobacteria lebih rendah.  Terlebih lagi, gaya hidup akhir-akhir ini telah mengubah komposisi mikroflora usus, dengan prevalensi enterobacteria pada Lactobacilli dan Bifidobacteria. Intervensi pada flora usus melalui konsumsi mikrobiota hidup (Lactobacilli), dapat membantu maturasi sistem imun yang tepat, dan menurunkan perkembangan alergi pada masa kanak-kanak.

Dari salah satu hasil review beberapa studi penggunaan Lactobacillus yang dikaitkan dengan gejala rinitis alergika dan asma dilakukan oleh Dr. Betsi GI, dkk, yang dipublikasikan dalam jurnal Annals of Allergy, Asthma, & Immunology tahun 2008. dalam review tersebut memasukan beberapa studi klinis acak tersamar-gada, dan menunjukkan hasil bahwa; 9 dari 12 RCT yang mengevaluasi manfaat klinis pada rinitis alergika memperlihatkan adanya perbaikan terkait dengan penggunaan probiotik. Seluruh RCT mengenai  rinitis alergika musiman memperlihatkan skor gejala dan penggunaan obat-obatan yang lebih rendah dengan penggunaan probiotik dibandingkan dengan plasebo.5 dari 8 RCT mengenai  rinitis alergika musiman  memperlihatkan adanya perbaikan pada clinical outcomes. RCT yang melaporkan penilaian berbagai parameter imunologik terhadap alergi memperlihatkan tidak adanya efek probiotik yang bermakna.

Probiotik mungkin mempunyai efek yang menguntungkan terhadap rinitis alergika dengan menurunkan tingkat keparahan gejala-gejala yang timbul dan penggunaan obat-obatan. Dibutuhkan lebih banyak studi yang berkualitas baik untuk memecahkan masalah ini.

by : admi pio, lolita

OHO Thiazolidindion, Semakin Terbukti Menyebabkan Fraktur?

Obat OHO golongan thiazolidindion pada pasien diabetes melitus berhubungan dengan peningkatan risiko fraktur tulang terutama fraktur tulang pinggul dan tulang pergelangan tangan.

Sebelumnya, dianggap bahwa pasien dengan diabetes tipe 2 memiliki densitas tulang yang lebih tinggi daripada normal, sehingga risiko kejadian fraktur lebih rendah. Namun ternyata dari penelitian yang dilakukan, diketahui terjadi peningkatan risiko fraktur, terutama pada tempat-tempat yang non-vertebra, dan ini tidak tergantung dari umur, indeks massa tubuh dan densitas tulang pada pasien–pasien diabetes ini, dan diperkirakan kejadian fraktur ini berhubungan dengan komplikasi diabetes, risiko trauma dan terutama; penggunaan obat antidiabetes.

Penelitian terbaru dilakukan oleh dr. Christoph Meier dari Boston University, Massachusetts, Amerika Serikat. Penelitian yang dilakukan adalah:

  • Jumlah    : 1020 pasien dengan diabetes yang:
    • Didiagnosa fraktur oleh dokter umum di Inggris dari tahun 1994 hingga 2005
    • Umur 30-89 tahun
    • Selain itu terlibat 3728 kontrol tandingan
  • Terapi    : Pioglitazone dan rosiglitazone
  • Hasil    :
    • Pasien yang menerima resep thiazolidindion dalam rentang 12 -18 bulan, memiliki risiko fraktur 2,43 kali dibandingkan pasien yang tidak diterapi menggunakan OHO golongan thiazolidindion.
    • Para peneliti mengatakan bahwa terjadi peningkatan risiko fraktur pada pinggul dan tulang-tulang osteoporosis non-vertebra, sehingga jumlah fraktur vertebral dan iga yang terjadi terlalu rendah untuk dihubungkan dengan pemberian thiazolidindion.
    • Peningkatan risiko obat thiazolidindion: pioglitazone dan rosiglitazone tidak berbeda bermakna dalam meningkatkan risiko fraktur, dengan angka kejadian berturut-turut 2,59 dan 2,38 kali, dibandingkan dengan yang tidak diteerapi menggunakan thiazolidindion.
    • Pemberian terapi OHO thiazolidindion dalam jangka waktu pendek tidakh meningkatkan risiko fraktur. Risiko fraktur dengan terapi obat golongan thiazolidindion terlihat terutama pada pasien yang diterapi lebih dari 2 tahun.
    • Para peneliti mengatakan juga bahwa penelitian ini masih perlu dikonfirmasikan dengan penelitian terkontrol tambahan lainnya.

Dalam editorial lainnya, para peneliti juga berpendapat bahwa data-data hasil penelitian ini juga perlu dilihat dari sudut pandang lain, bahwa OHO thiazolidindion, khususnya rosiglitazone dapat meningkatkan risiko penyakit kardiovaskular dan OHO thiazolidindion dapat meningkatkan berat badan, berefek samping hepatotoksik, menyebabkan retensi cairan dan gagal jantung kongestif. Disamping itu juga OHO golongan thiazolidindion lebih mahal dan tidak lebih unggul dibandingan OHO lainnya.

Para ahli berpendapat bahwa hingga kini tidak ada konfirmasi dari penelitian-penelitian jangka panjang mengenai superioritas thiazolidindion dibandingkan dengan OHO lainnya dalam menurunkan hasil klinik. Oleh karena itu, OHO yang lebih tua (sulfonylurea generasi ke-2 (dan ke-3) serta metformin diberikan sebagai terapi pilihan pada pasien dengan diabetes melitus tipe 2, di mana metformin tetap menjadi first line therapy.

Aspartam Dalam Minuman Berenergi

 

Aspartam merupakan pemanis buatan yang diizinkan penggunaannya dalam batas tertentu. Menurut ketentuan Surat Keputusan Kepala Badan POM No. H.K.00.05.5.1.4547 tentang Persyaratan Penggunaan Bahan Tambahan Pangan Pemanis Buatan dalam Produk Pangan, maka aspartam dapat digunakan secara aman dan tidak bermasalah bila sesuai takaran yang diperbolehkan. Untuk kategori pangan minuman berkarbonasi dan non karbonasi, batas maksimum penggunaan Aspartam adalah 600 mg/kg.

Kandungan aspartam pada produk minuman berenergi yang disebutkan pada pesan singkat/SMS tersebut, jika produk tersebut sudah terdaftar di Badan POM (cek nomor registrasi pada kemasannya), berarti sudah melalui proses evaluasi terhadap aspek keamanan, manfaat, dan mutunya, berarti kandungan aspartamnya sesuai dengan kadar yang diizinkan. Yang kemudian akan menjadi masalah adalah bila seseorang mengkonsumsi produk yang mengandung aspartam secara berlebihan sehingga jika diakumulasi dapat melebihi kadar asupan harian yang dapat diterima tubuh (acceptable daily intake/ADI).  Nilai ADI Aspartam adalah 50 mg/kg berat badan. Jadi sebaiknya kita tidak mengkonsumsi produk secara berlebihan.

Di dalam tubuh, Aspartam dipecah menjadi tiga macam senyawa, yaitu metanol, asam aspartat, dan fenilalanin. Meskipun metanol bersifat toksik bagi tubuh, berdasarkan penelitian diketahui bahwa konsumsi produk yang mengandung Aspartam tidak mencapai tingkat toksik metanol. Kesimpulan yang sama juga berlaku bagi asam aspartat. Namun demikian, sejumlah kecil fenilalanin dapat menyebabkan kerusakan otak berat pada individu yang menderita kelainan genetik fenilketonuria (Phenylketouria/PKU). Jadi sebaiknya produk yang mengandung Aspartam dihindarkan bagi penderita kelainan tersebut.

Neurotoksisitas aspartam bergantung pada peningkatan kadar aspartam di dalam darah, dan peningkatan kadar tersebut bergantung pada usia dan individu yang mengalami dan beresiko PKU (Stegink, 1979). Stegink (1979) menunjukkan bahwa menelan 100-200 mg/kg aspartam oleh orang dewasa maupun bayi, menghasilkan rata-rata konsentrasi plasma puncak sebesar 49 µmol fenilalanin/100 mL darah pada menit ke 45-90 setelah dicerna.  Kadar ini masih di bawah dosis toksik. Baik AMA (American Medical Association, 1986) dan AAP (American Academy of Pediatrics, 1985) menyatakan bahwa aspartam aman digunakan untuk orang yang tidak mengidap PKU dan aman untuk janin pada kadar yang telah ditentukan. American Diabetes Association (ADA) menyetujui bahwa aspartam aman digunakan.

sumber : http://ik.pom.go.id

Simvastatin Side Effects: Diabetes & What Else

The Food and Drug Administration upset the applecart when it announced that statin-type cholesterol-lowering medications like simvastatin (Zocor) could raise blood sugar levels and increase the risk for diabetes. Millions of people with elevated cholesterol are trying desperately to reduce their likelihood of having a heart attack or a stroke. The last thing they need is to have their blood sugar go up, since that can increase the risk of the very complications people are trying to avoid (heart attacks and strokes, not to mention kidney damage, nerve pain and eye problems).

The FDA has worded its warning cautiously:

“A small increased risk of raised blood sugar levels and the development of Type 2 diabetes have been reported with the use of statins.”

We are not so sure this is such a “small increased risk.” Eric Topol, MD, seems to agree with us. He is one of the country’s leading cardiologists. In an op-ed article published in the New York Times (March 4, 2012) titled, “The Diabetic Dilemma for Statin Users,” Dr. Topol points out that the way the data were analyzed could be misleading. The FDA lumped relatively “weak” statins together with more potent statins like atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor). With this data manipulation the FDA diluted the impact of potent statins on blood sugar increases. According to Dr. Topol, the stronger the statin and the higher the dose the greater the likelihood of diabetes. He states:

“More than 20 million Americans take statins. That would equate to 100,000 new statin-induced diabetics. Not a good thing for the public health and certainly not good for the individual affected with a new serious chronic illness.”

http://tinyurl.com/79raddj

Amidst the statistics we tend to forget that individuals are affected. We have heard from many people who have had significant problems with blood sugar control while taking a statin-type drug. The first case came to our attention almost ten years ago. A husband and wife taking Lipitor had increasing trouble controlling their glucose levels. Why did it take the FDA so long to figure this out?

What other side effects should we be paying more attention to when it comes to statin-type drugs:

• Altoprev (lovastatin extended-release)
• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin).

Products containing statins in combination with other drugs include:

• Advicor (lovastatin/niacin extended-release)
• Simcor (simvastatin/niacin extended-release)
• Vytorin (simvastatin/ezetimibe).

Potential adverse reactions patients and their families should be aware of include:

• Muscle pain or spasms (any where in the body, including legs, shoulders, back, arms or neck)
• Arthritis
• Blood sugar elevation
• Memory problems, cognitive dysfunction, confusion, amnesia
• Nerve pain, peripheral ne
uropathy, leg cramps
• Digestive upset, nausea, constipation, diarrhea, flatulence
• Headache
• Insomnia
• Urinary tract infections
• Skin reactions, hives
• Pancreatitis
• Sexual problems, erectile dysfunction,

What we do not know is how common some of these side effects may be. Until recently the FDA assumed that memory problems and blood sugar elevation were so rare as to be almost forgettable. The recent alert changes that equation. How common are sexual problems with statins? No one really knows. What about arthritis, nerve pain or peripheral neuropathy? Again we are clueless.

We recognize that some people really do need these medications to prevent a heart attack or a stroke. The data suggest that people who have clearly diagnosed heart disease can benefit. Those who have had one heart attack can reduce the risk of a second by taking a statin. And many individuals never suffer any side effects. Good for them. They are fortunate.

Others are not so lucky. We don’t know what the true incidence of some of the so-called minor side effects really is. That’s why we need your help. Please let us know how you or someone you love has fared on a statin-type drug. You can comment below. Thanks for letting us know about your experience. And one more thing…no one should stop a statin without consulting the prescriber. We do not want anyone to go from the frying pan into the fire. Your doctor needs to know about how you are doing on any medication, especially a statin!

6 Langkah Mendapatkan Tidur Berkualitas

 


Para Ahli tidur mengatakan bahwa tidur yang lelap tidak akan berhasil kita dapatkan, jika hanya memperbaiki sebagian perilaku.

Kita harus secara konsisten melakukan tip berikut ini, selama 6 minggu berturut-turut, untuk meningkatkan kualitas tidur.

 

 

1. Tidur secara rutin.

Tubuh sangat tergantung pada jadwal tidur yang regular. Jadi, cobalah untuk tidur dan bangun di saat yang sama setiap hari. Hal ini berarti kita tidak boleh membiarkan diri tidur hingga siang hari di akhir minggu atau saat libur.

Jika Anda tak bisa tidur cepat malam hari, tak perlu memaksa. Bangkit dari tempat tidur, dan beraktivitaslah di ruang lain. Pilih aktivitas yang tenang, seperti mendengarkan musik atau membaca, namun jangan membiarkan diri Anda tertidur ketika melakukan aktivitas itu. Kembalilah ke kamar tidur ketika Anda mengantuk. Lakukanlah hal ini setiap hari, sesuai kebutuhan Anda.

 

 

2. Berpakaian nyaman untuk tidur.

Kenakan baju tidur yang membuat Anda tidak merasa nyaman. Suhu tubuh kita cenderung turun menjelang tidur, namun akan kembali meningkat di tengah malam, dan kembali turun menjelang kita terbangun. Karenanya, pilihlah jenis baju tidur yang dapat membuat Anda bertahan melalui perubahan suhu tubuh ini. Kenakan selapis baju tidur di saat musim kemarau, dan sediakan selimut saat musim hujan.

3. Perhatikan kondisi kasur.

Tubuh membutuhkan kenyamanan saat tidur. Jadi, ganti segera kasur Anda jika tak dapat lagi menopang tubuh saat tidur.

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penyakit obesitas

Overweight dan Obesitas sebagai suatu resiko penyakit degeneratif PDF Cetak E-mail
Jumat, 15 April 2011 10:27

Overweight dan Obesitas adalah suatu kondisi kronik yang sangat erat hubungannya dengan peningkatan resiko sejumlah penyakit Degeneratif. Penyakit Degeneratif adalah suatu kondisi penyakit yang muncul akibat proses kemunduran fungsi sel-sel tubuh yaitu dari keadaan normal menjadi lebih buruk dan berlangsung secara kronis. Penyakit yang termasuk dalam kelompok ini adalah Diabetes Melitus Type II, Stroke, Hipertensi, Penyakit Kardiovaskular, Dislipidemia, dsb. Penyakit Degeneratif yang paling sering menyertai Obesitas adalah Diabetes melitus Type II, Hipertensi dan Hiperkolesterolemia (Dislipidemia). Sebuah data dari NHANES (National Health and Nutrition Examination Survey, US) tahun 1994 memperlihatkan bahwa dua per tiga pasien Overweight dan Obesitas dewasa mengidap paling sedikit satu dari penyakit kronis tersebut dan sebanyak 27 % dari mereka mengidap dua atau lebih penyakit.

 

 Overweight dan Obesitas saat ini sudah menjadi suatu masalah global yang serius. Data yang dikumpulkan dari seluruh dunia memperlihatkan bahwa terjadi peningkatan prevalensi Overweight dan Obesitas pada 10 sampai 15 tahun terakhir dengan angka kejadian terbanyak di Amerika. Saat ini diperkirakan sebanyak lebih dari 100 juta penduduk di seluruh dunia menderita Obesitas, dan angka ini masih akan terus meningkat. Diperkirakan apabila keadaan ini terus berlanjut maka pada tahun 2230 sebanyak 100 % penduduk Amerika Serikat akan menjadi Obese. Bagaimana dengan kondisi di Indonesia ? Menurut data yang diperoleh dari Direktorat Bina Gizi Masyarakat Depkes tahun 1997, sebanyak 12,8 % pria dewasa mengalami Overweight dan sebanyak 2,5 % mengalami Obesitas. Sedangkan pada wanita angka ini menjadi lebih besar lagi yaitu 20 % dan 5,9 %. 

 

 Perkiraan prevalensi overweight dan obesitas di Indonesia (Dit BGM DepKes, 1997)

   Dari perkiraan 210 juta penduduk Indonesia thn 2000 jumlah penduduk yang overweight diperkirakan mencapai 76.7 juta (17.5%) dan pasien obesitas berjumlah lebih dari 9.8 juta (4.7%). Berdasarkan data tersebut, dapat disimpulkan bahwa Overweight dan Obesitas di Indonesia telah menjadi masalah besar yang memerlukan penanganan secara serius.

 Indeks Massa Tubuh (IMT) Sebagai Alat Ukur Overweight & Obesitas

          Overweight dan Obesitas merupakan suatu akumulasi lemak berlebih di dalam tubuh yang dapat mengganggu kesehatan secara keseluruhan. Overweight dan Obesitas terjadi disebabkan oleh adanya ketidakseimbangan antara energi yang masuk dengan energi yang keluar. Metoda paling praktis dan sederhana dalam menentukan tingkat Overweight dan Obesitas pada seseorang adalah Indeks Massa Tubuh (IMT)/Body Mass Index. IMT diperoleh dengan cara membagi berat badan (kg) dengan kuadrat dari tinggi badan (meter). Nilai IMT yang didapat tidak dipengaruhi oleh umur dan jenis kelamin.


Klasifikasi IMT menurut World Health Organization (WHO) tahun 1998 mendefinisikan Overweight apabila diperoleh IMT ≥ 25 dan Obesitas apabila IMT ≥ 30. IMT ini bermanfaat dalam menentukan seberapa besar seseorang dapat terkena resiko penyakit-penyakit tertentu yang disebabkan karena berat badannya.

Resiko Penyakit Degeneratif pada Overweight & Obesitas

          Meningkatnya angka Overweight dan Obesitas secara global di seluruh dunia saat ini dianggap sebagai akibat dari beberapa faktor, antara lain peningkatan dalam konsumsi makanan padat energi tinggi lemak dan gula namun rendah dalam kandungan vitamin, mineral dan mikronutrien lain. Selain itu juga diakibatkan adanya suatu trend penurunan aktivitas fisik yang disebabkan oleh gaya hidup (sedentary), pekerjaan, perubahan model transportasi dan peningkatan urbanisasi. Overweight dan Obesitas yang dibiarkan memiliki dampak kesehatan yang cukup serius. Resiko menderita penyakit degeneratif akan meningkat secara progresif seiring dengan peningkatan Indeks Massa Tubuh (IMT). IMT yang meningkat merupakan faktor resiko utama penyakit-penyakit kronis seperti Kardiovaskular (penyakit Jantung dan Stroke), Diabetes (yang saat ini sudah menjadi epidemi global), gangguan otot dan tulang (paling sering adalah Osteoarthritis) dan beberapa penyakit keganasan. Pada anak, angka Obesitas juga semakin meningkat dari tahun ke tahun baik di negara maju maupun di negara sedang berkembang. Disamping itu Obesitas pada anak beresiko tinggi menjadi Obesitas pada usia dewasa dan berpotensi menimbulkan penyakit Degeneratif di kemudian hari.

           Beberapa studi epidemiologis yang telah dilakukan mengemukakan bahwa terdapat hubungan yang signifikan antara angka kejadian mortalitas (kematian) dan Obesitas. Diketahui terdapat peningkatan angka kematian yang dimulai pada IMT diatas 25 dan semakin jelas pada individu dengan IMT diatas atau sama dengan 30. Angka mortalitas pada individu dengan IMT diatas 30 penyebabnya bervariasi namun yang terbanyak adalah angka mortalitas yang disebabkan oleh penyakit Kardiovaskular. Penelitian yang dilakukan oleh Framingham Heart Study di Amerika menemukan adanya korelasi antara tekanan darah dan obesitas. Disebutkan pada studi tersebut bahwa pada individu dewasa muda dengan obesitas akan mengalami peningkatan tekanan darah sebanyak 10 kali lebih besar daripada individu dengan berat badan normal. 

  Strategi Pencegahan Overweight dan Obesitas

          Overweight dan Obesitas merupakan suatu kondisi dengan penyebab multi faktor, oleh karena itu penanganan yang tepat hendaknya mempertimbangkan pendekatan secara multi disiplin. Pencegahan Overweight dan Obesitas terdiri dari tiga tahapan yaitu Pencegahan primer, sekunder dan tertier. Pencegahan Primer adalah dengan pendekatan komunitas untuk mempromosikan cara hidup sehat. Usaha pencegahan dimulai dari lingkungan keluarga, sekolah, tempat kerja dan pusat kesehatan masyarakat. Pencegahan sekunder bertujuan untuk menurunkan prevalensi Obesitas sedangkan pencegahan tertier bertujuan untuk mengurangi Obesitas dan komplikasi penyakit yang ditimbulkannya.

           Pada dasarnya prinsip dari pencegahan dan penatalaksanaan Overweight dan Obesitas adalah mengurangi asupan energi serta meningkatkan keluaran energi, dengan cara pengaturan pola makan, peningkatan aktivitas fisik, modifikasi gaya hidup serta dukungan secara mental dan sosial.

 1. Pengaturan nutrisi dan pola makan

  Tujuan utama pengaturan nutrisi pada individu dengan overweight dan obesitas tidak hanya sekedar menurunkan berat badan, namun juga mempertahankan berat badan agar tetap stabil dan mencegah peningkatan kembali berat badan yang telah didapat. Konsumsilah sedikit lemak (30 % dari jumlah keseluruhan kalori yang dikonsumsi). Kurangi konsumsi makanan tinggi karbohidrat dan lemak, perbanyak konsumsi serat. Upayakan tetap memilih makanan dan minuman secara berhati-hati agar tetap dapat mengontrol kalori, lemak, gula dan garam yang dikonsumsi.Konsumsi makanan yang dilakukan harus tetap dapat memenuhi kecukupan gizi. Ini berarti vitamin dan mineral harus terdapat dalam jumlah yang sesuai dengan kebutuhan.

 2. Perbanyak aktivitas fisik

  Olahraga dan aktivitas fisik memberi manfaat yang sangat besar dalam penatalaksanaan overweight dan obesitas. Olahraga akan memberikan serangkaian perubahan baik fisik maupun psikologis yang sangat bermanfaat dalam mengendalikan berat badan. Contoh yang paling jelas adalah sebagai berikut,  jika kita melakukan aktivitas lari selama 1 jam penuh kegiatan ini akan membakar 600 kalori setara dengan kalori yang dihasilkan jika kita mengkonsumsi satu buah hamburger fast food. Olahraga yang dilakukan secara konsisten dan teratur tidak hanya dapat membakar kalori, namun juga mengurangi lemak, meningkatkan massa otot tubuh, dan memberi manfaat yang cukup baik secara psikologis.

3.  Modifikasi pola hidup dan perilaku

  Perubahan pola hidup dan perilaku diperlukan untuk mengatur atau memodifikasi pola makan dan aktifitas fisik pada individu dengan overweight dan obese. Dengan demikian diharapkan upaya ini dapat mengatasi hambatan-hambatan terhadap kepatuhan individu pada pola makan sehat dan olahraga. Strategi yang dapat dilakukan adalah pengawasan sendiri terhadap berat badan, asupan makanan dan aktivitas fisik; mengontrol keinginan untuk makan (motivasi keluarga dan lingkungan seringkali diperlukan dalam hal ini); mengubah perilaku makan dengan mengontrol porsi dan jenis makanan yang dikonsumsi; dan dukungan sosial dari keluarga dan lingkungan.

 

Kosmetik Aman Pada Ibu Hamil

Bagaimana tips menggunakan kosmetik selama hamil?

  • Konsultasikan apakah bahan yang dipakai aman untuk ibu hamil, tidak disarankan untuk facial dengan kosmetik yang mengandung bahan kimia seperti AHA, formaldehyde acid, glicolic acid dsb karena berbahaya bagi janin.
  • Bersihkan sisa kosmetik sebelum idur dan gunakanlah pelembab serta tabir surya sebelum beraktivitas di bawah sinar matahari. Krim khusus, minyak zaitun atau baby oil dapat mengurangi rasa gatal atau guratan kecoklatan akibat perut yang membesar.

Sekarang adalah saatnya membuat beberapa perubahan kulit dan kosmetik pilihan. Kendati masih sedikit penelitian mengenai ini, tetapi ada beberapa bahan yang biasanya ditemukan dalam produk perawatan kulit dan kosmetik yang diduga dapat mengganggu perkembangan janin. Oleh karenanya berhati-hatilah sebelum menggunakannya.

Bahan kosmetik apa saja yang berbahaya bagi ibu hamil?

Beberapa jenis kosmetika dari bahan sintesis harus diwaspadai karen adapat melewati plasenta dan masuk ke otak janin sehingga mengganggu perkembangan janin. Berikut ini kandungan zat dalam kosmetika yang harus anda hindari ketika sedang hamil:

  • Benzoil peroksida, ditemukan dalam banyak produk yang digunakan untuk mengobati jerawat, termasuk kategori C yang sebaiknya dihindari.
  • Salicylic acid (BHA atau beta hydroxxy acid), bahan ini ditemukan dalam produk yang digunakan untuk antipenuaan (antiaging) dan mengobati jerawat.
  • Retinol A, merupakan bentuk vitamin A yang digunakan mengobati jerawat dan pengelupasan kulit mati. Dosis tinggi vitamin A terbukti dapat mengganggu perkembangan bayi.
  • Parabéns, yaitu pengawet yang sangat umum digunakan banyak produk perawatan kulit. Penelitian klinis menunjukkan adanya hubungan bahan ini dengan efek buruk pada sistem reproduksi bayi laki-laki.
  • Assutane, obat jerawat ini beresiko menyebabkan janin lahir cacat yang serius dan kemungkinan keguguran.
  • Hidrokortison, krip topical ini mengakibatkan janin lahir cacat dan janin keracunan.
  • 1,4 Dioksana, Ini merupakan bahan bahaya yang tercantum pada setiap produk perawatan kulit karena merupakan bahan sintesis lain berbasis minyak bumi. Bahan ini hadir dalam banyak jenis produk rambut dan pelembab. Bahan ini dapat menyebabkan kanker dan pengaruh efek pada perkembangan janin.
  • Cream Hair Removers, kemungkinan bahan ini dapat diserap ke dalam kulit sehingga harus dihindari selama kehamilan.

Smoga pengetahuan tersebut dapat lebih membimbing para calon ibu  untuk menjaga keselamatan ibu sendiri dan anak dalam kandungan. Bukankah ALLAH itu indah dan menyukai keindahan (hadist). Maka perhatikanlah penampilan anda, meskipun beban anda bertambah dan sangat menguras tenaga. Tetaplah tampil cantik seperti sebelum dan awal anda bertemu dengan suami anda. Indahkanlah pandangan anda, sehingga orang lainpun akan meng-indahkan anda pada penghormatan mereka pada anda

Waspada Bahaya di Balik Krim Pemutih

Siapa perempuan yang tak bangga memiliki kulit putih berseri tanpa noda spot coklat atau kehitaman di wajah? Tidak ada. Bahkan yang berkulit gelap dari ‘sononya’ ingin tampak lebih putih. How come?

Bahkan iklan produk pemutih wara-wiri di televisi, belum lagi di media cetak. Anda tahu, dari dua produk pelembab yang terjual, salah satunya adalah produk pemutih kulit.

Apapun rela dilakukan perempuan untuk tampil lebih cantik dengan kulit putih cling. Bahkan harga bukan masalah, sekalipun harus mengeringkan tabungan bertahun-tahun! Putih sudah menjadi obsesi, yang tak jarang membuat kita lupa diri, tak waspada terhadap produk krim pemutih yang beredar di pasaran.

Mendapatkan kulit putih, atau tepatnya lebih cerah, tidak bisa dengan cara instan. Jika Anda menemukan putih dengan cara instan, katakan dalam hitungan minggu, patut dicurigai ada sesuatu di balik itu.

Secara umum terdapat berbagai jenis krim pemutih di pasaran. Krim-krim ‘ampuh’ ini umumnya mengandung berbagai jenis zat aktif seperti hidrokuinon, monobenzil dan monometil hidrokuinon, raksa, asam askorbat dan peroksida.

Namanya juga bahan kimia, selalu ada efek sampingnya jika tak digunakan sesuai takaran yang disarankan. Krim yang mengandung bahan aktif hidrokuinon amat mengesankan sekali cara kerjanya dalammembasmi spot hitam atau warna yang tidak merata pada kulit, meski hasilnya berbeda pada setiap individu.

Dalam suatu kajian yang telah dijalankan di Amerika Syarikat (Arndt dan Fitzpatrick, 1965), krim yang mengandungi 2% dan 5% hidrokuinon telah diuji ke atas 56 subjek yang mempunyai masalah spot kehitaman pada kulit. Menariknya, 12% dari jumlah subjek kajian adalah penduduk berketurunan kulit hitam. Mereka ini menggunakan krim mengandung hidrokuinon dua kali sehari selama tiga bulan.
Hasilnya menakjubkan. Krim mengandung hidrokuinon dapat menghilangkan spot hitam pada 44 orang yang mengikuti penelitian dari jumlah 56 responden.

Pemakaian hidrokuinon yang berlebihan bukannya tak membawa efek samping. Krim yang mengandungi 5% hidrokuinon telah dilaporkan memberi kesan sampingan (iritasi dan rasa terbakar pada kulit). Namun jika kadarnya hanya 2% pemakai hanya mengalami sedikit iritasi atau terbakar saja.

Pemakaian hidroquinon berlebih dapat menyebabkan kulit iritasi, dan jika dihentikan kulit akan seperti semula, bahkan bisa lebih buruk. Lebih bahaya lagi merkuri. Logam yang sebenarnya sudah dilarang itu memang menjadikan kulit tampak putih mulus, tetapi lama-kelamaan akan mengendap di bawah kulit. Setelah bertahun-tahun kulit akan biru kehitaman, bahkan dapat memicu timbulnya kanker.

Kadar zat pemutih hidroquinon untuk kosmetik hanya diperbolehkan dua persen, lebih dari itu harus diperlakukan sebagai obat.

Krim pemutih merupakan campuran bahan kimia yang bertujuan memucatkan noda hitam (cokelat) pada kulit. Dalam jangka waktu lama krim tersebut dapat menghilangkan atau mengurangi hiperpigmentasi pada kulit. Namun jangan salah, penggunaan yang terus-menerus justru akan menimbulkan pigmentasi dengan efek permanen.

Sayangnya, sekarang banyak konsumen kejeblos, menggunakan pemutih yang bermanfaat instan. Pemutih tersebut bisa menimbulkan efek rebound, yaitu memberikan respons berlawanan saat pemakaian dihentikan.

Hasil kajian tersebut juga menunjukkan bahawa krim ini hanya sesuai untuk pengguna berkulit cerah dengan spot kehitaman tidak banyak. Krim ini bekerja baik untuk perawatan kulit pada peringkat awal pembentukan bintik hitam.

Bagaimana krim seperti itu bekerja? Dari kajian ini didapat hasil hidrokuinon menghalangi pengeluaran melanin oleh melanosit di dalam epidermis. Hidrokuinon juga menembus kulit dan menyebabkan penebalan gentian kolagen.

Efek samping hidrokuinon memang sedikit saja terutama jika dipakai pada kadar rendah, namun ada rasa panas terbakar saat krim dengan hidrokuinon tinggi diaplikasikan pada kulit.

Jika krim seperti ini digunakan dalam jangka panjang, sementara kita juga terekspos sinar matahari, bukan kulit cerah merona yang kita dapat, melainkan sebaliknya. Spot coklat aau kehitaman justru bertambah, bahkan muncul bintik kekuningan pada kulit yang disebut okronosis. Kerusakan ini mungkin bersifat selamanya karena tidak ada yang dapat dilakukan untuk mengembalikan ke bentuk atau warna semula.

Hidrokuinon bukan saja berbahaya jika digunakan pada kulit pada kadar tinggi. Jika termakan zat ini dapat menyebabkan keracunan yang serius. Jika yang termakan mencapai kepekatan 5-15 gram akan menyebabkan kerusakan sel darah merah (hemolytic anemia).

Siapa sih yang tak ingin kulitnya putih dan mulus dalam hitungan minggu? Tapi harap diingat, begitu kosmetik dihentikan kulit menjadi hitam atau dikotori dengan flek-flek, bahkan merah seperti udang rebus, atau lebih parah lagi muncul kanker kulit.[]

Source: http://www.hanyawanita.com/

Bagaimana membangunkan ketaatan masyarakat atau pasien dalam menjalani terapi obat?

Berikut dikopikan hasil penelitian tentang intervensi pendidikan kesehatan untuk menumbuhkan kesadaran pasien asma dalam menjalani terapi obat agar tujuan terapi tercapai. Artikel diambil dari jurnal imunologi alergi asia pasifik.

Recent educational interventions for improvement of asthma medication adherence
Malin Axelssoncorresponding author1,2 and Jan Lötvall1
1Krefting Research Center, Institute of Medicine, Internal Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
2Department of Nursing, Health and Culture, University West, SE-461 86 Trollhättan, Sweden.
corresponding authorCorresponding author.
Correspondence: Malin Axelsson. Krefting Research Center, Institute of Medicine, Internal Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden. Tel: +46-31-786-67-16, Fax: +46-31-786-67-30, Email: malin.axelsson@gu.se
Received November 24, 2011; Accepted November 30, 2011.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Poor adherence to asthma medication treatment is a dilemma as it decreases the chance of achieving and maintaining a proper asthma control. Another dilemma is that there seems to be a small range of functional interventions that enhance adherence to long-term medication treatments. The aim was to review the last five years of published educational interventions for improving adherence to asthma medication. Through systematic database searches 20 articles were identified, which matched the inclusion criteria and described educational interventions to improve asthma self-management including adherence. The current review showed that addressing unintentional non-adherence in terms of incorrect inhaler technique by recurrent education improved the technique among many patients, but not among all. Phoning patients, as a means to remove medication beliefs as adherence barriers, seemed to be an effective educational strategy, shown as increased adherence. Involving patients in treatment decisions and individualising or tailoring educational support also seemed to have favourable effect on adherence. To conclude, addressing specific adherence barriers such as poor inhaler technique or medication beliefs could favour adherence. To change adherence behavior, the current review proposes that educational adherence support should be a collaborative effort between the patient and the health-care professional based on each individual patient’s needs and patient factors, including elements such as personality traits.
Keywords: Adherence barriers, Asthma, Medication behavior, Patient education, Personality
INTRODUCTION
A plethora of studies have reported about poor adherence to asthma medication treatment [14]. As an example, an overall adherence to asthma medication of 22% in a sample of 5,500 persons with asthma was reported in one study [5]. People with asthma, who display poor medication adherence, most likely run increased risk of experiencing poor asthma outcomes [4]. The chance of achieving and maintaining the goal of modern asthma treatment: a well-controlled asthma, may also diminish [6]. There are arguments stating that the discovery of effective methods to improve adherence almost certainly would have a more advantageous influence on health than any treatment. However, there seems to be a lack of fruitful interventions, which successfully improve both adherence and treatment outcome [7]. Therefore, the aim was to review the last five years of published educational interventions for improving adherence to asthma medication.
Method
Systematic searches were carried out in the databases PubMed, Cinahl and Scopus with the following limitations: English language, publication between 2007 and 2011, adults (≥18 years) and articles accessible in full-text versions. Inclusion criteria were that the articles should be based on an empirical intervention including efforts to improve adherence in adult persons with asthma. Reviews, guidelines and study protocols were excluded. The following search terms were used: asthma, adherence, compliance, medication and intervention. In PubMed the Mesh terms: behavioral medicine, patient education and health psychology were used and in Cinahl the heading: medication compliance was used. The search terms were used in combinations and together with the Boolean operators OR and AND. Twenty articles matched the stipulated criteria and were included in the current review.
Starting point
Thanks to the large body of adherence research conducted in recent decades, a rather good picture of factors that influence adherence behaviour is obtainable. The World Health Organization (WHO) has organized these factors into five dimensions: social/economic, therapy-related, patient-related, condition-related factors and those related to the health-care team and system [8]. As efforts to improve adherence are recommended to address these dimensions [9], the current review adheres to that recommendation and will present the articles accordingly.
Social and economic factors
In general, the influence of social/economic factors could pose challenges to treatment adherence [8, 10], but their effect on adherence shows an inconsistent pattern [8] and seems to vary by sample [11]. None of the articles included in this review specifically addressed this dimension.
Therapy-related factors
Because asthma medication usually is administered by inhalation, the patients need to have an adequate technique to allow the medication to deposit in the lungs. Although manufacturing companies are striving to develop inhalers that are user friendly, incorrect inhaler use seems common [12, 13]. Another problem is that many patients seem to be unaware of their incorrect inhaler technique [12]. Considering adherence, this could be referred to as unintentional non-adherence, which means that the patient has an intention to adhere to recommended treatment, but fails due to defective inhaler technique [14, 15]. Five of the articles included in this review specifically addressed the issue with incorrect inhaler technique in their educational interventions.
Interventions to improve inhaler technique
In all five studies improvements in patients’ inhaler technique were reported but Hardwell et al. [16] concluded that despite improvements the majority still used a faulty technique. The interventions were carried out by asthma nurses in two studies [16, 17], by pharmacists in two studies [18, 19] and by physicians in one study [20].
Repeated inhaler instructions were used as method to improve inhaler technique in three of the studies [16, 19, 20] and in the other two studies tailored and individualised educational strategies were used [17, 18]. Takemura et al. [20], invited 146 patients of which 25 received repeated instructions of inhaler use and their inhaler technique was checked regularly. The instructions comprised verbal information and demonstration provided by their physician. In the study conducted by Daiane de Oliveira and colleagues [19], patients assigned to the intervention (n=28) received instructions on correct use of medication on four occasions, while the control group (n=27) only received this information once. Hardwell et al. [16] enrolled patients (n=1,092) with uncontrolled asthma prescribed pressurised metered-dose inhaler (pMDI) to check their inhaler technique using an Aerosol Inhalation Monitor (AIM). Patients received specific education on pMDI use, if they failed any of the three set AIM parameters. Takemura et al. [20] reported that their intervention apart from improving inhaler skills also resulted in improvements in self-reported adherence. These findings were partly opposed to those reported by Daiane de Oliveira et al. [19], who reported that there was no difference between the groups as regards reported adherence, but the inhaler technique had improved in the intervention group by the end of the project. The intervention carried out by Hardwell et al. [16] resulted in a statistically significant increase in number of patients with appropriate pDMI use after two and three educational occasions, but a majority of the patients still used faulty inhaler technique.
In a randomised controlled trial, a tailor-made intervention, depending on the patient’s current asthma control, was used to optimise use of asthma medication [18]. The intervention group (n=94) received education on three occasions at the pharmacy and the control group (n=107) received usual care. The effect of this intervention was estimated after six months and was described as higher frequency of filled prescriptions and better inhaler technique in the intervention group compared to the control group. The use of rescue medication was decreased and fewer nighttime awakenings were reported in the intervention group. However, self-reported adherence was similar in both groups [18]. This inconsistency in adherence estimations (frequencies of prescription fills and self-reports) sheds light on the difficulties with adherence monitoring.
An individualised education program was used in patients defined as “poor adherers to asthma medication” [17]. The intervention comprised three individual sessions each lasting 30 min. In the first session a nurse checked the patient’s knowledge and skills about his/her prescribed inhaler. A trained nurse informed and demonstrated the skills for self-management of asthma including inhaler technique. In the second session, a pharmacist informed about dosage, effects and side-effects of the medication but also about the method of controlling dosage based on asthma symptoms and lung function measured with peak expiratory flow (PEF). During the third session, patients were provided a self-asthma action plan describing how to recognise and to handle an asthma attack. The plan also gave clear instructions about how to use the asthma medication, how to interpret PEF rates and to avoid triggers. This intervention specifically improved both inhaler skills and increased PEF values, suggesting that asthma control became better. These effects sustained eight weeks after the intervention and this was the last follow-up [17].
Patient-related factors
Patients’ perceptions of their asthma and their beliefs about asthma medication may influence adherence behaviour [9]. These perceptions and beliefs could result in so called intentional non-adherence, which is a result of a person’s conscious decision to deviate from the recommended treatment, for instance by under or overusing the medication or by prematurely terminating the treatment [14, 15]. Patients, who deny an asthma diagnosis, or patients, who do not perceive their asthma to be a chronic condition, seem more inclined to refrain from the medication treatment [21]. Medication beliefs are also known to influence adherence behavior. For instance, patients who regard the asthma medication as a necessity for their health, seem more motivated to follow the treatment recommendations [2123], whereas those who are concerned with side-effects or becoming dependent, tend to intentionally deviate from the recommendations [21, 23]. Patients who have concerns about regular medication intake, side-effects or poor effect, also tend to display a non-adherent behaviour [24]. In this review, one article specifically addressing illness perceptions and four studies addressing medication beliefs as a means to improve adherence, were included.
Illness perceptions
Illness perceptions as factors influencing adherence were addressed by Smith et al. [25] who intervened by using a self-management model of illness comprising a structured step-wise and patient-centered approach. The intervention lasted nine months and patients were randomised to intervention (n=35) or control group (n=56), which received usual care. The health-care providers used the model to help the patients to identify areas of everyday life when asthma control was difficult to achieve, to set goals and to find strategies how to deal with these problematic situations. Hereby, the patients were working with personal defined goals and strategies. This intervention did not result in improved adherence to asthma medication. Instead asthma control, asthma self-efficacy and asthma quality of life improved in both groups but more in the intervention group.
Medication beliefs
All four studies addressing medication beliefs reported that their approaches had a positive impact on medication barriers and adherence behaviour. In three studies, telephone calls were used as method to carry out the interventions whereas Clerisme-Beaty and colleagues [26] used quite a different method to address adherence and medication beliefs by using a specific drug presentation style. The presentation about the drug was aimed at increasing patients’ expectancy that the asthma medication could control the asthma symptoms adequately. Patients (n=25) who received the medication presented in this manner reported better adherence and they also expressed higher expectancy with the specific asthma medication.
In a randomised controlled trial [27], the effect of phone calls made by pharmacists to patients, who received their first prescription for a long-term disease (ten had asthma), was evaluated. Two weeks after the patients had filled their prescription, a pharmacist phoned the patient to ask if there were any problems with the medication, about adherence and whether any additional information was needed. The pharmacist gave information and advice depending on the patient’s expressed needs. Four weeks later a researcher phoned the patients asking about the medication and adherence. The intervention of the pharmacist calling the patients resulted in better self-reported adherence in comparison to the control group. According to the result section in the abstract, fewer problems with the medication were reported in the intervention group [27].
Telephone calls were combined with educational material sent by mail on three occasions, in an intervention conducted by Park et al. [28]. The study group (n=87) received two telephone calls from a trained care manager with a health-care background. The phone-calls were concentrated on barriers to asthma medication adherence and the development of asthma management strategies. The educational mailings comprised general medication adherence topics and asthma specific information. Each telephone call and mailing did also encourage the participant to carry out proper asthma management. The intervention lasted six months and resulted in a reduction in both adherence barriers and in days when housework and schoolwork were limited due to asthma. Additionally, a reduction in the number of days when the patients was unable to attend to social, recreational and family activities was seen.
The effect of an “interactive voice recognition call” on adherence to asthma medication treatment was evaluated by Bender et al. [29]. The intervention group (n=25) received a maximum of three robot-phone calls during the intervention period of ten weeks and the control group (n=25) received none. By the end of this project, the intervention group reported both increased adherence and a favourable change in medication beliefs.
Condition-related factors
The symptom variability characteristic for asthma is claimed to be an important barrier to remain in regular medication treatment. This typical asthma feature could thus lead to doubts about the diagnosis and the need for regular medication treatment [9], which may explain why initiated medication treatment sometimes is interrupted when the asthma symptoms vanish [22] or when the patients start to feel better [30]. On the other hand, an adherent behaviour seems more likely to occur among those who perceive their asthma as severe [22] but it has also been reported that poor adherence frequently occurs among asthmatics with uncontrolled disease [31, 32]. Two articles were included in this section of the review, of which one succeeded in improving adherence.
Patients with “difficult asthma” were invited to a two phase intervention [33]. The first phase comprised a “concordance discussion”, which addressed whether the patient was adherent or not. Briefly, poor adherence was determined using prescription refill frequency, and a plan to address adherence obstacles was actively discussed with the appropriate patients. At six months follow-up, an improvement in adherence among the patients (n=83) was seen, which was associated with improved lung function and a reduction of hospital admissions. The second phase comprised an individual psycho-educational intervention, which was planned in light of the patient’s stated reasons for not adhering to the prescribed asthma medication treatment. Nine patients were randomised to the intervention and 11 to the control group. The effect of the intervention was determined at 12 months and was seen in an increase in prescriptions filled, as well as a reduction in total oral corticosteroid doses taken [33].
Patients with moderate and severe asthma (n=333) participated in a randomised controlled trial testing whether an individualised problem-solving intervention improved adherence to inhaled corticosteroids and asthma outcomes [34]. The intervention group (n=165) took part in four 30 min sessions aimed at improving or maintaining adherence by addressing individual barriers to adherence and finding solutions to remove the barriers. The control group (n=168) received standard asthma education during four 30 min sessions covering asthma topics exclusive of adherence. Adherence, which was measured electronically, decreased in both groups. In contrast, both asthma control and asthma quality of life improved, but emergency department visits and hospitalisation were unaffected [34].
Provider-related factors
Patients’ dissatisfaction with the patient-provider interaction may have a negative impact on adherence behaviour. Another factor related to the health-care system could be that the appointments with the physicians are too short to include patient education and to provide written information about asthma [9]. Patients and physicians seem to have different perceptions about the content during appointments. For instance, patients think that inhaler technique and side-effects with the asthma medication is discussed more rarely than do the physicians [35]. Two of the articles included in this review addressed the interaction between the patient and the health-care provider and six studies focused on patient education.
Patient-provider interaction
Both studies included in this section of the review focused on stimulating to a collaborative effort between the patient and the health-care provider to improve adherence to asthma medication. The effect of “shared decision making” between the patient and clinician as regards asthma medication was investigated in a randomised controlled trial. The intervention group (n=182) shared in making decisions about the medication, in the other group the clinician made the decisions (n=180) and the third group received usual care (n=189). At follow-up after one year, the patients, who shared in making decisions about their asthma medication treatment, improved their adherence based on pharmacy data, but at follow-up after two years the intervention effect did not occur. Nevertheless, adherence was better at year two compared to baseline scores [36].
A “cueing therapeutic communication” between patients and their clinicians was used to improve adherence to inhaled corticosteroids and asthma control in another study. The cue intervention comprised of visually standardised interpreted peak flow graphs, which were aimed to enhance the communication about the patient’s treatment plan. Sixty-eight patients assigned to 22 clinicians were randomised to the intervention group and 71 patients assigned to 21 clinicians to the control group. At the first visit the patients received a brief education session and a booklet. Adherence was measured electronically but in some cases the inhalers’ own dose counters were used. This intervention did not improve adherence but it seemed that it had a positive influence on asthma control, as patients who participated in the intervention used fewer courses of oral steroids during winter and spring, reported fewer asthma worsenings and made fewer urgent care visits during winter in comparison to the control group. However, there was no difference in the patients’ perceptions of the communication between the clinicians between the two groups [37].
Asthma education
This section of the review comprises articles describing rather extensive educational interventions covering important aspects of asthma management required for an adequate self-management.
The two studies in which interventions had a clear effect on adherence, were conducted by Morisky et al. [38] and by Armour et al. [39]. The first study was a two year prospective evaluation of a cohort comprising of 15,275 patients, of which 35% had asthma. The aim was to determine the effect of a disease management program addressing physiological and behavioural health indicators by tailored education. The results in the asthma subgroup showed significant increase in adherence in relation to asthma medication and improved asthma symptoms in regard to severity, frequency, nocturnal awakenings and activity limitations. Additionally, the patient’s use of PEF monitoring to assess asthma was increased [38]. The second study tested the effect of a pharmacy asthma care program comprising targeted education on the asthma, medication, lifestyle, inhaler technique, adherence, medication problems and goal-setting. Fifty pharmacies were randomised to the intervention and control pharmacies and 165 patients completed the intervention and 186 control patients finalised the study. The intervention resulted in improved adherence to preventer medication and a simultaneous reduction in reliever medication use in the intervention group. Moreover, the risk of non-adherence decreased and asthma quality of life, asthma knowledge and asthma control improved [39].
Three additional studies using educational programs reported important progress in self-management but the effect was not clearly reflected in adherence behaviour.
The effect of asthma education in two intervention groups, which received specific asthma education comprising elements of asthma management, inhaler use techniques as well as written information, was investigated by Kritikos et al. [40]. In one intervention group, the education was provided by specially trained pharmacists and the other group by pharmacist researchers trained as asthma educators. The control group did only receive written information – the same as in the intervention groups. Adherence measured through self-reports improved in both intervention groups but not more than in the control group.
In the next study, Wang et al. [41] explored whether there were any differences in outcomes if the patients were provided with asthma education by a nurse, or asthma counseling by a pharmacist. The patients were randomly assigned to two intervention groups and one control group. The first intervention group (n=35) received education from a nurse including asthma knowledge, monitoring disease severity, PEF use, information about asthma medication and self-management such as triggers and handling asthma attacks. The second group (n=34) received the same education in combination with information about the function and side-effects of the asthma medication by a pharmacist. The control group received usual care. At the last follow-up after six months, the two intervention groups had no significantly higher adherence compared to the control group.
The impact of self-management education on adherence to asthma medication was studied by Janson et al. [42]. Eighty-four participants were randomised to an individualised self-management education (n=45) or to a control group (n=39) receiving usual care. The intervention lasted 30 minutes and was given on three occasions with two weeks interval. The first was held by a nurse and a respiratory therapist both certified as asthma educators. There was also a personalised part addressing results from spirometry, PEF, skin prick tests and specific strategies to remove triggers. Adherence was monitored electronically. Mean adherence did not differ between the intervention and the control groups. When adherence scores were dichotomised as ≥60% or <60%, the odds of maintaining ≥60% adherence was nine-fold for the intervention group. These odds were maintained at 24 weeks, when the intervention was finalised.
These last three studies considered, a positive effect on patient’s asthma knowledge was seen [4042]. In Wang’s study [41] no improvements in asthma quality of life were seen but in Kritikos’ study [40] an improvement in both asthma quality of life and inhaler technique was found in the intervention groups. Kritikos et al. [40] also found a reduction in severe asthma and in Janson’s study [42], the intervention group reported fewer symptoms than the controls but mean symptom scores decreased in both groups. The nocturnal awakenings decreased in the intervention group and the odds of experiencing awakenings decreased in this group. The use of rescue medication decreased in the intervention group versus in the control group but both groups decreased their use during the intervention.
The final study had a different approach in comparison with the other studies in this section as a learner centered intervention was used. The focus was on interactive discussions, problem-solving, social support and procedures to change asthma specific behaviour. Additionally, the participants were encouraged to support each other. Twenty-four patients were randomised to the intervention group and 21 in the control group. The intervention comprised seven weekly meetings lasting two hours. The effect of this self-management program was reflected in improved asthma knowledge and asthma quality of life, self-efficacy and patient activation. As regards use of controller medication the mean was already at intervention start 6.8 of a maximum 7 scores, which did not leave much space for an improvement [43].
DISCUSSION
With reference to the interventions accounted for in the present review, a reasonable conclusion is that stimulating the asthma patients to active participation in treatment planning seems to improve their self-management of asthma including adherence to prescribed asthma medication. As an example, increased adherence was seen among patients who shared in decisions about medication treatment [36] and among patients, whose medication problems and own treatment goals, were considered [39]. However, solving the dilemma with poor adherence is not that as easy as just engaging the patients, which was learnt from the study conducted by Smith et al. [25]. Regardless of ambitious efforts, not all interventions accounted for in the current review led to improved adherence. In some cases, because the control patients also improved their adherence behaviour, which brings to mind the famous Hawthorne effect [44].
Another conclusion is that medication barriers, which prevent adequate adherence to asthma medication, may be demolished by simple phone calls from a health-care professional [2729]. If we could spare a couple of minutes to make a phone call to follow-up on our asthma patients’ potential medication concerns, we may have a cost-effective method to promote adherence, which in continuation prevents poor asthma control. Another effective method may be to address unintentional non-adherence like poor inhaler skills with repeated instructions [16, 19, 20]. It is to be noted, as Hardwell et al. [16] put forward, that many patients have an incorrect technique despite having received education, which recommends that such instructions should be tailored to each patient’s ability and that inhaler technique should be checked at each health-care appointment.
Another important remark is that dif ferent health-care professions have an educational role in promoting adherence to medication as part of proper asthma self-management. Addressing adherence in various health-care relations and contexts may emphasise its importance as the connecting link between the prescribed asthma medication and advantageous asthma outcomes. This work may be facilitated by identification of persons with high probability to display poorer adherence behaviour to asthma medication. The tricky part is to estimate accurate adherence level and to identify which patients are likely to deviate from a prescribed treatment, in daily practice in clinical settings [45]. The influence of patients’ personality on health behaviours such as adherence to medication treatment could be one guiding tool in this aspect.
Personality could be described in terms of five broad and bipolar personality traits Neuroticism, Extraversion, Openness to experience, Agreeableness and Conscientiousness. Each of the five personality traits are hierarchical constructed by more specific personality traits. These five personality traits contribute to enduring and individual differences in disposition to display a certain behaviour in a given situation [46]. We have previously reported that persons with various chronic diseases, who scored higher on Neuroticism, lower on Agreeableness or lower on Conscientiousness, seemed more inclined to display poorer adherence to medication treatment [47]. In yet another study, we found that more impulsive young adults with asthma reported lower adherence to asthma medication than the less impulsive. Young adult men, who were either more antagonistic or alexithymic, also reported lower adherence to asthma medication [48]. Associations between Neuroticism and poorer adherence in men with asthma have also been reported [49]. The advantage of assessing personality in relation to adherence is that it provides an indication of potential personal needs [50], which could be useful targets when planning adherence support. For instance, less conscientiousness or impulsive persons, who tend to be less goal-directed and structured [46], may be less inclined to plan ahead. This behavior may not be conducive to regular medication intake. For that reason, they may benefit from support with reminders or incorporation of routines for their medication intake. In contrast, persons scoring high on Neuroticism, who could be described as worried and with difficulties handling stress [50], most likely need another type of adherence support.
Some of the interventions in the currently reviewed articles were described as individualised for instance in terms of using the patients level of asthma knowledge, inhaler or PEF skills as points of departures [17] or interpretation of spirometry, PEF rate or control over environmental exposures [42], which certainly is of significance. Nevertheless, none of the interventions focused on individual differences in terms of personality among the selected patients, as personality is a major contributor of behavior, including health behavior [47, 48]. Fig. 1 shows a hypothetical personality perspective on adherence interventions. As a suggestion, future interventions aimed at promoting adherence and preventing poor asthma control should focus on persons with high risk of displaying poor adherence to the prescribed asthma medication treatment. In this work, assessment of personality could provide a useful tool to identify patients’ different needs and resources [50], which could function as targets when planning forthcoming adherence support.
Fig. 1
Fig. 1

Hypothetical model suggesting the potential effect of personality on adherence interventions, symbolised by dashed arrows.
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