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This study combined a person-oriented approach with a psychosocial framework of help-seeking to examine factors associated with the intent to disclose dating violence among developing adolescents. Data came from adolescents in middle and high school in a rural area in the southeastern United States, who were surveyed annually for 4 years (Nwave 1 = 580; Mage = 13 years, SD = 1.48; 52.7% female; 49% Black, 39% White, 11% Hispanic, or other minorities). Results confirm expectations that intraindividual (adolescent views on violence and safety); interindividual (peer and family dynamics); positional (gender, having a supportive adult); and ideological factors are all significant predictors of patterns in help-seeking attitudes. However, predictive relevance of some factors varied across help-seeking groups and data collection periods, supporting the differential effects hypothesis. For example, while greater friend social support increased the odds of belonging to "friend confidants," it simultaneously decreased the odds of being a member of "parent confidants" and "moderate help-seekers" groups. Additionally, the influence of family functioning tended to decrease over time, eventually losing its explanatory value at Wave 4. The article concludes by discussing how integration of a person-centered methodological approach with a robust theoretical foundation advances our understanding of variability in adolescents' responses to dating violence. Consideration of diversity in adolescent intentions to react to interpersonal violence is discussed further in the context of policy and practice to enhance protective options and prevent or minimize harm. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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In this letter to the editor, we present questionnaire-based data assessing the patient journey of adults with moderate-severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the USA and five European countries. These data highlight how long and difficult the patient journey with CRSwNP can be and how improved disease awareness among physicians could lead to more timely diagnosis and treatment, and hence improved management of patients.
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BACKGROUND: Pulmonary arterial hypertension (PAH) is a life-threatening, progressive disease often diagnosed late in its course. OBJECTIVES: To present patient-reported data that were captured within a large, multinational, point-in-time survey of PAH-treating physicians and their patients to better understand the diagnostic journey. DESIGN: Cross-sectional survey conducted in five European countries (EU5), Japan and the USA. METHODS: PAH-treating pulmonologists, cardiologists, rheumatologists or internists (USA only) completed a patient record form (PRF) for the next four consecutive adult PAH patients they saw; these patients filled in a patient self-completion (PSC) form on an anonymous, voluntary basis. Our report focuses on patient data; data are from PSC forms unless stated otherwise. RESULTS: Physician-reported PRFs and self-completed PSC forms were obtained for 1152 and 572 patients, respectively. Patients' mean (SD) age was 59.1 (14.0) years, 55.6% were female, and 57.3% had idiopathic PAH. Patient-reported data showed an average delay of 17.0 months between symptom onset and PAH diagnosis. This is longer than physicians estimated (13.8 months): this disparity may be partly due to the time taken by patients to consult a physician about their symptoms [9.6 months overall, longest in the USA (15.3 months)]. Most patients (71.6%) initially consulted primary care physicians about their symptoms and 76.4% of patients were referred to a specialist. Misdiagnoses occurred in 40.9% of patients [most frequent in the USA (51.3%), least common in Japan (27.6%)] and they saw an average of 2.9 physicians overall (3.5 in EU5 versus 2.0 in Japan/USA) before being diagnosed. Diagnosis was most often made by cardiologists (50.4%) or pulmonologists (49.3%). CONCLUSION: Our data suggest that diagnostic delay in PAH results from patient- and physician-related factors, which differ across regions and include lack of awareness of PAH on both sides. Development of better screening strategies may help address this barrier to timely PAH diagnosis.
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Hipertensão Arterial Pulmonar , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Hipertensão Arterial Pulmonar/diagnóstico , Estudos Transversais , Diagnóstico Tardio , Hipertensão Pulmonar Primária Familiar , Inquéritos e QuestionáriosRESUMO
Background: Poor adherence to inhaled corticosteroids (ICSs) increases asthma morbidity and mortality and is influenced by patients' treatment beliefs. This study maps patients' beliefs about ICSs across 6 countries examining variations in beliefs, and their relationship with adherence and outcomes. Objective: We sought to explore the relationship between patient treatment beliefs, and adherence and outcomes in asthma across 6 countries. Methods: Patients 18 years or older with asthma, receiving ICS alone or in combination with a long-acting ß2-agonist, were included from a point-in-time paper survey of patients with asthma in Europe and the United States. Clinical characteristics, such as adherence and asthma control, were collected by self- and physician-report. Patients completed the Beliefs about Medicines Questionnaire, adapted for ICSs. Relationships between patient treatment beliefs, adherence, and outcomes were examined using regression analyses. Results: Data from 1312 patients were analyzed. Patients were from Germany (24%), the United States (21%), France (21%), Spain (16%), Italy (10%), and the United Kingdom (9%). Most had physician-reported mild-intermittent asthma (87%), and mean age was 40 ± 15.5 years. There was considerable variation in necessity beliefs between countries, with respondents in Italy having more doubts about treatment necessity and respondents in Spain showing higher concerns. Patients with doubts about ICS necessity and high concerns had lower self-reported (necessity: χ2(2) = 34.31, P < .001; concerns: χ2(2) = 20.98, P < .001) and physician-reported adherence (necessity: χ2(2) = 11.70, P = .003; concerns: χ2(2) = 34.45, P < .001). Patients with high necessity beliefs (F(2, 483) = 3.33; P = .037) and high concerns (F(2,483) = 23.46; P < .001) reported poorer control. Physician estimates of adherence did not correlate well with patient self-report (ρ = 0.178, P < .001). Conclusions: ICS necessity beliefs and concerns were associated with adherence and asthma control. This has implications for the design of adherence interventions.
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This observational study assessed the prevalence of co-existing type 2 inflammatory conditions [T2Cs; asthma, atopic dermatitis (AD), allergic rhinitis, and chronic rhinosinusitis with nasal polyps (CRSwNP)] in patients with moderate-to-severe (M/S) type 2 asthma, M/S CRSwNP, or M/S AD, in the real-world setting. Data from 761 physicians in the US and EUR5 were sourced from Adelphi Disease-Specific Programmes covering patients with M/S asthma (n = 899), M/S CRSwNP (n = 683), and M/S AD (n = 1497). At least one T2C was identified in 66%, 69%, and 46% of M/S asthma, M/S CRSwNP, and M/S AD cohorts, respectively, and 24%, 36% and 16% had at least two T2Cs; trends were similar in the US and EUR5. In patients with M/S asthma or M/S CRSwNP, T2Cs commonly presented as mild or moderate. The comorbidity burden suggests that an integrated treatment approach is warranted to address underlying type 2 inflammation in patients with M/S type 2 diseases.
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Asma , Dermatite Atópica , Pólipos Nasais , Rinite , Sinusite , Humanos , Dermatite Atópica/complicações , Dermatite Atópica/epidemiologia , Pólipos Nasais/complicações , Pólipos Nasais/epidemiologia , Prevalência , Rinite/complicações , Rinite/epidemiologia , Inflamação , Asma/complicações , Comorbidade , Sinusite/complicações , Sinusite/epidemiologia , Doença CrônicaRESUMO
INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) often have poor sleep quality and report a worsening of respiratory symptoms during night-time. However, current clinical guidelines for COPD management do not specifically consider nocturnal symptoms when recommending pharmacological treatment. This study aimed to better understand the burden of nocturnal symptoms in patients with COPD, and to evaluate the importance of nocturnal symptom control compared with daytime and overall symptom control. METHODS: Data were analyzed from the Adelphi Respiratory Disease Specific Programme, a point-in-time survey of physicians and their patients, conducted in the USA in 2019. Primary care physicians and pulmonologists who managed three or more patients with COPD per month were eligible for inclusion; eligible patients were ≥ 18 years old, with a physician-confirmed diagnosis of COPD. RESULTS: Surveys from 171 physicians and 800 patients were analyzed. Everyday symptoms were reported in 14% of patients. In total, 88% of patients reported daytime symptoms, and 74% of patients experienced nocturnal symptoms, with 7% reporting daily nocturnal symptoms. Patients experiencing nocturnal symptoms every day had the greatest impairment in their activity as per the Work Productivity and Activity Impairment questionnaire (mean total activity impairment, 66.9%; nocturnal symptoms once or twice a week, 41.1%; no nocturnal symptoms, 26.4%). Patients experiencing daily nocturnal symptoms also had the lowest quality of life (QoL) as per the EuroQoL 5-Dimension 3-Level score. Physicians reported prescribing therapy based on sustained 24-h symptomatic relief for the majority of patients (78%). They reported nocturnal symptom control as a factor in their choice of therapy for 38% of patients, and daytime symptom control as a reason for 61% of patients. CONCLUSION: Daytime and nocturnal symptoms are common among patients with COPD. Frequency of nocturnal symptoms is related to a significant impairment in activity and health-related QoL.
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OBJECTIVES: This study elicited the views of physicians and patients with vasomotor symptoms (VMS) associated with menopause on the impact of VMS and treatment patterns/perceptions. STUDY DESIGN: Data from the Adelphi VMS Disease Specific Programme, a point-in-time survey conducted in 5 European countries and the United States in 2020, were used. Primary care providers (PCPs) and gynecologists seeing ≥3 patients/week with VMS associated with menopause completed a survey and chart review; their patients were invited to complete a survey and questionnaires. MAIN OUTCOME MEASURES: Physicians reported treatment patterns and patient-specific symptoms and treatment preferences. Patients described symptoms, impact of VMS, and treatment satisfaction. RESULTS: Participants included 115 PCPs and 118 gynecologists. Physicians reviewed the charts of 1816 patients, 854 of whom completed surveys. Moderate/severe impact of VMS on sleep, mood, quality of life, and work/study was reported by 35.8 %, 31.6 %, 23.6 %, and 15.4 % of women, respectively. Based on chart review, 64.8 % of women were currently prescribed treatment for VMS, most commonly hormone therapy (HT; 73.1 %), followed by selective serotonin or serotonin-norepinephrine reuptake inhibitors (31.3 %). Most women (57.3 %) with VMS were eligible for HT but averse to using it. Despite 91.4 % of physicians finding HT to be effective, 62.7 % agreed (slightly-strongly) that their patients are generally reluctant to use it. One-third of women were dissatisfied with VMS control. CONCLUSIONS: VMS can considerably impact daily life. Effective treatment options that are better accepted could potentially improve management of VMS and lead to better quality of life for women with VMS associated with menopause. CLINICAL TRIAL REGISTRATION: None.
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Fogachos , Médicos , Feminino , Fogachos/tratamento farmacológico , Humanos , Menopausa , Qualidade de Vida , Serotonina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Estados UnidosRESUMO
Purpose: There is a high prevalence of chronic obstructive pulmonary disease (COPD) in the United States (US). Although guidelines are available for the treatment of COPD, evidence suggests that management of COPD in clinical practice is not always aligned with this guidance. This study aimed to further understand the current use of COPD maintenance medication in the US. Patients and Methods: This study was an analysis of data from the Adelphi Respiratory Disease Specific Programme (DSP™) 2019. Point-in-time data were collected from participating US physicians and their COPD patients. Physicians were either primary care physicians (PCPs) or pulmonologists, with a minimum workload of ≥3 COPD patients per month. Patients were aged ≥18 years with a physician-confirmed diagnosis of COPD. Results: In total, 171 physicians completed the survey (92 PCPs and 79 pulmonologists). Mean patient age was 66.4 years, 45% were female, with moderate COPD in 49.4% of patients and severe/very severe in 19.3%. Pulmonologists more frequently prescribed dual bronchodilation and triple therapy than PCPs, whereas inhaled corticosteroid/long-acting ß2-agonist was more frequently prescribed by PCPs than pulmonologists. For both physician types, the most common reason for prescribing their patients' current treatment was 24-hour symptom relief. The majority of PCPs (70.1%) and pulmonologists (71.9%) reported referring to COPD guidelines when making treatment decisions. Conclusion: Prescribing patterns for COPD patients were found to differ between PCPs and pulmonologists. Improved physician understanding of how to tailor treatment for each patient, based on current symptoms and exacerbation risk, could help optimize patient care in COPD.
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Médicos , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Adolescente , Corticosteroides , Agonistas de Receptores Adrenérgicos beta 2 , Adulto , Idoso , Broncodilatadores/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Antagonistas Muscarínicos , Padrões de Prática Médica , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Memorializes Gary B. Melton (1952-2020). Melton was a psychology polymath. Recognized as a fellow by American Psychological Association (APA) and 10 different divisions, he was also president of Divisions 41 and 37 and received an unprecedented four APA Distinguished Contribution Awards-Psychology in the Public Interest (1981, 2014); Public Service (1999); and International Advancement of Psychology (2005). For 30 years, Melton directed interdisciplinary centers and institutes, three of which he founded: At the University of Nebraska-Lincoln, University of South Carolina, and Clemson University. He was known by former students and close colleagues as a passionate advocate, a visionary leader, and a caring and loyal mentor and friend. Melton died September 20, 2020. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Distinções e Prêmios , Emoções , Humanos , Masculino , Sociedades Científicas , Estudantes , UniversidadesRESUMO
Adolescents' willingness to disclose violence in romantic relationships has important implications for their safety and overall well-being. However, research is limited on adolescent intentions to seek help for dating violence. Using self-report data from 493 rural youth (54% male, 49.7% African American), this study examined heterogeneity of adolescent help-seeking in relation to different forms of violence and sources of potential disclosure. Latent class analyses identified four distinct groups of adolescents: (a) Multi-help-seekers (20.5%) who are likely to seek help for any form of dating violence from multiple sources, (b) Reluctant help-seekers (21.1%) who are unlikely to seek help for any form of violence from any source, (c) Informal help-seekers (28.8%) who are willing to disclose dating violence primarily to caregivers and friends, and (d) Selective help-seekers (29.5%) with varied intentions to disclose some forms of violence to select people. Results further revealed that class membership was differentially related to gender and caregiver's level of education. Additionally, findings confirmed expectations that variation in adolescent well-being and safety measures was a function of membership in help-seeking classes. The article discusses these findings in the context of targeted programs and services to promote help-seeking among rural youth.
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BACKGROUND AND OBJECTIVE: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease that requires ongoing care and is associated with considerable socioeconomic burden. We evaluated the IPF care pathway from symptom recognition to treatment. We describe the impact of IPF on healthcare resource use (HCRU), quality of life (QoL) and work impairment, and report differences in patient and physician perspectives using real-world data from France, Germany, Japan and the United States. METHODS: Quantitative, point-in-time data were collected as part of the Adelphi IPF II Disease Specific Programme™. Physician-reported data (patient demographics, medical history, diagnoses, treatment) were matched to patient-reported data (HCRU, QoL, work impairment). HCRU was measured as physician visits and hospitalizations. QoL and work impairment were measured using the EuroQol-5 Dimensions (EQ-5D) and Work Productivity and Activity Impairment questionnaires. RESULTS: Overall, 244 physicians reported data on 1249 patients, 739 of whom self-reported data. Diagnostic delays of 0.8 (Germany) to 2.0 (Japan) years after symptom onset were reported; treatment initiation was further delayed. In all countries, patients more often reported symptoms in the survey than did their physicians. On average, patients underwent 7-10 clinical tests before diagnosis. Antifibrotic use increased from 57% (2016) to 69% (2019); only 50% of patients with moderate/severe IPF were satisfied with their treatment. The 12-month hospitalization rates were 24% (Japan) to 64% (United States). Patients reported low QoL (mean EQ-5D visual analogue scale: 61.7/100). CONCLUSION: Patients with IPF experience considerable diagnostic and treatment delays. More effective therapies and management are needed to reduce the disease burden.
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Fibrose Pulmonar Idiopática , Médicos , Efeitos Psicossociais da Doença , Humanos , Fibrose Pulmonar Idiopática/tratamento farmacológico , Fibrose Pulmonar Idiopática/terapia , Qualidade de Vida , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: To assess patient- and physician-reported reasons for discontinuing biologic therapy among patients with severe asthma from a real-world US cohort. METHODS: This retrospective analysis surveyed US physicians and their patients with severe asthma who were receiving/had previously received biologic therapy between August and December 2019. Physicians managing ≥3 patients with asthma per month completed surveys on disease management, demographics, exacerbation history, and biologic adherence for eligible patients. Patients could voluntarily complete a questionnaire, providing perceptions of their disease and treatment. RESULTS: 117 physicians completed case reports for 285 patients; 85 patients had discontinued biologic therapy. Physicians (n = 85) and patients (n = 64) reported patient request (28.2% and 46.9%), shortness of breath (45.9% and 23.4%), other chronic respiratory symptoms (29.4% and 10.9%), cost/reimbursement (17.7%/9.4% and 20.3%/7.8%), and exacerbations (25.9% and 10.9%) among the main reasons for biologic discontinuation. Patients who continued biologic therapy were older (mean age 47.6 years) than those who discontinued (43.8 years), and were more likely to have ≥2 exacerbations in the previous year (52.5% vs 35.3%), allergic rhinitis (70.0% vs 62.4%), or chronic rhinosinusitis (30.0% vs 12.9%). Side effects were cited as reasons by only 15.3% and 7.8% of physicians and patients, respectively. CONCLUSIONS: The most common reasons given for discontinuation of biologic therapy were lack of symptom control, exacerbations, cost, and patient request. These data highlight the complexity of care for this patient group and the need for ongoing, regular assessment of common challenges to biologic continuation and reasons for discontinuation, including both clinical and non-clinical factors.
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Asma , Produtos Biológicos , Asma/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Terapia Biológica , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Discordance between physicians' and patients' perceptions of asthma control may negatively impact symptom control, treatment, and outcomes. OBJECTIVE: To evaluate concordance between physicians' and patients' perceptions of overall asthma control and the association between perceived overall control and individual components of control. METHODS: U.S. survey data (Dec 2015-Feb 2016; Apr-Aug 2018) from the Respiratory Disease Specific Programme were analyzed. Physicians recorded patient disease characteristics and their perception of patients' asthma control. Patients' perception of control was assessed using the Asthma Control Test; responses were compared with level of symptom control per the Global Initiative for Asthma criteria and Work Productivity and Impairment questionnaire responses. Agreement and association were assessed by weighted kappa (κ) and Spearman rho (ρ), respectively. RESULTS: The study included 1,288 patients. Concordance between physician-perceived and patient-perceived asthma control in the prior 4 weeks was moderate (κ = 0.4951). Association between physicians' overall perception of asthma control and patients' overall Asthma Control Test score was also moderate (ρ = 0.5450). However, 61.5% of patients with self-reported, well-controlled asthma had shortness of breath 1 to 2 times/wk, 45.6% had 1 to 2 night-time awakenings/wk, and patients reported a mean (SD) daily activity impairment of 17.5% (16.2%). Only 21.8% of patients with self-reported, well-controlled asthma were classified as such by Global Initiative for Asthma symptom criteria. CONCLUSIONS: Patients' self-assessment of overall control does not accurately characterize the true level of control; thus, patients and physicians may benefit from working together to assess the individual components of asthma control to achieve better disease management, treatment decisions, and improved outcomes.
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Asma , Médicos , Asma/diagnóstico , Asma/epidemiologia , Humanos , Relações Médico-Paciente , Autorrelato , Inquéritos e QuestionáriosRESUMO
Purpose: To characterize and estimate the proportion of patients with chronic obstructive pulmonary disease (COPD) who continue to exacerbate while receiving triple therapy and further describe these patients according to blood eosinophil counts. Methods: This was an analysis of the 2017 Adelphi Real-World Respiratory Disease Specific Programme (DSP) survey of patients with COPD from France, Germany, Italy, Spain, and the United Kingdom (UK). Demographics were assessed on the date of completion of the physician/patient questionnaire; clinical characteristics were captured for the previous 12 months. The proportion of patients receiving triple therapy, who had experienced ≥2 moderate or ≥1 severe acute exacerbations of COPD (AECOPD) in the 12 months prior to index, and had blood eosinophil counts ≥150 cells/µL (T-AECOPD-EOS150) or ≥300 cells/µL (T-AECOPD-EOS300), were calculated. Results: In total, 2876 patients were included of which 762 had an eosinophil value. A higher proportion of patients in the ≥300 cells/µL eosinophil group (55.9%) compared with 150-<300 cells/µL (48.7%) and <150 cells/µL (47.1%) groups experienced ≥2 moderate and/or ≥1 severe AECOPD in the year prior to index. The ≥300 cells/µL eosinophil group had the lowest reported level of health-related quality of life (HRQoL). More severe disease in terms of comorbidities, lung function, healthcare resource use, and HRQoL was seen in patients with ≥2 moderate or ≥1 severe AECOPD in the year prior to index while receiving triple therapy, compared with patients who did not meet these criteria. In total, 10.6% and 6.2% of the COPD population, respectively, met the criteria for the T-AECOPD-EOS150 and T-AECOPD-EOS300 cohorts. Conclusion: This analysis demonstrates that there is a subpopulation of patients with COPD who continue to experience exacerbations despite receiving triple therapy; approximately three-quarters of these had eosinophils ≥150 cells/µL and one-third had eosinophils ≥300 cells/µL; these patients may benefit from eosinophil-targeted therapies.
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Corticosteroides/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Broncodilatadores/uso terapêutico , Eosinófilos , Pulmão/efeitos dos fármacos , Antagonistas Muscarínicos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Corticosteroides/efeitos adversos , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Idoso , Broncodilatadores/efeitos adversos , Progressão da Doença , Quimioterapia Combinada , Europa (Continente) , Feminino , Humanos , Contagem de Leucócitos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Sistema de Registros , Fatores de Tempo , Resultado do TratamentoRESUMO
Research is inconclusive about the trajectory of dating violence during adolescence and whether there are differences across gender and race/ethnicity. We examined dating victimization and perpetration trajectories among a diverse sample of rural youth (N = 580, 52.7% female, 49% Black, 39% White, 11% Hispanic or other minorities) in middle and high school who were surveyed annually across four years and explored the influences of gender and ethnicity. The results based on cohort-sequential latent growth modeling revealed that for boys, victimization peaked at 11th grade, and then declined. For girls, victimization was stable throughout adolescence. Perpetration was reported less frequently and increased steadily for males and females. For White youth, victimization peaked at grades 9 and 10, followed by a decline. For Black youth, victimization followed a linear increase. Perpetration trajectory followed a linear increase for White and Black but not Hispanic youth. The findings indicate that the developmental progression of dating violence during adolescence varies by demographics. The discussion focuses on future directions for research on teen dating violence among rural youth and implications for prevention and interventions initiatives.
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Comportamento do Adolescente/psicologia , Vítimas de Crime/psicologia , Violência por Parceiro Íntimo/psicologia , População Rural/estatística & dados numéricos , Adolescente , Atitude Frente a Saúde , Bullying/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Percepção SocialRESUMO
OBJECTIVES: The purpose of this literature review was to highlight the studies on mental health in relation to acculturation and ethnic identity and to identify research gaps. The results can be used to help inform future immigrant mental health workers and policy makers as well as provide information about the implications of immigrant mental health. METHODS: The literature search was conducted electronically, directed by a variety of key words. The search focused on five areas of immigrant mental health importance: (1) acculturation; (2) acculturation and mental health; (3) ethnic identity; (4) ethnic identity and mental health; and (5) acculturation, ethnic identity and mental health. A total of 171 articles were examined and 110 were included in the review. RESULTS: The information is presented in the following categories: acculturation; acculturation and mental health; ethnic identity; ethnic identity and mental health; and acculturation, ethnic identity and mental health. Research gaps are also presented. CONCLUSION: Overall, literature shows that acculturation, ethnic identity and mental health are closely related to one another affecting both, individuals and communities. This literature review will help to better inform practitioners who may encounter immigrants experiencing mental health issues due to acculturation and ethnic identity pressure. This review may also help policy makers identify specific obstacles that are not addressed in immigration policies which can affect the implementation of these policies. In addition, the information presented can be used as an instrument for researchers in the field. Despite the limited amount of information about immigrant mental health challenges, much work remains to fully support the affected individuals and their families.
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Aculturação , Emigrantes e Imigrantes/psicologia , Etnicidade/psicologia , Saúde Mental , Identificação Social , HumanosRESUMO
Background: Blood eosinophils may predict response to inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) where ICS is recommended in patients at high risk of exacerbations. The proportion of patients who may benefit the most from ICS-based therapy was quantified in a real-world population. Materials and methods: European data from the Adelphi Real World Respiratory Disease Specific Programme™ 2017 survey were collected from consecutive COPD patients by participating physicians. Overall, 1,528 patients were assessable for Global Initiative for COPD (GOLD) 2017 status and were included in the analysis. Results: More GOLD D patients had elevated eosinophil counts compared with GOLD B. The proportions of GOLD D patients with a history of ≥2 exacerbations and eosinophil counts of ≥150, ≥300, and ≥400 cells/µL were 81.2%, 39.4%, and 24.6%, respectively. In total, 10.6% of the patients had ≥300 eosinophils/µL and a history of ≥2 exacerbations. ICS-based therapy was received by 41.5% of GOLD B and 68.0% of GOLD D patients. Conclusion: There was no apparent relation between ICS use and eosinophil blood count. There are differences in the distributions of patients with frequent exacerbations and/or high blood eosinophil counts and the use of ICS in COPD. These data may provide information for the implementation of future treatment recommendations.
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Corticosteroides/administração & dosagem , Eosinófilos , Pulmão/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Corticosteroides/efeitos adversos , Idoso , Estudos Transversais , Progressão da Doença , Europa (Continente) , Feminino , Humanos , Contagem de Leucócitos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Sistema de Registros , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVES: Asthma is a chronic respiratory condition with a U.S. prevalence of 7.4%. Despite numerous treatment options, asthma remains poorly controlled in some patients. Uncontrolled asthma is associated with high healthcare resource utilization (HCRU) and reduced productivity. This study assessed symptoms, productivity, and HCRU of patients adherent to medium/high-dosage inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) treatment, and the relationship of asthma control with these parameters. METHODS: Data were collected in the U.S. in 2013-2016 in the Adelphi Respiratory Disease Specific Programme, a cross-sectional survey. Participating physicians (n = 258) each completed a record form for eligible patients, who were receiving medium/high-dosage ICS/LABA treatment with self-reported moderate/high adherence, completed the Asthma Control Test (ACT) and the Work Productivity and Activity Impairment (WPAI) questionnaire, and were included in the analyses. RESULTS: Patients (n = 428) had a mean of 59% symptom-free days in the past month. Wheezing was the most troublesome symptom for 25% of patients. In the previous 12 months, the mean number of exacerbations was 1.3; 15% of exacerbations required emergency room treatment and/or hospitalization. Mean physician visits for asthma was 5.7. Asthma impacted leisure/personal time frequently/constantly for 11% of patients, with 20% overall work impairment. Asthma was poorly controlled (ACT score ≤15) in 18% of patients; poorer asthma control was associated with higher rates of exacerbations, work impairment, and HCRU. CONCLUSION: Given the substantial burden described, greater attention to asthma monitoring and management is necessary. Identification of novel treatments may be important for patients not responding to medium/high-dosage ICS/LABA treatment.
Assuntos
Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Absenteísmo , Administração por Inalação , Adolescente , Corticosteroides/administração & dosagem , Adulto , Asma/fisiopatologia , Asma/psicologia , Broncodilatadores/administração & dosagem , Estudos Transversais , Preparações de Ação Retardada , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Eficiência , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Qualidade de Vida , Testes de Função Respiratória , Índice de Gravidade de Doença , Adulto JovemRESUMO
Background: Data suggesting that low physical activity levels are associated with increased mortality and exacerbations in patients with COPD have led to increasing interest in the role of physical activity in COPD. This study evaluated self-reported functional performance, a measure of physical activity impairment, according to current treatment regimen, lung function, symptoms, and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 groups in a large sample of patients with COPD. Methods: This multicenter, cross-sectional, observational study (study identifier: D5970R00003) included patients with COPD (≥40 years) in the USA. A self-completion questionnaire captured demographics and patient-reported outcomes, including the Functional Performance Inventory-Short Form (FPI-SF). Diagnosis and treatment history (including spirometry results) were extracted from medical charts. Multiple linear regression was used to determine the relationship between FPI-SF and FEV1 % predicted, and FPI-SF and COPD assessment test (CAT) score. Results: Overall, 1,775 patients participated (classified as GOLD 2017 group A, 14.8%; B, 46.6%; C, 2.6%; D, 36.0%). Physical activity impairment affected patients across all treatment regimens and GOLD groups (mean FPI-SF total score: 2.1), with the greatest impairment within FPI-SF observed for domains requiring most physical exertion, "physical exercise" and "maintaining the household" (mean FPI-SF scores: 1.7 and 1.8, respectively). Patients receiving loose triple therapy and those in GOLD group D had the highest impairment (mean FPI-SF total scores: both 1.9), and the lowest FEV1 % predicted (55.5% and 54.7%, respectively). FPI-SF total score correlated with FEV1 % predicted and more strongly with CAT score (all P<0.05). Conclusion: The stronger correlation between FPI-SF and CAT scores compared to FPI-SF and FEV1 % predicted suggests that symptoms may have a greater impact on patients' functional performance than lung function. Further longitudinal studies are required to establish a correlation between the effect of treatment on symptoms, lung function, and physical activity.