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1.
Epidemiol Infect ; 152: e6, 2023 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-38031438

RESUMEN

In July 2021, Public Health Wales received two notifications of salmonella gastroenteritis. Both cases has attended the same barbecue to celebrate Eid al-Adha, two days earlier. Additional cases attending the same barbecue were found and an outbreak investigation was initiated. The barbecue was attended by a North African community's social network. On same day, smaller lunches were held in three homes in the social network. Many people attended both a lunch and the barbecue. Cases were defined as someone with an epidemiological link to the barbecue and/or lunches with diarrhoea and/or vomiting with date of onset following these events. We undertook a cohort study of 36 people attending the barbecue and/or lunch, and a nested case-control study using Firth logistic regression. A communication campaign, sensitive towards different cultural practices, was developed in collaboration with the affected community. Consumption of a traditional raw liver dish, 'marrara', at the barbecue was the likely vehicle for infection (Firth logistic regression, aOR: 49.99, 95%CI 1.71-1461.54, p = 0.02). Meat and offal came from two local butchers (same supplier) and samples yielded identical whole genome sequences as cases. Future outbreak investigations should be relevant to the community affected by considering dishes beyond those found in routine questionnaires.


Asunto(s)
Intoxicación Alimentaria por Salmonella , Salmonella typhimurium , Humanos , Estudios de Casos y Controles , Gales/epidemiología , Estudios de Cohortes , Intoxicación Alimentaria por Salmonella/epidemiología , Brotes de Enfermedades , Hígado
2.
Epidemiol Infect ; 150: e115, 2022 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-35535456

RESUMEN

Between 21 November and 22 December 2020, a SARS-CoV-2 community testing pilot took place in the South Wales Valleys. We conducted a case-control study in adults taking part in the pilot using an anonymous online questionnaire. Social, demographic and behavioural factors were compared in people with a positive lateral flow test (cases) and a sample of negatives (controls). A total of 199 cases and 2621 controls completed a questionnaire (response rates: 27.1 and 37.6% respectively). Following adjustment, cases were more likely to work in the hospitality sector (aOR 3.39, 95% CI 1.43-8.03), social care (aOR 2.63, 1.22-5.67) or healthcare (aOR 2.31, 1.29-4.13), live with someone self-isolating due to contact with a case (aOR 3.07, 2.03-4.62), visit a pub (aOR 2.87, 1.11-7.37) and smoke or vape (aOR 1.54, 1.02-2.32). In this community, and at this point in the epidemic, reducing transmission from a household contact who is self-isolating would have the biggest public health impact (population-attributable fraction: 0.2). As restrictions on social mixing are relaxed, hospitality venues will become of greater public health importance, and those working in this sector should be adequately protected. Smoking or vaping may be an important modifiable risk factor.


Asunto(s)
COVID-19 , Adulto , COVID-19/epidemiología , Prueba de COVID-19 , Estudios de Casos y Controles , Demografía , Humanos , SARS-CoV-2
3.
Epidemiol Infect ; 150: e134, 2022 05 30.
Artículo en Inglés | MEDLINE | ID: mdl-35634739

RESUMEN

Prisons are susceptible to outbreaks. Control measures focusing on isolation and cohorting negatively affect wellbeing. We present an outbreak of coronavirus disease 2019 (COVID-19) in a large male prison in Wales, UK, October 2020 to April 2021, and discuss control measures.We gathered case-information, including demographics, staff-residence postcode, resident cell number, work areas/dates, test results, staff interview dates/notes and resident prison-transfer dates. Epidemiological curves were mapped by prison location. Control measures included isolation (exclusion from work or cell-isolation), cohorting (new admissions and work-area groups), asymptomatic testing (case-finding), removal of communal dining and movement restrictions. Facemask use and enhanced hygiene were already in place. Whole-genome sequencing (WGS) and interviews determined the genetic relationship between cases plausibility of transmission.Of 453 cases, 53% (n = 242) were staff, most aged 25-34 years (11.5% females, 27.15% males) and symptomatic (64%). Crude attack-rate was higher in staff (29%, 95% CI 26-64%) than in residents (12%, 95% CI 9-15%).Whole-genome sequencing can help differentiate multiple introductions from person-to-person transmission in prisons. It should be introduced alongside asymptomatic testing as soon as possible to control prison outbreaks. Timely epidemiological investigation, including data visualisation, allowed dynamic risk assessment and proportionate control measures, minimising the reduction in resident welfare.


Asunto(s)
COVID-19 , Prisiones , COVID-19/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Masculino , Reino Unido/epidemiología , Secuenciación Completa del Genoma
4.
Eur Eat Disord Rev ; 30(5): 592-603, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35791612

RESUMEN

OBJECTIVE: Up to 37% of patients with anorexia nervosa score above cut-off on autism screening measures. These individuals typically have poorer outcomes from standard eating disorder interventions and could therefore benefit from adaptations. Accurately identifying these individuals is important for improving autism referral processes and clinical pathway decisions. This study's aim was to identify subscales of questionnaires measuring constructs associated with either autism or eating disorders that, when combined with traditional autism screening measures, would improve the ability to identify women with restrictive eating disorders who might benefit from a full autism assessment. METHOD: One hundred and sixty women with restrictive eating disorders, with (n = 42) or without (n = 118) an autism diagnosis completed a battery of questionnaires. Using conditional stepwise binary logistic regression, we attempted to improve the autism spectrum quotient 10 item's (AQ-10) ability to discriminate between autistic and non-autistic women in a restrictive eating disorder sample. RESULTS: In a binary logistic regression model, the AQ-10 reliably discriminated between autistic and non-autistic women with an accuracy rate of 85% but had relatively low (69%) sensitivity, reflecting a high rate of false negatives. Adding three subscales to the model (Glasgow Sensory Questionnaire Auditory, Camouflaging Autistic Traits Questionnaire Compensation and Toronto Alexithymia Scale Externally Orientated Thinking) significantly improved its differentiating ability (accuracy = 88%, sensitivity = 76%, specificity = 92%). CONCLUSIONS: We have identified three subscales that, when used in combination with the AQ-10, may help clinicians understand the pattern of autistic traits in their patients with a restrictive eating disorder. This can inform clinical decisions about whether to refer for a full autism assessment and whether to adapt standard eating disorder treatments to accommodate autistic traits. Future studies are needed to test the model in samples where participants have undergone a full autism assessment.


Asunto(s)
Anorexia Nerviosa , Trastorno del Espectro Autista , Trastorno Autístico , Trastornos de Alimentación y de la Ingestión de Alimentos , Síntomas Afectivos , Anorexia Nerviosa/diagnóstico , Trastorno del Espectro Autista/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Femenino , Humanos , Encuestas y Cuestionarios
5.
Euro Surveill ; 26(32)2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34387184

RESUMEN

Most reported cases of human monkeypox occur in Central and West Africa, where the causing virus is endemic. We describe the identification and public health response to an imported case of West African monkeypox from Nigeria to the United Kingdom (UK) in May 2021. Secondary transmission from the index case occurred within the family to another adult and a toddler. Concurrent COVID-19-related control measures upon arrival and at the hospital, facilitated detection and limited the number of potential contacts.


Asunto(s)
COVID-19 , Mpox , Adulto , Humanos , Mpox/diagnóstico , Mpox/epidemiología , Monkeypox virus , Nigeria , SARS-CoV-2 , Reino Unido/epidemiología
6.
Eur Eat Disord Rev ; 28(1): 87-91, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31713309

RESUMEN

Cognitive remediation therapy (CRT) is an increasingly implemented intervention in psychiatric conditions. The majority of randomized treatment trials in psychiatry reports cognitive improvements resulting in better functional outcomes in CRT groups. This brief report from the national inpatient treatment programme for eating disorders demonstrates cognitive performance task-based improvements in patients with high and low autistic characteristics. This preliminary study shows feasibility and benefits of individual CRT in patients who have autism spectrum disorder features.


Asunto(s)
Anorexia Nerviosa/terapia , Trastorno del Espectro Autista/terapia , Remediación Cognitiva , Adulto , Anorexia Nerviosa/epidemiología , Trastorno del Espectro Autista/epidemiología , Comorbilidad , Estudios de Factibilidad , Femenino , Humanos , Resultado del Tratamiento , Adulto Joven
7.
Int Rev Psychiatry ; 31(4): 382-390, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30916597

RESUMEN

Admissions and re-admissions for inpatient care for anorexia nervosa have been increasing. The aim of this study was to examine whether the transition from inpatient care to the community could be facilitated by supplementing usual treatment with ECHOMANTRA (transition interventions) for both patients and carers. A case series study was employed using a mixed-methods approach to measure the feasibility and efficacy of augmenting intensive hospital treatment with ECHOMANTRA. A consecutive series of consenting patients (n = 31) and carers (n = 21) were assessed on admission, discharge, and at 3 months follow-up. These outcomes were compared with audit data (n = 152) previously collected (2007-2017). The length of stay for the ECHOMANTRA intervention group was 4.5 weeks less than the comparison group, and weight gain was 0.11 kg per week higher. Improvements in patient symptomology were sustained at follow-up. Thematic analysis of the feedback from both patients and carers suggests that the intervention is valued. Carer burden was reduced and their skills improved (both moderate size changes). In conclusion, both the acceptability and efficiency of inpatient care for anorexia nervosa may be improved by augmenting treatment to prepare for transition from inpatient care by giving support to both patients and their carers.


Asunto(s)
Anorexia Nerviosa/terapia , Tiempo de Internación , Evaluación de Procesos y Resultados en Atención de Salud , Educación del Paciente como Asunto , Automanejo , Cuidado de Transición , Adulto , Cuidadores , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/estadística & datos numéricos , Padres , Educación del Paciente como Asunto/métodos , Automanejo/métodos , Adulto Joven
8.
Eur Eat Disord Rev ; 26(4): 367-375, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29607561

RESUMEN

OBJECTIVE: The aim of this study was to examine the effectiveness of CREST interventions in individual and group formats for adult anorexia nervosa. Furthermore, this study also aims to analyse whether patients with high levels of autistic symptoms respond differently. METHODS: Participants' self-report measures were taken before and after individual and group interventions (N = 66 and N = 62, respectively). Mixed effects analysis was used to analyse overall response to both formats and assess interaction with autism symptoms. RESULTS: Significant improvements were observed for patients' alexithymia in individual format, and motivation increased for participants in both interventions. Significant interactions were observed between alexithymia, social anhedonia, and autism symptoms in individual format and alexithymia in group format. No interactions between autism and time were observed for either format. CONCLUSIONS: CREST in both formats offers participants improvements in social-emotional and motivational domains. Patients with high levels of autism symptoms also score high on both social anhedonia and alexithymia measures, but this does not affect their response to treatment.


Asunto(s)
Anorexia Nerviosa/psicología , Anorexia Nerviosa/terapia , Trastorno Autístico/complicaciones , Terapia Conductista/métodos , Emociones , Psicoterapia de Grupo , Psicoterapia/métodos , Adolescente , Adulto , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/psicología , Síntomas Afectivos/terapia , Anhedonia/fisiología , Trastorno Autístico/psicología , Cognición/fisiología , Femenino , Humanos , Masculino , Motivación , Autoinforme , Resultado del Tratamiento
9.
BMC Psychiatry ; 16(1): 334, 2016 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-27682072

RESUMEN

BACKGROUND: The current study aimed to evaluate group Cognitive remediation therapy (CRT) inpatients with Anorexia Nervosa (AN). We aimed to examine the treatment response of group CRT in AN patients with high or low levels of autistic traits. METHODS: Thirty-five in patients with an AN diagnosis received group CRT intervention for 6 sessions in a national eating disorder unit. All participants completed self-report questionnaires on thinking styles and motivation before and after the intervention. RESULTS: Patients with low autistic traits had statistically significant medium size effect improvements in self-reported thinking style scales as well as confidence (ability) to change. Patients with high autistic traits showed no statistically significant improvements in any outcome measure. CONCLUSIONS: The brief group format CRT intervention improves self-reported cognitive and motivational aspects in people with AN without autistic traits. For patients with higher autistic traits brief group CRT does not improve self-reported cognitive style or motivation. This finding suggests that brief group format CRT might not be the best suited format for individuals with elevated autistic traits and individual or more tailored CRT should be explored.

10.
Eur Eat Disord Rev ; 24(6): 489-493, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27510320

RESUMEN

OBJECTIVE: This study aimed to evaluate the perfectionism group intervention in adults with anorexia nervosa (AN) in an inpatient setting. METHOD: Adults with AN (N = 35) received six weekly sessions of the empirically informed intervention with experiential exercises. Participants' self-reported perfectionism and satisfaction were collected pre-group and post-group intervention. RESULTS: Statistically, significant differences were observed for overall perfectionism, concern over mistakes and personal standard dimensions of perfectionism. Participants found the sessions useful and felt confident in using the skills they had learnt. CONCLUSIONS: The revised perfectionism group with experiential exercises seemed to be a practical and helpful intervention for patients with AN in an inpatient programme. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.


Asunto(s)
Anorexia Nerviosa/psicología , Anorexia Nerviosa/terapia , Satisfacción del Paciente , Perfeccionismo , Psicoterapia de Grupo/métodos , Adulto , Trastornos de Alimentación y de la Ingestión de Alimentos , Femenino , Humanos , Pacientes Internos , Satisfacción Personal , Autoinforme , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto Joven
11.
BJPsych Open ; 10(4): e131, 2024 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-39056242

RESUMEN

BACKGROUND: Autistic women are at high risk of developing restrictive eating disorders (REDs), such as anorexia nervosa. AIMS: This study provides an overview of the clinical characteristics of autistic women with REDs to (i) enhance understanding of increased risk, and (ii) support the identification of autistic women in eating disorder services. METHOD: We compared self-reported autistic and disordered eating characteristics of: autistic participants with REDs (Autism + REDs; n = 57); autistic participants without REDs (Autism; n = 69); and women with REDs who are not autistic (REDs; n = 80). We also included a group of women with high autistic traits (HATs) and REDs, but no formal autism diagnosis (HATs + REDs; n = 38). RESULTS: Autism + REDs participants scored similarly to Autism participants in terms of autistic characteristics and to REDs participants in terms of experiencing traditional disordered eating symptoms. Autism + REDs participants were distinguished from both groups by having more restricted and repetitive behaviours and autism-specific eating behaviours related to sensory processing, flexibility and social differences. HATs + REDs participants showed a similar pattern of scores to Autism + REDs participants, and both also presented with high levels of co-occurring mental health difficulties, particularly social anxiety. CONCLUSION: The presentation of autistic women with REDs is complex, including both traditional disordered eating symptoms and autism-related needs, as well as high levels of co-occurring mental health difficulties. In eating disorder services, the REDs presentation of autistic women and those with HATs should be formulated with reference to autism-specific eating behaviours and co-occurring difficulties. Treatment adaptations should be offered to accommodate autistic characteristics and related needs.

12.
J Med Microbiol ; 72(6)2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37288574

RESUMEN

Introduction. In England and Wales, cryptosporidiosis cases peak in spring and autumn, associated with zoonotic/environmental exposures (Cryptosporidium parvum, spring/autumn) and overseas travel/water-based activities (Cryptosporidium hominis, autumn). Coronavirus disease 2019 (COVID-19) restrictions prevented social mixing, overseas travel and access to venues (swimming pools/restaurants) for many months, potentially increasing environmental exposures as people sought alternative countryside activities.Hypothesis. COVID-19 restrictions reduced incidence of C. hominis cases and potentially increased incidence of C. parvum cases.Aim. To inform/strengthen surveillance programmes, we investigated the impact of COVID-19 restrictions on the epidemiology of C. hominis and C. parvum cases.Methodology. Cases were extracted from the Cryptosporidium Reference Unit (CRU) database (1 January 2015 to 31 December 2021). We defined two periods for pre- and post-COVID-19 restrictions implementation, corresponding to before and after the first UK-wide lockdown on 23 March 2020. We conducted a time series analysis, assessing differences in C. parvum and C. hominis incidence, trends and periodicity between these periods.Results. There were 21 304 cases (C. parvum=12 246; C. hominis=9058). Post-restrictions implementation incidence of C. hominis dropped by 97.5 % (95 % CI: 95.4-98.6 %; P<0.001). The decreasing incidence trend pre-restrictions was not observed post-restrictions implementation due to lack of cases. No periodicity change was observed post-restrictions implementation. There was a strong social gradient; there was a higher proportion of cases in deprived areas. For C. parvum, post-restrictions implementation incidence fell by 49.0 % (95 % CI: 38.4-58.3 %; P<0.001). There was no pre-restrictions incidence trend but an increasing incidence trend post-restrictions implementation. A periodicity change was observed post-restriction implementation, peaking 1 week earlier in spring and 2 weeks later in autumn. The social gradient was the inverse of that for C. hominis. Where recorded, 22 % of C. hominis and 8 % of C. parvum cases had travelled abroad.Conclusion. C. hominis cases almost entirely ceased post-restrictions implementation, reinforcing that foreign travel seeds infections. C. parvum incidence fell sharply but recovered post-restrictions implementation, consistent with relaxation of restrictions. Future exceedance reporting for C. hominis should exclude the post-restriction implementation period but retain it for C. parvum (except the first 6 weeks post-restrictions implementation). Infection prevention and control advice should be improved for people with gastrointestinal illness (GI) symptoms to ensure hand hygiene and swimming pool avoidance.


Asunto(s)
COVID-19 , Criptosporidiosis , Cryptosporidium parvum , Cryptosporidium , Humanos , Criptosporidiosis/epidemiología , Criptosporidiosis/prevención & control , Gales/epidemiología , Factores de Tiempo , Genotipo , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles , Inglaterra/epidemiología
13.
Disabil Rehabil ; 44(20): 5878-5886, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-34498994

RESUMEN

OBJECTIVE: We investigated the effectiveness of graded exercise therapy (GET) delivered to patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in a routine, specialist clinic by measuring patient-reported outcome data collected prospectively over several timepoints alongside therapy. Benchmarking analyses were used to compare our results with those found in randomised controlled trials (RCTs). METHODS: Data were collected from patients, with a diagnosis of CFS/ME, who had been referred to a specialist clinical service in South London. Measures included Chalder Fatigue Questionnaire, Physical Functioning Subscale of the Short-Form Health Questionnaire, and the Work and Social Adjustment Scale. Change on each measure was calculated over time using linear mixed-model analyses. Within group effect sizes were calculated and compared with previous RCTs. RESULTS: Fatigue scores were significantly reduced by session 4 (-5.18, 95%CIs -7.90, -2.45) and at follow-up (-4.73, 95%CIs -7.60, -1.85). Work and social adjustment and physical functioning progressively improved over the course of therapy, reaching significance at discharge and maintained at follow-up (WSAS -4.97, 95%CIs -7.97, -1.97; SF-36 10.75, 95%CIs 2.19, 19.31). CONCLUSIONS: GET is an effective treatment for CFS/ME within clinical practice. However, effect sizes were smaller in routine clinical practice than RCTs suggesting that avenues for augmentation need to be considered.Implications for rehabilitationIt is important to assess whether patient reported outcomes of treatments that have been evaluated in the context of clinical trials are similar in routine clinical practice.This study shows fatigue severity, physical functioning, and work and social adjustment can significantly improve after graded exercise therapy for patients with chronic fatigue syndrome within a specialist service.Benchmarking methods showed clinical outcomes obtained smaller effect sizes than randomised controlled trials - techniques to maximise patient outcomes should be considered.


Asunto(s)
Terapia Cognitivo-Conductual , Síndrome de Fatiga Crónica , Benchmarking , Terapia Cognitivo-Conductual/métodos , Terapia por Ejercicio/métodos , Síndrome de Fatiga Crónica/diagnóstico , Síndrome de Fatiga Crónica/terapia , Humanos , Atención Secundaria de Salud
14.
Influenza Other Respir Viruses ; 15(3): 371-380, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547872

RESUMEN

BACKGROUND: The population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19. METHODS: We examined 3115 hospital discharges to a national cohort of 1068 adult care homes and subsequent outbreaks of COVID-19 occurring between 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics, including size and type of provision. RESULTS: A total of 330 homes experienced an outbreak, and 544 homes received a discharge over the study period. Exposure to hospital discharge was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.47, P = .29) after adjusting for care home characteristics. Care home size was the most significant predictor. Hazard ratios (95% CI) in comparison with homes of <10 residents were as follows: 3.40 (1.99, 5.80) for 10-24 residents; 8.25 (4.93, 13.81) for 25-49 residents; and 17.35 (9.65, 31.19) for 50+ residents. When stratified for care home size, the outbreak rates were similar for periods when homes were exposed to a hospital discharge, in comparison with periods when homes were unexposed. CONCLUSION: Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk.


Asunto(s)
COVID-19/epidemiología , Brotes de Enfermedades , Casas de Salud , SARS-CoV-2 , Estudios de Cohortes , Humanos , Alta del Paciente , Modelos de Riesgos Proporcionales
15.
BJPsych Open ; 6(3): e51, 2020 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-32419683

RESUMEN

BACKGROUND: Patients with co-occurring anorexia nervosa and autism respond differently to eating disorder treatments. Previous interviews with patients with both conditions and clinicians working in eating disorder services has highlighted service and treatment adaptations might be beneficial and could improve outcomes for these individuals. AIMS: The aim of this study was to explore carers' experiences of current treatment approaches for people with autism who have anorexia nervosa, and their views on how these can be improved. METHOD: Ten carers of a loved one diagnosed with autism and anorexia nervosa were interviewed using a semi-structured interview schedule and the transcripts were analysed with thematic analysis. RESULTS: Four key themes emerged from the interviews: the role of autism in anorexia nervosa, carers' problems with clinical services, the impact on carers and suggestions for future improvements. CONCLUSIONS: Carers agreed that autism played a significant role in the development and maintenance of their daughters' anorexia nervosa. However, this comorbidity does not appear to be appropriately addressed in current treatment provisions. They described several difficulties, including problems getting an autism diagnosis and the perception that eating disorder services did not accept or adapt around the condition. This resulted in feelings of frustration and isolation for families, a scenario exacerbated by a perceived lack of support or specific resources for carers of individuals on the autism spectrum. Clinical recommendations on the basis of the current and previous studies are outlined.

16.
J R Soc Med ; 113(10): 394-402, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32930040

RESUMEN

OBJECTIVES: Cognitive behavioural therapy is commonly used to treat chronic fatigue syndrome and has been shown to be effective for reducing fatigue and improving physical functioning. Most of the evidence on the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome is from randomised control trials, but there are only a few studies in naturalistic treatment settings. Our aim was to examine the effectiveness of cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic setting and examine what factors, if any, predicted outcome. DESIGN: Using linear mixed effects analysis, we analysed patients' self-reported symptomology over the course of treatment and at three-month follow-up. Furthermore, we explored what baseline factors were associated with improvement at follow-up. SETTING: Data were available for 995 patients receiving cognitive behavioural therapy for chronic fatigue syndrome at an outpatient clinic in the UK. PARTICIPANTS: Participants were referred consecutively to a specialist unit for chronic fatigue or chronic fatigue syndrome. MAIN OUTCOME MEASURES: Patients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale and Global Improvement and Satisfaction. RESULTS: Patients' fatigue, physical functioning and social adjustment scores significantly improved over the duration of treatment with medium to large effect sizes (|d| = 0.45-0.91). Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. None of the regression models convincingly predicted improvement in outcomes with the best model being (R2 = 0.137). CONCLUSIONS: Patients' fatigue, physical functioning and social adjustment all significantly improved following cognitive behavioural therapy for chronic fatigue syndrome in a naturalistic outpatient setting. These findings support the growing evidence from previous randomised control trials and suggest that cognitive behavioural therapy could be an effective treatment in routine treatment settings.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Emociones/fisiología , Síndrome de Fatiga Crónica/terapia , Estado de Salud , Calidad de Vida , Adulto , Síndrome de Fatiga Crónica/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Autoinforme , Resultado del Tratamiento , Reino Unido/epidemiología
17.
BMJ Open ; 10(8): e038017, 2020 08 16.
Artículo en Inglés | MEDLINE | ID: mdl-32801205

RESUMEN

OBJECTIVE: To compare National Health Service (NHS) organisations' testing pathways for patients with suspected COVID-19 in the community versus standard hospital testing practices. PERSPECTIVE: NHS commissioners and services. METHODS: During the containment phase of the COVID-19 pandemic we developed a community model pathway for COVID-19 testing in Wales with testing teams undertaking swabbing for COVID-19 in individuals' usual place of residence. We undertook a cost-minimisation analysis comparing the costs to the NHS in Wales of community testing for COVID-19 versus standard hospital testing practices and ambulance conveyancing. We analysed data from patients with suspected COVID-19 between January and February 2020 and applied assumptions of costs from national contractual and reference costs for ambulances, staffing and transportation with market costs at the time of publication. RESULTS: 177 patients with suspected COVID-19 underwent community testing via local NHS organisations between January and February 2020 with a mean age of 46.1 (IQR 27.5-56.3). This was 92% of total patients who were tested for COVID-19 during this period. We estimate, compared with standard hospital testing practices, cash savings in improved productivity for the NHS of £24,539 during this time period, in addition to further non-monetised benefits for hospital and ambulance flow. CONCLUSIONS: Community testing for COVID-19 in Wales is now an established pathway and continues to bring benefits for patients, local healthcare organisations and the NHS. Further application of this model in other settings and to other infectious diseases may herald promising returns.


Asunto(s)
Técnicas de Laboratorio Clínico/economía , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/economía , Vías Clínicas/economía , Pandemias/economía , Neumonía Viral/diagnóstico , Neumonía Viral/economía , Medicina Estatal/economía , Adulto , Ambulancias/economía , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Análisis Costo-Beneficio , Humanos , Persona de Mediana Edad , SARS-CoV-2 , Gales
18.
Brain Sci ; 9(1)2019 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-30642112

RESUMEN

Low self-esteem is a common feature in Anorexia Nervosa (AN) and has been hypothesised to act as a predisposing, precipitating, and perpetuating factor. The aim of this study was to assess the effectiveness of a Cognitive Behavioural Therapy (CBT)-based self-esteem group in a naturalistic setting of patients with AN in an inpatient treatment programme. Included in this study were 119 female patients diagnosed with AN, with all participants completing self-report questionnaires before and after the intervention. The group consisted of five to six weekly sessions. The self-esteem group led to a statistically significant improvement in self-esteem, which could not be explained by an increase in BMI alone, suggesting that the group is facilitating positive changes within an AN group. The group also had a small effect on improving patients self-perceived ability to change. These findings suggest that the brief self-esteem group has some benefits in improving patients' self-esteem/self-efficacy and should be replicated in the future with a control condition to confirm findings.

19.
Autism ; 23(1): 123-130, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29105513

RESUMEN

Previous research has demonstrated links between anorexia nervosa and autism spectrum disorder however, few studies have examined the possible impact of symptoms of autism spectrum disorder on clinical outcomes in anorexia nervosa. The aim of this study was to examine the association between symptoms of autism spectrum disorder and eating disorders, and other psychopathology during the course of inpatient treatment in individuals with anorexia nervosa. Participants with anorexia nervosa (n = 171) completed questionnaires exploring eating disorder psychopathology, symptoms of depression and anxiety, and everyday functioning at both admission and discharge. Characteristics associated with autism spectrum disorder were assessed using the Autism Spectrum Quotient, short version. Autism spectrum disorder symptoms were significantly positively correlated with eating disorder psychopathology, work and social functioning, and symptoms of depression and anxiety, but not with body mass index. Autism Spectrum Quotient, short version scores remained relatively stable from admission to discharge but there was a small, significant reduction in scores. There was no interaction between time and Autism Spectrum Quotient, short version scores on clinical symptom change. In anorexia nervosa, autism spectrum disorder symptoms appear to be associated with a more severe clinical presentation on admission to inpatient care. Autism spectrum disorder symptoms as assessed by self-report measures may be exacerbated by other mental health psychopathology, which warrants further investigation.


Asunto(s)
Anorexia Nerviosa/psicología , Trastorno del Espectro Autista/psicología , Adolescente , Adulto , Anorexia Nerviosa/complicaciones , Anorexia Nerviosa/terapia , Ansiedad/complicaciones , Ansiedad/psicología , Trastorno del Espectro Autista/complicaciones , Trastorno del Espectro Autista/terapia , Depresión/complicaciones , Depresión/psicología , Empleo/psicología , Femenino , Humanos , Persona de Mediana Edad , Ajuste Social , Encuestas y Cuestionarios , Adulto Joven
20.
Front Psychiatry ; 9: 96, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29615940

RESUMEN

BACKGROUND: Anorexia nervosa (AN) is characterized by severe malnutrition as well as inefficiencies in neurocognitive functioning, which are believed to contribute to the maintenance of disordered eating. The aim of this study was to examine the impact of individual cognitive remediation therapy (CRT) on neurocognition in AN. METHODS: A total of 145 adult women from an eating disorders inpatient program took part in the present study. All participants were given individual CRT in addition to treatment as usual. Neurocognitive processes were assessed at baseline and at the end of treatment using task-based and self-report measures. The task-based measures included the Rey-Osterrieth Complex Figure test and the Brixton test, which were used to assess central coherence and set-shifting. The Detail and Flexibility Questionnaire was used to examine patients self-reported detail focus and cognitive flexibility. RESULTS: Participants showed significant improvement in task-based measures of neurocognition following CRT. There were no significant changes in self-report measures. CONCLUSION: These findings suggest that CRT may be an effective intervention targeting inefficiencies in neurocognition in AN. Future studies may benefit from assessing neural changes associated with these improvements and conducting randomized controlled trials to replicate these findings.

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