RESUMEN
Screening for depression may identify persons for HIV prevention services and to ensure linkage to care for ART and mental health. We assessed factors associated with depressive symptoms using multiple logistic regression among 15- to 29-year-old gay, bisexual or other men who have sex with men (MSM) and transgender women who have sex with men (TGW) attending HIV prevention clinics at Silom Community Clinic or Bangrak Hospital in Bangkok or Rainbow Clinic in Nakhon Sawan, Thailand. We defined depressive symptoms as a self-report of feelings of sadness that impacted daily life in the past one month. Among 192 MSM, 51 TGW, and 11 gender-questioning persons screened: 12.6% met the criteria for depression; 5.9% had new HIV diagnosis. Independently associated factors which increase the risk of depressive symptoms included: studying in a private school (AOR 7.17); experiencing any type of bullying (AOR 2.8); having a partner with HIV (AOR 4.1); and learning about the study from sources other than a friend (AOR 4.2). Given many youths had depressive symptoms, screening for depression and connection to mental health services would be beneficial in sexual health settings to meet the needs of HIV-vulnerable youth.
Asunto(s)
Depresión , Infecciones por VIH , Homosexualidad Masculina , Personas Transgénero , Humanos , Masculino , Tailandia/epidemiología , Adolescente , Infecciones por VIH/psicología , Infecciones por VIH/epidemiología , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Femenino , Adulto Joven , Depresión/epidemiología , Depresión/psicología , Adulto , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Factores de Riesgo , Parejas Sexuales/psicologíaRESUMEN
BACKGROUND: The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes. AIM: We aimed to quantify practice change following TARGET. METHODS: Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann-Whitney test. RESULTS: The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018-2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and <1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively. CONCLUSION: In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.
RESUMEN
Aim Ladies Gaelic football and Camogie are leading female sports in Ireland. Referees are essential to the game, however, no research has examined injury in referees that officiate over female Gaelic games to date. Therefore, this study aims to retrospectively examine the musculoskeletal injury profile and injury prevention practices of referees that officiate over female Gaelic games. Methods A retrospective anonymous questionnaire examined injuries that occurred in the previous 12 months in currently active Ladies Gaelic football and Camogie referees (n=170). Incidence and repeat incidence proportions were calculated along with descriptive statistics. Results In 2019, 42.9% (n=73) of referees sampled sustained an injury with 27.4% (n=20) sustaining two or more. Injuries primarily occurred to the lower extremity (79.6%,n=78), particularly the lower leg (20.4%,n=20) and knee (18.4%,18). Muscle strains and cramps (55.1%,n=54) were most frequent and injuries predominantly occurred during games (71.4%,n=70). Referees largely completed a warm-up but just 30.6% (n=52) conducted a cool-down. Over half had undertaken injury prevention education but only 37.6% (n=64) incorporated injury prevention elements into their training. Conclusion Just over two in five referees that officiate female Gaelic games became injured in the previous year, however their utilisation of injury prevention strategies, beyond completing a warm-up, is lacking. Thus, a referee specific injury prevention programme should be developed and if found to be effective, incorporated into a comprehensive injury prevention strategy by the governing bodies.
Asunto(s)
Traumatismos en Atletas , Sistema Musculoesquelético , Deportes de Equipo , Femenino , Humanos , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/prevención & control , Incidencia , Estudios Retrospectivos , Sistema Musculoesquelético/lesionesRESUMEN
OBJECTIVES: To assess feasibility of a future randomised controlled trial (RCT) of clinical and cost-effectiveness of lifestyle information and commercial weight management groups to support postnatal weight management to 12 months post-birth. DESIGN: Two-arm feasibility trial, with nested mixed-methods process evaluation. SETTING: Inner-city unit, south England. POPULATION: Women with body mass indices (BMIs) ≥25 kg/m2 at pregnancy booking or normal BMIs (18.5-24.9 kg/m2 ) identified with excessive gestational weight gain at 36 weeks of gestation. METHODS: Randomised to standard care plus commercial weight management sessions commencing 8-16 weeks postnatally or standard care only. MAIN OUTCOMES: Feasibility outcomes included assessment of recruitment, retention, acceptability and economic data collation. Primary and secondary end points included difference between groups in weight 12 months postnatally compared with booking (proposed primary outcome for a future trial), diet, physical activity, smoking, alcohol, mental health, infant feeding, NHS resource use. RESULTS: In all, 193 women were randomised: 98 intervention and 95 control; only four women had excessive gestational weight gain. A slightly greater weight change was found among intervention women at 12 months, with greatest benefit. Among women attending ten or more weight management sessions. There was >80% follow up to 12 months, low risk of contamination and no group differences in trial completion. CONCLUSION: It was feasible to recruit and retain women with BMIs ≥25 kg/m2 to an intervention to support postnatal weight management; identification of excessive gestational weight gain requires consideration. Economic modelling could inform out-of-trial costs and benefits in a future trial. A definitive trial is an important next step. TWEETABLE ABSTRACT: A feasibility RCT of postnatal weight support showed women with BMIs ≥25 kg/m2 can be recruited and followed to 12 months postnatally.
Asunto(s)
Ganancia de Peso Gestacional , Estilo de Vida , Periodo Posparto , Programas de Reducción de Peso , Adulto , Índice de Masa Corporal , Análisis Costo-Beneficio , Estudios de Factibilidad , Femenino , Conductas Relacionadas con la Salud , Humanos , Embarazo , Reino UnidoRESUMEN
OBJECTIVE: To evaluate whether vaginoscopy or standard hysteroscopy was more successful in the outpatient setting. DESIGN: Randomised controlled multicentre trial. SETTING: Outpatient hysteroscopy clinics at two UK hospitals. POPULATION: 1597 women aged 16 or older undergoing an outpatient hysteroscopy. METHODS: Women were allocated to vaginoscopy or standard hysteroscopy using third party randomisation stratified by menopausal status with no blinding of participants or clinicians. MAIN OUTCOME MEASURES: The primary outcome was 'success', a composite endpoint defined as: a complete procedure, no complications, a level of pain acceptable to the patient, and no sign of genitourinary tract infection 2 weeks after the procedure. RESULTS: Vaginoscopy was significantly more successful than standard hysteroscopy [647/726 (89%) versus 621/734 (85%), respectively; relative risk (RR) 1.05, 95% CI 1.01-1.10; P = 0.01]. The median time taken to complete vaginoscopy was 2 minutes compared with 3 minutes for standard hysteroscopy (P < 0.001). The mean pain score was 42.7 for vaginoscopy, which was significantly less than standard hysteroscopy 46.4 (P = 0.02). Operative complications occurred in five women receiving vaginoscopy and 19 women receiving standard hysteroscopy (RR 0.26, 95% CI 0.10-0.69). CONCLUSIONS: Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy and therefore should be considered the technique of choice for outpatient hysteroscopy. TWEETABLE ABSTRACT: Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy.
Asunto(s)
Histeroscopía/métodos , Enfermedades del Cuello del Útero/diagnóstico , Vagina , Atención Ambulatoria/métodos , Femenino , Humanos , Histeroscopía/efectos adversos , Histeroscopía/psicología , Persona de Mediana Edad , Dolor/prevención & control , Dimensión del Dolor , Satisfacción del Paciente , Enfermedades del Cuello del Útero/psicologíaRESUMEN
Deficits in trunk control predict ACL injuries which frequently occur during high-risk activities such as cutting. However, no existing trunk control/core stability program has been found to positively affect trunk kinematics during cutting activities. This study investigated the effectiveness of a 6-week dynamic core stability program (DCS) on the biomechanics of anticipated and unanticipated side and crossover cutting maneuvers. Thirty-one male, varsity footballers participated in this randomized controlled trial. Three-dimensional trunk and lower limb biomechanics were captured in a motion analysis laboratory during the weight acceptance phase of anticipated and unanticipated side and crossover cutting maneuvers at baseline and 6-week follow-up. The DCS group performed a DCS program three times weekly for 6 weeks in a university rehabilitation room. Both the DCS and control groups concurrently completed their regular practice and match play. Statistical parametric mapping and repeated measures analysis of variance were used to determine any group (DCS vs control) by time (pre vs post) interactions. The DCS resulted in greater internal hip extensor (P=.017, η2 =0.079), smaller internal knee valgus (P=.026, η2 =0.076), and smaller internal knee external rotator moments (P=.041, η2 =0.066) during anticipated side cutting compared with the control group. It also led to reduced posterior ground reaction forces for all cutting activities (P=.015-.030, η2 =0.074-0.105). A 6-week DCS program did not affect trunk kinematics, but it did reduce a small number of biomechanical risk factors for ACL injury, predominantly during anticipated side cutting. A DCS program could play a role in multimodal ACL injury prevention programs.
Asunto(s)
Extremidad Inferior/fisiología , Acondicionamiento Físico Humano , Torso/fisiología , Lesiones del Ligamento Cruzado Anterior/prevención & control , Fenómenos Biomecánicos , Humanos , Masculino , Movimiento , Fútbol , Adulto JovenRESUMEN
Aims Despite no previous research, it is anecdotally reported that hurling and camogie players modify their helmet and faceguard, which is against GAA regulations and can potentially increase injury risk. This study aimed to establish the prevalence and rationale behind modifications in hurling and camogie. Methods An online questionnaire was completed by 304 players aged over 18 (62% hurlers, 38% camogie players) which consisted of 27 questions. Results Appearance (43%) was the primary reasons for helmet brand choice, with just 1.6% citing safety as a main reason for choice. Surprisingly, 8% of helmets were already modified when purchased and 31% of participants made further modifications, primarily switching faceguards and removal of bars. Restricted vision, comfort and perceived poor quality of the helmet/faceguard were the most common reasons for modification. Players predominantly (75.8%) agreed that further education on modifications is required. Conclusion Future research on the relationship between helmet/faceguard modification and injury risk is required.
Asunto(s)
Traumatismos en Atletas/etiología , Traumatismos en Atletas/prevención & control , Diseño de Equipo/efectos adversos , Diseño de Equipo/normas , Dispositivos de Protección de la Cabeza/efectos adversos , Dispositivos de Protección de la Cabeza/normas , Equipo Deportivo/efectos adversos , Equipo Deportivo/normas , Traumatismos en Atletas/epidemiología , Femenino , Humanos , Masculino , Riesgo , Seguridad , Encuestas y CuestionariosRESUMEN
Despite the popularity of collegiate Gaelic football in Ireland and the recent expansion into the United Kingdom and United States, no previous study has examined injury incidence. A prospective epidemiological study was implemented to establish injury incidence in 217 (19.3 ± 1.9 years) male collegiate Gaelic footballers from two collegiate institutions in one season. An injury was defined as any injury sustained during training or competition resulting in time lost from play or athlete reported restricted performance. Athletic therapy and training students, alongside a certified athletic and rehabilitation therapist, attended all training/matches over one season, and injuries were recorded using a standardized injury report form. The match injury rate was 25.1 injuries per 1000 h, with a significantly higher match injury rate noted in fresher players (players in their 1st year of higher education) (41.6 injuries per 1000 h) than senior players (12.7 injuries per 1000 h). Lower limb injuries were predominant (71.1%), particularly in the hamstring (15.5%), knee (14.1%), and ankle (11.3%). Soft-tissue injuries predominated, particularly strains (32.4%) and sprains (27.5%). A scan and surgery was required in 31% and 12% of injuries, respectively. Thus, injuries are prevalent in male collegiate Gaelic football, and injury prevention programs are required.
Asunto(s)
Traumatismos en Atletas/epidemiología , Fútbol Americano/lesiones , Adolescente , Traumatismos del Tobillo/epidemiología , Humanos , Incidencia , Irlanda , Traumatismos de la Rodilla/epidemiología , Masculino , Músculo Esquelético/lesiones , Prevalencia , Estudios Prospectivos , Traumatismos de los Tejidos Blandos/epidemiología , Esguinces y Distensiones/epidemiología , Universidades , Adulto JovenRESUMEN
The initial step in developing injury prevention strategies is to establish the epidemiology of injury. However there has been no published research on injury in Gaelic handball. This study describes the epidemiology of injury in 75 Gaelic handball players utilising a retrospective questionnaire. 88% of participants reported one or more injuries. Injuries to the upper limb were prevalent (52.9%), followed by the lower limb (30.3%). The shoulder (17.6%), finger (10.5%) and ankle (9.8%) were the primary sites of injury. Injuries occurred most frequently in December (9.7%), January (9.7%), February (9.7%) and November (8.7%). Injuries predominantly occurred during games (82.4%). Injuries were primarily severe (54.7%), with 14.6% of participants admitted to hospital due to injury. Given that this is the only study on Gaelic handball to date, prospective epidemiological studies and further research on injury prevention strategies are necessary.
RESUMEN
BACKGROUND: Previous studies have shown significant within-person changes in binge eating and emotional eating across the menstrual cycle, with substantial increases in both phenotypes during post-ovulation. Increases in both estradiol and progesterone levels appear to account for these changes in phenotypic risk, possibly via increases in genetic effects. However, to date, no study has examined changes in genetic risk for binge phenotypes (or any other phenotype) across the menstrual cycle. The goal of the present study was to examine within-person changes in genetic risk for emotional eating scores across the menstrual cycle. METHOD: Participants were 230 female twin pairs (460 twins) from the Michigan State University Twin Registry who completed daily measures of emotional eating for 45 consecutive days. Menstrual cycle phase was coded based on dates of menstrual bleeding and daily ovarian hormone levels. RESULTS: Findings revealed important shifts in genetic and environmental influences, where estimates of genetic influences were two times higher in post- as compared with pre-ovulation. Surprisingly, pre-ovulation was marked by a predominance of environmental influences, including shared environmental effects which have not been previously detected for binge eating phenotypes in adulthood. CONCLUSIONS: Our study was the first to examine within-person shifts in genetic and environmental influences on a behavioral phenotype across the menstrual cycle. Results highlight a potentially critical role for these shifts in risk for emotional eating across the menstrual cycle and underscore the need for additional, large-scale studies to identify the genetic and environmental factors contributing to menstrual cycle effects.
Asunto(s)
Emociones/fisiología , Conducta Alimentaria/fisiología , Trastornos de Alimentación y de la Ingestión de Alimentos , Ciclo Menstrual/metabolismo , Sistema de Registros , Adolescente , Adulto , Bulimia/etiología , Bulimia/genética , Bulimia/metabolismo , Ambiente , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/genética , Trastornos de Alimentación y de la Ingestión de Alimentos/metabolismo , Femenino , Predisposición Genética a la Enfermedad , Humanos , Estudios Longitudinales , Adulto JovenRESUMEN
BACKGROUND: The efficacy of infliximab has been demonstrated in patients with both acute severe and moderate-severe ulcerative colitis (UC). However, there is a need for 'real-life data' to ensure that conclusions from trial settings are applicable in usual care. We therefore examined the national experience of anti-tumour necrosis factor-α (TNF-α) therapy in UC. METHODS: Case notes review of patients with UC who had received compassionate access (CA) anti-TNF-α therapy from prospectively maintained inflammatory bowel disease databases of six Australian adult teaching hospitals. RESULTS: Patients either received drug for acute severe UC (ASUC) failing steroids (n = 29) or for medically refractory UC (MRUC) (n = 35). In ASUC, the treating physicians judged that anti-TNF-α therapy was successful in 20/29 patients (69%); in these cases, anti-TNF-α was able to be discontinued (after 1-3 infusions in 19/20 responders) as clinical remission was achieved. Consistent with this perceived benefit, only 7/29 (24%) subsequently underwent colectomy during a median follow up of 12 months (interquartile range (IQR) 5-16). Eight of the 35 patients with MRUC (23%) required colectomy during a median follow up of 28 months (IQR 11-43). The majority of these patients (20/35 or 57%) had anti-TNF-α therapy for ≥4 months, whereas, 27/29 (93%) of ASUC patients had CA for ≤3 months. CONCLUSIONS: These data show an excellent overall benefit for anti-TNF-α therapy in both ASUC and MRUC. In particular, only short-duration anti-TNF-α was required in ASUC. These real-life data thus support the clinical trial data and should lead to broader use of this therapy in UC.
Asunto(s)
Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/epidemiología , Ensayos de Uso Compasivo/métodos , Infliximab/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Anciano , Australia/epidemiología , Colitis Ulcerosa/diagnóstico , Femenino , Humanos , Infliximab/farmacología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We report the discovery of an unusually complex and regionally unique bone artefact in a Late Pleistocene archaeological assemblage (c. 35 ka [thousands of years ago]) from the site of Matja Kuru 2 on the island of Timor, in Wallacea. The artefact is interpreted as the broken butt of a formerly hafted projectile point, and it preserves evidence of a complex hafting mechanism including insertion into a shaped or split shaft, a complex pattern of binding including lateral stabilization of the cordage within a bilateral series of notches, and the application of mastic at several stages in the hafting process. The artefact provides the earliest direct evidence for the use of this combination of hafting technologies in the wider region of Southeast Asia, Wallacea, Melanesia and Australasia, and is morphologically unparallelled in deposits of any age. By contrast, it bears a close morphological resemblance to certain bone artefacts from the Middle Stone Age of Africa and South Asia. Examination of ethnographic projectile technology from the region of Melanesia and Australasia shows that all of the technological elements observed in the Matja Kuru 2 artefact were in use historically in the region, including the unusual feature of bilateral notching to stabilize a hafted point. This artefact challenges the notion that complex bone-working and hafting technologies were a relatively late innovation in this part of the world. Moreover, its regional uniqueness encourages us to abandon the perception of bone artefacts as a discrete class of material culture, and to adopt a new interpretative framework in which they are treated as manifestations of a more general class of artefacts that more typically were produced on perishable raw materials including wood.
Asunto(s)
Huesos , Tecnología , Animales , Arqueología , Fósiles , Historia Antigua , Indonesia , Tecnología/historia , Tecnología/instrumentaciónRESUMEN
Pulmonary transit time (PTT), defined as the time taken for a contrast agent bolus to pass from the right ventricle to the left ventricle, is a surrogate for non-invasive assessment of preload. It is used in several imaging modalities: pulmonary angiography, echocardiography and cardiac magnetic resonance (CMR). Many recent studies have highlighted the prognostic value of PTT. Therefore, we sought to evaluate PTT in a consecutive cohort of patients undergoing CMR. We retrospectively evaluated PTT normalised for heart rate in 278 patients (66% male, mean age 58 ± 11 years) who underwent CMR between August 2017 and November 2021 with a diagnosis of dilated cardiomyopathy, infarct, hypertrophy, valvular, myocarditis, other pathology or no pathology ("normal"). Normalised pulmonary transit time (nPTT) was higher in men than in women (8.4 ± 1.3 beats vs 7.5 ± 1.1 beats, p = 0.002) in the "normal" group. nPTT was moderately correlated with left ventricular end-diastolic volume (LVEDV) (r2 = 0.19; p < 0.001), left ventricular end-systolic volume (LVESV) (r2 = 0.34; p < 0.001) and left ventricular ejection fraction (LVEF) (r2 = 0.29; p < 0.001). nPTT was significantly higher in patients with dilated cardiomyopathy (11.3 ± 5.4 beats; p < 0.001), infarct (9.5 ± 2.9 beats; p < 0.001) or valvular heart disease (9.5 ± 3.1 beats; p = 0.006) than in patients included in the "normal" group (7.9 ± 1.3 beats). The nPTT is an important marker of pathology. Its value depends on sex and type of pathology, but it is not specific for any type of pathology.
Asunto(s)
Cardiomiopatía Dilatada , Función Ventricular Izquierda , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Estudios Retrospectivos , Valor Predictivo de las Pruebas , Espectroscopía de Resonancia Magnética , InfartoRESUMEN
BACKGROUND: TB preventive treatment (TPT) reduces morbidity and mortality among people living with HIV (PLHIV). Despite the successful scale-up of TPT in Malawi, monitoring and evaluation have been suboptimal. We utilized the Malawi Population-Based HIV Impact Assessment (MPHIA) 2020-2021 survey data to estimate TPT uptake and completion among self-reported HIV-positive persons. METHODS: We estimated the proportion of HIV-positive respondents who had ever undergone TPT, and determined the percentage of those currently on TPT who had completed more than 6 months of treatment. Bivariate and multivariable logistic regression were performed to calculate the odds ratios for factors associated with ever-taking TPT. All variables were self-reported, and the analysis was weighted and accounted for in the survey design. RESULTS: Of the HIV+ respondents, 38.8% (95% CI 36.4-41.3) had ever taken TPT. The adjusted odds of ever taking TPT were 8.0 and 5.2 times as high in the Central and Southern regions, respectively, compared to the Northern region; 1.9 times higher among those in the highest wealth quintile, and 2.1 times higher for those on antiretroviral therapy >10 years. Of those currently taking TPT, 56.2% completed >6 months of TPT. CONCLUSION: These results suggest low TPT uptake and >6 months' completion rates among self-reported HIV+ persons. Initiatives to create demand and strengthen adherence would improve TPT uptake.
CONTEXTE: Le traitement préventif de la TB (TPT) réduit la morbidité et la mortalité chez les personnes vivant avec le VIH (PVVIH). Malgré l'extension réussie du TPT au Malawi, le suivi et l'évaluation n'ont pas été optimaux. Nous avons utilisé les données de l'enquête MPHIA (Malawi Population-Based HIV Impact Assessment) 20202021 pour estimer l'adoption et l'achèvement du TPT parmi les personnes se déclarant séropositives. MÉTHODES: Nous avons estimé la proportion de répondants séropositifs qui avaient déjà subi un TPT et déterminé le pourcentage de ceux qui sont actuellement sous TPT et qui ont terminé plus de 6 mois de traitement. Une régression logistique bivariée et multivariable a été effectuée pour calculer les rapports de cotes des facteurs associés au fait d'avoir déjà pris un TPT. Toutes les variables étaient autodéclarées et l'analyse a été pondérée et prise en compte dans la conception de l'enquête. RÉSULTATS: Parmi les répondants séropositifs, 38,8% (IC 95% 36,441,3) avaient déjà pris du TPT. Les probabilités ajustées de prise de TPT étaient 8,0 et 5,2 fois plus élevées dans les régions du centre et du sud, respectivement, que dans la région du nord ; 1,9 fois plus élevées chez les personnes appartenant au quintile de richesse le plus élevé, et 2,1 fois plus élevées chez les personnes suivant une thérapie antirétrovirale depuis plus de 10 ans. Parmi ceux qui prennent actuellement un TPT, 56,2% ont terminé >6 mois de TPT. CONCLUSION: Ces résultats suggèrent un faible taux d'utilisation du TPT et des taux d'achèvement de >6 mois parmi les personnes déclarées séropositives. Des initiatives visant à créer une demande et à renforcer l'adhésion permettraient d'améliorer l'utilisation du TPT.
RESUMEN
BACKGROUND: Older people represent the majority of cancer patients but their specific needs are often ignored in the development of health-related quality of life (HRQOL) instruments. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD15 was developed to supplement the EORTC's core questionnaire, the QLQ-C30, for measuring HRQOL in patients aged >70 years in oncology studies. METHODS: Patients (n=518) from 10 countries completed the QLQ-C30, QLQ-ELD15 and a debriefing interview. Eighty two clinically stable patients repeated the questionnaires 1 week later (test-retest analysis) and 107 others, with an expected change in clinical status, repeated the questionnaires 3 months later (response to change analysis, RCA). RESULTS: Information from the debriefing interview, factor analysis and item response theory analysis resulted in the removal of one item (QLQ-ELD15î²QLQ-ELD14) and revision of the proposed scale structure to five scales (mobility, worries about others, future worries, maintaining purpose and illness burden) and two single items (joint stiffness and family support). Convergent validity was good. In known-group comparisons, the QLQ-ELD14 differentiated between patients with different disease stage, treatment intention, number of comorbidities, performance status and geriatric screening scores. Test-retest and RCA analyses were equivocal. CONCLUSION: The QLQ-ELD14 is a validated HRQOL questionnaire for cancer patients aged î¶70 years. Changes in elderly patients' self-reported HRQOL may be related to both cancer evolution and non-clinical events.
Asunto(s)
Estado de Salud , Neoplasias/psicología , Calidad de Vida/psicología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Evaluación Geriátrica , Humanos , Masculino , Neoplasias/fisiopatología , Estudios Prospectivos , Psicometría/instrumentación , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
This case-study compared traditional, face-to-face classroom-based teaching with asynchronous online learning and teaching methods in two sets of students undertaking a problem-based learning module in the multilevel and exploratory factor analysis of longitudinal data as part of a Masters degree in Public Health at Maastricht University. Students were allocated to one of the two study variants on the basis of their enrolment status as full-time or part-time students. Full-time students (n = 11) followed the classroom-based variant and part-time students (n = 12) followed the online asynchronous variant which included video recorded lectures and a series of asynchronous online group or individual SPSS activities with synchronous tutor feedback. A validated student motivation questionnaire was administered to both groups of students at the start of the study and a second questionnaire was administered at the end of the module. This elicited data about student satisfaction with the module content, teaching and learning methods, and tutor feedback. The module coordinator and problem-based learning tutor were also interviewed about their experience of delivering the experimental online variant and asked to evaluate its success in relation to student attainment of the module's learning outcomes. Student examination results were also compared between the two groups. Asynchronous online teaching and learning methods proved to be an acceptable alternative to classroom-based teaching for both students and staff. Educational outcomes were similar for both groups, but importantly, there was no evidence that the asynchronous online delivery of module content disadvantaged part-time students in comparison to their full-time counterparts.
Asunto(s)
Instrucción por Computador/métodos , Aprendizaje Basado en Problemas/métodos , Salud Pública/educación , Estadística como Asunto/educación , Adulto , Evaluación Educacional , Femenino , Humanos , Masculino , Motivación , Evaluación de Programas y Proyectos de Salud , Estudiantes/psicología , Encuestas y Cuestionarios , Enseñanza/métodosAsunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Hemangiosarcoma/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias Óseas/patología , Neoplasias Óseas/terapia , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Proliferación Celular , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Equipos y Suministros/efectos adversos , Femenino , Hemangiosarcoma/patología , Hemangiosarcoma/terapia , Humanos , Enfermedad Iatrogénica , Radioterapia/efectos adversos , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/terapiaRESUMEN
BACKGROUND: This pilot prospective study investigated the effect of a periodic fasting mimicking diet (FMD) on metabolic health factors in patients with Prostate Cancer (PC). There is a well-documented association between PC and metabolic health. Impaired metabolic health is a significant risk factor for the development of PC, and a metabolic syndrome can be induced by hormonal therapies commonly required for its management. (ClinicalTrials.gov Identifier: NCT04292041). METHODS: We introduced a periodic 4-day FMD -low in calories, sugars, and proteins but high in unsaturated fats -to a cohort of PC patients and features of metabolic syndrome. 29/35 patients completed 3-monthly cycles of the 4-consecutive day packaged FMD. We compared the subjects' baseline weight, abdominal circumference (AC), blood pressure (BP) and selected laboratory results to the same measurements 3-months after completing the FMD cycles. RESULTS: Several important metabolic factors showed improvements post-intervention. On average patients' weights dropped by 3.79 kg (95% CI: -5.61, -1.97, p = 0.0002). AC was reduced on average by 4.57 cm, (95% CI: -2.27, -6.87, p = 0.0003). There was also a decrease in systolic and diastolic BP by 9.52 mmHg (95% CI: -16.16, -2.88, p = 0.0066) and 4.48 mmHg (95% CI: -8.85, -0.43, p = 0.0316) respectively. A sub-analysis indicates that FMD had more relevant effects in 'at-risk' patients than those with normal values of risk factors for metabolic syndrome. For example, subjects with baseline levels of systolic BP > 130 mmHg experienced a greater reduction in BP(-16.04 mmHg, p = 0.0001) than those with baseline systolic BP < 130 mmHg (-0.78 mmHg, p = 0.89). CONCLUSIONS: The FMD cycles were safely introduced to this small cohort of PC patients with little or no observed toxicity, and a high overall compliance of 83%. Analysis of the metabolic variables showed an overall decrease in weight, AC, and BP. Larger clinical trials focused on metabolic risk factors, PC quality of life and progression free survival are needed to assess the effect of the FMD on prostate cancer patients.
Asunto(s)
Hipertensión , Síndrome Metabólico , Neoplasias de la Próstata , Humanos , Masculino , Presión Sanguínea , Dieta , Ayuno , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Síndrome Metabólico/epidemiología , Síndrome Metabólico/complicaciones , Estudios Prospectivos , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/complicaciones , Calidad de Vida , Proyectos PilotoRESUMEN
BACKGROUND: The Nottinghamshire Lymphoma Registry contains the details of all the patients diagnosed with lymphoma (since 1 January 1973) within a defined geographical area with a population of 1.1 million. It was therefore possible to study the outcome of treatment for Hodgkin's disease for three 10-year cohorts (1973-1982, 1983-1992 and 1993-2002).The aims of the study were to compare survival time among the three patient cohorts, to identify prognostic factors and to estimate relative survival. METHODS: A total of 745 patients diagnosed between 1973 and 2002 were analysed for survival. Survivorship was estimated by the Kaplan-Meier method and parametric survival models. An accelerated failure-time regression was used for multivariate analysis. RESULTS: Overall, patients were observed for 9.8 (0.3-34.82) years (median(range)), on average. One, five and fifteen-year disease-specific survival was found to be 87% (85-90%), 77% (74-80%) and 70% (67-74%), respectively. For those for diagnosed between 1973 and 1982, the 15-year survival was found to be 57%; for 1983-1992, it was 74% and for 1993-2002, it was 83% (P<0.001). The difference remained significant after adjusting for prognostic factors. The actuarial risk of developing a second malignancy at 20 years was for the 1973-1982 cohort, 12.4%, and for the 1983-1992 cohort, 18.8%. CONCLUSION: Treatment advances and effective management of toxicities of treatment over time, have resulted in a significantly longer survival for patients with Hodgkin's disease diagnosed within a defined population.