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1.
Dis Colon Rectum ; 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38653494

RESUMO

BACKGROUND: Segmental colectomy in ulcerative colitis is performed in select patients who may be at increased risk for postoperative morbidity. OBJECTIVE: To identify ulcerative colitis patients who underwent segmental colectomy and assess their postoperative and long-term outcomes. DESIGN: Retrospective case series. SETTING: A tertiary-care inflammatory bowel disease center. PATIENTS: Ulcerative colitis patients who underwent surgery between 1995 and 2022. INTERVENTION: Segmental colectomy. MAIN OUTCOME MEASURES: Postoperative complications, early and late colitis, metachronous cancer development, completion proctocolectomy-free survival rates and stoma at follow-up. RESULTS: Fifty-five patients were included [20 (36.4%) female; 67.8 (57.4-77.1) years of age at surgery; body mass index 27.7 (24.2-31.1) kg/m2; median follow-up 37.3 months]. ASA score was III in 32 (58.2%) patients, 48 (87.3%) had at least one comorbidity, 48 (87.3%) had Mayo endoscopic subscore of 0-1. Patients underwent right hemicolectomy (28, 50.9%), sigmoidectomy (17, 30.9%), left hemicolectomy (6, 10.9%), low anterior resection (2, 3.6%), or a non-anatomic resection (2, 3.6%) for; endoscopically unresectable polyps (21, 38.2%), colorectal cancer (15, 27.3%), symptomatic diverticular disease (13, 23.6%), and stricture (6, 10.9%). Postoperative complications occurred in 16 (29.1%) patients [7 (12.7%) Clavien-Dindo Class III-V]. Early and late postoperative colitis rates were 9.1% and 14.5%, respectively. Metachronous cancer developed in 1 patient. 4 (7.3%) patients underwent subsequent completion proctocolectomy with ileostomy. Six (10.9%) patients had stoma at the follow-up. Two and 5-year completion proctocolectomy-free survival rates were 91% and 88%, respectively. LIMITATIONS: Retrospective study, small sample size. CONCLUSIONS: Segmental colectomy in ulcerative colitis is associated with low postoperative complication rates, symptomatic early colitis and late colitis rates, metachronous cancer development and the need for subsequent completion proctocolectomy. Therefore, it can be safe to consider select patients, such as the elderly with quiescent colitis and other indications for colectomy. See Video Abstract.

2.
Adapt Phys Activ Q ; 41(1): 176-197, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37391195

RESUMO

Physical activity (PA) in the early years is foundational for growth and development and associated with numerous health benefits. However, the prevalence of PA participation among the pediatric population with disabilities is less clear. This systematic review aimed to synthesize the existing literature on PA levels of young children (0-5.99 years) with disabilities. Empirical quantitative studies were collected from seven databases and reference hand searching; 21 studies were included in the review. PA levels varied widely based on disability type and measurement strategies, but overall, PA levels were low. Future research should address the underrepresentation of measurement and reporting of the PA levels of young children with disabilities.


Assuntos
Crianças com Deficiência , Criança , Humanos , Pré-Escolar , Exercício Físico
3.
J Appl Res Intellect Disabil ; 37(1): e13177, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37987194

RESUMO

BACKGROUND: The COVID-19 pandemic has had a negative impact on the mental health of people with intellectual and developmental disabilities. Numerous pandemic-related stressors experienced by people with intellectual and developmental disabilities may have impacted their ability to thrive, which has been linked to mental health outcomes. The current study examined the associations among COVID-19 stressors, thriving, and mental health problems among youth and adults with intellectual and developmental disabilities. METHOD: Caregivers of 159 people with intellectual and developmental disabilities between 12 and 35 years of age from Canada completed an online questionnaire. RESULTS: A mediation analysis revealed that COVID-19 stressors were positively associated with mental health problems, and that thriving partially mediated this association. CONCLUSION: Our findings suggest that experiences of thriving may be an important target for mental health support for people with intellectual and developmental disabilities.


Assuntos
COVID-19 , Deficiência Intelectual , Adulto , Criança , Adolescente , Humanos , Saúde Mental , COVID-19/epidemiologia , Pandemias , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/psicologia , Canadá/epidemiologia
4.
Colorectal Dis ; 25(6): 1257-1266, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36945106

RESUMO

AIM: The management of anastomotic leak after sigmoid colectomy for diverticular disease has not been well defined. Specifically, there is a lack of literature on optimal types of reoperations for leaks. The aim of this study was to describe and compare reoperative approaches and their postoperative outcomes. METHODS: We performed a retrospective cohort study using the NSQIP Colectomy Module (2012-2019) and single-institution chart review. Patients with diverticular disease who underwent elective sigmoid colectomy were included. Primary outcomes were anastomotic leak requiring reoperation and management of anastomotic leak. RESULTS: Of 37,471 patients who underwent sigmoid colectomy for diverticular disease, 1003 (2.7%) suffered an anastomotic leak, of whom 583 underwent reoperation. Of the 572 patients who were not initially diverted and underwent reoperation for leak, 302 (52.8%) were managed with stoma creation - 200 (35.0%) with colostomy and 102 (17.8%) with ileostomy. The remaining 47.2% underwent colectomy with reanastomosis, suturing of large bowel, and drainage. There were no differences in length of stay, readmission, or mortality between patients who underwent ileostomy or colostomy at reoperation (p > 0.05). Single-institution analysis demonstrated that 100% of patients with ileostomies underwent subsequent ileostomy closure, compared to 60% of patients with colostomies. CONCLUSIONS: In patients who suffer anastomotic leaks after sigmoid colectomy for diverticular disease and undergo reoperations, ileostomy at the time of reoperation appears to be safe, with comparable results to colostomy. Ileostomies were more frequently closed than colostomies. When faced with a colorectal anastomotic leak, ileostomy creation may be considered.


Assuntos
Fístula Anastomótica , Colostomia , Humanos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Colostomia/efeitos adversos , Colostomia/métodos , Ileostomia/efeitos adversos , Ileostomia/métodos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Estudos Retrospectivos , Colectomia/efeitos adversos , Colectomia/métodos
5.
Adapt Phys Activ Q ; 40(3): 465-474, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36640778

RESUMO

This report provides an expert appraisal of the Canadian Para Report Card on physical activity (PA) for children and adolescents with disabilities. Thirteen indicators were graded by a panel of researchers, representatives from disability and PA organizations, and parents of children and adolescents with disabilities using benchmarks of the Global Matrix 4.0 and previous Canadian PA Report Cards. Facilitated panel discussions were used to appraise the available evidence based on data gaps, opportunities, and recommendations. The available data sources included four nationally generalizable or representative data sets. Grades were assigned to 8/13 indicators and ranged from B+ to F. Data gaps in measurement and national surveillance systems were identified. Ableism was an issue identified within some of the reporting benchmarks. The absence of PA from existing accessibility legislation in Canada was a policy gap of concern. Recommendations related to research, surveillance, and policy are provided to enhance PA among children and adolescents with disabilities in Canada.


Assuntos
Pessoas com Deficiência , Esportes , Criança , Humanos , Adolescente , Promoção da Saúde , Política de Saúde , Canadá , Exercício Físico
6.
Ann Surg ; 275(1): e181-e188, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32886462

RESUMO

OBJECTIVE: To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. SUMMARY OF BACKGROUND DATA: Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration. METHODS: We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or "contextual" barriers within Andersen Behavioral Model of Health Services Use. RESULTS: Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time. CONCLUSIONS: Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.


Assuntos
Cirurgia Bariátrica , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Pesquisa Qualitativa , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Atenção Primária à Saúde , Estados Unidos/epidemiologia , Redução de Peso/fisiologia
7.
Dis Colon Rectum ; 65(1): e5-e13, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882636

RESUMO

INTRODUCTION: Ileocolic resection for Crohn's disease traditionally does not include a high ligation of the ileocolic pedicle, and most commonly is performed with a stapled side-to-side ileocolic anastomosis. The mesentery has recently been implicated in the pathophysiology of Crohn's disease. Two techniques have been developed and are associated with reduced postoperative recurrence: the Kono-S anastomosis that excludes diseased mesentery and extended mesenteric excision that resects diseased mesentery. We aimed to assess the technical feasibility and safety of a novel combination of techniques: mesenteric excision and exclusion. TECHNIQUES: This initial report is a single-center descriptive study of consecutive adults who underwent mesenteric excision and exclusion for primary or recurrent ileocolic Crohn's disease from September 2020 to June 2021. Medication exposure and endoscopic balloon dilation before surgery were recorded. Phenotype was classified using the Montreal Classification. Thirty-day outcomes were reported. A video of the mesenteric excision and exclusion including the Kono-S anastomosis is presented. RESULTS: Twenty-two patients with ileocolic Crohn's disease underwent mesenteric excision and exclusion: 100% had strictures, 59% had fistulas, 81% were on biologics, and 27% had previous ileocolic resection(s). Seventy-two percent underwent laparoscopic procedures, a mesenteric defect was closed in 86%, omental flaps were fashioned in 77%, and 3 patients were diverted. Median operative time was 175 minutes. Median postoperative stay was 4 days. At 30 days, there were 2 readmissions for reintervention: 1 seton placement and 1 percutaneous drainage of a sterile collection. There were no cases of intra-abdominal sepsis or anastomotic leak. CONCLUSIONS: Mesenteric excision and exclusion represents an innovative, progressive, and promising approach that appears to be highly feasible and safe. Further study is warranted to determine if mesenteric excision and exclusion is associated with reduced postoperative recurrence of ileocolic Crohn's disease.


Assuntos
Anastomose Cirúrgica/métodos , Terapia Combinada/efeitos adversos , Doença de Crohn/cirurgia , Mesentério/cirurgia , Adulto , Produtos Biológicos/uso terapêutico , Colo/cirurgia , Constrição Patológica/epidemiologia , Doença de Crohn/fisiopatologia , Estudos de Viabilidade , Feminino , Fístula/epidemiologia , Humanos , Íleo/cirurgia , Laparoscopia/estatística & dados numéricos , Masculino , Mesentério/patologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Segurança , Suturas/efeitos adversos
8.
Arch Phys Med Rehabil ; 102(11): 2109-2116.e1, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33932359

RESUMO

OBJECTIVE: To examine the associations among social networks and loneliness on health and life satisfaction in adults with chronic spinal cord injury/dysfunction (SCI/D). DESIGN: Cross-sectional telephone survey study. SETTING: Tertiary spinal cord injury rehabilitation center in Ontario, Canada. PARTICIPANTS: Community-dwelling adults with chronic SCI/D (N=170). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcome measures were the Short-Form 36 to assess health and the Life Satisfaction-11 to assess life satisfaction. RESULTS: A hierarchical regression model predicting physical health accounted for 24% (P<.001) of the variance. The only social network variable to significantly contribute to the model was having a higher proportion of network members living in one's household (P<.05). A model predicting mental health accounted for 44% (P<.001) of the variance, with having a higher proportion of network members living in one's household (P<.05) and lower feelings of loneliness (P<.001) associated with better mental health. Finally, the model predicting life satisfaction accounted for 62% (P<.001) of the variance, with lower greater levels of social network intimacy (P<.01) and lower feelings of loneliness (P<.001) being significant predictors. CONCLUSIONS: These findings highlight the importance of having access to network members in one's home for better physical and mental health after SCI/D as well as the negative association between loneliness and mental health and life satisfaction. There is a need for approaches to ensure that people with SCI/D in the community feel supported to mitigate feelings of loneliness to optimize their health and wellbeing.


Assuntos
Nível de Saúde , Solidão/psicologia , Satisfação Pessoal , Rede Social , Traumatismos da Medula Espinal/psicologia , Atividades Cotidianas , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Ontário , Modalidades de Fisioterapia , Qualidade de Vida , Centros de Reabilitação , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Traumatismos da Medula Espinal/reabilitação
9.
J Sports Sci ; 39(21): 2434-2443, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34157957

RESUMO

When designing efficacy trials, researchers have a responsibility to "do no harm" and to "do good". Given the psychological vulnerability of adolescent girls with overweight and obesity, it is important to consider the implications of participating in weight-related research studies. We investigated psychological outcomes from a 12-week laboratory-based randomised controlled trial aimed at improving body composition and bone health in adolescent girls with overweight and obesity. Sixty-three participants were randomised to three groups (Recommended dairy diet plus exercise (RDa, n = 24); Low dairy diet plus exercise (LDa, n = 25); no-intervention control (n = 14)). Self-Determination Theory-informed strategies were applied in both intervention groups to foster motivation and enhance psychological wellbeing. Motivation, perceived competence and self-perceptions were measured at 0 and 12 weeks. Fifty-four participants (24 RDa, 23 LDa, 7 Control) provided complete psychological data. There were no between group differences in 0- to 12-week change in motivation, perceived competence or global self-worth. Both intervention groups showed significant improvements in physical self-worth (p = 0.001), body satisfaction (p = 0.002) and perceived physical conditioning (p = 0.002), compared with the control group. A theory-informed, laboratory-based diet and exercise intervention produced favourable psychological outcomes for adolescent girls with overweight and obesity.


Assuntos
Dieta Redutora , Terapia por Exercício , Estilo de Vida Saudável , Sobrepeso/psicologia , Sobrepeso/terapia , Obesidade Infantil/psicologia , Obesidade Infantil/terapia , Adolescente , Terapia Comportamental , Composição Corporal , Criança , Dieta Saudável , Feminino , Humanos , Motivação , Autonomia Pessoal , Autoimagem , Resultado do Tratamento
11.
J Health Commun ; 22(6): 523-531, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28481157

RESUMO

Few people with multiple sclerosis engage in physical activity. Messaging interventions may motivate more physical activity among these individuals. The purpose of this online study was to evaluate an intervention presenting participants with multiple sclerosis (N = 237) with risk information (i.e., information demonstrating people with multiple sclerosis are more likely to experience certain health issues) or no risk information followed by gain- or loss-framed physical activity messages. Participants completed questionnaires on Days 1, 6, and 28 and received information material on Days 2-5. The dependent variables were as follows: physical activity intentions and behavior, response and task efficacy, perceived threat (i.e., perception of threat to health issues relevant to people with multiple sclerosis), and avoidance (i.e., avoiding thinking about/doing something about the health issues presented in the messages). Analyses indicated physical activity and response efficacy increased over time. Also, participants receiving risk information had higher levels of physical activity and perceived threat. However, manipulation checks showed no differences between participants regarding perceptions of risk information or gain/loss-framed messages. Despite the lack of impact of the framing intervention, this study suggests that a brief informational intervention can positively influence physical activity and certain correlates of physical activity among people with multiple sclerosis.


Assuntos
Exercício Físico/psicologia , Comunicação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Esclerose Múltipla/psicologia , Adulto , Feminino , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Medição de Risco , Inquéritos e Questionários
12.
J Health Commun ; 19(6): 676-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24479817

RESUMO

The primary purpose was to examine the relative cognitive processing of gain-framed versus loss-framed physical activity messages following exposure to health risk information. Guided by the Extended Parallel Process Model, the secondary purpose was to examine the relation between dwell time, message recall, and message-relevant thoughts, as well as perceived risk, personal relevance, and fear arousal. Baseline measures of perceived risk for inactivity-related disease and health problems were administered to 77 undergraduate students. Participants read population-specific health risk information while wearing a head-mounted eye tracker, which measured dwell time on message content. Perceived risk was then reassessed. Next, participants read PA messages while the eye tracker measured dwell time on message content. Immediately following message exposure, recall, thought-listing, fear arousal, and personal relevance were measured. Dwell time on gain-framed messages was significantly greater than loss-framed messages. However, message recall and thought-listing did not differ by message frame. Dwell time was not significantly related to recall or thought-listing. Consistent with the Extended Parallel Process Model, fear arousal was significantly related to recall, thought-listing, and personal relevance. In conclusion, gain-framed messages may evoke greater dwell time than loss-famed messages. However, dwell time alone may be insufficient for evoking further cognitive processing.


Assuntos
Cognição/fisiologia , Atividade Motora , Comunicação Persuasiva , Adolescente , Adulto , Informação de Saúde ao Consumidor , Movimentos Oculares , Feminino , Humanos , Masculino , Medição de Risco , Adulto Jovem
13.
ANZ J Surg ; 94(5): 952-953, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38426390

RESUMO

We demonstrate the technical details of laparoscopic-assisted endoscopic 'clean sweep' for small bowel polyp clearance in Peutz Jeghers Syndrome. A 'clean sweep' reduces the risk for future recurrences but was previously performed with an open technique. A minimally invasive approach is safe, reduces bowel trauma and has good postoperative outcomes.


Assuntos
Pólipos Intestinais , Intestino Delgado , Laparoscopia , Síndrome de Peutz-Jeghers , Humanos , Laparoscopia/métodos , Síndrome de Peutz-Jeghers/cirurgia , Pólipos Intestinais/cirurgia , Intestino Delgado/cirurgia , Masculino , Feminino , Adulto , Resultado do Tratamento
14.
Int J Behav Nutr Phys Act ; 10: 88, 2013 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-23829582

RESUMO

BACKGROUND: Transitioning to parenthood is a major life event that may impact parents' personal lifestyles, yet there is an absence of theory-based research examining the impact of parenthood on motives for dietary behaviour. As a result, we are unaware of the social cognitive variables that predict eating behaviour among those transitioning to parenthood. The purpose of the study was to examine eating behaviour motives across 12 months within the framework of the theory of planned behavior (TPB) and compare these across groups of new parents, non-parents, and established parents. METHODS: Non-parents (n = 92), new parents (n = 135), and established parents (n = 71) completed TPB questionnaires assessing attitudes, subjective norms, perceived behavioral control (PBC), and intentions and three day food records at baseline, and 6- and 12-months post-delivery (for parents) and 6- and 12-months post-baseline (for non-parents). RESULTS: Repeated measures ANOVAs revealed that among men, new- and established-parents had greater intentions to eat healthy compared to non-parents, F(2) = 3.59, p = .03. Among women, established parents had greater intentions than new- and non-parents, F(2) = 5.33, p = .01. Among both men and women during the first 6-months post-delivery, new-parents experienced decreased PBC, whereas established parents experienced increased PBC. Overall, affective attitudes were the strongest predictor of intentions for men (ß = 0.55, p < .001) and women (ß = 0.38, p < .01). PBC predicted changes in fruit and vegetable consumption for men (ß = 0.45, p = .02), and changes in fat consumption for men (ß = -0.25, p = .03) and women (ß = -.24, p < .05), regardless of parent status. CONCLUSION: The transition to parenthood for new and established parents may impact motivation for healthy eating, especially PBC within the framework of TPB. However, regardless of parental status, affective attitudes and PBC are critical antecedents of intentions and eating behaviour. Interventions should target affective attitudes and PBC to motivate healthy eating and may need to be intensified during parenthood.


Assuntos
Comportamento Alimentar , Comportamentos Relacionados com a Saúde , Acontecimentos que Mudam a Vida , Motivação , Adulto , Dieta , Registros de Dieta , Gorduras na Dieta/administração & dosagem , Feminino , Seguimentos , Frutas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pais , Inquéritos e Questionários , Verduras
15.
J Heart Valve Dis ; 22(5): 716-23, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24383387

RESUMO

BACKGROUND AND AIM OF THE STUDY: Short-term postoperative warfarin therapy has been used to decrease neurologic events following mitral valve repair or bioprosthetic replacement (MVR). The study aim was to compare the short- and long-term outcomes of patients undergoing mitral valve surgery with or without short-term postoperative warfarin. METHODS: A single academic US institution retrospective review was performed on discharged patients who underwent MVR between January 1996 and March 2010. Patients were allocated to two groups: MVR with four to six weeks of postoperative warfarin (n = 315; Warfarin group) or MVR without postoperative warfarin (n = 257; No warfarin group). Patients who required either preoperative or postoperative warfarin for any disease process (e.g., atrial fibrillation, mechanical valve, deep venous thrombosis) were excluded. Logistic and Cox proportional hazards regression models were constructed to evaluate the effects of warfarin on short- and long-term outcomes, respectively. Adjusted odds ratios (AOR) and adjusted hazard ratios (AHR), with 95% confidence intervals (CI) were constructed for each outcome. To reduce selection bias, propensity scoring methods were employed to balance the groups with respect to 54 preoperative variables. RESULTS: Mean age was not significantly different between groups (No warfarin group = 56.8 +/- 14.5 years versus Warfarin group 55.9 +/- 12.9 years; p = 0.46). The average length of hospital stay was 9.8 +/- 8.4 days and 7.3 +/- 4.5 days in the No warfarin and Warfarin groups, respectively (p < 0.001). At the six-week follow up the incidences of stroke (p = 0.74), pleural effusions (p = 0.88), pericardial effusions (p = 0.75), and bleeding complications (p = 0.30) were similar between the two groups. In an unadjusted Kaplan-Meier analysis, the No warfarin group had a poorer long-term survival than the Warfarin group (p < 0.001). However, after propensity adjustment, the benefit of warfarin was not statistically significant (AHR = 0.66, 95% CI 0.40-1.08, p = 0.098). CONCLUSION: The use of postoperative warfarin following MVR does not reduce the incidence of stroke at early follow up. However, there remains a trend for improved long-term outcomes in those patients receiving postoperative warfarin therapy.


Assuntos
Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Cuidados Pós-Operatórios/métodos , Acidente Vascular Cerebral/prevenção & controle , Varfarina/administração & dosagem , Anticoagulantes/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Georgia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
16.
Appl Physiol Nutr Metab ; 48(2): 226-230, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36423353

RESUMO

A lack of disability-specific knowledge among practitioners poses a significant barrier to physical activity (PA) participation for persons with physical disabilities (PWPDs). This study aimed to identify perceived training needs of health and fitness practitioners to support PA for PWPDs. Canadian health and fitness practitioners (n = 115; 81% female) completed an online survey. More specialized training and access to information about PA for PWPDs are needed. In-person training, webinars, and lived experiences of PWPDs are recommended.


Assuntos
Pessoas com Deficiência , Humanos , Feminino , Masculino , Canadá , Exercício Físico , Inquéritos e Questionários , Aptidão Física
17.
Disabil Rehabil ; 44(14): 3400-3409, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-33356633

RESUMO

PURPOSE: To advance the understanding of perceived social isolation among persons with spinal cord injury (SCI), the objectives of the present study were to explore: (1) experiences of perceived social isolation and (2) factors that contribute to perceived social isolation. METHODS: Interpretive description qualitative methodology was used to conduct semi-structured interviews with 30 individuals with SCI from across Ontario (Canada) from November 2016 to August 2017. Data were analyzed using thematic analysis. RESULTS: Participants identified disruption to social networks that seemed to impact perceived social isolation. Five major themes were identified: (1) impact on structure and frequency of social network; (2) importance of feeling heard; (3) importance of employment, hobbies, and sports; (4) need to improve physical accessibility and built environment; and (5) individual characteristics. Changes in quality of social networks, rather than size, contributed to greater feelings of perceived social isolation. The built environment, maintenance of employment, hobbies, and sports, social media, and technology use, as well as individual traits, were also found to impact perceived social isolation. CONCLUSION: Future research should focus on the development of programs to help maintain or improve social network quality for persons with SCI to minimize the impact of perceived social isolation.IMPLICATIONS FOR REHABILITATIONPerceived social isolation, resulting from physical and environmental barriers, is a challenge that is faced by many individuals who are living in the community with a spinal cord injury (SCI).Rehabilitation and community programs should utilize an individualized approach to find solutions to challenges faced by this population to prevent the effects of perceived social isolation.Education on how to adapt to changes in social network, together with the provision of access to peer-to-peer support groups, and SCI specific return to work or leisure programs, is recommended as an essential component of rehabilitation.


Assuntos
Traumatismos da Medula Espinal , Humanos , Atividades de Lazer , Ontário , Pesquisa Qualitativa , Isolamento Social , Traumatismos da Medula Espinal/reabilitação
18.
J Spinal Cord Med ; 45(2): 173-179, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-32379551

RESUMO

Context: There has been no known research investigating the association between leisure time physical activity (LTPA), loneliness, and life satisfaction among people with spinal cord injury or dysfunction (SCI/D). The relationship between these constructs is worthy of consideration given the positive health impacts of LTPA, the negative health impacts of loneliness, and heightened negative effects of loneliness on life satisfaction for individuals with SCI/D.Objectives: To examine the relationship between LTPA and loneliness, and examine loneliness as a possible mediator of the relationship between LTPA and life satisfaction among individuals with SCI/D.Design and Participants: Community dwelling individuals with SCI/D (N = 170) participated in a telephone-based survey as part of a larger project.Measures: LTPA (i.e. The Leisure Time Physical Activity Questionnaire-SCI, UCLA Loneliness Scale-3, and the Life Satisfaction Questionnaire-11 were administered to the participants.Results: Significant bivariate relationships were observed between LTPA and life satisfaction (r = .18, P = .02), LTPA and loneliness (r = -.15, P = .045), and loneliness and life satisfaction (r = -.69, P < .001). Mediation analyses suggest that loneliness significantly mediated the relationship between LTPA and life satisfaction (indirect effect = .003, 95% bootstrap CI = .0004 to .0062, CSI = .113).Conclusion: This was the first study to show evidence of a negative association between LTPA and loneliness among people with SCI/D, and to establish a conceptual model for understanding the potential mediating role of loneliness in the relationship between LTPA and life satisfaction among people with SCI/D.


Assuntos
Solidão , Traumatismos da Medula Espinal , Estudos Transversais , Exercício Físico , Humanos , Atividades de Lazer , Satisfação Pessoal
19.
Disabil Health J ; 14(3): 101060, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33478910

RESUMO

BACKGROUND: Adolescents with disabilities (AWD) often report higher loneliness levels than adolescents without disabilities, as they frequently encounter barriers to social participation. A negative relationship between physical activity (PA) and loneliness has been established outside of AWD populations, while few studies have examined this association among AWD. Research investigating the relationship between PA and loneliness has not systematically examined aspects of PA experiences that may influence this relationship. OBJECTIVES: The objectives of this study were to: a) examine the direct relationship between PA and loneliness among AWD, and b) examine the quality of PA experiences, as framed within a quality participation conceptualization, as a possible moderator of the relationship between PA and loneliness. METHODS: This study was a cross-sectional sub-analysis of data from The National Physical Activity Measurement Study. Participants included 40 Canadian adolescents, age 10-17, with any type of disability who completed a series of questionnaires either online or via telephone/video interview. RESULTS: PA and loneliness were not significantly related at the bivariate level (r = -0.10, p = .54), but quality of PA participation significantly moderated the relationship between PA and loneliness (95% C.I. = 0.002-0.019, p = .02). These results suggest that greater PA rates were significantly and negatively associated with loneliness among AWD who reported experiencing high quality PA experiences. CONCLUSIONS: This research can be used as evidence to inform mechanistic studies with causal data to provide more robust findings on the possible value of high-quality PA experiences to mitigate feelings of loneliness among AWD.


Assuntos
Pessoas com Deficiência , Solidão , Adolescente , Canadá , Criança , Estudos Transversais , Exercício Físico , Humanos
20.
Artigo em Inglês | MEDLINE | ID: mdl-34280983

RESUMO

BACKGROUND: Physical activity (PA) messages have demonstrated success in targeting parent support for PA. However, little research exists to inform the development and dissemination of optimally effective PA messages targeting parents. A synthesis of existing literature is necessary to inform message development and dissemination strategies. Unique considerations for parents of children with disabilities (CWD) should be identified given a need for inclusive PA messaging that consider the needs of CWD and their families. METHODS: Systematic scoping methodologies included a peer-reviewed literature search and expert consultation to identify literature regarding PA messages targeting parents, and considerations for parents of CWD. RESULTS: Thirty-four articles that met eligibility criteria were included for examination. Twenty-eight studies were identified regarding the PA messages targeting parents; six themes and 12 subthemes emerged from these articles. Six studies were identified regarding unique considerations for parents of CWD; three themes and four subthemes emerged from these articles. CONCLUSIONS: Through knowledge synthesis, this research can contribute to a knowledge translation process to inform practice guidelines for the development and dissemination of PA messages targeting parents, while also providing unique considerations for PA messages targeting parents of CWD.


Assuntos
Crianças com Deficiência , Exercício Físico , Criança , Humanos , Conhecimento , Pesquisa Translacional Biomédica
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