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2.
BMC Med ; 18(1): 124, 2020 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-32375776

RESUMEN

BACKGROUND: To mitigate and slow the spread of COVID-19, many countries have adopted unprecedented physical distancing policies, including the UK. We evaluate whether these measures might be sufficient to control the epidemic by estimating their impact on the reproduction number (R0, the average number of secondary cases generated per case). METHODS: We asked a representative sample of UK adults about their contact patterns on the previous day. The questionnaire was conducted online via email recruitment and documents the age and location of contacts and a measure of their intimacy (whether physical contact was made or not). In addition, we asked about adherence to different physical distancing measures. The first surveys were sent on Tuesday, 24 March, 1 day after a "lockdown" was implemented across the UK. We compared measured contact patterns during the "lockdown" to patterns of social contact made during a non-epidemic period. By comparing these, we estimated the change in reproduction number as a consequence of the physical distancing measures imposed. We used a meta-analysis of published estimates to inform our estimates of the reproduction number before interventions were put in place. RESULTS: We found a 74% reduction in the average daily number of contacts observed per participant (from 10.8 to 2.8). This would be sufficient to reduce R0 from 2.6 prior to lockdown to 0.62 (95% confidence interval [CI] 0.37-0.89) after the lockdown, based on all types of contact and 0.37 (95% CI = 0.22-0.53) for physical (skin to skin) contacts only. CONCLUSIONS: The physical distancing measures adopted by the UK public have substantially reduced contact levels and will likely lead to a substantial impact and a decline in cases in the coming weeks. However, this projected decline in incidence will not occur immediately as there are significant delays between infection, the onset of symptomatic disease, and hospitalisation, as well as further delays to these events being reported. Tracking behavioural change can give a more rapid assessment of the impact of physical distancing measures than routine epidemiological surveillance.


Asunto(s)
Número Básico de Reproducción , Infecciones por Coronavirus , Epidemias/prevención & control , Pandemias , Neumonía Viral , Aislamiento Social , Actividades Cotidianas , Adulto , Betacoronavirus , Trazado de Contacto , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Política de Salud , Humanos , Incidencia , Relaciones Interpersonales , Modelos Teóricos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Encuestas y Cuestionarios , Reino Unido/epidemiología
3.
Complement Ther Clin Pract ; 39: 101166, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32379637

RESUMEN

BACKGROUND: Different degrees of disorders are reported in respiratory function, physical function and psychological function in patients with corona virus disease 2019 (COVID-19), especially in elderly patients. With the experience of improved and discharged COVID-19 patients, timely respiratory rehabilitation intervention may improve prognosis, maximize functional preservation and improve quality of life (QoL), but there lacks of studies worldwide exploring the outcome of this intervention. OBJECTIVE: To investigate the effects of 6-week respiratory rehabilitation training on respiratory function, QoL, mobility and psychological function in elderly patients with COVID-19. METHODS: This paper reported the findings of an observational, prospective, quasi-experimental study, which totally recruited 72 participants, of which 36 patients underwent respiratory rehabilitation and the rest without any rehabilitation intervention. The following outcomes were measured: pulmonary function tests including plethysmography and diffusing lung capacity for carbon monoxide (DLCO), functional tests (6-min walk distance test), Quality of life (QoL) assessments (SF-36 scores), activities of daily living (Functional Independence Measure, FIM scores), and mental status tests (SAS anxiety and SDS depression scores). RESULTS: After 6 weeks of respiratory rehabilitation in the intervention group, there disclosed significant differences in FEV1(L), FVC(L), FEV1/FVC%, DLCO% and 6-min walk test. The SF-36 scores, in 8 dimensions, were statistically significant within the intervention group and between the two groups. SAS and SDS scores in the intervention group decreased after the intervention, but only anxiety had significant statistical significance within and between the two groups. CONCLUSIONS: Six-week respiratory rehabilitation can improve respiratory function, QoL and anxiety of elderly patients with COVID-19, but it has little significant improvement on depression in the elderly.


Asunto(s)
Infecciones por Coronavirus/rehabilitación , Neumonía Viral/rehabilitación , Terapia Respiratoria , Actividades Cotidianas , Anciano , Ansiedad/etiología , Ansiedad/terapia , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/psicología , Estudios Prospectivos , Calidad de Vida , Pruebas de Función Respiratoria , Terapia Respiratoria/métodos , Caminata
4.
Psychiatry Res ; 287: 112934, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32229390

RESUMEN

A COVID-19 epidemic has been spreading in China and other parts of the world since December 2019. The epidemic has brought not only the risk of death from infection but also unbearable psychological pressure. We sampled college students from Changzhi medical college by using cluster sampling. They responded to a questionnaire packet that included the 7-item Generalized Anxiety Disorder Scale (GAD-7) and those inquiring the participants' basic information. We received 7,143 responses. Results indicated that 0.9% of the respondents were experiencing severe anxiety, 2.7% moderate anxiety, and 21.3% mild anxiety. Moreover, living in urban areas (OR = 0.810, 95% CI = 0.709 - 0.925), family income stability (OR = 0.726, 95% CI = 0.645 - 0.817) and living with parents (OR = 0.752, 95% CI = 0.596 - 0.950) were protective factors against anxiety. Moreover, having relatives or acquaintances infected with COVID-19 was a risk factor for increasing the anxiety of college students (OR = 3.007, 95% CI = 2.377 - 3.804). Results of correlation analysis indicated that economic effects, and effects on daily life, as well as delays in academic activities, were positively associated with anxiety symptoms (P < .001). However, social support was negatively correlated with the level of anxiety (P < .001). It is suggested that the mental health of college students should be monitored during epidemics.


Asunto(s)
Trastornos de Ansiedad , Ansiedad , Infecciones por Coronavirus/psicología , Salud Mental , Neumonía Viral/psicología , Estudiantes de Medicina , Actividades Cotidianas , Adulto , Ansiedad/etiología , Ansiedad/psicología , Trastornos de Ansiedad/etiología , Trastornos de Ansiedad/psicología , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Epidemias , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , Factores de Riesgo , Apoyo Social , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Universidades , Adulto Joven
5.
Medicine (Baltimore) ; 99(16): e19641, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311935

RESUMEN

BACKGROUND: We conducted this meta-analysis to analyze the effectiveness of balance training in improving postoperative rehabilitation outcomes in hip fracture surgery patients. METHODS: The Cochrane Library, Web of Science, Embase, and PubMed electronic databases were searched from their inception to December 2018. We selected prospective clinical control analyses and high-quality randomized controlled trials (RCTs) following the inclusion standards. We used Stata 12.0 to perform the meta-analysis. Where possible, the standard mean difference (SMD) with the 95% confidence interval (CI) was determined using a random effects model. RESULTS: Ten RCTs involving 955 hips (balance training = 487, control = 468) published between 2002 and 2019 were assessed for eligibility of inclusion in the meta-analysis. Balance training was shown to remarkably improve the aspects of quality of life associated with physical health (standard mean difference [SMD], 2.20; 95% CI, 1.63-2.78, P = .000), a fast gait speed (SMD, 1.01; 95% CI, 0.25-1.77, P = .009), and balance (SMD = 0.26, 95% CI: [0.12, 0.41], P = .000). Moreover, the balance training group showed increases in independence in activities of daily living (ADLs), performance task scores, and health-related quality of life (HRQoL) scores compared with the control group (P < .05). CONCLUSION: According to the present meta-analysis, balance training improves one's independence in activities of daily living, performance tasks, lower limb strength, gait, and total physical function compared with no balance training. More high-quality RCTs with large sample sizes are required for the identification of the best balance training program after hip fracture.


Asunto(s)
Actividades Cotidianas , Fracturas de Cadera/rehabilitación , Modalidades de Fisioterapia , Equilibrio Postural , Terapia por Ejercicio , Humanos , Rendimiento Físico Funcional , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Velocidad al Caminar
6.
Rev Saude Publica ; 54: 35, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32267369

RESUMEN

OBJECTIVE: To estimate the prevalence of robustness among older adults assisted in primary health care and identify factors in successful aging. METHODS: This is a cross-sectional study conducted with older adults in Northern Minas Gerais, Brazil. Two questionnaires were used for data collection: the Brazilian Older Americans Resources and Services Multidimensional Function Assessment Questionnaire (BOMFAQ) and the Clinical-Functional Vulnerability Index IVCF-20). The adjusted prevalence ratios were obtained by robust Poisson regression. Statistical analysis was performed for older adults in general (60 to 107 years) and stratified by age: from 60 to 79 years and 80 years or more. RESULTS: A total of 1,750 older adults aged 60 to 107 years participated; between them, 48.7% were robust. Older adults aged 60 to 79 years (n = 1,421) and 80 years or more (n = 329) had a prevalence of robustness of 55.4% and 19.3%, respectively. Some factors associated with successful aging were: positive self-perception of health, dancing habits, walking habits, absence of cognitive impairment, absence of depressive symptoms and polypathology, as well as daily life independence. After adjustment by age, the absence of polypathology and independence for activities of daily living stand out for robustness between 60 and 79 years; in those aged 80 years and over, independence for activities of daily living and dance practice presented greater strength of association. CONCLUSION: The prevalence of robust older adults in primary care is considered satisfactory for the older population in general but decreases with age and is associated with the absence of diseases and disabilities. These results denote the need to redesign the health care system, focusing on promoting and preventing clinical-functional vulnerability.


Asunto(s)
Envejecimiento Saludable/fisiología , Estilo de Vida Saludable/fisiología , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Autoevaluación Diagnóstica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios
7.
Einstein (Sao Paulo) ; 18: eAO5263, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32267368

RESUMEN

OBJECTIVE: To assess the health profile of community-dwelling older adults, according to sex, assisted by the Elderly Caregiver Program of the City of São Paulo. METHODS: Secondary data of 535 older adults, assisted by ten Elderly Caregiver Program teams from the southern region of São Paulo, were collected from medical records and the Multidimensional Evaluation of Older People in Primary Care, after verifying the inclusion and exclusion criteria for the study and obtaining subjects' consent. RESULTS: Older adults assisted by this program were predominantly female (77.6%), mean age of 76.2±8.0 years. They had negative self-rated health (67.8%), difficulties in instrumental activities of daily living (68.4%) and signs of mood changes (60.3%). A high prevalence of older adults with vision problems (58.8%), polypharmacy (58.1%), memory-related complaints (55.8%) and multiple morbidities (50.6%) were observed. The prevalence of multiple morbidities, polypharmacy, cognitive impairment and signs of mood changes were higher in women. On the other hand, men reported more hearing problems than women. CONCLUSION: The poorer health conditions of the older adults in this study, evidenced by a high prevalence of subjects with negative self-rated health, difficulties in instrumental activities of daily living, multiple morbidities, polypharmacy and other complaints (sensorial changes, depressive and cognitive symptoms), reinforce the importance of this program as a long-term care policy and as a way to ensure these older adults can continue living in their communities.


Asunto(s)
Evaluación Geriátrica/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Actividades Cotidianas , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Polifarmacia , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios
8.
Medicine (Baltimore) ; 99(17): e19851, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332641

RESUMEN

This study was conducted with the aim of determining pain acceptance levels in patients with chronic pain attending an algology outpatients' department.The research was conducted as a descriptive and cross-sectional study. The population of the study consisted of 97 patients with chronic pain who attended the Algology Outpatients' Department of the Health Implementation and Research Center of Bursa Uludag University. A Patient Description Form and a Chronic Pain Acceptance Questionnaire (CPAQ) were used to collect research data.The participants' mean sub-score for accomplishing activities by patients with chronic pain was found to be 31.10 ±â€Š11.84, their mean sub-score for pain willingness was 36.65 ±â€Š10.37, and their mean score for the total scale was 67.76 ±â€Š18.30. A statistically significant difference was found between the participants' total score means and their sub-score means according to their education level and frequency of experiencing pain (P < .05), but no statistically significant difference was found according to such factors as age, profession, marital status, or medications used (P > .05).It was found that female sex was generally exposed to chronic pain, and factors such as age, marital status, and drug treatment did not differ in the rate of acceptance of chronic pain, and the rate of acceptance of pain in workers was higher, those with lower education level were lower. There is a need that new studies with larger sample groups regarding the factors affecting the acceptance of chronic pain.


Asunto(s)
Adaptación Psicológica , Dolor Crónico/psicología , Actividades Cotidianas , Factores de Edad , Anciano , Analgésicos/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Estudios Transversales , Escolaridad , Femenino , Humanos , Masculino , Estado Civil , Persona de Mediana Edad , Ocupaciones , Dimensión del Dolor , Calidad de Vida , Factores Sexuales
10.
Medicine (Baltimore) ; 99(14): e19495, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243365

RESUMEN

INTRODUCTION: Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment. METHODS AND ANALYSIS: We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index. DISCUSSION: Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis. ETHICS AND DISSEMINATION: The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.


Asunto(s)
Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Transcraneal de Corriente Directa/métodos , Extremidad Superior , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Potenciales Evocados Motores , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Recuperación de la Función , Adulto Joven
11.
Medicine (Baltimore) ; 99(15): e19648, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282713

RESUMEN

BACKGROUND: Xingnaojing injection (XNJi) is widely used for acute cerebral hemorrhage. However, the efficacy of XNJi for acute cerebral hemorrhage has not been comprehensively proved by systematic analysis yet. Therefore, it is essential to evaluate the efficacy and safety of XNJi in an evidence-based method. METHODS: Six databases were searched with XNJi used for acute cerebral hemorrhage in randomized controlled trials (RCTs). Meta-analysis was performed by Review Manager 5.3. The efficacy rate, brain edema, cerebral hematoma, neurological deficit score, hs-crp, Glasgow Coma Scale (GCS), and activities of daily living (ADL) were systematically evaluated. The Cochrane risk of bias was used to evaluate the methodological quality of eligible studies. RESULTS: This study is registered with PROSPERO (CRD42018098737). Twenty-nine studies with a total of 2638 patients were included in this meta-analysis. Compared with conventional treatment, XNJi got higher efficacy rate (OR = 3.37, 95% CI [2.65, 4.28], P < .00001). Moreover, XNJi showed significant enhancement of efficacy rate via subgroup analysis in course and dosage. In addition, XNJi demonstrated significant improvement in Chinese stroke scale (CSS) and National Institutes of Health Stroke Scale (NHISS) (mean difference [MD] = -4.74, 95% CI [-5.89, -3.60], P < .00001; MD = -4.45, 95% CI [-5.49, -3.41], P < .00001), GCS (MD = 2.72, 95% CI [2.09, 3.35], P < .00001). It also remarkably decreased the level of hs-crp (MD = -6.50, 95% CI [-7.79, -5.21], P < .00001), enhanced ADL (MD = 20.38, 95% CI [17.98, 22.79], P < .00001), and alleviated hematoma and edema (MD = -2.53, 95% CI [-4.75, -0.31] P < .05; MD = -1.74 95% CI [-2.42, -1.07] P < .00001) compared with conventional treatment. CONCLUSION: XNJi is effective in treating acute cerebral hemorrhage with significant improvement of CSS, NHISS and impairment of hs-crp, hematoma, and edema compared with conventional treatment. Moreover, XNJi got remarkable efficacy at the dose of 20, 30, 60 mL and from 7 to 28 days. No serious adverse reactions occurred. These results were mainly based on small-sample and low-quality studies. Therefore, more rigorous, large-scale RCTs were further needed to confirm its efficacy, safety, and detailed characteristic of application.


Asunto(s)
Hemorragia Cerebral/tratamiento farmacológico , Medicamentos Herbarios Chinos/administración & dosificación , Actividades Cotidianas , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Edema Encefálico/epidemiología , Proteína C-Reactiva/análisis , Proteína C-Reactiva/efectos de los fármacos , Hemorragia Cerebral/epidemiología , Medicamentos Herbarios Chinos/efectos adversos , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Escala de Coma de Glasgow/estadística & datos numéricos , Hematoma , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
Medicine (Baltimore) ; 99(15): e19669, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282718

RESUMEN

BACKGROUND: Alzheimer's disease (AD) is the most common cause of dementia. Traditional Chinese formula Danggui Shaoyao San (DSS) has been considered a potential therapeutic approach for AD. However, no systemic review regarding its efficacy and safety has been conducted. Herein, we propose a protocol for the study that aims to evaluate the efficacy and safety of DSS in patients with AD. METHODS: Sixteen electronic databases including PubMed, EMBASE, Cochrane database, Web of science, Chinese National Knowledge Infrastructure, VIP, Wanfang database, China Biomedical Literature Database, Chinese Clinical Trial Registry System, Koreanstudies Information Service System, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, DBpia, Korean Traditional Knowledge Portal, Japanese CiNii databases and J-STAGE databases will be searched from the inception up to February 29, 2020. Randomized controlled trials (RCTs) that meet the pre-specified eligibility criteria will be included. RevMan software (V.5.3.5) will be used to perform data synthesis following data extraction and publication risk assessment. Subgroup and sensitivity analysis will be performed according to the condition of included RCTs. The primary outcomes include changes in the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), and Activities of Daily Living scale (ADL). Additional outcomes are clinical effective rate and adverse event rate. The Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the strength of the evidence. RESULTS: This study will provide a well-reported and high-quality synthesis of RCTs on the efficacy and safety of DSS for the treatment of AD. CONCLUSION: This systematic review protocol will be helpful for providing evidence of whether DSS is an effective and safe therapeutic approach for patients with AD. ETHICS AND DISSEMINATION: Ethical approval is not necessary as this protocol is only for systematic review and does not involve privacy data or conduct an animal experiment. This protocol will be disseminated by a peer-review journal or conference presentation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020150450.


Asunto(s)
Enfermedad de Alzheimer/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Medicina China Tradicional/métodos , Actividades Cotidianas , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/diagnóstico , Demencia/epidemiología , Demencia/etiología , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Seguridad , Sensibilidad y Especificidad , Resultado del Tratamiento
14.
Rev Saude Publica ; 54: 39, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32321056

RESUMEN

OBJECTIVE: To examine and map the consequences of chronic pain in adulthood. METHOD: Documents addressing the impact of chronic pain on the psychological and social spheres of people suffering from chronic pain, published in Spanish and English between 2013 and 2018, were included. Those who addressed pharmacological treatments, chronic pain resulting from surgical interventions or who did not have access to the full text were excluded. Finally, 28 documents from the 485 reviewed were included. RESULTS: Studies show that pain is related to high rates of limitation in daily activities, sleep disorders and anxiety-depression spectrum disorders. People in pain have more problems to get the workday done and to maintain social relationships. Chronic pain is also associated with worse family functioning. CONCLUSIONS: This review shows that limitations in the ability to perform activities of daily living, sleep, psychological health, social and work resources and family functioning are lines of interest in published articles. However, knowledge gaps are detected in areas such as the influence of having suffered pain in childhood or adolescence, the consequences of non-fulfillment of working hours and gender inequalities.


Asunto(s)
Dolor Crónico/psicología , Actividades Cotidianas/psicología , Adolescente , Adulto , Anciano , Ansiedad/psicología , Depresión/psicología , Relaciones Familiares/psicología , Humanos , Persona de Mediana Edad , Trastornos del Sueño-Vigilia/psicología , Adulto Joven
15.
Health Qual Life Outcomes ; 18(1): 50, 2020 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-32127015

RESUMEN

BACKGROUND: The provision of psychometrically valid patient reported outcomes (PROs) improves patient outcomes and reflects their quality of life. Consequently, ad hoc clinician-generated questionnaires of the past are being replaced by more rigorous instruments. This change, while beneficial, risks the loss/orphaning of decades-long information on difficult to capture/chronically ill populations. The goal of this study was to assess to the quality of data retrieved from these legacy questionnaires. METHODS: Participants included 8563 patients who generated a total of 12,626 hospital admissions over the 2004-2014 study period. Items used to screen for issues related to function, mood, symptoms, and social support among patients with chronic disease were identified in our medical center's patient information questionnaire. Cluster and exploratory factor analyses (EFA) followed by multidimensional item response theory (MIRT) analyses were used to select items that defined factors. Scores were derived with summation and MIRT approaches; inter-factor relationships and relationships of factor scores to assigned diagnostic codes were assessed. Rasch analyses assessed the constructs' measurement properties. RESULTS: Literature review and clinician interviews yielded four hypothesized constructs: psychological distress/wellbeing, symptom burden, social support, and physical function. Rasch analyses showed that, while all had good measurement properties, only one, function, separated individuals well. In exploratory factor analyses (EFA), 11 factors representing depression, respiratory symptoms, musculoskeletal pain, family support, mobility, activities of daily living, alcohol consumption, weight loss, fatigue, neurological disorders, and fear at home were identified. Based on the agreement between EFA and cluster analyses as well as Cronbach's alpha, six domains were retained for analyses. Correlations were strong between activities of daily living and mobility (.84), and moderate between pain and mobility (.37) and psychological distress (.59) Known-group validity was supported from the relationships between factor scores and the relevant diagnostic code assignments (.12 to .20). CONCLUSIONS AND DISCUSSION: Items from ad hoc clinician-generated patient information questionnaires can be aggregated into valid factors that assess supportive care domains among chronically ill patients. However, the binary response options offered by many screening items limit their information content and consequently, as highlighted by Rasch analyses, their ability to meaningfully discriminate trait levels in these populations.


Asunto(s)
Actividades Cotidianas/psicología , Calidad de Vida , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/psicología , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría/métodos
17.
Einstein (Sao Paulo) ; 18: eAO4831, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32215467

RESUMEN

OBJECTIVE: To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. METHODS: Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. RESULTS: Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). CONCLUSION: There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.


Asunto(s)
Actividades Cotidianas , Procedimientos Ortopédicos/rehabilitación , Educación del Paciente como Asunto/métodos , Entrenamiento Simulado/métodos , Artroplastia/rehabilitación , Femenino , Hospitalización , Humanos , Desplazamiento del Disco Intervertebral/rehabilitación , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Alta del Paciente , Satisfacción del Paciente , Periodo Posoperatorio , Reproducibilidad de los Resultados , Escoliosis/rehabilitación , Escoliosis/cirugía , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Resultado del Tratamiento
18.
Rev Bras Epidemiol ; 23: e200002, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130391

RESUMEN

OBJECTIVES: To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units. METHODS: This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model. RESULTS: The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). CONCLUSION: Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.


Asunto(s)
Evaluación de la Discapacidad , Personas con Discapacidad/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Renta/estadística & datos numéricos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multinivel , Distribución por Sexo , Factores Sexuales , Factores Socioeconómicos
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(2): 220-225, 2020 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-32164133

RESUMEN

Objective: To investigate the prevalence of impairment on daily life and to determine the correlation between physical fitness and activities of daily life among the Chinese elderly. Methods: Data were extracted from the 2015 China Health and Retirement Longitudinal Study database. Chi-square tests were performed to explore the prevalence of impairment of activities of daily life among the elderly with different characteristics. Binary logistic regression method was used to identify the relationship between physical fitness and activities of daily life. Results: The overall prevalence on the impairment of basic activities in daily life was 6.6% (297/4 355) and the prevalence of impairment of instrumental activities on daily life was 26.0% (1 167/4 485), among the Chinese elderly. Factors as BMI, muscle strength, ability of balance and the ability of activities were all closely related to activities of daily living, but differences between blood pressure and ADL presented no statistical significance. Conclusion: Physical fitness could affect the activities of daily life at different levels. Elderly with higher or lower BMI, poorer muscle strength, ability on balance and activities were at a greater possibility to suffer from the impairment of ADL.


Asunto(s)
Actividades Cotidianas , Aptitud Física , Anciano , China , Humanos , Estudios Longitudinales
20.
Internist (Berl) ; 61(3): 254-260, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32030437

RESUMEN

The peripheral nervous system is subject to changes during the aging process, e.g., deep tendon reflexes decrease, as proprioception does. In contrast, polyneuropathies have to be distinguished from age-associated changes as independent diseases with etiologies similar to those in younger ages. Incidence of polyneuropathies is reported about 118/100,000, the overall prevalence in the general population is estimated to be about 1% and rises to up to 7% in the elderly. Etiology includes metabolic disorders, primary inflammatory polyneuropathies, systemic disorders and vasculitic neuropathies. Due to the age-specific increase of the prevalence of certain etiologies, neuropathies associated with diabetes, malignancy, and monoclonal gammopathies are even more common in older patients. However, the proportion of cryptogenic neuropathies, e.g. neuropathies without obvious cause, increases also with age. In older age, polyneuropathies additionally impair mobility and increase the risk of falling, thus the assessment of functional abilities is mandatory. It is essential to try to identify the underlying cause by a systematic approach including history, clinical investigation, neurophysiological and lab exams. Treatment of polyneuropathies is based on therapy of underlying conditions and requires management of neuropathic pain in the majority of cases. Physiotherapy and rehabilitation target pain relief and sustaining activities of daily living.


Asunto(s)
Envejecimiento , Nefropatías Diabéticas , Gammopatía Monoclonal de Relevancia Indeterminada , Paraproteinemias , Polineuropatías/etiología , Actividades Cotidianas , Anciano , Humanos , Neuralgia , Manejo del Dolor
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