Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34.884
Filtrar
1.
Instr Course Lect ; 69: 607-624, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017755

RESUMEN

Symptomatic lumbar disk herniation is abundantly common in adult patients and can cause significant pain and disability in those affected. Both surgical and nonsurgical treatment options exist for the management of this heterogeneous condition; thus, it is important that surgeons and other healthcare providers understand the appropriate indications for surgical treatment of patients with lumbar disk herniation. Though there is still lack of consensus regarding the optimal treatment of lumbar disk herniation in all situations, many principles and preferred techniques are agreed upon in the literature. In this chapter, we provide an in-depth overview of the anatomy and pathophysiology, natural history, physical examination, treatment decision making, surgical treatment options, and postoperative complications pertaining to lumbar disk herniation.


Asunto(s)
Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Adulto , Consejo , Humanos , Dolor , Examen Físico , Resultado del Tratamiento
3.
JAMA ; 323(2): 140-148, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31935026

RESUMEN

Importance: Guidelines endorsing vegetable-enriched diets to improve outcomes for prostate cancer survivors are based on expert opinion, preclinical studies, and observational data. Objective: To determine the effect of a behavioral intervention that increased vegetable intake on cancer progression in men with early-stage prostate cancer. Design, Setting, and Participants: The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) was a randomized clinical trial conducted at 91 US urology and medical oncology clinics that enrolled 478 men aged 50 to 80 years with biopsy-proven prostate adenocarcinoma (International Society of Urological Pathology grade group = 1 in those <70 years and ≤2 in those ≥70 years), stage cT2a or less, and serum prostate-specific antigen (PSA) level less than 10 ng/mL. Enrollment occurred from January 2011 to August 2015; 24-month follow-up occurred from January 2013 to August 2017. Interventions: Patients were randomized to a counseling behavioral intervention by telephone promoting consumption of 7 or more daily vegetable servings (MEAL intervention; n = 237) or a control group, which received written information about diet and prostate cancer (n = 241). Main Outcomes and Measures: The primary outcome was time to progression; progression was defined as PSA level of 10 ng/mL or greater, PSA doubling time of less than 3 years, or upgrading (defined as increase in tumor volume or grade) on follow-up prostate biopsy. Results: Among 478 patients randomized (mean [SD] age, 64 [7] years; mean [SD] PSA level, 4.9 [2.1] ng/mL), 443 eligible patients (93%) were included in the primary analysis. There were 245 progression events (intervention: 124; control: 121). There were no significant differences in time to progression (unadjusted hazards ratio, 0.96 [95% CI, 0.75 to 1.24]; adjusted hazard ratio, 0.97 [95% CI, 0.76 to 1.25]). The 24-month Kaplan-Meier progression-free percentages were 43.5% [95% CI, 36.5% to 50.6%] and 41.4% [95% CI, 34.3% to 48.7%] for the intervention and control groups, respectively (difference, 2.1% [95% CI, -8.1% to 12.2%]). Conclusions and Relevance: Among men with early-stage prostate cancer managed with active surveillance, a behavioral intervention that increased vegetable consumption did not significantly reduce the risk of prostate cancer progression. The findings do not support use of this intervention to decrease prostate cancer progression in this population, although the study may have been underpowered to identify a clinically important difference. Trial Registration: ClinicalTrials.gov Identifier: NCT01238172.


Asunto(s)
Consejo , Neoplasias de la Próstata/dietoterapia , Verduras , Espera Vigilante , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Teléfono
4.
J Oral Facial Pain Headache ; 34(1): 77­82, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30978270

RESUMEN

AIMS: To evaluate the effectiveness of counseling on pain intensity and oral health-related quality of life (OHRQoL) in temporomandibular disorders (TMD) patients. METHODS: Fifty female patients diagnosed with TMD were divided into two groups: a group of waiting list patients (control group) and a group of patients who received counseling therapy (experimental group) involving education about etiologic factors, avoidance of parafunctional habits, and sleep, as well as dietary advice. All patients were evaluated at baseline and 7, 15, 30, and 60 days later. Patients reported pain intensity using a visual analog scale (VAS), and the Oral Health Impact Profile (OHIP-14) was used to assess the impact of pain on OHRQoL. Statistical analyses were performed using the split-plot analysis of variance (SPANOVA) design, with post hoc Student t tests for independent samples and for dependent samples, adopting a significance level of P < .05. RESULTS: The control group consisted of 24 female patients with a mean age of 39.96 ± 13.93 years, and the experimental group consisted of 26 female patients with a mean age of 35.15 ± 10.78 years. Counseling was considered effective for reducing pain intensity, with a significant improvement observed at 7 days (P < .001). Counseling was also responsible for a significant improvement in the impact of TMD on OHRQoL at all follow-up time points analyzed (P < .001). When comparing the groups, a significant difference was observed for both pain intensity and TMD impact on OHRQoL during follow-up (P < .05). CONCLUSION: Counseling seems to significantly improve pain and OHRQoL in patients.


Asunto(s)
Calidad de Vida , Trastornos de la Articulación Temporomandibular , Adulto , Consejo , Femenino , Humanos , Persona de Mediana Edad , Salud Bucal , Manejo del Dolor , Adulto Joven
5.
Pflege ; 33(1): 34-42, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31842660

RESUMEN

Challenges in dementia care at home - The situation at home of a married couple Abstract. Background: People with dementia and their relatives are faced with major challenges due to complex dementia symptoms. Families need information and counselling in order to find adequate dementia care services tailored to their needs. AIM: This case report's objective is to exemplify the domestic situation of a married couple who is faced with significant challenges within the family and the care system due to the husband's dementia and Parkinson's disease. METHODS: The Dementia Care Nurse project included case monitoring; by means of different assessments relevant information was recorded and the family's situation described. RESULTS: The family's problems and their need for support were multifaceted and entailed reimbursement of costs, application for care services as well as management of challenging behaviours and reduction of the caregiver's psychosocial burden. CONCLUSIONS: The family, particularly the spouse caregiver, was effectively supported in meeting the challenges of dementia, e. g. by drawing on professional services and sorting out entitlement to benefits. From the perspective of the experience in the project, independent counselling structures such as a case management approach are indispenable in order to stabilise the domestic situation.


Asunto(s)
Cuidadores , Demencia , Adaptación Psicológica , Cuidadores/psicología , Consejo , Humanos
7.
Pan Afr Med J ; 34: 62, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31803344

RESUMEN

Introduction: Ninety-one percent of global Human Immunodeficiency Virus (HIV) infection in children occurs in sub-Saharan Africa. Provider Initiated Testing and Counselling (PITC) Strategy is a means of reducing missed opportunities for HIV exposed or infected children. The present study determined the prevalence of HIV infection using PITC Strategy among children seen at the Paediatric Emergency Unit of Federal Medical Centre (FMC), Ido-Ekiti, and the possible route of transmission. Methods: Cross-sectional study on prevalence of HIV infection using PITC model. 530 new patients whose HIV serostatus were unknown and aged 15 years or below were recruited consecutively and offered HIV testing. Serial algorithm testing for HIV infection using Determine HIV-1/2 and Uni-Gold rapid test kits was adopted. Seropositive patients younger than eighteen months had HIV Deoxyribonucleic Acid Polymerase Chain Reaction (HIV DNA PCR) test for confirmation. Results: Twenty-four (4.5%) of the 530 patients were confirmed to have HIV infection; of whom 19 (79.2%) were less than 18 months of old; with age range of 5 to 156 months. Fifteen (62.5%) of the infected children were females; likewise, the gender specific infection rate was higher (%) among the females compared with (%) among the males. Two of the HIV infected children's mothers were late, while the remaining 22 mothers (%) were HIV seropositive. Mother-to-child-transmission was the most likely route of transmission in the children. Conclusion: PITC strategy is vital to the early diagnosis and effective control of HIV infection in children. However, this cannot be totally effective if PMTCT is not optimized.


Asunto(s)
Consejo/métodos , Infecciones por VIH/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Tamizaje Masivo/métodos , Adolescente , Niño , Preescolar , Estudios Transversales , Diagnóstico Precoz , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Humanos , Lactante , Masculino , Nigeria/epidemiología , Prevalencia , Factores Sexuales
8.
Rev. psicanal ; 26(3): http://revista.sppa.org.br/index.php/RPdaSPPA/article/view/470/490, dez. 2019.
Artículo en Portugués | LILACS | ID: biblio-1050026

RESUMEN

O grupo formado a partir da parceria SMED ­ SPPA, que há mais de doze anos trabalha com o estudo e com a aplicação de técnicas que disponibilizem o conhecimento psicanalítico na formação continuada de profissionais voltados à educação infantil, expandiu-se para um grupo de pesquisa interinstitucional e interdisciplinar com a finalidade de estudar as Rodas de conversa SMED ­ SPPA através de metodologia desenvolvida ao longo desses anos. O presente artigo descreve sucintamente a história da parceria entre as duas instituições, apresentando também a Fase 1 do Projeto de Pesquisa Diálogo entre educação e psicanálise: rodas de conversa entre SMED e SPPA. Trata-se de pesquisa naturalística com abordagem qualitativa exploratória. Trabalha-se com uma amostra de dois grupos, compostos, cada um, por vinte educadores, um assessor pedagógico da SMED e dois psicanalistas da SPPA. Para a coleta de dados, são utilizados os seguintes instrumentos: gravação de vídeos das reuniões; cadernos de campo escritos pelos psicanalistas e assessores e, por fim, questionários sobre expectativas a serem preenchidos pelos educadores. As narrativas que emergem da transcrição dos vídeos são analisadas pelo método de Bardin. Aproveitar-se-á a primeira experiência de campo (Fase 1) para a definição das categorias temáticas significativas, de tal forma que a sua relevância seja testada em uma segunda rodada do trabalho de campo (AU)


The group formed from the SMED ­ SPPA partnership, which for over twelve years has been working with the study and application of techniques that provide psychoanalytic knowledge in the continuing education of professionals focused on early childhood education, formed an interinstitutional and interdisciplinary research group. The purpose of this research is to study the SMED ­ SPPA Conversation circles, a methodology developed over the years and which is a product of this partnership. This article briefly describes the history of the partnership between the two institutions, and also presents Phase 1 of the Research Project Dialogue between education and psychoanalysis: conversation circles between SMED and SPPA. It is a naturalistic research with exploratory qualitative approach. We work with a sample with two groups, each consisting of twenty educators, one SMED pedagogical advisor and two SPPA psychoanalysts. For data collection, the following instruments are used: video recording of meetings; field notebooks written by psychoanalysts and advisors; questionnaires about expectations to be fulfilled by educators. The narratives that emerge from the transcription of the videos will be analyzed by Bardin's method. The first field experiment (Phase 1) will be used to define meaningful thematic categories, so that their relevance is tested in a second round of fieldwork


El grupo formado a partir de la asociación SMED ­ SPPA, que durante más de doce años ha estado trabajando con el estudio y la aplicación de técnicas que proporcionan conocimiento psicoanalítico en la educación continua de profesionales centrados en la educación infantil, formó un grupo de investigación interinstitucional e interdisciplinario. El propósito de esta investigación es estudiar las ruedas de conversación SMED ­ SPPA, una metodología desarrollada a lo largo de los años y que es un producto de esta asociación. Este artículo describe brevemente la historia de la asociación entre las dos instituciones y también presenta la Fase 1 del Proyecto de Investigación Diálogo entre educación y psicoanálisis: ruedas de conversación entre SMED y SPPA. Es una investigación naturalista con enfoque cualitativo exploratorio. Trabajamos con una muestra con dos grupos, cada uno compuesto por veinte educadores, un asesor pedagógico de SMED y dos psicoanalistas de SPPA. Para la recolección de datos, se utilizan los siguientes instrumentos: grabación de video de reuniones; cuadernos de campo escritos por psicoanalistas y asesores; cuestionarios sobre expectativas que deben cumplir los educadores. Las narraciones que emergen de la transcripción de los videos son analizadas por el método de Bardin. El primer experimento de campo (Fase 1) se utilizará para definir categorías temáticas significativas, de modo que su relevancia se evalúe en una segunda ronda de trabajo de campo


Asunto(s)
Marginación Social , Servicios Comunitarios de Salud Mental , Consejo , Discriminación Social , Técnicas de Observación Conductual
9.
Kardiologiia ; 59(10S): 31-40, 2019 Jul 23.
Artículo en Ruso | MEDLINE | ID: mdl-31876460

RESUMEN

Purpos. To assess the effectiveness of preventive counseling with focus on diet modification followed by remote support via telephone on awareness of cardiovascular (CV) risk factors (RFs) in patients (pts) with high/very high CV risk. Material and methods. This is a prospective randomized controlled study of 100 pts with high/very high CV risk (5-9% and ≥10% according to the SCORE scale) and any 2 criteria for metabolic syndrome.  Pts were randomized into 2 groups in 1:1 ratio - the intervention group (n=50) and the control group (n=50). The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the awareness of the basic CV RFs, including open questions. The awareness was assessed at baseline, 6 and 12 months. Results. The groups were well balanced according to demographic and clinical features. The results of the study revealed an extremely low awareness of major CV RFs of pts in both groups at baseline: practically none of them indicated as RFs for cardiovascular disease elevated cholesterol (8,0% and 4,0%, respectively) and blood pressure (14.0% and 4.0%). At 6 month the level of awareness of CV RFs has increased significantly. Moreover, pts of the intervention group were more informed about elevated cholesterol (58,0% vs. 28,0%; p<0,01) and unhealthy diet (76,0% vs. 52,0%; p<0,05). At 12 month the level of awareness of CV RFs was significantly higher in both groups  to compare from baseline. Conclusion. Preventive counseling with focus on diet modification followed by 3 months  remote support via phone provided a significant improvement of awareness of CV RFs in pts with high/very high CV risk.


Asunto(s)
Enfermedades Cardiovasculares , Presión Sanguínea , Consejo , Humanos , Estudios Prospectivos , Factores de Riesgo
10.
BMC Infect Dis ; 19(1): 1076, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864297

RESUMEN

BACKGROUND: HIV voluntary counseling and testing (VCT) is a crucial gateway to all strategies related to care, prevention and treatment of human immunodeficiency virus (HIV) infection. Nevertheless, utilization of voluntary counselling and testing (VCT) service among adults is very low in Ethiopia. The objective of this study is to identify determinants associated with VCT utilization among adult women aged 15-49 in Ethiopia. METHODS: A cross-sectional study was conducted based on data taken from the Ethiopian Demographic Health Survey (EDHS) 2016. Using cluster sampling, 14,369 women aged 15-49 years were selected from all the nine administrative regions and two city administrations. Logistic regression was used to analyze factors associated with HIV VCT utilization. RESULTS: Overall prevalence of ever tested for HIV was 53% (95% CI, 52, 54). Aged 20-44, ever married, being at higher socio economic position (SEP) and having risky sexual behavior were factors which are positively associated with VCT utilization. Being Muslims in urban and protestants in rural were factors significantly and negatively associated with VCT utilization. Those who had stigmatizing attitude both in urban and rural and who had comprehensive knowledge in rural were less likely to utilize VCT service. CONCLUSION: VCT utilization among women in Ethiopia is demonstrating better improvement in recent years. However, stigmatizing attitude continued to be among the major factors, which are negatively affecting VCT uptake among women in Ethiopia. Concerted efforts should be made by all stakeholders to mitigate stigma, improve socio economic inequities and increase awareness on the benefit of VCT in controlling HIV in the society. In this aspect, the role of religious leader, schools, health extension workers and community leaders should not be undermined.


Asunto(s)
Consejo/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Tamizaje Masivo/psicología , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Estigma Social , Factores Socioeconómicos , Adulto Joven
11.
J Am Dent Assoc ; 150(12): 995-1003, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31761028

RESUMEN

BACKGROUND: Oral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers. METHODS: The authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office. RESULTS: Overall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline. CONCLUSIONS: Oral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers. PRACTICAL IMPLICATIONS: Potential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.


Asunto(s)
Neoplasias de la Boca , Cese del Hábito de Fumar , Adulto , Consejo , Detección Precóz del Cáncer , Personal de Salud , Humanos , Encuestas Nutricionales , Medición de Resultados Informados por el Paciente
12.
J Med Life ; 12(3): 221-224, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31666820

RESUMEN

The last decade has seen incredible advances in the genetic era, in next-generation sequencing of cell-free DNA in the maternal plasma, detecting abnormal fetal chromosomes. Non-invasive prenatal testing (NIPT) has showed increased sensitivity and specificity for Down syndrome superior to any other screening test. Technical advances have made possible the detection of other conditions which does not necessarily mean clinical benefit for the patient. Private laboratories have added multiple conditions in the panel of NIPT, but some of these abnormalities are so rare, that their prevalence is not even clear. Data regarding clinical performance of extended NIPT is lacking. Implementation of such a test has to be carefully weighed, and not only the benefits but also the harm should be taken into account.


Asunto(s)
Diagnóstico Prenatal/métodos , Trisomía/diagnóstico , Consejo , Síndrome de Down/diagnóstico , Femenino , Feto/diagnóstico por imagen , Feto/patología , Humanos , Embarazo , Organización Mundial de la Salud
13.
Medicine (Baltimore) ; 98(44): e17552, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689758

RESUMEN

This study aimed to investigate the effect of comprehensive education and care (CEC) program on anxiety, depression, quality of life, and survival in patients with hepatocellular carcinoma (HCC) who underwent surgical resection.Totally 136 patients with HCC who underwent hepatectomy were randomly assigned to CEC group and control group as 1:1 ratio. CEC group received health education, psychological nursing, caring activity, and telephone condolence, whereas control group received basic health education and rehabilitation for 12 months. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS); quality of life was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30).HADS-Anxiety (HADS-A) score was decreased at 9 month (M9) and M12, and reduction in HADS-A score (M12-M0) was greater in CEC group compared with control group. At M12, percentage of anxiety patients was less, but anxiety severity was similar in CEC group compared with control group. HADS-Depression (HADS-D) score was decreased at M12, and reduction in HADS-D score (M12-M0) was greater in CEC group compared with control group. At M12, percentage of depression patients were less but depression severity was similar in CEC group compared with control group. In addition, QLQ-C30 global health status and functional score was increased at M12, and score improvement (M12-M0) was greater in CEC group compared with control group. In addition, overall survival was longer in CEC group compared with control group.CEC relieves anxiety and depression, improves quality of life, and prolongs survival in patients with HCC underwent surgical resection.


Asunto(s)
Ansiedad/terapia , Carcinoma Hepatocelular/psicología , Consejo/métodos , Depresión/terapia , Neoplasias Hepáticas/psicología , Educación del Paciente como Asunto/métodos , Adulto , Anciano , Carcinoma Hepatocelular/rehabilitación , Carcinoma Hepatocelular/cirugía , Femenino , Estado de Salud , Humanos , Neoplasias Hepáticas/rehabilitación , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Psicoterapia de Grupo/métodos , Calidad de Vida , Teléfono
14.
Psychiatr Prax ; 46(8): 432-438, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31683333

RESUMEN

OBJECTIVE: This study aimed at investigating the perspective of executives on the implementation of peer support in psychiatric facilities - an aspect that has been insufficiently addressed in research so far. METHODS: We guided qualitative interviews with eleven executives of psychiatric institutions from Germany and Switzerland, in which peer workers are employed. The interview transcripts were evaluated according to the principles of content analysis. RESULTS: The study participants evaluated the inclusion of peer workers very positively overall. Peer support was described as a special quality feature of a psychiatric institution. In addition, improvements were reported with regard to a more respectful and conscious interaction with colleagues and patients as well as a more positive therapeutic climate. Based on their experience, the executives named a number of change management tasks, e. g. with regard to the preparation of the organization, personnel selection and financing, job descriptions and the integration of the peer workers in the team. DISCUSSION: Our results underline the specific advantages of peer support for the further development of psychiatric practice. Some implications for personnel management are discussed.


Asunto(s)
Consejo , Trastornos Mentales/terapia , Grupo Paritario , Alemania , Humanos , Relaciones Interpersonales , Entrevistas como Asunto , Trastornos Mentales/psicología , Suiza
15.
BMC Health Serv Res ; 19(1): 694, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615525

RESUMEN

BACKGROUND: Group-based Diabetes Prevention Programs (DPP), aligned with recommendations from the Centers for Disease Control and Prevention, promote clinically significant weight loss and reduce cardio-metabolic risks. Studies have examined implementation of the DPP in community settings, but less is known about its integration in healthcare systems. In 2010, a group-based DPP known as the Group Lifestyle Balance (GLB) was implemented within a large healthcare delivery system in Northern California, across three geographically distinct regional administration divisions of the organization within 12 state counties, with varying underlying socio-demographics. The regional divisions implemented the program independently, allowing for natural variation in its real-world integration. We leveraged this natural experiment to qualitatively assess the implementation of a DPP in this healthcare system and, especially, its fidelity to the original GLB curriculum and potential heterogeneity in implementation across clinics and regional divisions. METHODS: Using purposive sampling, we conducted semi-structured interviews with DPP lifestyle coaches. Data were analyzed using mixed-method techniques, guided by an implementation outcomes framework consisting of eight constructs: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. RESULTS: We conducted 33 interviews at 20 clinics across the three regional administrative divisions. Consistencies in implementation of the program were found across regions in terms of satisfaction with the evidence base (acceptability), referral methods (adoption), eligibility criteria (fidelity), and strategies to increase retention and effectiveness (sustainability). Heterogeneity in implementation across regions were found in all categories, including: the number and frequency of sessions (fidelity); program branding (adoption); lifestyle coach training (adoption), and patient-facing cost (cost). Lifestyle coaches expressed differing attitudes about curriculum content (acceptability) and suitability of educational level (appropriateness). While difficulties with recruitment were common across regions (feasibility), strategies used to address these challenges differed (sustainability). CONCLUSIONS: Variation exists in the implementation of the DPP within a large multi-site healthcare system, revealing a dynamic and important tension between retaining fidelity to the original program and tailoring the program to meet the local needs. Moreover, certain challenges across sites may represent opportunities for considering alternative implementation to anticipate these barriers. Further research is needed to explore how differences in implementation domains impact program effectiveness.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Promoción de la Salud/métodos , California , Consejo , Prestación de Atención de Salud/organización & administración , Femenino , Educación en Salud/métodos , Personal de Salud , Estilo de Vida Saludable , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Proyectos de Investigación , Pérdida de Peso
17.
BMC Health Serv Res ; 19(1): 744, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651321

RESUMEN

BACKGROUND: Many relatives of close family members suffering from dementia have taken on the caregiver role. While intervention studies have revealed promising results on caregiver burden, distress, and depression, there is a lack of knowledge about how caregivers' perceived relationship with their ill family member influences the burden of care. This study examined whether a psychosocial intervention influenced this perceived relationship from the caregivers' perspective. We also explored whether the caregivers' perception of the care receiver's attitude and behavior changed over time, and whether caregiver stress and mood differed following the intervention. METHODS: The participating caregivers and care receivers were randomly assigned to a psychosocial intervention comprising education about dementia, counselling and group sessions, or to treatment as usual. The study investigated caregivers' experience of expressed emotion using the Felt Expressed Emotion Rating Scale (FEERS), a self-report questionnaire that captures caregivers' perception of criticism (CC) and emotional over-involvement (EOI) exhibited by the family members with dementia. RESULTS: A total of 208 dyads were enrolled in the study. There were no significant differences between the intervention and control groups in the studied variables. Caregivers' perception of CC and EOI was low but fluctuated somewhat, whereas their mood and stress level were stable during the follow-up period. CONCLUSIONS: According to the FEERS, the intervention did not influence caregivers' perception of CC and EOI, and there was no difference between the intervention and control groups regarding caregivers' perceived relationship. Despite the increased symptoms of dementia, caregivers' level of distress and mood remained stable, and they seemed to maintain a positive perception of the quality of their relationship with the care receiver. TRIAL REGISTRATION: Clinical.Trials.gov Sept. 2009, NCT01287767.


Asunto(s)
Cuidadores/psicología , Demencia/psicología , Apoyo Social , Adaptación Psicológica , Adulto , Anciano , Consejo , Depresión/psicología , Emoción Expresada , Familia/psicología , Femenino , Educación en Salud , Humanos , Masculino , Persona de Mediana Edad , Método Simple Ciego , Percepción Social , Estrés Psicológico/psicología , Encuestas y Cuestionarios
18.
Gan To Kagaku Ryoho ; 46(10): 1486-1490, 2019 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-31631126

RESUMEN

As part of proactive efforts to support working cancer patients at medical establishments, patients were given advice not to quit working after diagnosis and invited to a cancer counseling and support center. Further, medical treatment plans focusing on treatment period were presented prior to the start of treatment. These plans can be useful for cancer patients who seek support from their employers about changing their working conditions during treatment. Although these active support initiatives for newly diagnosed working cancer patients tended to contribute to a decrease in the rate of early job termination, the number of cancer patients who quit their work did not decrease significantly. There was a limit to work-related support at the clinical site. It is essential for many professionals to collaborate, such as clinicians, occupational health staff and working support professionals in the promotion of measures for balancing work and treatment for cancer patients. In the Tokai area, we set up the Cancer and Employment Workshop in 2015. We have been working to establish a local network to comprehensively support these patients.


Asunto(s)
Empleo , Neoplasias , Consejo , Humanos
19.
J Pediatr Adolesc Gynecol ; 32(5S): S36-S42, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31585617

RESUMEN

Unplanned or unwanted pregnancy among adolescents is a worldwide public health issue. In many countries unmarried young women are denied contraceptive services. Long-acting reversible contraceptive methods such as the intrauterine devices (IUDs) have been shown to be more effective than short-acting such as the pill, and safe also for adolescents. The popularity has varied a lot with time and between populations. Health care providers, health system, and user factors all influence IUD use. A good sexuality education through school provides a foundation, and health care providers give specific individual counseling. International and country-specific guidelines have been published during the past decade indicating the advantage of IUDs. New smaller size devices make placement easier for nulliparous adolescents. Still the uptake has remained rather low in most regions, cost being one barrier. Several municipalities have started to provide long-acting reversible contraceptive methods for adolescents free of charge, and this has led to a significant increase in IUD use, accompanied by a reduction in abortion rates. Adolescent-friendly services should offer low-cost or free contraception, including male and female condoms, emergency contraception, and a full range of modern methods, including long-acting reversible methods, according to adolescents' preferences and needs.


Asunto(s)
Anticoncepción/métodos , Dispositivos Intrauterinos , Salud Reproductiva/educación , Adolescente , Anticoncepción/economía , Consejo/métodos , Femenino , Salud Global , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Dispositivos Intrauterinos/economía , Dispositivos Intrauterinos/estadística & datos numéricos , Masculino , Guías de Práctica Clínica como Asunto , Embarazo , Adulto Joven
20.
Afr J AIDS Res ; 18(3): 198-204, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31575338

RESUMEN

Background: South Africa has the largest HIV/AIDS epidemic globally and the largest anti-retroviral treatment (ART) programme in the world, yet HIV incidence is still chronically high in South Africa, especially in KwaZulu-Natal province (KZN). In light of this, a study was conducted to investigate the extent of challenges making the management of HIV/AIDS difficult in people living with HIV (PLWH) in KZN, South Africa. Methods: A cross-sectional study was carried out with 297 study participants living with HIV and receiving ART from three selected clinics in the Ethekwini Metro of KZN. A self-administered questionnaire assessed the challenges experienced by PLWH, their knowledge of their condition and their management thereof. One-way frequency tables were used to descriptively assess participant responses. Associations between certain demographic characteristics and responses to HIV treatment management challenges were assessed using chi-square tests, with statistical significance set at p < 0.05. Results: One-fifth of the participants (n = 60; 20.1%) were within the 18-23 age group, with over 53% (n = 158) having secondary level education. Some of the challenges cited included: difficulty in obtaining medication, mainly due to cost; side effects resulting in non-adherence; shame for taking medication in public (younger patients were more likely to feel ashamed for taking their medication in public [χ2 = 20.3, p = 0.009]); and non-disclosure of HIV-positive status to partners. We found a significant association between education and financial status and management of their condition [χ2 = 11.2, p = 0.011]. Conclusion: These findings that challenges still exist have implications for more robust programmes on education and counselling to address such challenges.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/psicología , Terapia Antirretroviral Altamente Activa/economía , Costo de Enfermedad , Accesibilidad a los Servicios de Salud , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adolescente , Adulto , Consejo , Estudios Transversales , Epidemias , Femenino , VIH , Humanos , Masculino , Persona de Mediana Edad , Parejas Sexuales , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA