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1.
Minerva Surg ; 76(1): 57-61, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33754590

RESUMEN

BACKGROUND: Obesity represents a risk factor for COVID-19 infection. Therefore, in order to reduce COVID-19 related comorbidities in obese population a continuation of obesity treatment is needed. However, bariatric procedures were postponed because of COVID-19 restrictions, delaying treatment for obese patients seeking for surgery. This study aimed to test the feasibility of a telematics pre-operative psychological and nutritional assessment as an alternative tool during COVID-19 outbreak. METHODS: Twenty-six patients were contacted. The pre-operative assessment consisted in 3-weekly one-to-one online sessions and a final in-person multidisciplinary session. The protocol feasibility has been evaluated on the following outcome: rejection rate (%), dropout rate (%), compliance and satisfaction's degree. RESULTS: Eighteen participants completed the whole protocol and 10% dropped-out. Seventy-two percent of participants obtained an excess weight loss ≥5%. All participants were satisfied of the telematics assessment. CONCLUSIONS: COVID-19 emergency has changed standard hospital procedures and this study could represent a landmark for an online pre-operative assessment method to adopt in case of new restrictions.


Asunto(s)
Cirugía Bariátrica , Evaluación Nutricional , Cuidados Preoperatorios/métodos , Pruebas Psicológicas , Medios de Comunicación Sociales , Adulto , Estudios de Factibilidad , Femenino , Humanos , Intervención basada en la Internet , Masculino , Cooperación del Paciente/estadística & datos numéricos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Proyectos Piloto , Estudios Prospectivos , Pérdida de Peso
2.
Medicine (Baltimore) ; 100(12): e25248, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761720

RESUMEN

INTRODUCTION: Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and an elevated level of serum parathyroid hormone (PTH). PHPT presents with a complex set of renal, skeletal, and neuropsychological symptoms. Parathyroidectomy (PTX) is a radical treatment that is recommended for all physically symptomatic patients with PHPT. However, psychiatric symptoms are not considered as an indication for surgery. There remains an important issue from the view of perioperative management of whether PTX should be performed with the presence of uncontrolled psychiatric symptoms or deferred until severe psychiatric symptoms have been controlled. We report a case of mild hypercalcemia that caused severe psychosis in PHPT, which improved dramatically following PTX and resulted in successful postoperative management. PATIENT CONCERN: Our patient was a 68-year-old Japanese woman. She was diagnosed with PHPT, which was triggered by mild hypercalcemia. She was due to receive an operation for osteoporosis and kidney stones. She had severe psychosis, despite medication. Blood examinations revealed mild hypercalcemia (10.4 mg/dL, 8.8-10.1 mg/dL) and elevated serum levels of intact PTH (184.0 pg/mL, 10-65 pg/mL). DIAGNOSIS: She was diagnosed with severe psychosis caused by mild hypercalcemia in PHPT. INTERVENTIONS: Although she was treated with 37.5 mg quetiapine and 2 mg risperidone daily, she was excessively sedated and rejected oral treatment. Therefore, we decided to perform the operation. OUTCOMES: Immediately following surgery, serum levels of calcium, and intact PTH were normalized. Her psychotic symptoms ceased completely 5 days after surgery. CONCLUSION: We emphasize that PHPT presents with various severe psychiatric symptoms, even in mild hypercalcemia. Psychiatric symptoms may be the only salient symptoms in PHPT, and thus clinicians should suspect PHPT in patients with psychiatric symptoms and mild hypercalcemia. Furthermore, PTX is recommended for PHPT-even in the presence of severe uncontrolled psychiatric symptoms, which carries risks for postoperative management-because psychiatric symptoms are expected to improve and good postoperative management is possible.


Asunto(s)
Hipercalcemia , Hiperparatiroidismo Primario , Paratiroidectomía/métodos , Trastornos Psicóticos , Fumarato de Quetiapina/uso terapéutico , Risperidona/uso terapéutico , Anciano , Antipsicóticos/uso terapéutico , Femenino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiología , Hipercalcemia/psicología , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/psicología , Hiperparatiroidismo Primario/cirugía , Hormona Paratiroidea/sangre , Cooperación del Paciente/psicología , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/etiología , Trastornos Psicóticos/fisiopatología , Trastornos Psicóticos/terapia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
3.
Artículo en Inglés | MEDLINE | ID: mdl-33673637

RESUMEN

Since the unfolding of the novel coronavirus global pandemic, public health research has increasingly suggested that certain groups of individuals may be more exposed to the virus. The aim of this contribution was to investigate whether workers grouped into several latent classes, based on two perceived economic stressors, would report different levels of enactment of the Centers for Disease Control (CDC) recommended behaviors to prevent the spread of such virus. We also tested propositions regarding the potential differential predictors of compliance behavior, differentiating between cognitive (i.e., attitudes toward the CDC guidelines) and affective (i.e., COVID-specific worry) predictors. Using a longitudinal dataset of 419 U.S. workers, we did not find significant differences among the levels of CDC guidelines enactment across three latent classes, representing a range of economic vulnerability. We found that cognitive attitudes were a significantly stronger predictor of compliance with CDC guidelines for workers in the most economically secure class, whereas worry was a significantly stronger predictor of compliance for the most vulnerable counterpart. We discuss these findings in light of the Conservation of Resources theory and other health behavior theories, being mindful of the need to further understand the differential impact of this health and economic crisis on employees facing economic stressors.


Asunto(s)
Ansiedad/epidemiología , Actitud , /psicología , Pandemias , Adulto , Centers for Disease Control and Prevention, U.S. , Humanos , Cooperación del Paciente , Estados Unidos
5.
Niger J Clin Pract ; 24(3): 393-399, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33723114

RESUMEN

Background: Self-efficacy is defined as the ability of an individual to perform an action successfully or her/his perception of being able to control events. The self-efficacy perception of diabetes management may affect well-being of the patient. Aims: This study aimed to examine the relationships between self-efficacy of diabetes management and well-being in patients with type 2 diabetes. Subjects and Methods: The study used a descriptive correlational design. Sample of the study included 200 patients with type 2 diabetes. Sociodemographic and disease-related questionnaire form "Self-Efficacy Scale for Diabetes Management" and "Well-Being Questionnaire" have been used as data collection tools. Multiple linear regression analysis was performed to explore the predictors of well-being in patients with type 2 diabetes. Results: Self-efficacy level, age, level of compliance with treatment, and state of doing exercise were found to be statistically significant predictors of well-being in type 2 diabetic patients. Self-efficacy level for diabetes management was found to be the strongest predictor of well-being in patients with type 2 diabetes. Conclusion: Self-efficacy level of diabetes management is a factor that affects well-being in type 2 diabetes patients and it should be considered during interventions for improving the well-being of patients.


Asunto(s)
Diabetes Mellitus Tipo 2 , Autoeficacia , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Cooperación del Paciente , Autocuidado , Encuestas y Cuestionarios
6.
J Korean Acad Nurs ; 51(1): 80-91, 2021 Feb.
Artículo en Coreano | MEDLINE | ID: mdl-33706333

RESUMEN

PURPOSE: The purpose of this study was to identify factors influencing health behavior compliance in adult patients with moyamoya. METHODS: A descriptive correlation study was conducted to investigate the factors influencing health behavior compliance. Participants were 142 adult patients diagnosed with moyamoya disease who were hospitalized or visited an outpatient clinic in the Gyeonggi province. Data were collected from December 16, 2019 to April 14, 2020 using self-report questionnaires and analyzed using the IBM SPSS 26.0 Win software. RESULTS: The hierarchical multiple regression analysis demonstrated that self-efficacy (ß = .60, p < .001), social support (ß = .13, p = .032), and age (ß = .21, p = .005) affected the health behavior of adults with moyamoya disease. These 3 variables explained 62.0% of the variance of health behavior compliance, and the most influential factor was self-efficacy. CONCLUSION: Based on the results of this study, it concludes that nursing interventions should be focused on self-efficacy and social support to improve health behavior compliance with adult patients diagnosed with moyamoya disease. For that, various strategies to enhance self-efficacy and social support should be developed and actively applied in the clinical setting for adult moyamoya patients.


Asunto(s)
Conductas Relacionadas con la Salud , Enfermedad de Moyamoya/psicología , Cooperación del Paciente , Adulto , Factores de Edad , Femenino , Humanos , Conocimiento , Masculino , Persona de Mediana Edad , Enfermedad de Moyamoya/patología , Autoeficacia , Apoyo Social , Factores Socioeconómicos , Encuestas y Cuestionarios
7.
JAMA Netw Open ; 4(3): e210490, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33651111

RESUMEN

Importance: Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting. Objective: To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity. Design, Setting, and Participants: This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness. Exposure: A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder. Main Outcomes and Measures: Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay. Results: Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11). Conclusions and Relevance: To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.


Asunto(s)
/terapia , Personas sin Hogar , Aislamiento de Pacientes , Cuarentena , Adulto , Femenino , Hospitales Públicos , Vivienda , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , Grupo de Atención al Paciente , Cooperación del Paciente , Readmisión del Paciente , Transferencia de Pacientes , Estudios Retrospectivos , San Francisco , Poblaciones Vulnerables
8.
Artículo en Inglés | MEDLINE | ID: mdl-33668540

RESUMEN

Knowledge on compliance with governmental recommendations in combating the spread of COVID-19 in different groups is important to target efforts. This study investigated the adherence to the governmental implemented COVID-19 measures and its predictors in Danish university students, a not-at-risk group for COVID-19 mortality and normally characterized by many social contacts. As part of the COVID-19 International Student Wellbeing Study, a survey on socio-demographic situation, study information, living arrangements, lifestyle behaviors, stress, questions about COVID-19 infection and knowledge and concern about COVID-19 infection was sent via email to relevant university students in Denmark in May, 2020 (n = 2.945). Stepwise multiple linear regression analysis was employed. Our results showed that around 60% of the students were not concerned about COVID-19, while 68% reported that they followed governmental measures. The main facilitators for following the recommendations were older age, concern about COVID-19 and depression, while barriers were living in a student hall, being physical active or reporting mental stress. Only 9% of the variation in adhering to governmental recommendations could be explained by the analyzed predictors. Results may inform health communication. Emotionally appealing information rather than knowledge-based information may be more effective in motivating students to follow COVID-19 measures.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Cooperación del Paciente , Estudiantes , Adulto , Estudios Transversales , Dinamarca , Femenino , Gobierno , Conductas Relacionadas con la Salud , Humanos , Masculino , Encuestas y Cuestionarios , Adulto Joven
9.
Front Public Health ; 9: 632914, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33643995

RESUMEN

Background: The Coronavirus disease 2019 (COVID-19) pandemic is a major threat to public health and has had a significant impact on all aspects of life. An effective vaccine is the most anticipated resolution. This study aims to evaluate Jordanian intent to be vaccinated. Methods: This is a cross-sectional web-based study. Sample characteristics were gathered, and the participants were classified according to the degree of COVID-19 risk based on the categories of the Centers for Disease Control and Prevention (CDC). Participants' KAP toward COVID-19 were assessed, and two scores were calculated: knowledge score and practice score. The association between different sample characteristics and these scores was identified using binary logistical regressions. The participants' vaccination intention was evaluated and multinomial logistic regression was applied to identify the predictors of vaccination intention. Finally, the reasons behind the participants' vaccination refusal/hesitation were determined and categorized into different groups. Results: 1,144 participants were enrolled in the study (females = 66.5%). 30.4% of the participants were at high risk of COVID-19 complications, and 27.5% were at medium risk. Overall, participants' knowledge of COVID-19 symptoms, transmission methods, protective measures, and availability of cure were high (median of knowledge score = 17 out of 21). High protective practices were followed by many participants (median of practice score = 7 out of 10). 3.7% of participants were infected, and 6.4% suspected they were infected with the COVID-19 virus. 36.8% of the participants answered "No" when asked if they would take the vaccine once it becomes available, and 26.4% answered, "Not sure." The main reasons for the participants' vaccination refusal or hesitancy were concerns regarding the use of vaccines and a lack of trust in them. Conclusion: Participants reported high refusal/hesitancy. Several barriers were identified, and efforts should be intensified to overcome these barriers.


Asunto(s)
Cooperación del Paciente , Vacunación , Adolescente , Adulto , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , Encuestas y Cuestionarios , Vacunas Virales/administración & dosificación , Adulto Joven
10.
Front Public Health ; 9: 644538, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33643998

RESUMEN

The rapid advancement in vaccine development represents a critical milestone that will help humanity tackle the COVID-19 pandemic. However, the success of these efforts is not guaranteed, as it relies on the outcomes of national and international vaccination strategies. In this article, we highlight some of the challenges that Romania will face and propose a set of solutions to overcome them. With this in mind, we discuss issues such as the infrastructure of vaccine storage and delivery, the deployment and administration of immunisations, and the public acceptance of vaccines. The ways in which Romanian society will respond to a national COVID-19 vaccination campaign will be contingent on appropriate and timely actions. As many of the problems encountered in Romania are not unique, the proposed recommendations could be adapted and implemented in other countries that face similar issues, thereby informing better practices in the management of the COVID-19 pandemic.


Asunto(s)
/prevención & control , Programas de Inmunización/organización & administración , Cooperación del Paciente , Concienciación , Prestación de Atención de Salud , Humanos , Pandemias , Rumanía , Revelación de la Verdad
12.
Medicine (Baltimore) ; 100(9): e24900, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655951

RESUMEN

OBJECTIVE: We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries-anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)-for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). METHODS: Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. RESULTS: Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. CONCLUSIONS: Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.


Asunto(s)
Descompresión Quirúrgica/métodos , Ligamentos Longitudinales/cirugía , Metaanálisis en Red , Osificación del Ligamento Longitudinal Posterior/cirugía , Cooperación del Paciente , Espondilosis/cirugía , Vértebras Cervicales , Humanos , Laminectomía/métodos , Laminoplastia/métodos , Osificación del Ligamento Longitudinal Posterior/complicaciones , Fusión Vertebral/métodos , Espondilosis/etiología
13.
Lancet HIV ; 8(2): e87-e95, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539762

RESUMEN

BACKGROUND: Two phase 3 clinical trials showed that use of a monthly vaginal ring containing 25 mg dapivirine was well tolerated and reduced HIV-1 incidence in women by approximately 30% compared with placebo. We aimed to evaluate use and safety of the dapivirine vaginal ring (DVR) in open-label settings with high background rates of HIV-1 infection, an important step for future implementation. METHODS: We did a phase 3B open-label extension trial of the DVR (MTN-025/HIV Open-label Prevention Extension [HOPE]). Women who were HIV-1-negative and had participated in the MTN-020/ASPIRE phase 3 trial were offered 12 months of access to the DVR at 14 clinical research centres in Malawi, South Africa, Uganda, and Zimbabwe. At each visit (monthly for 3 months, then once every 3 months), women chose whether or not to accept the offer of the ring. Used, returned rings were tested for residual amounts of dapivirine as a surrogate marker for adherence. HIV-1 serological testing was done at each visit. Dapivirine amounts in returned rings and HIV-1 incidence were compared with data from the ASPIRE trial, and safety was assessed. This study is registered with ClinicalTrials.gov, NCT02858037. FINDINGS: Between July 16, 2016, and Oct 10, 2018, of 1756 women assessed for eligibility, 1456 were enrolled and participated in the study. Median age was 31 years (IQR 27-37). At baseline, 1342 (92·2%) women chose to take the DVR; ring acceptance was more than 79% at each visit up until 12 months and 936 (73·2%) of 1279 chose to take the ring at all visits. 12 530 (89·3%) of 14 034 returned rings had residual dapivirine amounts consistent with some use during the previous month (>0·9 mg released) and the mean dapivirine amount released was greater than in the ASPIRE trial (by 0·21 mg; p<0·0001). HIV-1 incidence was 2·7 per 100 person-years (95% CI 1·9-3·8, 35 infections), compared with an expected incidence of 4·4 per 100 person-years (3·2-5·8) among a population matched on age, site, and presence of a sexually transmitted infection from the placebo group of ASPIRE. No serious adverse events or grade 3 or higher adverse events observed were assessed as related to the DVR. INTERPRETATION: High uptake and persistent use in this open-label extension study support the DVR as an HIV-1 prevention option for women. With an increasing number of HIV-1 prophylaxis choices on the horizon, these results suggest that the DVR will be an acceptable and practical option for women in Africa. FUNDING: The Microbicide Trials Network and the National Institute of Allergy and Infectious Diseases, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health, all components of the US National Institutes of Health.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Dispositivos Anticonceptivos Femeninos , Infecciones por VIH/prevención & control , Pirimidinas/uso terapéutico , Tenofovir/uso terapéutico , Administración Intravaginal , Adulto , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/inmunología , Humanos , Malaui , Cooperación del Paciente/estadística & datos numéricos , Seguridad del Paciente , Seroconversión , Sudáfrica , Resultado del Tratamiento , Uganda , Zimbabwe
14.
Lancet HIV ; 8(2): e67-e76, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539760

RESUMEN

BACKGROUND: UNAIDS recommends integrating methadone or buprenorphine treatment of opioid use disorder with HIV care to improve HIV outcomes, but buprenorphine adoption remains limited in many countries. We aimed to assess whether HIV clinic-based buprenorphine plus naloxone treatment for opioid use disorder was non-inferior to referral for methadone maintenance therapy in achieving HIV viral suppression in Vietnam. METHODS: In an open-label, non-inferiority trial (BRAVO), we randomly assigned people with HIV and opioid use disorder (1:1) by computer-generated random number sequence, in blocks of ten and stratified by site, to receive HIV clinic-based buprenorphine plus naloxone treatment or referral for methadone maintenance therapy in six HIV clinics in Vietnam. The primary outcome was HIV viral suppression at 12 months (HIV-1 RNA ≤200 copies per mL on PCR) by intention to treat (absolute risk difference [RD] margin ≤13%), compared by use of generalised estimating equations. Research staff actively queried treatment-emergent adverse events during quarterly study visits and passively collected adverse events reported during HIV clinic visits. This study is registered with ClinicalTrials.gov, NCT01936857, and is completed. FINDINGS: Between July 27, 2015, and Feb 12, 2018, we enrolled 281 patients. At baseline, 272 (97%) participants were male, mean age was 38·3 years (SD 6·1), and mean CD4 count was 405 cells per µL (SD 224). Viral suppression improved between baseline and 12 months for both HIV clinic-based buprenorphine plus naloxone (from 97 [69%] of 140 patients to 74 [81%] of 91 patients) and referral for methadone maintenance therapy (from 92 [66%] of 140 to 99 [93%] of 107). Buprenorphine plus naloxone did not demonstrate non-inferiority to methadone maintenance therapy in achieving viral suppression at 12 months (RD -0·11, 95% CI -0·20 to -0·02). Retention on medication at 12 months was lower for buprenorphine plus naloxone than for methadone maintenance therapy (40% vs 65%; RD -0·53, 95% CI -0·75 to -0·31). Participants assigned to buprenorphine plus naloxone more frequently experienced serious adverse events (ten [7%] of 141 vs four of 140 [3%] assigned to methadone maintenance therapy) and deaths (seven of 141 [5%] vs three of 141 [2%]). Serious adverse events and deaths typically occurred in people no longer taking ART or opioid use disorder medications. INTERPRETATION: Although integrated buprenorphine and HIV care may potentially increase access to treatment for opioid use disorder, scale-up in middle-income countries might require enhanced support for buprenorphine adherence to improve HIV viral suppression. The strength of our study as a multisite randomised trial was offset by low retention of patients on buprenorphine. FUNDING: National Institute on Drug Abuse (US National Institutes of Health).


Asunto(s)
Buprenorfina/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Metadona/uso terapéutico , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Quimioterapia Combinada , Femenino , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/virología , Cooperación del Paciente/estadística & datos numéricos , ARN Viral/sangre , Distribución Aleatoria , Resultado del Tratamiento , Vietnam , Carga Viral/efectos de los fármacos
15.
Nutr Metab Cardiovasc Dis ; 31(4): 1247-1256, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33549445

RESUMEN

BACKGROUND AND AIMS: This study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults. METHODS AND RESULTS: After a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HRmean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HRmean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05). CONCLUSION: Despite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03212391 (July 11, 2017).


Asunto(s)
Ejercicio Físico , Obesidad/terapia , Caminata , Adiposidad , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Tolerancia al Ejercicio , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Fuerza Muscular , Obesidad/diagnóstico , Obesidad/fisiopatología , Cooperación del Paciente , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Pérdida de Peso
16.
J Hand Surg Asian Pac Vol ; 26(1): 47-51, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559583

RESUMEN

Background: Stack splint is commonly used for mallet finger treatment but patients had a tendency to frequently remove it because of skin complications. We hypothesized that a comprehensively instructed splinting regime would increase patients' compliance and lead to favorable outcomes with fewer skin complications. The aims of this study were to assess the patients' compliance and to evaluate outcomes with that particular splinting regime. Methods: Forty-six consecutive patients were enrolled in this prospective study. They were instructed to wear the Stack splint for 24 hours a day every day in the first six weeks and remove it once a day for 10 minutes to vent. They were told to support distal interphalangeal joint volarly both while wearing the splint and when it was removed. Free movement of proximal interphalangeal joint within the splint was checked after each application. Following whole-day regime for 6 weeks, night splinting continued for 2 more weeks. Range of motion, skin complications, patients' compliance and satisfaction were assessed at last follow-up. Results: There were 26 patients with a mean age of 39.8 and mean follow-up period of 6.7 months. No skin complications or proximal interphalangeal joint stiffness were reported. However, nine patients declared that they wore the splint ≤ 4 weeks, the compliance rate to our regime was 65.4% (17/26). In the 17 fully compliant patients, mean distal interphalangeal joint extension lag was 12.4 and nine of them (52.9%) were satisfied with the outcome. Conclusions: Our both hypotheses failed; comprehensive instructions for the splinting regime did not improve patients' compliance satisfactorily, nor did it lead to favorable outcomes. Although Stack splint has practical points, we no longer use it.


Asunto(s)
Traumatismos de los Dedos/terapia , Férulas (Fijadores) , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Satisfacción del Paciente , Estudios Prospectivos , Adulto Joven
17.
Health Psychol ; 40(3): 166-177, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33630638

RESUMEN

OBJECTIVE: To examine the psychological mediators of exercise adherence among older adults in a group-based physical activity randomized controlled trial. METHOD: Older adults (≥65 years) were randomized to one of three conditions as part of the "GrOup-based physical Activity for oLder adults" (GOAL) randomized controlled trial. These included similar age same gender (SASG) and similar age mixed gender (SAMG) exercise programs that were informed by the tenets of self-categorization theory, and a "standard" mixed age mixed gender (MAMG) exercise program. Participants represented a subgroup (n = 483, Mage = 71.41 years) from the larger trial (n = 627) who completed measures of the trial's putative psychological mediators (i.e., group cohesion and affective attitudes) over the course of the 24-week exercise programs. RESULTS: Piecewise latent growth modeling revealed different trajectories between participants in the two intervention conditions (SASG, SAMG) when compared with the comparison MAMG condition with regard to perceptions of group cohesion and affective attitudes. Results of subsequent cross-lagged panel modeling revealed that better program adherence in the two intervention conditions, when compared with the referent MAMG condition, was mediated by perceptions of group cohesion. CONCLUSIONS: The findings provide insight into how the two intervention programs differentially strengthened perceptions of group cohesion and affective attitudes over time. Consistent with self-categorization theory, the results also shed light on the role of group cohesion, in particular, as a psychological mechanism of action to promote older adults' exercise adherence behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Ejercicio Físico/psicología , Conductas Relacionadas con la Salud , Cooperación del Paciente/psicología , Actividades Cotidianas , Anciano , Actitud Frente a la Salud , Terapia por Ejercicio/métodos , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Aptitud Física/psicología , Conducta Sedentaria
18.
A A Pract ; 15(2): e01398, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33625120

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic prompted the creation of novel techniques to protect patients and health care providers. Simulations showed that disposable oxygen face tents act as a physical barrier and can be repurposed as a negative airflow tent. This case study presents a pediatric patient requiring dental surgery, ineligible for preoperative testing for COVID-19 due to developmental delay and aggression. Precautionary measures were taken by means of full personal protective equipment (PPE) and negative airflow tent. The tent added additional protection and is a promising new technique that is disposable, widely available, and offers full access to proceduralists.


Asunto(s)
/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Equipo de Protección Personal , Extracción Dental , Agresión/psicología , Movimientos del Aire , Anestesia General , Niño , Discapacidades del Desarrollo/psicología , Humanos , Masculino , Cooperación del Paciente/psicología
19.
Lancet HIV ; 8(2): e106-e113, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539757

RESUMEN

Ending the AIDS epidemic by 2030 will require addressing stigma more systematically and at a larger scale than current efforts. Existing global evidence shows that stigma is a barrier to achieving each of the 90-90-90 targets; it undermines HIV testing, linkage to care, treatment adherence, and viral load suppression. However, findings from both research studies and programmatic experience have helped to inform the growing body of knowledge regarding how to reduce stigma, leading to key principles for HIV stigma reduction. These principles include immediately addressing actionable drivers of stigma, centring groups affected by stigma at the core of the response, and engaging opinion leaders and building partnerships between affected groups and opinion leaders. Although there is still room to strengthen research on stigma measurement and reduction, in particular for intersectional stigma, the proliferation of evidence over the past several decades on how to measure and address stigma provides a solid foundation for immediate and comprehensive action.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Epidemias/prevención & control , Miedo/psicología , Estigma Social , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/virología , Fármacos Anti-VIH/uso terapéutico , Femenino , VIH/efectos de los fármacos , VIH/crecimiento & desarrollo , VIH/patogenicidad , Humanos , Masculino , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Aislamiento Social/psicología , Cumplimiento y Adherencia al Tratamiento/psicología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Carga Viral/efectos de los fármacos
20.
Lancet HIV ; 8(2): e77-e86, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539761

RESUMEN

BACKGROUND: The Ring Study, a phase 3 trial in 1959 sexually active women (randomised 2:1), showed a favourable safety profile and a 31% HIV-1 infection risk reduction for a vaginal ring containing 25 mg of dapivirine, compared with a placebo ring. We report here the DREAM study, which aimed to evaluate safety, adherence, and HIV-1 incidence in those using the dapivirine vaginal ring (DVR) in open-label use. METHODS: The DREAM study is an open-label extension of The Ring Study, done at five research centres in South Africa and one research centre in Uganda. Former participants from The Ring Study, who remained HIV-negative and who did not discontinue the study due to an adverse event or safety concern that was considered to be related to the investigational product, were eligible. Women who were pregnant, planning to become pregnant, or breastfeeding at screening for DREAM were excluded. All participants received the DVR for insertion at the enrolment visit. Participants attended a 1-month follow-up visit and could either proceed with visits once every 3 months or attend monthly visits up to month 3 and then continue with visits once every 3 months. At each visit, HIV testing and safety evaluations were done, and residual dapivirine measured in used rings (approximately 4 mg is released from the DVR over 28 days of consistent use). HIV-1 incidence was compared descriptively with the simulated incidence rate obtained from bootstrap sampling of participants in the placebo group of The Ring Study, matched for research centre, age, and presence of sexually transmitted infections at enrolment. This study is registered with ClinicalTrials.gov, NCT02862171. FINDINGS: Between July 12, 2016, and Jan 11, 2019, 1034 former participants from The Ring Study were screened, 941 were enrolled and 848 completed the trial. 616 (65·5%) of 941 participants reported treatment-emergent adverse events. Of these, six (0·6%) had events considered to be treatment-related. No treatment-related serious adverse events were reported. Measurements of monthly ring residual amounts in participants enrolled in both trials showed consistently lower mean values in DREAM than in The Ring Study. Arithmetic mean ring residual amounts of participants in The Ring Study DVR group who enrolled in DREAM were 0·25 mg lower (95% CI 0·03-0·47; p=0·027) than the mean ring residual amounts of these participants in The Ring Study. 18 (1·9%) HIV-1 infections were confirmed during DVR use, resulting in an incidence of 1·8 (95% CI 1·1-2·6) per 100 person-years, 62% lower than the simulated placebo rate. INTERPRETATION: Although efficacy estimation is limited by the absence of a placebo group, the observed low HIV-1 incidence and improved adherence observed in DREAM support the hypothesis that increased efficacy due to improved adherence occurs when women know the demonstrated safety and efficacy of the DVR. The feasibility of a visit schedule of once every 3 months was shown, indicating that the DVR can be used in a real-world situation in usual clinical practice. FUNDING: The Ministry of Foreign Affairs (MFA) Denmark, Flanders MFA, Irish Aid, Dutch MFA, UK Aid from the UK Government's Foreign, Commonwealth and Development Office, and the US President's Emergency Plan for AIDS Relief through the US Agency for International Development.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Dispositivos Anticonceptivos Femeninos , Infecciones por VIH/prevención & control , Pirimidinas/uso terapéutico , Tenofovir/uso terapéutico , Administración Intravaginal , Adolescente , Adulto , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/inmunología , Humanos , Persona de Mediana Edad , Cooperación del Paciente/estadística & datos numéricos , Seguridad del Paciente , Seroconversión , Sudáfrica , Resultado del Tratamiento , Uganda
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