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2.
Adv Exp Med Biol ; 1191: 543-559, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002945

RESUMEN

Anxiety is prevalent in childhood and adolescence. Youth with maladaptive responses to common situations and stressors are at risk of having anxiety disorders. Persistent anxiety symptoms and anxiety disorders can be debilitating with long-term adverse outcomes in adulthood. Hence, decreasing the burden of anxiety disorders is an important public health priority. Development of anxiety disorders has a multifactorial etiology. There is a considerable complex interaction of genetics, temperament, parenting behavior, environmental triggers, and physiologic factors. Identification of these risk factors is key to early detection, prevention, and development of applicable management approaches. Despite several evidence-based treatments published, there are limited prevention strategies available. Effective implementation of prevention strategies is essential and can be achieved by either elimination or reduction of the negative risk factors or strengthening the protective factors on anxiety symptoms and anxiety disorders. This chapter reviews the common risk and protective factors and provides current literature on prevention strategies for pediatric and adolescent anxiety disorders.


Asunto(s)
Trastornos de Ansiedad/prevención & control , Trastornos de Ansiedad/psicología , Adolescente , Trastornos de Ansiedad/genética , Niño , Humanos , Responsabilidad Parental , Prevalencia , Factores Protectores , Factores de Riesgo , Temperamento
3.
Vasc Health Risk Manag ; 16: 1-10, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32021223

RESUMEN

Icosapent ethyl is a highly purified formulation of eicosapentaenoic acid, a type of omega-3 fatty acid contained in fish oil. While omega-3 fatty acids have long been thought to have cardioprotective benefits, the Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) has helped to establish icosapent ethyl as an evidence-based therapy for risk reduction of atherosclerotic cardiovascular disease (ASCVD). REDUCE-IT, however, was by no means an overnight success story. Close examination of the evidence shows that the trial was a culmination of many lessons learned from previous studies. The purpose of this manuscript is to review contemporary evidence of icosapent ethyl in ASCVD risk reduction and the clinical implication of this promising therapy.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Suplementos Dietéticos , Ácido Eicosapentaenoico/análogos & derivados , Animales , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Suplementos Dietéticos/efectos adversos , Ácido Eicosapentaenoico/efectos adversos , Ácido Eicosapentaenoico/uso terapéutico , Medicina Basada en la Evidencia , Humanos , Factores Protectores , Medición de Riesgo , Factores de Riesgo
4.
Oncology ; 98(3): 161-167, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31962315

RESUMEN

BACKGROUND: The effect of anesthetic techniques on cancer recurrence has been the subject of intensive research in the past years, as it affects a large proportion of the population. The use of opioids and halogenated agents in cancer patients during the perioperative period may be related to higher rates of cancer recurrence and reduced disease-free survival. METHODS: This was a prospective study. The sample was composed of 100 patients who underwent a radical cystectomy for infiltrating bladder cancer in a reference center. We compared disease-free survival associated with combined anesthesia versus opiate-based analgesia. The relationship between the administered hypnotic and disease-free survival was also investigated. RESULTS: The median disease-free survival of the patients who received combined anesthesia was 585 (240-1,005) days versus 210 (90-645) days in the other group. A significant difference was observed between the two groups (p = 0.01). Combined analysis of all groups revealed significant differences in disease-free survival between patients who received combined anesthesia with propofol (510 [315-1,545] disease-free days) and those who received sevoflurane and opioids (150 [90-450] disease-free days) (p = 0.02). CONCLUSIONS: Anesthesia may play a crucial role in tumor relapse, as it is administered at the moment of the greatest risk of dissemination: surgical handling of the tumor. Opioids and volatile agents have been related to an increased risk for cancer recurrence. We compared the use of propofol + local anesthesia versus sevoflurane + opioids and also found that disease-free survival was longer among patients who received propofol + local anesthesia. Disease-free survival increases with the use of propofol in combination with epidural anesthesia in patients who undergo surgery for infiltrating bladder cancer.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Anestesia por Inhalación , Anestesia Intravenosa , Anestésicos Intravenosos/administración & dosificación , Cistectomía , Propofol/administración & dosificación , Neoplasias de la Vejiga Urinaria/cirugía , Analgésicos Opioides/efectos adversos , Anestesia por Inhalación/efectos adversos , Anestesia por Inhalación/mortalidad , Anestesia Intravenosa/efectos adversos , Anestesia Intravenosa/mortalidad , Anestésicos Intravenosos/efectos adversos , Cistectomía/efectos adversos , Cistectomía/mortalidad , Supervivencia sin Enfermedad , Humanos , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Propofol/efectos adversos , Estudios Prospectivos , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patología
5.
BMJ ; 368: l6880, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31992555

RESUMEN

Autism spectrum disorder (referred to here as autism) is one of several overlapping neurodevelopmental conditions that have variable impacts on different individuals. This variability results from dynamic interactions between biological and non-biological risk factors, which result in increasing differentiation between individuals over time. Although this differentiation continues well into adulthood, the infancy period is when the brain and behavior develop rapidly, and when the first signs and symptoms of autism emerge. This review discusses advances in our understanding of the causal pathways leading to autism and overlapping neurodevelopmental conditions. Research is also mapping trajectories of brain and behavioral development for some risk groups, namely later born siblings of children with autism and/or infants referred because of developmental concerns. This knowledge has been useful in improving early identification and establishing the feasibility of targeted interventions for infant risk groups before symptoms arise. However, key knowledge gaps remain, such as the discovery of protective factors (biological or environmental) that may mitigate the impact of risk. Also, the dynamic mechanisms that underlie the associations between risk factors and outcomes need further research. These include the processes of resilience, which may explain why some individuals at risk for autism achieve better than expected outcomes. Bridging these knowledge gaps would help to provide tools for early identification and intervention that reflect dynamic developmental pathways from risk to outcomes.


Asunto(s)
Trastorno Autístico , Encéfalo/crecimiento & desarrollo , Desarrollo Infantil , Factores Protectores , Trastorno Autístico/diagnóstico , Trastorno Autístico/epidemiología , Trastorno Autístico/psicología , Diagnóstico Precoz , Humanos , Lactante , Pronóstico , Resiliencia Psicológica , Factores de Riesgo
6.
Medicine (Baltimore) ; 99(1): e18461, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895777

RESUMEN

This study was conducted to examine the effect of protective factors on the relationship between crisis episodes and depression in the elderly population in Taiwan.In this study, the Taiwan Longitudinal Study on Aging was used as basis for a cross-sectional secondary data analysis. After eliminating respondents below the age of 65 years and those with missing values, 2426 samples were collected. Predictive variables, such as crisis episodes, personal resources, family ties, social participation, and social support, were investigated, and the dependent variable of "depression status" was measured using the Center for Epidemiologic Studies Depression scale.According to the results of regression analysis, the protective factors of self-assessed health (ß = -0.290, P < .001), instrumental support (ß = -0.153, P < .001), financial satisfaction (ß = -0.126, P < .001), emotional support (ß = -0.101, P < .001), crisis episodes (ß = 0.087, P < .001), support satisfaction (ß = -0.081, P < .001), leisure participation (ß = -0.053, P < .05), family ties (ß = -0.048, P < .05), and community participation (ß = -0.042, P < .05) had a significant effect on depression status. Moreover, leisure participation had a moderating effect on the relationship between crisis episodes and depression (ß = -0.07, P < .01). In addition, according to path analysis results, family ties had a significant negative predictive power on depression (ß = -0.225, P < .001), as did social support (ß = -0.978, P < .001). The predictive power of crisis episodes on depression through social support was 0.197 (-0.201 × -0.978 = 0.197, P < .001), and it was -0.324 (-0.331 × -0.978 = -0.324, P < .001) through social participation, which indicated that social support plays a mediating role between crisis episodes and depression and between social participation and depression.Strengthening effective protective factors can improve the resilience of elderly people and enable them to cope with dilemmas rapidly and effectively when faced with crisis episodes as well as restore their health status and enjoy a satisfactory life.


Asunto(s)
Depresión/epidemiología , Resiliencia Psicológica , Índice de Severidad de la Enfermedad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Depresión/diagnóstico , Progresión de la Enfermedad , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores Protectores , Apoyo Social , Taiwán/epidemiología
7.
Immunology ; 159(2): 178-182, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31613998

RESUMEN

Hepatitis B virus (HBV) infection causes a self-limiting disease in most individuals. However, < 10% of infected subjects develop a chronic disease. Genetic host variability of polymorphic genes at the interface of innate and acquired immunity, such as killer immunoglobulin-like receptors (KIR), their human leucocyte antigen (HLA) and IgG allotypes (GM), could explain this different clinical picture. We previously showed a protective role of the KIR2DL3 gene for the development of chronic hepatitis B (CHB), and a detrimental role of the KIR ligand groups, HLA-A-Bw4 and HLA-C2. We have expanded the previous analysis genotyping patients for GM23 and GM3/17 allotypes. The comparison of the patients with CHB with those who resolved HBV infection showed that the presence of GM17 allele virtually eliminated the risk of developing CHB (OR, 0·03; 95% CI, 0·004-0·16; P < 0·0001). In addition, the combination of GM17, KIR2DL3, HLA-A-Bw4 and HLA-C2 was highly sensitive to predict the outcome of HBV infection.


Asunto(s)
Antígenos HLA-B/genética , Antígenos HLA-C/genética , Hepatitis B Crónica/prevención & control , Alotipos de Inmunoglobulina Gm/genética , Receptores KIR2DL3/genética , Estudios de Casos y Controles , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Antígenos HLA-B/inmunología , Antígenos HLA-C/inmunología , Virus de la Hepatitis B/inmunología , Hepatitis B Crónica/genética , Hepatitis B Crónica/inmunología , Interacciones Huésped-Patógeno , Humanos , Alotipos de Inmunoglobulina Gm/inmunología , Fenotipo , Factores Protectores , Receptores KIR2DL3/inmunología , Medición de Riesgo , Factores de Riesgo
8.
Ann Vasc Surg ; 62: 183-190.e1, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30710629

RESUMEN

BACKGROUND: There is varying evidence regarding the effects of body mass index (BMI) on outcomes of endovascular aneurysm repair (EVAR). This study investigates the effects of BMI on an index of perioperative and postoperative outcomes after EVAR. METHODS: Four hundred ninety-two patients who underwent elective EVAR at Mount Sinai Hospital were included in this study. Patients were classified as either normal weight (BMI = 18.5-25), overweight (BMI = 25-30), or obese (BMI>30). Chi-squared tests were used to determine significant differences between weight classes across an index of outcomes. The following outcomes were collected: intraoperative complications (e.g., conversion to open), perioperative complications (e.g., hematoma, bowel ischemia, and so forth), and postoperative outcomes (endoleak, sac enlargement, sac shrinkage, access site infection, prolonged postoperative length of stay, reintervention, stroke, claudication/lower extremity ischemia, deep vein thrombosis, limb occlusion, renal complications, abdominal aortic aneurysm (AAA) rupture, AAA-related mortality, and all-cause mortality). Kaplan-Meier survival analysis and a log-rank test were used to determine meaningful differences in all-cause mortality following EVAR between the respective weight classes. Subsequently, multivariate Cox proportional hazards were performed for selection of outcomes, with weight classes as predictors. Finally, a multivariate logistic regression was performed for postoperative hospital stay. Subgroup multivariate analysis was also performed examining only class I obese patients, rather than all obese patients. RESULTS: Overweight patients were significantly less likely to experience all-cause mortality up to 9 years after EVAR than normal-weight patients in both Kaplan-Meier and multivariable Cox proportional hazards models. Obese patients similarly had a lower risk of mortality in Kaplan-Meier analysis, but this did not persist in the multivariate analysis. Overweight patients were also significantly less likely to require a postoperative hospital stay longer than 1 day when compared with normal-weight patients. Finally, obese patients were less likely to have a sac shrinkage greater than 5 mm after EVAR, but were also less likely to have an endoleak. CONCLUSIONS: This study adds to the debate on the effects of BMI on outcomes of EVAR. Obesity was not a risk factor for negative perioperative or postoperative outcomes after EVAR with the exception of decreased sac shrinkage. Obese patients were less likely to have an endoleak, and overweight patients were protected against all-cause mortality and longer postoperative hospital stays.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Índice de Masa Corporal , Procedimientos Endovasculares , Obesidad/complicaciones , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Obesidad/diagnóstico , Obesidad/mortalidad , Valor Predictivo de las Pruebas , Factores Protectores , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
9.
Angiology ; 71(1): 27-37, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31533437

RESUMEN

We assessed the cardiovascular safety of long-term direct-acting oral anticoagulant (DOAC) treatment. A search of the medical literature was performed from inception until May 31, 2019. Inclusion criteria were (1) randomized trial that assessed the clinical efficacy and/or safety of 1 or more DOAC, (2) control group including oral anticoagulation and/or antiplatelet and/or placebo treatment, and (3) the incidence of acute coronary syndrome during follow-up was reported. Fixed-effect and random-effects models were applied. The analyzed outcomes were myocardial infarction (MI), major bleeding, and mortality. Twenty-eight randomized clinical trials (196 761 patients) were included. Rivaroxaban was associated with a 21% reduction in the relative risk of MI when compared to placebo (relative risk [RR]: 0.79 [95% credible interval, CrI: 0.65-0.94]) and a 31% reduction (RR: 0.70 [95% CrI: 0.53-0.89]) when compared to dabigatran. Apixaban resulted in 24% (RR: 0.76 [95% CrI: 0.58-0.99]) and vitamin K antagonists anticoagulation resulted in 19% (RR: 0.81 [95% CrI: 0.65-0.98]) risk reduction compared to dabigatran. The computed probability of being the first best choice of treatment was 61.8% for rivaroxaban. Cardiovascular safety shows considerable heterogeneity among oral anticoagulants. Treatment with rivaroxaban is associated with reduced rate of MI.


Asunto(s)
Anticoagulantes/administración & dosificación , Infarto del Miocardio/prevención & control , Administración Oral , Anticoagulantes/efectos adversos , Esquema de Medicación , Hemorragia/inducido químicamente , Humanos , Infarto del Miocardio/mortalidad , Metaanálisis en Red , Factores Protectores , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
10.
Nurs Educ Perspect ; 41(1): 43-45, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31860487

RESUMEN

A correlation pilot study was conducted to examine relationships between resilience protective factors and moral distress associated with clinical practica in nursing students. Aggregate moral distress rating was x = 3.67. Two of four resilience protective factor subcategories demonstrated significant inverse correlations with moral distress rating. Inverse correlations were found between social support and moral distress (r = -.27, p < .05) and between goal efficacy and moral distress (r = -.37, p < .01). The findings should help educators prioritize resilience-enhancing educational strategies.


Asunto(s)
Principios Morales , Estrés Psicológico , Estudiantes de Enfermería , Humanos , Proyectos Piloto , Factores Protectores , Estudiantes de Enfermería/psicología
11.
Maturitas ; 132: 17-23, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31883658

RESUMEN

OBJECTIVE: To estimate the risk of hand osteoarthritis (HOA) associated with hormone replacement therapy (HRT). METHODS: We conducted a nested case-control study using data from the UKbased Clinical Practice Research Datalink (1998-2017). In the study inception cohort comprised women at age 45. We matched women with incident HOA during follow-up (cases) to osteoarthritisfree controls on age and calendar date (index date, ID), in a ratio of 1:4. We applied conditional logistic regression to calculate odds ratios (OR) with 95 % confidence intervals (CI) of HOA associated with new HRT use compared with non-use overall, and for women with recorded menopause we calculated separate ORs according to the time between menopause and HRT initiation (current users), and the time between HRT cessation and the ID (past users), versus non-users. RESULTS: There were 3440 cases and 13,760 controls (mean age: 50.9 ± 4.1 years). We observed an adjusted OR (aOR) of HOA of 1.32 (95 % CI 1.17-1.48) in HRT users (versus nonusers), which attenuated to 0.98 (95 % CI 0.85-1.14) in women with recorded menopause. Current users (versus nonusers) who initiated HRT 3 months before or after menopause had an aOR of 0.72 (95 % CI 0.55-0.96), while aORs increased with later HRT initiation. Among past users (versus non-users), we observed an aOR of 1.25 (95 % CI 0.86-1.81) when HRT use was stopped ≤18 months before the ID, approaching the null with increasing duration between HRT cessation and the ID. CONCLUSION: Current HRT use was associated with a decreased risk of HOA if initiated around menopause, but the risk reduction disappeared after HRT cessation.


Asunto(s)
Terapia de Reemplazo de Hormonas/estadística & datos numéricos , Menopausia , Osteoartritis/epidemiología , Estudios de Casos y Controles , Bases de Datos Factuales , Femenino , Mano , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Factores Protectores , Factores de Riesgo , Reino Unido/epidemiología
12.
Vasc Health Risk Manag ; 15: 463-475, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31802880

RESUMEN

Background: To investigate whether chronic adherence to the French Nutrition and Health Program (PNNS) guidelines was associated with better cardiovascular health. Methods: A study nested within the SU.VI.MAX2 cohort was conducted on participants without cardiovascular risk factors. Long-term adherence to the PNNS guidelines was estimated using validated dietary scores from 2007 and 2012. Individuals who did (PNNS+) and did not (PNNS-) continuously adhere to the PNNS guidelines were included. Applanation tonometry, impedance cardiography, laser doppler flowmetry, heart rate, heart rate variability, endothelial function was used for the assessment of cardiovascular health. Results: A total of 49 subjects (mean age 65.4 ± 5.6 years, 75.5% women) had been included. Those in the PNNS+ group (n=26) were older, had a higher BMI and fat mass than those in the PNNS- group, both groups had similar metabolic parameters. After adjusting for sex, age, and BMI, PNNS+ subjects were found to have a lower heart rate (60.2 ± 8.0 vs 64.3 ± 8.4 beats/min, p=0.042), a lower heart rate × systolic blood pressure product (7166 ± 1323 vs 7788 ± 1680 beats× mmHg/min, p = 0.009), a longer diastole duration (66.7 ± 3.1% vs 64.6 ± 4.1% of the cardiac cycle duration, p=0.049), and a shorter tension-time index (2145 ± 489 vs 2307 ± 428 ms * mmHg, p=0.018) compared to the PNNS- group. Conclusion: Long-term adherence to the PNNS guidelines had a favorable impact on heart rate, diastole duration, and myocardial oxygen consumption. Clinical Trial Registration number: NCT01579409.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Frecuencia Cardíaca , Miocardio/metabolismo , Consumo de Oxígeno , Ingesta Diaria Recomendada , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Diástole , Método Doble Ciego , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estado Nutricional , Valor Nutritivo , Paris , Estudios Prospectivos , Factores Protectores , Conducta de Reducción del Riesgo , Factores de Tiempo
13.
Vasc Health Risk Manag ; 15: 485-502, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31802882

RESUMEN

Introduction: Smoking is a major risk factor for cardiovascular diseases (CVDs) and for many types of cancers. Despite recent policies, 1.1 billion people are active smokers and tobacco is the leading cause of mortality and illness throughout the world. The aim of this work was to identify smoking cessation interventions which could be implemented in primary care and/or at a community level. Methods: A systematic review of CVDs prevention guidelines was realized using the ADAPTE Process. These were identified on G-I-N and TRIP databases. Additionally, a purposive search for national guidelines was successfully undertaken. Guidelines focusing on non-pharmacological lifestyle interventions, published or updated after 2011, were included. Exclusion criteria were specific populations, management of acute disease and exclusive focus on pharmacological or surgical interventions. After appraisal with the AGREE II tool, high-quality guidelines were included for analysis. High-grade recommendations and the supporting bibliographic references were extracted. References had to be checked in detail where sufficient information was not available in the guidelines. Results: Nine hundred and ten guidelines were identified, 47 evaluated with AGREE II and 26 included. Guidelines recommended that patients quit smoking and that health care professionals provided advice to smokers but failed to propose precise implementation strategies for such recommendations. Only two guidelines provided specific recommendations. In the guideline bibliographic references, brief advice (BA) and multiple session strategies were identified as effective interventions. These interventions used Prochaska theory, motivational interviewing or cognitive-behavioral therapies. Self-help documentation alone was less effective than face-to-face counseling. Community-based or workplace public interventions alone did not seem effective. Discussion: Behavioral change strategies were effective in helping patients to give up smoking. BA alone was less effective than multiple session strategies although it required fewer resources. Evidence for community-based interventions effectiveness was weak, mainly due to the lack of robust studies.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Servicios de Salud Comunitaria , Consejo , Atención Primaria de Salud , Conducta de Reducción del Riesgo , Fumadores/psicología , Cese del Hábito de Fumar/psicología , Adolescente , Adulto , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Adulto Joven
14.
BMC Public Health ; 19(1): 1675, 2019 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-31830933

RESUMEN

BACKGROUND: This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by local community mental health specialists (CMHSs) who strive to connect at-risk youth to treatment and brief, adjunctive interventions piloted in past research. METHODS: Our primary aim is to evaluate which brief interventions, alone or in combination, have the greater effect on suicide ideation (primary outcome) and resilience (secondary outcome) among AI youth ages 10-24 ascertained for suicide-related behaviors by the tribal surveillance system. We are using a Sequential Multiple Assignment Randomized Trial with stratified assignment based on age and suicidal-behavior type, and randomizing N = 304 youth. Brief interventions are delivered by AI CMHSs, or by Elders with CMHS support, and include: 1) New Hope, an evidence-based intervention to reduce immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections; and 2) Elders' Resilience, a culturally-grounded intervention to promote resilience through connectedness, self-esteem and cultural identity/values. The control condition is Optimized Case Management, which all study participants receive. We hypothesize that youth who receive: a) New Hope vs. Optimized Case Management will have significant reductions in suicide ideation; b) Elders' Resilience vs. Optimized Case Management will have significant gains in resilience; c) New Hope followed by Elders' Resilience will have the largest improvements on suicide ideation and resilience; and d) Optimized Case Management will have the weakest effects of all groups. Our secondary aim will examine mediators and moderators of treatment effectiveness and sequencing. DISCUSSION: Due to heterogeneity of suicide risk/protective factors among AI youth, not all youth require the same types of interventions. Generating evidence for what works, when it works, and for whom is paramount to AI youth suicide prevention efforts, where rates are currently high and resources are limited. Employing Native paraprofessionals is a means of task-shifting psychoeducation, culturally competent patient support and continuity of care. TRIAL REGISTRATION: Clinical Trials NCT03543865, June 1, 2018.


Asunto(s)
Indios Norteamericanos/psicología , Suicidio/etnología , Suicidio/prevención & control , Adolescente , Niño , Femenino , Humanos , Indios Norteamericanos/estadística & datos numéricos , Masculino , Evaluación de Programas y Proyectos de Salud , Factores Protectores , Proyectos de Investigación , Resiliencia Psicológica , Factores de Riesgo , Ideación Suicida , Adulto Joven
15.
Prax Kinderpsychol Kinderpsychiatr ; 68(7): 639-653, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31711401

RESUMEN

Shame and Compassion: Potential Mechanisms Behind Bullying and Depressive Symptoms With a prevalence of 11 % depression is a relevant topic for child- and adolescent-psychiatry. Different factors play a role in genesis and maintenance of depressive symptoms. Shame-proneness and experience with bullying are discussed as reinforcing factors. On the other hand self-compassion is considered to be a protective factor. In this study it is analyzed, whether shame-proneness and self-compassion moderate the influence of bully-experience on depressive symptoms. Data of depressive adolescent in-patients (n = 37) and healthy controls (n = 19) is analyzed. It could be shown that high shame-proneness reinforces the influence of bully-experience on depressive symptoms. General self-compassion has no moderating influence. However, self-kindness is a protective factor against the negative impact of bully-experience on depressive symptoms. Results are discussed regarding their relevance for therapy and prevention.


Asunto(s)
Acoso Escolar/psicología , Depresión/psicología , Empatía , Factores Protectores , Vergüenza , Adolescente , Depresión/prevención & control , Depresión/terapia , Trastorno Depresivo/prevención & control , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Humanos
16.
Prog Cardiovasc Dis ; 62(5): 431-435, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31711788

RESUMEN

In the past five decades, cardiorespiratory fitness (CRF) has become fairly established as an important risk factor or marker for cardiovascular disease (CVD), as well as CVD - and all-cause mortality. Substantial evidence supports a strong inverse association between baseline levels of CRF and the risk of developing CVD risk factors, including dyslipidemia. Additionally, accumulating evidence also supports that maintaining or improving a certain level of CRF over time leads to a lower rate of developing CVD risk factors, such as dyslipidemia, and also improves survival. Recent evidence also supports the role of resistance exercise and muscular strength to reduce the development of metabolic syndrome and hypercholesterolemia and potentially reduce development of diabetes as well, in addition to improving survival. Therefore, great efforts are needed to increase both CRF and muscle strength with aerobic exercise and resistance exercise in the primary and secondary prevention of CVD.


Asunto(s)
Capacidad Cardiovascular , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/prevención & control , Estilo de Vida Saludable , Lípidos/sangre , Conducta de Reducción del Riesgo , Biomarcadores/sangre , Enfermedades Cardiovasculares/mortalidad , Dislipidemias/sangre , Dislipidemias/mortalidad , Estado de Salud , Humanos , Fuerza Muscular , Pronóstico , Factores Protectores , Entrenamiento de Resistencia , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
18.
Pan Afr Med J ; 33: 203, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692798

RESUMEN

Introduction: Medication-overuse headaches (MOHs) are the least studied of all headaches in Africa. Methods: We conducted a longitudinal study in order to describe our experience with patients placed in Neurology Outpatient observation in Brazzaville over a period of 4 years, from September 2010 to August 2014. All patients with chronic primary headaches, according to the International Classification of Headache Disorders (ICHD) (2nd edition), were included in the study. All patient with secondary headaches or who hadn't given consent were excluded. The patients were divided into two groups: those who had progressed to medication-overuse and those who didn't meet the criteria for medication-overuse (without-MOH). The variables used were the sociodemographic characteristics of patients, the clinical features of primary headaches and MOH treatment. Results: The study population was constituted by 193 patients out of 212. The average age of patients was 42 ± 14 years, of whom 66.32% were women. MOH rate was 35.75%. The associated factors were: early age (p=0.003), concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (p=0.0001) as well as self-medication (p<0.0001). By contrast, higher education (p<0.0001) and the use of NSAID alone (0.002) were protective factors against the onset of MOH. Ambulatory withdrawal was the most practiced treatment and amitriptyline was the most commonly used medication. Conclusion: Medication-overuse headaches are frequent in patients placed in Neurology Outpatient observation in Africa and deserve identification for a better management.


Asunto(s)
Cefaleas Secundarias/epidemiología , Trastornos de Cefalalgia/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Congo , Escolaridad , Femenino , Trastornos de Cefalalgia/terapia , Cefaleas Secundarias/terapia , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Protectores , Factores de Riesgo , Adulto Joven
19.
Clin Interv Aging ; 14: 1797-1815, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31695349

RESUMEN

Purpose: The main objective of this study was to investigate abuse of residents with either dementia or Alzheimer's disease in long-term care settings, to identify facilitators and barriers surrounding implementation of systems to prevent such occurrences, and to draw conclusions on combating the issue of abuse. Patients and methods: A systematic review was conducted using the Medline, CINAHL, and Academic Search Ultimate databases. With the use of key terms via Boolean search, 30 articles were obtained which were determined to be germane to research objectives. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Residents with dementia or Alzheimer's disease are at greater risk of abuse. The growing population could increase this problem exponentially. The most common facilitators were the introduction of policies/programs in the facility, education, and working conditions. The most cited barriers were poor training, lack of research, and working conditions in the long-term care setting. Conclusion: The examples given would be useful in minimizing the potential for abuse in the long-term care setting. Leadership can take an active role in the prevention of abuse of the elderly through their actions, education of employees, and changes in the work environment.


Asunto(s)
Enfermedad de Alzheimer , Maltrato al Anciano/prevención & control , Personal de Salud/educación , Política Organizacional , Lugar de Trabajo/organización & administración , Anciano , Enfermedad de Alzheimer/psicología , Demencia/psicología , Hogares para Ancianos/organización & administración , Humanos , Cuidados a Largo Plazo , Casas de Salud/organización & administración , Factores Protectores , Factores de Riesgo
20.
Nutr Metab Cardiovasc Dis ; 29(12): 1273-1287, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31669106

RESUMEN

AIMS: Dietary pattern (DP) analysis has emerged as a holistic method to understand the effects of food intake on health outcomes. Though dietary intake has been associated with cardiovascular disease, the association of DPs and carotid intima-media thickness (CIMT), a robust early marker of cardiovascular disease progression has not been comprehensively investigated. This study systematically explores the association of a posteriori and a priori DPs and CIMT. DATA SYNTHESIS: Through a systematic search of MEDLINE, CINAHL, and Web of Science, twenty studies that derived DPs using a posteriori or a priori methods with CIMT as an outcome were included. Four cross-sectional studies and 1 cohort paper reported a statistically significant association between increased consumption of 'unhealthy' foods (i.e processed meat, soda drinks and refined grain) and increased CIMT. While four cross-sectional studies reported a statistically significant association of DPs characterized by increased consumption of 'healthy' foods (i.e fruit and vegetables, fish) and decreased CIMT. DPs derived from each study varied depending on derivation method, study design and use of dietary data collection method. CONCLUSION: Findings from this review are generally supportive of a trend between DPs with higher consumption of 'healthy' foods and lower consumption of 'unhealthy' foods and decreased CIMT; however, the association was largely not statistically significant. Evidence was overwhelmingly heterogeneous due to differences seen in DPs based on location and culture, sample characteristics and adjustment for confounders. Long-term prospective observational and interventional studies with standardized sample selection and dietary data collection are needed to significantly establish the role of DPs on CIMT.


Asunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Dieta , Conducta Alimentaria , Conducta de Reducción del Riesgo , Adulto , Anciano , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/prevención & control , Dieta/efectos adversos , Dieta Mediterránea , Enfoques Dietéticos para Detener la Hipertensión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Nutritivo , Valor Predictivo de las Pruebas , Prevención Primaria , Pronóstico , Factores Protectores , Ingesta Diaria Recomendada , Medición de Riesgo , Factores de Riesgo
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