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2.
Transl Behav Med ; 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34487181

RESUMO

Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.

3.
J Patient Exp ; 8: 23743735211034962, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395851

RESUMO

Trying to care for patients with medically unexplained symptoms (MUS) can lead to frustration and disappointment for both patients and health care professionals alike. Learning positive ways to assist patients avoids professionals collapsing into therapeutic nihilism. We sought to understand how people with such symptoms can live well despite (or even because of) their condition. Chronic fatigue was chosen as the exemplar symptom. Participants were invited to join the research if they, themselves, considered they were living well with this symptom. One-on-one interviews using an appreciative enquiry approach were performed and thematic analysis undertaken. Twelve participants were interviewed before data saturation occurred. The emotional stance or relationship a participant had with, and towards, their illness was the primary determinant underlying their interpretation of "living well." Five major themes of this meta-theme were identified: (1) engaging with elusiveness, (2) befriending uncertainty, (3) reflecting on self, (4) living creatively, and (5) moving in stillness. Encouraging patients who are struggling with MUS to consider how they emotionally engage with their illness via these 5 positive dynamics may lead to better health outcomes for patients and happier, more fulfilled health care professionals.

4.
Am J Transplant ; 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34331749

RESUMO

Porcine cells devoid of three major carbohydrate xenoantigens, αGal, Neu5GC, and SDa (TKO) exhibit markedly reduced binding of human natural antibodies. Therefore, it is anticipated that TKO pigs will be better donors for human xenotransplantation. However, previous studies on TKO pigs using old world monkeys (OWMs) have been disappointing because of higher anti-TKO pig antibodies in OWMs than humans. Here, we show that long-term survival of renal xenografts from TKO pigs that express additional human transgenes (hTGs) can be achieved in cynomolgus monkeys. Kidney xenografts from TKO-hTG pigs were transplanted into eight cynomolgus recipients without pre-screening for low anti-pig antibody titers. Two recipients of TKO-hTG xenografts with low expression of human complement regulatory proteins (CRPs) (TKO-A) survived for 2 and 61 days, whereas six recipients of TKO-hTG xenografts with high CRP expression (TKO-B) survived for 15, 20, 71, 135, 265, and 316 days. Prolonged CD4+ T cell depletion and low anti-pig antibody titers, which were previously reported important for long-term survival of αGal knock-out (GTKO) xenografts, were not always required for long-term survival of TKO-hTG renal xenografts. This study indicates that OWMs such as cynomolgus monkeys can be used as a relevant model for clinical application of xenotransplantation using TKO pigs.

5.
J Am Geriatr Soc ; 69(11): 3232-3241, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34325481

RESUMO

BACKGROUND: Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. We describe the PRIME-KNEE study as an example of ongoing research to validate provocative clinical tests and biomarkers that predict resilience to specific health stressors. METHODS: PRIME-KNEE is an ongoing, prospective cohort study that will enroll 250 adults ≥60 years undergoing total knee arthroplasty. Data are collected at baseline (pre-surgery), during surgery, daily for 7 days after surgery, and at 1, 2, 4, and 6 months post-surgery. Provocative tests include a cognition-motor dual-task walking test, cerebrovascular reactivity assessed by functional near-infrared spectroscopy, peripheral blood mononuclear cell reactivity ex vivo to lipopolysaccharide toxin and influenza vaccine, and heart rate variability during surgery. Cognitive, psychological, and physical performance batteries are collected at baseline to estimate prestressor reserve. Demographics, medications, comorbidities, and stressor characteristics are abstracted from the electronic medical record and via participant interview. Blood-based biomarkers are collected at baseline and postoperative day 1. Repeated measures after surgery include items from a delirium assessment tool and pain scales administered daily by telephone for 7 days and cognitive change index (participant and informant), lower extremity activities of daily living, pain scales, and step counts assessed by Garmin actigraphy at 1, 2, 4, and 6 months after surgery. Statistical models use these measures to characterize resilience phenotypes and evaluate prestressor clinical indicators associated with poststressor resilience. CONCLUSION: If PRIME-KNEE validates feasible clinical tests and biomarkers that predict recovery trajectories in older surgical patients, these tools may inform surgical decision-making, guide pre-habilitation efforts, and elucidate mechanisms underlying resilience. This study design could motivate future geriatric research on resilience.

6.
Transl Behav Med ; 11(9): 1676-1681, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34080638

RESUMO

The Veterans Health Administration (VHA) is undergoing a transformational shift from disease-focused care to a Whole Health model that emphasizes physical, mental, emotional, and spiritual health and well-being. As this shift is occurring, women veterans using VHA services face challenges navigating a system that has historically served a primarily male demographic, without consistent consensus on which services require specialization by gender. A quality improvement project was conducted to solicit feedback on VHA behavioral and wellness programs from women veterans enrolled in VHA mental healthcare services. A multi-disciplinary work group of clinical researchers and healthcare providers developed a needs assessment survey to assess patient needs and preferences for behavioral health services. A convenience sample of female veterans using VHA mental healthcare services within a comprehensive Women's Health Clinic were invited to complete this anonymous survey. 107 women Veterans 18-65+ years old (65.3% African American; 5.9% LatinX; 54.2% aged under 55) completed the survey. Over 50% of patients endorsed relationships, physical activity, sleep/nightmares, pain management, anger, or spiritual/moral pain as top wellness priorities. Programatic preferences included location (located at the main VA Hospital) and gender composition (female only group formats). Schedule conflicts were the most frequently cited barriers. Results from this quality improvement project highlight considerations for tailoring the content and delivery of behavioral services for women veterans with mental health conditions.


Assuntos
Serviços de Saúde Mental , Veteranos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos , Adulto Jovem
7.
Eur J Med Genet ; 64(9): 104234, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34082156

RESUMO

In this report, we describe an unusual case of progressive hemifacial atrophy or Parry-Romberg syndrome in a 10-year-old girl with progressive hemifacial microsomia and limb anomalies who had brain magnetic resonance imaging (MRI) findings of white matter hyper-intensities. Patients typically present with neurological manifestations such as epilepsy, facial pain, and migraines and ophthalmological symptoms in conjunction with white matter lesions. The patient demonstrated normal cognition and psychomotor development despite the presence of white matter lesions in her frontal lobe that is commonly associated with neurological symptoms. This report brings attention to the complicated relationship between facial, limb and brain imaging findings in Parry-Romberg syndrome and differentiates it from hemifacial microsomia syndrome.


Assuntos
Encéfalo/patologia , Hemiatrofia Facial/patologia , Síndrome de Goldenhar/patologia , Deformidades Congênitas dos Membros/patologia , Encéfalo/diagnóstico por imagem , Criança , Hemiatrofia Facial/genética , Feminino , Síndrome de Goldenhar/genética , Humanos , Deformidades Congênitas dos Membros/genética , Fenótipo
8.
West J Nurs Res ; : 1939459211024646, 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34137309

RESUMO

COVID-19 greatly impacted nursing education and required nursing faculty and students to quickly adapt to changes caused by disease mitigation. The purpose of this study was to examine the mediating effects of resilience between the influence of demographics and school-related risk factors and nursing faculty and student quality of life (QoL) during the COVID-19 pandemic. A secondary data analysis was conducted using structural equation modeling to examine the mediating role of resilience on latent variables. Resilience had a positive, direct effect on nursing faculty and student QoL. Having a designated home workspace and being well-prepared for online learning had positive, indirect effects on QoL, mediated through resilience. Assisting children with schoolwork had a negative impact on the psychological and environmental QoL domains. Remarkably, having a caregiver role positively influenced the psychological QoL domain. Supporting and promoting faculty and nursing students' health and well-being is imperative during and after the pandemic.

9.
Br J Pharmacol ; 178(17): 3463-3475, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33864386

RESUMO

BACKGROUND AND PURPOSE: Reduced bioavailability of NO, a hallmark of sickle cell disease (SCD), contributes to intravascular inflammation, vasoconstriction, vaso-occlusion and organ damage observed in SCD patients. Soluble guanylyl cyclase (sGC) catalyses synthesis of cGMP in response to NO. cGMP-amplifying agents, including NO donors and phosphodiesterase 9 inhibitors, alleviate TNFα-induced inflammation in wild-type C57BL/6 mice and in 'humanised' mouse models of SCD. EXPERIMENTAL APPROACH: Effects of the sGC stimulator olinciguat on intravascular inflammation and renal injury were studied in acute (C57BL6 and Berkeley mice) and chronic (Townes mice) mouse models of TNFα-induced and systemic inflammation associated with SCD. KEY RESULTS: Acute treatment with olinciguat attenuated increases in plasma biomarkers of endothelial cell activation and leukocyte-endothelial cell interactions in TNFα-challenged mice. Co-treatment with hydroxyurea, an FDA-approved SCD therapeutic agent, further augmented the anti-inflammatory effect of olinciguat. In the Berkeley mouse model of TNFα-induced vaso-occlusive crisis, a single dose of olinciguat attenuated leukocyte-endothelial cell interactions, improved blood flow and prolonged survival time compared to vehicle-treated mice. In Townes SCD mice, plasma biomarkers of inflammation and endothelial cell activation were lower in olinciguat- than in vehicle-treated mice. In addition, kidney mass, water consumption, 24-h urine excretion, plasma levels of cystatin C and urinary excretion of N-acetyl-ß-d-glucosaminidase and neutrophil gelatinase-associated lipocalin were lower in Townes mice treated with olinciguat than in vehicle-treated mice. CONCLUSION AND IMPLICATIONS: Our results suggest that the sGC stimulator olinciguat attenuates inflammation, vaso-occlusion and kidney injury in mouse models of SCD and systemic inflammation.


Assuntos
Anemia Falciforme , Doenças Vasculares , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Animais , Humanos , Inflamação , Camundongos , Camundongos Endogâmicos C57BL , Guanilil Ciclase Solúvel
10.
J Am Geriatr Soc ; 69(7): 1846-1855, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33755991

RESUMO

BACKGROUND: Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE: This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults. DESIGN: Qualitative research PARTICIPANTS: Semi-structured interviews and focus groups were conducted with medically-ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system. APPROACH: Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model. KEY RESULTS: A consistent theme among patients and providers was that "mobility is medicine." Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient-provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines. CONCLUSION: Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.


Assuntos
Deambulação Precoce/psicologia , Estado Funcional , Pacientes Internados/psicologia , Recursos Humanos em Hospital/psicologia , Caminhada/psicologia , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Limitação da Mobilidade , Pesquisa Qualitativa
11.
Nurse Educ ; 46(3): 143-148, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33417408

RESUMO

BACKGROUND: COVID-19 and the associated measures to mitigate the spread of the virus have significantly disrupted nursing education. PURPOSE: The purpose of this study was to examine the relationship between quality of life (QoL), resilience, and associated factors among nursing students during the unprecedented COVID-19 pandemic and subsequent social distancing requirements. METHODS: A cross-sectional study using an anonymous survey with nursing students (n = 152) was conducted at a public university in rural Appalachia in April 2020. Instruments included World Health Organization Quality of Life-BREF, Connor Davidson Resilience Scale, demographics and school-related questionnaires, and an open-ended question. Data were analyzed using descriptive, bivariate, and multiple linear regression analyses. RESULTS: Resilience, having online experience, and being well prepared for online learning were associated with each QoL domain. Remarkably, 21% to 54% of nursing student QoL scores indicated poor QoL. CONCLUSIONS: Cultivating resilience among nursing students may improve QoL, help with academic success, and prepare students to sustain the demands associated with the nursing profession.


Assuntos
COVID-19 , Educação à Distância , Qualidade de Vida , Resiliência Psicológica , Estudantes de Enfermagem/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Distanciamento Físico , Fatores Socioeconômicos , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
12.
J Pharm Pract ; 34(5): 755-760, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32089040

RESUMO

OBJECTIVE: In cases of oral factor Xa (FXa) inhibitor-associated acute major bleeding, several reversal strategies are available. Current guidelines recommend a dose of 50 U/kg if using 4-factor prothrombin complex concentrate (4F-PCC). A paucity of data exists with the use of 4F-PCC for FXa inhibitor reversal for acute major bleeding, specifically the most efficacious dosing regimens and safety data. The purpose of this case series is to describe the utilization of 4F-PCC for reversal of oral FXa inhibitor-associated acute major bleeding. METHODS: This retrospective case series included all admitted patients 18 years and older who received 4F-PCC for oral FXa inhibitor-associated major bleeding. Major bleeding was defined using the International Society of Thrombosis and Hemostasis definition for major bleeding in nonsurgical patients. The primary outcome was achievement of hemostasis. RESULTS: A total of 31 patients met inclusion criteria, with 17 receiving rivaroxaban and 14 receiving apixaban. Intracranial hemorrhage was the most common type of bleeding occurring in 15 (55%) patients. The median dose of 4F-PCC was 37 U/kg. Of the patients evaluated in the primary end point analysis, 68% achieved effective hemostasis. Four (12.9%) patients experienced a documented thrombotic event within 7 days of receiving 4F-PCC. CONCLUSION: The use of 4F-PCC for FXa inhibitor-associated acute major bleeding was effective for the majority of patients. The rate of thrombotic events appears higher compared to previously published studies, although major confounders exist and larger studies are needed to fully evaluate the safety of 4F-PCC for this indication.


Assuntos
Fatores de Coagulação Sanguínea , Inibidores do Fator Xa , Anticoagulantes , Inibidores do Fator Xa/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Humanos , Estudos Retrospectivos
13.
Transl Behav Med ; 11(2): 686-691, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-32535635

RESUMO

Compared to their male counterparts, women experience alarmingly high rates of sexual violence (SV). Nearly 20% of women in the USA have been victims of SV, and prevalence of sexual assault among female service members is reported to be even higher, up to 50%. SV results in negative health outcomes like posttraumatic stress disorder, depression, obesity, poor body image, and pain-related disability. Exercise has been shown to positively impact both mental and physical health outcomes in populations experiencing posttraumatic symptoms, yet women survivors of SV are often excluded from exercise trials in trauma-affected populations. The purpose of this paper is to comment on the importance of incorporating women-specific trauma-informed principles in the content and delivery of exercise interventions in trauma-affected populations, particularly as it relates to SV. Researchers discuss the implications of female-specific and trauma-informed exercise considerations for SV survivors. This commentary highlights the need for trauma-informed implementation efforts and outcome measurements in exercise interventions involving women affected by SV. Researchers call for (a) increased qualitative work on trauma-specific implementation efforts across exercise intervention domains and (b) increased assessment of trauma-specific outcomes in exercise trials.


Assuntos
Pessoas com Deficiência , Delitos Sexuais , Transtornos de Estresse Pós-Traumáticos , Exercício Físico , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/terapia , Sobreviventes
14.
J Eval Clin Pract ; 27(5): 1194-1204, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33089607

RESUMO

RATIONALE, AIMS, AND OBJECTIVES: Uncertainty is a complex and constant phenomenon in clinical practice. How medical students recognize and respond to uncertainty impacts on their well-being, career choices, and attitudes towards patients. It has been suggested that curricula should do more to prepare medical students for an uncertain world. In order to teach medical students about uncertainty, we need to understand how uncertainty has been conceptualized in the literature to date. The aim of this article is to explore existing models of uncertainty and to develop a framework of clinical uncertainty to aid medical education. METHOD: A scoping literature review was performed to identify conceptual models of uncertainty in healthcare. Content and inductive analyses were performed to explore three dimensions of clinical uncertainty: sources of uncertainty, subjective influencers and responses to uncertainty. RESULTS: Nine hundred one references were identified using our search strategy, of which, 24 met our inclusion criteria. It was possible to classify these conceptual models using one or more of three dimensions of uncertainty; sources, subjective influencers, and responses. Exploration and further classification of these dimensions led to the development of a framework of uncertainty for medical education. CONCLUSION: The developed framework of clinical uncertainty highlights sources, subjective influencers, responses to uncertainty, and the dynamic relationship among these elements. Our framework illustrates the different aspects of knowledge as a source of uncertainty and how to distinguish between those aspects. Our framework highlights the complexity of sources of uncertainty, especially when including uncertainty arising from relationships and systems. These sources can occur in combination. Our framework is also novel in how it describes the impact of influencers such as personal characteristics, experience, and affect on perceptions of and responses to uncertainty. This framework can be used by educators and curricula developers to help understand and teach about clinical uncertainty.


Assuntos
Educação Médica , Estudantes de Medicina , Tomada de Decisão Clínica , Currículo , Humanos , Incerteza
15.
Nurse Educ ; 46(1): 17-22, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32941307

RESUMO

BACKGROUND: The COVID-19 pandemic and subsequent social distancing guidelines greatly impacted the quality of life (QoL) of nursing faculty. PURPOSE: The purpose of this study was to examine the relationship of QoL, resilience, and associated factors among nursing faculty during the COVID-19 pandemic. METHODS: In April 2020, a cross-sectional, anonymous survey was conducted with nursing faculty in a public university in rural Appalachia (n = 52). Instruments included QoL, resilience scales, work-related, and demographic variables. Descriptive, bivariate, and multiple linear regression analyses were used to analyze data. A content analysis was used to analyze an open-ended question. RESULTS: Resilience was the strongest variable to predict each of the QoL domains. Nursing faculty who reported better QoL were those who were able to adapt to changes and challenges mandated during the COVID-19 pandemic. CONCLUSIONS: Evidence-based programs to build resilience and improve nursing faculty working conditions and their QoL are needed.


Assuntos
COVID-19/psicologia , Docentes de Enfermagem/psicologia , Qualidade de Vida , Resiliência Psicológica , Adulto , Região dos Apalaches , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Distanciamento Físico , SARS-CoV-2 , Inquéritos e Questionários
16.
Ann Intern Med ; 174(3): 298-307, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33370174

RESUMO

BACKGROUND: Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs. OBJECTIVE: To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). DESIGN: Randomized controlled trial. (ClinicalTrials.gov: NCT02653768). SETTING: 2 U.S. Department of Veterans Affairs sites. PARTICIPANTS: 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. INTERVENTION: Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. MEASUREMENTS: Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. RESULTS: In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. LIMITATION: Participants were mostly male veterans, and follow-up was limited. CONCLUSION: Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. PRIMARY FUNDING SOURCE: Department of Veterans Affairs, Health Services Research and Development Service.


Assuntos
Terapia por Exercício/métodos , Osteoartrite do Joelho/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
J Am Geriatr Soc ; 69(4): 1045-1050, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33368144

RESUMO

OBJECTIVE: Post-traumatic stress disorder (PTSD) is common in Veterans. Symptoms can perpetuate into late life, negatively impacting physical and mental health. Exercise and social support are beneficial in treating anxiety disorders such as PTSD in the general population, although less is known about the impact on Veterans who have lived with PTSD for decades. This study assessed associations between social connectedness, physical function and self-reported change in PTSD symptoms among older Veterans specifically participating in Gerofit. DESIGN: Prospective clinical intervention. SETTING: Twelve sites of Veterans Affairs (VA) Gerofit exercise program across the United States. PARTICIPANTS: Three hundred and twenty one older Veteran Gerofit participants (mean age = 74) completed physical assessments and questionnaires regarding physical and emotional symptoms and their experience. MEASUREMENTS: Measures of physical function, including 30-second chair stands, 10-m and 6-min walk were assessed at baseline and 3 months; change in PTSD symptoms based on the Diagnostic Statistical Manual-5 (DSM-5) assessed by a self-report questionnaire; and social connection measured by the Relatedness Subscale of the Psychological Need Satisfaction in Exercise scale (PNSE) were evaluated after 3 months of participation in Gerofit. RESULTS: Ninety five (29.6%) Veterans reported PTSD. Significant improvement was noted in self-rated PTSD symptoms at 3 months (P < .05). Moderate correlation (r = .44) was found between social connectedness with other participants in Gerofit and PTSD symptom improvement for those Veterans who endorsed improvement (n = 59). All participants improved on measures of physical function. In Veterans who endorsed PTSD there were no significant associations between physical function improvement and PTSD symptoms. CONCLUSION: Veterans with PTSD that participated in Gerofit group exercise reported symptom improvement, and social connectedness was significantly associated with this improvement. In addition to physical health benefits, the social context of Gerofit may offer a potential resource for improving PTSD symptoms in older Veterans that warrants further study.


Assuntos
Educação/métodos , Exercício Físico , Sistemas de Apoio Psicossocial , Interação Social , Transtornos de Estresse Pós-Traumáticos , Veteranos , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Saúde Mental , Desempenho Físico Funcional , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Inquéritos e Questionários , Estados Unidos , Veteranos/psicologia , Veteranos/estatística & dados numéricos
18.
Chronic Dis Transl Med ; 7(1): 14-26, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33251031

RESUMO

A significant number of SARS-CoV-2 (COVID-19) pandemic patients have developed chronic symptoms lasting weeks or months which are very similar to those described for myalgic encephalomyelitis/chronic fatigue syndrome. This study reviews the current literature and understanding of the role that mitochondria, oxidative stress and antioxidants may play in the understanding of the pathophysiology and treatment of chronic fatigue. It describes what is known about the dysfunctional pathways which can develop in mitochondria and their relationship to chronic fatigue. It also reviews what is known about oxidative stress and how this can be related to the pathophysiology of fatigue, as well as examining the potential for specific therapy directed at mitochondria for the treatment of chronic fatigue in the form of antioxidants. This study identifies areas which require urgent, further research in order to fully elucidate the clinical and therapeutic potential of these approaches.

19.
J Spec Pediatr Nurs ; 26(1): e12313, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32970924

RESUMO

PURPOSE: The purpose of this study was to examine the feasibility and preliminary effectiveness of using wearable activity tracker technology, integrated with altruistic motivation in children to increase physical activity (PA), fitness, and prosocial behavior. DESIGN AND METHODS: A quasiexperimental design was employed in two 4th grade classrooms in a rural southern state. The intervention was a wearable PA tracker and a web-based curriculum with activities to earn power points redeemable to provide life-saving food to undernourished kids internationally. Seventeen children in the intervention group participated in the 10-week PA program and 18 children were in the wait listed control group. Three measures were assessed in both groups at baseline and postintervention: (a) PA measured with accelerometers, (b) fitness levels measured with shuttle run, and (c) prosocial behavior measured with Strengths and Difficulties questionnaire. RESULTS: Of the 35 children enrolled, the majority were nine years old (n = 28), black (n = 31) and female (n = 23). An overall enrollment rate of 88%, attrition rate of 9%, and an accelerometer noncompliance rate of 25% was determined to assess feasibility. There was no statistical significance between the control and intervention group outcome variables. The average minutes of PA in the control group decreased 8 min from baseline to postintervention (p = .05). In the intervention group, PA decreased by 10 min from baseline to postintervention (p = .12). In both the control and intervention groups, prosocial behavior scores decreased (p = .09 control; p = .62 intervention). The fitness scores, VO2 max, did not significantly change (intervention p = .21; control p = .35). PRACTICE IMPLICATIONS: Developing effective interventions that foster PA and dissuade sedentary behaviors are essential to enhancing PA and fitness levels. The recruitment, retention, and accelerometer wear adherence suggest this setting, with this population is feasible. The intervention is deliverable, however, the potential of wearable activity trackers and the effect of prosocial behavior that benefits others in increasing PA and improving cardiorespiratory fitness, should be further researched by building on the successful elements of this study.


Assuntos
Monitores de Aptidão Física , Dispositivos Eletrônicos Vestíveis , Adolescente , Altruísmo , Criança , Exercício Físico , Estudos de Viabilidade , Feminino , Humanos , Motivação , Aptidão Física , Tecnologia
20.
Am J Geriatr Psychiatry ; 29(6): 565-572, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33162307

RESUMO

OBJECTIVE: Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention. DESIGN: Qualitative study. SETTING: Face-to-face semistructured interviews conducted after the Warrior Wellness trial was completed. PARTICIPANTS: Fifteen veterans (100% male, 93% African American or Black, 100% non-Hispanic or Latinx, average age = 68.7 years) who completed the Warrior Wellness exercise program. MEASUREMENTS: Semistructured interviews were conducted using an interview guide that assessed veterans' experience in Warrior Wellness and recommendations for future intervention modifications. Interviews were subsequently transcribed and analyzed by thematic analysis. RESULTS: Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains. Finally, veterans provided several suggestions for modifying the intervention such as increasing its duration, adding a nutritional component, and including significant others in enrollment. CONCLUSIONS: This study offers valuable insights into the intervention and interpersonal factors that veterans view as important for their engagement in exercise, the perceived benefits of exercise, and the ways in which interventions designed for this population can be refined.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Afro-Americanos , Idoso , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/terapia
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