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1.
Health Expect ; 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33621426

RESUMO

INTRODUCTION: The aim of this study is to analyse different ways of participation during the development of a clinical guideline to improve the early detection of psychosis and to deploy a comprehensive treatment plan to improve prognosis and social integration. MATERIALS AND METHOD: The clinical guideline was developed using the ADAPTE method with the participation of 40 authors and 80 external reviewers. The process was divided into three major phases: set up, adaptation and finalization. During adaptation and completion, a total of 44 patients and 18 family caregivers were involved. RESULTS AND CONCLUSIONS: The different roles assumed by the patients and their family caregivers were described, depending on the panel in which they participated, with diverse grades of complexity: a user as author, integration of the results of qualitative research with the participation of local users and family caregivers, 13 users as individual external reviewers and the participation of users and caregiver organizations in the external review. In the guideline, contributions from patients during the qualitative research were included in an innovative way, placing them just behind the recommendations. On the other hand, the results of the family caregivers' study were included in a specific area of uncertainty. Further, the expressed point of view was considered as the collective demands of users and family caregivers' organizations in the cost-benefit analysis made by the organizing committee. There were diverse ways to conduct direct patient participation during the guideline development, ensuring that their individual experiences contributed significantly to the final version.

2.
J Med Internet Res ; 22(6): e15845, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501276

RESUMO

BACKGROUND: Primary care is a major access point for the initial treatment of depression, but the management of these patients is far from optimal. The lack of time in primary care is one of the major difficulties for the delivery of evidence-based psychotherapy. During the last decade, research has focused on the development of brief psychotherapy and cost-effective internet-based interventions mostly based on cognitive behavioral therapy (CBT). Very little research has focused on alternative methods of treatment for depression using CBT. Thus, there is a need for research into other therapeutic approaches. OBJECTIVE: This study aimed to assess the effectiveness of 3 low-intensity, internet-based psychological interventions (healthy lifestyle psychoeducational program [HLP], focused program on positive affect promotion [PAPP], and brief intervention based on mindfulness [MP]) compared with a control condition (improved treatment as usual [iTAU]). METHODS: A multicenter, 4-arm, parallel randomized controlled trial was conducted between March 2015 and March 2016, with a follow-up of 12 months. In total, 221 adults with mild or moderate major depression were recruited in primary care settings from 3 Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of the Patient Health Questionnaire-9 (PHQ-9) from pretreatment (time 1) to posttreatment (time 2) and up to 6 (time 3) and 12 (time 4) months' follow-up. Secondary outcomes included the visual analog scale of the EuroQol, the Short-Form Health Survey (SF-12), the Positive and Negative Affect Schedule (PANAS), and the Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages. RESULTS: A moderate decrease was detected in PHQ-9 scores from HLP (ß=-3.05; P=.01) and MP (ß=-3.00; P=.01) compared with iTAU at posttreatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding well-being, MP and PAPP reported better PHI results than iTAU at 6 months post treatment. PAPP intervention significantly decreased PANAS negative affect scores compared with iTAU 12 months after treatment. CONCLUSIONS: The low-intensity, internet-based psychological interventions (HLP and MP) for the treatment of depression in primary care are more effective than iTAU at posttreatment. Moreover, all low-intensity psychological interventions are also effective in improving medium- and long-term quality of life. PAPP is effective for improving health-related quality of life, negative affect, and well-being in patients with depression. Nevertheless, it is important to examine possible reasons that could be implicated for PAPP not being effective in reducing depressive symptomatology; in addition, more research is still needed to assess the cost-effectiveness analysis of these interventions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN82388279; http://www.isrctn.com/ISRCTN82388279. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-015-0475-0.

3.
Int J Qual Health Care ; 32(6): 356-363, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32427320

RESUMO

OBJECTIVE: The aim was to develop a clinical guideline for managing generalised anxiety disorder in Primary Health Care and Mental Health, using guideline adaptation methods. DESIGN: A clinical guideline was developed, following the methods of the ADAPTE group, and implemented in a Primary Health Care District and in Mental Health Services in Spain. SETTING: Regional University Hospital of Málaga and District of Primary Health Care Málaga-Guadalhorce (Spain). PARTICIPANTS: The participants were family physicians, psychiatrists and clinical psychologists. The phases of the process included definition of clinical scenarios, literature search and guidelines appraisal, elaboration of recommendations, conducting focus groups with users diagnosed with generalised anxiety disorder, linking the testimonials of users with recommendations, external review and implementation by multifaceted interventions. RESULTS: The final release included 49 Recommendations, of which 47 are from the 2011 NICE guidance for GAD and 2 of the 2011 NICE guideline for common mental disorder. Finally, seven recommendations needed to be adapted to the Spanish health care context, and three recommendations were excluded. CONCLUSIONS: A guideline aimed to improve the quality and effectiveness of the care provided to people with generalised anxiety disorder has been released. The use of adaptation methods has simplified the use of resources and time. This guideline and the process designed for its implementation constitute a suitable collection of resources for the improvement on detection and treatment of GAD in primary health care. Adaptation methods play a key role in the knowledge translation continuum.

4.
Int J Ment Health Nurs ; 29(3): 521-530, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31908140

RESUMO

To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision-making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision-making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.

5.
Behav Brain Res ; 381: 112442, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-31862469

RESUMO

It is known that electrical stimulation of the external lateral parabrachial nucleus (NLPBe) can sustain concurrent taste and place learning. Place preferences can be learned through different procedures. Previous studies demonstrated that electrical stimulation of the PBNLe can generate aversive and preference place learning using concurrent procedures. In the concurrent procedure, the animals can move freely in the maze, and intracranial electrical stimulation is associated with their voluntary stay in one of the two maze compartments. However, the rewarding properties of most stimuli, whether natural or drugs of abuse, have usually been investigated using the sequential procedure, in which animals are confined while receiving the unconditioned stimulus and then undergo a choice test without stimulation in a later phase. This study examined whether this stimulation can sustain place preference learning in sequential tasks. Results demonstrated that place preferences can also be induced by the electrical stimulation of the NLBe using sequential procedures. These findings suggest that the NLPBe may form part of a brain reward axis that shares certain characteristics with those observed in the processing of natural rewarding agents and especially of drugs of abuse.

6.
Behav Brain Res ; 336: 15-21, 2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-28844853

RESUMO

Electrical stimulation of the parabrachial complex and related insular cortex induces concurrent conditioned place preference (CPP) in a naloxone-dependent manner. Furthermore, repeated rewarding activation of these regions generates tolerance, i.e., a reduction of the reinforcing effect. This study examined the effects of contingent and non-contingent stimulation in a CPP task. In the former modality, the animals can voluntarily select areas of the maze and thereby determine whether or not they receive stimulation. In the non-contingent procedure, the animals passively receive the administration of the rewarding electrical current while confined in the preferred place. Tolerance to the rewarding stimulation was observed in the non-contingent procedure, in which the external lateral parabrachial subnucleus (LPBe) was stimulated in a behaviorally passive task, but not in the contingent procedure. In contrast, no tolerance was observed in the group receiving rewarding stimulation of the lateral hypothalamus after either contingent or non-contingent brain activation. These findings are discussed in terms of the rewarding effects induced after contingent or non-contingent administration of electrical or chemical rewarding agents.


Assuntos
Tolerância a Medicamentos/fisiologia , Região Hipotalâmica Lateral/fisiologia , Núcleos Parabraquiais/fisiologia , Animais , Comportamento Animal/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Condicionamento Clássico/fisiologia , Estimulação Encefálica Profunda/métodos , Estimulação Elétrica/métodos , Masculino , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Ratos , Ratos Wistar , Recompensa , Técnicas Estereotáxicas
7.
Acta Neurobiol Exp (Wars) ; 77(3): 236-243, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29182614

RESUMO

The parabrachial complex has been related to the processing of both rewarding and aversive signals. This pontine area is activated after the gastrointestinal administration of rewarding nutrients, in taste aversion learning, and in response to the reinforcing and aversive effects of some drugs of abuse. Electrical stimulation of this region can induce, in different animals, preference or aversion behaviors towards a place in a rectangular three-chamber maze task. This study examined the effect of tiapride, a D2/D3 receptor antagonist, on the aversive or rewarding effects induced by electrical stimulation of the external lateral parabrachial subnucleus (NLPBe). As previously observed, administration of tiapride interrupted the aversive effect induced by NLPBe electrical stimulation. However, in contrast to the effects of dopamine antagonists on other rewarding systems, tiapride did not impair the place preference induced by NLPBe stimulation, an activation effect that is subject to tolerance. Tiapride administration also appeared to have no effect on the horizontal motor activity (crossings) of the electrically stimulated animals. We discuss the specific relevance of parabrachial reward with respect to other reinforcing brain components or systems, especially in relation to the preference effect of drugs of abuse, such as opiates, after dopamine antagonist administration.


Assuntos
Antipsicóticos/farmacologia , Aprendizagem da Esquiva/efeitos dos fármacos , Condicionamento Operante/efeitos dos fármacos , Núcleos Parabraquiais/fisiologia , Recompensa , Cloridrato de Tiaprida/farmacologia , Análise de Variância , Animais , Relação Dose-Resposta a Droga , Estimulação Elétrica/métodos , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Distribuição Aleatória , Ratos , Ratos Wistar
8.
Psychiatr Serv ; 68(8): 759-761, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28669282

RESUMO

Depression is the most frequent psychiatric disorder in primary health care, and the evidence shows that there is suboptimal management by primary care practitioners, perhaps owing to difficulties in decision making. Because clinical guidelines can improve decision making and management, a clinical guideline to manage depression in primary health care was developed in adherence to the ADAPTE method and was implemented in the Málaga Primary Health Care District in Spain. This column reports on the guideline development process, which produced a set of resources to improve the quality of primary health care-based depression care in Spain.


Assuntos
Tomada de Decisão Clínica , Depressão/terapia , Transtorno Depressivo/terapia , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/normas , Humanos , Espanha
9.
Neurobiol Learn Mem ; 136: 21-27, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27660078

RESUMO

The parabrachial complex is known to participate in various rewarding and aversive processes, including those related to the learning of taste or place discrimination and the motivational effects of drugs of abuse, such as morphine. This study shows that electrical stimulation of the external lateral parabrachial (LPBe) subnucleus induces consistent place avoidance or place preference in three-compartment rectangular mazes. Administration of naloxone, an opiate antagonist, blocks both motivational effects induced by the intracranial electrical stimulation. Subsequent re-administration of the electrical stimulation was found to recover its aversive but not its rewarding effects after vehicle administration. These results are discussed in relation to different natural and artificial agents involved in the induction of avoidance and preference motivational processes, especially with regard to the opioid system.


Assuntos
Aprendizagem da Esquiva/fisiologia , Comportamento Animal/fisiologia , Motivação/fisiologia , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Núcleos Parabraquiais/fisiologia , Recompensa , Aprendizagem Espacial/fisiologia , Animais , Aprendizagem da Esquiva/efeitos dos fármacos , Comportamento Animal/efeitos dos fármacos , Estimulação Elétrica , Masculino , Motivação/efeitos dos fármacos , Núcleos Parabraquiais/efeitos dos fármacos , Ratos , Ratos Wistar , Aprendizagem Espacial/efeitos dos fármacos
10.
Behav Brain Res ; 312: 14-9, 2016 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-27283973

RESUMO

The parabrachial complex has been related to various rewarding behavioral processes. As previously shown, electrical stimulation of the lateral parabrachial external (LPBe) subnucleus induces opiate-dependent concurrent place preference. In this study, two groups of animals (and their respective controls) were subjected to sessions of rewarding brain stimulation daily or on alternate days. The rats stimulated every other day maintained a consistent preference for the place associated with the brain stimulation. However, as also found in the Insular Cortex, there was a progressive decay in the initial place preference of animals receiving daily stimulation. These data suggest that the rewarding effects induced by electrical stimulation of LPBe subnucleus may be subject to tolerance. These findings are discussed with respect to other anatomical areas showing reward decay and to the reinforcing effects induced by various electrical and chemical rewarding agents.


Assuntos
Núcleos Parabraquiais/fisiologia , Recompensa , Animais , Condicionamento Clássico , Estimulação Elétrica , Masculino , Ratos , Ratos Wistar
11.
Brain Res ; 1630: 64-72, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-26562666

RESUMO

The insular cortex (IC) has been related to various reinforcing behavioral processes. This study examined the effect of electrical stimulation of the posterior agranular IC on concurrent place preferences. Two groups of animals and their respective controls underwent rewarding brain stimulation every day or on alternate days. While the rats stimulated every other day maintained their preference for the place associated with brain stimulation, those stimulated every day evidenced a reduction in their place preference, suggesting tolerance to the stimulation's rewarding effect. A 15% increase in the current intensity produced a recovery of the preferences of the daily-stimulated rats but had no effect on those stimulated on alternate days. These results are discussed in terms of the rewarding effects induced by different electrical and chemical rewarding agents.


Assuntos
Córtex Cerebral/fisiologia , Estimulação Elétrica/métodos , Recompensa , Autoestimulação/fisiologia , Animais , Neuroestimuladores Implantáveis , Masculino , Distribuição Aleatória , Ratos Wistar , Esquema de Reforço , Comportamento Espacial/fisiologia
12.
Acta Neurobiol Exp (Wars) ; 74(3): 307-16, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25231850

RESUMO

The parabrachial complex has been related to various rewarding or aversive behavioral processes, including taste aversion learning and conditioned place aversion. This study examined the effect of tiapride, an antagonist of D2/D3 dopaminergic receptors, on place aversion induced by electrical stimulation of the external lateral parabrachial (LPBe) nucleus. Results obtained show that brain-stimulated animals avoid the area of the maze associated with electrical stimulation but show no such behavioral rejection when they receive an injection of 30 mg/kg tiapride. Furthermore, tiapride did not appear to affect the horizontal motor activity (crossing) of the animals. These results are discussed in the context of the different natural and artificial modalities used to induce aversive behavior and their relationship with dopamine systems.


Assuntos
Aprendizagem da Esquiva/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Condicionamento Psicológico/fisiologia , Estimulação Elétrica , Cloridrato de Tiaprida/farmacologia , Animais , Aprendizagem da Esquiva/fisiologia , Comportamento Animal/efeitos dos fármacos , Encéfalo/patologia , Dopamina/metabolismo , Masculino , Ratos Wistar , Recompensa , Cloridrato de Tiaprida/administração & dosagem
13.
Acta méd. colomb ; 25(2): 60-67, mar.-abr. 2000. tab, graf
Artigo em Espanhol | LILACS | ID: lil-358432

RESUMO

Objetivo: Identificar los estudios clínicos controlados (ECC), los estudios clínicos aleatorizados (RCT) y metaanálisis publicados en las revistas de salud de Colombia, en el período comprendido entre 1948 y 1998. Material y métodos: se ubicaron 255 revistas del listado suministrado por la Hemeroteca del Instituto Colombiano para la Educación Superior (ICFES), se seleccionaron 85 a nivel nacional y 42 que correspondían a la ciudad de Santafé de Bogotá que cumplían con los siguientes requisitos: 1) ser llevado a cabo en humanos; 2) comparar dos o más intervenciones entre sí; 3) asignación aleatoria de las intervenciones; 4) diseño prospectivo en la planificación de las intervenciones y asignación de los sujetos. Se utilizó la metodología "Guía para la búsqueda manual de ensayos clínicos controlados" propuesta por el Centro Cochrane Español. Resultados: en el período comprendido entre octubre del 98 y octubre del 99 se revisaron 22 publicaciones de la ciudad de Santafé de Bogotá, encontrándose un total de 151 estudios distribuidos así: 133 CCT, 16 RCT y dos metaanálisis, ocupando los primeros lugares: Revista Colombiana de Anestesiología, Revista Colombiana de Ginecología y Obstetricia, Acta de Otorrinolaringología y Cirugía de Cabeza y Cuello, Revista de la Sociedad Colombiana de Pediatría y Acta Médica Colombiana. Los temas más publicados fueron: ginecología y obstetricia 12 ensayos (sin clasificar), trauma seis ensayos, infectología cinco ensayos (sin clasificar) y patología osteomuscular tres ensayos. Conclusiones: la identificación de publicaciones con validez metodológica permite evaluar la calidad de la investigación y de las publicaciones en nuestro medio, además de comparar si corresponden a prioridades nuestras. Es necesario completar el estudio incluyendo el resto de las publicaciones identificadas en las diferentes ciudades del país.


Assuntos
Estudos de Casos e Controles , Colômbia , Metanálise , Publicação Periódica/tendências , Publicação Periódica
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