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1.
Artigo em Inglês | MEDLINE | ID: mdl-34639836

RESUMO

The World Health Organization (WHO) estimated that physical inactivity (PI) is responsible for 20 to 30% of all non-communicable diseases. We aimed to analyze the effectiveness of a multiple health behavior change (MHBC) intervention to increase physical activity (PA) in patients 45 to 75 years old who had at least 2 of 3 unhealthy behaviors (tobacco use, reduced fruit and vegetable consumption, and insufficient PA). The MHBC intervention is based on the Transtheoretical Model and the conceptual framework of the "5 A's" and includes an individually tailored intervention, group sessions, and the use of community resources. We included 3062 participants, 1481 in the intervention group and 1581 in the control group. After 12 months, there were no differences in PA intensity measured by metabolic_equivalent_of_task_minutes/week (adjusted mean difference: 284.093, 95% CI: -298.24, 866.42) nor in the proportion of participants who increased PA levels to moderate or high (OR: 1.02, 95% CI: 0.85, 1.23; p = 0.822), and no differences in blood pressure, weight loss, or waist circumference. We found an increased proportion of patients in the intervention group who followed the WHO recommendations for PA (OR: 1.29; 95% CI: 1.04, 1.60; p = 0.02). We concluded that the intervention did not lead to a significant increase in PA.

2.
Nutrients ; 13(8)2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34444884

RESUMO

BACKGROUND: The relationship between the quality of the diet and the adherence to the Mediterranean diet with the presence of persistent or recurrent depressive symptoms have been described. The objective of this study is to analyze the relationship between adherence to the Mediterranean diet and the intake of specific foods in primary care patients aged 45 to 75, having subclinical or major depression. The study also specifically analyzes this relationship in individuals suffering from chronic diseases. METHODS: A cross-sectional descriptive study was conducted. 3062 subjects met the inclusion criteria from the EIRA study. Sociodemographic variables, clinical morbidity, depression symptomatology (PHQ-9) and adherence to Mediterranean diet (MEDAS) were collected. RESULTS: Being female, younger, with a higher BMI, consuming more than 1 serving of red meat a day and drinking more than one carbonated or sugary drink daily, not consuming 3 servings of nuts a week and not eating 2 vegetables cooked in olive oil a week are predictors of having higher depressive symptomatology. CONCLUSIONS: Assessing the type of diet of patients presenting depressive symptoms and promoting adherence to a healthy diet is important, especially in patients with chronic diseases. However, depression is a very complex issue and the relationship between nutrition and depression must be further examined.


Assuntos
Depressão/dietoterapia , Dieta Saudável/estatística & dados numéricos , Dieta Mediterrânea/psicologia , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Estudos Transversais , Depressão/psicologia , Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia
3.
Int J Behav Nutr Phys Act ; 18(1): 88, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215275

RESUMO

BACKGROUND: Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. METHODS: An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. RESULTS: The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. CONCLUSION: The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. TRIAL REGISTRATION: Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.


Assuntos
Comportamentos Relacionados com a Saúde , Custos de Cuidados de Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Qualidade de Vida/psicologia , Idoso , Análise Custo-Benefício , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Anos de Vida Ajustados por Qualidade de Vida
4.
Artigo em Inglês | MEDLINE | ID: mdl-34071171

RESUMO

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.


Assuntos
Diabetes Mellitus , Qualidade de Vida , Exercício Físico , Hábitos , Humanos , Atenção Primária à Saúde , Fumar , Espanha/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33918698

RESUMO

Mental disorders are one of the greatest public health concerns of our time, and they are affected by social factors. To reduce the considerable burden of mental disorders, more global and systematic knowledge of the social determinants of mental health is necessary. This paper presents the results of the 27 studies included in the International Journal of Environmental Research and Public Health Special Issue, "Social Determinants of Mental Health". The studies are grouped into four broad categories: social inclusion and mental health, young people's mental health, mental health at work, and mental health service users. The results cover different countries, age populations, settings, and methodologies. Finally, the main findings on the relationship between social determinants and mental health are presented and summarized.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Determinantes Sociais da Saúde
6.
BMC Public Health ; 21(1): 368, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596889

RESUMO

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .


Assuntos
COVID-19/psicologia , Saúde Global/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Período Pós-Parto/psicologia , Gestantes/psicologia , Adulto , Europa (Continente)/epidemiologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Proteção , Projetos de Pesquisa , Fatores de Risco
7.
Clin Psychol Rev ; 82: 101931, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33137611

RESUMO

Although evidence exists for the efficacy of interventions to prevent depression, little is known about its prevention through online interventions. We aim to assess the effectiveness of online psychological and psychoeducational interventions to prevent depression in heterogeneous populations. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted based on literature searches in eight electronic data bases and other sources from inception to 22 July 2019. Of the 4181 abstracts reviewed, 501 were selected for full-text review, and 21 RCTs met the inclusion criteria, representing 10,134 participants from 11 countries and four continents. The pooled SMD was -0·26 (95%CI: -0·36 to -0·16; p < 0.001) and sensitivity analyses confirmed the robustness of this result. We did not find publication bias but there was substantial heterogeneity (I2 = 72%; 95%CI, 57% to 82%). A meta-regression including three variables explained 81% of the heterogeneity. Indicated prevention and interactive website delivery were statistically associated with higher effectiveness, and no association was observed with risk of bias. Online psychological and psychoeducational interventions have a small effect in reducing depressive symptoms in non-depressed and varied populations, and the quality of evidence is moderate. Given that these types of interventions are very accessible and can be applied on a wide scale, they should be further developed and implemented. Registration details: Registration number (PROSPERO): CRD42014014804.

9.
J Anxiety Disord ; 76: 102317, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33096463

RESUMO

The aim of this study was to assess the available evidence on potential moderators of psychological and psychoeducational interventions for the prevention of anxiety. A systematic review using PubMed, PsycINFO, Web of Science, Embase, OpenGrey, and CENTRAL was performed up to October 2019. Two independent researchers assessed the fulfillment of eligibility criteria, extracted the data and performed a quality assessment of the included studies. Outcomes were moderators of the reduction of anxious symptoms or the incidence of anxiety disorders. Fourteen studies reporting results on moderator analyses performed in 13 randomized controlled trials were included. Twenty-seven potential moderators were organized into six categories: sociodemographic, clinical characteristics, cognitive variables, life events, interpersonal functioning and intervention characteristics. The most frequently examined variables were gender, age and baseline anxiety. We found insufficient evidence for all moderator categories studied. In children and adolescents, we found some studies with significant results for the low family support variable and higher levels of anxiety symptoms at baseline, which were both associated with higher effectiveness. Limited conclusions can be drawn about for whom and under what conditions interventions work in the prevention of anxiety. A strong need to improve the methodological quality and the number of moderator studies was identified.


Assuntos
Transtornos de Ansiedade , Ansiedade , Adolescente , Ansiedade/prevenção & controle , Transtornos de Ansiedade/prevenção & controle , Criança , Humanos
10.
Clin Psychol Rev ; 79: 101859, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32505982

RESUMO

Psychological and psychoeducational interventions have proven to be effective in preventing depression. However, the identification of the patients that benefit the most from each type of intervention has not yet been established. A systematic review was performed of the literature on moderators of preventive psychological and psychoeducational interventions for depression in all types of population. A search was performed on PubMed, PsycINFO, Web of Science, Embase, Cochrane Central Register of Controlled Trials and OpenGrey up to July 2019. Fulfillment of eligibility criteria, data collection, and study quality assessment were assessed by two independent researchers. Outcomes were moderators of the reduction of depressive symptoms or the incidence of depression. Twenty-seven moderator effect studies performed in 19 randomized controlled trials were included. Thirty-four potential sociodemographic, clinical, interpersonal, personality and life-event moderators were evaluated. Baseline depressive symptoms, gender, age, baseline parental depression and social support were the most frequently studied potential moderators. In interventions for children and adolescents, the moderator for which evidence was strongest was having parents free of depression at baseline. Psychological and psychoeducational interventions seem to be more effective in children and adolescents who exhibit a lower use of substances and whose parents do not have symptoms of depression at baseline. In adults, a lower age was associated with greater effects of preventive interventions. ETHICS: As this systematic review is based on published data, approval from the local ethics committee was not required.

11.
Br J Gen Pract ; 70(suppl 1)2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32554688

RESUMO

BACKGROUND: Primary care is the ideal setting for promotion and prevention intervention. Multiple risk behaviour interventions present several advantages over single-risk lifestyle interventions. Multiple risk behaviour interventions could be easily implemented in primary care to prevent non-communicable disease and depression. AIM: To test the effectiveness of a multiple risk behaviour intervention to promote Mediterranean diet, physical activity, and/or smoking cessation in people attending Spanish primary health care with incidence of depression and symptoms of depression. METHOD: This was a secondary analysis of the EIRA study that aims to test the effectiveness of a multiple risk behaviour intervention to promote healthy lifestyles. Twenty-six primary care centres were randomised to receive multiple risk behaviour intervention or usual care. The multiple risk behaviour intervention included individual sessions, group sessions, communitarian activities, and SMS reception. Participants were followed for 10-14 months. The primary outcomes of this study were incidence of depression and reductions of depressive symptoms. RESULTS: Three thousand and sixty-seven participants were included. Females accounted for 45.13% and 93.88% were Spanish. Age varied between 45 and 75 years old. The effectiveness of the intervention will be calculated using the Patient Health Questionnaire (PHQ-9) and the Composite International Diagnostic Interview ( CIDI) depression section. Linear and logistic regression will be used to create predictive models. CONCLUSION: Primary care is the most accessible service in the health system for patients. Hence primary care is the ideal setting for health education, promotion, and prevention interventions. This study will provide high-quality evidence about the effectiveness of multiple risk behaviour interventions over depression prevention.

12.
BMJ Open ; 10(5): e034424, 2020 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-32423929

RESUMO

INTRODUCTION: The prevalence of postpartum depression (PPD) is 17%, and the incidence is 12% worldwide. Adverse consequences for mothers and babies have been associated with this disease. To assess the effectiveness of psychological, psychoeducational and psychosocial interventions in preventing PPD, a systematic review and meta-analysis (SR/MA) will be conducted. METHODS AND ANALYSIS: A SR/MA will be performed following the indications of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies will be identified through MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, OpenGrey, Australian New Zealand Clinical Trial Registry, ClinicalTrials.gov and evidencebasedtherapy.org from inception until 31 January 2020. Bridging searches will be also conducted until the review is completed. The selection criteria will be as follows: (1) subjects will be pregnant females or females who have given birth in the last 12 months and who were non-depressive at baseline; (2) psychological, psychoeducational and psychosocial interventions; (3) comparator will be usual care, attention control, waiting list or no intervention; (4) outcomes will be specific results on PPD; and (5) the design of the studies will be randomised controlled trials. No restrictions regarding the year of publication, the setting of the intervention or the language of publication will be considered. Pooled standardised mean differences and 95% CIs will be calculated. The risk of bias of the studies will be assessed through the Cochrane Collaboration risk of bias tool. Heterogeneity between the studies will be determined by the I2 and Cochran's Q statistics. Sensitivity and subgroup analyses will also be performed. Publication bias will be checked with funnel plots and Egger's test. Heterogeneity will be explored by random-effects meta-regression analysis. ETHICS AND DISSEMINATION: The ethical assessment was not required. The results will be presented at conferences and disseminated through publications. PROSPERO REGISTRATION NUMBER: CRD42018109981.


Assuntos
Depressão Pós-Parto , Intervenção Psicossocial , Adolescente , Adulto , Austrália , Depressão Pós-Parto/prevenção & controle , Feminino , Humanos , Saúde Mental , Mães , Gravidez , Gravidez na Adolescência , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Prev Med ; 134: 106067, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32194097

RESUMO

Though many studies have explored the association between single-risk lifestyle interventions and depression, unhealthy lifestyle factors often co-occur, with adults engaging in two or more risk behaviours. To date, little is known about the effectiveness of universal multiple-risk lifestyle interventions to reduce depressive symptoms. We conducted a SR/MA to assess the effectiveness of universal multiple-risk lifestyle interventions (by promoting a healthy diet, physical activity and/or smoking cessation) to reduce depressive symptoms in adults. We searched MEDLINE, Scopus, CENTRAL, PsycINFO, WOS, OpenGrey, the ICTRP and other sources from inception to 16 September 2019. We selected only randomized controlled trials, with no restrictions on language or setting. Our outcome was the reduction of depressive symptoms. We calculated the standardized mean difference using random-effect models. Sensitivity, sub-group and meta-regression analyses were performed. Of the 9386 abstracts reviewed, 311 were selected for full-text review. Of these, 23 RCTs met the inclusion criteria, including 7558 patients from four continents. Twenty RCTs provided valid data for inclusion in the meta-analysis. The pooled SMD was -0.184 (95% CI, -0.311 to -0.057; p = 0.005). We found no publication bias, but heterogeneity was substantial (I2 = 72%; 95% CI: 56% to 82%). The effectiveness disappeared when only studies with a low risk of bias were included. The quality of evidence according GRADE was low. Although a small preventive effect was found, the substantial heterogeneity and RCTs with lower risk of bias suggested no effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms in a varied adult population. Further evidence is required.


Assuntos
Depressão/prevenção & controle , Dieta Saudável , Exercício Físico , Estilo de Vida , Comportamento de Redução do Risco , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha
14.
BMJ Open ; 9(3): e026842, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30878992

RESUMO

INTRODUCTION: Many studies have explored the impact of lifestyle interventions on depression. However, little is known about the effectiveness of complex multiple-risk lifestyle interventions in reducing symptoms of depression. Our objective is to assess the effectiveness of complex multiple-risk lifestyle interventions in reducing depressive symptoms in the adult population by the acquisition of at least two healthy habits-healthy diet, physical activity and/or smoking cessation. For such purpose, a systematic review and meta-analysis of randomised controlled trials will be conducted. METHOD AND ANALYSIS: MEDLINE (through Ovid and PubMed), Scopus, Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, OpenGrey Register (System for Information on Grey Literature in Europe) and the International Clinical Trials Registry Platform will be searched for relevant articles. Additionally, a supplementary manual search will be performed using lists of references, references to expert authors and other systematic reviews and/or meta-analyses. Study selection, data extraction (target habits, country, target populations, conditions and statistical data to name a few) and assessment of the risk of bias will be performed separately by two independent researchers. The primary outcome measure will be the reduction of depression symptoms, as measured by validated instruments. We will calculate pooled standardised mean differences and 95% CIs using random-effect models. Heterogeneity, sensitivity and publication bias will be assessed, and sub-group analysis will be performed. Heterogeneity will be explored by random-effects meta-regression analysis. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. The results of this systematic review and meta-analysis will be presented in relevant conferences and published in a peer-review journal. The findings of this study could have important clinical and scientific implications for the improvement of symptoms of depression. PROSPERO REGISTRATION NUMBER: CRD42018100253; Pre-results.


Assuntos
Depressão/prevenção & controle , Comportamento de Redução do Risco , Terapia Cognitivo-Comportamental , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
15.
Eur J Cardiovasc Nurs ; 18(1): 38-47, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29909641

RESUMO

BACKGROUND: Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. METHODS: MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS: We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. CONCLUSIONS: Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.


Assuntos
Reabilitação Cardíaca/psicologia , Doença das Coronárias/reabilitação , Infarto do Miocárdio/reabilitação , Cooperação do Paciente/psicologia , Pacientes Desistentes do Tratamento/psicologia , Prevenção Secundária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Estudos Prospectivos , Pesquisa Qualitativa
16.
BMJ Open ; 8(11): e022012, 2018 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-30498036

RESUMO

INTRODUCTION: Although evidence exists for the efficacy of psychosocial interventions in preventing depression, little is known about its prevention through online interventions. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials assessing the effectiveness of online interventions in preventing depression in heterogeneous populations. METHODS AND ANALYSIS: We will conduct a systematic review and meta-analysis of randomised controlled trials that will be identified through searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Australia New Zealand Clinical Trials Register . We will also search the reference lists provided in relevant studies and reviews. Experts in the field will be contacted to obtain more references. Two independent reviewers will assess the eligibility criteria of all articles, extract data and determine their risk of bias (Cochrane Collaboration Tool). Baseline depression will be required to have been discarded through standardised interviews or validated self-reports with standard cut-off points. The outcomes will be the incidence of new cases of depression and/or the reduction of depressive symptoms as measured by validated instruments. Pooled standardised mean differences will be calculated using random-effect models. Heterogeneity and publication bias will be estimated. Predefined sensitivity and subgroup analyses will be performed. If heterogeneity is relevant, random-effect meta-regression will be performed. ETHICS AND DISSEMINATION: The results will be disseminated through peer-reviewed publication and will be presented at a professional conference. Ethical assessment is not required as we will search and assess existing sources of literature. TRIAL REGISTRATION NUMBER: CRD42014014804; Results.


Assuntos
Depressão/prevenção & controle , Transtorno Depressivo/prevenção & controle , Internet , Psicoterapia/métodos , Terapia Cognitivo-Comportamental , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Projetos de Pesquisa , Resultado do Tratamento
18.
PLoS One ; 13(7): e0200636, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30011341

RESUMO

BACKGROUND: Empirical evidence has shown that cardiac rehabilitation programs are effective in reducing morbidity and mortality, improving quality of life in patients with cardiovascular disease. Despite the benefits, women have a high cardiac rehabilitation dropout rate. Our aim was to explore women's perceptions about the reasons they faced for dropout from these programs. METHODS: Semi-structured interviews were conducted with women (n = 10) after dropping out from three different cardiac rehabilitation centers in Spain. In addition, a focus group and a semi-structured interview with cardiovascular professionals were conducted. From a grounded theory perspective, thematic analysis was used to derive themes from interview transcripts. RESULTS: The women were between 41 and 70 years. We identified five general themes that illustrated reasons for cardiac rehabilitation dropout: intrapersonal reasons (self-reported health, self-reported mental health, health beliefs); interpersonal reasons (family caregiver role, work conflicts); logistical reasons (transport, distance); cardiac rehabilitation program characteristics (perception of the objective of cardiac rehabilitation, exercise component, inconvenient timing, cardiac rehabilitation equipment); and health system reasons (financial assistance for transport, long waiting list). The cardiovascular professionals found barriers to cardiac rehabilitation completion similar to those found by the women. CONCLUSIONS: In order to prevent cardiac rehabilitation dropout in women, modular and flexible programs are needed. In addition, the inclusion of primary care centers or community resources could improve cardiac rehabilitation completion in women. Psychological assessment and counseling during cardiac rehabilitation should be included as an essential part of the programs and recommended for those women with depressive symptoms. Finally, improved financial assistance for transport from the health system is essential.


Assuntos
Reabilitação Cardíaca , Doenças Cardiovasculares , Adulto , Feminino , Humanos , Pacientes Desistentes do Tratamento
19.
BMC Public Health ; 18(1): 874, 2018 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-30005705

RESUMO

BACKGROUND: Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. METHODS: This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the "5A's". It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the "Consolidated Framework for Implementation Research", a set of discrete implementation strategies and an evaluation framework. DISCUSSION: EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 .Retrospectively registered on May 2, 2017.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Atenção Primária à Saúde , Idoso , Análise Custo-Benefício , Feminino , Promoção da Saúde/economia , Comportamentos de Risco à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Espanha , Inquéritos e Questionários
20.
An. psicol ; 33(3): 556-567, oct. 2017. graf, tab
Artigo em Inglês | IBECS | ID: ibc-165630

RESUMO

Objective: The aim of this research is to identify and analyze the measures for the assessment of stressful life events created/adapted for its use in Spanish adult population, published in national and international literature, with a focus on psychometric properties and its association with health measures. Methods: A systematic review was carried out to identify all instruments identified through searches of MEDLINE; ProQuest Health and Medical Complete; ProQuest Psychology Journals; PsycARTICLES; PsycINFO; Psicodoc; OpenSIGLE from inception until 31 January 2016. Two independent researchers assessed the eligibility criteria of all articles, subtracted data and assessed its psychometric properties. Results: Twelve measures, which satisfied the inclusion criteria, were selected. The measures showed a large heterogeneity. Most of them did not include any information on its psychometric properties or needed to provide further data, since a few of them assessed its test-retest stability and/or internal structure. The questionnaires created or adapted by González de Rivera y Morena (1983), Sandín y Chorot (1987), Fernández y Mielgo (1992), Gracia y Herrero (2004), and Motrico et al. (2013) showed significant associations with health variables. Discussion: Further research is needed to clarify the association of these instruments with mental and physical health measures, which would facilitate its clinical application. These results are very useful in order to select a measure for the assessment of stressful life events in clinical practice and research in Spain (AU)


Objetivo: Este estudio pretende identificar y analizar los instrumentos de evaluación de los eventos vitales estresantes creados/adaptados para su uso con población española adulta, publicados en la literatura nacional e internacional, con especial atención en sus propiedades psicométricas y en su asociación con medidas de problemas de salud. Métodos: Se llevó a cabo una revisión sistemática de la literatura de todos los instrumentos publicados a través de los buscadores MEDLINE; ProQuest Health y Medical Complete ProQuest Psychology Journals PsycARTICLES PsycINFO Psicodoc OpenSIGLE desde la fecha de inicio hasta el 31 de enero de 2016. Dos investigadores independientes evaluaron la elegibilidad de todos los artículos, extrajeron los datos y evaluaron sus propiedades psicométricas. Resultados: Se seleccionaron 12 instrumentos que cumplían los criterios de inclusión en el estudio. Las medidas presentaron una gran heterogeneidad. La mayoría no incluían información sobre sus propiedades psicométricas o necesitaban aportar más datos, ya que eran pocas los que evaluaban su estabilidad test-retest y/o su estructura interna. Los cuestionarios creados o adaptados por González de Rivera y Morena (1983), Sandín y Chorot (1987), Fernández y Mielgo (1992), Gracia y Herrero (2004) y Motrico et al. (2013) mostraron asociaciones significativas con variables de problemas de salud. Discusión: Se requieren más estudios sobre la asociación de los instrumentos con variables de problemas de salud mental y física, lo que facilitaría su aplicación clínica. Estos resultados tienen una gran utilidad a la hora de seleccionar un instrumento de evaluación de eventos vitales estresantes en el ámbito clínico y de investigación en España (AU)


Assuntos
Humanos , Psicometria/instrumentação , Estresse Psicológico/diagnóstico , Acontecimentos que Mudam a Vida , Testes Psicológicos , Transtornos de Adaptação/psicologia , Reprodutibilidade dos Testes , Reprodutibilidade dos Testes , Adaptação Psicológica
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