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1.
J Alzheimers Dis ; 80(4): 1705-1712, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33646168

RESUMO

BACKGROUND: The social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients and their caregivers. OBJECTIVE: We aim to evaluate the neurological decline of patients with dementia and the caregivers' burden during the pandemic. METHODS: We performed a cross-sectional study. Caregivers of dementia patients following in the outpatient clinic were included. A structured telephone interview composed of the Neuropsychiatric Inventory Questionnaire (NPI-Q), Zarit Burden Interview (ZBI), Beck Depression (BDI) and Anxiety (BAI) Inventories to address cognitive, behavioral, and functional changes associated with social distancing during the Sars-Cov-2 outbreak. Patients were divided in two groups according to caregivers' report: with perceived Altered Cognition (AC) and Stable Cognition (SC). RESULTS: A total of 58 patients (median age: 57 years [21-87], 58.6%females) and caregivers (median age: 76.5 years [55-89], 79.3%females) were included. Cognitive decline was shown by most patients (53.4%), as well as behavioral symptoms (48.3%), especially apathy/depression (24.1%), and functional decline (34.5%). The AC group (n = 31) presented increased behavioral (67.7%versus 25.9%, p = 0.002) and functional (61.3%versus 3.7%, p < 0.001) changes when compared to the SC group. In the AC group, ZBI, BDI, NPI-Q caregiver distress, and NPI-Q patient's severity of symptoms scores were worse than the SC group (p < 0.005 for all). CONCLUSION: Patients' neuropsychiatric worsening and caregiver burden were frequent during the pandemic. Worsening of cognition was associated with increased caregivers' psychological distress.


Assuntos
COVID-19/psicologia , Cuidadores/psicologia , Demência/psicologia , Transtornos Mentais/psicologia , Angústia Psicológica , Isolamento Social/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Cuidadores/tendências , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Pandemias , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-33431602

RESUMO

INTRODUCTION: Lockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: We performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown. RESULTS: In total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: -0.39% (-4.3 mmol/mol) (p<0.0001 and type 2 diabetes: -0.62% (-6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001). CONCLUSIONS: An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.


Assuntos
Glicemia/metabolismo , COVID-19/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Exercício Físico/fisiologia , Ganho de Peso/fisiologia , Adulto , Idoso , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/tendências , COVID-19/epidemiologia , COVID-19/psicologia , Estudos de Coortes , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Exercício Físico/psicologia , Feminino , Controle Glicêmico/psicologia , Controle Glicêmico/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Comportamento Sedentário
3.
J Orthop Surg Res ; 15(1): 322, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787965

RESUMO

BACKGROUND: World Health Organization declared coronavirus disease-19 (COVID-19) a global pandemic on 11 March 2020, after the coronavirus claimed 4628 lives worldwide. Mental health challenges such as making impossible decisions and working under extreme pressures are expected to be faced by frontline healthcare workers who are directly involved in the care of COVID-19 patients. However, we question if significant stress levels might also be observed in a subspecialty musculoskeletal outpatient department, where staff are not first-line care providers of COVID-19 patients. We hypothesize that these healthcare workers also face significant psychological strain, and we aim to objectively determine the prevalence using a validated caregiver strain index. METHODS: A cross-sectional study was conducted in outpatient musculoskeletal clinics in a tertiary hospital in Singapore. We collected basic demographic data and used a 13-question tool adapted from the validated Caregiver Strain Index (CSI) to measure psychological strain in these healthcare workers. Participants were divided into 2 groups depending on the level of strain experienced. RESULTS: A total of 62 healthcare workers volunteered for this study. There were 32 participants (51.6%) who had 7 or more positive responses (group 1) and the remaining 30 participants (48.4%) were allocated to group 2. There were no significant differences between the two groups in terms of demographic data. "Work adjustments" (74.2%), "changes in personal plans" (72.6%), and finding it "confining" (72.6%) garnered the most positive responses in the questionnaire. On the other hand, "financial concerns" garnered the least positive responses (21.0%). CONCLUSION: The protracted duration of the COVID-19 outbreak and its resultant prolonged adjustments can have unintended consequences of wearing down healthcare resources otherwise allocated to chronic and elective conditions. Countries should ensure that measures are put in place to safeguard the mental well-being of our healthcare workers to avoid needing another reactive strategy in this battle against COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Ortopedia/tendências , Ambulatório Hospitalar/tendências , Pandemias , Pneumonia Viral/psicologia , Adulto , Idoso , Infecções por Coronavirus/terapia , Estudos Transversais , Feminino , Pessoal de Saúde/tendências , Humanos , Masculino , Saúde Mental/tendências , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Doenças Musculoesqueléticas/terapia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Singapura/epidemiologia , Adulto Jovem
4.
Anesth Analg ; 131(1): 228-238, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-30998561

RESUMO

BACKGROUND: Hospitals achieve growth in surgical caseload primarily from the additive contribution of many surgeons with low caseloads. Such surgeons often see clinic patients in the morning then travel to a facility to do 1 or 2 scheduled afternoon cases. Uncertainty in travel time is a factor that might need to be considered when scheduling the cases of to-follow surgeons. However, this has not been studied. We evaluated variability in travel times within a city with high traffic density. METHODS: We used the Google Distance Matrix application programming interface to prospectively determine driving times incorporating current traffic conditions at 5-minute intervals between 9:00 AM and 4:55 PM during the first 4 months of 2018 between 4 pairs of clinics and hospitals in the University of Miami health system. Travel time distributions were modeled using lognormal and Burr distributions and compared using the absolute and signed differences for the median and the 0.9 quantile. Differences were evaluated using 2-sided, 1-group t tests and Wilcoxon signed-rank tests. We considered 5-minute signed differences between the distributions as managerially relevant. RESULTS: For the 80 studied combinations of origin-to-destination pairs (N = 4), day of week (N = 5), and the hour of departure between 10:00 AM and 1:55 PM (N = 4), the maximum difference between the median and 0.9 quantile travel time was 8.1 minutes. This contrasts with the previously published corresponding difference between the median and the 0.9 quantile of 74 minutes for case duration. Travel times were well fit by Burr and lognormal distributions (all 160 differences of medians and of 0.9 quantiles <5 minutes; P < .001). For each of the 4 origin-destination pairs, travel times at 12:00 PM were a reasonable approximation to travel times between the hours of 10:00 AM and 1:55 PM during all weekdays. CONCLUSIONS: During mid-day, when surgeons likely would travel between a clinic and an operating room facility, travel time variability is small compared to case duration prediction variability. Thus, afternoon operating room scheduling should not be restricted because of concern related to unpredictable travel times by surgeons. Providing operating room managers and surgeons with estimated travel times sufficient to allow for a timely arrival on 90% of days may facilitate the scheduling of additional afternoon cases especially at ambulatory facilities with substantial underutilized time.


Assuntos
Centros Médicos Acadêmicos/normas , Ambulatório Hospitalar/normas , Admissão e Escalonamento de Pessoal/normas , Cirurgiões/normas , Centros Cirúrgicos/normas , Viagem , Centros Médicos Acadêmicos/tendências , Agendamento de Consultas , Lista de Checagem/normas , Lista de Checagem/tendências , Florida/epidemiologia , Seguimentos , Humanos , Visita a Consultório Médico/tendências , Ambulatório Hospitalar/tendências , Admissão e Escalonamento de Pessoal/tendências , Estudos Prospectivos , Cirurgiões/tendências , Centros Cirúrgicos/tendências , Fatores de Tempo , Viagem/tendências
5.
Seizure ; 75: 34-42, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31874357

RESUMO

BACKGROUND AND PURPOSE: Although anxiety disorders (ADs) occur frequently in people with epilepsy (PWE) and impair quality of life and treatment outcomes, current efforts to categorize and investigate AD subtypes in PWE remain insufficient. Thus, the present meta-analysis aimed to determine the current prevalence rates of any AD type and various AD subtypes in PWE managed by outpatient clinics. METHODS: MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS were searched to identify and select studies that assessed the prevalence of ADs or individual AD subtypes in adult PWE under the routine care of outpatient epilepsy clinics in tertiary hospitals. Only studies that used gold-standard diagnostic tools for assessing ADs were included in this meta-analysis. RESULTS: The database search ultimately identified 15 studies, of which 9 provided current prevalence rates of any type of AD. The pooled estimated prevalence of any AD was 26.1 %. Of the 15 total studies, 13 provided current prevalence rates of generalized anxiety disorder (GAD), revealing an overall estimated prevalence of 18.2 %. In terms of current prevalence rates, GAD was highest, followed by agoraphobia, social phobia, panic disorder, and obsessive-compulsive disorder. CONCLUSIONS: Among PWE managed in the outpatient epilepsy clinics of tertiary care hospitals, the current prevalence of any AD was 26.1 %, and GAD was the most prevalent subtype of AD.


Assuntos
Transtornos de Ansiedade/epidemiologia , Epilepsia/epidemiologia , Ambulatório Hospitalar/tendências , Centros de Atenção Terciária/tendências , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Epilepsia/psicologia , Epilepsia/terapia , Humanos , Resultado do Tratamento
6.
Psychiatry Res ; 280: 112525, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31445423

RESUMO

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are developed from exposure to traumatic events including war, interpersonal violence and natural disasters. We investigated prevalence and trauma-related information in patients from an outpatient psychiatric unit in Brazil among 2014-2017. A prevalence of ASD/PTSD of 40.8% was found in 179 patients. Female, Caucasian, married, mostly educated during 10-12 years long and employed patients composed a main profile. The presence of any previous trauma in adulthood and childhood were related to ASD/PTSD with longer follow-up time. This study provides evidence of stress-related disorders in a heterogeneous environment.


Assuntos
Ambulatório Hospitalar/economia , Pobreza/economia , Transtornos de Estresse Pós-Traumáticos/economia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Traumático Agudo/economia , Transtornos de Estresse Traumático Agudo/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Pacientes Ambulatoriais/psicologia , Pobreza/psicologia , Pobreza/tendências , Prevalência , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Traumático Agudo/psicologia , Fatores de Tempo , Violência/economia , Violência/psicologia , Violência/tendências
7.
Psychiatry Res ; 276: 94-99, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31030006

RESUMO

The aim of this study was to evaluate the extent of internalised stigma and possible predictors in adults with a diagnosis of autism spectrum disorder (ASD). We measured internalised stigma in a sample of 149 adults with ASD and an IQ ≥70 (79.2% male, mean age 31.8 years), using the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). The mean ISMI-10 score was 1.93 (SD=0.57), with 15.4% of participants reporting moderate or severe internalised stigma. Moderate or severe stigma was more frequent in persons aged ≥35 years (OR: 4.36), and in individuals with low educational level (OR: 6.00). IQ, sex and ASD diagnostic subtype (ICD-10) did not influence stigma severity. Compared to other mental disorders, the level of internalised stigma in adults with ASD without intellectual disability appears to be lower.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Mecanismos de Defesa , Estigma Social , Adolescente , Adulto , Idoso , Transtorno do Espectro Autista/diagnóstico , Feminino , Alemanha/epidemiologia , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/psicologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
9.
Int J Health Plann Manage ; 34(2): e1257-e1271, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30901132

RESUMO

BACKGROUND: Because of increasing demand, hospitals in England are currently under intense pressure resulting in shortages of beds, nurses, clinicians, and equipment. To be able to effectively cope with this demand, the management needs to accurately find out how many patients are expected to use their services in the future. This applies not just to one service but for all hospital services. PURPOSE: A forecasting modelling framework is developed for all hospital's acute services, including all specialties within outpatient and inpatient settings and the accident and emergency (A&E) department. The objective is to support the management to better deal with demand and plan ahead effectively. METHODOLOGY/APPROACH: Having established a theoretical framework, we used the national episodes statistics dataset to systematically capture demand for all specialties. Three popular forecasting methodologies, namely, autoregressive integrated moving average (ARIMA), exponential smoothing, and multiple linear regression were used. A fourth technique known as the seasonal and trend decomposition using loess function (STLF) was applied for the first time within the context of health-care forecasting. RESULTS: According to goodness of fit and forecast accuracy measures, 64 best forecasting models and periods (daily, weekly, or monthly forecasts) were selected out of 760 developed models; ie, demand was forecasted for 38 outpatient specialties (first referrals and follow-ups), 25 inpatient specialties (elective and non-elective admissions), and for A&E. CONCLUSION: This study has confirmed that the best demand estimates arise from different forecasting methods and forecasting periods (ie, one size does not fit all). Despite the fact that the STLF method was applied for the first time, it outperformed traditional time series forecasting methods (ie, ARIMA and exponential smoothing) for a number of specialties. PRACTISE IMPLICATIONS: Knowing the peaks and troughs of demand for an entire hospital will enable the management to (a) effectively plan ahead; (b) ensure necessary resources are in place (eg, beds and staff); (c) better manage budgets, ensuring enough cash is available; and (d) reduce risk.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Previsões/métodos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Modelos Estatísticos , Ambulatório Hospitalar/estatística & dados numéricos , Ambulatório Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Reino Unido
10.
Alzheimers Res Ther ; 11(1): 8, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30654834

RESUMO

INTRODUCTION: Subjective cognitive decline (SCD) in cognitively unimpaired older individuals has been recognized as an early clinical at-risk state for Alzheimer's disease (AD) dementia and as a target population for future dementia prevention trials. Currently, however, SCD is heterogeneously defined across studies, potentially leading to variations in the prevalence of AD pathology. Here, we compared the prevalence and identified common determinants of abnormal AD biomarkers in SCD across three European memory clinics participating in the European initiative on harmonization of SCD in preclinical AD (Euro-SCD). METHODS: We included three memory clinic SCD samples with available cerebrospinal fluid (CSF) biomaterial (IDIBAPS, Barcelona, Spain, n = 44; Amsterdam Dementia Cohort (ADC), The Netherlands, n = 50; DELCODE multicenter study, Germany, n = 42). CSF biomarkers (amyloid beta (Aß)42, tau, and phosphorylated tau (ptau181)) were centrally analyzed in Amsterdam using prespecified cutoffs to define prevalence of pathological biomarker concentrations. We used logistic regression analysis in the combined sample across the three centers to investigate center effects with regard to likelihood of biomarker abnormality while taking potential common predictors (e.g., age, sex, apolipoprotein E (APOE) status, subtle cognitive deficits, depressive symptoms) into account. RESULTS: The prevalence of abnormal Aß42, but not tau or ptau181, levels was different across centers (64% DELCODE, 57% IDIBAPS, 22% ADC; p < 0.001). Logistic regression analysis revealed that the likelihood of abnormal Aß42 (and also abnormal tau or ptau181) levels was predicted by age and APOE status. For Aß42 abnormality, we additionally observed a center effect, indicating between-center heterogeneity not explained by age, APOE, or the other included covariates. CONCLUSIONS: While heterogeneous frequency of abnormal Aß42 was partly explained by between-sample differences in age range and APOE status, the additional observation of center effects indicates between-center heterogeneity that may be attributed to different recruitment procedures. These findings highlight the need for the development of harmonized recruitment protocols for SCD case definition in multinational studies to achieve similar enrichment rates of preclinical AD.


Assuntos
Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/líquido cefalorraquidiano , Disfunção Cognitiva/epidemiologia , Autoavaliação Diagnóstica , Ambulatório Hospitalar/tendências , Idoso , Doença de Alzheimer/psicologia , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Disfunção Cognitiva/psicologia , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fragmentos de Peptídeos/líquido cefalorraquidiano , Prevalência , Proteínas tau/líquido cefalorraquidiano
11.
Int J Cardiol ; 277: 140-146, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30131230

RESUMO

BACKGROUND: Incidence and prognostic impact of heart failure (HF) progression has been not well addressed. METHODS: From 2009 until 2015, consecutive ambulatory HF patients were recruited. HF progression was defined by the presence of at least two of the following criteria: step up of ≥1 New York Heart Association (NYHA) class; decrease LVEF ≥ 10 points; association of diuretics or increase ≥ 50% of furosemide dosage, or HF hospitalization. RESULTS: 2528 met study criteria (mean age 76; 42% women). Of these, 48% had ischemic heart disease, 18% patients with LVEF ≤ 35%. During a median follow-up of 2.4 years, overall mortality was 31% (95% CI: 29%-33%), whereas rate of HF progression or death was 57% (95% CI: 55%-59%). The 4-year incidence of HF progression was 39% (95% CI: 37%-41%) whereas the competing mortality rate was 18% (95% CI: 16%-19%). Rates of HF progression and death were higher in HF patients with LVEF ≤ 35% vs >35% (HF progression: 42% vs 38%, p = 0.012; death as a competing risk: 22% vs 17%, p = 0.002). HF progression identified HF patients with a worse survival (HR = 3.16, 95% CI: 2.75-3.72). In cause-specific Cox models, age, previous HF hospitalization, chronic obstructive pulmonary disease, chronic kidney disease, anemia, sex, LVEF ≤ 35% emerged as prognostic factors of HF progression. CONCLUSIONS: Among outpatients with HF, at 4 years 39% presented a HF progression, while 18% died before any sign of HF progression. This trend was higher in patients with LVEF ≤ 35%. These findings may have implications for healthcare planning and resource allocation.


Assuntos
Progressão da Doença , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Ambulatório Hospitalar/tendências , Características de Residência , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Mortalidade/tendências
12.
J Oncol Pharm Pract ; 25(1): 130-139, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29938594

RESUMO

BACKGROUND: Patients receiving anticancer therapies are frequently prescribed complex and high-risk medication regimens, which at times can result in medication misadventures. The objective of this review was to assess the effect of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies, including patients undergoing radiotherapy. METHODS: A systematic review of original publications indexed in EMBASE, MEDLINE and Cochrane Library from June 2007 to June 2017. Eligible studies evaluated outpatient pharmacy clinic services for cancer patients and reported at least one medication-related quantitative outcome measure. Two authors independently reviewed full-text articles for inclusion, then extracted data and performed quality and risk of bias assessments. RESULTS: Of 908 identified publications, 13 met predefined eligibility criteria; 1 randomised control trial, 2 controlled cohort studies and 10 uncontrolled before-after studies. Many excluded studies described outpatient pharmacy services but lacked medication-related outcomes. All included studies had informative practice model designs, with interventions for drug-related problems including drug dose optimisation ( n = 8), reduced drug interaction ( n = 6) and adverse drug reaction reporting ( n = 3). Most studies ( n = 11) reported on symptom improvement, commonly nausea ( n = 7) and pain ( n = 5). Of four studies in radiotherapy cohorts, pharmacist involvement was associated with improved symptoms, satisfaction and wellbeing scores. CONCLUSION: Few studies have objectively assessed outpatient pharmacy cancer services, even fewer in the radiotherapy settings. Although the results support these services, significant heterogeneity and bias in the study designs prohibit robust conclusions and further controlled trials are required.


Assuntos
Assistência Ambulatorial/métodos , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Ambulatório Hospitalar , Serviço de Farmácia Hospitalar/métodos , Assistência Ambulatorial/tendências , Estudos de Coortes , Humanos , Neoplasias/diagnóstico , Ambulatório Hospitalar/tendências , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
14.
Respir Res ; 19(1): 246, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541548

RESUMO

BACKGROUND: Few studies have investigated the associations between outdoor air pollution and outpatient visits for respiratory diseases (RDs) in general population. METHODS: We collected daily outpatient data of primary RDs from five hospitals in Jinan during January 2012 and December 2016, as well as daily measurements of air pollutants from the Jinan Environmental Monitoring Center and daily meteorological variables from the China Meteorological Data Sharing Service System. A generalized additive model (GAM) with quasi-Poisson regression was constructed to estimate the associations between daily average concentrations of outdoor air pollutants (PM2.5,PM10, SO2, NO2, CO and O3) and daily outpatient visits of RDs after adjusting for long-time trends, seasonality, the "day of the week" effect, and weather conditions. Subgroup analysis stratified by gender, age group and the type of RDs was conducted. RESULTS: A total of 1,373,658 outpatient visits for RDs were identified. Increases of 10 µg/m3 in PM2.5, PM10, NO2, CO and O3 were associated with0.168% (95% CI, 0.072-0.265%), 0.149% (95% CI, 0.082-0.215%), 0.527% (95% CI, 0.211-0.843%), 0.013% (95% CI, 0.003-0.023%), and 0.189% (95% CI, 0.032-0.347%) increases in daily outpatient visits for RDs, respectively. PM2.5 and PM10 showed instant and continuous effects, while NO2, CO and O3 showed delayed effects on outpatient visits for RDs. In stratification analysis, PM2.5 and PM10 were associated with acute RDs only. CONCLUSIONS: Exposure to outdoor air pollutants including PM2.5, PM10, NO2, CO and O3 associated with increased risk of outpatient visits for RDs.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Assistência Ambulatorial/tendências , Exposição Ambiental/efeitos adversos , Ambulatório Hospitalar/tendências , Transtornos Respiratórios/epidemiologia , Adolescente , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Respiratórios/induzido quimicamente , Transtornos Respiratórios/terapia , Adulto Jovem
15.
BMC Geriatr ; 18(1): 293, 2018 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-30486785

RESUMO

BACKGROUND: Risk factors associated with opioid-induced adverse reactions (OIARs) in the elderly population have not been well defined. The objective of this study was to determine effects of various risk factors on incidence of OIARs in male elderly patients. METHODS: A retrospective cohort study in Korea Veterans Hospital was performed. Data were analyzed in male patients aged 65 years and older who received morphine, oxycodone, or codeine. Binomial variables describing patient-related and drug-related characteristics were constructed. Associations between these variables and frequency of OIARs were determined. Odds ratio (OR) and adjusted odds ratio (AOR) were calculated from univariate and multivariable analyses, respectively. Attributable risk was obtained by (1-1/OR)*100%. RESULTS: Of 316 patients, 28% experienced at least one adverse event. The most common adverse events were gastrointestinal problems (n = 59) and central nerve system adverse effects (n = 20). The odds of OIARs in patients with opioid use ≥12 weeks was increased by 80% compared to those with opioid use < 12 weeks. Attributable risk of GABA analogues was 64~78% in constructed Models. Compared to codeine users, patients using morphine and oxycodone had 653 and 473% increased odds for OIARs, respectively. MME ≥ 60 mg/day had a 317% increased odds for OIARs (95% CI: 1.92-9.04) compared to MME < 60 mg/day. Opioid combination therapy had a 139% increased odds for OIARs compared to monotherapy. CONCLUSIONS: These findings have significant implications for clinical use of opioid in elderly patients. Our study suggests that low dose short-term use will pose less risk of OIARs for the elderly, whereas concomitant use of GABA analogues, strong opioids and dual-opioid therapy may increase the risk of OIARs. Therefore, clinician should carefully monitor patients when starting opioid therapy in older population.


Assuntos
Analgésicos Opioides/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hospitais de Veteranos/tendências , Ambulatório Hospitalar/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Tontura/induzido quimicamente , Tontura/diagnóstico , Tontura/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Humanos , Masculino , Oxicodona/efeitos adversos , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
16.
Respir Res ; 19(1): 182, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30236104

RESUMO

BACKGROUND: Few data are available on the long-term effect of pulmonary rehabilitation (PR) and on long PR programs in interstitial lung diseases (ILD). We aimed to evaluate the effects of PR on exercise capacity (6-Minute Walking Distance, 6MWD; Peak Work Rate, Wmax), quality of life (St George's Respiratory Questionnaire, SGRQ), quadriceps force (QF) and objectively measured physical activity in ILD after the 6-month PR-program and after 1 year. METHODS: 60 patients (64 ± 11 years; 62% males; 23% with IPF) were randomly assigned to receive a 6 month-PR program or usual medical care. RESULTS: Exercise capacity, quality of life and muscle force increased significantly after the program as compared to control (mean,95%CI[ll to ul]; 6MWD + 72,[36 to 108] m; Wmax 19, [8 to 29]%pred; SGRQ - 12,[- 19 to - 6] points; QF 10, [1 to 18] %pred). The gain was sustained after 1 year (6MWD 73,[28 to 118] m; Wmax 23, [10 to 35]%pred; SGRQ - 11,[- 18 to - 4] points; QF 9.5, [1 to 18] %pred). Physical activity did not change. CONCLUSIONS: PR improves exercise tolerance, health status and muscle force in ILD. The benefits are maintained at 1-year follow-up. The intervention did not change physical activity. TRIAL REGISTRATION: Clinicaltrials.gov NCT00882817 .


Assuntos
Tolerância ao Exercício/fisiologia , Exercício Físico/fisiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/reabilitação , Idoso , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Fatores de Tempo , Resultado do Tratamento
17.
Psychiatry Res ; 269: 134-139, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30145295

RESUMO

This study investigated gender differences in the prevalence of sleep disturbance and related demographic and clinical characteristics, including quality of life (QOL), in Chinese outpatients. Up to 4399 adult outpatients (2896 females, 1503 males) who visited the neurological, cardiovascular, gastrointestinal, and gynaecological outpatient clinics in four general hospitals were recruited. Demographic and clinical data including QOL were collected by using self-report questionnaires. The prevalence of sleep disturbance in female outpatients (671/2896, 23.2%) was significantly higher than in male outpatients (302/1503, 20.1%) and remained significant after adjusting for significant confounders in the regression analysis. In the regression analysis, divorced/widowed and unemployed status were independently associated with a higher frequency of sleep disturbance in females, while educational level was independently associated with males only. Among these factors, depressive symptoms and older age were the most common risk factors for sleep disturbance in both genders. Sleep disturbance was not associated with the mental domains of the QOL assessments in both genders. This study suggests that sleep disturbance is more frequent in female outpatients and is associated with multiple factors in both genders. A longitudinal study is warranted to confirm the current findings.


Assuntos
Hospitais Gerais/tendências , Ambulatório Hospitalar/tendências , Pacientes Ambulatoriais/psicologia , Caracteres Sexuais , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida/psicologia , Transtornos do Sono-Vigília/diagnóstico , Desemprego/psicologia , Viuvez/psicologia
18.
BMC Endocr Disord ; 18(1): 53, 2018 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-30081878

RESUMO

BACKGROUND: Diabetic foot ulceration is a serious limb-threatening complication of diabetes. It is the common cause of hospital admissions and amputations. The objective of the study was to determine the prevalence of diabetic foot ulcers (DFU) and its association with age, gender, duration of diabetes, peripheral neuropathy (PN), peripheral arterial disease (PAD) and HbA1c. METHODS: A total of 1940 people (≥ 30 years of age) with type 2 diabetes coming to the Sakina Institute of Diabetes and Endocrine Research (specialist diabetes clinic) at Shalamar Hospital, Lahore, Pakistan, were recruited over a period of 1 year from January 2016 to January 2017. The foot ulcers were identified according to the University of Texas classification. PN was assessed by biothesiometer and PAD by ankle-brachial index (< 0.9). Body weight, height, body mass index (BMI), HbA1c and duration of diabetes were recorded. RESULTS: The prevalence of DFU was 7.02%, of which 4.5% of the ulcers were on the planter and 2.6% on the dorsal surface of the foot; 8.5% of the persons had bilateral foot ulcers and 0.4% subjects had Charcot deformity. There was significant association of foot ulcers with age, duration of diabetes, HbA1c, PN and PAD, whereas no association was observed with gender and BMI. PN and PAD were observed in 26.3 and 6.68% of people with diabetes respectively. Neuropathic ulcers and neuro-ischemic ulcers were identified in 74 and 19% of the study population. Logistic regression analysis revealed significant odds ratio for peripheral neuropathy 23.9 (95% confidence interval (5.41-105.6). CONCLUSIONS: Peripheral neuropathy is the commonest cause of foot ulcers. An optimum control of blood glucose to prevent neuropathy and regular feet examination of every person with diabetes may go a long way in preventing foot ulceration.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Ambulatório Hospitalar/tendências , Centros de Atenção Terciária/tendências , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia
19.
BMC Nephrol ; 19(1): 183, 2018 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-30025520

RESUMO

BACKGROUND: Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. METHODS: Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. RESULTS: Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. CONCLUSIONS: Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.


Assuntos
Hospitais de Veteranos/tendências , Ambulatório Hospitalar/tendências , Pesquisa Qualitativa , Insuficiência Renal Crônica/terapia , United States Department of Veterans Affairs/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais de Veteranos/normas , Humanos , Masculino , Ambulatório Hospitalar/normas , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/normas
20.
BMC Psychiatry ; 18(1): 232, 2018 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021544

RESUMO

BACKGROUND: Data on the prevalence of insomnia symptoms in medical outpatient clinics in China are lacking. This study examined the prevalence of insomnia symptoms and their socio-demographic correlates in patients treated at medical outpatient clinics affiliated with four general hospitals in Guangzhou, a large metropolis in southern China. METHOD: A total of 4399 patients were consecutively invited to participate in the study. Data on insomnia and its socio-demographic correlates were collected with standardized questionnaires. RESULTS: The prevalence of any type of insomnia symptoms was 22.1% (95% confidence interval (CI): 20.9-23.3%); the prevalence of difficulty initiating sleep was 14.3%, difficulty maintaining sleep was 16.2%, and early morning awakening was 12.4%. Only 17.5% of the patients suffering from insomnia received sleeping pills. Multiple logistic regression analysis revealed that male gender, education level, rural residence, and being unemployed or retired were negatively associated with insomnia symptoms, while lacking health insurance, older age and more severe depressive symptoms were positively associated with insomnia symptoms. CONCLUSIONS: Insomnia symptoms are common in patients attending medical outpatient clinics in Guangzhou. Increasing awareness of sleep hygiene measures, regular screening and psychosocial and pharmacological interventions for insomnia are needed in China. TRIAL REGISTRATION: ChiCTR-INR-16008066 . Registered 8 March 2016.


Assuntos
Hospitais Gerais/tendências , Ambulatório Hospitalar/tendências , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural/tendências , Higiene do Sono/fisiologia , Inquéritos e Questionários , Adulto Jovem
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