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1.
Medicine (Baltimore) ; 98(52): e18230, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876704

RESUMO

BACKGROUND: Acute radiation dermatitis (ARD) is a common adverse effect in patients undergoing radiotherapy. Mometasone furoate cream (MMF) was reported to significantly reduce ARD, especially in breast cancer. Clinically, ARD is more critical and more difficult to prevent in patients with head and neck squamous cell carcinoma (HNSCC) than in those with breast cancer, because a higher dose of radiotherapy is required in HNSCC cases. The aim of this study was to evaluate the effect of MMF local application on radiation dermatitis in patients with HNSCC. METHODS: HNSCC patients scheduled for bilateral radical radiotherapy to the neck with identical radiation doses were enrolled. One side of the neck skin (test groups) of the patients were randomized to apply a thin layer of MMF once a day from the date of first radiotherapy until either 2 weeks after end of radiotherapy or until the test side skin developed ARD lesions, while the other side of neck (control groups) didn't apply any medication. The severity of ARD was evaluated weekly by using the modified radiation therapy oncology group score, pain intensity, and itch stages. RESULTS: Forty-one patients (82 targets) were analyzed. There was a significant difference between the ARD scores on the test side and the control side. MMF reduced the stages of ARD when the radiotherapy dose was <6000 cGY (P = .01) but showed no improvement when the dose was ≥6000 cGY (P = .699). Compared to the control side, local application of MMF significantly reduced the itch and pain scores of the test side skin regardless of the radiotherapy dose and ARD stage (P < .001) during radiotherapy. CONCLUSIONS: This study showed that MMF inunction after high-dose radiotherapy (>50 Gy) can prevent ARD, especially when the radiation dose is <6000 cGY.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Furoato de Mometasona/uso terapêutico , Radiodermatite/prevenção & controle , Administração Cutânea , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Furoato de Mometasona/administração & dosagem , Estudos Prospectivos , Autocuidado/métodos , Creme para a Pele , Adulto Jovem
2.
Pan Afr Med J ; 33: 162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565124

RESUMO

Introduction: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. Methods: Descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. Results: The average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. Conclusion: The practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.


Assuntos
Nefropatias/terapia , Diálise Renal/métodos , Autocuidado/métodos , Adulto , Idoso , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Humanos , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Marrocos , Cooperação do Paciente/estatística & dados numéricos
3.
Lakartidningen ; 1162019 Sep 09.
Artigo em Sueco | MEDLINE | ID: mdl-31503319

RESUMO

There is a growing body of evidence that mindfulness and compassion are effective in reducing stress in health care. Focus meditation brings back the wandering mind to our breath and body. This attention skill can be practiced as STOP-sign: 'Stop, Take a breath, Observe and Priority first' when facing an emergency. Insight meditation helps us to observe our thoughts, let them pass and bring clarity. This noting technique can be practiced as SOAL: 'Stop, Observe, Accept, and Let go' when there is emotional distress. Better emotional regulation may also protect us from over-identification to negative affect. Mindfulness promotes transformation from empathy to compassion with focus on intention and motivation to alleviate. Compassion training may generate positive affect as antidote to empathy fatigue. Self-compassion embraces our difficulties in our life with the insight of common humanity and improves self-care. Group training at work place can be effective for implementation in health care.


Assuntos
Esgotamento Profissional/prevenção & controle , Pessoal de Saúde/psicologia , Atenção Plena/métodos , Fadiga por Compaixão/prevenção & controle , Empatia , Humanos , Meditação , Estresse Ocupacional/prevenção & controle , Autocuidado/métodos
4.
Rev Lat Am Enfermagem ; 27: e3164, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432918

RESUMO

OBJECTIVE: to translate and cross-culturally adapt the Behavior Change Protocol for educational practices in Diabetes Mellitus. METHOD: methodological study aimed at cross-cultural adaptation, comprising the steps of translation, back-translation, assessment by an expert committee and pre-testing of the instrument on a sample of 30 healthcare service users with type 2 Diabetes Mellitus. RESULTS: the instrument was assessed based on criteria pertaining semantic, idiomatic, conceptual and cultural equivalence between the original instrument and the translated version, its mean Content Validity Index being 0.85. CONCLUSION: results showed content validity indicating the instrument's successful cross-cultural adaptation to the Brazilian culture for use in educational practices targeting self-care in type 2 DM.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto/normas , Autocuidado/normas , Inquéritos e Questionários/normas , Tradução , Brasil , Comparação Transcultural , Características Culturais , Feminino , Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Educação de Pacientes como Assunto/métodos , Valores de Referência , Reprodutibilidade dos Testes , Autocuidado/métodos
5.
BMC Public Health ; 19(1): 963, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319838

RESUMO

BACKGROUND: To determine whether age is a barrier against acceptability of cervicovaginal self-sampling in screening for cervical cancer at two gynecology outpatient clinics. METHODS: This is a cross-sectional study involving 116 women over 21 years of age with an abnormal Pap smear. Clinical and laboratorial data were recorded in electronic files. Women received detailed self-collection instructions. After the self-sampling procedure (Evalyn Brush®), women were instructed to answer a questionnaire about vaginal self-sampling acceptability that consisted of seven multiple-choice items. The participants were divided into three age brackets: 21 to 29 years, 30 to 49 years, and 50 years and over. Chi-square, Fischer exact, Kolmogorov-Smirnov and Kruskal-Wallis tests were used. RESULTS: The analysis of the participants' perception of the procedure stratified according to age groups showed a decline in the fear of hurting oneself during the procedure as age increased. Most participants reported that it was very easy to understand how to use the self-sampling brush and that it was easy to use it. Most of them were neither embarrassed nor afraid of getting hurt during the procedure. The majority preferred self-sampling to collection by a healthcare professional. The main reason was practicality: the possibility of choosing the place and time for sampling. CONCLUSIONS: The participating women found self-collection simple to understand and easy to accept regardless of age. The younger women indicated more fear and discomfort in self-sampling, which points to the need for attraction strategies that are more appealing to the younger generations.


Assuntos
Fatores Etários , Detecção Precoce de Câncer/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/psicologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/psicologia , Adulto , Estudos Transversais , Detecção Precoce de Câncer/métodos , Feminino , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/psicologia , Projetos Piloto , Autocuidado/métodos , Inquéritos e Questionários , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/métodos , Adulto Jovem
6.
Rev Lat Am Enfermagem ; 27: e3143, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340340

RESUMO

OBJECTIVE: to develop, evaluate and correlate the acceptability of an educational mobile application to patients submitted to orthognathic surgery. METHOD: methodological study based on systematic instructional design with contents aimed at patient learning through a mobile application. Usability and user satisfaction were evaluated by 30 patients in the perioperative stage through an electronic questionnaire sent by social networks, e-mail and business card, measured using the System Usability Scale instrument validated in Portuguese and user satisfaction with an instrument based on another study, after its applications. Data were analyzed with descriptive statistics and Spearman correlation. RESULTS: the application named "OrtogApp" features content validated in a previous study included five learning content sessions essential for managing perioperative care, and it is available on IOS and Android platforms. Usability corresponded to 79.8 + 15.4 points and the satisfaction index was 82.9%; correlation of age, schooling and uses of the application with the instruments was not significant. CONCLUSION: OrtogApp is an educational application with content validated by professionals, resulting in high user satisfaction and good usability. Patients may use the application as supportive educational material to supplement guidance provided by perioperative nurses and/or surgeons during perioperative care.


Assuntos
Aplicativos Móveis , Cirurgia Ortognática , Período Perioperatório/educação , Cuidados Pós-Operatórios/educação , Adulto , Brasil , Telefone Celular/instrumentação , Comportamento do Consumidor , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Autocuidado/métodos , Inquéritos e Questionários , Telemedicina/métodos , Adulto Jovem
7.
BMC Med ; 17(1): 127, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31311573

RESUMO

BACKGROUND: Smartphone apps are becoming increasingly popular for supporting diabetes self-management. A key aspect of diabetes self-management is appropriate medication-taking. This study aims to systematically assess and characterise the medication management features in diabetes self-management apps and their congruence with best-practice evidence-based criteria. METHODS: The Google Play and Apple app stores were searched in June 2018 using diabetes-related terms in the English language. Apps with both medication and blood glucose management features were downloaded and evaluated against assessment criteria derived from international medication management and diabetes guidelines. RESULTS: Our search yielded 3369 Android and 1799 iOS potentially relevant apps; of which, 143 apps (81 Android, 62 iOS) met inclusion criteria and were downloaded and assessed. Over half 58.0% (83/143) of the apps had a medication reminder feature; 16.8% (24/143) had a feature to review medication adherence; 39.9% (57/143) allowed entry of medication-taking instructions; 5.6% (8/143) provided information about medication; and 4.2% (6/143) displayed motivational messages to encourage medication-taking. Only two apps prompted users on the use of complementary medicine. Issues such as limited medication logging capacity, faulty reminder features, unclear medication adherence assessment, and visually distracting excessive advertising were observed during app assessments. CONCLUSIONS: A large proportion of diabetes self-management apps lacked features for enhancing medication adherence and safety. More emphasis should be given to the design of medication management features in diabetes apps to improve their alignment to evidence-based best practice.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Adesão à Medicação , Aplicativos Móveis , Autocuidado/métodos , Autogestão/métodos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Humanos , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Aplicativos Móveis/normas , Aplicativos Móveis/estatística & dados numéricos , Autocuidado/normas , Autocuidado/estatística & dados numéricos , Autoeficácia , Autogestão/estatística & dados numéricos , Smartphone
8.
Rev Bras Enferm ; 72(3): 700-706, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269135

RESUMO

OBJECTIVE: To evaluate the effect of educational intervention in the adherence to self-care activities and functional health literacy and numeracy in people with type 2 diabetes mellitus. METHODS: This was a quasi-experimental study conducted in two units of the Brazilian Family Health Strategy, involving people with diabetes. Educational interventions occurred in three meetings, weekly, lasting 60 minutes on average. Data were collected using the Questionário de Autocuidado com o Diabetes, before and after the interventions. RESULTS: 55 people participated in the study. After the interventions, the greatest difference for a better adherence to self-care was the item "inspecting the inside of the shoes before putting them on", with 3.29 days in the week delta at analytical level. The worst was "taking insulin shots as recommended", with 0.00 days a week delta at basic level. CONCLUSION: Educational interventions had a positive effect on adherence to self-care and functional literacy in health.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Alfabetização em Saúde/métodos , Autocuidado/métodos , Idoso , Brasil , Diabetes Mellitus Tipo 2/psicologia , Feminino , Promoção da Saúde/métodos , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade
9.
Rev Bras Enferm ; 72(3): 780-787, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269146

RESUMO

OBJECTIVE: to describe the validation of the booklet on self-care with the feet of people with diabetes. METHOD: methodological study, focusing on the validation of a printed booklet. The content and appearance of the booklet was validated by 23 judges divided into three groups: 11 content and appearance, seven technicians and five of the area of design and marketing. The appearance was validated by 30 people with type 2 Diabetes Mellitus. RESULTS: the judges in the nursing area allowed the validation of material with a Content Validity Index (CVI) of 0.99, judges in the area of design and marketing with Suitability Assessment of Materials (SAM) of 99.2% and the target audience with concordance index of 99.4%. CONCLUSION: the educational booklet proved to be valid and reliable educational material to be used in order to promote compliance with self-care with the feet of people with Diabetes Mellitus.


Assuntos
Pé Diabético/terapia , Folhetos , Educação de Pacientes como Assunto/normas , Autocuidado/instrumentação , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/psicologia , Humanos , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Autocuidado/normas , Inquéritos e Questionários , Estudos de Validação como Assunto
10.
BMC Public Health ; 19(1): 898, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286953

RESUMO

BACKGROUND: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. METHODS: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi- or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. RESULTS: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). CONCLUSION: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/métodos , Testes Sorológicos/métodos , Adulto , Estudos de Viabilidade , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/psicologia , Prevalência , Estudos Prospectivos , Autocuidado/psicologia , Testes Sorológicos/psicologia , Profissionais do Sexo , África do Sul/epidemiologia , Adulto Jovem
11.
Niger J Clin Pract ; 22(6): 806-811, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187766

RESUMO

Objective: Studies related to traditional practices and benefits have been usually performed among women. The literature regarding the traditional practices used by men in Turkey and around the world and their expected benefits is more limited. The aim of this study was to examine the traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths. Materials and Methods: The descriptive study was performed between May and July 2017 in Izmir, Turkey. In total, 151 women with infertility were included. The data related to the use of this practice by men were obtained from women partners. "Personal information form" and "traditional practices evaluation form" were used to obtain the data. Results: In total, 35.8% of the women and 25.8% of the men used traditional practices. The 24.4% of women and 52.1% of men used other practices such as figs, onion cures, and hacamat, whereas 18.2% of women and 14.9% of men used various herbs. The benefits they expected from traditional practices were facilitating conception, ensuring follicle development in women, increasing sperm count, and quality and facilitating conception in men. Overall, 37.0% of women learned of these practices from their friends, 30.7% of men learned from their partners, 20.4% of women and 20.6% of men learned from the internet. Conclusion: The couples in this study widely used traditional practices to solve fertility problems and learned from their friends and partners.


Assuntos
Terapias Complementares , Fertilidade , Infertilidade/terapia , Fitoterapia , Autocuidado/métodos , Adulto , Feminino , Amigos , Humanos , Comportamento de Busca de Informação , Internet , Masculino , Medicina Tradicional , Preparações de Plantas/uso terapêutico , Análise do Sêmen , Cônjuges , Turquia
13.
Cien Saude Colet ; 24(5): 1689-1698, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166504

RESUMO

The treatment of chronic kidney disease (CKD) places a major burden on patients and their families. Interventions such as nutritional management, medication regimen, and renal replacement therapies require active patient participation. An integrative literature review was carried out to identify articles on the engagement and participation of people with CKD in their care. The Medical Subject Headings (MeSH) "Kidney Failure, Chronic", "Self Care", and "Patient Participation" were used to conduct a search on the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the U.S. National Library of Medicine® (Medline/PubMed), Biblioteca Virtual em Saúde (Bireme). A total of 21 articles published between 2012 and 2016 were selected. The most commonly used data collection and analysis techniques were semi-structured interviews and phenomenological thematic analysis, respectively. The articles were categorized into the following thematic groups: illness management and treatment; involvement in the decision-making process; advanced care plan; and home peritoneal dialysis. We found that there is a lack of qualitative research in certain areas, namely kidney transplant recipients and people with initial stages of CKD. People with CKD should be encouraged to actively engage in their own care, which in turn requires the knowledge, motivation and support of health professionals.


Assuntos
Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/métodos , Autocuidado/métodos , Humanos , Transplante de Rim , Participação do Paciente , Projetos de Pesquisa , Transplantados
14.
Diabetes Res Clin Pract ; 152: 29-38, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082445

RESUMO

AIMS: To evaluate the effectiveness of a theory-based foot care education intervention program (3STEPFUN) for people with type 2 diabetes at low risk of developing a foot ulcer. METHODS: A controlled, pre-test/ post-test quasi-experimental design was used. From 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received (1) a small group intensive education and hands-on skills session; (2) a foot care kit and documents; and (3) three regular booster follow-up phone calls over 6 months. Generalised Estimating Equations models were undertaken to examine the impact of the intervention on outcomes over time. RESULTS: The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: improved preventive foot care behaviour (p = 0.001); and decreased prevalence of foot risk factors for ulceration (i.e. dry skin, corns/ callus) (OR: 0.04, 95% CI 0.01 - 0.13, p < 0.001). CONCLUSIONS: The study's findings provide evidence of 3STEPFUN on improving foot self-care behaviour and preventing minor foot problems. Further study with formal RCT design and longer follow-up time to examine the effects on decreasing foot ulcer incidence is recommended.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Pé Diabético/prevenção & controle , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Idoso , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Pé/patologia , Comportamentos Relacionados com a Saúde/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Método Simples-Cego
15.
Behav Sci Law ; 37(3): 247-258, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31119794

RESUMO

Accumulating evidence supports the efficacy of cognitive behavioral therapy for suicide prevention (CBT-SP) as an empirically supported treatment approach for suicidal patients. In light of these findings, several procedures pulled from CBT-SP have been recommended for standard care with suicidal patients. The present article provides an overview of the procedures used in CBT-SP and discusses how these procedures meet, or even exceed, standard of care expectations for outpatient mental healthcare clinicians. Finally, the relevance of clinician fidelity to the CBT-SP model when evaluating standard of care expectations is discussed.


Assuntos
Terapia Cognitivo-Comportamental/normas , Motivação , Padrão de Cuidado , Ideação Suicida , Suicídio/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Intervenção na Crise/métodos , Intervenção na Crise/normas , Ajustamento Emocional , Humanos , Pacientes Ambulatoriais , Planejamento de Assistência ao Paciente/normas , Medição de Risco/normas , Autocuidado/métodos , Autocuidado/normas , Apoio Social , Suicídio/psicologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(21): e15704, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124947

RESUMO

INTRODUCTION: Mibyeongbogam (MBBG) is a mobile application developed for subhealth status self-management in the Republic of Korea. It aims to assess a user's subhealth status, and then to recommend relevant traditional Korean medicine (TKM)-based health-promoting strategies. The purpose of this study is to evaluate the feasibility and effectiveness of MBBG's employment for the subhealth management of general healthy adults. METHODS: This is a prospective, open-label, parallel group, randomized controlled trial that will seek to enroll 150 healthy adults, aged 30 to 49 years old, from 2 hospitals in the Republic of Korea. The eligible participants will then be randomly allocated to either the MBBG or control group, at a 1:1 allocation ratio. The MBBG group will use the application for 12 weeks, while the control group will undergo no intervention. The awareness of subhealth status will be primarily assessed. Health promoting behaviors, quality of life, TKM-based health questionnaires, and physical examination results will be assessed as secondary outcomes. DISCUSSION: The primary endpoint will be tested with a 2-sample t test, or a Wilcoxon rank sum test. Any other continuous variables will be tested via an analysis of covariance, while categorical variables will be tested by a Chi-squared or Fisher exact test. Repeated measure analysis of variance will be performed to explore any in-group differences. The results will be addressed with a 95% confidence interval. We expect that MBBG will be the 1st TKM-based mobile application to be feasible for primary care in subhealth management. TRIAL REGISTRATION: CRIS (Clinical Research Information Service), KCT0003488, February 11, 2019.


Assuntos
Promoção da Saúde/métodos , Nível de Saúde , Estilo de Vida Saudável , Aplicativos Móveis , Autocuidado/métodos , Adulto , Biomarcadores , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , República da Coreia , Projetos de Pesquisa
17.
Hypertension ; 73(6): 1231-1239, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31067190

RESUMO

The use of self-monitoring of blood pressure, with or without telemonitoring, to guide therapy decisions by physicians for patients with hypertension has been recently demonstrated to reduce blood pressure compared with using clinic monitoring (usual care). However, both the cost-effectiveness of these strategies compared with usual care, and whether the additional benefit of telemonitoring compared with self-monitoring alone could be considered value for money, are unknown. This study assessed the cost-effectiveness of physician titration of antihypertensive medication using self-monitored blood pressure, with or without telemonitoring, to make hypertension treatment decisions in primary care compared with usual care. A Markov patient-level simulation model was developed taking a UK Health Service/Personal Social Services perspective. The model adopted a lifetime time horizon with 6-month time cycles. At a willingness to pay of £20 000 per quality-adjusted life year, self-monitoring plus telemonitoring was the most cost-effective strategy (£17 424 per quality-adjusted life year gained) compared with usual care or self-monitoring alone (posting the results to the physician). However, deterministic sensitivity analysis showed that self-monitoring alone became the most cost-effective option when changing key assumptions around long-term effectiveness and time horizon. Overall, probabilistic sensitivity analysis suggested that self-monitoring regardless of transmission modality was likely to be cost-effective compared with usual care (89% probability of cost-effectiveness at £20 000/quality-adjusted life year), with high uncertainty as to whether telemonitoring or self-monitoring alone was the most cost-effective option. Self-monitoring in clinical practice is cost-effective and likely to lead to reduced cardiovascular mortality and morbidity.


Assuntos
Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/economia , Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Atenção Primária à Saúde/economia , Autocuidado/economia , Telemedicina/economia , Determinação da Pressão Arterial/métodos , Análise Custo-Benefício , Humanos , Hipertensão/tratamento farmacológico , Modelos Econômicos , Autocuidado/métodos
18.
Rev Bras Enferm ; 72(suppl 1): 159-165, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942358

RESUMO

OBJECTIVE: To analyze health as a right from the perspective of care of the self, in the conception of nursing professionals. METHOD: Qualitative study, carried out in a Federal Hospital of the city of Rio de Janeiro, with the participation of 10 nurses and 20 nursing technicians through interviews recorded, transcribed and analyzed in light of the Discursive Textual Analysis. RESULTS: Two categories emerged: Health as the right of professionals and their "non-right" to health; and Care of the self for the health professional: work and torture. CONCLUSION: There are many challenges to overcome, such as the search for satisfactory public funding, the need to improve the quality of Primary Health Care services, the implementation of a care model compatible with the country's demographic and epidemiological situation; all professionals need an effective endorsement for care of the self, such as their knowledge of the right to health.


Assuntos
Assistência à Saúde/métodos , Direitos Humanos/psicologia , Enfermeiras e Enfermeiros/psicologia , Adulto , Brasil , Feminino , Humanos , Masculino , Enfermeiras e Enfermeiros/normas , Pesquisa Qualitativa , Autocuidado/métodos
19.
AIDS Behav ; 23(9): 2421-2431, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30993478

RESUMO

To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Abuso Sexual na Infância/psicologia , Terapia Cognitivo-Comportamental/métodos , Aconselhamento/métodos , Infecções por HIV/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Autocuidado/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Criança , Infecções por HIV/psicologia , Soronegatividade para HIV , Homossexualidade Masculina/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Comportamento de Redução do Risco , Comportamento Sexual , Parceiros Sexuais , Transtornos de Estresse Pós-Traumáticos/psicologia
20.
Theor Med Bioeth ; 40(2): 141-149, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30972615

RESUMO

Virtue theory in philosophical bioethics has influenced clinical ethics with depictions of the virtuous doctor or nurse. Comparatively little has been done with the concept of the virtuous patient, however. Bioethicists should correct the asymmetry in virtue theory between physician virtues and patient virtues in a way that provides a practical theory for the new patient-centered medicine-something clinicians and administrators can take seriously.


Assuntos
Bioética , Filosofia , Autocuidado/psicologia , Humanos , Direitos do Paciente/ética , Autocuidado/métodos
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