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1.
Medicine (Baltimore) ; 99(44): e22862, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126330

RESUMO

The aim of this study was to assess the levels of self-perceived burden (SPB) and self-management behavior in elderly stroke survivors during the first 3 months after acute stroke, and to explore the correlation between them.A total of 203 consecutive hospitalized elderly patients diagnosed with stroke were recruited. Self-perceived Burden Scale and Stroke Self-management Scale in 1 month (T1) and 3 months (T2) post-stroke were assessed and compared.The score of SPB in elderly stroke survivors was 28.96 ±â€Š5.50 and 27.25 ±â€Š6.17 at T1 and T2, respectively. Stroke self-management scale scored 165.93 ±â€Š9.82 at T1 and 167.29 ±â€Š10.60 at T2. In the first 3 months post-stroke, the physical burden was dominant (T1 14.73 ±â€Š3.07, T2 14.40 ±â€Š3.13), and the behavior of stroke symptoms and signs monitoring (T1 27.58 ±â€Š6.56, T2 28.64 ±â€Š6.43) and rehabilitation exercise management (T1 21.40 ±â€Š3.28, T2 20.74 ±â€Š3.15) was the worst. SPB was negatively correlated with self-management behavior (T1 r = -.202, T2 r = -.511).Elderly stroke survivors experienced a medium level of SPB and self-management behavior in the first 3 months post-stroke. There is a positive relationship between reduced SPB and improved self-management behavior. Addressing the characteristics and correlations as well as development of targeted interventions for SPB decreasing is beneficial to improving self-management behavior for elderly survivors.


Assuntos
Efeitos Psicossociais da Doença , Autoimagem , Autogestão/psicologia , Reabilitação do Acidente Vascular Cerebral/psicologia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Autogestão/métodos , Autogestão/estatística & dados numéricos , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
2.
Int J Chron Obstruct Pulmon Dis ; 15: 2487-2494, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116465

RESUMO

Background: Social distancing and restriction measures during the COVID-19 epidemic may have impacts on medication availability and healthcare utilization for COPD patients, and thereby affect standard disease management. We aimed to investigate the change of respiratory symptoms, pharmacological treatment and healthcare utilization of COPD patients during the epidemic in Beijing, China. Methods: We conducted a single-center, cross-sectional survey performed at Peking University Third Hospital and recruited patients with COPD who were interviewed by phone call. Clinical data, including respiratory symptoms, pharmacological treatment, management and healthcare access before and during the COVID-19 epidemic from January 25 to April 25, 2020, were collected. Results: A total of 153 patients were enrolled for analysis. Before the epidemic, 81.7% (125/153) had long-term maintenance medication and ICS/LABA (60.8%) and LAMA (57.5%) were most commonly used. During the epidemic, 75.2% (115/153) maintained their pharmacological treatment and 6.5% (10/153) had to reduce or stop taking medications, with a slight decrease of patients taking ICS/LABA (53.6%) and LAMA (56.9%). Most of the patients [76.5% (117/153)] had a low symptom burden, with a CAT score <10 during the epidemic. Of 153 patients, 45 (29.4%) patients reported worsening of respiratory symptoms but only 15.6% (7/45) sought medical care in hospitals, while the remaining expressed concerns about cross-infection in the hospital (55.5%, 25/45) or had mild symptoms which were managed by themselves (28.8%, 13/45). Conclusion: During the COVID-19 epidemic in Beijing, most of our COPD patients maintained their long-term pharmacological treatment and had mild-to-moderate symptoms. Approximately, 30.0% of the patients experienced worsening of respiratory symptoms, but most of them did not seek medical care in the hospital due to concerns about cross-infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Pequim , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Doença Pulmonar Obstrutiva Crônica/complicações , Autogestão
3.
Int J Chron Obstruct Pulmon Dis ; 15: 2621-2627, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33122900

RESUMO

Purpose: On March 16, 2020, the Spanish government declared a state of alarm due to the rapid spread of coronavirus disease 2019 (COVID-19). Patients with chronic obstructive pulmonary disease (COPD) were restricted to remain confined at home, and medical visits were cancelled for 3 months. The impact of this lockdown on the manifestations of COPD and the quality-of-life of these patients has not been explored. Patients and Methods: One hundred patients with COPD were interviewed by telephone from May 2-18, 2020. The interviews included questions about the lockdown, missed medical appointments, fears of the disease, possible COVID-19 infection, and exacerbations of COPD suffered during this period and their management. In addition, the COPD Assessment Test, the Hospital Anxiety and Depression, and the 5-Dimension Euro Quality-of-Life questionnaires were administered. Results: Sixty-four (64%) patients claimed to have strictly complied with the lockdown, and only 42 (42%) stated they had left home at least once during lockdown. Only one patient (1%) was hospitalized due to COVID-19, and 13 (13%) patients presented an exacerbation of COPD self-managed at home with no admissions due to exacerbation of COPD during this period. A medical consultation or complementary test was cancelled in 90% of the patients, but 61% had a medical telephone visit with a high degree of satisfaction (mean 9.3/10). Most patients declared that their feeling regarding lung disease and general health was similar or even better during lockdown (82% and 81%, respectively). Conclusion: Our results indicate that in general lockdown had a low impact on COPD patients. Only one patient was affected by COVID-19, but moderate exacerbations of COPD were not infrequent. Although many medical visits and test were cancelled, patients were very satisfied with the medical telephone visits.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Isolamento Social , Idoso , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Autogestão , Espanha , Inquéritos e Questionários
4.
Nutrients ; 12(10)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33008059

RESUMO

COVID-19 related restrictions aimed at curbing the spread of the coronavirus result in changes in daily routines and physical activity which can have a negative effect on eating and health habits. The aim of the study was to assess the impact of the COVID-19 pandemic on patients with diabetes and their nutrition and health behaviours. A survey conducted in July 2020 included 124 individuals with type 1 (n = 90) and 2 (n = 34) diabetes mellitus from Poland. To assess nutritional and health behaviours, an online questionnaire covering basic information, anthropometric data, and details regarding physical activity, eating, and hygiene habits was used. Almost 40% of all respondents with type 1 and 2 diabetes mellitus (DM) stated that their disease self-management had significantly improved. Over 60% of all participants declared that they had started eating more nutritious and regular meals during the COVID-19 pandemic. Enhanced hygiene, in particular, during the period, a statistically significant increase in hand sanitiser use was reported by respondents (18% vs. 82%, p < 0.001). The study demonstrated that the pandemic had a significant impact on the behaviour of patients with DM. Improved disease self-management and making healthy, informed food and hygiene choices were observed.


Assuntos
Infecções por Coronavirus , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Dieta , Comportamentos Relacionados com a Saúde , Pandemias , Pneumonia Viral , Autogestão , Adolescente , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Comportamento Alimentar , Feminino , Desinfecção das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Inquéritos e Questionários , Adulto Jovem
5.
Can Fam Physician ; 66(10): 745-747, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33077454
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5673-5677, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019264

RESUMO

While there have been several efforts to use mHealth technologies to support asthma management, none so far offer personalised algorithms that can provide real-time feedback and tailored advice to patients based on their monitoring. This work employed a publicly available mHealth dataset, the Asthma Mobile Health Study (AMHS), and applied machine learning techniques to develop early warning algorithms to enhance asthma self-management. The AMHS consisted of longitudinal data from 5,875 patients, including 13,614 weekly surveys and 75,795 daily surveys. We applied several well-known supervised learning algorithms (classification) to differentiate stable and unstable periods and found that both logistic regression and naïve Bayes-based classifiers provided high accuracy (AUC > 0.87). We found features related to the use of quick-relief puffs, night symptoms, frequency of data entry, and day symptoms (in descending order of importance) as the most useful features to detect early evidence of loss of control. We found no additional value of using peak flow readings to improve population level early warning algorithms.


Assuntos
Asma , Autogestão , Telemedicina , Asma/diagnóstico , Teorema de Bayes , Humanos , Aprendizado de Máquina
7.
Eur J Endocrinol ; 183(6): 551-559, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33055299

RESUMO

Introduction: The low prevalence of pituitary diseases makes patient autonomy crucial, and self-management programs should be more common. Objectives: To assess the efficacy of an education program for patients with pituitary diseases in terms of patients' quality of life, satisfaction and goal attainment. Design and methods: Adult patients with pituitary disorders were recruited in a tertiary referral center and chose at least three of eight possible sessions on various topics, from disease management to psychosocial issues. Patients were included if they attended at least three sessions between 2012 and 2016 and completed the initial, final, and follow-up questionnaires. Data on quality of life (SF36), satisfaction and goal attainment were analyzed. Results: Fifty-three patients were included (33 women; mean age, 53.5 years). There were a significant quality of life improvements in terms of physical and psychic limitation scores at the final assessment that persisted at follow-up evaluation. Most patients reached their objectives, especially those on sharing experiences and improving autonomy and self-confidence. More than half set new objectives at the end of the program, the most popular one being to reinforce their knowledge of their pituitary disease, its evolution and treatment (17.1% of patients). The mean overall satisfaction score was 3.75/4. At follow-up evaluation, patients reported improved self-management of pituitary disease (3.6/5) and improved self-efficacy (3.8/5). Conclusion: Individualizing the educational objectives of patients with pituitary disease improves the way they live with their disease. If confirmed in other cohorts, this approach could become the gold standard for education programs in rare endocrine diseases.


Assuntos
Educação de Pacientes como Assunto/normas , Doenças da Hipófise/psicologia , Doenças da Hipófise/terapia , Autogestão/psicologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Projetos Piloto , Doenças da Hipófise/diagnóstico , Qualidade de Vida/psicologia , Autogestão/métodos , Inquéritos e Questionários/normas
9.
Stud Health Technol Inform ; 273: 182-188, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087610

RESUMO

The COVID-19 pandemic has posed several challenges on citizens and health systems. Information and Communication Technology (ICT) can be a valuable tool in providing tools for self-assessment and reporting of physical symptoms, early detection of symptom changes, up to date information towards citizen empowerment, personalized recommendations and communication with healthcare providers in case of need. To this direction, this paper reports on the design and implementation of a novel technical infrastructure to support citizens with possible or confirmed COVID-19 disease. The designed platform builds upon an existing personal health record to facilitate symptom tracking, self-management, and personalized recommendations, effective communication channels between patients and clinicians and public health authorities assisting citizens to remain longer safe at home.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Autogestão , Telemedicina , Betacoronavirus , Humanos
10.
J Diabetes Sci Technol ; 14(6): 1107-1110, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33050727

RESUMO

With the recent pivot to telehealth as a direct result of the COVID-19 pandemic, there is an imperative to ensure that access to affordable devices and technologies with remote monitoring capabilities for people with diabetes becomes equitable. In addition, expanding the use of remote Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) services will require new strategies for achieving long-term, effective, continuous, data-driven care. The current COVID-19 pandemic has especially impacted underserved US communities that were already disproportionately impacted by diabetes. Historically, these same communities have faced barriers in accessing timely and effective diabetes care including access to DSMES and MNT services, and diabetes technologies. Our call to action encourages all involved to urge US Federal representatives to widen access to the array of technologies necessary for successful telehealth-delivered care beyond COVID-19.


Assuntos
Computação em Nuvem/tendências , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Assistência de Saúde Universal , Infecções por Coronavirus/terapia , Democracia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Diabetes Mellitus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/tendências , Humanos , Invenções/tendências , Área Carente de Assistência Médica , Pandemias , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/tendências , Pneumonia Viral/terapia , Autogestão/métodos , Autogestão/tendências , Telemedicina/métodos , Telemedicina/organização & administração
11.
BMC Med Inform Decis Mak ; 20(1): 216, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912224

RESUMO

BACKGROUND: Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services. METHODS: Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges. RESULTS: Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully. CONCLUSIONS: The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Pessoal de Saúde/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Telemedicina/organização & administração , Grécia , Humanos , Entrevistas como Assunto , Equipe de Assistência ao Paciente , Pesquisa Qualitativa , Autogestão
12.
Stroke ; 51(10): 2910-2917, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912091

RESUMO

BACKGROUND AND PURPOSE: Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. METHODS: From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. RESULTS: Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01-1.12]), severe (IRR, 2.34 [95% CI, 1.65-3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07-2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08-1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95-0.99]). CONCLUSIONS: Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01763203.


Assuntos
Ataque Isquêmico Transitório/prevenção & controle , Qualidade de Vida , Autogestão , Acidente Vascular Cerebral/prevenção & controle , Idoso , Doença Crônica/prevenção & controle , Doença Crônica/psicologia , Feminino , Humanos , Ataque Isquêmico Transitório/psicologia , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Autoeficácia , Acidente Vascular Cerebral/psicologia
13.
Int J Chron Obstruct Pulmon Dis ; 15: 2127-2133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982205

RESUMO

Pulmonary rehabilitation (PR) is an important, evidence-based treatment that improves outcomes for people with COPD. Individualized exercise programmes aim to improve exercise capacity; self-management education and psychological support are also provided. Translating increased exercise capacity into sustained behavioural change of increased physical activity is difficult. Other unresolved problems with PR programmes include improving uptake, completion, response and sustaining long-term benefit. We offer a different perspective drawn from clinical experience of PR, quantitative and qualitative studies of singing groups for people with COPD, and stroke rehabilitation research that gives psychological factors a more central role in determining outcomes after PR. We discuss Take Charge; a simple but effective psychological intervention promoting self-management--that could be used as part of a PR programme or in situations where PR was declined or unavailable. This may be particularly relevant now when traditional face-to-face group programmes have been disrupted by COVID-19 precautions.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Pesquisa de Reabilitação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sistemas de Apoio Psicossocial , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Projetos de Pesquisa , Autogestão/métodos , Autogestão/psicologia , Resultado do Tratamento
14.
J Pediatr Psychol ; 45(9): 977-982, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929482

RESUMO

The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.


Assuntos
Betacoronavirus , Doença Crônica/terapia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Autogestão/estatística & dados numéricos , Telemedicina/métodos , Adolescente , Criança , Doença Crônica/psicologia , Infecções por Coronavirus/psicologia , Humanos , Aplicativos Móveis , Pneumonia Viral/psicologia , Autogestão/métodos
15.
Pflege ; 33(5): 319-328, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996864

RESUMO

The process of medication self-management: a model revision based on a qualitative secondary analysis Abstract. Background: For safe and effective use of medication, specific skills are required which are inherent in the concept of medication self-management. In order to provide adequate counseling, it is important for registered nurses, physicians and pharmacists to know how medication self-management works in everyday life for the people affected. This process was presented in 2013 in a first conceptual model by Bailey et al. Aim: The purpose of this study was to enhance the empirical foundation of the existing model and to gain an in-depth theoretical understanding of the process of medication self-management. METHOD: A qualitative secondary analysis was conducted based on data from a semi-standardized survey (n = 395) of people in Austria, who regularly take medicine. The data were analysed according to the structuring content analysis. RESULTS: The extended model shows a new kind of logic. While the steps "fill", "take", "monitor" and "react" are always conducted one after the other, "integrate" and "maintain" form components that are mutually dependent and start after successfully completing the first four steps. "Understand" is a component that influences all steps. The whole process is influenced by personal, socio-economic, disease and medication-related factors, by supportive systems and by the overall health care system. CONCLUSIONS: Based on the present study, the drug self-management process is a complex, multi-layered and iterative one. In the context of counselling, it is important to focus on "understanding" at every step.


Assuntos
Adesão à Medicação/psicologia , Autogestão/psicologia , Áustria , Humanos , Modelos Psicológicos , Pesquisa Qualitativa
16.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(7): 834-839, 2020 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879087

RESUMO

OBJECTIVE: Emerging adult patients with Type 1 diabetes mellitus (T1DM) appear to have a reduced opportunities on learning and exercise, a decreased skill in learning and work, a lower degree of social support due to fear and avoidance of social interaction. This study aimed to assess the level of social avoidance and distress in emerging adults with T1DM, and to explore the correlation between social avoidance and distress and self-management or glycemic control. METHODS: A total of 342 T1DM patients aged 18-30 years old were recruited from 8 tertiary hospitals in Hunan Province from September 2014 to February 2019. The questionnaire included general information questionnaire, the Social Avoidance and Distress Scale (SAD), and Self-management Scale of Type 1 Diabetes for Chinese Adults (SMOD-CA). The total scores of SAD in emerging adult patients with T1DM were compared with those of norm. Correlation between glycated hemoglobin (HbA1c) and social avoidance and distress of emerging adult patients with T1DM was analyzed. RESULTS: The total score of SAD (11.13±6.18) in emerging adults with T1DM was significantly higher than that in healthy adults (t=77.06, P<0.01). Pearson correlation analysis showed that the scores of SAD, social avoidance subscale, and social distress subscale were negatively correlated with the scores of SMOD-CA (all P<0.01), and they were positively correlated with HbA1c (all P<0.01). Multivariate linear regression analysis showed that social avoidance and distress, self-management, gender, and educational level were independent influential factors for HbA1c in emerging adults with T1DM. CONCLUSION: The degree of social avoidance and distress of emerging adult patients with T1DM is higher than that of healthy people. The higher the degree of social avoidance and distress, the lower the level of self-management and the worse the control of blood sugar. Attention should be paid to social avoidance and distress in emerging adults with T1DM, and targeted interventions should be formulated.


Assuntos
Diabetes Mellitus Tipo 1 , Autogestão , Adolescente , Adulto , Glicemia , Estudos Transversais , Hemoglobina A Glicada/análise , Humanos , Inquéritos e Questionários , Adulto Jovem
17.
BMJ Open ; 10(9): e040951, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32912958

RESUMO

OBJECTIVES: To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. DESIGN: Analysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020. SETTING: Community. PARTICIPANTS: 9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and 'other' (<1%) (eg, lung cancer and pulmonary endometriosis). OUTCOME MEASURES: Study responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. RESULTS: 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. CONCLUSIONS: COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.


Assuntos
Infecções por Coronavirus , Exercício Físico , Pandemias , Pneumonia Viral , Saúde Pública , Doenças Respiratórias , Autogestão , Isolamento Social/psicologia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Ansiedade/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Solidão/psicologia , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Saúde Pública/métodos , Saúde Pública/normas , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/fisiopatologia , Doenças Respiratórias/psicologia , Comportamento de Redução do Risco , Autogestão/métodos , Autogestão/psicologia , Autogestão/tendências , Reino Unido
18.
COPD ; 17(5): 601-617, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32892650

RESUMO

COPD is a major cause of morbidity and mortality worldwide and carries a huge and growing economic and social burden. Telemedicine might allow the care of patients with limited access to health services and improve their self-management. During the COVID-19 pandemic, patient's safety represents one of the main reasons why we might use these tools to manage our patients. The authors conducted a literature search in MEDLINE database. The retrieval form of the Medical Subject Headings (Mesh) was ((Telemedicine OR Tele-rehabilitation OR Telemonitoring OR mHealth OR Ehealth OR Telehealth) AND COPD). We only included systematic reviews, reviews, meta-analysis, clinical trials and randomized-control trials, in the English language, with the selected search items in title or abstract, and published from January 1st 2015 to 31st May 2020 (n = 56). There was a positive tendency toward benefits in tele-rehabilitation, health-education and self-management, early detection of COPD exacerbations, psychosocial support and smoking cessation, but the heterogeneity of clinical trials and reviews limits the extent to which this value can be understood. Telemonitoring interventions and cost-effectiveness had contradictory results. The literature on teleconsultation was scarce during this period. The non-inferiority tendency of telemedicine programmes comparing to conventional COPD management seems an opportunity to deliver quality healthcare to COPD patients, with a guarantee of patient's safety, especially during the COVID-19 outbreak.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Telemedicina/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Autogestão
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