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1.
Artigo em Alemão | MEDLINE | ID: mdl-33258048

RESUMO

BACKGROUND: Diabetes mellitus and depression are diseases with a rising prevalence in Germany. Journalistic media coverage offers the opportunity to inform the public about options for prevention and therapy. Research shows that media portrayals of different prevention and treatment options might influence health behavior as well as policy support and eventually structural healthcare. OBJECTIVES: To date, little is known about the media coverage of the prevention and treatment of diabetes mellitus and depression. This study aims at demonstrating how diabetes mellitus and depression are portrayed in the German news media, focusing on options for prevention and therapy. MATERIALS AND METHODS: A quantitative content analysis of German print and online media from 2012 to 2018 was conducted. In sum, N = 645 articles on diabetes mellitus (n = 219) and depression (n = 426) were analyzed. RESULTS AND DISCUSSION: Diabetes mellitus and depression are rarely the main subject in German news coverage despite their high prevalence. Depression is reported more frequently than diabetes mellitus - often, however, in the context of suicide or celebrities. Regarding diabetes mellitus, reports differentiated insufficiently between the various types. For both conditions, pharmacotherapy was mentioned more frequently than low-threshold measures and structural prevention opportunities, which might have adverse consequences for those seeking help. Overall, to establish prevention and low-threshold forms of therapy as treatment options in the public, strategic communicators should focus more on them.


Assuntos
Diabetes Mellitus , Suicídio , Depressão/epidemiologia , Depressão/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Alemanha/epidemiologia , Humanos , Meios de Comunicação de Massa
2.
Anaesthesia ; 76(1): 82-90, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32761611

RESUMO

Prehabilitation aims to increase the endurance capacity of patients who are awaiting major surgery. However, there are no studies investigating the implementation of this demanding and expensive intervention in low-income countries. This study aimed to assess the impact of a 4-week trimodal prehabilitation program on the physical and psychological health of patients waiting for colorectal surgery compared with a control group managed according to enhanced recovery after surgery principles supplemented by nutritional care. This study was a single-centre, randomised controlled trial. The primary outcome measures for the physical aspects were 6-minute walking distance (6MWD) and incentive spirometry, whereas the psychological elements were measured using the 36-item short form survey questionnaire and the hospital anxiety and depression score. In total, data from 149 patients were analysed (77 in the prehabilitation group and 72 in the control group). At the time of surgery, patients in the prehabilitation group had improved 6MWD and incentive spirometry compared with the control group (median (IQR [range]) percentage improvement 131% (112-173 [68-376]) vs. 107% (99-120 [63-163]); p < 0.001 and 113% (100-125 [75-200]) vs. 100% (100-112 [86-167]); p < 0.001 respectively). Patients in the prehabilitation group also had reduced anxiety scores compared with the control group (mean (SD) anxiety score (4 (3) vs. 5 (3) respectively; p = 0.032). However, these effects did not translate into improvements in postoperative mortality and morbidity, or a reduction in duration of hospital stay. Trimodal (physical, emotional and nutritional) prehabilitation is able to improve functional status as well as some parameters of emotional and physical well-being of patients waiting for colorectal surgery.


Assuntos
Cirurgia Colorretal/psicologia , Nível de Saúde , Saúde Mental , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Ansiedade/prevenção & controle , Ansiedade/psicologia , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/psicologia , Espirometria , Inquéritos e Questionários , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-33327407

RESUMO

Mindfulness and Shinrin-yoku (SY) translated as forest bathing, is potentially effective to alleviate mental health issues related to the COVID-19 pandemic and beyond. The purpose of this article is to provide a translational and pragmatic approach to understanding mindfulness in the context of SY and psychological wellbeing through a rapid review of the literature. The background of mindfulness and SY practice are discussed and the emotional, neuroendocrine, and neurobiological responses are examined. Next, a rapid review of the literature examined six studies, published between 2010 and 2020 to determine what is known regarding the relationship between SY, mindfulness, and psychological wellbeing. The studies included 21-360 participants with a mean age of 20-55 years. The results demonstrated a significant positive correlation between nature, mindfulness, and measures of psychological wellbeing. During uncertain events, including COVID-19, weaving mindfulness with SY may be specifically important to at-risk groups, those experiencing depression, loneliness, and social isolation, and at-risk populations such as college students, veterans, and professionals with high levels of stress. The goal of this review is to provide a thorough background and support of this cost-effective modality to promote overall psychological wellbeing as a preventative measure to those at risk or experiencing psychological illnesses.


Assuntos
Depressão/prevenção & controle , Atenção Plena , Estresse Psicológico/prevenção & controle , Adulto , Humanos , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-33339317

RESUMO

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.


Assuntos
Transtornos Mentais/prevenção & controle , Prevenção Primária , Adolescente , Adulto , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , Depressão/epidemiologia , Depressão/prevenção & controle , Humanos , Transtornos Mentais/epidemiologia , Pandemias , Comportamento Autodestrutivo/prevenção & controle , Ideação Suicida , Adulto Jovem
5.
Work ; 67(4): 767-769, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33325427

RESUMO

The potential ramifications of the COVID-19 pandemic global shut down on physical education providers and youth sport coaches may be particularly severe due to substantial cutbacks on many of their normal activities. This population faces unique challenges in engaging in "virtual learning" given the physical nature of their job, potentially leading to sedentary lifestyle, weight gain, and the development of depressive mood disorders. This commentary aims to explore options to mitigate worsening of stress, depression, physical inactivity, and social disconnection in youth sport coaches following the guidelines of the American College of Sports Medicine (ACSM) and to call attention to this vulnerable demographic which has been substantially impacted by the COVID-19 pandemic.


Assuntos
/prevenção & controle , Tutoria , Educação Física e Treinamento , Quarentena , Esportes Juvenis/psicologia , Adaptação Psicológica , Depressão/prevenção & controle , Dieta Saudável , Humanos , Estresse Ocupacional/prevenção & controle , Pandemias , Comportamento Sedentário , Isolamento Social
6.
Med Sci Monit ; 26: e930340, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33323916

RESUMO

Alterations in complex behavioral patterns during the extended period of the COVID-19 pandemic are predicted to promote a variety of psychiatric disease symptoms due to enforced social isolation and self-quarantine. Accordingly, multifaceted mental health problems will continue to increase, thereby creating a challenge for society and the health care system in general. Recent studies show that COVID-19 can directly or indirectly influence the central nervous system, potentially causing neurological pathologies such as Alzheimer disease and Parkinson disease. Thus, chronic COVID-19-related disease processes have the potential to cause serious mental illnesses, including depression, anxiety, and sleep disorders. Importantly, mental health problems can foster systemic changes in functionally-linked neuroendocrine conditions that heighten a person's susceptibility to COVID-19 infection. These altered defense mechanisms may include compromised "self-control" and "self-care", as well as a "lack of insight" into the danger posed by the virus. These consequences may have serious social impacts on the future of COVID-19 survivors. Compounding the functionally related issues of altered mental health parameters and viral susceptibility are the potential effects of compromised immunity on the establishment of functional herd immunity. Within this context, mental health takes on added importance, particularly in terms of the need to increase support for mental health research and community-based initiatives. Thus, COVID-19 infections continue to reveal mental health targets, a process we must now be prepared to deal with.


Assuntos
/complicações , Saúde Mental , Sobreviventes/psicologia , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/prevenção & controle , Doença de Alzheimer/virologia , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , /psicologia , Depressão/epidemiologia , Depressão/prevenção & controle , Depressão/psicologia , Suscetibilidade a Doenças/psicologia , Humanos , Pandemias , Doença de Parkinson/epidemiologia , Doença de Parkinson/prevenção & controle , Doença de Parkinson/virologia , Autocuidado/psicologia , Autocontrole/psicologia , Isolamento Social/psicologia
7.
BMJ Open ; 10(12): e043728, 2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33303472

RESUMO

OBJECTIVE: The COVID-19 pandemic had a substantial impact on university students, including those in medical schools, with disruption in routine education causing significant psychological distress. The objective of this study was to evaluate the factors associated with psychological distress among medical students during the period of enforced home quarantine from March through May 2020. DESIGN: A cross-sectional study. SETTING: One Japanese medical school. PARTICIPANTS: 571 medical students. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-administered electronic questionnaires including the K-6 scale for psychological distress, the Rosenberg Self-Esteem Scale (RSES) for self-esteem and the General Self-Efficacy Scale (GSES) for self-efficacy were distributed. To assess the determinant factor for psychological distress, variables such as sex, grade in school, living conditions, and RSES and GSES scores were evaluated in regression analysis. RESULTS: 163 respondents (28.5%) scored ≥5 on the K-6 scale, indicating a significant degree of psychological distress. Logistic regression revealed that a higher score on RSES (p<0.001) and GSES (p<0.01) was an independent factor associated with lower levels of psychological distress. Multiple regression analysis focusing on students with a K-6 score ≥5 revealed that higher scores on RSES correlated with lower levels of psychological distress. By contrast, those with higher GSES scores also scored higher for indicators of psychological distress. CONCLUSIONS: This study identified that self-efficacy and self-esteem were both influential factors for predicting psychological distress during the current COVID-19 pandemic. Medical schools should provide support for mental health and educational initiatives directed at enhancing self-esteem and self-efficacy, with a focus on improving personal resilience. In emergency situations, such as that faced in response to the COVID-19 pandemic, initial programmes might target students with higher levels of self-efficacy. By contrast, under routine situations, these efforts should be directed towards students with lower self-esteem as primary means to prevent depression.


Assuntos
/psicologia , Saúde Mental , Autoeficácia , Estresse Psicológico/epidemiologia , Estudantes de Medicina/psicologia , Adolescente , Adulto , Estudos Transversais , Depressão/prevenção & controle , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Escalas de Graduação Psiquiátrica , Resiliência Psicológica , Inquéritos e Questionários , Adulto Jovem
8.
Eur Rev Med Pharmacol Sci ; 24(21): 11381-11385, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33215459

RESUMO

OBJECTIVE: This study aims to discuss the effects of simulation training on improving the pre-examination, triage, prevention, and control of coronavirus disease 2019 (COVID-19), explain the psychological states of pre-examination and triage staff in general hospitals during the COVID-19 epidemic, and analyze relevant influencing factors. This study may serve as a reference of psychological consultation services to medical staff. SUBJECTS AND METHODS: This study included 60 nurses assigned in the pre-examination department, fever clinics, and isolation wards of a general hospital from January 26th to February 1st, 2020. Before assuming the posts, the nurses received simulation training on the clinical reception of suspected patients with COVID-19. Operation skills of the nurses before and after the training were assessed. RESULTS: The percent of passing significantly increased from 65% before the training to 98.33% after training (p<0.05). Training also significantly relieved the anxiety and depression of the nurses (p<0.05). CONCLUSIONS: Scenario-simulation training can increase the emergency abilities of pediatric nurses in the prevention and control of the COVID-19 epidemic and relieve the anxiety of nurses.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Enfermeiras Pediátricas/psicologia , Estresse Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Treinamento por Simulação/organização & administração , Adulto , Ansiedade/prevenção & controle , Ansiedade/psicologia , Betacoronavirus/patogenicidade , Competência Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/prevenção & controle , Depressão/psicologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hospitais Pediátricos/organização & administração , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Enfermeiras Pediátricas/organização & administração , Exposição Ocupacional/efeitos adversos , Estresse Ocupacional/psicologia , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Carga de Trabalho/psicologia , Adulto Jovem
9.
Lancet Child Adolesc Health ; 4(12): 899-908, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33217359

RESUMO

Paediatric patients with cancer undergo multiple treatments and procedures that can be invasive and painful. Virtual reality technologies could support the management of paediatric cancer. This Review focuses on the physiological and psychological efficacy of virtual reality in supportive care management. Virtual reality has shown potential in reducing pain scores, pulse rates, and distress scores, but has no significant effect on other indicators, such as anxiety, fear, and depression. Several virtual reality characteristics might affect its effectiveness when used in the paediatric cancer setting. Virtual reality games with high fidelity (eg, fully-isolating head-mounted display, stereo sound, and controllers) components provide a higher level of immersion, presence, and narrative engagement, which could better manage pain. Personalising the virtual reality experience to the patient and procedure would also improve accessibility and comfort. Clinicians should work closely with virtual reality developers to ensure that the virtual reality applications used are appropriate for their patients.


Assuntos
Neoplasias/psicologia , Manejo da Dor/métodos , Realidade Virtual , Adolescente , Ansiedade/prevenção & controle , Criança , Depressão/prevenção & controle , Humanos , Neoplasias/terapia , Dor Processual/terapia , Estresse Psicológico/prevenção & controle
10.
BMJ Open ; 10(11): e041133, 2020 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-33247023

RESUMO

INTRODUCTION: Mental health disorders are common during pregnancy and the postnatal period and can have serious adverse effects on women and their children. The consequences for global mental health due to COVID-19 are likely to be significant and may have a long-term impact on the global burden of disease. Besides physical vulnerability, pregnant women are at increased risk of mental health problems such as anxiety, depression and post-traumatic stress disorder due to the consequences of social distancing. It can result in altered healthcare routines, less support from the family and friends, and in some cases, partners not being allowed to be present during prenatal visits, labour and delivery. Higher than expected, rates of perinatal anxiety and depression have been already reported during the pandemic. Pregnant women may also feel insecure and worried about the effects of COVID-19 on their unborn child if they get infected during pregnancy. Today, young urban women are used to using internet services frequently and efficiently. Therefore, providing mental health support to pregnant women via internet may be effective in ameliorating their anxiety/depression, reducing the risk of serious mental health disorders, and lead to improved maternal and perinatal outcomes. OVERARCHING AIM: Our aim is to explore the effectiveness of a web-based psychosocial peer-to-peer support intervention in reducing the risk and severity of perinatal mental health disorders and preventing adverse pregnancy outcomes among pregnant women living in metropolitan urban settings. METHODS AND ANALYSIS: We plan to conduct a multicentre prospective randomised controlled trial, Mental health of Urban Mothers trial. Pregnant women living in large metropolitan cities will be recruited using internet-based application through non-profit organisations' websites. The women who consent will be randomised to receive a web-based peer-to-peer support intervention or usual care. Data will be analysed to identify the effects of intervention on Edinburgh Postnatal Depression Score and Generalised Anxiety Disorder 7 scores as well as pregnancy outcomes. The impact of COVID-19 pandemic on maternal stress will be assesed using Impact Event Scale-R. Any differences in outcomes between cities will be addressed in subgroup analyses. ETHICS AND DISSEMINATION: The study will be conducted according to the principles of Good Clinical Practice and will follow the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the ethical review board of Chinese University of Hong Kong (IRB number 2019-8170) and Shanghai Center for Women's and Children's Health (international review board (IRB) number 2020-F001-12). The results will be disseminated at national and international scientific conferences, published in peer-reviewed medical journals and spread to the public through social media, news outlets and podcasts. TRIAL REGISTRATION NUMBER: NCT04363177; Trial sponsor Karolinska Institute, CLINTEC, Stockholm, Sweden.


Assuntos
/psicologia , Transtornos Mentais/prevenção & controle , Saúde Mental , Complicações na Gravidez/psicologia , Psicoterapia/métodos , Estresse Psicológico/prevenção & controle , População Urbana , Ansiedade/etiologia , Ansiedade/prevenção & controle , Criança , Depressão/etiologia , Depressão/prevenção & controle , Depressão Pós-Parto/prevenção & controle , Feminino , Humanos , Internet , Transtornos Mentais/etiologia , Mães/psicologia , Pandemias , Grupo Associado , Gravidez , Resultado da Gravidez , Gestantes/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Estresse Psicológico/etiologia
11.
PLoS One ; 15(11): e0239575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33211701

RESUMO

Using a multilevel model, this study examined emotion dysregulation as a mediator between dispositional mindfulness and mental health among Chinese emerging adults. Participants were 191 Chinese emerging adults (female = 172) between 18 and 27 years old (M = 21.06 years, SD = 2.01 years), who completed a questionnaire that assessed their dispositional mindfulness, emotion dysregulation, and mental health outcomes for three times over 12 months, with a three-month lag between each time point. Within-person analysis revealed that emotion dysregulation mediated between dispositional mindfulness and mental health outcomes, including subjective well-being and symptoms of depression and anxiety. Time was positively associated with emotion dysregulation and negatively associated with symptoms of depression and anxiety. Between-person analysis revealed that emotion dysregulation negatively mediated between dispositional mindfulness and symptoms of depression and anxiety, but not subjective well-being. These findings call attention to within-person versus between-person effects of emotion dysregulation as a mediator between dispositional mindfulness and psychological outcomes, particularly of symptoms of depression and anxiety. Attesting to the relations established in western societies, the relations are also applicable to emerging adults in the Chinese context. Evidence was thus advanced to inform translational research efforts that promote mindfulness and emotion regulation as assets of mental health.


Assuntos
Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Depressão/diagnóstico , Depressão/prevenção & controle , Atenção Plena , Adolescente , Adulto , China , Emoções , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
12.
Trials ; 21(1): 929, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33203440

RESUMO

OBJECTIVES: Primary Objective: To determine the feasibility of delivering a protocolised, remote, online, Eye Movement Desensitisation and Reprocessing (EMDR) intervention, within 12-weeks of hospital discharge, for adult survivors of Covid-19 related critical illness. Secondary objectives: To investigate whether remotely delivered EMDR can improve psychological outcome following Covid-19 related critical illness, specifically Post-Traumatic Stress Disorder (PTSD), anxiety and depression. TRIAL DESIGN: This is a single centre, randomised controlled cohort feasibility trial. PARTICIPANTS: Participants will be recruited following discharge from the Intensive Care Unit at University Hospital Southampton, United Kingdom. Eligible patients will have received mechanical ventilation for a minimum of 24 hours, tested Covid-19 positive by polymerase chain reaction, will be over the age of 18 years and have the capacity to provide informed consent. Patients will be excluded if they have pre-existing cognitive impairment, pre-existing psychotic diagnosis or are not expected to survive post-hospital discharge. INTERVENTION AND COMPARATOR: Group one: patients in the control arm will receive their standard package of prescribed care, following discharge home from hospital. If they experience any adverse physical or psychological health-conditions, they will access care through the usual available channels. Group two: patients randomly allocated to the intervention arm will receive their standard package of prescribed care, following discharge home from hospital. In addition, they will be referred to the Intensive Psychological Therapies Service in Poole, United Kingdom. They will receive an online appointment within 12-weeks of discharge home from hospital. They will receive a maximum of eight, weekly sessions of EMDR, delivered by a trained psychological therapist, following the Recent Traumatic Episode Protocol (R-TEP). Appendices 1 and 2 of the attached trial protocol contain a detailed description of the R-TEP intervention, written in accordance with the Template for Intervention Description and Replication (TIDieR) checklist and guide. MAIN OUTCOMES: The primary outcome from this trial will be feasibility. Feasibility will be determined by recruitment rates, expressed as a percentage of eligible patients approached, completion of the EMDR intervention, completion of final assessment at 6-months, incidence of attributable adverse events and protocol adherence by the psychological therapists. Secondary, exploratory outcomes will be assessed by comparison between the control and intervention groups at 6-months post-hospital discharge. Psychometric evaluation will consist of the PTSD Checklist-Civilian Version and Hospital Anxiety and Depression Scale. In addition, we will assess health-related quality of life using the EQ5D-5L, physical activity using wrist worn activity monitors and nutritional state using the Council of Nutrition Appetite Questionnaire. RANDOMISATION: Consenting participants will be randomly allocated to intervention or usual care using an internet-based system (ALEATM). Participants will be randomly assigned, on a 1:1 ratio, to receive either standard care (control) or the standard care plus online EMDR R-TEP (Intervention) BLINDING (MASKING): Due to the nature of the intervention, participants cannot be blinded to group allocation. 6-month patient reported outcome measures will be completed using an online, electronic case report form. Group allocation will be masked during data analysis. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): This is a feasibility study, the results of which will be used to power a definitive study if appropriate. We anticipate a 25% mortality /loss to follow-up. A total of 26 patients will be recruited to this study, 13 patients in each arm. TRIAL STATUS: CovEMERALD opened to recruitment on 23rd September 2020 with an anticipated recruitment period of 6-months. We are using protocol version number 1.2 (1st June 2020) TRIAL REGISTRATION: CovEMERALD was registered on clinicaltrials.gov NCT04455360 on 2nd July 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Assuntos
Ansiedade , Infecções por Coronavirus , Depressão , Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Pandemias , Pneumonia Viral , Qualidade de Vida , Transtornos de Estresse Pós-Traumáticos , Adulto , Ansiedade/etiologia , Ansiedade/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Estado Terminal/psicologia , Estado Terminal/reabilitação , Depressão/etiologia , Depressão/prevenção & controle , Estudos de Viabilidade , Feminino , Serviços Hospitalares de Assistência Domiciliar , Humanos , Intervenção Baseada em Internet , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Técnicas Psicológicas , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle
13.
JAMA Netw Open ; 3(11): e2025095, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33170263

RESUMO

Importance: Improving care during the postpartum period is a clinical and policy priority. During the comprehensive postpartum visit, guidelines recommend delivery of a large number of assessment, screening, and counseling services. However, little is known about services provided during these visits. Objective: To examine rates of recommended services during the comprehensive postpartum visits and differences by insurance type. Design, Setting, and Participants: This cross-sectional study included 20 071 093 weighted office-based postpartum visits (645 observations) with obstetrical-gynecological or family medicine physicians from annual National Ambulatory Medical Care Surveys from December 28, 2008, to December 31, 2016, and estimated multivariate regression models to calculate the frequency of recommended services by insurance type, controlling for visit, patient, and physician characteristics. Data analysis was conducted from November 1, 2019, to September 1, 2020. Exposures: Visit paid by Medicaid vs other payment types. Main Outcomes and Measures: Visit length and binary indicators of blood pressure measurement, depression screening, contraceptive counseling or provision, pelvic examinations, Papanicolaou tests, breast examinations, medication ordered or provided, referral to other physician, and counseling for weight reduction, exercise, stress management, diet and/or nutrition, and tobacco use. Results: A total of 20 071 093 weighted comprehensive postpartum visits to office-based family medicine or obstetrical-gynecological physicians were included (mean patient age, 29.7 [95% CI, 29.1-30.3] years). Of these visits, 34.3% (95% CI, 27.6%-41.1%) were covered by Medicaid. Mean visit length was 17.4 (95% CI, 16.4-18.5) minutes. The most common procedures were blood pressure measurement (91.1% [95% CI, 88.0%-94.2%]), pelvic examinations (47.3% [95% CI, 40.8%-53.7%]), and contraception counseling or provision (43.8% [95% CI, 38.2%-49.3%]). Screening for depression (8.7% [95% CI, 4.1%-12.2%]) was less common. When controlling for visit, patient, and physician characteristics, the only significant difference in visit length or provision of recommended services based on insurance type was a difference in provision of breast examinations (14.7% [95% CI, 8.0%-21.5%] for Medicaid vs 25.6% [95% CI, 19.4%-31.8%] for non-Medicaid; P = .02). Conclusions and Relevance: These findings suggest that receipt of recommended services during comprehensive postpartum visits is less than 50% for most services and is similar across insurance types. These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Cuidado Pós-Natal/normas , Adulto , Aconselhamento , Estudos Transversais , Depressão/diagnóstico , Depressão/prevenção & controle , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Exame Ginecológico/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/métodos , Acesso aos Serviços de Saúde/normas , Humanos , Cobertura do Seguro/tendências , Programas de Rastreamento/métodos , Visita a Consultório Médico/tendências , Encaminhamento e Consulta/estatística & dados numéricos , Estados Unidos/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-33031994

RESUMO

As the infected cases of COVID-19 reach more than 20 million with more than 778,000 deaths globally, an increase in psychiatric disorders including anxiety and depression has been reported. Scientists globally have been searching for novel therapies and vaccines to fight against COVID-19. Improving innate immunity has been suggested to block progression of COVID-19 at early stages, while omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been shown to have immunomodulation effects. Moreover, n-3 PUFAs have also been shown to improve mood disorders, thus, future research is warranted to test if n-3 PUFAs may have the potential to improve our immunity to counteract both physical and mental impact of COVID-19.


Assuntos
Ansiedade/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Depressão/prevenção & controle , Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Fatores Imunológicos/administração & dosagem , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Ansiedade/imunologia , Ansiedade/metabolismo , Ansiedade/virologia , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/virologia , Citocinas/biossíntese , Citocinas/imunologia , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/imunologia , Células Dendríticas/virologia , Depressão/imunologia , Depressão/metabolismo , Depressão/virologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/imunologia , Células Epiteliais/virologia , Ácidos Graxos Ômega-3/imunologia , Ácidos Graxos Ômega-3/metabolismo , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Interações Hospedeiro-Patógeno/imunologia , Humanos , Imunidade Inata/efeitos dos fármacos , Fatores Imunológicos/imunologia , Fatores Imunológicos/metabolismo , Linfócitos/efeitos dos fármacos , Linfócitos/imunologia , Linfócitos/virologia , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Macrófagos/virologia , Pneumonia Viral/imunologia , Pneumonia Viral/metabolismo , Pneumonia Viral/virologia
16.
Cancer Cytopathol ; 128(10): 679-680, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006815
17.
Trials ; 21(1): 870, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087178

RESUMO

BACKGROUND: The acknowledgment of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders, and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the 'My Health too' CBT program-a program we have developed for healthcare workers facing the pandemic-on immediate perceived stress and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy). METHODS: Powered for superiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels > 16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores at 8 weeks. Secondary outcomes include depression, insomnia, and PTSD symptoms; self-reported resilience and rumination; and credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks), and at 3-month and 6-month follow-up. DISCUSSION: This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers' mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis. TRIAL REGISTRATION: ClinicalTrials.gov NCT04362358 , registered on April 24, 2020.


Assuntos
Betacoronavirus/genética , Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/terapia , Pessoal de Saúde/psicologia , Intervenção Baseada em Internet/estatística & dados numéricos , Pneumonia Viral/terapia , Adulto , Idoso , Biblioterapia/métodos , Estudos de Casos e Controles , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Assistência à Saúde/estatística & dados numéricos , Depressão/epidemiologia , Depressão/prevenção & controle , Feminino , França/epidemiologia , Humanos , Masculino , Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Prevalência , Estudos Prospectivos , Resiliência Psicológica , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Resultado do Tratamento
18.
PLoS One ; 15(10): e0240839, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33095794

RESUMO

BACKGROUND: Many people living with diabetes are at risk for poor glycemic control, hyperlipidemia, hypertension, and macro vascular complications. Glycemic control and psychological wellbeing of the patient is mandatory for diabetes management. Addressing these issues in the early stages of the disease are the best interventions for decreasing poor glycemic control and psychological problems. OBJECTIVE: To explore and analyze the literature for evidence of the effect of Motivational Interviewing (MI) intervention has on glycosylated hemoglobin A1C (HgbA1C) and depression in people with Type 2 diabetes mellitus (T2DM). METHODS: A systemic review and meta-analysis of studies published in Cochrane Library, Google scholar, PubMed, & clinical trials.gov between 01/01/2009 and 12/06/2020 was performed. Inclusion criteria included RCT and pre post studies that assessed the effects of Motivational Interviewing on Hgb.A1C and depression in adults with T2DM. Weighted mean differences with 95% confidence intervals were calculated for continuous data. The data were synthesized and analyzed in a narrative form in systematic review and meta-analysis which was conducted using RevMan 5.2.0 & STATA version 11 software. Data were evaluated by weighted mean differences (WMDs) and 95% CIs. RESULT: Of the total identified 121 studies, eight were eligible for inclusion in the review. The pooled results showed that MI resulted in a significant improvement of mean HgbA1C level in the intervention group when compared with the control group (WMD, -0.29; 95% CI, -0.47 to -0.10; p = 0.003, I2 = 48%). Effect of MI intervention on depressive symptoms was identified through subgroup analysis according to intervention session time (30 or 60-80 minutes) and Follow-up period (3 or 24 months) then result showed that there was no significant difference in the reduction of depressive symptoms between the intervention and control groups. The output results were (WMD, -1.58; 95% CI, -5.05 to -0.188; p = 0.37; I2 = 48%), (WMD, -4.30; 95% CI, -9.32 to -0.73; p = 0.09; I2 = 95%), (WMD, -4.45; 95% CI, -10.58 to 1.69; p = 0.16; I2 = 96%) and (WMD, -2.12; 95% CI, -5.54 to 1.30; p = 0.22; I2 = 83%) respectively. CONCLUSION: The pooled result in meta-analysis indicated that motivational interviewing is effective in reducing HgbA1C but not depressive symptoms of patients with type 2 diabetes. Motivational interviewing intervention is important for diabetes management and effective in glycemic control with no effect on the reduction of depressive symptoms among persons with type 2 diabetes mellitus. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42019146368.


Assuntos
Depressão , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia , Entrevista Motivacional , Adulto , Glicemia/análise , Depressão/complicações , Depressão/prevenção & controle , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/complicações , Hiperglicemia/prevenção & controle
19.
JAMA Netw Open ; 3(10): e2020807, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33052404

RESUMO

Importance: To our knowledge, there are no evidence-based interventions to prevent chronic emotional distress (ie, depression, anxiety, and posttraumatic stress [PTS]) in critical care survivors and their informal caregivers. Objective: To determine the feasibility and preliminary effect of the novel dyadic resiliency intervention Recovering Together (RT) on reducing symptoms of depression, anxiety, and PTS among hospitalized patients and their informal caregivers. Design, Setting, and Participants: This single-blind, pilot randomized clinical trial of RT vs an educational control was conducted among 58 dyads in which either the survivor or caregiver endorsed clinically significant symptoms of depression, anxiety, or PTS. The study was conducted in the neuroscience intensive care unit at Massachusetts General Hospital. Data were collected from September 2019 to March 2020. Interventions: Both RT and control programs had 6 sessions (2 at bedside and 4 via live video after discharge), and both survivor and caregiver participated together. Main Outcomes and Measures: The primary outcomes were feasibility of recruitment and intervention delivery, credibility, and satisfaction. The secondary outcomes included depression and anxiety (measured by the Hospital Depression and Anxiety Scale), PTS (measured by the PTSD Checklist-Civilian Version), and intervention targets (ie, mindfulness, measured by the Cognitive and Affective Mindfulness Scale-Revised; coping, measured by the Measure of Current Status-Part A; and dyadic interpersonal interactions, measured by the Dyadic Relationship Scale). Main outcomes and targets were assessed at baseline, 6 weeks, and 12 weeks. Results: The 58 dyads were randomized to RT (29 dyads [50.0%]; survivors: mean [SD] age, 49.3 [16.7] years; 9 [31.0%] women; caregivers: mean [SD] age, 52.4 [14.3] years; 22 [75.9%] women) or control (29 dyads [50.0%]; survivors: mean [SD] age, 50.3 [16.4] years; 12 [41.3%] women; caregivers, mean [SD] age, 52.1 [14.9], 17 [58.6%] women). Feasibility (recruitment [76%], randomization [100%], and data collection [83%-100%]), adherence (86%), fidelity (100%; κ = 0.98), satisfaction (RT: 57 of 58 [98%] with scores >6; control: 58 of 58 [100%] with scores >6), credibility (RT: 47 of 58 [81%] with scores >6; control: 46 of 58 [80%] with scores >6), and expectancy (RT: 49 of 58 [85%] with scores >13.5; 51 of 58 [87%] with scores >13.5) exceeded benchmarks set a priori. Participation in RT was associated with statistically and clinically significant improvement between baseline and postintervention in symptoms of depression (among survivors: -4.0 vs -0.6; difference, -3.4; 95% CI, -5.6 to -1.3; P = .002; among caregivers: -3.8 vs 0.6; difference, -4.5; 95% CI, -6.7 to -2.3; P < .001), anxiety (among survivors: -6.0 vs 0.3; difference, -6.3; 95% CI, -8.8 to -3.8; P < .001; among caregivers: -5.0 vs -0.9; difference, -4.1; 95% CI, -6.7 to -1.5, P = .002), and PTS (among survivors: -11.3 vs 1.0; difference, -12.3; 95% CI, -18.1 to -6.5, P < .001; among caregivers, -11.4 vs 5.0; difference, -16.4, 95% CI, -21.8 to -10.9; P < .001). Improvements sustained through the 12-week follow-up visit. We also observed RT-dependent improvement in dyadic interpersonal interactions for survivors (0.2 vs -0.2; difference, 0.4; 95% CI, 0.0 to 0.8; P = .04). Conclusions and Relevance: In this pilot randomized clinical trial, RT was feasible and potentially efficacious in preventing chronic emotional distress in dyads of survivors of the neuroscience intensive care unit and their informal caregivers. Trial Registration: ClinicalTrials.gov Identifier: NCT03694678.


Assuntos
Cuidadores/psicologia , Estado Terminal/psicologia , Angústia Psicológica , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Adaptação Psicológica , Adulto , Idoso , Ansiedade/prevenção & controle , Lesões Encefálicas Traumáticas/psicologia , Neoplasias Encefálicas/psicologia , Depressão/prevenção & controle , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena , Projetos Piloto , Método Simples-Cego , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/prevenção & controle
20.
Psychiatr Danub ; 32(Suppl 3): 353-359, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030452

RESUMO

Divorce is a life event with a high level of stress for the entire family. Research shows that the number of divorces is on a steady rise. Family is very important for development of the children and changes within the family, after the divorce, could make consequences on them. Children are dependent on parents and disadvantaged during divorce because it is out of their control. They cannot predict how long will it take and what will be the outcome of divorce which includes separation from close family members, school change, change of home, change of life style and so on. Children often lack information and skills to overcome the challenges that the divorce carries. Conflicting relationships between parents make up the biggest obstacle that makes it difficult for a child to successfully deal with changes in the family. Even though parents deal with heavy feelings, it is desirable to put them the child and his interests in the first place. In order to stabilize the family system it is needed 2 up to 4 years. Children differ from one another in the reactions to the divorce, but there are some emotional reactions that are characteristic for most children of divorced parents, and the most often children reactions are of depressive symptoms, anxiety, anger, lower self-esteem and so on. The emotional reactions of children during the divorce can vary relative to the gender and age of the child. However, the divorce of a parent does not necessarily have to be so negative for children, especially if parents behave in an adequate way and they endeavor to act in such a way to make this process as painless as possible for children.


Assuntos
Divórcio/psicologia , Psicologia da Criança , Autoimagem , Adolescente , Transtornos de Ansiedade/prevenção & controle , Transtornos de Ansiedade/psicologia , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Masculino , Pais/psicologia
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