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1.
J Diabetes Complications ; 35(4): 107858, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33573890

RESUMO

AIMS: To analyze trajectories of psychosocial health among people with diabetes during the first three months of lockdowns and reopenings of the COVID-19 pandemic in Denmark. METHODS: An online longitudinal survey of 2430 people with diabetes consisting of six questionnaire waves (Q1-Q6) was conducted between March 19 and June 25, 2020. Psychosocial outcomes assessed were COVID-19 worries, quality of life, feelings of social isolation, psychological distress, diabetes distress, anxiety, and general and diabetes-specific loneliness. Trajectories in psychosocial health were analyzed with linear multilevel mixed-effects models. Subgroup analyses were conducted. RESULTS: In total, 1366 (56%) people with diabetes responded to the first questionnaire. COVID-19 worries, feelings of social isolation, psychological distress, anxiety and general loneliness had all improved at Q6 compared to Q1 (p < 0.001). In general, improvements in psychosocial health started after the first reopening phase (April 15); however, general loneliness increased up to the first reopening phase (p ≤  0.001) before decreasing, and quality of life decreased up to the first reopening phase (p = 0.002), with no improvements to follow. Subgroup analyses revealed that women had larger decreases in feelings of social isolation (p < 0.001) and in psychological distress (p = 0.035) and increases in quality of life (p < 0.001), between Q1 and Q6, compared to men. CONCLUSIONS: Psychosocial health in people with diabetes improved following reopening of society. However, increases in loneliness and decreases in quality of life during lockdown indicates a potential need to mitigate the acute effects of such policies.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis , Diabetes Mellitus/psicologia , Saúde Mental , Idoso , Ansiedade/epidemiologia , /psicologia , Dinamarca , Feminino , Humanos , Solidão , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Isolamento Social , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Fatores de Tempo
2.
BMJ Open ; 11(1): e043590, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468529

RESUMO

INTRODUCTION: The COVID-19 pandemic resulted in a national lockdown in India from midnight on 25 March 2020, with conditional relaxation by phases and zones from 20 April. We evaluated the impact of the lockdown in terms of healthcare provisions, physical health, mental health and social well-being within a multicentre cross-sectional study in India. METHODS: The SMART India study is an ongoing house-to-house survey conducted across 20 regions including 11 states and 1 union territory in India to study diabetes and its complications in the community. During the lockdown, we developed an online questionnaire and delivered it in English and seven popular Indian languages (Hindi, Tamil, Marathi, Telegu, Kannada, Bengali, Malayalam) to random samples of SMART-India participants in two rounds from 5 May 2020 to 24 May 2020. We used multivariable logistic regression to evaluate the overall impact on health and healthcare provision in phases 3 and 4 of lockdown in red and non-red zones and their interactions. RESULTS: A total of 2003 participants completed this multicentre survey. The bivariate relationships between the outcomes and lockdown showed significant negative associations. In the multivariable analyses, the interactions between the red zones and lockdown showed that all five dimensions of healthcare provision were negatively affected (non-affordability: OR 1.917 (95% CI 1.126 to 3.264), non-accessibility: OR 2.458 (95% CI 1.549 to 3.902), inadequacy: OR 3.015 (95% CI 1.616 to 5.625), inappropriateness: OR 2.225 (95% CI 1.200 to 4.126) and discontinuity of care: OR 6.756 (95% CI 3.79 to 12.042)) and associated depression and social loneliness. CONCLUSION: The impact of COVID-19 pandemic and lockdown on health and healthcare was negative. The exaggeration of income inequality during lockdown can be expected to extend the negative impacts beyond the lockdown.


Assuntos
/prevenção & controle , Assistência à Saúde/normas , Diabetes Mellitus/psicologia , Saúde Mental , Isolamento Social/psicologia , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Feminino , Serviços de Saúde , Humanos , Índia , Modelos Logísticos , Solidão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos e Questionários
3.
Curr Probl Cardiol ; 46(4): 100737, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33412349

RESUMO

BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.


Assuntos
Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Diabetes Mellitus/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/psicologia , Dieta/estatística & dados numéricos , Dislipidemias/epidemiologia , Dislipidemias/psicologia , Ingestão de Alimentos , Exercício Físico/psicologia , Feminino , Frutas , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , América Latina/epidemiologia , Masculino , Saúde Mental , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Verduras
4.
Diabetes Metab Syndr ; 15(1): 93-98, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33316765

RESUMO

BACKGROUND AND AIM: Uncontrolled diabetes has emerged as one of the major risk factors for mortality in patients with coronavirus disease (COVID-19). Physical inactivity, alterations in dietary habits, and inability to seek guidance from the physician are some of the contributing factors. This study aims to assess the self-care practices and psychological distress during the pandemic among diabetic patients visiting the institute's out patient department. METHOD: A convenient sampling method was used to recruit subjects from a representative clinical sample using validated scales like the Summary of Diabetes Self-Care Activities (SDSCA) and Kessler Psychological Distress Scale (K10). RESULT: The study enrolled a total of 108 subjects with the mean age being 56.3 years. The everyday healthy eating plan was followed by 76.85% (N = 83) subjects and daily physical activity for at least 30 min performed by 50% (54) subjects. Only 12.04% (13) subjects tested their blood sugar and 6.48% (7) respondents checked their feet daily. There was no significant difference found between the SDSCA and psychological distress based on socio-demographic variables. CONCLUSION: Participants in this study typically reported a good level of self-care behavior particularly for diet followed by exercise whereas the self-care behavior was not adequate for foot care and blood-glucose testing. People were not too anxious about COVID-19. This study highlighted the fact that people with diabetes should monitor their blood sugar levels more often along with their foot care.


Assuntos
/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Angústia Psicológica , Autocuidado/métodos , Adulto , Idoso , Glicemia/metabolismo , /psicologia , Estudos Transversais , Diabetes Mellitus/psicologia , Pé Diabético/epidemiologia , Pé Diabético/prevenção & controle , Pé Diabético/psicologia , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Autocuidado/psicologia
5.
J Diabetes ; 13(4): 339-352, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33351239

RESUMO

AIMS: To determine the prevalence and factors associated with depression and anxiety among people with and without diabetes during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: A cross-sectional questionnaire-based study collecting demographic and mental health data from 2166 participants living in the Arab Gulf region (568 with diabetes, 1598 without diabetes). Depression and anxiety were assessed using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale, respectively. RESULTS: The prevalence of depression and anxiety symptoms were 61% and 45%, in people with diabetes (PWD) and 62% and 44%, respectively, in people without diabetes. PWD who have had their diabetes visit canceled by the clinic were more likely to report depression and anxiety symptoms than those without diabetes (odds ratio [95% confidence interval]: 1.37 [1.02, 1.84] and 1.37 [1.04, 1.80], for depression and anxiety; respectively). PWD who had no method of telecommunication with their health care providers (HCP) during the pandemic, PWD with A1C of ≥ 10%, women, employees (particularly HCPs), students, unmarried individuals, and those with lower income were more likely to report depression and/or anxiety symptoms (all P < 0.01). Fear of acquiring the coronavirus infection; running out of diabetes medications; or requiring hospitalization for hypoglycemia, hyperglycemia, or diabetic ketoacidosis; and lack of telecommunication with HCPs were all associated with significantly higher odds of having depression and anxiety symptoms among PWD. CONCLUSIONS: The remarkably high prevalence of depression and anxiety symptoms during the COVID-19 pandemic, particularly among subgroups of PWD, calls for urgent public health policies to address mental health during the pandemic and reestablish health care access for PWD.


Assuntos
Diabetes Mellitus/psicologia , Saúde Mental , Pandemias , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Arábia/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Inquéritos e Questionários , Telecomunicações
6.
PLoS One ; 15(12): e0244420, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351852

RESUMO

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities' misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19.


Assuntos
/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , /patogenicidade , Adaptação Fisiológica , Adulto , Idoso , /virologia , Agentes Comunitários de Saúde/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais do Sexo/psicologia , Minorias Sexuais e de Gênero/psicologia , África do Sul/epidemiologia , Estereotipagem
7.
PLoS One ; 15(12): e0243465, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332410

RESUMO

Continuous glucose monitoring (CGM) improves treatment with lower blood glucose levels and less patient effort. In combination with continuous insulin application, glycemic control improves and hypoglycemic episodes should decrease. Direct feedback of CGM to continuous subcutaneous insulin application, using an algorithm is called a closed-loop (CL) artificial pancreas system. Commercial devices stop insulin application by predicting hypoglycemic blood glucose levels through direct interaction between the sensor and pump. The prediction is usually made for about 30 minutes and insulin delivery is restarted at the previous level if a rise in blood glucose is predicted within the next 30 minutes (hybrid closed loop system, HCL this is known as a predictive low glucose suspend system (PLGS)). In a fully CL system, sensor and pump communicate permanently with each other. Hybrid closed-loop (HCL) systems, which require the user to estimate the meal size and provide a meal insulin basis, are commercially available in Germany at the moment. These systems result in fewer hyperglycemic and hypoglycemic episodes with improved glucose control. Open source initiatives have provided support by building do-it-yourself CL (DIYCL) devices for automated insulin application since 2014, and are used by a tech-savvy subgroup of patients. The first commercial hybrid CL system has been available in Germany since September 2019. We surveyed 1054 patients to determine which devices are currently used, which features would be in demand by potential users, and the benefits of DIYCL systems. 9.7% of these used a DIYCL system, while 50% would most likely trust these systems but more than 85% of the patients would use a commercial closed loop system, if available. The DIYCL users had a better glucose control regarding their time in range (TIR) and glycated hemoglobin (HbA1c).


Assuntos
Automonitorização da Glicemia/instrumentação , Diabetes Mellitus/psicologia , Adolescente , Adulto , Idoso , Glicemia/análise , Automonitorização da Glicemia/métodos , Criança , Pré-Escolar , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Feminino , Alemanha , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Lactente , Recém-Nascido , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
8.
PLoS One ; 15(12): e0243947, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315926

RESUMO

Infections of diabetic foot ulcers are common, generally recalcitrant and often complicated by antibiotic resistance. Alternative antimicrobial strategies are needed. Phage therapy is a promising alternative that is being rediscovered. Despite phage therapy's 100-year history, there have been no investigations into patient thoughts and concerns. This study aimed to explore patient awareness of and concern about antibiotic resistance and gain insight into the perceptions of phage therapy among a patient group that could potentially benefit from phage therapy. Patients with an active or resolved (healed or amputated) diabetic foot ulcer were eligible to participate. A survey was distributed digitally to eligible patients across Scotland via the NHS Research Scotland Diabetes Network and hard copies were available in diabetic foot clinics at the Royal Infirmary of Edinburgh and Queen Elizabeth University Hospital, Glasgow. A focus group of five survey respondents was held in Glasgow. Fifty-five survey responses were obtained. There was a high level of awareness (76.4%; N = 55) and concern (83.3%; N = 54) about antibiotic resistance. While largely aware of viruses, most patients had not heard of phage or phage therapy. Patients were no more concerned about phage than antibiotic therapy, with most suggesting more information could alleviate any concerns. Patient acceptability of phage therapy was high, a finding confirmed by the focus group. Patients are concerned about antibiotic resistance and supportive of 'new' antimicrobials. We have demonstrated that patients are supportive, enthusiastic and accepting of phage therapy. Although 'Western' phage therapy remains in its infancy, an understanding of patient ideas, concerns and expectations will be important in eventually shaping and successfully reintroducing phage therapy.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Pé Diabético/tratamento farmacológico , Conhecimento do Paciente sobre a Medicação , Terapia por Fagos , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Diabetes Mellitus/patologia , Diabetes Mellitus/psicologia , Pé Diabético/epidemiologia , Pé Diabético/psicologia , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Terapia por Fagos/psicologia , Escócia/epidemiologia , Cicatrização/genética
9.
Niger J Clin Pract ; 23(10): 1431-1436, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047702

RESUMO

Background: Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. Method: This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. Results: One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16-10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32-12.29) were found to be correlates of current major depression. Conclusion: The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/sangue , Diabetes Mellitus/psicologia , Feminino , Hemoglobina A Glicada/análise , Hospitais de Ensino , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Autocuidado , Inquéritos e Questionários
10.
PLoS One ; 15(9): e0239035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915906

RESUMO

BACKGROUND: Trust in healthcare providers has been shown to improve several clinical and patient-reported outcomes. However, its relationship with depression and anxiety has not been investigated among patients with chronic health conditions, such as diabetes. Therefore, the aim of this study was to examine whether trust in primary care physicians among patients with diabetes is associated with their levels of depression and/or anxiety. METHOD: Adult patients (≥18 years) with a diagnosis of diabetes, confirmed through their electronic health records, were recruited and interviewed from the primary care clinics of three public hospitals. Patient trust in primary care physicians was assessed using the Health Care Relationship (HCR) Trust scale. Depression and anxiety were assessed using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7), respectively. Two multiple linear regression analyses were conducted to examine the association of HCR-Trust scores with PHQ-9 and GAD-7 scores controlling for age, sex, Charlson comorbidity index score, education, health literacy, annual income, nationality, duration of illness, and research site. RESULTS: The number of patients who agreed to be interviewed was 367. Most of the participants were female (61.54%) and Saudi (92.86%). High HCR-Trust scores were negatively associated with PHQ-9 scores (ß = -0.18; 95% CI: -0.23 --0.13; P = < .0001), and GAD-7 scores (ß = -0.17; 95% CI: -0.22- -0.12; P = < .0001). CONCLUSIONS: Trust in primary care physicians among patients with diabetes was associated with lower levels of depression and anxiety. Therefore, healthcare providers should adopt a patient-centered care approach that fosters trust in the relationship between their patients and themselves. Further research should explore whether interventions that foster shared decision-making and trust in healthcare providers might also improve the health outcomes of patients with diabetes.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus/psicologia , Médicos de Atenção Primária/psicologia , Relações Profissional-Paciente , Adulto , Idoso , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Arábia Saudita/epidemiologia , Confiança
11.
PLoS One ; 15(8): e0238094, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822414

RESUMO

INTRODUCTION: Hypoglycemia is a true medical emergency, which needs prompt recognition and treatment to prevent organ damage and mortality. Knowledge about the prevention of hypoglycemia is an important step to self-care practice because informed people are more likely to have a better hypoglycemia prevention practice. The aim of this study was to explore hypoglycemia prevention practice and its associated factors among diabetes patients at a university teaching hospital in Ethiopia. METHOD: A cross-sectional study was carried out on a total of 422 systematically selected diabetic patients at the University of Gondar Referral and Teaching Hospital. Data were collected using a pre-tested, structured, and interviewer-administered questionnaire. The collected data was analyzed by SPSS version 20 and associated variables were measured using binary logistic regression and within 95% confidence interval. A p-value <0.05 was considered as statistically significant. RESULT: From the total of 422 diabetic patients, 61.6% were males, 70.1% of them were urban dwellers, 37.9% of them were unable to write and read, and 70.6% of the participants were taking insulin. The majority of respondents had good knowledge of (77.5%) and practice of (93.1%) hypoglycemia prevention. Only good participant knowledge about hypoglycemia prevention was strongly associated with the practice of its prevention (AOR: 2.87 (1.2-6.8), p = 0.01). CONCLUSION AND RECOMMENDATION: Even though diabetic patients with good knowledge of hypoglycemia and its prevention was strongly associated with good prevention practice, there exists a gap in knowledge of hypoglycemia prevention. Hence, we recommend counseling be offered to patients regarding hypoglycemia during their visit to the diabetic clinic. Counseling points such as common clinical symptoms, its negative consequence, as well as remedial options are essential elements for the improvement of their practice on its prevention.


Assuntos
Diabetes Mellitus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hipoglicemia/prevenção & controle , Adolescente , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/patologia , Etiópia , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Autocuidado , Inquéritos e Questionários , Adulto Jovem
12.
Medicine (Baltimore) ; 99(32): e21495, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769885

RESUMO

The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients' health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients' health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Mellitus/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Assistência Ambulatorial/psicologia , Bases de Dados Factuais , Diabetes Mellitus/psicologia , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Taiwan
13.
Health Qual Life Outcomes ; 18(1): 266, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746855

RESUMO

BACKGROUND: The prevalence of diabetes mellitus (DM) among patients with chronic kidney disease (CKD) has been increasing in recent years in China. This study aimed to evaluate the association between DM and health-related quality of life (HRQOL) in patients with CKD. METHODS: In our study, participants with CKD stage 1 to 4 from 39 centers in China were screened and enrolled. The Kidney Disease Quality of Life (KDQOL™-36) questionnaire was used to assess HRQOL. Participants were divided into a diabetic group and a non-diabetic group. Demographic data, clinical data, and HRQOL scores were compared between the two groups. Multivariable robust regression was used to analyze the factors related to HRQOL in CKD patients. RESULTS: A population of 2742 CKD patients was included in this study. CKD patients with DM were older and had lower education level, longer treatment periods and a higher prevalence of cardiovascular disease than CKD patients without DM (P < 0.05). HRQOL scores in the "symptoms and problems", "effects of kidney disease", and "SF-12 physical function" dimensions were significantly lower in the diabetic group than the non-diabetic group (86.88 ± 13.76 vs. 90.59 ± 10.75, 84.78 ± 14.86 vs. 87.28 ± 12.45, and 41.40 ± 9.77 vs. 45.40 ± 8.82, respectively, all P < 0.05). DM was negatively correlated with the symptoms and problems (regression coefficient for log transformed [175-score] = 0.010) and the SF-12 physical function dimension (regression coefficient = - 2.18) (all P < 0.05). CONCLUSION: HRQOL of diabetic patients with CKD was worse than that of non-diabetic patients with CKD. DM was an independent and negative factor affecting HRQOL in patients with CKD.


Assuntos
Diabetes Mellitus/psicologia , Qualidade de Vida , Insuficiência Renal Crônica/psicologia , Adulto , Idoso , Estudos de Casos e Controles , China/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia
14.
Health Qual Life Outcomes ; 18(1): 258, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738912

RESUMO

BACKGROUND: This study investigates the health-related quality of life (HRQOL) of female patients with congenital adrenal hyperplasia (CAH) in Malaysia. The objectives were to attain socio-demographic and medical data on these Malaysian females with CAH and establish their health-related quality of life (HRQOL) in comparison to age matched diabetic controls. METHODS: A cross-sectional study was conducted over 6 months in the two main tertiary centres for CAH patients in Malaysia. Participants including 59 female-raised CAH patients (mean age ± SD = 16.3 ± 4.2 years, range 10-28 years) compared to 57 age-matched female diabetic patients (mean age ± SD = 16.5 ± 3.4 years, range 10-26 years). Socio-demographic and medical profiles was obtained through semi-structured interviews. HRQOL of participants were evaluated utilising validated, Malay translated questionnaires which were age appropriate: Pediatric Quality of Life Inventory (PedsQL v4.0) scales for Child (8-12) and Adolescent (13-18) and Medical Outcome Survey 36-item Short Form version. These were then compared to the diabetic controls. RESULTS: The CAH participants consisted of children (ages 10-12 years, n = 12), adolescents (ages 13-17 years, n = 29) and adults (≥ 18 years, n = 18). The majority were Malays (64.4%) and had salt-wasting CAH (67.8%). There were no significant differences between the total mean score of the HRQOL of the combined children and adolescents CAH group (total mean score ± SD = 81.6 ± 17.9, 95% CI = 75.6-87.6) when compared to age-matched diabetic patients (total mean score ± SD = 80.8 ± 11.0, 95% CI = 77.0-84.5, P = 0.81, effect size = 0.05); no significant difference between the adult CAH and diabetic controls in the physical [median score (IQR) CAH vs diabetics; 49.3 (11.4) vs. 50.2 (6.1), P = 0.60, effect size = 0.09] and the mental composite scores [median score (IQR) CAH vs. diabetics; 47.8 (14.1) vs. 50.0 (10.8), P = 0.93, effect size = 0.01]. CONCLUSIONS: The HRQOL of the Malaysian CAH cohort were comparable to the diabetic controls.


Assuntos
Hiperplasia Suprarrenal Congênita/psicologia , Qualidade de Vida , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Criança , Estudos Transversais , Diabetes Mellitus/psicologia , Feminino , Humanos , Malásia , Inquéritos e Questionários , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-32630232

RESUMO

(1) Background: In the context of a child with Type 1 Diabetes Mellitus (T1DM), the rearrangement of the family's lifestyle can account for an increased risk of experiencing psychosocial problems for both child and parents. Those few studies on pediatric diabetes, which focused on parents' perception of children's psychological strengths and weaknesses, reported significantly higher rates of children's emotional and conduct problems associated with an imbalance in the Hemoglobin A1c (HbA1c). The main aim of this paper was to assess the role of parental perception of children's psychosocial symptoms as a mediator of the perceived parenting stress, considering mother and father separately. (2) Methods: The study involved 12 parent couples (Mothers Mage = 40.25, SD = 6.58; Fathers Mage = 42.5, SD = 6.38) of children with T1DM aged between 7 and 11 years (Mage = 8.8, SD = 0.996). Parents completed questionnaires such as the Strengths and Difficulties Questionnaire for parents and their perspective of their child, and the Parenting Stress Index-Short Form. (3) Results: Mothers and fathers had significant differences in the perception of their child's internalizing symptoms. Specifically, mothers present a greater perception of the mentioned symptoms compared to fathers. Mediation models showed that only for fathers' perception of the child conduct problems has a significant role between the fathers' perception of dysfunctional interaction with the child and the HbA1c. (4) Conclusions: The current study provides useful evidence also for clinical settings, suggesting that an interesting interplay between parenting stress, perception of children's symptoms and glucometabolic control should be taken into consideration.


Assuntos
Diabetes Mellitus/psicologia , Poder Familiar/psicologia , Criança , Pai , Feminino , Humanos , Masculino , Mães , Relações Pais-Filho , Projetos Piloto
17.
Transl Behav Med ; 10(4): 819-826, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710626

RESUMO

COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team's capacity to respond swiftly to patients' changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.


Assuntos
Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Saúde Mental , Infecções por Coronavirus , Diabetes Mellitus , Pandemias , Pneumonia Viral , Autogestão , Telemedicina , Betacoronavirus , Criança , Comportamento Infantil , Serviços Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Diabetes Mellitus/terapia , Humanos , Determinação de Necessidades de Cuidados de Saúde , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Formulação de Políticas , Sistemas de Apoio Psicossocial , Medição de Risco , Comportamento de Redução do Risco , Autogestão/métodos , Autogestão/tendências , Telemedicina/organização & administração , Telemedicina/tendências
18.
PLoS One ; 15(6): e0234718, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584823

RESUMO

Evidence exists that depression interacts with physical illness to amplify the impact of chronic conditions like diabetes. The co-occurrence of these two conditions leads to worse health outcomes and higher healthcare costs. This study seeks to understand what demographic and socio-economic indicators can be used to predict co-occurrence at both the state and the individual level. Diabetes and depression are modeled as a bivariate normal distribution using data from the Behavioral Risk Factor Surveillance System 2016-2017 cohorts. The tetrachoric (latent) correlation between diabetes and depression is 17.2% and statistically significant, however the likelihood of any person being diagnosed with both conditions is small-as high as 4.3% (Arizona) and as low as 2.3% (Utah). We find that demographic characteristics (sex, age, and race) operate in opposite directions in predicting diabetes and depression diagnosis. Behavioral indicators (BMI≥30, smoking, and exercise); and life outcomes, (schooling attainment, marital and veteran status) work in the same direction to produce co-occurrence and as such are more powerful predictors of co-occurrence than demographic characteristics. It is important to have a rapid and efficient instrument to diagnoses co-occurrence. Simple questions about lifestyle choices, educational attainment and family life could help bridge the gap between primary care and psychological services with beneficial spillovers for patient-doctor communication.


Assuntos
Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Políticas , Estados Unidos/epidemiologia , Adulto Jovem
19.
Rev Med Suisse ; 16(697): 1206-1209, 2020 Jun 10.
Artigo em Francês | MEDLINE | ID: mdl-32520460

RESUMO

Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case illustrates the intertwining of the affective and cognitive dimensions of diabetes burden and its influence on DSM skills. Emotional regulation is a recognized determinant to implement effective and long-term DSM skills as well as access to DSM interventions. In order to improve DSME/S interventions efficacy, the role of emotional dimensions, new technologies and therapeutic advances needs to be considered.


Assuntos
Diabetes Mellitus/terapia , Autocuidado , Autogestão , Diabetes Mellitus/psicologia , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Regulação Emocional , Humanos
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