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1.
BMJ ; 371: m4290, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328164

RESUMO

OBJECTIVE: To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions. DESIGN: Systematic review of randomised and non-randomised controlled trials. DATA SOURCES: Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. STUDY SELECTION: Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome. DATA EXTRACTION AND SYNTHESIS: Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials. RESULTS: 24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05). CONCLUSIONS: These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107099.


Assuntos
Criança Hospitalizada/psicologia , Terapia do Riso/métodos , Doença Aguda/psicologia , Ansiedade/psicologia , Ansiedade/terapia , Criança , Doença Crônica/psicologia , Fadiga/psicologia , Fadiga/terapia , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Manejo da Dor/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Psicológico/psicologia , Estresse Psicológico/terapia
2.
Sci Rep ; 10(1): 7845, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398682

RESUMO

Risk perceptions typically underlie a complex social dynamic: Risk-related information is transmitted between individuals, this information influences risk perceptions, and risk perceptions influence which information is transmitted. This can lead to a social amplification of risk. We test how stress, a widespread affective state, influences the social dynamics of risk perception. Participants (N = 146) read articles about the controversial antibacterial agent Triclosan and were then asked to inform another person about Triclosan. Before and after reading the articles, participants reported their concern about Triclosan. Stress exposure before the task led to a smaller increase in concern in response to the articles. The stronger the increase in cortisol, the smaller the increase in concern. Furthermore, participants in the stress group transmitted less negative information about Triclosan to others. In contrast, participants' subjective feelings of stress were associated with higher concern and more alarming risk communication. We conclude that feeling stressed can amplify risk perception, whereas the endocrine stress reaction can attenuate risk perception when information about risk is exchanged in a social context.


Assuntos
Percepção , Estresse Psicológico/psicologia , Doença Aguda/psicologia , Feminino , Humanos , Masculino , Risco , Adulto Jovem
3.
J Psychosom Res ; 134: 110110, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32345456

RESUMO

Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD. OBJECTIVE: Examine brain correlates of mental stress in patients with CAD with and without a history of angina. METHODS: Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina. RESULTS: Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history. CONCLUSIONS: Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.


Assuntos
Angina Pectoris/psicologia , Encéfalo/fisiopatologia , Estresse Psicológico/complicações , Doença Aguda/psicologia , Adulto , Angina Pectoris/complicações , Encéfalo/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Estresse Psicológico/diagnóstico por imagem , Estresse Psicológico/fisiopatologia
4.
Fortschr Neurol Psychiatr ; 88(2): 121-138, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32102104

RESUMO

Acute psychotic disorders (APS) are characterized by an acute onset as well as a wide array of symptoms including affective, psychotic, and psychomotor symptoms. They occur independently of substance use or organic disorders. In most cases, patients recover fully and without residues within a short period of time. However, APS tend to show a relapsing course, and transitions into other psychiatric disorders (schizophrenia, bipolar disorder) may occur.


Assuntos
Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Doença Aguda/psicologia , Transtorno Bipolar , Humanos , Transtornos Psicóticos/complicações , Recidiva , Esquizofrenia
5.
J Physiother ; 66(1): 39-44, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31862258

RESUMO

QUESTION: Do measures of state anxiety and trait anxiety in people with acute low back pain (ALBP) improve prediction of chronic low back pain (CLBP), defined as pain or pain-related disability at 12 weeks? DESIGN: Observational multi-centre prospective cohort study in primary physiotherapy care with measurements at baseline and at 12 weeks of state and trait anxiety, as well as other established prognostic factors for CLBP. PARTICIPANTS: People with nonspecific ALBP, aged 18 to 60 years, who had been pain free for ≥ 3 months before their current ALBP, and who were being treated according the Dutch clinical guidelines. OUTCOME MEASURES AND ANALYSIS: CLBP was defined as a pain score ≥ 3/10 on the Numerical Pain Rating Scale (primary outcome), and as a pain-related disability score ≥ 19/70 on the Pain Disability Inventory. Univariate and multivariate logistic regression analyses estimated how the risk of CLBP differed with state and trait anxiety and other established prognostic factors. RESULTS: Most (204 of 225) participants completed both assessments. State anxiety was an independent predictor of CLBP, whether defined as pain or pain-related disability at 12 weeks, in contrast to trait anxiety. State anxiety improved the predictive performance of the model, with area under the curve (AUC) increasing from 0.64 (95% CI 0.56 to 0.71) to 0.75 (95% CI 0.68 to 0.82) and Nagelkerke's R2 increasing from 0.08 to 0.24 for the primary outcome measure, pain. For the secondary outcome measure, pain-related disability: AUC 0.63 (95% CI 0.54 to 0.72) improved to 0.73 (95% CI 0.65 to 0.82) and Nagelkerke's R2 increased from 0.05 to 0.16. Adding trait anxiety to the prognostic model for pain improved the AUC from 0.64 (95% CI 0.56 to 0.71) to 0.70 (95% CI 0.62 to 0.77) and Nagelkerke's R2 from 0.08 to 0.15. CONCLUSION: State anxiety in patients with ALBP improved prediction of CLBP, defined as pain and pain-related disability at 12 weeks.


Assuntos
Ansiedade/psicologia , Dor Lombar/psicologia , Doença Aguda/psicologia , Adolescente , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prognóstico , Estudos Prospectivos , Adulto Jovem
6.
J Affect Disord ; 260: 342-348, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31521872

RESUMO

BACKGROUND: Few studies have investigated the proportion of patients with depression who experience worsening of depression symptoms during adequate antidepressant treatment. The current study aimed to investigate the proportion and predictors of worsening depression during antidepressant treatment in a multi-center randomized trial involving patients with major depression. METHODS: We defined the deterioration of depression using depression symptom severity evaluated by total Patient Health Questionnaire (PHQ-9) score increases from week 0 to week 9 during acute phase antidepressant treatment. Patients' baseline demographic and clinical data, change in PHQ-9 scores from week 0 to week 3, and side effects at week 3 were evaluated as potential predictors of subsequent deterioration of depression. RESULTS: Of 1,647 patients, 99 (6.0%) exhibited deterioration of depression, and this proportion was smaller when reliable change index criteria were applied. Logistic regression analysis revealed that the following factors were significantly associated with deterioration of depression: younger age at onset of first episode of major depressive disorder, current older age, and greater increase in PHQ-9 scores between week 0 and week 3. LIMITATIONS: The time of the primary endpoint might not have been sufficiently long. The present study did not include a placebo arm, and potentially relevant predictors might not have been comprehensively investigated. CONCLUSIONS: A small proportion of patients may experience deterioration of depression during acute phase antidepressant treatment. Age at onset at first depressive episode, current age, and early negative response to antidepressants may be useful predictors of subsequent worsening of depression.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Doença Aguda/psicologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Resultado do Tratamento
7.
Eur J Oncol Nurs ; 41: 49-55, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358257

RESUMO

PURPOSE: This study explores how newly diagnosed patients with acute leukemia (AL) experience the diagnosis and the initial treatment, and their need and preferences for social support. METHODS: Explorative semi-structured individual interviews were carried out in patients with AL (n = 18) four to sixteen weeks post diagnosis. Thematic analysis was used to analyze the qualitative interview data. RESULTS: Identified themes were 1) Jolted by the diagnosis, and subtheme Loss of personal autonomy; 2) Restoring normality in everyday life, and subtheme Facing a new social identity; and 3) A lifeline of hope. Being newly diagnosed with AL was experienced as traumatic, which negatively affected personal autonomy and everyday life. There was a pressing need to restore a sense of normality in everyday life while managing a new social identity as a cancer patient. Social support from family, friends and other patients were invaluable and experienced as an important lifeline. CONCLUSION: Receiving a life threatening diagnose and undergoing chemotherapeutic treatment had a negative impact on everyday life which required re-establishing daily life activities. This increased the need for social support which had a distinct role in facilitating the patients' coping strategy. CLINICAL IMPLICATIONS: It is important to support and strengthen the patient's social network from the time of diagnosis. Future studies should examine the feasibility and benefit of experienced-based social support from peers (former patients) to patients with AL.


Assuntos
Doença Aguda/psicologia , Adaptação Psicológica , Leucemia/diagnóstico , Leucemia/psicologia , Leucemia/terapia , Determinação de Necessidades de Cuidados de Saúde , Pacientes/psicologia , Apoio Social , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
8.
J Adv Nurs ; 75(11): 2811-2819, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31350761

RESUMO

AIMS: To examine characteristics of parents of children with acute, albeit mild, illnesses who used ambulance transport unnecessarily. DESIGN: A cross-sectional study. METHODS: From 2016 - 2017, we recruited parents who visited the emergency room of a Japanese paediatric hospital and whose children were discharged without hospitalization. Participants whose children arrived by ambulance were classified as using ambulance services unnecessarily. Participants answered a questionnaire consisting of parents' characteristics, including health literacy scales and the Parents' Uncertainty regarding their Children with Acute Illness Scale. We conducted a receiver operating characteristic analysis to convert the Parents' Uncertainty regarding their Children with Acute Illness Scale results to binary scores. We analysed questionnaire responses using logistic regression analysis. RESULTS: Analysed data were from 171 participants. The cut-off score was 59 for the Parents' Uncertainty regarding their Children with Acute Illness Scale. Results of the logistic regression indicated that parents who did not use resources to obtain information regarding their child's illness, had low health literacy, were observing presenting symptoms for the first time in their child, or had high uncertainty, were significantly more likely to unnecessarily use ambulances. CONCLUSION: Publicizing available resources regarding child health information, social healthcare activities to raise parents' health literacy and providing explanations in accordance with parents' uncertainty, especially when confronting new symptoms in their child, might reduce unnecessary ambulance use. IMPACT: Of patients transported to hospitals by ambulance, the rate of paediatric parents with mild conditions has been found to be high. The study findings could contribute to the appropriateness of using ambulances and have implications for policymakers and healthcare providers, particularly in the Japanese paediatric emergency system. In particular, parental uncertainty, one of four significant characteristics, could be resolved in clinical settings. Generalization for global health services requires further research.


Assuntos
Doença Aguda/psicologia , Ambulâncias/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Pais/psicologia , Enfermagem Pediátrica/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Inquéritos e Questionários
9.
Nord J Psychiatry ; 73(6): 349-356, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271338

RESUMO

Background: Treatment satisfaction predicts treatment adherence and long-term outcome for patients with psychosis. It is therefore important to understand the underpinnings of patient satisfaction in psychosis treatment for optimal treatment delivery. Aims: To examine the associations between satisfaction and level and change in positive symptoms, insight, depression and side effects of antipsychotics in previously medicated and antipsychotic-naïve patients. Method: Data derive from a randomised trial, with 226 respondents at baseline and 104 at follow-up. The measures were the positive subscale and insight item from the Positive and Negative Syndrome Scale, Calgary Depression Scale, the UKU Consumer Satisfaction Rating Scale, and the UKU side effects scale. Structural equation modelling was used to test the model. The full information maximum likelihood estimator used all available data. Results: In the sample of 226 patients, 67.3% were male and 44.2% were antipsychotic-naïve. The mean age was 34.1 years. For previously medicated patients, satisfaction was predicted by level of insight (b = -2.21, ß = -0.42) and reduction in positive symptoms (b = -0.56, ß = -0.39). For antipsychotic-naïve patients, satisfaction was predicted by level and change of insight (b = -2.21, ß = -0.46), change in depression (b = -0.37, ß = -0.26) and side effects (b = -0.15, ß = -0.30). All predictors were significant at the 0.05 level. Conclusion: Reducing positive symptoms and side effects are important to enhance patient satisfaction. However, improving insight and reducing depression are more important in antipsychotic-naïve patients.


Assuntos
Antipsicóticos/uso terapêutico , Satisfação do Paciente , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Doença Aguda/psicologia , Doença Aguda/terapia , Adulto , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Acute Med ; 18(2): 71-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127795

RESUMO

Resilience is the 'ability to bounce back'. We want to investigate whether measurement of resilience during an acute hospital admission is feasible. We conducted a feasibility study. Resilience was measured using the Brief Resilience Scale. Results were contextualized by measuring chronic disease burden, anxiety, depression, coping strategies and personality traits. 56 or 103 patients approached took part in the study. A group of 12 patients undergoing pulmonary rehabilitation served as a control group. We found evidence of low resilience in 4/44 (9%) patients admitted as medical emergencies. Low resilience was statistically related to the Hospital Anxiety and Depression Scale and a number of coping strategies and personality traits. We found no relation between measures of resilience and previous admissions to hospital. The concept of resilience might be applicable to unscheduled admissions to hospital. Larger studies are required to establish whether low resilience is common and amenable to intervention. REC number 17/WA/0024.


Assuntos
Doença Aguda , Adaptação Psicológica , Resiliência Psicológica , Doença Aguda/psicologia , Ansiedade , Estudos de Viabilidade , Humanos , Pacientes Internados/psicologia
11.
Medicine (Baltimore) ; 98(21): e15452, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124928

RESUMO

OBJECTIVE: To analyze clinical and sociodemographic properties of the patients as measured by the "Hospital Anxiety and Depression Scale-HADS" including the subscale regarding anxiety (HAD-A) in emergency department (ED) and to detect the effect of a session of Benson relaxation method (BRM) on high anxiety level. METHODS: Adult patients presented to the state hospital ED in seven days were recruited in this prospective study. Patients with high (≥8) scores were randomized to the treatment or control groups. They were asked to pursue BRM to alleviate anxiety. RESULTS: Six hundred thirty-four patients were recruited (mean age 44.1 and 52% were female). Patients with acute exacerbation or with psychiatric illness, with a systemic disease and higher acuity level had higher HAD-A scores (P < .05). BRM group had a mean score change higher than controls (7.2 ±â€Š2.9 vs 3.4 ±â€Š2.6, t test, P = .026). CONCLUSIONS: Patients who underwent BRM had larger decreases in HAD-A scores than others.


Assuntos
Doença Aguda/psicologia , Ansiedade/terapia , Serviços Médicos de Emergência/métodos , Psicoterapia Breve/métodos , Terapia de Relaxamento/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
14.
Health Qual Life Outcomes ; 17(1): 58, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971261

RESUMO

BACKGROUND: Evidence of quality of life implications of asthma attacks are limited, particularly when measured on a utility scale, which enables calculating Quality-Adjusted Life-Years (QALYs) and comparisons with other health conditions and services. Therefore, this study sought to estimate the utility loss associated with an asthma-related crisis event (accident and emergency (A&E) attendance or hospital admission). METHODS: Participants were recruited in a cohort study from A&E and hospital admissions at three UK hospitals. They completed the EuroQol-5 Dimensions 5-Level (EQ-5D-5 L), Asthma Quality of Life Questionnaire (AQLQ), Time trade-off (TTO), and peak flow and symptom diary over 8 weeks, where three different methods (EQ-5D-5 L, AQLQ, and TTO), were used to estimate utilities. The mean difference between two time points were estimated using the Wilcoxon signed rank test. RESULTS: From baseline to week 8, mean increases (95% CI) were estimated to be 0.086 (0.019-0.153), 0.154 (0.112-0.196) and 0.132 (0.063-0.201) for EQ-5D-5 L, AQL-5D (preference-based measure derived from AQLQ), and TTO respectively over 8 weeks (p < 0.01). CONCLUSION: Asthma crisis events are estimated to be associated with a mean utility loss of between 0.086 and 0.132. The utility decrement can be used to assign values to asthma-related crisis events, which can enhance economic evaluations. TRIAL REGISTRATION: NCT02771678 . Registered 13 May 2016.


Assuntos
Asma/psicologia , Qualidade de Vida , Doença Aguda/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários
15.
BMJ Open ; 9(4): e026786, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30944138

RESUMO

OBJECTIVES: Patients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients' decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs' perception of such patients. This qualitative study explores the GPs' view regarding motives and competences of patients self-referring to EDs, and also GPs' rationale for or against physician-initiated ED referrals. DESIGN: Qualitative study with semi-structured, face-to-face interviews; qualitative content analysis. SETTING: GP practices in Berlin, Germany. PARTICIPANTS: 15 GPs (female/male: 9/6; mean age 53.6 years). RESULTS: The interviewed GPs related a wide spectrum of factors potentially influencing their patients' decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients' surmised rationale corresponded to GPs' reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients' health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy. CONCLUSIONS: Health education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals. TRIAL REGISTRATION NUMBER: DRKS00011930.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Serviço Hospitalar de Emergência , Clínicos Gerais/psicologia , Encaminhamento e Consulta , Doença Aguda/psicologia , Adulto , Plantão Médico/métodos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/psicologia , Pesquisa Qualitativa , Índice de Gravidade de Doença
16.
J Psychosom Res ; 121: 14-23, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30712815

RESUMO

OBJECTIVES: To evaluate the separate and combined associations of socioeconomic status (SES) and depression with the incidences of acute myocardial infarction (AMI) and stroke. METHODS: We conducted a population-based cohort study using nationwide health insurance claims data collected from 2002 to 2016 in South Korea. A total of 2,705,090 subjects aged 20 years or older for whom had health screening data were collected between 2004 and 2005 were analyzed. The hazard ratios (HRs) for the incidences of AMI and stroke were calculated using Cox proportional regression analyses. RESULTS: After adjusting for cardiovascular risk factors, a low SES was associated with increased risks of AMI (HR, 1.16; 95% confidence interval (CI), 1.14-1.19) and stroke (HR, 1.13; 95% CI, 1.11-1.14) incidence. Depression was also associated with an increased incidence of AMI (HR, 1.26; 95% CI, 1.21-1.31) and stroke (HR, 1.24; 95% CI, 1.21-1.27). Patients with depression who had a low SES exhibited significantly increased risks of AMI (HR, 1.47; 95% CI, 1.36-1.60) and stroke (HR, 1.37; 95% CI, 1.30-1.44) compared to patients with a high SES who were not diagnosed with depression. Depression showed a positive effect modification of low and medium SES compared to high SES on the association with AMI but not with stroke. CONCLUSIONS: Subjects with both a low SES and depression displayed the highest risk. Both SES and depression should be considered in cardiovascular risk assessments, particularly in individuals with depression who have a low SES.


Assuntos
Infarto do Miocárdio/epidemiologia , Classe Social , Acidente Vascular Cerebral/epidemiologia , Doença Aguda/epidemiologia , Doença Aguda/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Depressão/complicações , Feminino , Humanos , Incidência , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/psicologia , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Adulto Jovem
17.
Resuscitation ; 135: 130-136, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30612968

RESUMO

BACKGROUND: The first clinical re-assessment after admission to hospital probably provides the best opportunity to detect clinical deterioration or failure to improve, and decide if care should be intensified. AIM: Compare changes the day after admission in the patient's subjective feelings and objective findings that included age, gender, the National Early Warning Score (NEWS) on admission, gait stability and mid-upper arm circumference (MUAC) on admission, and changes in NEWS, gait stability and mental alertness. SETTING: Acutely ill medical patients admitted to a low-resource sub-Saharan hospital. METHODS: Prospective observational study. RESULTS: 1810 patients were reassessed 18 h after hospital admission. Logistic regression identified NEWS and gait stability on admission, a subjective feeling of improvement, the change in NEWS, and MUAC as clinically significant predictors of in-hospital mortality. Stratifying patients according to their NEWS on admission altered the predictive value of the four other predictors: for patients with an admission NEWS < 3 a subjective feeling of improvement is the most powerful predictor of a good outcome. For patients with an admission NEWS > = 3 the change in NEWS, gait stability on admission and MUAC provide additional prognostic information. CONCLUSION: NEWS and gait stability on admission, MUAC, a subjective feeling of improvement, and change in NEWS the day after admission are all clinically significant predictors of in-hospital mortality.


Assuntos
Doença Aguda , Tomada de Decisão Clínica/métodos , Cognição , Autoavaliação Diagnóstica , Análise da Marcha , Sinais Vitais , Doença Aguda/mortalidade , Doença Aguda/psicologia , Doença Aguda/terapia , Deterioração Clínica , Unidades de Observação Clínica/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Uganda
18.
BMJ Open ; 9(1): e026524, 2019 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-30670530

RESUMO

INTRODUCTION: Clown intervention may playing an important complementary role in paediatric care and recovery. However, data on its utility for symptom cluster management of hospitalised children and adolescents in acute and chronic disorders are yet to be critically evaluated. As clinicians strive to minimise the psychological burden during hospitalisation, it is important that they are aware of the scientific evidences available regarding clown intervention for symptom management. We aim to provide quality evidence for the effectiveness of clown intervention on symptom cluster management in paediatric inpatients, both in acute and chronic conditions. METHODS AND ANALYSIS: A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycINFO, CINAHL, LILACS and SciELO databases will be searched from January 2000 to December 2018. Primary outcomes will include measures related with the effect of clown intervention on symptom cluster of paediatric inpatients (anxiety, depression, pain, fatigue, stress and psychological, emotional responses and perceived well-being). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Jadad Scale as well as Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomized Studies Tool for NRCTs. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score for both fixed and random effect models. I 2 statistics will be used to assess heterogeneity and identify their potential sources. ETHICS AND DISSEMINATION: As it will be a systematic review, without human beings involvement, there will be no requirement for ethical approval. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia. TRIAL REGISTRATION NUMBER: CRD42018107099.


Assuntos
Ansiedade/prevenção & controle , Terapia do Riso , Pediatria , Estresse Psicológico/terapia , Doença Aguda/psicologia , Doença Crônica/psicologia , Hospitalização , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
19.
J Complement Integr Med ; 16(3)2019 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-30661058

RESUMO

Background Anxiety in patients with myocardial infarction (MI) which has a very negative effect on the prognosis of their disease and their physical and mental health. We performed this study in order to find the impact of a peer based education (PE) on anxiety in patients with MI. Methods This was a randomized clinical trial study. The study participants included 60 patient with MI, who were randomly divided into two groups. The first group received routine education and the other one received PE. We assessed anxiety before and 30 days after the intervention through a valid questionnaires. Data were analyzed by independent sample t-test, two-way ANOVA and the Bonferroni test. Results The majority of samples were male, married, self-employer, and living in city. After 30 days intervention the anxiety score was significantly lower in the PE group compare to the control group. Conclusion Our findings indicated that the implication of PE as an educational element in decreasing anxiety score and can be considered as a method for continuing of care, and could as well as be a good approach for other patients.


Assuntos
Estilo de Vida , Infarto do Miocárdio/psicologia , Doença Aguda/psicologia , Adulto , Ansiedade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
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