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3.
Pan Afr Med J ; 39: 43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422166

RESUMO

RATIONALE: high premium is placed on infertility in Nigerian culture. Data is limited on its association with emotional problems in Nigeria. AIMS: to develop content for a culturally relevant and cost-effective psychoeducational intervention package and to evaluate its effectiveness for reducing symptoms of anxiety and depression. Sample size estimate: Methods and design: a multi-method study design including development and validation (which includes focus group discussions) of an audio-visual tool which will serve as the intervention in a randomized controlled trial. Data will be analyzed with interim and survival analyses. POPULATION STUDIED: one hundred and 138 (68 per group) infertile women attending infertility clinic in Ibadan. STUDY OUTCOMES: anxiety and depressions scores assessed with the hospital depression and anxiety scale (HADS) at 0, 3 and 6 weeks. DISCUSSION: it is hoped that the use of the audio-visual tool will improve participants depression and anxiety scores and that the tool will be used for education in routine clinic use and community awareness on psychosocial effects of infertility.


Assuntos
Ansiedade/psicologia , Depressão/prevenção & controle , Infertilidade Feminina/psicologia , Educação de Pacientes como Assunto/métodos , Recursos Audiovisuais , Feminino , Humanos , Nigéria , Escalas de Graduação Psiquiátrica
7.
Nutrients ; 13(7)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34371825

RESUMO

The coronavirus pandemic enforced social restrictions with abrupt impacts on mental health and changes to health behaviors. From a randomized clinical trial, we assessed the impact of culinary education on home cooking practices, coping strategies and resiliency during the first wave of the COVID-19 pandemic (March/April 2020). Participants (n = 28) were aged 25-70 years with a BMI of 27.5-35 kg/m2. The intervention consisted of 12 weekly 30-min one-on-one telemedicine culinary coaching sessions. Coping strategies were assessed through the Brief Coping with Problems Experienced Inventory, and resiliency using the Brief Resilient Coping Scale. Home cooking practices were assessed through qualitative analysis. The average use of self-care as a coping strategy by the intervention group was 6.14 (1.66), compared to the control with 4.64 (1.69); p = 0.03. While more intervention participants had high (n = 5) and medium (n = 8) resiliency compared to controls (n = 4, n = 6, respectively), this difference was not significant (p = 0.33). Intervention participants reported using home cooking skills such as meal planning and time saving techniques during the pandemic. The key findings were that culinary coaching via telemedicine may be an effective intervention for teaching home cooking skills and promoting the use of self-care as a coping strategy during times of stress, including the COVID-19 pandemic.


Assuntos
Adaptação Psicológica , COVID-19/psicologia , Culinária , Educação à Distância/métodos , Ajustamento Emocional , Educação de Pacientes como Assunto/métodos , Culinária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Testes Psicológicos , Resiliência Psicológica , Inquéritos e Questionários
8.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371903

RESUMO

Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals' preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage.


Assuntos
Culinária , Dieta Saudável , Conhecimentos, Atitudes e Prática em Saúde , Fenômenos Fisiológicos da Nutrição Materna , Motivação , Valor Nutritivo , Educação de Pacientes como Assunto , Adulto , Comportamento Alimentar , Feminino , Grupos Focais , Promoção da Saúde , Humanos , Michigan , Estado Nutricional , Gravidez , Pesquisa Qualitativa , Recomendações Nutricionais
9.
BMJ ; 374: n1493, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380627

RESUMO

Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Custos de Medicamentos/legislação & jurisprudência , Adesão à Medicação/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Fármacos Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Ensaios Clínicos como Assunto , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Comorbidade , Humanos , Equipe de Assistência ao Paciente/ética , Polimedicação , Guias de Prática Clínica como Assunto , Papel Profissional/psicologia , Sistemas de Alerta/instrumentação
10.
J Headache Pain ; 22(1): 96, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34418953

RESUMO

BACKGROUND: Tension-type headache (TTH) has been ranked the second most prevalent health condition worldwide. Non-pharmacological treatments for TTH are widely used as a supplement or an alternative to medical treatment. However, the evidence for their effects are limited. Therefore, the aim of this study was to review the evidence for manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education as treatments for TTH on the effect of headache frequency and quality of life. METHODS: A systematic literature search was conducted from February to July 2020 for clinical guidelines, systematic reviews, and individual randomised controlled trials (RCT). The primary outcomes measured were days with headache and quality of life at the end of treatment along with a number of secondary outcomes. Meta-analyses were performed on eligible RCTs and pooled estimates of effects were calculated using the random-effect model. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). In addition, patient preferences were included in the evaluation. RESULTS: In all, 13 RCTs were included. Acupuncture might have positive effects on both primary outcomes. Supervised physical activity might have a positive effect on pain intensity at the end of treatment and headache frequency at follow-up. Manual joint mobilisation techniques might have a positive effect on headache frequency and quality of life at follow-up. Psychological treatment might have a positive effect on stress symptoms at the end of treatment. No relevant RCTs were identified for patient education. The overall certainty of evidence was downgraded to low and very low. No serious adverse events were reported. A consensus recommendation was made for patient education and weak recommendations for the other interventions. CONCLUSION: Based on identified benefits, certainty of evidence, and patient preferences, manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture, and patient education can be considered as non-pharmacological treatment approaches for TTH. Some positive effects were shown on headache frequency, quality of life, pain intensity and stress symptoms. Few studies and low sample sizes posed a challenge in drawing solid conclusions. Therefore, high-quality RCTs are warranted.


Assuntos
Terapia por Acupuntura , Cefaleia do Tipo Tensional , Exercício Físico , Cefaleia , Humanos , Educação de Pacientes como Assunto , Cefaleia do Tipo Tensional/terapia
11.
Eye Contact Lens ; 47(9): 526-532, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34424226

RESUMO

OBJECTIVE: To evaluate the content, quality, and reliability of keratoconus-related YouTube videos as sources for patient education. METHODS: YouTube was queried using the keywords "keratoconus," "contact lenses for keratoconus," "corneal cross-linking," and "corneal transplant surgery for keratoconus." Two ophthalmologists independently classified videos as useful, misleading, or patient testimonials and rated them using the DISCERN score (range, 16-75), Journal of the American Medical Association score (JAMAS; range, 0-4), Global Quality Score (GQS; range, 1-5), and Keratoconus-Specific Score (KSS; range, 0-32). Interrater agreement was analyzed using intraclass correlation coefficients. Multivariate linear regression models were fitted to identify factors associated with quality and popularity indices. RESULTS: Of the 300 videos screened, 201 were included in the study, 58% were classified as useful, 13% as misleading, and 29% as patient views. Overall video quality was poor, with an average DISCERN score of 22, JAMAS of 1.2, GQS of 1.8, and KSS of 4.5. Misleading videos scored significantly lower than average but had higher popularity compared with useful videos. Video length inversely correlated with popularity index. Television shows were more likely to share misleading information than other uploaders, whereas all videos uploaded by university channels provided useful information but constituted only 12% of all videos. CONCLUSIONS: Videos rated the best source of information were not the ones most popular. YouTube has great potential to change the attitude of individuals both for and against the right choice. Therefore, health professionals should act to use this potential in favor of effective and reliable health communication.


Assuntos
Ceratocone , Mídias Sociais , Humanos , Ceratocone/terapia , Educação de Pacientes como Assunto , Reprodutibilidade dos Testes , Estados Unidos
12.
Nutrients ; 13(7)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34371967

RESUMO

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population's needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.


Assuntos
Bulimia/psicologia , Bulimia/terapia , Insegurança Alimentar , Obesidade/psicologia , Obesidade/terapia , Design Centrado no Usuário , Adulto , Idoso , Custos e Análise de Custo , Dieta Saudável , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Refeições , Pessoa de Meia-Idade , Motivação , Determinação de Necessidades de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos
13.
Ann R Coll Surg Engl ; 103(8): 615-620, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464578

RESUMO

INTRODUCTION: The Future of Surgery report from the Royal College of Surgeons of England acknowledges the important role that three-dimensional imaging will play in support of personalised surgical interventions. One component of this is preoperative planning. We investigated surgeons' and patients' perceptions of this evolving technology. MATERIALS AND METHODS: Ethical approval was obtained. From a normal computed tomography scan, three-dimensional models of the stomach, pancreas and rectum were rendered and printed on an Ultimaker™ three-dimensional printer. Semi-structured interviews were performed with surgeons and patients to explore perceived model effectiveness and utility. Likert scales were used to grade responses (1 = strongly disagree; 10 = strongly agree) and qualitative responses recorded. RESULTS: A total of 26 surgeons (9 rectal, 9 oesophagogastric, 8 pancreatic) and 30 patients (median age 62 years, interquartile range, IQR, 68-72 years; 57% male) were recruited. Median surgeon scores were effectiveness for preoperative planning, 6 (IQR 3-7), authenticity, 5 (IQR 3-6), likability, 6 (IQR 4-7), promoting learning, 7 (IQR 5-8), utility, 6 (IQR 5-7) and helping patients, 7 (IQR 5-8). Median patient scores were usefulness to the surgeon, 8 (IQR 7-9), authenticity, 8 (IQR 6-8), likability, 8 (IQR 7-8), helping understanding of condition, 8 (IQR 8-9), helping understanding of surgery, 8 (IQR 7-9) and feeling uncomfortable, 1 (IQR 1-4). Median overall decisional conflict score (0 = no; 100 = high) was 22 (IQR 19-28) and decision effectiveness was 25 (IQR 19-30). DISCUSSION: Overall, patients and surgeons considered that three-dimensional printed models were effective and had potential utility in education and, to a lesser extent, preoperative planning. Patient decisional conflict and effectiveness scores were weighted towards certainty in decision making but had room for improvement, which three-dimensional models may help to facilitate.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Consentimento Livre e Esclarecido , Modelos Anatômicos , Cuidados Pré-Operatórios , Impressão Tridimensional , Idoso , Atitude do Pessoal de Saúde , Feminino , Neoplasias Gastrointestinais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas , Educação de Pacientes como Assunto , Reto , Estômago , Reino Unido
15.
N Z Med J ; 134(1538): 77-88, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239147

RESUMO

AIMS: Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS: Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS: The majority (76%) of the cohort (male, 76%; Maori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS: Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.


Assuntos
COVID-19/prevenção & controle , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Profissionais de Enfermagem , Padrões de Prática em Enfermagem , Telemedicina , Idoso , Fator Natriurético Atrial/sangue , Pressão Sanguínea , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Satisfação do Paciente , Projetos Piloto , Guias de Prática Clínica como Assunto , Precursores de Proteínas/sangue , SARS-CoV-2 , Volume Sistólico , Telemedicina/economia , Telemedicina/organização & administração , Telefone , Viagem/economia
17.
Ann Intern Med ; 174(7): ITC97-ITC112, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34251902

RESUMO

This review focuses on the diagnosis and management of menopause, highlighting both hormonal and nonhormonal treatment options. In particular, the article focuses on recent data on the risks and benefits of hormone therapy to help clinicians better counsel their patients about decision making with regard to understanding and treating menopause symptoms.


Assuntos
Menopausa/fisiologia , Neoplasias da Mama/etiologia , Doenças Cardiovasculares/prevenção & controle , Transtornos Cognitivos/etiologia , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Estilo de Vida Saudável , Fogachos/tratamento farmacológico , Fogachos/terapia , Humanos , Menopausa/sangue , Menopausa/psicologia , Osteoporose Pós-Menopausa/prevenção & controle , Educação de Pacientes como Assunto , Medição de Risco , Inibidores de Captação de Serotonina/uso terapêutico , Sudorese/fisiologia , Vagina/fisiologia , Sistema Vasomotor/fisiologia
19.
BMJ ; 374: n1380, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253540

RESUMO

Synthetic glucocorticoids are widely used for their anti-inflammatory and immunosuppressive actions. A possible unwanted effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal axis, which can lead to adrenal insufficiency. Factors affecting the risk of glucocorticoid induced adrenal insufficiency (GI-AI) include the duration of glucocorticoid therapy, mode of administration, glucocorticoid dose and potency, concomitant drugs that interfere with glucocorticoid metabolism, and individual susceptibility. Patients with exogenous glucocorticoid use may develop features of Cushing's syndrome and, subsequently, glucocorticoid withdrawal syndrome when the treatment is tapered down. Symptoms of glucocorticoid withdrawal can overlap with those of the underlying disorder, as well as of GI-AI. A careful approach to the glucocorticoid taper and appropriate patient counseling are needed to assure a successful taper. Glucocorticoid therapy should not be completely stopped until recovery of adrenal function is achieved. In this review, we discuss the factors affecting the risk of GI-AI, propose a regimen for the glucocorticoid taper, and make suggestions for assessment of adrenal function recovery. We also describe current gaps in the management of patients with GI-AI and make suggestions for an approach to the glucocorticoid withdrawal syndrome, chronic management of glucocorticoid therapy, and education on GI-AI for patients and providers.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Síndrome de Abstinência a Substâncias , Doença Aguda , Insuficiência Adrenal/tratamento farmacológico , Doença Crônica , Síndrome de Cushing/induzido quimicamente , Aconselhamento Diretivo , Humanos , Sistema Hipotálamo-Hipofisário , Educação de Pacientes como Assunto , Fatores de Risco , Síndrome de Abstinência a Substâncias/tratamento farmacológico
20.
Nutrients ; 13(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34204893

RESUMO

Good nutritional support is crucial for the immune system to fight against coronavirus disease 2019 (COVID-19). However, in the context of a pandemic with a highly transmissible coronavirus, implementation of nutrition practice may be difficult. A multicenter electronic survey involving 62 dieticians was conducted, in order to understand barriers associated with dieticians' adherence to nutrition guidelines for hospitalized COVID-19 patients in Indonesia. 69% of dieticians felt under stress when performing nutrition care, and 90% took supplements to boost their own immunity against the coronavirus. The concerns related to clinical practice included a lack of clear guidelines (74%), a lack of access to medical records (55%), inadequate experience or knowledge (48%), and a lack of self-efficacy/confidence (29%) in performing nutritional care. Half (52%) of the dieticians had performed nutrition education/counseling, 47% had monitored a patient's body weight, and 76% had monitored a patient's dietary intake. An adjusted linear regression showed that guideline adherence independently predicted the dieticians' nutrition care behaviors of nutrition counselling (ß: 0.24 (0.002, 0.08); p = 0.04), and monitoring of body weight (ß: 0.43 (0.04, 0.11); p = 0.001) and dietary intake (ß: 0.47(0.03, 0.10); p = 0.001) of COVID-19 patients. Overall, adherence to COVID-19 nutrition guidelines is associated with better nutritional management behaviors in hospitalized COVID-19 patients.


Assuntos
COVID-19 , Fidelidade a Diretrizes , Hospitalização , Estado Nutricional , Nutricionistas , Pandemias , Assistência ao Paciente , Peso Corporal , Competência Clínica , Aconselhamento , Dieta , Feminino , Humanos , Indonésia , Modelos Lineares , Masculino , Política Nutricional , Estresse Ocupacional , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Autoeficácia
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