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1.
BMJ ; 367: l5837, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666218

RESUMO

OBJECTIVE: To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction. DESIGN: Quasi-experimental longitudinal study. SETTING: Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018. PARTICIPANTS: 104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period. MAIN OUTCOME MEASURES: Primary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census). RESULTS: The analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81). CONCLUSIONS: A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.


Assuntos
Ingestão de Energia/fisiologia , Fast Foods/efeitos adversos , Rotulagem de Alimentos , Obesidade/prevenção & controle , Restaurantes/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Fast Foods/estatística & dados numéricos , Dieta Saudável , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Ensaios Clínicos Controlados não Aleatórios como Assunto , Obesidade/epidemiologia , Obesidade/etiologia , Prevalência , Sudeste dos Estados Unidos/epidemiologia
2.
Medicine (Baltimore) ; 98(45): e17935, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702680

RESUMO

BACKGROUND: Recently, many kinds of cages for cervical fusion have been developed to avoid the related complications caused by tricortical iliac crest graft. The existing literature has reported the excellent clinical efficacy and superior fusion rate. However, various types of cages have their own disadvantages. Which bone graft material is the best choice for cage with the fewest complications? At present, there is still no conclusion. METHODS: By reviewing patients with 1 to 2-level cervical degenerative disease in our hospital with a novel cage made of allograft or polyetheretherketone (PEEK), we evaluated the efficacy and reliability of the new cage in anterior cervical discectomy and fusion (ACDF). From 2015 to 2016, a prospective review of 58 and 49 consecutive cases with spondylotic radiculopathy or myelopathy undergoing ACDF using allograft (group A) and PEEK (group B) cage were performed. The follow-up ranged from 12 to 40 months. Intraoperative index, clinical outcome and complications were recorded. Radiographs evaluated segmental and overall cervical lordosis, the height of the intervertebral space, interbody height ratio (IHR), cage positioning, and fusion state. RESULTS: A total of 134 cages were implanted. Compared to preoperatively, the visual analog scale (VAS) and neck disability index (NDI) were reduced postoperatively without any change during the subsequent follow-up in both groups. There was no migration or extrusion of the cages at the latest follow-up. There were 2 and 4 patients suffering dysphagia respectively. In both groups, the intervertebral height, IHR, segmental and overall cervical lordosis were significantly greater than pre-operation (P < .05) and were maintained at the last follow-up, but were not statistically significant (P > .05). The allograft group achieved a fusion rate of 100% (58/58) according to CT scans at 3 months post-operation, while PEEK group was 91.8% (45/49), which reached 95.9% (47/49) at 6 months and 100% at 12 months. In addition, the fusion state was maintained in all patients at the last follow-up. CONCLUSION: Our data showed that the new allograft cage is superior to the PEEK cage in providing a high fusion rate and fewer complications after 1-level and 2-level ACDF procedures. It may represent an excellent alternative to other cages.


Assuntos
Aloenxertos/transplante , Discotomia/métodos , Fixadores Internos , Degeneração do Disco Intervertebral/cirurgia , Cetonas/uso terapêutico , Polietilenoglicóis/uso terapêutico , Fusão Vertebral/métodos , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Próteses e Implantes , Resultado do Tratamento
3.
Biochim Biophys Acta Rev Cancer ; 1872(2): 188315, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31647985

RESUMO

BACKGROUND: Breast cancer has, due to its high incidence, the highest mortality of cancer in women. The most common molecular type of breast cancer is the luminal subtype, which expresses estrogen and progesterone receptors and is typically treated with surgery and adjuvant endocrine therapy (ET). Estrogen receptor alpha (ERα), encoded by the estrogen receptor-1 (ESR1) gene, is expressed in approximately 70% of all breast cancers, and ET represents a major treatment modality in ERα-positive cancers. However, resistance to different ET evolves frequently, leading to disease progression or recurrence in ER+ breast cancer. Acquired mutations in the Ligand Binding Domain (LBD) of the ERα referred as ESR1 mutations; could be selected by ET itself leading to resistance over the course of ET therapy. OBJECTIVE: The goal of this review is to estimate the effect of Aromatase Inhibitors (AIs), Tamoxifen (TAM) and Fulvestrant (FUL) on the development of ESR1 mutations in hormone-sensitive advanced breast cancer. METHODS: A systematic review of qualitative studies published between January 1st, 2007 and March 1st, 2019 was conducted using the PubMed and Thomas Reuters Web of Science databases. Search terms included ESR1 mutations, estrogen receptor, breast cancer, recurrent, metastatic disease, aromatase inhibitors, fulvestrant and tamoxifen. Only full-text studies in English concerning the development of ESR1 mutations and their outcomes on disease progression were included. Selection of studies was performed using predefined data fields, taking study quality indicators into consideration. Inclusion criteria of the study populations were: Ghoncheh et al. (2016) [1] female patients above 18 years; Nielsen et al. (2011) [2] Estrogen-receptor positive (ER+) breast cancer in the advanced setting; Reinert et al. (2017) [3] previous exposure to endocrine therapy including SERDs (preferably Fulvestrant), SERMs (preferably Tamoxifen) or Aromatase Inhibitors. RESULTS: The current review enrolled 16 articles, including 4 multicentre double blinded RCTs and 12 cohorts and comprising a total of 2632 patients. The overall incidence rate of the ESR1 mutation was 24% (95% CI: 18%-31%). We observed that D538G was the most frequent ESR1 mutation. Several studies showed that prior endocrine therapy (AIs, TAM, FUL) could result in an ESR1 mutation and therapy resistance leading to disease progression or recurrence. Different mechanisms had been implied to explain the underlying ET resistance. One of the key findings of this work is the significant difference in ESR1 mutation incidence between patients with and without AI therapy (OR: 9.34, 95% CI: 3.28-26.62, P ≤.001). CONCLUSION: ESR1 mutations are not uncommon phenomenon in patients with hormone-sensitive advanced breast cancer. There is a significant higher incidence rate of ESR1 mutations in patients with previous AI-containing therapeutic regimens, compared to those who received non-AI containing regimes. These ESR1 mutations could lead to the development of complete endocrine resistance to AI, whereas only partial resistance is seen in case of TAM or FUL.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Resistencia a Medicamentos Antineoplásicos , Receptor alfa de Estrogênio/genética , Mutação , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/genética , Feminino , Fulvestranto/uso terapêutico , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamoxifeno/uso terapêutico
4.
Accid Anal Prev ; 132: 105277, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31514087

RESUMO

The sequence of instantaneous driving decisions and its variations, known as driving volatility, prior to involvement in safety critical events can be a leading indicator of safety. This study focuses on the component of "driving volatility matrix" related to specific normal and safety-critical events, named "event-based volatility." The research issue is characterizing volatility in instantaneous driving decisions in the longitudinal and lateral directions, and how it varies across drivers involved in normal driving, crash, and/or near-crash events. To explore the issue, a rigorous quasi-experimental study design is adopted to help compare driving behaviors in normal vs unsafe outcomes. Using a unique real-world naturalistic driving database from the 2nd Strategic Highway Research Program (SHRP), a test set of 9593 driving events featuring 2.2 million temporal samples of real-world driving are analyzed. This study features a plethora of kinematic sensors, video, and radar spatiotemporal data about vehicle movement and therefore offers the opportunity to initiate such exploration. By using information related to longitudinal and lateral accelerations and vehicular jerk, 24 different aggregate and segmented measures of driving volatility are proposed that captures variations in extreme instantaneous driving decisions. In doing so, careful attention is given to the issue of intentional vs. unintentional volatility. The volatility indices, as leading indicators of near-crash and crash events, are then linked with safety critical events, crash propensity, and other event specific explanatory variables. Owing to the presence of unobserved heterogeneity and omitted variable bias, fixed- and random-parameter discrete choice models are developed that relate crash propensity to unintentional driving volatility and other factors. Statistically significant evidence is found that driver volatilities in near-crash and crash events are significantly greater than volatility in normal driving events. After controlling for traffic, roadway, and unobserved factors, the results suggest that greater intentional volatility increases the likelihood of both crash and near-crash events. A one-unit increase in intentional volatility is associated with positive vehicular jerk in longitudinal direction increases the chance of crash and near-crash outcome by 15.79 and 12.52 percentage points, respectively. Importantly, intentional volatility in positive vehicular jerk in lateral direction has more negative consequences than intentional volatility in positive vehicular jerk in longitudinal direction. Compared to acceleration/deceleration, vehicular jerk can better characterize the volatility in microscopic instantaneous driving decisions prior to involvement in safety critical events. Finally, the magnitudes of correlations exhibit significant heterogeneity, and that accounting for the heterogeneous effects in the modeling framework can provide more reliable and accurate results. The study demonstrates the value of quasi-experimental study design and big data analytics for understanding extreme driving behaviors in safe vs. unsafe driving outcomes.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/psicologia , Aceleração/efeitos adversos , Big Data , Bases de Dados Factuais , Desaceleração/efeitos adversos , Tomada de Decisões , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto
5.
BMC Public Health ; 19(1): 962, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319828

RESUMO

BACKGROUND: India faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women's groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits. METHODS: We tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation's primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children. RESULTS: We interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51-0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59-0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96-1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55-0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47-0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57-0.93). CONCLUSIONS: Crèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches. TRIAL REGISTRATION: The evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019.


Assuntos
Transtornos da Nutrição Infantil/terapia , Aconselhamento/métodos , Desnutrição/terapia , Educação de Pacientes como Assunto/métodos , Mulheres/psicologia , Adulto , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/psicologia , Pré-Escolar , Estudos Transversais , Feminino , Visita Domiciliar , Humanos , Índia/epidemiologia , Lactente , Masculino , Desnutrição/epidemiologia , Desnutrição/psicologia , Mães/psicologia , Ensaios Clínicos Controlados não Aleatórios como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , População Rural
6.
BMC Public Health ; 19(1): 993, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340787

RESUMO

BACKGROUND: Breastfeeding has important positive long-term health consequences for infants and mothers. The World Health Organization recommends that all infants should be exclusively breastfed for six months or longer, and advises continuation of breastfeeding for two years or beyond. However, these recommendations are not met in many countries. This study examined whether a comprehensive, evidence-based breastfeeding intervention, the Breastfeeding Support Programme (BSP), promotes prolonged duration and exclusivity of breastfeeding among its participants. METHODS: A quasi-experimental design was used to compare breastfeeding duration and exclusivity in the BSP group (N = 66) to breastfeeding duration and exclusivity in a control group (N = 72). Participants who followed the BSP were provided with 6 consults delivered by a lactation consultant. The consults started during pregnancy and continued up until 10 weeks after delivery. Participants in the control group did not follow the BSP. Pretest and posttest questionnaires were administered through the internet. A Cox proportional hazards regression analysis was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cessation of any and exclusive breastfeeding, while controlling for differences at baseline. RESULTS: The effect of the BSP on survival rates for any and exclusive breastfeeding were significant while controlling for differences between the two groups at baseline (respectively HR = 0.34, p < .001 [95% CI = 0.18-0.61] and HR = 0.46, p < .001 [95% CI = 0.29-0.72]). Among mothers in the BSP group there was on average 66% less risk of cessation of any breastfeeding and on average 54% less risk of cessation of exclusive breastfeeding at any point in time compared to those in the control group. CONCLUSIONS: The BSP appears to be an effective means to delay cessation of any and exclusive breastfeeding cessation and therefore to increase breastfeeding duration and exclusivity. This is an important finding, because earlier cessation of breastfeeding than desired is a common problem in many countries. Future research into the effectiveness of the BSP could consider random assignment to conditions and test the effectiveness of the intervention in other populations to investigate further whether wide-scale implementation of this intervention could be useful to promote breastfeeding.


Assuntos
Aleitamento Materno/psicologia , Mães/psicologia , Grupos de Autoajuda , Fatores de Tempo , Adulto , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Gravidez , Avaliação de Programas e Projetos de Saúde , Modelos de Riscos Proporcionais
7.
PLoS Med ; 16(6): e1002834, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31237869

RESUMO

BACKGROUND: There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors. METHODS AND FINDINGS: We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992-2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971-2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS ß -0.036, 95%CI: -0.06, -0.02, p < 0.01; NHANES ß -0.032, 95%CI: -0.05, -0.02, p < 0.01), depression (HRS ß -0.049, 95%CI: -0.07, -0.03, p < 0.01), triglycerides (NHANES ß -0.039, 95%CI: -0.06, -0.01, p < 0.01), and heart disease (HRS ß -0.025, 95%CI: -0.04, -0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS ß 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES ß 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS ß 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES ß 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS ß 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts. CONCLUSIONS: This study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Escolaridade , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos Nutricionais/métodos , Fatores de Risco , Estados Unidos/epidemiologia
8.
J Clin Nurs ; 28(19-20): 3651-3659, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31192481

RESUMO

AIM AND OBJECTIVES: To examine the factors that influence nursing students' mathematics self-efficacy, the effect of numeracy instruction on self-efficacy, and the association between self-efficacy and numeracy test performance. BACKGROUND: Medication administration errors, including administering incorrect dosages or infusion rates, can result in serious harm to patients. Hence, it is essential that nursing students are adequately prepared with the necessary numeracy skills during their nursing program. DESIGN: This quasi-experimental cohort study used a pre- and post-test survey design. The study complied with the STROBE checklist for cohort research. METHODS: In total, n = 715 undergraduate first year nursing students participated in the study from June to October 2017 at a single multi-campus university in the Western Sydney region of Australia. Data were collected at three time-points: (a) baseline, including assessing pre-instruction mathematics self-efficacy (NSE-Math scale); (b) 6-week follow-up; including assessing post-instruction mathematics self-efficacy; and (c) numeracy test performance was collected at 7-week follow-up. FINDINGS: At baseline, those with high NSE-Math scale scores were more likely to be male and have at least high school advanced mathematics level education. Following structured numeracy instruction, NSE-Math scale scores increased significantly, and those who obtained a satisfactory grade in their numeracy assessment were more likely to have high NSE-Math scale scores and high academic performance in the previous semester. CONCLUSION: The study shows that structured numeracy instruction improved mathematics self-efficacy, which in turn influenced numeracy test performance. RELEVANCE TO CLINICAL PRACTICE: Using a structured medication numeracy pedagogical approach, to teach skills in nursing undergraduate programs, provides students with the foundations to improve mathematics self-efficacy and to be successful and safe with medication numeracy calculations and administration in clinical practice.


Assuntos
Matemática/educação , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Austrália , Estudos de Coortes , Bacharelado em Enfermagem/métodos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Autoeficácia , Autoavaliação , Adulto Jovem
9.
Medicine (Baltimore) ; 98(20): e15484, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096447

RESUMO

INTRODUCTION: The purpose of this study protocol is to provide the methodology for a review to compare the effect of statins vs physical exercise interventions and the effect of different types of physical exercise, on reducing arterial stiffness associated with cardiovascular diseases and mortality. METHODS AND ANALYSIS: The literature search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception until July 31, 2019. We will include randomized controlled trials, nonrandomized experimental studies, and controlled pre-post studies assessing the effect in the general population of statins and physical exercise interventions on arterial stiffness measured by pulse wave velocity. The Cochrane Collaboration's tool and the Quality Assessment Tool for Quantitative Studies will be used to assess the risk of bias for studies included in the systematic review. A Bayesian network meta-analysis will be carried out to determine the comparative effect of the different physical exercise interventions and/or statin intervention. ETHICS AND DISSEMINATION: This study will generate evidence about the effectiveness of both statins and exercise on reducing arterial stiffness that potentially can be transferred to patients and practitioners. Moreover, in light of the importance of reducing arterial stiffness for preventing cardiovascular disease, the evidence provided by this study will be potentially suitable to be included in cardiovascular clinical practice guidelines. STRENGTHS AND LIMITATIONS: This protocol describes the methods of a study examining, using network meta-analysis strategies, the efficacy of statins and different types of exercise on improving arterial stiffness, which is an early marker of atherosclerosis. The results of this study could immediately help clinicians to recommend the best evidence-based intervention to their patients to reduce arterial stiffness and, as a consequence, prevent major complications, such as heart failure, stroke, or myocardial infarction. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019123120.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Exercício/fisiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Rigidez Vascular/efeitos dos fármacos , Doenças Cardiovasculares/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Meta-Análise em Rede , Ensaios Clínicos Controlados não Aleatórios como Assunto , Avaliação de Resultados (Cuidados de Saúde) , Análise de Onda de Pulso/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Rigidez Vascular/fisiologia
10.
Cuad. psicol. deporte ; 19(2): 83-101, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183271

RESUMO

Según la Teoría de la Autodeterminación (Deci y Ryan, 1985, 2002), el estilo interpersonal que utilice el educador puede tener un fuerte impacto en la motivación de los estudiantes. Los objetivos de este artículo fueron: (I) explicar la justificación y desarrollo de un programa de formación basado en esta teoría para promover el apoyo a la autonomía; (II) describir el protocolo de estudio y los procedimientos de evaluación del programa de formación; y (III) probar la integridad del protocolo de estudio para una futura intervención. De un total de 40 docentes de educación física, se asignarán 20 a un grupo de intervención o a un grupo control (n = 20). Durante un período de 8 semanas, los docentes del grupo de intervención completarán un programa de formación en apoyo a la autonomía a través de varias fases. Se evaluarán indicadores que caracterizan el estilo interpersonal de apoyo a la autonomía de forma cualitativa y cuantitativa, tanto al docente como al estudiante. La recogida de los datos de la línea base cuantitativa se llevará a cabo un mes antes del inicio de la intervención y un mes después de la finalización del período de intervención. Los datos cuantitativos se analizarán mediante análisis multinivel. Para explorar las percepciones del programa de formación, también se llevará a cabo un seguimiento a través de entrevistas semiestructuradas con docentes y miembros de la clase, de cuatro a seis semanas después del final de la intervención. Este estudio cuenta con la aprobación del Comité de Ética de las instituciones participantes. Los hallazgos del estudio se difundirán a través de revistas de impacto científico y presentaciones en conferencias sobre la temática de estudio de carácter internacional


No disponible


No disponible


Assuntos
Humanos , Autonomia Pessoal , Educação Física e Treinamento , Docentes/psicologia , Motivação , Ensaios Clínicos Controlados não Aleatórios como Assunto , Apoio Social , Determinação de Necessidades de Cuidados de Saúde , Docentes/educação
11.
Medicine (Baltimore) ; 98(21): e15622, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124941

RESUMO

BACKGROUND: Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS: The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS: Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS: This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
BMC Public Health ; 19(1): 589, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101095

RESUMO

BACKGROUND: Despite growing evidence for the multiple health benefits of community gardening, longitudinal studies based on quantitative data are needed. Here we describe the protocol of JArDinS, a quasi-experimental study, aimed at assessing the impact of community garden participation (a natural experiment) in the adoption of more sustainable lifestyles. METHODS: Gardeners (n = 80) starting gardening in a community garden in Montpellier (France) will be recruited. Volunteers with no experience in community gardening and matched for age range, gender, household income and household composition will be recruited in a control group (n = 80). The sustainability of lifestyles in its social/health, environmental and economic dimensions will be assessed from a food supply diary (recording type, quantity and price of foods acquired in a 1-month period and the carbon impact of relevant food trips), a triaxial accelerometer (measuring physical activity) and online questionnaires on mental and social health, sensitivity to food waste, and connection with nature. Change of outcomes after 1 year will be compared between the natural experiment and the control groups. DISCUSSION: This study will provide information on the impact of participation in a community garden on the different dimensions of sustainability, based on a robust quasi-experimental design allowing causality evaluation. TRIAL REGISTRATION: The JArDinS study was registered at clinicaltrials.gov as NCT03694782 . Date of registration: 3rd October 2018, retrospectively registered.


Assuntos
Participação da Comunidade/psicologia , Jardinagem/métodos , Estilo de Vida , Desenvolvimento Sustentável , População Urbana , Adulto , Feminino , Abastecimento de Alimentos , França , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Projetos de Pesquisa , Inquéritos e Questionários , Voluntários
13.
BMC Pregnancy Childbirth ; 19(1): 109, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940102

RESUMO

BACKGROUND: Operative vaginal birth is a common procedure used to expedite birth after full cervical dilatation where there is a clinical need to do so (15% of births in the UK in 2016). The acquisition of skills for operative vaginal birth is dependent on the exposure of junior obstetricians to situations in which they can undertake directly supervised learning from senior accouchers. The Royal College of Obstetricians and Gynaecologists has recently introduced the first structured course in operative vaginal birth. To date, there have been no attempts to determine the clinical impact of a structured training package for operative vaginal birth. METHODS: The STROBE study is a quasi-experimental before-after interrupted time-series study of the effect of simulation training in operative vaginal birth for obstetricians on clinical outcomes of women and babies following operative vaginal birth. Similar to a stepped-wedge design, the intervention will be gradually implemented in all participating units but at different time periods. The primary outcome is failed operative vaginal birth with the first intended instrument. Secondary maternal outcomes are; use of second instrument to achieve operative vaginal birth, caesarean section, episiotomy, perineal trauma (1st, 2nd, 3rd, 4th degree tear), cervical tear requiring suturing, general anaesthesia and estimated blood loss. Secondary neonatal outcomes are; Apgar score at one, five, and ten minutes, Umbilical artery pH, shoulder dystocia, admission to Neonatal Intensive Care Unit and death within 28 days of birth. The analysis will be intention-to-treat (per unit) on the primary and secondary outcomes. The STROBE study received approval from the Health Research Authority and is sponsored by North Bristol NHS Trust. Results will be published in an open-access peer-reviewed medical journal within one year of completion of data gathering. DISCUSSION: The STROBE study will help establish our understanding of the effectiveness of locally-delivered simulation training for operative vaginal birth. Robust evidence supporting the effectiveness of such an approach would add weight to the argument supporting regular, local training for junior obstetricians in operative vaginal birth. TRIAL REGISTRATION: ISRCTN11760611 05/03/2018 (retrospectively registered).


Assuntos
Parto Obstétrico/educação , Obstetrícia/educação , Treinamento por Simulação/métodos , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Análise de Séries Temporais Interrompida/métodos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Observacionais como Assunto , Gravidez , Projetos de Pesquisa , Vagina
14.
J Clin Nurs ; 28(15-16): 2990-3000, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30938871

RESUMO

AIMS AND OBJECTIVES: To evaluate whether implementing the Modified Early Warning Scoring system impacts nurses' free text notes related to Airway, Breathing, Circulation and Pain in general ward medical and surgical patients. BACKGROUND: The quality of nursing documentation in patient health records is important to secure patient safety, but faces multiple challenges whether being paper-based or electronic. Nurses' ability to draw a complete picture of the patient situation is thereby compromised. Structured use of the Modified Early Warning Score, found to reduce unexpected death, might affect nurses' free text documentation of clinical observations. DESIGN: A prospective, pre- and postinterventional, nonrandomised study adhering to the EQUATOR guideline TREND. METHODS: Data on nurses' free text notes were obtained in 1,497 patient records during one preinterventional (March-June 2009) and two postinterventional study periods (September-December 2010 and March-June 2011) in a Danish university hospital. Data were organised by the Airway, Breathing and Circulation principles and by nurses' working shifts in the 56 hr surrounding the first recording of deviating vital parameters or a Modified Early Warning Score ≥ 2. Preinterventional free text notes were compared with notes from the two postinterventional periods, respectively. RESULTS: In the 8-hr working shift where deviations in vital parameters were recorded for the first time, nurses' free text notes related to patients' breathing (B) increased significantly, comparing 2009 with 2010 and 2011, respectively. In the 24 hr following initial deviations in vital parameters, a significant increase in free text notes was identified concerning Airway, Breathing and Circulation-related symptoms or problems. CONCLUSION: Mandatory use of the Modified Early Warning Score and related implementation activities significantly impacts nursing documentation of free text notes. RELEVANCE TO CLINICAL PRACTICE: Nurses' practice of communicating observed clinical symptoms by documenting free text notes should be supported through measures to enhance situation awareness.


Assuntos
Registros de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital/normas , Segurança do Paciente/normas , Adulto , Estudos Controlados Antes e Depois , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Prospectivos , Medição de Risco/métodos
16.
Epidemiol Health ; 41: e2019011, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999735

RESUMO

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including "miltefosine," "glucantime," and "Leishmania." The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I2 index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.


Assuntos
Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina/uso terapêutico , Fosforilcolina/análogos & derivados , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Fosforilcolina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
Sex Reprod Healthc ; 19: 1-8, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928129

RESUMO

OBJECTIVE: To investigate the effect on infant blood glucose levels of an intervention consisting of early, frequent breastfeeding and two hours of immediate uninterrupted skin-to-skin contact following birth of term infants born to mothers with diet-treated gestational diabetes (GDM). STUDY DESIGN: Quasi-experimental study design with a historical control group (n = 132) and an intervention group (n = 401) testing a procedure to prevent neonatal hypoglycemia. MAIN OUTCOME MEASURES: Data collection on blood glucose levels, hypoglycemia incidence with a cut-off of <2.5 mmol/l, breastfeeding within the first two hours after birth, breastfeeding frequency within the first six hours, and amount of formula given to hypoglycemic infants. RESULTS: Mean blood glucose levels in the intervention group at two and four hours were within safe limits: 3.37 mmol/l (95% CI: [3.30, 3.44]) and 3.40 mmol/l (95% CI: [3.34, 3.46]), respectively. Infants suffering a hypoglycemic event within four hours after birth decreased from 22.7% (n = 30/132) in the control group to 10.2% (n = 41/401) in the intervention group. The mean number of breastfeeds in the intervention group (six hours) was 2.41 compared to 1.34 in the control group (seven hours), an increase of 80%. Only 41 of 401 infants in the intervention group were interrupted in immediate interaction with their mother because of hypoglycemia. We failed to obtain sufficient data on skin-to-skin contact. CONCLUSION: Maintaining skin-to-skin contact for infants of mothers with diet-treated GDM, monitoring blood glucose levels until obtaining two values >2.4 mmol/l and encouraging early frequent breastfeeding is a safe strategy to prevent hypoglycemia.


Assuntos
Aleitamento Materno , Diabetes Gestacional/dietoterapia , Hipoglicemia/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Adulto , Glicemia/metabolismo , Dinamarca , Feminino , Humanos , Hipoglicemia/sangue , Recém-Nascido , Método Canguru , Ensaios Clínicos Controlados não Aleatórios como Assunto , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Tempo
18.
Int J Gynaecol Obstet ; 146(1): 74-79, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31026343

RESUMO

OBJECTIVE: To analyze the cost-effectiveness of maternity waiting homes (MWHs) in rural Liberia by examining the cost per life saved and economic effect of MWHs on maternal mortality. METHODS: A cost-effectiveness analysis was used to evaluate costs and economic effect of MWHs on maternal mortality in rural Liberia to guide future resource allocation. A secondary data analysis was performed based on a prior quasi-experimental cohort study of 10 rural primary healthcare facilities, five with a MWH and five without a MWH, that took place from October 30, 2010 to February 28, 2015. RESULTS: Calculations signified a low cost per year of life saved at MWHs in a rural district in Liberia. Total population-adjusted number of women's lives saved over 3 years was 6.25. CONCLUSION: While initial costs were considerable, over a period of 10 or more years MWHs could be a cost-effective and affordable strategy to reduce maternal mortality rates in Liberia. Discussion of the scaling up of MWH interventions for improving maternal outcomes in Liberia and other low- and middle-income countries is justified. Findings can be used to advocate for policy changes to increase the apportionment of resources for building more MWHs in low resource settings.


Assuntos
Serviços de Saúde Materna/economia , Cuidado Pré-Natal/economia , Adulto , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Libéria , Morte Materna/prevenção & controle , Mortalidade Materna , Ensaios Clínicos Controlados não Aleatórios como Assunto , Gravidez , Cuidado Pré-Natal/métodos , População Rural
19.
Acta Cir Bras ; 34(2): e201900206, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30843939

RESUMO

PURPOSE: To compare open Lichtenstein repair and laparoscopic transabdominal preperitoneal (TAPP) repair to treat primary unilateral hernia, regarding systemic inflammatory response, postoperative pain, and complications. METHODS: A non-randomized prospective cohort study, with the preoperative and postoperative (24 hours) collection of blood samples for C reactive protein (CRP), interleukin 6 (IL-6), leukocyte and neutrophil analysis. Visual Analog Scale (VAS) was used to quantify the level of pain, and the operative time was correlated with the inflammatory response. VAS and CRP were also obtained on the 8th postoperative day. RESULTS: Groups were homogeneous regarding preoperative characteristics. There were no differences between groups in 24h values of CRP, IL-6, leukocytes, neutrophils or VAS. Similarly, CRP and VAS did not differ between groups on the 8th postoperative day. However, the operative time for laparoscopic hernia repair was longer than the time for the open procedure. There was a weak correlation (r coefficient 0.31) between the duration of the surgical procedure and the VAS score at the eighth day. CONCLUSIONS: There were no statistically significant differences in the inflammatory response, pain scores, or complications between groups. We conclude that there is no advantage performing a primary unilateral hernia repair by laparoscopy.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Dor Pós-Operatória , Síndrome de Resposta Inflamatória Sistêmica , Biomarcadores/sangue , Proteína C-Reativa , Feminino , Hérnia Inguinal/sangue , Herniorrafia/efeitos adversos , Humanos , Interleucina-6 , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Duração da Cirurgia , Dor Pós-Operatória/sangue , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Resultado do Tratamento , Escala Visual Analógica
20.
Medicine (Baltimore) ; 98(13): e14899, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921187

RESUMO

This study aimed to compare the clinical efficacy of stenting compared with standardized medical treatment in patients with moderate to severe vertebral artery origin stenosis (VAOS).Patients diagnosed with moderate to severe VAOS and indicated to undergo vertebral artery stenting were enrolled. Patients were divided into stenting group and standardized medical treatment group. All patients underwent transcranial Doppler (TCD) before and after treatment. Incidence of new cerebral infarction, transient ischemic attack (TIA), improvement of clinical symptoms, and National Institutes of Health Stroke Scale (NIHSS) score were observed.A total of 98 patients were enrolled. Vertebral artery stenting implant was accepted by 43 patients. Two weeks after treatment, the NIHSS score in the stenting group decreased significantly compared to that in the standardized medical treatment group. The modified Rankin Scale (mRS) score in the stenting group at three months was significantly lower than that in the medical treatment group (P = .044). The extent of vascular stenosis in the stent group decreased significantly (76.5 ±â€Š10.0% vs. 13.7 ±â€Š5.9%, t = 35.878, P = .000). The adverse events occurred in 9 (16.4%) patients in the medical treatment group and 5 (11.6%) in the stenting group (P = .506). There was one case with new cerebral infarction in the stenting group, whereas the medical treatment group showed 1 case with TIA and three with new cerebral infarction during follow-up after 3 months. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) of stenosis vertebral artery, and PSV of basilar artery were significantly higher in the stent group than those in the standardized medical group (P < .05).Stenting for VAOS, rather than standardized medical treatment, can effectively relieve vascular stenosis, alter vertebral-basilar artery hemodynamics, and improve neurological function, with low perioperative complications.


Assuntos
Hemodinâmica/fisiologia , Stents/efeitos adversos , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Constrição Patológica/patologia , Feminino , Seguimentos , Humanos , Incidência , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Prognóstico , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Ultrassonografia Doppler Transcraniana/métodos , Artéria Vertebral/patologia , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/terapia
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