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1.
Lancet Glob Health ; 8(11): e1408-e1417, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33069301

RESUMO

BACKGROUND: Smoking cessation is important in patients with tuberculosis because it can reduce the high rates of treatment failure and mortality. We aimed to assess the effectiveness and safety of cystine as a smoking cessation aid in patients with tuberculosis in Bangladesh and Pakistan. METHODS: We did a randomised, double-blind, placebo-controlled, trial at 32 health centres in Bangladesh and Pakistan. Eligible patients were adults (aged >18 years in Bangladesh; aged >15 years in Pakistan) with pulmonary tuberculosis diagnosed in the previous 4 weeks, who smoked tobacco on a daily basis and were willing to stop smoking. Patients were randomly assigned (1:1) to receive behavioural support plus either oral cytisine (9 mg on day 0, which was gradually reduced to 1·5 mg by day 25) or placebo for 25 days. Randomisation was done using pregenerated block randomisation lists, stratified by trial sites. Investigators, clinicians, and patients were masked to treatment allocation. The primary outcome was continuous abstinence at 6 months, defined as self-report (of not having used more than five cigarettes, bidis, a water pipe, or smokeless tobacco products since the quit date), confirmed biochemically by a breath carbon monoxide reading of less than 10 parts per million. Primary and safety analysis were done in the intention-to-treat population. This trial is registered with the International Standard Randomised Clinical Trial Registry, ISRCTN43811467, and enrolment is complete. FINDINGS: Between June 6, 2017, and April 30, 2018, 2472 patients (1527 patients from Bangladesh; 945 patients from Pakistan) were enrolled and randomly assigned to receive cytisine (n=1239) or placebo (n=1233). At 6 months, 401 (32·4%) participants in the cytisine group and 366 (29·7%) participants in the placebo group had achieved continuous abstinence (risk difference 2·68%, 95% CI -0·96 to 6·33; relative risk 1·09, 95% CI 0·97 to 1·23, p=0·114). 53 (4·3%) of 1239 participants in the cytisine group and 46 (3·7%) of 1233 participants in the placebo group reported serious adverse events (94 events in the cytisine group and 90 events in the placebo group), which included 91 deaths (49 in the cytisine group and 42 in the placebo group). None of the adverse events were attributed to the study medication. INTERPRETATION: Our findings do not support the addition of cytisine to brief behavioural support for the treatment of tobacco dependence in patients with tuberculosis. FUNDING: European Union Horizon 2020 and Health Data Research UK. TRANSLATIONS: For the Bengali and Urdu translations of the abstract see Supplementary Materials section.


Assuntos
Alcaloides/uso terapêutico , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Tuberculose/epidemiologia , Adulto , Azocinas/uso terapêutico , Bangladesh/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Psicoterapia Breve , Quinolizinas/uso terapêutico , Tabagismo/psicologia , Resultado do Tratamento
2.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32928988

RESUMO

CONTEXT: Adolescents with problematic substance use (SU) are at risk for far-reaching adverse outcomes. OBJECTIVE: Synthesize the evidence regarding the effects of brief behavioral interventions for adolescents (12-20 years) with problematic SU. DATA SOURCES: We conducted literature searches in Medline, the Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo through October 31, 2019. STUDY SELECTION: We screened 33 272 records and citations for interventions in adolescents with at least problematic SU, retrieved 1831 articles, and selected 22 randomized controlled trials of brief interventions meeting eligibility criteria for meta-analysis. DATA EXTRACTION: We followed Agency for Healthcare Research and Quality guidelines. We categorized brief interventions into components, including motivational interviewing (MI), psychoeducation, and treatment as usual. Outcomes included SU (abstinence, days used per month) for alcohol and cannabis, and substance-related problem scales. Strength of evidence (SoE) was assessed. RESULTS: Both pairwise and network meta-analyses were conducted by using random effects models. Compared to treatment as usual, the use of MI reduces heavy alcohol use days by 0.7 days per month (95% credible interval [CrI]: -1.6 to 0.02; low SoE), alcohol use days by 1.1 days per month (95% CrI -2.2 to -0.3; moderate SoE), and overall substance-related problems by a standardized net mean difference of 0.5 (95% CrI -1.0 to 0; low SoE). The use of MI did not reduce cannabis use days, with a net mean difference of -0.05 days per month (95% CrI: -0.26 to 0.14; moderate SoE). LIMITATIONS: There was lack of consistently reported outcomes and limited available comparisons. CONCLUSIONS: The use of MI reduces heavy alcohol use, alcohol use days, and SU-related problems in adolescents but does not reduce cannabis use days.


Assuntos
Entrevista Motivacional , Psicoterapia Breve , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Humanos
3.
Epidemiol Psychiatr Sci ; 29: e150, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32744223

RESUMO

Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic 'at risk', to experiencing 'mental distress', 'sub-syndromal symptoms' and finally 'mental disorders'. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.


Assuntos
Antidepressivos/uso terapêutico , Transtornos Mentais/terapia , Serviços Preventivos de Saúde/estatística & dados numéricos , Psicoterapia Breve/estatística & dados numéricos , Feminino , Humanos , Renda , Masculino , Transtornos Mentais/prevenção & controle , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços Preventivos de Saúde/organização & administração
4.
Yakugaku Zasshi ; 140(8): 1063-1069, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32741864

RESUMO

Quantitative NMR (qNMR) has been developed as an absolute quantitation method to determine the purity or content of organic compounds including marker compounds in crude drugs. The "qNMR test" has been introduced into the crude-drug section of the Japanese Pharmacopoeia (JP) for determining the purity of reagents used for the assay in the JP. In Supplement II to the JP 17th edition published in June 2019, fifteen compounds adopted qNMR test were listed as the reagents for the assay. To establish the "qNMR test" in the crude drug section of the JP, there were several problems to be solved. Previously, we reported that the handling impurity signals from reference substances and targeted marker compounds, chemical shifts of reference substances, and peak unity of signals of targeted marker compounds are important factors to conduct qNMR measurements with intended accuracy. In this study, we investigated that the hygroscopicity of reagents could cause the changes in the compounds' purity depending on increasing their water content. Twenty-one standard products used for the crude-drug test in JP were examined by water sorption-desorption analysis, and ginsenosides and saikosaponins were found to be hygroscopic. To prepare a sample solution of saikosaponin b2 for qNMR analysis, samples need to be maintained for 18 h at 25°C and 76% relative humidity; further, samples need to be weighed at the same humidity for the qNMR analysis.


Assuntos
Contaminação de Medicamentos/prevenção & controle , Higroscópicos/química , Higroscópicos/normas , Indicadores e Reagentes/normas , Espectroscopia de Ressonância Magnética/métodos , Farmacopeias como Assunto/normas , Ginsenosídeos/química , Ginsenosídeos/normas , Umidade , Japão , Ácido Oleanólico/análogos & derivados , Ácido Oleanólico/química , Ácido Oleanólico/normas , Psicoterapia Breve , Saponinas/química , Saponinas/normas , Temperatura , Água/análise
5.
J Oleo Sci ; 69(9): 1125-1132, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32788521

RESUMO

Controlling the size of nanoparticles is important for drug delivery methods such as pulmonary administration, transdermal administration, and intravenous administration. In this study, we have investigated the effect of polymer conformation in organic solvents on the size of the nanoparticles. Poly(L-lactide-co-glycolide) (PLLGA), a promising nanoparticle carrier, was used as the polymer. A mixed solution of dichloromethane, which is a good solvent, and a lower alcohol (methanol, ethanol, and 1-propanol), which is a poor solvent, was used as the solvent for dissolving PLLGA. An oil-in-water emulsion was prepared by sonication using the mixed solution of organic solvents in which PLLGA was dissolved as a dispersed phase and an amino acid aqueous solution as a continuous phase. Nanocomposite particles were prepared from the emulsion using a spray dryer and redispersed in purified water to obtain the PLLGA nanoparticles. The conformation of PLLGA molecules in the organic solvents was evaluated by analyzing the results of the viscosity measurements. The polymer coil radius and the volume per polymer coil were observed to decrease with the increase in the ratio of the lower alcohol in the solvent, whereas these values tended to decrease with the use of more hydrophilic lower alcohols. In addition, based on the results of the calculated entanglement index, it was found that when the hydrophobicity of the dispersed phase is reduced, the polymers were hardly entangled with each other. These results were significant, specifically when the ratio of the lower alcohol in the solvent was low. Estimation of the Pearson's correlation coefficients indicated that there were positive correlations between these indices and the mean volume diameter of PLLGA nanoparticles. This study shows that changing the composition of the dispersed phase, in which the PLLGA is dissolved, can change the conformation of the PLLGA molecules and control the size of the PLLGA nanoparticles.


Assuntos
Cloreto de Metileno/química , Nanopartículas/química , Tamanho da Partícula , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Solventes/química , Portadores de Fármacos , Sistemas de Liberação de Medicamentos , Emulsões , Interações Hidrofóbicas e Hidrofílicas , Conformação Molecular , Psicoterapia Breve , Sonicação
6.
Psychol Trauma ; 12(S1): S174-S176, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32551775

RESUMO

During the unprecedented COVID-19 pandemic, people around the world have faced a myriad of heart-rending and ethically difficult scenarios (e.g., not being able to tend to a sick or dying loved one) that may lead to subsequent guilt, shame, or moral injury. Trauma-informed guilt reduction therapy is a brief intervention that helps clients accurately appraise their role in a stressful event (such as those experienced during the COVID-19 pandemic) and find positive ways to express important values going forward. Future studies of trauma-informed guilt reduction therapy with those affected by COVID-19 will be helpful for clarifying its effectiveness with this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Infecções por Coronavirus/psicologia , Culpa , Princípios Morais , Pneumonia Viral/psicologia , Trauma Psicológico/terapia , Vergonha , Adulto , Humanos , Pandemias , Trauma Psicológico/etiologia , Psicoterapia Breve
7.
J Oleo Sci ; 69(7): 703-710, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32522945

RESUMO

A series of gemini quaternary ammonium surfactants containing carboxylate counterion with the formula C17H35CONH(CH2)2N+(CH3)2(CH2)2N+(CH3)2(CH2)2 NHCO C17H35·2Y (Y=HCOO-, CH3COO-, CH3CHOHCOO-) have been synthesized by a counterion conversion process and characterized by Fourier transform infrared spectroscopy and mass spectroscopy. It is found that these surfactants reduce the surface tension of water to a minimum value of 26.78 mN·m-1 at a concentration of 1.21 ×10-5 mol·L-1. TEM images reveal that aggregates with vesicles or tubular structure are spontaneously formed in these surfactants aqueous solution with the concentration of 1×10-3 mol·L-1. It is also found that they are effective corrosion inhibitors for A3 steel in acid solution and have superior antibacterial activity at a concentration of 0.1g·L-1.


Assuntos
Antibacterianos , Corrosão , Compostos de Amônio Quaternário/química , Compostos de Amônio Quaternário/farmacologia , Aço , Propriedades de Superfície , Tensoativos/química , Relação Dose-Resposta a Droga , Microscopia Eletrônica de Transmissão , Conformação Molecular , Imagem Molecular , Psicoterapia Breve , Compostos de Amônio Quaternário/síntese química , Tensoativos/síntese química , Água
8.
Trials ; 21(1): 402, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: covidwho-245680

RESUMO

OBJECTIVES: This study aims to assess the effectiveness of delivering Solution Focused Brief Therapy (SFBT) through telecommunication with a group of adolescents who present anxiety symptoms during the COVID-19 outbreak. We hypothesize that participants who are randomly assigned to receive 2-4 sessions of Solution Focused Brief Therapy would have better clinical outcomes than participants who are in the waitlist group. We additionally hypothesized that using SFBT can also change participants' depression levels and their coping strategies in dealing with distress during the COVID-19 pandemic. TRIAL DESIGN: This study employs a randomized delayed crossover open label controlled trial in adolescents who are presenting anxiety symptoms during the COVID-19 outbreak. Participants who meet the enrollment criteria stated below will be invited to participate in this study through telecommunication. Those accepting will be randomly allocated to the intervention group or waitlist group.


Assuntos
Ansiedade/terapia , Betacoronavirus , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Psicoterapia Breve , Ensaios Clínicos Controlados Aleatórios como Assunto , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina
9.
Trials ; 21(1): 402, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404126

RESUMO

OBJECTIVES: This study aims to assess the effectiveness of delivering Solution Focused Brief Therapy (SFBT) through telecommunication with a group of adolescents who present anxiety symptoms during the COVID-19 outbreak. We hypothesize that participants who are randomly assigned to receive 2-4 sessions of Solution Focused Brief Therapy would have better clinical outcomes than participants who are in the waitlist group. We additionally hypothesized that using SFBT can also change participants' depression levels and their coping strategies in dealing with distress during the COVID-19 pandemic. TRIAL DESIGN: This study employs a randomized delayed crossover open label controlled trial in adolescents who are presenting anxiety symptoms during the COVID-19 outbreak. Participants who meet the enrollment criteria stated below will be invited to participate in this study through telecommunication. Those accepting will be randomly allocated to the intervention group or waitlist group.


Assuntos
Ansiedade/terapia , Betacoronavirus , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Psicoterapia Breve , Ensaios Clínicos Controlados Aleatórios como Assunto , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina
10.
Pediatrics ; 145(Suppl 2): S165-S174, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358207

RESUMO

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.


Assuntos
Legislação de Medicamentos , Uso da Maconha/legislação & jurisprudência , Adolescente , Comorbidade , Estudos Transversais , Humanos , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/terapia , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Transtornos Mentais/epidemiologia , Entrevista Motivacional , Psicoterapia Breve , Estados Unidos , Adulto Jovem
11.
J Oleo Sci ; 69(5): 455-460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32378549

RESUMO

Emulsions are colloid dispersions which are attractive for use as drug carriers due to their simple structure and facile preparation. However, their low physicochemical stability has been problematic. In order to solve this problem, a spontaneous emulsification technique composed of porous silica particles has been developed. In this study, we investigated the conditions for effective formation of protein-encapsulated solid-in-oil-in-water (S/O/W) emulsions using this technique. Porous silica particles having a hydrophilic surface promoted the formation of a fine and uniform emulsion. It was found that the progression of emulsification was affected by electrolytes in aqueous solution. Moreover, it was confirmed that the S/O/W emulsion prepared using this method could successfully encapsulate protein.


Assuntos
Emulsões/química , Dióxido de Silício/química , Fenômenos Químicos , Estabilidade de Medicamentos , Eletrólitos , Interações Hidrofóbicas e Hidrofílicas , Óleos , Tamanho da Partícula , Psicoterapia Breve , Água
12.
Am J Psychother ; 73(3): 95-106, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32380842

RESUMO

OBJECTIVE: Despite increasing evidence for the effectiveness of intensive short-term dynamic psychotherapy (ISTDP), evidence supporting the purported mechanisms of change in ISTDP is lacking. This systematized review aimed to describe the major theorized mechanisms of change in ISTDP, critically evaluate the emerging literature pertaining to its purported mechanisms, and explore directions for future research. METHODS: A systematized search of the literature was conducted by using online databases (PsychInfo, PubMed, EMBASE, and CINAHL). RESULTS: Fourteen studies met inclusion criteria. The included studies explored at least one theorized ISTDP mechanism of change and attempted to operationalize or otherwise empirically examine the mechanism in relation to the therapeutic process. Examined mechanisms included "unlocking the unconscious" and specific therapist interventions. CONCLUSIONS: The current body of literature has several limitations, most notably the lack of a consensus definition for unlocking the unconscious. This difficulty in measuring mechanisms of change is common across therapeutic modalities and limits the validity and comparability of findings. Despite these limitations, the literature suggests a possible association between theorized mechanisms of change and positive therapy outcomes. Future research directions are discussed.


Assuntos
Psicoterapia Breve , Humanos , Resultado do Tratamento
13.
Complement Ther Clin Pract ; 39: 101122, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379661

RESUMO

BACKGROUND: and purpose: Cognitive-behavioral therapy and psychodynamic psychotherapy are common psychotherapies used for mental disorders. The purpose of the present article was to achieve an integration of cognitive-behavioral therapy and short-term psychodynamic psychotherapy that enjoys simultaneously the effects of cognitive-behavioral therapies and the stability of short-term psychodynamic psychotherapies. MATERIALS AND METHODS: It was a pre-test/post-test experimental study. Selected based on a purposive non-probabilistic sampling method, the sample studied here consisted of 36 people diagnosed with generalized anxiety according to Clinical Diagnostic Interview, psychiatrist diagnosis and Hamilton Rating Scale for Anxiety (HRSA). They were divided randomly into three 12 person groups: two treated groups by integrative therapy and cognitive-behavioral therapy, and one control group. Only pre-test and post-test were employed for the control group without any kind of treatment. To select patients and evaluate the effects of each type of treatments, the "Hamilton Rating Scale for Anxiety" and "Beck Depression Inventory" were applied for the pre-test/post-test and the differential diagnosis, respectively. The results obtained were analyzed by covariance and ANOVA analyses using SPSS software. RESULTS: The results of the study indicate the efficacy of both cognitive-behavioral therapy and integrative therapy in the treatment of generalized anxiety and integrative therapy was more effective in the treatment of generalized anxiety compared to cognitive-behavioral therapy. CONCLUSION: Integrative treatment not only to be effective in the treatment of generalized anxiety disorder and the reduction of its symptoms, but also to be more effective than cognitive-behavioral therapy.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Psicoterapia Breve/métodos , Psicoterapia Psicodinâmica/métodos , Adolescente , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Psicoterapia/métodos , Resultado do Tratamento , Adulto Jovem
14.
BMC Public Health ; 20(1): 559, 2020 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-32334547

RESUMO

BACKGROUND: Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient's smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)). METHODS: We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012-September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free policy; C) enhancements to the patient electronic healthcare record (EHCR) which included C1) a temporary form to record the financial incentivisation of ASK and ACT (OFFER) C2) amendments to how VBA was recorded in the EHCR and C3) the integration of a new electronic national referral system in the EHCR. The recording of ASK, ADVISE, ACT (OFFER/CONSENT) were extracted using a de-identified psychiatric case register. RESULTS: There were 8976 admissions of 5434 unique individuals during the study period. Following A) financial incentive, the odds of recording ASK increased (OR: 1.56, 95%CI: 1.24-1.95). Following B) comprehensive smoke-free policy, the odds of recording ADVICE increased (OR: 3.36, 95%CI: 1.39-8.13). Following C1) temporary recording form, the odds of recording ASK (OR:1.99, 95%CI:1.59-2.48) and recording ACT (OFFER) increased (OR: 4.22, 95%CI: 2.51-7.12). Following C3) electronic referral system, the odds of recording ASK (OR:1.79, 95%CI: 1.31-2.43) and ACT (OFFER; OR: 1.09, 95%CI: 0.59-1.99) increased. There was no change in recording VBA outcomes following C2) amendments to VBA recording. CONCLUSIONS: Financial incentives and the recording of incentivised outcomes, the comprehensive smoke-free policy, and the electronic referral system, were associated with increases in recording individual VBA elements, but other changes to the EHCR were not. System-level changes may facilitate staff recording of VBA provision in mental health settings.


Assuntos
Registros Médicos/normas , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Psicoterapia Breve/estatística & dados numéricos , Abandono do Hábito de Fumar/psicologia , Adulto , Feminino , Hospitalização , Humanos , Masculino
15.
Cochrane Database Syst Rev ; 4: CD012005, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32297974

RESUMO

BACKGROUND: Inflammatory bowel disease (IBD) is an umbrella term used to describe a group of chronic, progressive inflammatory disorders of the digestive tract. Crohn's disease and ulcerative colitis are the two main types. Fatigue is a common, debilitating and burdensome symptom experienced by individuals with IBD. The subjective, complex nature of fatigue can often hamper its management. The efficacy and safety of pharmacological or non-pharmacological treatments for fatigue in IBD is not yet established through systematic review of studies. OBJECTIVES: To assess the efficacy and safety of pharmacological and non-pharmacological interventions for managing fatigue in IBD compared to no treatment, placebo or active comparator. SEARCH METHODS: A systematic search of the databases Embase, MEDLINE, Cochrane Library, CINAHL, PsycINFO was undertaken from inception to July 2018. A top-up search was run in October 2019. We also searched the Cochrane IBD Group Specialized Register, the Cochrane Central Register of Controlled Trials, ongoing trials and research registers, conference abstracts and reference lists for potentially eligible studies. SELECTION CRITERIA: Randomised controlled trials of pharmacological and non-pharmacological interventions in children or adults with IBD, where fatigue was assessed as a primary or secondary outcome using a generic or disease-specific fatigue measure, a subscale of a larger quality of life scale or as a single-item measure, were included. DATA COLLECTION AND ANALYSIS: Two authors independently screened search results and four authors extracted and assessed bias independently using the Cochrane 'Risk of bias' tool. The primary outcome was fatigue and the secondary outcomes included quality of life, adverse events (AEs), serious AEs and withdrawal due to AEs. Standard methodological procedures were used. MAIN RESULTS: We included 14 studies (3741 participants): nine trials of pharmacological interventions and five trials of non-pharmacological interventions. Thirty ongoing studies were identified, and five studies are awaiting classification. Data on fatigue were available from nine trials (1344 participants). In only four trials was managing fatigue the primary intention of the intervention (electroacupuncture, physical activity advice, cognitive behavioural therapy and solution-focused therapy). Electroacupuncture Fatigue was measured with Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) (scores range from 0 to 52). The FACIT-F score at week eight was 8.00 points higher (better) in participants receiving electroacupuncture compared with no treatment (mean difference (MD) 8.00, 95% CI 6.45 to 9.55; 1 RCT; 27 participants; low-certainty evidence). Results at week 16 could not be calculated. FACIT-F scores were also higher with electroacupuncture compared to sham electroacupuncture at week eight (MD 5.10, 95% CI 3.49 to 6.71; 1 RCT; 30 participants; low-certainty evidence) but not at week 16 (MD 2.60, 95% CI 0.74 to 4.46; 1 RCT; 30 participants; low-certainty evidence). No adverse events were reported, except for one adverse event in the sham electroacupuncture group. Cognitive behavioural therapy (CBT) and solution-focused therapy Compared with a fatigue information leaflet, the effects of CBT on fatigue are very uncertain (Inflammatory Bowel Disease-Fatigue (IBD-F) section I: MD -2.16, 95% CI -6.13 to 1.81; IBD-F section II: MD -21.62, 95% CI -45.02 to 1.78; 1 RCT, 18 participants, very low-certainty evidence). The efficacy of solution-focused therapy on fatigue is also very uncertain, because standard summary data were not reported (1 RCT, 98 participants). Physical activity advice One 2 x 2 factorial trial (45 participants) found physical activity advice may reduce fatigue but the evidence is very uncertain. At week 12, compared to a control group receiving no physical activity advice plus omega 3 capsules, FACIT-F scores were higher (better) in the physical activity advice plus omega 3 group (FACIT-F MD 6.40, 95% CI -1.80 to 14.60, very low-certainty evidence) and the physical activity advice plus placebo group (FACIT-F MD 9.00, 95% CI 1.64 to 16.36, very low-certainty evidence). Adverse events were predominantly gastrointestinal and similar across physical activity groups, although more adverse events were reported in the no physical activity advice plus omega 3 group. Pharmacological interventions Compared with placebo, adalimumab 40 mg, administered every other week ('eow') (only for those known to respond to adalimumab induction therapy), may reduce fatigue in patients with moderately-to-severely active Crohn's disease, but the evidence is very uncertain (FACIT-F MD 4.30, 95% CI 1.75 to 6.85; very low-certainty evidence). The adalimumab 40 mg eow group was less likely to experience serious adverse events (OR 0.56, 95% CI 0.33 to 0.96; 521 participants; moderate-certainty evidence) and withdrawal due to adverse events (OR 0.48, 95%CI 0.26 to 0.87; 521 participants; moderate-certainty evidence). Ferric maltol may result in a slight increase in fatigue, with better SF-36 vitality scores reported in the placebo group compared to the treatment group following 12 weeks of treatment (MD -9.31, 95% CI -17.15 to -1.47; 118 participants; low-certainty evidence). There may be little or no difference in adverse events (OR 0.55, 95% CI 0.26 to 1.18; 120 participants; low-certainty evidence) AUTHORS' CONCLUSIONS: The effects of interventions for the management of fatigue in IBD are uncertain. No firm conclusions regarding the efficacy and safety of interventions can be drawn. Further high-quality studies, with a larger number of participants, are required to assess the potential benefits and harms of therapies. Future studies should assess interventions specifically designed for fatigue management, targeted at selected IBD populations, and measure fatigue as the primary outcome.


Assuntos
Fadiga/terapia , Doenças Inflamatórias Intestinais/complicações , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Terapia Cognitivo-Comportamental , Eletroacupuntura , Exercício Físico , Fadiga/etiologia , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/efeitos adversos , Compostos Férricos/efeitos adversos , Hematínicos/efeitos adversos , Humanos , Psicoterapia Breve , Pironas/efeitos adversos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Rev Infirm ; 69(257): 43-44, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32146967

RESUMO

In the field of addictology, care integrates activities that reactivate forgotten senses, emotions and postures. A "Photographs" workshop, led by a nurse in the addictology department, was modulated into a "Brief group photo-motivational intervention" to help people quit smoking. From this experience emerged an educational sequence of "Photo-Expression" integrated into the patient's therapeutic education programme "Help to stop smoking".


Assuntos
Abandono do Hábito de Fumar/métodos , Humanos , Entrevista Motivacional , Educação de Pacientes como Assunto , Fotografação , Psicoterapia Breve , Psicoterapia de Grupo
17.
J Oleo Sci ; 69(3): 271-276, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32051359

RESUMO

In this study, we investigated the direct detection of DNA, without pretreatment, using a quartz crystal microbalance (QCM) sensor. This sensor is modified by a self-assembled monolayer of a thiol derivative that has an amino group as the terminal functional group. Contact angle values and the attenuated total reflectance Fourier transform infrared (ATR/FT-IR) spectra of the QCM sensors after immersion into an ethanol solution of thiol derivatives clearly showed that self-assembled monolayers of the derivatives were formed on the QCM sensors. Although QCM measurements using unmodified and carboxylic group-modified sensors could not detect DNA-Na salt, the sensor modified with amino groups could detect the DNA. This system can be used for the analysis of the interaction between DNA and DNAbinding proteins.


Assuntos
DNA/análise , Técnicas de Microbalança de Cristal de Quartzo/métodos , Compostos de Sulfidrila/química , Etanol , Psicoterapia Breve , Espectroscopia de Infravermelho com Transformada de Fourier
18.
Psychiatry Res ; 286: 112804, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32001003

RESUMO

Major depressive disorder (MDD) is a disease that severely impairs psychosocial functioning and decreases the subject's quality of life. Patients who received psychotherapy have a better long-term therapeutic response than those who have only been treated with antidepressants or have not been treated. There are few studies in the literature that follow the outcomes of psychotherapeutic treatments for depression for more than two years. The aim of this study is to compare the therapeutic response of two models of brief psychotherapy for MDD treatment (Cognitive Behavioral Therapy and Short-term Psychodynamic Psychotherapy) with naturalistic controls who received treatment as usual in a three-year follow-up. This is a sample of 75 outpatients, mostly women (82.7%), with a median age of 33 (27-44). The interventions took place in 50-minute sessions once a week for 14 to 16 weeks. Outcomes were assessed at baseline and three years after the intervention. Regarding depressive symptoms, the therapeutic response was maintained three years after the conclusion of the brief models of psychotherapy. Functional capacity long-term maintenance depended not only on the intervention but also on the education level, the work situation and the severity of depressive symptoms at the beginning of the treatment.


Assuntos
Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Transtorno Depressivo Maior/terapia , Psicoterapia Psicodinâmica/métodos , Adulto , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pacientes Ambulatoriais , Psicoterapia Breve , Qualidade de Vida , Resultado do Tratamento
19.
NeuroRehabilitation ; 46(2): 143-155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083598

RESUMO

BACKGROUND: Brain injury is considered a chronic condition and the medical model has long been the traditional paradigm underlying rehabilitation programs for people after acquired brain injury (ABI). In recent years, strengths-based approaches have been increasingly proposed, but little has been written about specific psychotherapeutic application in ABI rehabilitation. OBJECTIVE: To describe a strengths-based model, Solution-Focused Brief Therapy (SFBT) and its clinical application to individuals with ABI and their families. METHODS: The author describes the assumptions, tenets, and principles of SFBT, a competency-based and resource-based model that orients to the future and focuses on strengths and successes. A direct comparison is made between the traditional medical paradigm and the solution-focused paradigm. RESULTS: Key ingredients of SFBT are described, including specific strategies, techniques, and its clinical application with individuals with ABI and their families. Limitations around using SFBT and the need for further research with ABI populations are reported. CONCLUSIONS: SFBT is a welcome shift away from the problem-saturated stories that underlie traditional rehabilitation approaches. The strengths-based underpinning of SFBT is a promising psychotherapeutic intervention that merits further investigation with ABI populations.


Assuntos
Lesões Encefálicas/psicologia , Lesões Encefálicas/terapia , Terapia Familiar/métodos , Psicoterapia Breve/métodos , Humanos , Redação
20.
BMC Public Health ; 20(1): 30, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914971

RESUMO

BACKGROUND: Young people account for more than a quarter of new HIV infections in the US, with the majority of cases among young men who have sex with men; young transgender women are also vulnerable to infection. Substance use, particularly alcohol misuse, is a driver of sexual transmission and a potential barrier to engagement in the HIV prevention and care continuum, however vulnerable youth are difficult to reach for substance use services due, in part, to complex social and structural factors and limited access to health care. The Community Prevention Services Task Force recommends electronic screening and brief intervention as an evidence-based intervention for the prevention of excessive alcohol consumption; however, no prior studies have extended this model to community-based populations of youth that are susceptible to HIV infection. This paper describes the study protocol for an electronic screening and brief intervention to reduce alcohol misuse among adolescents and young adults vulnerable to HIV infection in community-based settings. METHODS: This study, Step Up, Test Up, is a randomized controlled trial of an electronic alcohol screening and brief intervention among youth, ages 16-25, who are vulnerable to HIV infection. Individuals who present for HIV testing at one of three community-based locations are recruited for study participation. Eligibility includes those aged 16-25 years, HIV-negative or unknown HIV status, male or trans female with a history of sex with men, and English-speaking. Participants who screen at moderate to high risk for alcohol misuse on the Alcohol Use Disorders Identification Test (AUDIT) are randomized (1:1) to either an electronic brief intervention to reduce alcohol misuse or a time-and attention-matched control. The primary outcome is change in the frequency/quantity of recent alcohol use at 1, 3, 6 and 12-month follow-up. DISCUSSION: Testing of evidence-based interventions to reduce alcohol misuse among youth vulnerable to HIV infection are needed. This study will provide evidence to determine feasibility and efficacy of a brief electronically-delivered intervention to reduce alcohol misuse for this population. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02703116, registered March 9, 2016.


Assuntos
Alcoolismo/prevenção & controle , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Programas de Rastreamento/métodos , Psicoterapia Breve , Pessoas Transgênero/psicologia , Populações Vulneráveis/psicologia , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Projetos de Pesquisa , Medição de Risco , Pessoas Transgênero/estatística & dados numéricos , Resultado do Tratamento , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
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