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1.
Nutr J ; 20(1): 45, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985515

RESUMO

BACKGROUND: COVID-19 has impacted mental health globally, however, associations between anxiety and appetitive traits during the pandemic are unreported. This study evaluated anxiety symptom severity and associations with appetitive traits in students at a large public University in the U.S. during the pandemic. METHODS: Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, anxiety symptoms in the past 2 weeks assessed by the Generalized Anxiety Disorder Scale (GAD-7), and appetitive traits assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. Mean scores for eight AEBQ scales (four food approach and four food avoidance traits) were calculated. Differences in mean scores were examined between participants with moderate to severe anxiety symptoms (GAD-7 score ≥ 10) and those with mild to no anxiety symptoms (GAD-7 score < 10) via independent samples t-tests and effect sizes. Associations between GAD-7 score and individual appetitive traits were also examined, adjusting for age and gender. RESULTS: Of the 1243 students who completed the survey (57% undergraduates; mean age = 26.5 years), 51.9% reported moderate to severe anxiety symptoms. Groups experiencing the highest degree of moderate to severe anxiety symptoms included transgender, gender fluid, and other-gendered participants (73.6%); the youngest age group [18-20 years (62%)]; undergraduate students (60.7%); and Hispanic/Latinx participants (57.7%). Participants with moderate to severe anxiety symptoms had higher scores for most food approach and avoidance traits but lower scores for enjoyment of food than those with mild to no anxiety symptoms. Effect sizes were largest for hunger and emotional over-eating (Cohen's d = 0.31 and 0.30, respectively). Adjusting for age and gender, GAD-7 score was significantly and positively associated with hunger, emotional over-eating, food and satiety responsiveness, and food fussiness and negatively associated with enjoyment of food. CONCLUSIONS: Over half of students at a U.S. University reported moderate to severe anxiety symptoms during COVID-19. More severe anxiety symptoms were associated with increased hunger, emotional over-eating, and food and satiety responsiveness and decreased enjoyment of food. Universities must consider strategies to address anxiety, particularly in younger students; transgender, gender fluid, and students of other genders; and across race/ethnicities keeping in mind associations with appetitive traits.


Assuntos
Ansiedade , Apetite , COVID-19/psicologia , Estudantes/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Questionário de Saúde do Paciente , SARS-CoV-2 , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
2.
Medicine (Baltimore) ; 100(21): e24763, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032691

RESUMO

BACKGROUND: We carried out a randomized trial of an emergency department (ED)-based nursing intervention to evaluate the impact of an ED nursing intervention on ED revisits, patient perceptions of continuity of care, illness perceptions, self-care capacities and psychological symptoms. METHOD: We conducted a randomized controlled trial to compare the ED-based intervention with usual care. The protocol was reviewed and approved by the Research Ethics Board of the Huzhou Central Hospital & Affiliated Central Hospital Huzhou University (K901923-021), each participant signed a written consent before participating, and SPIRIT guidelines were followed throughout. To be eligible, patients ready for discharge from the ED had to be at risk for ED return based on 2 criteria: at least one ED visit during the year prior to the initial visit, and current treatment with at least 6 medications. Exclusion criteria included cognitive problems (e.g., dementia) that would preclude provision of informed consent either noted in the medical chart or identified based on the clinical judgment of the project nurse. To avoid multiple interveners for the same patient, we also excluded patients already receiving other regular follow-up (e.g., at a specialized clinic in the hospital or from external resources). The major outcomes were assessed with the Heart Continuity of Care Questionnaire, the Illness Perception Questionnaire-Revised, the Therapeutic Self-Care Tool, the Hospital Anxiety and Depression Scale, and the Self-Reported Medication-Taking Scale. RESULTS: Two hundred patients who met the inclusion criteria were included in our study, Table 1 showed the effects of nursing intervention on measures of clinical outcomes. DISCUSSION: The ED is a major entry point into the health care system of many countries. Unnecessary ED revisits may result in overcrowding, increased waiting time, and failure to provide appropriate emergency care. The ED-based interventions literature focuses primarily on service use and ways to reduce ED revisits, with very little focus on impacting secondary outcomes. Because of their potential link with health service utilization, secondary outcomes such as perceived continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence might influence ED revisits. Future research was needed to better understand the complex relationship between ED utilization and a variety of intermediary factors in order to develop interventions that will optimize ED utilization.


Assuntos
Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência/organização & administração , Pacientes Internados/psicologia , Alta do Paciente , Autocuidado , Adulto , Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Ansiedade/psicologia , Continuidade da Assistência ao Paciente/organização & administração , Depressão/diagnóstico , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Masculino , Questionário de Saúde do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(21): e26042, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032729

RESUMO

INTRODUCTION: Psoriasis is a common chronic relapsing inflammatory skin disease, which may have considerable detrimental effects on the quality of life. Considering high costs and side effects associated with the use of conventional medications, acupuncture, as one of complementary and alternative nonpharmacological therapies, is commonly used in the management of psoriasis for reducing itching, repairing the skin lesions, etc. However, the effects of acupuncture in the management of psoriasis are still inconsistent, especially in psychosocial abnormality due to psoriasis. Therefore, we designed a randomized controlled trials (RCT) involving a placebo control to ensure participants' blinding to investigate the effects of acupuncture for psoriasis in improving typical clinical symptoms and psychosocial abnormality. METHODS: A singlecenter RCT was designed. 220 participants who meet the eligibility criteria will be randomly allocated into manual acupuncture group or sham acupuncture group in a 1:1 ratio. Participants will respectively receive 15 minutes manual acupuncture or sham acupuncture per session, 3 sessions per week, totally 12 weeks. Psoriasis Area and Severity Index scores, body surface area (BSA), Medical Outcomes Study 36-Item Short-Form Health Survey, Montgomery-Asberg Depression Rating Scale, and Depression, Anxiety, and Stress Scale-21 will be evaluated by blinded operators at baseline and 12 weeks. All analyses will be based on an intention-to-treat principle. The results will be published in an international peer-reviewed journal. DISCUSSION: The results of this study are expected to clarify the effects of acupuncture on improving typical clinical symptoms and psychosocial abnormality of patients with psoriasis. It will contribute to clinical practice of acupuncture in the management of psoriasis. TRIAL REGISTRATION: Chinese Clinical Trail Registry: ChiCTR2100045481. Registration date: April 17, 2021.


Assuntos
Terapia por Acupuntura/métodos , Ansiedade/terapia , Depressão/terapia , Psoríase/terapia , Qualidade de Vida , Adolescente , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/etiologia , Depressão/diagnóstico , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente/estatística & dados numéricos , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
4.
BMC Psychiatry ; 21(1): 238, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952234

RESUMO

BACKGROUND: The Patient Health Questionnaire-9 (PHQ-9) has been proposed as a reliable and valid screening instrument for depressive symptoms with one latent factor. However, studies explicitly testing alternative model structures found support for a two-dimensional structure reflecting a somatic and a cognitive-affective dimension. We investigated the bidimensional structure of the PHQ-9, with a somatic (sleeping problems, fatigability, appetitive problems, and psychomotor retardation) and a cognitive-affective dimension (lack of interest, depressed mood, negative feelings about self, concentration problems, and suicidal ideation), and tested for sex- and regional-differences. METHODS: We have included data from the GEnder-Sensitive Analyses of mental health trajectories and implications for prevention: A multi-cohort consortium (GESA). Privacy-preserving analyses to provide information on the overall population and cohort-specific information and analyses of variance to compare depressive, somatic and cognitive-affective symptoms between sexes and cohorts were executed in DataSHIELD. In order to determine the dimensionality and measurement invariance of the PHQ-9 we tested three models (1 factor, 2 correlated factors, and bifactor) via confirmatory analyses and performed multi-group confirmatory factor analysis. RESULTS: Differences between sex and cohorts exist for PHQ-9 and for both of its dimensions. Women reported depressive symptoms in general as well as somatic and cognitive-affective symptoms more frequently. For all tested models an acceptable to excellent fit was found, consistently indicating a better model fit for the two-factor and bifactor model. Scalar measurement invariance was established between women and men, the three cohorts, and their interaction. CONCLUSIONS: The two facets of depression should be taken into account when using PHQ-9, while data also render support to a general factor. Somatic and cognitive-affective symptoms assessed by the PHQ-9 can be considered equivalent across women and men and between different German populations from different regions.


Assuntos
Depressão , Questionário de Saúde do Paciente , Estudos de Coortes , Depressão/diagnóstico , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Inquéritos e Questionários
5.
Sci Prog ; 104(2): 368504211014696, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33950712

RESUMO

COVID-19 is a sudden, infectious disease that can be life-threatening and may cause people to feel panic and anxiety. This study aimed to investigate the clinical characteristics and psychological status of a specific population using an internet consultation platform during the outbreak of COVID-19. The questionnaire survey included questions regarding basic information (e.g. area, sex, age, occupation, and education level), clinical characteristics, and cognitive and psychological status concerning COVID-19 from January 31, 2020 to March 31, 2020. There were 277 patients (43.49%) with three or more symptoms, 121 (12.11%) with a clinical questionnaire score ≥8, and 6.81% who lived in Hubei in the previous 14 days. Of the respondents, 4.9% had contact fever or were confirmed to have COVID-19 in the previous 14 days. The respondents were mostly aware that COVID-19 can be transmitted from person to person and via the respiratory tract, but awareness of general susceptibility and specific symptoms of COVID-19 was low. Multivariate analysis showed that urban residents, clerk/students and higher education groups were well aware of COVID-19. Regarding mental health, the anxiety score of the respondents was 7.12 ± 2.32, and the proportion of anxiety was 54.15%. Younger women were more likely to have anxiety when they experienced positive symptoms. Individuals with a Hubei residence history and those who had contact with an individual with a fever or were confirmed patients in the previous 14 days were more likely to have moderate or severe anxiety. The COVID-19-related knowledge of the respondents was generally good but still could have been improved. Their psychological status was also affected by the pandemic. The internet consultation platform played a positive role in spreading pandemic-related information, providing medical help and psychological counseling, and strengthening early warning to the potential high-risk population.


Assuntos
COVID-19/psicologia , Saúde Mental , SARS-CoV-2 , Telemedicina , Adolescente , Adulto , COVID-19/epidemiologia , China/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Questionário de Saúde do Paciente , Inquéritos e Questionários , Adulto Jovem
6.
Medicine (Baltimore) ; 100(17): e25401, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907094

RESUMO

ABSTRACT: The study aimed to explore the reliability and validity of the Sub-Health Measurement Scale version 1.0 (SHMS v1.0) for the assessment of the suboptimal health status (SHS) of Tianjin residents.This was a cross-sectional study that surveyed 2640 urban residents in Tianjin from June 2016 to January 2018. Demographic and clinical characteristics were collected. Each subject completed the SHMS v1.0 and Short Form-36 (SF-36) scale assessments.The retest coefficient was 0.675. The overall Cronbach's α coefficient was 0.921. The correlation between SHMS v1.0 and SF-36 was 0.781 (P < .01). The SHS frequency increased with age, from 62.4% in participants ≤25 years of age to 72.8% in those ≥ 56 years of age. The multivariable analysis showed that female sex (P < .001), age >25 years old (P = .009), bachelor degree or above (P < .001), obesity (P < .0), regular smoking (P = .043), frequent drinking (P = .045), sleep time < 6 hours (P = .006), working time >10 hours (P < .001), physical exercise <5 times/mo (P < .001), and adverse events >9 (P < .001) were associated with SHS.The prevalence of SHS is high among urban residents in Tianjin.


Assuntos
Inquéritos Epidemiológicos/normas , Questionário de Saúde do Paciente/normas , Vigilância da População/métodos , População Urbana/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , China/epidemiologia , Doença Crônica/epidemiologia , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores Sexuais
7.
Rev. ecuat. pediatr ; 22(1): 1-8, Abril 30, 2021.
Artigo em Inglês | LILACS | ID: biblio-1222375

RESUMO

Introducción: La Organización mundial de la salud expresa que la depresión es un trastorno mental frecuente, caracterizado por aparición de tristeza, pérdida de interés o placer, sentimientos de culpa o falta de autoestima, trastornos del sueño, apetito, sensación de cansancio y falta de concentración. El objetivo del presente estudio fue determinar la prevalencia de depresión y factores asociados en los adolescentes de 14 a 18 años estudiantes de la Unidad Educativa Luis Cordero en la ciudad de Azogues en el año 2019. Métodos: se realizó una investigación de tipo analítica y transversal. La muestra fue de 262 estudiantes de 14 a 18 años en la Unidad Educativa Luis Cordero. Se aplicó una encuesta, que incluyó la escala HAD (Hospital anxiety and Depression Scale ), la información fue recolectada en formularios, se procesaron los datos utilizando el programa SPSS V.15 mediante frecuencia absoluta, porcentaje, Chi cuadrado y Odds ratio con un Intervalo de Con-fianza de 95% y valor P=0.05. Resultados: al aplicar el Cuestionario HAD se determinó una prevalencia de depresión del 25.9%. La depresión en mujeres fue de 14.1%, mientras que en hombres fue el 11.8%, residen en áreas urbanas (21.4%), no tienen padres migrantes (19.5%), su percepción de la existencia de violencia intrafamiliar (23.3%) y su percepción de bajo rendimiento académico (21%). En cuanto a la edad, no se encontró diferencias, correspondiendo cada grupo etario al 13%. Conclusiones: la prevalencia de depresión en los adolescentes es alta, los más afectados son las mujeres y los que presentan bajo rendimiento académico; sin encontrar asociación estadística entre las variables analizadas y la presencia de depresión.


Introduction: The World Health Organization has stated that depression is a very frequent mental disorder, characterized by the appearance of sadness, loss of interest or pleasure, feelings of guilt or lack of self-esteem, sleep or appetite disorders, feeling tired, and having a lack of concentration. The aim of this study was to determine the prevalence of depression and associated factors in adolescents from 14 to 18 years students of the Luis Cordero High School in the city of Azogues, Cañar-Ecuador in the year 2019. Methods: An analytical and cross-sectional investigation was carried out. The sample con-sisted of 262 students aged 14 to 18 in the Luis Cordero Luis Cordero High School. A survey was applied, which included the Hospital Anxiety and Depression Scale (HADS). Information was collected on forms, the data was processed using the SPSS V.15 program by absolute frequency, percentage, Chi square and odds ratio with a 95% confidence Interval and value P=0.05, which are represented in tables. Results: When applying the HADS questionnaire, students were determined to have a rate of depression of 26%. The prevalence of depression in women was 14.1%, while in men it was 11.8%. These students resided in urban areas (21.4%) and did not have migrant parents (19.5%). The existence of domestic violence was 23.3% and poor academic performance was 21%. Regarding age, no differences were found with each age group corresponding to 13%. Conclusions: The prevalence of depression in adolescents is high. The most affected are women and those with poor academic performance. However, there was no statistical association between the analyzed variables and the presence of depression.


Assuntos
Estudantes , Adolescente , Depressão , Ansiedade , Questionário de Saúde do Paciente
8.
Psychiatr Danub ; 33(1): 95-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33857052

RESUMO

BACKGROUND: There are reports from countries and in the scientific literature that COVID-19 affect also mental health worldwide. The aim of this study was to understand the level of depression as a result of the COVID-19 situation and possible associations with sociodemographic variables. SUBJECTS AND METHODS: It's a cross-sectional study. The participants were 155 respondents recruited online in the period 27.04.2020 until 05.06.2020, who completed the Albanian version of PHQ-9. RESULTS: Mean score of depression resulted 10.94 (SD=9.22). 63% of participants agreed that the situation has worsened their psychological state; 35.6% had a mild to severe form of depression and 18.7% had minimal symptoms. 13.4% of participants saw iCBT as helpful, 16.8% a little while 65.8% wanted to try it. Significantly higher depression resulted for females and age-group 18 to 24 years. No significant differences by levels of education, marital status, employment, socio-economic status and by expectations regarding iCBT. Gender and perception of worsened psychological state showed predictive abilities for depression. CONCLUSION: The situation with Covid-19 has increased depression levels especially among females and 18 to 24 years old and thus expectations for e-psychotherapy. Online treatments seem feasible solutions for outbreak times. Studies in future are needed to better scientifically elaborate these findings.


Assuntos
COVID-19 , Questionário de Saúde do Paciente , Adolescente , Adulto , Ansiedade , Estudos Transversais , Depressão/epidemiologia , Surtos de Doenças , Feminino , Humanos , Kosovo , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-33804879

RESUMO

(1) Background: The Patient Health Questionnaire-9 (PHQ-9) is a tool that screens patients for depression in primary care settings. In this study, we evaluated the efficacy of PHQ-9 in evaluating suicidal ideation (2) Methods: A total of 8760 completed questionnaires collected from college students were analyzed. The PHQ-9 was scored in combination with and evaluated against four categories (PHQ-2, PHQ-8, PHQ-9, and PHQ-10). Suicidal ideations were evaluated using the Mini-International Neuropsychiatric Interview suicidality module. Analyses used suicide ideation as the dependent variable, and machine learning (ML) algorithms, k-nearest neighbors, linear discriminant analysis (LDA), and random forest. (3) Results: Random forest application using the nine items of the PHQ-9 revealed an excellent area under the curve with a value of 0.841, with 94.3% accuracy. The positive and negative predictive values were 84.95% (95% CI = 76.03-91.52) and 95.54% (95% CI = 94.42-96.48), respectively. (4) Conclusion: This study confirmed that ML algorithms using PHQ-9 in the primary care field are reliably accurate in screening individuals with suicidal ideation.


Assuntos
Questionário de Saúde do Paciente , Ideação Suicida , Depressão/diagnóstico , Humanos , Aprendizado de Máquina , Programas de Rastreamento , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
10.
Front Public Health ; 9: 603273, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33748059

RESUMO

Background: Since the coronavirus disease-2019 (COVID-19) outbreak, intensive care unit (ICU) healthcare workers were responsible for the critical infected patients. However, few studies focused on the mental health of ICU healthcare workers. This study aimed to investigate the psychological impact of COVID-19 on ICU healthcare workers in China. Methods: We distributed the nine-item Patient Health Questionnaire (PHQ-9) and seven-item General Anxiety Disorder questionnaire (GAD-7) online to ICU healthcare workers in China. Respondents were divided into frontline and second-line according to whether they have contact with COVID-19 patients. Depressive and anxiety symptoms of all respondents were evaluated based on their questionnaire scores. Results: There were 731 ICU healthcare workers finally enrolled in our study, including 303 (41.5%) male, 383 (52.4%) doctors, and 617 (84.4%) aged 26-45 years. All in all, 482 (65.9%) ICU healthcare workers reported symptoms of depression, while 429 (58.7%) reported anxiety. There was no significant difference between frontline (n = 325) and second-line (n = 406) respondents in depression (P = 0.15) and anxiety severity (P = 0.56). Logistic regression analysis showed that being female, ICU work time >5 years, and night duty number ≥10 were risk factors of developing depressive and anxiety symptoms. Income reduction was separately identified as risk of anxiety. Additionally, ICU work time >5 years was also identified as risk of developing moderate-severe depressive and anxiety symptoms. Conclusions: Frontline ICU work was not associated with higher risk of depressive and anxiety symptoms during COVID-19 pandemic remission period in China. Actions like controlling night duty number, ensuring vacation, and increasing income should be taken to relieve mental health problem. Furthermore, we should pay close attention to those who had worked long years in ICU.


Assuntos
Ansiedade/epidemiologia , COVID-19 , Depressão/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva , Questionário de Saúde do Paciente/estatística & dados numéricos , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
11.
Medicine (Baltimore) ; 100(13): e25426, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787652

RESUMO

ABSTRACT: The aim of this study was to assess the relationship of heartburn in pediatric patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS) with gastrointestinal symptoms, sleep disturbances, and psychologic distress.The overlap in symptoms of FD, IBS, and gastroesophageal reflux disease (GERD) predicts greater symptom severity and decreased quality of life and presents opportunities for improved diagnostic classification and personalized therapeutics.A cross-sectional observational study of 260 pediatric patients with abdominal pain was conducted. Patients completed standardized questionnaires assessing clinical symptoms, sleep quality, and psychologic symptoms during routine clinical care. Questionnaire data were compared for patients reporting heartburn and not reporting heartburn using χ2 and t tests where appropriate.Gastrointestinal symptoms were significantly more prevalent among patients with a positive report of heartburn (vs a negative report of heartburn): pain with eating (83% vs 67%, P = .007), bloating (63% vs 44%, P = .005), acid regurgitation (47% vs 24%, P ≤ .001), and chest pain (45% vs 20%, P ≤ .001). Likewise, initiating and maintaining sleep (P = .007), arousal/nightmares (P = .046), sleep-wake transition (P = .001), hyperhidrosis during sleep (P = .016), and anxiety (P = .001) and depression (P = .0018) were also significantly increased in patients who reported heartburn versus patients who did not report heartburn.Patients with a positive report of heartburn, whether classified as having FD and/or IBS, had increased gastrointestinal symptoms, sleep disturbances, anxiety, and depression than patients with a negative report of heartburn. A better understanding of these associations may allow for personalized treatment for youth with abdominal pain and heartburn as a primary symptom.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Dispepsia/complicações , Azia/etiologia , Síndrome do Intestino Irritável/complicações , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Biópsia , Criança , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Dispepsia/diagnóstico , Dispepsia/patologia , Dispepsia/psicologia , Endoscopia do Sistema Digestório , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/patologia , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Azia/psicologia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Síndrome do Intestino Irritável/psicologia , Masculino , Questionário de Saúde do Paciente/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Autorrelato/estatística & dados numéricos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia
12.
Trials ; 22(1): 171, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648555

RESUMO

BACKGROUND: The coronavirus-19 (COVID-19) has reached pandemic status and is affecting countries all over the world. The COVID-19 pandemic is accompanied by various stressors that require adjustment in everyday life and possibly changes in personal future prospects. While some individuals cope well with these challenges, some develop psychological distress including depressive symptoms, anxiety, or stress. Internet-based self-help interventions have proven to be effective in the treatment of various mental disorders such as depression and anxiety. Based on that, we developed an internet-based self-help program for individuals with psychological distress due to the situation surrounding the COVID-19 pandemic. The 3-week self-help program consists of 6 modules comprising texts, videos, figures, and exercises. Participants can request guidance within the self-help program (guidance on demand). The primary aim of this study is to evaluate the efficacy and feasibility of the self-help program compared to a waiting control condition. METHODS: The design is a parallel group randomized controlled trial. Participants are allocated to a 3-week self-help intervention plus care as usual or a 3-week waiting period with only care as usual. There are follow-ups after 6 weeks and 18 weeks. At least 80 participants with COVID-19 pandemic related psychological distress will be recruited. Primary outcome are depressive symptoms. Secondary outcomes include anxiety and chronic stress, suicidal experiences and behavior, health-related quality of life, generalized optimism and pessimism, embitterment, optimistic self-beliefs, emotion regulation skills, loneliness, resilience, and the satisfaction with and usability of the self-help program. DISCUSSION: To the best of our knowledge, this is one of the first studies investigating the efficacy of an internet-based self-help program for psychological distress due to the situation surrounding the COVID-19 pandemic. Thus, the results of this study may give further insight into the use of internet-based self-help programs in pandemic-related psychological distress. TRIAL REGISTRATION: ClinicalTrials.gov NCT04380909 . Retrospectively registered on 8 May 2020.


Assuntos
Ansiedade/terapia , COVID-19 , Depressão/terapia , Intervenção Baseada em Internet , Autocuidado , Estresse Psicológico/terapia , Ansiedade/psicologia , Depressão/psicologia , Regulação Emocional , Humanos , Solidão , Otimismo , Questionário de Saúde do Paciente , Satisfação do Paciente , Pessimismo , Angústia Psicológica , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resiliência Psicológica , SARS-CoV-2 , Autoeficácia , Autogestão , Estresse Psicológico/psicologia , Ideação Suicida
13.
J Psychosom Res ; 144: 110415, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33743398

RESUMO

OBJECTIVE: The aim of this cross-sectional web-based study was to examine self-reported mental distress, psychosocial burdens, working conditions and potential risk and protective factors for depressive and anxiety symptoms during the COVID-19 pandemic in health care workers (HCW). METHODS: In the largest survey on mental health of HCW conducted during the first wave of COVID-19 in Europe (N = 8071 HCW), we investigated depressive (Patient Health Questionnaire-2, PHQ-2), and anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), working conditions, and psychosocial burden of 3678 HCW of three health care professions in hospitals: physicians (n = 1061), nurses (n = 1275), and medical technical assistants (MTA, n = 1342). RESULTS: The prevalence of clinically significant levels of depressive and anxiety symptoms was 17.4% and 17.8% for physicians, 21.6% and 19.0% for nurses, and 23.0% and 20.1% for MTA, respectively. All three professions demonstrated significantly elevated PHQ-2 and GAD-2 scores, when compared with general German population before the pandemic, but lower scores in relation to that during the pandemic. Multiple linear regression analyses revealed that higher levels of depressive symptoms were associated with insufficient recovery during leisure time, increased alcohol consumption, and less trust in colleagues in difficult situations at work. In addition, elevated anxiety scores were related to increased fear of becoming infected with COVID-19. CONCLUSION: During the pandemic HCW demonstrated a lower burden of mental distress compared to the general population. Nevertheless, a high percentage of HCW demonstrates psychosocial distress, so that the establishment of regular mental health screening and prevention programmes for HCW is indicated.


Assuntos
Ansiedade/epidemiologia , COVID-19/psicologia , Depressão/epidemiologia , Pessoal de Saúde/psicologia , Hospitais , Saúde Mental , Local de Trabalho , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Fatores de Proteção , Funcionamento Psicossocial , Fatores de Risco
14.
Psychiatry Res ; 299: 113855, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33721788

RESUMO

The COVID-19 pandemic has caused unprecedented isolation and mental health effects; few studies have characterized this in sexual and gender (SGM) minority young people, a particularly vulnerable population. This cross-sectional study sought to analyze the mental health outcomes of SGM young people (18-30 years) during the early stages of the pandemic in the United States (April 13-June 18, 2020) and to explore how factors related to SGM identity impact mental health, such as lifetime discrimination, family support, and pre-existing mental health conditions. An online survey collected socio-demographic information and assessed for both mental health (depression (PHQ-8), anxiety (GAD-7), PTSD (PCL-C)) and COVID-19-related outcomes (COVID-19-related worries and COVID-19-related grief). Out of 981 participants, 320 (32.6%) identified as SGM. SGM had significantly higher levels of depression and PTSD symptoms as well as COVID-19-related worries and grief than non-SGM, even after controlling for family support, lifetime discrimination, and pre-existing mental health diagnoses. These findings suggest that not only has the COVID-19 pandemic disproportionately impacted SGM mental health, but that minority stress factors cannot fully explain this impact. Thus, clinicians and societal stakeholders (schools, employers, policymakers) must think beyond traditional minority stress factors (family support, discrimination) and pre-pandemic disparities to support this vulnerable population as the pandemic progresses.


Assuntos
COVID-19/psicologia , Carga Global da Doença , Saúde Mental/estatística & dados numéricos , Fatores Sexuais , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Ansiedade/psicologia , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Questionário de Saúde do Paciente , SARS-CoV-2 , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
15.
Lancet Digit Health ; 3(4): e231-e240, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33766287

RESUMO

BACKGROUND: Common mental disorders can be effectively treated with psychotherapy, but some patients do not respond well and require timely identification to prevent treatment failure. We aimed to develop and validate a dynamic model to predict psychological treatment outcomes, and to compare the model with currently used methods, including expected treatment response models and machine learning models. METHODS: In this prediction model development and validation study, we obtained data from two UK studies including patients who had accessed therapy via Improving Access to Psychological Therapies (IAPT) services managed by ten UK National Health Service (NHS) Trusts between March, 2012, and June, 2018, to predict treatment outcomes. In study 1, we used data on patient-reported depression (Patient Health Questionnaire 9 [PHQ-9]) and anxiety (Generalised Anxiety Disorder 7 [GAD-7]) symptom measures obtained on a session-by-session basis (Leeds Community Healthcare NHS Trust dataset; n=2317) to train the Oracle dynamic prediction model using iterative logistic regression analysis. The outcome of interest was reliable and clinically significant improvement in depression (PHQ-9) and anxiety (GAD-7) symptoms. The predictive accuracy of the model was assessed in an external test sample (Cumbria Northumberland Tyne and Wear NHS Foundation Trust dataset; n=2036) using the area under the curve (AUC), positive predictive values (PPVs), and negative predictive values (NPVs). In study 2, we retrained the Oracle algorithm using a multiservice sample (South West Yorkshire Partnership NHS Foundation Trust, North East London NHS Foundation Trust, Cheshire and Wirral Partnership NHS Foundation Trust, and Cambridgeshire and Peterborough NHS Foundation Trust; n=42 992) and compared its performance with an expected treatment response model and five machine learning models (Bayesian updating algorithm, elastic net regularisation, extreme gradient boosting, support vector machine, and neural networks based on a multilayer perceptron algorithm) in an external test sample (Whittington Health NHS Trust; Barnet Enfield and Haringey Mental Health Trust; Pennine Care NHS Foundation Trust; and Humber NHS Foundation Trust; n=30 026). FINDINGS: The Oracle algorithm trained using iterative logistic regressions generalised well to external test samples, explaining up to 47·3% of variability in treatment outcomes. Prediction accuracy was modest at session one (AUC 0·59 [95% CI 0·55-0·62], PPV 0·63, NPV 0·61), but improved over time, reaching high prediction accuracy (AUC 0·81 [0·77-0·86], PPV 0·79, NPV 0·69) as early as session seven. The performance of the Oracle model was similar to complex (eg, including patient profiling variables) and computationally intensive machine learning models (eg, neural networks based on a multilayer perceptron algorithm, extreme gradient boosting). Furthermore, the predictive accuracy of a more simple dynamic algorithm including only baseline and index-session scores was comparable to more complex algorithms that included additional predictors modelling sample-level and individual-level variability. Overall, the Oracle algorithm significantly outperformed the expected treatment response model (mean AUC 0·80 vs 0·70, p<0·0001]). INTERPRETATION: Dynamic prediction models using sparse and readily available symptom measures are capable of predicting psychotherapy outcomes with high accuracy. FUNDING: University of Sheffield.


Assuntos
Algoritmos , Transtornos de Ansiedade/terapia , Depressão/terapia , Valor Preditivo dos Testes , Psicoterapia , Resultado do Tratamento , Adolescente , Adulto , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Questionário de Saúde do Paciente , Dados de Saúde Coletados Rotineiramente , Reino Unido , Adulto Jovem
16.
South Med J ; 114(3): 129-132, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655304

RESUMO

OBJECTIVES: This project was developed because residents need to gain knowledge and experience in promptly recognizing patients with suicidal ideation. Our study allowed pediatric interns the opportunity to manage a simulated 16-year-old actively suicidal patient in the resident continuity clinic for a well-child visit. METHODS: During their first year, each resident receives simulation training. The simulation scenario for this study involves the use of a standardized patient (SP). Sessions take place in the pediatric simulation center and are recorded for observation and review. The scenario was scripted and piloted to ensure standardization in educational intervention. Postscenario, participants have a nonjudgmental debriefing with the attending physician and the SP. An anonymous survey is completed after training. Enrollment was June 2016-September 2019, with two to three 1-hour cases monthly. RESULTS: Seventy-one postgraduate year-1 residents participated. Sixty-one residents left the suicidal patient alone/unobserved. Fifteen participants never learned of the intent of suicide during their initial intake with the patient but believed that she was depressed. The mean time to ask about suicidal ideation, when applicable, was 8:32 minutes (standard deviation 4:10 minutes, range 2:15-24:48 minutes). Common learning themes included realistic exposure to an actively suicidal patient and simulation debriefing/direct feedback from the SP. CONCLUSIONS: Practicing this crucial but somewhat rare primary care mental health emergency for all interns was possible when structured monthly. Feedback was extremely positive, with learners' feeling more prepared postsimulation. Our simulation experience also allows supervisors to assess intern's individual abilities to communicate in a difficult patient scenario which is an important physician competency as defined by the Accreditation Council for Graduate Medical Education.


Assuntos
Internato e Residência/métodos , Questionário de Saúde do Paciente , Pediatria/educação , Treinamento por Simulação , Ideação Suicida , Adolescente , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Simulação de Paciente , Atenção Primária à Saúde
17.
Health Qual Life Outcomes ; 19(1): 41, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541362

RESUMO

BACKGROUND: The PROMIS depression scales are reliable and valid measures that have extensive normative data in general population samples. However, less is known about how responsive they are to detect change in clinical settings and how their responsiveness compares to legacy measures. The purpose of this study was to assess and compare the responsiveness of the PROMIS and Patient Health Questionnaire (PHQ) depression scales in three separate samples. METHODS: We used data from three clinical trials (two in patients with chronic pain and one in stroke survivors) totaling 651 participants. At both baseline and follow-up, participants completed four PROMIS depression fixed-length scales as well as legacy measures: Patient Health Questionnaire 9-item and 2-item scales (PHQ-9 and PHQ-2) and the SF-36 Mental Health scale. We measured global ratings of depression change, both prospectively and retrospectively, as anchors to classify patients as improved, unchanged, or worsened. Responsiveness was assessed with standardized response means, statistical tests comparing change groups, and area-under-curve analysis. RESULTS: The PROMIS depression and legacy scales had generally comparable responsiveness. Moreover, the four PROMIS depression scales of varying lengths were similarly responsive. In general, measures performed better in detecting depression improvement than depression worsening. For all measures, responsiveness varied based on the study sample and on whether depression improved or worsened. CONCLUSIONS: Both PROMIS and PHQ depression scales are brief public domain measures that are responsive (i.e., sensitive to change) and thus appropriate as outcome measures in research as well as for monitoring treatment in clinical practice. Trial registration ClinicalTrials.gov ID: NCT01236521, NCT01583985, NCT01507688.


Assuntos
Dor Crônica/diagnóstico , Medição da Dor/normas , Questionário de Saúde do Paciente , Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Adulto , Idoso , Dor Crônica/psicologia , Ensaios Clínicos como Assunto , Depressão/diagnóstico , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos
18.
Neurogastroenterol Motil ; 33(5): e14092, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33550640

RESUMO

BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.


Assuntos
Ansiedade/psicologia , COVID-19 , Dispepsia/fisiopatologia , Gastroenteropatias/fisiopatologia , Azia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Estresse Psicológico/psicologia , Dor Abdominal/fisiopatologia , Dor Abdominal/psicologia , Adulto , Dor no Peito/fisiopatologia , Dor no Peito/psicologia , Controle de Doenças Transmissíveis , Dispepsia/psicologia , Feminino , Gastroenteropatias/psicologia , Azia/psicologia , Humanos , Síndrome do Intestino Irritável/psicologia , Itália , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Política Pública , SARS-CoV-2 , Inquéritos e Questionários
19.
JAMA Netw Open ; 4(2): e2036065, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528551

RESUMO

Importance: There is uncertainty about the role that military deployment experiences play in suicide-related outcomes. Most previous research has defined combat experiences broadly, and a limited number of cross-sectional studies have examined the association between specific combat exposure (eg, killing) and suicide-related outcomes. Objective: To prospectively examine combat exposures associated with suicide attempts among active-duty US service members while accounting for demographic, military-specific, and mental health factors. Design, Setting, and Participants: This cohort study analyzed data from the Millennium Cohort Study, an ongoing prospective longitudinal study of US service members from all military branches. Participants were enrolled in 4 phases from July 1, 2001, to April 4, 2013, and completed a self-administered survey at enrollment and every 3 to 5 years thereafter. The population for the present study was restricted to active-duty service members from the first 4 enrollment phases who deployed in support of the wars in Iraq and Afghanistan. Questionnaire data were linked with medical encounter data through September 30, 2015. Data analyses were conducted from January 10, 2017, to December 14, 2020. Exposures: Combat exposure was examined in 3 ways (any combat experience, overall combat severity, and 13 individual combat experiences) using a 13-item self-reported combat measure. Main Outcomes and Measures: Suicide attempts were identified from military electronic hospitalization and ambulatory medical encounter data using the International Classification of Diseases, Ninth Revision codes. Results: Among 57 841 participants, 44 062 were men (76.2%) and 42 095 were non-Hispanic White individuals (72.8%), and the mean (SD) age was 26.9 (5.3) years. During a mean (SD) follow-up period of 5.6 (4.0) years, 235 participants had a suicide attempt (0.4%). Combat exposure, defined broadly, was not associated with suicide attempts in Cox proportional hazards time-to-event regression models after adjustments for demographic and military-specific factors; high combat severity and certain individual combat experiences were associated with an increased risk for suicide attempts. However, these associations were mostly accounted for by mental disorders, especially posttraumatic stress disorder. After adjustment for mental disorders, combat experiences with significant association with suicide attempts included being attacked or ambushed (hazard ratio [HR], 1.55; 95% CI, 1.16-2.06), seeing dead bodies or human remains (HR, 1.34; 95% CI, 1.01-1.78), and being directly responsible for the death of a noncombatant (HR, 1.81; 95% CI, 1.04-3.16). Conclusions and Relevance: This study suggests that deployed service members who experience high levels of combat or are exposed to certain types of combat experiences (involving unexpected events or those that challenge moral or ethical norms) may be at an increased risk of a suicide attempt, either directly or mediated through a mental disorder.


Assuntos
Transtorno Depressivo/epidemiologia , Homicídio/estatística & dados numéricos , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Exposição à Guerra/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Transtorno Depressivo/psicologia , Feminino , Homicídio/psicologia , Humanos , Guerra do Iraque 2003-2011 , Masculino , Análise de Mediação , Destacamento Militar , Militares/psicologia , Questionário de Saúde do Paciente , Modelos de Riscos Proporcionais , Transtornos de Estresse Pós-Traumáticos/psicologia , Tentativa de Suicídio/psicologia , Estados Unidos/epidemiologia , Lesões Relacionadas à Guerra/epidemiologia , Lesões Relacionadas à Guerra/psicologia , Adulto Jovem
20.
JAMA Netw Open ; 4(2): e2037107, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33599773

RESUMO

Importance: Decision aids can help inform appropriate selection of total knee replacement (TKR) for advanced knee osteoarthritis (OA). However, few decision aids combine patient education, preference assessment, and artificial intelligence (AI) using patient-reported outcome measurement data to generate personalized estimations of outcomes to augment shared decision-making (SDM). Objective: To assess the effect of an AI-enabled patient decision aid that includes education, preference assessment, and personalized outcome estimations (using patient-reported outcome measurements) on decision quality, patient experience, functional outcomes, and process-level outcomes among individuals with advanced knee OA considering TKR in comparison with education only. Design, Setting, and Participants: This randomized clinical trial at a single US academic orthopedic practice included 129 new adult patients presenting for OA-related knee pain from March 2019 to January 2020. Data were analyzed from April to May 2020. Intervention: Patients were randomized into a group that received a decision aid including patient education, preference assessment, and personalized outcome estimations (intervention group) or a group receiving educational material only (control group) alongside usual care. Main Outcomes and Measures: The primary outcome was decision quality, measured using the Knee OA Decision Quality Instrument (K-DQI). Secondary outcomes were collaborative decision-making (assessed using the CollaboRATE survey), patient satisfaction with consultation (using a numerical rating scale), Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) score, consultation time, TKR rate, and treatment concordance. Results: A total of 69 patients in the intervention group (46 [67%] women) and 60 patients in the control group (37 [62%] women) were included in the analysis. The intervention group showed better decisional quality (K-DQI mean difference, 20.0%; SE, 3.02; 95% CI, 14.2%-26.1%; P < .001), collaborative decision-making (CollaboRATE, 8 of 69 [12%] vs 28 of 60 [47%] patients below median; P < .001), satisfaction (numerical rating scale, 9 of 65 [14%] vs 19 of 58 [33%] patients below median; P = .01), and improved functional outcomes at 4 to 6 months (mean [SE] KOOS JR, 4.9 [2.24] points higher in intervention group; 95% CI, 0.8-9.0 points; P = .02). The intervention did not significantly affect consultation time (mean [SE] difference, 2.23 [2.18] minutes; P = .31), TKR rates (16 of 69 [23%] vs 7 of 60 [12%] patients; P = .11), or treatment concordance (58 of 69 [84%] vs 44 of 60 [73%] patients; P = .19). Conclusions and Relevance: In this randomized clinical trial, an AI-enabled decision aid significantly improved decision quality, level of SDM, satisfaction, and physical limitations without significantly impacting consultation times, TKR rates, or treatment concordance in patients with knee OA considering TKR. Decision aids using a personalized, data-driven approach can enhance SDM in the management of knee OA. Trial Registration: ClinicalTrials.gov Identifier: NCT03956004.


Assuntos
Inteligência Artificial , Tomada de Decisão Compartilhada , Técnicas de Apoio para a Decisão , Osteoartrite do Joelho/terapia , Educação de Pacientes como Assunto , Satisfação do Paciente , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Questionário de Saúde do Paciente , Medidas de Resultados Relatados pelo Paciente , Medição de Risco
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