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1.
Pediatr Blood Cancer ; 70(3): e30167, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36625401

RESUMO

OBJECTIVE: Processing speed (PS) is a vulnerable cognitive skill in pediatric cancer survivors as a consequence of treatments and, less consistently, tumor region. Studies conventionally examine graphomotor PS; emerging research suggests other aspects of PS may be impacted. This study examined types of PS in pediatric brain tumor survivors to determine which aspects are impaired. Given discordance across studies, we additionally investigated the relationship between brain region and PS. METHODS: The sample consisted of 167 pediatric brain tumor patients (100 supratentorial). PS (oral naming, semantic fluency, phonemic fluency, motor speed, graphomotor speed, visual scanning) was gathered via clinical neuropsychological assessment. To examine PS by region, infratentorial and supratentorial groups were matched on age at diagnosis and neuropsychological assessment, and time since diagnosis. RESULTS: The whole sample performed below normative means on measures of oral naming (p < .001), phonemic fluency (p < .001), motor speed (p = .03), visual scanning (p < .001), and graphomotor speed (p < .001). Only oral naming differed by region (p = .03), with infratentorial tumors associated with slower performance. After controlling for known medical and demographic risk factors, brain region remained a significant predictor of performance (p = .04). Among the whole sample, greater than expected proportions of patients with impairment (i.e., >1 standard deviation below the normative mean) were seen across all PS measures. Infratentorial tumors had higher rates of impairments across all PS measures except phonemic fluency. CONCLUSIONS: Results indicate pediatric brain tumor survivors demonstrate weaknesses in multiple aspects of PS, suggesting impairments are not secondary to peripheral motor slowing alone. Additionally, tumor region may predict some but not all neuropsychological outcomes in this population.


Assuntos
Neoplasias Encefálicas , Neoplasias Infratentoriais , Humanos , Criança , Neoplasias Encefálicas/complicações , Testes Neuropsicológicos , Sobreviventes
2.
Artigo em Inglês | MEDLINE | ID: mdl-36674143

RESUMO

Accumulating evidence indicates that the COVID-19 pandemic carries risks to psychological health and represents a collective traumatic experience with consequences at the social, economic, and health levels. The primary aim of this study was to collect ongoing COVID-19 survivors' pandemic-related experiences as expressed through the use of metaphors; the secondary aim was to explore socio-demographic variables associated with the metaphor orientation as negative, positive or neutral. An observational follow-up survey was conducted and reported according to the STROBE guidelines. Patients ≥ 18 years, who were treated for COVID-19 during the first wave (March/April 2020) and who were willing to participate in a telephone interview were involved and asked to summarize their COVID-19 experience as lived up to 6 and 12 months in a metaphor. A total of 339 patients participated in the first (6 months) and second (12 months) data collection. Patients were mainly female (51.9%), with an average age of 52.9 years (confidence interval, CI 95% 51.2-54.6). At 6 months, most participants (214; 63.1%) used a negative-oriented metaphor, further increasing at 12 months (266; 78.5%), when they used fewer neutral-/positive-oriented metaphors (p < 0.001). At the 6-month follow-up, only three individual variables (female gender, education, and experiencing symptoms at the COVID-19 onset) were significantly different across the possible metaphor orientation; at 12 months, no individual variables were significantly associated. This study suggests increasingly negative lived experiences over time and the need for personalized healthcare pathways to face the long-term traumatic consequences of COVID-19.


Assuntos
COVID-19 , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , COVID-19/epidemiologia , Seguimentos , Metáfora , Pandemias , Sobreviventes
3.
J Rehabil Med ; 55: jrm00368, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36714933

RESUMO

OBJECTIVE: International guidelines recommend early screening for identification of patients who are at risk of long-term cognitive impairments after cardiac arrest. However, information about predictors is not provided. A systematic review of the literature was performed to identify early predictors of long-term cognitive outcome after cardiac arrest. METHODS: Scopus and PubMed were systematically searched to identify studies on early predictors of long-term cognitive outcome in patients after cardiac arrest. The population included adult cardiac arrest survivors and potential early predictors were demographics, early cognitive screening scores, imaging measures, electroencephalographic measures, and levels of blood biomarkers. Two investigators reviewed studies for relevance, extracted data and assessed risk of bias. RESULTS: Five articles were included. Risk of bias was assessed as low or moderate. Most detected longterm cognitive impairments were in the domain of memory. Coma duration (2 studies), early cognitive impairments by the self-developed clinical Bedside Neuropsychological Test Battery (BNTB) screener (2 studies), and high S-100B levels on day 3 (2 studies) were the most prominent identified determinants of cognitive impairment on the group level. On the individual patient level, a score on the BNTB of ≤ 94.5 predicted cognitive impairments at 6 months after cardiac arrest (1 study without external validation). Studies on brain imaging and electroencephalography are lacking. CONCLUSION: Early bedside cognitive screening can contribute to prediction of long-term cognitive impairment after cardiac arrest. Evidence is scarce for S-100B levels and coma duration and absent for measures derived from brain imaging and electroencephalography.


Assuntos
Disfunção Cognitiva , Parada Cardíaca , Adulto , Humanos , Coma , Parada Cardíaca/complicações , Parada Cardíaca/psicologia , Encéfalo , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Sobreviventes/psicologia
4.
BMC Psychol ; 11(1): 9, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635775

RESUMO

BACKGROUND: Depressive symptoms are a significant psychological complication of stroke, impacting both survivors and informal caregivers of survivors. Randomized controlled trials are needed to determine optimal non-pharmacological strategies to prevent or ameliorate depressive symptoms in stroke survivors and their informal caregivers. METHODS: A prospective, randomized, parallel-group, single-center, feasibility study. Participants were assigned to a 4-week meditation intervention or expressive writing control group. The intervention comprised four facilitator-led group meditation sessions, one session per week and building upon prior session(s). Descriptive statistics were used to examine the proportion of eligible individuals who enrolled, retention and adherence rates, and the proportion of questionnaires completed. Data were collected at baseline, immediately after the 4-week intervention period, and 4 and 8 weeks after the intervention period. Secondary analysis tested for changes in symptoms of depression (Center for Epidemiologic Studies-Depression [CES-D]), anxiety [State-Trait Anxiety Inventory for Adults (STAI)], and pain (Brief Pain Inventory-Short Form) in the intervention group via paired t tests. Linear mixed models were used to compare longitudinal changes in the measures between the groups. Intervention and trial design acceptability were preliminary explored. RESULTS: Seventy-one (77%) individuals enrolled and 26 (37%) completed the study (baseline and 8-week post-intervention visits completed). Forty-two (66%) participants completed baseline and immediate post-intervention visits. Mean questionnaire completion rate was 95%. The median meditation group session attendance rate for the intervention group was 75.0%, and the mean attendance rate was 55%. Non-significant reductions in CES-D scores were found. Paired t tests for stroke survivors indicated a significant reduction from baseline through week 8 in BPI-sf severity scores (p = 0.0270). Repeated measures analysis with linear mixed models for informal caregivers indicated a significant reduction in in STAI-Trait scores (F [3,16.2] = 3.28, p = 0.0479) and paired t test showed a significant reduction from baseline to week 4 in STAI-Trait scores (mean = - 9.1250, 95% CI [- 16.8060 to 1.4440], p = 0.0262). No between-group differences were found. CONCLUSIONS: Future trials will require strategies to optimize retention and adherence before definitive efficacy testing of the meditation intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03239132. Registration date: 03/08/2017.


Assuntos
Meditação , Acidente Vascular Cerebral , Adulto , Humanos , Cuidadores/psicologia , Estudos de Viabilidade , Dor , Estudos Prospectivos , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/psicologia , Sobreviventes
5.
Transl Psychiatry ; 13(1): 4, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36609484

RESUMO

The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes ( http://itr.med.unc.edu/aurora/parcoord/ ). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.


Assuntos
Smartphone , Transtornos de Estresse Pós-Traumáticos , Humanos , Ansiedade/psicologia , Transtornos de Ansiedade , Fatores de Risco , Sobreviventes/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico
6.
BMJ Open Respir Res ; 10(1)2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36653059

RESUMO

INTRODUCTION: Pain is a common and debilitating symptom in survivors of critical illness. The 'Core Outcome Set for Survivors of Acute Respiratory Failure' proposes that the pain and discomfort question of the EuroQol 5 Dimension 5 Level (EQ-5D-5L) could be used to assess pain in this group, however, it was recognised that further research is required to evaluate how this single question compares to other more detailed pain tools. This study aims to evaluate the relationship between the pain and discomfort question of the EQ-5D-5L and the Brief Pain Inventory (BPI) in survivors of critical illness. METHODS: This study retrospectively analysed paired EQ-5D-5L and BPI data extracted from a prospective, multicentre study evaluating the impact of a critical care recovery programme. 172 patients who received a complex recovery intervention and 108 patients who did not receive this intervention were included. Data were available for the intervention cohort at multiple time points, namely, baseline, 3 months and 12 months. While, data were available for the usual care cohort at a single time point (12 months). We assessed the correlation between the pain and discomfort question of the EQ-5D-5L and two separate components of the BPI: severity of pain and pain interference. RESULTS: Correlation coefficients comparing the pain and discomfort question of the EQ-5D-5L and the BPI pain severity score ranged between 0.73 (95% CI 0.63 to 0.80) and 0.80 (95% CI 0.72 to 0.86). Correlation coefficients comparing the pain and discomfort question of the EQ-5D-5L and the BPI pain interference score ranged between 0.71 (95% CI 0.62 to 0.79) and 0.83 (95% CI 0.76 to 0.88) across the various time points. CONCLUSIONS: The pain and discomfort question of the EQ-5D-5L correlates moderately well with a more detailed pain tool and may help to streamline assessments in survivorship studies. More in-depth tools may be of use where pain is the primary study outcome or a patient-reported concern.


Assuntos
Estado Terminal , Qualidade de Vida , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Dor/epidemiologia , Dor/etiologia , Sobreviventes
7.
Sci Rep ; 13(1): 1079, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658164

RESUMO

Appetite loss, a common but serious issue in older patients, is an independent risk factor for sarcopenia, which is associated with high mortality. However, few studies have explored the phenomenon of appetite loss after discharge from the intensive care unit (ICU). Therefore, we aimed to describe the prevalence of appetite loss and relationship between appetite loss and depression in patients living at home 12 months after intensive care. This study involved secondary analysis of data obtained from a published ambidirectional study examining post-intensive care syndrome 12 months after discharge (SMAP-HoPe study) conducted in 12 ICUs in Japan. We included patients aged > 65 years. The Short Nutritional Assessment Questionnaire and Hospital Anxiety Depression Scale were used for the analysis. Descriptive statistics and a multilevel generalized linear model were used to clarify the relationship between appetite loss and depression. Data from 468 patients were analyzed. The prevalence of appetite loss was 25.4% (95% confidence interval [CI], 21.5-29.4). High severity of depression was associated with a high probability of appetite loss (odds ratio, 1.2; 95%CI, 1.14-1.28; p = 0.00). Poor appetite is common 12 months after intensive care and is associated with the severity of depression.


Assuntos
Apetite , Unidades de Terapia Intensiva , Humanos , Idoso , Cuidados Críticos , Alta do Paciente , Sobreviventes
8.
BMC Health Serv Res ; 23(1): 58, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36658565

RESUMO

BACKGROUND: Post-stroke visual impairment (VI) is a common but under-recognized care challenge. Common manifestations of post-stroke VI include: diplopia, homonymous hemianopia, oscillopsia secondary to nystagmus, and visual inattention or neglect. In acute care settings, post-stroke VI recognition and treatment are often sub-optimal as emphasis is placed on survival. Stroke survivors with VI often face inconsistencies when accessing care out of hospital because variable availability and subsidization of visual rehabilitation. We sought to identify gaps in care experienced by stroke survivors with VI from stroke survivors' and care providers' perspectives. METHODS: We conducted a qualitative description study across 12 care sites in Alberta, Canada, using semi-structured interviews. Survivor interviews focused on the health system experience. Provider interviews discussed approaches to care, perceived gaps, and current resources. Interviews were audio-recorded and transcribed. Iterative content analysis was completed using NVivo 12. We promoted rigour through an audit trail, open-ended questions, thick description, and collaborative coding. RESULTS: We completed 50 interviews: 19 survivor interviews and 31 provider interviews. The majority of survivors were male (n = 14) and recruited from community settings (n = 16). Providers varied in profession and location within the care continuum. Two key themes emerged from the provider and survivor interviews pertaining to (a) facets of visual rehabilitation (sub-themes: access, resources, and multidisciplinary professional interaction); and (b) functioning with post-stroke VI (sub-themes: early experiences post-stroke and living with VI in the real world). CONCLUSIONS: The visual rehabilitation model needs to be optimized to ensure transparent inter-disciplinary communication and efficient referral pathways. Future research will focus on evaluating the effectiveness of post-stroke care from multiple perspectives in Alberta.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Alberta , Acidente Vascular Cerebral/complicações , Sobreviventes , Pesquisa Qualitativa , Transtornos da Visão/etiologia
9.
Curr Opin Pediatr ; 35(1): 84-90, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36592027

RESUMO

PURPOSE OF REVIEW: There is a growing population of adolescent and young adult (AYA, ages 15-39 years) cancer patients and survivors, and the field of AYA oncology is rapidly evolving. Despite an increased focus on survival and quality of life for AYAs, gaps in knowledge remain. The current review focuses on what is known across several domains unique to AYA cancer care as well as areas of improvement and future directions in research and intervention. RECENT FINDINGS: Due to the developmental stages included in the AYA age range, a cancer diagnosis and treatment can affect relationships, education and employment, finances, and long-term health differently than diagnoses in younger or older populations. Recent studies that have focused on these unique aspects of AYA cancer care, including health-related quality of life (HRQoL), fertility, financial toxicity, barriers to clinical trial enrollment, genetic predisposition, and survivorship care are included in the current review. SUMMARY: Although studies have described many of the challenges faced by AYAs across the cancer continuum from diagnosis to survivorship, more work is needed, particularly in systematically measuring HRQoL, eliminating barriers to clinical trial enrollment, addressing financial toxicity, and increasing access to fertility preservation and high-quality survivorship care.


Assuntos
Preservação da Fertilidade , Neoplasias , Humanos , Adolescente , Adulto Jovem , Adulto , Qualidade de Vida , Neoplasias/diagnóstico , Neoplasias/terapia , Sobreviventes
10.
BMC Psychol ; 11(1): 21, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36698197

RESUMO

BACKGROUND: One third of cancer patients and survivors experience psychological distress. Previous studies have shown that online mindfulness-based cognitive therapy (eMBCT) supports cancer patients and survivors in managing distress. Lack of peer support and asynchronicity during online interventions have been reported as barriers for treatment adherence and can result in higher drop-out rates. Considering this, two new formats of eMBCT were created. The primary objective of the Buddy trial is to evaluate the (cost) effectiveness of blended and unguided eMBCT versus care as usual (CAU) on psychological distress among cancer patients and survivors. Secondary objectives include evaluating effects on other psychological outcomes and investigating working mechanisms and treatment effect moderators. METHODS: The Buddy trial is a parallel three-armed randomized controlled trial. Participants will be randomly assigned to blended therapist-assisted eMBCT, unguided individual eMBCT or CAU. Eligible participants will be Dutch-speaking adult cancer patients or survivors with access to internet. The primary outcome will be psychological distress scores as assessed by the Hospital Anxiety and Depression scale immediately post-treatment. Secondary outcome measures include fear of cancer recurrence (FCRI), fatigue (CIS-F), rumination (RRQ), mindfulness skills (FFMQ), decentering (EQ), self-compassion (SCS-SF), positive mental health (MHCSF), health related quality of life (EQ-5D), and costs associated with psychiatric illness (TiC-P). Outcome measures will be evaluated at baseline, mid-treatment, immediately post-treatment, and three-, six-, and nine-months follow-up. Possible mediators, such as engagement with interventions (TWEETS), and moderators will be also analyzed. DISCUSSION: There is room to improve eMBCT for cancer patients prior to implementation to ensure adherence and scalability. Blended and unguided eMBCT may reduce psychological distress and improve quality of life and be easily accessible to cancer patients and survivors. Trial registration clinicaltrials.gov, NCT05336916, registered on April 20th, 2022. https://clinicaltrials.gov/ct2/show/NCT05336916 .


Assuntos
Terapia Cognitivo-Comportamental , Atenção Plena , Neoplasias , Adulto , Humanos , Atenção Plena/métodos , Qualidade de Vida , Terapia Cognitivo-Comportamental/métodos , Neoplasias/terapia , Neoplasias/psicologia , Sobreviventes , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Stroke ; 54(2): 396-406, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36689591

RESUMO

Telehealth has seen rapid expansion into chronic care management in the past 3 years because of the COVID-19 pandemic. Telehealth for acute care management has expanded access to equitable stroke care to many patients over the past two decades, but there is limited evidence for its benefit for addressing disparities in the chronic care of patients living with stroke. In this review, we discuss advantages and disadvantages of telehealth use for the outpatient management of stroke survivors. Further, we explore opportunities and potential barriers for telehealth in addressing disparities in stroke outcomes related to various social determinants of health. We discuss two ongoing large randomized trials that are utilizing telehealth and telemonitoring for management of blood pressure in diverse patient populations. Finally, we discuss strategies to address barriers to telehealth use in patients with stroke and in populations with adverse social determinants of health.


Assuntos
COVID-19 , Equidade em Saúde , Acidente Vascular Cerebral , Telemedicina , Humanos , Pandemias , Sobreviventes
16.
BMJ Open ; 13(1): e069016, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36669847

RESUMO

INTRODUCTION: Poor recovery of the upper limb following a stroke has been recognised as a significant problem in the UK. Although there is good evidence that early, intense rehabilitation can lead to upper limb recovery, often this is not maintained, with less than 50% of people regaining the ability to use their upper limb for independent function at 6 months. Upper limb recovery potential is reported for many years poststroke, yet current long-term provision is insufficient. METHODS AND ANALYSIS: 60 participants will be recruited into this feasibility study, with 30 allocated to a Post Rehabilitation Enablement Programme (PREP) alone and 30 allocated to a combined programme, PREP Plus, consisting of PREP and the Graded Repetitive Arm Supplementary Programme (GRASP). We will aim to complete four iterative waves. Within each wave, the intervention design will be refined, based on participant feedback. Within each wave, there will be one cluster unit (one intervention group ;PREP Plus) and one control group ;PREP alone)). A total of five PREP sites within Northern Ireland Health and Social Care Trusts will be used for this study. PREP Plus will have a home exercise component along with exercises logs and a behaviour contract. Qualitative and quantitative measures will evaluate the acceptability and feasibility to determine how feasible it is to embed the intervention into practice, as well as to determine the feasibility of a larger, mixed-methods, randomised controlled trial to assess intervention efficacy. Clinical endpoints will also be explored. ETHICS AND DISSEMINATION: This study has been approved by the Health and Social Care Research Ethics Committee A, IRAS project ID (278620). Participants will provide informed consent prior to participating in the study. Information outlining the purpose of the study, what data will be collected and how the data will be managed will be provided. Results will be published in peer-reviewed journals and any published data will be available on the university data repository. The project management group will advise on different avenues for dissemination to ensure it reaches appropriate audiences. TRIAL REGISTRATION NUMBER: NCT05090163.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Estudos de Viabilidade , Reabilitação do Acidente Vascular Cerebral/métodos , Vida Independente , Extremidade Superior , Sobreviventes , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
BMJ Open ; 13(1): e065075, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36669845

RESUMO

INTRODUCTION: Fear of cancer recurrence (FCR) is a prevalent and frequently debilitating response to a cancer diagnosis, affecting a substantial proportion of cancer survivors. Approximately 30% of local Hong Kong Chinese cancer survivors in a recent survey reportedly experienced persistent high FCR over the first-year post-surgery. This was associated with lower levels of psychological well-being and quality of life. A manualised intervention (ConquerFear) developed primarily based on the Self-Regulatory Executive Function Model and the Rational Frame Theory, has been found to reduce FCR effectively among Caucasian cancer survivors. The intervention now has been adapted to a Chinese context; ConquerFear-HK. The primary aim of this study is to evaluate its efficacy vs a standard-survivorship-care control (BasicCancerCare) in FCR improvement in a randomised control trial (RCT). METHODS AND ANALYSIS: In this RCT, using the sealed envelope method, 174 eligible Chinese cancer survivors will be randomised to either the ConquerFear-HK or BasicCancerCare intervention. Both interventions include six sessions over 10 weeks, which will be delivered via face to face or online by trained therapists. The ConquerFear-HK intervention incorporates value classification, metacognitive therapy, attentional training, detached mindfulness and psychoeducation; BasicCancerCare includes relaxation training, dietary and physical activity consultations. Participants will be assessed at prior randomisation (baseline; T0), immediately postintervention (T1), 3 months (T2) and 6 months postintervention (T3) on the measures of FCR (Fear of Cancer Recurrence Inventory) as a primary outcome; metacognition (30-item Metacognitions Quesionnaire) and cognitive attentional syndrome (Cognitive-attentional Syndrome Questionnaire) as process outcomes; psychological distress (Hospital Anxiety and Depression Scale), cancer-related distress (Chinese Impact of Events Scale), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire) and treatment satisfaction are secondary outcomes. ETHICS AND DISSEMINATION: Ethics approval has been obtained from HKU/HA HKW Institutional Review Board (ref: UW19-183). The patients/participants provide their written informed consent to participate in this study. The study results will be disseminated through international peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT04568226.


Assuntos
Sobreviventes de Câncer , Metacognição , Humanos , Sobreviventes de Câncer/psicologia , Recidiva Local de Neoplasia/psicologia , Medo/psicologia , Sobreviventes/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Artigo em Inglês | MEDLINE | ID: mdl-36673679

RESUMO

There is limited knowledge on the relationship between neighborhood factors and mental health among displaced disaster survivors, particularly among women. Hurricane Katrina (Katrina) was the largest internal displacement in the United States (U.S.), which presented itself as a natural experiment. We examined the association between neighborhood socioeconomic status (SES) and mental health among women up to 10 years following Katrina (N = 394). We also investigated whether this association was modified by move status, comparing women who were permanently displaced to those who had returned to their pre-Katrina residence. We used hierarchical linear models to measure this association, using data from the American Community Survey and the Gulf Coast Child and Family Health study. Neighborhood SES was created as an index which represented social and economic characteristics of participants' neighborhoods. Mental health was measured using mental component summary (MCS) scores. Increased neighborhood SES was positively associated with mental health after controlling for age, race/ethnicity, economic positioning, time, and move status (19.6, 95% Confidence Interval: 5.8, 33.7). Neighborhood SES and mental health was also modified by move status. These findings underscore the need to better understand the impacts of socioeconomic conditions and health outcomes among women affected by natural disasters.


Assuntos
Tempestades Ciclônicas , Saúde Mental , Feminino , Humanos , Estudos Longitudinais , Classe Social , Sobreviventes/psicologia , Estados Unidos
19.
Crit Care Med ; 51(2): 212-221, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36661449

RESUMO

OBJECTIVES: To characterize early unmet nonmedication discharge needs (UDNs), classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUAs) and explore their association with 90-day readmission and mortality among survivors of acute respiratory failure (ARF) who were discharged home. DESIGN: Prospective multicenter cohort study. SETTING: Six academic medical centers across United States. PARTICIPANTS: Adult survivors of ARF who required an ICU stay and were discharged home from hospital. INTERVENTIONS: None. Exposure of interest was the proportion of UDN for the following categories: DME, HHS, and FUA ascertained within 7-28 days after hospital discharge. MEASUREMENTS AND MAIN RESULTS: Two hundred eligible patients were recruited between January 2019 and August 2020. One-hundred ninety-five patients were included in the analytic cohort: 118 were prescribed DME, 134 were prescribed HHS, and 189 needed at least one FUA according to discharge plans. 98.4% (192/195) had at least one identified nonmedication need at hospital discharge. Median (interquartile range) proportion of unmet needs across three categories were 0 (0-15%) for DME, 0 (0-50%) for HHS, and 0 (0-25%) for FUA, and overall was 0 (0-20%). Fifty-six patients (29%) had 90-day death or readmission. After adjusting for prespecified covariates, having greater than the median level of unmet needs was not associated with an increased risk of readmission or death within 90 days of discharge (risk ratio, 0.89; 0.51-1.57; p = 0.690). Age, hospital length of stay, Acute Physiology and Chronic Health Evaluation II severity of illness score, and Multidimensional Scale Perceived Social Support score were associated with UDN. CONCLUSIONS: UDN were common among survivors of ARF but not significantly associated a composite outcome of 90-day readmission or death. Our results highlight the substantial magnitude of UDN and identifies areas especially vulnerable to lapses in healthcare coordination.


Assuntos
Alta do Paciente , Insuficiência Respiratória , Adulto , Humanos , Estados Unidos/epidemiologia , Estudos Prospectivos , Readmissão do Paciente , Estudos de Coortes , Hospitais , Sobreviventes , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Tempo de Internação
20.
BMC Public Health ; 23(1): 123, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653799

RESUMO

BACKGROUND: Increased numbers of domestic abuse cases were reported at the start of the COVID-19 pandemic. Many people experiencing abuse faced barriers to seeking support with service closures affecting the sector. Available evidence suggests women are overrepresented in the reported cases of intimate partner violence (IPV) and we aimed to learn more about how their lives were impacted by social distancing restrictions. METHODS: We conducted an online qualitative interview study, using reflexive thematic analysis. Interviews were conducted between April 2021 and March 2022. 18 women in the UK with past experiences of IPV provided informed consent and participated in this study. RESULTS: During the analysis, we identified five themes relating to the impact of lockdown restrictions on participants' lives, including: (1) Lockdown meant being confined to a place where abuse was escalating, (2) Barriers to accessing support, including "cancelled" services and missed opportunities to intervene during interactions in lockdown with frontline workers. (3) Increased feelings of fear, isolation, and loss of control, particularly during the early stages of the pandemic from the combination of abuse and pandemic-related changes to daily life. (4) Some forms of support were more accessible during the pandemic, such as provision of online psychological support and social groups. Participants also accessed new forms of support for the first time during the pandemic, in some cases sparked by posts and content on social media about abuse awareness. (5) For some, psychosocial wellbeing transformed during the pandemic, with several participants using the word "freedom" when reflecting on their experience of simultaneously escaping abuse and living through the COVID-19 pandemic. CONCLUSIONS: In this study, we explored the views of female survivors of IPV in the UK during the COVID-19 pandemic. Our results highlight the importance of combined public awareness campaigns and community intervention points for victims to safely seek help during social distancing restrictions. Having the time and space to reflect on healing after escaping abuse was described by women in our study as a benefit from their lives in lockdown, which is a factor that could be incorporated into future initiatives developed to support people subjected to violence and abuse.


Assuntos
COVID-19 , Violência por Parceiro Íntimo , Humanos , Feminino , COVID-19/epidemiologia , Pandemias , Distanciamento Físico , Controle de Doenças Transmissíveis , Violência por Parceiro Íntimo/psicologia , Sobreviventes/psicologia , Reino Unido/epidemiologia
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