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Arch Dermatol Res ; 316(6): 328, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824251

RESUMO

Observational studies have revealed associations between various dietary factors and skin conditions. However, the causal relationship between diet and skin condition is still unknown. Data on 17 dietary factors were obtained from the UK Biobank. Data on four skin conditions were derived from the UK Biobank and another large-scale GWAS study. Genetic predictions suggested that the intake of oily fish was associated with a lower risk of skin aging (OR: 0.962, P = 0.036) and skin pigmentation (OR: 0.973, P = 0.033); Tea intake was associated with a lower risk of skin pigmentation (OR: 0.972, P = 0.024); Salad/raw vegetables intake was associated with a lower risk of keratinocyte skin cancer (OR: 0.952, P = 0.007). Coffee intake was associated with increased risk of skin aging (OR: 1.040, P = 0.028); Pork intake was associated with increased risk of skin aging (OR: 1.134, P = 0.020); Beef intake was associated with increased risk of cutaneous melanoma (OR: 1.013, P = 0.016); Champagne plus white wine intake was associated with increased risk of cutaneous melanoma (OR: 1.033, P = 0.004); Bread intake was associated with increased risk of keratinocyte skin cancer (OR: 1.026, P = 0.013). Our study results indicate causal relationships between genetically predicted intake of oily fish, tea, salad/raw vegetables, coffee, pork, beef, champagne plus white wine, and bread and skin conditions.


Assuntos
Dieta , Análise da Randomização Mendeliana , Neoplasias Cutâneas , Humanos , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Envelhecimento da Pele/genética , Pigmentação da Pele/genética , Café/efeitos adversos , Estudo de Associação Genômica Ampla , Reino Unido/epidemiologia , Chá/efeitos adversos , Fatores de Risco
3.
Pediatr Allergy Immunol ; 35(6): e14169, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38837464

RESUMO

BACKGROUND: Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in infants. RSV bronchiolitis is associated with an increased risk of subsequent wheezing. We aimed to document the parents' perception of the link between RSV infection and subsequent wheezing, wheezing-related healthcare and family resources use, and its impact on family daily life. METHODS: This cross-sectional online survey enrolled 1200 parents with at least one child ≤6y living in the United States, United Kingdom, Spain, and Italy. Children diagnosed with RSV bronchiolitis before age of 2 years were included in the RSV group, and those never diagnosed with RSV bronchiolitis in the Reference group. RESULTS: The odds of wheezing were 4.5-fold (95%CI 3.5-5.9) higher in the RSV than in the Reference group. The odds increased to 7.7-fold (95%CI 5.4-11.1) among children who were hospitalized, and 9-fold (95%CI 5.1-16.6) among those admitted to pediatric intensive care with RSV bronchiolitis. Similar trends were observed across all countries. In total, 57% of parents reported their child's wheezing to have moderate to severe impact on their emotional well-being, and 53% on their daily life activities and/or social life. 64% of parents reported moderate-severe impact of wheezing on child's quality of sleep and 49% and 46% reported a moderate-severe impact on their children's emotional well-being and physical activities. CONCLUSIONS: This survey suggests an association between RSV infection and subsequent wheezing in children across different countries. Wheezing, especially in association with RSV infection, was associated with increased healthcare utilization and costs, and significantly impacted parents' and children daily life.


Assuntos
Pais , Sons Respiratórios , Infecções por Vírus Respiratório Sincicial , Humanos , Estudos Transversais , Infecções por Vírus Respiratório Sincicial/epidemiologia , Pais/psicologia , Masculino , Feminino , Lactente , Pré-Escolar , Itália/epidemiologia , Inquéritos e Questionários , Espanha/epidemiologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Hospitalização/estatística & dados numéricos , Vírus Sincicial Respiratório Humano , Adulto , Criança , Efeitos Psicossociais da Doença
4.
Musculoskeletal Care ; 22(2): e1904, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38837521

RESUMO

BACKGROUND: Musculoskeletal disorders (MSKDs) are a significant reason for general practice consultations in the United Kingdom. Current models of care include consultation with a General Practitioner (GP) or a First Contact Physiotherapy Practitioner (FCPP). Evidence suggests that FCPP led care is safe, yet it is unknown whether patients share this belief. PURPOSE: To explore patients' perspectives of general practice consultation for MSKDs, including views on safety, satisfaction and recommendations for future practice. METHODS: A secondary data analysis utilising qualitative data from the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire completed by 426 general practice patients who consulted with a MSKD between December 2019 and October 2022. Responses to the question 'What changes, if any, would you suggest to your GP surgery to make sure that health care is provided safely?' were analysed using content analysis. RESULTS: 606 responses across three timepoints were analysed. Two themes and six subthemes were identified; views on safety and satisfaction (inherent trust in the system, provision of face-to-face appointments, prompt access to care, person-centred care) and recommendations for future practice (appointment system: prompt access to face-to-face appointments, delivery of care: co-ordinated and collaborative person-centred care). CONCLUSIONS: Patients commented that FCPP consultations provided quick and accurate diagnoses and targeted advice. Recommendations for future practice included prompt access to face-to-face appointments, phone calls to be answered more quickly, improved communication for test results and follow ups, patients to feel listened to with a more individualised approach, and better continuity of care.


Assuntos
Medicina Geral , Doenças Musculoesqueléticas , Satisfação do Paciente , Pesquisa Qualitativa , Encaminhamento e Consulta , Humanos , Doenças Musculoesqueléticas/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Inquéritos e Questionários , Reino Unido
5.
J Foot Ankle Res ; 17(2): e12017, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38837882

RESUMO

BACKGROUND: Ingrown toenails are a common pathology. Although a range of conservative and surgical measures are widely used for this condition, little is known about their use in practice. This study explored current practice relating to the treatment or management of ingrown toenails by podiatrists in the UK. METHODS: A cross-sectional online survey (Qualtrics, Provo, UT, USA) conducted between March to June 2020 was distributed to practicing podiatrists treating or managing ingrown toenails in the UK. RESULTS: A total of 396 practicing podiatrists responded (60.1% based in the private sector). The majority (88.6%) performed nail surgery most commonly (54.3%) less than five a month. Nearly all (95%) only performed nail avulsion with or without chemical matrixectomy, universally using phenol (97.2%). Application time and number of applications varied but was most commonly applied three times (61.5%) for a total of 3 minutes (75%). Aftercare varied considerably between public and private sectors, with public sectors offering fewer follow-up appointments. CONCLUSIONS: Although there is a variation in clinical practice throughout the treatment pathway, almost all respondents offered nail avulsion with phenol matrixectomy, whereas very few provided incisional nail surgery. This data provides the most comprehensive description of how UK podiatrists conduct nail surgery for onychocryptosis.


Assuntos
Unhas Encravadas , Podiatria , Padrões de Prática Médica , Humanos , Unhas Encravadas/terapia , Unhas Encravadas/cirurgia , Estudos Transversais , Podiatria/estatística & dados numéricos , Reino Unido , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Fenol/uso terapêutico , Masculino , Feminino , Dedos do Pé , Unhas/cirurgia , Pesquisas sobre Atenção à Saúde
6.
Am J Clin Nutr ; 119(6): 1386-1396, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38839194

RESUMO

BACKGROUND: The independent effect of waist-to-height ratio (WHtR) and body fat percentage (BF%) on ischemic cardiovascular disease (CVD) remains uncertain. OBJECTIVES: This study aimed to investigate the independent associations of WHtR and BF% with ischemic CVD. METHODS: This prospective cohort study used data from the UK Biobank. BF% was calculated as fat mass divided by body weight, measured by bioimpedance. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for overall and sex-specific associations of BF% and WHtR with risks of ischemic CVD and its main subtypes [myocardial infarction (MI) and ischemic stroke (IS)], adjusted for a range of potential confounders, including mutual adjustment for BF% and WHtR. RESULTS: In total, 468,333 participants without existing CVD were included in the analysis. During 12 y of follow-up, 20,151 ischemic CVD events, 13,604 MIs, and 6681 ISs were recorded. WHtR was linearly associated with ischemic CVD, MI, and IS, with an HR per 5% increase of 1.23 (95% CI: 1.20, 1.25), 1.24 (95% CI: 1.21, 1.27), and 1.22 (95% CI: 1.18, 1.26), respectively, independent of BF%. A stronger association between WHtR and MI was seen in females than in males. The association of BF% with these outcomes was substantially attenuated in both sexes after adjustment for WHtR. For example, in females, the HR (highest compared with lowest fifth) was reduced from 1.94 (95% CI: 1.76, 2.15) to 1.04 (95% CI: 0.90, 1.01) for ischemic CVD, from 2.04 (95% CI: 1.79, 2.32) to 0.97 (95% CI: 0.81, 1.16) for MI, and from 1.81 (95% CI: 1.54, 2.13) to 1.07 (95% CI: 0.85, 1.33) for IS. CONCLUSIONS: WHtR, when used as a proxy measure for central obesity, is linearly associated with ischemic CVD in both sexes, which is independent of BF%. In contrast, the relationship of BF% with these health outcomes is predominantly driven by its correlation with WHtR.


Assuntos
Tecido Adiposo , Bancos de Espécimes Biológicos , Razão Cintura-Estatura , Humanos , Masculino , Feminino , Estudos Prospectivos , Reino Unido/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Adulto , Estudos de Coortes , Biobanco do Reino Unido
8.
Trials ; 25(1): 359, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38835102

RESUMO

BACKGROUND: Providing supported self-management for people with asthma can reduce the burden on patients, health services and wider society. Implementation, however, remains poor in routine clinical practice. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a UK-wide cluster randomised implementation trial that aims to test the impact of a whole-systems implementation strategy, embedding supported asthma self-management in primary care compared with usual care. To maximise opportunities for sustainable implementation beyond the trial, it is necessary to understand how and why the IMP2ART trial achieved its clinical and implementation outcomes. METHODS: A mixed-methods process evaluation nested within the IMP2ART trial will be undertaken to understand how supported self-management was implemented (or not) by primary care practices, to aid interpretation of trial findings and to inform scaling up and sustainability. Data and analysis strategies have been informed by mid-range and programme-level theory. Quantitative data will be collected across all practices to describe practice context, IMP2ART delivery (including fidelity and adaption) and practice response. Case studies undertaken in three to six sites, supplemented by additional interviews with practice staff and stakeholders, will be undertaken to gain an in-depth understanding of the interaction of practice context, delivery, and response. Synthesis, informed by theory, will combine analyses of both qualitative and quantitative data. Finally, implications for the scale up of asthma self-management implementation strategies to other practices in the UK will be explored through workshops with stakeholders. DISCUSSION: This mixed-methods, theoretically informed, process evaluation seeks to provide insights into the delivery and response to a whole-systems approach to the implementation of supported self-management in asthma care in primary care. It is underway at a time of significant change in primary care in the UK. The methods have, therefore, been developed to be adaptable to this changing context and to capture the impact of these changes on the delivery and response to research and implementation processes.


Assuntos
Asma , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão , Humanos , Asma/terapia , Autogestão/métodos , Resultado do Tratamento , Reino Unido , Autocuidado/métodos , Avaliação de Processos em Cuidados de Saúde
9.
J Glob Health ; 14: 04102, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38843050

RESUMO

Background: Low lung function is associated with an increased risk of age-related diseases. However, the relationship between age-related macular degeneration (AMD), the leading cause of blindness, and lung function remains unclear. We aimed to investigate whether low lung function increases the risk of AMD and the potential mechanisms behind this association. Methods: We conducted a prospective cohort analysis of 409 230 UK Biobank participants with completed lung function after excluding individuals with AMD. We used Cox proportional hazards models to estimate the risk of AMD incidence and mediation models to explore potential mechanisms driven by inflammatory markers, erythrocyte-related measures, and metabolites. Results: Overall, 6477 AMD cases were diagnosed across an average of 12.4 years of follow-up. Participants with low lung function had an increased risk of developing AMD compared to those with high lung function (forced vital capacity: adjusted hazard ratio (aHR) = 1.20 (95% confidence interval (CI) = 1.07-1.34); forced expiratory volume in one second: aHR = 1.32 (95% CI = 1.18-1.47); peak expiratory flow: aHR = 1.32 (95% CI = 1.20-1.45)). Inflammatory markers and erythrocyte-related measures mediated this relationship, acting as a pathway through which low lung function influenced AMD. The interactions of body mass index (BMI), sex, and smoking were significant and the effect of lung function on AMD was higher in men, obese, and smoking populations. Conclusions: The increased risk of AMD was associated with low lung function, with inflammatory and erythrocyte-related markers mediating this relationship. This suggests that improvements in lung function could reduce the risk of AMD, thereby promoting health and longevity.


Assuntos
Degeneração Macular , Humanos , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Degeneração Macular/epidemiologia , Idoso , Fatores de Risco , Reino Unido/epidemiologia , Pulmão/fisiopatologia , Testes de Função Respiratória , Incidência , Adulto , Modelos de Riscos Proporcionais
10.
PLoS One ; 19(6): e0304132, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843140

RESUMO

International students' mental health has become an increasing concern in recent years, as more students leave their country for better education. They experience a wide range of challenges while studying abroad that have an impact on their psychological well-being. These challenges can include language obstacles, cultural differences, homesickness, financial issues and other elements that could severely impact the mental health of international students. Given the limited research on the demographic, cultural, and psychosocial variables that influence international students' mental health, and the scarcity of studies on the use of machine learning algorithms in this area, this study aimed to analyse data to understand the demographic, cultural factors, and psychosocial factors that impact mental health of international students. Additionally, this paper aimed to build a machine learning-based model for predicting depression among international students in the United Kingdom. This study utilized both primary data gathered through an online survey questionnaire targeted at international students and secondary data was sourced from the 'A Dataset of Students' Mental Health and Help-Seeking Behaviors in a Multicultural Environment,' focusing exclusively on international student data within this dataset. We conducted data analysis on the primary data and constructed models using the secondary data for predicting depression among international students. The secondary dataset is divided into training (70%) and testing (30%) sets for analysis, employing four machine learning models: Logistic Regression, Decision Tree, Random Forest, and K Nearest Neighbor. To assess each algorithm's performance, we considered metrics such as Accuracy, Sensitivity, Specificity, Precision and AU-ROC curve. This study identifies significant demographic variables (e.g., loan status, gender, age, marital status) and psychosocial factors (financial difficulties, academic stress, homesickness, loneliness) contributing to international students' mental health. Among the machine learning models, the Random Forest model demonstrated the highest accuracy, achieving an 80% accuracy rate in predicting depression.


Assuntos
Aprendizado de Máquina , Saúde Mental , Estudantes , Humanos , Masculino , Feminino , Estudantes/psicologia , Adulto Jovem , Depressão/diagnóstico , Adulto , Inquéritos e Questionários , Adolescente , Reino Unido
11.
PLoS One ; 19(6): e0303876, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843162

RESUMO

BACKGROUND: Data published early in the COVID-19 pandemic suggested that smokers infected with SARS-CoV-2 were more likely to need hospital treatment or die than non-smokers, and thus this was seen as a motivator to encourage smokers to make a quit attempt. Live Life Better Derbyshire (LLBD) is an integrated lifestyle service providing free support for residents Derbyshire, UK, who want to quit smoking. On 19 March 2020, LLBD converted from offering face-to-face cessation support to a smoking cessation service delivered remotely. METHODS: Interrupted time series analysis to investigate the impact of COVID-19, and the shift to remote delivery of smoking cessation support, on the number of smokers who accessed cessation support with LLBD, set a quit date, and self-reported having quit at 4-week follow-up. RESULTS: 11,393 episodes of smoking cessation support were opened with LLBD between 01 January 2018 and 31 December 2021. The weekly count of all outcomes was increasing prior to the date when LLBD converted to remote-only delivery. There was a 20% immediate drop in the number of episodes opened coinciding with this date (IRR 0.88, 95% CI 0.646-0.992) but no change in the number of quit dates set or 4-week quits or the underlying longer-term trends. CONCLUSIONS: The COVID-19 pandemic, and associated shift to remote delivery of smoking cessation support by LLBD, had no substantial sustained overall impact on measures of smoking cessation service activity and success.


Assuntos
COVID-19 , Análise de Séries Temporais Interrompida , Abandono do Hábito de Fumar , Humanos , Abandono do Hábito de Fumar/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Masculino , SARS-CoV-2 , Feminino , Pandemias , Reino Unido/epidemiologia , Adulto , Pessoa de Meia-Idade
12.
PLoS One ; 19(6): e0300834, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843190

RESUMO

BACKGROUND: Family group conferences (FGCs) in child welfare bring immediate and wider family members together to decide on the best way to meet a child's needs. Unlike professionally led meetings, the aim is for decisions to be made by or with family members. Qualitative and mixed-method research with FGC participants tends to show positive experiences: most participants feel their voices are heard; FGCs facilitate family-driven solutions and closer relationships-within families and with social workers. Although there is existing literature on FGCs, there is a paucity of robust comparative UK evaluations, i.e., randomised controlled trials or quasi-experimental studies. Comparative studies internationally have focused on a narrow range of outcomes, not recognised the importance of context, and paid little attention to the quality of delivery. Some qualitative studies have considered process and context but there is scant measurement of these. The aims of this study are, firstly, to establish how FGCs improve outcomes for families and what factors vary their quality, and, secondly, to assess longer-term outcomes in terms of service use and associated costs. METHODS: Given the importance of process and context, evaluation informed by realist and complex systems approaches is needed. This multi-method evaluation includes a survey of FGC services in all UK local authorities (n = 212) to map service provision; co-design of programme theory and evaluation measures with family members who have experienced an FGC (n = 16-24) and practitioners (n = 16-24) in two sites; a prospective single-arm study of FGC variability and outcomes after six months; and comparison of service use and costs in FGC participants (n≥300 families) and a control group (n≥1000) after two years using a quasi-experiment. DISCUSSION: This is a pragmatic evaluation of an existing intervention, to identify what mechanisms and contexts influence effective process and longer-term outcomes. The study is registered with Research Registry (ref. 7432).


Assuntos
Família , Humanos , Família/psicologia , Criança , Feminino , Proteção da Criança , Reino Unido , Masculino , Inquéritos e Questionários
13.
PLoS One ; 19(6): e0301890, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843248

RESUMO

BACKGROUND: In April 2018, the UK government implemented a levy on soft drinks importers and manufacturers, tiered according to the amount of sugar in drinks. The stated aim was to encourage manufacturers to reduce sugar and portion sizes. Previous evidence suggests that the policy has been successful in reducing sugar in drinks in the short-term since implementation, but their sustained effects have not been explored. This study aimed to assess the impact of the soft drink industry levy (SDIL) on sugar levels, price, portion size and use of non-sugar sweeteners in the medium-term. METHODS AND FINDINGS: Product data from 30 November 2017 to 14 March 2020 from one major UK retail supermarket were analysed (112,452 observations, 126 weekly time points). We used interrupted time series analysis, to assess the impact of the soft-drink industry levy (SDIL) on levy-eligible soft drinks, with exempt drinks (i.e. 100% fruit juices, milks, flavoured milks) acting as a comparator series. At the point of implementation of the SDIL (April 2018) there was a step change in the proportion of eligible drinks with sugar content below the SDIL levy threshold (5g per 100ml) (+0.08, 95%CI: +0.04, +0.12), with a similar sized decrease in the proportion in the highest levy category (> = 8g sugar per 100ml) (-0.06, 95%CI: -0.10, -0.03). Between April 2018 and March 2020, the proportion of eligible drinks below the SDIL levy threshold continued to gradually increase (p = 0.003), while those in the highest levy category decreased (p = 0.007). There was a step change in price of eligible drinks in the higher levy category at the point of implementation of +£0.049 (95%CI: +£0.034, +£0.065) per 100mL (for comparison, the levy is set at £0.024 per 100mL for this group). Trends in price for the high levy category were not altered by the SDIL. In the no levy category, there was a step change in price at the implementation (+£0.012 per 100mL, 95%CI: +£0.008, +£0.023), followed by a second step change in October 2018 (-£0.018p per 100mL, 95%CI: -£0.033, -£0.001p). The volume of products in the higher levy group decreased at the time of the implementation (-305mL on average including multipacks, 95%CI: -511, -99). The change in trend for the product volume of drinks in the higher levy group between April 2018 and March 2020 was in the increasing direction (+704mL per year, 95%CI: -95, 1504), but it did not meet our threshold for statistical significance (p = 0.084). There were no changes observed in the volume of lower levy drinks or no levy drinks. There was a step change in the proportion of drinks with non-sugar sweeteners at the implementation of the SDIL (+0.04, 95%CI: +0.02, +0.06). CONCLUSION: These results suggest that the SDIL was successful in [1] producing reductions in sugar levels that were maintained over the medium term up to March 2020 and [2] a reduction in product volume for higher tier drinks that may be diminishing over time. Our results also show that the SDIL was associated with a maintained price differential between high and low sugar drinks.


Assuntos
Bebidas Gaseificadas , Análise de Séries Temporais Interrompida , Bebidas Gaseificadas/economia , Reino Unido , Humanos , Comércio , Indústria Alimentícia/tendências
14.
Med Care ; 62(7): 449-457, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38848138

RESUMO

OBJECTIVE: The aim of this study was to explore heterogeneity in the cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with continuous positive airway pressure (CPAP) in children following extubation. DESIGN: Using data from the FIRST-line support for Assistance in Breathing in Children (FIRST-ABC) trial, we explore heterogeneity at the individual and subgroup levels using a causal forest approach, alongside a seemingly unrelated regression (SUR) approach for comparison. SETTINGS: FIRST-ABC is a noninferiority randomized controlled trial (ISRCTN60048867) including children in UK paediatric intensive care units, which compared HFNC with CPAP as the first-line mode of noninvasive respiratory support. PATIENTS: In the step-down FIRST-ABC, 600 children clinically assessed to require noninvasive respiratory support were randomly assigned to HFNC and CPAP groups with 1:1 treatment allocation ratio. In this analysis, 118 patients were excluded because they did not consent to accessing their medical records, did not consent to follow-up questionnaire or did not receive respiratory support. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study is the incremental net monetary benefit (INB) of HFNC compared with CPAP using a willingness-to-pay threshold of £20,000 per QALY gain. INB is calculated based on total costs and quality adjusted life years (QALYs) at 6 months. The findings suggest modest heterogeneity in cost-effectiveness of HFNC compared with CPAP at the subgroup level, while greater heterogeneity is detected at the individual level. CONCLUSIONS: The estimated overall INB of HFNC is smaller than the INB for patients with better baseline status suggesting that HFNC can be more cost-effective among less severely ill patients.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Análise Custo-Benefício , Aprendizado de Máquina , Humanos , Pressão Positiva Contínua nas Vias Aéreas/economia , Feminino , Masculino , Lactente , Reino Unido , Pré-Escolar , Unidades de Terapia Intensiva Pediátrica/economia , Cânula , Oxigenoterapia/economia , Oxigenoterapia/métodos , Anos de Vida Ajustados por Qualidade de Vida , Criança
15.
J Med Internet Res ; 26: e45469, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38848556

RESUMO

BACKGROUND: Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. OBJECTIVE: Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. METHODS: Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. RESULTS: For the entire sample (N=19,211), mean weight loss was -3.24% (SD 4.58%) at 3 months and -5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients' messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). CONCLUSIONS: Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design.


Assuntos
Aplicativos Móveis , Obesidade , Redução de Peso , Humanos , Estudos Retrospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Obesidade/terapia , Programas de Redução de Peso/métodos , Programas de Redução de Peso/estatística & dados numéricos , Alemanha , Reino Unido , Suíça
16.
17.
Br J Nurs ; 33(11): 481, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38850137
18.
Br J Nurs ; 33(11): 482, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38850136
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