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OBJECTIVE: There is a significant cardiac morbidity and mortality after endovascular aneurysm repair (EVAR). However, information about long-term risk of cardiac events after EVAR and potential predictors is lacking. Therefore, the aim of this study was to determine incidence and predictors of major adverse cardiac events (MACE) at 1 and 5 years after elective EVAR for infrarenal abdominal aortic aneurysms. METHODS: Baseline, perioperative, and postoperative information of 320 patients was evaluated. The primary outcome was the incidence of MACE after EVAR, which was defined as acute coronary syndrome, unstable angina pectoris, de novo atrial fibrillation, hospitalization for heart failure, mitral valve insufficiency, revascularization (including percutaneous coronary intervention and coronary artery bypass grafting), as well as cardiovascular and noncardiovascular death. Kaplan-Meier analyses were performed to determine incidences of MACE, MACE excluding noncardiovascular death and cardiac events by excluding noncardiovascular and vascular death from MACE. Predictors of MACE were identified using univariate and multivariate binary regression analysis. RESULTS: Through 1 and 5 years of follow-up after EVAR, freedom from MACE was 89.4% (standard error [SE], 0.018) and 59.8% (SE, 0.033), freedom from MACE excluding noncardiovascular death was 94.7% (SE, 0.013) and 77.5% (SE, 0.030) and freedom from cardiac events was 96.0% (SE, 0.011) and 79.1% (SE, 0.030), respectively. Predictors for MACE within 1 year were American Society of Anesthesiologists (ASA) score of III or IV (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.52-6.59) and larger abdominal aortic diameter (OR, 1.04; 95% CI, 1.01-1.08). A history of atrial fibrillation (OR, 0.14; 95% CI, 0.03-0.60) was a negative predictor factor. Predictors for MACE through 5 years were a history of heart failure (OR, 4.10; 95% CI 1.36-12.32) and valvular heart disease (OR, 2.31; 95% CI, 0.97-5.51), American Society of Anesthesiologists score of 3 or 4 (OR, 1.66; 95% CI, 0.96-2.88), and older age (OR, 1.04; 95% CI, 1.01-1.08). CONCLUSIONS: MACE is a common complication during the first 5 years after elective EVAR. Cardiac diseases at baseline are strong predictors for long-term MACE and potentially helpful in optimizing future postoperative long-term follow-up.
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Aneurisma da Aorta Abdominal , Fibrilação Atrial , Implante de Prótese Vascular , Procedimentos Endovasculares , Insuficiência Cardíaca , Humanos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Fibrilação Atrial/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Fatores de Tempo , Insuficiência Cardíaca/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Medição de RiscoRESUMO
BACKGROUND: Nurses' ability to apply evidence effectively in practice is a critical factor in delivering high-quality patient care. Evidence-based practice (EBP) is recognised as the gold standard for the delivery of safe and effective person-centred care. However, decades following its inception, nurses continue to encounter difficulties in implementing EBP and, although models for its implementation offer stepwise approaches, factors, such as the context of care and its mechanistic nature, act as barriers to effective and consistent implementation. It is, therefore, imperative to find a solution to the way evidence is applied in practice. Evidence-informed practice (EIP) has been mooted as an alternative to EBP, prompting debate as to which approach better enables the transfer of evidence into practice. Although there are several EBP models and educational interventions, research on the concept of EIP is limited. This article seeks to clarify the concept of EIP and provide an integrated systems-based model of EIP for the application of evidence in clinical nursing practice, by presenting the systems and processes of the EIP model. Two scenarios are used to demonstrate the factors and elements of the EIP model and define how it facilitates the application of evidence to practice. The EIP model provides a framework to deliver clinically effective care, and the ability to justify the processes used and the service provided by referring to reliable evidence.
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Estudantes de Enfermagem , Prática Clínica Baseada em Evidências , Humanos , Organizações , Qualidade da Assistência à Saúde , Inquéritos e QuestionáriosRESUMO
Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.
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Almoço , Açúcares , Criança , Dieta , Humanos , Refeições , Instituições Acadêmicas , LanchesRESUMO
BACKGROUND: In recent years, the availability of publicly available data related to public health has significantly increased. These data have substantial potential to develop public health policy; however, this requires meaningful and insightful analysis. Our aim is to demonstrate how data analysis techniques can be used to address the issues of data reduction, prediction and explanation using online available public health data, in order to provide a sound basis for informing public health policy. METHODS: Observational suicide prevention data were analysed from an existing online United Kingdom national public health database. Multi-collinearity analysis and principal-component analysis were used to reduce correlated data, followed by regression analyses for prediction and explanation of suicide. RESULTS: Multi-collinearity analysis was effective in reducing the indicator set of predictors by 30% and principal component analysis further reduced the set by 86%. Regression for prediction identified four significant indicator predictors of suicide behaviour (emergency hospital admissions for intentional self-harm, children leaving care, statutory homelessness and self-reported well-being/low happiness) and two main component predictors (relatedness dysfunction, and behavioural problems and mental illness). Regression for explanation identified significant moderation of a well-being predictor (low happiness) of suicide behaviour by a social factor (living alone), thereby supporting existing theory and providing insight beyond the results of regression for prediction. Two independent predictors capturing relatedness needs in social care service delivery were also identified. CONCLUSIONS: We demonstrate the effectiveness of regression techniques in the analysis of online public health data. Regression analysis for prediction and explanation can both be appropriate for public health data analysis for a better understanding of public health outcomes. It is therefore essential to clarify the aim of the analysis (prediction accuracy or theory development) as a basis for choosing the most appropriate model. We apply these techniques to the analysis of suicide data; however, we argue that the analysis presented in this study should be applied to datasets across public health in order to improve the quality of health policy recommendations.
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Política de Saúde , Saúde Pública/estatística & dados numéricos , Prevenção do Suicídio , Suicídio/estatística & dados numéricos , Humanos , Valor Preditivo dos Testes , Análise de Componente Principal , Análise de Regressão , Reino UnidoRESUMO
BACKGROUND: There is a lack of evidence-based quantitative clinical methods to adequately assess posture. Our team developed a clinical photographic posture assessment tool (CPPAT) and implemented this tool in clinical practice to standardize posture assessment. The objectives were to determine the level of acceptance of the CPPAT and to document predictors as well as facilitators of and barriers to the acceptance of this tool by clinicians doing posture re-education. METHODS: This is a prospective study focussing on technology acceptance. Thirty-two clinician participants (physical therapists and sport therapists) received a 3-5 h training workshop explaining how to use the CPPAT. Over a three-month trial, they recorded time-on-task for a complete posture evaluation (photo - and photo-processing). Subsequently, participants rated their acceptance of the tool and commented on facilitators and barriers of the clinical method. RESULTS: Twenty-three clinician participants completed the trial. They took 22 (mean) ± 10 min (SD) for photo acquisition and 36 min ± 19 min for photo-processing. Acceptance of the CPPAT was high. Perceived ease of use was an indirect predictor of intention to use, mediated by perceived usefulness. Analysis time was an indirect predictor, mediated by perceived usefulness, and a marginally significant direct predictor. Principal facilitators were objective measurements, visualization, utility, and ease of use. Barriers were time to do a complete analysis of posture, quality of human-computer interaction, non-automation of posture index calculation and photo transfer, and lack of versatility. CONCLUSION: The CPPAT is perceived as useful and easy to use by clinicians and may facilitate the quantitative analysis of posture. Adapting the user-interface and functionality to quantify posture may facilitate a wider adoption of the tool.
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Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Doenças Musculoesqueléticas/diagnóstico , Fotografação/normas , Fisioterapeutas/psicologia , Médicos/psicologia , Postura , Atitude Frente aos Computadores , Canadá , Europa (Continente) , Humanos , Interpretação de Imagem Assistida por Computador/normas , Doenças Musculoesqueléticas/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Fluxo de TrabalhoRESUMO
We present a case of an endovascular aneurysm repair for a Q-fever-infected acute abdominal aortic aneurysm with aortocaval fistula. Type 2 endoleak persisted after successful endovascular repair.
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Aneurisma Infectado/cirurgia , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Febre Q/microbiologia , Veias Cavas/cirurgia , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Angiografia Digital , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/microbiologia , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/microbiologia , Endoleak/diagnóstico , Humanos , Masculino , Flebografia/métodos , Febre Q/complicações , Febre Q/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veias Cavas/diagnóstico por imagem , Veias Cavas/microbiologiaRESUMO
According to the foundations of economic theory, agents have stable and coherent "global" preferences that guide their choices among alternatives. However, people are constrained by information-processing and memory limitations and hence have a propensity to avoid cognitive load. We propose that this in turn will encourage them to respond to "local" preferences and goals influenced by context and memory representations.
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Cognição , Modelos Psicológicos , Teoria da Probabilidade , Teoria Quântica , HumanosRESUMO
Postural and spinal deformities are major contributing factors to musculoskeletal (MSK) disorders. Posture screening and assessment can help to identify early morphological deformities, thereby preventing progression and reducing or correcting them with effective treatments. The study evaluates both intra- and inter-repeatability of using a mobile structured light sensor with a structured light pattern for building an accurate 3D human model and its use in postural screening. 16 young males (age: 25 ± 5.6 years, height: 172 ± 5.3 cm, mass: 69 ± 8.6 kg) participated without any musculoskeletal pain or pre-existing leg or spinal abnormalities. An iPad-based 3D mobile scanning tool, Structure SensorTM (2018 version), was used to capture the participants' back and whole-body shape. The collected data (3D model) were realigned and processed in the open-source software, Netfabb BasicTM (7.2 version). For each participant, five trained raters individually measured three trials of standing back and body posture on two separate occasions to calculate both intra- and inter-rater reliability. With the use of this software, nine postural variables and angular displacements were individually measured by the raters. The results indicated good to excellent intra-rater and good to moderate inter-rater reliability for measuring 78% (7 out of 9) of postural variables with an ICC ranging from 0.70 to 0.98. The remaining 22% of variables (2 out of 9; lateral pelvic tilt and right frontal knee angle) showed moderate to low inter- and intra-rater reliability, with ICCs ranging from 0.26 to 0.79.
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Introduction: For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors. Methods: A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible. Results: Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation). Discussion: These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.
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In a series of experiments, Kusev et al. (Journal of Experimental Psychology: Human Perception and Performance 37:1874-1886, 2011) studied relative-frequency judgments of items drawn from two distinct categories. The experiments showed that the judged frequencies of categories of sequentially encountered stimuli are affected by the properties of the experienced sequences. Specifically, a first-run effect was observed, whereby people overestimated the frequency of a given category when that category was the first repeated category to occur in the sequence. Here, we (1) interpret these findings as reflecting the operation of a judgment heuristic sensitive to sequential patterns, (2) present mathematical definitions of the sequences used in Kusev et al. (Journal of Experimental Psychology: Human Perception and Performance 37:1874-1886, 2011), and (3) present a mathematical formalization of the first-run effect-the judgments-relative-to-patterns model-to account for the judged frequencies of sequentially encountered stimuli. The model parameter w accounts for the effect of the length of the first run on frequency estimates, given the total sequence length. We fitted data from Kusev et al. (Journal of Experimental Psychology: Human Perception and Performance 37:1874-1886, 2011) to the model parameters, so that with increasing values of w, subsequent items in the first run have less influence on judgments. We see the role of the model as essential for advancing knowledge in the psychology of judgments, as well as in other disciplines, such as computer science, cognitive neuroscience, artificial intelligence, and human-computer interaction.
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Julgamento , Memória Episódica , Modelos Psicológicos , Resolução de Problemas , Discriminação Psicológica , Humanos , Reconhecimento Fisiológico de Modelo , Reprodutibilidade dos TestesRESUMO
Background: To produce graduates with strong knowledge and skills in the application of evidence into healthcare practice, it is imperative that all undergraduate health and social care students are taught, in an efficient manner, the processes involved in applying evidence into practice. The two main concepts that are linked to the application of evidence into practice are "evidence-based practice" and "evidence-informed practice." Globally, evidence-based practice is regarded as the gold standard for the provision of safe and effective healthcare. Despite the extensive awareness of evidence-based practice, healthcare practitioners continue to encounter difficulties in its implementation. This has generated an ongoing international debate as to whether evidence-based practice should be replaced with evidence-informed practice, and which of the two concepts better facilitate the effective and consistent application of evidence into healthcare practice. Objectives: The primary objective of this systematic review was to evaluate and synthesize literature on the effectiveness of evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior of undergraduate health and social care students toward the application of evidence into practice. Specifically, we planned to answer the following research questions: (1) Is there a difference (i.e., difference in content, outcome) between evidence-informed practice and evidence-based practice educational interventions? (2) Does participating in evidence-informed practice educational interventions relative to evidence-based practice educational interventions facilitate the application of evidence into practice (as measured by, e.g., self-reports on effective application of evidence into practice)? (3) Do both evidence-informed practice and evidence-based practice educational interventions targeted at undergraduate health and social care students influence patient outcomes (as measured by, e.g., reduced morbidity and mortality, absence of nosocomial infections)? (4) What factors affect the impact of evidence-informed practice and evidence-based practice educational interventions (as measured by, e.g., course content, mode of delivery, multifaceted interventions, standalone intervention)? Search Methods: We utilized a number of search strategies to identify published and unpublished studies: (1) Electronic databases: we searched Academic Search Complete, Academic search premier, AMED, Australian education index, British education index, Campbell systematic reviews, Canada bibliographic database (CBCA Education), CINAHL, Cochrane Library, Database of Abstracts of Reviews on Effectiveness, Dissertation Abstracts International, Education Abstracts, Education complete, Education full text: Wilson, ERIC, Evidence-based program database, JBI database of systematic reviews, Medline, PsycInfo, Pubmed, SciELO (Scientific Electronic Library Online), and Scopus; (2) A web search using search engines such as Google and Google scholar; (3) Grey literature search: we searched OpenGrey (System for Information on Grey Literature in Europe), System for information on Grey Literature, the Society for Research on Educational Effectiveness, and Virginia Henderson Global Nursing e-Repository; (4) Hand searching of journal articles; and (5) Tracking bibliographies of previously retrieved studies. The searches were conducted in June 2019. Selection Criteria: We planned to include both quantitative (including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies) and qualitative primary studies (including, case series, individual case reports, and descriptive cross-sectional studies, focus groups, and interviews, ethnography, phenomenology, and grounded theory), that evaluate and compare the effectiveness of any formal evidence-informed practice educational intervention to evidence-based practice educational intervention. The primary outcomes were evidence-informed practice and evidence-based practice knowledge, attitudes, understanding, and behavior. We planned to include, as participants, undergraduate pre-registration health and social care students from any geographical area. Data Collection and Analysis: Two authors independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full-text of selected articles. Discrepancies were resolved through discussion or consultation with a third author. We found no article eligible for inclusion in this review. Main Results: No studies were found which were eligible for inclusion in this review. We evaluated and excluded 46 full-text articles. This is because none of the 46 studies had evaluated and compared the effectiveness of evidence-informed practice educational interventions with evidence-based practice educational interventions. Out of the 46 articles, 45 had evaluated solely, the effectiveness of evidence-based practice educational interventions and 1 article was on evidence-informed practice educational intervention. Hence, these articles were excluded as they did not meet the inclusion criteria. Authors' Conclusions: There is an urgent need for primary studies evaluating the relative effectiveness of evidence-informed practice and evidence-based practice educational interventions targeted at improving undergraduate healthcare students' competencies regarding the application of evidence into practice. Such studies should be informed by current literature on the concepts (i.e., evidence-informed practice and evidence-based practice) to identify the differences, similarities, as well as appropriate content of the educational interventions. In this way, the actual effect of each of the concepts could be determined and their effectiveness compared.
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INTRODUCTION: Research indicates that both observed and imagined actions can be represented in the brain as two parallel sensorimotor representations. One proposal is that higher order cognitive processes would align these two hypothetical action simulations. METHODS: We investigated this hypothesis using an automatic imitation paradigm, with functional near-infrared spectroscopy recordings over the prefrontal cortex during different motor simulation states. On each trial, participants (n = 14) observed a picture of a rhythmical action (instructed action) followed by a distractor movie showing the same or different action. Participants then executed the instructed action. Distractor actions were manipulated to be fast or slow, and instructions were manipulated during distractor presentation: action observation (AO), combined action observation and motor imagery (AO+MI) and observe to imitate (intentional imitation). A pure motor imagery (MI) condition was also included. RESULTS: Kinematic analyses showed that although distractor speed effects were significant under all instructions (shorter mean cycle times in execution for fast compared to slow trials), this imitation bias was significantly stronger for combined AO+MI than both AO and MI, and stronger for intentional imitation than the other three automatic imitation conditions. In the left prefrontal cortex, cerebral oxygenation was significantly greater for combined AO+MI than all other instructions. Participants reported that their representation of the self overlapped with the observed model significantly more during AO+MI than AO. CONCLUSION: Left prefrontal activation may therefore be a neural signature of AO+MI, supporting attentional switching between concurrent representations of self (MI, top-down) and other (AO, bottom-up) to increase imitation and perceived closeness.
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Comportamento Imitativo , Córtex Pré-Frontal , Fenômenos Biomecânicos , Humanos , Imaginação/fisiologia , Comportamento Imitativo/fisiologia , Córtex Pré-Frontal/diagnóstico por imagemRESUMO
In preparation for unavoidable collisions, autonomous vehicle (AV) manufacturers could program their cars with utilitarian ethical algorithms that maximize the number of lives saved during a crash. However, recent research employing hypothetical AV crash scenarios reveals that people are not willing to purchase a utilitarian AV despite judging them to be morally appropriate (Bonnefon, Shariff, & Rahwan, 2016). This important result, indicating evidence for a social dilemma, has not yet been psychologically explored by behavioral scientists. In order to address the psychological underpinnings of this phenomenon, we developed and tested a novel theoretical proposal - perspective-taking accessibility (PT accessibility). Accordingly, we established that providing participants with access to both situational perspectives (AV buyers can be passengers or pedestrians) in crash scenarios, eliminated the behavioral inconsistency between their utilitarian judgments of moral appropriateness and non-utilitarian purchasing behavior. Moreover, our full PT accessibility induced respondents' utilitarian prosocial judgments and purchasing behavior (Experiments 1a and 1b) and consistent utilitarian preferences across judgment tasks (Experiment 2). Crucially, with full PT accessibility, participants' utilitarian purchasing behavior as well as their willingness to buy and ride utilitarian AVs were informed by their utilitarian moral judgments. Full PT accessibility provides the participants with even odds of being a pedestrian or passenger in crash scenarios, and thus impartiality. It could be argued that full PT accessibility is a new type of 'veil of ignorance', which is not based on purposely induced self-interest and uneven risk options (as in Huang, Greene, & Bazerman, 2019), but rather is based on even odds of being a passenger or pedestrian, and therefore with even 50/50 chance to die/live as passenger or pedestrian. Under these circumstances one can measure utilitarian preferences.
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Julgamento , Princípios Morais , Comportamento do Consumidor , Teoria Ética , Humanos , ProbabilidadeRESUMO
BACKGROUND: Late diagnosis of HIV, hepatitis B (HBV) and hepatitis C (HCV) remains relatively common in the UK and many people who present late have missed opportunities for testing in primary care. The objective was to assess the effectiveness and acceptance of a prototype application (BBV_TP1), embedded in a primary care electronic health record (EHR), to increase real-time blood-borne virus (BBV) testing. METHODS: This prospective cohort study assessed BBV_TP1 in 14 general practices in North East England, in comparison with 54 similar practices in 2019. Rates of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) testing in practices were measured before and after the application was activated. Patient and clinician acceptance of the technology was assessed by surveys. RESULTS: In the 6 months following the intervention, HIV testing rates increased 555% and combined HBV/HCV testing rates increased 362%. No significant differences were observed for any BBV testing rates in the nonintervention practices over the same period. Monthly testing rates declined towards baseline after initial increases. Clinician's perceptions of the prompt system were positive, with average additional time required for BBV test discussion in consultations estimated at 2âmin. The patient survey also showed high acceptance of the technology. CONCLUSION: This pilot study demonstrated that BBV_TP1 increased BBV testing rates in primary care via targeted screening, although testing rates subsequently fell whilst the application remained active. Such systems can potentially reduce late diagnoses, while having high acceptance by clinicians and patients. Larger studies with longer follow-up are needed to demonstrate efficacy and cost-effectiveness.
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Infecções por HIV , Hepatite B , Hepatite C , Registros Eletrônicos de Saúde , Infecções por HIV/diagnóstico , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Humanos , Programas de Rastreamento , Projetos Piloto , Atenção Primária à Saúde , Estudos ProspectivosRESUMO
Offering lower-energy food swaps to customers of online supermarkets could help to decrease energy (kcal) purchased and consumed. However, acceptance rates of such food swaps tend to be low. This study aimed to see whether framing lower-energy food swaps in terms of cost savings or social norms could improve likelihood of acceptance relative to framing swaps in terms of health benefits. Participants (n = 900) were asked to shop from a 12-item shopping list in a simulation online supermarket. When a target high-energy food was identified in the shopping basket at check-out, one or two lower-energy foods would be suggested as an alternative (a "swap"). Participants were randomised to only see messages emphasising health benefits (fewer calories), cost benefits (lower price) or social norms (others preferred this product). Data were analysed for 713 participants after exclusions. Participants were offered a mean of 3.17 swaps (SD = 1.50), and 12.91% of swaps were accepted (health = 14.31%, cost = 11.49%, social norms = 13.18%). Swap acceptance was not influenced by the specific swap frame used (all p > .170). Age was significantly and positively associated with swap acceptance (b = 0.02, SE = 0.00, p < .001), but was also associated with smaller decreases in energy change (b = 0.46, SE = .19, p = .014). Overall, offering swaps reduced both energy (kcal) per product (b = -9.69, SE = 4.07, p = .017) and energy (kcal) per shopping basket (t712 = 11.09, p < .001) from pre- to post-intervention. Offering lower-energy food swaps could be a successful strategy for reducing energy purchased by customers of online supermarkets. Future research should explore alternative solutions for increasing acceptance rates of such swaps.
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Comportamento de Escolha , Comportamento do Consumidor/economia , Ingestão de Energia , Abastecimento de Alimentos/economia , Normas Sociais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Adulto JovemAssuntos
Músculos Abdominais/fisiologia , Colite/fisiopatologia , Procedimentos Endovasculares/instrumentação , Artéria Mesentérica Superior , Isquemia Mesentérica/terapia , Contração Muscular , Falha de Prótese , Doenças do Colo Sigmoide/fisiopatologia , Stents , Idoso , Colite/complicações , Colite/diagnóstico , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The primary aim of the current study was to test the effect of the presentation design of a test alert system on healthcare workers' (HCWs') decision-making regarding blood-borne virus (BBV) testing. The secondary aim was to determine HCWs' acceptance of the system. An online survey used a within-subjects research design with four design factors as independent variables. The dependent variable was clinical decision. Ten realistic descriptions of hypothetical patients were presented to participants who were asked to decide whether to request BBV testing. The effect of a pre-set course of action to request BBV testing was significant when additional information (cost-effectiveness, date of last BBV test or risk assessment) was not presented, with a 16% increase from 30 to 46% accept decisions. When risk assessment information was presented without a pre-set course of action, the effects of cost-effectiveness (27% increase) and last test date (23% decrease) were significant. The main reason for declining to test was insufficient risk. HCWs' acceptance of the test alert system was high and resistance was low. We make recommendations from the results for the design of a subsequent real-world trial of the test alert system.
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Infecções Transmitidas por Sangue , Tomada de Decisões , Eletrônica , Pessoal de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Medição de Risco/métodos , Adulto , Infecções Transmitidas por Sangue/diagnóstico , Infecções Transmitidas por Sangue/prevenção & controle , Patógenos Transmitidos pelo Sangue , Feminino , Humanos , Masculino , Viroses/prevenção & controle , Viroses/transmissãoRESUMO
Understanding human behavior from the perspective of normative and descriptive theories depends on human agents having stable and coherent decision-making preferences. Both utility theory (expected rational behavior; von Neumann & Morgenstern, 1947) and prospect theory, with its certainty equivalent (CE) method (expected irrational behavior; Tversky & Kahneman, 1992), assume stable behavioral patterns of risk preferences. In contrast, our research pursues the opposite proposal: Human preferences (rational or irrational) are not stable; variations in the decision context during risk elicitation determine people's preferences even when the utilities of choice options are available. Accordingly, we found evidence that decision makers reverse their risk preferences between CE tasks with logarithmically spaced certainty (unequal number of risk-averse and risk-seeking sure options) and linearly spaced certainty (equal number of risk-averse and risk-seeking sure options). The results revealed that the effect of probability range (low and high) on preferences, predicted by prospect theory, is an artifact of the logarithmically spaced sure options. When the sure options were linearly spaced, the probability range no longer influenced risk preferences, indicating a preference reversal between decision tasks. Our findings highlight a need to investigate how the predictions of descriptive decision-making theories are shaped by their risk elicitation methods. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Assuntos
Tomada de Decisões/fisiologia , Assunção de Riscos , Adulto , Comportamento de Escolha/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , ProbabilidadeRESUMO
BACKGROUND: Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate. METHODS: Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions. RESULTS: The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups. CONCLUSION: Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).