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1.
BMC Cancer ; 23(1): 271, 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-36964485

RESUMO

OBJECTIVES: To evaluate the effectiveness of an innovative supervised exercise programme to mitigate the loss of lean body mass, functional capacity and quality of life in people with head and neck cancer, as well as to identify the optimal moment to apply it, before or after radiotherapy treatment, compared with the prescription of a physical activity plan carried out autonomously. METHODS: Patients with squamous cell carcinoma of the head and neck (n = 144), treated with radiotherapy, will be randomly assigned to one of 3 comparison groups: pre-radiotherapy supervised exercise, post-radiotherapy supervised exercise and autonomous exercise, stratifying by human papillomavirus infection and previous surgery. The exercise programme will be carried out in 36 sessions over 12 weeks, combining moderate and high intensity strength and aerobic exercises. The main outcome variable is the change in lean body mass at 6 months measured by bioimpedance, while secondary variables are functional capacity, symptoms, quality of life and adverse effects. Longitudinal generalised mixed models will be used for the analyses of the repeated measurements at 3, 6, and 12 months after baseline. CONCLUSIONS: The pilot study supports the feasibility and safety of the project. However, as the programme progressed, attendance at the sessions decreased. Strategies will be necessary for increasing attendance, as well as involving the patient in their recovery and other incentives. Follow-up after treatment to assess acute/late toxicity will enable us to know the response to both the exercise programme and its adherence. TRIAL REGISTRATION: NCT04658706 Date and version identifier: March 1, 2023. Version 1.1.


Assuntos
Terapia por Exercício , Neoplasias de Cabeça e Pescoço , Humanos , Terapia por Exercício/métodos , Qualidade de Vida , Projetos Piloto , Exercício Físico , Neoplasias de Cabeça e Pescoço/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Br J Gen Pract ; 51(464): 182-6, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11255898

RESUMO

BACKGROUND: Somatisation disorder is an underdiagnosed and difficult problem for family physicians. Early diagnosis of somatisers is a very important factor in improving health outcomes. AIM: To assess the validity of the Othmer and DeSouza test (a seven-item questionnaire) used by general practitioners as a screening instrument for the diagnosis of somatisation disorder in primary care. DESIGN OF STUDY: A cross-sectional study of patients presenting with unexplained multiple chronic physical symptoms. SETTING: A total of 149 patients were selected for the study by 29 family physicians in the primary health care centres of the Basque Health Service in the metropolitan area of Bilbao, Bizkaia, Spain. METHODS: Participating patients completed the Othmer and DeSouza test, carried out by family physicians. Their answers were compared with the results of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). This psychiatric interview was administered blind to 144 patients by trained psychiatrists. RESULTS: A total of 19% of patients were diagnosed as having somatisation disorder by the SCAN psychiatric interview. The discriminating capacity of the Othmer and DeSouza test for all possible screening thresholds (> or = 1, > or = 2, ... > or = 6 symptoms) was very low and positive predictive values ranged between 19% and 33%. With respect to negative predictive values, even in the absence of affirmative responses to all seven questions, the pretest probability of being a non-somatiser case remained unchanged. CONCLUSION: Our data indicate that the Othmer and DeSouza test does not present clinically useful predictive values in primary care patients with suggestive symptoms of somatisation disorder.


Assuntos
Programas de Rastreamento/normas , Transtornos Somatoformes/diagnóstico , Adulto , Doença Crônica , Estudos Transversais , Medicina de Família e Comunidade , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
3.
Br J Gen Pract ; 50(459): 803-7, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11127170

RESUMO

BACKGROUND: Smoking cessation clinical practice guidelines are based on randomised clinical trials reporting outcomes in persons who participate in these studies. However, many practitioners are sceptical about the effectiveness of these recommendations when applied to the general population in everyday routine consultation. AIM: To evaluate the results of a comprehensive smoking cessation programme in routine primary care practice. METHOD: All smokers consulting in 10 general practices during one year participated in a non-randomised controlled trial. The percentages of subjects in the intervention (n = 1203, seven practices) and control (n = 565, three practices) groups who reported sustained abstinence between six and 12 months follow-up and were validated biochemically were compared. The effect of the programme was adjusted to baseline differences in both groups by multiple logistic regression analyses. RESULTS: The programme resulted in an increase of five percentage points (95% CI = 3.1%-6.8%) in the validated and sustained one-year abstinence probability, with 7.1% for all of the intervention practices (adjusted OR = 3.7, 95% CI = 2.4-5.7). CONCLUSION: Programmes that combine advice to stop smoking to all smokers attending general practices with the offering of support, follow-up, and nicotine patches to those willing to stop are feasible and effective in routine practice, as primary care clinicians need only identify 20 smokers to get one additional success attributable to the programme.


Assuntos
Abandono do Hábito de Fumar/estatística & dados numéricos , Administração Cutânea , Adolescente , Adulto , Idoso , Algoritmos , Medicina Baseada em Evidências , Medicina de Família e Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nicotina/administração & dosagem , Nicotina/agonistas , Avaliação de Programas e Projetos de Saúde , Abandono do Hábito de Fumar/métodos , Fatores Socioeconômicos
4.
Br J Gen Pract ; 48(437): 1824-7, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10198500

RESUMO

BACKGROUND: Frequent attendance, which accounts for a high proportion of the general practitioner's (GP's) workload, is still poorly understood. AIM: To assess the association and impact of exposure to chronic physical illness, mental disorders, life stress, and sociodemographic factors on the frequent attendance of primary health care medical services. METHOD: Nine general practices in Bizkaia, Spain, participated in a case-control study. Cases were patients who exceeded the 90th percentile in the distribution of the number of visits that they made on their own initiative from January 1993 to March 1994. Controls were those for whom a single, patient-initiated consultation was registered. A total of 102 cases and 100 controls were selected by stratified sampling proportional to the size of each practice. We estimated odds ratios and population attributable fractions for frequent attendance in relation to being exposed to the study variables, adjusted by demographic characteristics by means of logistic regression analysis. RESULTS: Medium-high life stress (adjusted odds ratio (AOR) = 4.5, 95% confidence interval (CI) = 1.7-12.8), chronic physical illness (AOR = 3.1; 95% CI = 1.4-6.9), mental disorder (AOR = 2.5; 95% CI = 1.3-5.1), and age were associated with patient-initiated frequent attendance. The adjusted population attributable fraction for chronic physical illness was 41%, 30.9% for mental disorder, and 15.2% for life stress. CONCLUSION: There is evidence that patient-initiated frequent attendance is related to genuine physical and psychosocial needs; therefore, recognition requires a bio-psychosocial approach on the part of GP.


Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Fatores Socioeconômicos , Espanha , Estresse Psicológico/terapia
5.
Actas Urol Esp ; 27(7): 513-6, 2003.
Artigo em Espanhol | MEDLINE | ID: mdl-12938580

RESUMO

BACKGROUND: To evaluate the effect of a humidity detector device on the quality of life of patients with urinary incontinence IU. METHOD: Quasi-experimental study: a series of ten cases followed for a month. The devices were placed and the questionnaires filled in before and after using it for at least ten hours a day during a month. Health related quality of life was assessed through the questionnaires for IU convalidated and adapted to our specific environment: Urogenital Inventory Distress (UDI) and Incontinence Impact Questionary (IIQ). An improvement of 58 points by a four option Likert scale was considered a positive impact in the quality of life (IIQ). The scores obtained in UDI and IIQ are described before and after use the device and paried T test and Wilcoxon sign test were carried out to compare the scores obtained in each instance. The capacity to detect a difference of 58 points on the UDI scale was calculated (minimum relevant difference). A binomial test was undertaken to ascertain a probability of achieving an increase in the above mentioned index which would exceed the clinical relevance threshold. RESULTS: Average increase in IIQ improvement: x = 5.48 (Std Error = 20.43) 95% CI = -34.56 to 45.56. Average increase in UDI improvement: x = -11.87 (Std Error = 20.70) 95% IC = -52.45 to 28.70. The power of the analysis to detect as relevant a difference of a 588 point increase in IIQ 71.1% and probability of obtaining a relevant improvement in the questionnaire IIQ 10% (IC 95%) 0% to 39.4%. CONCLUSIONS: A negative impact in the Quality of Life due to frequent changes of incontinence pads.


Assuntos
Qualidade de Vida , Tecnologia Assistiva , Incontinência Urinária/terapia , Humanos , Umidade , Tampões Absorventes para a Incontinência Urinária , Satisfação do Paciente , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia
6.
Eur Psychiatry ; 26(7): 428-35, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21306876

RESUMO

OBJECTIVES: To describe and compare the prevalence of mental disorders across primary care populations, and estimate their impact on quality of life. METHODS: Cross-sectional multilevel analysis of a systematic sample of 2539 attendees to eight primary care centres in different regions of Spain, assessed with the WHO Composite International Diagnostic Interview (CIDI 1.1), the Short Form Health Survey (SF-36) quality of life questionnaire and the SF-6D utility index. RESULTS: The 12-month prevalence of any mental disorder was 23% (95% confidence interval: 21-24%), 10% had mood, 9% anxiety, 5% organic, 4% somatoform, and 1% alcohol use disorders, with a significant between-centre variability (P<0.001). People with mental disorders had one standard deviation lower mental quality of life than the general population. We estimated that 1831 quality-adjusted life-years (QALYs) are lost annually per 100,000 patients due to mental disorders, without considering mortality. Mood disorders have the worst impact with an annual loss of 1124 QALYs per 100,000 patients, excluding mortality (95% confidence interval: 912-1351). CONCLUSIONS: Prevalence rates were similar to those obtained in international studies using the same diagnostic instrument and, given the significant between-centre variability found, it is recommended that mental health statistics be considered at small area level. Mental disorders, and especially mood disorders, are associated with very poor quality of life and higher scores on disability indexes than other common chronic conditions.


Assuntos
Efeitos Psicossociais da Doença , Transtornos Mentais , Atenção Primária à Saúde/estatística & dados numéricos , Perfil de Impacto da Doença , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Entrevista Psicológica , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Prevalência , Qualidade de Vida/psicologia , Fatores Sexuais , Fatores Socioeconômicos , Espanha , Inquéritos e Questionários
8.
Actas Esp Psiquiatr ; 31(4): 171-6, 2003.
Artigo em Espanhol | MEDLINE | ID: mdl-12838439

RESUMO

INTRODUCTION: The user's satisfaction with the health services is an area of increasing interest. Usually the relation between satisfaction and expectations is not taken into account. The objective [corrected] of this paper is to describe the user's expectations, before treatment, in an out patient Mental Health Center and to investigate their satisfaction with the service adjusted by these expectations. METHODS: During six months all patients attending an outpatient mental health center of the Basque Public Health Service, are interviewed (n=315). The survey included the basic sociodemographic variables, one questionnaire of expectations and another one of clinical symptomatology (SCL-90-R). The patients were reviewed six months later by a new SCL-90-R and a questionnaire on satisfaction (CSQ-8). In order to select the factors which gathered the most important expectations, an analysis of principal components was made. A model, incluiding the best variables to explain satisfaction with the service, was adjusted by means of multiple linear regression, taking the expectations into account. RESULTS: Expectations on psychological explorations and interventions were greater than those on biological characteristics. Three factors called <>, <> and <> explained 10 % of the variance. For each increasing point in the initial SCL-90-R, the index of satisfaction decreased 0.02. For each point added to symptomatic recovery, the same index rose in 0.03. CONCLUSIONS: Satisfaction with the service was associated with less severity in initial psychopathology, symptomatic recovery and biological expectations. The psychological expectations were associated with less satisfaction.


Assuntos
Atitude Frente a Saúde , Centros Comunitários de Saúde Mental/normas , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Área Programática de Saúde , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Espanha/epidemiologia , Inquéritos e Questionários
9.
Gac Sanit ; 15(4): 312-9, 2001.
Artigo em Espanhol | MEDLINE | ID: mdl-11578560

RESUMO

OBJECTIVE: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? METHODS: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. RESULTS: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1). CONCLUSIONS: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.


Assuntos
Abandono do Hábito de Fumar , Fumar/terapia , Adulto , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
10.
Am Rev Respir Dis ; 148(1): 6-9, 1993 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8317816

RESUMO

We conducted a proportional morbidity study to determine the factors associated with, patterns of, and proportion of cases of tuberculosis with drug resistance in Puerto Rico. We abstracted data from 279 report forms of new cases of tuberculoses reported to the Puerto Rico Health Department between 1987 and 1990 in which isolates had been tested for drug susceptibility. Overall, 55 (19.7%) of the 279 cases of tuberculosis were resistant to at least one drug, and 27 (9.7%) were resistant to more than one drug. Among the 59 patients with previous tuberculosis therapy, 20 (33.9%) had isolates that were drug-resistant. Among the 220 without previous therapy, 35 (15.9%) had isolates that were drug-resistant. For all 279, resistance to isoniazid (INH) was most common (11.1%) followed by streptomycin (SM) (10%), rifampin (RIF) (4.3%), ethambutol (EMB) (2.2%), and pyrazidimide (PZA) (1.1%). A history of previous tuberculosis therapy (odds ratio [OR] = 2.71, 95% confidence interval [CI] = 1.34-5.48) and being born outside the United States and Puerto Rico (OR = 4.76, CI = 1.69-13.39) were independently associated with drug resistance. Because of the high proportion of drug-resistant tuberculosis in Puerto Rico we recommend (1) that all persons in Puerto Rico in whom tuberculosis is diagnosed should initially receive four-drug therapy (INH, RIF, EMB, and PZA), (2) that susceptibility testing be done on initial Mycobacterium tuberculosis isolates from all patients, and (3) that those with a history of previous tuberculosis therapy or those who are foreign-born have very careful clinical and microbiologic follow-up.


Assuntos
Antituberculosos/antagonistas & inibidores , Tuberculose Pulmonar/epidemiologia , Distribuição de Qui-Quadrado , Intervalos de Confiança , Resistência Microbiana a Medicamentos , Quimioterapia Combinada , Humanos , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Mycobacterium tuberculosis/efeitos dos fármacos , Razão de Chances , Prevalência , Porto Rico/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia
11.
Aten Primaria ; 32(8): 475-80, 2003 Nov 15.
Artigo em Espanhol | MEDLINE | ID: mdl-14636505

RESUMO

OBJECTIVE: To evaluate the effectiveness of an innovative programme to promote physical activity (PEPAF) introduced into the daily consultations of the family doctor. DESIGN: Clinical trial with control, randomised for groups of 100 patients seen by one of the 70 doctors taking part, allocated to two parallel groups and monitored for 24 months.Setting. 13 primary care centres coordinated through the Network of Research into Preventive and Health Promotion Activities conducted in primary care. PARTICIPANTS: Sample with probability of 7000 sedentary patients, selected from among those who consulted for any reason their family doctor during the third quarter of 2003. Patients with cardiovascular disease or other problems meaning that exercise could cause adverse effects will be excluded. INTERVENTIONS: The doctors allocated to the PEPAF will design a plan of physical activity with those patients prepared to make the change. Those not prepared to will be briefly counselled and given material to help them. All will be monitored at random. The control group doctors will postpone any systematic intervention on exercise until after 2005, excepting those patients whose health problem is directly related to a sedentary life-style. MEASUREMENTS: The main measurement of results will be the increase in the level of physical activity from the base measurement to those at 3, 6, 12 and 24 months, using 7-day physical activity recall. Health-related quality of life (SF 36) and physical fitness will also be measured. Variables that might be predictive or confusing, such as sex, age, comorbidity, social class, etc., will be considered. Analysis. The average changes observed in the two groups will be compared, on the basis of intention to treat, through analysis of covariance. We will use mixed-effect models able to cover the intra-patient, intra-doctor and intra-centre correlation.


Assuntos
Exercício Físico , Promoção da Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Humanos
12.
Aten Primaria ; 29(9): 558-61, 2002 May 31.
Artigo em Espanhol | MEDLINE | ID: mdl-12061987

RESUMO

OBJECTIVE: To explore the feasibility of a brief psychosocial intervention for somatizing patients in the Primary Care setting and its potential effects on these patients' quality of life. DESIGN: Prospective series of 12 cases, with pre and post-intervention analyses.Setting. Three general practices of the Basque Health Service. PATIENTS: Consecutive sample of 12 patients, between 18 and 65 years-old, complaining about at least six medically unexplained symptoms for female patients or at least four for male patients. Intervention and measurement. DEPENAS intervention was carried out: Detection- Explanation-Plan-Exploration- Normalization-Action-Follow-up. Differences between before- and after-intervention health-related quality of life (SF-36) were compared and group interviews were held with the three collaborator general practitioners. RESULTS: Overall quality of life improvement was estimated in 8 points (SD, 13.4; P =.073). Intra-GP correlation coefficients, necessary for estimate the size of the clinical trial, were null for five scales, and 0.058, 0.098 and 0.28 for the other three scales. Group interviews showed that DEPENAS bio-psycho-social intervention is acceptable for general practitioners and that there was a high risk of contamination when the same doctor simultaneously treated some patients and not others. CONCLUSIONS: The improvement seen after the intervention, although not totally attributable to it due to the lack of a control group, justify the need of conducting a clinical controlled trial randomised by GPs to avoid contamination.


Assuntos
Atenção Primária à Saúde , Transtornos Somatoformes/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Psicoterapia Breve , Qualidade de Vida , Análise de Regressão , Transtornos Somatoformes/diagnóstico
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