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Moimaz, Suzely Adas Saliba
Texto completo SciELO Brasil
[PMID]:29267676
[Au] Autor:Bordin D; Fadel CB; Santos CBD; Garbin CAS; Moimaz SAS; Saliba NA
[Ad] Endereço:Universidade Estadual Paulista "Júlio de Mesquita Filho" - Unesp, Araçatuba School of Dentistry, Department of Pediatric and Social Dentistry, Araçatuba, SP, Brazil.
[Ti] Título:Determinants of oral self-care in the Brazilian adult population: a national cross-sectional study.
[So] Source:Braz Oral Res;31:e115, 2017 Dec 18.
[Is] ISSN:1807-3107
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:This study aims to investigate variables related to adherence to oral self-care in the Brazilian adult population. It is an exploratory study, using secondary data from a population-based survey on a representative sample of the adult population of the entire Brazilian territory (n=60202). The sample was selected using a multiple stage approach. The oral self-care indicator was defined by grouping the variables: periodicity of dentist appointments, use of dental floss, toothbrush and toothpaste, frequency of brushing and replacement of the toothbrush. The scores obtained from the indicator were categorized into adequate, partially adequate, and inadequate care. Statistical analysis consisted of dimensionality reduction, and oral self-care-related variables were submitted to logistic regression. The variables mostly related to inadequate or partially adequate oral self-care were: illiteracy (OR = 11.20, OR = 4.81), low educational level (OR = 3.50, OR = 1.96), negative oral health self-concept (OR=3.73, OR=1.74), absence of natural teeth (OR = 4.98, OR=2.60), edentulous lower arch (OR = 3.09; _____), number of missing upper teeth (OR=1.14, OR=1.05), absence of health insurance (OR=2.23, OR=2.07), sedentary lifestyle (OR=2.77, OR=1.51), and smoking (OR=2.18, OR=1.40). It was concluded that the individual's level of education is one of the main factors for adherence to adequate oral self-care, followed by level of oral health self-concept and tooth loss. Likewise, lifestyle also bears a significant influence.
[Mh] Termos MeSH primário: Inquéritos de Saúde Bucal/estatística & dados numéricos
Saúde Bucal/estatística & dados numéricos
Cooperação do Paciente/estatística & dados numéricos
Autocuidado/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Brasil
Estudos Transversais
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Masculino
Meia-Idade
Fatores Sexuais
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:28746168
[Au] Autor:Pittalis S; Orchi N; De Carli G; Navarra A; Chiaradia G; Puro V; Girardi E
[Ad] Endereço:*Clinical Epidemiology Unit, National Institute for Infectious Disease "L. Spallanzani"-IRCCS, Rome, Italy †Infectious Disease Epidemiology Unit, AIDS Reference Centre, National Institute for Infectious Disease "L. Spallanzani"-IRCCS, Rome, Italy.
[Ti] Título:HIV Self-Testing in Italy.
[So] Source:J Acquir Immune Defic Syndr;76(3):e84-e85, 2017 11 01.
[Is] ISSN:1944-7884
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Sorodiagnóstico da AIDS
Infecções por HIV/diagnóstico
Acesso aos Serviços de Saúde/estatística & dados numéricos
Kit de Reagentes para Diagnóstico/utilização
Autocuidado
[Mh] Termos MeSH secundário: Sorodiagnóstico da AIDS/utilização
Adulto
Aconselhamento Diretivo
Infecções por HIV/epidemiologia
Conhecimentos, Atitudes e Prática em Saúde
Promoção da Saúde
Homossexualidade Masculina
Seres Humanos
Itália/epidemiologia
Masculino
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:LETTER; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Reagent Kits, Diagnostic)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1097/QAI.0000000000001507


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[PMID]:28468749
[Au] Autor:Farmer A; Williams V; Velardo C; Shah SA; Yu LM; Rutter H; Jones L; Williams N; Heneghan C; Price J; Hardinge M; Tarassenko L
[Ad] Endereço:Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
[Ti] Título:Self-Management Support Using a Digital Health System Compared With Usual Care for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.
[So] Source:J Med Internet Res;19(5):e144, 2017 May 03.
[Is] ISSN:1438-8871
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We conducted a randomized controlled trial of a digital health system supporting clinical care through monitoring and self-management support in community-based patients with moderate to very severe chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to determine the efficacy of a fully automated Internet-linked, tablet computer-based system of monitoring and self-management support (EDGE' sElf-management anD support proGrammE) in improving quality of life and clinical outcomes. METHODS: We compared daily use of EDGE with usual care for 12 months. The primary outcome was COPD-specific health status measured with the St George's Respiratory Questionnaire for COPD (SGRQ-C). RESULTS: A total of 166 patients were randomized (110 EDGE, 56 usual care). All patients were included in an intention to treat analysis. The estimated difference in SGRQ-C at 12 months (EDGE-usual care) was -1.7 with a 95% CI of -6.6 to 3.2 (P=.49). The relative risk of hospital admission for EDGE was 0.83 (0.56-1.24, P=.37) compared with usual care. Generic health status (EQ-5D, EuroQol 5-Dimension Questionnaire) between the groups differed significantly with better health status for the EDGE group (0.076, 95% CI 0.008-0.14, P=.03). The median number of visits to general practitioners for EDGE versus usual care were 4 versus 5.5 (P=.06) and to practice nurses were 1.5 versus 2.5 (P=.03), respectively. CONCLUSIONS: The EDGE clinical trial does not provide evidence for an effect on COPD-specific health status in comparison with usual care, despite uptake of the intervention. However, there appears to be an overall benefit in generic health status; and the effect sizes for improved depression score, reductions in hospital admissions, and general practice visits warrants further evaluation and could make an important contribution to supporting people with COPD. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 40367841; http://www.isrctn.com/ISRCTN40367841 (Archived by WebCite at http://www.webcitation.org/6pmfIJ9KK).
[Mh] Termos MeSH primário: Doença Pulmonar Obstrutiva Crônica/terapia
Autocuidado/métodos
[Mh] Termos MeSH secundário: Idoso
Feminino
Nível de Saúde
Seres Humanos
Masculino
Qualidade de Vida
Inquéritos e Questionários
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.2196/jmir.7116


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[PMID]:28747158
[Au] Autor:Iwaya T; Doi T; Seichi A; Hoshino Y; Ogata T; Akai M
[Ad] Endereço:Nagano University of Health and Medicine, 11-1 Imaihara Kawanajima-chou Nagano-shi, Nagano, 381-2227, Japan.
[Ti] Título:Characteristics of disability in activity of daily living in elderly people associated with locomotive disorders.
[So] Source:BMC Geriatr;17(1):165, 2017 Jul 26.
[Is] ISSN:1471-2318
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ageing is associated with a decline of motor function and ability to perform daily activities. Locomotive disorders are one of the major disorders resulting in adverse health condition in elderly people. Concept of Locomotive syndrome (LoS) was proposed to tackle the problems and prolong healthy life expectancy of people with locomotive disorders. To develop intervention strategy for LoS it is mandatory to investigate impairments, functional disabilities which people with locomotive disorder experience and to examine relationships among these parameters. For this purpose we have developed Geriatric Locomotive Function Scale-25 (GLFS-25). Though several physical performance tests were reported for identification or monitoring the severity of LoS, there are few studies reported on characteristics of disability which people with locomotive disorders experience. The aim of this study was to report the characteristics of ADL disabilities in elderly people with locomotive disorders in terms of numbers and degree of activity limitations. METHODS: We organized a cohort study and recruited 314 participants aged 65 years and over from five orthopedic clinics or nursing care facilities. This was a cross-sectional study to use the baseline data of such cohort. ADL disabilities were assessed using GLFS-25 scale arranging the GLFS-25 scores in ordinal levels using "R language" program. Numbers and degrees of activity limitations were determined and compared among the levels. Frequency of limitation in activities regarding social activity, housework, locomotion, mobility and self-care was compared among across the disability level. RESULTS: The GLFS-25 score was mathematically categorized into 7 levels. The number of activity limitations and the degrees of each activity limitation were significantly greater in high GLFS-25 levels than in low levels. Difficulties in mobility appeared in less severe level, difficulties in domestic and social life appeared in moderately severe level, and difficulties in self-care appeared in advanced level. CONCLUSIONS: High GLFS-25 score represented high degree of disability on ADLs. Concordant increase of numbers of activity limitation and severity progression in activity limitation may contribute to progression of disability. Activity limitation may occur in the following order: sports activity, walking, transferring, and self-care.
[Mh] Termos MeSH primário: Atividades Cotidianas
Avaliação da Deficiência
Avaliação Geriátrica
Locomoção
Limitação da Mobilidade
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Qualidade de Vida
Autocuidado
Síndrome
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1186/s12877-017-0543-z


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[PMID]:29489652
[Au] Autor:Cho HJ; Hong TH; Kim M
[Ad] Endereço:Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
[Ti] Título:Physical and nutrition statuses of geriatric patients after trauma-related hospitalization: Data from the Korean National Health and Nutrition Examination Survey 2013-2015.
[So] Source:Medicine (Baltimore);97(9):e0034, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Population aging is associated with increasing numbers of geriatric trauma patients, and various studies have evaluated their short-term outcomes, assessment, and treatment. However, there is insufficient information regarding their long-term outcomes. This study evaluated the physical and nutritional statuses of geriatric patients after trauma-related hospitalization.Data regarding physical and nutritional status were obtained from the Korean National Health and Nutrition Examination Survey VI (2013-2015).A total of 21,069 individuals participated in the survey, including 5650 geriatric individuals. After excluding individuals with missing data, 3731 cases were included in the analyses. The average age was 68 years, and most individuals were women (n = 2055, 55.08%). There were 94 patients had been hospitalized because of trauma. Trauma-related hospitalization among geriatric patients was significantly associated with reduced strength exercise (23.56% vs 12.99%, P = .043), activity limitations caused by joint pain (0.65% vs 3.31%, P = .028), self-care problems (8.00% vs 16.77%, P = .008), pain or discomfort (29.48% vs 40.51%, P = .024), hypercholesterolemia (27.37% vs 39.36%, P = .037), and mastication discomfort (39.98% vs 57.85% P = .005). The adjusted analyses revealed that trauma-related hospitalization was independently associated with activity limitations caused by joint pain (odds ratio [OR]: 5.04, 95% confidence interval [CI]: 1.29-19.67, P = .020), self-care problems (OR: 2.24, 95% CI: 1.11-4.53, P = .025), pain or discomfort (OR: 1.77, 95% CI: 1.08-2.89, P = .023), and mastication discomfort (OR: 2.06, 95% CI: 1.22-3.46, P = .007).Medical staff should be aware that geriatric patients have relatively poor physical and nutritional statuses after trauma-related hospitalization, and manage these patients accordingly.
[Mh] Termos MeSH primário: Avaliação Geriátrica
Nível de Saúde
Hospitalização
Estado Nutricional
Ferimentos e Lesões/terapia
[Mh] Termos MeSH secundário: Atividades Cotidianas
Idoso
Estudos Transversais
Feminino
Seres Humanos
Masculino
Inquéritos Nutricionais
Qualidade de Vida
República da Coreia
Autocuidado
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010034


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Registro de Ensaios Clínicos
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[PMID]:28459925
[Au] Autor:Carrasquillo O; Lebron C; Alonzo Y; Li H; Chang A; Kenya S
[Ad] Endereço:Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
[Ti] Título:Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial.
[So] Source:JAMA Intern Med;177(7):948-954, 2017 Jul 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Community health worker (CHW) intervention is a promising approach to address type 2 diabetes among Latinos. However, evidence from randomized clinical studies is limited. Objective: To compare a CHW intervention with enhanced usual care. Design, Setting, and Participants: This 52-week, single-blind, randomized clinical trial included 300 Latino adults aged 18 to 65 years who were treated in 2 public hospital outpatient clinics in Miami-Dade County, Florida, from July 1, 2010, through October 31, 2013. Eligible participants had a hemoglobin A1c (HbA1c) level of 8.0 or greater. Follow-up was completed January 31, 2015, and data were analyzed from March 10, 2015, to June 6, 2016. Interventions: A 1-year CHW intervention consisted of home visits, telephone calls, and group-level activities. Main Outcomes and Measures: Primary outcomes included systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLC) levels, and HbA1c levels. Secondary outcomes included body mass index, medication regimen intensification, and self-reported measures of diet, physical activity, and medication regimen adherence. Results: Of the 300 participants randomized (135 men [45%] and 165 women [55%]; mean [SD] age, 55.2 [7.0] years), we obtained follow-up data on 215 (71.7%). Participants in the CHW group received a median of 4 home visits and 20 telephone calls. After adjusting for baseline values and covariates, participants in the CHW group had an HbA1c level that was 0.51% lower (95% CI, -0.94% to -0.08%) than that of participants in the enhanced usual care group. The reduction in SBP of 4.62 mm Hg (95% CI, -9.01 to -0.24 mm Hg) did not meet the preplanned target of 8 mm Hg and was not statistically significant in unadjusted models. No significant differences in LDLC levels (mean difference, -8.2 mg/dL; 95% CI, -18.8 to 2.3 mg/dL) or any of the preplanned secondary outcomes were observed. Post hoc analyses suggest that the intervention may be more beneficial among those with worse control of their type 2 diabetes at baseline. Conclusions and Relevance: Among Latinos with poorly controlled type 2 diabetes, a 12-month CHW intervention lowered HbA1c levels by 0.51%. The intervention did not lead to improvements in LDLC levels, and the findings with respect to SBP were variable and half of what was targeted. Future studies should examine whether CHW interventions affect other measures, such as access to health care or social determinants of health. Trial Registration: clinicaltrials.gov Identifier: NCT01152957.
[Mh] Termos MeSH primário: Serviços de Saúde Comunitária
Agentes Comunitários de Saúde
Diabetes Mellitus Tipo 2
Cooperação do Paciente/etnologia
[Mh] Termos MeSH secundário: Adulto
Atitude do Pessoal de Saúde
Glicemia/análise
Serviços de Saúde Comunitária/métodos
Serviços de Saúde Comunitária/organização & administração
Agentes Comunitários de Saúde/organização & administração
Agentes Comunitários de Saúde/psicologia
Diabetes Mellitus Tipo 2/diagnóstico
Diabetes Mellitus Tipo 2/etnologia
Diabetes Mellitus Tipo 2/psicologia
Diabetes Mellitus Tipo 2/terapia
Comportamento Alimentar/etnologia
Comportamento Alimentar/fisiologia
Feminino
Florida/epidemiologia
Hemoglobina A Glicada/análise
Hispano-Americanos/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Autocuidado/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.0926


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[PMID]:29357380
[Au] Autor:Debussche X; Besançon S; Balcou-Debussche M; Ferdynus C; Delisle H; Huiart L; Sidibe AT
[Ad] Endereço:Department of Endocrinology Diabetology Nutrition, Felix Guyon University Hospital, Saint-Denis, La Réunion.
[Ti] Título:Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali.
[So] Source:PLoS One;13(1):e0191262, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Our objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali). METHODS: We conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months. RESULTS: 177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003. CONCLUSIONS: Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future. TRIAL REGISTRATION: ClinicalTrials.gov NCT01485913.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/terapia
Autogestão/métodos
[Mh] Termos MeSH secundário: Adulto
Países em Desenvolvimento
Diabetes Mellitus Tipo 2/sangue
Feminino
Hemoglobina A Glicada/metabolismo
Seres Humanos
Masculino
Mali
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Educação de Pacientes como Assunto/métodos
Grupo Associado
Autocuidado/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191262


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[PMID]:29278546
[Au] Autor:Meier-Gibbons F; Berlin MS; Töteberg-Harms M
[Ad] Endereço:Eye Center Rapperswil, Merkurstrasse 50, Rapperswil, Switzerland.
[Ti] Título:Twenty-four hour intraocular pressure measurements and home tonometry.
[So] Source:Curr Opin Ophthalmol;29(2):111-115, 2018 Mar.
[Is] ISSN:1531-7021
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE OF REVIEW: IOP is the only treatable risk factor contributing to glaucoma and most management and treatment of glaucoma is based on IOP. However, current IOP measurements are limited to office hours and control of glaucoma in many patients would benefit from the ability to monitor IOP diurnally so as not to miss abnormal pressures, which occur outside of office hours Consequently, to improve patient care, the ability to enable accurate and minimally disruptive diurnal IOP monitoring would improve caring for these patients. RECENT FINDINGS: The studies we selected for this review can be divided into three categories: self-/home-tonometry, continuous invasive intraocular pressure measurements, and continuous noninvasive ocular measurements. SUMMARY: The desire to obtain better insight in our patients' true diurnal IOP has led to the development of home-tonometers, in addition to extraocular and intraocular continuous pressure measurement devices. All of the devices have respective advantages and disadvantages, but none to date completely fulfills the goal of providing a true diurnal IOP profile.Video abstracthttp://links.lww.com/COOP/A27.
[Mh] Termos MeSH primário: Ritmo Circadiano/fisiologia
Pressão Intraocular/fisiologia
Monitorização Ambulatorial
Tonometria Ocular/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Hipertensão Ocular/diagnóstico
Autocuidado/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE
[do] DOI:10.1097/ICU.0000000000000460


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[PMID]:29351295
[Au] Autor:Spoorenberg SLW; Wynia K; Uittenbroek RJ; Kremer HPH; Reijneveld SA
[Ad] Endereço:University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands.
[Ti] Título:Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: A randomised controlled trial on Embrace.
[So] Source:PLoS One;13(1):e0190751, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the effects of the population-based, person-centred and integrated care service 'Embrace' at twelve months on three domains comprising health, wellbeing and self-management among community-living older people. METHODS: Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults' risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain 'Health.' The Groningen Well-being Indicator and two quality of life questions measured 'Wellbeing.' The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for 'Self-management.' Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile. RESULTS: 1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater-but clinically irrelevant-improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater-but clinically relevant-deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results. CONCLUSIONS: This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde/organização & administração
Vida Independente
Assistência Centrada no Paciente
Qualidade de Vida
Autocuidado
[Mh] Termos MeSH secundário: Atividades Cotidianas
Idoso
Idoso de 80 Anos ou mais
Feminino
Idoso Fragilizado
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190751


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[PMID]:29381914
[Au] Autor:Wang Z; Zheng J; Zhao Y; Xiang Y; Chen X; Zhao F; Jin Y
[Ad] Endereço:Department of Orthopaedics, Henan Provincial People's Hospital.
[Ti] Título:Preoperative bathing with chlorhexidine reduces the incidence of surgical site infections after total knee arthroplasty: A meta-analysis.
[So] Source:Medicine (Baltimore);96(47):e8321, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical site infection is a devastating postoperative complication, and the occurrence ranges from 1% to 2% after total knee arthroplasty (TKA). The efficacy of the preoperative use of chlorhexidine for reducing infection has been debated. This meta-analysis aimed to examine the efficacy of the use of chlorhexidine to prevent surgical site infections after TKA. METHODS: In February 2017, a systematic literature review was conducted using the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) and retrospective comparative study (RCS) that compared the use of chlorhexidine versus control washes to prep patients for TKA were retrieved. The primary endpoint was to compare the total incidence of infection with and without the use of chlorhexidine. The secondary outcomes were the incidence of infection in low-risk category patients, moderate-risk category patients, and high-risk category patients. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects modeling when necessary. RESULTS: Four clinical trials that included 8787 patients (chlorhexidine group: n = 2615, control group: n = 6172) were ultimately included in the meta-analysis. Chlorhexidine was associated with a reduced total incidence of infection, corresponding to a reduction of 1.69% [risk ratio (RR) = 0.22; 95% confidence interval (95% CI) = 0.12-0.40; P = .000]. Similarly, chlorhexidine was associated with a reduction in the incidence of infection among patients in the moderate-risk category (RR, 0.18; 95% CI, 0.05-0.63; P = .007) and the high-risk category (RR, 0.13; 95% CI, 0.03-0.67; P = .014). There was no significant difference between the incidence of infection in low-risk category patients with chlorhexidine use compared with the use of control washes (RR, 0.60; 95% CI, 0.22-1.60; P = .330). CONCLUSION: The preoperative use of chlorhexidine could reduce the total incidence of infection and the incidence of infection in moderate-risk and high-risk category patients. The overall evidence and the number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of chlorhexidine on reducing the incidence of infection after TKA.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/administração & dosagem
Artroplastia do Joelho/métodos
Banhos/métodos
Clorexidina/administração & dosagem
Infecção da Ferida Cirúrgica/prevenção & controle
[Mh] Termos MeSH secundário: Seres Humanos
Cuidados Pré-Operatórios
Estudos Retrospectivos
Fatores de Risco
Autocuidado
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008321



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