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Pesquisa : F02.784.176.350 [Categoria DeCS]
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[PMID]:28924062
[Au] Autor:Feldman-Winter L; Szucs K; Milano A; Gottschlich E; Sisk B; Schanler RJ
[Ad] Endereço:Department of Pediatrics, Children's Regional Hospital, Cooper University Health Care, Cooper Medical School, Rowan University, Camden, New Jersey; winter-lori@cooperhealth.edu.
[Ti] Título:National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014.
[So] Source:Pediatrics;140(4), 2017 Oct.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014. METHODS: Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; = 832), PS #57 (2004; response rate = 55%; = 675), and PS #89 (2014; response rate = 51%; = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs). RESULTS: From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [ < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems ( < .01). CONCLUSIONS: Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Aleitamento Materno
Pediatras
Padrões de Prática Médica/tendências
[Mh] Termos MeSH secundário: Adulto
Aconselhamento à Distância/estatística & dados numéricos
Aconselhamento à Distância/tendências
Feminino
Pesquisas sobre Serviços de Saúde
Hospitais
Seres Humanos
Lactente
Recém-Nascido
Modelos Logísticos
Masculino
Meia-Idade
Política Organizacional
Padrões de Prática Médica/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171112
[Lr] Data última revisão:
171112
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE


  2 / 25 MEDLINE  
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[PMID]:28520768
[Au] Autor:Abdulrahman SA; Rampal L; Ibrahim F; Radhakrishnan AP; Kadir Shahar H; Othman N
[Ad] Endereço:Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, Malaysia.
[Ti] Título:Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial.
[So] Source:PLoS One;12(5):e0177698, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART). OBJECTIVE(S): Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. METHODS: A single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman's ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention. RESULTS: The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39-96.97) as compared to the control group (87.5; 95% CI: 86.14-88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group. CONCLUSION: Mobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.
[Mh] Termos MeSH primário: Síndrome de Imunodeficiência Adquirida/tratamento farmacológico
Terapia Antirretroviral de Alta Atividade/métodos
Telefone Celular
Aconselhamento à Distância/métodos
Cooperação do Paciente
Grupo Associado
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Malásia
Masculino
Meia-Idade
Telemedicina/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170519
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0177698


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[PMID]:28276580
[Au] Autor:Ritchie HE; Oakes DJ; Hegedus E; Hill M; Kennedy D
[Ad] Endereço:Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
[Ti] Título:Counselling regarding paternal exposures: Can we do better?
[So] Source:Aust N Z J Obstet Gynaecol;57(2):162-167, 2017 Apr.
[Is] ISSN:1479-828X
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: MotherSafe is a free telephone-based counselling service for the general public and healthcare providers concerned about exposures during pregnancy and breastfeeding. Calls relating to paternal exposures are less common, but can cause distress to the person concerned. This review seeks to identify the key concerns and what information is available to address these concerns. AIMS: To review calls made to MotherSafe about paternal exposures to teratogens during the 16 year period, 2000-2015, and to document any patterns or changes in calls over the period. MATERIALS AND METHODS: A retrospective descriptive assessment of a prospectively collected database (2000-2015) was undertaken. Telephone counselling records identified the drugs of concern regarding paternal exposures. The information about paternal exposures provided in consumer and production information was also reviewed. RESULTS: Of a total of 253 103 calls received at MotherSafe between 2000 and 2015, 1072 calls (0.4%) were regarding paternal exposures. The majority of these calls related to immunomodifiers (19%), hair loss products (11%) and antidepressant medications. CONCLUSIONS: Paternal exposures represent a small proportion of all the counselling calls made to MotherSafe. The study highlighted the deficient and often misleading information about paternal exposures found in most consumer and product information sheets or via the internet. The study indicates the important role of Teratogen Information Services like Mothersafe in providing evidence-based information to both consumers and healthcare providers.
[Mh] Termos MeSH primário: Aconselhamento à Distância/normas
Linhas Diretas/estatística & dados numéricos
Exposição Paterna/efeitos adversos
Teratogênios/toxicidade
[Mh] Termos MeSH secundário: Inibidores de 5-alfa Redutase/efeitos adversos
Antidepressivos/efeitos adversos
Informação de Saúde ao Consumidor/normas
Feminino
Finasterida/efeitos adversos
Seres Humanos
Fatores Imunológicos/efeitos adversos
Masculino
Gravidez
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (5-alpha Reductase Inhibitors); 0 (Antidepressive Agents); 0 (Immunologic Factors); 0 (Teratogens); 57GNO57U7G (Finasteride)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.1111/ajo.12584


  4 / 25 MEDLINE  
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[PMID]:27477616
[Au] Autor:Ohtaki Y; Oi Y; Doki S; Kaneko H; Usami K; Sasahara S; Matsuzaki I
[Ad] Endereço:Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
[Ti] Título:Characteristics of Telephone Crisis Hotline Callers with Suicidal Ideation in Japan.
[So] Source:Suicide Life Threat Behav;47(1):54-66, 2017 Feb.
[Is] ISSN:1943-278X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Hotline callers do not always have suicidal ideation and previous studies have noted that the rate of such callers is limited. Crisis hotline counselors must be able to identify high-risk callers in order to provide appropriate support. This study investigated the characteristics of Japanese crisis hotline callers in 2012 (N = 541,694) and is the first to analyze crisis hotline data for all parts of Japan over 1 year. About 14% of the callers had suicidal ideation and 6% had a history of attempted suicide. The odds ratio for suicidal ideation among those with a history of attempted suicide was 15.5. The suicidal ideation rate was much smaller compared to previous studies in other countries. There is a psychological barrier that must be broken for high-risk people to use support hotlines. In addition, attempted suicide is a strong exclusive predisposing factor for death due to suicide; therefore, counselors should pay careful attention to callers with a history of attempted suicide. The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.
[Mh] Termos MeSH primário: Intervenção na Crise/métodos
Linhas Diretas
Ideação Suicida
Suicídio
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Aconselhamento à Distância/métodos
Feminino
Linhas Diretas/organização & administração
Linhas Diretas/normas
Seres Humanos
Japão/epidemiologia
Masculino
Prognóstico
Suicídio/prevenção & controle
Suicídio/psicologia
Suicídio/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160802
[St] Status:MEDLINE
[do] DOI:10.1111/sltb.12264


  5 / 25 MEDLINE  
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[PMID]:27697658
[Au] Autor:Olthuis JV; Wozney L; Asmundson GJ; Cramm H; Lingley-Pottie P; McGrath PJ
[Ad] Endereço:Department of Psychology, University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada. Electronic address: j.olthuis@unb.ca.
[Ti] Título:Distance-delivered interventions for PTSD: A systematic review and meta-analysis.
[So] Source:J Anxiety Disord;44:9-26, 2016 Dec.
[Is] ISSN:1873-7897
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.
[Mh] Termos MeSH primário: Terapia Cognitiva/métodos
Aconselhamento à Distância/métodos
Internet
Qualidade de Vida/psicologia
Transtornos de Estresse Pós-Traumáticos/terapia
Videoconferência
[Mh] Termos MeSH secundário: Seres Humanos
Transtornos de Estresse Pós-Traumáticos/psicologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161005
[St] Status:MEDLINE


  6 / 25 MEDLINE  
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[PMID]:27513363
[Au] Autor:Littleton H; Grills AE; Kline KD; Schoemann AM; Dodd JC
[Ad] Endereço:Department of Psychology, East Carolina University, 104 Rawl Building, Greenville, NC, 27858, USA. Electronic address: littletonh@ecu.edu.
[Ti] Título:The From Survivor to Thriver program: RCT of an online therapist-facilitated program for rape-related PTSD.
[So] Source:J Anxiety Disord;43:41-51, 2016 Oct.
[Is] ISSN:1873-7897
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:This study evaluated the efficacy of the From Survivor to Thriver program, an interactive, online therapist-facilitated cognitive-behavioral program for rape-related PTSD. Eighty-seven college women with rape-related PTSD were randomized to complete the interactive program (n=46) or a psycho-educational self-help website (n=41). Both programs led to large reductions in interview-assessed PTSD at post-treatment (interactive d=2.22, psycho-educational d=1.10), which were maintained at three month follow-up. Both also led to medium- to large-sized reductions in self-reported depressive and general anxiety symptoms. Follow-up analyses supported that the therapist-facilitated interactive program led to superior outcomes among those with higher pre-treatment PTSD whereas the psycho-educational self-help website led to superior outcomes for individuals with lower pre-treatment PTSD. Future research should examine the efficacy and effectiveness of online interventions for rape-related PTSD including whether treatment intensity matching could be utilized to maximize outcomes and therapist resource efficiency.
[Mh] Termos MeSH primário: Terapia Cognitiva
Aconselhamento à Distância/métodos
Estupro/reabilitação
Transtornos de Estresse Pós-Traumáticos/terapia
Sobreviventes/psicologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Comportamentos Relacionados com a Saúde
Seres Humanos
Estupro/psicologia
Transtornos de Estresse Pós-Traumáticos/psicologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171001
[Lr] Data última revisão:
171001
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160812
[St] Status:MEDLINE


  7 / 25 MEDLINE  
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[PMID]:27467033
[Au] Autor:Giotakos O; Papadomarkaki E
[Ad] Endereço:Psychiatric Department, 414 Military Hospital, Athens, Greece.
[Ti] Título:[Online Counselling: The prospect of a therapeutic connection].
[So] Source:Psychiatriki;27(2):127-35, 2016 Apr-Jun.
[Is] ISSN:1105-2333
[Cp] País de publicação:Greece
[La] Idioma:gre
[Ab] Resumo:Over the last few years, Internet has become an integral part of daily life. An abundant source of information and a principal gateway of communication between individuals, Internet has been continuously gaining considerable ground as a tool of awareness and intervention in the area of public health. With regard to the field of mental health, Internet exhibits a credible potential in facilitating dialogue not only between experts and their beneficiaries but also between stakeholders. Moreover and with regard to various aspects of public concern, it can serve as a circulation portal of educational material between students and teachers. The advent of remote support services dates back in the decade of 1970-1980. In the present time, they consist of informative guides and self-help groups or online counselling. The latter is defined as the process in which both parties, namely the therapist and the client, are involved in an oral or written conciliation through means of an internet connection, videoconferencing, live chat or e-mail exchange. The benefits of this practice - accessibility, relocation, convenience, anonymity, facilitation of face-to-face psychotherapy and low cost - could make online counseling, in specific cases, the treatment of choice. While the usage of the World Wide Web seems promising for the rectification of mental health disorders, there is some debate among experts regarding the ethical aspect of practicing psychotherapy in an interactive digital environment. Issues such as technical expertise and the tackling of related problems, difficulties in the diagnostic process, interchange of verbal and nonverbal cues, crisis management, safeguarding the therapeutic alliance, protection of personal data, age restriction, keeping boundaries in relation to the setting, the time and the dynamics of the therapeutic relationship and, finally, training and supervisory process of online therapist, are some subjects of disagreement. Relevant research reveals the effectiveness of online counseling in decreasing the magnitude of reported symptoms, with a direct positive impact on the improvement of daily functioning and on future relapses. However, the usefulness of developing a therapeutic relationship through internet connection is being criticized by a group of clinicians, with their main arguments revolving around spatiotemporal issues and the reliability of incoming information. Some other researchers correlate the therapeutic alliance concluded in the context of electronic communication with a positive therapeutic effect. The data on the effectiveness of online practice are not sufficient to draw a definite conclusion. In an era of direct and rapid communication, it is imperative to encourage further research, for the determination of optimal conditions with respect to the practice of internet-delivered psychotherapy and the patients' well being as a result of treatment.
[Mh] Termos MeSH primário: Aconselhamento à Distância/métodos
Transtornos Mentais
Técnicas Psicológicas
Psicoterapia
[Mh] Termos MeSH secundário: Comunicação
Seres Humanos
Internet
Transtornos Mentais/diagnóstico
Transtornos Mentais/terapia
Técnicas Psicológicas/instrumentação
Psicoterapia/instrumentação
Psicoterapia/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170403
[Lr] Data última revisão:
170403
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160729
[St] Status:MEDLINE


  8 / 25 MEDLINE  
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[PMID]:27395805
[Au] Autor:Farrell LJ; Oar EL; Waters AM; McConnell H; Tiralongo E; Garbharran V; Ollendick T
[Ad] Endereço:School of Applied Psychology and Menzies Health Institute QLD, Griffith University, Australia. Electronic address: l.farrell@griffith.edu.au.
[Ti] Título:Brief intensive CBT for pediatric OCD with E-therapy maintenance.
[So] Source:J Anxiety Disord;42:85-94, 2016 Aug.
[Is] ISSN:1873-7897
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Cognitive behaviour therapy (CBT), incorporating exposure and response prevention (ERP), has received strong empirical support for the treatment of paediatric OCD, and moreover, is considered the first line treatment of choice (Geller & March, 2012). However, despite the availability of effective treatments for this chronic and debilitating disorder, only a small proportion of youth receive these evidence-based approaches. The present study aimed to examine the effectiveness of an intensive ERP-based treatment for youth OCD, using a multiple baseline controlled design. Children and youth (N=10; aged 11-16 years) with a primary diagnosis of OCD were randomly assigned to a 1- or 2-week baseline monitoring condition followed by the intervention. The efficacy of the intensive treatment, involving 1 session psychoeducation, 2-sessions ERP plus e-therapy maintenance was examined across parent- child- and clinician-rated measures at post-treatment and 6-month follow-up. Overall, there were significant reductions across time on almost all measures (except self-report anxiety), and moreover, the majority of the sample (80%) were considered reliably improved, and meeting clinically significant change. At post-treatment, 60% were in remission of symptoms, and at 6-month follow-up this increased to 70%. These findings provide strong support for intensive, time-limited approaches to ERP-based CBT for children and youth with OCD.
[Mh] Termos MeSH primário: Terapia Cognitiva/métodos
Aconselhamento à Distância/métodos
Transtorno Obsessivo-Compulsivo/terapia
[Mh] Termos MeSH secundário: Adolescente
Criança
Feminino
Seres Humanos
Masculino
Transtorno Obsessivo-Compulsivo/psicologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160711
[St] Status:MEDLINE


  9 / 25 MEDLINE  
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[PMID]:27260323
[Au] Autor:Lindh A; Sjöström M; Stenlund H; Samuelsson E
[Ad] Endereço:Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. anna.lindh@regionjh.se.
[Ti] Título:Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year.
[So] Source:Int Urogynecol J;27(12):1857-1865, 2016 Dec.
[Is] ISSN:1433-3023
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION AND HYPOTHESIS: The objective was to determine predictors of long-term success in women with stress urinary incontinence (SUI) treated with a 3-month pelvic floor muscle training (PFMT) program delivered via the Internet or a brochure. METHODS: We included 169 women with SUI ≥1 time/week who completed the 1-year follow-up (n = 169, mean age 50.3, SD 10.1 years). Three outcome variables defined success after 1 year: Patient Global Impression of Improvement (PGI-I), International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), and sufficient treatment. Using logistic regression, we analyzed data from the baseline, and from the 4-month and 1-year follow-ups, for potential predictors of success. RESULTS: Of the participants, 77 % (129 out of 169) were successful in ≥1 of the outcomes, 23 % (37 out of 160) were successful in all 3. Participants with successful short-term results were more likely to succeed in the corresponding outcome at 1 year than those without successful short-term results (adjusted odds ratios [ORs]: PGI 5.15, 95 % confidence interval [CI] 2.40-11.03), ICIQ-UI SF 6.85 (95 % CI 2.83-16.58), and sufficient treatment 3.78 (95 % CI 1.58-9.08). Increasing age predicted success in PGI-I and sufficient treatment (adjusted OR 1.06, 95 % CI 1.02-1.10, and 1.08, 95 % CI, 1.03-1.13 respectively). Compared with not training regularly, regular PFMT at 1 year predicted success for PGI and sufficient treatment (adjusted OR 2.32, 95 % CI 1.04-5.20, and 2.99, 95 % CI 1.23-7.27 respectively). CONCLUSION: The long-term success of a non-face-to-face treatment program for SUI with a focus on PFMT can be predicted by successful short-term results, increasing age, and the performance of regular PFMT after 1 year.
[Mh] Termos MeSH primário: Aconselhamento à Distância
Terapia por Exercício
Incontinência Urinária por Estresse/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160605
[St] Status:MEDLINE


  10 / 25 MEDLINE  
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Registro de Ensaios Clínicos
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[PMID]:26965429
[Au] Autor:van Dongen AJ; Nelen WL; IntHout J; Kremer JA; Verhaak CM
[Ad] Endereço:Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands angelique.vandongen@radboudumc.nl.
[Ti] Título:e-Therapy to reduce emotional distress in women undergoing assisted reproductive technology (ART): a feasibility randomized controlled trial.
[So] Source:Hum Reprod;31(5):1046-57, 2016 05.
[Is] ISSN:1460-2350
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:STUDY QUESTION: Is it feasible to evaluate a personalized e-therapy program (Internet based) for women during fertility treatment aimed to reduce the chance of having clinically relevant symptoms of anxiety and/or depression after unsuccessful assisted reproductive technology (ART) treatment within a randomized controlled trial (RCT)? STUDY ANSWER: The evaluation of a personalized e-therapy program is feasible, reflected by good acceptability and integration within current guidelines, but adjustments to the e-therapy program and study design of the RCT have to be made to enhance demand, practicality and efficacy. WHAT IS KNOWN ALREADY: Internet-based interventions are promising in reducing psychological distress, especially when treatment is personalized to specific risk profiles of patients. However in fertility care, the beneficial effects of personalized e-therapy on psychological distress and its implementation in daily clinical care still have to be evaluated. STUDY DESIGN, SIZE, DURATION: To evaluate the feasibility of a personalized e-therapy program, we conducted a two-arm, parallel group, single-blind feasibility randomized controlled trial with a 1:1 allocation. Feasibility was assessed in terms of demand, acceptability, practicality, implementation, integration and limited efficacy. Women were included between 1 February 2011 and 1 June 2013. Women in the control group received care as usual, whereas women in the intervention group received in addition to their usual care access to a personalized e-therapy program. Women were monitored until 3 months after the start of their first ART cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS: In a university hospital in the Netherlands women who were screened as at risk for emotional adjustment problems and intended to start their first ART cycle were invited, and of them 120 were randomized. Of these women, 48% in the intervention group were compliant to the intervention. Outcome measures associated with the feasibility to analyse this e-therapy program within an RCT were assessed. MAIN RESULTS AND THE ROLE OF CHANCE: It is feasible to evaluate a personalized e-therapy program within an RCT. The acceptability was good, as was the integration within current clinical guidelines and care. However, the demand reflected by a participation rate of 44% was low, since most women declined participation because they felt no need for support at that moment. The practicality of the intervention was moderate illustrated by a relatively high dropout rate (30%) due to practical concerns. The intervention was effective, shown by a reduction in the percentage women having clinically relevant symptoms of anxiety and/or depression in the compliant intervention group compared with the control group 3 months after the first ART cycle; risk difference of 24% (95% CI: 2-46%; ITALIC! P = 0.03). LIMITATIONS, REASONS FOR CAUTION: The large non-participation rate (56%) needs further evaluation. This also could have influenced results on limited efficacy. Barriers for participation could be assessed more in-depth. Moreover, ∼30% dropped out. This percentage is comparable with other e-health studies. Finally, this is a single-centre study. Generalizability could be enlarged by a multi-centre approach. WIDER IMPLICATIONS OF THE FINDINGS: In clinical fertility care, personalizing an e-therapy program to the patients' risk profile is promising and feasible. However, in future studies, we recommend modification of the study protocol by for example offering the intervention to the preferred moment in the treatment process. Moreover, adjustment of the study protocol tailored to the found barriers and facilitators is needed. When performing a multi-centre consecutive RCT to assess the effectiveness of personalized e-therapy in fertility care, the findings of this study, for example concerning the preferred timing or reasons for non-participation, could be helpful. STUDY FUNDING/COMPETING INTERESTS: NutsOhra (Study Number 0702-94) funded this study with an unrestricted grant. There were no competing interests. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT 01283607. TRIAL REGISTRATION DATE: 21 January 2011. DATE OF FIRST PATIENT'S ENROLMENT: February, 2011.
[Mh] Termos MeSH primário: Aconselhamento à Distância
Infertilidade Feminina/psicologia
Internet
Técnicas de Reprodução Assistida/psicologia
Estresse Psicológico/terapia
[Mh] Termos MeSH secundário: Adulto
Ansiedade/terapia
Depressão/terapia
Estudos de Viabilidade
Feminino
Seres Humanos
Países Baixos
Pacientes Desistentes do Tratamento
Método Simples-Cego
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170209
[Lr] Data última revisão:
170209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160312
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1093/humrep/dew040



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