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[PMID]:29437667
[Au] Autor:Adab P; Pallan MJ; Lancashire ER; Hemming K; Frew E; Barrett T; Bhopal R; Cade JE; Canaway A; Clarke JL; Daley A; Deeks JJ; Duda JL; Ekelund U; Gill P; Griffin T; McGee E; Hurley K; Martin J; Parry J; Passmore S; Cheng KK
[Ad] Endereço:Institute of Applied Health Research, University of Birmingham, Birmingham, UK p.adab@bham.ac.uk.
[Ti] Título:Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study).
[So] Source:BMJ;360:k211, 2018 02 07.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. DESIGN: Cluster randomised controlled trial. SETTING: UK primary schools from the West Midlands. PARTICIPANTS: 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively. INTERVENTIONS: The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills. MAIN OUTCOME MEASURES: The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. RESULTS: Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference -0.075 (95% confidence interval -0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was -0.027 (-0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). CONCLUSIONS: The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. TRIAL REGISTRATION: Current Controlled Trials ISRCTN97000586.
[Mh] Termos MeSH primário: Avaliação de Processos e Resultados (Cuidados de Saúde)
Obesidade Pediátrica/prevenção & controle
Serviços de Saúde Escolar/organização & administração
[Mh] Termos MeSH secundário: Índice de Massa Corporal
Criança
Inglaterra
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k211


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[PMID]:28459931
[Au] Autor:Trepanowski JF; Kroeger CM; Barnosky A; Klempel MC; Bhutani S; Hoddy KK; Gabel K; Freels S; Rigdon J; Rood J; Ravussin E; Varady KA
[Ad] Endereço:Department of Kinesiology and Nutrition, University of Illinois at Chicago.
[Ti] Título:Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial.
[So] Source:JAMA Intern Med;177(7):930-938, 2017 Jul 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy. Objective: To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. Design, Setting, and Participants: A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois. Interventions: Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase. Main Outcomes and Measures: The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. Results: Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group. Conclusions and Relevance: Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction. Trial Registration: clinicaltrials.gov Identifier: NCT00960505.
[Mh] Termos MeSH primário: Restrição Calórica/métodos
Doenças Cardiovasculares/prevenção & controle
Jejum
Obesidade
[Mh] Termos MeSH secundário: Adulto
Glicemia/análise
Glicemia/metabolismo
Doenças Cardiovasculares/metabolismo
Dietoterapia/métodos
Jejum/fisiologia
Jejum/psicologia
Comportamento Alimentar/fisiologia
Feminino
Seres Humanos
Insulina/análise
Insulina/sangue
Masculino
Meia-Idade
Obesidade/diagnóstico
Obesidade/dietoterapia
Obesidade/metabolismo
Obesidade/psicologia
Avaliação de Processos e Resultados (Cuidados de Saúde)
Cooperação do Paciente
Fatores de Risco
Perda de Peso
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Insulin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[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.2017.0936


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[PMID]:28465460
[Au] Autor:Menjot de Champfleur N; Saver JL; Goyal M; Jahan R; Diener HC; Bonafe A; Levy EI; Pereira VM; Cognard C; Yavagal DR; Albers GW
[Ad] Endereço:From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (G.W.A.); Department of Radiology (M.G.) and Department of Clinical Neurosciences (M.G.), University of Calgary, Alberta, Canada; Division of Interventional Neuroradiology (
[Ti] Título:Efficacy of Stent-Retriever Thrombectomy in Magnetic Resonance Imaging Versus Computed Tomographic Perfusion-Selected Patients in SWIFT PRIME Trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke).
[So] Source:Stroke;48(6):1560-1566, 2017 06.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The majority of patients enrolled in SWIFT PRIME trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) had computed tomographic perfusion (CTP) imaging before randomization; 34 patients were randomized after magnetic resonance imaging (MRI). METHODS: Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the modified Rankin Scale score at 90 days. Patients with the target mismatch profile for enrollment were identified on MRI and CTP. RESULTS: MRI selection was performed in 34 patients; CTP in 139 patients. Baseline National Institutes of Health Stroke Scale score was 17 in both groups. Target mismatch profile was present in 95% (MRI) versus 83% (CTP). A higher percentage of the MRI group was transferred from an outside hospital ( =0.02), and therefore, the time from stroke onset to randomization was longer in the MRI group ( =0.003). Time from emergency room arrival to randomization did not differ in CTP versus MRI-selected patients. Baseline ischemic core volumes were similar in both groups. Reperfusion rates (>90%/TICI [Thrombolysis in Cerebral Infarction] score 3) did not differ in the stentriever-treated patients in the MRI versus CTP groups. The primary efficacy analysis (90-day mRS score) demonstrated a statistically significant benefit in both subgroups (MRI, =0.02; CTP, =0.01). Infarct growth was reduced in the stentriever-treated group in both MRI and CTP groups. CONCLUSIONS: Time to randomization was significantly longer in MRI-selected patients; however, site arrival to randomization times were not prolonged, and the benefits of endovascular therapy were similar. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.
[Mh] Termos MeSH primário: Isquemia Encefálica/diagnóstico por imagem
Isquemia Encefálica/terapia
Circulação Cerebrovascular
Imagem de Difusão por Ressonância Magnética/métodos
Fibrinolíticos/uso terapêutico
Avaliação de Processos e Resultados (Cuidados de Saúde)
Stents
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/terapia
Trombectomia/métodos
Ativador de Plasminogênio Tecidual/uso terapêutico
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Isquemia Encefálica/etiologia
Doenças das Artérias Carótidas/complicações
Terapia Combinada
Feminino
Seres Humanos
Infarto da Artéria Cerebral Média/complicações
Masculino
Meia-Idade
Método Simples-Cego
Acidente Vascular Cerebral/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016669


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[PMID]:28461147
[Au] Autor:Diel R; Ringshausen F; Richter E; Welker L; Schmitz J; Nienhaus A
[Ad] Endereço:Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel. Member of the German Center for Lung Research (ARCN); Airway Research Center North (ARCN), German Center for Lung Research (DZL) LungClinic Grosshansdorf. Electronic address: roland.diel@epi.uni-kiel.de.
[Ti] Título:Microbiological and Clinical Outcomes of Treating Non-Mycobacterium Avium Complex Nontuberculous Mycobacterial Pulmonary Disease: A Systematic Review and Meta-Analysis.
[So] Source:Chest;152(1):120-142, 2017 07.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pulmonary disease caused by nontuberculous mycobacteria (NTM) is steadily increasing worldwide. METHODS: A systematic review of non-Mycobacterium avium complex studies published prior to October 2016 was conducted with respect to microbiological and clinical outcomes of current treatment regimens. RESULTS: We retrieved 352 citations, which yielded 24 studies eligible for evaluation. Sixteen studies were retrospective chart reviews, three studies were prospective, and only five studies were randomized. The weighted average proportion of sputum culture conversion (SCC) after subtracting posttreatment relapses for patients with M abscessus was 41.2% (95% CI, 28.6%-54.5%) but was 69.8% (95% CI, 41.0%-91.9%) with subspecies M massiliense in macrolide-containing regimens, 80.2% (95% CI, 58.4%-95.2%) in patients with M kansasii, 32.0% (95% CI, 16.5%-49.8%) for M xenopi (MX) and 54.4% (95% CI, 34.7%-73.4%) for M malmoense. SCCs in the total of 55 patients who underwent lung resection and had MX or M abscessus was high at 75.9%. The risk of bias was low in four of five randomized studies. However, heterogeneous use of outcome parameters (eight definitions of "relapse," eight of "treatment success," and four of "cure") hampered comparison of nonrandomized studies as well as producing possible bias by a posteriori exclusion (13.3%) and uncompleted treatment of participants (25.3%). CONCLUSIONS: As a sustained microbiological response without surgery is unsatisfactory in treating M abscessus, MX, and M malmoense, functional and quality of life aspects should be given more emphasis in the individual evaluation of treatment outcome. Further, properly planned studies with sufficient power are needed, as are new drugs or better-tolerated application of current antibiotics, or both.
[Mh] Termos MeSH primário: Pneumopatias
Infecções por Micobactéria não Tuberculosa
Complexo Mycobacterium avium
Micobactérias não Tuberculosas
[Mh] Termos MeSH secundário: Ensaios Clínicos como Assunto
Gerenciamento Clínico
Seres Humanos
Pneumopatias/diagnóstico
Pneumopatias/microbiologia
Pneumopatias/terapia
Técnicas Microbiológicas/métodos
Infecções por Micobactéria não Tuberculosa/diagnóstico
Infecções por Micobactéria não Tuberculosa/microbiologia
Infecções por Micobactéria não Tuberculosa/terapia
Complexo Mycobacterium avium/efeitos dos fármacos
Complexo Mycobacterium avium/isolamento & purificação
Complexo Mycobacterium avium/patogenicidade
Micobactérias não Tuberculosas/efeitos dos fármacos
Micobactérias não Tuberculosas/isolamento & purificação
Micobactérias não Tuberculosas/patogenicidade
Avaliação de Processos e Resultados (Cuidados de Saúde)
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28455318
[Au] Autor:Rantner B; Kollerits B; Roubin GS; Ringleb PA; Jansen O; Howard G; Hendrikse J; Halliday A; Gregson J; Eckstein HH; Calvet D; Bulbulia R; Bonati LH; Becquemin JP; Algra A; Brown MM; Mas JL; Brott TG; Fraedrich G; Carotid Stenosis Trialists' Collaboration
[Ad] Endereço:From the Department of Vascular Surgery (B.R., G.F.) and Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology (B.K.), Medical University of Innsbruck, Austria; Cardiovascular Associates of the Southeast, Birmingham, AL (G.S.R.); Department of Neurolog
[Ti] Título:Early Endarterectomy Carries a Lower Procedural Risk Than Early Stenting in Patients With Symptomatic Stenosis of the Internal Carotid Artery: Results From 4 Randomized Controlled Trials.
[So] Source:Stroke;48(6):1580-1587, 2017 06.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Patients undergoing carotid endarterectomy (CEA) for symptomatic stenosis of the internal carotid artery benefit from early intervention. Heterogeneous data are available on the influence of timing of carotid artery stenting (CAS) on procedural risk. METHODS: We investigated the association between timing of treatment (0-7 days and >7 days after the qualifying neurological event) and the 30-day risk of stroke or death after CAS or CEA in a pooled analysis of individual patient data from 4 randomized trials by the Carotid Stenosis Trialists' Collaboration. Analyses were done per protocol. To obtain combined estimates, logistic mixed models were applied. RESULTS: Among a total of 4138 patients, a minority received their allocated treatment within 7 days after symptom onset (14% CAS versus 11% CEA). Among patients treated within 1 week of symptoms, those treated by CAS had a higher risk of stroke or death compared with those treated with CEA: 8.3% versus 1.3%, risk ratio, 6.7; 95% confidence interval, 2.1 to 21.9 (adjusted for age at treatment, sex, and type of qualifying event). For interventions after 1 week, CAS was also more hazardous than CEA: 7.1% versus 3.6%, adjusted risk ratio, 2.0; 95% confidence interval, 1.5 to 2.7 ( value for interaction with time interval 0.06). CONCLUSIONS: In randomized trials comparing stenting with CEA for symptomatic carotid artery stenosis, CAS was associated with a substantially higher periprocedural risk during the first 7 days after the onset of symptoms. Early surgery is safer than stenting for preventing future stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00190398; URL: http://www.controlled-trials.com. Unique identifier: ISRCTN57874028; Unique identifier: ISRCTN25337470; URL: http://www.clinicaltrials.gov. Unique identifier: NCT00004732.
[Mh] Termos MeSH primário: Artéria Carótida Interna/cirurgia
Estenose das Carótidas/cirurgia
Endarterectomia das Carótidas/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Stents/efeitos adversos
Acidente Vascular Cerebral/etiologia
[Mh] Termos MeSH secundário: Idoso
Estenose das Carótidas/epidemiologia
Endarterectomia das Carótidas/estatística & dados numéricos
Procedimentos Endovasculares/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Stents/estatística & dados numéricos
Acidente Vascular Cerebral/epidemiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016233


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[PMID]:29461352
[Au] Autor:Omogbai T; Milner KA
[Ad] Endereço:Author Affiliations: Nurse Manager (Mr Omogbai), Hudson Valley Veteran Affairs Healthcare System, New York; Associate Professor (Dr Milner), College of Nursing, Sacred Heart University, Fairfield, Connecticut.
[Ti] Título:Implementation and Evaluation of Shared Medical Appointments in Veterans With Diabetes: A Quality Improvement Study.
[So] Source:J Nurs Adm;48(3):154-159, 2018 Mar.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study is to implement and evaluate shared medical appointments (SMA) in veterans with diabetes. BACKGROUND: Health systems are challenged to meet the complex care needs of veterans with diabetes. Use of SMA has resulted in significant improvements in A1c, blood pressure, and self-management skills in this population. METHODS: Shared medical appointments were implemented in a Veterans Administration Health System. A1c, blood pressure, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, weight, and height were collected at baseline, 3 months, and 6 months; hospitalization anytime; and veteran satisfaction at baseline and 6 months. RESULTS: From October 15, 2015, to March 15, 2016, 30 male veterans with diabetes participated in monthly SMA. Outcome measures except for high-density lipoprotein improved significantly (P < .02) from baseline to 6 months. No veterans were hospitalized. Veteran satisfaction increased significantly (P < .001). CONCLUSION: Shared medical appointment can be a highly effective intervention for veterans with diabetes. Nursing leaders need to be at the forefront of implementing SMA for populations with chronic conditions.
[Mh] Termos MeSH primário: Agendamento de Consultas
Doenças Cardiovasculares/prevenção & controle
Diabetes Mellitus/terapia
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Melhoria de Qualidade/organização & administração
Saúde dos Veteranos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doenças Cardiovasculares/diagnóstico
Doenças Cardiovasculares/epidemiologia
Comorbidade
Complicações do Diabetes/prevenção & controle
Complicações do Diabetes/terapia
Processos Grupais
Pesquisas sobre Serviços de Saúde
Implementação de Plano de Saúde
Seres Humanos
Masculino
Registros Médicos
New York
Estudos de Casos Organizacionais
Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos
Avaliação de Programas e Projetos de Saúde
Melhoria de Qualidade/normas
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000590


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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


  8 / 24376 MEDLINE  
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[PMID]:29443750
[Au] Autor:Liu DY; Wang ZG; Gao Y; Zhang HM; Zhang YX; Wang XJ; Peng D
[Ad] Endereço:Department of Respiratory Medicine, The People's Hospital of Yan'an, Yan'an.
[Ti] Título:Effect and safety of roflumilast for chronic obstructive pulmonary disease in Chinese patients.
[So] Source:Medicine (Baltimore);97(7):e9864, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This trial aimed to evaluate the efficacy and safety of roflumilast for treating Chinese patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 120 patients with COPD were recruited and were randomly divided into 2 groups (an intervention group and a placebo group) at a 1:1 ratio. Patients received either roflumilast or placebo 500 µg once daily for a total of 12 months. The primary outcome was lung function, measured by the change from baseline of forced expiratory volume in 1 second (FEV1), FVC = forced vital capacity (FVC), and FEF25-75%. The secondary outcome measurements included the quality of life, measured with the St. George's Respiratory Questionnaire (SGRQ). All outcomes were measured at the end of 12-month treatment and 3-month follow-up after the treatment. In addition, adverse events (AEs) were also recorded during the treatment period. RESULTS: FEV1, FVC, FEF25-75%, and SGRQ were significantly better in the intervention group than those in the placebo group at the end of 12-month treatment and 3-month follow up after treatment. Moreover, AEs were much higher with roflumilast than placebo in this study. CONCLUSIONS: The findings suggest that roflumilast has promising effect to improve lung function in Chinese population with COPD.
[Mh] Termos MeSH primário: Aminopiridinas
Benzamidas
Doença Pulmonar Obstrutiva Crônica
Qualidade de Vida
[Mh] Termos MeSH secundário: Idoso
Aminopiridinas/administração & dosagem
Aminopiridinas/efeitos adversos
Grupo com Ancestrais do Continente Asiático
Benzamidas/administração & dosagem
Benzamidas/efeitos adversos
Ciclopropanos/administração & dosagem
Ciclopropanos/efeitos adversos
Método Duplo-Cego
Monitoramento de Medicamentos
Feminino
Seres Humanos
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Inibidores da Fosfodiesterase 4/administração & dosagem
Inibidores da Fosfodiesterase 4/efeitos adversos
Doença Pulmonar Obstrutiva Crônica/diagnóstico
Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
Doença Pulmonar Obstrutiva Crônica/etnologia
Doença Pulmonar Obstrutiva Crônica/psicologia
Testes de Função Respiratória/métodos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Aminopyridines); 0 (Benzamides); 0 (Cyclopropanes); 0 (Phosphodiesterase 4 Inhibitors); 0P6C6ZOP5U (Roflumilast)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009864


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[PMID]:27772015
[Au] Autor:Angus LE; Boritz T; Bryntwick E; Carpenter N; Macaulay C; Khattra J
[Ad] Endereço:a Department of Psychology , York University , Toronto , Ontario , Canada.
[Ti] Título:The Narrative-Emotion Process Coding System 2.0: A multi-methodological approach to identifying and assessing narrative-emotion process markers in psychotherapy.
[So] Source:Psychother Res;27(3):253-269, 2017 May.
[Is] ISSN:1468-4381
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Recent studies suggest that it is not simply the expression of emotion or emotional arousal in session that is important, but rather it is the reflective processing of emergent, adaptive emotions, arising in the context of personal storytelling and/or Emotion-Focused Therapy (EFT) interventions, that is associated with change. METHOD: To enhance narrative-emotion integration specifically in EFT, Angus and Greenberg originally identified a set of eight clinically derived narrative-emotion integration markers were originally identified for the implementation of process-guiding therapeutic responses. Further evaluation and testing by the Angus Narrative-Emotion Marker Lab resulted in the identification of 10 empirically validated Narrative-Emotion Process (N-EP) markers that are included in the Narrative-Emotion Process Coding System Version 2.0 (NEPCS 2.0). RESULTS: Based on empirical research findings, individual markers are clustered into Problem (e.g., stuckness in repetitive story patterns, over-controlled or dysregulated emotion, lack of reflectivity), Transition (e.g., reflective, access to adaptive emotions and new emotional plotlines, heightened narrative and emotion integration), and Change (e.g., new story outcomes and self-narrative discovery, and co-construction and re-conceptualization) subgroups. To date, research using the NEPCS 2.0 has investigated the proportion and pattern of narrative-emotion markers in Emotion-Focused, Client-Centered, and Cognitive Therapy for Major Depression, Motivational Interviewing plus Cognitive Behavioral Therapy for Generalized Anxiety Disorder, and EFT for Complex Trauma. Results have consistently identified significantly higher proportions of N-EP Transition and Change markers, and productive shifts, in mid- and late phase sessions, for clients who achieved recovery by treatment termination. CONCLUSIONS: Recovery is consistently associated with client storytelling that is emotionally engaged, reflective, and evidencing new story outcomes and self-narrative change. Implications for future research, practice and training are discussed.
[Mh] Termos MeSH primário: Emoções
Narração
Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos
Processos Psicoterapêuticos
Psicoterapia/métodos
[Mh] Termos MeSH secundário: Adulto
Transtornos de Ansiedade/terapia
Terapia Cognitiva/métodos
Transtorno Depressivo Maior/terapia
Seres Humanos
Entrevista Motivacional/métodos
Trauma Psicológico/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1080/10503307.2016.1238525


  10 / 24376 MEDLINE  
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[PMID]:29298509
[Au] Autor:Park YM; Oh KH; Cho JG; Baek SK; Kwon SY; Jung KY; Woo JS
[Ad] Endereço:1 Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea.
[Ti] Título:Changes in Voice- and Swallowing-Related Symptoms After Thyroidectomy: One-Year Follow-Up Study.
[So] Source:Ann Otol Rhinol Laryngol;127(3):171-177, 2018 Mar.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We analyzed the changes in voice- and swallowing-related symptoms that occurred over time in patients who underwent thyroidectomy and identified any associated risk factors. METHODS: One hundred and three patients who underwent thyroidectomy were enrolled. RESULTS: The mean thyroidectomy voice-related questionnaire (TVQ) score before surgery was 12.41 ± 12.19; it significantly increased to 28.24 ± 18.01 ( P < .001) 1 month postoperatively, decreased to 24.02 ± 17.30 ( P = .014) and 20.66 ± 15.29 ( P = .023) 3 and 6 months postoperatively, respectively. It was continuously decreased to 18.83 ± 14.63 twelve months postoperatively. The temporal changes in TVQ scores between patients who underwent total thyroidectomy or lobectomy were significantly different. There was a statistically significant difference in the temporal changes in TVQ according to whether neck dissection was performed. The temporal changes in TVQ in patients with and without extrathyroidal extension were significantly different. CONCLUSIONS: Voice- and swallowing-related discomfort in patients who received thyroidectomy showed dynamic changes over time. There was a significant difference in the degree of change according to clinicopathological factors. Patients with these risk factors may benefit from appropriate patient education and various rehabilitation programs for symptom relief.
[Mh] Termos MeSH primário: Transtornos de Deglutição
Esvaziamento Cervical
Complicações Pós-Operatórias
Tireoidectomia
Distúrbios da Voz
[Mh] Termos MeSH secundário: Adulto
Idoso
Transtornos de Deglutição/diagnóstico
Transtornos de Deglutição/etiologia
Transtornos de Deglutição/fisiopatologia
Transtornos de Deglutição/prevenção & controle
Feminino
Seres Humanos
Efeitos Adversos de Longa Duração/diagnóstico
Efeitos Adversos de Longa Duração/fisiopatologia
Efeitos Adversos de Longa Duração/prevenção & controle
Masculino
Meia-Idade
Esvaziamento Cervical/efeitos adversos
Esvaziamento Cervical/métodos
Avaliação de Processos e Resultados (Cuidados de Saúde)
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/fisiopatologia
Complicações Pós-Operatórias/prevenção & controle
República da Coreia
Fatores de Risco
Tireoidectomia/efeitos adversos
Tireoidectomia/métodos
Tireoidectomia/reabilitação
Fatores de Tempo
Distúrbios da Voz/diagnóstico
Distúrbios da Voz/etiologia
Distúrbios da Voz/fisiopatologia
Distúrbios da Voz/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180105
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417751472



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