RESUMO
Objective: Although insomnia often compounds tinnitus, sleeping problems in people experiencing tinnitus are rarely treated. This study investigates the experiences of participants receiving Cognitive Behavioural Therapy for insomnia (CBTi) as part of a randomised controlled trial for managing tinnitus-related insomnia. The aim of this study is to gain detailed insight into participants' perceptions and experiences of this treatment.Design: Semi-structured interviews were conducted via phone or in-person by one of the two clinical psychologists who facilitated the CBTi sessions. Reflexive thematic analysis with semantic inductive approach was used for analysis to keep the research question theoretically flexible.Study samples: Eight participants (three females, age range 32-69 years) were interviewed six months after CBTi completion.Results: Three superordinate themes were identified: "Common humanity and transcending individual distress," "Changing the things I can" and "Accepting the things I cannot change." The group environment helped participants to normalise their experiences. Reliable tinnitus/sleep information and robust behavioural change techniques helped participants to respond and relate to their condition differently.Conclusion: Generally, participants reported long-term benefits from CBTi to treat tinnitus-related insomnia, particularly increased confidence, and getting on with life. CBTi is multi-component, so clinicians need to respond to individual preferences and lifestyles.
Assuntos
Terapia Cognitivo-Comportamental, Distúrbios do Início e da Manutenção do Sono, Zumbido, Feminino, Humanos, Terapia Cognitivo-Comportamental/métodos, Sono, Distúrbios do Início e da Manutenção do Sono/etiologia, Distúrbios do Início e da Manutenção do Sono/terapia, Zumbido/terapia, Resultado do Tratamento, Masculino, Adulto, Pessoa de Meia-Idade, IdosoRESUMO
OBJECTIVE: This study aims to explore vaccination acceptance among individuals with a history of preterm birth between March and June during the pre-COVID (2019), early-COVID (2020), and late-COVID (2021) periods. STUDY DESIGN: This is a cross-sectional, retrospective cohort study of pregnant individuals with a history of preterm birth (<37 weeks' gestation) who initiated care of a subsequent pregnancy during pre-COVID (March-June 2019), early-COVID (March-June 2020), or late-COVID (March-June 2021). The primary outcome of interest was vaccination status for influenza, Tdap, and COVID-19 vaccines. Fisher's exact and chi-square tests were used to investigate association between vaccination status and time periods, race/ethnicity, and insurance. RESULTS: Among 293 pregnancies, influenza vaccination rate was highest in early-COVID (p < 0.05). There was no statistically significant difference in Tdap or COVID-19 vaccination between time periods. COVID-19 vaccination was highest in individuals with private insurance (p < 0.05). There was no statistically significant difference in vaccination status by race/ethnicity. CONCLUSION: In this study on high-risk pregnant individuals, the majority of our cohort remained unvaccinated against COVID-19 into the late-COVID period. Additionally, their influenza vaccination rates were greater than the national average in early-COVID and substantially lower than the national average in late-COVID. This shift in influenza vaccination acceptance may have been sparked by COVID-19 vaccine distribution beginning in January 2021 leading to overall vaccination hesitancy. Standardized guidelines and counseling concerning prenatal safety in recommended immunizations may serve as important tools of reassurance and health promotion. KEY POINTS: · Maternal infections during pregnancy are a risk factor for preterm birth.. · High-risk cohort had low influenza vaccination post-COVID possibly due to COVID-19 vaccine hesitancy.. · Vaccination education may be a uniquely important tool among high-risk pregnant patients..
Assuntos
Vacinas contra COVID-19, Vacinas contra Difteria, Tétano e Coqueluche Acelular, Vacinas contra Influenza, Nascimento Prematuro, Vacinação, Feminino, Humanos, Recém-Nascido, Gravidez, COVID-19/prevenção & controle, Vacinas contra COVID-19/administração & dosagem, Estudos Transversais, Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem, Vacinas contra Influenza/administração & dosagem, Influenza Humana/prevenção & controle, Nascimento Prematuro/etiologia, Estudos Retrospectivos, Vacinação/estatística & dados numéricosRESUMO
The purpose of this study was to explore the sex difference and effects of blood pressure (BP) on the relationship between serum uric acid (SUA) and carotid plaque in patients with coronary heart disease (CHD). This large multicenter retrospective study included 12099 patients with CHD (aged 35-75 years) between January 1, 2014 and September 30, 2020. Patients were divided into three groups according to systolic BP (SBP) and diastolic BP (DBP), and the SUA levels in males and females were converted into three groups. Logistic regression was used to analyze the influence of sex and BP on the relationship between SUA levels and carotid plaque in patients with CHD. In the model of male BP subgroups, using the BP of group A (normal with SBP <120 mmHg and DBP <80 mmHg) as a reference, SUA levels were significantly correlated with the occurrence of carotid plaque under different BP states (P < .001). In contrast, in the model of female BP subgroups, most of these correlations were not statistically significant. Our study showed that SUA levels were significantly associated with carotid plaque occurrence in males with CHD, which remained significant across different BP states.
Assuntos
Doença da Artéria Coronariana, Placa Aterosclerótica, Humanos, Masculino, Feminino, Pressão Sanguínea/fisiologia, Ácido Úrico, Estudos Retrospectivos, Fatores de RiscoRESUMO
This qualitative study provides a platform for women veterans to inform our perspective of their experienced impacts following military sexual trauma (MST). We engaged 23 women veterans in semistructured interviews and used a grounded theory-informed thematic analytic approach, to interpret women's experiences. Women described negative impacts of their MST experiences across psychological, behavioral, and occupational domains. Less frequently, women discussed experiences of posttraumatic growth. These results aid our understanding of the complexities of women's posttrauma experiences and suggest that holistic intervention frameworks focused on a range of potential intervention targets are warranted in helping women veterans recover from MST.
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Vítimas de Crime, Militares, Delitos Sexuais, Transtornos de Estresse Pós-Traumáticos, Veteranos, Feminino, Humanos, Veteranos/psicologia, Trauma Sexual Militar, Delitos Sexuais/psicologia, Pesquisa Qualitativa, Militares/psicologia, Transtornos de Estresse Pós-Traumáticos/etiologia, Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
PURPOSE: Sex differences may exist in opioid use disorder (OUD) treatment. This study examined the treatment effects of buprenorphine/naloxone (BUP/NX) and methadone (MET) on the Clinical Opiate Withdrawal Scale (COWS) score in individuals with OUD and tested whether the associations differ by sex. METHOD: We performed a secondary analysis of the data from the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol-0027. A total of 1269 participants (861 males and 408 females) being aged 18 or older with OUD were randomly assigned to receive BUP/NX (n = 740) or MET (n = 529). The paired t test was initially used to compare the COWS scores between pre-dose and post-dose for BUP/NX and MET treatments, separately. The linear mixed model was used to examine the changes in COWS score adjusted for baseline demographic, substance use, and mental health disorders. The interaction of sex and treatment was detected and stratified analysis by sex was conducted. RESULTS: The paired t test showed that both BUP/NX and MET treatments significantly reduced the COWS scores (p values <0.0001). BUP/NX revealed higher COWS scores than MET (p = 0.0008) and females demonstrated significantly higher COWS scores than males (p = 0.0169). Stratified by sex, BUP/NX compared with MET revealed higher COWS scores only in males (p = 0.0043), whereas baseline amphetamines use disorder and major depressive disorder were significantly associated with COWS scores in females (p = 0.0158 and 0.0422, respectively). CONCLUSIONS: Both BUP/NX and MET are effective in decreasing opioid withdrawal symptoms via COWS scores, however, treatment plans for OUD by clinical providers should consider sex differences.
Assuntos
Buprenorfina, Transtorno Depressivo Maior, Transtornos Relacionados ao Uso de Opioides, Síndrome de Abstinência a Substâncias, Humanos, Feminino, Masculino, Buprenorfina/uso terapêutico, Antagonistas de Entorpecentes/uso terapêutico, Naloxona/uso terapêutico, Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico, Transtornos Relacionados ao Uso de Opioides/reabilitação, Tratamento de Substituição de Opiáceos, Caracteres Sexuais, Combinação Buprenorfina e Naloxona/uso terapêutico, Metadona/uso terapêutico, Síndrome de Abstinência a Substâncias/tratamento farmacológicoRESUMO
Efficacious strategies can now prevent the transmission of HIV from mother to child. However, transmission rates remain unacceptably high, especially in sub-Saharan Africa. Understanding women's perinatal transitions can inform interventions to support adherence to preventive strategies. Therefore, we applied Transitions Theory in a longitudinal qualitative study to explore perinatal transitions among women living with HIV in western Kenya. We conducted in-depth interviews with 30 women living with HIV at 3 key time points and, using our findings, described the theory's concepts in terms of participants' experiences. We then proposed theory-based interventions that could support smooth transition processes and positive outcomes.
Assuntos
Infecções por HIV, Mães, Gravidez, Criança, Feminino, Humanos, Quênia, Transmissão Vertical de Doenças Infecciosas/prevenção & controle, Estudos Longitudinais, Infecções por HIV/prevenção & controle, Pesquisa QualitativaRESUMO
The purpose of this study is to identify statistically distinguishable trajectories of childhood body mass index (BMI), an important indicator of developmental status of children, and to provide a summary description of demographic characteristics of children based on these distinctive trajectories. Using data from the Healthy Communities Study (HCS), a large longitudinal dataset with oversamples of Hispanic and Black children across 130 communities in the USA, a group-based trajectory analysis approach was used to estimate trajectories of children based on their BMI-z scores. The three most distinguishable BMI trajectory groups identified for the HCS children show no marked increase or decrease in standardized BMI over an age range of 2 to 11. Approximately 28.5% of children were in a trajectory group with consistently obese BMI-z scores for their sex and age. The patterns of BMI trajectory groups identified for boys and girls are similar, but BMI-z scores for boys tend to be slightly higher than those for girls. These BMI trajectories are characterized by racial/ethnic and socioeconomic status disparities. Hispanic and Black children were more likely to be in the obese trajectory group than White children. Children with parents having less education, or children from low family income level, were more likely to be in the obese trajectory group than counterpart children. The findings suggest that BMI disparities exist from the early years of childhood and persist across childhood, with higher BMI associated with Black and Hispanic children as well as those from low socioeconomic status backgrounds.
Assuntos
Etnicidade, Obesidade Infantil, Grupos Raciais, Criança, Feminino, Humanos, Masculino, Índice de Massa Corporal, Hispânico ou Latino, Estudos Longitudinais, Disparidades Socioeconômicas em Saúde, Negro ou Afro-Americano, Pré-EscolarRESUMO
PURPOSE: It is aimed to raise awareness about the science of nursing for women's health and the use of nursing theories and models in research by reviewing the studies using theories or models in postpartum care. DATA SOURCES: The data of the study were obtained by searching YÖK National Thesis Center, EBSCOhost, PubMed, Web of Science, Cochrane, and ScienceDirect databases. Reviewed studies were analyzed in terms of the type of research, sample characteristics, purpose, the field of use of theory and model in the research, and research results. CONCLUSIONS: As a result of the review, it was noted that in the studies, Orem's Self-Care Deficit Nursing Theory/Model (n = 9), Roy's Adaptation Theory (n = 7), and Kolcaba's Theory of Comfort (n = 7) were the most used theories, theories and models were not used in a systematic structure at every stage of the research, and positive outcomes were obtained with the theory and model-based nursing interventions. IMPLICATIONS FOR NURSING PRACTICE: The application of theory and model in postpartum care can be chosen by nurses as it improves patient outcomes. Furthermore, the use of theories and models in research to develop nursing knowledge will benefit nursing science while increasing professional autonomy.
Assuntos
Teoria de Enfermagem, Cuidado Pós-Natal, Humanos, Feminino, Gravidez, Modelos de Enfermagem, AutocuidadoRESUMO
OBJECTIVE: To explore the expectations of Brazilian and German patients regarding metastatic cancer and palliative chemotherapy. METHODS: Interviews with 48 metastatic cancer patients from Brazil and Germany were conducted. The interviews were transcribed and analyzed using the thematic analysis approach to identify common themes. The sociodemographic data were collected using an instrument developed by the authors. RESULTS: A total of 48 patients participated in the study (58% were Brazilian and 42% were German). Of all participants, 35% were men and 65% were women. The participants' mean age was 41 years. The general idea captured from the interviewees' speech was that their diseases were curable or "while there is chemotherapy, there is life"; thus, the data analysis enabled the elaboration of the central theme, entitled "Mistaken expectations of metastatic cancer patients regarding palliative chemotherapy: While there is chemotherapy, there is life," with 5 subthemes, namely: (1) communication and expectations; (2) normal life; (3) the person behind the disease; (4) religiosity and spirituality; and (5) the fortitude to choose between continuing or discontinuing treatment. SIGNIFICANCE OF RESULTS: Regardless of cultural aspects, patients with metastatic cancer on palliative chemotherapy tend to believe in the healing potential of treatments. Dividing expectations only into curable or incurable is insufficient, as even patients who have acknowledged the incurability of their disease expect to live, as long as they remain under treatment as if the disease did not exist.
Assuntos
Neoplasias, Cuidados Paliativos, Masculino, Humanos, Feminino, Adulto, Brasil, Motivação, Neoplasias/tratamento farmacológico, Comunicação, Pesquisa QualitativaRESUMO
INTRODUCTION: Due to the risk of thrombosis, nearly all children supported by extracorporeal membrane oxygenation (ECMO) receive systemic anticoagulation. While heparin has traditionally been used, there are reports of increased use of direct thrombin inhibitors. We sought to describe the use of anticoagulation in children supported by ECMO in the United States using a large administrative database. METHODS: We performed a retrospective cohort study of children supported by ECMO within the Pediatric Health Information System (PHIS) database. Pediatric encounters involving ECMO from 2012 to 2020 were identified. Data regarding demographics, diagnoses, anticoagulation, complications, and outcomes were extracted for eligible encounters. RESULTS: Eleven thousand five hundred ninety-five encounters that involved ECMO were identified. Fifty-four percent were male with an age range of 0-17 years and a median (IQR) age of 0 (0-2) years. Unfractionated heparin (UFH) only was used in 94% (95% CI: 93.6-94.5%) of encounters and UFH followed by bivalirudin in 5% (95% CI: 4.3-5.1%) of cases. There was a significant difference in the use of bivalirudin from 2012 to 2020 (p < 0.001). Differences in anticoagulation regimens were observed between infants and children (p = 0.004) and between those with and without cardiac indications for ECMO (p < 0.001). Four percent (95% CI: 4.1-4.8%) of encounters were associated with diagnostic coding for thrombosis and differences in occurrence of thrombosis were observed between different anticoagulant regimens (p < 0.001). CONCLUSIONS: Though the majority of children on ECMO in the United States receive heparin anticoagulation, there is an increase in use of direct thrombin inhibitors. Prospective studies must evaluate the efficacy of different anticoagulants in this patient population.
Assuntos
Oxigenação por Membrana Extracorpórea, Sistemas de Informação Hospitalar, Trombose, Lactente, Humanos, Masculino, Criança, Estados Unidos, Recém-Nascido, Pré-Escolar, Adolescente, Feminino, Heparina/uso terapêutico, Oxigenação por Membrana Extracorpórea/efeitos adversos, Estudos Retrospectivos, Estudos Prospectivos, Anticoagulantes/uso terapêutico, Antitrombinas, Trombose/tratamento farmacológico, Trombose/epidemiologia, Trombose/etiologiaRESUMO
OBJECTIVE: To identify whether infection, cervical laceration and perineal laceration are associated with postpartum hemorrhage in the setting of vaginal delivery induced by Cook balloon catheter. MATERIALS AND METHODS: The retrospective study included 362 women who gave birth vaginally at or beyond 37 weeks of gestation with a diagnosis of postpartum hemorrhage between February 2021 to May 2022, of which including 216 women with induction of labor (Cook balloon catheter followed by oxytocin or oxytocin) and 146 women with spontaneous delivery. Risk factors for postpartum hemorrhage were collected and compared. RESULTS: 362 women were divided into three groups, group 1 with spontaneous delivery, group 2 with oxytocin, group 3 with Cook balloon catheter followed by oxytocin. There was no significant difference in incidence of infection within three groups (P > 0.05). The rate of cervical laceration and perineal laceration was significantly higher in group 3 compared with groups 2 and 1 (P < 0.05); Multivariate logistic regression analysis found that compared with group 1, either group 3 or group 2 was associated with increased risks of cervical laceration and perineal laceration (P < 0.05), and compared with group 2, group 3 was not associated with increased risks of cervical laceration and perineal laceration (P > 0.05). CONCLUSION: Infection, cervical laceration and perineal laceration are identified not to be independent risk factors for postpartum hemorrhage for women undergoing labor with Cook balloon catheter; Cervical laceration and perineal laceration increase the risk of postpartum hemorrhage in women with labor induction.
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Lacerações, Hemorragia Pós-Parto, Doenças do Colo do Útero, Gravidez, Feminino, Humanos, Hemorragia Pós-Parto/etiologia, Hemorragia Pós-Parto/terapia, Ocitocina, Lacerações/etiologia, Estudos Retrospectivos, Parto Obstétrico/efeitos adversos, Trabalho de Parto Induzido, Doenças do Colo do Útero/etiologia, Cateteres UrináriosRESUMO
INTRODUCTION: Discrimination experiences may be a contributing factor to the elevated prevalence of mental health problems among adults experiencing homelessness. METHODS: Using survey data (N = 552) collected from adults seeking services at an urban day shelter, the relationships between everyday and major discrimination experiences, distress tolerance, and mental health problems (depression, anxiety, post-traumatic stress disorder, poor mental health days) were characterized. Distress tolerance was examined as a moderator of the relationship between discrimination and mental health problems. RESULTS: Participants were predominantly from racially minoritized groups (59.6%), non-Hispanic (88.7%), and male (70.9%), with an average age of 45.7 years old (SD = 11.7). Descriptive analyses indicated that the main reason for discrimination differed between racially privileged (i.e., White participants) and racially minoritized participants (i.e., participants who identified as Black, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, or multi-race), such that homelessness was most commonly endorsed among racially privileged participants while racial discrimination was most commonly reported among racially minoritized participants. Multivariate logistic regression analyses revealed associations between everyday discrimination, major discrimination, and distress tolerance with mental health problems. Distress tolerance did not moderate the relations between discrimination and mental health problems in most analyses. Notably, major discrimination was no longer associated with all mental health variables when both everyday and major discrimination were included in all models. CONCLUSION: Findings suggest that reducing everyday discrimination and addressing the adverse impact of everyday discrimination experiences may have a beneficial impact on mental health.
Assuntos
Pessoas Mal Alojadas, Racismo, Adulto, Humanos, Masculino, Pessoa de Meia-Idade, Feminino, Saúde Mental, Racismo/psicologia, Ansiedade/epidemiologia, Transtornos de AnsiedadeRESUMO
Infants face the highest risk of abuse and neglect nationally. There is a compelling need to understand the individual risk factors and needs of families of maltreated infants so that prevention efforts can be tailored for optimal effectiveness. Using linked birth certificate and CPS records data, we employed latent class analysis to identify distinct profiles of perinatal health factors associated with infant maltreatment. Classes were then regressed onto two key child welfare outcomes-removal from the home and re-report. Results indicated 10 latent classes primarily associated with supervisory neglect and presumed prenatal substance exposure. Rapid repeat pregnancy, smoking during pregnancy and inadequate prenatal care emerged as key risk factors. Presumed substance exposure was associated with high risk of removal from the home and low risk of re-report. The opposite was found for supervisory neglect. Substantial variation existed across classes and types of maltreatment, suggesting a need for tailored prevention strategies.
Assuntos
Maus-Tratos Infantis, Serviços de Proteção Infantil, Feminino, Humanos, Lactente, Gravidez, Maus-Tratos Infantis/prevenção & controle, Proteção da Criança, Fatores de Risco, FumarRESUMO
Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.
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Comportamento do Adolescente, Minorias Sexuais e de Gênero, Feminino, Humanos, Adolescente, Estados Unidos/epidemiologia, Assunção de Riscos, Comportamento Sexual, HeterossexualidadeRESUMO
The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw conclusions about what we do (or do not) owe them. This paper argues that at best the concept of "personhood" is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood.
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Aborto Induzido, Bioética, Gravidez, Feminino, Animais, Humanos, Pessoalidade, Inteligência Artificial, Obrigações MoraisRESUMO
BACKGROUND: The brain is built up during pregnancy. How it functions afterwards depends on how the expectant mother's diet nourishes it. Walnuts contain significant quantities of polyunsaturated fatty acids (PUFAs) and bioactive phytochemicals, which enhance brain health and function even with advancing age. This study examined the effects of a walnut-enriched diet (WED) on corticohippocampal histoarchitecture and gene expression in rat offspring. MATERIALS AND METHODS: Twenty-eight female adult Wistar rats (n= 7) averaging about 185 g in weight were used for this study. After mating, pregnant dams were split randomly into four groups: A (standard rat chow/control), B (WED from GD 0 - PND 21), C (WED from GD 0 - PND 1), D (WED from PND 1 - PND 21). Offspring of dams were sacrificed at adolescence (PND 35), with brain tissues of interest harvested for subsequent analyses. RESULTS: We observed no significant correlates in litter size, body, and brain weights across the experimental groups. Histomorphology revealed no distortion in cellular layering and delineation of cells in the PFC and dentate gyrus of both control and WED groups. Nissl staining intensity was enhanced in the offspring of dams exposed to WED versus the control, indicating improved proteostasis. Upregulated mRNA expression of DNMT3a, H2Ax, OPA1, and BDNF was observed in cortical and hippocampal tissues of WEDexposed offspring compared with the control group. CONCLUSION: A diet enriched with African walnuts during early development induced changes predictive of cognitive improvements and enhanced stress-response signalling, plasticity, and neural resilience in rat offspring.
Assuntos
Juglans, Efeitos Tardios da Exposição Pré-Natal, Gravidez, Ratos, Animais, Feminino, Humanos, Ratos Wistar, Hipocampo/metabolismo, Dieta, Expressão GênicaRESUMO
This study aims to reveal dynamic changes in prosodic prominence patterns associated with Parkinson's disease (PD). To fulfill this purpose, the study proposes an exploratory methodology involving measuring a novel syllable-based prosody index (SPI) and performing functional principal component analyses (fPCAs) in a semi-automatic manner. First, SPI trajectories were collected from 31 speakers with PD before and after speech therapy and from 36 healthy controls. Then, the SPI trajectories were converted to continuous functions using B-splines. Finally, the functional SPIs were examined using fPCAs. The results showed that PD was associated with an increase of overall prominence for male speakers. The findings regarding higher prominence patterns in PD were supported by traditional phonetic measurements. For female speakers, however, there were no significant differences in prosodic prominence between speakers with PD and healthy controls. The results encourage to explore the proposed methodology also in analyses of other forms of atypical speech.
Assuntos
Doença de Parkinson, Humanos, Masculino, Feminino, Projetos Piloto, Doença de Parkinson/complicações, Medida da Produção da Fala, Fala, Distúrbios da FalaRESUMO
This research aims to deepen our understanding of patients' satisfaction with therapeutic patient education (TPE) in oncology. The research model proposed was tested, with structural equation modeling, on 207 French breast-cancer patients who participated in a TPE program. The results confirm that post-TPE empowerment and relational proximity to the TPE team are two major antecedents of patient's satisfaction-and attitude and word-of-mouth toward TPE are two important consequences of this concept of satisfaction. However, the established relationships are moderated by the patients' profiles (i.e., utilitarin believers, passionate followers, or holistic followers) in terms of the perceived value of their own experience of patient education. These results will enable stakeholders to adapt their TPE promotion strategies to the profiles of the patients. The study will also help to demonstrate and highlight the patient benefits of TPE to various stakeholders and thus will favor access to this personalized care practice, which is essential in the management of chronic diseases, but is still limited in oncology.
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Neoplasias da Mama, Satisfação do Paciente, Humanos, Feminino, Doença Crônica, Neoplasias da Mama/terapiaRESUMO
Women have experienced increased rates of intimate partner violence (IPV) since the onset of the COVID-19 global pandemic, and at the same time requirements for physical distancing and/or remote delivery of services have created challenges in accessing services. We synthesized research evidence from 4 systematic reviews and 20 individual studies to address how IPV interventions can be adapted within the context of the pandemic. As many interventions have been delivered via various technologies, access to technology is of particular importance during the pandemic. Our results can inform the provision of services during the remainder of the COVID-19 pandemic including how to support women who have little access to in-person services.
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COVID-19, Violência por Parceiro Íntimo, Humanos, Feminino, PandemiasRESUMO
Background: Gallbladder torsion is a rare cause of an acute abdomen, predominantly occurring in elderly women and less frequently diagnosed in the pediatric population. The diagnosis is difficult and rarely made preoperatively. However, suspicion needs to be raised in children with acute onset of abdominal pain. Ultrasound can demonstrate different signs putting forward the diagnosis but findings are often non-specific, therefore clinical suspicion should prompt a laparoscopic exploration.Case presentation: We report a case of a 12-month old girl consulting with progressive abdominal discomfort and vomiting. Ultrasound revealed an enlarged gallbladder with thickening of the wall but without demonstrable color Doppler flow and a more horizontal orientation outside its normal anatomic fossa. Gallbladder torsion was suspected. Emergency laparoscopic exploration confirmed the diagnosis and a laparoscopic cholecystectomy was performed. The postoperative course was uneventful.Conclusions: Gallbladder torsion, although rare, should be included in the differential diagnosis of an acute abdomen in children. Early recognition is necessary for a favorable outcome. The diagnosis might be supported by ultrasound but remains difficult, which is why laparoscopic exploration should be considered when the diagnosis remains unclear.
