Hasil untuk "Nursing"

Shijiao Zhang, Yanding Su, Ao Han et al.

<b>Background</b>: Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive disease that easily develops into cirrhosis and hepatocellular carcinoma, but its pathogenesis is not clear, and most therapeutic drugs have obvious limitations. However, Babao Dan (BBD) has a good therapeutic effect on liver disease, but its treatment mechanism is still to be studied. Therefore, we further investigated the mechanism of BBD in treating MASH. <b>Methods</b>: We predicted BBD-related targets through network pharmacology and further verified the binding ability of BBD-related targets through molecular docking. We also detected relevant indicators before and after model treatment, as well as metabolomics analysis and identification of the mechanism of action of BBD on MASH. <b>Results</b>: Through network pharmacology methods, 158 key cross targets and the top 10 core targets were identified, and it was determined that the PI3K-AKT signaling pathway plays an important regulatory role in the treatment of MASH with BBD. The molecular docking results indicate that the representative compounds quercetin and 17 Beta Estradiol have good binding activity with five core targets. Metabolomics has identified four metabolic biomarkers, such as Piceid, and it is determined that the key pathway for BBD treatment of MASH is the bile secretion pathway. <b>Conclusions</b>: BBD effectively treats MASH by modulating Piceid and other biomarkers, targeting ESR1 and other core proteins via quercetin and 17-beta-estradiol, and regulating the PI3K-AKT and bile secretion pathways to alleviate liver injury.

Rob Horne, Caroline Sabin, Trudie Chalder et al.

Background Antiretroviral therapy has transformed human immunodeficiency virus infection intoa chronic condition associated with normal life expectancy. In the United Kingdom, the uptake of antiretroviral therapy is generally high, but a delay in starting antiretroviral therapy and non-adherence compromise the health and well-being of people living with human immunodeficiency virus, increase the risk of transmission of human immunodeficiency virus and increase National Health Service costs. Objectives The overall aim was to improve antiretroviral therapy uptake and adherence by addressing perceptual and practical barriers. The objectives were to (1) identify culturally specific beliefs and other factors influencing uptake of and adherence to antiretroviral therapy that have not emerged in previous research; (2) refine existing methods for assessing perceptual and practical barriers to antiretroviral therapy uptake and adherence; (3) develop an intervention to increase antiretroviral therapy uptakeand adherence; (4) determine intervention feasibility and acceptability; (5) evaluate intervention efficacy;(6) assess the short- and long-term costs and cost-effectiveness of the interventions and (7) prepare for implementation within the National Health Service. Design Objective 1 – in-depth interviews with Black African and Black Caribbean people living with human immunodeficiency virus (n = 52); objective 2 – adaptation of the Beliefs about Medicines Questionnaire; objective 3 – development of the Supporting UPtake and Adherence to antiretroviral therapy service intervention; objective 4 – feasibility study (n = 213) and acceptability/process interviews (n = 24); objective 5 – observational study (n = 484) and randomised controlled trial (n = 143); objective 6 – systematic review, cost-effectiveness analysis (n = 210) and economic modelling; and objective 7 – preparatory implementation work with people living with human immunodeficiency virus and human immunodeficiency virus clinic staff. Setting National Health Service human immunodeficiency virus clinics in England with a high proportion of ethnic minority populations. Participants People living with human immunodeficiency virus. Interventions Adherence support – cognitive–behavioural therapy plus care as usual. Main outcome measures Workstream 1 – adapted Beliefs about Medicines Questionnaire–antiretroviral therapy. Workstream 2 – feasibility study: participant recruitment and withdrawal rates. Workstream 3 – randomised controlled trial – primary outcome: medication event monitoring system adherence. Workstream 4 – incremental cost-effectiveness ratio. Results Workstream 1 – qualitative studies were used to refine the Beliefs about Medicines Questionnaire – antiretroviral therapy and, together with our preparatory research, to inform the cognitive–behavioural therapy-based intervention. Workstream 2 – recruitment to the randomised controlled trial and observational study was deemed feasible. Thematic analysis of exit interviews with recipients of the SUPA intervention demonstrated that the intervention was acceptable and addressed perceptual and practical barriers to antiretroviral therapy. In Workstream 3, we did not meet the recruitment targets and our trial was underpowered for the primary outcome: 143 participants met the inclusion criteria and were randomised (care as usual, n = 72; care as usual plus cognitive–behavioural therapy, n = 71). There was no significant effect of cognitive–behavioural therapy on the primary end point. Of the 112 participants (care as usual, n = 55; cognitive–behavioural therapy, n = 57) for whom sufficient data for primary end-point analysis were available, 17 (15.2%) met the primary end point (> 80% of months with an average monthly adherence of ≥ 90%) [9 (16.4%) in the care-as-usual group and 8 (14.0%) in the cognitive–behavioural therapy group (p = 0.94)]. Secondary end points: median Medication Event Monitoring System adherence at 12 months was 61.9% in the care-as-usual group and 66.5% in the cognitive–behavioural therapy group (p = 0.40), representing a 7.5% uplift in adherence. Participants who were randomised to receive the intervention, based on perceptions of antiretroviral therapy at baseline (low antiretroviral therapy necessity beliefs, and/or high antiretroviral therapy concerns), experienced a greater decrease in antiretroviral therapy concerns [care as usual −0.9 (95% confidence interval −1.4 to −0.5) vs. cognitive–behavioural therapy −0.6 (95% confidence interval −0.8 to −0.3); p = 0.03], treatment intrusiveness [median change in highly active antiretroviral treatment (antiretroviral therapy) Intrusiveness Scale scores: care as usual −0.5 (95% confidence interval −5.6 to 18.0) vs. cognitive–behavioural therapy −5.6 (95% confidence interval −20.4 to 1.2); p = 0.03] and depression scores [median change in depression score: care as usual 0 (95% confidence interval −1.5 to 2.0) vs. cognitive–behavioural therapy −1 (95% confidence interval −3 to 0); p = 0.02] between baseline and 12 months. Workstream 4 – cognitive–behavioural therapy resulted in 0.056 more quality-adjusted life-years than care as usual (95% confidence interval 0.0029 to 0.083). The incremental cost-effectiveness ratio was £11,189 per quality-adjusted life-year. At a threshold of £20,000 per quality-adjusted life-year, there was > 90% likelihood that the intervention would be more cost-effective than care as usual. There was a 13% likelihood that the intervention would produce more quality-adjusted life-years and result in lower health and social care costs than care as usual. A Markov model showed that, over the longer term, cognitive–behavioural therapy results in fewer quality-adjusted life-years and higher costs and, therefore, care as usual would be the more cost-effective option. Limitations Our primary outcome of full Medication Event Monitoring System adherence was problematic, our randomised controlled trial was underpowered and we were unable to demonstrate a significant difference in our primary outcome. Conclusions Patients who received the Supporting UPtake and Adherence to antiretroviral therapy service intervention benefited from a reduction in antiretroviral therapy concerns, a reduction in antiretroviral therapy intrusiveness and reduced depressive symptoms, and from improved quality of life. The intervention was likely to be cost-effective for the National Health Service within 12 months. Future work Given the difficulty in recruiting people at a high risk of non-engagement with human immunodeficiency virus care, future work assessing the effectiveness of adherence interventions may require alternative, non-standard randomised controlled trial designs. Further studies are necessary to recalibrate our understanding of the levels of antiretroviral therapy adherence necessary to achieve viral load suppression. Study registration The trial is registered as ISRCTN35514212 and the study is registered as CRD42019072431. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-0109-10047) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary Human immunodeficiency virus treatment (known as antiretroviral therapy) is very effective, but some patients do not get the full benefit because they delay treatment or miss doses. This increases the chances of getting ill and the risk of passing human immunodeficiency virus on to others. There are many reasons why people delay treatment or take less than has been prescribed, including beliefs and concerns about treatment and practical difficulties. People from United Kingdom Black African and Caribbean communities often experience difficulties with human immunodeficiency virus treatment, but few studies have focused on this group. We interviewed 52 people from Black African and Caribbean communities about their views and experiences of human immunodeficiency virus and its treatment, and designed questionnaires to measure these. After consulting with people living with human immunodeficiency virus, we developed a new service to help people get the best from human immunodeficiency virus treatment (i.e. Supporting UPtake and Adherence to antiretroviral therapy). The Supporting UPtake and Adherence to antiretroviral therapy service included a video and booklet about human immunodeficiency virus and antiretroviral therapy and up to four meetings or telephone calls with a nurse to address questions and concerns. We compared the Supporting UPtake and Adherence to antiretroviral therapy service with usual National Health Service care to test whether or not patients who received the Supporting UPtake and Adherence to antiretroviral therapy intervention were more likely to take antiretroviral therapy as prescribed by their doctor (known as adherence). We also tested whether or not the Supporting UPtake and Adherence to antiretroviral therapy programme benefited patients by reducing antiretroviral therapy concerns and practical difficulties, and if it improved depression and provided value for money for the National Health Service. It was more difficult than we expected to recruit people to the trial. Because of this, and difficulties in measuring the amount of antiretroviral therapy taken, we did not show that people who received the Supporting UPtake and Adherence to antiretroviral therapy intervention took more antiretroviral therapy over 12 months than those who received normal care. People who received the Supporting UPtake and Adherence to antiretroviral therapy intervention benefited from reduced concerns about antiretroviral therapy and antiretroviral therapy interfered less in their lives. People who received the Supporting UPtake and Adherence to antiretroviral therapy intervention were also less depressed and used fewer extra National Health Service services. The Supporting UPtake and Adherence to antiretroviral therapy service represented value for money in the short term. Scientific summary Background Antiretroviral therapy (ART) is highly effective and the majority of people living with human immunodeficiency virus (PLWH) in the UK now have an undetectable viral load and a near-normal life expectancy and pose a low risk of onward human immunodeficiency virus (HIV) transmission. However, adherence to ART is necessary to suppress and maintain an undetectable HIV viral load. Substantial numbers of PLWH in the UK are not prescribed ART or have a detectable viral load when prescribed ART. This is a problem because both delays to start ART and non-adherence compromise the health and well-being of PLWH, increase the risk of HIV transmission and increase NHS costs. There is a need for a pragmatic, evidence-based approach to increase uptake and adherence to ART. Interventions to increase adherence across long-term conditions have had limited success, and it is not yet clear which strategies are most effective. To optimise engagement with ART, there is a need to understand why people with HIV may not want to, or be unable to, initiate and take ART. Our preparatory research was conducted across multiple chronic illnesses, including HIV infection, and in different cultural contexts and showed that adherence was consistently related to both perceptions of their treatment [i.e. how patients judged their personal necessity for treatment (necessity beliefs) relative to their concerns about potential adverse effects] and practical difficulties with taking treatment, such as limitations in capability and opportunity. This work influenced the National Institute for Health and Care Excellence (NICE) guidelines for adherence that recommend tailoring adherence support to address the specific perceptual and practical barriers that are salient for the individual. Aim The aim of this programme was to improve engagement with ART (uptake and adherence) by addressing perceptual and practical barriers, providing the evidence base for HIV care and informing the implementation of NHS policy. Figure a shows an overview of the programme and highlights the various components of each workstream (WS). FIGURE aProgramme overview. AC, ancillary study; BMQ, Beliefs about Medicines Questionnaire; CAU, care as usual; CBT, cognitive–behavioural therapy; IPA, interpretative phenomenological analysis; RCT, randomised controlled trial; SUPA, Supporting UPtake and Adherence to ART. Objectives Identify culturally specific beliefs and other factors influencing uptake of and adherence to ART that have not emerged in previous research. Refine our existing methods for eliciting and measuring the salient perceptual and practical factors influencing uptake of and adherence to ART. Develop an intervention (including intervention manuals, materials and therapeutic intervention) to increase uptake of and adherence to ART. Determine the feasibility and acceptability of the intervention. Evaluate the efficacy of the intervention for increasing ART uptake and adherence. Assess the costs and cost-effectiveness of providing the intervention in the short and long term. Prepare for implementation within the NHS. Methods and results Workstream 1: intervention development Workstream 1 addressed objectives 1–3 in three studies from discussions with our patient and public involvement group, clinical advisors and our analysis of gaps in the published literature on adherence to antiretrovirals, it became apparent that people from UK Black African and Caribbean communities often experience difficulties with HIV treatment, but few studies have focused on this group. We therefore paid particular attention to this group in our intervention development studies. Study 1 identified culturally specific beliefs and other factors influencing the uptake of and adherence to ART in Black African and Caribbean communities that have not emerged in previous research. We interviewed 52 men and women from Black African and Caribbean communities in London who had been identified as having previous or current problems adhering to their medication. Two separate analyses were conducted. The first used interpretative phenomenological analysis to understand the lived experiences of taking ART among a group of women from West Africa (n = 10), which was a previously under-represented community in HIV adherence research. The analysis identified issues and challenges that the women experienced with adherence to ART. The following three overarching themes were identified: (1) negative experiences of medication, (2) temporal improvement and (3) spurs to adherence. The second analysis used framework analysis to identify perceptual and practical barriers to adherence (n = 52). This analysis of in-depth interviews with people with demonstrated suboptimal adherence showed that perceptual barriers to ART could be grouped into two overarching themes: doubts about the need for ART and concerns about potential harm and stigma. The findings of our preparative research were discussed with patient representatives and practising clinicians from centres with a large proportion of men who have sex with men (MSM). The consistent view was that our preparative research findings remained relevant for MSM and that further research in this group to inform our measures of perceptual and practical barriers to ART was unnecessary. Study 2 refined existing methods to measure patients’ perceptions of ART. The study 1 findings were used to refine our measures of perceptual and practical barriers to ART uptake and adherence with four items added to the Beliefs about Medicines Questionnaire (BMQ)-ART. Study 3 developed an intervention to address barriers and facilitate ART uptake and adherence. Medical Research Council guidance was applied to develop a cognitive–behavioural therapy (CBT)-based intervention to support uptake and adherence to ART. The intervention, intervention manual and animations were developed by an Intervention Development Group, including experts in adherence, behaviour change theory, CBT, HIV medicine, nursing, pharmacy and HIV patient advocacy. It was informed by our preparatory research and the findings of study 1, incorporating: standardised information about HIV and its treatment, designed to address common, adherence-related misconceptions and concerns and signpost patients to further support to help overcome practical difficulties with taking ART and reduce the degree to which ART interfered with daily living (ART intrusiveness), delivered through an animated video and a booklet personalised discussion with a HIV nurse to introduce the Supporting UPtake and Adherence to ART (SUPA) video and booklet and address barriers to adherence, applying CBT techniques in up to four sessions – the first was face to face, with further sessions in clinic or by telephone follow-up, determined by patient preference. The intervention manual and animation were reviewed by the SUPA management group and members of the target population. User testing and further development of materials were conducted with PLWH, who were recruited through the Africa Advocacy Foundation (AAF). Workstream 2: feasibility and acceptability of the Supporting UPtake and Adherence to antiretroviral therapy (cognitive–behavioural therapy) intervention Study 4 determined the feasibility and acceptability of the SUPA (CBT) intervention. Study 4 included the following two components. Quantitative feasibility study nested within the randomised controlled trial to determine the feasibility of the Supporting UPtake and Adherence to antiretroviral therapy intervention Over an initial period of 14 months, 213 PLWH were recruited to an observational study, of whom 86 were eligible for the randomised controlled trial (RCT) and 46 were successfully randomised [23 to the care as usual (CAU) group and 23 to the CBT group]. Rates of attrition were low: of the 213 patients enrolled in the observational study, only 5 were not reached for follow-up appointments. Of the 46 patients randomised, 2 withdrew. Qualitative feasibility study The qualitative feasibility study was a thematic analysis of qualitative interviews conducted with people randomised to receive the SUPA intervention. This analysis determined the acceptability of the SUPA intervention and explored the process of change. Twenty-four people from the PLWH community in the UK were interviewed about their experiences of taking part in the trial and receiving the SUPA intervention. Participants reported various reasons for enrolling in the trial, including the desire to learn about HIV and its treatment, play an active role in their health care, and give something back to other PLWH. Intervention sessions gave participants the opportunity to discuss their concerns about ART and to receive confidential advice and support. Participants indicated that the intervention materials were relevant and accessible. The findings indicated that the intervention addressed misconceptions about HIV, provided a rationale for taking ART, reduced concerns about ART and provided practical strategies for adherence and emotional support. Workstream 3: randomised controlled trial efficacy of the Supporting UPtake and Adherence to antiretroviral therapy cognitive–behavioural therapy-based intervention to support antiretroviral therapy uptake and adherence The efficacy of the SUPA intervention was examined in a RCT. A two-step consent process was followed. ART-naive PLWH who had received a treatment offer were recruited from eight HIV clinics in England to take part in an observational study. Participants completed the BMQ-ART, and those who had perceptual barriers to ART (doubts about personal need for ART and/or concerns about ART), and were therefore deemed at risk of non-adherence, were invited to take part in the RCT. Those who consented to take part in the RCT were randomised to receive CAU or CBT (Figure b). Those who were not eligible for the RCT or who declined to take part remained in the observational study and completed the BMQ-ART at the 3-, 6- and 12-month follow-ups. FIGURE bThe SUPA study trial design. The primary end point was designed to capture both a delay to initiate treatment and non-adherence, and was developed in discussion with NIHR. In the months prior to ART initiation, adherence was set to 0%. After starting ART, the proportion of days within the month with full adherence was assessed using Medication Event Monitoring System (MEMS®) (AARDEX Group, Seraing, Belgium). Adherence within each patient-month was then classified as being good (≥ 90%) or poor (< 90%), and the prespecified primary outcome was met if individuals achieved good adherence in > 80% of the months during which they were under follow-up. The secondary outcomes were percentage MEMS adherence, self-reported adherence, changes in beliefs about ART, ART intrusiveness and practical difficulties with ART, perceptions of HIV, depression and anxiety, viral load suppression, regimen switches, treatment failure, and disengagement from care. Between March 2014 and July 2017, 1575 patients were assessed for eligibility, of whom 143 were randomised (CAU, n = 72; CBT, n = 71). Recruitment was challenging, and our target of 372 was not reached. The observational study included 484 individuals who were not eligible or chose not to take part in the RCT (RCT-eligible decliners at high non-adherence risk, n = 27; not eligible for RCT at low non-adherence risk, n = 457). Owing to the challenges in using MEMS, the number of participants with sufficient data for primary end-point analysis was 112 (CAU, n = 55; CBT, n = 57). Of those, 17 participants (15.2%) met the primary end point (> 80% of months, with an average monthly adherence of ≥ 90%) [9 (16.4%) in the CAU group and 8 (14.0%) in the CBT group (p = 0.94)]. There was no significant difference in the primary outcome (i.e. MEMS adherence) between the CBT and CAU groups at 12 months. There was a 7% improvement in median percentage adherence by MEMS in the CBT group relative to the CAU group (61.9% CAU and 66.5% CBT; p = 0.40). There was a significant increase in the proportion of people with high adherence (by self-reported Medication Adherence Report Scale) at 3 months’ follow-up (75% CAU and 81% CBT; p = 0.02). Participants randomised to receive CAU plus CBT benefited from a significantly greater reduction in ART concerns, ART intrusiveness and depression between baseline and 12 months than those randomised to receive CAU. There were no significant differences between the randomised groups in ART necessity beliefs (which were high in both groups), anxiety, illness perceptions, viral load, cluster of differentiation 4 (CD4) T-cell count, rates of treatment failure or treatment switches. Workstream 4: economic studies Workstream 4, study 6, addressed objective 6: assessing the costs and cost-effectiveness of the SUPA intervention in the short and long term. It comprised three substudies, as follows. Systematic review of economic evaluations of antiretroviral therapy adherence interventions A systematic literature search identified 20 studies reporting costs or cost-effectiveness of interventions to increase adherence to ART in PLWH. The quality of the economic evaluations was assessed. There was evidence of improved adherence and favourable cost-effectiveness ratios in people receiving adherence interventions compared with the control conditions. However, these effects tended to be short term. Trial-based cost-effectiveness analysis of the Supporting UPtake and Adherence to antiretroviral therapy intervention Use of the intervention and other health and social care services and HIV-specific medications were measured in the RCT (i.e. study 5) and costs were calculated. Quality-adjusted life-years (QALYs) were generated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Costs were compared at baseline and each follow-up time point. QALYs were compared, controlling for baseline EQ-5D-5L tariffs. Cost-effectiveness was assessed by combining incremental costs and incremental QALYs using an incremental cost-effectiveness ratio (ICER). The mean costs among the CBT group were £621 more than for the CAU group. This difference was not statistically significant [95% confidence interval (CI) –£569 to £1462]. CBT resulted in 0.056 more QALYs over the follow-up period than CAU, and this was significant (95% CI 0.0029 to 0.083). The ICER was £9143 per QALY. At a threshold of £20,000 per QALY, there was more than a 90% likelihood that CBT would be more cost-effective than CAU. There was a 19% likelihood that CBT would produce more QALYs and result in lower health and social care costs than CAU. A simulation model of the long-term cost-effectiveness of the intervention A Markov model was used to extrapolate for 15 years, in 12-month cycles beyond the trial period. Health states were defined by CD4 T-cell counts and all-cause mortality. The expected costs for those receiving CBT and CAU in the 15 years after the trial follow-up were less for CBT than for CAU, but CBT also resulted in fewer QALYs. Combining the trial period with the 15-year extrapolation period resulted in CBT having costs that were lower by £470 and 0.47 fewer QALYs. Therefore, in the long term, CAU is cost-effective with an ICER of £1187 per QALY. Workstream 5: preparing for implementation within the National Health Service Workstream 5 was intended to address objective 7: prepare for implementation within the NHS. Owing to the extended time needed for recruitment to the RCT, we were unable to carry out a full implementation WS. We have planned implementation strategies informed by NICE guidance on how to change practice. These involve identifying barriers to implementation by conducting study discussion groups in HIV clinics, discussion of our findings with HIV commissioners and conducting focus groups with PLWH at AAF. Workstream 6 (additional workstream): ancillary studies During the programme, we conceived an additional seven ancillary studies (WS6): patients’ perceptions of standard care ART perceptions and treatment outcomes in HIV-positive patients starting ART to protect their partners (treatment as prevention) compared with clinical need the level ART adherence required to achieve virological suppression in treatment-naive patients a systematic review and meta-analysis examining the content of effective adherence interventions beliefs about ART as predictors of side effects (analysis of historical data) associations between self-reported adherence and electronic monitoring of adherence the effect of the SUPA intervention on rates of engagement with HIV services. These ancillary studies were conceived on the assumption of complete and timely recruitment to the SUPA RCT; however, recruitment was lower and slower than expected for this hard-to-reach study population. Consequently, only six ancillary studies were feasible (1–6). Conclusions The SUPA programme fulfilled its objectives to develop and evaluate a pragmatic, theory-based intervention to support ART uptake and adherence among PLWH at risk of non-adherence by addressing perceptual and practical barriers. Recruitment to the SUPA RCT was slower than anticipated and our trial was underpowered with no effect on the primary outcome measure of adherence over 12 months. However, the SUPA intervention benefited recipients by reducing ART concerns, ART intrusiveness and depression and improving quality of life. It was also cost-effective during the follow-up period. Study registration The trial is registered as ISRCTN35514212 and the study is registered as CRD42019072431. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-0109-10047) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 8. See the NIHR Funding and Awards website for further award information.

Grazielly Nogueira Xavier do Nascimento, Vanessa Alves Mendes, Marina Nolli Bittencourt et al.

Resumo Objetivo analisar a experiência do paciente com os cuidados de Enfermagem durante a hospitalização pela COVID-19. Método estudo qualitativo, descritivo e exploratório conduzido com 32 pacientes pós-alta pela COVID-19, em um hospital universitário federal da Região Centro-Oeste do Brasil. Entre março de 2020 e novembro de 2021, foram realizadas as entrevistas semiestruturadas por meio da técnica do incidente crítico, para identificar os eventos marcantes na experiência dos pacientes durante a hospitalização. Os dados foram analisados por Análise de Conteúdo com o auxílio do software IRaMuTeQ®. Resultados os pacientes destacaram a comunicação eficaz e a boa organização dos serviços como os aspectos positivos, enquanto enfrentaram as dificuldades relacionadas à logística de isolamento, à infraestrutura física e ao planejamento da alta hospitalar. Esses problemas repercutiram na privacidade, aumentaram o estresse e complicaram a transição para o cuidado domiciliar. Conclusão e implicações para a prática a comunicação empática e o planejamento detalhado da alta, foram essenciais para melhorar a experiência do paciente na atenção hospitalar, especialmente mais críticos no contexto da pandemia. A prática de Enfermagem deve incorporar a humanização e a coordenação contínua do cuidado, por meio de medidas que garantam uma transição segura e de qualidade, e preparem melhor os serviços de saúde para enfrentar as futuras crises sanitárias.

S Pirbay, MD, S Abou Kassm, MD, MPH, C Di-Maggio, MD et al.

Objectives: Despite the benefits of geriatric telepsychiatry, the lack of support from the staff remains one of the major challenges it faces. We wanted to explore whether negative opinions towards telepsychiatry in nursing home (NH) stakeholders were affected by prior experience with this modality and by the level of geriatric psychiatric care provided in NH. Methods: We conducted an opinion survey towards telepsychiatry among NH stakeholders (executive managers and care providers) from 10 NH, divided into 5 groups of differing levels of geriatric psychiatric care: Group A used telepsychiatry, Group B had the smallest level of psychiatry care (i.e. without any mental health professional visit), Group C had visiting nurses of general psychiatry, Group D had visiting geriatric psychiatry nurses, Group E had mobile teams including nurses and geriatric psychiatrists. Results: 216 (78.5 %) questionnaires were returned We found significant differences among the groups (Mean Group A (meanA)=63.5, standard error of the mean Group A (SEMA)=1.6); meanB=67.9, SEMB=2.2; meanC=75.6, SEMC=1.6; meanD=69.6, SEMD=2.1; meanE=73.1, SEME=1.9; F(4208)=6.6333, p = 4.824 × 10–5). All groups except group B were significantly different from group A, even after adjusting for age, gender, professional category and knowledge of telepsychiatry. Discussion: Negative opinions towards telepsychiatry were negatively associated with telepsychiatry use in the NH and positively associated with a high level of geriatric psychiatric care, specifically the presence of mobile geriatric psychiatry teams. Conclusions: Our findings suggest that telepsychiatry and face-to-face geriatric psychiatry are in competition. Telepsychiatry acceptance program should aim at describing its complementarity to usual geriatric psychiatry care.

Lalu Rodi Sanjaya, Yana Setiawan

Diabetes Melitus (DM) merupakan salah satu penyakit kronis (menahun) tidak menular dan masih menjadi permasalahan besar di Dunia. DM tidak hanya dialami oleh kalangan dewasa saja namun juga oleh para remaja. Faktor risiko terjadinya penyakit DM sebagaian besar bisa dimodifikasi, sehingga oleh karena itu peneliti tertarik untuk melakukan penelitian ini sedini mungkin di kalangan remaja. Penelitian ini bertujuan untuk menganalis faktor-faktor risiko terhadap penyakit DM pada remaja. Penelitian adalah jenis penelitian kuantitatif dengan desain analitik korelasional. Populasi siswa kelas X-XI dengan sampel berjumlah 100 orang. Data dikumpulkan menggunakan kuesioner, dan dianalisis menggunakan bantuan komputerisasi SPSS. Analisis statistik menggunakan chi-square untuk menilai hubungan antara variabel status gizi dengan nilai GDS (p-value=0,294) dan hubungan antara pola aktivitas dengan nilai GDS yaitu (p-value=0,780). Kesimpulan dalam penelitian ini tidak ada hubungan antara status gizi dan pola aktivitas dengan nilai GDS pada remaja.

Jaudat KHALAILY

This article explores several key strategies in order to reach the goal of enabling home care for as long as possible for the elderly. Some of these strategies include: preventing falls and injuries, providing preventative medical care, promoting exercise and physical activity, ensuring proper nutrition, fostering social and familial support, and promoting financial preparedness. The research confirms that these strategies are effective in allowing elderly individuals to live out the remaining years of their lives in their own homes and avoid nursing care. Consistent medical examinations, regular treatment and physical activities allow for healthy and independent living. Fall prevention can improve the health and independence of elderly individuals because falls are a major cause of injury and death. Social support by family members, friends and professionals also contribute significantly to the mental and physical health of these individuals. In addition, improving and maintaining cognitive capabilities and emotional regulation have shown to have a strong connection to the overall health and well-being of the elderly.

A. Fahimzad, M. Khatmi, F. Shiva et al.

Meningitis and meningococcal septicemia are potentially life-threatening illnesses; young people in educational institutions have been repeatedly exposed to outbreaks of meningococcal infections. Since invasive meningococcal disease is preceded by pharyngeal carriage of Neisseria meningitidis, ascertaining the prevalence of meningococcal carriage in this population is of utmost importance. The aim of this study was to determine the rate of meningococcal carriage in students of Shahid Beheshti University of Medical Sciences. This cross-sectional study was conducted on pharyngeal swab specimens of 251 healthy asymptomatic students from November 2019 for one year. A questionnaire was used to find correlation between isolation of Neisseria spp. and the place of residence, number of roommates, antibiotic use in the last month, and smoking. One sample from each student was used for culture on general and selective culture media for Neisseria spp. Polymerase chain reaction was used for the final diagnosis of Neisseria meningitidis. Participants in the study included 222 medical students (88.4%), 23 nursing students (9.2%) and 6 radiology students (2.4%). Mean (IQR1) age of students was 23 years, 134 students were female, (53.4%); 234 students were single, (93.2%). 92 students (36.7%) lived in dormitories. Neisseria were isolated from 18 specimens (7.2%), of which 11 (4.4%) were pigmented bacteria. PCR assay did not detect Neisseria meningitidis in any of the samples. This study showed that meningococcal bacteria were not detected in any of the oropharyngeal specimens from students participating in the study during the one-year study period.

Boyan Liu, Xue Jiang, Xue Jiang et al.

Objective: To explore the effect of a low-dose hydrogen–oxygen (H2-O2) mixture inhalation in midlife/older adults with hypertension.Methods: This randomized, placebo-controlled trial included 60 participants with hypertension aged 50–70 years who were randomly divided into Air group (inhaled placebo air) or H2-O2 group [inhaled H2-O2 mixture (66% H2/33% O2)]. Participants in both groups were treated 4 h per day for 2 weeks. Four-limb blood pressure and 24-h ambulatory blood pressure were monitored before and after the intervention, and levels of plasma hormones related to hypertension were determined.Results: A total of 56 patients completed the study (27 in the Air group and 29 in the H2-O2 group). The right and left arm systolic blood pressure (SBP) were significantly decreased in H2-O2 group compared with the baseline levels (151.9 ± 12.7 mmHg to 147.1 ± 12.0 mmHg, and 150.7 ± 13.3 mmHg to 145.7 ± 13.0 mmHg, respectively; all p &lt; 0.05). Meanwhile, the H2-O2 intervention significantly decreased diastolic nighttime ambulatory blood pressure by 2.7 ± 6.5 mmHg (p &lt; 0.05). All blood pressures were unaffected in placebo group (all p &gt; 0.05). When stratified by age (aged 50–59 years versus aged 60–70 years), participants in the older H2-O2 group showed a larger reduction in right arm SBP compared with that in the younger group (p &lt; 0.05). In addition, the angiotensin II, aldosterone, and cortisol levels as well as the aldosterone-to-renin ratio in plasma were significantly lower in H2-O2 group compared with baseline (p &lt; 0.05). No significant differences were observed in the Air group before and after the intervention.Conclusion: Inhalation of a low-dose H2-O2 mixture exerts a favorable effect on blood pressure, and reduces the plasma levels of hormones associated with hypertension on renin-angiotensin-aldosterone system and stress in midlife/older adults with hypertension.

Maryam Shaygan, Pardis Bostanian, Mina Zarmehr et al.

Abstract Background Although the context of parenting has been incorporated into psychosocial pain research, very little attention has been paid to how parenting styles influence chronic pain in adolescents. The present study aimed to investigate the mediating role of self-esteem, emotional intelligence, and psychological distress in the association between parenting styles and chronic pain. Method Seven hundred and thirty nine adolescents and their parents participated in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Baumrind parenting style questionnaire was used to assess the parenting style (permissive, authoritarian, and authoritative parenting styles). The structural equation modelling (SEM) was carried out in M-Plus version 6 to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain. Results The results in the SEM models revealed that only the indirect paths from authoritative and authoritarian parenting styles to pain through emotional intelligence (βauthoritative = − 0.003, 95% CI = − 0.008 to − 0.003; βauthoritarian = 0.001, 95% CI = 0.001 to 0.003) and psychological distress (βauthoritative = − 0.010, 95% CI = − 0.021 to − 0.004; βauthoritarian = 0.008, 95% CI = 0.004 to 0.016) were significant. Indirect paths from permissive style to pain and the mediating role of self-esteem were not significant. Discussion Emotional intelligence and psychological distress significantly mediated the effects of authoritative and authoritarian parenting styles on chronic pain. The current results support the notion that interventions targeting effective parent–adolescent communication may be an important part of chronic pain management in adolescents. Moreover, the results provide rationale for targeting emotional intelligence and psychological distress in adolescents by explicitly teaching effective communication skills, expressing opinions and minds, and emotion regulation strategies.

Chaurasia Mukul, Agrawa Neha, Chourasia Ankita et al.

Background: Staphylococcus aureus (S. aureus) and its resistant form methicillinresistant S. aureus (MRSA) is one of the most common nosocomial pathogens causing a wide range of infections in humans. The anterior nares are the main ecological niche for S. aureus. Nasal carriage of S. aureus acts as an important reservoir of infection among the colonised healthcare workers and they transmit the infection to the community. The aim of the present study was to estimate the nasal colonisation of S. aureus (with special reference to MRSA) in healthcare workers (doctors and nursing staff) and its antibiotic susceptibility pattern. Methods: A descriptive study was planned in the Department of Microbiology, JLN Medical College, Ajmer (Rajasthan, India) after due approval from the institutional ethics committee. A total of 170 healthcare workers of either sex aged between 18 to 60 years were screened for S. aureus. Identification was done using standard microbiological techniques, by studying their morphology, colony and biochemical characteristics. MRSA was detected by cefoxitin disc diffusion test, oxacillin disc diffusion test, minimum inhibitory concentration (MIC) of oxacillin by E-test and oxacillin screen agar test. The observations were described in proportions and Chisquared test was used to find independence. Statistical significance was considered at 5 %. Results: Among 170 samples, 159 (93.53 %) samples (50 doctors and 109 nursing staff) had staphylococci colonisation. Among these 159 isolates, 34 (21.38 %) were S. aureus. Further, 8 (5.03 %) S. aureus isolates were resistant to both cefoxitin and oxacillin and had oxacillin MIC values ≥ 4 µg/mL and were considered MRSA. All the MRSA were detected in the nursing staff (males: 5.50 %, females: 1.83 %). All S. aureus and MRSA isolates were found sensitive to linezolid, vancomycin and mupirocin (minimum inhibitory concentration ≤ 4 µg/mL). Conclusion: Screening and treatment of healthcare workers colonised with MRSA should be an important component of hospital infection control policy. These measures will prevent spread of infection to patients and the community and thereby reduce the morbidity, mortality and healthcare costs associated with nosocomial infections.

YUAN Ling, GAO Chao, XING Xiuling et al.

ObjectiveTo explore the effect of auricular point pressing pill combined with heat sensitive moxibustion on the inflammatory level and immune function of early diabetic nephropathy patients.MethodsTotally 102 patients with early diabetic nephropathy were randomly divided into two groups:the control group with the treatment of valsartan;and the observation group with the treatment of auricular point pressing pill combined with heat sensitive moxibustion on the basis of the control group.The course of treatment lasted for 4 weeks.The changes of urinary neutrophil gelatinase associated lipocalin (NGAL),urinary N⁃acetyl⁃β⁃D⁃glucosidase(NAG),blood superoxide dismutase(SOD),renal function,inflammatory level and immune function were compared before and after treatment.ResultsAfter treatment,urinary NGAL(7.95±1.97)mg/L,urinary NAG(29.96±8.98）U/L in the observation group were lower than those in the control group(18.02±8.78)mg/L,(39.13±11.98)U/L,and blood SOD(147.12±13.13)U/mL in the observation group was higher than that in the control group(116.35±12.82)U/mL,The differences between the two groups were statistically significant(<italic>P</italic>&lt;0.05).Urinary β₂⁃microglobulin(β₂⁃MG),urinary albumin excretion rate(UAER),serum creatinine(Scr),blood urea nitrogen(BUN),high sensitive C⁃reactive protein(hs⁃CRP),interleukin⁃6(IL⁃6),tumor necrosis factor⁃α(TNF⁃α)in the observation group were significantly lower than those in the control group(<italic>P</italic>&lt;0.05).T⁃cells with CD₄⁺，CD₄⁺/CD₈⁺ in the observation group were significantly more than those in the control group.While,T⁃cells with CD₈⁺were significantly lower than those in the control group(<italic>P</italic>&lt;0.05).ConclusionAuricular point pressing pill combined with heat sensitive moxibustion can effectively improve the micro inflammatory state,immune function and oxidative stress response in early diabetic nephropathy patients.Furthermore,it can also effectively protect the renal tubular function of early diabetic nephropathy patients and delay the progression of diabetic nephropathy.

R. B. Freitas, D. N. Rômulo, G. M. Bianca et al.

Fruits of Euterpe spp. are rich in phenolic compounds, mainly anthocyanins, which are endowed with a high antioxidant capacity. The objective of the study was to evaluate the effects of derivatives from Euterpe spp. fruits on oxidative metabolism and inflammatory mediators. The oil (OE), total lyophilized pulp (LEE) and defatted pulp (LEDE) were obtained from the fruits of Euterpe edulis. Thirty-six animals were divided into four experimental groups: G1: Control; G2: OE (4%), G3: LEE (10%), G4: LEDE (10%), each of which received a particular extract in their diet for 50 days. The activities of catalase, glutathione-S-transferase, superoxide dismutase, malondialdehyde produced in liver and expression of pro-inflammatory cytokines tissue were lower in G4 than in the other groups. The study indicates that dietary supplementation with extracts of E. edulis has no deleterious effects and may be beneficial, especially for LEDE extracts containing high concentrations of anthocyanin.

Bruna Caroline Hirle de Souza, Virginia Luiza da Silva Ponte Cruz, Elizabeth Rose Costa Martins et al.

Objetivos: Descrever como o profissional de enfermagem lida com novas atribuições e responsabilidades, identificar e discutir os fatores facilitadores e dificultadores dessa transição para o trabalho de enfermagem. Método: Estudo descritivo, exploratório com abordagem qualitativa. Os participantes foram treze técnicos de enfermagem que passaram pela transição funcional e atualmente desenvolvem funções enquanto enfermeiros. Apresenta como cenário, unidades cirúrgicas de um hospital universitário, no rio de janeiro. Foram respeitados os aspectos éticos e legais da resolução nº466/2012 do CNS aprovado pelo CEP, com o nº 1.432.069. Utilizou-se a entrevista semiestruturada, para análise dos dados, realizou-se a análise de conteúdo. Resultados: Apresenta como categorias: o profissional técnico de enfermagem e a transição funcional para enfermeiro e os fatores facilitadores e dificultadores na transição funcional.  Conclusão: A transição funcional atende a necessidade do técnico na busca por conhecimento científico, crescimento profissional e evolução pessoal.

Catherine Ann Thibeault

Ana Carla Pereira Alves, Maria de Fátima Esmeraldo Ramos Figueiredo, Natalia Peixoto Luis de Sousa et al.

Este estudo definiu como objetivo identificar as percepções das gestantes sobre o uso de uma tecnologia educativa para ser utilizada no pré-natal. Pesquisa participante, descritiva e quantiqualitativa, realizada a partir da aplicação de um jogo educativo em duas unidades básicas de saúde do município de Brejo Santo-CE, no período de outubro a novembro de 2011, com 17 gestantes. Utilizou-se para coleta de dados um formulário e a observação participante e empregou-se a análise temática para o tratamento de dados. A maioria das gestantes tinha entre 26 e 29 anos, era casada, com baixa escolaridade e renda. Durante a aplicação do jogo, o grupo se mostrou bastante participativo, foram esclarecidas as dúvidas e troca das experiências. A avaliação realizada pelas gestantes mostrou que a estratégia contribuiu para o processo ensino-aprendizado. O grupo demonstrou uma excelente aceitação e desejo de participar novamente, demonstrando assim a adequabilidade do jogo para ser trabalhado com as gestantes. ABSTRACT: This study aimed at identifying perceptions of pregnant women about educational technology on prenatal care. Participatory, descriptive, quantitative, and qualitative research based on the application of na educational game with 17 pregnant women in two basic health units in the city of Brejo Santo, Ceará, Brazil, from October to November, 2011. Data was collected on the basis of both a form and participant observation. Thematic analysis was used for data treatment. Most pregnant women aged 26 to 29 years, were married, and had low education and income. The group proved to be very active during game application. Questions were addressed and experience exchanged. Assessment by the pregnant women indicated that the strategy contributed to the teachinglearning process. The group expressed high acceptance level and willingness to participate again. The game proved to be a suitable educational strategy for pregnant women. RESUMEN: Este estudio definió el objetivo de identificar las percepciones de las gestantes sobre el uso de una tecnologia educativa para ser utilizada en el prenatal. Investigación participante, descriptiva y cuanti-cualitativa, hecha a partir de la aplicación de un juego educativo en dos unidades básicas de salud del municipio de Brejo Santo-CE-Brasil, de octubre a noviembre de 2011, con 17 gestantes. Fue utilizado para recoger datos un formulario y la observación participante y para su tratamiento se empleó el análisis temático. La mayoría de las mujeres tenía entre 26 y 29 años, era casada, con baja escolaridad y renta. Durante la aplicación del juego, el grupo fue muy participativo, se expusieron las dudas y el intercambio de experiencias. La evaluación realizada por las gestantes mostró que la estrategia ha contribuido para el proceso de enseñanza-aprendizaje. Por lo tanto, el grupo ha demostrado una excelente aceptación y deseo de volver a participar, lo que demuestra la adecuabilidad del juego para ser trabajado con las mujeres gestantes.

Priscila Bastos Mayworm, Ana Paula Carvalho Orichio, Rodrigo Oliveira Setta et al.

INTRODUÇÃO   Após o advento da criação da Lei de Paulo Delgado, n° 10.216, disseminou-se a necessidade de estruturação na internação de forma a oferecer assistência integral à pessoa portadora de transtornos mentais, incluindo serviços médicos, de assistência social, psicológicos, ocupacionais, de lazer, e outros. O antigo modelo de assistência psiquiátrica no Brasil, deixou uma grande população de pacientes institucionalizados (pacientes cronificados), que devido à longa permanência dentro das instituições, trouxeram consigo seus efeitos iatrogênicos, como também a degeneração própria da idade avançada. Estes pacientes, e aqueles que frequentam a Instituição para um atendimento diário, ou para uma eventual internação, possuem como atividades terapêuticas, oficinas essencialmente de caráter manual e cognitivo, deixando de lado a prática de atividade física, que usualmente não está inserida nos atendimentos.  Com o objetivo de se adequar às normas vigentes, este trabalho tem como objeto de estudo o combate ao sedentarismo através das práticas de atividades físicas por pacientes psiquiátricos e as vantagens desta prática no incremento da qualidade de vida.   OBJETIVOS     Levantar informações na literatura científica acerca da prática de atividade física na redução do sedentarismo; Elaborar uma proposta de atividades físicas através de atuação interdisciplinar; Contribuir cientificamente para a área de atuação psiquiátrica de forma a divulgar a importância da prática de atividade física pelos pacientes no combate ao sedentarismo.   METODOLOGIA   Trata-se de um estudo de revisão bibliográfica sistemática sobre a prática de atividade física e seus benefícios. Tradicionalmente, a revisão sistemática é um estudo retrospectivo secundário que facilita a elaboração de diretrizes clínicas. Os estudos investigados podem ser ensaios clínicos aleatórios, estudos de acurácea, estudos coortes ou qualquer outro tipo de estudo (CLARKE, 2001).    RESULTADOS               Os resultados demonstram uma predominância de artigos que abordam a prática de exercícios físicos e seus benefícios para os pacientes que possuem episódios depressivos e de ansiedade, somente um dos cinco artigos incluídos na pesquisa trata de transtornos diferentes dos mencionados anteriormente, focalizando o trabalho nos benefícios proporcionados a jogadores patológicos que praticam a atividade física regularmente. A prática de atividade física é o grande aliado destes pacientes na melhora da qualidade de vida com os exercícios físicos. Os benefícios da prática de atividade física associados à saúde e o bem estar, assim como riscos predisponentes ao aparecimento e ao desenvolvimento de disfunções orgânicas relacionados ao sedentarismo, são amplamente apresentados e discutidos na literatura (BOUCHARD et.al, 1994).   CONCLUSÕES    Diante dos estudos descritos anteriormente, verifica-se que o exercício físico sistematizado pode acarretar diversos benefícios tanto na esfera física quanto mental do ser humano, proporcionando uma melhor qualidade de vida.  No entanto administrado de maneira equivocada e sem embasamento cientifico pode alterar negativamente os comportamentos dos pacientes prejudicando o desempenho físico e cognitivo dos mesmos.   REFERÊNCIAS   BRASIL, M. S. Secretaria de Políticas de Saúde. Departamento de Ações Programáticas Estratégicas. Plano de reorganização da atenção à hipertensão arterial e ao diabetes mellitus: hipertensão arterial e diabetes mellitus/ Departamento de ações programáticas estratégicas – Brasília: Ministério da Saúde, 2001. BOUCHARD C, SHEPHARD R. J., STEPHINS T. Physical activity, fitness and health: International Proceedings and Consensus Statement. Champaign, Illinois: Human Kinetics, 1994. COIMBRA, V. C. C.; GUIMARÃES, J.; SILVA, M.C.F.; KANTORSKI, L.; SCATENA, M.C.M. – Reabilitação psicossocial e família: considerações sobre a reestruturação da assistência psiquiátrica  no Brasil.  Revista Eletrônica de Enfermagem, v. 07, n 01, p. 99-104, 2005. PITTA, A. O que é reabilitação psicossocial no Brasil, hoje. In: PITTA, A. (org). Reabilitação psicossocial no Brasil. São Paulo: Hucitec, 1996. p. 19-26; Sociedade Brasileira de Cardiologia – IV Diretrizes Brasileiras de Hipertensão 2002; cap. 5:13-14 – SBC.

H Shahsavari, M Salsali, A Mohammadpour

In the many definitions that are accompanied with nursing, in addition to the scientific aspect, art has always been mentioned. Since Florence Nightingale introduced nursing as an art, several theorists have emphasized the aesthetic aspect of nursing in their literature. However, many experts believe that the word "art" has been accepted in nursing without deep thought and criticism.To judge the statement: "Nursing is an art", it seems that it is necessary to review the similarities and differences of "art" concept in nursing and other fields literature. Art has a complex and multidimensional meaning that is the backbone of many theories presented however, they each have their own strengths and weaknesses. Nursing has artistic properties but this characteristic is referred to as folk art and not to specific features of art. In comparing these theories with the concept of art used in nursing, it is essential to note that art in nursing refers to skills of nursing. In other words, nursing is not a kind of fine art.From the aesthetic perspective, nursing can be easily defined as a form of art however, we must put great importance in the inseparable words of "aesthetic" and "art of nursing". With such a connection, we are able to introduce and capture the true spirit of both art and nursing. In this article, we have reviewed the most important definitions and theories of art as a "specific term", and as "skill", where they have linked nursing to art. Moreover, we have discussed their similarities and differences.

Yara Perez Martins, Sandra Cristina Moretto

Trata-se da abordagem sobre a elaboração de um programa de Educação em Saúde, para um grupo de adolescentes. Tomou-se como base o referencial teórico sobre pesquisa-ação para se definir os procedimentos do trabalho. Para tanto, vêm-se desenvolvendo reuniões semanais com o grupo de adolescentes, nas quais a participação destes tem demonstrado que o medo, a vergonha, a insegurança, decorrentes da desinformação sobre saúde e a privação de contatos reais com a pessoa do outro, se constituem em importantes indicadores que dificultam o viver sadio dos adolescentes.