Primary Barriers of Adherence to a Structured Nutritional Intervention in Patients with Dyslipidemia

Purpose: To describe the primary barriers to adequately adhering to a structured nutritional intervention. Patients and methods: A total of 106 participants diagnosed with dyslipidemia and without a medical nutrition therapeutic plan were included in this two-year study conducted at the INCMNSZ dyslipidemia clinic in Mexico City. All patients were treated with the same structured strategies, including three face-to-face visits and two telephone follow-up visits. Diet plan adherence was evaluated at each site visit through a 3-day or 24-h food recall. Results: Barriers to adhere to the nutritional intervention were: lack of time to prepare their meals (23%), eating outside the home (19%), unwillingness to change dietary patterns (14%), and lack of information about a correct diet for dyslipidemias (14%). All barriers decreased significantly at the end of the intervention. Female gender, current smoking, and following a plan of more than 1500 kcal (R2 = 0.18 and p-value = 0.004) were associated with good diet adherence. Participants showed good levels of adherence to total caloric intake at visit 2 and 3, reporting 104.7% and 95.4%, respectively. Adherence to macronutrient intake varied from 65.1% to 126%, with difficulties in adhering to recommended carbohydrate and fat consumption being more notable. Conclusion: The study findings confirm that a structured nutritional intervention is effective in reducing barriers and improving dietary adherence and metabolic control in patients with dyslipidemias. Health providers must identify barriers to adherence early on to design interventions that reduce these barriers and improve adherence.

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Psychosocial factors associated with symptoms of generalized anxiety disorder in general practitioners during the COVID-19 pandemic

Journal of Investigative Medicine ◽

10.1136/jim-2020-001456 ◽

2020 ◽

Vol 68 (7) ◽

pp. 1228-1234 ◽

Cited By ~ 3

Author(s):

Alvaro Monterrosa-Castro ◽

Velia Redondo-Mendoza ◽

María Mercado-Lara

Keyword(s):

Anxiety Disorder ◽

General Practitioners ◽

Generalized Anxiety Disorder ◽

Healthcare Providers ◽

Demographic Factors ◽

Female Gender ◽

P Value ◽

Generalized Anxiety ◽

Health Providers ◽

Cross Sectional

Healthcare providers commonly experience symptoms of anxiety during public health crises and pandemics. The objective of the study was to identify the frequency of symptoms of generalized anxiety disorder (GAD) in general practitioners and to estimate the association with particular psychosocial and demographic factors. This is a cross-sectional study, where a total of 531 general practitioners completed an online form that contained sociodemographic variables, questions about fear and perceptions concerning medical work during the COVID-19 pandemic, 7-Item Generalized Anxiety Disorder Scale (GAD-7), questionnaire on psychosomatic problems and Fear of COVID-19 Scale. The presence of symptoms of GAD was defined by a GAD-7 score of 10 or more points. Voluntary and anonymous participation, acceptance of terms, and informed consent were requested. A p value of <0.05 was considered statistically significant. Symptoms of GAD were identified in 4 out of 10 Colombian general practitioners; the following psychosocial and demographic factors were associated with a greater presence of these symptoms: female gender, social discrimination, anguish, job disappointment, nightmares, stress and other symptoms of fear regarding the pandemic. Conversely, feeling protected by the state or employer, being satisfied with their job as a physician, and trusting government measures and information were associated with a lower presence of symptoms of GAD. These findings highlight the importance of timely psychotherapeutic and psychopharmacological interventions in these individuals. The authors suggest mental health providers should be deployed during times of crisis to decrease the risk of developing mental illness.

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110 Participants and Volunteer Host Experiences of First Steps Course for Those Newly Diagnosed with Parkinson’s: A Qualitative Study

Age and Ageing ◽

10.1093/ageing/afz197 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i37-i37

Author(s):

E R Bodger ◽

K Ibrahim ◽

H C Roberts

Keyword(s):

Information Support ◽

Newly Diagnosed ◽

Clinical Environment ◽

Structured Interviews ◽

Face To Face ◽

Lack Of Information ◽

Lack Of Control ◽

The Uk ◽

And Control

Abstract Introduction People with Parkinson’s (PwP) and their caregivers often report poor diagnosis experiences and a lack of information, support and control over Parkinson’s. First Steps is a two-day course delivered by volunteers with Parkinson’s, which aims to help those newly diagnosed and their caregivers face the future positively and take control of Parkinson’s. This study aimed to capture the views and experiences of participants and volunteer hosts of First Steps, and evaluate if it meets those aims. Methods Using purposive sampling, twelve participants comprising four PwP, five caregivers and three volunteer hosts were recruited. Face-to-face, semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analysed thematically. Results Course participants found First Steps informative, supportive, and helpful in feeling more positive about Parkinson’s. Participants were reassured by the hosts having Parkinson’s, despite prior concerns regarding seeing people who might have more advanced Parkinson’s. Some found First Steps more relatable than other support services and reported that the course complemented clinician-led courses as the content was aimed at caregivers as well as PwP, with variation in information delivery techniques. Among the PwP and caregivers, two thirds reported a lack of control over Parkinson’s and some felt First Steps had improved their control. Hosts felt they had control over Parkinson’s and perceived their role to be both challenging and rewarding. Conclusions First Steps was perceived as a helpful course, offering information and support for those newly diagnosed and their caregivers in a positive and non-clinical environment. Volunteer hosts felt more control over Parkinson’s than other participants, but there was evidence that the course helped some experience more control. Suggested course improvements included: additions to the presentation content with more emphasis on taking control, and offering group follow up sessions. This will inform current expansion across the UK.

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Are Signs of Temporomandibular Disorders Stable and Predictable in Adolescents With Headache?

Cephalalgia ◽

10.1111/j.1468-2982.2008.01593.x ◽

2008 ◽

Vol 28 (6) ◽

pp. 619-625 ◽

Cited By ~ 9

Author(s):

M-R Liljeström ◽

Y Le Bell ◽

K Laimi ◽

P Anttila ◽

M Aromaa ◽

...

Keyword(s):

Neurological Examination ◽

Temporomandibular Disorders ◽

Muscle Pain ◽

Signs And Symptoms ◽

Female Gender ◽

Population Based ◽

Face To Face

The aim of the present study was to study changes in signs and symptoms of temporomandibular disorders (TMD) and factors predicting TMD signs in adolescents with and without headache. A population-based sample ( n = 212) of 13-year-olds with and without headache was re-examined at the age of 16. The study included a questionnaire, face-to-face interview and somatic examination. In addition, a neurological examination, a muscle evaluation and a stomatognathic examination were performed. Significant changes were seen in TMD signs during the follow-up, but TMD signs at the end of the follow-up could not be predicted by baseline headache, sleeping difficulties, depression or muscle pain. TMD signs at the age of 16 were associated with female gender and muscle pain. We conclude that considerable changes in TMD signs occur in the follow-up of adolescents with and without headache. Headache-related TMD are not predictable in adolescents with and without headache.

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Psychological distress and its associated factors in the hypertensive patient (HTN-Pt) in Ludhiana, Punjab: A questionnaire-based retrospective study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i3.4823 ◽

2021 ◽

Vol 12 (3) ◽

pp. 2132-2138

Author(s):

Maninder Singh ◽

Bikram Singh ◽

Arshvir Kaur

Keyword(s):

Psychological Distress ◽

Alcohol Use Disorders ◽

Concomitant Administration ◽

P Value ◽

Age Group ◽

Herbal Drugs ◽

Herbal Supplements ◽

Face To Face ◽

High Prevalence

An elevation in blood pressure is an important risk factor of cardiovascular disease and several factors that can contribute to hypertension induce psychological distress. This study was aimed at estimating the prevalence of psychological distress and to assess general awareness regarding disease, concomitant substance abuse, and use of herbal drugs among hypertensive patients (HTN-Pt) at Satguru Pratap Singh (SPS) Hospitals, Ludhiana. The psychological distress was assessed using the standard Kessler-10 scale along with face-to-face interview among 275 outpatient department (OPD) HTN-Pt on follow-up. 15.30% (n=33) of total participants (n=213) had alcohol use disorders and 8.80% (n=19) of them were addicted to smoking habits. K10 scale results in patients, showed 46.9% (100) patients were suffering from psychological distress out of which 26% (n=56) were having mild, 17% (n=36) moderate and 4% (n=8) patients were having severe psychological distress. Highest percentage (33.80%) of patients with psychological distress were from age group 31-60 years of age (p value=0.003, COR= 0.240, 95% CI 0.072, 0.584). Many HTN-Pt were consuming the herbal supplements out of which 92 % of patients consuming grapes were found to have psychological distress (p value=0.034, COR= 0.380, 95% CI 0.155, 0.930). The results of the study indicated that there was a high prevalence of psychological distress in HTN-Pt belonging to age group of 31-60 years of age and patients involved in the consumption of grapes. This study asks for supervision on the concomitant administration of herbal supplements with allopathic medicines in HTN-Pt to avoid psychological distress.

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Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in Inducing Weight Loss among Obese Filipino Patients: A Randomized Controlled Trial

Journal of the ASEAN Federation of Endocrine Societies ◽

10.15605/jafes.035.02.06 ◽

2020 ◽

Vol 35 (2) ◽

pp. 181-189

Author(s):

Margaret Encarnacion ◽

◽

Oliver Allan Dampil ◽

Ludwig Damian ◽

Maria Leila Doquenia ◽

...

Keyword(s):

Weight Loss ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Caloric Intake ◽

P Value ◽

Sham Stimulation ◽

Parallel Group ◽

Significant Difference ◽

Lost To Follow Up

Objective. To determine the efficacy of rTMS in decreasing body mass index (BMI) versus sham stimulation among obese Filipino patients. Methodology. This was a single-center, randomized, sham-controlled, single-blind, parallel group trial. Participants were 15-65 years old with BMI ≥30 kg/m2 and weight stable for 6 weeks. Participants were randomized to receive real rTMS or sham stimulation. Each underwent 4 sessions of stimulation over 2 weeks. Anthropometrics, total caloric intake (TCI), and VAS score for appetite were taken at baseline, 2, 4, 6, and 12 weeks. Results. A total of 31 patients were randomized with 15 to the treatment and 14 to sham stimulation completing treatment, with 2 lost to follow-up. A significant decrease in BMI was noted after 4 weeks from the start of rTMS in the treatment group, (0.6±0.6, p-value=0.001), with weight change of -1.3±1.3 kg (p-value=0.009), but was no longer observed at 6 weeks onwards. No severe adverse effects were noted. Conclusion. rTMS to the DLPFC effectively decreased BMI (0.6±0.6) and weight (-1.3±1.3 kg) from baseline to 4 weeks. At 6-12 weeks after rTMS however, there was no longer a significant difference, indicating that 4 sessions of rTMS may not be enough to produce a prolonged effect on weight loss.

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AB0907-HPR UNEXPECTED DIFFERENCE IN ACCEPTANCE OF TELECONSULTATION BETWEEN PATIENTS WITH LUPUS AND RHEUMATOID ARTHRITIS WHO UNDERWENT TO A DEVELOPED AND IMPLEMENTED TELEMEDICINE INNOVATIVE PROGRAM AFTER THE DECLARATION OF QUARANTINE DUE TO THE COVID-19 PANDEMIC IN COLOMBIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3899 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1475.3-1476

Author(s):

S. M. Hernández-Zambrano ◽

R. A. Castiblanco-Montañez ◽

J. Chavez-Chavez ◽

D. P. Rivera-Triana ◽

A. Aza ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Categorical Variables ◽

P Value ◽

Systemic Lupus ◽

Telemedicine Service ◽

Face To Face ◽

The Face

Background:The Covid-19 pandemic has generated restrictions in the mobility of people, affecting the face-to-face care of patients with chronic diseases, including autoimmune. The health emergency has created the need to establish follow-up alternatives, giving rise to telemedicine.Objectives:To evaluate the level of attendance to teleconsultation and the face-to-face usual care in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who underwent to a developed innovative telemedicine program after the declaration of quarantine due to the Covid-19 pandemic.Methods:The present cross-sectional descriptive study reports retrospective data collected from patients with RA and SLE from March to June, 2020;. Since the beginning of March 2020 when Covid-19 was declared in Colombia as a health emergency establishing specific standards for outpatient care, our center has made the necessary legal and technical adjustments to develop an innovative telemedicine service to prevent the epidemiological risk. To all contacted patients were offered the option of teleconsultation or face-to-face consultation; a standardized protocol was set with clinimetry measures evaluated in both groups. Continuous variables were described using mean and standard deviation, and categorical variables were described using numbers and percentages. We performed chi-square tests of independence to determine differences between teleconsulting and conventional face-to-face consultation.Results:A total of 5745 RA patients were followed-up, 5292 (92.1%) by teleconsulting and 453 (7.9%) by conventional face-to-face consultation; among the group of SLE patients, a total of 646 were assessed, of which there were 386 (60%) by teleconsultation and 260 (40%) by face-to-face consultation; this highlights an important difference in the level of acceptance of the teleconsultation between patients with RA and SLE, being much lower in patients with SLE (p value< 0.0001). Regarding gender differences, in men, there were 33 (12.7%) SLE and 89 (19.6%) RA face-to-face consultations, while in women there were 227 (87.3%) SLE and 364 (80.4%) RA in a face-to-face consultation. Regarding patients who were attended through telemedicine, 45 (11.7%) SLE and 966 (18.3%) RA were men, while 341 (88.3%) SLE and 4326 (81.7%) RA were women; that means, in the RA cohort, a greater number of men prefer the face-to-face consultation than in the SLE cohort (p value< 0.0185). 10 RA patients were diagnosed with the Covid-19 in teleconsultation; in all cases, close contact with infected relatives was verified as the probable cause.Table 1.Differences by gender in the level of teleconsultation acceptance and face-to-face assistance in patients with SLE and RARA PatientsGenderTeleconsulting (%a)Face-to-face consultation (%a)Male105596691,57%898,43%Female4690432692,23%3647,77%SLE PatientsGenderTeleconsulting (%a)Face-to-face consultation (%a)Male784557,69%3342,31%Female56834160,03%22739,97%a Total percentage of patients by gender. RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus.Conclusion:Telemedicine may provide a viable option for the follow-up of patients with rheumatological diseases even beyond the pandemic. But unexpectedly, data showed an important difference in the acceptance of teleconsultation between patients with RA and SLE, being much higher in older and/or male patients with RA compared to patients with SLE; however, further studies are needed to support this conclusion.Disclosure of Interests:None declared

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Pattern of sub-clinical dysthyroidism in a postthyroidectomy cohort: Implications for supplementary treatment

East and Central African Journal of Surgery ◽

10.4314/ecajs.v23i3.2 ◽

2018 ◽

Vol 23 (3) ◽

pp. 95-99

Author(s):

Ronald Kintu-Luwaga ◽

Timothy Makumbi ◽

Cathy Kilyewala ◽

Jane O. Fualal

Keyword(s):

Total Thyroidectomy ◽

Prospective Cohort ◽

Statistical Significance ◽

Female Gender ◽

P Value ◽

Patient Demographics ◽

Accurate Dose ◽

History Of ◽

Biochemical Testing

Background: Defective thyroid functioning is referred to as dysthyroidism. Despite incomplete thyroidectomy or thyroxine supplementation, post-thyroidectomy patients may still experience dysthyroidism. Many times, this may be sub - clinical. This study aimed to assess the prevalence and pattern of sub-clinical dysthyroidism following thyroid surgery. Methods: In this prospective cohort study, 40 patients were consecutively recruited following conventional thyroidectomy and followed up to 12months. All patients were euthyroid at surgery. At 12 months serum TSH, T4 and T3 levels were measured and the patients clinically assessed. The prevalence and pattern of dysthyroidism was analysed statistically against the patient demographics, clinical and peri-operative variables for significance, using stata version 13. The confidence interval was at 95% and the statistical significance at a p-value of <0.05. Results: The mean age was 44.3 years (M:F= 1: 12.3). 20% of the patients had medical comorbidities. The types of surgery performed were sub-total thyroidectomy (55%), near total thyroidectomy (25%) and total thyroidectomy (20%). The prevalence of postoperative dysthyroidism was 52.5%. 22.7% of patients who underwent sub-total thyroidectomy had dysthyroidism. Most patients (90%) who were on thyroxine supplement (following total or near total thyroidectomy) still developed dysthyroidism (P= 0.017). The type of resection done had the greatest significance (P= 0.000). Other factors associated with dysthyroidism albeit non-significantly were history of pre-operative hyperthyroidism, middle age (40 - 60 years), and female gender. Conclusions: The prevalence of dysthyroidism in this cohort was high which may reflect the broader picture among post - thyroidectomy patients in this setting. Regular biochemical testing in post-thyroidectomy patients is important to identify and correct dysthyroidism early. This requires frequent follow-up and accurate dose adjustment, based on objective assessments like weight or body mass index. Keywords: post-thyroidectomy; dysthyroidism; hypothyroidism; hyperthyroidism; sub-clinical dysthyroidism; prospective; cohort

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Psychopathology 8½ Years Post Parasuicide

Crisis ◽

10.1027//0227-5910.20.3.115 ◽

1999 ◽

Vol 20 (3) ◽

pp. 115-120 ◽

Cited By ~ 9

Author(s):

Stephen Curran ◽

Michael Fitzgerald ◽

Vincent T Greene

Keyword(s):

Rating Scales ◽

Psychiatric Morbidity ◽

Parental Bonding ◽

Social Maladjustment ◽

Term Outcome ◽

Long Term Outcome ◽

Face To Face ◽

Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

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Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

The Open Orthopaedics Journal ◽

10.2174/1874325001913010266 ◽

2019 ◽

Vol 13 (1) ◽

pp. 266-271

Author(s):

Georgina Kakra Wartemberg ◽

Thomas Goff ◽

Simon Jones ◽

James Newman

Keyword(s):

Aseptic Loosening ◽

Revision Surgery ◽

Revision Arthroplasty ◽

Cost Effective ◽

Face To Face ◽

Primary Surgery ◽

Effective System ◽

Knee Revision Surgery ◽

Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

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CLINICO-PATHOLOGICAL AND RADIOLOGICAL PROGNOSTIC FACTORS IN CANCER CERVIX TREATED WITH CONCURRENT CHEMORADIATION

SRMS Journal of Medical Science ◽

10.21761/jms.v1i1.10940 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Manraj S. Kang ◽

Kamal Sahni ◽

Piyush Kumar ◽

Rajneesh Madhok ◽

Ratna Saxena ◽

...

Keyword(s):

Prognostic Factors ◽

Mitotic Index ◽

Univariate Analysis ◽

Disease Free Survival ◽

Concurrent Chemoradiation ◽

P Value ◽

Publication Date ◽

Cancer Cervix ◽

Stage Ib

<bold>Introduction:</bold> Cervical cancer is most common cancer in the rural and second most common in urban areas of our country. It accounts for 16% of all cancers. There are various clinical, Paper Submission Datepathological and radiological factors which dictate the prognosis of these cancer cervix patients. The present study evaluates clinical, pathological and radiological prognostic factors in cancer cervix treated with concurrent chemoradiation. <bold>Material and Methods:</bold> A total of 32 patients seen between 2012 and 2014 patients planned concurrent chemoradiation were evaluated in terms of clinical (age, stage, Hb% and HPV Paper Publication Date infection), pathological (histopathology type and subtype, grade, mitotic index, lymph-July 2016 vascular invasion and necrosis) and radiological (parametrial extension, disease dimension, lymph node, hydronephrosis and vascularity of tumour) prognostic factors. After pre-DOI treatment evaluation patient was planned for 3 Dimentional-Conformal Radiotherapy (50Gy/25#/5 weeks) with concurrent chemotherapy (Cisplatin 35mg/m<sup>2</sup>) followed by 3 applications of Intracavitary radiotherapy (6Gy/fraction) with 6 months follow up. Response was accessed according to WHO response criteria and univariate analysis was done using chi-square test. <bold>Results:</bold> Clinical factors: Age – better disease free survival in older patients (p value=0.003), stage - Lower stage had better survival (for stage Ib-IIa vs stage IIb p value = 0.003 and for stage Ib vs. IIIb p value = 0.0005), Hb% - 57% patients with Hb <10g/dl had recurrence at end of 6 months (p value=0.00001), HPV – High recurrence with HPV presence. Pathological factors like high Mitotic Index had more residual disease (p=0.0009), grade - No statistical significance. Radiological factors- volume of disease - 35 % patients with volume of disease > 6 cm had disease at end of 6 months, hydronephrosis - 40 % patient with hydronephrosis had recurrence (p value = 0.0005) at end of 6 months follow up and vascularity of tumour showed statistically no difference. <bold>Conclusion:</bold> Hb <10%, HPV infection, Mitotic index (3-5/HPF), stage IIIB, pelvic nodes were concluded as the independent poor prognostic factors.

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