APPLICATION OF EXERCISE COMBINED WITH LUNG REHABILITATION IN RESPIRATORY DISEASE

ABSTRACT Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by incomplete reversibility of airflow obstruction and persistent respiratory symptoms. Objective: To explore the therapeutic effect of physical exercise on patients with chronic obstructive pulmonary disease in pulmonary rehabilitation. Methods: Forty-eight experimental subjects were divided into control group, experimental group 1, and experimental group 2 for research. The control group received normal medical-related treatment without any other means of intervention. In addition to normal medical-related treatment, experimental group 1 received breathing training and educational interventions and experimental group 2 received exercise, breathing training and educational interventions. Results: The vital capacity of female subjects before and during the experiment ranged from 2.23±0.01 to 2.26±0.04, the FVC ranged from 2.00±0.02 to 2.01±0.03, the FEV1 ranged from 1.03±0.01 to 1.03±0.01,the FEV1% ranged from 55.50±1.29 to 55.25±1.71,the FEV1/FVC ranged from 51.44±0.24 to 50.84±1.00, andthe heart rate ranges from 65.00±0.82 to 65.50±1.29. Conclusions: Exercise training can increase the exercise tolerance of patients with COPD, relieve dyspnea, and improve the quality of life. Level of evidence II; Therapeutic studies - investigation of treatment results.

A Survey on Knowledge, Prevention, and Occurrence of Sexually Transmitted Infections among Freshmen from Four Italian Universities

Background. The peak of sexually transmitted infections (STI) among adolescents/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a survey among freshmen from four Italian universities. Methods. This observational cross-sectional study was conducted with an anonymous self-reported paper questionnaire, administered during teaching lectures to university freshmen of the northern (Padua, Bergamo, and Milan campuses) and southern (Palermo campus) parts of the country. Knowledge of STI (a linear numerical score), knowledge of STI prevention (dichotomous variable: yes vs. no) and previous STI occurrence (polytomous variable: “no”; “don’t know”; “yes”) were the outcomes in the statistical analysis. Results. The final number of freshmen surveyed was 4552 (97.9% response rate). The mean age of respondents was 21.4 ± 2.2 years and most of them (70.3%) were females. A total of 60% of students were in a stable romantic relationship. Only 28% respondents knew the most effective methods to prevent STI (i.e., condom and sexual abstinence), with a slightly higher prevalence of correct answers among females (31.3%) than males (25.8%). Students with history of STIs were 5.1%; they reported referring mostly to their general practitioner (GP) (38.1%) rather than discussing the problem with their partner (13.1%). At multivariable analysis, a significantly higher level of STI knowledge was observed in older students (25+ years of age), biomedical students, and those from a non-nuclear family; lower levels were found among students of the University of Palermo, and those who completed a vocational secondary school education. Those who had less knowledge about the most effective tools to prevent STIs included males, students from the University of Palermo, students registered with educational sciences, economics/political sciences, those of foreign nationality, and those whose fathers had lower educational levels. The risk of contracting STI was significantly lower only in students not in a stable relationship (relative risk ratio, RRR = 0.67; 95% confidence interval, 95%CI = 0.48; 0.94), whereas such risk was significantly higher in students with higher STI knowledge (RRR = 1.15; 95%CI = 1.08; 1.22). Discussion and Conclusions. University freshmen investigated in this study had poor knowledge of STIs and their prevention. Unexpectedly, those with higher levels of knowledge had an increased risk of STIs. There were no educational interventions—with good quality and long-term follow-ups—that increased the confidence that such SHE programs could have population level effects. A new high-quality study is therefore required to assess the effectiveness of an intervention generating behavioral changes; increasing only knowledge may not be sufficient.

Cyberchondria, Fear of COVID-19, and Risk Perception Mediate the Association between Problematic Social Media Use and Intention to Get a COVID-19 Vaccine

Vaccination is the most effective way to control the COVID-19 pandemic, but vaccination hesitancy threatens this effort worldwide. Consequently, there is a need to understand what influences individuals’ intention to get a COVID-19 vaccine. Restriction of information gathering on societal developments to social media may influence attitudes towards COVID-19 vaccination through exposure to disinformation and imbalanced arguments. The present study examined the association between problematic social media use and intention to get the COVID-19 vaccine, taking into account the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception. In a cross-sectional survey study, a total of 10,843 residents of Qazvin City, Iran completed measures on problematic social media use, fear of COVID-19, cyberchondria, COVID-19 risk perception, and intention to get a COVID-19 vaccine. The data were analyzed using structural equation modeling (SEM). The results showed that there was no direct association between problematic social media use and intention to get a COVID-19 vaccine. Nonetheless, cyberchondria, fear of COVID-19, and COVID-19 risk perception (each or serially) mediated associations between problematic social media use and intention to get a COVID-19 vaccine. These results add to the understanding of the role of problematic social media use in COVID-19 vaccine hesitancy, i.e., it is not the quantity of social media use per se that matters. This knowledge of the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception can be used by public health experts and policymakers when planning educational interventions and other initiatives in COVID-19 vaccination programs.

Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study

Purpose To investigate factors associated with delays in presentation and diagnosis of women with confirmed breast cancer (BC). Methods A cross-sectional study nested in an ongoing prospective cohort study of breast cancer patients at Dr Sardjito Hospital, Yogyakarta, Indonesia, was employed. Participants (n = 150) from the main study were recruited, with secondary information on demographic, clinical, and tumor variables collected from the study database. A questionnaire was used to gather data on other socioeconomic variables, herbal consumption, number of healthcare visits, knowledge-attitude-practice of BC, and open-ended questions relating to initial presentation. Presentation delay (time between initial symptom and first consultation) was defined as ≥3 months. Diagnosis delay was defined as ≥1 month between presentation and diagnosis confirmation. Impact on disease stage and determinants of both delays were examined. A Kruskal-Wallis test was used to assess the length and distribution of delays by disease stage. A multivariable logistic regression analysis was conducted to explore the association between delays, cancer stage and factors. Results Sixty-five (43.3%) patients had a ≥3-month presentation delay and 97 (64.7%) had a diagnosis confirmation by ≥1 month. Both presentation and diagnosis delays increased the risk of being diagnosed with cancer stage III-IV (odds ratio/OR 2.21, 95% CI 0.97–5.01, p = 0.059 and OR 3.03, 95% CI 1.28–7.19, p = 0.012). Visit to providers ≤3 times was significantly attributed to a reduced diagnosis delay (OR 0.15, 95% CI 0.06–0.37, p <0.001), while having a family history of cancer was significantly associated with increased diagnosis delay (OR 2.28, 95% CI 1.03–5.04, p = 0.042). The most frequent reasons for delaying presentation were lack of awareness of the cause of symptoms (41.5%), low perceived severity (27.7%) and fear of surgery intervention (26.2%). Conclusions Almost half of BC patients in our setting had a delay in presentation and 64.7% experienced a delay in diagnosis. These delays increased the likelihood of presentation with a more advanced stage of disease. Future research is required in Indonesia to explore the feasibility of evidence-based approaches to reducing delays at both levels, including educational interventions to increase awareness of BC symptoms and reducing existing complex and convoluted referral pathways for patients suspected of having cancer.

Learning clinical reasoning in the workplace: a student perspective

Introduction Clinical reasoning is a core competency for every physician, as well as one of the most complex skills to learn. This study aims to provide insight into the perspective of learners by asking students about their own experiences with learning clinical reasoning throughout the medical Master’s curriculum. Methods We adopted a constructivist approach to organise three semi-structured focus groups within the Master’s curriculum at the medical school of the Radboud University Medical Center in Nijmegen (Netherlands) between August and December 2019. Analysis was performed through template analysis. Results The study included 18 participants who (1) defined and interpreted clinical reasoning, (2) assessed the teaching methods and (3) discussed how they used their context in order to learn and perform clinical reasoning during their clinical rotations. They referred to a variety of contexts, including the clinical environment and various actors within it (e.g. supervisors, peers and patients). Conclusion With regard to the process by which medical students learn clinical reasoning in practice, this study stresses the importance of integrating context into the clinical reasoning process and the manner in which it is learnt. The full incorporation of the benefits of dialogue with the practice of clinical reasoning will require additional attention to educational interventions that empower students to (1) start conversations with their supervisors; (2) increase their engagement in peer and patient learning; (3) recognise bias and copy patterns in their learning process; and (4) embrace and propagate their role as boundary crossers.

Educational interventions involving physical manipulatives for improving children’s learning and development: a scoping review

WHY DID WE DO THIS RESEARCH?Hands-on learning activities with physical objects – or physical manipulatives (PMs) – can be great at encouraging children’s active participation in learning. Cast your mind back to your own childhood: do you remember using items like counters, shapes, or fraction bars in school? If so, you were using PMs! We wanted to find out what kind of research has been done on educational programmes involving PMs.WHAT DID WE DO?We conducted a scoping review – a type of literature review used to identify and broadly describe a body of research according to certain inclusion criteria. We searched several academic databases for studies that have tested the effectiveness of PM interventions with primary-age children; 102 studies met our inclusion criteria and were synthesised in the review.WHAT DID WE FIND?Most studies involved children between 4-6 years in school settings. They spanned 26 different countries, but almost all took place in high- or middle-income contexts, typically the USA. The interventions involved different PMs and hands-on activities (e.g., block building, shape sorting, paper folding), and evidence relating their effectiveness was mixed. Whilst some studies reported benefits to children’s math, spatial, or literacy skills, others did not, and many were hindered by methodological shortcomings. This means we must be cautious when drawing conclusions about the overall effectiveness of PM interventions. Nevertheless, the findings illustrate the many ways hands-on experiences with PMs can facilitate children’s active engagement in learning. Going forward, higher quality research is needed, as well as more studies testing PM interventions in lower-income contexts.

Palliative care in Primary Health Care: an integrative literature review

ABSTRACT Objectives: to analyze scientific evidence on the implementation and performance of palliative care in Primary Health Care. Methods: an integrative literature review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, carried out in the PubMed, SciVerse Scopus and LILACS databases, in December 2020, without a time frame. Results: 22 original scientific articles were analyzed, 14 classified as evidence level VI. The objective was to understand the experiences and roles of professionals, patients and families on palliative care in Primary Health Care, articles focused on the theme of management and organization of health services and on the importance of educational interventions on the subject. Final Considerations: evidence found relating palliative care in Primary Health Care points to the possibility of this care; health teams work closely with the family and their home, but the need to expand this theme is still perceived.

Religiously Conditioned Health Behaviors within Selected Religious Traditions

Background: Health is a value of paramount importance for human existence. It has a special place in every religious system, both on the doctrinal and practical levels. Most religions view health as a priority value to be cared for, and require followers of individual religious groups to take care of their physical and mental health, and to maintain a balance between body and spirit. The aim of the study was to verify whether the level of religious commitment significantly influences health behaviors and whether in selected religions the faithful have a different approach to health behaviors. Methods: This cross-sectional study was conducted on a group of 296 people—118 Seventh-day Adventists (SDA), 134 Catholics, and 14 Jews living in southern Poland, and 31 Muslims living in southern and north-eastern Poland. The following research tools were used as part of the diagnostic survey method: a questionnaire survey designed by us; the International Physical Activity Questionnaire (IPAQ); the Inventory of Health Behaviours (IHB); the Perceived Stress Scale (PSS 10) and anthropometric measurements, physical examination, laboratory tests. Results: Only 75% of Catholics who participated in the study declared a high level of religious commitment. On the other hand, all (100%) of SDA, Jews, and Muslim respondents declared their religious commitment at a high level. SDA were characterized by the most desirable health behaviors on the IHB (high and average levels), especially eating habits. They did not consume alcohol, did not smoke cigarettes. The physical activity of most ADS was high and moderate. Most of the SDA subjects were characterized by an average and low level of stress intensity. The most common correct scores for homocysteine, triglycerides, and CRP were SDA, cholesterol by Jews, glucose by Muslims, and HDL by Catholics. The most common negative results were: homocysteine, glucose and triglycerides among Jews, cholesterol and CRP among Catholics, HDL among Muslims. Optimal blood pressure was most common among Catholics, and hypertension was most often diagnosed among Jews. Most often, Muslims had the correct body weight, and at the same time it was the group of respondents most often diagnosed with obesity. In contrast, underweight was observed only among Catholics. The SDA subjects were most often overweight. Conclusions: The results suggest that public health professionals and nurses should develop culturally specific educational interventions, especially among Catholics.