Planejamento de educação parental on-line para um estilo de vida de peso saudável em pacientes pediátricos de cuidados primários de 6 a 12 anos

Background: Childhood obesity is a pandemic with immediate and future health risks that demand holistic, personalized, and innovative treatments. Healthcare providers struggle to provide such treatment within the constraints of medical visits. A theoretical and evidence-based eHealth intervention could engage parents and caregivers to improve health behaviors and increase reach to low-income vulnerable families, a high-risk chort often neglected in clinical research. This study aims to identify needs and preferences of potential users of an eHealth intervention. Methods: Focus groups and interviews of ethnically diverse, low-income parents and semi-structured interviews of primary healthcare staff obtained perspectives on the content and structure of a eHealth intervention intended to improve lifestyle habits to reduce childhood obesity. Research team members analyzed the data to identify specific needs and communication strategies for the target population.   Results:  Parents endorsed learning more about healthy eating, physical activity, and the effects of sugar-sweetened beverages on their child’s weight.  Parents reported a preference for bright colors, short texts, videos, summary quizzes, and additional resources to explore on their own and with their child. Healthcare staff reported time limitations during clinical visits and an interest in looping family progress into their EHR. Using an eHealth intervention, parents expect an improved relationship and increased trust with their child’s pediatrician.   Conclusion:  Parents and staff saw value in this tool and provided useful recommendations for its design. This eHealth intervention could create a health alliance between the healthcare provider and family, provide personalized content, and be scaled to address health disparities broadly.Antecedentes. la obesidad infantil es una pandemia con riesgos para la salud inmediatos y futuros que demandan tratamientos holísticos, personalizados e innovadores. Los proveedores de atención médica luchan por brindar dicho tratamiento dentro de las limitaciones de las visitas médicas. Una intervención de eSalud teórica y basada en la evidencia podría involucrar a los padres y cuidadores para mejorar los comportamientos de salud y aumentar el alcance a las familias vulnerables de bajos ingresos, un grupo de alto riesgo que a menudo se descuida en la investigación clínica. Este estudio tiene como objetivo identificar las necesidades y preferencias de los usuarios potenciales de una intervención de eSalud. Métodos. Grupos focales y entrevistas de padres étnicamente diversos y de bajos ingresos y entrevistas semiestructuradas del personal de atención primaria de la salud obtuvieron perspectivas sobre el contenido y la estructura de una intervención de eSalud destinada a mejorar los hábitos de estilo de vida para reducir la obesidad infantil. Los miembros del equipo de investigación analizaron los datos para identificar necesidades específicas y estrategias de comunicación para la población objetivo. Resultados. Los padres aprobaron aprender más sobre alimentación saludable, actividad física y los efectos de las bebidas azucaradas en el peso de sus hijos. Los padres informaron una preferencia por los colores brillantes, los textos breves, los videos, los cuestionarios resumidos y los recursos adicionales para explorar por su cuenta y con sus hijos. El personal de atención médica informó limitaciones de tiempo durante las visitas clínicas y un interés en incluir el progreso de la familia en su EHR. Con una intervención de eSalud, los padres esperan una mejor relación y una mayor confianza con el pediatra de su hijo. Conclusión. Los padres y el personal vieron valor en esta herramienta y brindaron recomendaciones útiles para su diseño. Esta intervención de eSalud podría crear una alianza de salud entre el proveedor de atención médica y la familia, brindar contenido personalizado y ampliarse para abordar las disparidades de salud de manera amplia.Antecedentes. A obesidade infantil é uma pandemia com riscos à saúde imediatos e futuros que demandam tratamentos holísticos, personalizados e inovadores. Os prestadores de cuidados de saúde lutam para fornecer esse tratamento dentro das limitações das consultas médicas. Uma intervenção teórica e baseada em evidências de eSaúde poderia envolver pais e cuidadores para melhorar os comportamentos de saúde e aumentar o alcance de famílias vulneráveis de baixa renda, um grupo de alto risco que muitas vezes é negligenciado em pesquisas clínicas. Este estudo visa identificar as necessidades e preferências dos potenciais utilizadores de uma intervenção de eSaúde. Métodos. Grupos focales y entrevistas de padres étnicamente diversos y de bajos ingresos y entrevistas semiestructuradas del personal de atención primaria de la salud obtuvieron perspectivas sobre el contenido y la estructura de una intervención de eSalud destinada a mejorar los hábitos de estilo de vida para reducir la obesidade infantil. Os membros da equipe de pesquisa analisaram os dados para identificar necessidades específicas e estratégias de comunicação para a população-alvo. Resultados. Os pais aprovaram aprender mais sobre alimentação saudável, atividade física e os efeitos das bebidas açucaradas no peso de seus filhos. Os pais relataram preferência por cores vivas, textos curtos, vídeos, questionários curtos e recursos adicionais para explorar sozinhos e com seus filhos. A equipe de saúde relatou limitações de tempo durante as visitas à clínica e interesse em incluir o progresso da família em seu EHR. Com uma intervenção de eSaúde, os pais esperam um melhor relacionamento e maior confiança com o pediatra de seus filhos. Conclusão. Os pais e funcionários viram valor nesta ferramenta e forneceram recomendações úteis para o seu design. Essa intervenção de eSaúde pode criar uma parceria de saúde entre o profissional de saúde e a família, fornecer conteúdo personalizado e ser ampliada para abordar amplamente as disparidades de saúde

Patient and provider‐level barriers to hepatitis C screening and linkage to care: A mixed‐methods evaluation

Achieving practice change can be challenging when guidelines shift from a selective risk‐based strategy to a broader population health strategy, as occurred for hepatitis C (HCV) screening (2012‐2013). We aimed to evaluate patient and provider barriers that contributed to suboptimal HCV screening and linkage‐to‐care rates after implementation of an intervention to improve HCV screening and linkage‐to‐care processes in a large, public integrated healthcare system following the guidelines change. As part of a mixed‐methods study, we collected data through patient surveys (n = 159), focus groups (n = 9) and structured observation of providers and staff (n = 9). We used these findings to then inform domains for the second phase, which consisted of semi‐structured interviews with patients across the screening‐treatment continuum (n = 24) and providers and staff at primary care and hepatology clinics (n = 21). We transcribed and thematically analysed interviews using an integrated inductive and deductive framework. We identified lack of clarity about treatment cost, treatment complications and likelihood of cure as ongoing patient‐level barriers to screening and linkage to care. Provider‐level barriers included scepticism about establishing HCV screening as a quality metric given competing clinical priorities, particularly for patients with multiple comorbidities. However, most felt positively about adding HCV as a quality metric to enhance HCV screening and linkage to care. Provider engagement yielded suggestions for process improvements that resulted in increased stakeholder buy‐in and real‐time enhancements to the HCV screening process intervention. Systematic data collection at baseline and during practice change implementation may facilitate adoption and adaptation to improve HCV screening guideline implementation. Findings identified several key opportunities and lessons to enhance the impact of practice change interventions to improve HCV screening and treatment delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155892/1/jvh13278.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155892/2/jvh13278_am.pd

The prevalence, age distribution and comorbidity of personality disorders in Australian women

OBJECTIVE: We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified sample of Australian women aged ⩾25 years. METHODS: Individual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population ( n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined. RESULTS: The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the individual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25-34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders. CONCLUSIONS: Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to individuals living with these disorders

Evaluation of the Oscillatory Interference Model of Grid Cell Firing through Analysis and Measured Period Variance of Some Biological Oscillators

Models of the hexagonally arrayed spatial activity pattern of grid cell firing in the literature generally fall into two main categories: continuous attractor models or oscillatory interference models. Burak and Fiete (2009, PLoS Comput Biol) recently examined noise in two continuous attractor models, but did not consider oscillatory interference models in detail. Here we analyze an oscillatory interference model to examine the effects of noise on its stability and spatial firing properties. We show analytically that the square of the drift in encoded position due to noise is proportional to time and inversely proportional to the number of oscillators. We also show there is a relatively fixed breakdown point, independent of many parameters of the model, past which noise overwhelms the spatial signal. Based on this result, we show that a pair of oscillators are expected to maintain a stable grid for approximately t = 5µ3/(4πσ)2 seconds where µ is the mean period of an oscillator in seconds and σ2 its variance in seconds2. We apply this criterion to recordings of individual persistent spiking neurons in postsubiculum (dorsal presubiculum) and layers III and V of entorhinal cortex, to subthreshold membrane potential oscillation recordings in layer II stellate cells of medial entorhinal cortex and to values from the literature regarding medial septum theta bursting cells. All oscillators examined have expected stability times far below those seen in experimental recordings of grid cells, suggesting the examined biological oscillators are unfit as a substrate for current implementations of oscillatory interference models. However, oscillatory interference models can tolerate small amounts of noise, suggesting the utility of circuit level effects which might reduce oscillator variability. Further implications for grid cell models are discussed

Surface modification of P dl LGA microspheres with gelatine methacrylate: Evaluation of adsorption, entrapment, and oxygen plasma treatment approaches

Injectable poly (dl-lactic-co-glycolic acid) (PdlLGA) microspheres are promising candidates as biodegradable controlled release carriers for drug and cell delivery applications; however, they have limited functional groups on the surface to enable dense grafting of tissue specific biocompatible molecules. In this study we have evaluated surface adsorption, entrapment and oxygen plasma treatment as three approaches to modify the surfaces of PdlLGA microspheres with gelatine methacrylate (gel-MA) as a biocompatible and photo cross-linkable macromolecule. Time of flight secondary ion mass spectroscopy (TOF SIMS) and X-ray photoelectron spectroscopy (XPS) were used to detect and quantify gel-MA on the surfaces. Fluorescent and scanning electron microscopies (SEM) were used to image the topographical changes. Human mesenchymal stem cells (hMSCs) of immortalised cell line were cultured on the surface of gel-MA modified PdlLGA microspheres and Presto-Blue assay was used to study the effect of different surface modifications on cell proliferation. Data analysis showed that the oxygen plasma treatment approach resulted in the highest density of gel-MA deposition. This study supports oxygen plasma treatment as a facile approach to modify the surface of injectable PdlLGA microspheres with macromolecules such as gel-MA to enhance proliferation rate of injected cells and potentially enable further grafting of tissue specific molecules

Caring for Cancer: Understanding the Access and Perceptions of Psychosocial Cancer Services in North Texas

It is estimated that nearly 14.5 million Americans are living with cancer today. A commonly overlooked component to quality cancer care, as defined by the Institute of Medicine, is the role of psychological and social support. Better known as psychosocial support, these needs reflect a broad spectrum of obstacles or assets in an individual’s personal life that may help or hinder their healing experience. Some psychosocial examples include coping skills, transportation to medical appointments, or appropriate knowledge to mitigate the physical impacts of the cancer process. Research has shown that by addressing these potential needs, a better health outcome may be achieved for cancer patients. Through participant observation at local psychosocial service establishments and through semi-structured interviews with service providers and adults diagnosed with cancer living in the Dallas-Fort Worth region, this thesis research seeks to explore how local cancer patients are learning of psychosocial services available to them, what barriers may exist in accessing these services, and what individuals may be doing to address their psychosocial needs, both formally or informally. Results yielded recommendations for local psychosocial providers to adjust their marketing of services and kinds of services offered as well as yielded recommendations for future academic research

Within the boundary fence: an investigation into the perceptions of men's experience of depression in rural and remote areas of Australia

This is a study exploring perceptions of men's experience of depression in rural and remote areas of Australia. The purpose of this investigation was to generate 'new' information that can inform models of diagnosis and primary care for the treatment of depression in men in rural and remote areas. Men and women were recruited from two North Queensland sites to participate in semistructured interviews in both an individual and focus group format and completing a series of questionnaires. A combination of grounded theory and content analysis was adopted to analyse the qualitative data, and develop theory around men's experience of depression in rural and remote areas. The findings of this study suggest that men's experience of depression within a rural context is defined by a process of 'internal compound' whereupon emotional distress can represent itself in avoidant and dulling behaviours along with self-reliant attempts to 'fix' the situation. From this study a language has been provided to give explanation to the experience of depression in men in rural and remote areas. The findings of this study have implications for, and provide opportunity for reform in, how we approach the recognition, diagnosis and treatment of depression for men in rural and remote areas

Reliability and validity of checklists and global ratings by standardized students, trained raters, and faculty raters in an objective structured teaching environment

BACKGROUND: Objective structured teaching exercises (OSTEs) are relatively new in medical education, with few studies that have reported reliability and validity. PURPOSE: To systematically examine the impact of OSTE design decisions, including number of cases, choice of raters, and type of scoring systems used. METHODS: We examined the impact of number of cases and raters using generalizability theory. We also compared scores from standardized students (SS), faculty raters (FR) and trained graduate student raters (TR), and examined the relation between behavior checklist ratings and global perception scores. RESULTS: Generalizability (g) coefficients for checklist scores were higher for SSs than TRs. The g estimates based on SSs\u27 global scores were higher than g estimates for FRs. SSs\u27 checklist scores were higher than TRs\u27 checklist scores, and SSs\u27 global evaluations were higher than FRs\u27 and TRs\u27 global scores. TRs\u27 relative to SSs\u27 global perceptions correlated more highly with checklist scores. CONCLUSIONS: SSs provide more generalizable checklist scores than TRs. Generalizability estimates for global scores from SSs and FRs were comparable. SSs are lenient raters compared to TRs and FRs