Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization:The cardiac patient's perspective

Objective: To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. Methods: Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). Results: Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 – 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. Conclusion: The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This “teachable window” for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. Practice Implications: Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.</p

Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization:The cardiac patient's perspective

Objective: To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. Methods: Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). Results: Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 – 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. Conclusion: The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This “teachable window” for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. Practice Implications: Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.</p

The COVID-19 Crisis as a Teachable Moment for Lifestyle Change in Dutch Cardiovascular Disease Patients

Objective: When lifestyle changes are needed, life events or crises such as COVID-19 may function as “teachable moments”. This study aimed to explore whether the pandemic can provoke a teachable moment regarding lifestyle change in cardiovascular disease patients.Method: In this cross-sectional survey study, 830 cardiovascular disease patients reported their intentions to change lifestyle, instigated by the corona crisis, together with risk perception, affective impact, and changed self-concept, based on a “teachable moments” framework.Results: Between 8 and 28% of the sample reported increased intentions to optimize lifestyle behaviors, particularly related to general lifestyle (28%), physical activity (25%), and diet (21%). Multivariate regression analyses revealed that changed self-concept was associated with higher intentions to improve general lifestyle (B = 0.26; CI = 0.19–0.33), physical activity (B = 0.23; CI = 0.16–0.30), and smoking (B = 0.29; CI = 0.01–0.57). In addition, changed self-concept and affective impact were both significantly associated with higher intentions to improve diet (resp. B = 0.29; CI = 0.21–0.36 and B = 0.12; CI = 0.04–0.21) and to limit alcohol consumption (resp. B = 0.22; CI = 0.13–0.30 and B = 0.11; CI = 0.01–0.20). We did not find evidence for an important role of risk perception on behavior change intentions.Conclusion: The COVID-19 crisis evoked a potential teachable moment for lifestyle change in cardiovascular disease patients, driven by a change in a patient's self-concept and to a lesser extent by an affective impact of the COVID-19 crisis. These results suggest an important window of opportunity for healthcare professionals to utilize the pandemic to promote a healthy lifestyle to their patients

Culture Conversion Among HIV Co-Infected Multidrug-Resistant Tuberculosis Patients in Tugela Ferry, South Africa

Little is known about the time to sputum culture conversion in MDR-TB patients co-infected with HIV, although such patients have, historically, had poor outcomes. We describe culture conversion rates among MDR-TB patients with and without HIV-co-infection in a TB-endemic, high-HIV prevalent, resource-limited setting.Patients with culture-proven MDR-TB were treated with a standardized second-line regimen. Sputum cultures were taken monthly and conversion was defined as two negative cultures taken at least one month apart. Time-to-conversion was measured from the day of initiation of MDR-TB therapy. Subjects with HIV received antiretroviral therapy (ART) regardless of CD4 count.Among 45 MDR-TB patients, 36 (80%) were HIV-co-infected. Overall, 40 (89%) of the 45 patients culture-converted within the first six months and there was no difference in the proportion who converted based on HIV status. Median time-to-conversion was 62 days (IQR 48-111). Among the five patients who did not culture convert, three died, one was transferred to another facility, and one refused further treatment before completing 6 months of therapy. Thus, no patients remained persistently culture-positive at 6 months of therapy.With concurrent second-line TB and ART medications, MDR-TB/HIV co-infected patients can achieve culture conversion rates and times similar to those reported from HIV-negative patients worldwide. Future studies are needed to examine whether similar cure rates are achieved at the end of MDR-TB treatment and to determine the optimal use and timing of ART in the setting of MDR-TB treatment

Professor ou tutor: uma linha tênue na docência em EAD

Este trabalho analisa a natureza docente do trabalho de tutoria na Educação a Distância (EAD), utilizando, como referência, os documentos oficiais do Ministério da Educação e Cultura (MEC) (Brasil, 2007) sobre as funções do tutor e as avaliações que os tutores do Centro de Educação Superior a Distância do Estado do Rio de Janeiro (CEDERJ) fazem de sua prática. Contextualiza a pesquisa, abordando questões teóricas relativas à docência na EAD, a qual envolve vários profissionais em sua atuação, incluindo o tutor. Revela que até o momento inexiste um termo que defina o papel do tutor no trabalho com a EAD, papel este que se torna cada vez maior e mais indefinido. Mostra que, embora tenha, reconhecidamente, uma função importante e determinante nos cursos a distância, o tutor ainda é um profissional que carece de perfil profissiográfico, que lhe confira uma formação definida e um espaço determinado na modalidade. O artigo revela, ainda, que cresce a necessidade de estudos que indiquem quais as suas principais funções, sua identidade profissional e, sobretudo, a caracterização de sua atuação docente na EAD. Analisa as respostas do questionário aplicado aos 38 tutores do CEDERJ/UERJ, no curso de Licenciatura em Pedagogia e, finalmente, conclui que os tutores são unânimes em considerar sua atuação como docente, embora não sejam reconhecidos nem remunerados como tal pela instituição onde atuam

RIED. Revista iberoamericana de educación a distancia

Resumen basado en el de la publicaciónAnaliza la naturaleza del trabajo tutorial en educación a distancia. Utiliza como clave de referencia los documentos oficiales del Ministerio brasileño de Educación y Cultura (MEC) (Brasil, 2007), para describir tanto las funciones del tutor como las evaluaciones que los tutores del Centro de Educación Superior a Distancia, Estado de Río de Janeiro (CEDERJ), ponen en práctica dentro de sus propias prácticas de enseñanza y evaluación. Muestra que hay una falta de terminología para definir el papel del tutor en la educación a distancia. Explica que, aunque el tutor es reconocido por tener un papel importante y específico en los cursos a distancia, todavía es un trabajador sin un perfil profesional. También revela la creciente necesidad de llevar a cabo más estudios que pongan de relieve el rol de los profesores, su portfolio profesional, su desempeño docente y el estilo de enseñanza en la educación a distancia. Se analizan las respuestas al cuestionario proporcionado a 38 tutores de CEDERJ / UERJ de la licenciatura en Pedagogía. Concluye que todos los tutores participantes se consideran como maestros, a pesar de no ser reconocidos como tales por la institución en la que trabajaban.EC

Inclusão na Cultura Digital: Aprendizado e Liberdade

O Hospital dia / Centro de Atenção Diária (HD/CAD) do Instituto de Psiquiatria do Brasil (IPUB) é um serviço de atenção diária que acompanha pacientes com transtornos psíquicos graves e persistentes, oferecendo cuidados clínicos e atenção psicossocial que favoreçam a sustentação do sujeito em sua singularidade. Diversas atividades terapêuticas são desenvolvidas para alcançar estes objetivos, dentre elas as oficinas terapêuticas. As oficinas terapêuticas são uma das principais formas de oferecer recursos de expressão, socialização e participação na vida social, podendo promover inclusão na sociedade através da arte, educação e trabalho. O curso de Inclusão da Cultura Digital é um projeto piloto, preparado ao longo do ano de 2018 e implementado no início deste ano, que articula a proposta pedagógica do Laboratório de informática para Educação / Núcleo Interdisciplinar para o Desenvolvimento Social (Lipe/NIDES), parceiros que contribuíram com apoio técnico e metodológico, com a perspectiva terapêutica do Serviço. Este projeto surgiu com o objetivo de acolher aqueles pacientes do Hospital dia que não participavam de outras oficinas terapêuticas e que de certa forma sinalizavam ter algum interesse em aprender novas tecnologias, assim como promover a inclusão da cultura digital, estimulando a autonomia, o compartilhamento de experiências, o respeito às diferenças e a integração social. O curso foi divulgado nos espaços que reúnem um número maior de usuários do Serviço e a formação da turma limitou-se ao número de computadores disponíveis. O curso foi estruturado, em seu módulo introdutório, em três etapas. O objetivo da primeira etapa foi trabalhar a coordenação motora fina e apresentar as partes de um computador e suas respectivas funções. Na segunda etapa, o objetivo está sendo a introdução e apropriação das funções do editor de texto, a partir da digitação e formatação. E a terceira etapa, o objetivo será a apresentação das novas formas de comunicação através do acesso à Internet, e seus cuidados. Utilizamos os princípios da metodologia participativa, não apenas por ser o embasamento teórico usado pelos nossos parceiros, mas principalmente por estarem alinhados a lógica de nosso Serviço. Favorecer a relação ensino-aprendizagem e mantêm um espaço de diálogo no processo pedagógico em constante transformação, é o nosso objetivo geral. E, parafraseando um aluno do curso, “Esse aprendizado e manuseio são importantes. Não quero ficar socialmente excluído.

The effect of stopping water exercise for 12 weeks on the functional fitness of elderly women

http://dx.doi.org/10.5007/1980-0037.2008v10n3p237 The objective of this study was to investigate the effect of a 12-week pause in exercising in water on the functional fitness of elderly women. The sample was 31 elderly women, with x _ = 68.97 years (SD = 5.34), all participants in a water exercise program. The women were tested in November 2005 and, after a 12-week pause in water exercises, in March2006, using the American Alliance for Health, Physical Education, Recreation and Dance – AAHPERD test battery. The statistical analysis was descriptive, using simple frequencies and percentages, plus the t test for paired samples. A statistically significant difference was observed between mean scores for coordination, agility and the general functional fitness index (GFFI) at the end of the exercise program and 12 weeks later. The GFFI and coordination scores had reduced after the 12-week period, but the participants’ agility had improved. It was concluded that a 12-week pause in water exercise impacted the GFFI of these elderly women. These results emphasize the importance of physical exercise during the ageing process and of raising awareness of the need for the elderly to keep physically active even during the holiday period in order to improve and/or maintain functional fitness levels

<b> The effect of stopping water exercise for 12 weeks on the functional fitness of elderly women </b>

The objective of this study was to investigate the effect of a 12-week pause in exercising in water on the functional fitness of elderly women. The sample was 31 elderly women, with x _ = 68.97 years (SD = 5.34), all participants in a water exercise program. The women were tested in November 2005 and, after a 12-week pause in water exercises, in March2006, using the American Alliance for Health, Physical Education, Recreation and Dance – AAHPERD test battery. The statistical analysis was descriptive, using simple frequencies and percentages, plus the t test for paired samples. A statistically significant difference was observed between mean scores for coordination, agility and the general functional fitness index (GFFI) at the end of the exercise program and 12 weeks later. The GFFI and coordination scores had reduced after the 12-week period, but the participants’ agility had improved. It was concluded that a 12-week pause in water exercise impacted the GFFI of these elderly women. These results emphasize the importance of physical exercise during the ageing process and of raising awareness of the need for the elderly to keep physically active even during the holiday period in order to improve and/or maintain functional fitness levels. ResumoEsse estudo teve como objetivo verificar a influência do período de interrupção de 12 semanas na aptidão funcional de mulheres idosas, praticantes de atividades aquáticas. A amostra foi composta por 31 idosas, com x _ = 68,97 anos (DP = 5,34), praticantes de atividades aquáticas, que fizeram os testes da Bateria da American Alliance for Health, Physical Education, Recreation and Dance – AAHPERD, em novembro de 2005 e após 12 semanas de interrupção (março de 2006). Os resultados dos testes foram comparados com os valores normativos para essa bateria. O tratamento estatístico foi descritivo, mediante a freqüência simples e percentagem, e o teste t para amostras emparelhadas/pareadas, com nível de significância de 5%. Observou-se diferença estatisticamente significativa entre os valores médios de coordenação, agilidade e do índice de aptidão funcional geral (IAFG) entre o final do programa e após o período de interrupção. Ocorreu uma diminuição no resultado do IAFG e da coordenação após o período de interrupção de 12 semanas, porém, a agilidade das participantes melhorou. Concluiu-se que o período de interrupção de 12 semanas de atividades aquáticas influencia o IAFG em idosas. Estes resultados reforçam a importância do exercício físico no processo de envelhecimento e da conscientização sobre as vantagens de se manterem ativos mesmo no período de férias para a melhora e/ou manutenção dos níveis da aptidão funcional das idosas

A cross-sectional analysis of factors associated with the teachable moment concept and health behaviors during pregnancy

Abstract Background Pregnancy is often associated with a change in health behaviors, leading some to suggest that pregnancy could be a teachable moment for lifestyle change. However, the prevalence and underlying mechanism of this phenomenon is not well understood. The aim of this study is to explore the prevalence of a teachable moment during pregnancy, the psychosocial factors that are associated with experiencing such a moment, and its association with actual health behaviors. Methods In this cross-sectional study, 343 pregnant Dutch women completed an online questionnaire. Participants reported on their intentions to change lifestyle due to pregnancy, their current health behaviors, and several psychosocial factors that were assumed to be linked to perceiving a teachable moment during pregnancy: perceived risk, affective impact, changed self-concept, and social support. Multivariable linear and logistic regression were applied to the data analysis. Results Results demonstrate that 56% of the women experienced a teachable moment based on intentions to change their health behavior. Multivariate regression analyses revealed that changed self-concept (β = 0.21; CI = 0.11–0.31), positive affect (positive β = 0.28; CI = 0.21–0.48), and negative affect (β = 0.12; CI = 0.00-0.15) were associated with higher intentions to change health behavior. Conversely, more perceived risk was associated with lower intentions to change health behavior (β=-0.29; CI = 0.31 − 0.13). Multivariate regression analyses showed a positive association between intentions to change health behavior and diet quality (β = 0.11; CI = 0.82–1.64) and physical activity (OR = 2.88; CI = 1.66-5.00). Conclusions This study suggests that pregnancy may be experienced as a teachable moment, therefore providing an important window of opportunity for healthcare professionals to efficiently improve health behaviors and health in pregnant women and their children. Results suggest that healthcare professionals should link communication about pregnancy-related health behaviors to a pregnant women’s change in identity, affective impact (predominantly positive affective impact) and risk perception to stimulate the motivation to change healthy behavior positively