918 research outputs found

    Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study

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    UNLABELLED: Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x¯ = 1.51, s = 0.75 v. x¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x¯ = 91.86, s = 22.96 v. x¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x¯ = 1.64, s = 0.95 v. x¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x¯ = 26.43, s = 8.02 v. x¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x¯ = 20.98, s = 10.00 v. x¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. HIGHLIGHTS: Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support

    Behavioral and Psychological Strategies of Long‐Term Weight Loss Maintainers in a Widely Available Weight Management Program

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    Objective The study’s purpose was to use validated questionnaires to identify novel behavioral and psychological strategies among weight loss maintainers (WLMs) in a commercial weight management program. Methods Participants were 4,786 WLMs in WW (formerly Weight Watchers, New York, New York) who had maintained weight loss  ≥ 9.1 kg (24.7 kg/23.8% weight loss on average) for 3.3 years and had a current mean BMI of 27.6 kg/m2. A control group of 528 weight‐stable individuals with obesity had a mean BMI of 38.9 kg/m2 and weight change  \u3c 2.3 kg over the previous 5 years. Results WLMs versus Controls practiced more frequent healthy dietary choices (3.3 vs. 1.9;  = 0.37), self‐monitoring (2.6 vs. 0.7;  = 0.30), and psychological coping (2.5 vs. 1.1;  = 0.25) strategies. WLMs also reported more willingness to ignore food cravings (4.4 vs. 3.5;  = 0.16) and had greater habit strength for healthy eating (5.3 vs. 3.2;  = 0.21). Standard canonical coefficients indicated that dietary (0.52), self‐monitoring (0.40), and psychological (0.14) strategies as well as habit strength for healthy eating (0.15) contributed independently and most (49.5% of variance) to discriminating groups. Conclusions In a widely available weight management program, more frequent practice of healthy dietary, self‐monitoring, and psychological coping strategies as well as development of greater habit strength for healthy eating differentiated long‐term WLMs from weight‐stable individuals with obesity

    Factors Associated with Providers’ Perceptions of Mental Health Care in Santa Luzia’s Family Health Strategy, Brazil

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    Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS—psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers’ perceptions of patient-centered mental health care (p \u3c 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs’ skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems

    Taking Root: Enduring Effect of Rhizosphere Bacterial Colonization in Mangroves

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    Mangrove forests are of global ecological and economic importance, but are also one of the world's most threatened ecosystems. Here we present a case study examining the influence of the rhizosphere on the structural composition and diversity of mangrove bacterial communities and the implications for mangrove reforestation approaches using nursery-raised plants.A barcoded pyrosequencing approach was used to assess bacterial diversity in the rhizosphere of plants in a nursery setting, nursery-raised transplants and native (non-transplanted) plants in the same mangrove habitat. In addition to this, we also assessed bacterial composition in the bulk sediment in order to ascertain if the roots of mangrove plants affect sediment bacterial composition. We found that mangrove roots appear to influence bacterial abundance and composition in the rhizosphere. Due to the sheer abundance of roots in mangrove habitat, such an effect can have an important impact on the maintenance of bacterial guilds involved in nutrient cycling and other key ecosystem functions. Surprisingly, we also noted a marked impact of initial nursery conditions on the rhizosphere bacterial composition of replanted mangrove trees. This result is intriguing because mangroves are periodically inundated with seawater and represent a highly dynamic environment compared to the more controlled nursery environment.In as far as microbial diversity and composition influences plant growth and health, this study indicates that nursery conditions and early microbial colonization patterns of the replants are key factors that should be considered during reforestation projects. In addition to this, our results provide information on the role of the mangrove rhizosphere as a habitat for bacteria from estuarine sediments

    Serum microRNA profiling to distinguish papillary thyroid cancer from benign thyroid masses

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    Objectives: Papillary thyroid cancer (PTC) is increasing in incidence. Fine needle aspiration is the gold standard for diagnosis, but results can be indeterminate. Identifying tissue and serum biomarkers, like microRNA, is therefore desirable. We sought to identify miRNA that is differentially expressed in the serum of patients with PTC. Methods: Serum miRNA was quantified in 31 female thyroidectomy patients: 13 with benign disease and 18 with PTC. qPCR results were compared for significant fold-changes in 175 miRNAs, against a pooled control. Results: 128 miRNA qualified for analysis. There were identifiable fold-changes in miRNA levels between benign and control, and between PTC and control. There were statistically significant fold changes in the level of four miRNAs between benign and PTC: hsa-miR-146a-5p and hsa-miR-199b-3p were down-regulated, while hsa-let7b-5p and hsa-miR-10a-5p were up-regulated. Conclusions: MicroRNA is differentially expressed in the serum of patients with PTC. Serum miRNA has the potential to aid in thyroid cancer diagnosis

    Serum microRNA profiling to distinguish papillary thyroid cancer from benign thyroid masses

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    Objectives: Papillary thyroid cancer (PTC) is increasing in incidence. Fine needle aspiration is the gold standard for diagnosis, but results can be indeterminate. Identifying tissue and serum biomarkers, like microRNA, is therefore desirable. We sought to identify miRNA that is differentially expressed in the serum of patients with PTC. Methods: Serum miRNA was quantified in 31 female thyroidectomy patients: 13 with benign disease and 18 with PTC. qPCR results were compared for significant fold-changes in 175 miRNAs, against a pooled control. Results: 128 miRNA qualified for analysis. There were identifiable fold-changes in miRNA levels between benign and control, and between PTC and control. There were statistically significant fold changes in the level of four miRNAs between benign and PTC: hsa-miR-146a-5p and hsa-miR-199b-3p were down-regulated, while hsa-let7b-5p and hsa-miR-10a-5p were up-regulated. Conclusions: MicroRNA is differentially expressed in the serum of patients with PTC. Serum miRNA has the potential to aid in thyroid cancer diagnosis

    Effect of teammates on changes in physical activity in a statewide campaign

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    Objective—Most Americans do not meet physical activity recommendations. Statewide campaigns can effectively increase activity levels. Reported herein are physical activity outcomes from Shape Up Rhode Island (SURI) 2007, a statewide campaign to increase steps through team-based competition. Given the importance of social networks in behavior change, this paper focused on the effects of team and team characteristics on activity outcomes. Method—For 16-weeks, 5333 adults comprising 652 teams wore pedometers and reported their steps online. Results—Participants’ daily steps increased from 7029(3915) at baseline to 9393(5976) at SURI end (p\u3c.001). There was a significant intraclass correlation for step change among team members (ICC=.09); thus, an individual’s change in steps was influenced by what team they were on. Moreover, baseline team characteristics predicted individual step change; being on a more active team was associated with greater increases in activity for individual members (p\u3c.001), whereas being on a team with a broad range of steps was associated with smaller changes in activity for individual members (p=.02). Conclusion—These findings are the first to suggest that team members influence individual activity outcomes in team-based statewide campaigns. Future research should explore ways to use social network factors to enhance team-based physical activity programs

    Blocking Zika virus vertical transmission.

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    The outbreak of the Zika virus (ZIKV) has been associated with increased incidence of congenital malformations. Although recent efforts have focused on vaccine development, treatments for infected individuals are needed urgently. Sofosbuvir (SOF), an FDA-approved nucleotide analog inhibitor of the Hepatitis C (HCV) RNA-dependent RNA polymerase (RdRp) was recently shown to be protective against ZIKV both in vitro and in vivo. Here, we show that SOF protected human neural progenitor cells (NPC) and 3D neurospheres from ZIKV infection-mediated cell death and importantly restored the antiviral immune response in NPCs. In vivo, SOF treatment post-infection (p.i.) decreased viral burden in an immunodeficient mouse model. Finally, we show for the first time that acute SOF treatment of pregnant dams p.i. was well-tolerated and prevented vertical transmission of the virus to the fetus. Taken together, our data confirmed SOF-mediated sparing of human neural cell types from ZIKV-mediated cell death in vitro and reduced viral burden in vivo in animal models of chronic infection and vertical transmission, strengthening the growing body of evidence for SOF anti-ZIKV activity

    O perfil de um grupo de pessoas hipertensas de acordo com conhecimento e gravidade da doença

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    We interviewed 205 hypertensives to characterize social demographic data, life style, history and awareness of hypertension. Most patients were female (72%), white (63%), over 40 years old (78%), married (60%), and had low level of education (68%). Their family income was lower than US$ 3000 a year (41%). In terms of weight, 75% were classified as overweight, 76% were non smoker, and 89% did not do any regular physical activity. The profile of the hypertensives who were unaware of the disease was: male, 20-40 years old, widow, not white, and non-obese. The profile of the hypertensives who had high level of hypertension (diastólic>; 110 mm Hg) was older than 60 years old, not married, overweight, low level of education, low income, with more than 5 years of hypertension, and previously treated.Foram entrevistados 205 hipertensos em tratamento ambulatorial para avaliar o papel do perfil bio-social no conhecimento e grau de gravidade da doença. As características da população foram: 72% mulheres, 63% brancos, 78% com mais de 40 anos, 60% casados, 68% com baixa escolaridade, 41% com renda de 1 a 3 salários, 75% com peso elevado, 76% não fumantes, 89% sem atividade física regular, e das mulheres 48% já tinham usado hormônios anticoncepcionais. A análise evidenciou que a ausência de conhecimento se associou com sexo masculino, idade entre 20 e 40 anos, viúvo, não branco e peso normal. Pressão arterial mais elevada (diastólica>; 110 mm Hg) se associou com mais de 60 anos, não casado, acima do peso, baixa escolaridade, baixa renda, com mais de 5 anos de hipertensão e já ter feito tratamento anterior
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