ABSTRACT
ABSTRACT Background: There is very low-quality evidence that the transtheoretical stages of change model combined with physical activity or diet, or both, can result in significant improvements in dietary and physical activity habits. Objective: To evaluate the association between stages of change on weight reduction, after a nutritional intervention, in patients with cardiovascular risk. Methods: In a randomized controlled clinical trial, patients >18 years old with body mass index ≥25 kg/m2 and at least two cardiovascular risk factors were distributed to an intervention or control group. The intervention group received, according to stage of change, a multidisciplinary intervention formed by a nutritionist, a psychologist, a chef and a physiotherapist to improve healthy eating, while the control group was given a nutritional prescription. Stage of change from the transtheoretical model, anthropometric variables, physical activity, and 24-hour recall of food intake were measured at baseline and 12 months postintervention. The main outcomes were change in weight, waist and hip circumferences. Results: We included 188 subjects (intervention group= 93, control group= 95), where 75% were female, 68.6% had obesity, and mean age 50.3±13. After 12-months, subjects in the intervention group that were ready to change showed a greater decrease in weight and energy intake, with differences between ready to change vs not ready to change subjects and an interaction between intervention group and ready to change. Conclusions: An intervention with a multidisciplinary team can be as effective as the current standard of care in promoting weight loss when taking into account baseline stage of change.
RESUMEN Introducción: existe poca evidencia sobre el efecto de la etapa de cambio del modelo transteórico en conjunto con actividad física, dieta, o ambas, en los hábitos dietéticos y de actividad física. Objetivo: evaluar el efecto de una intervención nutricional y la etapa de cambio inicial sobre la reducción de peso después de una intervención nutricional en pacientes con riesgo cardiovascular. Métodos: Ensayo clínico controlado aleatorizado. Pacientes >18 años con índice de masa corporal ≥25 kg/m2 y al menos 2 factores de riesgo cardiovascular fueron asignados a: grupo intervención o grupo control. El grupo de intervención recibió de acuerdo a la etapa de cambio una intervención multidisciplinaria formada por: nutricionista, psicólogo, chef y fisioterapeuta, mientras que el grupo control solo recibió prescripción nutricional habitual. Se evaluaron al inicio del estudio y 12 meses después de la intervención: etapa de cambio del modelo transteórico, variables antropométricas, actividad física y recordatorio de 24 horas. Resultados: se incluyeron 188 sujetos (grupo intervención 93, grupo control 95), 75% eran mujeres, 68,6% tenían obesidad, con promedio de 50.3±13. Después de 12 meses, los sujetos en el grupo de intervención que estaban listos para el cambio, mostraron una mayor disminución en el peso y en el consumo calórico, con diferencias estadísticamente significativas en la interacción grupo y etapa de cambio. Conclusiones: Una intervención con un equipo multidisciplinario puede ser tan eficaz como el tratamiento habitual para promover la pérdida de peso cuando se tiene en cuenta la etapa de cambio basal.
ABSTRACT
El Trastorno por Déficit de Atención con Hiperactividad (TDAH) es abordado bajo una perspectiva integral e interdisciplinaria desde la Atención Primaria de Salud en Chile. La presente investigación buscó conocer cuál es la percepción de los efectos de un tratamiento multimodal en madres con hijos diagnosticados con TDAH, en un Centro de Salud Familiar. Se utilizó un diseño cualitativo de tipo descriptivo, utilizando como técnica la entrevista individual focalizada. La muestra estuvo compuesta por cuatro figuras maternas. Se realizó un análisis de contenido convencional, con triangulación por investigador y expertos. Los resultados señalan la percepción de efectos en: desarrollo individual del niño, dinámica familiar y ámbito escolar. En relación con el desarrollo individual del niño, se han identificado percepciones de los efectos del tratamiento en las áreas emocional, conductual y social. En la dinámica familiar, se reconocen dos aspectos, uno relacionado con el desempeño del rol de los padres y otro referente a la relación vincular padres/hijo. En cuanto a la percepción de los efectos del tratamiento en el entorno escolar, se identifican mejoras en la adaptación escolar, el rendimiento, las relaciones interpersonales y el comportamiento escolar. Se discute, el progreso percibido en el campo afectivo, en el que se observan mejoras en autoestima, madurez emocional, autoconfianza y relaciones sociales de mejor calidad que impactan favorablemente en una mejor calidad de vida del niño y su familia. Se enfatiza la necesidad de una visión despatologizadora e integral del niño en la intervención, con énfasis en sus competencias e interacción familiar.
Attention Deficit Hyperactivity Disorder (ADHD) is defined as a neuropsychiatric picture of behavioral manifestation, chronic, symptomatically evolutive and of probable genetic transmission (Aboitiz & Carrasco, 2009) that impacts the different areas of development, for the child and his family (Silver, 2010). Research has shown that students with ADHD have a higher educational risk, due not only to academic and learning difficulties, but also to social difficulties, rejection of their peers and a decrease in teaching expectations (Valero, 2013). One of the most notorious characteristics, through out the life cycle, is the frequent association that ADHD presents with other psychiatric disorders; anxious, affective and oppositional disorders (Larson, Russ, Khan & Halfon, 2011), the latter being the most prevalent in children and adolescents (Garrido, 2013). In coherence with the above, the World Health Organization (WHO) has established that psychiatric disorders that begin in childhood or adolescence should be a priority for Public Health (Vicente, Saldivia, De la Barra, Melipillán, Valdivia & Kohn 2012). In Chile, it is approached from an integral and interdisciplinary perspective from Primary Health Care, based on the evidence that multimodal treatment is ideally recommended for its approach, understanding it as a multidisciplinary treatment according to the biopsychosocial model seeks to complement resources psychopharmacological, psychotherapeutic and psychopedagogical. The present investigation seeks to know what is the perception of the effects of a multimodal treatment in mothers with children diagnosed with ADHD, in a Family Health Center. A qualitative design of descriptive type was used, using the focused individual interview as a technique. The sample consisted of four maternal figures, who accessed the interviews after having duly signed an informed consent. An analysis of the conventional content of the interviews was carried out, with triangulation by researchers and experts. The results indicate the perception of the effects on: the individual development of the child, the family dynamics and the school environment. In relation to the individual development of the child, perceptions of the effects of treatment in the emotional, behavioral and social areas have been identified. In the family dynamics, two aspects are recognized, one related to the performance of the role of the parents and the other related to the relationship between mother and child. Regarding paternal roles, they indicate greater participation on the part of the father, changes in the organization of family daily life, in the parenting patterns, in the behavioral management of themselves and a greater satisfaction with their maternal role. Regarding the relationship, mothers perceive a greater level of empathy, the promotion of more autonomy and an improvement in the expression of affects. Regarding the perception of the effects of treatment in the school environment, improvements in school adaptation, performance, interpersonal relationships and school behavior are identified. We mainly discuss the perceived progress in the affective field, where the findings show improvements in self-esteem and emotional maturity, by observing their children more cheerful, expressive, communicative and with greaterself-confidence, better quality social relationships that impact on a better quality of life for both the child and his family. The need for a depathologizing and integral vision of the child in the intervention processes is emphasized, with emphasis on their competences and family interaction, where reorganization processes, changes of roles and parenting patterns are more functional to the needs of the child. Regarding the limitations of this study, we can mention the small number of participants, which could affect the richness of the experiences of the phenomenon studied. Likewise, it is estimated that for future research it would be relevant to know the perception of the child and other significant actors, such as parents and teachers.