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Resumen Objetivo: Evaluar los efectos de una intervención multidisciplinaria, para mejorar la adhesión al tratamiento en diabetes mellitus tipo 2 (DM2) de comunidades rurales. Materiales y Métodos: Participaron 26 pacientes (15 mujeres) con DM2 (M edad = 60 DT = 12) de dos comunidades rurales del noroeste de México. Se aplicaron los inventarios de Depresión y Ansiedad de Beck y el Inventario de Calidad de Vida y Salud. Se midió la glucosa en el ayuno y la hemoglobina glicosilada antes y después de la intervención. Resultados: La intervención mostró una disminución en depresión y ansiedad, así como una mejor calidad de vida. También se detectó una disminución de la glucosa en ayuno. Se calculó la prueba t de Student para examinar las diferencias en las variables señaladas tomadas en dos momentos, antes de iniciar el programa y al finalizar el programa. Se observaron menores niveles de sintomatología depresiva, ansiedad y mayores niveles de calidad de vida al finalizar el programa. Además, el nivel de glucosa en sangre descendió de manera significativa. Conclusiones: Se analizaron las implicaciones de intervenciones de este tipo en comunidades rurales, detectándose la necesidad de implementar políticas públicas que permitan mejorar condiciones en población vulnerable.
Abstract Objective: To evaluate the effects of a multidisciplinary intervention in patients with type 2 Diabetes Mellitus from rural communities. Materials and methods: Twenty-six patients (15 women and 11 men) with DM2 from two rural communities in northwestern Mexico participated. The average age was 60 years. The Beck Depression and Anxiety Inventory and Inventario de Calidad de Vida y Salud were applied, in addition to fasting glucose and glycosylated hemoglobin before and after the intervention. Results: Statistically significant pretest-postest changes were detected in depression and anxiety (p=.006 y p=.002 respectively). by Student's t for related samples and the size of the median and large effect by Cohen's d in the psychological variables. In fasting blood glucose changes were detected between the first and last sessions. However in glycosylated hemoglobin only 6 patients decreased their levels. Conclusions: Future studies involving community members to support the behavioral change of patients with DM2 are proposed.
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Resumen En México, una de cada cuatro personas con diabetes mellitus tipo 2 (DM2) tiene un control aceptable de la enfermedad. Consecuentemente, el propósito de este estudio fue determinar el cambio clínico de una intervención cognitivo-conductual en el control metabólico (CM) de la DM2 y variables psicológicas asociadas (malestar emocional asociado a diabetes mellitus [MEADM], sintomatología depresiva y bienestar psicológico). Se utilizó un diseño cuasiexperimental pretest-postest con seguimiento a los tres meses. Los resultados muestran un efecto muy alto de la intervención en el MEADM del pretest al postest (g = 1.399) y al seguimiento (g = 1.478); un efecto moderado del pretest al postest (g = 0.461) y alto del pretest al postest (g = 1.036) en el bienestar psicológico. Se necesita más tiempo para que la HbA1c y la sintomatología depresiva lleguen a rangos de control.
Abstract In Mexico, one of four people with type 2 diabetes mellitus has an acceptable control. Thus, the purpose of this study was to determine the clinical change of a cognitive-behavioral intervention on metabolic control and associated psychological variables (emotional distress, depressive symptomatology and psychological well-being) in people with this disease. A quasi-experimental pretest posttest design with a follow-up of one and three months was used. Results show a very high effect on the emotional distress to the pretest to posttest (g = 1.399) and to the follow-up (g = 1.478); a moderate effect from pretest to posttest (g = 0.461) and high from pretest to posttest (g = 1.036) in psychological well-being. More time is needed for the HbA1c and depressive symptomatology reach ranges of control.
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Humanos , Masculino , Feminino , Estresse Fisiológico , Cognição , Diabetes Mellitus , Diabetes Mellitus Tipo 2RESUMO
Objective To study the therapeutic effect of rehabilitation exercise and cognitive-behavioral intervention on the patients with tinnitus. Methods 110 patients were divided into two groups, with 55 cases in each group. Conventional nursing was delivered to the control group, while the patients in the experimental group received conventional nursing as well as rehabilitation exercise and cognitive-behavioral intervention (6 months).The patients were evaluated by Tinnitus handicap inventory (THI),self-rating anxiety scale(SAS)and self-rating depression Scale(SDS)before the intervention,at 1 month and 6 months after the intervention. Results The levels of anxiety,severity of depression and tinnitus classification at 1 month and 6 months after the intervention in both groups were significantly different(all P<0.001).The levels of anxiety,depression and tinnitus in the experimental group were lower than those in the control group.The effect of tinnitus recovery at1 month and 6 months after the intervention in both groups was statistically significant (all P<0.05). The tinnitus recovery in the experimental group was better than that in the control group. Conclusion Rehabilitation exercise and cognitive-behavioral intervention can improve the therapeutic effect on tinnitus, reduce anxiety and depression in patients and deserve clinical application.
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Objective To investigate the effect of combination therapy with cognitive behavior on the quality of life of patients with gastroduodenal ulcer.Methods The patients with gastroduodenal ulcer treated in our hospital from April 2015 to April 2017 were randomly divided into intervention group and control group according to the order of treatment.Both groups were treated with bismuth-containing quadruple therapy and routine nursing was performed.The intervention group received cognitive behavior on this basis.SF-36 scale was used to evaluate the quality of life of the two groups of patients, and the prognosis of the patients was evaluated.The patient satisfaction was investigated by the self-designed questionnaire of patient satisfaction questionnaire.The clinical efficacy, treatment compliance, quality of life improvement, prognosis and satisfaction were compared between the two groups.Results The total effective rate was 96.67%(58/60) in the intervention group and 81.67%(49/60) in the control group.The total effective rate of the intervention group was significantly higher than that of the control group(P<0.05).The scores of SF-36 scale in the intervention group were higher than those in the control group(P<0.05).The incidence of complications in the intervention group was lower than that in the control group, and the satisfaction rate was higher than that of the control group(P<0.05).Conclusion Cognitive behavioral intervention combined with bismuth quadruple therapy for gastroduodenal ulcer can improve the patient's compliance and efficacy, significantly improve the quality of life of patients, improve patient satisfaction, with clinical application value.
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Objective To explore the effectof cognitive behavioral Intervention on the quality of life and cognitive lever of patients with venous thrombus embolism. Methods 164 patients with Venous Thrombus Embolism were randomly divided into control group and research group, the control group received routine care, The study group received cognitive behavior intervention. The cognitive lever and quality of life score was measured between before and after the intervention. Results Before the intervention, the difference score of living quality and cognitive lever in the two groups has no statistical significance (P > 0.05), and after intervention, the cognition lever and the three aspects of risk factors, anticoagulant knowledge and treatment methods of research group scored (28.47 ± 7.63), (7.38 ± 2.48), (6.82±2.73), (3.64±1.59) points which were significantly higher than the control group scored (20.54±5.49), (4.31±2.14), (3.72±1.62), (2.18±1.36) points (t=7.635, 8.469, 8.822, 6.299, P<0.01),the quality of life and four dimensions of daily life ability, pain, social activities, mental scored ( 37.04 ± 7.08), [9.00 (5.00, 11.00)],(9.04 ± 1.55),(5.52 ± 1.59),(14.00 ± 3.06) points which showed great improvement than the control group scored [49.50(39.75-59.25)], [11.50 (6.75, 16.00)], (10.05 ± 1.65), (7.95 ± 2.19), (19.18 ± 3.88) points. There were significant difference in the quality of life and four dimensions between the two groups. (Z=-3.558,-2.143, t=2.102, 4.274, 4.991, P<0.05 or 0.01). Conclusions The quality of life for the venous thrombus embolism patients were in lower level. The cognitive behavioral intervention could correcting their bad behavior and negative emotions, eventually improve the quality of life of venous thrombus embolism patients.
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Objective To explore the effectof cognitive behavioral Intervention on the quality of life and cognitive lever of patients with venous thrombus embolism. Methods 164 patients with Venous Thrombus Embolism were randomly divided into control group and research group, the control group received routine care, The study group received cognitive behavior intervention. The cognitive lever and quality of life score was measured between before and after the intervention. Results Before the intervention, the difference score of living quality and cognitive lever in the two groups has no statistical significance (P > 0.05), and after intervention, the cognition lever and the three aspects of risk factors, anticoagulant knowledge and treatment methods of research group scored (28.47 ± 7.63), (7.38 ± 2.48), (6.82±2.73), (3.64±1.59) points which were significantly higher than the control group scored (20.54±5.49), (4.31±2.14), (3.72±1.62), (2.18±1.36) points (t=7.635, 8.469, 8.822, 6.299, P<0.01),the quality of life and four dimensions of daily life ability, pain, social activities, mental scored ( 37.04 ± 7.08), [9.00 (5.00, 11.00)],(9.04 ± 1.55),(5.52 ± 1.59),(14.00 ± 3.06) points which showed great improvement than the control group scored [49.50(39.75-59.25)], [11.50 (6.75, 16.00)], (10.05 ± 1.65), (7.95 ± 2.19), (19.18 ± 3.88) points. There were significant difference in the quality of life and four dimensions between the two groups. (Z=-3.558,-2.143, t=2.102, 4.274, 4.991, P<0.05 or 0.01). Conclusions The quality of life for the venous thrombus embolism patients were in lower level. The cognitive behavioral intervention could correcting their bad behavior and negative emotions, eventually improve the quality of life of venous thrombus embolism patients.
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RESUMODiminuir fatores de risco para cardiopatias pode melhorar a qualidade de vida e reduzir a mortalidade e morbidade relacionadas a elas.O presente estudo avaliou a eficácia de uma intervenção cognitivo-comportamental em grupo sobre ansiedade, depressão, estresse e saúde cardiovascular em cardiopatas. Foram avaliados 91 pacientes antes e após participação nos grupos, com entrevistas semiestruturadas, Inventários Beck (Ansiedade e Depressão) e Inventário de Sintomas de Stress para Adultos de Lipp. Coletaram-se medidas fisiológicas para cálculo do escore de Framingham. A participação no grupo resultou em redução dos sintomas de ansiedade, depressão, estresse e melhora do enfrentamento ao estresse. Não houve diferença no escore de Framingham. A intervenção se mostrou eficaz para a redução dos fatores de risco psicológicos nessa amostra.
ABSTRACTReducing risk factors for cardiovascular diseases may increase quality of life and decrease mortality and morbidity secondary to these disorders.The present study evaluated the efficacy of a cognitive-behavioral group intervention on anxiety, depression, stress and cardiovascular health of cardiac patients. Ninety-one patients were assessed before and after the group intervention by means of semi-structured interviews, the Beck Anxiety and Depression Inventories and the Lipp's Stress Symptoms Inventory for Adults. Cardiovascular status was estimated using the Framingham Score. The intervention decreased anxiety, depression, and stress, and improved coping with stress. No significant differences were seen for the Framingham Scores. The intervention was effective in improving psychological risk factors for the investigated sample.
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Objective To explore the influence of cognitive-behavioral intervention on the anxiety and oral health-related quality of life in adult orthodontic patients.Methods 152 adult orthodontic patients whose MDAS scores were greater than 11 were divided into the intervention group and the control group according Multistage Grouping Process.The former were treated with MBT appliance combined with cognitive-behavioral intervention,and the latter were treated with MBT appliance only.The State-Trait Anxiety Inventory(STAI) was adopted to evaluate anxiety in all patients during orthodontic treatment,and the UK oral health-related quality of life questionnaire(OHRQoL-UK) was adopted to evaluate the oral health-related quality of life in all patients before and after orthodontic treatment,respectively.Results 1.After 3 and 6 months cognitive-behavioral intervention,the scores of SAI in the intervention group(50.37±9.18,35.65±8.92) were significantly reduced compared to the control group(56.62± 10.52,54.13± 10.03) (P＜0.01).After 6 months cognitive-behavioral intervention,the scores of TAI in the intervention group(47.92±6.82) were significantly reduced compared to the control group(51.52±7.41) (P ＜0.05).2.After the orthodontic treatment,the scores of OHRQoL-UK in the intervention group(58.27±13.43) were significantly improved compared to the control group (51.99± 11.69) (P＜ 0.01).3.The oral health-related quality of life after the orthodontic treatment were significantly related to post-treatment anxiety of adult orthodontic patients(r=-0.192 ～-0.459,P＜ 0.05).Conclusion Cognitive-behavioral intervention can effectively reduce anxiety and improve the oral health-related life quality in the adult orthodontic patients.
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Objective To explore the application effect of cognitive behavioral intervention on chronic obstructive pulmonary disease nursing care.Methods 80 patients with chronic obstructive pulmonary disease were randomly divided into an experimental group and a control group(n=40).Both groups were given medical treatment and conventional nursing care,and the control group was given the cognitive behavioral intervention nursing care additionally.The average days of stay,the ratio of readmission,the treatment adherence,and smoking cessation rate in one year were recorded.Moreover,the life quality of the two groups was analyzed with a CAT assessment test.Results Compared with the control group,the experimental group achieved shorter average days of stay,higher medication adherence and smoking cessation rate,lower readmission rate and admission rate.The experimental group achieved better life quality with lower CAT value than the control group.Conclusion Cognitive behavioral intervention can obviously improve the treatment effectiveness of patients with chronic obstructive pulmonarv disease.
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Objective To explore the effects of cognitive behavioral intervention in psychological nursing of young female patients with facial burn.Methods 64 cases of young women patients with facial bum were selected as the research object,and randomly divided into the observation group and the control group,with 32 cases in each group.The observation group was given the cognitive behavioral intervention and the control group was done by conventional nursing methods.The anxiety and depression scores between the two groups before and after the intervention were compared.Results After injury,the anxiety and depression scores of both the observation group and the control group were higher than those of the domestic norm; the anxiety and depression scores between two groups showed no statistic significance before intervention,and after intervention,the anxiety and depression scores between two groups had significant difference,scores of the observation group were lower than those of the control group.Conclusions Cognitive behavioral intervention can reduce anxiety and depression of young female patients with facial burn.It is a kind of effective psychological nursing method,and worthy of clinical promotion.
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Objective To investigate the effect of cognitive behavioral intervention on depression state and compliance of senile patients with cerebral apoplexy. Methods 46 senile patients with cerebral apoplexy were divided into the intervention group(22 cases)and the control group(24 cases).The control group was given conventional treatment and nursing,based onthe above methods,cognitive behavioral intervention was added to the intervention group,6 weeks were taken as one treatment course.Using self-rating depression scale(SDS) and self-made compliance questionnaire to evaluate the depression and compliance before and after 6 weeks of treatment. Results The SDS score was obviously lower,the treatment compliance was better in the intervention group after 6 weeks compared with the control group. Conclusions The cognition behavioral intervention is helpful to improve the depression of senile patients with cerebral apoplexy,enhance the treatment compliance and improve patients' quality of life.
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Objective To explore the mutual relationship of cognitive behavioral intervention and negative emotion of leukaemia patients. Methods According to hospital dual order, 120 patients were divided into the treatment group and the control group with 60 cases in each group, the control adopted routine treatment and nursing, upon this basis, the treatment group received cognitive behavioral intervention.Anxiety and depression of two groups were compared with SAS and SDS scale. Results SAS and SDS score changed significantly in the treatment group before and after the treatment, while in the control group,the SAS, SDS score did not changed statistically. Conclusions cognitive behavioral intervention can effectively improve the anxiety and depression of leukaemia patients, and improve the quality of life and deserves further clinical promotion.
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Foram investigados efeitos da intervenção cognitivo-comportamental sobre a adesão inadequada à terapia antirretroviral. Participaram dois homens (P1 e P2) acometidos pela Aids. Uma mulher soropositiva (P3) funcionou como controle. Foram comparadas avaliações de comportamento de adesão, estratégias de enfrentamento, expectativa de autoeficácia para aderir à terapia e variáveis biológicas de três momentos - linha de base (LB), imediatamente após (M2) e três meses depois (M3) da intervenção. Os participantes P1 e P2 relataram aumentos nos níveis de adesão à terapia, nos escores de autoeficácia e no enfrentamento focalizado no problema. A participante P3 manteve adesão insuficiente e baixos escores de autoeficácia. Conclui-se que a intervenção cognitivo-comportamental teve efeitos positivos sobre a adesão à terapia antirretroviral.
The study investigated the effects of cognitive-behavioral intervention on inadequate adherence to the antiretroviral therapy. The participants were two men with AIDS (P1 and P2). A HIV positive woman (P3) was a control subject. It was compared behavior adherence evaluation, strategies of coping, expectation of self-efficacy and biological variables of three periods - baseline (BL), immediately after (M2) and three months after (M3) the intervention. The participants P1 and P2 reported increases on the levels of adherence to the therapy, on the scores of self-efficacy and on problem-focused coping. The participant P3 maintained unsatisfactory levels of adherence and low scores of self-efficacy. It was concluded that cognitive-behavioral intervention has positive effects on the adherence to the antiretroviral therapy.
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Humanos , Masculino , Feminino , Síndrome da Imunodeficiência Adquirida , Cooperação do Paciente , Terapia Cognitivo-Comportamental , AutoeficáciaRESUMO
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Abstract: The chronical abuse of addictive substances is a major public health problem, due to the seriousness of the consequences: fatal automobile accidents or others involving traumatic injury and emergency medical care, chronic physical diseases such as cirrhosis of the liver, cardiovascular complaints, cerebrovascular problems and pancreatitis, as well as disability and disruption in different functional areas of daily life, whether social, psychological, legal, personal, family, economic or professional. These factors include: depression, anxiety, loss of sleep, loss of support networks, suicide, violence, injury in fights, homicide, financial debt, divorce, loss of employment, hospitalization, crime and imprisonment, among others. It is therefore required to establish multidisciplinary intervention models that respond to the seriousness of the problem. In Mexico, reports show that there is a need for the development of more intervention models for chronic users of addictive substances, which include systematic implementation and evaluation as well as medium- and long-term measurements to assess effectiveness. Intervention services often do not go beyond support for the initial detoxification. Additionally, the high cost of most treatment schemes makes them inaccessible to the majority of the people affected by these problems. Intervention models must be designed and developed to include elements from other models that have proven to be reliable and effective on the basis of empirical evidence. The Community Reinforcement Approach or "CRA" intervention model has gained recognition in scientific literature and from international institutions (the National Institute of Drug Addiction, NIDA, and the National Institute of Alcoholism and Alcohol Abuse, NIAAA) as one of the most effective means in reducing consumption by chronic users of addictive substances. Consequently, the objective of this research was to use a pilot project to adapt, systemize, implement and assess the impact of the Community Reinforcement Approach intervention model in reducing consumption patterns among chronic dependent users of alcohol and other drugs within the Mexican population. A cognitive-behavioral intervention model was applied to 9 chronic users who had requested psychological help at the Psychological Service Centers of the Faculty of Psychology. The average age of the users was 35. Seven of them were male and two female. The most commonly consumed addictive substance was alcohol by six users, with other drugs accounting for three (benzodiazepine, marihuana, cocaine, solvents and amphetamines). On average, the subjects had spent 14 years in schooling. Five of them were single, one was married, one cohabiting and two divorced. With regard to the occupations of the sample, one was a student, two had abandoned a course of study, four were employed before treatment and two were unemployed. The criteria that the users had to meet for inclusion in the study were: to be aged 18 or over; to be able to read and write; to have a medium-to-severe level of alcohol dependence corresponding to a range between 22 and 47 points on the Alcohol Dependence Scale (ADS) and/or a substantial-to-severe level of dependence on other drugs of between 11 and 20 points according to the Drug Abuse Questionnaire (DAQ); to consume a quantity of 14 or more measures of alcohol per occasion and/ or 20 or more measures per week for men, and 10 or more per occasion or 15 or more per week for women; to have been treated or interned on at least one previous occasion; to suffer consumption-related difficulties in different areas of daily life. The duration of the treatment period was from 15 to 24 sessions, depending on the specific training needs of each user. Sessions lasted 1% hours, and were given twice a week. The methodology used was single case with repetitions and follow-up. The cognitive-behavioral model included the following intervention components: Functional Analysis, Demonstration of Non-Consumption, Daily Life Goals, Communication, Problem Solving, Consumption Refusal, Marriage Guidance, Employment Searches, Recreational and Social Skills and Prevention of Relapses. The didactic techniques used in the training for each of the aforementioned components were: verbal instruction, modeling, behavioral trials and feedback. The original model (CRA) was adapted to include the following changes: 1) More communication skills were integrated, including listening, starting conversations, giving and receiving criticism, giving and receiving recognition, and sharing positive and negative feelings; 2) Relapse prediction variables were assessed: self-effectiveness and triggers; 3) New skills for refusing consumption were added: interrupting interaction, justification for non-consumption. Occurrence records were kept for the application in natural settings of the skills taught. In addition, teaching materials were prepared, along with information brochures on different addictive substances and the different training components, lists of community resources and therapist checklists to guarantee the systematic implementation of the model. The pre-post-test evaluation methods were: Retrospective Baseline (RETBAS), Self-Recording, Situational Confidence Scale and/or Drug Consumption Self-Confidence Scale, Daily Life General Satisfaction Scale, Inventories of Drug Consumption Situations and/or Inventories of Alcohol Consumption Situations. The significant changes identified in this preliminary research were: decreases in consumption patterns during and after treatment, since in the pre-post-test statistical analysis for paired samples the results t= 4.75 p = .001 were obtained in the comparison of baseline and treatment, and t= 4.28 p=.002 in the comparison of the baseline and follow-up; increases in the levels of general satisfaction in daily life following treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t=-3.94 and p=.004 were obtained, and t=-4.03 and p=.004 in the pre-follow-up comparison; increases in levels of self-effectiveness after treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t= -5.08 and p=.001 were obtained, and t= 4.37 and p=.002 in the pre-follow-up comparison; decrease in the number of consumption triggers after treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t= 5.80 and p=.000 were obtained, and t= 5.3 and p=.001 in the pre-follow-up comparison. As a result of the foregoing, the researchers were able to verify the effectiveness of this intervention model in significantly reducing consumption patterns in nine chronic dependent users of addictive substances. Similarly, the model had a significant impact on consumption prediction variables, as well as increasing self-effectiveness levels and eliminating triggers to avoid relapses. Users learnt how to create a more satisfying day-to-day lifestyle, by including activities incompatible with consumption. Finally, in repetitions of the implementation of this intervention model, it is recommended that a training component be introduced for emotion management (depression, anxiety and anger), as well as an assessment of cognitive functioning as a relapse prediction variable, and the participation of users that have been part of a social-recreational activity group to reinforce sustained abstinence in the long term.