Intervenciones cognitivo conductuales para diabéticos en México / Cognitive behavioral interventions for diabetics in Mexico

RESUMEN: Antecedentes: La diabetes mellitus (DM) tiene una alta prevalencia en México. Se estima que sólo una cuarta parte de los casos está metabólicamente controlada. Se requiere de intervenciones eficaces que coadyuven a controlarla, como las cognitivo conductuales. Objetivo: Realizar una revisión por temas de las intervenciones cognitivo conductuales utilizadas en México para mejorar el control de la DM. Método: Las intervenciones cognitivo conductuales para la revisión se obtuvieron de bases de datos (Redalyc, Dialnet, SciELO), el Catálogo TESIUNAM, centros de documentación especializados, libros, referencias de los estudios analizados y consulta a expertos. Se incluyeron trabajos realizados entre 1990 y 2014. Se analizaron variables relacionadas con la intervención y para evaluar las características metodológicas se utilizaron los criterios del CONSORT (Consolidated Standards of Reporting Trials / Estándares Consolidados de Reporte de Ensayos). Resultados: Fueron incluidos diecinueve estudios que cumplían con los criterios necesarios. 11 intervenciones buscaban mejorar la adherencia al tratamiento y/o al autocuidado; 11 mejorar el estado de ánimo y 10 buscaban aumentar la calidad de vida y/o bienestar psicológico. De los 19 estudios, 18 reportaron resultados favorables para el control de la DM. Sólo dos estudios cumplieron con más del 50% de los criterios sugeridos por el CONSORT. Discusión y conclusión: Los alcances de las intervenciones son cortos, ya que las muestras de los estudios apenas promedian 26.21 participantes y los periodos de seguimiento promedian 2.15 meses. La mayoría de los estudios no cumple (o solo parcialmente) con los criterios del CONSORT, lo cual pone en discusión los efectos alcanzados en las intervenciones.

ABSTRACT: Background: Diabetes mellitus (DM) is highly prevalent in Mexico. It is estimated that only a quarter of such cases are metabolically controlled. Control of DM requires effective interventions, such as cognitive behavioral therapy. Objective: To conduct a subject review of cognitive behavioral interventions used in Mexico to improve the control of DM. Method: Cognitive behavioral interventions for the review were obtained from databases (Redalyc, Dialnet, SciELO), the TESIUNAM Catalog, specialist libraries, books, references of the analyzed studies, and consultations with experts. Studies carried out between 1990 and 2014 were included. Certain variables related to the intervention were analyzed; to evaluate the methodological characteristics, the criteria set by the CONSORT (Consolidated Standards of Reporting Trials) was used. Results: Nineteen studies that met the inclusion criteria were included. Eleven interventions were looking for improved adherence to treatment and/or self-care, 11 were looking for improved mood, and 10 were looking for better quality of life and/or psychological well-being. Of the 19 studies, 18 reported favorable results for control of DM. Only two studies met with more than 50% of the criteria suggested by the CONSORT. Discussion and conclusion: The scope of the interventions is short because study samples averaged just 26.21 participants and follow-up periods averaged 2.15 months. Most of the studies do not or only partially meet with CONSORT criteria, putting into question the effects achieved in the interventions.

Measurement of Family-centered care perception and parental stress in a neonatal unit / Avaliação da percepção do cuidado centrado na família e do estresse parental em unidade neonatal / Evaluación de la percepción del cuidado centrado en la familia y del estrés parental en una unidad neonatal

ABSTRACT Objective: to evaluate the effects of the implementation of the Patient and Family-Centered Care Model on parents and healthcare perceptions and parental stress. Method: a quasi-experimental study developed in a neonatal unit of a university hospital in the municipality of São Paulo, Brazil, with the implementation of this model of care. Data collection were performed by two sample groups, one using non-equivalent groups of parents, and another using equivalent groups of healthcare professionals. The instruments Perceptions of Family-Centered Care-Parent Brazilian Version, Perceptions of Family-Centered Care-Staff Brazilian Version and Parental Stress Scale: Neonatal Intensive Care Unit, were applied to 132 parents of newborns hospitalized and to 57 professionals. Results: there was a statistically significant improvement in the perceptions of the parents in most items assessed (p ≤0,05) and for the staff in relation to the family welcome in the neonatal unit (p = 0.041) and to the comprehension of the family's experience with the infant´s hospitalization (p = 0,050). There was a reduction in the average scores of parental stress, with a greater decrease in the Alteration in Parental Role from 4,2 to 3,8 (p = 0,048). Conclusion: the interventions improved the perceptions of parents and healthcare team related to patient and family-centered care and contributed to reducing parental stress.

RESUMO Objetivo: avaliar os efeitos da implementação do Modelo do Cuidado Centrado no Paciente e Família na percepção de pais e profissionais de saúde e no estresse parental. Método: Estudo quase experimental com grupos não equivalentes para avaliação dos efeitos da intervenção na percepção de pais; e com grupos equivalentes para a avaliação na percepção de profissionais de saúde, desenvolvido na unidade neonatal de um hospital universitário do município de São Paulo. Os instrumentos, Percepção do Cuidado Centrado na Família- Pais versão brasileira, Percepção do Cuidado Centrado na Família- Equipe versão brasileira e Parental Stress Scale: Neonatal Intensive Care Unit, foram aplicados com 132 pais de recém-nascidos internados e 57 profissionais da equipe. Resultados: houve melhora estatisticamente significante na percepção dos pais na maioria dos itens avaliados (p≤0,05) e para os profissionais em relação ao acolhimento da família na unidade neonatal (p= 0,041) e a compreensão da vivência da família com a hospitalização (p=0,050). Houve redução dos escores médios do estresse parental, com maior queda na Alteração do Papel de Pais de 4,2 para 3,8 (p=0,048). Conclusão: as intervenções realizadas melhoraram a percepção de pais e de profissionais da equipe de saúde sobre o Cuidado Centrado no Paciente e Família e contribuíram para a redução do estresse parental.

RESUMEN Objetivo: evaluar los efectos de la implementación del Modelo del Cuidado Centrado en el Paciente y la Familia en la percepción de los padres y profesionales de la salud y en lo estrés parental. Método: estudio cuasi-experimental con grupos no equivalentes para evaluar los efectos de la intervención en la percepción de los padres; y grupos equivalentes para evaluar la percepción de los profesionales de la salud, desarrollado en la unidad neonatal de un hospital universitario en el municipio de Sao Paulo. Los instrumentos de Percepción del Cuidado Centrado en el Paciente y la Familia- Padres versión brasileña, Percepción del Cuidado Centrado en el Paciente y la Familia-Equipo versión brasileña y Parental Stress Scale: Neonatal Intensive Care Unit, se aplicaron a 132 padres de los recién nacidos hospitalizados y 57 profesional del equipo. Resultados: se observó una mejoría estadísticamente significativa en la percepción de los padres en la mayoría de los ítems evaluados (p = 0,05) y para los profesionales en relación con el cuidado de la familia en la unidad neonatal (p = 0,041) y la comprensión de la experiencia de la familia con la hospitalización (p = 0,050). Hubo una reducción en las puntuaciones medias de estrés de los padres, con una mayor disminución en la Alteración del Rol Parental 4.2 a 3.8 (p = 0,048). Conclusión: las intervenciones mejoran la percepción de los padres y los profesionales del equipo de salud en el Cuidado Centrado en el Paciente y la Familia y ha contribuido a reducir el estrés de los padres.

Efecto de una intervención centrada en la reducción de factores de riesgo cardiovascular en estudiantes universitarios / Effects of an intervention to reduce cardiovascular risk factors in university students

Background: Interventions aiming to reduce obesity and sedentary behaviors in young adults could be a feasible and effective approach to prevent cardiovascular diseases. Aim: To evaluate the effect of a lifestyle-based intervention on reducing cardiovascular risk factors in university students. Material and Methods: Sixty university students aged 21 ± 1 years (n = 44 females) took part on a 17 weeks lifestyle intervention consisting in education about healthy lifestyles and physical training, during a curricular course about health promotion and healthy lifestyles. At baseline and at the end of the intervention participants completed a lifestyles questionnaire and provided fasting blood samples to quantify glucose and lipids profile. Results: After the intervention significant reductions in the prevalence of hyperglycemia (-10.0%), high blood pressure (-16.7%) and physical inactivity (-26.7%) were observed. Moreover, a significant reduction in body weight, waist circumference, blood pressure, total cholesterol, triglycerides and an increase in HDL cholesterol were observed after intervention. Conclusions: The implementation of an intervention to promote healthy lifestyles is an effective way of reducing cardiovascular risk factors in university students.

Intervenções escolares de médio e longo prazo para promoção de atividade física: Revisão sistemática / Medium and long term school-based interventions to promote physical activity: a systematic review

Apesar das evidências consistentes sobre a efetividade de intervenções no âmbito escolar, reconhece-se a necessidade do entendimento sobre os efeitos a médio e longo prazo. Além da utilização de variadas estratégias, as intervenções também apresentam diferentes frequências e durações, o que pode estar diretamente relacionado aos resultados de efetividade. Desta forma, o objetivo desta revisão foi descrever estudos de intervenção de promoção da atividade física de base escolar, com pelo menos um ano letivo de duração. A busca bibliográfica foi realizada na base de dados do PubMed, contemplando publicação dos últimos cinco anos; intervenções de base escolar; faixa etária majoritariamente entre 6 e 18 anos; que não restringissem grupos específicos e tivessem como um dos desfechos principais a atividade física. Os artigos foram analisados por um par de pesquisadores, passando por análise descritiva e, posteriormente, julgados quanto à qualidade a partir dos critérios de Donws and Black. O total de 13 artigos foi selecionado. A análise dos componentes das intervenções revelou uma grande variedade de estratégias, como o aumento do número e/ou tempo das aulas de Educação Física, capacitação de professores, utilização de materiais didáticos, atividades extraclasse, envolvimento dos pais, entre outras. Mesmo alguns estudos mostrando alterações significativas após a intervenção, estas não se mantiveram em longo prazo. Novos estudos são necessários, assim como a busca por estratégias efetivas de promoção da atividade física e saúde na escola com maior potencial de manutenção dos efeitos.

Despite strong evidences regarding the effectiveness of school based interventions, it is recognized the need to understand their medium and long-term effects. Besides the implementation of several strategies, the interventions show different frequency and duration, which may be associated to the effectiveness. Therefore, the aim of the present review was to describe intervention studies aiming to promote PA with a length of ≥1 academic-year. A literature research was carried out in PubMed database using the following descriptors: published in the last 5 years; school-based interventions; mostly aged between 6-18 years old without restricting specific groups; and PA as one of the major outcomes. The articles were analyzed by two researchers and it was submitted to a descriptive analysis. Afterwards, the articles were judged on the basis of quality using the Downs and Black criteria. A total number of 13 articles were selected. The analysis of the interventions revealed a wide variety of strategies, such as increasing the number and/or the time of physical education classes, teachers training, use of instructional material, extracurricular activities, and parental involvement among others. Even though some interventions showed significant changes after the intervention, these changes did not remain in the long term. Further studies are required, as well as new strategies to promote PA and health at schools with a higher potential for medium and long-term effectiveness.

Healthy lifestyle and behavior literacy of residents living in Xicheng District of Beijing in 2008 vs.2012 / 中华健康管理学杂志

Objective To learn healthy lifestyle and behavior literacy of residents living in Xicheng District of Beijing between 2008 and 2012 and to explore the influencing factors of healthy lifestyle and behavior literacy.Methods A total of 1 347 or 2 900 adults aged 18-60 years old were recurited from Xicheng District by using multistage stratified cluster sampling method in 2008 and 2012,respectively.Chisquare test and non-conditional logistic regression were used to analyze the effectiveness of 2-year intervention on healthy lifestyle and behavior literacy.Results The rate of healthy lifestyle and behavior literacy was 14.8％ vs.30.8％ in 2008 or 2012,respectively (x2=123.574,P＜0.05).For those with relatively lower education level (e.g.junior high school or below),the figure showed no statistically significant difference (x2=1.378,P＞0.05).In multivariate logistic regression analysis,female (odds ratio (OR)=1.350),education level (college/bachelor degree:OR=2.035,master degree or above:OR=2.554),monthly family income (＞5 000 RMB:OR=1.399) and investigation time (2012:OR=2.278) were influencing factors of healthy lifestyle and behavior literacy.Conclusion Remarkable improvement in healthy lifestyle and behavior literacy during 2012 as compared to 2008 could be attributed to the comprehensive interventions.In the future,those of low-literacy or low-income should be the mian target of modification of healthy lifestyle and behavior literacy.