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1.
PLoS One ; 17(2): e0263228, 2022.
Article in English | MEDLINE | ID: covidwho-1674010

ABSTRACT

OBJECTIVES: The aim was to investigate the impact of a group-based weight management programme on symptoms of depression and anxiety compared with self-help in a randomised controlled trial (RCT). METHOD: People with overweight (Body Mass Index [BMI]≥28kg/m2) were randomly allocated self-help (n = 211) or a group-based weight management programme for 12 weeks (n = 528) or 52 weeks (n = 528) between 18/10/2012 and 10/02/2014. Symptoms were assessed using the Hospital Anxiety and Depression Scale, at baseline, 3, 12 and 24 months. Linear regression modelling examined changes in Hospital Anxiety and Depression Scale between trial arms. RESULTS: At 3 months, there was a -0.6 point difference (95% confidence interval [CI], -1.1, -0.1) in depression score and -0.1 difference (95% CI, -0.7, 0.4) in anxiety score between group-based weight management programme and self-help. At subsequent time points there was no consistent evidence of a difference in depression or anxiety scores between trial arms. There was no evidence that depression or anxiety worsened at any time point. CONCLUSIONS: There was no evidence of harm to depression or anxiety symptoms as a result of attending a group-based weight loss programme. There was a transient reduction in symptoms of depression, but not anxiety, compared to self-help. This effect equates to less than 1 point out of 21 on the Hospital Anxiety and Depression Scale and is not clinically significant.


Subject(s)
Anxiety Disorders/prevention & control , Depression/prevention & control , Quality of Life , Self-Management/methods , Weight Loss , Weight Reduction Programs/statistics & numerical data , Anxiety Disorders/epidemiology , Case-Control Studies , Cost-Benefit Analysis , Depression/epidemiology , Female , Humans , Male , Middle Aged , Quality-Adjusted Life Years , United Kingdom
3.
Lancet Glob Health ; 10(1): e105-e113, 2022 01.
Article in English | MEDLINE | ID: covidwho-1586172

ABSTRACT

BACKGROUND: Clinical trials have established the high effectiveness and safety of medication abortion in clinical settings. However, barriers to clinical abortion care have shifted most medication abortion use to out-of-clinic settings, especially in the context of the COVID-19 pandemic. Given this shift, we aimed to estimate the effectiveness of self-managed medication abortion (medication abortion without clinical support), and to compare it to effectiveness of clinician-managed medication abortion. METHODS: For this prospective, observational cohort study, we recruited callers from two safe abortion accompaniment groups in Argentina and Nigeria who requested information on self-managed medication abortion. Before using one of two medication regimens (misoprostol alone or in combination with mifepristone), participants completed a baseline survey, and then two follow-up phone surveys at 1 week and 3 weeks after taking pills. The primary outcome was the proportion of participants reporting a complete abortion without surgical intervention. Legal restrictions precluded enrolment of a concurrent clinical control group; thus, a non-inferiority analysis compared abortion completion among those in our self-managed medication abortion cohort with abortion completion reported in historical clinical trials using the same medication regimens, restricted to participants with pregnancies of less than 9 weeks' gestation. This study was registered with ISCRTN, ISRCTN95769543. FINDINGS: Between July 31, 2019, and April 27, 2020, we enrolled 1051 participants. We analysed abortion outcomes for 961 participants, with an additional 47 participants reached after the study period. Most pregnancies were less than 12 weeks' duration. Participants in follow-up self-managed their abortions using misoprostol alone (593 participants) or the combined regimen of misoprostol plus mifepristone (356 participants). At last follow-up, 586 (99%) misoprostol alone users and 334 (94%) combined regimen users had a complete abortion without surgical intervention. For those with pregnancies of less than 9 weeks' gestation, both regimens were non-inferior to medication abortion effectiveness in clinical settings. INTERPRETATION: Findings from this prospective cohort study show that self-managed medication abortion with accompaniment group support is highly effective and, for those with pregnancies of less than 9 weeks' gestation, non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting. These findings support the use of remote self-managed models of early abortion care, as well as telemedicine, as is being considered in several countries because of the COVID-19 pandemic. FUNDING: David and Lucile Packard Foundation. TRANSLATIONS: For the Arabic, French, Bahasa Indonesian, Spanish and Yoruba translations of the Article see Supplementary Materials section.


Subject(s)
Abortion, Induced , Self Administration , Self-Management/methods , Abortifacient Agents/administration & dosage , Argentina , COVID-19 , Cohort Studies , Female , Humans , Mifepristone/administration & dosage , Misoprostol/administration & dosage , Nigeria , Pregnancy , Prospective Studies , Surveys and Questionnaires
4.
Diabet Med ; 39(4): e14755, 2022 04.
Article in English | MEDLINE | ID: covidwho-1550817

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). METHODS: The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. RESULTS: One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p < 0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. CONCLUSION: This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/therapy , Health Personnel , Self-Management/education , Telemedicine , Adult , Attitude of Health Personnel , Biomedical Technology/education , Blood Glucose Self-Monitoring/instrumentation , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/epidemiology , Glycemic Control/instrumentation , Health Personnel/organization & administration , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Insulin Infusion Systems , Pandemics , Patient Education as Topic/methods , Patient Education as Topic/organization & administration , Remote Consultation/methods , Remote Consultation/organization & administration , Self-Management/methods , Self-Management/psychology , Surveys and Questionnaires , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United Kingdom/epidemiology
5.
Pregnancy Hypertens ; 26: 54-61, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1386481

ABSTRACT

OBJECTIVE: This study aimed to understand the views and practice of obstetricians regarding self-monitoring for hypertensive disorders of pregnancy (blood pressure (BP) and proteinuria), the potential for self-management (including actions taken on self-monitored parameters) and to understand the impact of the COVID-19 pandemic on such views. DESIGN: Cross-sectional online survey pre- and post- the first wave of the COVID-19 pandemic. SETTING AND SAMPLE: UK obstetricians recruited via an online portal. METHODS: A survey undertaken in two rounds: December 2019-January 2020 (pre-pandemic), and September-November 2020 (during pandemic) RESULTS: 251 responses were received across rounds one (150) and two (101). Most obstetricians considered that self-monitoring of BP and home urinalysis had a role in guiding clinical decisions and this increased significantly following the first wave of the COVID-19 pandemic (88%, (132/150) 95%CI: 83-93% first round vs 96% (95%CI: 92-94%), (97/101), second round; p = 0.039). Following the pandemic, nearly half were agreeable to women self-managing their hypertension by using their own readings to make a pre-agreed medication change themselves (47%, 47/101 (95%CI: 37-57%)). CONCLUSIONS: A substantial majority of UK obstetricians considered that self-monitoring had a role in the management of pregnancy hypertension and this increased following the pandemic. Around half are now supportive of women having a wider role in self-management of hypertensive treatment. Maximising the potential of such changes in pregnancy hypertension management requires further work to understand how to fully integrate women's own measurements into clinical care.


Subject(s)
Attitude of Health Personnel , COVID-19/epidemiology , Hypertension, Pregnancy-Induced/therapy , Pandemics , Self-Management/methods , Adult , Blood Pressure Monitoring, Ambulatory/methods , Cross-Sectional Studies , Female , Humans , Hypertension, Pregnancy-Induced/epidemiology , Incidence , Male , Middle Aged , Pregnancy , Retrospective Studies , United Kingdom/epidemiology
6.
BMC Neurol ; 21(1): 284, 2021 Jul 20.
Article in English | MEDLINE | ID: covidwho-1319459

ABSTRACT

BACKGROUND: The purpose of this study was to describe the effects of COVID-19 social distancing on the function, health, and well-being of people with Parkinson disease (PD), and test the association of these effects with patients' activation levels, i.e., their skills and confidence in managing their health. METHODS: Community-dwelling individuals with PD answered an anonymous web-based survey. Part 1 included 27 multiple-choice questions regarding changes in function, health, medical care, and well-being. Part 2 consisted of the Patient Activation Measure, which enquired about skills and confidence in managing one's health. RESULTS: Respondents (N = 142) reported decreases in various function (24.8%-37.3%), health (33.8%-43%), and well-being (26.1%-47.1%) domains. Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 67.8% associated this with the cessation of rehabilitative treatments or decrease in physical activity. Patients' activation levels were inversely correlated with increased assistance for activities of daily living, increased tiredness, worsening symptoms, and lack of support from family and friends. CONCLUSIONS: Social distancing had a major negative impact on the health and function of people with PD. PRACTICAL IMPLICATIONS: Supporting people with PD skills and confidence in managing health may preserve their physical and mental health during this period of dramatic changes in life's circumstances.


Subject(s)
COVID-19/psychology , Mental Health , Parkinson Disease/psychology , Physical Distancing , Self-Management/psychology , Activities of Daily Living/psychology , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Exercise/physiology , Exercise/psychology , Female , Health Behavior/physiology , Humans , Male , Middle Aged , Parkinson Disease/epidemiology , Parkinson Disease/therapy , Self-Management/methods , Surveys and Questionnaires
8.
Contraception ; 103(6): 377-379, 2021 06.
Article in English | MEDLINE | ID: covidwho-1157217

ABSTRACT

The COVID-19 pandemic has exposed the vulnerability of global contraception provision, exacerbating the barriers to access reproductive health services, leading to suspension of clinical services and disruption of supply chains. Critical to combatting this crisis is the expansion of healthcare to include self-care approaches to de-medicalize contraception and increase an individual's agency in determining what method they use, when they use it, and where they obtain it. Expanding the mix of self-administered contraceptives is essential for ensuring choice, access, and availability. We highlight advances in the self-care movement and actions needed to strengthen self-management approaches to maximize our chances of preventing a reproductive health crisis.


Subject(s)
COVID-19 , Contraception/methods , Contraceptive Devices/supply & distribution , Family Planning Services/supply & distribution , Health Services Accessibility , Self-Management/methods , Family Planning Services/methods , Global Health , Humans , Self Administration
9.
Pacing Clin Electrophysiol ; 44(3): 451-461, 2021 03.
Article in English | MEDLINE | ID: covidwho-1075890

ABSTRACT

BACKGROUND: As the pandemic continues to unfold, effective, technology-based solutions are needed to help patients with atrial fibrillation (AF) maintain their health and well-being during the outbreak of COVID-19. METHODS: This single-center, pilot study investigated the effects of a 4-week (eight sessions) virtual AF self-management program. Questionnaires were completed at baseline and 1 week after the intervention, and assessed AF knowledge, adherence to self-management behaviors, mental health, physical function, and disease-specific quality of life in patients with AF. Secondary outcomes included knowledge of COVID-19, intervention, acceptability, and satisfaction. RESULTS: Of 68 patients who completed baseline questionnaires, 57 participated in the intervention and were included in the analysis (mean age of 73.4 ± 10.0 years, 60% male). Adherence to AF self-monitoring behaviors, including monitoring their heart rate (p < .001), heart rhythm (p = .003), and blood pressure (p = .013) were significantly improved at the end of the intervention compared with baseline. Symptom identification (p = .007) and management (p < .001) also improved. Reductions in sleep disturbance (p < .001), anxiety (p = .014), and depression (p = .046) were also observed. Misinformation and inaccurate beliefs about COVID-19 were significantly reduced at the end of the intervention compared with baseline. CONCLUSIONS: This pilot study suggests that a virtual patient education program could have beneficial effects on adherence to guideline-recommend self-care of AF, emotional wellbeing, physical function, and knowledge of COVID-19 in patients with AF. Future randomized studies in larger samples are needed to determine the clinical benefits of the intervention.


Subject(s)
Atrial Fibrillation/therapy , COVID-19 , Home Care Services , Self-Management/methods , Telemedicine , Aged , Aged, 80 and over , COVID-19/epidemiology , Disease Outbreaks , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot Projects , Treatment Outcome
10.
Support Care Cancer ; 29(8): 4819-4825, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1064505

ABSTRACT

OBJECTIVE: We examined the qualitative impact of an online integrative oncology (IO) treatment program, designed in response to the restrictions created by the current COVID-19 pandemic. METHODS: Patients undergoing chemotherapy were seen by an integrative physician (IP), together co-designing an IO treatment program of ≥ 6 weekly treatments to alleviate symptoms and improve quality of life (QoL). IO practitioners guided patients and their caregivers online in self-treatment with manual/touch, movement, and/or mind-body modalities. Narratives of both patients and IO practitioners were analyzed for systematic coding, identifying barriers and advantages of the online treatment program. RESULTS: Narratives obtained from 30 patients and eight IO-trained practitioners were examined. The patients had undergone 169 online IO sessions with a total of 327 IO interventions during the 3-month study period. Patient narratives included reflections on both non-specific effects (e.g., less of a "sense of isolation") and specific QoL-related outcomes with the online intervention. IO practitioner narratives focused on barriers to providing manual-movement and mind-body modalities, suggesting practical recommendations on how to address specific QoL-related outcomes using the online IO "toolbox." CONCLUSIONS: Effective online IO practitioner-guided treatments are feasible and may induce both specific and non-specific QoL-related effects. Future research needs to explore online IO interventions for additional situations in which access to IO care is limited.


Subject(s)
COVID-19 , Integrative Oncology , Internet-Based Intervention , Neoplasms , Quality of Life , COVID-19/epidemiology , COVID-19/prevention & control , Complementary Therapies/methods , Continuity of Patient Care , Female , Humans , Integrative Oncology/methods , Integrative Oncology/trends , Male , Middle Aged , Narration , Neoplasms/epidemiology , Neoplasms/psychology , Neoplasms/therapy , Pregnancy , SARS-CoV-2 , Self-Management/methods , Self-Management/psychology
11.
Prim Care Diabetes ; 15(3): 417-423, 2021 06.
Article in English | MEDLINE | ID: covidwho-1002958

ABSTRACT

OBJECTIVE: We learned about the health condition of people with diabetes during the COVID-19 epidemic through a questionnaire survey. We conducted a randomized controlled study to confirm the effectiveness of remote management using the mobile phone WeChat app on comprehensive management of diabetes mellitus during the COVID-19 epidemic. METHODS: We distributed questionnaires that collected information on the health condition of people with diabetes during the COVID-19 epidemic through the WeChat app. We assigned 90 cases to the intervention group and 90 cases to the control group. The intervention group was managed remotely through the WeChat app, and the control group received traditional medical treatment. The blood glucose, blood pressure, body mass index (BMI), time in range (TIR) and incidence of hypoglycemia were compared after three months of follow-up. RESULTS: The BMI and postprandial blood glucose (PBG) of the control group at 3 months was significantly higher than that at baseline (P < 0.001), and TIR decreased at 3 months (P < 0.05). There was no significant difference in blood pressure compared with baseline in the control group, while blood pressure decreased in the intervention group (P < 0.05). In the intervention group, fast blood glucose(FBG) and PBG decreased compared with their baseline values, and the TIR level increased, both of which were statistically significant (P < 0.001). The FBG, PBG, and TIR of the intervention group were better than those in the control group at 3 months (P < 0.05). There was no difference in the incidence of hypoglycemia between the two groups. CONCLUSION: During the COVID-19 epidemic, diabetes treatment has been facing new challenges, and the traditional treatment mode is limited. Remote management can increase TIR without increasing the risk of hypoglycemia. Remote management can prevent weight gain and improve patients' self-management and compliance during the COVID-19 epidemic.


Subject(s)
Blood Glucose Self-Monitoring/methods , Blood Glucose/metabolism , COVID-19/epidemiology , Cell Phone , Diabetes Mellitus, Type 2/blood , Mobile Applications , Self-Management/methods , Adolescent , Adult , Aged , Diabetes Mellitus, Type 2/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
12.
Australas Psychiatry ; 29(2): 189-193, 2021 04.
Article in English | MEDLINE | ID: covidwho-969644

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 and the consequent public health and social distancing measures significantly impacted on service continuity for mental health patients. This article reports on contingency planning initiative in the Australian public sector. METHODS: Ninety-word care synopses were developed for each patient. These formed the basis for guided conversations between case managers and consultant psychiatrists to ensure safe service provision and retain a person-centred focus amidst the threat of major staffing shortfalls. RESULTS: This process identified vulnerable patient groups with specific communication needs and those most at risk through service contraction. The challenges and opportunities for promoting safety and self-management through proactive telehealth came up repeatedly. The guided conversations also raised awareness of the shared experience between patients and professionals of coronavirus disease 2019. CONCLUSION: There is a parallel pandemic of anxiety which creates a unique opportunity to connect at a human level.


Subject(s)
COVID-19/psychology , Mental Disorders/therapy , Mental Health Services , Patient Care Planning , Patient-Centered Care/methods , Telemedicine/methods , Australia , COVID-19/prevention & control , Humans , Interprofessional Relations , Mental Disorders/psychology , Mental Health Services/organization & administration , Needs Assessment/organization & administration , Patient Care Planning/organization & administration , Patient Safety , Patient-Centered Care/organization & administration , Professional-Patient Relations , Self-Management/methods , Self-Management/psychology , Telemedicine/organization & administration , Triage/methods , Triage/organization & administration
14.
Diabetes Metab Syndr ; 15(1): 63-68, 2021.
Article in English | MEDLINE | ID: covidwho-957018

ABSTRACT

BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has affected people's lives including patients with type 1 diabetes mellitus (T1DM). We aimed to investigate the impact of the COVID-19 lockdown on psychological status, self-management behaviors, and diabetes care maintenance among Saudi adults with T1DM using insulin pump therapy. METHODS: This cross-sectional study used a web survey to collect data on Saudi adults with T1DM who were treated in the specialized insulin pump clinic at King Abdulaziz Medical City-Jeddah, Saudi Arabia. We used the Patient Health Questionnaire-9 and General Anxiety Disorder-7 scales to measure depression and anxiety. RESULTS: Of the 70 patients who received the survey, 65 completed it. Overall, 23.1% and 29.2% of the patients reported moderate to severe and mild depression, respectively; 18.5% and 24.6% reported moderate to severe and mild anxiety, respectively. Compared with pre-lockdown, adherence to a healthy diet and regular physical activity decreased in 67.7% and 41.5% of the patients, respectively. Most patients maintained their adherence to insulin pump behaviors; frequent self-monitoring of blood glucose increased in 47% of glucometer users. Most patients benefited from phone visits or virtual education sessions, but 66.2% of the patients reported difficulty obtaining at least one type of insulin pump supply. CONCLUSIONS: Promoting self-management behaviors and psychological wellbeing of patients with T1DM using insulin pump therapy is crucial during a lockdown. Telemedicine is a useful alternative to in-person appointments, but strategies to ensure that patients have access to adequate resources during lockdown must be developed.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Insulin Infusion Systems , Quarantine/methods , Self-Management/methods , Adult , COVID-19/prevention & control , Cross-Sectional Studies , Diabetes Mellitus, Type 1/psychology , Female , Humans , Insulin Infusion Systems/psychology , Male , Quarantine/psychology , Saudi Arabia/epidemiology , Self-Management/psychology , Telemedicine/methods
15.
Epilepsy Behav ; 115: 107658, 2021 02.
Article in English | MEDLINE | ID: covidwho-947487

ABSTRACT

The COVID-19 pandemic has caused global anguish unparalleled in recent times. As cases rise, increased pressure on health services, combined with severe disruption to people's everyday lives, can adversely affect individuals living with chronic illnesses, including people with epilepsy. Stressors related to disruption to healthcare, finances, mental well-being, relationships, schooling, physical activity, and increased isolation could increase seizures and impair epilepsy self-management. We aim to understand the impact that COVID-19 has had on the health and well-being of people with epilepsy focusing on exposure to increased risk of seizures, associated comorbidity, and mortality. We designed two online surveys with one addressing people with epilepsy directly and the second for caregivers to report on behalf of a person with epilepsy. The survey is ongoing and has yielded 463 UK-based responses by the end of September 2020. Forty percent of respondents reported health changes during the pandemic (n = 185). Respondents cited a change in seizures (19%, n = 88), mental health difficulties (34%, n = 161), and sleep disruption (26%, n = 121) as the main reasons. Thirteen percent found it difficult to take medication on time. A third had difficulty accessing medical services (n = 154), with 8% having had an appointment canceled (n = 39). Only a small proportion reported having had discussions about epilepsy-related risks, such as safety precautions (16%, n = 74); mental health (29%, n = 134); sleep (30%, n = 140); and Sudden Unexpected Death in Epilepsy (SUDEP; 15%, n = 69) in the previous 12 months. These findings suggest that people with epilepsy are currently experiencing health changes, coupled with inadequate access to services. Also, there seems to be a history of poor risk communication in the months preceding the pandemic. As the UK witnesses a second COVID-19 wave, those involved in healthcare delivery must ensure optimal care is provided for people with chronic conditions, such as epilepsy, to ensure that avoidable morbidity and mortality is prevented during the pandemic, and beyond.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/standards , Epilepsy/epidemiology , Pandemics , Surveys and Questionnaires , Adolescent , Adult , COVID-19/prevention & control , Caregivers/standards , Delivery of Health Care/methods , Epilepsy/therapy , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics/prevention & control , Pilot Projects , Risk Factors , Self-Management/methods , Sudden Unexpected Death in Epilepsy/epidemiology , Sudden Unexpected Death in Epilepsy/prevention & control , United Kingdom/epidemiology , Young Adult
18.
J Diabetes Sci Technol ; 14(6): 1107-1110, 2020 11.
Article in English | MEDLINE | ID: covidwho-858408

ABSTRACT

With the recent pivot to telehealth as a direct result of the COVID-19 pandemic, there is an imperative to ensure that access to affordable devices and technologies with remote monitoring capabilities for people with diabetes becomes equitable. In addition, expanding the use of remote Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) services will require new strategies for achieving long-term, effective, continuous, data-driven care. The current COVID-19 pandemic has especially impacted underserved US communities that were already disproportionately impacted by diabetes. Historically, these same communities have faced barriers in accessing timely and effective diabetes care including access to DSMES and MNT services, and diabetes technologies. Our call to action encourages all involved to urge US Federal representatives to widen access to the array of technologies necessary for successful telehealth-delivered care beyond COVID-19.


Subject(s)
Cloud Computing/trends , Coronavirus Infections/epidemiology , Diabetes Mellitus/therapy , Health Services Accessibility/trends , Pneumonia, Viral/epidemiology , Telemedicine/trends , Universal Health Care , COVID-19 , Coronavirus Infections/therapy , Democracy , Diabetes Complications/epidemiology , Diabetes Complications/therapy , Diabetes Mellitus/epidemiology , Health Services Accessibility/organization & administration , Healthcare Disparities/organization & administration , Healthcare Disparities/trends , Humans , Inventions/trends , Medically Underserved Area , Pandemics , Patient Education as Topic/methods , Patient Education as Topic/organization & administration , Patient Education as Topic/trends , Pneumonia, Viral/therapy , Self-Management/methods , Self-Management/trends , Telemedicine/methods , Telemedicine/organization & administration
19.
Int J Chron Obstruct Pulmon Dis ; 15: 2127-2133, 2020.
Article in English | MEDLINE | ID: covidwho-802252

ABSTRACT

Pulmonary rehabilitation (PR) is an important, evidence-based treatment that improves outcomes for people with COPD. Individualized exercise programmes aim to improve exercise capacity; self-management education and psychological support are also provided. Translating increased exercise capacity into sustained behavioural change of increased physical activity is difficult. Other unresolved problems with PR programmes include improving uptake, completion, response and sustaining long-term benefit. We offer a different perspective drawn from clinical experience of PR, quantitative and qualitative studies of singing groups for people with COPD, and stroke rehabilitation research that gives psychological factors a more central role in determining outcomes after PR. We discuss Take Charge; a simple but effective psychological intervention promoting self-management--that could be used as part of a PR programme or in situations where PR was declined or unavailable. This may be particularly relevant now when traditional face-to-face group programmes have been disrupted by COVID-19 precautions.


Subject(s)
Communicable Disease Control , Coronavirus Infections , Exercise Therapy , Health Behavior , Pandemics , Pneumonia, Viral , Pulmonary Disease, Chronic Obstructive , Rehabilitation Research , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Exercise Therapy/methods , Exercise Therapy/organization & administration , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Psychosocial Support Systems , Pulmonary Disease, Chronic Obstructive/psychology , Pulmonary Disease, Chronic Obstructive/rehabilitation , Research Design , SARS-CoV-2 , Self-Management/methods , Self-Management/psychology , Treatment Outcome
20.
J Pediatr Psychol ; 45(9): 977-982, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-766666

ABSTRACT

The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.


Subject(s)
Betacoronavirus , Chronic Disease/therapy , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Patient Compliance/statistics & numerical data , Pneumonia, Viral/prevention & control , Self-Management/statistics & numerical data , Telemedicine/methods , Adolescent , COVID-19 , Child , Chronic Disease/psychology , Coronavirus Infections/psychology , Humans , Mobile Applications , Pneumonia, Viral/psychology , SARS-CoV-2 , Self-Management/methods
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