The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study.

BACKGROUND: World Health Organization approved vaccines have demonstrated relatively high protection against moderate to severe COVID-19. Prospective vaccine effectiveness (VE) designs with first-hand data and population-based controls are nevertheless rare. Neighborhood compared to hospitalized controls, may differ in compliance to non-pharmacuetical interventions (NPI) compliance, which may influence VE results in real-world settings. We aimed to determine VE against COVID-19 intensive-care-unit (ICU) admission using hospital and community-matched controls in a prospective design. METHODS: We conducted a multicenter, observational study of matched cases and controls (1:3) in adults ≧18 years of age from May to July 2021. For each case, a hospital control and two community controls were matched by age, gender, and hospital admission date or neighborhood of residence. Conditional logistic regression models were built, including interaction terms between NPIs, lifestyle behaviors, and vaccination status; the model's ß coefficients represent the added effect these terms had on COVID-19 VE. RESULTS: Cases and controls differed in several factors including education level, obesity prevalence, and behaviors such as compliance with routine vaccinations, use of facemasks, and routine handwashing. VE was 98·2% for full primary vaccination and 85·6% for partial vaccination when compared to community controls, and somewhat lower, albeit not significantly, compared to hospital controls. A significant added effect to vaccination in reducing COVID-19 ICU admission was regular facemask use and VE was higher among individuals non-compliant with the national vaccine program, and/or tonroutine medical visits during the prior year. CONCLUSION: VE against COVID-19 ICU admission in this stringent prospective case-double control study reached 98% two weeks after full primary vaccination, confirming the high effectiveness provided by earlier studies. Face mask use and hand washing were independent protective factors, the former adding additional benefit to VE. VE was significantly higher in subjects with increased risk behaviors.

Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non-pharmacological delirium prevention program.

OBJECTIVE: To evaluate the contribution of applying the theoretical framework of implementation science for adherence to non-pharmacological interventions to prevent delirium. METHODS: A quasi-experimental prospective design was conducted from March 2017 to October 2018 in a teaching hospital. Participants included 149 healthcare staff and 72 elderly inpatients. A non-pharmacological delirium prevention program was designed, applied and evaluated in accordance with the consolidated framework for advancing implementation research (CFIR). The primary outcome was the global adherence rate to 12 predefined indicators, comparing measurements at baseline (O1), after training (O2) and at a 6-month follow-up (O3) assessed by an external reviewer. Staff knowledge and beliefs about delirium were assessed using a validated tool, and delirium incidence was evaluated using the confusion assessment method. RESULTS: Overall adherence increased from 58.2% (O1) to 77.9% (O2) and 75.6% (O3) (O2 vs. O1: p < 0.001 and O3 vs. O1: p < 0.001). Staff perceptions regarding implementation of non-pharmacological interventions increased from 74.8% to 81.9% (p = 0.004). Delirium incidence was non-significantly reduced from 20% (O1) to 16% (O3) (p = 0.99). CONCLUSIONS: Implementation of a delirium prevention program using a CFIR model was useful in improving adherence to activities included in this program, as well as improving the knowledge and beliefs regarding delirium by healthcare workers. The impact of this implementation strategy on the incidence of delirium should be evaluated in a larger scale multicenter trial.

Prescribed Versus Preferred Intensity Resistance Exercise in Fibromyalgia Pain.

Exercise is the treatment of choice for fibromyalgia (FM), but little is known about resistance exercise prescription to modulate pain in this condition. This study aimed to compare the effects of different resistance exercise models, comprising self-selected or prescribed intensity, on pain in FM patients. In a cross-over fashion, 32 patients underwent the following sessions: (i) standard prescription (STD; 3 × 10 repetitions at 60% of maximal strength); (ii) self-selected load with fixed number of repetitions (SS); (iii) self-selected load with volume load (i.e., load × sets × repetitions) matched for STD (SS-VM); and (iv) self-selected load with a free number of repetitions until achieving score 7 of rating perceived exertion (SS-RPE). Pain, assessed by Visual Analogic Scale (VAS) and Short-Form McGill Pain Questionnaire (SF-MPQ), was evaluated before and 0, 24, 48, 72, and 96 h after the sessions. Load was significantly lower in SS, SS-VM, SS-RPE than in STD, whereas rating perceived exertion and volume load were comparable between sessions. VAS scores increased immediately after all sessions (p < 0.0001), and reduced after 48, 72, 96 h (p < 0.0001), remaining elevated compared to pre-values. SF-MPQ scores increased immediately after all exercise sessions (p = 0.025), then gradually reduced across time, reaching baseline levels at 24 h. No significant differences between sessions were observed. Both prescribed and preferred intensity resistance exercises failed in reducing pain in FM patients. The recommendation that FM patients should exercise at preferred intensities to avoid exacerbated pain, which appears to be valid for aerobic exercise, does not apply to resistance exercise.

Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review.

Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.

Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia - FTD: a call for randomised controlled studies / Reforço da s habilidades dos cuidadores e da função do paciente no manejo não farmacológico da demência frontotemporal -DFT: necessidade para estudos clínicos randomizadose controlados

FTD is a unique condition which manifests with a range of behavioural symptoms, marked dysfunction in activities of daily living ADL and increased levels of carer burden as compared to carers of other dementias. No efficacious pharmacological interventions to treat FTD currently exist, and research on pharmacological symptom management isvariable. The few studies on non-pharmacological interventions in FTD focus on either the carer or the patients? symptoms, and lack methodological rigour. This paper reviews and discusses current studies utilising non-pharmacological approaches, exposing the clear need for more rigorous methodologies to be applied in this . Finally, a successful randomised controlled trial helped reduce behaviours of concern in dementia, and through implementing participation in tailored activities, the FTD-specific Tailored Activities Program TAP is presented. Crucially, this protocol has scope to target both the person with FTD and their carer. This paper highlights that studies in this area would help to elucidate the potential for using activities to reduce characteristic behaviours in FTD, improving quality of life and the caregiving experience in FTD.

A DFT é uma condição única que se manifesta por uma variedade de sintomas, principalmente em atividades da vida diária (AVD) e aumento da carga sobre os cuidadores em comparação aos cuidadores de outras demências. Não existe nenhuma intervenção farmacológica para tratamento da DFT até o momento e pesquisas sobre o manejo farmacológico dos sintomas são variáveis. Os poucos estudos em intervenção não farmacológica em DFT focam nos cuidadores ou emsintomas dos pacientes, faltando rigor metodológico. Este artigo revisa e discute os estudos atuais que utilizam abordagem não farmacológica, o que expõe a clara necessidade para metodologias mais rigorosas a serem aplicadas neste campo. Finalmente, um ensaio clinico randomizado bem sucedido ajudou na redução de comportamentos em demência, através da implementação da participação em atividades ajustadas, é apresentado o FTD-specific Tailored Activities Program (TAP). Este protocolo visa abordar tanto o paciente com DFT quanto seu cuidador. Este manuscrito evidencia que pesquisas dentro desta area ajudariam a elucidar o potencial em usar estas atividades para redução dos comportamentos característicos em DFt, melhorando a qualidade de vida e experiências dos cuidadores em DFT.

Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia (FTD): A call for randomised controlled studies.

FTD is a unique condition which manifests with a range of behavioural symptoms, marked dysfunction in activities of daily living (ADL) and increased levels of carer burden as compared to carers of other dementias. No efficacious pharmacological interventions to treat FTD currently exist, and research on pharmacological symptom management is variable. The few studies on non-pharmacological interventions in FTD focus on either the carer or the patients' symptoms, and lack methodological rigour. This paper reviews and discusses current studies utilising non-pharmacological approaches, exposing the clear need for more rigorous methodologies to be applied in this field. Finally, a successful randomised controlled trial helped reduce behaviours of concern in dementia, and through implementing participation in tailored activities, the FTD-specific Tailored Activities Program (TAP) is presented. Crucially, this protocol has scope to target both the person with FTD and their carer. This paper highlights that studies in this area would help to elucidate the potential for using activities to reduce characteristic behaviours in FTD, improving quality of life and the caregiving experience in FTD.

A DFT é uma condição única que se manifesta por uma variedade de sintomas, principalmente em atividades da vida diária (AVD) e aumento da carga sobre os cuidadores em comparação aos cuidadores de outras demências. Não existe nenhuma intervenção farmacológica para tratamento da DFT até o momento e pesquisas sobre o manejo farmacológico dos sintomas são variáveis. Os poucos estudos em intervenção não farmacológica em DFT focam nos cuidadores ou em sintomas dos pacientes, faltando rigor metodológico. Este artigo revisa e discute os estudos atuais que utilizam abordagem não farmacológica, o que expõe a clara necessidade para metodologias mais rigorosas a serem aplicadas neste campo. Finalmente, um ensaio clinico randomizado bem sucedido ajudou na redução de comportamentos em demência, através da implementação da participação em atividades ajustadas, é apresentado o FTD-specific Tailored Activities Program (TAP). Este protocolo visa abordar tanto o paciente com DFT quanto seu cuidador. Este manuscrito evidencia que pesquisas dentro desta area ajudariam a elucidar o potencial em usar estas atividades para redução dos comportamentos característicos em DFt, melhorando a qualidade de vida e experiências dos cuidadores em DFT.

Intervenciones no farmacológicas en el insomnio primario: la evidencia de los ensayos clínicos controlados en los últimos diez años (1998-2008) / Non-pharmacological interventions in primary insomnia: controlled clinical trial findings (1998-2008)

Introducción: El insomnio es un trastorno del sueño que afecta al 10% de la población general e impacta a quien lo padece emocional, física y socialmente, por lo que es importante su adecuado diagnóstico y tratamiento. Objetivo: Describir los principales hallazgos de las intervenciones no farmacológicas sobre insomnio primario según la metodología de ensayos clínicos controlados. Método: Revisión sistemática durante febrero del 2009 en la base de datos de Ensayos Clínicos Controlados de Cochrane. Se seleccionaron artículos escritos en inglés, portugués o español publicados entre 1998 y 2008. Las palabras clave utilizadas fueron: primary insomnia, management, treatment y non pharmacological. Se descartaron artículos sobre insomnio secundario, con sólo resultados preliminares y aquellos escritos en idioma diferente a los establecidos. Al final se analizaron 37 artículos. Resultados: La modalidad de intervención más usada fue la combinación de técnicas cognitivo-conductuales (TCC). De manera general, todas las intervenciones tuvieron resultados positivos en la calidad del sueño. Las mejorías fueron de moderadas a altas y se mantuvieron a través del seguimiento. Según lo obtenido, el mejor tratamiento para el insomnio es la TCC, aunque otras opciones, como la máscara de luz, presentan resultados alentadores. Conclusiones: Hay hallazgos ciertos sobre los beneficios de las intervenciones no farmacológicas en el insomnio primario, con más estudios referentes a la TCC. Se plantea la necesidad de realizar estudios que evalúen dosis respuesta y la costo-efectividad de estas intervenciones...

Introduction: Insomnia is the most common sleep disorder and it affects approximately 10% of the world’s population causing a negative impact on sufferers’ emotional, physical, and social wellbeing. Several non−pharmacological treatments have been developed that appear to be effective. Objective: To analyze the main findings on primary insomnia. Methodology: During February 2009, a systematic review was undertaken using the Cochrane Database of Controlled Clinical Trials. A selection was made of articles written in English, Portuguese, and Spanish published between 1998 and 2008. The key words used were: primary insomnia, management, treatment and non−pharmacological. An analysis was carried out on 37 articles. Results: In general, all interventions had positive effects on the quality of sleep. With most of the combined techniques, the improvements were moderate−to−high and they were maintained through follow-up. According to the evidence gathered, the best non−pharmacological treatment was Cognitive Behavioral Therapy (CBT) although other intervention options such as Light Exposure produced encouraging results. The non−pharmacological approach gave better long−term results than pharmacological treatments. Conclusions: There is evidence of the benefits of non−pharmacological interventions for primary insomnia. Further research is necessary to evaluate the dose−response ratio and the cost−effectiveness of treatments...

Intervenções de grupo para sobrecarga de cuidadores de pacientes com demência: uma revisão sistemática / Group interventions focused on the burden of caregivers of patients with dementia: a systematic review

CONTEXTO: Além de orientações gerais sobre como lidar com o paciente, o cuidador familiar do sujeito com demência deve receber apoio para enfrentar as dificuldades do progresso da doença e aliviar a sua sobrecarga, seus sintomas depressivos e ansiosos. OBJETIVOS: Avaliar os modelos teóricos e metodológicos utilizados, assim como o efeito das intervenções de grupo na sobrecarga de cuidadores de pessoas com demência. MÉTODO: Busca nas bases de dados ISI, PubMed/Medline, SciELO e Lilacs de artigos sobre a eficácia de intervenções não farmacológicas com cuidadores de pessoas com demência, entre janeiro de 1999 e agosto de 2010, utilizando as palavras-chave: "demência", "cuidador", "sobrecarga", "intervenções não farmacológicas" e grupo/grupos". Os estudos encontrados foram organizados em duas categorias: intervenções psicoeducacionais ou psicossociais e psicoterapêuticas. RESULTADOS: Foram selecionados 37 artigos, sendo 31 de abordagem psicoeducacional ou psicossocial e 6, psicoterapêutica, com resultados estatisticamente significativos relacionados à eficácia das intervenções em grupo para a sobrecarga de cuidadores de pacientes com demência. Em 33 casos, houve melhora principalmente nos escores de depressão e estresse dos cuidadores. CONCLUSÃO: Apesar de apresentarem índices de eficácia, as intervenções em grupo para cuidadores de pessoas com demência ainda necessitam de estudos randomizados que visem à solução de problemas metodológicos importantes desse tipo de tratamento, como a falta de padronização das abordagens educacionais, o número de participantes ou o período de duração do grupo.

BACKGROUND: Besides receiving general orientations about how to deal with a patient with dementia, the caregiver needs support to cope with the progress of the disease and to alleviate his burden, as well as his depressive and anxious symptoms. OBJECTIVES: To evaluate the theoretical and methodological models used, as well as the effect of the group interventions on the burden of caregivers of people with dementia. METHOD: Search of articles at ISI, PubMed/Medline, SciELO and Lilacs about the efficacy of non pharmacological interventions with caregivers of patients with dementia, from January 1999 to August 2010, using the keywords: "dementia", "caregiver", "burden", "non pharmacological interventions", and "group/groups". The studies found were organized in two categories: psychoeducational or psychosocial interventions and psychotherapeutic interventions. RESULTS: Thirty seven articles were selected, 31 psychoeducational or psychosocial interventions and 6 psychoterapeutic ones, with statistically significant results related to the efficacy of group interventions on the burden of caregivers of people with dementia in 33 cases. There was an improvement especially on the scores of caregivers' depression and stress. DISCUSSION: In spite of efficacy, the group interventions for caregivers of people with dementia still need randomized studies aimed at the solution of important methodological problems of this kind of treatment, like the lack of standardized educational approaches, the number of participants or the duration of the group.