Background
Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients ...in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives.
Methods
We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients’ and caregivers’ preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions.
Results
We included 148 reviews covering T2DM (
n
= 53 35.8%), obesity (
n
= 20 13.5%), COPD (
n
= 32 21.6%), HF (
n
= 38 25.7%), and those with more than one disease (
n
= 5 3.4%). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions.
Conclusion
The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention’s usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
Aim: The COVID-19 pandemic, the first registered in the last 100 years, triggered fear and uncertainty, with manifestations related to stress, anxiety, and depression, mainly in health professionals. ...The study aimed to evaluate the psychological impact of the community quarantine, implemented due to the COVID-19 pandemic, in pediatric dentists and pediatric dentistry graduate students in Latin America. Materials and Methods: Convenience sample made up of 139 pediatric dentists and postgraduate pediatric dentistry students from different Latin American countries, who were asked to fill out a questionnaire, submitted electronically, with prior authorization of participation through an informed consent. The anonymity of the participants was protected using identification codes, and only their email address was requested for subsequent follow-up. Results: The multivariate model shows an association between the value of the PSS-14 v25 questionnaire and the different study variables; thus, the variables-quality of sleep (P ≤ 0.001), number of biosafety measures (P≤0.02), age (P = 0.04), and perception of their state of health (P = 0.03)-were statistically significant in the perceived stress and subjective well-being, caused by COVID-19 lockdown. In the same way, in the most representative demographic variables related to the affective and social support perceived by the participant, it was observed that, with increasing age, there is a decrease in perceived affective support and, consequently, in participants with mandatory quarantine and time restriction; there is a perception of not having emotional support. Conclusion: The disease caused by COVID-19 has modified the habits and quality of life of all professionals in the health field. The psychological impact that the community quarantine implemented due to the COVID-19 pandemic has produced is evident, as older and female individuals more frequently present signs of stress and anxiety, manifested by fear and uncertainty.
Objective. Dental caries remains a prevalent disease worldwide. Several epidemiological studies have shown that it affects the oral health of the pediatric population, and the Galapagos population in ...Ecuador is no exception. The aim of this study was to determine the prevalence of dental caries and its association, based on baseline information from the Galapagos Oral Health Study (ESSO-Gal), in children of the Galapagos Islands, Ecuador. Methods. A cross-sectional study was conducted involving 804 children aged 2–11 years. The prevalence of dental caries was assessed using the International Caries Detection and Assessment System (ICDAS II) criteria, while the presence of dental biofilm was assessed using the Silness–Löe index. Descriptive statistics, including frequency analysis and measures of central tendency and dispersion, were performed. Inferential statistical analyses were conducted to identify associations between variables. Statistical analyses were performed using the SPSS version 25.0 statistical program. Results. The caries prevalence rates based on ICDAS II codes 1–6, 1–2, and 3–6 were 98.01%, 96.9%, and 85%, respectively. A statistically significant difference was observed among the different islands regarding the cutoff point for ICDAS II codes 3–6 (p≤0.001). Participants aged 6–11 years had the highest caries prevalence. Conclusions. The results show a high prevalence of dental caries among children in the Galapagos Islands, which increases with age. Contrary to expectations, the study did not find a significant correlation between the severity of dental caries and the presence of dental biofilm.
Carious lesions have traditionally been treated by non-selective (complete or total) removal of carious tissue. However, due to its risks and adverse effects, carious tissue removal techniques have ...been developed, based on the preservation of tooth tissue, including the stepwise removal. The objective of this summary is to clarify the uncertainty about the effectiveness and safety of the stepwise removal technique compared to complete removal.
To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by searching multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from identified reviews, reanalyzed data from primary studies, performed a meta-analysis, and prepared summary tables of results using the GRADE method.
We identified three systematic reviews that included five primary studies, four of them corresponding to randomized trials. We concluded that stepwise removal may reduce the risk of pulp exposure, the risk of signs and symptoms of pulp disease and the risk of restoration failure, but the certainty of the evidence is low.
Introduction: Self-management (SM) interventions are complex interventions and one of the main components of high-quality chronic disease care for which the incorporation of the perspectives of ...patients and their informal caregivers is crucial. We aim to identify, appraise and synthesise the evidence exploring patients' and caregivers' perspectives on SM interventions. More precisely, we aim to 1) describe how they value the importance of outcomes of SM interventions, and 2) identify the factors that might impact on acceptability and feasibility of SM interventions based on their preferences and experiences.
Methods and analysis: We will conduct four mixed-methods overviews as part of COMPAR-EU, a European Union (EU) funded project aimed to identify the most effective and cost-effective SM interventions for chronic obstructive pulmonary disease (COPD), heart failure (HF), obesity, and type 2 diabetes mellitus (T2DM). We will search in MEDLINE, CINAHL, and PsycINFO for systematic reviews of studies addressing patients' preferences on outcomes, or their experiences with SM alongside their disease trajectory or with SM interventions, published in English. Selection of studies and data extraction will be conducted in pairs. We will assess the overlap of studies and methodological quality. We will follow a three-step synthesis process: 1) narrative synthesis for quantitative evidence, 2) thematic synthesis for qualitative evidence, and 3) integration of findings in the interpretation phase. Additionally, we will consult on the relevance of findings with patients and their caregivers.
Systematic review registration: PROSPERO
CRD42019117867
Dental caries have been traditionally managed with the non-selective removal of carious tissue (total removal). However, the adverse effects and fear that this technique produces in patients has ...promoted the use of more conservative caries removal techniques such as chemo-mechanical removal, but there is still controversy regarding its effectiveness and safety.
We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings tables using the GRADE approach.
We identified seven systematic reviews including 34 studies overall, of which 30 correspond to randomized trials. We concluded that chemo-mechanical caries removal probably reduces the need for anesthesia. Additionally, chemo-mechanical caries removal may decrease the pain experienced by the patient, decrease the risk of restoration failure and increase the time of the procedure for the removal of deep caries, but the certainty of the evidence is low. We are uncertain whether chemo-mechanical caries removal reduces the risk of pulp exposure as the certainty of the evidence has been assessed as very low.
Evidence-based medicine (EBM) is defined as the integration of the best available evidence from scientific studies with clinical experience (and context) and with patients' values and preferences. ...The objective of the present study was to describe self-perceived EBM competencies in physicians and medical students enrolled in a massive virtual EBM course.
Analytical cross-sectional study. People interested in a free virtual EBM course fulfilled their data in a virtual form for their registration in September 2020. In this form, 22 competencies related to four dimensions of EBM were evaluated: asking a clinical question, search, analysis, and application; using a 5-option Likert scale. The resulting database was analyzed, selecting people who claimed to be physicians or medical students of 18 years or more.
1793 participants were included: 1130 medical students and 663 physicians; more than 80% lived in Peru. The frequency of participants who agreed or strongly agreed with feeling qualified in each competence ranged: from 39.2% to 57.8% for the competencies of the 'Asking a clinical question' dimension, from 39.2% to 56.1% for 'Search,' from 19.9% to 32.0% for 'Analysis,' and from 19.6% to 29.9% for 'Application.' Both in physicians and students, the lowest frequencies were for the competencies of interpretation of impact measures, graphs, and results of systematic reviews; as well as shared decision making and calculation of expected benefit. Physicians who graduated more recently scored better on competencies from search and analysis dimensions.
Among physicians and medical students enrolled in the course, self-perception of competencies was lower in the dimensions of analysis and application. More recently graduated physicians seem to have a greater self-perception of their research and analysis skills, probably due to curricular updates.
List of abbreviations: EBM: Evidence-based medicine; CIMBE, for its acronym in Spanish: International Course on Evidence-Based Medicine; SOCIMEP, for its acronym in Spanish: Peruvian Medical Student Scientific Society
El estado ecuatoriano consagra la salud como un derecho funadamental a través de su consitución, para garantizar este derecho ha implementado múltiples estrategias de salud pública a través del ...Ministerio de Salud. Sin embargo, la inclusión de la salud bucal en estas políticas es una deuda sanitaria pues poco ha sido articulada en estas iniciativas. El presente artículo pretende hacer un resumen de las políticas en salud pública odontológica consideradas por los autores como un eje importante en la cobertura de servicios de la salud en el país. Además considerar que posiblemente la ausencia de información actualizada sobre el estado de salud bucal de los ecuatorianos, contribuye directamente en falta de implementación de nuevas intervenciones basadas en evidencia científica que apoye la toma de decisiones informadas.
Estado de la salud bucal en el Ecuador Parise-Vasco, Juan Marcos; Zambrano-Achig, Paula; Viteri-García, Andrés ...
Odontología sanmarquina,
07/2020, Letnik:
23, Številka:
3
Journal Article
Recenzirano
Odprti dostop
En el Ecuador se presenta una alta prevalencia e incidencia de diferentes patologías bucales, este escenario es similar en muchos países de la región. Las enfermedades orales constituyen un problema ...de salud pública, debido a que requiere un alto costo en su manejo y control; es por ello que se ha generado énfasis en realizar actividades preventivas que permitan mejorar el panorama. Han sido varias las medidas adoptadas por entes gubernamentales en el Ecuador para reducir la incidencia principalmente de caries dental, desde la prevención masiva a través de la fluoración de diferentes elementos de consumo humano, la promoción y prevención de salud oral a través de la enseñanza de técnicas de cepillado dental, difusión del correcto uso de seda dental, detección temprana de placa bacteriana, charlas educativas motivadoras y colocación de sellantes en superficies oclusales de molares definitivos en escolares de poblaciones urbano-marginales y rurales. Sin embargo, dichas estrategias no han conseguido ser monitoreadas, evaluadas ni reportadas para conocer su efectividad en la mejora de la salud oral en nuestro país.
This is the second version (first update) of the living systematic review, replacing the previous version (available as a data supplement). When citing this paper please consider adding the version ...number and date of access for clarity.
To determine and compare the effects of drug prophylaxis on severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (covid-19).
Living systematic review and network meta-analysis (NMA).
World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 4 March 2022.
Randomised trials in which people at risk of covid-19 were allocated to prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles.
After duplicate data abstraction, we conducted random-effects bayesian network meta-analysis. We assessed risk of bias of the included studies using a modification of the Cochrane risk of bias 2.0 tool and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach.
The second iteration of this living NMA includes 32 randomised trials which enrolled 25 147 participants and addressed 21 different prophylactic drugs; adding 21 trials (66%), 18 162 participants (75%) and 16 (76%) prophylactic drugs. Of the 16 prophylactic drugs analysed, none provided convincing evidence of a reduction in the risk of laboratory confirmed SARS-CoV-2 infection. For admission to hospital and mortality outcomes, no prophylactic drug proved different than standard care or placebo. Hydroxychloroquine and vitamin C combined with zinc probably increase the risk of adverse effects leading to drug discontinuation—risk difference for hydroxychloroquine (RD) 6 more per 1000 (95% credible interval (CrI) 2 more to 10 more); for vitamin C combined with zinc, RD 69 more per 1000 (47 more to 90 more), moderate certainty evidence.
Much of the evidence remains very low certainty and we therefore anticipate future studies evaluating drugs for prophylaxis may change the results for SARS-CoV-2 infection, admission to hospital and mortality outcomes. Both hydroxychloroquine and vitamin C combined with zinc probably increase adverse effects.
This review was not registered. The protocol established a priori is included as a supplement.
This study was supported by the Canadian Institutes of Health Research (grant CIHR-IRSC:0579001321).
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