RESUMEN
STUDY DESIGN: A process evaluation of a clinical trial. OBJECTIVES: To describe the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial research study called 'My Care My Call', a novel telephone-based, peer-led self-management intervention for adults with chronic SCI 1+ years after injury. SETTING: Connecticut and Greater Boston Area, MA, USA. METHODS: Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. Self-management was the focus of each 6-month PHC-peer relationship. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application. RESULTS: PHCs performed three principal roles: Role Model, Supporter, and Advisor. Role Model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As Supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of Advisor using CTs and IDSs to teach and strategize with peers about SCI self-management. CONCLUSION: The SCI PHC performs a powerful, flexible role in promoting SCI self-management among peers. Analysis of PHC roles can inform the design of peer-led interventions and highlights the importance for the provision of peer mentor training.
Asunto(s)
Tutoría , Grupo Paritario , Automanejo , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/rehabilitación , Comunicación , Humanos , Relaciones Interpersonales , Aprendizaje , Evaluación de Procesos, Atención de Salud , Investigación Cualitativa , Apoyo Social , TeléfonoRESUMEN
AN is a serious mental illness best treated in the community. Those with critically low weight require hospitalisation. There is little published research on AN in Ireland. The aim of this audit was to evaluate the Irish experience. The mean age on admission was 13.5 yrs which is 6 mo earlier than 2002 figures. Boys represented 6/20 (30%) of admissions. On admission girls were more underweight than boys (0.4th centile V 9th centile for BMI). This was despite girls presenting to hospital sooner than boys post onset of symptoms. Aside from low weight, over-exercising and food restricting were the most common presenting features. Inpatient weight restoration is successful with a mean weekly weight gain of 930g which is within the recommended range of 500-1000g/wk. Mean hospital stay was 38 days.
Asunto(s)
Anorexia Nerviosa/epidemiología , Hospitales Pediátricos/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Adolescente , Peso Corporal , Femenino , Estudios de Seguimiento , Humanos , Irlanda/epidemiología , Tiempo de Internación/tendencias , Masculino , Pronóstico , Estudios RetrospectivosRESUMEN
STUDY DESIGN: Single-blind randomized controlled trial of 6 months' duration. OBJECTIVES: To evaluate the efficacy of a novel telehealth intervention, 'CareCall', on reducing pressure ulcers and depression and enhancing the use of appropriate health care. SETTING: General community, Massachusetts and Connecticut, United States METHODS: 'CareCall' is an automated, interactive voice response system that combines patient education, cognitive behavioral interventions, screening and referrals, with alerts to a nurse telerehabilitation coordinator for direct non-emergent phone follow up. Participants consisted of a convenience sample of 142 persons with multiple sclerosis or spinal cord injury using a wheelchair >6 h per day. The intervention group received CareCall (n=71) The control group received usual care (n=71). The main outcome measures were: The pressure ulcer scale for healing tool, Patient Health Questionnaire-9 depression scale, Cornell Services Index and Craig Hospital Inventory of Environmental Factors-Short Form Question 5. RESULTS: CareCall achieved a reduction in presence of pressure ulcers at 6 months in women (P<0.0001). Among those with baseline depression, CareCall reduced 6-month severity of depression, adjusting for age and gender (P<0.047). CareCall did not have a significant impact on health-care utilization (OR=1.8, P=0.07), but did significantly improve participants' report of health-care availability (OR=2.03, P<0.04). CONCLUSION: This is the first study to demonstrate the efficacy of a largely automated telehealth intervention for adults with spinal cord dysfunction. Future research needs to replicate this study in a larger, multisite trial.
Asunto(s)
Úlcera por Presión/terapia , Enfermedades de la Médula Espinal/terapia , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Adulto , Anciano , Terapia Cognitivo-Conductual , Interpretación Estadística de Datos , Depresión/etiología , Depresión/psicología , Personas con Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/terapia , Enfermeras y Enfermeros , Educación del Paciente como Asunto , Proyectos Piloto , Úlcera por Presión/etiología , Úlcera por Presión/prevención & control , Calidad de Vida , Factores Socioeconómicos , Enfermedades de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Encuestas y Cuestionarios , Resultado del TratamientoAsunto(s)
Ortopedia , Pediatría , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Niño , Humanos , Estados UnidosRESUMEN
Four East Asian ethnic and four racial VNTR RFLP Southern California databases were used to determine the impact of population substructure on fixed-bin genotype probability estimates. Two calculations were used for population-level probabilities: Stratified sampling, which takes substructuring into account, and pooling, which ignores it. Using 1000 four-locus genotypes, the relative difference between probabilities calculated with the stratified and the pooled methods did not exceed one order of magnitude out of about 11 orders of magnitude for East-Asian racial genotypes. Pooled estimates differed from cognate ethnic values by less than one order of magnitude out of about six. These findings suggest substructuring of races by major ethnic groups does not lead to large errors. Racial genotype probability variances were on average about twice the ethnic variances. Multi-racial total population probabilities calculated by the pooled and stratified methods differed by less than one order of magnitude out of five.
Asunto(s)
Población Negra/genética , Etnicidad/genética , Etnicidad/estadística & datos numéricos , Frecuencia de los Genes , Repeticiones de Minisatélite , Polimorfismo de Longitud del Fragmento de Restricción , Población Blanca/genética , Asiático , California/etnología , Interpretación Estadística de Datos , Bases de Datos Factuales/estadística & datos numéricos , Genotipo , Hispánicos o Latinos , Humanos , Probabilidad , Análisis de RegresiónRESUMEN
Bootstrapping was used to examine the effect of sampling error and measurement error and its correlation on fixed-bin genotype probabilities. Bootstrap confidence intervals (Cls) were made relative to the point estimate using the log of the inverse of the probabilities. From databases of 200-250 genotypes, sampling error alone yielded median relative 95% CIs of from one order of magnitude out of five for one locus to one out of ten for four loci. Measurement error of the test genotype fragments increased the latter to about one order of magnitude out of eight. Database measurement error and its correlation had only a slight effect on multi-locus probability uncertainty. Together, these uncertainties are several orders of magnitude greater than error due to population substructuring of a race by its major component ethnic groups.
Asunto(s)
Repeticiones de Minisatélite , Polimorfismo de Longitud del Fragmento de Restricción , Proyectos de Investigación/estadística & datos numéricos , Intervalos de Confianza , Interpretación Estadística de Datos , Genotipo , Humanos , Probabilidad , Reproducibilidad de los Resultados , Muestreo , Sesgo de SelecciónRESUMEN
To examine the impact that intra- and interracial genetic diversities have on VNTR RFLP-fragment-size distributions, a multiracial (East Asian, African American, U.S. Southwest Hispanic, and European Caucasian) and multiethnic (Chinese, Japanese, Korean, and Vietnamese) database has been constructed for the following loci: D1S7, D2S44, D4S139, and D10S28. Homogeneity between samples was examined using the Komologorov-Smirnov two-sample test for RFLP fragment sizes and a log-likelihood test for fixed-bin frequencies with theoretical and Monte Carlo empirical significance levels. Small but significant differences between theoretical and empirical significance-level distributions were observed with both procedures, particularly with the latter. The significance levels of the two types of tests were poorly correlated. Statistically significant differences in fragment-size and fixed-bin distributions were found within and between races, with greater differences occurring between races. Cluster analysis and principal components analysis, using different similarity measures, did not support the hypothesis of greater intra- than interracial diversity, which suggests that ethnic variation can be conservatively estimated by racial variation.
Asunto(s)
Etnicidad/genética , Medicina Legal/métodos , Repeticiones de Minisatélite/genética , Polimorfismo de Longitud del Fragmento de Restricción , Grupos Raciales/genética , Estadística como Asunto/métodos , Análisis por Conglomerados , Bases de Datos Factuales , Humanos , Modelos Estadísticos , Método de Montecarlo , Análisis MultivarianteRESUMEN
A case of cornual pregnancy was uncertain at laparoscopy, made by ultrasound, and confirmed at laparotomy.