RESUMO
AIMS: Patients with Chagas disease and heart failure (HF) have a poor prognosis similar to that of patients with ischaemic or dilated cardiomyopathy. However, the impact of body composition and muscle strength changes in these aetiologies is still unknown. We aimed to evaluate these parameters across aetiologies in two distinct cohort studies [TESTOsterone-Heart Failure trial (TESTO-HF; Brazil) and Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF; Germany)]. METHODS AND RESULTS: A total of 64 male patients with left ventricular ejection fraction ≤40% were matched for body mass index and New York Heart Association class, including 22 patients with Chagas disease (TESTO-HF; Brazil), and 20 patients with dilated cardiomyopathy and 22 patients with ischaemic heart disease (SICA-HF; Germany). Lean body mass (LBM), appendicular lean mass (ALM), and fat mass were assessed by dual energy X-ray absorptiometry. Sarcopenia was defined as ALM divided by height in metres squared <7.0 kg/m2 (ALM/height2 ) and handgrip strength cut-off for men according to the European Working Group on Sarcopenia in Older People. All patients performed maximal cardiopulmonary exercise testing. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Chagasic and ischaemic patients had lower total fat mass (16.3 ± 8.1 vs. 19.3 ± 8.0 vs. 27.6 ± 9.4 kg; P < 0.05) and reduced peak oxygen consumption (VO2 ) (1.17 ± 0.36 vs. 1.15 ± 0.36 vs. 1.50 ± 0.45 L/min; P < 0.05) than patients with dilated cardiomyopathy, respectively. Chagasic patients showed a trend towards decreased LBM when compared with ischaemic patients (48.3 ± 7.6 vs. 54.2 ± 6.3 kg; P = 0.09). Chagasic patients showed lower handgrip strength (27 ± 8 vs. 37 ± 11 vs. 36 ± 14 kg; P < 0.05) and FBF (1.84 ± 0.54 vs. 2.75 ± 0.76 vs. 3.42 ± 1.21 mL/min/100 mL; P < 0.01) than ischaemic and dilated cardiomyopathy patients, respectively. There was no statistical difference in the distribution of sarcopenia between groups (P = 0.87). In addition, FBF correlated positively with LBM (r = 0.31; P = 0.012), ALM (r = 0.25; P = 0.046), and handgrip strength (r = 0.36; P = 0.004). In a logistic regression model using peak VO2 as the dependent variable, haemoglobin (odds ratio, 1.506; 95% confidence interval, 1.043-2.177; P = 0.029) and ALM (odds ratio, 1.179; 95% confidence interval, 1.011-1.374; P = 0.035) were independent predictors for peak VO2 adjusted by age, left ventricular ejection fraction, New York Heart Association, creatinine, and FBF. CONCLUSIONS: Patients with Chagas disease and HF have decreased fat mass and exhibit reduced peripheral blood flow and impaired muscle strength compared with ischaemic HF patients. In addition, patients with Chagas disease and HF show a tendency to have greater reduction in total LBM, with ALM remaining an independent predictor of reduced functional capacity in these patients. The percentage of patients affected by sarcopenia was equal between groups.
Assuntos
Doença de Chagas , Insuficiência Cardíaca , Idoso , Brasil/epidemiologia , Alemanha , Força da Mão , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Força Muscular , Músculos , Volume Sistólico , Testosterona/análogos & derivados , Função Ventricular EsquerdaRESUMO
INTRODUCTION: While several previous meta-analyses have documented the short-term efficacy of cognitive-behavioral therapy (CBT), its long-term efficacy remains unknown. Posttraumatic stress disorder (PTSD) is a serious, debilitating, often chronic and disabling disease. OBJECTIVE: To estimate the long-term efficacy of CBT in the treatment of PTSD by assessing the maintenance of the effect after one year of follow-up. METHOD: We performed a systematic review through electronic database searches including ISI Web of Science, PubMed, PsycInfo and Pilots. We included randomized studies in which CBT was compared with a control group (waiting list or usual care) in adults with PTSD that reported at least one year of CBT follow-up. RESULTS: Our search identified 2,324 studies and 8 were selected. CBT was shown to be effective in the treatment of PTSD in the post-treatment period. Improvement in PTSD symptoms was statistically significant in relation to the control group. The improvement observed in the treatment group or single group (formed by both treatment group and control group, which was submitted to the intervention after a few weeks on the waiting list) was maintained in the follow-up. CONCLUSION: Due to the lack of control groups in the follow-up period in six of the eight studies included in this review, there is still no proper methodological basis to assert that CBT has lasting effects in the treatment of PTSD. Our study found serious methodological shortcomings and the need to fill this gap in the literature through the development of studies with robust and sophisticated designs.
Assuntos
Terapia Cognitivo-Comportamental , Transtornos de Estresse Pós-Traumáticos/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do TratamentoRESUMO
Abstract Introduction: While several previous meta-analyses have documented the short-term efficacy of cognitive-behavioral therapy (CBT), its long-term efficacy remains unknown. Posttraumatic stress disorder (PTSD) is a serious, debilitating, often chronic and disabling disease. Objective: To estimate the long-term efficacy of CBT in the treatment of PTSD by assessing the maintenance of the effect after one year of follow-up. Method: We performed a systematic review through electronic database searches including ISI Web of Science, PubMed, PsycInfo and Pilots. We included randomized studies in which CBT was compared with a control group (waiting list or usual care) in adults with PTSD that reported at least one year of CBT follow-up. Results: Our search identified 2,324 studies and 8 were selected. CBT was shown to be effective in the treatment of PTSD in the post-treatment period. Improvement in PTSD symptoms was statistically significant in relation to the control group. The improvement observed in the treatment group or single group (formed by both treatment group and control group, which was submitted to the intervention after a few weeks on the waiting list) was maintained in the follow-up. Conclusion: Due to the lack of control groups in the follow-up period in six of the eight studies included in this review, there is still no proper methodological basis to assert that CBT has lasting effects in the treatment of PTSD. Our study found serious methodological shortcomings and the need to fill this gap in the literature through the development of studies with robust and sophisticated designs.
Resumo Introdução: Várias meta-análises anteriores documentaram a eficácia a curto prazo da terapia cognitivo-comportamental (TCC). No entanto, sua eficácia a longo prazo permanece desconhecida. O transtorno de estresse pós-traumático (TEPT) é uma doença crônica grave, debilitante e incapacitante. Objetivo: Estimar a eficácia a longo prazo da TCC no tratamento do TEPT, avaliando a manutenção do efeito após um ano de seguimento. Métodos: Realizamos uma revisão sistemática através de pesquisas nas bases de dados eletrônicas ISI Web of Science, PubMed, PsycInfo e Pilots. Incluímos estudos randomizados nos quais a TCC foi comparada com um grupo controle (lista de espera ou tratamento usual) em adultos com TEPT que relataram pelo menos um ano de seguimento da TCC. Resultados: A pesquisa identificou 2.324 estudos e 8 foram selecionados. A TCC mostrou-se eficaz no tratamento do TEPT no período pós-tratamento. A melhora nos sintomas de TEPT foi estatisticamente significativa em relação ao grupo controle. A melhora observada no grupo de tratamento ou grupo único (formado por ambos os grupos de tratamento e controle, que foi submetido à intervenção após algumas semanas na lista de espera) foi mantida no seguimento. Conclusão: Devido à ausência de grupo controle no período de follow-up em 6 dos 8 estudos incluídos nesta revisão, ainda não há base metodológica adequada para afirmar que a TCC tem efeitos duradouros no tratamento do TEPT. Nosso estudo encontrou graves deficiências metodológicas e a necessidade de preencher essa lacuna na literatura através de estudos com delineamentos robustos e sofisticados.
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Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Terapia Cognitivo-Comportamental , Fatores de Tempo , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Natural disasters can have devastating consequences. Each year, about 225 million people are victims of natural disasters worldwide, and up to 13,5 million of these people can develop post-traumatic stress disorder (PTSD) in the first or second year following the disaster. Cognitive-behavior therapy (CBT) is the first-choice treatment for this disorder. In order to evaluate the efficacy of psychotherapeutic treatment based on cognitive-behavior therapy for people who developed post traumatic stress disorder after natural disasters we conducted a systematic search of published studies. We used the terms reported below in the electronic databases ISI Web of Science, PsycINFO, PubMed, PILOTS and Scopus with no restrictions of language or publication date. Articles that described randomized controlled, non-randomized controlled and non controlled studies on the efficacy of cognitive-behavior therapy for individuals diagnosed with post-traumatic stress disorder after exposure to a natural disaster were eligible for inclusion. The studies were required to use a standardized measure of effectiveness before and after the intervention and have a group of patients who had used cognitive-behavior therapy as the only intervention. Our search identified 820 studies, and 11 were selected for this review. These 11 studies involved 742 subjects, 10 related to earthquakes and 1 to a hurricane. The cognitive-behavior therapy techniques used were various: 7 studies used exposure therapy, 2 studies used problem solving, and the only 2 studies with adolescents used techniques including reconstructions and reprocessing of the traumatic experience. As limitations, the search involved only five electronic databases, no experts in the field were consulted, and the heterogeneity of the findings made it impossible to perform a meta-analysis. The results suggest the efficacy of cognitive-behavior therapy, particularly exposure techniques, for the treatment of post-traumatic stress disorder after earthquakes. However, further studies with stronger methodologies, i.e. randomized-control trials and non-randomized controlled trials, are needed.
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Terapia Cognitivo-Comportamental/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Ensaios Clínicos como Assunto , HumanosRESUMO
BACKGROUND: Non-remission rates to pharmacotherapy for anxiety disorders are related to higher relapse rates, decreased quality of life and greater functional impairment. Here we sought to investigate the efficacy of cognitive-behavior therapy (CBT) as a next-step strategy in the treatment of patients with anxiety disorders who did not remit after a pharmacological intervention. METHOD: We carried out a systematic review in the ISI, Pubmed and PsycINFO/PsychLit databases. Studies that did not use CBT and that did not focus on resistance to drug therapy were excluded. We considered resistant patients who failed to respond (did not fully remit) to an adequate trial of pharmacotherapy and still exhibited residual symptoms of anxiety disorder. RESULTS: We identified 603 references in our survey, of which 17 were included: eight were on OCD, five on panic disorder, and four on PTSD. No studies were found on social anxiety disorder and generalized anxiety disorder. We observed a lack of standardization of terminology and of definitions of resistance, which makes comparison of results difficult. Finally, all of the identified studies showed benefits from the addition of CBT as a next-step strategy. LIMITATIONS: A limited number of randomized controlled studies were found. CONCLUSIONS: CBT seems to be a promising next-step strategy for patients with anxiety disorders who did not remit with drug-based therapies. However, further clinical trials with strong methodological designs are needed to definitely establish its efficacy in this population.