AT improves psychopathology in Asian patients with schizophrenia following an acute exacerbation of illness.

BackgroundPoor adherence to medication in schizophrenia spectrum disorders leads to inadequate symptom control. Adherence therapy (AT) is an intervention that seeks to reduce patients’ psychiatric symptoms by enhancing treatment adherence. We aimed to systematically review the trial evidence of the effectiveness of AT on improving clinical outcomes in these patients.MethodSystematic review and meta-analysis of published RCTs. We included studies testing AT as an adjunct intervention against treatment as usual or a comparator intervention in the general adult psychiatric population. The primary outcome of interest was improvement in psychiatric symptoms.ResultsWe included six studies testing AT in schizophrenia spectrum disorders published since 2006. A meta-analysis showed AT significantly reduced psychiatric symptoms compared to usual treatment over a follow-up period of less than 1 year. We found no significant effects of AT on patients’ adherence and adherence attitudes.ConclusionsAT is an effective adjunctive treatment for people with schizophrenia spectrum disorders.ProsperoCRD42015016779Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0801-1) contains supplementary material, which is available to authorized users.

Context: Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against 'aggressive' measures. Evidence Acquisition: This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences. Results: As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other. Conclusions: Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from 'moderate, severe or worst' pain.

Background Strengthening primary care is considered a global strategy to address non-communicable diseases and their comorbidity. However, empirical evidence of the longer-term benefits of capacity building programmes for primary care teams contextualised for low- and middle-income countries is scanty. In Thailand, a series of system-based capacity building programmes for primary care teams have been implemented for a decade. An analysis of the relationship between these systems-based trainings in diverse settings of primary care and quantified patient outcomes was needed. Methods Facility-based and community-based cross-sectional surveys were used to obtain data on exposure of primary care team members to 11 existing training programmes in Thailand, and health profiles and health-related quality of life of their patients measured in EuroQol-5 Dimension (EQ-5D) scale. Using a multilevel modelling, the associations between primary care provider’s training and patient’s EQ-5D score were estimated by a generalized linear mixed model (GLMM). Results While exposure to training programmes varied among primary care teams nationwide, District Health Management Learning (DHML) and Contracting Unit of Primary Care (CUP) Leadership Training Programmes, which put more emphasis on bundling of competencies and contextualising of applying such competencies, were positively associated with better health-related quality of life of their multimorbid patients. Conclusions Our report provides systematic feedback to a decade-long investment on system-based capacity building for primary care teams in Thailand, and can be considered as new evidence on the value of human resource development in primary care systems in low- and middle-income countries. Building multiple competencies helps members of primary care teams collaboratively manage district health systems and address complex health problems in different local contexts. Coupling contextualised training with ongoing programme implementation could be a key entity to the sustainable development of primary care teams in low and middle income countries which can then be a leverage for improving patients outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0951-6) contains supplementary material, which is available to authorized users.

Background: Flooding is recognizing as a risk element that effect many difficulties to children and could impact to their academic performance. In order to buffer such risk condition, some abilities are required to overcome that situation. One of abilities is resilience. The main purpose of this study was to investigate predictor of internal factors (age, illness, gender, emotion, behaviour, spirituality and physical activity) in resilience of elementary school-aged children who exposed the major flood in Serang, Indonesia. The framework used in this study was Resilience Model proposed by Karol Kumpfer.Methods: A cross-sectional correlation design was employed to accomplishing the study. The total final samples were 162 children who were 9-12 years and who were studied in 3rd to 6th years. All of them are those who were exposed to major flood in Undar Andir, Serang, Indonesia in 2013. The instruments used were self-report questionnaires. The Connor-Davidson Resilience Scale- 10, The Daily Spiritual Experience Scale, The Strengths and Difficulties Questionnaire and The Physical Activity Questionnaire were utilized in this study after the validity and reliability test. Pearson’s correlation, point biserial and multiple regressions were employed for analysing data.Results: The results showed that there were significant correlated between behaviour (r = 0.157, p <0.05), spirituality (r = 0.261, p<0.01), physical activity (r = 0.185, p<0.05), and resilience of children. However, age, illness, gender, and emotion were not significantly correlated with resilience. In multiple regressions, spirituality showed as a predictor of resilience (Beta = 0.213, p <0.05) in children after exposing the flood.Conclusions: In conclusions, flooding is considered as a risk for children. In order to prevent the potential problems due to flood, children need protective factor. This study discovered that high spirituality increases resilience of children. Therefore, spirituality is well thought-out as an internal protective factor of resilience. This study suggested the developing of nursing intervention with religion-activities.