Effectiveness health education and infant therapeutic group therapy on baby aged 0-6 months to prevent stunting risk factors: mother depression

Background: Stunting is a global and national problem that can be detected at the age of 2. Therefore, before this age, promotion efforts must be conducted to prevent stunting risk factors in the future. This study aims to determine the effect of health education and infant's Therapeutic Group Therapy on stunting's risk factor: maternal postpartum depression in Indonesia.Design and Methods: This study employed a quasi-experimental design with a pre-test and post-test with a control group. This study employed a purposive sampling technique, with 96 respondents divided into two groups. Intervention group 1 consisted of 48 people who received health education, and group 2 consisted of 48 people who received health education and infant's Therapeutic Group Therapy. The data were collected using the Depression Inventory-II (DI II) questionnaire with a bivariate analysis of the Wilcoxon test and frequency distribution.Results: The results show that health education and infant's Therapeutic Group Therapy significantly influence the risky factors in stunting: maternal depression. It can be concluded that there were significant changes in maternal postpartum depression in intervention group 1 and intervention group 2, but in intervention group 2 who got Health Promotion and Therapeutic Group Therapy (TKT) for Infants there was a bigger and more significant decrease.Conclusions: Nursing action, infants' Therapeutic Group Therapy, and health education are recommended to prevent risk factors for stunting: mother depression. The results of this study are expected to underlie the development of mental health promotion to prevent stunted against maternal depression and preventive programs. In addition, the research is expected to underly provision of curative and rehabilitative programs for stunted.

Thrombotic microangiopathy after kidney transplantation: Analysis of the Brazilian Atypical Hemolytic Uremic Syndrome cohort

Background Atypical Hemolytic Uremic Syndrome (aHUS) is an ultra-rare disease that potentially leads to kidney graft failure due to ongoing Thrombotic Microangiopathy (TMA). The aim was evaluating the frequency of TMA after kidney transplantation in patients with aHUS in a Brazilian cohort stratified by the use of the specific complement-inhibitor eculizumab. Methods This was a multicenter retrospective cohort study including kidney transplant patients diagnosed with aHUS. We collected data from 118 transplant centers in Brazil concerning aHUS transplanted patients between 01/01/2007 and 12/31/2019. Patients were stratified into three groups: no use of eculizumab (No Eculizumab Group), use of eculizumab for treatment of after transplantation TMA (Therapeutic Group), and use of eculizumab for prophylaxis of aHUS recurrence (Prophylactic Group). Results Thirty-eight patients with aHUS who received kidney transplantation were enrolled in the study. Patients’ mean age was 30 years (24–40), and the majority of participants was women (63% of cases). In the No Eculizumab Group (n = 11), there was a 91% graft loss due to the TMA. The hazard ratio of TMA graft loss was 0.07 [0.01–0.55], p = 0.012 in the eculizumab Prophylactic Group and 0.04 [0.00–0.28], p = 0.002 in the eculizumab Therapeutic Group. Conclusion The TMA graft loss in the absence of a specific complement-inhibitor was higher among the Brazilian cohort of kidney transplant patients. This finding reinforces the need of eculizumab use for treatment of aHUS kidney transplant patients. Cost optimization analysis and the early access to C5 inhibitors are suggested, especially in low-medium income countries.

Improving Adolescent Mental Health Development through Therapeutic Group Therapy in Saint Beatrix Orphanage, Sidoarjo

Adolescents who live at an orphanage may be at risk of mental disorders among adolescents. As adolescent orphans usually have bad memories, therapeutic groups are alternatives to overcome this issue. A civic engagement program was conducted to tackle development issues in adolescents as it performed a therapeutic approach with their peers. This program involved twenty-one female adolescents in Saint Beatrix orphanage Sidoarjo. They took a pre-test, which indicated a low level of knowledge about adolescent development. Group therapy was conducted in seven sessions, each of which took an hour. In the evaluation stage, questionnaires were distributed to test the adolescents’ knowledge about adolescent development. After conducting the therapeutic group therapy, it showed that adolescents’ knowledge about the development stages and their challenges improved. Based on the result of the Wilcoxon Sign Rank Test, it's known that p-value = 0,000 with (ɑ<0.05), which means therapeutic group therapy may enhance knowledge about adolescent development stages to promote a healthy lifestyle in adolescents

Therapeutic Group of The Elderly: Knowledge About Diabetes Mellitus and Arterial Hypertension

Control and the care are continuous challenges in the treatment of chronic diseases, and it is necessary to know the users’ realities in order to seek intervention alternatives. The study aimed to identify the participants’ knowledge in a therapeutic group of the elderly regarding diabetes mellitus and systemic arterial hypertension. Descriptive and exploratory study with a qualitative approach, conducted with 12 elderly in the therapeutic group. Semi-structured interviews were used as data collection technique. Data were transcribed and analyzed using the content analysis technique. In the results the category about the participants’ knowledge on the diseases emerged, namely: etiological factors; main signs, symptoms and complications; drug therapy; use of herbal medicines; food control; lifestyle and regular follow-up at the health unit. It was concluded that the participants have knowledge about the diseases; however, they cultivate habits that can trigger complications. Knowledge from experience should not be neglected, but should be directed towards achieving the goal of the therapeutic group, helping to improve the understanding of the elderly about their disease (s) and stimulating self-care.Keywords: Therapeutics. Health Education. Chronic Disease. Self-Care. ResumoO controle e o cuidado são desafios contínuos na terapêutica das doenças crônicas, sendo necessário conhecer as realidades dos usuários para buscar alternativas de intervenção. O estudo objetivou identificar o conhecimento dos participantes de um grupo terapêutico de idosos em relação ao diabetes mellitus e hipertensão arterial sistêmica. Estudo descritivo e exploratório, com abordagem qualitativa dos dados. A pesquisa foi realizada no munícipio de Itabuna na Bahia, na Unidade de Saúde da Família Simão Fitterman, no ano de 2014. Participaram do estudo 12 idosos do Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (HIPERDIA), que participaram das reuniões do grupo terapêutico de idosos. A técnica utilizada para coleta de dados foi a entrevista com roteiro semiestruturado, realizadas nas reuniões do grupo terapêutico da unidade referida. O instrumento de coleta foi composto por dados sócio demográficos, conceitos e fatores desencadeantes das doenças estudadas, tratamento não farmacológico, complicações, prevenção e noções de autocuidado. Concluiu-se que os participantes possuem conhecimento sobre as doenças, entretanto cultivam hábitos que podem desencadear complicações. O conhecimento advindo da experiência, não deve ser negligenciado, mas direcionado ao alcance do objetivo do grupo terapêutico, contribuindo na melhoria do entendimento dos idosos sobre sua (s) doença (s), e estimulando o autocuidado.Palavras-chave: Terapêutica. Educação em Saúde. Doença Crônica. Autocuidado.

A comparative study of total knee arthroplasty outcome for stiff knee with or without sequential antirheumatic drug treatment

Background The aim of this study was to evaluate the influence of antirheumatic drug treatment on knee function of stiff knee patients after total knee arthroplasty (TKA). Methods Twenty-seven patients (44 knees) of active RA (rheumatoid arthritis) or AS (ankylosing spondylitis) with stiff knees were included in this study. And they were divided into two groups according to continue antirheumatic drug treatment or not after TKA: the therapeutic group (16 patients, 27 knees) and the controlled group (11 patients, 17 knees). The outcomes were assessed by Knee Society Score (KSS), Visual Analogue Scale (VAS), range of motion (ROM) (at week 6, month 6, year 1, and year 2), “Forgotten Joint” Scale (FJS), with or without crutch, satisfaction, and revision (at year 2). The knee prosthetic loosening was evaluated by the followed X-ray at each following time. Results The mean follow-up time was 51 months (34–69 months). The KSS was higher at week 6 after TKA in the therapeutic group (p < 0.05); however, the functional scores of KSS at month 6, year 1, and year 2 in the controlled group were more points improved. The therapeutic patients preferred the knee more at month 6, year 1, and year 2. The differences of KSS clinical scores (at month 6, year 1, and year 2), VAS, ROM, Crutch and FJS between the two groups were not statistically significant (p > 0.05). Conclusion For patients with stiff knees, the sequential antirheumatic drug treatment after TKA had no obvious effect on postoperative KSS, but can improve the satisfaction. Level of evidence Therapeutic level II. See Instructions for Authors for a complete description of levels of evidence.

Enhancing the application of therapeutic group therapy (TKT) for school-age children in Delima, Pekanbaru

Children are highly prone to certain psychological challenges, particularly at elementary level. These problems are predominantly influenced by environmental and academic conditions. Therefore, this research aims to stimulate the growth and development of school-age children from various perspectives. This activity was conducted at Al-Qur'an Education Park, Baitul Arsy Mosque, Hamlet 008, Delima village, Tampan sub-district, Pekanbaru, between September-December 2020. Additionally, the class II-VI students were selected as the participants during the seven TKT sessions. The research implementation incorporated description, modeling, role-playing, feedback and transfer techniques. Session 1 comprised of a comprehensive analysis on the growth and developmental characteristics of the school-age children. Meanwhile, sessions 2, 3, 4, 5 and 6 involved the stimulations of motor, cognitive and language, emotional and personality, moral and spiritual as well as the psycho-social perspectives. However, session 7 encompassed the overall stimulation from 1-6. The students are more knowledgeable about self-responsibility and psychological changes. This phenomenon tends to boost confidence as well as the ability to establish friendships and improve academic learning.

Therapeutic versus Prophylactic Anticoagulation for Patients Admitted to Hospital with COVID-19 and Elevated D-dimer Concentration (ACTION): An Open-Label, Multicentre, Randomised, Controlled Trial

Background. COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. Methods. We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged ≥18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0·3–0·7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed. Findings. From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28.899 (34.8%) wins in the therapeutic group and 34.288 (41.3%) in the prophylactic group (win ratio 0.86 [95% CI 0.59–1.22], p=0·40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3.64 [95% CI 1.61–8.27], p=0.0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group. Interpretation. In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation.

A Comparative Study of Total Knee Arthroplasty Outcome for Stiff Knee with or without Sequential Antirheumatic Drug Treatment

BackgroundTo evaluate influence of antirheumatic drug treatment on knee function of patients with stiff knee after total knee arthroplasty (TKA). MethodsTwenty-seven patients (44 knees) of active RA (rheumatoid arthritis) or AS (ankylosing spondylitis) with stiff knee were included in this study. And they were divided into two groups according to continue antirheumatic drug treatment or not after TKA: the therapeutic group (16 patients, 27 knees) and the controlled group (11 patients, 17 knees). The outcomes were assessed by Knee Society Score (KSS), Visual Analogue Scale (VAS), range of motion (ROM) (at week 6, month 6, year 1 and year 2), “Forgotten Joint” Scale (FJS), with or without crutch, satisfaction and revision (at year 2). The knee prosthetic loosening was evaluated by the followed X-ray at each following time. ResultsThe mean follow-up time was 51 months (34-69 months). The KSS were higher at week 6 after TKA in the therapeutic group (p < 0.05), however, the functional scores of KSS at month 6, year 1 and year 2 in the controlled group were more points improved. The therapeutic patients preferred the knee more at month 6, year 1 and year 2. The differences of KSS clinical scores (at month 6, year 1 and year 2), VAS, ROM, Crutch and FJS between the two groups were not statistically significant (p＞0.05). ConclusionFor patients with stiff knees, the sequential antirheumatic drug treatment after TKA had no effect on postoperative KSS, but can improve the satisfaction.Level of evidenceTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Nicolás Caparrós (1941–2021): A larger-than-life group analyst

This is a homage to Nicolás Caparrós, in memoriam. He was an unusual, and universal, psychiatrist, psychoanalyst and group analyst, who developed an analytic and bonding model which was closely related to Bowlby’s conception of group attachment. In his therapeutic group technique, Dr Caparrós was decidedly idiosyncratic, integrative and inclusive. He was a Bionian, intellectually, when it came to defining unconscious defence mechanisms. However, his interventions within the group had a more distinct Foulkesian essence, as he put the emphasis on communication. Foulkes had sought to keep communication alive in his groups, to the point of considering it identical to the process of therapy itself. For Dr Caparrós, communication generates the group, defines it and maintains it.

The Impact of Introducing Successive Biosimilars on Changes in Prices of Adalimumab, Infliximab, and Trastuzumab—Polish Experiences

Biosimilars are cheaper than original drugs and are thus of interest to the public. The aim of this article is to assess the benefits of introducing more than one biosimilar for the same substance (active pharmaceutical ingredient, API). The hypothesis is that the introduction of successive biosimilars of a specific original drug reduces the price of the selected API. The study focuses on drug prices varying with the successive arrival of new biosimilars. Three drugs that have at least three reimbursed biosimilars on the market were selected, two from the same therapeutic group (adalimumab and infliximab) and one (trastuzumab) representing another class of drugs. The following data were analyzed: price variation after the introduction of the first, second, and third biosimilar, and the average price reduction for all three biosimilars. Additionally, a literature review was conducted. The reimbursement of each new biosimilar is beneficial since it is associated with a price reduction in percentage terms. However, the first biosimilar brought about the greatest savings due to the higher initial prices of the original drugs and to Polish reimbursement rules. This article is helpful for when taking healthcare decisions regarding the pricing of and reimbursement for new biosimilars.