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Mental Health, Health-related Quality of Life and Behaviors among Outpatients during the COVID-19 Pandemic: A Multiple Hospitals and Health Centers Study in Vietnam

為了解決ai-1 sport ptt的問題，作者NGUYEN HOANG MINH 這樣論述：

BackgroundGlobally, the coronavirus disease (COVID-19) pandemic has been placing unprecedented challenges and burdens on various aspects of life, such as economics, culture, politics, education, and healthcare. The uncertainty of COVID-19 increases concerns and fear in the communities, especially i

n those with symptoms like COVID-19 (S-LikeCV19). Additionally, many countries have implemented preventive measures (e.g., lockdown, home confinement, social distancing), leading to considerable changes in peoples’ lives, such as working and learning from home, unemployment, lack of physical connect

ion, and food insecurity. Besides, it is reported that people with underlying health conditions (UHC) and infected with COVID-19 have a higher risk of serious symptoms and complications. Therefore, COVID-19-related factors (e.g., fear, lockdown, S-LikeCV19) and UHC may influence peoples’ psychologic

al health and health behaviors, further lowering their health-related quality of life (HRQoL). Furthermore, people who need health services encountered many challenges during the pandemic, such as difficulties in accessibility, examination and treatment delays, and concerns about COVID-19 infection.

From a public health perspective, it is crucial to understand the impacts of COVID-19-related factors and explore protective factors that can improve lifestyles, psychological health, and HRQoL in outpatients. In addition, due to unavailable specific treatments, non-pharmaceutical interventions (e.g

., adherence to preventive measures, health knowledge improvement, healthy lifestyles) are highly recommended to mitigate the consequences of the COVID-19 pandemic.Therefore, this study was conducted on outpatients during the initial stage of the COVID-19 pandemic for the following purposes:(1) To e

xplore the impacts of UHC, S-LikeCV19, and lockdown on anxiety and depressive symptoms; and examine the modification effects of health behaviors (e.g., eating behaviors, physical activity, smoking, drinking) and preventive behaviors.(2) To explore impacts of UHC, S-LikeCV19, lockdown, and fear of CO

VID-19 (F-CV19) on HRQoL; and examine the modification effects of health literacy, eHealth literacy (eHEALS), digital healthy diet literacy (DDL).(3) To explore impacts of UHC, S-LikeCV19, lockdown, and fear of COVID-19 (F-CV19) on changes in eating behaviors and physical activity; and examine the m

odification effects of eHEALS, DDL.MethodsA cross-sectional study was conducted from 14th February to 31st May 2020 in 18 hospitals and health centers in Vietnam. Data were obtained from 8291 outpatients, including socio-demographic characteristics, UHC, S-LikeCV19, F-CV19, health-related behaviors

(smoking, drinking, eating behaviors, and physical activity), preventive behaviors, eHEALS, DDL, depression (measured by 9-item Patient Health Questionnaire), anxiety (measured by 7-item Generalized Anxiety Disorders), and HRQoL (measured by 36-item Short Form Survey). In addition, multiple linear a

nd logistic regression; and interaction models were performed to explore potential associations.ResultsThe prevalence of anxiety and depression was 12.5% and 22.3%, respectively. Patients with UHC had 3.44 times higher anxiety likelihood and 2.71 times higher depression likelihood, while patients wi

th S-LikeCV19 had 3.31 times higher anxiety likelihood and 3.15 times higher depression likelihood than their counterparts. Similarly, patients under lockdown were 2.39 and 2.89 times more likely to have anxiety and depression than those without lockdown, respectively. Interaction models indicated h

igh compliance with preventive behaviors, unchanged/more physical activity, and unchanged/healthier eating behaviors significantly attenuated the associations of UHC, S-LikeCV19, and lockdown with anxiety and depressive symptoms. In addition, unchanged/more alcohol drinking significantly attenuated

the association between UHC and anxiety. Furthermore, the association between S-LikeCV19 and depression was attenuated by higher health literacy scores in outpatients during the pandemic.This study showed that only fear of COVID-19 was negatively associated with HRQoL (B, -0.79; 95% CI, -0.88 to -0.

70; p < 0.001). Interaction models suggested that the inverse association between F-CV19 and HRQoL was mitigated by higher eHEALS scores or higher DDL scores.Patients with UHC, or with S-LikeCV19, or under lockdown had 54%, 52%, and 62% lower likelihoods of unchanged/healthier eating behaviors, and

21%, 58%, and 22% lower likelihoods of unchanged/more physical activity. Interaction models indicated that the association between lockdown and eating behaviors was significantly attenuated by higher DDL scores. Meanwhile, the association between lockdown and physical activity was significantly miti

gated by higher eHEALS scores. There was no statistically significant interaction of UHC and S-LikeCV19 with DDL and eHEALS on changes in health behavior outcomes.Conclusions:During the pandemic, patients under lockdown period, or with UHC, or S-LikeCV19 were more likely to have anxiety and depressi

ve symptoms; and less likely to have unchanged/healthier eating behaviors and unchanged/more physical activity. In addition, patients with higher F-CV19 were more likely to have poorer HRQoL.High adherence to preventive behaviors, physical activity, and healthy eating behaviors could mitigate the ne

gative impacts of UHC, S-LikeCV19, and lockdown on anxiety and depression. In addition, higher health literacy could mitigate the impact of S-LikeCV19 on depression during the pandemic. Besides, alcohol drinking was found to lower the impact of UHC on anxiety.Moreover, better eHEALS and DDL could mi

tigate the adverse impacts of F-CV19 on HRQoL. Higher eHEALS could help to alleviate the impact of lockdown on physical activity, while higher DDL could mitigate the impact of lockdown on eating behaviors.Our findings provide timely and reliable evidence for appropriate strategies to enhance healthy

lifestyles, preventive behaviors, eHEALS, and DDL, thereby preventing outpatients from psychological disorders and improving their HRQoL during the pandemic.

發展與測試運用SMART設計運動介入對降低肥胖社區居民內臟脂肪之成效

為了解決ai-1 sport ptt的問題，作者張祐瑄 這樣論述：

背景：內臟脂肪堆積與肥胖有高度相關且會導致高血壓、心血管疾病及胰島素阻抗，根據文獻可知藉由運動可以有效改善。然而，目前最佳降低內臟脂肪的運動策略仍無一致的共識。目的：本研究主要的目的為發展與測試針對肥胖的社區民眾有效降低內臟脂肪的運動種類和處方內的運動次序。研究目標包含確認最佳降低內臟脂肪的運動策略，以及探討降低內臟脂肪的重要因素。方法：以立意取樣招募台灣南部40至64歲、無飲食熱量限制之男性體脂超過25%及女性體脂超過30%的社區居民。以序貫多重隨機試驗方法(sequential multiple assignment randomized trial, SMART)進行為期共16週、二階

段各8週的運動介入。受試者於第一階段接受隨機分配至每週3次(含兩次監督下的運動和一次在家運動)、為期8週的30分鐘至少中強度有氧運動組或20分鐘間歇運動組。以身體組成分析儀進行測量，若其內臟脂肪比起受試前未降低大於3%，則於第二階段1:1隨機分配至中強度有氧運動合併額外的10分鐘抗阻力運動組或交換進入第一階段另一組的治療組(高強度間歇運動或有氧運動)。若受試者於第一階段介入後內臟脂防降低大於3%，則持續維持第一階段的運動直至16週。內臟脂肪測量的時間點包含研究介入前(T0)、第一階段結束後(T1)及第二階段結束後(T2)。所收集的資料以廣義估計式(Generalized estimating

equations) 和羅吉斯迴歸 (logistic regression) 分析最佳降低內臟脂肪的運動種類及探討預測第一階段內臟脂肪降低的重要因素。研究結果：本研究共招募116位個案並接受第一階段的隨機分派至有氧運動組(58位)及高強度間歇運動組(58位)。共有53位個案完成第一階段的有氧運動，其中34人有氧運動在第一階段結束後內臟脂肪下降3%以上，故第二階段持續有氧運動直至16週結束(組別A)；無明顯效果者則接受第二次的隨機分派至有氧合併抗阻力運動組(9位，組別B)或高強度間歇運動組(10位，組別C)。共有54位個案在第一階段完成高強度間歇運動，其中29人內臟脂肪下降3%以上，故第二階段

持續高強度間歇運動直至16週結束(組別D)；無明顯反應者則接受第二次的隨機分派至有氧合併抗阻力運動組(14位，組別E)或有氧運動組(11位，組別F)。研究整體的流失率為12.93%，包含9位在第一階段和6位在第二階段過程中退出。各組個案對於運動的遵從性為68.18%至80.15%。第一階段8週後的運動結果顯示，有氧運動降低內臟脂肪的效果優於高強度間歇運動(β = −4.10, P = 0.029)。針對第一階段對有氧運動無明顯效果者，組別C的內臟脂肪下降成效在第二階段優於組別B (β = -7.36, P = 0.006)；針對第一階段對高強度間歇運動無明顯效果者，第二階段中組別E和組別F降內

臟脂肪則無明顯差異。為期二階段16週最佳的運動策略，組別A和組別D兩組無統計上差異，並且在第一和第二階段皆優於其他四組。羅吉斯迴歸結果顯示接受有氧運動的個案在運動介入前內臟脂肪≧100 cm2者，比起內臟脂肪< 100 cm2有較高的勝算比(OR = 8.80, p = 0.019)、以及三酸甘油脂