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Vacuum‐assisted closure therapy combined with bi‐pectoral muscle flap for the treatment of deep sternal wound infections

Abstract

Deep sternal wound infection (DSWI) is a fatal complication after median sternotomy. This study was to assess the effect of vacuum‐assisted closure (VAC) combined with bi‐pectoral muscle advancement flap therapy on rehabilitation for the treatment of DSWI. Fifty‐two patients with DSWI underwent treatment of VAC and bi‐pectoral muscle flap. These patients were followed‐up 12 months postoperation. The patient characteristics, duration of VAC therapy, the mean hospital stay, and postoperative complications were retrospectively analysed. All patients underwent 1 to 3 VAC treatment sessions before closure. Fifty‐one of 52 DSWI patients were cured to discharge; the mean hospital stay was 26.5 days. The drainage tube continued to drain a large amount of bloody fluid in three patients after the wound was closed. Respiratory failure occurred in one patient with severe mediastinal and pulmonary infections and died eventually in hospital. One patient died of acute cerebral haemorrhage during the12‐month follow‐up. VAC therapy combined with bi‐pectoral muscle flap is a simple and effective treatment for DSWIs with short hospital stays and few complications. However, this is a retrospective case series presentation with no comparison group; further large‐scale controlled studies are needed.

Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses 情绪劳动策略是否会对情绪枯竭和职业认同产生影响,反之亦然?源自新聘护士的证据

Abstract

Aims

The aim was to examine the reciprocal relationships of emotional labour strategies with emotional exhaustion and professional identity.

Design

This study adopted a four‐wave cross‐lagged panel design.

Methods

Survey data were collected in 2018 from a sample of 171 newly hired nurses from 58 hospitals in 11 provinces of China. Nurses’ emotional labour (i.e., deep acting and surface acting), emotional exhaustion and professional identity were repeatedly measured. Cross‐lagged panel analyses were conducted to examine the reciprocal relationships we hypothesized.

Results

We found that emotional exhaustion was positively related to surface acting (but not vice versa); deep acting was negatively related to emotional exhaustion (but not vice versa); professional identity was positively related to deep acting (but not vice versa).

Conclusion

Our findings suggest that deep acting and professional identity may decrease the level of emotional exhaustion, whereas emotionally exhausted nurses are more likely to employ surface acting strategies.

Impact

This research finding will have an impact on the nursing management. Healthcare managers may consider workshops or training and development programs that promote nurses’ professional identify to promote nurses’ use of deep acting and consequently reduce their level of emotional exhaustion, which has been associated with a variety of negative consequences, such as low quality of patient service, high medical accidents, and turnover rate.

目的

研究情绪劳动策略与情绪枯竭和职业认同的相互关系。

设计

本研究采用四波交叉滞后组设计。

方法

2018年,对我国11个省份58家医院的171名新聘护士进行问卷调查,收集数据。反复测量护士的情绪劳动(即深层伪装和表层伪装)、情绪枯竭和职业认同。采用交叉滞后组分析来检验我们先前假设的相互关系。

结果

我们发现,情绪枯竭与表层伪装呈显著正相关(反之不成立);深层伪装与情绪枯竭呈显著负相关(反之不成立);职业认同与深层伪装呈显著正相关(反之不成立)。

结论

我们的研究结果表明,深层伪装和职业认同可能会降低情绪枯竭的程度,而面临情绪枯竭的护士更有可能采用表层伪装策略。

影响

本项研究发现将对护理管理工作产生影响。医疗保健管理人员可能会考虑举办研讨会或开展培训和发展计划,以提高护士的职业认同感,从而促进护士采用深层伪装策略,降低他们的情绪枯竭程度。同时情绪枯竭还与各种负面影响有关,如患者服务质量低,医疗事故频发,人员流动率高。

The relationship of workplace violence and nurse outcomes: Gender difference study on a propensity score matched sample 工作场所暴力与护士结局的关系:倾向性评分匹配样本的性别差异研究

Abstract

Aims

To investigate workplace violence and nurse outcomes by comparing gender differences.

Design

A secondary analysis of cross‐sectional survey data.

Methods

Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi‐group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 – August 2014.

Results

Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses.

Conclusion

Male nurses experience more workplace violence by staff than female nurses. Besides responding emotionally to workplace violence like female nurses, male nurses also respond behaviourally.

Impact

What problem did the study address? Gender differences in workplace violence and its relationship to nurse outcomes. What were the main findings? Male nurses experienced more workplace violence than female nurses, linked directly to less intention to stay. Workplace violence linked to less job satisfaction and intention to stay in nurses was mediated by burnout. Where and on whom will the research have impact? Gender‐based prevention of and coping with workplace violence should be included in nursing training.

目的

通过比较性别差异,探讨工作场所暴力与护士结局的关系。

设计

横向调查数据的二次分析。

方法

通过国际医院结局研究中的四个项目对工作场所暴力进行衡量研究。护士结局以工作倦怠、工作满意度和留任意愿为衡量指标。我们采用倾向性评分匹配,生成一个由108名男性护士和288名女性护士组成的社会人口平衡数据集。基于情绪事件理论提出了一个假设关系模型。通过利用好比较统计方法和多组结构方程建模来分析性别差异。数据于2013年12月至2014年8月在中国收集。

结果

相比于女护士,男护士更容易遭受工作场所暴力,留任意愿较低。除了通过与女护士分享工作倦怠的调解作用(与情绪事件理论一致)外,工作场所暴力与男护士的留任意愿降低直接相关。

结论

男护士比女护士更容易遭受工作场所暴力。除了像女护士一样对工作场所暴力做出情绪反应外,男护士还会做出行为上的反应。

影响

本项研究解决了哪些问题?工作场所暴力的性别差异及其与护士去留的关系。主要结果是什么?男护士比女护士更容易遭受工作场所暴力,这与其留任意愿较低直接相关。工作场所暴力与工作满意度和留任意愿降低相关,且通过工作倦怠调解。本项研究将适用于何处且对哪些人产生影响?护理培训应包括基于性别的工作场所暴力预防和应对措施。

Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial

Abstract

Aims

To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet‐based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy.

Design

A prospective, single‐blinded, randomized controlled trial.

Methods

We performed a prospective, endoscopist‐blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017–March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection.

Results

A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ2 test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p < .001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p = .029) based on the χ2 test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group (p < .001) based on the χ2 test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively (p = .008), based on the χ2 test.

Conclusion

Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy.

Impact

This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation.

Trial registration: Chinese clinical trial registration number: ChiCTR1900024666.

Well‐being and thriving in sheltered housing versus ageing in place: Results from the U‐age sheltered housing study

Abstract

Aims

To explore to what extent type of residence (sheltered housing or ageing in place) contributes to thriving and well‐being in older adults, when controlling for age, sex, living alone, being a widow and adjusting for functional status, self‐rated health, and depressive mood.

Design

A matched cohort study.

Methods

A self‐report survey was sent out to a total population of residents in all sheltered housings in Sweden and a matched control group ageing in place (N = 3,805). The data collection took place between October 2016–January 2017.

Results

The interaction analyses related to thriving showed that with increasing level of depressive mood and decreasing levels of self‐rated health and functional status, those residing in sheltered housing generally reported higher levels of thriving, as compared with those ageing in place. Well‐being was not found to be significantly associated with type of accommodation.

Conclusion

There may be features in sheltered housing that are associated with resident thriving especially among individuals with impairments of function, health or mood, although further studies are required to identify these specific features.

Impact

This study informs staff and policymakers about thriving and well‐being in sheltered housing accommodations. These findings may be used to further the development of sheltered housing accommodations.

Development and psychometric properties of the maternal health needs scale in Chinese maternal women

There is very limited research on maternal health needs and no reliable validated research tools have been developed. The purpose of this study was to develop and test a Maternal Health Needs Scale (MHNS) in Chinese maternal women.

New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management m

Por: Zhu · Z. · Li · Y. · Meng · X. · Han · J. · Li · Y. · Liu · K. · Shen · J. · Qin · Y. · Zhang · H.
Introduction

Warfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation follow-up system after valve replacement surgery. This system will provide doctors and patients with more standardised and safer follow-up methods as well as a method to further reduce the risk of warfarin anticoagulation-related complications and improve its therapeutic effects.

Methods and analysis

A prospective, multicentre, randomised, controlled trial will be conducted. A total of 700 patients who require long-term warfarin anticoagulation monitoring after heart valve replacement will be enrolled and randomly divided at a 1:1 ratio into a traditional outpatient anticoagulation management group and a group undergoing a new method of management based on the internet technology with follow-up for 1 year. Differences in the percentage of time in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis and other related complications will be observed. The primary endpoint is the difference in the TTR between the two groups. The purpose of this study is to explore a safer and more effective mode of doctor–patient interaction and communication in the internet era. As of 13 July 2019, 534 patients had been enrolled.

Ethics and dissemination

This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. The results will be published in a peer-reviewed medical journal.

Trial registration number

ChiCTR1800016204.

Impact of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: protocol for a multicentre prospective study

Por: Li · D. · Dong · W. · Liu · Y. · Wang · J. · Mu · Y. · Zhou · H. · Wang · J. · Zhou · S. · Chen · Y.
Introduction

Metoprolol is the most frequently used β-receptor blockers; however, the prescribed dose in China is far less than the recommended doses in the guidelines. Based on the Chinese and International guidelines and the Chinese clinical practice, we are conducting this study (NCT03413410) to test the feasibility and tolerability of the metoprolol optimal dosing pathway by observing the percentage of patients achieving target dose in Chinese acute coronary syndrome (ACS) patients during hospitalisation.

Methods and analysis

A total of about 1000 patients aged ≥18 years, hospitalised for ACS will be enrolled from ~15 hospital sites in China between February 2018 and April 2019. The percentage of patients achieving the target metoprolol dosage at discharge is the primary endpoint. The secondary endpoints included the following: mean heart rate (HR) and blood pressure (BP) of the patients who have achieved target dose at discharge and during the follow-up period, percentage of patients experiencing bradycardia (HR

Ethics and dissemination

The study protocol has been approved by the Ethics committee of the Chinese PLA General Hospital (number: S2017-112-01). Study findings will be disseminated through presentations at national and international conferences and submitted for publications in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov registry (NCT03413410).

Design, development and randomised controlled trial of a smartphone application, 'QinTB, for smoking cessation in tuberculosis patients: study protocol

Por: Lin · H. · Lin · Y. · Zheng · Y. · Liu · Z. · Chang · C.
Introduction

Providing smoking cessation treatment is an important intervention for tuberculosis (TB) patients. Mobile technologies, such as smartphone applications, have shown promising potential. However, there are few effective applications that could support TB patients in their efforts to quit smoking. To address this problem, we will develop a smartphone application ‘QinTB’ to help TB patients quit smoking, and we will evaluate the clinical efficacy of this application by using a randomised controlled trial (RCT).

Methods and analysis

This is a two-step study. In the first step, we will develop a smartphone application based on an interactive application of the transtheoretical model and protection motivation theory. Then, we will perform an RCT using a two-arm design; a total of 400 patients will be randomly assigned to the application group or the doctors’ advice group; both treatments will be 6 months and follow-up will be 12 months; the primary outcome is the biochemically verified 6 month sustained abstinence rate; data will be analysed on an intention-to-treat basis.

Ethics and dissemination

This study was approved by the Ethics Committee of Beijing Research Institute for Tuberculosis Control and Prevention. We will disseminate the findings of this study through peer-reviewed publications and conference presentations.

Trial registration number

This study was registered in the Chinese Clinical Trial Registry (ChiCTR1900022008) and the stage is Pre-results.

Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment

imageBackground The relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment. Some researchers have found that health literacy risk may be associated with cognitive impairment in older adults. Objectives The purpose of this study was to delineate the difference in health literacy risk between older adults with mild cognitive impairment and those with normal cognitive function. Methods We conducted a survey study to explore the health literacy risk in older adults with and without mild cognitive impairment. Data were collected from 412 subjects between 60 and 91 years of age (260 without and 152 with mild cognitive impairment) between June and December 2016 in China. Cognitive function was measured using the Mini-Mental Status Examination, Montreal Cognitive Assessment, Global Deterioration Scale, Activities of Daily Living, and Hamilton Depression Rating Scale. Health literacy was measured using the Chinese Citizen Health Literacy Questionnaire. Results The scores of total health literacy and its three dimensions (basic health knowledge and mind, basic skills, and health lifestyle and behavior) were lower in those with mild cognitive impairment. Older adults with normal cognitive function had adequate or marginal health literacy levels, whereas those with mild cognitive impairment had marginal or inadequate health literacy levels. Using multiple logistic regression analysis, we found that health literacy risk, education level, age, marital status, and body mass index were independent risk factors for mild cognitive impairment. Discussion These results suggest that low health literacy may be a predictor of mild cognitive impairment. Screening for lower health literacy risk should be included in multidimensional geriatric evaluation.

Peripheral arterial disease screening and diagnostic practice: A scoping review

Abstract

Early reliable, valid screening, diagnosis, and treatment improve peripheral arterial disease outcomes, yet screening and diagnostic practices vary across settings and specialties. A scoping literature review described reliability and validity of peripheral ischaemia diagnosis or screening tools. Clinical studies in the PUBMED database January 1, 1970, to August 13, 2018, were reviewed summarising ranges of reliability and validity of peripheral ischaemia diagnostic and screening tools for patients with non‐neuropathic lower leg ischaemia. Peripheral ischaemia screening and diagnostic practices varied in parameters measured such as timing, frequency, setting, ordering clinicians, degree of invasiveness, costs, definitions, and cut‐off points informing clinical and referral decisions. Traditional ankle/brachial systolic blood pressure index <0.9 was a reliable, valid lower leg ischaemia screening test to trigger specialist referral for detailed diagnosis. For patients with advanced peripheral ischaemia or calcified arteries, toe‐brachial index, claudication, or invasive angiographic imaging techniques that can have complications were reliable, valid screening, and diagnostic tools to inform management decisions. Ankle/brachial index testing is sufficiently reliable and valid for use during routine examinations to improve timing and consistency of peripheral ischaemia screening, triggering prompt specialist referral for more reliable, accurate Doppler, or other diagnosis to inform treatment decisions.

Occurrence and multilocus genotyping of <i>Giardia duodenalis</i> from post-weaned dairy calves in Sichuan province, China

by Jiaming Dan, Xueping Zhang, Zhihua Ren, Liqin Wang, Suizhong Cao, Liuhong Shen, Junliang Deng, Zhicai Zuo, Shumin Yu, Ya Wang, Xiaoping Ma, Haifeng Liu, Ziyao Zhou, Yanchun Hu, Hualin Fu, Changliang He, Yi Geng, Xiaobin Gu, Guangneng Peng, Zhijun Zhong

Giardia duodenalis is a zoonotic parasitic protist and poses a threat to human and animal health. This study investigated the occurrence of G. duodenalis infection in post-weaned calves from Sichuan province, China. Faecal samples were collected from a total of 306 post-weaned calves (3–12 months old) from 10 farms, including 4 intensive feeding farms and 6 free-ranging farms. The overall infection rate of G. duodenalis was 41.2% (126/306) based on the PCR results at any of the three genetic loci: beta-giardin (bg), triose-phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes. Giardia duodenalis assemblages E (n = 115, 91.3%), A (n = 3, 2.4%), and A mixed with E (n = 8, 6.3%) were identified among the 126 positive specimens. Multilocus sequence typing of G. duodenalis revealed 34 assemblage E multilocus genotypes (MLGs), 1 assemblage A MLG and 7 mixed assemblage (A and E) MLGs. The eBURST data showed a high degree of genetic diversity within assemblage E MLGs. The phylogenetic tree revealed that MLG E3 was the primary MLG subtype in Sichuan province and also the most widely distributed in China.

Relations of magnesium intake to cognitive impairment and dementia among participants in the Womens Health Initiative Memory Study: a prospective cohort study

Por: Lo · K. · Liu · Q. · Madsen · T. · Rapp · S. · Chen · J.-C. · Neuhouser · M. · Shadyab · A. · Pal · L. · Lin · X. · Shumaker · S. · Manson · J. · Feng · Y.-Q. · Liu · S.
Objective

To examine the associations of dietary and supplemental magnesium (Mg) as assessed by a semi-quantitative food frequency questionnaire with cognitive outcomes among ageing women.

Design

This work conducts a prospective cohort study of participants enrolled in the Women’s Health Initiative Memory Study (WHIMS), which was subsequently extended and named WHIMS-Epidemiology of Cognitive Health.

Setting

Forty clinical centres in the USA.

Participants

Postmenopausal women aged 65–79 years without dementia on enrolment.

Main outcome measures

Physician-adjudicated mild cognitive impairment (MCI) and/or probable dementia (PD).

Results

Participants were excluded (n=1006) if they had extreme values of dietary energy intake, had missing or extreme body mass index values, with prevalent MCI/PD at baseline, received only one cognitive assessment or had been followed up for 20 years of follow-up, 765 (11.8%) out of 6473 participants developed MCI/PD. For MCI/PD and MCI, the risks tended to be lower among participants in quintiles Q2–Q5 of Mg consumption compared with those in the lowest quintile. Participants in Q3 had a significantly lower risk of MCI/PD (HR 0.69, 95% CI 0.53 to 0.91) and MCI (HR 0.63, 95% CI 0.45 to 0.87) after multivariate adjustments. No significant association was observed between total Mg intake and PD. The association between total Mg intake, MCI/PD and MCI was non-linear as suggested by the likelihood test.

Conclusions

Total Mg intake between the estimated average requirement and the recommended dietary allowances may associate with a lower risk of MCI/PD and MCI.

Trial registration number

NCT00685009.

A school-based, multi-faceted health promotion programme to prevent obesity among children: protocol of a cluster-randomised controlled trial (the DECIDE-Children study)

Por: Liu · Z. · Wu · Y. · Niu · W.-Y. · Feng · X. · Lin · Y. · Gao · A. · Zhang · F. · Fang · H. · GAO · P. · Li · H.-J. · Wang · H. · the study team for the DECIDE-children study · Wang · Liu · Lin · Feng · Li · Zhou · Li · Jin · Li · Cheng · Di Wang · Song · Zhou · Xu · Song · Gao · Chen · Shang
Introduction

Obesity is a public health concern that is becoming increasingly more serious worldwide. Effective and sustainable childhood obesity prevention strategies may help to reduce the prevalence of obesity and may have an impact on lifelong health. However, few such strategies have been rigorously evaluated for Chinese children in different regions of China.

Methods and analysis

The Diet, ExerCIse and CarDiovascular hEalth-Children is a cluster-randomised controlled trial that aims to assess the effectiveness and sustainability of a school-based, multi-faceted intervention to prevent obesity among Grade 4 primary school students (8–10 years old) in China. Twenty-four schools (approximately 1200 students) from above average, average and below average developed regions in China will be randomised to an intervention (12 schools) or usual practice (12 schools) group. The intervention will last for one school year (9 months) and consists of activities towards students, parents and school environment. A smartphone application will be used to assist in providing information on, monitoring and providing feedback on the behaviours and body weight of the students. Data will be collected at baseline, 4 months, 9 months and 21 months. The primary outcome will be the difference between groups in the change in students’ body mass index at 9 months after the baseline investigation. The secondary outcomes will include the differences between groups in the changes in anthropometric measures, diet, physical activity levels and other measures at the follow-up visits. A variety of process evaluation methods will be used to evaluate the implementation process of the complex intervention.

Ethics and dissemination

This study was approved by the Peking University Institution Review Board (IRB00001052-18021). The results will be disseminated through publication in peer-reviewed journals, presentations at conferences and in lay summaries provided to school staff and participants.

Trial registration number

NCT03665857.

Pyoderma gangrenosum at multiple sites in a post‐colostomy ulcerative colitis patient with chronic hepatitis B virus: A case report

Abstract

Pyoderma gangrenosum is an uncommon ulcerative cutaneous lesion manifesting as rapidly progressing single or multiple skin ulcers. Permanent stoma in inflammatory bowel disease patients remains an independent risk of pyoderma gangrenosum. In the current report, we describe a case of pyoderma gangrenosum in a post‐colostomy ulcerative colitis patient with chronic hepatitis B. Pyoderma gangrenosum began seemingly as peristomal dermatitis that rapidly developed into painful ulcerations with subsequent appearance of sterile pustules and ulcerations in the left lower leg. The patient significantly improved after active management with prednisolone, antiviral therapy with entecavir, and wound dressings. Our case suggests that physicians and surgeons should have a high index of suspicion of pyoderma gangrenosum in post‐colostomy ulcerative colitis patients who develop peristomal dermatitis.

Resilience among stroke survivors: A cohort study of the first 6 months 中风幸存者的恢复能力:前6个月的定群研究

Abstract

Aims

To explore (a) resilience among patients over the first 6 months following a first ischaemic stroke; (b) factors associated with resilience at hospitalization, 1, 3, and 6 months postdischarge; (c) baseline predictors of resilience at 6 months postdischarge.

Design

a cohort study.

Methods

From February 2017–January 2018, 217 patients presenting at two hospitals with a first ischaemic stroke were recruited. Their resilience, medical coping styles, general self‐efficacy, functional independency, socio‐demographic, and clinical data were assessed while they were still in hospital (baseline) and at 1, 3, and 6 months after discharge.

Results

Resilience among stroke patients decreased significantly 1 month after hospital discharge and remained stable. Predictors of resilience were as follows: self‐efficacy and resignation at baseline; number of children, functional independency, general self‐efficacy, and resignation at 1 month; and religion, resignation, self‐efficacy, confrontation at 3 months and 6 months. The baseline factors that predicted resilience at 6 months were income level, religion, stroke severity at discharge, self‐efficacy, and resignation.

Conclusion

Stroke survivors experienced a significant decrease in resilience from hospitalization until 1‐month postdischarge. Factors contributing to resilience after a stroke varied across time. Self‐efficacy and coping styles were particularly important and contributed to long‐term resilience.

Impact

Understanding resilience among stroke survivors is needed to inform the development of interventions to enhance the psychological recovery of survivors. The levels of resilience among stroke survivors were low compared with those in the normal older population. Nurses should provide greater psychological support during hospitalization to stroke survivors and especially to those with lower income, higher stroke severity at discharge, no religion, lower self‐efficacy, or who use resignation as a coping strategy as those survivors may have lower resilience 6 months later. Future studies are needed to test interventions designed to change or modify stroke survivors' coping styles and promote self‐efficacy, thereby enhancing higher resilience.

目的

探讨(a)首发缺血性中风后患者前6个月的恢复能力;(b)出院后1、3和6个月再次住院时影响恢复能力相关因素;(c)出院后6个月恢复能力的基线预测指标。

设计

定群研究。

方法

从2017年2月至2018年1月,在两家医院共招募了217名首发缺血性中风患者。并对他们在住院期间(基线)和出院后1、3和6个月的恢复能力、医疗应对方式、一般自我效能感、功能独立性、社会人口学和临床数据进行评估。

结果

中风患者出院后1个月恢复能力明显下降,并保持稳定。恢复能力的预测指标如下:基线时的自我效能感和辞职打算;1个月时的子女陪护人数、功能独立性、一般自我效能感和子女人数;3个月和6个月时的宗教信仰、辞职打算、自我效能感和对抗。预测6个月时的恢复能力的基线因素包括收入水平、宗教信仰、出院时中风严重程度、自我效能感和辞职打算。

结论

从住院到出院后1个月,中风幸存者的恢复能力明显下降。影响中风后恢复能力的因素随时间而变化。自我效能感和应对方式尤其重要,对长期恢复能力有一定影响。

影响

有必要了解中风幸存者的恢复能力,以便制定干预措施,提高幸存者的心理康复能力。与正常老年人相比,中风幸存者的恢复能力水平较低。护士应在中风幸存者住院期间为其提供更大的心理支持,尤其是那些收入较低、出院时中风严重程度较高、无宗教信仰、自我效能感较低的患者,或是那些将辞职作为应对策略的患者,因为此类幸存者在6个月后的恢复能力可能较低。

未来需要进行进一步的研究,以对旨在改变中风幸存者应对方式并提高自我效能感的干预措施进行检验,从而提高恢复能力。

Association between the number of teeth and frailty among Chinese older adults: a nationwide cross-sectional study

Por: Gu · Y. · Wu · W. · Bai · J. · Chen · X. · Chen · X. · Yu · L. · Zhang · Q. · Zou · Z. · Luo · X. · Pei · X. · Liu · X. · Tan · X.
Objectives

To explore the association between the number of teeth and frailty among older Chinese adults using a nationally representative sample.

Design

Cross-sectional analysis was carried out using the 2014 wave data from the Chinese Longitudinal Healthy Longevity Survey, which used a targeted random-sampling design.

Setting

This research was conducted in communities from nearly half of the counties and cities in 22 out of 31 provinces throughout China.

Participants

Of the 6934 interviewees aged ≥65 years, the final analysis included 3635 older adults who had completed the 2014 wave survey on the variables included in the study.

Primary and secondary outcome measures

Outcome variables included frailty, measured by the Frailty Index, and number of teeth. Covariates included demographic characteristics (ie, age, sex, co-residence, marital status, years of education and financial support), body mass index (BMI) and health behaviours (ie, smoking, drinking and exercise). A univariate logistic regression was used to test the factors associated with frailty. A multiple logistic regression model was used, using the frailty score as the dependent variable and the number of teeth together with significant covariates as the independent variables.

Results

The prevalence of frailty was 27.68%. The mean number of teeth present was 9.23 (SD=10.03). The multiple logistic regression showed that older adults’ demographic variables, health behaviours, BMI, tooth number and chewing pain were significantly associated with frailty. After adjusting for the covariates, older adults with fewer teeth had significantly higher odds of frailty than those with 20 or more teeth (no teeth: OR=2.07, 95% CI 1.53 to 2.80; 1 to 10 teeth: OR=1.77, 95% CI 1.31 to 2.38), except for older adults with 11 to 20 teeth (OR=1.30, 95% CI 0.93 to 1.82).

Conclusions

The presence of fewer teeth is significantly associated with frailty status among older Chinese adults. Future studies are needed to explain the specific mechanisms underlying how oral health status is associated with frailty.

Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort

Por: Axfors · C. · Bränn · E. · Henriksson · H. E. · Hellgren · C. · Kunovac Kallak · T. · Fransson · E. · Lager · S. · Iliadis · S. I. · Sylven · S. · Papadopoulos · F. C. · Ekselius · L. · Sundström-Poromaa · I. · Skalkidou · A.
Purpose

With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection.

Participants

From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16–18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort.

Findings to date

In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case–control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic–pituitary–adrenal axis and immune system.

Future plans

In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.

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