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Is reduced heart rate variability associated with functional somatic disorders? A cross-sectional population-based study; DanFunD

Por: Jorgensen · T. · Dantoft · T. M. · Petersen · M. W. · Gormsen · L. · Winter-Jensen · M. · Fink · P. · Linneberg · A. · Benros · M. E. · Eplov · L. F. · Bjerregaard · A. A. · Schovsbo · S. U. · Brinth · L. S.
Objectives

It has been hypothesised that functional somatic disorders (FSD) could be initiated by sympathetic predominance in the autonomic nervous system as measured by low heart rate variability (HRV). Earlier studies on the association between HRV and FSD are small case–control studies hampered by selection bias and do not consider the great overlap between the various FSDs. The aim of the present study is to assess any associations between HRV and various FSDs and whether chronic stress confounds such an association.

Design

A cross-sectional general population-based study.

Setting

The Danish Study of Functional Somatic Disorders conducted 2013–2015 in 10 municipalities in the western part of Greater Copenhagen, Denmark.

Participants

A total of 6891 men and women aged 18–72 years were included in the analyses after exclusion of 602 persons with missing HRV data. Various delimitations of FSD (chronic fatigue, chronic widespread pain, irritable bowel and bodily distress syndrome) were identified by validated questionnaires and diagnostic interviews. HRV parameters in time and frequency domains were calculated from successive beat-to-beat heart rate (HR) data using the ‘E-motion’ HR monitor device during 7 min of supine rest. Chronic stress was assessed by Cohen’s self-perceived stress scale.

Outcome measures

Logistic regression analyses were used to calculate possible associations between the various delimitations of FSD and HRV adjusting for chronic stress.

Results

Persons with FSD had a slightly higher mean HR and lower HRV as measured by time domain parameters, whereas associations with frequency domain parameters were not consistent. Adjusting for chronic stress attenuated associations slightly.

Conclusion

The study supports a sympathetic predominance in persons with FSD, which could not be entirely explained by chronic stress. However, it is not possible to conclude whether the association is a causal factor to or a consequence of FSD.

Experiences of older vulnerable people with ischemic heart disease and their peer mentors: A qualitative process evaluation

Abstract

Aim

To understand the content and context of a realized peer mentor intervention, and to explore how mentors and mentees experienced the intervention.

Design

The study was designed as a qualitative process evaluation of a 24-week peer mentor intervention.

Methods

Semi-structured individual interviews were conducted from November 2021 to May 2022 in a purposeful sample of older vulnerable people with ischemic heart disease, referred to as mentees (n = 13), and their peer mentors (n = 12). Thematic analysis was used to analyse, categorize and interpret interview data.

Results

Five themes captured the content and context of the peer mentor intervention as experienced by mentors and mentees. ‘Takes one to know one’, stressing the importance of the mentor–mentee matching process; ‘Varying demand for mentors’, illustrating the difficulties in predicting who has the greatest need for mentoring; ‘Varying degree of familiarity’, describing the mentor–mentee relationship as a continuum from formal mentor to informal friend; ‘Putting the patient first’, illustrating how mentors support mentees based on their personal experiences of successful recovery while letting the mentee set the pace and goals; and ‘Varying view of success’, showing how intervention success is perceived differently by mentors and mentees.

Conclusions

The study provides new knowledge on how and under what contextual circumstances a mentor intervention works. These findings are important for the implementation of future peer mentor interventions to achieve successful peer mentor support.

Implications and Impact

Non-attendance and drop-out from the cardiac rehabilitation program are prevalent problems among older vulnerable people with cardiovascular disease. This study describes a low-cost peer mentor intervention that can support this group of patients.

Reporting Method

Standards for reporting qualitative research (SRQR) guided our study.

Patient or Public Contribution

A board of cardiovascular patients have contributed to the development and implementation of the intervention being evaluated.

Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model

Por: Zhu · W. · Liang · D. · Petersen · J. D. · Zhang · W. · Huang · J. · Dong · Y.
Objectives

Whether the routine delivery of diabetes-related knowledge can change patients’ attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China.

Design

A cross-sectional study.

Setting

Yuhuan City, Zhejiang Province, China.

Participants

A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below.

Primary and secondary outcome measures

A questionnaire based on existing scales and expert consultation was applied to assess patients’ socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients’ characteristics and KAP.

Results

No significant association was found between patients’ knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p

Conclusions

While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients.

Needs assessment in patients with inflammatory bowel disease in the encounter and communication with healthcare professionals: A fieldwork study

Abstract

Aim

To explore how patients with Inflammatory bowel disease experienced encounters with healthcare professionals in two gastrointestinal outpatient clinics to demonstrate what matters in the communication between patients and healthcare professionals.

Design

This fieldwork study is part of a larger study developing an application for patients with inflammatory bowel disease in a framework inspired by Participatory Design. Participatory design consists of three phases and this study focused on the first phase, needs assessment. A phenomenological hermeneutic approach and qualitative methods were applied to obtain an understanding of patients' needs.

Methods

Three weeks of participant observations and three focus groups with 14 subjects were conducted at two university hospitals in Denmark. Field notes and interview transcripts were analysed using condensation of meaning and interpreted based on interactional nursing practice theory. The reporting method adhered to the EQUATOR guideline: COREQ.

Results

Four themes emerged: Easy and dependable access to healthcare professionals. Predictability of follow-up appointments. Importance of privacy during patient exams and Quality of time spent with healthcare professionals.

Conclusion

Easy, dependable access, privacy, presence and predictability of follow-up appointments were important to patients with Inflammatory Bowel Disease.

Implications for the profession and patient care

In communication with patients with inflammatory bowel disease, healthcare professionals must be aware of privacy and the importance of predictable follow-up agreements. They must be aware that presence and easy, reliable access positively affect patients' self-care skills.

Patient contribution

This study is part of a larger project based on Participatory design involving patients and healthcare professionals in the development of technology to support communication.

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