Chronic Illness最新文献

ObjectivesLong-term health effects of Omicron infection, particularly persistent Long COVID in hospitalized patients, require further investigation.MethodsPatients hospitalized for Omicron infection (Dec 2022-Mar 2023) underwent follow-ups at 6 months and 1 year post-discharge. Univariate/multivariate analyses identified mortality predictors, symptom trends, and optimal CRP levels (mg/L) thresholds.ResultsAmong 410 patients, 59 died; mortality predictors included age (OR = 1.070), ICU admission (OR = 15.748), diabetes (OR = 3.363), antibacterial use (OR = 0.283), and lymphocyte count (OR = 0.099). At 6 months, 86.0% reported ≥1 symptom (83.5% at 1 year). Fatigue, cough, and snoring were most common, with symptom counts decreasing significantly over time. Symptomatic patients had longer hospital stays (P = 0.022), lymphopenia (P = 0.036), and elevated CRP levels (P = 0.010). A CRP level ≥15.38 mg/L was associated with a greater risk of symptom persistence and may serve as a potential predictive marker.ConclusionHospitalized Omicron survivors experience prolonged symptoms, with ICU admission, age, and diabetes as key mortality risks. Fatigue and snoring may persist despite overall improvement. Elevated CRP and prolonged hospitalization in symptomatic patients underscore the need for long-term monitoring and interventions targeting high-risk groups.

ObjectivesContinuity of care is a critical component of successful hypertension management. With the growing prevalence of people living with both hypertension and disabilities, it is essential to explore how disability impacts continuity of care. This study aimed to investigate whether disability is associated with continuity of care among people with hypertension.MethodsThis study was a retrospective observational cross-sectional analysis using the 2019 Korea National Health Insurance Service-National Sample Cohort database. A total of 104,280 individuals diagnosed with hypertension aged 30 years and older were included. Multivariate logistic regression was used to examine the impact of disability on the odds of having higher continuity of care, measured using the Bice-Boxerman index, adjusting for sociodemographic factors.ResultsPeople with hypertension who also have physical disabilities were 6.6% less likely to achieve optimal COC compared to those without disabilities (Odds ratio = 0.934; 95% confidence interval = 0.875, 0.998).ConclusionPhysical disability significantly reduces the likelihood of achieving optimal COC in hypertension management. Targeted interventions addressing barriers faced by people with disabilities and hypertension are critical for improving care coordination and health outcomes.DiscussionThis study highlights the need for disability-inclusive healthcare policies and practices to reduce disparities in hypertension care.

ObjectivesTo evaluate religion and spirituality (R/S) and spiritual/religious coping (SRC) in patients with type 2 diabetes mellitus (T2DM).MethodsThis is a study of 124 patients with T2DM, performed in a diabetes outpatient clinic of a teaching hospital in a medium-sized city in Minas Gerais, Brazil. Patients answered a socioeconomic classification questionnaire, the Duke University Religion Index (DUREL), and a validated Portuguese version of the Brief Spiritual/Religious Coping (Brief-SRCOPE) Scale.ResultsThe DUREL scores showed that the studied patients presented mean high levels of organizational religious activity (4.31, SD = 1.43), non-organizational activity (4.68, SD = 1.22), as well as intrinsic religiosity (13.90, SD = 1.94). The SRC total score was 3.67 (SD = 0.36) and the positive coping scale score 3.54 (SD = 0.55); both values were considered elevated. R/S played an important role in the lives of the T2DM patients.ConclusionThe SRC scores showed that R/S were being used in a positive way in addressing the challenges posed by this chronic disease.

ObjectivesThis study aimed to develop and validate a generic, non-disease-specific, self-assessment measure that recognizes patients' health capacities and their empowering process of health promotion in chronic illness by using Bodyknowledging as the theoretical frame.MethodsItem generation and expert content validity analysis were the first steps in instrument development. Potential items were then validated in focus group interviews with six patients diagnosed with various chronic diseases. The research team reviewed the resulting items and undertook item reduction. A sample of adults (n = 357) with chronic disease surveyed the instrument items. Exploratory factor analysis with Oblimin rotation was conducted.ResultsA 3-factor solution was identified: nine items on the regaining health and wellness subscale, seven items on the uncertainty and bereavement subscale, and eight items on the loss of control and distancing subscale. Cronbach alpha for the scale was .92. The final 24-item instrument is non-disease-specific and broadly applicable for use in health promotion within the context of chronic disease. The instrument demonstrates high internal consistency reliability with initial face and construct validity.DiscussionThe new instrument has the potential for measuring patients' empowering process of health promotion in chronic disease and the outcomes of person-centered interventions and may guide clinicians in tailoring individual support.

ObjectiveTo document the occurrence of post-intensive care syndrome (PICS) in intensive care unit (ICU) survivors with coronavirus disease-2019 (COVID-19) up to one year.MethodsRetrospective observational study at a university hospital post-ICU outpatient clinic. Patients were followed up in-person at 1 month, 3 months, 6 months and one-year after hospital discharge. Cognitive, physical and psychological domains of PICS were evaluated. PICS was defined as at least one dysfunction in the assessment tools in each domain.ResultsSixty-four patients were evaluated during the study period. Median age was 62.5 (55.0-71.0). Fifty-eight percent of them were male. Median APACHE II and admission SOFA scores were 13 (10-16) and 3 (3-4), respectively. Sixty-four, 54, 44, 20 patients were evaluated during the 1 -month, 3-month, 6-month and one-year visits. 94% of patients had PICS at the 1st visit and this declined to 75% in one-year. The ratio of patients who fulfilled all PICS domains were 15%, 10%, 13% and 13%, respectively at 4 follow-up visits. Physical impairment was the most commonly observed dysfunction during all visits.DiscussionThis study showed that at least one domain of PICS persisted in 75% of patients at one-year in COVID-19 ICU survivors.

ObjectivesMany factors affect caregiver burden. Limited studies exist on the effect of social support and fatigue on family caregivers. This study aims to explore the impact of fatigue and social support on the burden experienced by family caregivers of palliative care patients.MethodsThe study was conducted with 80 family caregivers. Data were collected using the Piper Fatigue Scale, the Burden Interview, and the Multidimensional Scale of Perceived Social Support. Regression analysis was used to evaluate the data.ResultsThe regression analysis revealed that higher scores on the MSPSS were significantly associated with lower Burden Interview scores (p < 0.05). Conversely, higher PFS scores were significantly correlated with increased Burden Interview scores (p < 0.05).DiscussionBoth fatigue and social support play a critical role in shaping the caregiving burden experienced by family caregivers. Interventions aimed at reducing caregiver fatigue and enhancing social support may help alleviate this burden.

ObjectiveThis study aimed to evaluate the psychometric properties of the Persian version of the TSQM-14 in patients with hypertension in IranMethodsThis cross-sectional study was conducted among hypertensive patients referred to primary healthcare centers in Kerman City between January and February 2021. Cronbach's alpha and total-item correlation were used to evaluate internal consistency, while the Intraclass Correlation Coefficient (ICC) was employed to assess test-retest reliability. Construct validity was examined using structural equation modeling (SEM), known-groups validity, and convergent validity.ResultsA total of 319 participants took part in the study, with a mean age of 56.7 years (SD = 13.0), and 57.7% (n = 184) were female. The Cronbach's alpha and ICC values of the TSQM-14 for the composite scales were 0.83 and 0.91, respectively, indicating good reliability. The SEM indices for TSQM-14 demonstrated adequate model fit, with χ² = 118.9 (P ≤ 0.001), CFI = 0.96, RMSEA = 0.07, TLI = 0.95, and NFI = 0.91. The mean (standard deviation (SD)) scores of the composite scale for patients in the uncontrolled group (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and the controlled group were 50.2 (SD = 6.6) and 47.6 (SD = 6.1), respectively (P = 0.021). Additionally, the Spearman correlation coefficient between the TSQM-14 scale and the MMAS-8 was 0.30 (P < 0.001), demonstrating a weak but significant correlation.ConclusionsThis study demonstrated that the Persian version of the TSQM-14 has acceptable reliability, as well as construct and convergent validity, for assessing treatment satisfaction among hypertensive patients.

ObjectiveThis study investigated how patients managed their chronic diseases, focusing on burden of treatment, within the primary care level in Mendoza Province, Argentina.MethodThe study used a mixed-methods approach, including a qualitative component with a purposive sampling of patients with diabetes, hypertension, or depression using primary care services, and a quantitative component with secondary analysis of databases from public and social security. Ten focus group sessions were conducted at primary healthcare centers in urban and rural areas. The Burden of Treatment theory was used to frame the analysis.ResultsThe study found that accessing care was difficult due to appointment difficulties and long waiting times, and obtaining medication and laboratory tests at secondary centers was also problematic. Non-emergency hospital care required primary care referrals, and users in rural areas faced access problems. Financial constraints were significant, with co-payments in social security sector, transportation costs, and lost work revenue. Strategies employed included networking, emergency service use, careful planning, and taking loans.ConclusionThis study underscores the complex implications of chronic disease management in a subnational healthcare system and provides insights for policymakers and healthcare providers.

ObjectivesThis review aims to identify the content of family-based interventions that are commonly used for primary caregivers of people diagnosed with chronic illness. In addition, the psychological-related outcome measures of the FAMIs will be examined.MethodsPRISMA was adopted for the review process. We searched CINAHL, Scopus, and Web of Science databases for studies that implemented a family-based intervention for family caregivers of patients with chronic illness. We reviewed articles published between January 2000 and January 2021. Two independent reviewers, multiple researcher triangulation, and peer review were employed to ensure the validity and reliability of the data.ResultsWe included 11 studies in this systematic literature review. In total, seven themes emerged under the content of family-based intervention consisting of family elements, skills, information, activities, positive psychology, recovery, and roles and responsibility. The psychological related outcome measures of the intervention include recovery, patient care management, skills improvement, emotional management, family relationships, and self-functioning.DiscussionThe aspect of family functioning may help the family caregivers to empower themselves and build up their inner strength to face unexpected situations. The results highlighted the importance of the involvement of the experts in family therapy in helping family caregivers. Cultural implications were also highlighted.

ObjectivesThe purpose of this study was to assess the extent of diuretic nonadherence and to understand the reasons for diuretic nonadherence among patients with a 90-day heart failure hospital readmission.MethodsThis study utilized a convergent parallel mixed-method design. The extent and reasons for medication nonadherence were measured using the Domains of Subjective Extent of Nonadherence scale. Semi-structured interviews were used to understand patients' reasons for nonadherence. Descriptive and regression tests were used to analyze quantitative data. Thematic analysis was used for qualitative data analysis. Meta-inferences were developed from merged data.ResultsEighty-two adults participated in the study. The merged data indicated that 61% of participants were diuretic nonadherent. The analysis of merged data revealed 3 meta-inferences: (1) Diuretic nonadherence may not be entirely unintentional or intentional; (2) Fearing a loss of dignity contributes to diuretic nonadherence; and (3) Diuretic nonadherence is an act of self-determination.DiscussionIn this study, diuretic nonadherence was a complex mix of unintentional and intentional reasons, a strategy to protect against dignity loss, and an effort to gain control over diuretic effects. A need for dignity and self-determination may be important drivers of nonadherence and should be considered by clinicians and researchers.