Chronic Illness最新文献

Objectives: This study was conducted with the aim of determining the validity and reliability of the Persian version of "General Medication Adherence Scale (GMAS)" in chronic patients in Iran.

Methodology: The study was conducted among patients with chronic diseases in five hospitals of Iran. In this study, after cultural validation, using the steps of Content, Response Reaction, and Internal structure evaluations, the research sample was increased to 150 individuals for exploratory factor analysis (EFA) and 313 chronic patients for confirmatory factor analysis (CFA) to confirm the construct validity. Cronbach's alpha coefficient was used to assess internal consistency, and test-retest method was used to evaluate the reliability of the tool.

Findings: The results of EFA and CFA confirmed the tool with three factors and 11 items. The R² index in the above model was estimated at 0.99, indicating that 99% of the variation in medication adherence scores in research units was explained by GMAS with 11 items. The main indices of the model in factor analysis were all above 0.9, indicating a good fit for the model.

Discussion: Overall, the study results showed that the Persian version of GMAS has acceptable and practical characteristics for evaluating medication adherence, and it can be used as a valid tool in various related fields.

Objectives: Spinal cord injury (SCI) results in mild to severe functional limitations, decreasing a person's ability to perform activities of daily living. This study aims to identify the influence of SCI characteristics and self-efficacy on functional limitations, controlling for sociodemographic factors.

Methods: Participants for this cross-sectional descriptive study included 272 persons with SCI. The participants completed questionnaires on sociodemographic information, secondary physical conditions, self-efficacy, and functional limitations, using an online Qualtrics Survey. Multiple hierarchical regression analysis was performed to test the hypothesis.

Results: Participants reported higher functional limitations on dressing the lower body and managing their bowels compared to other activities of daily living. The sociodemographics, injury characteristics, and self-efficacy collectively accounted for 66% variance in functional limitations. A higher level of secondary physical conditions and tetraplegia injury contributed to higher functional limitations. As hypothesized, greater self-efficacy significantly contributed to low functional limitations above and beyond sociodemographic and SCI-related variables.

Discussion: Functional limitations following SCI are a pervasive challange in persons with SCI. Early recognition and management of secondary conditions and implementation of psychological interventions to strengthen self-efficacy in performing activities and managing secondary complications could potentially enhance functional independence and, ultimately, quality of life in this population.

Objectives: Dyadic interventions, involving two persons with a preexisting close relationship, offer the opportunity to activate support persons (SPs) to improve health for adults with chronic conditions. Requiring SP coparticipation can challenge recruitment and bias samples; however, the associations between voluntary SP coparticipation and recruitment outcomes across patient characteristics are unknown.

Methods: The Family/Friend Activation to Motivate Self-care 2.0 randomized controlled trial (RCT) enrolled adults with Type 2 diabetes (T2D) from an academic health system. Participants were asked-but not required-to invite an SP to coenroll. Using data from the electronic health record we sought to describe RCT enrollment in the setting of voluntary SP coparticipation.

Results: In a diverse sample of adults with (T2D) (48% female, 44% minoritized race/ethnicity), most participants (91%) invited SPs and (89%) enrolled with SPs. However, prerandomization withdrawal was significantly higher among participants who did not have consenting SPs than those who did. Females were less likely to invite SPs than males and more Black PWD were prerandomization withdrawals than randomized.

Discussion: Voluntary SP coenrollment may benefit recruitment for dyadic sampling; however, more research is needed to understand if these methods systematically bias sampling and to prevent these unintended biases.

Objective: The current study aimed to better understand how parent-child relationships might moderate the effects of the presence and severity (as measured by physical quality of life) of a chronic illness on psychological problems in emerging adulthood.

Methods: The participants included 538 emerging adults (53.5% women) with a mean age of 19.04. The participants completed an online study including chronic illness questions, the World Health Organization Quality of Life-Brief, the Parental Environment Questionnaire, and the Adult Self-Report scale.

Results: Endorsing a health condition significantly associated with psychological problems in emerging adult men. The three-way interaction between endorsing a health condition, physical quality of life, and maternal parent-child relationship quality significantly predicted psychological problems in emerging adult men and women. Specifically, higher maternal relationship quality was associated with a weaker relation between psychological problems and having a health condition with a low physical quality of life.

Discussion: The emerging adults who reported the most psychological problems also reported having a health condition, low physical quality of life, and low maternal relationship quality, highlighting that the combination of these variables predicted the highest rate of psychological problems. A low maternal relationship quality contributes to poor psychological adjustment while a high maternal relationship quality contributes to good psychological adjustment.

Objectives: Diabetes is a complex disease requiring daily self-management of diet and activity, yet many patients do not receive recommended self-management education, medical nutrition therapy, or team-based care that includes registered dietitian nutritionists (RDNs). Such service deficits contribute to challenges in meeting combined diabetes care goals. We evaluated the impact of adding RDN-supervised dietetic interns to an established primary care interprofessional education/teamwork model on patients' clinical outcomes and health professions students' team skills.

Methods: Electronic health records were retrospectively analyzed to evaluate the impact of interprofessional care teams including dietetic practitioners on patient outcomes and compare these changes to outcomes achieved with the previous model without such participation. Pre-test/post-test surveys were used to evaluate health professions students' self-reported changes in team skills.

Results: Patient outcomes for glycemic control, systolic blood pressure, triglycerides, and depression improved significantly, and emergency department visits decreased by 79% after interprofessional care. Average hemoglobin A1c levels decreased from 11.6% to 8.3% (p < .001), an additional 1.1% reduction over previous results, following incorporation of dietetic practitioners. Students reported increased team skills after interprofessional care participation.

Discussion: Health professions and dietetic program faculty should collaborate to develop interprofessional best practice primary care models for patients with diabetes.

Objective: To test associations between socio-clinical factors, self-management and patient activation among patients with Parkinson's disease (PD), and to explore the use of regression tree to find the cut-off levels of socio-clinical factors which associate with lower or higher self-management behaviours and patient's activation.

Methods: A cross-sectional study of patients with PD (n = 62) who underwent assessment of their socio-clinical factors including age, gender, cognitive status, comorbidities, disease severity (motor and non-motor symptoms) and social support. The associations of these factors to specific aspects of self-management behaviours including utilization of rehabilitative treatments, physical activity and patient activation were tested.

Results: Most patients did not utilize rehabilitative treatments. Non-motor symptoms and cognitive status were significantly associated with physical activity (R² = 0.35, F_{(3, 58)} = 10.50, p < 0.001). Non-motor symptoms were significantly associated with patient activation (R² = 0.30, F_{(1, 30)} = 25.88, p < 0.001). Patients with Mini-Mental State Exam score ≤24 performed less physical activity, relative to those with a higher score. Patients with ≤5 non-motor symptoms showed higher activation relative to those with >5.

Conclusion: In PD, disease-specific clinical characteristics overshadow other personal factors as determinants of self-management behaviours. The role of non-motor symptoms in reduced self-management behaviours and activation is highlighted.

Objectives: This study aims to develop and pilot a hospital care coordination team intervention for patients with multimorbidity and identify key uncertainties.

Methods: Practice-based, participatory pilot study with mixed methods in a middle-large teaching hospital. We included adult patients who had visited seven or more outpatient specialist clinics in 2018. The intervention consisted of an intake, a comprehensive review by a dedicated care coordination team, a consultation to discuss results and two follow-up appointments. We collected both quantitative and qualitative data.

Results: Out of 131 invited patients, 28 participants received the intake and comprehensive review. The intervention resulted in mixed outputs and short-term outcomes. Among the 28 participants, 21 received recommendations for at least two out of three categories (medication, involved medical specialists, other). Patients' experienced effects ranged from no to very large effects. Key uncertainties were how to identify patients with a need for care coordination and the minimum of required data that can be collected during regular clinical care with feasible effort.

Discussion: Recruitment and selection for hospital care coordination should be refined to include patients with multimorbidity who might benefit most. Outcomes of research and clinical care should align and first focus on evaluating the results of care coordination before evaluating health-related outcomes.

Objective: This study aims to explore beliefs and perceptions about hypertension among patients living with hypertension in a local district in the Eastern region of Ghana.

Methods: A descriptive qualitative approach was adopted, and the Health Belief Model was used to guide the data collection, analysis, and organization of the study findings. Overall, seventeen participants were interviewed. In-depth interviews were conducted using a semistructured interview guide. Participants were conveniently selected from a district local Government Hospital. Data gathered were transcribed verbatim and analyzed using thematic analysis.

Results: Almost all the participants acknowledged hypertension as a severe but chronic illness that can cause sudden death. They also identified that lifestyle practices and individual attitudes were associated with the hypertension condition's causes, management, and control. The findings revealed several unscientific misconceptions and beliefs about hypertension, which could influence their disease management and control decisions.

Discussion: Patients' decisions on alternative treatment for hypertension are primarily based on beliefs and misconceptions based on the information they receive from unregulated media and peers. The prevention and control of hypertension should focus on behavior and lifestyle modification which needs reinforcement through health education and promotion.

Objective: To explore how communication is perceived and care is negotiated amongst IA healthcare teams by drawing on the perspectives of each team member.

Method: This analysis drew on data from an ongoing three-year study exploring team-based IA care. We interviewed 11 participants including two men with IA and their family care providers and healthcare providers. We used a three-staged analytic process and integrated broad tenets of social network theory to understand the relational dimensions of team members experiences.

Result: Analysis revealed three themes regarding communication and care: (1) seeking/sharing information, (2) striving to coordinate unified care, and (3) providing patients a voice.

Discussion: This study emphasizes the importance of understanding team dynamics beyond the dyad of patient and care provider. Negotiating power and decision-making in IA care is a dynamic process involving shifting levels of responsibility amongst a care team. Communication-based strategies that extend dyadic interactions may enhance teamwork and health outcomes in chronic conditions.

Objective: Bile reflux gastritis is caused by the backward flow of duodenal fluid into the stomach. A retrospective cohort study was performed to estimate the prevalence and risk factors of bile reflux gastritis postcholecystectomy, and to evaluate the endoscopic and histopathologic changes in gastric mucosa.

Methods: Patients with refractory upper abdominal pain right below the ribs with symptoms of bloating, burping, nausea, vomiting, and bile regurgitation during the period from January 2018 to December 2020, submitted to Zagazig University Hospitals were enrolled in this study. The studied 64 patients were divided into two groups; the control group (CG): 30 subjects who had never undergone any biliary interventions, and the post-cholecystectomy group (PCG): 34 patients who had undergone cholecystectomy.

Results: The prevalence of bile reflux gastritis was (16.7%) and (61.8%) in CG and PCG, respectively. Diabetes, obesity, elevated gastric bilirubin, and elevated stomach pH were all risk factors for bile reflux gastritis in both groups (r = .28,.48,.78,.57 respectively). Age, sex, epigastric pain, heartburn, vomiting, and the existence of bile reflux gastritis, on the other hand, had no correlation.

Discussion: After a cholecystectomy, bile reflux gastritis is prevalent, especially among obese and diabetic patients.