Chronic Illness最新文献

Objective: To determine the effect of an anticipated care plan, structured around hospital discharge (PC-AH-US), regarding the caregiving load of people with NTCD residing in Colombia, 2019-2021.

Method: This is a quasi-experimental study with pre- and post-intervention measurements. It includes 1170 participants who represented 585 chronic disease patient-caregiver pairs. We compared the PC-AH-US intervention, to the regular intervention.

Results: The PC-AH-US intervention group showed better results in all dimensions when compared to the regular intervention group: Awareness 8.7 (SD: 0.7) and 6.8 (SD: 1.7); Acknowledgement of their unique conditions 11.3 (SD: 1.0) and 9.4 (SD: 1.8); Capacity to fulfill care tasks 8.8 (SD: 0.7) and 7.5 (SD: 1.5); Wellbeing 11.4 (SD: 0.90) and 8.87 (SD: 2.3); Anticipation 5.88 (SD: 0.4) and 4.7 (SD: 1.1) and Support Network 11.4 (SD: 0.8) and 9.9 (SD: 2.5).

Conclusion: The PC-AH-US intervention group showed a statistically significant decrease in the caregiving load for people with NTCD (p < 00). There were no significant institutional differences in readmissions or deaths. The PC-AH-US intervention backs institutional policies meant to care for people with NTCD.

Objectives: We assess the impact of the COVID-19 pandemic on health, treatment adherence and expectations of patients with chronic diseases in Vietnam.

Methods: We conducted a national cross-sectional study using a questionnaire survey, distributed through social networks and presented on Google Forms. The survey was performed during two months of the most stringent social distancing in Vietnam (between 21 July and 21 September 2021).

Results: Most of the participants said that the COVID-19 epidemic had affected their daily activities (91.9%), health (53.6%), sleep behavior (52.3%), and mental health (79.8%). During social distancing in Vietnam, three-quarter could not go to hospitals for periodic health examination; nearly half of respondents did not do daily physical activity; a quarter of respondents did not adhere to recommended diet plan. Factors associated with the effect of the COVID-19 epidemic on patient's health included those living in Ho Chi Minh City (p = 0.015), lived alone (p = 0.027), uncontrolled chronic conditions (p < 0.001), treatment dissatisfaction or experienced anxiety/stress (p < 0.001). Factors associated with medication adherence included the elderly (p = 0.015), having periodic health examination (p = 0.012), direct consultation (p = 0.003), and telemedicine (p = 0.007).

Conclusion: This study highlights the urgent need for better chronic management strategies for the new post-COVID era in the future.

Objectives: This systematic review aimed to examine the effects of long-term oxygen therapy on the mental state of patients with chronic obstructive pulmonary disease.

Methods: Web of Science, Medline, CINAHL, EMBASE, ProQuest, and Cochrane Library were selected to search for relevant studies. We followed the Cochrane Handbook for Systematic Reviews of Interventions, adopted the Cochrane risk-of-bias tool and Risk Of Bias In Non-randomized Studies of Interventions tool, and synthesized the outcomes narratively with Grading of Recommendations, Assessment, Development and Evaluations evidence profile.

Results: Six studies were included. Moderate quality of evidence supported no effects of long-term oxygen therapy on the mental state in patients with severe resting hypoxemia and moderate resting hypoxemia (or exertional desaturation) at follow-up of 6 to 12 months; however, adverse effects on mental state among patients with moderate resting or exertional desaturation were reported at the follow-up of 36 to 48 months.

Discussion: Nurses should focus on the mental state of patients treated with long-term oxygen therapy, especially those who use it for a prolonged time. Due to ethical constraints in this study, a quasi-experimental study with faithful consideration of internal validity can be commenced in the future.

Objective: To evaluate the effectiveness of blood pressure (BP) self-monitoring and peer mentoring to improve the control of hypertension in clinical practice in primary care centers (PCCs) located in low-resource settings in Argentina.

Methods: An individual randomized controlled trial was carried out to test two different approaches based on behavioral interventions in PCCs in Argentina. Hypertensive adults were randomly assigned to one of three arms: BP self-monitoring, peer mentoring, and usual care. The primary outcome was the change in BP values from baseline to the end of follow-up at 3 months. A qualitative approach of participants' experiences of the peer mentoring arm was also conducted.

Results: A total of 442 participants with hypertension were included in the study. Self-monitoring and peer mentoring interventions did not show a significant difference in BP control compared to usual care. However, this trial showed an improvement regarding antihypertensive medication adherence among those assigned to the peer mentoring intervention compared to the control at the end of follow-up (p = 0.031).

Discussion: Self-monitoring and peer mentoring interventions did not demonstrate to be effective in BP control compared to usual care. Implementing a peer support strategy was demonstrated to be feasible and effective in improving medication adherence in this population.

Objectives: We investigated how individuals with chronic obstructive pulmonary disease (COPD) and multi-morbidity (MM) navigate barriers and facilitators to their health management.

Methods: We conducted a mixed-methods study using semi-structured interviews and survey assessments of adults with COPD, hypertension, and/or diabetes. We recruited 18 participants with an average age of 65, with 39% being male, 50% Black, and 22% Hispanic/Latino/a. Five investigators used an iterative, hybrid-coding process combining a priori and emergent codes to analyze transcripts and compare quantitative and qualitative data for themes.

Results: Participants reported a generalized approach to their health rather than managing MMs separately. Individuals with good or mixed adherence found daily routines facilitated regular medication use, while those with poor adherence experienced complex prescriptions and life stressors as barriers. Walking was viewed as beneficial but challenging due to limited mobility. Most participants viewed diet as important to their MMs, but only two reported high diet quality and many held inaccurate beliefs about healthy diet choices.

Discussion: Participants with MM were highly motivated to engage in self-management activities, but some individuals experienced barriers to maintaining them. Emphasizing an individualized clinical approach to assessing and solving patient barriers may improve self-management outcomes in this complex population.

Objective: This study aimed to assess the perceptions towards chronic disease self-management and its program among patients with chronic diseases.

Methods: A cross-sectional study using pre-validated questionnaire was conducted among patients with chronic diseases at outpatient pharmacy in a hospital in Penang, Malaysia from April to June 2021.

Results: Of 270 patients participated in this study, 87.8% were interested in chronic disease self-management. Nonetheless, they faced common barriers including time constraint (71.1%), no health monitoring devices (44.1%) and poor health knowledge (43.0%). More than half of the patients expressed that having a better knowledge of the disease and its treatment (64.1%), getting supportive guidance from healthcare providers (59.6%) and having monitoring devices (58.1%) were the top three facilitators to self-management. The patients preferred chronic disease self-management programs that (a) discuss the topic of motivation (b) are available both as mobile applications and hands-on training, (c) individual session, (d) range between 1 and 5 sessions with a duration of 1 to 2 h/session, (e) occurring on monthly basis, (f) conducted by doctor or healthcare professionals and (g) fully sponsored by government or at affordable fee.

Conclusion: The findings serve as pre-requisite step in future design and development of chronic disease self-management program, targeting the patients' needs and preferences.

Objective: Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the United States, affecting approximately 1 million Americans. However, there is a dearth of research on the employment experiences of individuals with PD. This research article makes a crucial contribution to the literature by examining the role of disability stigma in shaping employment options in PD, with relevance to the experiences of adults with chronic and/or progressive diseases more broadly.

Methods: The author conducted individual semi-structured interviews with 23 adults under the age of 65 with PD. Interviews were audio-recorded and transcribed. The author utilized an integrated approach to analysis, primarily employing a thematic analysis approach. Additionally, a narrative analysis strategy, the Listening Guide, was integrated into the broader thematic analysis to deepen analysis of discrimination and stigma.

Results: Findings demonstrate how internalized, anticipated and/or experienced disability-related stigma profoundly affects employment experiences, influencing participants' work outcome expectations and acting as an employment barrier.

Discussion: Findings have implications for health care practice and education, disability policy, early intervention strategies after the onset of PD and priorities for future research.

Objectives: This study investigated the relationship between parent-reported degree of openness and extent of problems in parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent and family wellbeing and adolescent glycaemic control.

Methods: A cross-sectional quantitative survey was conducted. Parents completed measures of parent-adolescent communication, parent monitoring of diabetes care, diabetes family responsibility, parent knowledge of diabetes care, parent activation, parent diabetes distress, and diabetes family conflict.

Results: In total, 146 parents/guardians (121 mothers, mean age 46.56 years, SD 5.18) of adolescents aged 11-17 years (mean age 13.9 years, SD 1.81) with Type 1 diabetes completed the survey. Open parent-adolescent communication was significantly correlated to adolescents' voluntarily disclosing diabetes-specific information to their parents more frequently, increased parental knowledge of their adolescent's diabetes care completion, parents feeling more capable and willing to take action in relation to their adolescent's diabetes health, lower levels of diabetes-related parental distress, less diabetes-specific family conflict, and optimal glycaemic control.

Discussion: Parent-adolescent communication has an important role to play in Type 1 diabetes healthcare management and psychosocial wellbeing during adolescence. Optimising open parent-adolescent communication represents a potentially useful target for interventional research and should be considered by healthcare professionals during healthcare encounters.

Objectives: To determine the prevalence of vitamin B12 deficiency in a Tunisian population with type 2 diabetes (T2D) on metformin treatment for more than three years and to identify its risk factors. Methods: This is a cross-sectional study conducted on 257 patients with T2D treated with metformin for at least three years. Patients were divided into two groups according to their vitamin B12 status. Low vitamin B12 was defined as ≤ 203 pg/mL. Results: The mean age of the patients was 59.8  ±  7.9 years. The mean duration of metformin use was 10.2  ±  5.2 years. The mean vitamin B12 level was 294.9  ±  156.4 pg/mL. The prevalence of vitamin B12 deficiency was 28.4%. Male gender, HbA1c < 7% and hyperhomocysteinemia were significantly associated with vitamin B12 deficiency (respectively p  =  0.02, p < 0.001, p < 0.001). Homocysteine level was negatively correlated with vitamin B12 level (r  =  -0.2, p  =  0.001). Dose and duration of metformin treatment, peripheral neuropathy and anemia were not associated with vitamin B12 deficiency. On multivariate analysis, HbA1c < 7% and hyperhomocysteinemia were independently associated with vitamin B12 deficiency (respectively OR = 3.2, 95%CI  =  [1.6-6.3] and OR = 2.3, 95%CI  =  [1.2-4.2]). Discussion: The prevalence of vitamin B12 deficiency in patients with T2D on metformin treatment was high. Hyperhomocysteinemia is associated with vitamin B12 deficiency suggesting that the deficit occurs at the tissue level.

Objectives: To support patients with limited health literacy with the challenges they face in the day-to-day management of their disease(s), numerous self-management interventions (SMIs) have been developed. To date, it is unclear to what extent SMIs have been developed for chronically ill patients with limited health literacy. This study aims to provide a description of these SMIs and to provide insight in their methodological components.

Methods: A secondary analysis of the COMPAR-EU database, consisting of SMIs addressing patients with diabetes, chronic obstructive pulmonary disease, obesity and heart failure, was conducted. The database was searched for SMIs addressing health literacy, including cognitive aspects and the capacity to act.

Results: Of the 1681 SMIs in the COMPAR-EU database, 35 studies addressed health literacy, describing 39 SMIs. The overview yields a high variety in interventions given, with overlapping information, but also lacking of specific details.

Discussion: This descriptive analysis shows that there was a large variety in the extensiveness of the description of intervention characteristics and their justification or explanation. A focus on the broad concept of health literacy, including functional skills, cognitive skills and the capacity to act could improve the effectiveness. This should be taken into account in the future development of SMIs.