The moderating effect of social cognitive factors on self-management activities and HbA1c in Thai adults with type-2 diabetes

BackgroundDiabetes mellitus (DM) has become a serious chronic disease. Self-management strategies help persons with DM make choices which will develop skills needed to reach their goal of blood glucose control and allow them to be successful in reaching goals.ObjectiveTo examine the impact of self-management activities on HbA1c for persons with DM and to examine the impact of social support, self-efficacy and Buddhist values as moderators on the relationship between the self-management activities and HbA1c.MethodThis study is a cross-sectional design. The sample included 401 Thai adults diagnosed with type 2 diabetes, aged 20–65 years old who had at least one HbA1c test in the last three months were recruited. Participants completed four questionnaires to measure self-management activities, as well as self-efficacy, Buddhist values and social support as moderating factors on self-management activities and HbA1c.ResultsThe self-management activities were negatively associated (β = −2.05, p ≤ 0.001) with HbA1c. The Social support, self-efficacy and Buddhist values had a significant interaction effect between selfmanagement activities and HbA1c (β = −0.97, p ≤ 0.05, β = −0.18, p ≤ 0.05 and β = −2.76, p ≤ 0.001).ConclusionThe diabetes self-management activities were more strongly associated with HbA1c under conditions of high social support, self-efficacy and health beliefs with Buddhist values. Future interventions for T2DM self-management programs should incorporate mechanisms to measure and support these factors.     

Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression,anxiety, and stress levels

AimThe aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic.MethodsAn anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21).ResultsOf the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001).ConclusionIn this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.     

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it

BackgroundAlthough the emotional and psychological impact of nurses’ work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health.AimThe objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors.DesignA cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021.MethodsSociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates.FindingsAbout 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses.ConclusionGiven the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated.ImpactGiven these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.     

初产妇母乳喂养自我效能影响因素及与产后抑郁的相关性分析

目的：探讨初产妇母乳喂养自我效能影响因素及其与产后抑郁的相关性。方法：采用母乳喂养自我效能量表和爱丁堡产后抑郁量表对200例产后6周的初产妇进行调查。结果：初产妇的母乳喂养自我效能总分为（108．08±21．43）分;多元线性回归分析结果显示,参加孕妇学校学习、配偶对母乳喂养的态度、产后抑郁和年龄4个变量进入了回归模型,解释产后6周母乳喂养自我效能总变异的60．9％;初产妇的产后抑郁与母乳喂养自我效能呈负相关（P〈0．01）。结论：初产妇的产后抑郁与母乳喂养自我效能相关;初产妇母乳喂养自我效能的影响因素分析可以为医护人员采取相应措施提供参考,从而有效地提高产妇的母乳喂养自我效能,提高母乳喂养率及母乳喂养程度。     

Nurses' occupational satisfaction during Covid-19 pandemic

BackgroundCovid-19 has brought healthcare workers in general and nurses in particular into the limelight as never before. It is important to study the intensity of the impact of this pandemic on the profession.ObjectiveThis study aims to assess the occupational satisfaction during the pandemic of Covid-19 among the nurses in Israel, to shed light on conditions of work and to identify factors associated with low occupational satisfaction.MethodsCross-sectional study of 130 Israeli nurses. Minnesota Satisfaction and Measure of Job Satisfaction questionnaire with 28 items was used to assess occupational satisfaction.ResultsIn the multivariable model, nurses working in the community had higher occupational satisfaction than those working in hospitals (β = 0.24, p = .032); nurses who took care of patients who tested positive for Covid-19 had significantly lower occupational satisfaction than others (β = −0.48, p = .009). Most of the sample reported lack of personal protective equipment (PPE). Nurses who experienced lack of PPE reported lower occupational satisfaction than those who did not (3.4 vs. 3.8, p = .039). Occupational satisfaction was mainly based on the component, built by the intrinsic characteristics of the occupation related to the personal accomplishment.Most of nurses had to increase their workload as a result of staff shortages, but the elevation of the workload was not associated with lower occupational satisfaction.ConclusionEven under the circumstances of the pandemic, the most important nurses` occupational values are worthwhile accomplishments, importance of professional challenge, diversity and interest in the job, personal growth and development and independence in their practice.     

Perceived control and quality of life among recipients of implantable cardioverter defibrillator

BackgroundPerceived control is strongly associated with health-related quality of life (HRQOL) among patients with chronic conditions, and it is possible to increase perceived control with appropriate intervention. Little is known about the relationship between perceived control and HRQOL in implantable cardioverter defibrillator (ICD) recipients.ObjectivesTo determine the relationship of perceived control with quality of life in ICD recipients and to determine predictors of perceived control in this population.MethodsA total of 263 ICD recipients (63% male, age 61 ± 14 years) completed the Control Attitude Scale-Revised to measure perceived control and completed self-reported measures on potential correlates of perceived control (i.e., depressive symptoms, anxiety, social support, and ICD concerns). The EuroQol-5D was used to measure HRQOL. Regression analysis was used to determine predictors of perceived control and its relationship to HRQOL, controlling for covariates.ResultsLower perceived control (β = 0.30, p < .01), and higher levels of depression (β = −0.30, p < .01) and anxiety (β = −0.18, p < .05) predicted lower levels of HRQOL. Higher anxiety (β = −0.17, p < .05), higher depression (β = −0.23, p < .05), lower social support (β = 0.26, p < .01), and higher ICD-related concerns (β = −0.16, p < .05) independently predicted lower perceived control.ConclusionsInterventions targeting patients' ICD concerns and psychosocial factors before, and continuing after, ICD insertion are needed to improve ICD recipients' perceived control and, in turn, their HRQOL.     

Early predictors of mortality for moderate to severely ill patients with Covid-19

BackgroundDetermining the factors affecting the mortality and clinical conditions of the patients with Covid-19 are indispensable needs in developing patient treatment algorithms. We aimed to determine the parameters that can predict the mortality of moderate to severely ill patients with laboratory confirmed Covid-19.MethodsModerate to severely ill, Covid-19 patients older than 18 years were included. Mild Covid-19 patients and the ones with negative polymerase chain reaction test results were excluded from the study. The primary outcome of the study was 30-day mortality rate and we aimed to determine the factors affecting mortality in moderate to severely ill Covid-19 patients.Results168 patient results were analyzed. Median age of the patients was 59.5 (48.3 to 76) and 90 (53.6%) were male. According to multivariate regression analysis results, the presence of any comorbid disease (p = 0.027, HR = 26.11 (95%CI: 1.45 to 471.31)), elevated C-reactive protein levels (CRP) (p < 0.001, HR = 1.24 (95%CI: 1.11 to 1.38)) and presence of dyspnea (p = 0.026, HR = 4.26 ((95%CI: 1.19 to 15.28)) were found to significantly increase the mortality, while high pulse O 2 saturation level (p < 0.001, HR = 0.90 (95%CI: 0.82 to 0.99) was found to decrease. When receiver operating characteristic curve was created for laboratory tests, it was determined that white blood cell counts, neutrophil counts, CRP levels and neutrophil/lymphocyte ratio predicted mortality while Lymphocyte levels did not.ConclusionDyspnea, the presence of any comorbid disease, elevated CRP levels, and low pulse O 2 saturation levels predict mortality in moderate to severely ill Covid-19 patients.     

Knowledge and attitudes of family members towards postpartum depression

BackgroundPostpartum depression (PPD) has been recently recognized as a public health issue. While family members play an important role in early recognition of PPD among women, research that explores family members awareness on PPD is limited from India.AimTo explore the knowledge and attitudes of family members towards postpartum depression.MethodsThis was a cross-sectional survey carried out among family members of postpartum women (N = 202) at a pediatric tertiary care center. The data was collected through face to face interview technique using a structured questionnaire.ResultsThe mean scores on knowledge (18.92 ± 3.27) attitude (31.39 ± 4.91) scales suggest that a majority of the participants had a good level of knowledge (54%) and positive attitudes (69.7%) towards women with postpartum depression. However, misconceptions and negative stereotypes related to postpartum depression still prevailed. Family members who had a good level of education (χ2 = 4.21, p < 0.05) and had come across women with postpartum depression (χ2 = 13.27, p < 0.001) hold positive attitudes towards postpartum depression compared to family members with a lower level of education and those did not come across women with postpartum depression.ConclusionThe findings of the present study suggest the need for educational campaigns to improve perinatal mental health literacy and address prejudices and negative stereotypes related to postpartum depression among family members.     

Relationship of fear of COVID-19 and pregnancy-related quality of life during the COVID-19 pandemic

AimThe aim of this study was to determine the relationship between fear of COVID-19 and quality of life in Iranian pregnant women during the COVID-19 pandemic.MethodsThis cross-sectional study was carried out on 250 Iranian pregnant women. Data was collected through questionnaires including demographic and obstetric characteristics, fear of COVID-19 and quality of life. An adjusted general linear model was used to determine the relationship between variables.ResultsThere was a negatively significant relationship between fear of COVID-19 and quality of life (P < 0.001). Based on the adjusted general linear model, it was expected that if COVID-19 fear score increased, the quality of life score would decrease significantly (B = -0.21, 95%CI: −0.34 to −0.09, P = 0.001).ConclusionThis study indicated a reverse correlation between fears of COVID-19 and quality of life. Therefore, developing appropriate interventions in order to overcome the fear caused by COVID-19 are recommended to improve pregnant women's quality of life.     

The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department

BackgroundThe COVID-19 pandemic brought important changes in access to the Emergency Department (ED). At present, an analysis of how the COVID-19 pandemic has changed not only the number but also the nature of the urgency of ED access is not available. This study aimed to verify the effect of the COVID-19 pandemic on the urgency of patients admitted to the ED utilizing timebased analyses.MethodsA quasi-experimental interrupted time series analysis based on a retrospective review of data from all ED admissions occurring at the Merano Hospital (Italy) from 1 January 2015 to 30 June 2021 was conducted.ResultsFrom January 2015 to June 2021, 416,560 patients were admitted to the ED. Since the pandemic outbreak, the trend of urgent patients (classified as orange and red by triage) remained unchanged compared to the pre-pandemic period (p = 0.095, p = 0.155). In contrast, patients classified as blue (non-urgent) increased exponentially since the outbreak of the pandemic (p < 0.001).ConclusionThe present study reported stability in urgent codes (orange and red) since the pandemic outbreak while a dramatic increase in non-urgent codes (blue and green) is reported. The results of the study may indicate the need to find health policy solutions to manage this large increase in nonurgent patients requiring assessment in EDs since the outbreak of the pandemic.     

Resilience as a mediator between compassion fatigue,nurses' work outcomes,and quality of care during the COVID-19 pandemic

BackgroundNurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses' CF in relation to job outcomes and care quality during the pandemic.AimsThis study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses' job outcomes (job satisfaction and turnover intention) and care quality.DesignAn online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines.ResultsOverall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = −0.145, p = 0.019), lower job satisfaction (β = −0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = −0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = −0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001).ConclusionFrontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses' job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.     

Fear of COVID-19 and social distancing on the health behavior of coronary heart disease patients

PurposeThis study aimed to provide basic data to improve the health behavior of patients diagnosed with coronary artery disease during pandemics such as that caused by coronavirus disease 2019 (COVID-19) by identifying the fear of COVID-19 and the degree of social distancing behavior of coronary patients.MethodsIn this study, 162 patients diagnosed with coronary artery disease who received follow-up care at the cardiovascular center of Dong-A University Hospital in Busan were selected. The variables examined in this study included subjects' general characteristics and disease-related characteristics, fear of COVID 19, social distancing behavior, and health behavior. Data were collected from June 8–25, 2021, and data analysis was performed using the IBM SPSS26.0 program.ResultsThe results showed that older participants, those who were religious, those with cohabitants, and those who showed better compliance with social distancing showed better health behavior practice. Factor with the greatest influence on the health behavior of patients with coronary artery disease was social distancing behavior (β = 0.299, p < .001).ConclusionAfter the COVID-19 pandemic, it is necessary to develop a health care program to promote the health behavior of high-risk patients, including coronary artery disease, in preparation for the COVID-19 era. The younger the patient, the fewer health activities are undertaken when living alone, so appropriate education and support for these individuals should increase the rate of implementation of health activities for coronary artery disease.     

The effect of postintensive care syndrome on the quality of life of intensive care unit survivors: A secondary analysis

BackgroundDespite increasing interest in postintensive care syndrome and the quality of life of intensive care unit survivors, the empirical literature on the relationship between these two variables is limited.ObjectivesThis study aimed to examine whether postintensive care syndrome predicts the quality of life of intensive care unit survivors.MethodsWe analysed secondary data, which were collected as part of a larger cross-sectional study. The participants were recruited from six health institutions in Korea. The data of 496 survivors who had been admitted to an intensive care unit for at least 48 h during the past year were analysed. They responded to measures of postintensive care syndrome and quality of life.ResultsThe participants' mean physical and mental component summary scores (quality of life) were 40.08 ± 8.99 and 40.24 ± 11.19, respectively. Physical impairment (β = ?0.48, p < 0.001), unemployment (β = ?0.19, p < 0.001), low income (β = ?0.11, p = 0.004), older age (β = ?0.08, p = 0.039), and cognitive impairment (β = ?0.11, p = 0.045) predicted lower physical component summary scores. Mental (β = ?0.49, p < 0.001) and cognitive impairment (β = ?0.14, p = 0.005) and low income (β = ?0.09, p = 0.014) predicted mental component summary scores.ConclusionsThe participants reported poor physical and mental health–related quality of life. Postintensive care syndrome, unemployment, low income, and older age were the main predictors of poor quality of life. In addition, postintensive care syndrome was a stronger risk factor for poor quality of life than demographic characteristics and intensive care unit treatment factors.     

Resilience,Social Support,Loneliness and Quality of Life during COVID-19 Pandemic: A Structural Equation Model

AimTo determine the parsimonious model of the interrelationships of personal resilience, social support, loneliness and quality of life (QoL) and to identify the mediating effect of loneliness among nursing students amidst the pandemic.BackgroundThe coronavirus 2019 (COVID-19) pandemic led to control measures which increased loneliness among students due to disrupted social connections and sudden shift to virtual learning. During these changes, resilience and social support can significantly influence how learners deal with pandemic-related stresses thus, minimizing loneliness and enhancing QoL. Although studies posited the influence of resilience and social support with loneliness and QoL, these were conducted prior the COVID-19 pandemic wherein loneliness and feelings of isolation play a crucial part.DesignCorrelational, theory testing using covariance-based structural equation modelingMethodsA total of 550 nursing students from a comprehensive university in Manila, Philippines were recruited from September to October 2021 and answered four standardized, validated scales.ResultsA good and parsimonious model (x²/df = 2.84, RMSEA = 0.058, GFI = 0.999, CFI = 0.999, PNFI = 0.048) highlighted the mediating effect of loneliness between social support, personal resilience and QoL. While personal resilience positively influenced the physical and psychological domains of QoL, social support positively affected the social relationships and environmental domains. Loneliness was a strong, negative predictor of the psychological and social domains of QoL and had a moderate, negative effect on the physical domain. Personal resilience also mediated the influence of social support on loneliness and QoL.ConclusionSocial support and personal resilience positively affected QoL, while loneliness had a negative effect. Through the mediation of loneliness, the effects of social support on QoL decreases. However, the mediation of resilience further decreases loneliness and improves QoL. The presented model assists nurse educators and administrators in developing strategies to enhance social support, resilience and QoL among students while mitigating the negative effects loneliness during the pandemic.Tweetable abstractLoneliness and Resilience are mediators of student nurses’ quality of life during COVID-19 pandemic. Social support is the common predictor.