Exercise interventions for frail older adults with diabetes: A scoping review.

There is a paucity of evidence on exercise interventions for frail older adults with diabetes. This scoping review aims to identify the scope of the current literature on the characteristics and effects of exercise interventions for frail older adults with diabetes. A search without time limitation was conducted in eight databases. 14 studies were finally included. Resistance exercise and multicomponent exercise were the most common types of exercise. There was considerable variation in the frequency, duration and intensity of exercise interventions. Studies reported improvements in frailty status, physical function, blood glucose and lipid levels and economic effectiveness. The most frequent combined interventions involved nutrition and education. Although evidence was limited, the potential benefits of exercise interventions for frail older adults with diabetes were substantial. Further high-quality studies are needed to explore the most effective and cost-saving exercise interventions for frail older adults with diabetes.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression.

AIMS: To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions. DESIGN: A cross-sectional study reported according to the STROBE checklist. METHODS: A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro. RESULTS: Self-care ability was positively associated with social support (ß = .229) and resilience (ß = .290), and negatively associated with depression (ß = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability. CONCLUSION: Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Effects of exercise interventions on physical, psychological and social outcomes in frail older adults: An overview of systematic reviews.

AIMS: To comprehensively synthesise existing evidence from systematic reviews regarding the effects of exercise interventions on physical, psychological and social outcomes in frail older adults to provide reference for clinical practice. BACKGROUND: Frailty is highly prevalent in older adults and associated with increased adverse health outcomes. Some systematic reviews have assessed the effectiveness of exercise interventions in frail older adults with varied inclusion criteria, methodology quality, types of exercise and outcome measures. DESIGN: An overview of systematic reviews reported following the PRISMA checklist. METHODS: PubMed, Embase, CINAHL, Web of Science and Cochrane database were searched from inception until June 2023 to identify relevant systematic reviews with or without meta-analysis of randomised controlled trails. Two reviewers independently selected articles, extracted data, assessed quality and summarised findings. RESULTS: A total of 17 systematic reviews were included, with methodology quality varying from moderate to critically low. The most frequent types of exercise were multicomponent exercise and resistance-based exercise in community and long-term care facilities, respectively. Exercise interventions had positive effects on most physical outcomes and depression, but inconsistent effects on cognitive function and quality of life. The quality of the evidence for most outcomes was low and very low. CONCLUSIONS: This overview highlights the importance of exercise interventions to improve physical, psychological and social aspects in frail older adults and provides evidence on characteristics of exercise interventions for frailty in various settings. RELEVANCE TO CLINICAL PRACTICE: Multicomponent exercise and resistance-based exercise should be recommended for frail older adults. There is a need of more well-designed research with large sample size and validated definition of frailty. Long-term effects, adherence during and after exercise interventions, adverse events and cost-effectiveness should be emphasised in future studies. TRIAL AND PROTOCOL REGISTRATION: The overview protocol was registered on the International Prospective Register of Systematic reviews (CRD 42021281327). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were applied to report the results.

The mediating effect of self-directed learning ability between professional identity and burnout among nursing students.

Objectives: Burnout influences students' academic performance and mental health. This study analyzed the relationship between professional identity, self-directed learning ability, and burnout, and examined the mediating effect of self-directed learning ability between professional identity and burnout among nursing students. Methods: 884 nursing students were recruited at two medical universities in China. Demographic information, Academic Burnout Scale, Professional Identity Questionnaire for Nursing Students, and Self-directed Learning Instrument were distributed to collect data. Results: Both professional identity (ß = -0.17) and self-directed learning ability (ß = -0.43) showed negative associations with students' burnout. Meanwhile, there was a partial mediating effect of self-directed learning ability between professional identity and burnout (-0.24, 95% CI = -0.30, -0.20). Conclusions: Nursing educators should emphasize on developing effective strategies to improve nursing students' professional identity and self-directed learning ability to prevent or reduce their burnout.

Self-Efficacy, Coping Strategies and Quality of Life among Patients with Chronic Hepatitis B.

This study aimed to examine the relationships of self-efficacy, coping strategies, and quality of life (QoL) among patients with chronic hepatitis B and to explore whether coping strategies play a mediating role. In this cross-sectional study, 193 patients with chronic hepatitis B from two tertiary hospitals were recruited. Data were collected using a self-report questionnaire. The results indicated that physical and mental QoL were positively associated with self-efficacy and negatively associated with resignation coping. Moreover, resignation coping partially mediated the relationship between self-efficacy and physical and mental QoL. Our findings indicated that healthcare providers can enhance self-efficacy with an emphasis on reducing the use of resignation coping to better improve QoL among patients with chronic hepatitis B.

Diagnostic accuracy of the FRAIL scale for frailty screening in community-dwelling older adults with diabetes: A cross-sectional study.

There is limited evidence on the diagnostic accuracy of the FRAIL scale in community-dwelling older adults with diabetes. This study aimed to validate the diagnostic accuracy and determine the optimal cutoff point of the FRAIL scale in community-dwelling older adults with diabetes using the Fried Frailty Phenotype as the reference standard. A total of 489 community-dwelling older adults with diabetes aged 60 or above were recruited in this cross-sectional study. The FRAIL scale showed good diagnostic accuracy for frailty screening. The optimal cutoff point for frailty screening in older adults with diabetes was 2. The agreement between the FRAIL scale and the Fried Frailty Phenotype was substantial. The FRAIL scale classified more participants as frail (29.24%) than the Fried Frailty Phenotype (22.09%). These findings provide evidence that the FRAIL scale is a valid tool that can be applied to community-dwelling older adults with diabetes.

Relationship of Organizational Support, Psychological Capital, and Engagement Among Clinical Nursing Teachers.

BACKGROUND: Clinical nursing teachers play a critical role in nursing education, and their engagement is important to ensure the quality of clinical teaching. PURPOSE: To describe the level of engagement and determine the relationships among organizational support, psychological capital, and engagement among clinical nursing teachers. METHODS: A cross-sectional study was conducted among 246 clinical nursing teachers, from 4 teaching hospitals in China, using a self-report questionnaire. The questionnaire measured organizational support, psychological capital, and work engagement. RESULTS: Clinical nursing teachers reported a medium level of engagement in teaching. Both organizational support and psychological capital had positive effects on teachers' engagement. Psychological capital partially mediated the relationship between organizational support and engagement. CONCLUSIONS: Measures to improve organizational support and psychological capital are essential to enhance the engagement among clinical nursing teachers.

Prevalence and associated factors of burnout among nursing students: A systematic review and meta-analysis.

OBJECTIVES: To systematically estimate the global prevalence of burnout among nursing students, and examine the associated factors of burnout in this population. DESIGN: A systematic review and meta-analysis. REVIEW METHODS AND DATA SOURCES: PubMed, Embase, Web of Science, and CINAHL were searched from inception to June 30th, 2022. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the global prevalence of burnout among nursing students. Subgroup analysis, meta-regression analysis, publication bias, and sensitivity analysis were also conducted. RESULTS: A total of 21 studies were included, involving 10,861 nursing students. In the random-effects model, the pooled prevalence of burnout was 23.0 % (95 % CI = 15.6-30.5 %) in nursing students. The pooled prevalence of emotional exhaustion, depersonalization, and reduced personal accomplishment was 47.1 %, 32.2 %, and 43.5 %, respectively. Main associated factors of burnout included demographic (e.g., age and grade), educational (e.g., workload, academic satisfaction, and incivility experience), physical (e.g., sleep quality and physical activity), and psychological (e.g., self-efficacy and personality traits) factors. CONCLUSIONS: Burnout is common in nursing students, with demographic, educational, physical, and psychological factors affecting their burnout. Early screening of burnout and interventions to prevent and reduce burnout should be considered for nursing students.

Effects of exercise interventions on physical and psychological outcomes in frail older adults: Protocol for an overview of systematic reviews.

AIMS: To systematically summarize the existing evidence regarding the effects of exercise interventions on physical and psychological outcomes in frail older adults and appraise the quality and strength of the evidence. DESIGN: An overview protocol. METHODS: A literature search of PubMed, Embase, Web of Science, CINAHL and Cochrane Database of Systematic Reviews will be conducted to identify relevant systematic reviews with or without meta-analysis on exercise interventions for frail older adults. Two independent reviewers will select articles, extract data and appraise the quality of included reviews. Physical and psychological outcomes will be synthesized using narrative summaries. The methodological quality of included reviews and the quality of evidence will also be assessed. RESULTS: This overview will present the evidence on the effects of exercise interventions on physical and psychological outcomes for frail older adults, contributing to the implementation of exercise interventions to improve health outcomes for this population.

Prevalence and risk factors of cognitive frailty in community-dwelling older adults with diabetes: A systematic review and meta-analysis.

AIMS: Cognitive frailty can increase the risk of adverse health outcomes in older adults. Estimates of the prevalence of cognitive frailty among older adults with diabetes varied widely in literature. This study aimed to conduct a systematic review and meta-analysis to assess the pooled prevalence of cognitive frailty and risk factors in community-dwelling older adults with diabetes, providing evidence for healthcare professionals to better understand the status of cognitive frailty and help develop effective interventions. METHODS: Databases of PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index of Nursing and Allied Health, Proquest, China National Knowledge Infrastructure and China Biology Medicine were searched from inception to February 10th, 2022. The reviewers independently selected studies, extracted data and assessed the quality of studies. Pooled prevalence of cognitive frailty and risk factors were estimated. Subgroup analysis, meta-regression analysis, sensitivity analysis and publication bias were also conducted. RESULTS: A total of 15 studies with 6391 participants were included in this review. The pooled prevalence of cognitive frailty was 11% (95%CI = 7.9-14%) in community-dwelling older adults with diabetes. Pooled estimates showed that increasing age, higher level of HbA1c, shorter night sleep duration and depression were risk factors, and regular exercise was the protective factor of cognitive frailty in community-dwelling older adults with diabetes. CONCLUSION: Cognitive frailty was common in community-dwelling older adults with diabetes. Routine screening of cognitive frailty and effective interventions should be implemented for this population in community settings. REGISTRATION: PROSPERO ID CRD42021276973.

Illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate the relationship between illness uncertainty, self-perceived burden and quality of life and explore the mediating role of self-perceived burden between illness uncertainty and quality of life in patients with chronic myeloid leukaemia. BACKGROUND: Patients with chronic myeloid leukaemia need long-term, potentially lifelong therapy to control the disease, which affects their quality of life. There is a need for exploring potentially changeable factors to develop interventions. Little is known about the effects of illness uncertainty and self-perceived burden on quality of life in this population. DESIGN: A cross-sectional study. METHODS: A convenience sample of 248 patients with chronic myeloid leukaemia was recruited from four university hospitals from February to August 2020. Participants were assessed with the Mishel Uncertainty in Illness Scale, Self-Perceived Burden Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The STROBE checklist was used to report the results. RESULTS: Illness uncertainty and self-perceived burden were negatively associated with quality of life in patients with chronic myeloid leukaemia. Self-perceived burden partially mediated the relationship between illness uncertainty and quality of life. The indirect effect was -0.101, accounting for 22.9% of the total effect. CONCLUSION: The findings revealed the relationship between illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia. Self-perceived burden exerted a mediating role between illness uncertainty and quality of life in this population. RELEVANCE TO CLINICAL PRACTICE: This study alerts healthcare providers to pay attention to patients' illness uncertainty and self-perceived burden, which can contribute to develop effective interventions to improve the quality of life among patients with chronic myeloid leukaemia in the clinical practice.

Perceived social support, resilience and health self-efficacy among migrant older adults: A moderated mediation analysis.

Migrant older adults become more disadvantaged in health due to aging and migration-related problems. This study aimed to examine the mediating role of resilience in the relationship between perceived social support and health self-efficacy, and to test whether gender moderated the mediating effect of resilience between perceived social support and health self-efficacy among migrant older adults. A total of 184 migrant older adults were recruited from five communities. Resilience played a partial mediating role in the relationship between perceived social support and health self-efficacy. Moreover, age moderated the relationship between resilience and health self-efficacy. The relationship between resilience and health self-efficacy was stronger in male older adults than female ones. These findings provide a better understanding of the effects of perceived social support and resilience on health self-efficacy, which could guide targeted interventions for community health nurses to promote health self-efficacy among migrant older adults.

Proactive personality, professional self-efficacy and academic burnout in undergraduate nursing students in China.

BACKGROUND: Academic burnout can affect nursing students' academic performance and psychological well-being. Little is known about the associations between proactive personality, professional self-efficacy and academic burnout. PURPOSE: To assess the prevalence of academic burnout in undergraduate nursing students and to explore the associations between proactive personality, professional self-efficacy and academic burnout among nursing students in China. METHODS: This study used a cross-sectional design. Undergraduate nursing students were recruited from five medical schools in China to participate in an online survey from April to May 2020. The Proactive Personality Scale, Professional Self-Efficacy Scale for Nursing Students and Academic Burnout Scale were used to measure students' proactive personality, professional self-efficacy and academic burnout. RESULTS: A total of 1219 nursing students completed the questionnaire. The prevalence of academic burnout was 31.5% in nursing students, and improper behaviour showed the highest subscale score. Proactive personality, professional self-efficacy and academic year were negatively associated with nursing students' academic burnout. CONCLUSIONS: Academic burnout is prevalent in undergraduate nursing students in China. This study contributes to the understanding of the associations between proactive personality, professional self-efficacy and academic burnout in nursing students. Nursing educators should develop strategies to enhance students' proactivity and professional self-efficacy to decrease their academic burnout.

The prevalence of frailty among community-dwelling older adults with diabetes: A meta-analysis.

BACKGROUND: Coexistence of frailty and chronic diseases including diabetes is related to a higher risk of adverse health outcomes. There is an increasing interest in the intersection of diabetes and frailty. Understanding the prevalence of frailty in older adults with diabetes is of great importance. However, estimates of the prevalence of frailty among this population varied widely in the relevant literature. OBJECTIVES: To conduct a systematic review and meta-analysis to estimate the overall prevalence of frailty and prefrailty among community-dwelling older adults with diabetes, and examine the risk factors associated with frailty in this population. METHODS: PubMed, Web of Science, Embase, Wiley Cochrane Library, and Cumulative Index of Nursing and Allied Health were searched from inception to May 30th, 2020. Investigators assessed eligibility, extracted data and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. RESULTS: A total of 32 studies met the inclusion criteria, involving 14,450 individuals. The pooled prevalence of frailty and prefrailty in older adults with diabetes was 20.1% (95% CI = 16.0-24.2%) and 49.1% (95%CI = 45.1-53.1%), respectively, with significant heterogeneity across the studies. Frailty was more prevalent in older adults with diabetes than those without diabetes (OR = 1.61, 95%CI = 1.47-1.77, p < 0.001). The pooled prevalence of frailty was lower in studies using Frailty Phenotype to define frailty (16.3%) and conducted in Asia (14.3%). Female gender and unmarried status were risk factors of frailty among this population. CONCLUSION: Frailty and prefrailty are common in community-dwelling older adults with diabetes. Early screening of frailty and interventions should be integrated into diabetes care for older adults to prevent and reduce the negative effects of frailty at the community level. Better quality longitudinal research is required to examine the temporal relationship between diabetes and frailty.

Self-management behaviors in adults with chronic hepatitis B: A structural equation model.

BACKGROUND: Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications. OBJECTIVES: To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B. DESIGN: A cross-sectional study. SETTINGS: Hepatology units in two hospitals in Chongqing, China. PARTICIPANTS: A total of 306 patients with chronic hepatitis B were recruited. METHODS: Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data. RESULTS: The final model showed good model fit. Social support directly influenced self-management behaviors (ß = 0.19, p < 0.01), and indirectly influenced self-management behaviors (ß = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (ß = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (ß = 0.12, p < 0.05) through self-efficacy. CONCLUSIONS: Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.

Psychological distress and self-management behaviours among patients with chronic hepatitis B receiving oral antiviral therapy.

AIMS: To assess the prevalence and associated factors of psychological distress among patients with chronic hepatitis B receiving oral antiviral therapy and explore the association between psychological distress and self-management behaviours among this population. DESIGN: A cross-sectional study. METHODS: A convenience sample of 188 patients with chronic hepatitis B receiving oral antiviral therapy was recruited from March-October 2018 to complete a self-report questionnaire including the Chinese version of Depression Anxiety Stress Scale-21 and Chronic Hepatitis B Self-Management Scale. Logistic regression analysis and hierarchical multiple regression analysis were used to determine the factors associated with psychological distress and the association between psychological distress and self-management behaviours respectively. RESULTS: The prevalence of depression, anxiety, and stress symptoms were 33.0%, 38.3% and 17.6% respectively. Depression was associated with older age, female gender, lower education level and longer treatment duration; anxiety was associated with female gender and longer treatment duration; and stress was associated with age of 31-40 years, female gender and unmarried status. There were significant associations between depression and anxiety symptoms and self-management behaviours. CONCLUSION: Psychological distress was prevalent among patients with chronic hepatitis B receiving oral antiviral therapy and had a negative impact on self-management. Interventions targeting depression and anxiety symptoms may be beneficial to improve self-management behaviours for this population. IMPACT: This study explored the factors associated with psychological distress in patients with chronic hepatitis B receiving oral antiviral therapy. The findings showed psychological distress was more common in patients who were with older age, female, less educated, unmarried and receiving longer duration of treatment and psychological distress was significantly associated with self-management behaviours. Nurses and other healthcare providers should provide interventions to reduce the risk of psychological distress and improve self-management behaviours for this population.

Relationship of social support and health-related quality of life among migrant older adults: The mediating role of psychological resilience.

Migrant older adults are influenced by an accumulation of aging and adversities related to migration. This study aimed to evaluate the effects of psychological resilience and social support on health-related quality of life (HRQOL) among migrant older adults, and examine the mediating effect of psychological resilience between social support and HRQOL. A total of 149 migrant older adults were recruited from five communities in Chongqing, China. Social support and psychological resilience were positively associated with physical and mental HRQOL among migrant older adults. Psychological resilience had a partial mediating effect on the relationship between social support and physical and mental HRQOL. These findings provide a better understanding of how social support and psychological resilience work together to affect HRQOL, and it could guide the interventions to promote HRQOL among migrant older adults in the community.

Effect of peer support intervention on diabetes distress in people with type 2 diabetes: A systematic review and meta-analysis.

AIMS: To assess the effect of peer support intervention on diabetes distress in people with type 2 diabetes. BACKGROUND: Diabetes distress may be decreased by peer support intervention, but findings about the effect of peer support on diabetes distress have been mixed. DESIGN: A systematic review and meta-analysis of randomized controlled studies. DATA SOURCES: PubMed, Embase, CENTRAL, PsycINFO, Web of Science, and CINAHL databases were searched for randomized controlled trials from inception to 30 June 2018. REVIEW METHODS: Investigators assessed eligibility, extracted data, and assessed methodological quality. Standardized mean difference and 95% confidence intervals were calculated for pooled effect size. RESULTS: A total of 13 studies included in systematic review and 10 in meta-analysis. In the random-effects model, the pooled effect size showed current peer support intervention did not significantly reduce diabetes distress in type 2 diabetes population compared with usual care. CONCLUSION: High quality and well-designed studies targeting at reducing diabetes distress are needed to further test the effect of peer support intervention on diabetes distress.

Factors for self-management activities among rural patients with chronic hepatitis B: A cross-sectional study.

AIMS AND OBJECTIVES: To assess the self-management activities among rural patients with chronic hepatitis B (CHB), and the influence of psychosocial and demographic factors on their self-management activities. BACKGROUND: Chronic hepatitis B is a serious public health concern. Rural patients may have limited access to healthcare services. Although self-management is important for controlling chronic hepatitis B, few studies focus on the self-management activities among rural patients with chronic hepatitis B. Understanding self-management activities and related factors in this population are important to design and implement appropriate intervention strategies. DESIGN: A cross-sectional study. METHODS: From June-December 2017, totally 236 rural patients with chronic hepatitis B were recruited from hepatology department in two hospitals in Chongqing, China. The questionnaire included demographic characteristics, Chronic Hepatitis B Self-Management Scale, Self-Efficacy for Managing Chronic Disease, and Social Support Rating Scale. The study followed the STROBE checklist. RESULTS: Rural patients with chronic hepatitis B reported poor self-management activities for the score indexes of symptom management (57.36%), lifestyle management (54.89%), psychosocial coping (54.84%) and disease information management (53.11%) were all below 60%. Self-efficacy, objective support, subjective support, gender, education level and marital status showed significant effect on self-management activities. CONCLUSION: Rural patients with chronic hepatitis B were found to perform insufficient self-management activities. Self-efficacy, social support, gender, education level and marital status were identified to influence their self-management activities. RELEVANCE TO CLINICAL PRACTICE: Self-management activities should be promoted among rural patients with chronic hepatitis B. The factors that were identified in this study should be addressed when developing interventions to promote the performance of self-management activities for rural patients with chronic hepatitis B.