Caregiver Burden Among Informal Caregivers of Persons Living with HIV/AIDS in Liangshan Prefecture, China.

Purpose: Previous studies revealed that informal caregivers for persons living with HIV/AIDS (PLWHA) experience perceived caregiver burden. Although Liangshan prefecture is one of the areas with the fastest growing HIV/AIDS epidemics in China, little is known about burden of informal caregivers for PLWHA. This study aimed to evaluate caregiver burden and these predictors among informal caregivers of PLWHA in Liangshan prefecture, China. Methods: This was a cross-sectional study conducted from August to December 2017. We used convenience sampling to recruit informal caregivers of PLWHA. A total of 222 participants completed questionnaires including demographic information, caregiving-related information, and caregiver burden (measured by Zarit Burden Interview, ZBI). SPSS software was used to analyze the data. Independent student's t-test, one-way analysis of variance (one-way ANOVA), Spearman rank correlation, and multiple linear regression analysis were performed. Results: The mean ZBI score was 40.61 (SD = 14.47), and 199 (89.6%) informal caregivers had a mild or above caregiver burden. Multiple linear regression analysis revealed that older age (P=0.003), caregivers with poor health (P=0.002), parent-caregivers (P=0.001), poorer ability in 'balancing caregiving needs and their own needs' (P<0.001), and 'managing emotional needs' (P=0.014) were significantly associated with higher level of caregiver burden. Conclusion: The majority of informal caregivers had perceived caregiver burden in Liangshan prefecture of China. Findings emphasize that health-care providers, medical institutions and government should develop educational programs and policy to improve caregiver's ability to cope with caregiving for PLWHA, and take more attention to caregivers with health problem, at older age, parent-caregivers. These may contribute to reducing caregiver burden among informal caregivers of PLWHA.

Are nurses prepared to respond to next infectious disease outbreak: A narrative synthesis.

AIM: The review aimed to present a synthesis of nurses' preparedness for infectious disease and the components of emergency preparedness. DESIGN: Narrative synthesis. METHODS: A systematic search and screening for relevant studies were conducted to locate the relevant articles. The included studies were examined for scientific quality using the Mixed Methods Appraisal Tool. The findings of included studies were synthesized by a narrative synthesis approach. RESULTS: Totally 15 studies were included, and 4 themes associated with nurses' preparedness for pandemic were identified: knowledge and skills, psychological preparation, external resources, and attitude and intention. CONCLUSIONS: Most nurses express a positive willingness to respond to epidemics, although they do not believe they are adequately prepared. Some measures should be taken for improving nurses' emergency preparedness, including providing ongoing training, protective equipment, safe working environment and psychological intervention, improving nurses' resilience and accelerating the sharing of scientific information about epidemics.

Psychological resilience of patients with bladder cancer after radical cystectomy and urinary diversion: A cross-sectional study.

OBJECTIVE: The aims of this study were to investigate the current state of psychological resilience and identify its associated factors in bladder cancer (BC) patients undergoing radical cystectomy (RC). METHODS: A cross-sectional study, using convenience sampling was conducted among 248 patients recruited from urology department of a tertiary hospital in Shenyang, China. According to the resilience in illness model, participants were invited to finish a questionnaire included demographic and disease-related information, Connor-Davidson Resilience Scale, Mishel Uncertainty in Illness Scale, Medical Coping Modes Questionnaire, Social Support Rating Scale, Family adaptation, partnership, growth, affection, and resolve Index and Herth Hope Index. Multiple regression analysis was conducted to explore the predictors of resilience. RESULTS: The average resilience score of 53.45 ± 6.22 among BC patients undergoing RC. Multiple regression showed that the associated factors of resilience of postoperative BC patients were gender (ß = -0.142, p = 0.002), living in town (ß = -0.103, p = 0.052), living alone (ß = 0.118, p = 0.026), almost need to be taken care of (ß = 0.094, p = 0.064), illness uncertainty (ß = -0.249, p < 0.001), confrontation (ß = 0.091, p = 0.077), acceptance-resignation (ß = -0.205, p < 0.001), social support (ß = 0.122, p = 0.029) and hope (ß = 0.350, p < 0.001). These predictors accounted for 56.9% of the total variance in resilience (F = 14.964, p < 0.001). CONCLUSIONS: Resilience among BC patients undergoing RC needs to be further improved. Hope was the most important variable influencing resilience in BC patients undergoing RC. In the future, we need to pay more attention to the psychological status of patients and encourage them to face the disease with positive emotion and positive coping style to enhance the hope and resilience of patients, so as to improve the quality of life of patients with BC undergoing RC.

The effects of WeChat-based educational intervention in patients with ankylosing spondylitis: a randomized controlled trail.

BACKGROUND: Ankylosing spondylitis (AS), as a common inflammatory rheumatic disease, often causes depression and impaired health-related quality of life (QoL). Although positive effects of patient education have been demonstrated, limited studies explored the benefits of education via mobile applications for AS patients. This study aimed to evaluate the effects of the WeChat-based educational intervention on depression, health-related QoL, and other clinical outcomes in AS patients. METHODS: We conducted a single-blind randomized controlled trial from March to December 2017. Patients were recruited and randomized into the intervention group which received a 12-week WeChat-based educational intervention (consisting of four individual online educational sessions, online educational materials) or the control group receiving standard care. Data was collected at baseline and 12 weeks. Outcomes were measured by Beck Depression Inventory-II, the Medical Outcomes Study Short Form 36-item Health Survey (SF-36), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Patient Global Score (BAS-G), and visual analog scales. RESULTS: A total of 118 patients with AS were included and analyzed. Measures at baseline were comparable between groups. After the intervention, the intervention group reported significant higher scores of all domains of SF-36 except for physical functioning and validity, compared with the control group. Additionally, patients in the intervention group had lower depressive symptoms than the control group. No significant difference in other outcomes was observed at 12 weeks. CONCLUSIONS: This study found that the 12-week educational intervention via WeChat had positive effects on reducing depressive symptoms and improving health-related QoL in Chinese patients with AS. We suggest that this intervention can be integrated into current routine care of AS patients. TRIAL REGISTRATION: This study has been approved by the hospital's ethics committee (ID: 20160364) in 2016 and registered at the Chinese Clinical Trail Registry (registry number: ChiCTR-IPR-16009293 ).

Psychological impact of COVID-19 outbreak on frontline nurses: A cross-sectional survey study.

AIMS AND OBJECTIVES: This study aimed to portray the prevalence and associated factors of psychological distress among frontline nurses during COVID-19 outbreak. BACKGROUND: The COVID-19 outbreak has posed great threat to public health worldwide. Nurses fighting against the epidemic on the frontline might be under great physical and psychological distress. This psychological distress was predominantly described as sleep disturbance, symptoms of anxiety and depression, post-traumatic stress, inability to make decisions and even somatic symptoms. DESIGN: Cross-sectional study. METHODS: Frontline nurses from designated hospitals for COVID-19 patients were invited to complete an online survey by convenience sampling, and the survey included six main sections: the General Health Questionnaire, the Perceived Social Support Scale, the Simplified Coping Style Scale, the Impact of Event Scale-Revised, socio-demographic, occupation and work history. Multiple logistic analysis was used to identify the potential risk factors of psychological distress. The study methods were compliant with the STROBE checklist. RESULTS: Of the 263 frontline nurses, 66 (25.1%) were identified as psychological distress. Multiple logistic analysis revealed that working in emergency department, concern for family, being treated differently, negative coping style and COVID-19-related stress symptom were positive related to psychological distress. Perceived more social support and effective precautionary measures were negatively associated with psychological distress. CONCLUSIONS: The study demonstrated that COVID-19 had a significant psychological impact on frontline nurses. Early detection of psychological distress and supportive intervention should be taken according to the associated factors to prevent more serious psychological impact on frontline nurses. RELEVANCE TO CLINICAL PRACTICE: This study highlighted that the frontline nurses were suffering from varying degrees of psychological distress, which needed early screening and supportive intervention for preventing more serious psychological impact on frontline nurses. Beside, more specific measurement should be combined with the GHQ-12 to assess the varying degrees of psychological distress in frontline nurses.

HIV-Related Stigma Among People Living With HIV in Liangshan Yi Autonomous Prefecture, China.

HIV-related stigma is a worldwide phenomenon that can lead to a series of negative outcomes. Our aim was to determine the prevalence of HIV-related stigma and its associated factors among people living with HIV in Liangshan Yi Autonomous Prefecture, China. A cross-sectional study was performed between September and December 2017. A total of 318 participants were included. The mean participant score on the Berger HIV Stigma Scale was 105.13 (SD = 21.58), showing a moderate level of stigma. In multivariable regression analysis, HIV-related stigma was more severe for participants with no religious beliefs, a shorter period since HIV diagnosis, nondisclosure of HIV status to sexual partners or friends, more affective support, and less emotional/information support. To reduce HIV-related stigma, health care providers should draw more attention to targeted interventions to assist those who may have a greater risk of stigma.

Status and associated characteristics of HIV disclosure among people living with HIV/AIDS in Liangshan, China: A cross-sectional study.

Human immunodeficiency virus (HIV) disclosure is a prerequisite to get access to antiretroviral therapy (ART) and social support. Increased disclosure of HIV status has been shown to reduce mother-to-child transmission and high-risk sexual behaviors. Limited studies were conducted to get an insight into HIV disclosure among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLWHA) in Liangshan.Our study aimed to investigate the status and associated characteristics of HIV disclosure among PLWHA in Liangshan.We conducted a cross-sectional study using a stratified, convenience sampling method from August to December in 2017. All of the participants were from Liangshan, a typical impoverished mountainous area which also has a long history of drug production and drug trade. Each participant completed a structured questionnaire including HIV disclosure status, demographic and HIV-related characteristics, social support, and perceived HIV-related stigma. We performed a binary regression analysis to detect associated characteristics of HIV disclosure among PLWHA in Liangshan.A final sample size of 318 participants was included in this study. The overall prevalence of HIV disclosure was 83.6% (266/318). In binary logistic regression analysis, PLWHA who had higher educational levels, and got infected by sexual transmission were less likely to disclose their HIV status (both P < .05). HIV nondisclosure was correlated with a higher level of perceived HIV-related stigma (P < .01).The prevalence of HIV disclosure was relatively low in Liangshan. Healthcare workers are suggested to conduct more counseling and education to promote safe sexual behaviors and reduce perceived stigma among PLWHA, then enhance HIV serostatus disclosure.

Predictors of medication nonadherence in patients with systemic lupus erythematosus in Sichuan: a cross-sectional study.

PURPOSE: The aim of this study was to determine the prevalence and predictors of medication nonadherence among patients with systemic lupus erythematosus (SLE) in Sichuan. PATIENTS AND METHODS: A cross-sectional investigation was performed. Participants were recruited by consecutive sampling from the Rheumatic Clinic of a university hospital between June and September 2016. Patients' self-reported medication adherence was assessed by the eight-item Morisky Medication Adherence Scale. Additional surveys included patients' demographics, and clinical and treatment characteristics. Logistic regression analysis was used to identify the predictors of medication nonadherence. RESULTS: A total of 140 patients were included in analysis. The percentage of patients classified as nonadherent to medication was 75%. Low education, rural residency, childlessness, limited comprehension of medication instructions, side effects experienced, dissatisfaction with treatment and better physical health were associated with an increased risk of nonadherence. CONCLUSION: This study demonstrated a high prevalence of medication nonadherence among SLE patients in Sichuan, and factors associated with the nonadherence are multifaceted. Interventions for these factors, such as appropriate adjustment of the service resources for patients with rheumatic disease in rural communities and improved communication between the health care providers and the patients, may contribute to improve the medication adherence of this cohort.

Effects of transitional care on self-care, readmission rates, and quality of life in adult patients with systemic lupus erythematosus: a randomized controlled trial.

BACKGROUND: Lack of adequate self-care, frequent admissions, and poor quality of life are common and serious problems in adult patients with systemic lupus erythematosus (SLE). Some studies have revealed that transitional care is effective in improving self-care and quality of life as well as reducing rehospitalization rates. However, limited studies explored its effects in adult patients with SLE. Therefore, we performed a study to examine the effects of transitional care on self-care, readmission rates, and quality of life in adult patients with SLE. METHODS: This study was a single-center, single-blind, and parallel-group randomized controlled trial comparing transitional care with usual care in SLE patients from a university hospital in China. Evaluations were conducted at baseline before discharge and at 3 months after discharge by using hospital readmission rate, the Exercise of Self-Care Agency Scale, and the Medical Outcomes Study Short Form 36-item Health Survey for self-care and quality of life. Data were collected between June and December 2016. RESULTS: Compared with the usual care group, the transitional care group reported significantly greater improvement in self-care and quality of life. Additionally, the 30-day readmission rate for the patients in the transitional care group was significantly lower than in the usual care group, and this effect remained significant at 60 and 90 days after patient discharge. CONCLUSION: This study shows that transitional care improves self-care and quality of life in adult patients with SLE and reduces readmissions. However, further studies are needed. TRIAL REGISTRATION: China clinical trial registry, ChiCTR-IPR-16007708 . Registered January 5, 2016.

Prevalence and factors associated with disturbed sleep in outpatients with ankylosing spondylitis.

Sleep disturbance is prevalent among patients with ankylosing spondylitis (AS) and is considered a multifactorial issue. The study was designed to investigate sleep disturbance and its associated factors in AS outpatients in Southwest China. Patients were recruited by convenience sampling in this cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), the Bath AS Patient Global Score (BAS-G), and the Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality, disease activity, function status, global well-being, depression, and anxiety. Spearman's correlation, t test, ANOVA, and multiple linear regression analysis were used to explore the associated factors of sleep disturbance. Of the 281 outpatients included in the study, 190 (67.6%) patients had sleep disturbance. The married patients, the patients with extra-spinal manifestation, depression and anxiety, longer duration of diagnostic delay, higher disease activity, worse functional status and global well-being, high level of pain, and fatigue, had poorer sleep quality (P < 0.05). Multiple linear regression analysis revealed age (ß = 0.087, P = 0.102), BAS-G (ß = 0.181, P = 0.003), fatigue (ß = 0.170, P = 0.002), anxiety (ß = 0.151, P = 0.002) and nocturnal back pain (ß = 0.192, P = 0.001), extra-spinal manifestation (ß = 0.120, P = 0.012), and duration of diagnostic delay (ß = 0.174, P = 0.001) were the contributors to PSQI. Sleep disturbance is common in AS patients in Southwest China. It may be useful to keep regular exercise, strengthen the management of pain, relieve anxiety, and prevent and treat extra-spinal manifestation for improving sleep quality.

Self-care agency in systemic lupus erythematosus and its associated factors: a cross-sectional study.

PURPOSE: The aim of this study was to estimate the level of self-care agency and explore its associated factors in patients with systemic lupus erythematosus (SLE). PATIENTS AND METHODS: In this cross-sectional study, all patients were from a tertiary general hospital between July and October 2016 in Southwest China. The self-care agency was assessed using the Exercise of Self-care Agency Scale. Other variables were measured by the Visual Analog Scale, Systemic Lupus Erythematosus Disease Activity Index 2000, the physical component summary, and mental component summary of the 36-item Short Form Health Survey. Multivariate regression analysis was performed to explore the associated factors of self-care agency. RESULTS: A total of 123 patients were recruited. The mean score of Exercise of Self-care Agency Scale was 86.29. In univariate analysis, self-care agency of patients differed in regard to gender, work status, educational level, household income monthly per capita, and disease activity (P<0.05). Additionally, higher body mass index, higher level of fatigue, and worse mental health were found in patients with lower self-care agency (P<0.05). The stepwise multivariate regression analysis showed that male gender (P=0.001), lower educational level (P=0.003), lower household income monthly per capita (P<0.001), and worse mental health (P<0.001) could predict lower self-care agency. CONCLUSION: Patients with SLE had a middle level of self-care agency, suggesting that there is still much scope for improvement. The lower level of self-care agency was associated with male gender, lower educational level, lower household income monthly per capita, and worse mental health. Therefore, health care providers should develop targeted and comprehensive interventions to enhance self-care agency in patients with SLE.