Differential effects of age on quality of sleep and depression in patients receiving maintenance haemodialysis.

BACKGROUND: Poor quality of sleep and depression are common and highly associated with each other in patients on haemodialysis. We aimed to investigate whether they share common risk factors and how age may influence their development. METHODS: Cross-sectional observation study on 120 haemodialysis patients with quality of sleep and depression assessed by Pittsburgh Sleep Quality Index (PSQI) and Taiwanese Depression Questionnaire (TDQ), respectively. RESULTS: The prevalence of poor quality of sleep and depression was 92.5% and 43.3%, respectively. PSQI scores were associated with age, gender, education and monthly income while TDQ scores were associated with low serum creatinine and albumin levels. Elderly patients at ages older than 65 had the highest average PSQI score (12.26 ± 4.35) than the young group at age 20-44 (8.25 ± 4.39) (P = 0.028) but the average TDQ scores were similar across three age groups. The proportion of those who had high PSQI scores was significantly higher in the elderly group (54.4%, P = 0.017) and the 44-65-years group (51.9%, P = 0.028) than the young group (16.7%). The proportion of those who reported normal quality of sleep was much lower in the elderly group (0.0%) than the other two groups (25.0%, P < 0.001 and 11.7%, P < 0.01). The proportions of those who had different ranges of TDQ scores did not show such a pattern of strong age dependence. CONCLUSIONS: Poor quality of sleep in haemodialysis patients is associated with socio-economic factors while depression is more related to biochemistry indicators. A majority of older patients suffer very poor quality of sleep while depression appears equally severe and common across different age groups.

The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery.

BACKGROUND: Little is known about the relationship of the American Society of Anesthesiologists Physical Status Classification scores (ASA scores) on patient outcomes following hip fracture surgery in Asian countries. Therefore, this study explored the association of patients' preoperative ASA scores on trajectories of recovery in physical functioning and health outcomes during the first year following postoperative discharge for older adults with hip-fracture surgery in Taiwan. METHODS: The data for this study was generated from three prior studies. Participants (N = 226) were older hip-fracture patients from an observational study (n = 86) and two clinical trials (n = 61 and n = 79). Participants were recruited from the trauma wards of one medical center in northern Taiwan and data was collected prior to discharge and at 1, 3, 6, and 12 months after hospital discharge. Participants were grouped as ASA class 1-2 (50.5%; ASA Class 1, n = 7; ASA Class 2, n = 107) and ASA class 3 (49.5%, n = 112). Measures for mortality, service utilization, activities of daily living (ADL), measured by the Chinese Barthel Index, and health related quality of life, measured by Medical Outcomes Study Short Form-36, were assessed for the two groups. Generalized estimating equations (GEE) were used to analyze the changes over time for the two groups. RESULTS: During the first year following hip-fracture surgery, ASA class 1-2 participants had significantly fewer rehospitalizations (6%, p = .02) and better scores for mental health (mean = 70.29, standard deviation = 19.03) at 6- and 12-months following discharge than those classified as ASA 3. In addition, recovery of walking ability (70%, p = .001) and general health (adjusted mean = 58.31, p = .003) was also significantly better than ASA 3 participants. CONCLUSIONS: There was a significant association of hip-fracture patients classified as ASA 1-2 with better recovery and service utilization during the first year following surgery. Interventions for hip fractured patients with high ASA scores should be developed to improve recovery and quality of life.

A single question regarding mobility in the World Health Organization quality of life questionnaire predicts 3-year mortality in patients receiving chronic hemodialysis.

Low quality of life, depression and poor quality of sleep are associated with increased mortality in hemodialysis patients. It is not clear which factor has the highest predictive power and what the core element is to explain the predictability. We thus conducted a prospective cohort study that included 151 hemodialysis adults. Three traits of interest were assessed by World Health Organization Quality of Life questionnaire, an abbreviated version (WHOQOL-BREF), Taiwanese Depression Questionnaire, and Athens Insomnia Scale, respectively. They were followed for more than 3 years and the all-cause mortality was 30.5%. The prevalence of quality of life at the lowest tertile, depression and poor quality of sleep was 19.9%, 43.0% and 74.2%, respectively. Discriminant analysis showed the standardized coefficient of each factor as 0.813, -0.289 and 0.066, indicating the highest discriminating power by quality of life to predict mortality. Question 15 "how well are you able to get around?" in the physical health domain of WHOQOL-BREF independently associated a hazard ratio of mortality 0.623 (95% confidence interval 0.423-0.918). Subjective perception of overall quality of life was more related to psycho-social-environmental factors. In conclusion, mobility is an independent and powerful predictor to long term mortality in patients on chronic hemodialysis.

Influence of Religious Beliefs on the Health of Cancer Patients.

BACKGROUND: This study investigated the influence of religious beliefs on the health of cancer patients and identified the factors contributing to the influence. MATERIALS AND METHODS: A questionnaire survey was conducted using a convenient sampling method. A structured questionnaire was used to the samplings, and the data of 200 cancer patients were collected. RESULTS: The effects of religion on the health of cancer patients achieved an average score of 3.58. The top five effects are presented as follows: (a) Religion provides me with mental support and strength, (b) religion enables me to gain confidence in health recovery, (c) religion motivates me to cope with disease-related stress positively and optimistically, (d) religion helps me reduce anxiety, and (e) religion gives me courage to face uncertainties regarding disease progression. Moreover, among the demographic variables, gender, type of religion, and experience of religious miracles contributed to the significantly different effects of religion on patients. Specifically, the effect of religion on the health of patients who were female and Christian and had miracle experiences was significantly (< .01) higher than that on other patients. CONCLUSIONS: These results are helpful in understanding the influence of religious beliefs on the health of cancer patients and identified the factors contributing to the influence. The result can serve as a reference for nursing education and clinical nursing practice.

Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy.

BACKGROUND: Breast cancer patients frequently experience psychological distress during the chemotherapy period. OBJECTIVES: This study aimed to evaluate the effect of relaxation with guided imagery on patients with breast cancer. PATIENTS AND METHODS: A two-group, pretest-posttest, quasi-experimental design with a randomized controlled trial was conducted. Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study. These patients were randomly assigned to the experimental group (n = 32) or to the control group (n = 33). Both groups received chemotherapy self-care education, but the experimental group also received relaxation with guided imagery training. The training on relaxation with guided imagery was conducted before chemotherapy, and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy. RESULTS: The experimental group showed significant decreases in insomnia (-0.34 ± 0.83, P < 0.05), pain (-0.28 ± 0.58, P < 0.05), anxiety (-3.56 ± 2.94, P < 0.00), and depression (-2.38 ± 2.70, P < 0.00) between the pretest and the posttest. Comparing the two groups, statistically significant differences were found in the overall symptom distress (B = 0.11, P < 0.05), insomnia (B = 0.50, P <0.05), depression (B = 0.38, P < 0.05), and numbness in physical symptoms (B = 0.38, P < 0.05), as well as in anxiety (B = 3.08, P < 0.00) and depression (B = 1.86, P < 0.00) in psychological distress. One week of relaxation with guided imagery can significantly improve the overall symptoms of distress, insomnia, depression, physical symptoms, and anxiety, and can decrease psychological distress. CONCLUSIONS: Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients.

Development and preliminary testing of an instrument to measure healthiness of lifestyle among breast cancer survivors.

Monitoring lifestyle to maintain health is an important issue for breast cancer survivors. No multidimensional instrument has previously been available specifically for assessing overall healthiness of lifestyle among breast cancer survivors. This study aims (i) to establish the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS) and (ii) to examine the reliability and validity of the established scale. A quantitative cross-sectional design was used. This project was conducted in four phases. In phase I, using the Health-Promoting Lifestyle Profile as the core concept, we created 50 preliminary measurement items. In phase II, we invited 10 breast cancer survivors and five professional experts to conduct a content validity assessment. In phases III and IV, a total of 220 breast cancer survivors were enrolled to assess the construct validity and the internal consistency and reliability. The final HLI-BCS contains 20 items across five domains: dietary habits, environment and physiology, health responsibility and stress management, social and interpersonal relations and spiritual growth. Through the information presented in the HLI-BCS, breast cancer survivors can assess their lifestyles on multiple dimensions and subsequently adjust their lifestyles to enhance their recovery and quality of life.

HPV vaccine knowledge and perceived risk of cervical cancer among female college students in Taiwan.

AIMS: The study targeted the HPV vaccine knowledge and perceived risk of cervical cancer among female college students in Taiwan as well as the relationship between knowledge of the HPV vaccine and perceived risk of cervical cancer. MATERIALS AND METHOD: The results of this study on female college students are described using descriptive and correlation designs. A convenience sampling approach was employed with a self-filling structured questionnaire. RESULTS: A total of 150 students completed the questionnaire. Values were 7.49 for the mean HPV vaccine knowledge scale and 18.0 for their mean perceived risk of cervical cancer scale. HPV vaccine knowledge was positively correlated with perceived risk of cervical cancer. CONCLUSIONS: The findings of this study can serve as a reference for future HPV prevention in Taiwan.

Healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors.

AIMS: The purpose of the present study was to investigate healthy lifestyle changes during the period before and after breast cancer diagnosis in Taiwan. MATERIALS AND METHOD: Lifestyle changes during the period before and after cancer diagnosis were assessed by convenience sampling with a structured questionnaire for breast cancer survivors. RESULTS: A total of 235 breast cancer survivors completed the healthy lifestyle scale. The mean values before and after breast cancer diagnosis of the participants were 3.27 and 3.73. The final five dimensions for the period before breast cancer diagnosis were: had not experienced stress; had exercised; had maintained sleep quality; had maintained body weight; and had maintained relationships. The final five dimensions for the period after breast cancer diagnosis were: sleep quality; had not experienced stress; relationship; had exercised; and had maintained body weight. A paired-t test was applied to examine the differences before and after cancer diagnosis, revealing that the total average scores of the participants on the healthy lifestyle scale clearly differed statistically (t= -17.20, p<0.01); and the nine dimensions before and after testing also demonstrate a marked statistical difference (p<0.01). CONCLUSIONS: These findings are helpful in understanding the healthy lifestyle changes during the period before and after cancer diagnosis among breast cancer survivors. It is expected that these results can offer references of self-care for this group of patients.

Use of complementary and alternative medicine among breast cancer survivors in Taiwan.

AIMS: The purpose of this study was to investigate complementary and alternative medicine use among breast cancer survivors in Taiwan. MATERIALS AND METHODS: This study employed a descriptive research design approach to detail the CAM use among the target population. Convenience sampling was used along with a structured questionnaire. RESULTS: A total of 230 breast cancer survivors completed the use CAM scale. Prayer, reading books, taking antioxidants, eating various grains, and maintaining a vegetarian diet proved to be the five most frequently used CAM practices among patients in our study. More than 50.0% of the participants reported praying occasionally. More than 40.0% of participants read books occasionally, and 38.7% stated that they occasionally take antioxidants. CONCLUSIONS: These results provide more insight into CAM use for nurses who care for breast cancer patients.

Relationships between cause of cancer and breast cancer-related factors in breast cancer survivors.

AIMS: The purposes of this study were to (1) to identify the causes of cancer in breast cancer survivors in Taiwan; and (2) to investigate the influence of demographic characteristics and breast cancer-related factors on the cause of cancer. MATERIALS AND METHOD: This study details the related investigative results on survivors with breast cancer using a descriptive and correlational design. A convenience sampling approach was employed. A structured questionnaire was used to assess the participants. RESULTS: A total of 230 breast cancer survivors completed the questionnaire. Low-scoring cause of cancer participants were older adults (OR = 2.49, p<0.05) who were already of menopausal status (OR = 2.28, p < 0.05). Around 72% of participants agreed high responsibility. Our breast cancer survivors felt stress had caused their breast cancer. CONCLUSIONS: These findings are helpful in understanding the relationship between cause of cancer and related factors in breast cancer survivors.

Breast cancer survivors' efforts to renew and preserve their health in Taiwan.

AIMS: This study was designed to describe the personal life experiences of breast cancer survivors regarding their efforts to recover and preserve their health in Taiwan. METHOD: The study utilized a qualitative research method, wherein purposive sampling, one-on-one, face-to-face, in-depth semi-structured interviews were conducted. The data were then analyzed using content analysis. Data were saturated after interviewing 15 cancer survivors. RESULTS: Three common themes emerged: introspection on the cause of the cancer, realization of a harmonized lifestyle, and reflecting on the strong will to survive. CONCLUSIONS: These findings are helpful in understanding the relationship between breast cancer survival and individual efforts to restore and preserve health.

The effects of education program on knowledge and intention of breast cancer screening in Taiwan.

AIMS: The purpose of this study was to investigate the effects of a breast cancer screening educational program on women's knowledge and intention to seek breast cancer screening in Taiwan. MATERIALS AND METHOD: This study describes the knowledge and intention of breast cancer screening changes during the period pre and post group education. A pre-test and post-test were used in both the experimental and the control groups. A convenience sampling was used. Two structured questionnaires were used. RESULTS: The mean knowledge of breast cancer screening scores (pre-test and post-test) of the experimental group participants were 12.6 and 14.0. Then the mean knowledge of breast cancer screening scores (pre-test and post-test) of the control group participants were 11.8 and 12.1. The mean intention of breast cancer screening scores (pre-test and post-test) of the experimental group participants were 11.4 and 13.5. And the mean intention of breast cancer screening scores (pre-test and post-test) of the control group participants were 11.6 and 12.4. An independent-t test was applied to examine the differences among the two groups, revealing that the average post-test knowledge score differ significantly between the two groups (t=4.18, p<.00); and the post-test intention also demonstrate a marked statistical difference (t=2.07, p<.05). A paired-t test was applied to examine the differences of each group, revealing that the total average scores of the experimental group participants on the knowledge of breast cancer screening scale clearly differ statistically (t=-5.54, p<.00); and the pre-test and post-test intention testing also demonstrate a marked statistical difference (t=-7.70, p<.00). CONCLUSIONS: These findings are helpful in understanding the knowledge and intention of breast cancer screening changes during the period pre and post group education. It is expected that these results can offer a reference for clinical breast cancer prevention.