Identifying symptom clusters among pregnant women during early and late pregnancy.

OBJECTIVES: To investigate the status of multiple psychosomatic symptoms among women and identify symptom clusters at different gestational stages. METHODS: This was a cross-sectional study and a consecutive sample of 557 pregnant women were recruited. They were asked to complete the Memorial Symptom Assessment Scale, and to supply sociodemographic and clinical information. Spearman correlation analysis, partial correlation networks, and hierarchical cluster analysis were carried out to identify the optimal number of symptom clusters. RESULTS: The top five scores for symptoms in early pregnancy were nausea, lack of appetite, feeling drowsy, lack of energy, and vomiting. Weight gain, difficulty sleeping, sweating, lack of energy, and dry mouth scored high in late pregnancy. Four clusters were identified in early pregnancy, and three clusters were determined in late pregnancy. CONCLUSIONS: Women experience multiple psychosomatic symptoms during pregnancy, and the manifestation of symptoms varies at different stages. The present study has provided new insights into symptom clusters in pregnant women.

Effects of Resilience-Promoting Interventions on Cancer Patients' Positive Adaptation and Quality of Life: A Meta-analysis.

BACKGROUND: Resilience-promoting interventions (RPIs) are increasingly used for cancer patients. However, there are few comprehensive reports on the efficacy of RPIs in cancer patients. OBJECTIVE: A meta-analysis of randomized controlled trials (RCTs) was conducted to systematically evaluate the effects of RPIs on resilience, posttraumatic growth (PTG), and quality of life in cancer patients. METHODS: Two authors conducted independent literature searches in electronic databases (PubMed, Scopus, Web of Science, MEDLINE, EBSCO [ASC], Cochrane library, China National Knowledge Infrastructure, Wan Fang Data, and Chinese Scientific and Technological Journal Database) from the first available date to February 2021. Then, eligible studies were selected, data for meta-analysis were extracted, and the risk of bias was evaluated. RESULTS: Sixteen independent randomized controlled trials with 1620 participants were included. Meta-analysis showed that RPIs significantly improved the level of resilience and PTG among cancer patients. Further analysis indicated that both group and individual interventions could enhance resilience and PTG levels. However, RPIs did not significantly enhance the quality of life in cancer patients. CONCLUSIONS: Clinical evidence from current randomized controlled trials shows that RPIs can improve the positive adaptation in cancer patients through either group intervention or individual intervention methods. In the future, the impact of RPIs on the quality of life needs further validation. IMPLICATIONS FOR PRACTICE: Interventions to enhance the positive adaptation for patients with cancer are needed. Considering that both group and individual forms of RPIs can improve resilience and PTG, future clinical intervention methods can be considered in combination with the specific situation of research implementation.

The structure of menopausal syndrome: Using network analysis to understand unique symptomatic relationships.

OBJECTIVE: To explore the network structure underlying the symptoms of menopausal syndrome and to identify the central and bridge symptoms of menopause among middle-aged women. METHODS: This is a cross-sectional survey study conducted in the Chinese community with a total of 1829 women aged 40-65 years. The Menopause Rating Scale (MRS) was used to assess the menopausal syndrome, including somato-vegetative, psychological, and urogenital subdomains. The network analysis was performed to determine the central and bridge symptoms of menopause. RESULTS: In the network of menopausal symptoms, anxiety, vaginal dryness, depressive mood, and irritability were the most central symptoms. Depressive mood, anxiety, and vaginal dryness were also detected as the bridge symptoms. The estimated network between the symptoms had good stability (CS-strength = 0.75 and CS-edge = 0.75). CONCLUSION: The present network analysis provided unique insights into the inner structure of menopausal symptoms. Psychological symptoms should be considered as the core symptoms in developing relevant interventions to improve the health and well-being of middle-aged women.

Psychosocial resources moderate the association between stress and insomnia among patients with digestive system cancers.

This study explored the profiles of psychosocial resources combined with resilience and family care, and analyzed their moderating effects on the relationship between stress and insomnia in patients with digestive system cancers. A total of 366 patients were recruited to participate in this study from two tertiary hospitals in China. They were assessed using the Perceived Stress Scale - 4 items, Insomnia Severity Index, Family Concern Index Questionnaire, and 10-item Connor-Davidson Resilience Scale. Latent profile analysis and the BCH (Bolck, Croon & Hagenaars) method were used to identify the subtypes and estimate the moderating role of psychosocial coping resources. About 62.3% of participants had insomnia symptoms. Insomnia was positively correlated to the stress (r = 0.25, P < 0.001). The latent classes were the low resources class (32.8%), the medium resources class (46.1%), and high resources class (21.1%). Among these, in low (estimate value = 0.563, P = 0.003) and medium (estimate value = 0.301, P = 0.029) resources class, stress had an effect on insomnia. There was no association between stress and insomnia in high resources class (estimate value = 0.165, P = 0.637). Stress might be associated with to insomnia problems, whereas patients with high psychosocial resources are more not vulnerable. Interventions to improve family function and resilience could contribute to easing the insomnia of patients with digestive system cancers.

Coping Style, Insomnia, and Psychological Distress Among Persons With Gastrointestinal Cancer.

BACKGROUND: Although insomnia has been shown to play an important role in psychological distress among gastrointestinal cancer patients, little is known about the internal mechanisms underlying this relation. Coping styles have been shown to moderate the effect of sleep on emotion, and this moderating effect may be age-dependent. OBJECTIVE: The aim of this study was to test how age and coping styles moderate the role of insomnia on psychological distress among gastrointestinal cancer patients. METHODS: This was a descriptive cross-sectional study with a convenience sample. A total of 352 patients with gastrointestinal cancer from two tertiary hospitals were recruited to participate in this study. The Kessler Psychological Distress Scale, the Insomnia Severity Index, and the Simplified Coping Style Questionnaire were used to assess patients' psychological distress, insomnia, and coping styles, respectively. We performed hierarchical multiple regression and Johnson-Neyman statistical analysis to probe the moderating effect of coping styles and age. RESULTS: The mean age of the participants was 58.32 years. Nearly half of the participants reported psychological distress, and many reported insomnia. Insomnia was significantly positively associated with psychological distress. Coping styles and age moderated the relationship between insomnia and distress. Specifically, positive coping buffered the effect of insomnia on psychological distress only for subjects aged 34 years and younger; negative coping exacerbated the above relationship in patients aged 68 years and older while weakening the relationship in participants aged 51 years and younger. DISCUSSION: There are age differences in the moderating role of coping styles on the relationship between insomnia and distress among gastrointestinal cancer patients. This study provides preliminary evidence to inform tailored guidance on coping styles by age groups to attenuate the risk for psychological distress related to insomnia in the cancer population.

When experiencing a surgery: Gastrointestinal cancer patients' longitudinal trajectories in psychological stress and their association with quality of recovery.

Objective: Surgical treatment, particularly for gastrointestinal cancer, is a burdensome prospect for many patients. Psychological stress is a common complaint; however, little is known about its patterns in perioperative patients. This study aimed to identify distinct trajectories of perioperative stress and explore antecedent factors and hospitalization outcomes among different trajectories in patients with gastrointestinal cancer. Methods: A longitudinal study was conducted on 203 patients with gastrointestinal surgical cancer at a specialized oncology hospital in China. Psychological stress was assessed at five perioperative time points (1-3 days before surgery; 1-3 days, 4-6 days, 7-9 days after surgery, and before discharge). A growth mixture model was used to analyze the potential stress trajectories. Multinomial logistic regression was used to identify the characteristics associated with different trajectories. Results: Three stress trajectories were identified: recovery class (RC, 60.6%), chronic class (CC, 29.5%), and deterioration class (DC, 9.9%). Compared with CC, RC exhibited a shorter length of stay and better recovery quality, and was related to employment, low illness perception, and positive coping; DC reported lower recovery quality from 7 to 9 days after surgery to discharge and was associated with poor education level, history of surgery, stoma, smoking, and preoperative insomnia. Conclusions: Most surgical patients were insulated from stress due to psychosocial resources, and thus displayed good recovery. However, many patients had moderate stress that did not improve or worsen over the perioperative period, which still needs to be screened and provided with early stress management.

Gender-Based Differences in the Relationships Among Social Support, Positive Psychological Capital, and Sleep Quality in Patients Implanted With Pacemakers: A Moderated Mediation Model.

BACKGROUND: Sleep disorders are common and seriously affect the prognosis of patients implanted with pacemakers. AIMS: In this study, it was investigated whether social support directly impacts sleep quality and whether positive psychological capital mediates and gender moderates the relationship between social support and sleep quality among this group. METHODS: A total of 178 patients implanted with pacemakers were recruited to participate in the study from 2 tertiary hospitals in Shandong, China. Patients were assessed using the Perceived Social Support Scale, Positive PsyCap Questionnaire, and Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression and the PROCESS macro were used to test the mediating and moderated mediating effects. RESULTS: Patients' mean PSQI score was (8.48 ± 4.50), and 71.30% of the patients had sleep problems (PSQI > 5). Social support scores were negatively correlated with PSQI scores (r = -0.19, P = .010) and positively correlated with positive psychological capital scores (r = 0.45, P < .001). In addition, positive psychological capital scores were negatively related to PSQI scores (r = -0.39, P < .001). The confidence interval (CI) from the bootstrap output indicated that positive psychological capital played a mediating role between social support and sleep quality (95% CI, -0.098 to -0.033), and gender moderated the association between social support and sleep via positive psychological capital (95% CI, -0.087 to -0.006). CONCLUSION: The sleep problems of this population cannot be ignored. Gender-based differences should be considered when guiding such patients toward using internal and external resources to cope with sleep problems.

Identifying the different subtypes in menopausal symptoms among middle-aged women in China: a latent class analysis.

OBJECTIVE: Many studies have focused on the severity and prevalence of menopausal symptoms among middle-aged women, which are limited by heterogeneity and diversity of subtypes. Subtyping facilitates the adaptation to prevention and clinical intervention strategies that target women. To determine the existence of significant subgroups of women with similar menopausal symptoms, a person-centered approach was used to identify potential profiles of women during the menopausal transition. In addition, we aimed to examine the association between latent subtypes and individual factors. METHODS: This cross-sectional study included 797 middle-aged women, aged 40 to 60 years, who were recruited from Shandong Province, China, between December 2017 and August 2018. We identified the subtypes in menopausal symptoms by performing a latent class analysis according to the self-reported Menopause Rating Scale and evaluated the robustness of our identified subtypes using a sensitivity analysis. Multinomial logistic regression was performed to explore the association between emergent latent subtypes and sociodemographic, clinical, and psychosocial characteristics. RESULTS: The mean age of participants was 49.83 ± 5.05 years. (1) Four potential classes were identified in middle-aged women: "severe symptoms" (14.9%), "dominant sleep-emotion symptoms" (31.4%), "physical/mental exhaustion symptoms" (32.5%), and "no symptoms" (21.2%). The four classes were also verified using a sensitivity analysis according to age and menopause status subgroups, which revealed the robust subtypes of menopausal symptoms. (2) The odds ratio of neuroticism, chronic diseases, and gynecological diseases were significantly higher for the "severe symptoms," "dominant sleep-emotion symptoms," and "physical/mental exhaustion symptoms" classes, compared to the "no symptoms" class, while the odds ratio of mindfulness and social support were lower. CONCLUSIONS: A person-centered approach for middle-aged women could address the unmet need to understand the heterogeneity of menopausal symptoms. Subtyping facilitates the identification of the potential causes of menopausal symptoms and the development of personalized interventions.

Video Summary:http://links.lww.com/MENO/A830 .

Individual and additive-effect relationships of sleep problems and severe menopausal symptoms among women in menopausal transition.

OBJECTIVE: Sleep problems and menopausal symptoms are both common complaints among midlife women. However, the associations of the quality and quantity of sleep problems with the severity of menopausal symptoms have not been well studied. Thus, this study aims to examine the relationships between individual sleep problems and the additive number of sleep problems with severe menopausal symptoms among women during the menopausal transition. METHODS: Using the convenience sampling, a total of 848 middle-aged women in China were investigated from December 2017 to August 2018. All participants completed a questionnaire on sleep problems, Menopause Rating Scale, and the general information questionnaire. Based on the cutoff of the Menopause Rating Scale, participants were divided into the nonsevere menopausal symptom group and severe menopausal symptoms group. Propensity score matching was used to balance covariates between the two groups. Stepwise binary logistic regression and restricted cubic spline were applied to analyze the associations of individual and additive sleep problems with severe menopausal symptoms. RESULTS: After propensity score matching, no significant difference was observed between the nonsevere menopausal symptoms group and severe menopausal symptoms group (Ps > 0.05). Logistic regression analysis showed that five sleep problems ("feeling too hot," "having pain," "restless legs syndrome," "taking medicine to help sleep," and "having trouble staying awake") were closely associated with severe menopausal symptoms. The restricted cubic spline curve showed an upward trend in odds ratios between the number of these five sleep problems and severe menopausal symptoms, and women were more than twice as likely to suffer severe menopausal symptoms when they experienced more than three of these individual sleep problems. CONCLUSION: Both the individual and additive number of sleep problems exerted significant effects on severe menopausal symptoms. It might be useful for healthcare providers to set guidelines to support a healthy menopausal transition for midlife women.

The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples.

To determine if perceived stigma is positively associated with psychological distress, and examine if self-esteem has a moderating effect on the relationship between stigma and psychological distress among infertile Chinese couples. 369 infertile couples completed questionnaires including socio-demographic and clinical characteristics, stigma, self-esteem, and psychological distress. Stigma had a significant, positive association with psychological distress (r = 0.461, P < 0.01). Self-esteem moderated the association between stigma and psychological distress differently for men compared to women. Stigma had a positive, moderate association with psychological distress in men with high self-esteem compared to men with low self-esteem (t = 3.232, P < 0.01). However, there was no significant difference in the relationship between stigma and psychological distress between women with high and low self-esteem, tests of the simple slopes showed that non-significant difference of slopes between the two groups (t = -0.017, P = 0.987). The results indicate that self-esteem buffers the net effect of stigma on psychological distress in men but not women. Future research should focus on interventions that use self-esteem as a way to decrease the negative association of stigma with psychological distress, especially among men who are infertile and have low self-esteem.

Symptom clusters in head and neck cancer patients with endotracheal tube: Which symptom clusters are independently associated with health-related quality of life?

PURPOSE: The point of view of symptom clusters (SCs) may develop an efficient symptom management strategy to enhance health-related quality of life (HRQoL) in head and neck (HNC) patients with endotracheal tube (ETT). The study aims to investigate the possible SCs in HNC patients with ETT and determine whether there was an independent relationship between one or more SCs and HRQoL. METHODS: A cross-sectional study design was adopted, and 203 HNC patients with ETT were recruited. They took measurements of General Information Questionnaire, MD Anderson Symptom Inventory-Head & Neck, and Twelve-Item Short-Form Health Survey (SF-12). Spearman correlations, partial correlations, and hierarchical cluster analysis were performed to determine latent number of SCs, and covariance analyses were used to determine independent associations between SCs and SF-12. This study followed STROBE Statement. RESULTS: Pain SCs (pain, distressed, short of breath, and sadness), fatigue SCs (fatigue/weakness, restless, and sleepy), digestive SCs (appetite loss, constipation, and nausea), HNC-specific SCs (dry mouth and mucus), and tracheostomy-related SCs (difficulty swallowing and difficulty with voice and speech) were found. After adjusting covariant variables, this study found independent relationships of pain SCs and fatigue SCs with physical component summary of SF-12, and between fatigue SCs and mental component summary of SF-12. CONCLUSIONS: Multiple SCs were found in those HNC patients. Pain SCs and fatigue SCs were independently associated with HRQoL. In process of caring HNC patients with ETT, it is vital to focus on SCs, especially on pain SCs and fatigue SCs, which might effectively improve patients' HRQoL.

Relationship between neuroticism and sleep quality among asthma patients: the mediation effect of mindfulness.

OBJECTIVE: The aims of this study were to investigate the prevalence of sleep disturbance; to validate the associations between neuroticism, mindfulness, and sleep quality; and to further examine whether mindfulness mediates the relationship between neuroticism and sleep quality among asthma patients. METHODS: This study was conducted with 193 asthma patients from outpatient clinics. They completed questionnaires including the neuroticism subscale of the Big Five Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), and the Mindful Attention Awareness Scale (MAAS). Structural equation model was used to analyze the relationships among neuroticism, mindfulness, and sleep quality, with mindfulness as a mediator. RESULTS: The mean global PSQI score was 7.57 (SD = 3.25), and 69.9% of asthma patients reported poor sleep quality (cutoff score > 5). Structural equation model analysis showed that neuroticism was significantly associated with global PSQI scores (ß = 0.198, P = 0.006), and mindfulness (ß = - 0.408, P < 0.001), respectively; mindfulness was associated with global PSQI scores (ß = - 0.250, P = 0.006). Furthermore, mindfulness mediated the relationship between neuroticism and global PSQI scores, in which the mediation effect was 0.102 (- 0.408 × - 0.250), and the bootstrapped 95% CI did not include zero (0.032, 0.208, P = 0.021). CONCLUSIONS: Sleep disturbance is a serious health concern among asthma patients. This study illuminated the latent mediating mechanism of mindfulness on neuroticism and sleep quality, and implied that intervention and prevention programs on mindfulness might be beneficial in improving sleep quality in asthma patients.

[Triterpenoids from roots of Rosa laevigata].

To study the triterpenoids from the roots of Rosa laevigata. The silica gel column chromatography was used to separate the chemical constituents from the roots of Rosa laevigata Michx. HPLC was used to analyze its purity, chemical and spectroscopy methods were used to determine their structures. 12 constituents were isolated and identified as(2R, 19R)methyl 2-acetyloxy-19- hydroxyl-3-oxo-urs-12-en-28-carboxylate(1), pomonic acid (2), 18, 19-seco, 2α, 3α-dihydroxy-19-oxo-urs-11, 13(18)-dien-28-oic acid(3), swinhoeic acid (4), myrianthic acid(5), 2α, 3ß, 19α-trihydroxy-24-oxo-urs-12-en-oic acid (6), tormentic acid(7), arjunic acid (8), 1ß-hydroxyeuscaphic acid(9), quadranoside Ⅷ (10), alpinoside(11), rubuside B (12). Compounds 1-4, 6, 9, 11-12 were obtained from this plant for the first time. Compounds 2-4, 6, 11-12 were obtained from the genus Rosa for the first time.