Psychological Health of Wives’of Patients with Chronic Illnesses

Objectives:Chronic illnesses are more prevalent in males.The expectations of caregiving,thus falls on the women.Role expectations from women,increases stress,strain and the possibility of Psychological health concerns.In this paper,we explore the psychological health,as well as the levels of marital and sexual satisfaction of women caregivers.Method:The sample consisted of 35 women,whose husbands were diagnosed with,and undergoing treatment for a chronic illness(Coronary Heart Disease(CHD);Diabetes;or Cancer).Three standardized questionnaires,the Index of Marital Satisfaction(IMS),Index of Sexual Satisfaction(ISS)and the Depression Anxiety Stress Scale 21(DASS 21)were used.Results:Correlational and predictive analysis were conducted on the data.Clinically significant marital and sexual dissatisfaction were found.Wives’also reported moderate levels of depression and anxiety,but severe levels of stress.Depression and Sexual satisfaction were found to be significant predictors of marital satisfaction.Discussion:Women caregiver are impacted by the illness status of their spouse.The additional stress of caregiving,along with societally ascribed roles and responsibilities on women creates a more difficult,stressful environment,which affects psychological health and well-being.

Predictive value of controlling nutritional status score for progression to chronic critical illness in elderly patients with sepsis

Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Methods:739 elderly patients with sepsis admitted from January 2020 to December 2022 were selected as the study objects,and were divided into chronic critical illness group(n=188)and non-chronic critical illness group(n=551)according to whether chronic critical illness disease occurred.Clinical data of the patients were collected and compared.The predictive value of CONUT score,PNI and NLR in the progression of senile sepsis to chronic severe disease was compared,and the optimal threshold value was determined,which was used to convert the numerical variables into binary variables.Through univariate analysis and multivariate Logistic regression analysis,the risk factors affecting the progression of elderly sepsis patients to chronic critical illness disease were screened out,and the prediction model was built based on the nomogram.The efficacy and clinical utility of the prediction model were evaluated by the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results:The best cut-off value for CONUT score in predicting elderly sepsis progressing to chronic critical illness was 4 points.The predictive performance of CONUT score(AUC=0.739)was better than that of PNI(AUC=0.609)and NLR(AUC=0.582)in elderly sepsis progressing to chronic critical illness(CONUT score vs PNI:Z=5.960,P<0.001;CONUT score vs NLR:Z=6.119,P<0.001).Univariate analysis showed that age,CCI score,SOFA score,sepsis shock,serum Lac,CONUT score,mechanical ventilation(MV),and continuous renal replacement therapy(CRRT)treatment were related to elderly sepsis progressing to chronic critical illness(P<0.05).Multivariate logistic regression analysis showed that CONUT score≥4 points,age≥75 years,CCI score≥3 points,SOFA score>5 points,sepsis shock,and serum Lac≥4 mmol/L were independent risk factors for elderly sepsis progressing to chronic critical illness(P<0.05).The nomogram showed that CONUT score had the greatest contribution value in predicting elderly sepsis progressing to chronic critical illness.Based on this,the nomogram prediction model had an AUC of 0.846[95%CI(0.812~0.879)],with a sensitivity of 75.5%and specificity of 81.3%,indicating good predictive performance.The calibration curve was close to the ideal curve,and the DCA threshold had clinical utility advantages when ranging from 0.1 to 0.9.Conclusion:The nomographic prediction model based on CONUT score can effectively predict the risk probability of senile sepsis progressing to chronic critical illness,helpful for clinicians to identify the high risk group of chronic and severe senile sepsis,which is helpful for clinicians to identify high-risk populations of elderly sepsis with chronic critical illness.

Perceived resource support for chronic illnesses among diabetics in north-western China

A high level of social support can improve long-term diabetes self-management. Support from a single source has been evaluated. This study aims to analyze support from multiple and multilevel sources for diabetic patients by using the Chronic Illness Resources Survey （CIRS）. Factors influencing the utilization of the CIRS were also evaluated. A total of 297 patients with diabetes were investigated using the CIRS and Perceived Diabetes Self-management Scale in Shihezi City, China. Descriptive statistics were used to explain demographic variables and scores of the scales. Factors affecting the utilization of chronic illness resources were determined through univariate analysis and then examined by multivariate logistic regression analysis. Of the 297 diabetic patients surveyed, 67% failed to reach the standard （more than 3 points） of utilizing chronic illness resources. Moreover, utilization of chronic illness resources was positively moderately correlated with self-management of diabetes （r = 0.75, P 〈 0.05）. According to the multivariate logistic regression analysis, age （OR, 3.42; 95%CI, 1.19-9.84） and monthly income （OR, 5.27; 95%CI, 1.86-14.90） were significantly positively associated with the CIRS score. Individuals with high school （OR, 2.61; 95%CI, 1.13-6.05） and college （OR, 3.02; 95%CI, 1.13-8.04） degrees obtained higher scores in the survey than those with elementary school education. Results indicated that utilization of resources and support for chronic illness self-management, particularly personal adjustment and organization, were not ideal among diabetics in the communities of north-western China. Improved utilization of chronic illness resources was conducive for proper diabetes self-management. Furthermore, the level of utilization of chronic illness resources increased with age, literacy level, and monthly income.

Validation of the 8-Item Morisky Medication Adherence Scale in Chronically Ill Ambulatory Patients in Rural Greece

Objective: To validate a Greek version of the structured self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) and determine its psychometric properties in patients with chronic illnesses. Methods: A cross-sectional survey was conducted in a small public hospital and a public health care centre, in a rural town in western Greece. The sample consisted of 100 patients with various chronic illnesses. Data were collected between January-May 2011, on the Greek version of the MMAS-8 and Beliefs about Medicines Questionnaire (BMQ). Results: Scale’s reliability analysis revealed an overall Cronbach’s alpha of 0.753 and the corrected item to total correlations, were greater than 0.30 for each of the 8 items comprising the medication adherence scale, showing good internal consistency. Convergent validity was supported by a significant correlation between the present scale’s total score and the BMQ-Specific Necessity score (Spearman’s rho = 0.492, p < 0.001). Conclusion: The current study showed acceptable reliability and validity of the Greek version of the 8-item MMAS to measure adherence to medications for various chronic illnesses. The validated Greek version of the MMAS-8 can help towards understanding adherence barriers in Greece so as to develop effective strategies to increase adherence and reduce the costs.

Controversies regarding transplantation of mesenchymal stem cells

Mesenchymal stem cells(MSCs)have tantalized regenerative medicine with their therapeutic potential,yet a cloud of controversies looms over their clinical tran-splantation.This comprehensive review navigates the intricate landscape of MSC controversies,drawing upon 15 years of clinical experience and research.We delve into the fundamental properties of MSCs,exploring their unique immuno-modulatory capabilities and surface markers.The heart of our inquiry lies in the controversial applications of MSC transplantation,including the perennial debate between autologous and allogeneic sources,concerns about efficacy,and lingering safety apprehensions.Moreover,we unravel the enigmatic mechanisms surro-unding MSC transplantation,such as homing,integration,and the delicate balance between differentiation and paracrine effects.We also assess the current status of clinical trials and the ever-evolving regulatory landscape.As we peer into the future,we examine emerging trends,envisioning personalized medicine and innovative delivery methods.Our review provides a balanced and informed perspective on the controversies,offering readers a clear understanding of the complexities,challenges,and potential solutions in MSC transplantation.

Dose of Telehealth to Improve Community-Based Care for Adults Living with Multiple Chronic Conditions: A Systematic Review

The purpose of this systematic review is to identify evidence of the appropriate dose of telehealth intervention services provided to community dwelling adults experiencing chronic illness or disability related to effectiveness, quality, safety, and cost. Academic Search Complete, CINAHL, MEDLINE, Cochrane, and JBI were searched using combinations of “telehealth or telemedicine or telemonitoring or telepractice or telenursing or telecare AND chronic illness or chronic disease”. Of the identified 449 articles, 47 articles met the inclusion criteria. Most study designs were quasi-experimental one group pre-test post-test (N = 16) with few Randomized Controlled Trials (N = 12). Twenty-three published articles studied the effect of telehealth for one chronic condition (49.9%) while 24 (51.1%) examined the effectiveness of telehealth for multiple chronic conditions. Measurement of telehealth outcomes varied and included efficacy, healthcare utilization, quality, adherence, cost, and safety. No standard measure of dose could be extrapolated. Length of intervention was measured and reported differently in each study. The dose of telehealth services that improve care effectiveness, quality, safety, and cost is still unknown for community dwelling adults experiencing chronic illness. The findings from this systematic review do indicate that longer duration of telehealth services (51 weeks), regardless of modality, produced positive outcomes as opposed to those with shorter durations (37 - 38 weeks) that produced neutral or mixed results. Collecting and reporting data related to clinical workflow such as dose of intervention specific to disease and type of modality is recommended. Rigorous study design including standard measurement at the RCT and Comparative Effectiveness level is still needed.

Progression of intervention-focused research for Gulf War illness

The Persian Gulf War of 1990 to 1991 involved the deployment of nearly 700,000 American troops to the Middle East.Deployment-related exposures to toxic substances such as pesticides,nerve agents,pyridostigmine bromide(PB),smoke from burning oil wells,and petrochemicals may have contributed to medical illness in as many as 250,000 of those American troops.The cluster of chronic symptoms,now referred to as Gulf War Illness(GWI),has been studied by many researchers over the past two decades.Although over$500 million has been spent on GWI research,to date,no cures or condition-specific treatments have been discovered,and the exact pathophysiology remains elusive.Using the 2007 National Institute of Health(NIH)Roadmap for Medical Research model as a reference framework,we reviewed studies of interventions involving GWI patients to assess the progress of treatment-related GWI research.All GWI clinical trial studies reviewed involved investigations of existing interventions that have shown efficacy in other diseases with analogous symptoms.After reviewing the published and ongoing registered clinical trials for cognitivebehavioral therapy,exercise therapy,acupuncture,coenzyme Q10(CoQ10),mifepristone,and carnosine in GWI patients,we identified only four treatments(cognitive-behavioral therapy,exercise therapy,CoQ10,and mifepristone)that have progressed beyond a phase II trial.We conclude that progress in the scientific study of therapies for GWI has not followed the NIH Roadmap for Medical Research model.Establishment of a standard case definition,prioritized GWI research funding for the characterization of the pathophysiology of the condition,and rapid replication and adaptation of early phase,single site clinical trials could substantially advance research progress and treatment discovery for this condition.

Common chronic health problems and life satisfaction among Macao elderly people

Aim:Most elderly people live with one or more health problems and their quality of life is affected.This study aimed to compare life satisfaction of elderly people living with common chronic medical illness compared with those without these health conditions in order to identify conditions that most affect life satisfaction of elderly people living in the community.Method:The data was collected by a questionnaire survey of 529 elderly living in community dwellings of Macao using a single measure of life satisfaction and self-reported common chronic medical illness diagnosed by a physician.A purposeful stratified random sampling method was used.Independent sample t-tests were conducted to compare participants who had a health condition to those without a health condition.Results:Respondents who indicated the lowest life satisfaction were those with fracture after the age of 60,eye illness,chronic bronchitis/emphysema,and metabolic arthritis/arthritis.For men,prostate problems was also significantly related to low life satisfaction.Conclusion:Lowest life satisfaction was reported among Macao elderly people living with mobility related chronic medical illness.Policies and practices should pay more attention to mobility related health problems or issues of elderly people,such as eye health and neuromuscular weaknesses.

A description of resilience for Norwegian home-living chronically ill oldest older persons

Background: Despite worsening health the chronically ill oldest older persons have expressed feelings of inner strength, which can be understood as resilience. The objective was to describe and compare the characteristics of resilience in two different age groups of chronically ill oldest older persons living at home and who needed help from home nursing care. Design: Cross-sectional design was used to describe and compare the resilience qualities between the two age groups. Methods: The inclusion criteria were 80 years or older, living at home with chronic disease, receiving help from home nursing care, and with the capacity to be interviewed. A sample of 120 oldest older women (n = 79) and men (n = 41) separated in two age groups, aged 80- 89 and 90+ years, participated in the study. Resilience characteristics were measured by Resilience Scale. Results: The whole group of oldest older people was vulnerable in relation to the characteristics of perseverance, self-reliance, and existential aloneness. Despite reduced physical health they reported a meaningful life, and equanimity. Even if there were no significant differences between the age groups among the oldest older persons in the characteristics of Resilience Scale (RS), in the characteristic of meaning there was a tendency of interaction between age and how much help from home nursing care the participants received. Conclusions: It is important to focus on the individual aging and the risk of developing illness and disabilities rather than focusing on chronologic age. Possessing meaning in life and equanimity may be strengths to meet challenges through illness and growing older.

Towards an Effective Communication in the Care of Patients with Long Term Disease in Kenya via Cybernetic—A Systematic Review

In this paper, to effectively treat chronic disorders and improve the standard of care, effective communication between patients and healthcare professionals was essential. The aim of the study was to review the literature on how good communication might improve treatment outcomes for Kenyan patients with chronic and terminal illnesses and to determine whether Cybernetic electronic communication can improve those outcomes even more. We uncovered the history of treatment outcomes for chronic and terminal diseases in this research study, both with and without communication at the core of the patient’s care plan. We discussed the importance of good communication in the treatment of patients with chronic and terminal illnesses and why it is a momentous endeavor comparable to medical diagnosis and treatment for the long-term health of patients. To locate pertinent material for the background literature study, we carried out a comprehensive literature search. Although the preliminary literature review was a continuation of the introduction research, it also highlighted the paucity of local Kenyan literature and suggested that improved communication might help patients with chronic and terminal illnesses have better treatment outcome. Methodology maintained the literature search, as a systematic literature review focused on core of the study, making separate sections of the same body necessary. This ensured that a methodological literature search section is as comprehensive as possible. We used an integrated PRISM model to limit a comprehensive literature search and a systematic literature review design as part of the overall process. Non-probability sampling and snowball approaches on literary papers over the previous 17 years were used in this arrangement. Since this was a multidisciplinary study, the four experts who also serve as authors were chosen from within their respective fields of expertise to design the study. They created search strategies, generated key words, looked up keywords in database engines, assessed the results of the literature using the PRISMA logical model, looked over successful literature, and triangulated their findings. The conclusions of the experts individually revealed a convergence of thoughts, beliefs, and practices across. The study concluded that even though there isn’t much research done in Kenya on the same subject;what is available illustrates how crucial good communication is for patients with chronic illnesses. The study’s findings also highlighted the positive effects of effective communication between patients and healthcare professionals on treatment plan adherence, patient satisfaction, and overall health outcomes. The results also noted that in order to improve patient care and outcome, Kenyan healthcare workers should underscore developing their communication skills. The study also found that the incorporation of cybernetics is crucial if a truly effective communication is required so as to enable centered care for patients with long-term diseases in Kenya. The goal of the Cybernetics is to activate genuinely effective communication in the care of Patients with long-term disease in Kenya. This study is organized to begin with an abstract, followed by keywords, an introduction, literature review, methodology, findings, discussion, and finally conclusions.

Deep Learning Based Process Analytics Model for Predicting Type 2 Diabetes Mellitus

Process analytics is one of the popular research domains that advanced in the recent years.Process analytics encompasses identification,monitoring,and improvement of the processes through knowledge extraction from historical data.The evolution of Artificial Intelligence(AI)-enabled Electronic Health Records(EHRs)revolutionized the medical practice.Type 2 Diabetes Mellitus(T2DM)is a syndrome characterized by the lack of insulin secretion.If not diagnosed and managed at early stages,it may produce severe outcomes and at times,death too.Chronic Kidney Disease(CKD)and Coronary Heart Disease(CHD)are the most common,long-term and life-threatening diseases caused by T2DM.There-fore,it becomes inevitable to predict the risks of CKD and CHD in T2DM patients.The current research article presents automated Deep Learning(DL)-based Deep Neural Network(DNN)with Adagrad Optimization Algorithm i.e.,DNN-AGOA model to predict CKD and CHD risks in T2DM patients.The paper proposes a risk prediction model for T2DM patients who may develop CKD or CHD.This model helps in alarming both T2DM patients and clinicians in advance.At first,the proposed DNN-AGOA model performs data preprocessing to improve the quality of data and make it compatible for further processing.Besides,a Deep Neural Network(DNN)is employed for feature extraction,after which sigmoid function is used for classification.Further,Adagrad optimizer is applied to improve the performance of DNN model.For experimental validation,benchmark medical datasets were used and the results were validated under sev-eral dimensions.The proposed model achieved a maximum precision of 93.99%,recall of 94.63%,specificity of 73.34%,accuracy of 92.58%,and F-score of 94.22%.The results attained through experimentation established that the pro-posed DNN-AGOA model has good prediction capability over other methods.

Role of theories in school-based diabetes care interventions:A critical review

BACKGROUND Diabetes is one of the most common chronic diseases of childhood.School plays an essential role in the management of student diabetes,which reduces the risk of short-and long-term diabetes complications and ensures that students are wellpositioned for optimal academic performance and growth.AIM The aim of this review was to systematically identify and synthesize the literature concerning theory-based diabetes care interventions in K-12 schools in the United States.It critically assessed the specific role of theories and associated essential constructs in intervention design,implementation,outcome measurement,and evaluation.METHODS Relevant literature was identified by keyword searches of the Cochrane Library,PubMed,and Web of Science.RESULTS Four interventions met the eligibility criteria and were included in the review.Of those,two evaluated online diabetes education programs for school personnel and the other two assessed in-person interventions.Three studies adopted a onegroup pre-post study design,and the remaining one adopted a one-shot casestudy design.Three of the interventions adopted social cognitive theory,and the remaining one was guided by the diffusion of innovations theory.Three studies identified core constructs of a theory as predictors of behavioral change.Two used theory to select or develop intervention techniques.Two studies used theory to customize participant intervention techniques.Two studies discussed their findings in the context of theory.No study used theory to select potential intervention participants.CONCLUSION In conclusion,despite the value of theory in intervention design and evaluation,theory-based diabetes interventions at school remain scarce.Future research may seek ways to better integrate theory and empirical research.

Perceived Stress and Coping Styles among the General Population in Saudi Arabia during COVID-19 Pandemic

This article examines the stress levels,coping responses,and influence of adaptive and maladaptive coping styles on stress in Saudi Arabia during the COVID-19 pandemic.An online cross-sectional survey was distributed to the attendees of a pandemic-related awareness webinars.The questionnaire assessed demographic and clinical characteristics,coping strategies(the brief COPE inventory),and stress levels(the Perceived Stress Scale).A multivariate linear regression analysis was conducted to assess the predictors of stress.The highest adaptive and maladaptive coping styles were reported for religion and self-distraction.Certain groups were independently more vulnerable to experience stress,including young-and middle-aged adults,females,students,and those with a lowto-middle income,with a personal or familial history of mental conditions,and living with someone with COVID-19 in their close circle.Higher levels of stress were also predicted by lower levels of using positive coping styles,particularly positive reframing,planning,and returning to religion,and higher levels of negative coping styles,such as venting,self-blame,and denial.Future psychotherapeutic interventions through the media and digital solutions are warranted to mitigate and manage stress by targeting vulnerable groups,promoting active coping styles,and discouraging negative coping strategies.

Unmet supportive care needs in families of children with chronic health conditions: an Australian cross‑sectional study

Background The aim of this study was to identify similarities and diferences in the unmet supportive care needs(USCN)of families of children with major chronic health conditions(CHCs)using a universal need assessment tool.Methods A cross-sectional online survey involving parents of children with congenital heart disease(CHD),type 1 diabetes mellitus(T1D),cancer,and asthma diagnosed within the last 5 years recruited via social media and support organizations.Thirty-four items assessing the USCN across six domains(care needs,physical and social needs,informational needs,support needs,fnancial needs,child-related emotional needs)were responded to on a 4-point Likert scale[no need(1)to high need(4)].Descriptive statistics identifed the level of need,and linear regressions identifed factors associated with higher need domain scores.Due to small numbers,the asthma group was excluded from comparisons across CHCs.Results One hundred and ninety-four parents completed the survey(CHD:n=97,T1D:n=50,cancer:n=39,and asthma:n=8).Parents of children with cancer were most likely to report at least one USCN(92%),followed by parents of children with T1D(62%).The fve most commonly reported USCN across CHCs were drawn from four domains:child-related emotional,support,care,and fnancial.Three need items were included in the top fve needs for all conditions.A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support.Conclusions Using a universal need assessment tool,this is one of the frst studies to characterize USCN in families of children diagnosed with common CHCs.While proportions endorsing diferent needs varied across conditions,the most endorsed needs were similar across the illness groups.This suggests that support programs or services could be shared across diferent CHCs.

Assessment of burden and coping strategies among caregivers of cancer patients in sub-Saharan Africa

BACKGROUND Cancer is a devastating and debilitating chronic disease that affects both patients and family members.Available evidence has confirmed that the care of chronically ill relatives by family members can be very challenging.This is because caregiving of cancer patients often presents a high level of burden on the caregivers.Consequently,this leads to a necessity to adopt coping mechanisms to cushion the effect of the burden experienced during caregiving.AIM To determine the burden experienced and coping strategies among caregivers of advanced cancer patients attending University of Calabar Teaching Hospital(UCTH),Cross River State,Nigeria.METHODS The study adopted a descriptive cross-sectional study design and the study population included informal family caregivers providing services to histologically diagnosed advanced cancer patients receiving treatment at the UCTH at the time of this survey.A researcher-developed structured questionnaire,a 22-item standardized validated Zarit Burden Interview(ZBI)and a modified 17-item Coping Orientation to Problems Experienced(COPE)Inventory were used to collect data from 250 eligible informal caregivers who were selected with regard to caregiver’s characteristics,caregivers’level of burden and caregiver’s coping strategies,respectively.Data gathered from the respondents were collated,coded and analyzed using Statistical Package for Social Sciences(SPSS version 24.0)software and Predictive Analytical Software(PAS version 19.0).Chi-square was used to test for association between categorical variables at the 0.05 level of significance.The results are presented in tables and charts.RESULTS The respondents consisted of more females 132(62.86%)than males 78(37.14%).The majority of respondents(46.2%)were aged between 31-50 years with a mean age of 35.9±18.1 years.The assessment of burden level revealed that 97 caregivers(46.19%)experienced severe burden,37(17.62%)experienced trivial or no burden,while 76(36.2%)perceived moderate burden.The coping strategies used by caregivers to ease the level of burden experienced during caregiving included;acceptance,reprioritization,appreciation,family,positive self-view and empathy.Also,it was documented that there was a strong association between caregivers’level of burden and coping strategies(P=0.030).Findings also showed that age(P=0.000),sex(P=0.000),educational status(P=0.000),functional ability(P=0.000),duration of care(P=0.000),desire to continue caregiving(P=0.000)and type of cancer(P=0.000)were statistically significantly associated with caregivers’coping strategies.CONCLUSION There is great recognition of the role of informal caregivers in improving the health of their relatives and family members who are chronically ill.It was recommended that support groups in collaboration with health care providers should organize a symposium for informal caregivers on the intricacies of caregiving in chronically ill patients.This would create a platform for experience sharing,information dissemination and health care professional-caregiver interaction to enhance positive caregiving outcomes.

Can Chronic Heart Disease Lead to Active Suicidal Ideation?一A Case Report of a Planned Suicide

The link between chronic illness and depression is complex but indisputable.Individuals with depression may resort to suicide to end their suffering,especially if they have an intractable and incurable illness.Evidence suggests that young people with chronic illness are more likely than older individuals to experience concomitant mental illnesses and thus have an increased risk of suicide attempts.Determined suicidal individuals may use either multiple,potentially fatal,methods in a single event or a single,excessively fatal method to ensure that they do not survive.This may happen in cases where an individual attempts suicide for the first time.In these circumstances,determining the cause of suicide is of paramount importance for future risk assessment and prevention.This report describes the case of a patient with known heart disease who self-inflicted multiple,sharp force injuries on his neck and wrists to end his life.