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.

Insomnia in Patients Suffering from Chronic Medical Illnesses: Prevalence and Impact of IAYT

Background: Sleep is an important lifestyle factor to be addressed in patients having chronic non-communicable diseases. Data revealing prevalence of insomnia in chronic medical illnesses (CMIs) in Indian population are lacking. Yoga has been found effective in improving sleep quality in patients with chronic medical illnesses (CMIs). Aim: To find the prevalence of insomnia in major chronic medical illnesses and to assess the effect of Integrated Approach of Yoga Therapy (IAYT) on them. Methods and Material: From the outpatients and inpatients of our integrative therapy clinics, 200 patients (116 males;84 females) in the age range 49.57 ± 11.71 years, who satisfied the inclusion criteria and were diagnosed by the physician with any of the four major categories of CMIs: cardio-pulmonary, diabetes, musculoskeletal, and psychiatric were screened for insomnia using Insomnia Severity Index (ISI) scale. Those found suffering from clinically significant insomnia (ISI score > 14) were admitted and a residential IAYT intervention was given for a week. Before and after the intervention, ISI and Pittsburg insomnia rating scale (PIRS) were administered to assess extent of insomnia. Data was analyzed before and after the intervention using paired t-test. Results: Taking all patients of CMIs together, we found that 35% suffered from clinical insomnia, out of which, 12.5% had severe and 22.5% had moderate insomnia. We also found that prevalence of clinical insomnia was highest among those suffering from psychiatric illnesses (62.07%) and minimum in those having musculoskeletal disorders (28.05%). Those suffering from diabetes mellitus and cardio-pulmonary disorders reported prevalence of 32.25% and 31.94% respectively. After IAYT intervention of one week, extent of clinical insomnia reduced from 35% at the baseline to 8.5% in all patients of CMIs taken together. Following changes were observed in percentage of patients suffering from clinical insomnia in different CMIs before and after one week of IAYT intervention: 1) In psychiatric patients, the percentage reduced from 62.07% to 24.13%;2) In diabetic patients, the percentage reduced from 32.27% to 3.0%;3) In patients having musculoskeletal disorders, the percentage reduced from 28.05% to 8.53%;and 4) In patients having cardio-pulmonary illnesses, the percentage reduced from 31.94% to 2.7%. Conclusion: Prevalence of insomnia is higher in patients suffering from chronic medical illnesses. IAYT intervention of one week may be helpful in reducing extent of insomnia in this population.

Correlates of Depression among Patients Diagnosed with Chronic Illnesses in Saudi Arabia

Background: Depression contributes to an increased medical morbidity and mortality among patients with chronic medical illnesses. The purpose of this study was to investigate correlates of depression among patients diagnosed with chronic illnesses in Saudi Arabia. Methods: A cross sectional survey using 412 patients diagnosed with chronic illnesses has been used to collected data in regards to depressive symptoms, psychological distress, coping, and life satisfaction. Results: 25.2% of the patients reported that they had moderate to severe depressive symptoms, and about 13.8% of them had mild level of depression. Psychological distress and life satisfaction were significant correlates with depressive symptoms (r = 0.33, 0.54, p < 0.001), while coping strategies is not. The results also showed that there is a significant and negative correlation between patients’ age and depression score (r = 0.17, p ≤ 0.001). Regarding gender differences, the analysis showed that there was no significant difference between male and female patients in their depressive symptoms (t = ﹣0.69, p = 0.488). Conclusion: implication for clinical practice and research discussed.

Effect of Social Media Used by Medical Professionals in Facilitating the Treatment of Chronic Illnesses

The objective of this research is to describe the effect of social media use by medical professionals in facilitating the treatment of chronic illnesses in chronically ill individuals. This study focuses on the prominent social media used by medical professionals and the way it is used to manage health conditions of chronically ill individuals.

Psychosocial Health Status of Patients Diagnosed with Chronic Illnesses in Jordan

Background: The comorbidity between chronic physical conditions and psychosocial health consequences is becoming a research interest for researchers in the field. The purpose of this study was to investigate the psychosocial health status of patients diagnosed with chronic illnesses in Jordan. Methods: A cross sectional survey using 806 patients diagnosed with chronic illnesses has been used to collect data in regards to depressive symptoms, psychological distress, coping, optimism, life satisfaction, and perceive social support. Results: 17.5% of the patients reported that they had moderate to severe depressive symptoms, and about 50% of them had high level of optimism and life satisfaction, moderate level of effectiveness of coping skills, psychological distress, and perceived social support from family, friends and others. There were significant association between patients’ age and their scores on perception of social support from family, friends and others, life satisfaction, and psychological distress (p > 0.05). While, male and female patients were different in their depressive symptoms (t = -2.57, p = 0.01), perceived social support from others (t = -2.06, p = 0.04), and optimism (t = 2.29, p = 0.02). Also, patients had differences in their depressive symptoms, perceived social support from friends, others and friends, optimism, life satisfaction, and psychological distress related to their medical diagnoses (p < 0.05). Conclusion: Patients with chronic illness are in need for psychological care, and periodic psychological screening is one step toward maintaining their psychological wellbeing.

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.

爱丁堡大学“Living with chronic illness”课程对我国护理教育的启示

从教学概述、教学目标、教学内容、教学方法、课程考核5个方面对爱丁堡大学Living with chronic illness课程进行介绍。结合我国护理教学现状,建议我国护理教育增加慢性病病人人文关怀相关课程,鼓励护生从病人角度学习慢性病病人护理,增强教学内容的时效性,推广适合我国护理教育的多样化教学方式,重视护生科研能力、评判性思维、团队协作能力和解决实际问题能力的培养。

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.

Patient’s Experience of the Outcomes of Engaging in a Broadly Applicable Health Promotion Intervention for Individuals Facing Chronic Illness

The aim of this study was to explore the health-related outcomes of a new health promotion intervention designed to be broadly applicable among people diagnosed with chronic illness. Qualitative process analysis was applied and a purposeful sample of 52 patients, representing a variety of long-term conditions, was invited to participate in the pilot-implementation and evaluation of the program. Participants attended individually or in groups in seven sessions held over a six-month period. A lay-based conceptual framework that revealed the bodily knowledge of patients with chronic illness as a resource for health was used as the frame for the program content and interdisciplinary health professionals who had undergone 80 hours of training led the program. The pedagogical approaches were varied in order to engage patients in health promotion work. In-depth evaluation interviews took place soon after program completion and data were analyzed in-depth by means of content analysis in order to identify patterns of health-related themes and the program’s possible active ingredients. The intervention was implemented successfully across clinical sites and diagnostic categories. Participants reported improved ability to manage illness-related problems and greater awareness and utilization of personal resources for health after they had participated in the program. They were able to think more positively about their own capabilities, gained greater understanding of factors that made their health condition better or worse, and became more active. Participants identified empowerment and social participation as important outcomes of engaging in the new program.

Coronary heart disease beliefs and misconceptions among cardiac patients and people with chronic illness

What people believe about their illness may affect how they cope with it. It has been suggested that such beliefs may be commonly held within society. This cross-sectional investigation examined the cardiac beliefs and misconceptions among cardiac patients and people with chronic illness. Participants with a noncardiac chronic illness hold similar cardiac misconceptions to people with heart disease (p = 0.58). Both groups showed high agreement on “people with heart disease should take life easy” and “always avoid anything that might bring on angina”. People with chronic illness are more likely than cardiac patients to believe that “once you have has one heart attack you are bound to have another one”.

Serenity—Uses in the Care of Chronically Ill Older Patients: A Concept Clarification

Serenity is an emotional experience that contributes to the acceptance of a situation. One phenomenon in the care of chronically ill older patients and patients in end of life care is that too much focus is placed on the patient’s disease. This can contribute to anxiety, sadness or sense of isolation. For older people that are chronically ill or in care at the end of life, it is important that the registered nurse can help them to find serenity. Further knowledge is needed about how the concept of serenity is used in relation to the care of older chronically ill patients. Aim: The purpose of this concept analysis was to clarify how serenity is used in nursing and in relation to the care of chronically ill older patients. Method: The study follows Rodgers’ evolutionary method of concept analysis. Findings: Serenity is a state of physical, mental, emotional and spiritual balance when life conditions can be managed or accepted. Through the experience of serenity the chronically ill older patient is able to find or develop the self in order to continue with dignity. The concept is most used at the lowest described levels of the self, including a perception of personal safety. The highest level involves a sense of wholeness and awareness. Conclusion: The concept of serenity is used in relation to chronically ill older patients as a condition where the patient finds balance and thus can manage or accept their situation. Chronically ill older patients will not recover. For that reason it needed a better understanding about what factors to experience serenity are needed. Further research is also needed to examine how registered nurses can support older chronically patients in finding serenity with the help of nursing interventions.

The Investigation of Relative Efficacy Family Training and Life Strategies on Caring Chronic Mental Illness in Family

This research is a semi-empirical study aiming to examine the effect of family trainings and life skills among the families, if Mashhad with chronic mental disorders. In doing this research, a sample of 300 subjects has been chosen in the stratified random and systematic approach from the families of chronic mental disorders who have been admitted in round the clock centers in Mashhad and who have been in the waiting list and these subjects have been divided to two groups of experiment and control randomly and we introduce family trainings and life skills to the experiment group. There was no training to control group. These two groups were tested in period to the beginning of trainings and post training with instruments such as taking care and mental disorders attitude questionnaire, life skills attitude questionnaire, California social adjustment? questionnaire, Rosenberg self-esteem, general health questionnaire and epidemiological mental disorders questionnaire. The result indicated that training had no effect on the attitude of families toward taking care of mental disorder, but family member’s attitude toward mental disorder had been changed. These trainings have been influential on changing family member’s attitude toward life skills, social adjustment, self-esteem, mental health increase and reducing mental disorders.

Systematic review of character development and childhood chronic illness

AIM: To review empirical evidence on character development among youth with chronic illnesses.METHODS: A systematic literature review was conducted using Pub Med and PSYCHINFO from inception until November 2013 to find quantitative studies that measured character strengths among youth with chronic illnesses. Inclusion criteria were limited to English language studies examining constructs of character development among adolescents or young adults aged 13-24 years with a childhood-onset chronic medical condition. A librarian at Duke University Medical Center Library assisted with the development of the mesh search term. Two researchers independently reviewed relevant titles(n = 549), then abstracts(n = 45), and finally manuscripts(n = 3).RESULTS: There is a lack of empirical research on character development and childhood-onset chronic medical conditions. Three studies were identified that used different measures of character based on moral themes. One study examined moral reasoning among deaf adolescents using Kohlberg's Moral Judgement Instrument; another, investigated moral values of adolescent cancer survivors with the Values In Action Classification of Strengths. A third study evaluated moral behavior among young adult survivors of burn injury utilizing the Tennessee Self-Concept, 2nd edition. The studies observed that youth with chronic conditions reasoned at less advanced stages and had a lower moral self-concept compared to referent populations, but that they did differ on character virtues and strengths when matched with healthy peers for age, sex, and race/ethnicity. Yet, generalizations could not be drawn regarding character development of youth with chronic medical conditions because the studies were too divergent from each other and biased from study design limitations.CONCLUSION: Future empirical studies should learn from the strengths and weaknesses of the existing literature on character development among youth with chronic medical conditions.

Satisfaction of Chronic Illness Patients at Felege Hiwot Referral Hospital, Bahir Dar City, Northwest Ethiopia

Introduction: Patient satisfaction is a popular way of evaluating quality of health care given in health facilities. This study was done to assess the level of chronic illness Patients’ Satisfaction in Felege Hiwot Referral Hospital, Bahir Dar City, Ethiopia. Method: Cross-sectional study was conducted by involving 415 patients using systematic sampling method at Felege Hiwot referral hospital, Bahir Dar City, Ethiopia from 1st September, 2012 to 2nd November, 2012. Structured questionnaire was data collection tool. The questionnaire was prepared in English. It was translated to Amharic and back to English. Discrepancies in the translation were resolved by mutual agreement with the research team. Pre-testing was done prior to the actual data collection process on a sample of 20 respondents and modified accordingly. The study was approved by ethics review board of Bahir Dar University. The collected data were checked for completeness and consistency before being coded, entered and analyzed using SPSS version 19. Result: The overall level of satisfaction of chronic illness patients in this hospital was 242 (58.3%) which is lower as compared to other local studies in Ethiopia. More than 40% of the patients were not satisfied with the service. Conclusion and Recommendations: The current level of patients’ satisfaction in the hospital is totally unacceptable care for a referral hospital situated in the capital city of a region in which more than 20 million people reside. Therefore, there is a need to revisit care given to chronic illness patients, and appropriate strategy should be designed to address the lifelong care needs of patients with chronic illness in our set up.

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.

社区共病老年人居家疾病体验的质性研究

背景面对老年慢性病患病率高、多种慢性病共存形势带来的严峻挑战,社区共病老年人的健康问题亟待关注。共病管理模式正不断被探索实践,疾病体验作为来自患者自我报告的健康信息有望成为“以患者为中心”社区共病管理模式的重点内容。目的 深入了解社区共病老年人居家的真实疾病体验,为社区共病老年人的个性化健康管理和支持策略提供依据。方法 采用目的抽样法、最大差异化抽样于2022年8—9月在郑州市某社区卫生服务中心所管辖的4个社区中抽取符合条件的访谈对象,基于信息饱和的原则最终纳入20例研究对象。在研究目的、文献回顾及专家咨询结果的基础上初步拟定访谈提纲,预访谈2例后确定最终访谈提纲。以现象学研究方法为指导,对研究对象进行半结构式访谈。采用Golaizzi分析法分析资料。结果 共提炼出4个主题和11个亚主题,主要有长期存在的症状困扰(身体功能障碍、疲劳、睡眠障碍、疼痛)、负性心理体验(对未来生活的无助感和担忧、社会价值感和自我认同感降低、社交活动改变的孤独感)、与共病和谐共存的积极心态(感恩知足、积极适应)、困境下的期望(希望功能改善、寻求多方社会支持)。结论 身体功能障碍、睡眠障碍、疲劳、疼痛是社区共病老年人最关注的健康困扰,社区共病老年人的症状管理和多元社会支持有待加强。未来有望采用多维数据进行动态化健康评估,探索共病的共性和个体性规律,实现社区共病的精准管理及干预。

家庭赋权干预对慢性肾脏病患儿心理状态及家属疾病不确定感的影响

目的研究自身家庭赋权干预对慢性肾脏病患儿心理状态及其家属疾病不确定感影响。方法选择武汉大学人民医院2019年8月-2022年8月收治的800例慢性肾脏病患儿及其主要照护人为研究对象,将患儿随机分为观察组和对照组各400例(每例包含1名患儿及1名主要照护人)。对照组研究对象入组后仅采用健康宣教,观察组在对照组基础上加入家庭赋权干预,观察两组研究对象干预前后儿童焦虑障碍自评量表(SCARED)、儿童抑郁障碍自评量表(DSRSC)评分,及其主要照护人疾病不确定感家属量表(MUIS-FM)、照顾能力量表(FCTI)、简易应对方式量表(SCSQ)评分。结果干预后观察组患儿SCARED、DSRSC得分为(12.75±2.52)分、(8.22±1.70)分,均显著低于对照组[(14.77±2.37)分、(9.56±1.48)分](P<0.05);干预后观察组患儿主要照护人MUIS-FM量表中不确定性、复杂性、信息缺乏、不可预测性得分为(30.25±2.86)分、(20.18±1.94)分、(9.27±1.71)分、(8.05±2.14)分,均显著低于对照组[(34.04±3.15)分、(23.26±1.70)分、(10.99±1.84)分、(10.37±2.09)分](P<0.05);干预后观察组患儿主要照护人SCSQ量表积极应对得分为(22.37±4.05)分,高于对照组[(19.61±3.58)分](P<0.05),而消极应对得分为(9.06±2.15)分,低于对照组[(10.37±2.70)分](P<0.05);干预后观察组患儿主要照护人FCTI量表中适应照顾角色、应变及提供协助、处理个人情绪需要、评估家人及社区资源、调整个人生活与照顾需求为(3.28±0.85)分、(2.91±0.62)分、(2.77±0.85)分、(3.26±1.09)分、(3.07±0.85)分,均显著低于对照组[(4.33±1.04)分、(4.24±1.07)分、(3.83±0.99)分、(5.17±1.78)分、(4.11±1.36)分](P<0.05)。结论家庭赋权干预可在一定程度上改善慢性肾脏病患儿自身不良心理状态,同时还有利于照护者改善疾病不确定感,以积极的方式应对问题,更好地提升其照护能力。

云南省农村居民2011年和2021年五种常见慢性病疾病负担的变化研究

背景慢性病已成为影响人群健康的主要公共卫生问题,我国的慢性病患者数量持续增加,死亡病例数也逐年递增,患者疾病负担正逐渐加重。掌握慢性病疾病负担的变化情况,对慢性病的防控工作意义重大,但目前鲜见针对云南省农村常见慢性病疾病负担变化的研究。目的分析云南省农村居民2011年和2021年5种常见慢性病[高血压、冠心病、脑卒中、哮喘和慢性阻塞性肺疾病(COPD)]疾病负担的变化情况。方法采用重复横断面设计,分别于2011年和2021年采用多阶段分层随机抽样方法选取云南省8400名和7700名≥35岁的农村居民为研究对象,收集研究对象现场问卷调查和体格检查数据,以及5种常见慢性病的死因数据;采用主成分分析法,选取文化程度、家庭人均年收入和医疗服务可及性3个变量构建社会经济地位(SEP)指标,利用各变量系数计算SEP综合得分,并依据SEP综合得分的四分位数将社会经济地位分为低、中等偏下、中等偏上和高4个等级;采用伤残调整寿命年(DALY)测量5种慢性疾病的疾病负担大小。结果与2011年比较,2021年云南省农村居民的高血压(25.14%与41.57%)、脑卒中(1.03%与2.52%)和COPD(9.23%与12.60%)的总体患病率均升高(P均<0.05),且男性、女性和各个社会经济地位人群的患病率也升高(P<0.05);冠心病(2.02%与2.30%)和哮喘(1.36%与1.61%)的总体患病率无明显变化(P>0.05),但男性和高社会经济地位人群的冠心病患病率、男性和中等偏上社会经济地位人群的哮喘患病率却升高(P<0.05);男性2021年5种慢性病的患病率均高于女性(P<0.05);2021年不同社会经济地位人群的COPD患病率呈递减趋势(χ^(2)_(趋势)=6.801,P<0.001)。此外,冠心病(10.45与18.18)、脑卒中(12.80与23.20)、哮喘(4.54与9.10)和COPD(35.99与49.07)的每千人口DALY均升高,高血压(1.38和1.26)降低;其中以COPD的每千人口DALY和伤残所致生命损失年(YLD)较高,脑卒中的每千人口早死所致生命损失年(YLL)较高。结论云南省农村居民2021年5种常见慢性病的患病率和疾病负担与2011年比较,以升高为主,且2021年COPD的疾病负担最重,男性和低社会经济地位人群是未来慢性病防控的重点人群。应采取有针对性的预防和控制策略,降低慢性病对人群健康的危害。

视神经脊髓炎谱系疾病患者疾病感知与自我管理的相关性研究

目的探讨视神经脊髓炎谱系疾病(NMOSD)患者疾病感知及自我管理的现况,并分析两者的相关性。方法采用方便抽样法选取2022年7月至2023年3月在重庆医科大学附属第一医院神经内科就诊的98例NMOSD患者为研究对象。分别采用简易疾病感知问卷(BIPQ)及慢性病自我管理研究测量表(CDSMS)等调查患者的疾病感知情况和慢性病自我管理情况;采用Pearson相关分析疾病感知与自我管理的相关性;采用多元线性逐步回归分析影响患者疾病感知的因素。结果NMOSD患者疾病感知总分为(44.52±8.12)分,慢性病自我管理总分为(52.15±15.29)分。不同文化程度、职业类型、医保费用支付方式、家庭人均月收入、疾病所处时期、扩展的残疾状态量表(EDSS)评分患者的疾病感知得分比较,差异均有统计学意义(P<0.05)。多元线性逐步回归分析显示,患者文化程度、家庭月收入、疾病所处时期、医保支付方式为疾病感知的影响因素(P<0.05)。Pearson相关性分析结果显示,NMOSD患者疾病感知量表的总分及各维度得分与慢性病自我管理能力量表的总分及各维度得分均呈负相关(P<0.05)。结论医务人员应该关注NMOSD患者心理因素,帮助患者改善负面感受,正确认识和理解疾病知识,树立积极的健康信念,提高患者的疾病自我管理能力,从而更好地提升患者的生活质量。

生活的回归:青年慢病病人身份认同的质性研究

通过对8名青年慢病病人疾病经历和主观体验的分析,发现他们的疾痛叙事围绕着两个维度展开,初患病时的疾病感知以及带病生存过程中遭遇的困境。虽然疾病打破了青年慢病病人的日常生活,但他们能够接受自身疾病、重新回归日常生活,这一转变过程中身份认同起到关键性作用。价值认同自洽、家庭支持、网络社群归属以及社会角色调适是青年慢病病人身份认同形成的深层机制,从中可以窥见青年慢病病人接受疾病、回归日常生活过程中宏观结构形塑与微观个体建构的交织逻辑,研究最后提出了相关建议。