The status quo and influence of self-management behaviors in convalescent stroke patients

Objective： The aims of this study were to investigate the status quo of self-management behaviors in stroke patients at the recovery stage and to explore its influencing factors.Methods： A total of 440 hospitalized convalescent stroke patients were recruited and investigated using the Basic Situation Questionnaire, Self-management Behavior Scale of Stroke, Stroke Prevention Knowledge Questionnaire and Social Support Rating Scale.Results： The mean self-management behavior score was （151.95±23.58）, and dimensions in descending order were as follows： dietary management, drug safety management, social function and interpersonal relationships, life management, emotion management, rehabilitation exercise management and disease management. Five regional self-management behavior scores were statistically significant, and the scores from Minnan and Minzhong of the Fujian province, China, were higher than the others. Gender, age, family income and self-management behavior were significantly correlated （P〈0.05）; educational level, stroke knowledge level, social support level and self-management behavior were positively correlated, and the difference was statistically significant （P〈0.01）. Conclusions： The overall self-management level of convalescent stroke patients should be improved to strengthen health education; focus on the educational level, which is relatively low; strengthen the social support system of patients; stimulate the enthusiasm and initiative of self-management disease patients to promote disease rehabilitation and improve the quality of life.

Self-Management Behaviors of Patients with Hypertension in Daily Life

Background: In a rapidly aging Japanese society, the number of patients with hypertension has seen a steady increase. The basic treatments for hypertension are maintaining blood pressure through medication and preventing complications. It is important for patients with hypertension to perform self-management. This improves their lifestyle while controlling their blood pressure to prevent complications and maintain good health. Purpose: This study aimed to examine the actual self-management behavior ability of patients with hypertension and to clarify the factors involved in their self-management behavior. Methods: A total of 150 patients with hypertension were included in this study. The following data were obtained from the patients as background information: sex, age, years with disease, whether they are receiving antihypertensive agents, type of antihypertensive agent, blood test data, heart thoracic ratio, left ventricular ejection fraction, pulse wave, pulse wave velocity, and height. The levels of self-management skills of the patients were also assessed using the “Instrument to Measure the Self-care of patients with Hypertension” developed by Tsuboi et al. Results: The associations among self-management behaviors in daily life, such as diet, exercise, stress, medication, alcohol intake, and smoking, were analyzed in patients with hypertension. The subjects were classified into the following three groups: aged 65 years or below (Group A), early stage elderly individuals (Group B), and late-stage elderly individuals aged 75 years or over (Group C). The results showed that the subjects in Group C had higher self-management scores for diet, exercise, stress, medication, and drinking than the subjects in the other two groups. The scores of smoking and self-management of the subjects in Group A were high but their other self-management scores were low. All the subjects were taking between 1 to 3 types of oral antihypertensive drugs. The rate of achievement of the target blood pressure was 50% or more in all the three groups. However, the pulse wave velocity was high in all the three groups. Conclusion: The results indicate that the risk of developing disorders of the brain and cardiovascular system is high in all the three groups, owing to the high degree of arteriosclerosis. Therefore, increasing the number of nursing interventions is expected to reduce blood pressure, maintain and promote self-management behavior in daily life, and prevent the onset of complications. The results suggest that nursing interventions involving lifestyle guidance for improving the self-management skills of patients are urgently needed by patients under 65 years of age.

Awareness, self-management behaviors, health literacy and kidney function relationships in specialty practice

AIM To determine the relationship between chronic kidney disease(CKD) awareness(CKD-A), self-management behaviors(CKD-SMB) knowledge, performance of CKDSMBs, health literacy(HL) and kidney function. METHODS Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-managementknowledge tool(CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR(e GFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts. RESULTS One-hundred-fifty patients participated in the study. e GFRs ranged from 17-152 m L/min per 1.73 m2. Majority(83%) of respondents had stage 3 or 4 CKD, low HL(63%), and were CKD aware(88%). Approximately 40%(10/25) of patients in stages 1 and 2 and 6.4%(8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage(P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents(≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, "controlling blood pressure" differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, "controlling blood pressure"(P = 0.02), and "keeping healthy body weight"(P = 0.01). Adjusted multivariate analyses between CKD-A and:(1) HL; and(2) CKD-SMB knowledge were nonsignificant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB(P < 0.05). CONCLUSION CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower e GFR, suggesting the need for focused patient education in CKD stages 1.

Positive correlations between the health locus of control and self-management behaviors in hemodialysis patients in Xiamen

Objective:To investigate the association between the health locus of control and selfmanagement behaviors in patients receiving hemodialysis.Methods:Patients receiving hemodialysis in Xiamen,Fujian province,from December 2014 to March 2015 answered the Chinese version of the Multidimensional Health Locus of Control scale and the self-management behavior questionnaire.Results:The participants in this study indicated that they believed others exerted more control over their health than themselves or chance.In addition,the majority of participants had a medium to low level of self-management behaviors.Positive correlations were also observed between a participant's health locus of control and their level of selfmanagement behaviors.Internal health locus of control and external(others)health locus of control were significant predictors of self-management behaviors controlling for the effect of payment method.Conclusion:The results of this study provided evidence that there is a strong relationship between the health locus of control and self-management behaviors in hemodialysis patients.This study provides important information for medical professionals as they design strategies to educate hemodialysis patients on their health locus of control and selfmanagement behaviors.

Development and validation of a self-management behavior questionnaire for Chinese enterostomy patients

Objectives:This study aimed to develop a self-management behavior questionnaire for Chinese enter-ostomy patients and examine its reliability and validity.Methods:Guided by the theory of self-management,an initial questionnaire was generated through literature review,group meetings,and two rounds of an expert consultation.Finally,the reliability and validity of the questionnaire were validated through a questionnaire survey of 200 enterostomy patients were selected from the Affiliated Hospital of Medical University from June 2016 to March 2017.Results:The content validity index was 0.80e1.00.The exploratory factor analysis yielded a five-factor(dietary behavior,psychosocial behavior,symptom management behavior,medical compliance behavior,information management behavior),consisting of 40 items.The cumulative variance contri-bution rate was 65.42%.The Cronbach’s a coefficient for the total questionnaire was 0.972,and for the five factors ranged from 0.797 to 0.939,indicating a good internal consistency.The test-retest reliability was 0.867(P<0.01).The self-management behavior questionnaire score was negatively related to the Ostomy Skin Tool score(r=-0.800,P<0.01).Conclusions:The self-management behavior questionnaire developed in this study showed good reli-ability and validity and can be used to assess the self-management behavior of Chinese enterostomy patients.

A self-management application“painhousekeeper”to control cancer pain:a randomized controlled trial study protocol

Objective:Pain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’physical health,psychological well-being,and quality of life(QOL).Deficiency of pain care,inadequate pain communication,and reluctance toward pain medication contribute to the difficulties in improving the situation of patients with cancer pain.Fortunately,the integration of self-management and professional healthcare provides new opportunities for patients with cancer pain.Methods:A two-arm randomized controlled trial will be conducted to assess the effectiveness of self-management application compared with routine care among patients with cancer pain.Based on Orem’s self-care theory and Naylor’s transitional care theory,cancer pain self-management application“Pain-housekeeper”was developed with dual client:patient client and medical client.A total of 120 patients with cancer pain are recruited from two university-affiliated tertiary public hospitals in China.They are randomly assigned to the control group and the intervention group.The patients in the control group get routine care while the patients in the intervention group get routine care and Pain-housekeeper App.The intervention is delivered by registered doctors,nurses,and postgraduate nursing students specialized in pain care.Effect measurements for both groups are carried out with questionnaires at baseline(T0),after 4 weeks(T1)and after 12 weeks(T2).The primary outcomes include pain condition,self-efficacy,and QOL.The secondary outcomes include pain medication adherence,satisfaction,anxiety,and depression.Compliance of data submission,economic evaluation,usage,and clinical data are also considered in the test.Data for the evaluation are gathered continuously during the study period.Discussion:This article provides insight into the effectiveness of a theory-based self-management mobile application intervention delivered to patients with uncontrolled cancer pain.The results are used to help patients to improve cancer pain control,self-efficacy,and QOL.Conclusions:The findings of this article provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.

Status of Understanding of the Disease and Self-Management Behavior among Patients with Hypertension

Background: Hypertension is a lifestyle-related disease that has no subjective symptoms but could lead to severe complications. The goals of treatment for hypertension are to maintain blood pressure with medications and prevent complications. Measuring blood pressure at home regularly is critical for patients with hypertension. Purpose: This study aimed to 1) clarify the status of patients’ understanding of hypertension and self-management, 2) identify nursing practices that could support patients with hypertension in making them aware of the need for understanding hypertension, monitoring blood pressure at home, and engaging in self-management. Method: A questionnaire survey on understanding of the disease and self-management behavior was conducted among patients with hypertension who regularly visited outpatient clinics. As for data analysis, descriptive statistics were computed for patients’ attributes, clinical findings, understanding of the disease, and self-management behavior. Cross-tabulation and the chi-square test were used for each item on understanding of the disease and self-management behaviors. Results: Data were obtained from 150 participants (93 males and 57 females) with a mean age of 70 years. Patients with a higher understanding of the disease and those who were aware of the target blood pressure were more likely to engage in self-management behavior, including monitoring blood pressure at home, ensuring regular outpatient visits, and consulting with nurses or physicians. In addition, the percentage of patients who recognized the need to achieve their target blood pressure was higher among those who had a spouse and lived with their family. Discussion: Regular monitoring and recording of blood pressure at home are the most important self-management behaviors. Understanding of the disease and self-management behavior and support from the family are critical for maintaining appropriate self-management. Therefore, in cooperation with physicians, nurses should provide health education to patients and their families to enable them to perform appropriate self-management. Health expenditures increase with age, especially in those aged 65 years and over. The prevalence of hypertension increases with age;patients aged 65 years and over need to engage in self-management to maintain their target blood pressure. Nurses should provide patients with hypertension aged 65 years and over with appropriate nursing care to enable them to measure and record their blood pressure at home appropriately and regularly. Appropriate nursing care may help reduce the health expenditure. This may help reduce the health expenditure.

No pain, no social gains:A social-signaling perspective of human pain behaviors

In this review article, we describe a social-signaling perspective of human pain and pain empathizing behaviors which is based on the premise that pain percepts evolved to serve both intrapersonal as well as interpersonal, communicative functions. This perspective offers a generative framework for understanding the natural origin and proximate expression of felt pain and pain empathizing behaviors. The basic thesis is that humans evolved sensory-behavioral heuristics for perceiving and inhibiting exogenous and endogenous pain sensations as part of more general expressive styles characterized by the demonstration of vulnerability gestures(i.e., trustworthiness cues) versus empowerment gestures(i.e., capacity cues), and these styles ultimately facilitate broader selfprotection and social novelty-seeking life-history behavior strategies, respectively. We review the extant literature on how social contextual factors(e.g., audience characteristics) and how structural and functional components of individual's social network appear to influence the expression of pain behaviors in ways that support basic predictions from the social-signaling perspective. We also show how the perspective can be used to interpret conventional findings of sex differences in pain percepts and pain empathizing behaviors and for predicting how the situational context and individual's peer networks modulate these differences in vitro and in vitro. We conclude the article by describing how pain researchers may better understand how varying levels and divergent directions of changes in affect tend to co-occur with systematic changes in internal vs external pain sensitivities, and thus why, from an evolutionary perspective, pain may occur in the presence and absence of physical tissue damage.

Level of Labor Pain, Level of Labor Pain Behaviors, and Cultural Pain Behaviors among First-Time Indonesian Muslim Mothers

Background: Many factors influence the expressions of pain in primiparous women aside from contractions of the uterus. Objective: This study aimed to describe the level labor pain, level of labor pain behaviors based on cultural pain behaviors at 3 - 4 cm of cervical dilation or the beginning of the active phase of labor among primiparous Muslim women in Indonesia. Methods: This was a study with 42 primiparous Muslim women who gave birth in the labor room at Bhinneka Bhakti Husada Hospital and Community Health Center Pamulang, Indonesia from June until January 2017. The women were asked to describe on a 100 mm Visual Analogue Scale the intensity of level of labor pain in their abdomen during the last contractions at 3 - 4 cm of cervical dilation, and Pain Behaviors Observation Scale to observe pain behaviors. Descriptive statistics were used to analyze the data. Results: The findings showed that the mean score of level of labor pain at 3 - 4 cm of cervical dilation was 86.38 (SD = 4.47) and most participants experienced high level of labor pain (97.6%). The expression of cultural labor pain behaviors including saying praises to Allah, Asma’aul husna, reciting the Qur’an, sholawat.

Investigation of Specifics of Self-Management towards Dealing with Cancer Pain among Adult Outpatients

Purpose: This study aimed to identify specifics of self-management towards dealing with cancer pains among adult outpatients. Methods: Semi-structured interviews were conducted with 16 adult outpatients (9 males and 7 females) who suffered from cancer pain and the data obtained were analyzed using the qualitative synthesis method of KJ Ho. Results: An analysis of the results revealed these key findings for the following symbolic wording of the semi-structured interviews: Cooperative relationship with medical professionals;Problems originating from cancer pain;Self-regulation of analgesic medications based on the interactions with medical professionals;Self-regulation of the analgesic medications based on the physical perceptions of the effects;Self-regulation to maintain a balanced and calm mind, Fulfilling life by the pain alleviation and liberation from the restrictions imposed by the cancer;and Efforts to maintain their lives by themselves. Conclusion: Based on the cooperative relationship established with medical professionals, the patient carried out the self-regulation of cancer pain using analgesics, and self-regulation to maintain a balanced and calm mind. Nurses must therefore sufficiently educate patients regarding how to communicate successfully with medical professionals in order to improve cancer patients’ pain management regarding both physical and mental aspects.

Factors That Promote Autonomous and Controlled Motivation in Self-management Behavior of Hemodialysis Patients

This study examined the differences and primary factors from the impact of autonomous motivation and controlled motivation on the self-management behavior of hemodialysis patients.Anonymous,self-describing questionnaires were used for research on nine different dialysis facilities of 413 people who regularly visit.From using the primary factor results of multiple regression analysis,that took autonomous motivation and controlled motivation as the dependent variable,a path diagram was created that led to each motivation.The acknowledgement of autonomy support facilitated whether it was autonomous motivation or controlled motivation(The standardized coefficient was 0.385,0.346,p<0.0001).Positive evaluation coping skills were a primary factor that promoted autonomous motivation,while trait anxiety,disorders of social activities,and lack of motivation were primary factors that promoted controlled motivation.In order to raise the autonomous motivation to promote self-management behavior in patients with hemodialysis treatment,situations that easily cause amotivation and anxiety,as well as tendencies for depression should be assessed.Also the encouragement to attain positive evaluation coping skills to support patient autonomy appears to be effective.

Effects of the self-management training program on self-management behavior and blood pressure levels among elderly people with hypertension

Objective:To determine the effects of the Self-Management Training Program on self-management behavior and blood pressure(BP)levels among elderly people with hypertension(HT).Methods:This study was based on a quasi-experimental design using sampling groups composed of elderly residents of Pathum Thani Province with HT.Simple random sampling was applied to two sampling groups,an experimental group and a control group.However,the experimental group had been on the Self-Management Training Program based on the Creer concept.The Program’s contents included small-group health-education sessions and the patients’manual,Self-Management Training Skills for Self-Management Behavior.Small group discussions were held for self-reflection,to stimulate follow-up for self-management behavior training during home visits.The Self-Management Training Program was compared with programs involving the more usual care.Data were collected using the Self-Management Behavior for Hypertension Control Questionnaire and BP assessment tests.Data were analyzed using a descriptive statistic,chi-square test,pair t-test,repeated-measures Analysis of Variance(ANOVA),and repeated-measures Analysis Covariance(ANCOVA).Results:It was found that at 13 weeks after entering the program,the experimental group demonstrated a significantly lower systolic and diastolic BP with a baseline statistical significance(P<0.005),and that at the 4th week and the 13th week,there was a decrease in BP in the experimental group.The experimental group also had above-baseline self-management behavior scores that were higher than in the control group(P<0.01).Conclusions:Results from this study show that the Self-Management Program was useful for BP control and promoted sustainable self-management behavior.

Factors related to self-management behavior among persons with mild-to-moderate chronic obstructive pulmonary disease in Wenzhou,China

Objective:To describe the self-management(SM)behavior among persons with mild-to-moderate chronic obstructive pulmonary disease(COPD),and it examines the correlation between COPD knowledge,self-efficacy,perceived social support,and SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Methods:A simple random sampling technique was used to recruit 121 persons with mild-to-moderate COPD who visited the respiratory outpatient department of the First Affiliated Hospital of Wenzhou Medical University in Wenzhou,China.Research instruments include a demographic data questionnaire,COPD SM scale,COPD knowledge questionnaire,6-item chronic disease self-efficacy scale,and perceived social suppor t scale.Descriptive statistics and Pearson's Correlation were used for data analysis.Results:The findings show that the mean score of COPD SM scale was 2.70(SD=0.45).The Pearson correlation analysis revealed that the COPD knowledge(r=0.47,P<0.001),self-efficacy(r=0.28,P=0.001),and perceived social support(r=0.48,P<0.001)were positively correlated to the COPD SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Conclusions:The findings indicate that disease knowledge,self-efficacy,and perceived social support were related to SM behavior in persons with mild-to-moderate COPD,which provides a theoretical basis for developing SM interventions for persons with mildto-moderate COPD and improving this population's SM behavior.

Exploring the Influences of Continuous Self-Management Education on the Self-Care Skills and Health Behavior of Patients with PICC Intubation

Objective:To analyze the effects of continuous self-management education on the selfcare ability and health behavior of patients with tumor through peripherally inserted central venous catheters(PICC).Methods:The period from August 2018 to August 2020 was used as the research time range,and the random number table method was used as the basis for grouping.80 patients with malignant tumors who regularly performed fixed catheter maintenance care in the PICC clinic of our hospital were admitted in the experimental group(given PICC specialist nursing,and implemented continuous self-management education),and 80 patients with PICC tube malignant tumors discharged from the superior hospital during this time range served as the control group(return to the original catheterization hospital from time to time or perform catheter maintenance care in the nursing clinic of our hospital).The self-care ability scores,health behavior scores,and complications during intubation between both groups were analyzed.Results:(1)There was no significant difference in self-care ability score and healthy behavior score between groups before the intervention,P>0.05;the self-care ability score and health behavior score of the research group were better than the control group after intervention,P<0.05;(2)After investigation,the incidence of complications in the research group(2.50%)was lower than that of the control group(10.00%),but there was no difference between the groups,P>0.05.Conclusion:Continuous self-management education has good effects on improving the self-care ability of tumor patients with PICC intubation.It can urge patients to maintain good health behaviors and reduce complications.It is worthy of promotion.

Establishment of model of visceral pain due to colorectal distension and its behavioral assessment in rats

AIM： To establish a visceral pain model via colorectal distension （CRD） and to evaluate the efficiency of behavioral responses of CRD by measuring the score of abdominal withdrawal reflex （AWR） in rats. METHODS： Thirty-eight male SD rats weighing 180-240g were used to establish the visceral pain model. The rat was inserted intra-anally with a 7 cm long flexible latex balloon under ether anesthesia, and colorectal distensions by inflating the balloon with air were made 30 min after recovering from the anesthesia. Five AWR scores （AWR0 to AWR4） were used to assess the intensity of noxious visceral stimuli. It was regarded as the threshold of the minimal pressure （kPa）. For abdominal flatting was induced by colorectal distension. RESULTS： A vigorous AWR to distension of the descending colon and rectum was found in 100% of the awake rats tested. The higher the pressure of distension, the higher the score of AWR. The distension pressures of 0, 2.00, 3.33, 5.33 and 8.00 kPa produced different AWR scores （P〈0.05）. The pain threshold of AWR was constant for up to 80 min after the initial windup （first 1-3 distensions）, the mean threshold was 3.69±0.35 kPa. Systemic administration of morphine sulfate elevated the threshold of visceral pain in a dosedependent and naloxone reversible manner. CONCLUSION： Scoring the AWR during colorectal distensions can assess the intensity of noxious visceral stimulus. Flatting of abdomen （AWR 3） to CRD as the visceral pain threshold is clear, constant and reliable. This pain model and its behavioral assessment are good for research on visceral pain and analgesics.

Effects of Curcumin on Biological Behavior and NF-κB/TNF-α Pathway in Mice with Metastatic Bone Pain of Breast Cancer Induced by Walker 256 Cells

Background. The active ingredient curcumin of traditional Chinese medicine was selected as the research object to investigate the possible mechanism of breast cancer metastatic bone pain in mouse walker 256 cells and the effect of curcumin on the NF-κB/TNF-α pathway in order to provide a new idea for clinical treatment of breast cancer metastatic bone pain. Methods. By establishing an animal model of breast cancer bone metastasis in walker 256 cells, the biological behavior of nude mice was observed on the 8th day after successful modeling. Meanwhile, the low dose group, middle dose group and high dose group of mice were given 15 mg/kg, 25 mg/kg, 50 mg/kg of curcumin solution intraperitoneally in 21 days, and the right cavity bone and spinal cord distended in mice (L4-L6) tissues were used to detect related factors, Immunohistochemical method was used to detect c-fos in spinal cord. Expression levels of RANK, NF-κB and TNF-α were detected by RT-PCR and Western blot. Meanwhile, serum levels of Cox2, il-6, leukotriene and PGE2 were detected. Results. Observing the biological behavior index of nude mice, we found that the mechanical pain and thermal pain threshold decreased (p < 0.05), and the cold pain and spontaneous pain scores increased significantly (p < 0.05). After group study, the expression of c-fos in the cancer pain model group was significantly higher than that in the normal control group (p < 0.05), and with the increase of curcumin dose, the expression of c-fos in the high dose group was significantly lower than that in the solvent model group (p < 0.05). The expression of RANK, NF-κB, TNF-α was higher than that of the normal control group and decreased gradually with the increase of curcumin dose, among which the expression of high dose group was significantly lower than that of solvent group (p < 0.05). RANK, NF-κB, TNF-α protein expression was higher than that of normal control group and gradually decreased with the increase of curcumin dose. The levels of Cox2, IL-6, leukotriene and PGE2 in serum decreased with the increase of curcumin dose, and the high dose group decreased significantly (p < 0.05). Conclusions. On the 8th day after the success of the animal model of breast cancer bone metastasis in Walker 256 cells, abnormal biological behaviors such as heat pain, cold pain sensation and spontaneous hyperalgesia were observed. Further studies have found that the increased expression of rank on osteoclasts induced up-regulated expression of NF-κB and c-fos, induced expression of TNF-α gene, and could induce synthesis and release of leukotriene, PGE2 through direct activation of cyclooxygenase, inflammatory media IL-6 cascade reaction, resulting in pathological pain and hypersensitivity. Traditional Chinese medicine active ingredient curcumin could reduce RANK expression of osteoclast, inhibit cell NF-κB and spinal cord c-fos activity, reduce TNF-α expression, inhibit Cox2 activity, and reduce the synthesis and release of inflammatory factors leukotriene and PGE2, thus exerting its analgesic effect, which provides new ideas and methods for clinical treatment of metastatic bone pain in breast cancer.

Sexual Behaviors in Women with Primary and Secondary Provoked Vestibulodynia: A Controlled Study

Introduction: Provoked vestibulodynia affects 12% of the general female population and more specifically, 21% of women aged less than 30 years. Primary and secondary vestibulodynia are hypothesized to represent the endpoints of different etiologic pathways, although there is still little research addressing potential distinctions between these two groups, particularly with regard to sexuality. Aims: To compare sexual activity and behavior of women with provoked primary vestibulodynia (PVD1) and secondary vestibulodynia (PVD2) against age-matched controls. Methods: Fifty-seven participants (N = 57), mean age 25.72 (18-41) recruited from a gynecology clinic underwent a gynaecological examination and completed a self-report questionnaire: 20 (N = 20) were diagnosed with primary provoked vestibulodynia (PVD1), 19 (N = 19) with secondary provoked vestibulodynia (PVD2), and 18 (N = 18) were medically confirmed as no-pain controls. Main outcome: To verify any differences in the sexual behavior between primary, secondary vestibulodynias and controls. Results: Mean pain duration differed significantly in participants with PVD1 at 73.8 months against those with PVD2 at 37.4 months (p = 0.003). Frequency of sexual activity also differed significantly between the three groups (p = 0.012): the controls were at 27.8% against 0% in primary and secondary vestibulodynias for once or more a day. No significant difference was observed for the sexual arousal time and masturbation frequency. Vaginal penetration was overrepresented in controls (p 0.001) contrary to fellatio frequency (p = 0.016). Pain digital test was significantly different between the three groups in one finger (3.85 vs 0.08), two fingers (4.39 vs 0.06) or three fingers (5.39 vs 0.56) (PVD1 against controls), lubricated inserted fingers for pain verification (p 0.001). Conclusions: Provoked vestibulodynia generates problems in the sexual response and coital activity, this syndrome reflecting absence of pre-existing sexual problems, notably in the masturbatory activity and oral receptive female sex.

Effects of comprehensive nursing with cognitive behavioral therapy in orthodontic osteodilated arch treatment

BACKGROUND This work explored the effects of cognitive behavior therapy(CBT)-based comprehensive nursing intervention(CNI)mode in arch expansion to treat patients with orthodontic osteodilated arch(OOA).AIM To explore the application effect of CBT-based CNI model in orthodontic expansion arch treatment.METHODS Using convenient sampling method,81 patients with OOA were selected and rolled into a control group(Ctrl group,40 cases)and an observation group(Obs group,41 cases).During the treatment,patients in the Ctrl group received routine nursing intervention mode,and the those in the Obs group received CBT mode on the basis of this.Before and after intervention,the incidence of oral mucositis,the mastery rate of correct arch expansion method,self-rating anxiety scale score,soft scale index,and plaque index were compared for patients in different groups.In addition,satisfaction and complications were comparatively analyzed.RESULTS Incidence of oral mucositis in the Obs group was lower(14.6%vs 38.5%),and the mastery rate of correct arch expansion method was obviously higher(90.2%vs 55.0%)was obviously higher(all P<0.05).Meanwhile,the soft scale index and plaque index in the Obs group were much lower(P<0.05).The compliance(90.24%)and satisfaction(95.12%)in the Obs group were greatly higher(P<0.05).CONCLUSION The CBT-based CNI mode greatly improved the mastery rate of correct arch expansion method during arch expansion in treating patients with OOA and enhanced the therapeutic effect of arch expansion and the oral health of patients,improving the patient compliance.

Self-management behavior preferences and influencing factors in Chinese patients with recurrent gout:A qualitative study

Objectives:This study aimed to explore the preferences and influencing factors of self-management behaviors in patients with recurrent gout and provide a theoretical basis for developing targeted strategies to improve self-management preferences.Methods:A total of 10 patients with recurrent gout were recruited from the gout specialist outpatient clinic at a tertiary hospital in Shenyang,Liaoning Province,China.Semi-structured interviews were conducted with these patients,and the Kawakita Jiro(KJ)method was used to analyze the interview data.Results:After four rounds of screening by five researchers,35 codes were selected from an initial 132.After three rounds of discussion and induction,the KJ method identified seven domains of selfmanagement behavior preferences in patients with recurrent gout:1)extensive knowledge of gout,yet difficulty in distinguishing between accurate and inaccurate information;2)a passive attitude of“no pain,no management”;3)the challenge of changing entrenched daily habits;4)the optimistic but unrealistic belief of“self-delusion”;5)a tendency to seek medical attention late due to hopelessness of cure and familiarity with recurrences;6)preference for analgesics for gout recurrences while neglecting long-term urate-lowering therapy(ULT);and 7)gout-related stigma.Conclusion:The results of this study showed that the self-management behavior of patients with recurrent gout could be improved,especially in the aspects of medical seeking behavior,medication compliance,daily management and emotional management.At the same time,we found that gout stigma,difficulty in distinguishing true and false knowledge of gout and negative attitude of“ignoring pain”were significantly associated with self-management behavior.

Moxibustion eases chronic inflammatory visceral pain through regulating MEK, ERK and CREB in rats

AIM To investigate the effects of herb-partitioned moxibustion(HPM) on phosphorylation of mitogen-activated extracellular signal-regulated kinase(MEK)1, extracellular signal-regulated kinase(ERK)1/2 and c AMP response element binding protein(CREB) in spinal cord of rats with chronic inflammatory visceral pain(CIVP), and to explore the central mechanism of HPM in treating CIVP.METHODS Male Sprague-Dawley rats were randomized into normal, model, HPM, sham-HPM, MEK-inhibitor and dimethyl sulfoxide(DMSO) groups. The CIVP model was established using an enema mixture of trinitrobenzene sulfonic acid and ethanol. HPM was applied at bilateral Tianshu(ST25) and Qihai(CV6) acupoints in the HPM group, while in the sham-HPM group, moxa cones and herb cakes were only placed on the same points but not ignited. The MEK-inhibitor and DMSO groups received L5-L6 intrathecal injection of U0126 and 30% DMSO, respectively. Abdominal withdrawal reflex(AWR), mechanical withdrawal threshold(MWT) and thermal withdrawal latency(TWL) were applied for the assessment of pain behavior. The colonic tissue was observed under an optical microscope after hematoxylin-eosin staining. Expression of phosphor(p)MEK1, p ERK1/2 and p CREB in rat spinal cord was detected using Western blotting. The levels of MEK, ERK and CREB m RNA in rat spinal cord were detected using real-time polymerase chain reaction. RESULTS Compared with the normal group, the AWR scores were increased significantly(P < 0.01) and the MWT and TWL scores were decreased significantly(P < 0.05) in the model, sham-HPM and DMSO groups. Compared with the model group, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly in the HPM and MEK-inhibitor groups(P < 0.05). Compared with the sham-HPM and DMSO groups, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly(P < 0.05) in the HPM and MEK-inhibitor groups. Compared with the normal group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were increased significantly in the model, sham-HPM and DMSO groups(P < 0.01 or < 0.05). Compared with the model group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). Compared with the sham-HPM and DMSO groups, expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). CONCLUSION HPM down-regulates protein phosphorylation of MEK1, ERK1/2 and CREB, and m RNA expression of MEK, ERK and CREB, inhibiting activation of the MEK/ERK/CREB signaling pathway in the spinal cord of CIVP rats, which is possibly a critical central mechanism of the analgesic effect of HPM.