Describing Self-Care in Italian Adults with Heart Failure and Identifying Determinants of Poor Self-Care

Background: Self-care improves outcomes in patients with heart failure; however, no studies have been conducted on this topic in Italy. Aims: We aimed to describe self-care in Italian adults with heart failure and to identify sociodemographic and clinical determinants of self-care. Methods: A cross-sectional design was used to study 1192 heart failure patients enrolled across Italy. We measured self-care using the Self-Care of Heart Failure Index version 6.2, which measures self-care maintenance, management and confidence. Sociodemographic and clinical data were tested as potential determinants of self-care. Results: The mean age of the sample was 72 (SD = 11) years; 58% were male. In the three areas of self-care, scores ranged from 53.18 to 55.26 and few people were adequate in self-care (14.5% to 24.4% of the sample). Self-care behaviours particularly low in this population were symptom monitoring, exercise, use of reminders to take medicines and symptom recognition. Confidence in the ability to keep oneself free of symptoms and relieve symptoms was low. Taking fewer medications, poor cognition, older age, having a caregiver, being male and having heart failure for a shorter time predicted poor self-care maintenance. Poor cognition, not being employed, being male, and having worse New York Heart Association class predicted poor self-care management. Poor cognition, taking fewer mediations, older age, and male gender predicted poor self-care confidence. Conclusion: Self-care is poor in Italian heart failure patients. Determinants of poor self-care identified in this study can help to target patients’ education. Male gender and poor cognition were consistently associated with poor self-care maintenance, management and confidence

Psychometric Testing of the Self-Care of Heart Failure Index Version 6.2

The Self‐Care of Heart Failure Index Version 6.2 (SCHFI v.6.2) is widely used, but its psychometric profile is still questioned. In a sample of 659 heart failure patients from Italy, we performed confirmatory factor analysis (CFA) to test the original construct of the SCHFI v.6.2 scales (Self‐Care Maintenance, Self‐Care Management, and Self‐Care Confidence), with limited success. We then used exploratory factor analysis to determine the presence of separate scale dimensions, followed by CFA in a separate sub‐sample. Construct validity of individual scales showed excellent fit indices: CFI = .92, RMSEA = .05 for the Self‐Care Maintenance Scale; CFI = .95, RMSEA = .07 for the Self‐Care Management Scale; CFI = .99, RMSEA = .02 for the Self‐Care Confidence scale. Contrasting groups validity, internal consistency, and test‐retest reliability were supported as well. This evidence provides a new understanding of the structure of the SCHFI v.6.2 and supports its use in clinical practice and research

MOTIVATional intErviewing to Improve Self-Care in Heart Failure Patients (MOTIVATE-HF): Study Protocol of a Three-Arm Multicenter Randomized Controlled Trial

Aims Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support. Methods A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3 months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12 months after enrollment. Conclusion This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease

Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis

Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient\u27s care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes

A Dyadic Approach to Managing Heart Failure with Confidence

Background: The majority of heart failure (HF) self-care research remains focused on patients, despite the important involvement of family caregivers. Although self-care confidence has been found to play an important role in the effectiveness of HF self-care management on patient outcomes, no known research has examined self-care confidence within a dyadic context. Objective: The purpose of this study was to identify individual and dyadic determinants of self-care confidence in HF care dyads. Methods: Multilevel modeling, which controls for the interdependent nature of dyadic data, was used to examine 329 Italian HF dyads (caregivers were either spouses or adult children). Results: Both patients and caregivers reported lower-than-adequate levels of confidence, with caregivers reporting slightly higher confidence than patients. Patient and caregiver levels of confidence were significantly associated with greater patient-reported relationship quality and better caregiver mental health. Patient confidence in self-care was significantly associated with patient female gender, nonspousal care dyads, poor caregiver physical health, and low care strain. Caregiver confidence to contribute to self-care was significantly associated with poor emotional quality of life in patients and greater perceived social support by caregivers. Conclusions: Findings are supportive of the need for a dyadic perspective of HF self-care in practice and research as well as the importance of addressing the needs of both members of the dyad to maximize optimal outcomes for both

Single step synthesis of Janus nano-composite membranes by atmospheric aerosol plasma polymerization for solvents separation

Cette exposition à laquelle il a déjà été fait référence (http://musearti.hypotheses.org/?p=1307 et http://musearti.hypotheses.org/?p=1013) vient de faite l'objet d'une critique assez sévère de la lettre de la Tribune de l'art : http://www.latribunedelart.com/1925-quand-l-art-deco-seduit-le-monde Une "sensation d’inassouvissement ne nous lâchera pas de tout le parcours" dit l'auteur de cette critique. Ses reproches semblent un peu sévères : l’exposition serait incomplète, or elles le sont tou..