The role of self-efficacy in the self-care of patients with chronic conditions

Background. The management of chronic conditions requires that patients perform specific self-care behaviors and obtain the contribution of their families (e.g., for taking medications as prescribed and eating a healthy diet). Self-care is associated with better outcomes in chronic conditions (e.g., improved quality of life and mortality). However, patients often struggle to perform self-care. Self-efficacy, defined as the confidence to perform a certain behavior despite barriers, can improve patient self-care behaviors and the contribution of their family caregivers. However, so far, we still do not know whether patient self-efficacy can influence the relationship between family support and self-care in populations with multiple chronic conditions (MCC). Self-efficacy represents an easily targetable construct; the use of psychoeducational interventions such as motivational interviewing (MI) can improve intermediate outcomes (e.g., quality of life and self-care). However, little is known whether this intervention can also improve distal outcomes (i.e., mortality and health services use) as a result of self-care behavior change. Objective. The objective of this research program was to (i) describe the mechanism by which family support influences self-care in people with multiple chronic conditions, with particular focus on patient self-efficacy; (ii) develop an instrument to measure caregiver self-efficacy in contributing to patient self-care (CSE-CSC scale) in MCC, and (iii) investigate the influence of a MI intervention that targets self-efficacy, in improving health service use and mortality in a chronic disease population (i.e., heart failure) as a result of sustained behavior change. Methods. In the first cross-sectional study we analyzed data from the SODALITY study, which enrolled a sample of 541 older adults affected by MCC (mean age = 76.6 ± 7.3 years, 55.6% females) from seven Italian regions. Data were analyzed by descriptive statistics and a series of structural equation models. In the second cross-sectional study, we enrolled 358 caregivers (mean age = 54.6 ± 15.1 years, 71.5% females) of patients from the SODALITY study. Data were analyzed with descriptive statistics, exploratory and confirmatory factor analysis, and reliability analysis. In the third study we analyzed longitudinal data from the MOTIVATE-HF trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers) or Arm 3 (control group). months. We enrolled 510 patients (median age 74 years, 58% male) and caregivers (median age 55 years, 75% female) and we collected data at baseline and at 3, 6, 9 and 12 months. Above and beyond descriptive statistics, we performed a longitudinal generalized linear mixed model and unadjusted Cox proportional-hazards regression model. Results. In the first study depression and self-efficacy were significant mediators of the relationship between family support and self-care; however, in men, depression was not a significant mediator. In the second study, the dimensionality analysis of the CSE-CSC confirmed 2 factors within the scale. Construct validity testing showed significant correlations between the scores of the CSE-CSC scale and the scores of the Caregiver Contributions to Self-Care of Chronic Illness Inventory scales. Reliability coefficients were also satisfactory. In the third study, we found that at 12 months, 16.1%, 17% and 11.2% of patients used health-care services at least once in Arms 1, 2 and 3, respectively, without significant differences. At 3 months, 1.9%, 0.6% and 5.1% of patients died in Arms 1, 2 and 3, respectively. Mortality was lower in Arm 2 vs Arm 3 at 3 months (p=0.04), but no difference was found at subsequent follow-ups. Conclusion. This doctoral dissertation offers new knowledge on the self-efficacy construct in patients and caregivers in the context of MCC. The finding that self-efficacy is reaffirmed as essential in the dynamics of family and self-care in MCC allows us to target this construct more effectively in clinical environments. We also provided investigators with a new instrument to measure self-efficacy of the caregivers; this tool has adequate psychometric properties and is ready for use both in clinical practice and research. Finally, we provided evidence on the effectiveness of motivational interviewing on mortality in heart failure patients. Health care professionals will have stronger evidence to rely on, to incorporate MI into their interactions with patients. These results contribute to advancing the science of family nursing in HF self-care

A Middle-Range Theory of Social Isolation in Chronic Illness

: Chronic illnesses and social isolation are major public phenomena that drive health and social policy worldwide. This article describes a middle-range theory of social isolation as experienced by chronically ill individuals. Key concepts include social disconnectedness, loneliness, and chronic illness. Antecedents of social isolation include predisposing factors (e.g., ageism and immigration) and precipitating factors (e.g., stigma and grief). Outcomes of social isolation include psychosocial responses (e.g., depression and quality of life), health-related behaviors (i.e., self-care), and clinical responses (e.g., cognitive function and health service use). Possible patterns of social isolation in chronic illness are described

The role of upper-ocean heat content in the regional variability of Arctic sea ice at sub-seasonal timescales

In recent decades, the Arctic Ocean has undergone changes associated with enhanced poleward inflow of Atlantic and Pacific waters and increased heat flux exchange with the atmosphere in seasonally ice-free regions. The associated changes in upper-ocean heat content can alter the exchange of energy at the ocean–ice interface. Yet, the role of ocean heat content in modulating Arctic sea ice variability at sub-seasonal timescales is still poorly documented. We analyze ocean heat transports and surface heat fluxes between 1980–2021 using two eddy-permitting global ocean reanalyses, C-GLORSv5 and ORAS5, to assess the surface energy budget of the Arctic Ocean and its regional seas. We then assess the role of upper-ocean heat content, computed in the surface mixed layer (Qml) and in the 0–300 m layer (Q300), as a sub-seasonal precursor of sea ice variability by means of lag correlations. Our results reveal that in the Pacific Arctic regions, sea ice variability in autumn is linked with Qml anomalies leading by 1 to 3 months, and this relationship has strengthened in the Laptev and East Siberian seas during 2001–2021 relative to 1980–2000, primarily due to reduced surface heat loss since the mid-2000s. Q300 anomalies act as a precursor for wintertime sea ice variability in the Barents and Kara seas, with considerable strengthening and expansion of this link from 1980–2000 and 2001–2021 in both reanalyses. Our results highlight the role played by upper-ocean heat content in modulating the interannual variability of Arctic sea ice at sub-seasonal timescales. Heat stored in the ocean has important implications for the predictability of sea ice, calling for improvements in forecast initialization and a focus upon regional predictions in the Arctic region.</p

A family nurse-led intervention for reducing health services’ utilization in individuals with chronic diseases : The ADVICE pilot study

Objectives Intensive health services’ utilization is common in older individuals affected by chronic diseases. This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services’ use (readmissions and/or emergency service access) among older people affected by chronic conditions. Methods This is a non-randomized before-after pilot study. A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months. Standard home care was provided during the first four months’ period (months 1–4), followed by the educational intervention until the end of the study (months 5–8). The intervention, based on the teach-back method, consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment, potential complications, medication adherence, and health behaviours. Rates of health services’ use were collected immediately before (T0), and after the interventions (T1). Differences in utilization rates were examined by the McNemar’s test. Potential factors associated with the risk of health services’ use were explored with a Cox proportional hazard regression model. Results The sample (n = 78) was predominantly female (n = 50, 64.1%), and had a mean age of 76.2 (SD = 4.8) years. Diabetes mellitus was the most frequent disease (n = 27, 34.6%). McNemar’s test indicated a significant reduction in health services’ use at T1 (McNemar χ2 = 28.03, P < 0.001). Cox regressions indicated that time and patient education, as well as their interaction, were the only variables positively associated with the probability of health services’ use. Conclusion A teach-back intervention led by a family nurse practitioner has the potential to reduce health services’ use in older patients with chronic diseases

Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory

Background: Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD). Aims: The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI). Methods: The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores. Results: We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales. Conclusion: The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care

Deadwood in forest stands close to old-growthness under Mediterranean conditions in the Italian Peninsula

Considering that indicators of old-growth features can vary across the European ecoregions, this paper provides some results to identify the distinctive traits of old-growth forests in the Mediterranean ecoregion. Deadwood occurrence as indicator of naturalness is investigated in some remote forest areas that have developed in absence of anthropogenic disturbance over the past few decades. Eleven study sites across the Italian peninsula were elected and records of deadwood were carried out in 1-ha size plots. Deadwood volume, deadwood types and decay stages were inventoried in the selected sites. The amounts of deadwood indicate a large variability among the investigated forest stands: the total volume ranged between 2 and 143 m3ha-1, with an average of 60 m3ha-1. Lying deadwood is the most abundant component of deadwood in the investigated forests, due to the natural mortality occurring in the stands in relation to the processes established in the last decades. On the contrary, stumps are the less represented type of deadwood in almost all the study areas. All the decay classes are present in each study site. The amount of deadwood in Southern Europe, even if lower than that reported for North and Central European countries, could have a different meaning due to the faster decay occurring in Mediterranean forest ecosystems. For this reason, old-growth features and the characteristics of each indicator should be framed and referred to well-defined climatic and biogeographic contexts. Distinctively, under the conditions here investigated, three main deadwood features prove to characterize forest stands close to old-growthness: a ratio of dead to living wood not lower than 10%; lying deadwood much more abundant than the standing one; large range of deadwood size and decay classes across all the deadwood components

Adherence of systematic reviews to Cochrane RoB2 guidance was frequently poor : A meta epidemiological study

Objectives To assess whether the use of the revised Cochrane risk of bias tool for randomized trials (RoB2) in systematic reviews (SRs) adheres to RoB2 guidance. Methods We searched MEDLINE, Embase, Cochrane Library from 2019 to May 2021 to identify SRs using RoB2. We analyzed methods and results sections to see whether risk of bias was assessed at outcome measure level and applied to primary outcomes of the SR as per RoB2 guidance. The relation between SR characteristics and adequacy of RoB2 use was examined by logistic regression analysis. Results Two hundred-eight SRs were included. We could assess adherence in 137 SRs as 12 declared using RoB2 but actually used RoB1 and 59 did not report the number of primary outcomes. The tool usage was adherent in 69.3% SRs. Considering SRs with multiple primary outcomes, adherence dropped to 28.8%. We found a positive association between RoB2 guidance adherence and the methodological quality of the reviews assessed by AMSTAR2 (p-for-trend 0.007). Multivariable regression analysis suggested journal impact factor [first quartile vs. other quartiles] was associated with RoB2 adherence (OR 0.34; 95% CI: 0.16-0.72). Conclusions Many SRs did not adhere to RoB2 guidance as they applied the tool at the study level rather than at the outcome measure level. Lack of adherence was more likely among low and very low quality reviews

The zCOSMOS 10k-Bright Spectroscopic Sample

We present spectroscopic redshifts of a large sample of galaxies with I_(AB) < 22.5 in the COSMOS field, measured from spectra of 10,644 objects that have been obtained in the first two years of observations in the zCOSMOS-bright redshift survey. These include a statistically complete subset of 10,109 objects. The average accuracy of individual redshifts is 110 km s^(–1), independent of redshift. The reliability of individual redshifts is described by a Confidence Class that has been empirically calibrated through repeat spectroscopic observations of over 600 galaxies. There is very good agreement between spectroscopic and photometric redshifts for the most secure Confidence Classes. For the less secure Confidence Classes, there is a good correspondence between the fraction of objects with a consistent photometric redshift and the spectroscopic repeatability, suggesting that the photometric redshifts can be used to indicate which of the less secure spectroscopic redshifts are likely right and which are probably wrong, and to give an indication of the nature of objects for which we failed to determine a redshift. Using this approach, we can construct a spectroscopic sample that is 99% reliable and which is 88% complete in the sample as a whole, and 95% complete in the redshift range 0.5 < z < 0.8. The luminosity and mass completeness levels of the zCOSMOS-bright sample of galaxies is also discussed

Miller Fisher syndrome: an updated narrative review

IntroductionMiller Fisher syndrome (MFS) is considered a rare variant of Guillain-Barré syndrome (GBS), a group of acute-onset immune-mediated neuropathies characterized by the classic triad of ataxia, areflexia, and ophthalmoparesis. The present review aimed to provide a detailed and updated profile of all aspects of the syndrome through a collection of published articles on the subject, ranging from the initial description to recent developments related to COVID-19.MethodsWe searched PubMed, Scopus, EMBASE, and Web of Science databases and gray literature, including references from the identified studies, review studies, and conference abstracts on this topic. We used all MeSH terms pertaining to “Miller Fisher syndrome,” “Miller Fisher,” “Fisher syndrome,” and “anti-GQ1b antibody.”ResultsAn extensive bibliography was researched and summarized in the review from an initial profile of MFS since its description to the recent accounts of diagnosis in COVID-19 patients. MFS is an immune-mediated disease with onset most frequently following infection. Anti-ganglioside GQ1b antibodies, detected in ~85% of patients, play a role in the pathogenesis of the syndrome. There are usually no abnormalities in MFS through routine neuroimaging. In rare cases, neuroimaging shows nerve root enhancement and signs of the involvement of the central nervous system. The most consistent electrophysiological findings in MFS are reduced sensory nerve action potentials and absent H reflexes. Although MFS is generally self-limited and has excellent prognosis, rare recurrent forms have been documented.ConclusionThis article gives an updated narrative review of MFS with special emphasis on clinical characteristics, neurophysiology, treatment, and prognosis of MFS patients