Health-related quality of life and psychological distress in implantable cardioverter defibrillator patients with and without heart failure

Heart failure (HF) is one of the major health concerns worldwide due to high incidence and mortality. HF patients experience high level of psychological distress, particularly anxiety and depression. To increase survival rate, implantable cardioverter defibrillator (ICD) acts as a life-savor to deliver immediate shock to correct life-threatening arrhythmias as HF patients are the high-risk population for sudden cardiac arrest. It was attributed to unpredictable ICD shock. Moreover, some studies reported that ICD can improve health-related quality of life (HRQoL) among HF patients. However, ICD was evidenced to increase anxiety and depression. Psychological distress can also impair HRQoL of ICD patients. Due to different health conditions and health needs, ICD patients with and without HF can perceive different degrees of heightened psychological distress and declined HRQoL. Although the number of HF patients receiving ICD implantation has been increasing, inadequate knowledge is reported about their psychological status and HRQoL. To improve current ICD care to patients with and without HF, this study aimed to compare psychological status (anxiety and depression) and HRQoL and identify the relationships of personal and clinical characteristics with psychological status and HRQoL between ICD patients with and without HF. A total of 139 ICD patients were recruited, including 68 patients with HF. Those with HF perceived relatively higher depression and poorer physical HRQoL. Patients without HF who were married perceived better physical and mental health. Patients with HF who were more dependent have heightened anxiety and depression. The results shed light on the differences from the level of anxiety and depression among ICD patients with and without HF as well as their HRQoL so that ICD care for these two specific ICD patient groups can be directed. Family involvement is more significant for patients with and without HF

Psychological distress and health-related quality of life in implantable cardioverter defibrillator patients with coronary artery disease

Implantable cardioverter defibrillator (ICD) patients are found to have poorer health-related quality of life (HRQoL) and heightened psychological distress, particularly depression. Coronary artery disease (CAD) is evidenced to be associated with lowered HRQoL and more negative emotions. This study was to examine psychological status and HRQoL as well as identify factors associated with these two areas among ICD patients with a history of CAD. Of 57 ICD patients with CAD, most of them (91.2%) aged 60 or older with mean age 63.04 years old (SD=14.58). A majority of them were married (84.2%) and selfcare dependent (89.5%). All participants had a history of SCA experience. Almost 80% were the first ICD recipients and had ICD implantation more than one year. Only two of them had ICD shock experience. The participants were more depressive (mean 3.67±3.57). About 8.8% of patients had severe clinical depression (score ≥8) and 19.3% had severe clinical anxiety (score ≥8). The participants had relatively poorer mental health (mean 58.35±9.31) than physical health (mean 38.15±14.98). Female gender was found to have positive association with anxiety; whereas, having a history of DM has positive association with depression. Self-care dependence was the most significant factor associated with anxiety and depression. Depression was found to be negatively associated with physical health; whereas, anxiety was negatively associated with mental health. By contrast, having occupation and having a history of hyperlipidemia were found to be positively associated with physical health. The results showed that identification of factors enables nurses to develop strategies to remove or reduce the negative effects but to provide more support to foster the positive effects arising from the factors. The study results can direct healthcare policy makers implement strategies for optimizing HRQoL and reducing psychological burdens

A cross-sectional study: Collaborative learning approach enhances learning attitudes of undergraduate nursing students

Collaborative learning approach is an effective teaching method to receive optimal achievement in knowledge and skills. Since nursing is a profession that emphasizes multidisciplinary collaboration, collaborative learning approach has been commonly adopted in current nursing education to maximize students’ learning and develop their collaborative attributes. It is important that learning attitudes shall be positive to reach benefits of collaborative learning. This study was to examine how learning attitudes of nursing undergraduate students in respond to collaborative learning approach. The results may help nursing school administrators design more appropriate learning activities and give educators insights to implement collaborative learning approach more effectively

A survey: Knowledge about breast cancer and health beliefs towards screening practice among menopausal and postmenopausal women

Breast cancer is a major health problem with high mortality in women worldwide and has become the third most prevalent disease among women in Hong Kong. Knowledge about breast cancer is closely related to health beliefs towards screening practices for breast cancer. This study examined knowledge about breast cancer and breast cancer screening (BCS) beliefs among menopausal and postmenopausal women. A total of 213 eligible women, mostly aged 55 to 60, who were housewives or retired and were educated at secondary school level or above, were selected. A survey using the Chinese Breast Cancer Screening Beliefs (CBCSB) questionnaire was conducted. The results revealed that menopausal and postmenopausal women had better health beliefs towards breast cancer screening practices. Education was found to be positively associated with attitudes of BCS health beliefs. It indicates that education can affect attitudes towards breast cancer screening practice. Most of the women presented inadequate knowledge and they wished to receive more information about breast cancer although they were well-educated. It is important to note that knowledge about breast cancer cannot be effectively delivered to the at-risk women. In addition, menopausal and postmenopausal women can be more likely to seek more information about the effectiveness and side effects of the medication for breast cancer. Therefore, treatment about effectiveness, side effects, and prices ought to be included in current educational programs and healthcare services in the promotion schemes. Healthcare professionals should also pay more attention to better BCS practices in community-based educational programs with information on preventive measures for breast cancer to menopausal and postmenopausal women, particularly to those in lower socioeconomic classes

A survey of the perceived lifestyle risks of breast cancer in menopausal and postmenopausal women in Hong Kong

Breast cancer ranks as the most common cause of cancer death in women. If menopausal and postmenopausal women know the lifestyle risks associated with breast cancer and its preventive measures, they will make appropriate choices in order to enjoy their life and have a better chance of preventing this disease. This study attempted to explore perceived beliefs with regard to the lifestyle risks associated with breast cancer among menopausal and postmenopausal women in Hong Kong. A survey was designed that used a self-reporting questionnaire to assess the perceived beliefs of 223 women. Results showed that more than half of the participants held misconceptions about lifestyle breast cancer risks. Only those women who were well-educated and were worried about having breast cancer performed breast screening for cancer. The findings of this study suggest that health care professionals should channel resources to educate menopausal and postmenopausal women about the risks of breast cancer and to promote awareness of breast wellness and the value of breast cancer screening

Menopausal-specific quality of life among women in Hong Kong

This study aimed to explore the menopausal-specific quality of life and assess its relationship with the sociodemographic characteristics in menopausal and post-menopausal women in Hong Kong. A cross-sectional survey was conducted with 218 women aged between 45 and 80 or over. The quality of life was assessed by Menopause-Specific Quality of Life Questionnaire (MENQOLTM). Results showed that the mean scores for vasomotor domain: 2.59 ± 1.71; psycho-social domain: 2.77 ± 1.39; physical domain: 2.89 ± 1.23 and sexual domain 2.60 ± 1.16. The physical domain had the highest score in menopausal and post-menopausal women. Univariate analysis demonstrated that younger and less educated working post-menopausal women perceive lower quality of life. Our findings suggest that menopausal-related symptoms affect the quality of life

Antibiotics, gut microbiota, environment in early life and type 1 diabetes

The gut microbiota interact with innate immune cells and play an important role in shaping the immune system. Many factors may influence the composition of the microbiota such as mode of birth, diet, infections and medication including antibiotics. In diseases with a multifactorial etiology, like type 1 diabetes, manipulation and alterations of the microbiota in animal models have been shown to influence the incidence and onset of disease. The microbiota are an important part of the internal environment and understanding how these bacteria interact with the innate immune cells to generate immune tolerance may open up opportunities for development of new therapeutic strategies. In this review, we discuss recent findings in relation to the microbiota, particularly in the context of type 1 diabetes

Management of refractory ascites

The development of refractory ascites in approximately 10% of patients with decompensated cirrhosis heralds the progression to a more advanced stage of cirrhosis. Its pathogenesis is related to significant hemodynamic changes, initiated by portal hypertension, but ultimately leading to renal hypoperfusion and avid sodium retention. Inflammation can also contribute to the pathogenesis of refractory ascites by causing portal microthrombi, perpetuating the portal hypertension. Many complications accompany the development of refractory ascites, but renal dysfunction is most common. Management starts with continuation of sodium restriction, which needs frequent reviews for adherence; and regular large volume paracentesis of 5 L or more with albumin infusions to prevent the development of paracentesisinduced circulatory dysfunction. Albumin infusions independent of paracentesis may have a role in the management of these patients. The insertion of a covered, smaller diameter, transjugular intrahepatic porto-systemic stent shunt (TIPS) in the appropriate patients with reasonable liver reserve can bring about improvement in quality of life and improved survival after ascites clearance. Devices such as an automated low-flow ascites pump may be available in the future for ascites treatment. Patients with refractory ascites should be referred for liver transplant, as their prognosis is poor. In patients with refractory ascites and concomitant chronic kidney disease of more than stage 3b, assessment should be referred for dual liver-kidney transplants. In patients with very advanced cirrhosis not suitable for any definitive treatment for ascites control, palliative care should be involved to improve the quality of life of these patients