Search

The aim of this study was to report most recent data regarding the occurrence of influenza A virus H1N1v in the lower respiratory tract from a cohort of hospitalized adult patients during the winter season 2009/2010 and investigated the main clinical features and outcomes.A total of 130 consecutive BAL specimens (collected from October 2009-March 2010) of 101 patients were retrospectively analyzed for influenza A virus H1N1v positivity using a commercial kit.Overall, 19/130 (14.6%) BAL specimens from 17/101 (16.8%) patients were positive for the novel influenza A H1N1v virus. H1N1v resulted significantly more prevalent in immunocompetent subjects. As regards clinical features, H1N1v resulted more prevalent in respiratory insufficiency or acute respiratory illness. Thirteen patients died during the analytic period; three of them (23.1%) resulted positive to H1N1v but no direct association has been made.Our cohort study of influenza A H1N1v detection in BAL from hospitalized adult patients confirms the overall moderate clinical impact of this virus, as reported in most reports worldwide. It remains to be evaluated the role of reassortment with influenza virus strains circulating in the winter season 2010/2011 and its potential pathogenicity.

Background: The management of chronic diseases, particularly in children, requires an integrated physical and psychological approach to both sick children and their family. This is the case of Cystic Fibrosis (CF), a complex genetic chronic disease, where, a comprehensive evaluation of the emotional impact and an effective multidimensional approach are indicated. Aim: This study investigates on parenting stress in children and adolescents with CF and its determinants related to parents, children and the disease severity. Methods: The study involved 34.04% adult males and 65.96% adult females (range 21-55 years) and 47 children with CF, 54.35% males and 45.65% females (range 1-17 years). The data were obtained through a Parenting Stress Index - Short Form (PSI-SF) questionnaire. According to the PSI-SF scoring system, three types of stress were detected: a typical stress pattern (normal), a high stress pattern (increased) and a defensive response, which may be considered as a high stress feature in children which requires monitoring and clinical evaluation. Results: This study shows a significant presence of stress in females (60.23%), of subject married (84.62%), unemployed (69.23%) and with education level such as "middle School" (61.54%). Concerning children of parents with high stress, it resulted most frequent children with one sibling (53.85%). Finally, by univariate analysis, it resulted a significant positive correlation between parenting stress and disease degree of children. Instead by multivariate analysis, we found that the variables: Number of siblings and Birth order were a significant positive and negative predictor of parenting stress respectively. Conclusion: An increased stress level was detected in less than one third of parents of subjects with CF. These data may be related to the psychological support which is part of the routine management of CF care team. However, as children's features seem to act as a determinant of stress more than parental ones, the parental-child dysfunction should be the target for further integrated interventions. Background: The management of chronic diseases, particularly in children, requires an integrated physical and psychological approach to both sick children and their family. This is the case of Cystic Fibrosis (CF), a complex genetic chronic disease, where, a comprehensive evaluation of the emotional impact and an effective multidimensional approach are indicated. Aim: This study investigates on parenting stress in children and adolescents with CF and its determinants related to parents, children and the disease severity. Methods: The study involved 34.04% adult males and 65.96% adult females (range 21-55 years) and 47 children with CF, 54.35% males and 45.65% females (range 1-17 years). The data were obtained through a Parenting Stress Index – Short Form (PSI-SF) questionnaire. According to the PSI-SF scoring system, three types of stress were detected: a typical stress pattern (normal), a high stress pattern (increased) and a defensive response, which may be considered as a high stress feature in children which requires monitoring and clinical evaluation. Results: This study shows a significant presence of stress in females (60.23%), of subject married (84.62%), unemployed (69.23%) and with education level such as “middle School” (61.54%). Concerning children of parents with high stress, it resulted most frequent children with one sibling (53.85%). Finally, by univariate analysis, it resulted a significant positive correlation between parenting stress and disease degree of children. Instead by multivariate analysis, we found that the variables: Number of siblings and Birth order were a significant positive and negative predictor of parenting stress respectively. Conclusion: An increased stress level was detected in less than one third of parents of subjects with CF. These data may be related to the psychological support which is part of the routine management of CF care team. However, as children’s features seem to act as a determinant of stress more than parental ones, the parental-child dysfunction should be the target for further integrated interventions.

Today, nurses play a fundamental role in Public Health. In the last few decades the health profession has seen strong professional growth, in the areas of Clinical practice, Management and Education. In particular, this growth has been also informed by the progress being made in nursing research. In fact, nursing research has contributed to the establishment of support tools to facilitate and evaluate the daily work done by nurses, contributing significantly to the improvement of their professional performance.

Background and Objectives: Game addiction is an emerging problem in public health. A gaming disorder is characterized by a pattern of persistent or recurrent gaming behavior. The behavioral pattern is severe enough to implicate a significant involvement of family, social, educational, professional, or other relationships. Therefore, greater attention needs to be paid to potential addictive behaviors in terms of video games in order to identify both pre-adolescents and adolescents at risk and to provide them with adequate assistance. Materials and Methods: A random sample of 622 students including pre-adolescents and adolescents were enrolled from September 1st to October 31th 2016, and the Game Addiction Scale (GAS) interview was used to identify pathological students with both Monothetic and Polythetic analysis. Results: This study shows the presence of pathological students is equal to 1.93%, with 37.46% and 4.50% obtained with Monothetic and Polythetic analysis (global and partial), respectively. In our sample, the most frequent were students with a gaming time of 1 or 2 h, and students with a day gaming frequency of 1, 2, or 3 times a day. The items with more pathological students were Item 2 (i.e., Tolerance) and 4 (i.e., Withdrawal). Every item was positively correlated with Daily gaming time(hours) and Daily game frequency, excluding Item 4(i.e., Withdrawal). Finally, the Monothetic GAS score was positively correlated with Daily gaming time while the Polythetic Global GAS was positively correlated with Daily game frequency and negatively with Education level, instead, the Polythetic Partial GAS score was positively correlated with only Daily gaming time. Conclusion: Males are pathological gamblers more so than females and spend more time playing video games. An increase in Daily game frequency or Daily gaming time implicates an increase in video game addictions, while an increase in Education level, which generally corresponds to a greater age, implicates a decrease in game addiction. Finally, we observed that the correlations obtained between the Polythetic Partial GAS score with the independent variables such as Age, Gender, Education level, Daily gaming time (hours), and Daily game frequency were analogous to the significant correlations obtained with the Monothetic GAS score, while these correlations were different for the Polythetic Global GAS and the independent variables. These results suggest that the use of the original Polythetic scale should not be neglected.

Objectives: To explore and understand the lived experiences of women with endometriosis. Design: Qualitative study using Cohen phenomenology. Setting:The study was conducted in the general setting of a university hospital in southern Italy. Participants:A total of twenty five adult women with endometriosis. Results:The data analysis identified four main themes and two sub-themes.The main themes are: delay in diagnosis, which includes the sub-theme of the misunderstanding of one's state; worsening of one's life, which includes the sub-theme of a painful life; disastrous intimate life with one's partner; and uncertainty about being able to have one’s own children. Conclusions: The themes that emerged represent the starting point for further research and for the implementation of specific educational and support strategies that improve self-care, commitment and quality of life for women with endometriosis.

Purpose: Redo operations and preoperative antiplatelet/anticoagulant therapy can significantly increase surgical risk in congenital heart surgery. This is a retrospective study on the impact of preoperative aspirin therapy on the outcome of Tetralogy of Redo Fallot patients undergoing right ventricle outflow tract (RVOT) conduit implantation. Methods: Ten-years retrospective analysis of medical records was carried out. A total of 72 patients were divided into two groups: &ldquo, Daily-on-ASA&rdquo, group on daily therapy with aspirin (ASA) until 5 days from surgery and &ldquo, No-Home-ASA&rdquo, without it. Propensity match analysis was done in order to standardize the populations. Intraoperative and postoperative lengths were compared as well as the need for inotropic support. In addition, differences in blood transfusions and need for Fresh frozen plasma (FFP)/platelets (PLT) were analysed. Findings: Intraoperative lengths were similar between the groups. Not statistically significative differences about postoperative time to extubation (p = 0.34), ICU Stay (p = 0.31) or in-hospital stay (p = 0.36) were found. Drain loss was higher in the &ldquo, group (407.9 &plusmn, 96.7 mL vs. 349.5 &plusmn, 84.3 mL, p = 0.03) as well as blood transfusions (372.7 &plusmn, 255.1 mL vs. 220.1 &plusmn, 130.3 mL, p = 0.02) and PLT/FFP need (217.7 &plusmn, 132.1 mL vs. 118.7 &plusmn, 147.1 mL, p = 0.01). No differences were found in postoperative complications or re-explorations for bleeding. Implications: We found no advantages in surgical times and hospital stay comparing redo patients who stopped aspirin versus those that didn&rsquo, t take it in the last 6 months. However, our results suggest that redo patients undergoing RVOT conduit implantation who take daily aspirin are at higher risk of bleeding even if it is stopped 5 days before surgery.

Objective The primary aim of this article was to describe SARS‐CoV‐2 infection among pregnant women during the wild‐type and Alpha‐variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. Design National population‐based prospective cohort study. Setting A total of 315 Italian maternity hospitals. Sample A cohort of 3306 women with SARS‐CoV‐2 infection confirmed within 7 days of hospital admission. Methods Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. Main outcome measures COVID‐19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. Results We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID‐19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30–34 years (OR 1.43, 95% CI 1.09–1.87) and ≥35 years (OR 1.62, 95% CI 1.23–2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36–2.25), previous comorbidities (OR 1.49, 95% CI 1.13–1.98) and obesity (OR 1.72, 95% CI 1.29–2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre‐pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha‐variant period compared with the wild‐type period (OR 3.24, 95% CI 1.99–5.28). Conclusions Our results are consistent with a low risk of severe COVID‐19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha‐variant period there was a significant increase of severe COVID‐19 illness. Further research is needed to describe the impact of different SARS‐CoV‐2 viral strains on maternal and perinatal outcomes., Tweetable abstract The rate of severe COVID‐19 disease increased during the Alpha‐variant period compared with the wild‐type period.

Introduction: Given that emergency procedures must be performed immediately and without the possibility of sufficiently informing and preparing a patient, the lived experiences of patients who undergo emergency procedures and those who undergo elective procedures may well differ. Elucidating the lived experiences of patients who underwent percutaneous coronary intervention (PCI) with stent implantation in an emergency situation is crucial because such knowledge might prove helpful in tailoring post-procedure interventions intended to improve the lives of PCI patients. Aim: To describe the experiences of patients 1 month after they underwent emergency PCI with coronary stent implantation. Methods: Cohen's phenomenology was applied in this study. This method combines the characteristics of descriptive (Husserlian) phenomenology with those of interpretative (Gadmerian) phenomenology, and it is by nature an inductive approach. The participants were enrolled 1 month after undergoing PCI with coronary stent implantation. They were interviewed using open-ended questions to provide them full freedom of expression. They were asked to describe their experiences of the PCI and stent implementation they have gone through. This study followed the recommendations of the Standard for Reporting Qualitative Research. Results: Our sample consisted of 15 participants. Data analysis revealed three main themes: (1) catheter lab and pain, (2) anxiety and feeling uncertain about the future, and (3) lifestyle changes. The anxiety theme encompassed two subthemes: (a) anxiety related to the procedure and (b) anxiety related to the continuation of life. Conclusion: Our study is one of the first works to explicitly investigate the lived experiences of patients who underwent emergency PCI. Understanding the experiences of these patients is key in understanding their realistic needs and concerns. Relevance to clinical practice: Knowledge of the lived experiences of patients who underwent emergency PCI with coronary stent implantation is fundamental in identifying aspects that warrant tailored interventions.

Objective: To describe the incidence, clinical features and perinatal outcome of late onset growth restriction (FGR) associated with genetic syndromes or aneuploidy, structural malformation, or congenital infection. Methods: Retrospective multicenter cohort study conducted at four tertiary maternity hospitals in Italy. We included singleton pregnancies between 32+0 and 36+6 weeks of gestation with either abdominal circumference or estimated fetal weight

The Cardiac Children's Hospital Early Warning Score (C-CHEWS) is an early warning scale used to identify paediatric patients experiencing clinical deterioration which may warrant a transfer to an ICU. However, no studies have tested the C-CHEWS in an Italian paediatric cardiac population. The aims of this study were to translate/back-translate and validate the Italian version of the C-CHEWS and its algorithm.Retrospective study. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value were used to evaluate the performance of C-CHEWS. In additions the Cohen's kappa statistic was calculated to evaluate the agreement between patient's status described by C-CHEWS score (≥5) and actual ICU transfer.High discrimination was observed for sensitivity (81.5%), specificity (99.6%), accuracy (99.7%), positive predictive value (86.7%), and negative predictive value (99.8%). The Cohen's kappa score was observed to be equal to 0.837 (p-value0.001) indicating there was excellent significant agreement between a C-CHEWS score ≥ 5 and effective evaluation for patients transfer to an ICU.The Italian version of the C-CHEWS proved to be a sensitive, specific and reliable tool in the early detection of a physical deterioration of hospitalized paediatric cardiac surgical patients.This tool may help doctors, nurses and all healthcare professionals to promptly recognize and treat clinical deterioration and facilitate urgent transfers to the PICU.

Background: Abnormal umbilical, cerebral and uterine artery Doppler findings and fetal biometry below the 3rd percentile have been proposed as risk factors for perinatal complications in late-onset fetal growth restriction (FGR). Recent evidence has allowed to reach a consensus on the clinical use of Doppler ultrasound for the monitoring and timing of delivery in early-onset FGR, however there is limited data on the relationship between abnormal Doppler and severity of the growth restriction and adverse outcome when a diagnosis of late-onset FGR is made. Objective: To evaluate the relationship between the ultrasound parameters measured at diagnosis and perinatal adverse outcome within a cohort of late-onset FGR fetuses. Methods: This is a multicentre retrospective study between 2014 and 2019 including non-anomalous singleton pregnancies complicated by late-onset FGR, which was defined either by abdominal circumference (AC), estimated fetal weight (EFW) 95th percentile at diagnosis proved to be independently associated with obstetric intervention due to intrapartum distress (p95th percentile at diagnosis is independently associated with intrapartum distress leading to obstetric intervention.

To describe the type and the amount of formal and informal care received during the first year after home discharge and to identify the baseline predictors of the formal and informal care needs of stroke survivors.Longitudinal study. Data were collected between June 2013-May 2016.Survivors (N = 415) were enrolled during discharge from rehabilitation hospitals and interviewed at 3 (T1), 6 (T2), 9 (T3), and 12 (T4) months. The linear mixed effects model with random intercept and random slopes was used to trend for the amount of formal and informal care received by survivors during the four observation times.Regarding formal care, only physiotherapy and speech therapy decreased significantly over time. Stroke survivors received a mean of 17 hr of paid informal care per week at T1 and these hours did not significantly decrease after one year from discharge, while unpaid informal care decreased significantly over time. Higher numbers of paid informal caregiving were predicted by older age, higher education levels, lower physical functioning, and living without unpaid informal caregivers while higher numbers of unpaid informal care were predicted by lower physical functioning and living with unpaid informal caregivers.Stroke has a great effect on survivors' lives. During the first few months after rehabilitation hospital discharge, survivors need further care because they are often discharged before achieving independent functioning.The results of this study could be important to guide future interventions aimed at imporving stroke survivors' conditions after post rehabilitation hospital discharge.目的: 在于描述出院后第一年接受正式和非正式护理的类型和数量,并确定中风幸存者正式和非正式护理需求的基线预测指标。 设计: 纵向分析。2013年6月至2016年5月期间,收集了相关数据。 方法: 幸存者(415名)在康复医院出院时登记,并在3个月(T1)、6个月(T2)、9个月(T3)和12个月(T4)接受访谈。使用了具备随机截距和随机斜率的线性混合效应模型来预测幸存者在四次观察期间接受的正式和非正式护理数量。 结果: 关于正式护理,随着时间的推移,只有物理疗法和语言疗法在显著减少。中风幸存者在T1时每周平均接受17小时的有偿非正式护理,出院一年后这些时间没有显著减少,而无偿非正式护理却随着时间的推移显著减少。年龄越大、受教育水平越高、身体机能越差以及没有无酬非正式护理人员的生活预示着有酬非正式护理的人数会越来越多,而身体机能越差和与无酬非正式护理人员的生活预示着无酬非正式护理的人数会越来越多。 结论: 中风对幸存者的生活有很大影响。在康复医院出院后的头几个月里,幸存者需要进一步的护理,原因在于他们通常在能独立活动之前就出院了。 影响: 这项研究的结果对于指导旨在改善康复出院后中风幸存者状况的未来干预措施非常重要。.

Introduction The family members of a patient admitted to a COVID Intensive Care Unit (COVID-ICU) could not communicate with and stay close to their loved one, which resulted in them becoming dependent on hospital staff for remote updates. Objective To describe the lived experiences of families with a member admitted to a COVID-ICU. Methods A phenomenological study was conducted. The subjects were interviewed with open-ended questions to allow them full freedom of expression. The researchers involved in the analysis immersed themselves in the data, independently reading and rereading the transcripts to gain a sense of the entire dataset. Results Fourteen first-degree family members were recruited. Five main themes emerged: fear, detachment, life on standby, family-related loneliness in the COVID-ICU, and an unexpected event. Conclusions Knowing the experience of families who have a relative in the COVID-ICU is essential for recognizing and reducing the risk of developing symptoms of post-intensive care syndrome.

Aim and objectives: To assess the prevalence of anxiety, sleep disorders and self-efficacy and their predicting factors among nurses facing COVID-19. Background: The spread of COVID-19 throughout the world determined a series of modifications of several National Health Service organisations, with a potential series of psychological consequences among nurses, who were particularly afflicted by this situation of changes and precariousness. Design: A cross-sectional study was carried out from February-April 2020. Methods: A total of 1,005 nurses employed in different Italian hospital wards, during the COVID-19 pandemic, were recruited. Analyses were based on descriptive statistics and multivariate logistic regression. The STROBE checklist for cross-sectional studies was used in this study. Results: The prevalence of sleep disturbances, moderate anxiety and low self-efficacy was 71.4%, 33.23% and 50.65%, respectively. We found a positive correlation between anxiety and sleep quality (0.408; p < .0001) and negative correlations between self-efficacy and anxiety (-0.217; p < .0001) and sleep quality and self-efficacy (-0.134; p < .0001). The factor independently associated with all variables was gender. Females were more prone to sleep disturbances, anxiety and low levels of self-efficacy than males (p < .05). Conclusions: The prevalence of anxiety, sleep disorders and low self-efficacy among Italian nurses during the COVID-19 pandemic was high. Healthcare managers should recognise and consider these results to reduce the risk of the onset of major mental problems that could result in post-traumatic stress disorder. Relevance to clinical practice: Nurses facing major incidents as COVID-19 pandemic are among healthcare personnel exposed to a high risk to develop psychological disturbance that should be assessed and recognised, in order to find helpful coping strategies to inform support services and avoid to hesitate in post-traumatic stress disorders

The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room, the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother’s milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to “better safe than sorry” care choices. An improvement of the peripartum care indicators was observed over time.

Aim The aim of this study was to explore the experience of Italian nurses engaged in caring for patients with COVID-19. Background COVID-19 found the health care world unprepared to face an emergency of such magnitude. Italy was one of the most affected European countries, with more than 250,000 cases. Understanding the impact of events of this magnitude on nurses provides a framework of knowledge on which educational training could be based to face similar situations in the future to prevent further breakdown. Methods The hermeneutic approach by Cohen was used. Semi-structured interviews were conducted using a voice-over Internet protocol. Interviews were transcribed, read in depth and analysed. Results Twenty nurses were interviewed. Four themes were extracted: uncertainty and fear, alteration of perceptions of time and space, change in the meaning of 'to care' and changes in roles and relationships. Conclusions Psychological support in association with emergency training prevents stress and helps tackle compassion fatigue. Implications for nursing management Policies to improve nursing science should be developed to ensure better quality of care, a higher number of professionals and, consequently, an increase in the safety of patients.

To investigate the longitudinal growth trajectories of disease-specific quality of life (QoL) dimensions and their associations over 1 year.A longitudinal design. Data were collected between February 2015-May 2017.Four hundred and fifteen stroke survivors (mean age 70.6 years; 81% ischaemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every 3 months for 1 year. Changes in Stroke Impact Scale (SIS) dimension scores were evaluated using hierarchical linear models (HLMs) and linear, logarithmic, quadratic, and cubic time slope.We observed a significant linear and quadratic increase in most SIS dimensions from the baseline to 12-month follow-up, especially in physical dimensions. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimension scores were significantly associated with lower age, hypercholesterolaemia, and better physical functioning at baseline, while higher communication was associated with lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was associated with lower age, married status, better physical functioning, and left-hemisphere stroke. Better participation was associated with lower age and better physical functioning. No significant associations were observed for emotion.This study provides important information about the trajectories of stroke survivors' specific QoL and their associated variables.Stroke has a great impact on stroke survivors' QoL. Disease-specific QoL significantly increases from the baseline to 12-month follow-up, especially in physical dimensions. Lower age, hypercholesterolaemia, better physical functioning, and diagnosis of peripheral vascular disease seem to be associated with better QoL. Through the analyses of associated variables, we identified stroke survivors who are more at risk and who need more tailored interventions to improve their physical, psychological, emotional, and social dimensions.目的: 研究疾病特异性生活质量 (QoL) 各维度在1年内的纵向增长轨迹及其关联性。 设计: 一项纵向设计。在2015年2月至2017年5月之间收集数据。 方法: 招募了415名从康复医院出院的脑卒中幸存者 (平均年龄70.6岁; 81%为缺血性脑卒中) , 在1年内每隔3个月进行一次随访。使用多层线性模型 (HLMs) 和线性、对数、二次方和三次方时间斜率评估脑卒中影响量表 (SIS) 维度评分的变化。 结果: 据观察, 从基线检查到12个月的随访, 大多数脑卒中影响量表维度都呈显著的线性二次方增加趋势, 尤其是身体维度。沟通维度随着时间的推移保持稳定, 而记忆维度仅呈线性增加趋势。较高的身体维度评分与基线时较低的年龄、高胆固醇血症和较好的身体机能显著相关, 而较高的沟通维度评分与较低的年龄、较好的身体机能和周围血管疾病的诊断相关。较高的记忆维度评分与较低的年龄、已婚状态、较好的身体机能和左侧半脑中风相关。较高的参与维度评分与较低的年龄和较好的身体机能有关。情绪方面没有观察到显著的关联。 结论: 本研究提供了有关脑卒中幸存者的特定生活质量及其相关变量的重要轨迹信息。 影响: 脑卒中对脑卒中幸存者的生活质量影响很大。从基线检查到12个月的随访, 疾病特异性生活质量显著提高, 尤其是身体方面。较低的年龄、高胆固醇血症、较好的身体机能和周围血管疾病的诊断似乎与较高的生活质量相关。通过对相关变量的分析, 我们发现脑卒中幸存者的风险更高, 需要对脑卒中幸存者采取更具针对性的干预措施, 以改善脑卒中幸存者的生理、心理、情感和社会维度。.

Background Authors of previous research have not yet analyzed the role of potential moderators in the relationship between depressive symptoms and quality of life (QOL). Aims The aim of this study was to examine the moderating effect of mutuality between depressive symptoms and QOL in stroke survivor and caregiver dyads. Methods This study used a longitudinal design with 222 stroke survivor–caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed for 12 months. We examined survivor and caregiver QOL dimensions (physical, psychological, social, and environmental), depression, and mutuality at baseline and every 3 months. Hierarchical linear modeling was used to test 4 longitudinal dyadic moderation models (1 for each QOL domain). Results Survivors (50% male) and caregivers (65% female) were 70.8 (SD, 11.9) and 52.5 (SD, 13.1) years old, respectively. We observed no significant moderating effects of mutuality for survivors across the 4 dimensions of QOL over time. However, higher survivor mutuality was significantly associated with higher survivor psychological and social QOL at baseline. Regarding caregivers, caregiver mutuality significantly moderated the association between caregiver depressive symptoms and caregiver physical (B = 0.63, P < .05), psychological (B = 0.63, P < .01), and social (B = 0.95, P < .001) QOL at baseline, but not in environmental QOL. Higher caregiver mutuality was significantly associated with less improvement in caregiver physical QOL over time. Conclusions Mutuality is a positive variable on the association between depression and QOL for both members of the dyad at discharge but may lead to declines in physical health for caregivers over time. Further work is needed to understand the role of mutuality on long-term outcomes and associations with increased care strain.

Objective: To investigate the outcome of pregnancies with small baby, including both small for gestational age (SGA) and late fetal growth restriction (FGR) fetuses, undergoing induction of labor (IOL) with Dinoprostone, Misoprostol or mechanical methods. Study design: Medline, Embase and Cochrane databases were searched. Inclusion criteria were non-anomalous singleton pregnancies complicated by the presence of a small fetus, defined as a fetus with estimated fetal weight (EFW) or abdominal circumference (AC) 3rd centile with normal cerebroplacental Dopplers). Quality assessment of each included study was performed using the Risk of Bias in Non-randomized Studies-of Interventions tool (ROBINS-I), while the GRADE methodology was used to assess the quality of the body of retrieved evidence. Meta-analyses of proportions and individual data random-effect logistic regression were used to analyze the data. Results: 12 studies (1711 pregnancies) were included. In the overall population of small fetuses, composite adverse intra-partum outcome occurred in 21.2 % (95 % CI 10.0−34.9) of pregnancies induced with Dinoprostone, 18.0 % (95 % CI 6.9−32.5) of those with Misoprostol and 11.6 % (95 % CI 5.5−19.3) of those undergoing IOL with mechanical methods. Cesarean section (CS) for non-reassuring fetal status (NRFS) was required in 18.1 % (95 % CI 9.9−28.3) of pregnancies induced with Dinoprostone, 9.4 % (95 % CI 1.4−22.0) of those with Misoprostol and 8.1 % (95 % CI 5.0−11.6) of those undergoing mechanical induction. Likewise, uterine tachysystole, was recorded on CTG in 13.8 % (95 % CI 6.9−22.3) of cases induced with Dinoprostone, 7.5 % (95 % CI 2.1−15.4) of those with Misoprostol and 3.8 % (95 % CI 0–4.4) of those induced with mechanical methods. Composite adverse perinatal outcome following delivery complicated 2.9 % (95 % CI 0.5−6.7) newborns after IOL with Dinoprostone, 0.6 % (95 % CI 0–2.5) with Misoprostol and 0.7 % (95 % CI 0–7.1) with mechanical methods. In pregnancies complicated by late FGR, adverse intrapartum outcome occurred in 25.3 % (95 % CI 18.8−32.5) of women undergoing IOL with Dinoprostone, compared to 7.4 % (95 % CI 3.9−11.7) of those with mechanical methods, while CS for NRFS was performed in 23.8 % (95 % CI 17.3−30.9) and 6.2 % (95 % CI 2.8−10.5) of the cases, respectively. Finally, in SGA fetuses, composite adverse intrapartum outcome complicated 8.4 % (95 % CI 4.6−13.0) of pregnancies induced with Dinoprostone, 18.6 % (95 % CI 13.1−25.2) of those with Misoprostol and 8.7 (95 % CI 2.5−17.5) of those undergoing mechanical IOL, while CS for NRF was performed in 8.4 % (95 % CI 4.6−13.0) of women induced with Dinoprostone, 18.6 % (95 % CI 13.1−25.2) of those with Misoprostol and 8.7 % (95 % CI 2.5−17.5) of those undergoing mechanical induction. Overall, the quality of the included studies was low and was downgraded due to considerable clinical and statistical heterogeneity. Conclusions: There is limited evidence on the optimal type of IOL in pregnancies with small fetuses. Mechanical methods seem to be associated with a lower occurrence of adverse intrapartum outcomes, but a direct comparison between different techniques could not be performed.

ObjectiveThis study explored the lived experiences of women with congenital heart disease (CHD) during pregnancy and early motherhood.DesignQualitative study using semistructured interviews. Data were analysed according to interpretative phenomenological analysis.SettingSan Donato Milanese, Italy.Participants12 adult women during pregnancy or early motherhood.ResultsThree main themes emerged from the analysis that were labelled as follows: ‘Being a woman with CHD’; ‘Being a mother with CHD’; and ‘Don’t be alone’. Mothers described both positive and negative feelings about their pregnancies and transitions from childless women to mothers with CHD. They needed supportive care to improve the management of their health during pregnancy and early motherhood.ConclusionThis study explored the lived experiences of women with CHD during pregnancy and early motherhood. The emerged themes represent an initial framework for implementing theory-grounded educational and supportive strategies that improve self-care, engagement and quality of life for women with CHD. Furthermore, the study’s results provide guidance for operationalising the described experiences into items and domains for future cross-national surveys.

Background: Little is known about the protective effect of spirituality on the association between known risk factors such as depression and quality of life (QOL) in stroke survivor-care partner dyads. Therefore, the aim of this study was to evaluate the moderating role of spirituality on the association between depressive symptomatology and QOL in stroke survivor–care partner dyads. Methods and Results: Longitudinal design with 223 stroke survivor–care partner dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivors’ and care partners’ depression, quality of life, and spirituality. Examining the moderating role of spirituality on the association between depressive symptoms and QOL within survivor-care partner dyads, we used a traditional Actor-Partner-Interdependence Model and a basic Actor-Partner-Interdependence Model moderation model for a mixed variable. Survivors (51% male) and care partners (66% female) were 70.7 and 52.3 years old, respectively. The survivor’s spirituality significantly moderated the association between care partner depressive symptomatology and survivor psychological QOL (B=0.03, P P P P Conclusions: The findings from this study have broad implications for the role of spirituality in relation to QOL in medical-health contexts and the importance of examining such concepts within a dyadic framework. Greater awareness of the importance of spirituality among clinicians and nurses may improve cultural competence in healthcare services.

BACKGROUND: After discharge from a rehabilitation hospital, stroke survivors and their families may face considerable stroke-related direct costs. The total amount could be ascribed to the costs of formal and informal care and to the equipment or materials needed for care. OBJECTIVES: This study aims to describe the direct costs incurred after a stroke by survivors during their first poststroke year and to analyze the basic predictors of these costs. METHODS: Stroke survivors (N = 415) were enrolled for this study during discharge from rehabilitation hospitals (baseline) and interviewed at 3, 6, 9, and 12 months after discharge for a longitudinal study. The trend of the direct costs incurred during the follow-up (from T1 to T4; n = 239) was evaluated using a linear mixed-effects model. The mixed-effects model was used to identify the baseline predictors of the incurred direct costs from the stroke survivors. RESULTS: During the first year after discharge, stroke survivors spent approximately $3700 on stroke-related direct (ie, medical and nonmedical) costs. The highest direct costs occurred during the first 6 months, although there was not a significant change over time. The higher direct costs incurred were predicted by the linear effect of time, by the educational level (higher vs low), and by the lower Barthel Index score, whereas a higher perceived cost was predicted only by the linear effect of time and by the lower Barthel Index score. CONCLUSION: In the first poststroke year, direct costs have remained stable over time and can be predicted by the level of education and physical functioning. The identification of specific direct cost predictors would be helpful for developing more socially and economically tailored interventions for stroke survivors in their first year after their stroke

Purpose Studies have shown that spirituality plays an important role in enhancing the quality of life of stroke survivors and their caregivers. Spirituality has been associated with positive patient and caregiver outcomes, so a valid, reliable measure of spirituality is important. It has not been tested with stroke survivors and their caregivers, so the aim of this study was to evaluate the validity and reliability of the World Health Organization Quality of Life Spiritual Religious and Personal Belief (WHOQOL-SRPB) scale for stroke survivors and their caregivers. Methods In this cross-sectional study, 414 stroke survivors at 10 rehabilitation hospitals and 244 caregivers completed the WHOQOL-SRPB. The WHOQOL-SRPB’s factorial structure was assessed with confirmatory factor analysis (CFA), criterion-related validity was evaluated with the WHOQOL-BREF, and internal consistency reliability was assessed with Cronbach’s α and ordinal α. Results The CFA results supported the hypothesized eight-factor structure. The stroke survivor and the caregiver versions of the model both had excellent fit indices. The factor loadings for the final models were strong: 0.78–0.98 for stroke survivors and caregivers (p < 0.001). The criterion-related validity for the WHOQOL-SRPB showed weak to moderate correlations with all the WHOQOL-BREF dimensions. Both ordinal α and Cronbach’s α had values more than 0.70. Conclusions The WHOQOL-SRPB scale is a valid, reliable instrument for measuring spirituality in stroke survivors and caregivers. Given the importance of spirituality for stroke survivors and caregivers, the WHOQOL-SRPB scale is recommended as an important tool for clinical practice and research.