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Introduction: We know that patient and caregiver sex influence patient self-care and caregiver contribution to self-care in multiple chronic conditions. However, the role of dyad sex combination (e.g., male patient and female caregiver, female patient and male caregiver, male patient and caregiver, and female patient and caregiver) in influencing patient self-care and caregiver contribution to self-care remains unexplored. Our aim was to investigate the relationship between patient and caregiver sex combination and patient self-care and caregiver contribution to self-care in multiple chronic conditions.Design: Multicentre cross-sectional study.Methods: We enrolled patients with multiple chronic conditions and caregiver dyads in outpatient and community settings from April 2017 to December 2019. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory that measure, from the patient and caregiver perspective, self-care maintenance (i.e., behaviors to maintain illness stability), self-care monitoring (i.e., monitoring of illness signs and symptoms), and self-care management (i.e., behaviors to manage signs and symptoms). We used multivariate analysis of covariance to evaluate the association between sex and self-care and caregiver contribution to self-care.Results: We recruited 540 patient-caregiver dyads. Male patients cared by female caregivers performed higher self-care maintenance compared to female patients cared by female caregivers. Female caregivers caring for female patients performed higher caregiver contribution to self-care monitoring compared to male caregivers caring for female or male patients.Conclusions: Clinicians should consider the influence of patient and caregiver sex combination on self-care and caregiver contribution to self-care in multiple chronic conditions to provide tailored interventions.Clinical Relevance: Healthcare professionals should consider the patient and caregiver sex combination in the dyad to tailor better interventions aimed at improving patient self-care and caregiver contribution to self-care in multiple chronic conditions.

Intracellular mono-ADP-ribosyltransferases (mono-ARTs) catalyze the covalent attachment of a single ADP-ribose molecule to protein substrates, thus regulating their functions. PARP10 is a soluble mono-ART involved in the modulation of intracellular signaling, metabolism and apoptosis. PARP10 also participates in the regulation of the G1- and S-phase of the cell cycle. However, the role of this enzyme in G2/M progression is not defined. In this study, we found that genetic ablation, protein depletion and pharmacological inhibition of PARP10 cause a delay in the G2/M transition of the cell cycle. Moreover, we found that the mitotic kinase Aurora-A, a previously identified PARP10 substrate, is actively mono-ADP-ribosylated (MARylated) during G2/M transition in a PARP10-dependent manner. Notably, we showed that PARP10-mediated MARylation of Aurora-A enhances the activity of the kinase in vitro. Consistent with an impairment in the endogenous activity of Aurora-A, cells lacking PARP10 show a decreased localization of the kinase on the centrosomes and mitotic spindle during G2/M progression. Taken together, our data provide the first evidence of a direct role played by PARP10 in the progression of G2 and mitosis, an event that is strictly correlated to the endogenous MARylation of Aurora-A, thus proposing a novel mechanism for the modulation of Aurora-A kinase activity.

The study tested the construct validity and reliability of the Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease (COPD) Inventory and the Caregiver Self-Efficacy in Contributing to Self-Care of COPD Scale. The two instruments were developed by modifying the Self-Care of COPD Inventory and Self-Care Self-Efficacy Scale in COPD into caregiver versions. The psychometric properties were tested in a convenience sample of 261 informal caregivers of COPD patients recruited in Italy in two cross-sectional studies. Structural validity was tested by confirmatory factor analysis, construct validity by posing several hypotheses, and internal consistency through factor score determinacy and global reliability index for multidimensional scales. In confirmatory factor analysis, the caregiver contribution to self-care maintenance, monitoring and management scales, composing the Caregiver Contribution to Self-Care of COPD Inventory, presented good fit indices. Global reliability indices ranged 0.75–0.88. The caregiver self-efficacy scale presented a comparative fit index of 0.96 and a global reliability index of 0.82. The caregiver contribution to self-care and the caregiver self-efficacy scales correlated moderately among themselves and with the patient versions of the scales, and scores were higher with caregiver-oriented dyadic care types and female caregivers. Our study provides evidence of the two instruments’ construct validity and internal consistency.

The objective of this review was to evaluate the experiences of health care personnel with promoting a sense of home for older adults living in residential care facilities.Moving to a residential care facility represents a critical moment for older adults. It disrupts the continuity of their lives and distances them from significant people and objects. Health care personnel working in residential care facilities can help create a sense of home for residents. There is a lack of qualitative reviews reporting health care personnel's experiences with promoting a sense of home for older adults living in residential care settings.Qualitative studies exploring the experiences of health care personnel with promoting a sense of home for people aged 65 and older living in residential care facilities, including, but not limited to, nursing homes, residential care homes, retirement homes, assisted-living facilities, and skilled nursing facilities.This review followed a meta-aggregation approach according to JBI methodology for systematic reviews of qualitative evidence. PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science, and ILISI databases were searched, as well as Google Scholar, OpenGrey, and ProQuest Dissertations and Theses Global. Studies published in English, Italian, French, Portuguese, or Spanish were considered. Study selection, critical appraisal, data extraction, and data synthesis were conducted by two independent reviewers using the JBI approach and JBI standardized tools. Finally, the ConQual approach was used to assess the confidence level in the study findings.Seven studies conducted in Canada, the United States, the United Kingdom, Sweden, or the Netherlands between 2014 and 2020 were included. The studies reported the experiences of nurses, nurse aides, and directors of facilities. From the aggregation of 69 findings, 14 categories were generated that were then grouped into three synthesized findings describing the experiences of health care personnel as follows: the promotion of residents' sense of home in residential care facilities is influenced by i) the built environment, including private, single rooms with bathrooms, homelike-domestic spaces, personalization of residents' rooms, homelike interior and exterior design, and non-hospital-like environment; ii) the national and local policy and regulations, and work organization, as well as leadership of managers and directors; and 3) the facilities' care culture, including philosophy of care, maintaining autonomy of residents and ties with the community, participation in domestic and recreational activities, and family relationships. Based on ConQual scores, the confidence level in the synthesized findings was graded as low.According to health care personnel, the physical environment, interpersonal and social aspects, regulations, work organization, and facilities' care culture can contribute to creating a sense of home for older adults in residential care facilities. The evidence derived from this review can help health care personnel, facility directors, and policy-makers identify the changes that should be implemented to promote a sense of home in older adults residing in care facilities.PROSPERO CRD42020214383.

The aim was to explore nurses’ experiences of caring for and accompanying patients dying without the presence of family during the COVID-19 pandemic.A qualitative descriptive design was used.A purposive sample of registered nurses, caring for dying patients in Italian health-care settings during the COVID-19 pandemic, were selected. To capture a broad range of experiences, a maximum variety of participants about workplace, age, gender and work experience were included. A total of 31 nurses agreed to participate in the study; 28 participants were female; participants were aged 41 on average (range 25-63 years) and worked in hospitals and nursing homes in the Northern and Central Italian regions. Six focus groups were conducted from August to December 2020 through Microsoft Teams, reaching data saturation. The transcripts were analysed through inductive content analysis. The COREQ checklist was followed for study reporting.Four main categories emerged describing nurses’ experiences: hugely increased deaths in time of COVID-19; ensuring physical, emotional, interpersonal and spiritual care for dying patients and supporting their families despite difficulties; ensuring care procedures of patients’ bodies after death and psychological consequences of caring for dying people during the pandemic.Registered nurses provided physical, spiritual and emotional care to dying patients during the pandemic, despite limited resources and knowledge, standing in for relatives who were not allowed to visit them; the experiences of caring for dying patients in the absence of the family caused emotional distress in nurses.Health-care systems should develop guidelines aiming to meet the psychological needs of dying people in case of restrictions on patients’ family visits. Health-care administrators should offer services to support the grieving process of relatives who cannot accompany dying patients and to reduce emotional distress in nurses caring for dying patients.

Aim To identify, analyze and synthesize qualitative studies on caregivers' experiences of contributions to the self-care of patients with Chronic Obstructive Pulmonary Disease (COPD). Background COPD patients perform daily self-care behaviours to manage the disease. With aging and disease progression, patients need to rely on the contributions of informal caregivers, usually family members, for disease management. Caregivers' normal or habitual contributions to patients' self-care have not yet been completely investigated. Design Thematic synthesis of qualitative studies. Data sources CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, Scopus, Emcare and OpenGrey databases were searched from inception to September 2020. The search was restricted to English-language papers. Review methods Studies were critically appraised using the Critical Appraisal Skills Programme checklist. The initial line-by-line codes were aggregated into descriptive themes from which analytical themes were derived. Results Fifteen papers from nine countries, published 2009-2020, were included. Six analytical themes encompassing 22 descriptive themes were identified and grouped in two overarching themes describing caregivers' experiences of contributions to patients' self-care during the stable and exacerbation phases of COPD. In the stable phases, caregivers contribute through maintaining disease stability, promoting healthy behaviours, fostering normal life and helping perform daily activities. During exacerbations, caregivers contribute through assessing, monitoring and managing symptoms in collaboration with patients or autonomously. They contribute by performing actions, motivating patients, organizing care, sensing variations in symptoms, acquiring knowledge and educating patients, making decisions, communicating and collaborating with healthcare providers and patients and advocating for patients. Conclusion This thematic synthesis enlarges knowledge of caregivers' contributions to patients' self-care in COPD, detailing the ways by which caregivers provide care to patients. Impact Contributing daily to the self-care of a family member with COPD is a complex experience. Nurses need to acknowledge the importance of caregivers' contributions to patient disease management and develop effective educational interventions to support them.

To assess the level of chronic obstructive pulmonary disease (COPD)-related knowledge within patient and informal caregiver dyads, and to identify factors influencing the knowledge level considering the interdependence within the dyads.Patients with COPD and their informal caregivers present poor disease knowledge and different characteristics are associated with their level of knowledge. Disease knowledge and related characteristics have been assessed separately in patients and informal caregivers, without considering possible influence within the dyads.Cross-sectional study.A convenience sample of dyads was recruited in outpatient and inpatient settings in Central and South Italy. The Bristol COPD Knowledge Questionnaire was used to measure disease knowledge. Sociodemographic, clinical and caregiving characteristics, self-efficacy and depression were measured in patients and caregivers. Multilevel modelling was used to analyse COPD knowledge at the level of the dyad to control for interdependency between patients and informal caregivers. The STROBE guidelines for cross-sectional studies were followed for study reporting.We recruited 133 dyads. The total level of correct knowledge shared by dyads was 32.89%. Dyads presented higher levels of correct knowledge about disease symptoms, smoking cessation and vaccination, and lower about COPD treatment. Younger patients with greater self-efficacy, who attended pulmonary rehabilitation and were cared for by a spouse/partner with low levels of depression, and informal caregivers who were patients' spouse/partner were more likely to have higher levels of disease-related knowledge.Our study advances dyadic research in COPD. Future studies should investigate the effects of shared knowledge and incongruent knowledge (where one member knows more than the other) on patient self-care and caregiver contribution to patient self-care.Our study shows what knowledge nurses should provide in educational programmes directed at patients and caregivers, and which dyads have greater knowledge deficits, to whom offer targeted educational interventions.

The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory.Existing measures of caregiver contribution to self-care are disease-specific or behaviour-specific; no generic measures exist.A cross-sectional study.Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.The Caregiver Contribution to Self-Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self-care in chronic illnesses.目的: 本研究旨在检验慢性疾病护理人员自我照顾贡献量表的因子结构、内部一致信度及并发效度。 背景: 现有护理人员对自我照顾的贡献衡量标准均是以疾病或行为为基础;无通用衡量标准。 设计: 横断面研究。 方法: 2017年4月至2018年12月间,我们对358名慢性病患者及其护理人员进行随机抽样调查。患者已填写慢性疾病自我照顾量表,且护理人员已填写其对慢性病自我照顾贡献量表,此量表是在慢性疾病自我照顾量表的基础上修订,包括三个量表:护理人员对自我照顾的贡献,护理人员对自我照顾监控的贡献以及护理人员对自我照顾管理的贡献。各量表中,我们通过验证性因子分析对因子结构进行检验,并用因子得分确定系数、多维量表整体信度指标和克隆巴赫系数,以进行信度检验。同时,我们利用皮尔逊相关系数进行并发效度分析。 结果: 验证性因子分析可在护理人员自我照顾共享维持与管理量表中所列双因素结构和护理人员自我照顾监测量表中所列单因素结构中适用。一般模型可在组合项目的同时验证性因素分析中适用(比较拟合指数=0.933)。经预计,上述三个量表的信度介于0.701到0.961之间。慢性疾病护理人员自我照顾量表与慢性疾病患者自我照顾量表的并发效度呈弱相关,因此,慢性疾病患者自我照顾量表未充分使用。 结论: 慢性疾病护理人员自我照顾贡献量表有效、可靠,可在临床实践和研究中使用。 影响: 慢性疾病护理人员自我照顾贡献量表是评估护理人员对慢性疾病患者自我照顾的贡献程度的有效工具。.

The mechanistic target of rapamycin complex 1 (mTORC1) is a key metabolic hub that controls the cellular response to environmental cues by exerting its kinase activity on multiple substrates1–3. However, whether mTORC1 responds to diverse stimuli by differentially phosphorylating specific substrates is poorly understood. Here we show that transcription factor EB (TFEB), a master regulator of lysosomal biogenesis and autophagy4,5, is phosphorylated by mTORC1 via a substrate-specific mechanism that is mediated by Rag GTPases. Owing to this mechanism, the phosphorylation of TFEB—unlike other substrates of mTORC1, such as S6K and 4E-BP1— is strictly dependent on the amino-acid-mediated activation of RagC and RagD GTPases, but is insensitive to RHEB activity induced by growth factors. This mechanism has a crucial role in Birt–Hogg–Dube syndrome, a disorder that is caused by mutations in the RagC and RagD activator folliculin (FLCN) and is characterized by benign skin tumours, lung and kidney cysts and renal cell carcinoma6,7. We found that constitutive activation of TFEB is the main driver of the kidney abnormalities and mTORC1 hyperactivity in a mouse model of Birt–Hogg–Dube syndrome. Accordingly, depletion of TFEB in kidneys of these mice fully rescued the disease phenotype and associated lethality, and normalized mTORC1 activity. Our findings identify a mechanism that enables differential phosphorylation of mTORC1 substrates, the dysregulation of which leads to kidney cysts and cancer. Dysregulation of an mTORC1 substrate-specific mechanism leads to constitutive activation of TFEB, and promotes kidney cystogenesis and tumorigenesis in a mouse model of Birt–Hogg–Dube syndrome.

Self-care is essential to achieve positive clinical outcomes in patients with chronic diseases; however, self-care behaviors of people living with HIV (PLWH) have not been extensively studied due to the lack of validated measurements. We performed preliminary psychometric analyses of the structural validity and internal consistency of the Self-Care of Chronic Illness Inventory among 108 PLWH living in Italy and assessed self-care levels. Our findings largely replicate the instrument's original factor structure and indicated high internal consistency and reliability. Additionally, we found that PLWH performed self-care behaviors at suboptimal levels. Recommendations for clinical care and future investigations are advanced.

Objectives: Self-care of chronic conditions involves both patients and their informal caregivers and therefore might be considered as a dyadic phenomenon. Nevertheless, empirical evidence supporting a dyadic construct is unavailable. This study aimed to explore the existence of a dyadic construct in self-care maintenance, monitoring, and management in patients affected by chronic conditions and their informal caregivers. Methods: This study used a cross-sectional design. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory, which measure patient self-care and informal caregivers’ contribution to self-care maintenance, monitoring and management. Exploratory Structural Equation Modeling was performed to verify the existence of dyadic latent constructs in each scale in patients and informal caregivers. Results: A convenience sample of 493 patients and informal caregivers, with a mean age of 76.47 and 52.76 years, respectively, was studied. In the self-care maintenance scales, 2 correlated factors (r = 0.34, P < .001) were identified, indicating the presence of a dyadic second-order construct. In addition, 2 factors that were not correlated (r = 0.11, P = .064) were identified in the self-care monitoring scales, indicating the absence of a dyadic construct. Finally, we found a 3-factor model in the self-care management scales composed of both patient and caregiver items, indicating a dyadic first-order construct. Conclusions: Knowing which care behaviors are dyadic in chronic conditions is important for tailoring interventions to improve self-care. Self-care maintenance and management would benefit from dyadic interventions, while self-care monitoring would not. The results of this study may illuminate future theoretical and scientific developments in dyadic care of chronic illness.

Objectives: Family is a major source of support for older chronically-ill patients and known to be associated with better self-care. Depression and self-care self-efficacy are associated with healthy behaviors and thus may serve as mechanisms by which family support influences self-care. We explored depression and self-care self-efficacy as mediators of the relationship between perceived family support and self-care. Methods: Five hundred forty-one older adults with multiple chronic illnesses were recruited from outpatients and community settings. Three structural equation models (SEM) were fit on cross-sectional data. We measured perceived family support (subscale of the Multidimensional Scale of Perceived Social Support, scores range 1-7), depression (Patient Health Questionnaire, scores range 0-27), selfcare self-efficacy (Self-Care Self Efficacy Scale, standardized scores range 0-100), and self-care maintenance, monitoring, and management (Self-care of Chronic Illness Inventory, standardized scores range 0-100). Results: Participants (mean age = 76.6±7.3 yrs) were predominantly females (55.6%). In the full sample, depression and self-care self-efficacy mediated the relationship between perceived family support and self-care; in the gender-stratified SEM, men’s depression was no longer a significant mediator. Depression and self-care self-efficacy were significant mediators of the relation between perceived family support and self-care. Conclusion: In older chronically-ill patients, interventions addressing perceived family support may facilitate a rapid improvement in self-care self-efficacy and a decrease in depressive symptoms, particularly among women.

Aims: Explore the self-care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self-care during COVID-19 pandemic. Design: A descriptive qualitative design was used. The COREQ checklist was used for study reporting. Methods: Individual semi-structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle-range theory of self-care of chronic illness, which entails the three dimensions of self-care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis. Results: A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25years and caregivers of 45.76years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self-care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID-19 and in ensuring patients' self-care of chronic diseases through direct and indirect interventions. Conclusions: Critical events can modify the self-care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self-care and contributions to self-care behaviours. Impact: Patients with MCCs and their caregivers can react in different ways in their performances of self-care and contribution to patients' self-care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self-care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions.

Aims To examine the distribution of dyadic care types in multiple chronic conditions, compare self-care and caregiver contributions to patients' self-care in each care type and identify the patient and caregiver characteristics associated with each care type. Design Secondary analysis of a multicentre, cross-sectional study. Methods Patient-caregiver dyads were enrolled from outpatient clinics and community settings. The Dyadic Symptom Management Type Scale was used to categorize dyads by type. Self-care, self-efficacy, comorbidities and cognitive impairment were measured in patients, whereas caregiver contributions to patient self-care, self-efficacy, caregiver burden and hours of caregiving were measured in caregivers. Sociodemographic characteristics perceived social support and mutuality were measured in both patients and caregivers. Univariate and multivariate analyses were performed. Results A sample of 541 patient-caregiver dyads was examined. The most frequent dyadic care type was the collaborative-oriented (63%). In the patient-oriented type, patients scored higher on self-care compared with caregivers; in the caregiver-oriented and collaborative types, caregivers scored higher than patients supporting the typology. The patient-oriented type was associated with younger, healthier male patients with better cognitive status, who scored higher for mutuality and whose caregivers scored lower for burden. The caregiver-oriented type was associated with older, less educated patients, with caregivers experiencing higher burden and unemployment. The collaborative type was associated with sicker patients, with the caregiver more probably to be female and employed, with higher perceived social support, mutuality and burden. The incongruent dyadic care type was associated with lower caregiver mutuality. Impact In the context of multiple chronic conditions, clinicians should consider targeting any educational interventions aimed at improving patient self-care and caregiver contributions to self-care by dyadic care types.

Since the outbreak of the SARS-CoV-2 pandemic in 2020, many governments have been imposing confinement and physical distancing measures. No data exist on the effects of lockdowns on the health status of patients affected by chronic pathologies, specifically those with Chronic Obstructive Pulmonary Disease (COPD). Our study aims to establish variations across the psychological and cognitive profile of patients during the isolation period in Italy, in a cohort of patients affected by COPD, between February and May 2020. Forty patients with established COPD were comprehensively evaluated by geriatric multidimensional assessment before the spread of the epidemic in Italy, and submitted to a second evaluation during the subsequent lockdown. We assessed functional ability, basic and instrumental Activities of Daily Living (ADL and IADL), cognition and mood status. We compared the scores obtained at baseline against those obtained during the pandemic, and used mean differences for correlation with major clinical and functional indexes. The score differences from MMSE, ADL and IADL were statistically significant. Such differences were correlated to the presence of a caregiver and to the total number of family members living together. Remarkably, the loneliness dimension, more than the restrictions themselves, seemed to represent the major determinant of altered health status and depressed psycho-cognitive profile in our population. Also remarkably, we detected no correlation between the score variation and the respiratory function indexes of disease severity. The isolation measures adopted during the SARS-CoV-2 pandemic have triggered the classic clinical string associated to geriatric isolation, which leads to a deterioration of cognitive functions, independence and frailty levels in a population affected by a chronic degenerative disease, such as COPD. If considered from a multidimensional geriatric point of view, the individual benefit of isolation measures could be small or non-existent.

OBJECTIVE The objective of this review is to evaluate the experiences of health care personnel in promoting a sense of home for older adults living in residential care facilities. INTRODUCTION Moving to a residential care facility represents a critical moment for older adults as it disrupts their life and distances them from significant people and objects in their life. Health care personnel working in residential care facilities can assist residents by promoting a feeling of being at home for these residents. There is a lack of qualitative evidence reporting the experiences of health care personnel with regards to promoting a sense of home for older adults living in residential care facilities. INCLUSION CRITERIA This review will consider qualitative studies that explore the experiences of health care personnel in promoting a sense of home for people aged 65 years and over living in residential care facilities, including, but not limited to, nursing homes, residential care homes, retirement homes, assisted-living facilities, and skilled nursing facilities. METHODS The review will use a meta-aggregation approach following the JBI methodology for systematic reviews of qualitative evidence. MEDLINE, CINAHL, Embase, PsycINFO, Scopus, and Web of Science databases will be searched, together with Google Scholar, OpenGrey, and ProQuest Dissertations and Theses Global. Studies published in English, Italian, French, Portuguese, and Spanish will be included. Qualitative findings will be pooled using the JBI System for the Unified Management, Assessment and Review of Information. Methodological quality will be evaluated using the standard JBI critical appraisal checklist for qualitative research. The ConQual approach will be used to assess the confidence in the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020214383.

Aims and objectives To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. Background Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. Design The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. Methods The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. Results Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. Conclusions An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. Relevance to clinical practice Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Background Dependence is a common life experience and innate condition for human beings due to their bodily and relational essence, but in contemporary society, it has become a stressful condition. Care dependence is central to nursing, and patients with advanced cancer are often dependent on care. Understanding nurses' perceptions of care dependence can contribute to awareness of the impact it has on nurses. Objective The aim of this study was to explore palliative care nurses' experiences and perceptions regarding patient dependence. Methods Sixteen nurses taking care of dependent patients in a palliative care center in Rome were interviewed. Giorgi's descriptive phenomenological method was used. Results Nurses caring for dependent patients transcend the boundaries of dependence. Care dependence is an experience of powerlessness and regression. A patient's life in dependence is precarious, as they have to overcome the daily limits of life. Taking care of dependent patients requires nurses to manage the unmanageable and to know and to embrace change from within in order to build positive relations of personal closeness and reciprocal self-giving. Conclusions Nurses should be aware that self-transcendence and the consequent positive relations could make the difference in the experience of care dependence and promote personal growth for both patient and nurse. Positive and transcending relationships can transform care dependence into the opportunity to find meaning and purpose in life. Implications for practice The study highlights what nurses feel in caring for dependent patients. Understanding nurses' perceptions is important to delineate a proper caring for dependent patients.

Aims and objectives To describe which nursing activities are observed during the discharge of older patients with chronic diseases and to investigate the consistency between the nursing activities actually observed and those documented. Background The discharge from hospital of older patients with chronic diseases is a critical transition that can lead to dissatisfaction, delays in discharge, re-admission, adverse events and increased mortality. Although nurses' interventions during discharge are important for patient outcomes, little is known about the nursing activities actually performed as compared with those documented. Design An observational study of the nursing activities performed during patients' discharge and a retrospective audit of the nursing records of the same patients and nurses. Methods Structured nonparticipant observations were conducted of the activities performed by nurses at discharge. A retrospective audit of the nursing records relating to patient discharge, including the nursing diary and the assessment of critical issues at hospital discharge, was also conducted. The STROBE guidelines were followed (See Supporting Information Appendix S2). Results During hospital discharge of 102 patients, 1,224 nursing activities were observed. The number of activities was not related to patients' age, gender and educational level, nor to nurses' postgraduate education. Statistically significant correlations emerged between the number of activities observed and the nurses' work experience. Conclusions A predefined discharge plan guiding nurses' activities during discharge would enable them to respond better to the care needs of elderly patients. Relevance to clinical practice Results from the study could help clinical nurses to address care priorities of patients at discharge, by using appropriate plans and checklists and improving recording rates. Novice nurses should be supported when caring for elderly patients with chronic disease at discharge.

Objectives Caregiver self-efficacy—a caregiver’s belief in his/her ability to contribute to patient self-care—is associated with better patient and caregiver outcomes in single chronic conditions. It is, however, unknown if caregiver self-efficacy improves patient and caregiver outcomes in multiple chronic conditions (MCCs) because there is no instrument to measure this variable. We developed the 10-item Caregiver Self-Efficacy in Contributing to patient Self-Care (CSE-CSC) scale for that purpose, and we tested its psychometric characteristics in caregivers of patients with MCCs. Methods In this cross-sectional multisite study, we tested the structural validity of the CSE-CSC scale with exploratory and confirmatory factor analysis, and we tested construct validity by correlating CSE-CSC scores with those of the Caregiver Contributions to Self-Care of Chronic Illness Inventory. We also tested reliability, and precision of the CSE-CSC scale. Results The 358 enrolled caregivers (mean age 54.6 years; 71.5% female) cared for patients with an average of 3.2 chronic conditions. Structural validity was good, and it showed 2 factors within the scale. Construct validity showed significant correlations between scores of the CSE-CSC scale and the Caregiver Contributions to Self-Care of Chronic Illness Inventory. Reliability coefficients were between 0.90 and 0.97. Measurement error yielded satisfactory results. Conclusions The CSE-CSC scale is valid, reliable, and precise in measuring caregiver self-efficacy in contributing to patient self-care in MCCs. Because caregiver self-efficacy is a modifiable variable, the CSE-CSC scale can be used in clinical practice and research to improve patient and caregiver outcomes.

Background: Self-care refers to behaviors that individuals adopt to prevent or maintain the stability of an illness (self-care maintenance), to monitor signs and symptoms (self-care monitoring), and to respond to signs and symptoms of an illness exacerbation (self-care management). A generic measure of self-care, the Self-Care of Chronic Illness Inventory, based on the Theory of Self-Care of Chronic Illness, was developed for use in individuals with any number and type of chronic conditions. Objective: The current study investigated the measurement equivalence of the Self-Care of Chronic Illness Inventory in individuals from three different cultural groups. We were interested in determining if Italians, Swedes, and Americans interpret the measure in a conceptually similar way. Methods: This cross-sectional study enrolled 1629 patients, 784 recruited in Italy, 438 in Sweden and 407 in the United States. Self-care (self-care maintenance, self-care monitoring and self-care management) was measured with the Self-Care of Chronic Illness Inventory. A multi-group confirmatory factor analytic approach was used to assess the equivalence of the measures across the three countries. Configural, metric, scalar and strict invariance were tested through a series of nested models where increasingly stringent equality constraints were posited. Results: Participants were mostly males (56.3%), older adults (69.8%) and had at least two chronic conditions. Results indicated that three out of four measurement equivalence levels were partially or totally supported in all three of the Self-Care of Chronic Illness Inventory scales. The partial scalar invariance level was reached for self-care maintenance [chi(2)(50)=63.495, p = 0.095; RMSEA =0.022, p = 0.999, 90% CI= 0.000 0.038; CFI =0.981; TLI =0.977; SRMR =0.036], self-care monitoring [chi(2) (22)=28.770, p = 0.095; RMSEA = 0.024, p = 0.978, 90% CI =0.000 0.046; CFI= 0.996; TLI=0.995; SRMR= 0.054], and self-care management [chi(2) (51)=91.334, p = 0.001; RMSEA =0.048, p = 0.576, 90% CI =0.031 0.063; CFI = 0.949; TLI= 0.937; SRMR = 0.047 ] scales. Conclusions: These findings suggest that patients in the three countries used an identical cognitive framework or mental model when responding and used the 1-5 Likert response scale in an almost identical way, almost without bias. In spite of sociocultural differences, patients in these countries seem to share the same fundamental view of self-care. The results of the Self-Care of Chronic Illness Inventory will be comparable in these countries. (C) 2019 Elsevier Ltd. All rights reserved. Funding Agencies|Center of Excellence for Nursing Scholarship (CECRI) , Rome, Italy; National Institute for Nursing ResearchUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Nursing Research (NINR) [1R01NR018196]; Ruth L. Kirschstein NRSA Doctoral Fellow, Research on Vulnerable Women, Children and FamiliesUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [T32NR007100]

The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil.A multi-national study for cross-cultural validation of the Scale.From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution.The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach's alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χPatients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation.Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.目的: 自我护理自我效能量表(SCSES)是一种最新制定的对慢性病自我护理自我效能的自我报告测量方法。本研究调查了其在美国、中国(香港)、意大利、巴西等不同文化群体的测量等效性(ME)。 设计: 量表跨文化验证的跨国研究。 方法: 自2015年1月至2018年12月,研究员招募了957位患有慢性病的住院患者和门诊患者(美国:200;香港:300;意大利:285;以及巴西:142)进行了自我护理自我效能量表测量,并收集了参与者的门诊和人口数据。基于Meredith框架,多组验证性因素分析通过一系列嵌套模型评估了这四类人群的量表构型、度量、标量以及严格等值,并评估了因素解决方案的可靠性和一致性。 结果: 各组的平均年龄为65岁至77岁,其中男性占总参与者人数的56.4%。美国的单因素自我护理自我效能量表的克隆巴赫系数为0.93、中国(香港)为0.89、意大利为0.92、巴西为0.90。测量等效性的四个等级中的三个得到了部分或全部支持。达到的最高等级为部分标量不变性等级。(χ

Background: Self-care refers to behaviors that individuals adopt to prevent or maintain the stability of an illness (self-care maintenance), to monitor signs and symptoms (self-care monitoring), and to respond to signs and symptoms of an illness exacerbation (self-care management). A generic measure of self-care, the Self-Care of Chronic Illness Inventory, based on the Theory of Self-Care of Chronic Illness, was developed for use in individuals with any number and type of chronic conditions. Objective: The current study investigated the measurement equivalence of the Self-Care of Chronic Illness Inventory in individuals from three different cultural groups. We were interested in determining if Italians, Swedes, and Americans interpret the measure in a conceptually similar way. Methods: This cross-sectional study enrolled 1629 patients, 784 recruited in Italy, 438 in Sweden and 407 in the United States. Self-care (self-care maintenance, self-care monitoring and self-care management) was measured with the Self-Care of Chronic Illness Inventory. A multi-group confirmatory factor analytic approach was used to assess the equivalence of the measures across the three countries. Configural, metric, scalar and strict invariance were tested through a series of nested models where increasingly stringent equality constraints were posited. Results: Participants were mostly males (56.3%), older adults (69.8%) and had at least two chronic conditions. Results indicated that three out of four measurement equivalence levels were partially or totally supported in all three of the Self-Care of Chronic Illness Inventory scales. The partial scalar invariance level was reached for self-care maintenance [χ2(50) = 63.495, p = 0.095; RMSEA = 0.022, p = 0.999, 90% CI = 0.000 0.038; CFI = 0.981; TLI = 0.977; SRMR = 0.036], self-care monitoring [χ2(22) = 28.770, p = 0.095; RMSEA = 0.024, p = 0.978, 90% CI = 0.000 0.046; CFI = 0.996; TLI = 0.995; SRMR = 0.054], and self-care management [χ2(51) = 91.334, p = 0.001; RMSEA = 0.048, p = 0.576, 90% CI = 0.031 0.063; CFI = 0.949; TLI = 0.937; SRMR = 0.047] scales. Conclusions: These findings suggest that patients in the three countries used an identical cognitive framework or mental model when responding and used the 1-5 Likert response scale in an almost identical way, almost without bias. In spite of sociocultural differences, patients in these countries seem to share the same fundamental view of self-care. The results of the Self-Care of Chronic Illness Inventory will be comparable in these countries.

OBJECTIVE This multicentre study aimed to develop a measure of the perception of care dependence in patients diagnosed with cancer and to test its psychometric properties. METHODS The questionnaire was developed based on findings emerged from a meta-synthesis and from qualitative studies conducted in three hospitals in Italy. The draft questionnaire was tested for face and content validity and pilot-tested with patients. The questionnaire was completed by care-dependent patients with cancer. Test-retest was conducted to verify stability. Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust estimator. RESULTS AND CONCLUSION The Scale-Content Validity Index was 0.92. The final 15-item questionnaire was completed by 208 patients admitted to two hospitals. The EFA yielded a two-factor model including a positive and a negative perception of care dependence. Factor score determinacy coefficients, Cronbach's alpha coefficients, composite reliability coefficients and Intraclass Correlations Coefficients yielded satisfactory results confirming internal consistency and stability. The hedonic balance score is also available as a single indicator of subjective well-being. The study provides initial validation of the Care DEeP Questionnaire that can be used by cancer nurses to assess positive and negative patient experiences with care dependence and to personalise and improve their care.

Summary The transcription factor EB (TFEB) has emerged as a master regulator of lysosomal biogenesis, exocytosis, and autophagy, promoting the clearance of substrates stored in cells. c-Abl is a tyrosine kinase that participates in cellular signaling in physiological and pathophysiological conditions. In this study, we explored the connection between c-Abl and TFEB. Here, we show that under pharmacological and genetic c-Abl inhibition, TFEB translocates into the nucleus promoting the expression of its target genes independently of its well-known regulator, mammalian target of rapamycin complex 1. Active c-Abl induces TFEB phosphorylation on tyrosine and the inhibition of this kinase promotes lysosomal biogenesis, autophagy, and exocytosis. c-Abl inhibition in Niemann-Pick type C (NPC) models, a neurodegenerative disease characterized by cholesterol accumulation in lysosomes, promotes a cholesterol-lowering effect in a TFEB-dependent manner. Thus, c-Abl is a TFEB regulator that mediates its tyrosine phosphorylation, and the inhibition of c-Abl activates TFEB promoting cholesterol clearance in NPC models., Graphical Abstract, Highlights • c-Abl is a TFEB regulator that mediates its tyr phosphorylation • c-Abl inhibition promotes TFEB activity independently of mTORC1 • c-Abl inhibition reduces cholesterol accumulation in NPC1 models, Biological Sciences; Molecular Biology; Cell Biology

There is need for improvement in effective pressure ulcers preventive strategies.To study whether a multi-layer silicone-adhesive polyurethane foam dressing shaped for the sacrum prevents PUs development in addition to standard PU preventive care for at-risk hospitalized patients.Open-label, parallel group, multi-center randomized controlled trial.709 in-hospital patients at risk for pressure ulcers from 25 medical, surgical, and intensive care units of 12 Italian hospitals.A multi-layer silicone-adhesive polyurethane foam was applied to the sacrum in addition to standard PUs preventive care in the intervention group. In the control group, standard preventive care alone, including systematic pressure ulcer risk assessment, skin assessment three times per day, routine positioning every 4 h, use of active support surface as appropriate, and incontinence skin care, was guaranteed. Primary outcome was incidence of sacral pressure ulcers of any stage at seven days from hospital admission. Secondary outcomes were incidence of sacral pressure ulcers ≥ II stage, number of days needed to PU development, number of skin adverse events due to the foam dressing, number of dressings used for each patient, number of withdrawing patients due to discomfort caused by the foam dressing. Participants were evaluated at baseline and at seven days.In patients admitted to medical units, 15/113 controls and 4/118 in the intervention group developed sacral pressure ulcers (p = 0.010; absolute reduction 9.2%; NNT for benefit 11, 95% CI 6 to 44). In patients admitted to surgical units, 21/144 controls and 8/142 in the intervention group developed sacral pressure ulcers (p = 0.010; absolute reduction 8.9%; NNT for benefit 11 95% CI 6 to 49). Pressure ulcers incidence was not significantly different between the randomization arms (5.2% experimental vs 10.4% control, p = 0.141) in patients admitted to intensive care units. Overall, 46/358 (12.8%) controls and 17/351 (4.8%) in the intervention group developed sacral pressure ulcers (p0.001; absolute reduction 8%; number needed to treat (NNT) for benefit 12, 95% CI 8 to 26). Incidence of sacral pressure ulcers ≥ II stage did not differ significantly between the two groups. No adverse skin reactions and discomfort attributable to the foam application were reported.A sacral multi-layer silicone-adhesive polyurethane foam in addition to standard preventive care is effective for pressure ulcers prevention in at-risk hospitalized patients admitted to medical and surgical units.ClinicalTrials.gov NCT03900455. The registration (April 1st, 2019) occurred before the first patient was enrolled (October 21st, 2019).

Background and ObjectivesAgeism toward older adults, prevalent in contemporary societies, seems to be internalized during childhood and consolidated during adolescence. Although several instruments have been developed to measure adolescents’ ageism, they present a number of limitations. The study aimed at developing a new instrument, the Adolescents’ Ageism Toward Older Adults Scale, and testing its psychometric properties.Research Design and MethodsA three-phase process was followed: The instrument’s items were developed empirically from focus groups of adolescents; its content validity was evaluated; and finally, its psychometric properties were tested through a multicenter cross-sectional study involving 575 adolescents.ResultsExploratory factor analysis of the new scale retained 33 items grouped into 6 factors: moodiness, traditionalism, physical deterioration, antitechnologism, sageness, and sociability. Confirmatory factor analysis evidenced a second-order factor structure. Omega coefficients measuring internal consistency were above the cutoff of 0.60 for the 6 factors except for antitechnologism. Intraclass correlation coefficients for the entire scale and for the 6 factors were greater than 0.70, again excepting antitechnologism.Discussion and ImplicationsThe Adolescents’ Ageism Toward Older Adults Scale is a promising measure of adolescents’ negative and positive attitudes toward older adults. Its validation highlighted some criticalities that can be resolved by a few modifications. Further testing of the scale should be conducted after these modifications.

Background: Caregivers represent the core of patients’ care in hospital structures, in the process of care and self-care after discharge. We aim to identify the factors that affect the strain of caring for orthopedic patients and how these factors are related to the quality of life of caregivers. We also want to evaluate the role of caregivers in orthopedic disease, focusing attention on the patient–caregiver dyad. Methods: A comprehensive search on PubMed, Cochrane, CINAHL and Embase databases was conducted. This review was reported following PRISMA statement guidance. Studies were selected, according to inclusion and exclusion criteria, about patient–caregiver dyads. For quality assessment, we used the MINORS and the Cochrane Risk of BIAS assessment tool. Results: 28 studies were included in the systematic review; in these studies, 3034 dyads were analyzed. Caregivers were not always able to bear the difficulties of care. An improvement in strain was observed after behavioral interventions from health-care team members; Conclusions: The role of the caregiver can lead to a deterioration of physical, cognitive and mental conditions. The use of behavioral interventions increased quality of life, reducing the strain in caregivers of orthopedic patients. For this reason, it is important to consider the impact that orthopedic disease has on the strain of the caregiver and to address this topic.

Prostate cancer is the most common cancer in men worldwide and nowadays several treatments are available, each presenting risks and benefits. Therefore, deciding on the most appropriate treatment is particularly challenging for men at the time of the diagnosis.This review was aimed at identifying, analyzing, and synthesizing the qualitative evidence on the experience of deciding about treatment after a diagnosis of localized Prostate cancer (LPC) METHODS: A meta-synthesis according to the meta-aggregation approach of the Joanna Briggs Institute (JBI) was used. The CINAHL, MEDLINE, and PsycINFO databases were searched for qualitative studies published from January 1998 to August 2018 in English and Italian. Qualita- tive Assessment and Review Instrument of JBI was used.From the identified sixteen studies two synthesized findings were derived that describe the decision-making as a complex process made in condition of emotional distress and influenced by internal and external factors; men evaluate differently the possible risks and benefits of cancer treatment, and after deciding they try to cope with their choice.The review provides evidence that men with LPC's need to receive emotional support and comprehensive information about the treatment options to facilitate their decision. The healthcare team should refer men to a multidisciplinary cancer service to permit access to all the treatment options.Il cancro della prostata è la neoplasia più comune negli uomini in tutto il mondo. Attualmente sono disponibili diversi trattamenti che presentano rischi e benefici. Ne consegue che scegliere il trattamento più opportuno è particolarmente difficile per gli uomini con una recente diagnosi di cancro prostatico.La presente revisione ha lo scopo di identificare, analizzare e sintetizzare l’evidenza qualitativa sull’esperienza di decidere riguardo al trattamento dopo una diagnosi di cancro prosta- tico localizzato (LCP).E’ stata condotta una meta-sintesi secondo l’approccio della meta-aggregazione racco- mandato dal Joanna Briggs Institute (JBI). Sono stati ricercati studi qualitativi pubblicati da gennaio 1998 ad agosto 2018 in lingua inglese e italiana sulle banche dati CINAHL, MEDLINE e PsycINFO. E’ stata utilizzato lo strumento per le revisioni e la valutazione qualitativa del JBI.Sono stati identificati 16 studi dai quali sono stati derivati due risultati sintetici che descrivono la presa di decisione come un processo complesso che avviene in condizioni di distress emozionale e che è influenzato da fattori interni ed esterni; gli uomini valutano differentemente i possibili rischi e benefici dei trattamenti del cancro e dopo aver preso la decisione, cercano di adat- tarsi alla decisione presa.La revisione evidenzia come gli uomini con un tumore prostatico localizzato hanno bisogno di ricevere supporto emozionale e informazioni complete sulle opzioni di tratta- mento al fine di facilitare la loro decisione. Il team sanitario dovrebbe indirizzare gli uomini con una diagnosi recente di cancro prostatico a centri multidisciplinari che permettano loro l’accesso a tutte le opzioni di trattamento.

Aim: To develop the Self-Care in COVID-19 (SCOVID) scale and to test its psychometric characteristics in the general population. Methods: We tested SCOVID scale content validity with 19 experts. For factorial and construct validity, reliability, and measurement error, we administered the 20-item SCOVID scale to a sample of 461 Italians in May/June 2020 (mean age: 48.8, SD &plusmn, 15.8). Results: SCOVID scale item content validity ranged between 0.85&ndash, 1.00, and the total scale content validity was 0.94. Confirmatory factor analysis supported SCOVID scale factorial validity (comparative fit index = 0.91, root mean square error of approximation = 0.05). Construct validity was supported by significant correlations with other instrument scores measuring self-efficacy, positivity, quality of life, anxiety, and depression. Reliability estimates were good with factor score determinacy, composite reliability, global reliability index, Cronbach&rsquo, s alpha, and test-retest reliability ranging between 0.71&ndash, 0.91. The standard error of measurement was adequate. Conclusions: The SCOVID scale is a new instrument measuring self-care in the COVID-19 pandemic with adequate validity and reliability. The SCOVID scale can be used in practice and research for assessing self-care in the COVID-19 pandemic to preventing COVID-19 infection and maintaining wellbeing in the general population.

Introduction: Multiple Chronic Conditions (MCC) are highly prevalent in patients with cardiovascular diseases. Patients’ informal caregivers play an essential role to achieve both patient and caregiver health outcomes. Four Care Dyadic Types (DTs) of caregiver-patient relationships were previously described in heart failure depending on who is responsible for most of the care: patient-oriented, caregiver-oriented, collaborative, and incongruent (i.e., disagreement on who is responsible for the care). Since DTs in MCC were not described yet, this study aimed to describe the DTs in MCC management, and to identify the patient and caregiver characteristics associated with each type of DT. Methods: We conducted a cross-sectional study enrolling 541 dyads in outpatient settings in Italy. Patients were included in the study if they were ≥65 years old, affected by at least two chronic conditions, and had an informal caregiver ≥18 years old. The Dyadic Symptom Management Type scale was used to assess DTs. Logistic regression analysis was used to identify the characteristics associated with each DT. Results: Most patients and caregivers were female with a mean age of 76.54 (SD 7.23) years and 52.71 (SD 15.06) years, respectively. One third of the patients had heart failure. Younger patients with better cognitive status, fewer comorbidities, better relationship with their caregivers and male caregivers with a lower burden were associated with patient-oriented DT (14.2%, R 2 0.407). Older patients and caregivers with a higher burden were associated with caregiver-oriented DT (11.6%, R 2 0.388). Patients with more comorbidities, better relationship with their caregivers, and female caregivers with lower burden, perceiving strong social support, were associated with collaborative DT (58.8%, R 2 0.097). Caregivers with lower income, more frequently employed, providing more caregiving hours, and having a lower burden were associated with incongruent DT (15.4%, R 2 0.075). Conclusion: Different DTs were described in MCCs identifying specific patients and caregivers’ associated characteristics. This is helpful to classify the dyads and to tailor interventions aimed to empower patients and caregivers in MCCs.

Lysosomes fulfill multiple functions involved in cellular homeostasis and their dysfunction leads to substrates accumulation causing neurodegenerative diseases. The transcription factor EB (TFEB) has emerged as a master regulator of lysosomal biogenesis, exocytosis and autophagy, promoting the clearance of substrates stored in cells. c-Abl is a tyrosine kinase that participates in cellular signaling in physiological and pathophysiological conditions. In this study, we explored the connection between c-Abl and TFEB. Here we show that under pharmacological and genetic c-Abl inhibition, TFEB translocates into the nucleus promoting the expression of its target genes independently of its well-known regulator, mTORC1. Active c-Abl induces TFEB phosphorylation on tyrosine and the inhibition of this kinase promotes lysosomal biogenesis, autophagy and exocytosis. c-Abl inhibition in pharmacological Niemann Pick type-C (NPC) models, a neurodegenerative disease characterized by cholesterol accumulation in lysosomes, promotes a cholesterol-lowering effect in a TFEB dependent manner. In genetic NPC models, c-Abl inhibition promotes cellular clearance through TFEB activation. We propose the modulation of this novel c-Abl/TFEB axis, using the FDA-approved drugs Imatinib or Nilotinib, as a therapeutic strategy to treat different neurodegenerative storage disorders.

Rationale Patients who have multiple chronic conditions (MCCs) and their informal caregivers experience poorer health-related quality of life (HRQOL). Perceived social support has been shown to influence HRQOL. Objectives This study aimed at identifying the differences between patients' and caregivers' physical and mental HRQOL; and determining the association between their perception of social support from different sources, and their own and their dyad partner's HRQOL. Method Patients with MCCs and their caregivers (345 dyads) were enrolled in a multicenter cross-sectional study conducted in Italy. The Multidimensional Scale of Perceived Social Support measured perceived social support from family, friends, and significant others, and the 12-Item Short-Form Health Survey measured the physical and mental component of HRQOL in dyads. The dyadic analysis was conducted using the Actor-Partner Interdependence Model through structural equation modelling. Results Family support perceived by each member of the dyad was associated positively with their own mental HRQOL, and that family support perceived by caregivers was also associated positively with patients’ mental HRQOL. Greater family support perceived by caregivers was also associated with better physical HRQOL in both caregivers and patients. Moreover, greater friend-support perceived by each member of the dyad was positively associated with own physical HRQOL. Conclusions The study suggests the reciprocal influence of perceived social support from family and friends on physical and mental HRQOL in MCC dyads. Healthcare professionals should identify those people who are the main sources of support for each member of the dyad, and develop care plans that promote the maintenance and enhancing of this support.

This study developed two instruments, the Self-Care in Chronic Obstructive Pulmonary Disease (COPD) Inventory (SC-COPDI) and the COPD-Self-Care Self-Efficacy Scale (SCES), and tested their psychometric properties on a convenience sample of 498 patients from Northern, Central, and Southern Italy. First, the domains and the items of the SC-SCOPDI were generated based on the middle-range theory of self-care of chronic illness, comprising the dimensions of self-care maintenance, self-care monitoring, and self-care management, and the SCES-COPD was developed accordingly. Second, we assessed the content validity of each scale. Third, we conducted a multicenter cross-sectional study to test their structural validity, convergent and discriminative validity, internal consistency, and test–retest reliability. The theoretical dimensions of the two instruments were confirmed through confirmatory factor analysis. Convergent validity was demonstrated by the correlation among the three self-care scales and the Self-Efficacy Scale, and discriminative validity by higher self-care scale scores in individuals with greater COPD severity and poorer health status. The global reliability index ranged from .78 to .92 for all scales. The intraclass correlation coefficients were higher than .70. Further studies are needed to confirm the psychometric properties of the two instruments in different COPD populations and countries to extend their use in clinical practice.

Aim To describe a research protocol for a study designed to examine self-care in patient and caregiver dyads in coping with multiple chronic conditions, to evaluate the influence of dyad self-care on: (a) patient mortality, quality of life, hospital admissions, and the unplanned access of care; and (b) the positive aspects of caregiving. The specific conceptual framework that we developed for this study considers the predictors of self-care (at patient, caregiver, and dyadic levels), the process of self-care and the outcomes of self-care in patient and caregiver dyads with multiple chronic conditions. These elements in patient and caregiver dyads have not been well-studied to date. Design This is a multicentre longitudinal study with data collection at 0, 6, and 12 months. Methods We will use generic and specific tools to assess the predictors of self-care, the process of self-care and the outcomes of self-care in the dyads. The data will be analysed with descriptive and inferential statistics and multilevel modelling to control for the interdependent nature of dyadic data. The study was approved by an ethics committee and was funded by a grant from the Centre of Excellence for Nursing Scholarship Rome, in November 2015. Discussion This study seeks to determine the predictors and outcomes of self-care in patient and caregiver dyads within the context of multiple chronic conditions. Impact The results of this study will inform clinical practice and research by identifying variables that are modifiable and therefore amenable to interventions.

To investigate the relationship between depression and self-care behaviours in older individuals with multimorbidity.Cross-sectional study. Data were collected between April 2017 - June 2019.Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring, and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function.The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function.In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity.The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviours should be assessed first, as a potential first indicator of poor self-care.目的: 探讨多种慢性疾病的老年患者的抑郁与自我护理行为的关系。 设计: 横断式研究。收集2017年4月至2019年6月期间的数据。 方法: 来自社区和门诊部,年龄达到65岁以上,患有心力衰竭、糖尿病或慢性阻塞性肺疾病和其他慢性疾病的患者。需要去除患有痴呆和/或癌症的患者。患者健康问卷-9用于衡量抑郁水平,而慢性病自我护理调查表用于衡量自我护理的维持、监测和管理水平。通过先进行两组单变量分析,然后是多变量分析和阶梯分析,评估抑郁与自我护理之间的关系。第二组用于对照慢性疾病的数量、年龄和认知功能。 结果: 样本(N = 366)以女性为主(54.2%),平均年龄76.4岁。大多数受访者(65.6%)有轻度到非常严重的抑郁症状。初步分析表明,抑郁与自我护理的维持和监测之间存在显著的负相关联系,抑郁与多变量自我护理之间存在显著的负相关联系。阶梯分析则显示,即使保持慢性病的数量、年龄和认知功能的相同性后,自我护理的维持是与抑郁负相关的唯一衡量维度。 结论: 在患有多种疾病的人群中,抑郁与自我护理维持的相关性比自我护理的其他衡量维度因素都高。因此,在评估中应优先考虑自我护理的维持行为(如体育活动和药物治疗依从性),并在针对患有多种疾病的抑郁症老年人制定介入治疗时予以重点关注。 影响: 本研究结果有助于指导临床实践。在具有抑郁症状的患者中,应首先评估其自我护理的维持行为,作为自我护理不良的潜在第一指标。.

Purpose This systematic review identified, synthesized, and integrated concept analyses on self-care and related concepts. Design The guidelines for systematic literature reviews of the Joanna Briggs Institute were followed. Methods The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and EMBASE databases were searched for concept analyses published in the past 20 years. Findings A total of 26 concept analyses were identified that had been published on self-care, self-care agency, self-monitoring, self-management, self-management support, symptom management, and self-efficacy. Differences and commonalities in the examined literature were identified, and a model was delineated, explaining the relations among the various concepts from the nursing perspective. Conclusions The healthcare literature has broadly described self-care and related concepts; however, consensus on the definitions remains beyond our reach and should not be expected, due to the different perspectives and paradigms from which the concepts are interpreted. From a nursing perspective, self-care can be considered a broad concept encompassing the other concepts, which describe more specific individual levels of activities and processes. Clinical relevance Nurses are actively involved in disease management and self-management support as well as in promoting self-care in healthy and sick people. Referring to a model on self-care and related concepts could avoid misinterpretations in nursing practice, research, and policy.

The complexity of chronic obstructive pulmonary disease (COPD) can negatively impact the lives of people with the condition and compromise their capacity to take care of their needs. Unmet needs can then lead to significant morbidity, unpleasant emotional experiences and a poor quality of life; thus this systematic review aimed to identify, evaluate and synthesise the qualitative literature on the unmet needs of people with COPD. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. A systematic search of five databases was conducted, searching for articles published from January 1995 to May 2017. Eight papers were identified. Two researchers extracted the data and independently assessed their quality. The total sample of people with COPD included was 108. Nine categories were derived from 49 findings, and aggregated into three synthesised findings: (1) people with COPD have unmet needs regarding information about the disease; (2) people with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments; and (3) people with COPD have unmet care needs. This review showed qualitative evidence regarding the dimensions in which people with COPD express their unmet needs. The needs that are mainly unsatisfied include physical, psychosocial, informational and practical aspects, as well as the need for healthcare professional care. A global approach, which includes the areas identified by our findings, could lead to an improvement in the care of people with COPD and could improve the self-care management of those individuals who do not correctly identify their needs.

Aims and Objectives To explore the lived experiences of patients with haematological malignancies who had been in protective isolation during their hospital stay for autologous haematopoietic stem cell transplantation. Background Although protective isolation aims to benefit patients’ health by preventing infection, it could also imply harmful psycho-social implications for patients, such as loneliness. Design A descriptive phenomenological study was conducted in an Italian university hospital. Methods Nine patients with haematological malignancies who had been in protective isolation for autologous haematopoietic stem cell transplantation were enrolled. They were interviewed during their weekly ambulatory visits, which are usually carried out up to 100 days post-transplant, and asked about their stay in isolation. Giorgi's method of analysis was used to describe the experience of protective isolation from the patient’ perspective. Results Eight themes emerged: isolation is a defence, threats from which patients have to defend themselves, rules for defence, the burden of the defence, external strategies for defence, inner strengths for defence, defending loved ones and outcomes of the defence. The general structure was expressed as a defence from suffering. Conclusions While fighting a hard battle against cancer, informants largely accepted the strict isolation measure and represented it as a shield for an effective defence. Relevance to clinical practice Nurses should provide emotional and social support to help patients feel like active fighters and strengthen their strategies for an effective defence from suffering.

Objectives The Care Dependency Scale is a theory-based, comprehensive tool widely used in low-intensity care settings to evaluate patients’ dependency. This study aimed to test the psychometric properties of the Care Dependency Scale in intensive care units. Research methodology/design A multicentre cross-sectional validation study was conducted. Exploratory factor analysis and confirmatory factor analysis were performed using a Maximum Likelihood robust estimator with Geomin oblique rotation. Setting Adult patients admitted to intensive care units of four Italian hospitals. Results The sample included 453 patients (mean age = 68 years, 62% male). The exploratory factor analysis, conducted on a subsample of 227 patients, revealed a two-factor structure (Physical care dependency and Psychosocial care dependency) with good fit indexes. The confirmatory factor analysis was conducted on another subsample of 226 patients and a second-order factor was specified. The model tested yielded adequate fit indexes. Concurrent and known-groups validity, and reliability, were also adequate. Conclusion The Care Dependency Scale is a multidimensional, valid and reliable tool able to assess the care dependency of critically ill patients. It can help to distinguish between physical and psychosocial needs and to create a base for patient-customised and holistic care.