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Background and Objectives Most persons with dementia experience behavioral and psychological symptoms (BPSD). While there is evidence that structured activity programs can be beneficial for persons with dementia and their caregivers, it is not well understood how joint engagement in shared activities affects BPSD and caregiver stress. The purpose of this study was to examine the moderating effect of doing a shared activity on the BPSD and caregiver stress. Research Design and Methods This study used an intensive longitudinal observational design in which caregivers completed baseline and once-a-day diary surveys for 21 days. Caregivers were asked whether they did a pleasant noncare activity with their relative, the presence of 8 BPSD, and their stress level. A moderation model in a structural equation model examined the relationship between these variables. Results Our sample consisted of 453 caregivers (87.4% female, 51.4% non-Hispanic White, mean age 53 years [standard deviation { SD }: 14]) and person living with dementia whose mean age was 79 years (SD : 9). On days when the caregivers engaged in a shared activity together with person living with dementia, there was a significant decrease in the BPSD (estimate −0.038, standard error [ SE ] = 0.016, 95% confidence interval [CI]: −0.069, −0.007, p value = 0.018). The effects of engaging in a shared activity decreased the impact of caregiver stress by 0.052 (estimate −0.052, SE = 0.018, 95% CI: −0.087, −0.017, p value = 0.004). At the between-person level, no differences were found in BPSD across caregivers who engaged or did not engage in shared activities. Discussion and Implications The results of our study indicate that doing a shared activity is associated with reduced BPSD among persons with dementia and may buffer the impact of caregiver stress on BPSD. Shared activities should be considered a key intervention component for dementia caregivers. [ABSTRACT FROM AUTHOR]

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Self-care is an important concept in controlling COVID-19 disease and a simple and effective way to maintain and improve health. This study aimed to examine the role of general health and health literacy in predicting the self-care behaviors of patients with COVID-19. Methods: This research was a cross-sectional study with a predictive correlational design. The sample consisted of 385 patients with mild to moderate COVID-19 infection referring to the COVID-19 diagnosis and treatment center in Shahid Beheshti Hospital in Kashan City, Iran, from June to September 2021. The subjects were under quarantine at home and were recruited by convenience sampling. The data were collected by the general health questionnaire (GHQ- 28), the Iranian health literacy questionnaire (IHLQ), and a researcher-made questionnaire on self-care behaviors in patients with COVID-19 (SCB-COVID-19). The Pearson correlation coefficient, t-test, and logistic regression were used for data analysis in SPSS software, version 19. The significance level was set at P<0.05. Results: The Mean±SD scores of self-care behaviors, health literacy, and general health of the subjects were 224.89±21.49, 63.78±21.28, and 50.99±12.81, respectively. There were significant relationships between self-care behaviors and health literacy (r=0.567, P=0.001) and self-care behaviors and general health (r=235, P=0.001). Logistic regression showed that about 42% of self-care behaviors score changes are explained by health literacy and general health variables (R2=0.42) Conclusion: The results showed that self-care behaviors score changes are explained by health literacy and general health in COVID-19 patients. Our results can integrate into the body of knowledge to help improve the health and well-being of populations in the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Objectives: Nausea is one of the most important symptoms of patients undergoing chemotherapy. This study aims to determine the effects of aromatherapy with sour lemon on nausea in patients undergoing chemotherapy. Methods: A total of 50 patients undergoing chemotherapy were randomly assigned to experimental and placebo (control) groups. The two groups completed the visual analogue scale for nausea before and the first to the fourth week after starting the intervention. The intervention was performed during chemotherapy. Using a dropper, a paper towel was saturated with 3 drops of sour lemon essential oil; however, for the control group, 3 mL of water as a placebo was spread on a paper towel. The intervention in the experimental and control groups was performed once a week for 4 weeks during weekly chemotherapy sessions. Results: At the beginning of the study, no significant difference was observed between the mean score of nausea in the two groups (P>0.05). The first to the fourth week after starting the intervention, significant differences were observed between the mean score of nausea in the two groups (P<0.05). The results of the repeated measures analysis of variance indicated that the mean score of nausea changed over time in the experimental group, indicating a gradual decrease in the mean score of nausea (P<0.05). Discussion: Our findings indicated that aromatherapy with sour lemon can be effective in reducing nausea in patients undergoing chemotherapy. [ABSTRACT FROM AUTHOR]

Background: An increase of cultural diversity and treatment options offer opportunities and challenges related to end-of-life (EOL) care for healthcare providers and policymakers. EOL care planning can help reduce confusion and uncertainty when individuals and family members need to make decisions about EOL care options. Objective: The purpose of this study was to investigate preferences, attitudes, and behaviors regarding EOL care planning among young and middle-aged Iranian-American adults. Methods: A cross-sectional national sample of 251 Iranian-American adults completed surveys. Paper and online surveys in English and Persian were offered to potential participants. Results: All the participants completed online survey in English language. In incurable health conditions, 56.8% preferred hospitalization and intensive treatments. From the 40.6% participants who preferred comfort care, most preferred care at home (29.5%) compared to an institution (11.1%). Those who preferred hospitalization at EOL mostly preferred intensive and curative treatments. The mean score of attitudes toward advance decision-making was moderately high (11.48 ± 2.77). Favorable attitudes were positively associated with acculturation (r =.31, p <.001), age (r =.15, p <.05), and number of years living in the U.S. (r =.26, p <.001). Conversely, spirituality and favorable attitudes were negatively associated (r = −.17, p <.05). Conclusion: Immigrant and culturally diverse individuals have experienced different living and healthcare environments. These differences can influence their EOL care planning and decisions. Knowledge of diverse perspectives and cultures is essential to design culturally congruent plans of EOL care. [ABSTRACT FROM AUTHOR]

Background: Cancer is a chronic disease that affects different aspects of Quality of Life (QoL), including physical, financial, social, and emotional aspects. The PRECEDE-PROCEED model is a comprehensive method for assessing patients’ needs, and designing, implementing, and evaluating health promotion programs to meet their needs. This study aims to determine the effect of an educational program based on the PRECEDE-PROCEED model on Health-Related Quality of Life (HRQOL) and preventive behaviors in patients with breast cancer undergoing chemotherapy. Methods: This quasi-experimental impact evaluation study was performed on 90 outpatients with breast cancer (stages I and II) undergoing chemotherapy in Shahid Beheshti Hospital, Kashan, Iran from September 2018 to December 2019. The participants were randomly assigned into two groups of training (n=45) and control (n=45). The training group, in addition to routine care, received the educational program based on the PRECEDE-PROCEED model at eight two-hour group sessions for one month. The control group received routine care for cancer patients only. The participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and a researcher-made questionnaire based on the PRECEDE-PROCEED model (assessing predisposing, enabling, and reinforcing factors) before the study, immediately after, and two months after the intervention. Results: In the training group, the total Mean±SD of HRQOL before, immediately after, and two months after the intervention were 52.65±17.14, 64.79±15.66, and 63.95±18.63, respectively. Their total score of HRQOL and its dimensions (physical functioning, role functioning, emotional functioning, and symptoms) increased significantly over time (P<0.01). In this group, the scores of predisposing and enabling factors also increased immediately after and two months after the intervention (P<0.05); however, the score of reinforcing factors (social support) showed no significant increase (P>0.05). Conclusion: The educational program based on the PRECEDE-PROCEED model can improve the HRQOL and preventive behaviors in terms of predisposing factors (knowledge, attitude), and enabling factors (family support) in patients with breast cancer undergoing chemotherapy. We recommend this educational program for improving these patients’ QoL. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to determine the effectiveness of Thai massages on the general health of hemodialysis (HD) patients. Materials and Methods: In this clinical trial, 80 patients undergoing HD were randomly assigned to intervention and control groups. Before study, the two groups completed sociodemographic and general health questionnaire (GHQ-28) questionnaires. The control group received routine care for HD patients. In the intervention group, 60-min Thai massages were performed three times a week for 4 weeks. Immediately and 1 month after the last session of the intervention, the GHQ-28 questionnaire was completed by the two groups. Findings: There was no significant difference between the mean scores of general health in the two groups before the intervention (P > 0.05). But, immediately after and 1 month after the last session of the intervention, there were significant differences between the two groups in the total scores of general health and the scores of physical symptoms and anxiety subscales (P < 0.05). In the intervention group, the repeated measures ANOVA test showed significant differences between the total scores of general health as well as physical symptoms and anxiety subscales over time (P < 0.001). Conclusion: A Thai massage can be considered as an effective alternative for improving HD patients' general health as well as reducing physical symptoms and anxiety. [ABSTRACT FROM AUTHOR]

Background: Resilience is the individual's ability to maintain or restore mental health and physical function in the face of stressful events and adversity. However, educational interventions can enhance resilience. The present study was conducted to determine the effect of self-care education by peer groups on the resilience of patients with cancer. Methods: A Randomized Clinical Trial (RCT) was conducted on 80 patients with cancer referring to the chemotherapy center of Ayatollah Yathribi Hospital in Kashan City, Iran. The subjects were randomly assigned into the control and intervention groups (40 per group). Peer group members trained the intervention group in 4 sessions (one session per week), but the control group received routine care. The Connor-Davidson Resilience Scale (CD-RISC) was used to collect data at the beginning of the trial and then one week and three months after the intervention. Data analysis was performed using the independent t-test and repeated measures ANOVA in SPSS software, v. 16. Results: There was a significant difference between the mean score of the groups' resilience one week after the intervention (P=0.01), but no significant difference was seen between the groups' resilience scores three months after the study (P=0.11). However, based on the repeated measures ANOVA and the model's results using the Huynh-Feldt correction, there was an increase in the resilience score of the intervention group over time (P=0.008). Furthermore, there was a significant difference between the two groups in terms of time*group interaction, indicating a significant difference between the two groups in terms of resilience score over time (P=0.004). Conclusion: It is suggested that this intervention be provided by the healthcare team along with routine treatments to improve the resilience and mental health of patients with cancer. [ABSTRACT FROM AUTHOR]