Janet W. H. Sit

Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial

AIM To examine the effects of music intervention on the physiological stress response and the anxiety level among mechanically ventilated patients in intensive care unit. BACKGROUND Despite the fact that previous studies have found music interventions to be effective in stress and anxiety reduction, effects of music on the Chinese population are inconclusive and warranted systematic study to evaluate its effect fully for a different Asian culture. DESIGN A randomised placebo-controlled trial. METHODS A total of 137 patients receiving mechanical ventilation were randomly assigned to either music listening group, headphone group or control group. Outcome measures included the Chinese version of Spielberger State-Trait Anxiety Scale and physiological parameters (heart rate, respiratory rate, saturation of oxygen and blood pressure). RESULTS Comparison of mean differences (pretest score-posttest score) showed significant differences in heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure as well as the Chinese version of Spielberger State-Trait Anxiety Scale, but not in SaO(2) among the three groups (ranging from p < 0.001 to p = 0.007), of which greater mean differences were found in music listening group. A significant reduction in physiological stress response (heart rate and respiratory rate) over time was found in music listening group (p < 0.001 for both variables) and a significant increase in heart rate and respiratory rate over time in control group (p < 0.001 and p = 0.032), with no significant change over time in headphone group. Within group pretest-posttest comparison of the Chinese version of Spielberger State-Trait Anxiety Scale demonstrated a significant reduction in anxiety for the music listening group (p < 0.001) and headphone group (p < 0.001) but not the control group. CONCLUSIONS Our findings confirm that short-term therapeutic effects of music listening results in substantial reduction in physiological stress responses arising from anxiety in mechanically ventilated patients. RELEVANCE TO CLINICAL PRACTICE Music as a non-pharmacological nursing intervention can be used as complementary adjunct in the care of patients with low-energy states who tire easily, such as those requiring mechanical ventilator support.

A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee

The aim was to assess the self-efficacy and health outcomes of an adopted Arthritis Self-Management Programme (ASMP) among osteoarthritic knee sufferers in Hong Kong at 1 year. An experimental study with 95 participants assigned randomly to the intervention (n=45) or control group (n=50). Seventy-seven (81.1%) participants joined at least one out of three follow-ups in the 12 month period. Participants in the intervention group received a 6-week ASMP with an added exercise component in two general clinics. Outcome measures included arthritis self-efficacy (ASE) and health outcomes including pain and fatigue rating, self-rated health, daily activities limitation and number of unplanned arthritis-related medical consultations. Mean change (12 months minus baseline) and the effect size of the outcome measures were calculated by Mann–Whitney U test and nQuery Advisor 4.0. At 12 months, there were significant reductions of current pain (p=0.0001), pain at night (p=0.001), pain during walking (p=0.01) and number of unplanned arthritis-related medical consultations (p=0.03) and a significant increase in ASE for pain (p=0.01) and other symptoms (p=0.02) and self-rated health (p=0.04) among the intervention group but not for the control group. However, there were similarities in outcome measures of pain while switching from a sitting to a standing position, fatigue rating and physical functional limitation (p=0.15; p=0.22 and p=0.91, respectively) for both groups. Our findings add to the evidence that the modified arthritis empowering programme improved perception of control of osteoarthritis and three health outcomes after 12 months of treatment.

Prevalence and risk factors associated with prehypertension: Identification of foci for primary prevention of hypertension

Background and Research Objective:Prehypertension (pre-HT) has become an important public health issue in China because it identifies people at higher risk for hypertension (HT) and cardiovascular diseases. The aims of this study were to (1) examine the prevalence of pre-HT, (2) identify risk factors of pre-HT, and (3) identify factors that increase the likelihood of developing HT among the pre-HT group. Subject and Methods:This was a cross-sectional descriptive study. Community-dwelling residents of an urban district in Wuhan, central China (obtained from stratified random sampling), aged between 35 and 74 years completed the study. Data were collected by using a structured self-reporting questionnaire and a standardized protocol for blood pressure measurement and risk screening. Blood pressure categories were defined according to the results of the seventh report of the Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure. Results:Among the 1,448 participants, 618 (42.7%) had pre-HT. Multivariate logistic regression analysis revealed the risk factors of being overweight (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.26-2.98) or obese (aOR, 8.9; 95% CI, 1.14-62.3) and having above-optimal triglyceride level (aOR, 1.67; 95% CI, 1.24-2.26) were associated with pre-HT. Age and lower educational level were also associated with pre-HT risk. There was a clear trend toward an increased risk of HT among the pre-HT group with every 10-year increment in age starting from 45 years (aORs were 3.47, 6.82, and 7.58, respectively). Participants with Pre-HT currently engaging in sedentary work were also found to have a higher risk of developing HT. Other risk factors for HT included being overweight (aOR, 2.0; 95% CI, 1.50-2.68), a known family history of HT (aOR, 2.54; 95% CI, 1.98-3.26), and presence of diabetes mellitus (aOR, 2.51; 95% CI, 1.66-3.80). Conclusion:Prehypertension is common among residents in an urban district in central China. Findings of this study serve to identify the at-risk groups. Targeting these people early with therapeutic lifestyle changes may provide important long-term benefit for HT prevention.

Coping with breast cancer survivorship in Chinese women: the role of fatalism or fatalistic voluntarism.

Background: The existing knowledge on fatalism in the field of cancer has arisen largely from the cancer prevention and screening literature. Little is known about the role of fatalism in cancer survivorship, particularly within Chinese population. Objective: This study aimed to explore the role of fatalism in coping with breast cancer survivorship in Chinese women. Methods: In-depth interviews were conducted on 29 participants selected from those who attended a local cancer self-help organization in China. Interview transcripts were transcribed and analyzed using qualitative content analysis. Results: Although they actively engaged in emotional regulation and self-care management to cope with survivorship, participants believed in fatalism and accepted their inability to change the final outcome of cancer. Such contradictory behavioral and cognitive aspects of coping reported by participants highlighted the role of a complex belief system involving Ming in positively influencing the interpretation of fatalism and the actual coping efforts taken. Conclusions: Findings suggest that fatalism related to coping in the Chinese context combined 2 elements: fatalistic belief in and acceptance of the way things are as well as the exertion of personal efforts over the situation. As such, it seems more effectively depicted in terms of the emerging concept “fatalistic voluntarism.” Implications for Practice: When planning intervention for Chinese population, incorporating fatalistic voluntarism as a cognitive belief system in the process of adaptation to survivorship may be more culturally relevant for facilitating their coping behaviors.

Associated factors of post-stroke depression among Hong Kong Chinese: A longitudinal study

Abstract The aim of this study was to explore associated factors of post-stroke depression (PSD) among Chinese first-time stroke patients. A 6-month prospective design was adopted with data collected by face-to-face interviews and physical assessment at two observation time points: T1, within 48 h of admission to the rehabilitation hospitals and T2, 6 months after the first interview in the subjects current place of residence. The prevalence of PSD at T1 and T2 was found to be 69% and 48% respectively. Backward linear regression showed that five variables explained 55% of the variance of PSD at T2. Participants who had a higher level of depression at T2 tended to have a higher level of functional disability, less social companionship and poorer informational support. Those who had been homemaker at pre-morbid state and those who exhibited a higher level of depressive symptoms at T1 showed a higher level of depression at T2. The results of this study suggest that PSD could be a psychological condition arising from the disabling consequences and altered family roles caused by a stroke.

A quasi-experimental study on improving arthritis self-management for residents of an aged people's home in Hong Kong

Arthritis is one of the most prevalent activity-limiting conditions among older persons in developed countries. The aim of this quasi-experimental study was to assess the effect of an Arthritis Self-Management Programme (ASMP) on residents in a home for elderly people in Hong Kong. Forty-two residents completed baseline assessment. Thirty-seven residents (88.0%) completed the ASMP course, 1 and 16 week post-intervention questionnaires and assessment. There were 16 residents in the control group and 21 residents in the intervention group. Residents in the intervention group received a 6-week ASMP course. The conventional ASMP course was followed except that we emphasized and coached Tai Chi movements during the last three sessions. Outcome measures included arthritis self-efficacy, arthritis pain rating, functional and emotional status. At 16 weeks, there was significant increased overall arthritis self-efficacy score (p = 0.05), reduction of current arthritis pain rating (p = 0.05), improvement from baseline in quadriceps muscle strength (p = 0.03) and hamstring muscle strength (p = 0.02). However, there were no other significant improvements from baseline between the intervention and control groups. Our findings suggest that a self-management programme is effective in enhancing overall self-efficacy to manage arthritis, improving muscle strength and reducing arthritis pain among older people in long-term care settings.

Environmental Factors Associated with Altered Gut Microbiota in Children with Eczema: A Systematic Review

Eczema is a common skin condition that impairs children’s daily life activities and quality of life. Previous research shows that gut microbiome composition plays an important role in the development of eczema. The present review summarizes evidence on environmental factors related to altered gut microbiota in children with eczema. We searched Medline, PubMed, Embase, and the Cochrane database of Systematic Reviews through October 2015. The search strategy focused on articles published in peer-reviewed, English-language journals with no publication year limit. Only original studies and review articles that reported environmental factors on gut microbiome specific to eczema were included in this review. We selected six studies (total 1990 participants) for full review and identified that the composition of gut microbiota specific to eczema could be influenced by the following environmental factors: length of gestation, mode of delivery, type of feeding, method of treatment, number of older siblings, and other lifestyle factors. There has been inconsistent empirical evidence as to the modulatory effects of gut microbiota on immunological functions in children with eczema. Further research on the environmental-host-microbial interaction is needed to develop a strong base of knowledge for the development and implementation of prevention strategies and policies for eczema.

Tai chi qigong as a means to improve night-time sleep quality among older adults with cognitive impairment: a pilot randomized controlled trial.

Purpose Age-related cognitivee decline is a growing public health concern worldwide. More than a quarter of adults with cognitive impairment experience sleep disturbance. The objective of this pilot study was to evaluate the preliminary effects of tai chi qigong (TCQ) on improving the night-time sleep quality of older adults with cognitive impairment. Participants Older adults with cognitive impairment who complain of sleep disturbance. Methods A randomized controlled trial with two groups. Fifty-two subjects were recruited from two district elderly community centers and randomly assigned to either the TCQ group (n=27) or the control group (n=25). The intervention group received TCQ training consisting of two 60-minute sessions each week for 2 months. The control group was advised to maintain their usual activities. Sleep quality was measured by the Chinese Pittsburgh Sleep Quality Index. Quality of life was measured by Short-form 12, cognitive functions measured by mini-mental state examination, and subjective memory deficits measured by the memory inventory for Chinese. Results Data were collected at baseline, 2 months, and 6 months. Significant results were noted at 6 months in the Chinese Pittsburgh Sleep Quality Index global score (P=0.004), sleep duration (P=0.003), habitual sleep efficiency (P=0.002), and the Short-form 12 mental health component (P<0.001). The TCQ participants reported better sleep quality and a better (quality of life) mental health component than the control group. Conclusion TCQ can be considered a useful nonpharmacological approach for improving sleep quality in older adults with cognitive impairment. Clinical trial registration CUHK_CCT00448 (https://www2.ccrb.cuhk.edu.hk/registry/public/287).

Effectiveness of Interactive Self-Management Interventions in Individuals With Poorly Controlled Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

AIMS To identify, assess, and summarize available scientific evidence on the effectiveness of interactive self-management interventions on glycemic control and patient-centered outcomes in individuals with poorly controlled type 2 diabetes. METHODS Major English and Chinese electronic databases including Medline, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and WanFang Data were searched to identify randomized controlled trials that reported the effectiveness of interactive self-management interventions in individuals with poorly controlled type 2 diabetes (glycated hemoglobin [HbA1c] ≥ 7.5% or 58 mmol/mol), from inception to June 2015. Data extraction and risk-of-bias assessment were performed by two reviewers independently. Meta-analysis was performed using Review Manager 5.3. RESULTS A total of 16 trials with 3,545 participants were included in the meta-analysis. Interactive self-management interventions could have a beneficial effect in individuals with poorly controlled type 2 diabetes in reducing HbA1c (mean difference: -0.43%, 95% CI: -0.67% to -0.18%), improving diabetes knowledge (standardized mean difference [SMD]: 0.30, 95% CI: 0.03 to 0.58), enhancing self-efficacy (SMD: 0.29, 95% CI: 0.14 to 0.44), and reducing diabetes-related distress (SMD: -0.21, 95% CI: -0.39 to -0.04). Self-management interventions supported with theory and structured curriculum showed desirable results in glycemic control. The behavioral change techniques, including providing feedback on performance, problem-solving, and action planning, were associated with a significant reduction in HbA1c. LINKING EVIDENCE TO ACTION Individuals with poorly controlled type 2 diabetes could benefit from interactive self-management interventions. Interventions targeting patients with poorly controlled diabetes, those who are at the greatest risk of developing complications, should be prioritized. Our findings indicate that providing feedback on performance, problem-solving, and action planning are promising behavioral change techniques specifically for individuals with poor glycemic control.

Negative and positive life changes following treatment completion: Chinese breast cancer survivors’ perspectives

PurposeAlthough we acknowledge the negative and positive aspects of the cancer survivorship experience, we have little information on this issue from the perspective of Chinese breast cancer survivors. This study aimed to explore the perceptions of negative and positive life changes following treatment completion among this population.MethodsUsing purposive sampling, 29 breast cancer survivors were selected from the attendees of a local cancer self-help organization in middle China and proceeded with semi-structured in-depth interviews. Each interview was transcribed verbatim and analyzed using directed content analysis.ResultsTwo predetermined categories were identified to represent participant perception of the breast cancer survivorship experience, namely, negative life changes and positive life changes. The first category included fear of recurrence, symptom experience, poor body image, altered sexuality and intimacy, and financial burden. The second category consisted of new life perspective, personal growth, and enhanced relationships with family.ConclusionsOur findings contribute to the emerging evidence on the duality of breast cancer survivorship. This enhanced understanding of the specific negative and positive changes experienced by Chinese breast cancer survivors can assist health professionals in addressing survivorship issues by designing appropriate interventions to minimize negative consequences and enhance positive growth.