Youn-Jung Son

Influence of Health Literacy on HRQoL in Patients After PCI

Among increased concerns about the adverse health outcomes of inadequate health literacy, it still remains unclear how health literacy influences health-related quality of life (HRQoL) of patients who have undergone percutaneous coronary intervention (PCI). Therefore, the aim of the study was to examine the impact of health literacy on HRQoL in PCI patients at 6 months after discharge. This study used a self-reported questionnaire to assess health literacy, medication knowledge, and HRQoL in 238 patients. In hierarchical linear regression, health literacy was the strongest predictor of HRQoL after adjusting confounding factors (β = .23, p = .003). In addition, this study showed that medication knowledge acted as a partial mediator between health literacy and HRQoL. In conclusion, adequate health literacy is a contributing factor to better HRQoL in patients after PCI, and health literacy can lead to improved HRQoL in PCI patients through the acquisition of sufficient medication knowledge.

Perceived Social Support and Physical Activity Among Patients With Coronary Artery Disease.

Adherence to recommended physical activity after a cardiac event is important to prevent cardiac recurrence. Social support from peers and family is known to improve self-care in chronic illnesses, including cardiovascular disease. However, the relationship between social support from health care providers and physical activity among patients with coronary artery disease remains unclear. This cross-sectional study aimed to identify the relationship between perceived social support from health care providers and physical activity among patients with stable coronary artery disease. The study included 237 patients with stable coronary artery disease attending an outpatient clinic. Hierarchical linear regression found that perceived social support explained 12% of variance in physical activity, F(14, 222) = 7.37, p < .001. In addition, self-efficacy partially mediated the relationships between perceived social support and physical activity. Abundant support from health care providers plays a key role in promoting physical activity among patients with stable coronary artery disease.

Impact of left ventricular ejection fraction and medication adherence on major adverse cardiac events during the first year after successful primary percutaneous coronary interventions

AIMS AND OBJECTIVES To identify the impact of preprocedural left ventricular ejection fraction and adherence to prescribed medication on major adverse cardiac events in patients with a successful primary percutaneous coronary intervention. BACKGROUND Although advances in percutaneous coronary intervention for coronary artery disease have considerably reduced poor outcomes such as major adverse cardiac events, many patients still experience adverse outcomes after a percutaneous coronary intervention. Thus, in patients with percutaneous coronary intervention, it is extremely important to identify the predictors for major adverse cardiac events. DESIGN A retrospective and cross-sectional design. METHODS Three hundred and nineteen patients who underwent successful primary percutaneous coronary intervention participated in this study. Participants were assessed for major adverse cardiac events after percutaneous coronary intervention for the first year. Preprocedural left ventricular ejection fraction was measured by echocardiogram. Medication adherence was used with the validated Morisky Medication Adherence Scale-8 items at the first year after the successful primary percutaneous coronary intervention. RESULTS Of the 319 patients, 102 had major adverse cardiac events after the successful primary percutaneous coronary intervention. On the basis of Cox regression, after adjusting for patient characteristics, lower baseline left ventricular ejection fraction and medication nonadherence and were statistically significant and independent predictors of major adverse cardiac events. CONCLUSIONS Our results show that major adverse cardiac events after successful primary percutaneous coronary intervention are associated with low left ventricular ejection fraction at baseline and medication nonadherence after discharge. Therefore, healthcare providers should consider multidimensional approaches to improve low left ventricular ejection fraction and medication adherence. RELEVANCE TO CLINICAL PRACTICE The findings suggest that the classification of high-risk patients after percutaneous coronary intervention need to be based on level of preprocedural left ventricular ejection fraction. Follow-up of these patients may include educational interventions to enhance medication adherence, to decrease the prevalence of major adverse cardiac events.

Associations between Health Literacy, Cancer-Related Knowledge, and Preventive Health Behaviors in Community-Dwelling Korean Adults

This cross-sectional study aimed to examine the association between health literacy, cancer-related knowledge, and preventive health behaviors among community-dwelling adults in Korea. Data were collected from 542 adults aged ≥ 18 years living in five big provinces in Korea (Seoul, Gyeonggi-do, Gyeongsang-do, Chungcheong-do, and Gangwon-do). Socio-demographic and health-related characteristics were determined using structured questionnaires. Health literacy, cancer-related knowledge, and engagement in preventive health behaviors were measured using validated instruments. These three variables differed according to socio-demographic and health-related characteristics, such as education, sex, age, and marital status. In the hierarchical regression analysis, health literacy (β = 0.26, p < .001) and cancer-related knowledge (β = 0.21, p < .001) were significant predictors of preventive health behavior after adjusting for confounding variables. Cancer-related knowledge partially mediated the effect of health literacy on preventive health behaviors. Health literacy can play a key role in cancer prevention. It is important for healthcare providers to know how to deliver cancer-related knowledge and how to help people with low health literacy to engage in preventive health behaviors, using a variety of health information resources. Further research is needed to develop the instruments to assess comprehension of spoken and written health messages for cancer prevention and screening.

Depression and medication adherence among older Korean patients with hypertension: Mediating role of self‐efficacy

Many studies have reported the negative effects of depression on adherence to antihypertensive medication. However, little is known about the mechanism underlying this relationship in elderly patients with hypertension. The aim of this cross-sectional study is to examine the mediating role of self-efficacy in the relationship between depression and medication adherence among older patients with hypertension. The data were collected from October to December 2014. A total of 255 older patients with hypertension were assessed using the Geriatric Depression Scale, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale. Hierarchical linear regression analysis and the Sobel test were used to examine the mediating role of self-efficacy in the relationship between depression and medication adherence. Depression and self-efficacy were statistically significant predictors of medication adherence in older patients with hypertension. Self-efficacy partially mediated the relationship between depression and medication adherence. Interventions targeting self-efficacy could increase the confidence of patients in their ability to actively take their medicines. Moreover, health care providers should be aware of the importance of early detection of depression in older patients with hypertension. Future studies with longitudinal data are warranted to clarify the multidirectional relationships between depression, self-efficacy, and medication adherence.

Combined effect of left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention: a 12-month follow-up.

Background: Despite the technical advancement of percutaneous coronary intervention, major adverse cardiac events after percutaneous coronary intervention are still a critical issue in Korea as well as in western society. Recently, low left ventricular ejection fraction and depressive symptoms have been regarded as independent predictors of adverse outcomes after successful primary percutaneous coronary intervention. However, there are few studies on the combined effect of left ventricular ejection fraction at baseline and post-cardiac depressive symptoms on major adverse cardiac events after percutaneous coronary intervention. Aim: The aim of the current study is to examine the combined effect of low left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention. Methods: A total of 221 patients who underwent successful percutaneous coronary intervention were assessed for left ventricular ejection fraction and depressive symptoms at baseline and 1 month after discharge, using the patient health questionnaire 9. Major adverse cardiac event-free survival rates during the 12-month follow-up period were analysed by Kaplan–Meier survival curves and Cox proportional hazard regression methods. Results: We found that the combined effect of baseline left ventricular ejection fraction less than 60% and depressive symptoms at 1 month after discharge were significantly correlated with increased incidence of major adverse cardiac events after successful primary percutaneous coronary intervention (hazard ratio 4.049; 95% confidence interval 1.365–12.011) after adjusting for sex, high sensitivity C-reactive protein, depressive symptoms at baseline and comorbidity. Conclusions: Our results suggest that healthcare professionals should be aware of the necessity of early screening for post-cardiac depressive symptoms after discharge in percutaneous coronary intervention patients with a low left ventricular ejection fraction.

Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure

Background: Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure. Aims: We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Methods: This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews. Results: The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% (p = 0.001) and 55.1% vs. 34% (p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19–29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22–4.60) in patients with heart failure. Conclusion: It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.

Overactive Bladder is a Distress Symptom in Heart Failure

The prevalence of Heart failure (HF) is expected to increase worldwide with the aging population trend. The numerous symptoms of and repeated hospitalizations for HF negatively affect the patient’s quality of life and increase the patient’s economic burden. Up to 50% of patients with HF suffer from urinary incontinence (UI) and an overactive bladder (OAB). However, there are limited data about the relationship between UI, OAB, and HF. The association between HF and urinary symptoms may be directly attributable to worsening HF pathophysiology. A comprehensive literature review was conducted for all publications between January 2000 and November 2017 using the PubMed, Embase, and Cochrane databases. HF represents a major and growing public health problem, with an increased risk of UI and an OAB as comorbidities. Possible effects of HF on urinary problems may be mediated by the prescription of medications for symptomatic relief. Although diuretics are typically used to relieve congestion, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve survival, these classes of drugs have been suggested to worsen urinary symptoms in the presence of HF. Further research is required to understand the impact of UI and an OAB on the HF illness trajectory.

Effect of psychosocial interventions on the quality of life of patients with colorectal cancer: a systematic review and meta-analysis

BackgroundWe conducted a systematic review and meta-analysis of randomized controlled trials examining the effect of psychosocial interventions on the quality of life of patients with colorectal cancer.MethodsWe searched the main health-related databases for relevant papers. Then, we examined the titles and abstracts of the retrieved papers, applying exclusion criteria to filter out irrelevant papers; a more in-depth filtering process was then conducted by reading the full texts. Eight studies remained at the end of this process. Next, we performed data extraction and assessed the methodological quality of the selected studies. This was followed by computation of effect sizes and the heterogeneity of the results, and then an assessment of the potential bias.ResultsThe systematic review found that most of the interventions in these eight studies did not have a significant effect on quality of life. Meanwhile, the meta-analysis, the overall effect of psychosocial interventions at the post-intervention period was found to be statistically significant but small.ConclusionsThis meta-analysis provides evidence for the beneficial effect of face-to-face psychosocial interventions on the quality of life of colorectal cancer patients. It is, however, suggested that further studies be conducted on this topic to assess the roles of physical functioning and severity of symptoms before utilizing such face-to-face interventions.

Psychometric Evaluation of the Korean Version of Patient-Centered Care Scale for Hospital Nurses

Patient-centered care (PCC) encourages active collaboration and effective communication among patients, their family caregivers, and health-care providers to achieve high-quality care. Despite its importance, there is no validated and reliable Korean instrument for assessing PCC among health-care providers yet. This study aimed to establish a Korean version of the PCC (K-PCC) Scale using international translation guidelines and systematically evaluating its psychometric properties. The participants in this study were 424 nurses with a mean age of 28.07 years (±4.56) from two university hospitals in South Korea. Confirmatory factor analysis identified that the revised model, which included three factors (holistic, collaborative, and responsive care), had a satisfactory goodness of fit. The testing of item convergent and item-discriminant validity revealed a 100% scaling success. Criterion validity showed that nurses who had positive perceptions of K-PCC were more likely to practice PCC (r = .692, p < .001). The internal consistency for 23 items as a whole was good, at .935. From these results, K-PCC is considered a valid and reliable instrument for measuring health-care providers’ perceptions of PCC among Korean populations. Scale brevity and simplicity, together with rigorous testing, indicate that validation of the PCC Scale may be helpful for ensuring quality improvement in hospital settings.