Knowledge, attitudes, and practices toward cardiovascular complications among end-stage renal disease patients undergoing maintenance hemodialysis.

BACKGROUND: This study aimed to investigate the knowledge, attitudes, and practices (KAP) toward cardiovascular complications among end-stage renal disease patients undergoing maintenance hemodialysis. METHODS: This web-based cross-sectional study was conducted at Guangdong Provincial People's Hospital between December 2022, and May 2023. RESULTS: A total of 545 valid questionnaires were collected, with an average age of 57.72 ± 13.47 years. The mean knowledge, attitudes and practices scores were 8.17 ± 2.9 (possible range: 0-24), 37.63 ± 3.80 (possible range: 10-50), 33.07 ± 6.10 (possible range: 10-50) respectively. Multivariate logistic regression analysis showed that patients from non-urban area had lower knowledge compared to those from urban area (odds ratio (OR) = 0.411, 95% CI: 0.262-0.644, P < 0.001). Furthermore, higher levels of education were associated with better knowledge, as indicated by OR for college and above (OR = 4.858, 95% CI: 2.483-9.504), high school/vocational school (OR = 3.457, 95% CI: 1.930-6.192), junior high school (OR = 3.300, 95% CI: 1.945-5.598), with primary school and below as reference group (all P < 0.001). Besides, better knowledge (OR = 1.220, 95% CI: 1.132-1.316, P < 0.001) and higher educational levels were independently associated with positive attitudes. Specifically, individuals with a college degree and above (OR = 2.986, 95% CI: 1.411-6.321, P = 0.004) and those with high school/vocational school education (OR = 2.418, 95% CI: 1.314-4.451, P = 0.005) have more positive attitude, with primary school and below as reference group. Next, better attitude (OR = 1.174, 95% CI: 1.107-1.246, P < 0.001) and higher education were independently associated with proactive practices. Those with college and above (OR = 2.870, 95% CI: 1.359-6.059, P = 0.006), and those with high school/vocational school education (OR = 1.886, 95% CI: 1.032-3.447, P = 0.039) had more proactive practices, with primary school and below as reference group. CONCLUSIONS: End-stage renal disease patients undergoing maintenance hemodialysis demonstrated insufficient knowledge, positive attitudes, and moderate practices regarding cardiovascular complications. Targeted interventions should prioritize improving knowledge and attitudes, particularly among patients with lower educational levels and income, to enhance the management of cardiovascular complications in end-stage renal disease.

The long-term effect of repetitive transcranial magnetic stimulation in the treatment of intractable insomnia.

OBJECTIVE: To explore the differences in clinical efficacy of different courses of repetitive transcranial magnetic stimulation (rTMS) in the treatment of intractable insomnia and the duration of clinical efficacy after cessation of treatment. METHOD: 70 patients with intractable insomnia were randomly divided into 1 treatment course group and 2 treatment courses group. The rTMS course consisted of daily sessions of 1200 stimuli for the r-DLPFC at a frequency of 1 Hz and 800 stimuli for parietal lobe (CPZ) at a frequency of 1 Hz. The pitchburg sleep index (PSQI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and cardiopulmonary coupled sleep (CPC) were assessed for 35 patients in each group at baseline, at 2 weeks, and at 1 and 3 months after treatment. RESULT: The scores of PSQI, HAMD and HAMA in the 2 groups were significantly improved after 1 month of follow-up after rTMS treatment (p < 0.01). The long-term effect of different treatment courses is different. After 2 consecutive courses of treatment, there was still a significant difference between the 3-month follow-up and the pre-treatment period (p < 0.05). However, there was no statistical difference between the 3-month follow-up of one course of treatment and the pre-treatment period. The results of CPC test showed that the improvement of total sleep time (TST), and deep sleep time (DST) was basically consistent with the assessment of PSQI, HAMD and HAMA that the clinical efficacy of the 3-month follow-up was better than that of one course of treatment after 2 consecutive courses of treatment. CONCLUSION: The treatment of refractory insomnia by rTMS is effective, and the duration of the curative effect is related to the course of treatment. 2 consecutive courses of treatment still have a certain effect after 3 months, which is worthy of clinical promotion.