Factors of Influence on Diabetes Awareness in Older People With Chronic Obstructive Pulmonary Disease Comorbid With Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of mortality in this population. PURPOSE: This study was designed to investigate the predictive factors of diabetes awareness (DA), including diabetes knowledge (DK), and diabetes care behaviors (DCB) among older people with both COPD and T2DM. METHODS: This was a cross-sectional descriptive correlation study. One hundred thirty-three older-age patients with COPD comorbid with T2DM receiving treatment at a chest hospital were enrolled as participants. Both DK and DCB were utilized to measure DA. The Diabetes Knowledge Questionnaire was utilized to measure DK, and the Summary of Diabetes Self-Care Activities was used to evaluate DCB. RESULTS: The average glycated hemoglobin (HbA1c) was 7.68% ( SD = 1.55%), with 74 (55.6%) participants having a level > 7%. The average DA was 46.46% ( SD = 13.34%), the average DK was 53.42% ( SD = 18.91%), and the average DCB was 39.50% ( SD = 16.66%). In terms of demographic variables, age, diabetes education, diabetes shared care, and HbA1c were all significantly associated with DA, DK, and DCB (all p s < .05). The overall variance in DA was significantly explained by diabetes education and HbA1c (all p s < .05). The overall variance in DK was significantly explained by age, diabetes education, and HbA1c. The overall variance in DCB was significantly explained by diabetes education and HbA1c (all p s < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our study findings indicate that older adult patients with COPD comorbid with T2DM are at elevated risks of poor glycemic control and low DA. Healthcare professionals should be aware of these issues and develop appropriate DA plans to prevent poor glycemic control in this population. Providing accurate information on diabetes to older adults with COPD comorbid with T2DM is important to improving their DK and promoting better DCB.

The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby.

AIMS AND OBJECTIVES: To explore the meaning of rituals that women and their families perform after a stillbirth. BACKGROUND: A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened. DESIGN: Qualitative descriptive study. METHODS: In-depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth. RESULTS: Families engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy. CONCLUSIONS: Death-related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy. RELEVANCE TO CLINICAL PRACTICE: Health professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time.

Validation of the modified Chinese Cancer Survivor's Unmet Needs (CaSUN-C) for women with breast cancer.

OBJECTIVE: The aims of the study were to modify the Cancer Survivor's Unmet Need (CaSUN) Scale into a short form and then test its psychometric scale-specific properties for breast cancer survivors in Taiwan. METHODS: Using convenience sampling, recruited breast cancer survivors were separated into 2 samples (sample 1, n = 150, and sample 2, n = 162). First, we translated and modified the CaSUN to ensure cultural adaptation. Second, we used statistical methods to eliminate some items and conducted an exploratory factor analysis (EFA) using sample 1 to explore the factor structure of the CaSUN-C. Finally, we conducted a confirmatory factor analysis using sample 2 to confirm the structure suggested by the EFA and tested the criterion validity and known-group validity of the CaSUN-C. RESULTS: Twenty items within 4 factors (information, physical /psychological, medical care, and communication needs) were identified for the CaSUN-C. Each factor had acceptable internal consistency (Cronbach's Alpha = .61 to .82). The criterion validity was supported by the significant correlations between the CaSUN-C scores and scores on fear of recurrence and depression. Known-group comparisons revealed that women who survived more than 60 months had fewer physical/psychological needs than those less 60 months, which supported the validity of CaSUN-C. CONCLUSION: The CaSUN-C demonstrated acceptable reliability and validity for assessing unmet needs among breast cancer survivors in Taiwan. Using this simple assessment to target the individual needs of these survivors can help healthcare professionals provide personalized care efficiently.

Grief reactions of couples to perinatal loss: A one-year prospective follow-up.

AIMS AND OBJECTIVES: To explore couples' perceptions of the effects of perinatal loss on their marital relationship, social support and grief 1 year postloss, and analyse what factors changed the severity of their grief. BACKGROUND: Perinatal losses are traumatic events in the lives of families and can have serious long-term consequences for the psychological health of parents and any subsequent children. DESIGN: A prospective follow-up study. METHODS: We recruited, at a teaching hospital in southern Taiwan, a convenience sample of 30 couples whose babies either miscarried or were stillborn. At 1 month (T1), 3 months (T2), 6 months (T3) and 1 year (T4) after the pregnancy loss, all participants completed four questionnaires. To analyse the changing status of their grief and its related factors, we used a generalised estimating equation (GEE) to account for correlations between repeated observations. RESULTS: Postbereavement grief levels fell over the four time-points. Mothers reported feeling more grief than did the fathers. Couples with a history of infertility, no religious beliefs or no living children before the loss felt more grief from a perinatal miscarriage or stillbirth. Furthermore, couples reported more grief if their marital satisfaction level was low, if their socioemotional support from husband's parents was low or if they had never participated in a ritual for their deceased baby. CONCLUSIONS: Six months postloss is the crucial period for bereaved parents after a perinatal loss. Being a mother, having no previous living children and low-level socioemotional support from the husband's parents are significant high-risk factors for a high level of grief 1 year after perinatal death. RELEVANCE TO CLINICAL PRACTICE: We recommend that health professionals increase their ability to identify the factors that psychologically affect postloss grief. Active postloss follow-up programmes should focus on these factors to offer specific support and counselling.

Gestational weight gain and perinatal outcomes of subgroups of Asian-American women, Texas, 2009.

BACKGROUND: Asian-American subgroups are heterogeneous, but few studies had addressed differences on gestational weight gain (GWG) and perinatal outcomes related to GWG among this growing and diverse population. The purposes of this study were to examine whether Asian-American women are at higher risk of inadequate or excessive GWG and adverse perinatal outcomes than non-Hispanic White (NH-White) women, and to compare those risks among Asian-American subgroups. METHODS: This retrospective study included all singleton births to NH-Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnam, and NH-White women documented in 2009 Texas birth certificate data (N = 150,674). Data were analyzed using the χ(2) test, t test, multinomial logistic regression, and binary logistic regression. Chinese women were the reference group in the comparisons among Asian subgroups. FINDINGS: Asian women had a higher risk of inadequate GWG and gestational diabetes mellitus (GDM) than NH-White women. No difference in the odds of excessive GWG was found among Asian subgroups, although Japanese women had the highest risk of inadequate GWG. After adjusting for confounders, Korean women had the lowest risk of GDM (adjusted odds ratio [AOR], 0.49), whereas Filipino women and Asian Indian had the highest risks of gestational hypertension (AOR, 2.01 and 1.61), cesarean birth (AOR, 1.44 and 1.39), and low birth weight (AOR, 1.94 and 2.51) compared with Chinese women. CONCLUSIONS: These results support the heterogeneity of GWG and perinatal outcomes among Asian-American subgroups. The risks of adverse perinatal outcomes should be carefully evaluated separately among Asian-American subpopulations.

Birth outcomes of Hispanic women and risks or strengths associated with ethnicity and Texas border residence.

OBJECTIVE: To assess Hispanic ethnicity, border residence, or their interaction for association with risk of high gestational weight gain (GWG) and related outcomes. DESIGN: Retrospective analysis of 2009 birth data. SETTING: Texas. PARTICIPANTS: Participants included 146,458 Hispanic and 104,399 non-Hispanic (NH) White women. METHODS: We used adjusted odds ratios (AOR) in logistic regression analyses to test the association of Hispanic ethnicity, border residence, and their interaction with high GWG, cesarean birth, macrosomia, and breastfeeding status at discharge. RESULTS: After adjusting for covariates, risk of inadequate or excessive GWG was not associated with being a border resident, but Hispanic women compared to NH White women had an increased risk of inadequate GWG (AOR = 1.21, 99% confidence interval [CI] [1.17, 1.26]) and decreased risk of excessive GWG (AOR = 0.77, 99% CI [0.74, 0.79]). Risk of cesarean birth was increased for border residents (AOR = 1.22, 99% CI [1.05, 1.42]), and this risk was increased further among border residents who were Hispanic (AOR = 1.52, 99% CI [1.30, 1.77]). CONCLUSION: We found strengths and vulnerabilities among Hispanic and border-residing women. Hispanic women were at lower risk of excessive GWG than NH White women. Border-residing Hispanic women were at greater risk of cesarean birth than other women.

Postpartum health promotion interventions: a systematic review.

BACKGROUND: The postpartum period is a time of significant transition when women may discontinue positive health behaviors adopted during pregnancy. Little is known about the effectiveness of health promotion interventions targeting postpartum women. OBJECTIVE: The aim of this study was to synthesize the published evidence from randomized controlled trials conducted in the United States on the effectiveness of interventions promoting maternal health in the first year after childbirth. METHODS: Studies conducted in the United States and published from 1999 through May 2011 were identified in MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO and reviewed. RESULTS: Eleven studies were identified measuring health promotion behaviors as an outcome. Nine of the 11 targeted at-risk groups. Methodological problems included incomplete description of the intervention, steps taken to ensure representativeness of the sample, and identification and control of potential confounders. Diverse aspects of health promotion were addressed, the length of participant involvement differed, and the effectiveness of the interventions varied. DISCUSSION: Further research is needed to design interventions focused on promoting health in the general population of postpartum mothers.

The effects of a web-based supplementary program for facilitating nursing students' basic nursing skills.

This study examined the effects of an asynchronous Web-based supplementary learning program on the performance of nursing students' basic nursing skills. A posttest quasi-experimental design was used. Students in the intervention group (n = 62) were given login information to access the online program, while the control group (n = 99) was not. Data from both groups were collected before and 4 weeks after the intervention. An objective assessment of basic nursing skills was used to evaluate the level of skill demonstrated by the participants. Results indicate that the Web-based supplementary learning program is effective at strengthening students' basic nursing skills (P = .002). The findings also reveal that students in the intervention group showed higher-than-average satisfaction with the supplementary program (mean, 3.80 [SD, 0.81]). Thus, this Web-based program offers a learning opportunity for nursing students to enhance their skills beyond their formal lectures.

Timing of impairment and health-promoting lifestyles in women with disabilities.

The purpose of this study was to develop a substantive theory to explain how the timing of impairment in women's lives influenced health-promoting lifestyles among 45 women age 43 to 79 years with impairments of varying onset across the life course. From this grounded theory exploration, we suggest that women created health-related lifestyles that were comprised of changing abilities, roles, and rituals in support of perceived self. The ultimate goal of a healthy lifestyle was healthy aging, which was self-determination in the support of positive relationships. Environment and resources had direct influence on the perceived self. Our proposed substantive theory provides an understanding of how women develop a healthy lifestyle after the onset of permanent sensory or physical impairment. It also takes steps toward an understanding of how timing of impairment influences the perceptions women have of themselves and their health behaviors.