The Effects of Self-Aromatherapy Massage on Pain and Sleep Quality in Patients with Rheumatoid Arthritis: A Randomized Controlled Trial.

BACKGROUND: Rheumatoid arthritis is the most common form of inflammatory arthritis and can lead to pain, joint deformity, and disability, resulting in poor sleep quality and lower quality of life. The efficacy of aromatherapy massage on pain levels and sleep quality among rheumatoid arthritis patients remains unclear. AIMS: To investigate the effects of aromatherapy on pain and sleep quality among rheumatoid arthritis patients. METHODS: This randomized controlled trial enrolled 102 patients with rheumatoid arthritis from one regional hospital in Taoyuan, Taiwan. Patients were randomly assigned to the intervention (n = 32), placebo (n = 36), or control groups (n = 34). The intervention and placebo groups underwent self-aromatherapy hand massage guided by a self-aromatherapy hand massage manual and video for 10 minutes 3 times a week for 3 weeks. The intervention group used 5% compound essential oils, the placebo group used sweet almond oil, and the control group had no intervention. Pain, sleep quality and sleepiness were measured by using the numerical rating scale for pain, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale at baseline and at 1, 2, and 3 weeks after the intervention. RESULTS: The intervention and placebo groups had significantly decreased sleep quality and sleepiness scores from baseline to 3 weeks after aromatherapy massage. Compared with the control group, the intervention group showed statistically significant improvement in the sleep quality scores in the first weeks after aromatherapy massage (B = -1.19, 95% confidence interval [CI]: -2.35, -0.02, P =.046), but no statistically significant differences were found in the changes in pain levels from baseline to the three time points. CONCLUSIONS: Aromatherapy massage is effective in improving sleep quality in rheumatoid arthritis patients. More studies are needed to evaluate the effects of aromatherapy hand massage on the pain levels of rheumatoid arthritis patients.

The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery.

BACKGROUND: Little is known about the relationship of the American Society of Anesthesiologists Physical Status Classification scores (ASA scores) on patient outcomes following hip fracture surgery in Asian countries. Therefore, this study explored the association of patients' preoperative ASA scores on trajectories of recovery in physical functioning and health outcomes during the first year following postoperative discharge for older adults with hip-fracture surgery in Taiwan. METHODS: The data for this study was generated from three prior studies. Participants (N = 226) were older hip-fracture patients from an observational study (n = 86) and two clinical trials (n = 61 and n = 79). Participants were recruited from the trauma wards of one medical center in northern Taiwan and data was collected prior to discharge and at 1, 3, 6, and 12 months after hospital discharge. Participants were grouped as ASA class 1-2 (50.5%; ASA Class 1, n = 7; ASA Class 2, n = 107) and ASA class 3 (49.5%, n = 112). Measures for mortality, service utilization, activities of daily living (ADL), measured by the Chinese Barthel Index, and health related quality of life, measured by Medical Outcomes Study Short Form-36, were assessed for the two groups. Generalized estimating equations (GEE) were used to analyze the changes over time for the two groups. RESULTS: During the first year following hip-fracture surgery, ASA class 1-2 participants had significantly fewer rehospitalizations (6%, p = .02) and better scores for mental health (mean = 70.29, standard deviation = 19.03) at 6- and 12-months following discharge than those classified as ASA 3. In addition, recovery of walking ability (70%, p = .001) and general health (adjusted mean = 58.31, p = .003) was also significantly better than ASA 3 participants. CONCLUSIONS: There was a significant association of hip-fracture patients classified as ASA 1-2 with better recovery and service utilization during the first year following surgery. Interventions for hip fractured patients with high ASA scores should be developed to improve recovery and quality of life.

Utility of benzothiazoles as markers of tire-derived inputs to estuarine waters assessed by polyethylene sheets.

Tire-derived particles and polyethylene (PE) debris co-exist in estuaries and potentially deteriorate water quality. Chemicals can be emitted from tire-derived particles and resorb to PE debris. However, there was lack of information about the interaction (e.g., sorption and desorption) between tire-derived chemicals and PE debris. By combining batch sorption and desorption experiments along with in situ field deployment of PE sheets, we examined the utility of benzothiazoles (BTZs) sorbed in PE as suitable markers of tire-derived inputs. The sorptive characteristics and PE-water partition coefficients (often designated as Kpew) of selected tire-derived marker candidates, i.e., polycyclic aromatic hydrocarbons (PAHs), benzothiophenes (BTPs) and BTZs, were measured. Moderately polar BTPs and BTZs (except for 2-(4-morpholinyl) benzothiazole) reached equilibrium within 2-8 days, compared to 20 days for nonpolar PAHs. The measure Kpew values and octanol-water partition coefficients of PAHs and BTZs were linearly correlated with each other (r2 > 0.80; p < 0.05). The desorption potentiality of PAHs and BTZs from tire particles is consistent with the hydrophilic properties of the target chemicals, while desorption ratios of BTZs and PAHs are 25-87% and <20%, respectively. Samplers with PE sheets as the sorbent phase were deployed in Hailing Bay, an urbanized estuary in South China, to measure concentrations of PAHs, BTPs and BTZs. Benzothiazoles sorbed in PE samples were associated with the massive utilization of automobile tires, while PAHs were linked to the boat maintenance facilities and BTPs were not detected in any tire particle and field PE samples. Therefore sorbed BTZs in PE can potentially serve as chemical markers of tire-derived inputs to estuaries.

Predictors of fatigue in patients with heart failure.

AIMS AND OBJECTIVES: The purpose of this study was to examine the level of fatigue perceived by patients with heart failure and to explore the potential factors influencing fatigue. DESIGN: A cross-sectional, correlational design was used. METHODS: A convenience sample of 105 patients was recruited between July and September 2003 in northern Taiwan. The patients were interviewed, and their perceived fatigue was assessed with the modified Piper Fatigue Scale. The factors influencing fatigue were determined using a stepwise linear regression model. RESULTS: The majority of patients with heart failure experienced mild-to-moderate fatigue. Patients with higher levels of fatigue had worse physical functioning and more severe symptomatic and psychological distress. Symptomatic distress, psychological distress (depression and anxiety), New York Heart Association class, activities of daily living (ADL) and appraisal support by health care providers could explain 57.4% of the total variance of fatigue. Symptomatic distress was the strongest predictor of fatigue. CONCLUSION: Higher levels of fatigue were found in patients with heart failure who had symptomatic or psychological distress. Additional research focusing on developing effective methods to reduce fatigue in patients with heart failure is recommended. RELEVANCE TO CLINICAL PRACTICE: Nurses should help patients with heart failure to monitor their symptoms and report them to health care providers. Early management of symptoms and support by health care providers may reduce patients' fatigue, help maintain their physical functioning and improve their quality of life.

Risks of Breast and Endometrial Cancer in Women with Diabetes: A Population-Based Cohort Study.

OBJECTIVE: We investigated the overall and age-specific risks of developing breast and endometrial cancer among women with diabetes in a population-based cohort study. METHODS: Women with diabetes (n = 319310) and age-matched controls (n = 319308), selected from ambulatory care claims and beneficiary registry in 2000, respectively were linked to the in-patient claims (2000-2008) to identify admissions due to breast (ICD-9-CM: 174) and endometrial (ICD-9-CM: 182) cancer. The person-year approach with Poisson assumption was used to estimate the incidence density rate. The age-specific hazard ratios (HRs) of above malignancies in relation to diabetes with multivariate Cox proportional hazard regression. RESULTS: The overall incidence density rate of breast and endometrial cancer was estimated at 1.21 and 0.21 per 10,000 patient-years, respectively, for diabetes. The corresponding figures for controls were lower at 1.00 and 0.14 per 10,000 patient-years. Compared with the controls, the covariate adjusted HR for breast and endometrial cancer was 1.42 (95% confidence interval (CI) 1.34-1.50) and 1.71 (95% CI 1.48-1.97), respectively in women with diabetes. Elderly (> = 65 years) diabetes had the highest HR (1.61) of breast cancer, while the highest HR (1.85) of endometrial cancer was observed in diabetes aged < = 50 years. CONCLUSIONS: Diabetes may significantly increase the risks of breast and endometrial cancer in all age stratifications. Health education for strict adherence of cancer screening program in women with diabetes is essential.