Resilience in family caregivers of Asian older people with dementia: An integrative review.

AIM: To identify factors associated with resilience in family caregivers of Asian older people with dementia based on Luthar and Cicchetti's definition of resilience. DESIGN: Integrative review of resilience in family caregivers of Asian older people with dementia reported by studies with quantitative and qualitative research designs. DATA SOURCES: Databases used for the literature search included CINAHL, PubMed, EMBASE, PsycINFO and Google Scholar. REVIEW METHODS: A total of 565 potentially relevant studies published between January 1985 and March 2024 were screened, and 27 articles met the inclusion criteria. RESULTS: Family caregivers were most commonly adult children of care recipients, female and providing care in their home. Two themes emerged from the review: factors associated with adversity (dementia severity, caregiver role strain, stigma, family stress, female gender, low income and low education) and factors associated with positive adaptational outcomes (positive aspect of caregiving, social support and religiosity/spirituality). CONCLUSION: In our review of Asian research, four new factors-caregiver role strain, stigma, family stress and positive aspects of caregiving-emerged alongside those previously identified in Western studies. A paradigm shift was observed from a focus on factors associated with adversity to factors associated with positive adaptational outcomes, particularly after the issuance of the WHO's 2017 global action plan for dementia. However, a gap remains between WHO policy recommendations and actual research, with studies often neglecting to address gender and socioeconomic factors. IMPACT: The review findings will broaden healthcare providers' understanding of resilience in dementia caregivers and use them to develop comprehensive programmes aimed at reducing factors associated with adversity and enhancing those associated with positive adaptational outcomes. This approach can be customized to incorporate Asian cultural values, empowering caregivers to navigate challenges more effectively. NO PATIENT OR PUBLIC CONTRIBUTION: This paper is an integrative review and does not include patient or public contributions.

Cognitive Function and Self-Management Behaviors in Older Adults With Type 2 Diabetes.

BACKGROUND: Type 2 diabetes (T2D) is strongly associated with cognitive impairment. Decreased cognitive function could affect daily self-management behaviors critical for people with T2D. Executive function is significant for daily self-management, and decreased subjective cognitive function could be an early indicator of poor daily self-management. However, little is known about whether executive or subjective cognitive function affects daily self-management behaviors in older adults. OBJECTIVES: We investigated the effect of executive function or subjective cognitive function on daily self-management behaviors (diet, glucose management, physical activity, and physician contact) in older adults with T2D. METHODS: We used a cross-sectional, observational design with convenience sampling of 84 adults aged ≥60 years with T2D. Telephone-administered cognitive function tests measured participants' overall cognitive and executive function levels. Subjective cognitive function, diabetes self-management, and covariates, including demographic information (age, gender, race/ethnicity, and level of education), body mass index, depressive symptoms, and diabetes duration, were assessed using online surveys. Data were analyzed using bivariate correlation and backward stepwise regression. RESULTS: The mean age of the sample was 68.46 ± 5.41 years. Participants were predominantly female and White, and the majority had normal cognitive function. Controlling for demographics, body mass index, depressive symptoms, and diabetes duration, a decrease in executive function indicated by a greater number of errors made during the telephone-administered Oral Trail Making Test Part B relative to the sample was associated with poorer adherence to physician contact behaviors. Subjective cognitive function was not associated with any self-management behaviors. DISCUSSION: A reduction in executive function was associated with poorer adherence to physician contact behaviors in older adults with T2D and normal cognitive function; lack of adherence to physician contact behaviors could be an early indicator of declining cognitive function. Difficulties or changes in routine diabetes self-management behaviors should be closely monitored in older adults. Cognitive assessment should be followed when needed.

Impact of worries associated with COVID-19 on diabetes-related psychological symptoms in older adults with Type 2 diabetes.

This study examined the associations between worries associated with COVID-19, diabetes-specific distress, and depressive symptoms in older adults with type 2 diabetes (T2D), who are particularly vulnerable to COVID-19 and its psychological impacts. A cross-sectional online survey was conducted with 84 older adults with T2D from June to December 2020. Participants had little to moderate worries associated with COVID-19, with the greatest worries about the economy recession, followed by a family member catching COVID-19, lifestyle disruptions, and overwhelmed local hospitals. Bivariate correlation and tobit regression revealed that increases in worries associated with COVID-19 were associated with increased diabetes distress and depressive symptoms. Specifically, worries associated with COVID-19 increased diabetes-specific emotional burden and physician-related and regimen-related distress. Increased diabetes distress and depressive symptoms worsened by COVID-19 may ultimately lead to poor glucose control. Additional assessment by mental health experts should be considered for older adults with T2D during and after infectious disease pandemic.

Subjective cognitive decline in diabetes: Associations with psychological, sleep, and diabetes-related factors.

AIMS: To determine whether psychological, sleep, and diabetes-related factors were associated with subjective cognitive decline (SCD) in adults with type 2 diabetes (T2D). DESIGN: A secondary analysis with a cross-sectional, correlational design. METHODS: Data from two parent studies were combined. A total of 105 adults with diabetes were recruited from a Midwestern city in the United States from September 2013-March 2014 and September 2016-September 2017. Subjective cognitive decline was measured with the psychological-cognitive symptom subscale of the Diabetes Symptom Checklist-Revised. Psychological factors (diabetes distress, fatigue, and depressive symptoms) and sleep were measured using the Diabetes Distress Scale and Patient-Reported Outcomes Measurement Information System. Diabetes-related factors were measured with body mass index and glycaemia control. Quantile regression was used to examine the associations. RESULTS/FINDINGS: The mean age of the participants was 58.10 (SD 7.92) years and 58.1% were women. The participants' mean psychological-cognitive symptom score was 1.41 (SD 1.13). After controlling for age and gender, sleep disturbance, sleep-related impairment, and body mass index were associated with SCD in lower cognitive symptom quantile groups (5th to 30th percentiles). In contrast, fatigue and depressive symptoms were more strongly associated with SCD in higher quantile groups (70th to 95th percentiles). CONCLUSION: In adults with T2D, SCD was differentially associated with psychological, sleep, and diabetes-related factors depending on cognitive symptom percentiles. Adults with T2D require regular screening for SCD. If they complain of cognitive symptoms at clinical visits, different underlying factors should be assessed according to their symptom severity. IMPACT: Findings from this study provided evidence for early identification of SCD and its influencing factors, which may help to develop nursing interventions to recognize and/or delay the onset of cognitive impairment in adults with T2D.

Intra-individual variability in sleep is related to glycaemic control in adults with type 2 diabetes.

AIMS: To examine whether there were significant differences in sleep during weekdays/weekends and whether the intra-individual variability in sleep was related to glycaemic control in patients with type 2 diabetes. DESIGN: Correlational, longitudinal design. METHODS: Data were collected between February 2017-January 2018. In all, 56 adults with type 2 diabetes were included (60.7 years, 55.4% female). Sleep was measured using the Consensus Sleep Diary over 8 days. Intra-individual variability of sleep was calculated as the standard deviation of sleep variables. Standard deviations of sleep duration, sleep efficiency, sleep quality, and mid-sleep time were obtained. Glycaemic control was measured by haemoglobin A1C. Paired t test and multiple regression analysis were used. RESULTS: Overall, there were no differences in sleep parameters between weekdays and weekends. Participants slept 20 min more over the weekends than during weekdays. The mid-sleep time during weekends was about 35 min later than during weekdays. Intra-individual variability of sleep duration and mid-sleep ranged from 27.6-167.4 min and 13-137 min, respectively. Controlling for covariates (e.g., distress, symptoms, and self-care), larger variability in sleep duration, and mid-sleep were significantly related to higher A1C levels. CONCLUSION: Diabetes educators are recommended to include the assessment of intra-individual variability in sleep. Maintaining a regular sleep habit (e.g., sleep duration and sleep timing) should be highlighted during patient education. IMPACT: Intra-individual variability in sleep is an alternative dimension for sleep assessment. This study examined whether intra-individual variability in sleep was related to glycaemic control in an older sample of type 2 diabetes patients using a sleep diary across 8 days. This sample had a similar sleep pattern during weekdays and weekends. Larger intra-individual variabilities in sleep duration and mid-sleep time were independently related to worse glycaemic control. Diabetes patients are recommended to maintain a regular sleep routine.

Heart Rate Variability and Cardiorespiratory Fitness in Non-Hispanic Black Versus Non-Hispanic White Adolescents With Type 1 Diabetes.

BACKGROUND: Evidence indicates that fewer non-Hispanic black versus non-Hispanic white youths with type 1 diabetes are meeting treatment goals for optimal glycemic outcomes, predisposing them to risks for cardiovascular (CV) morbidity and mortality in adulthood. PURPOSE: We sought to assess the association of sex and race with heart rate variability (HRV) and cardiorespiratory fitness in adolescents with type 1 diabetes. The association between the HRV and cardiorespiratory outcomes with glucose control was also examined. METHODS: A secondary data analysis of 95 adolescents with type 1 diabetes (n = 66 non-Hispanic white n = 29 non-Hispanic black) was used. Using 24-hour Holter recordings, spectral and time domain measures of HRV were obtained. Cardiorespiratory fitness using a graded exercise test was completed. Descriptive statistics and Pearson correlation coefficients were used to assess associations between glucose control and study outcomes, and general linear models were applied to explore and quantify associations of sex and race with HRV and cardiorespiratory fitness. RESULTS: Body mass index (mean [standard deviation]) was similar between non-Hispanic black (23.5 [3.9]) and non-Hispanic white (22.7 [3.8]) adolescents. Females and non-Hispanic black adolescents had significantly lower HRV and cardiorespiratory fitness levels. Moderate associations were found between lower HRV and poorer glycemic control (HbA1c). Recent HbA1c was significantly higher in non-Hispanic black (9.7 [1.8]) than non-Hispanic white (8.2 [1.2]). CONCLUSION: Findings support the importance of early identification of CV health risks in adolescents with type 1 diabetes, particularly for non-Hispanic black adolescents. Interventions focused on overall improvement in glycemic control for adolescents with type 1 diabetes are a priority for minimizing future CV complications.

Associations between fatigue, sleep disturbance and eating style in adults with type 2 diabetes: A correlational study.

AIMS AND OBJECTIVES: To test the hypothesis that fatigue and sleep disturbance account for a significant amount of variation in eating styles among people with type 2 diabetes (T2D). BACKGROUND: Healthy eating is an important component of diabetes self-care but remains a major challenge. In people with T2D, symptoms of fatigue and sleep disturbance are pervasive. However, there is limited understanding of whether fatigue and sleep disturbance are associated with eating style in people with T2D. DESIGN: Correlational design. METHODS: This study was reported following the STROBE checklist. Data were collected between February 2017 and January 2018. A convenience sample of 64 T2D adults completed the Three-Factor Eating Questionnaire-R18V2 to measure eating style (e.g., emotional eating, cognitive restraint and uncontrolled eating). Diabetes distress, fatigue and sleep disturbance were measured using validated questionnaires. Hierarchical regression analyses were performed. RESULTS: Only age was a significant predictor (ß = -0.344) of cognitive restraint. Participant demographics, psychological factor and health-related factors contribute significantly to the model predicting emotional eating, but only diabetes distress was a significant predictor (ß = 0.433). Introducing fatigue and poor sleep quality explained an additional 12.0% of the variation in emotional eating. The final model explained 24.9% of the variation in emotional eating; both diabetes distress (ß = 0.294) and fatigue (ß = 0.360) were significant predictors. CONCLUSION: There is a strong, independent relationship of fatigue and diabetes distress with emotional eating T2D patients. The effect of improving fatigue and diabetes distress on eating style should be explored. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, nurses are recommended to include a detailed assessment of fatigue and distress in patients with diabetes. Additional to the conventional nutrition therapy focusing on diet advice, eating style should also be incorporated in diet education by diabetes nurses.

Relationship and variation of diabetes related symptoms, sleep disturbance and sleep-related impairment in adults with type 2 diabetes.

AIM: The objective of this study was to examine whether diabetes-related symptoms (e.g. fatigue, neuropathic pain, diabetes distress and depressive symptoms) were related to sleep disturbance and sleep-related impairment in adults with type 2 diabetes while controlling for potential covariates. BACKGROUND: In people with type 2 diabetes, sleep disturbance and sleep-related impairment are common and likely associated with diabetes-related symptoms. However, limited research has investigated the predictive ability of diabetes-related symptoms on sleep. DESIGN: A correlational, cross-sectional design was used. METHODS: Data were collected at a large university in the Midwestern United States from September 2013-March 2014. Multiple linear regression analyses were used to examine the relationship of diabetes-related symptoms (fatigue, neuropathic pain, distress and depressive symptoms) to sleep disturbance and sleep-related impairment. The instruments included Patient-Reported Outcomes Measurement Information System instruments, Diabetes Symptom Checklist and Diabetes Distress Scale. FINDINGS: In this study of adults with type 2 diabetes (N = 90; 52.2% female, mean age 57.4 years), gender, A1C, neuropathic pain and fatigue were significantly related to sleep disturbance when age, diabetes duration, depressive symptoms and distress were controlled. Those variables collectively explained 52% of the variation in sleep disturbance. Fatigue was significantly associated with sleep-related impairment when the same covariates were controlled. CONCLUSION: Findings suggested that diabetes-related symptoms, including neuropathic pain and fatigue, are strongly related to sleep disturbance and sleep-related impairment in adults with type 2 diabetes, underscoring the need to include detailed assessments of neuropathic pain and fatigue when evaluating sleep.

Sleep disturbance in people with diabetes: A concept analysis.

AIMS AND OBJECTIVES: To clarify the meaning of sleep disturbance in people with diabetes and examine its antecedents, attributes and consequences through concept analysis. BACKGROUND: Sleep is crucial for health, and people with diabetes are frequently beset with disturbances in their sleep. The concept of sleep disturbance in people with diabetes has not been clearly defined. The inconsistent use of sleep disturbance has created confusion and impeded our understanding of the sleep in people with diabetes. This analysis will provide a conceptual foundation of sleep disturbance in diabetes, thereby facilitating more effective means for assessment and treatment. DESIGN: Concept analysis. METHODS: A systematic search without time restriction on the publication year was carried out using PubMed, CINAHL, PsycINFO, Web of Science and ProQuest Dissertations and Theses. Rodgers's method of evolutionary concept analysis guided the analysis. Inductive thematic analysis was conducted to identify the attributes, antecedents and consequences. RESULTS: Based on the 26 eligible studies, two major attributes are that sleep disturbance is a symptom and is characterised by impaired sleep quality and/or abnormal sleep duration. Two antecedents are diabetes-related physiological change and psychological well-being. Sleep disturbance can result in impaired daytime functioning, glucose regulation and quality of life. CONCLUSIONS: Defining the concept of sleep disturbance in people with diabetes facilitates consistent use and effective communication in both practice and research. Sleep disturbance in people with diabetes is a complex symptom that includes impaired sleep quality and/or abnormal sleep duration. This paper contributes to the current knowledge of sleep in people with diabetes. Future research on antecedents and consequences of sleep disturbance is necessary for further clarifications. RELEVANCE TO CLINICAL PRACTICE: Findings from this paper underscore the need for nursing education, clinical assessment and effective management of sleep disturbance in people with diabetes.

The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review.

AIMS AND OBJECTIVES: To explore and synthesise current research to assess the state of science about the relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes. BACKGROUND: Sleep disturbance is suggested a risk factor for type 2 diabetes. Diabetes alone is a leading cause of death, but when coupled with sleep disturbance poses additional health risks. However, little is known about the relationship between sleep disturbance and glycaemic control in people with overt diabetes. DESIGN: An integrative review. METHODS: Whittemore and Knafl's methodology guided this integrative review. Original studies published before October 2016 were identified through systematic searches of seven databases using terms: diabet*; sleep or insomnia; glycem* or glucose or A1C or HbA1c or sugar; and their combinations. The matrix and narrative synthesis were employed to organise and synthesise the findings, respectively. The Crowe Critical Appraisal Tool was used to evaluate the study quality. RESULTS: A total of 26 studies were identified; 17 of which reported significant relationships between sleep measures and glycaemic control. In 13 studies, sleep duration was associated with glycaemic control in both linear (n = 2) and nonlinear (n = 3) relationships; however, eight studies reported no significant relationships. Sleep quality was significantly related to glycaemic control in 14 of 22 studies. Nine studies found no relationship between any measure of sleep and glycaemic control. CONCLUSIONS: There is strong evidence supporting the relationship between sleep quality and glycaemic control but further examination of the relationship between sleep duration and glycaemic control is warranted. Sleep disturbance, particularly impaired sleep quality, could potentially influence glycaemic control in adults with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE: Nurses who treat patients with diabetes should include assessment of sleep, education for healthy sleep, and referral for treatment of sleep disturbance in order to maximise the potential for achieving good glycaemic control.

Contributions of Comorbid Diabetes to Sleep Characteristics, Daytime Symptoms, and Physical Function Among Patients With Stable Heart Failure.

BACKGROUND: Diabetes mellitus (DM) and heart failure (HF) are often comorbid. Sleep disturbances, poor physical functioning, and high levels of daytime symptoms are prevalent and contribute to poor quality of life in both populations. However, little is known about the independent and additive effects of comorbid DM on sleep, physical function, and daytime symptoms among patients with HF. OBJECTIVE: The aim of this study was to investigate the extent to which comorbid DM confers independent and additive effects on sleep disturbance, physical functioning, and symptoms among patients with stable HF. METHODS: This secondary analysis was conducted on a sample of 173 stable class II to IV HF patients. Self-report and polysomnography were used to measure sleep quality, objective sleep characteristics, and sleep-disordered breathing. Physical function measures included wrist actigraphy, the 6-minute walk test (6MWT), and the Medical Outcomes Study 36-item Short Form physical component summary score. Fatigue, sleepiness, and depression were also measured. Univariate analyses and hierarchical regression models were computed. RESULTS: The sample included 173 (n = 119/68% HF and n = 54/32% HF plus DM) patients (mean [SD] age, 60.4 [16.1] years). In analyses adjusted for age, gender, body mass index, and New York Heart Association classification, the HF patients with DM had longer sleep latency and spent a greater percentage of time awake after sleep onset than the HF patients who did not have DM (all P < 0.05). There were no statistically significant differences in Respiratory Disturbance Index or self-reported sleep quality. Sleep duration was low in both groups. The patients with DM had shorter 6MWT distance, lower ratio of daytime to nighttime activity, as well as lower general health and self-reported physical function. Hierarchical regression models revealed that age and DM were the only significant correlates of the sleep variables, whereas age, gender, New York Heart Association class, and DM were all associated with 6MWT distance. CONCLUSIONS: Comorbid DM contributes independent and additive effects on sleep disturbances and poor physical functioning in patients with stable HF.

Glucose control and fatigue in type 2 diabetes: the mediating roles of diabetes symptoms and distress.

AIM: The purpose of this study was to examine the mediating influence of diabetes health characteristics (diabetes distress, depression symptoms and diabetes symptoms) on the relationship between glucose control and fatigue in adults with type 2 diabetes. BACKGROUND: In patients with type 2 diabetes, fatigue is common and can affect diabetes self-management behaviours. Although long thought to result from hyperglycaemia, little evidence supports a relationship between fatigue and glucose control. DESIGN: A cross-sectional, descriptive study design was used. METHOD: Data were combined from two studies conducted at a large urban university in the Midwestern United States, resulting in a total sample of 155 urban-dwelling adults with type 2 diabetes. Data were collected over the course of 6 days from 2013-March 2014. Fatigue and related biological and psychological phenomena were measured to perform path analyses using structural equation modelling methods. The STATA software was used to analyse the data. FINDINGS: In patients with A1C less than or equal to 7%, fatigue was related to diabetes distress and diabetes symptoms, but not to A1C directly or indirectly. In the group with A1C greater than 7%, fatigue was indirectly related to A1C; this relationship was mediated through diabetes symptoms, depression and diabetes distress. CONCLUSION: Our findings suggest that fatigue is indirectly related to glucose control, but only in patients who have elevated A1C levels. In those with adequate glucose control, fatigue is mainly influenced by the presence of diabetes symptoms and distress. In both groups, the number and severity of diabetes symptoms were the strongest predictors of fatigue, regardless of blood glucose control.

A family involvement and patient-tailored health management program in elderly Korean stroke patients' day care centers.

PURPOSE: This study aimed to examine the effects of a family involvement and functional rehabilitation program in an adult day care center on elderly Korean stroke patients' perceived health, activities of daily living, instrumental activities of daily living, and cost of health services, and on family caregivers' satisfaction. DESIGN: Using one-group pre- and posttest design, dyads consisting of 19 elderly stroke patients and family caregivers participated in 12-week intervention, including involvement of family caregivers in day care services and patient-tailored health management. FINDINGS: Outcomes of patients and caregivers were significantly improved (all p < .001). However, the cost of health services did not decrease significantly. CONCLUSIONS: This program improved functional levels and health perception of elderly stroke patients and caregivers' satisfaction. However, results must be interpreted with caution, because this was only a small, single-group pilot study. CLINICAL RELEVANCE: This program may be effective for elderly stroke patients and their caregivers.

Behavioral interventions and symptom cluster change in adults with chronic obstructive pulmonary disease and insomnia.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) and insomnia experience multiple co-occurring symptoms, but no studies have examined symptom cluster change over time in this population. OBJECTIVES: This study explored longitudinal patterns of symptom cluster profiles for adults with COPD and insomnia and evaluated whether behavioral interventions were associated with changes in symptom cluster profiles. METHODS: This study included 91 adults with COPD and insomnia who participated in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) and COPD education. The pre-specified symptom cluster included insomnia, dyspnea, fatigue, anxiety, and depression. Latent profile analysis identified participant groups with distinct symptom cluster profiles at baseline, immediately post-intervention, and at 3-month follow-up; latent transition analysis then estimated the probability of group membership change over time. Multinomial logistic regression was used to determine whether the interventions were associated with changes in symptom cluster profiles. RESULTS: Three groups were identified at each of three time-points: Class 1 (low symptom burden), Class 2 (intermediate), and Class 3 (high). Classes 1 and 2 showed less movement to other classes (16 % and 38 %, respectively), whereas Class 3 showed greater transition (64 %). The CBT-I intervention was significantly associated with movement to a lower symptom burden group (Class 3 to 2 or 2 to 1). CONCLUSIONS: CBT-I, with or without COPD education, shows promise as a tailored intervention to reduce symptom burden in the study population. Study findings will facilitate development of interventions to reduce the severity of multiple co-occurring symptoms in people with COPD and insomnia. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: A Behavioral Therapy for Insomnia Co-existing with COPD; Identifier: NCT01973647.

Effects of daily sleep on physical activity after cardiac surgery.

BACKGROUND: Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients. OBJECTIVES: This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery. METHODS: Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses. RESULTS: Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time. CONCLUSIONS: Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.

Information Needs and Its Association With Depressive Symptoms in People With Type 2 Diabetes.

PURPOSE: The purpose of this study was to describe the information needs and examine its association with depressive symptoms in people with type 2 diabetes (T2D). METHODS: A descriptive, correlational design was used. People with T2D (N = 358) were recruited from 12 communities in Shanghai, China. Self-reported information needs and depressive symptoms were measured using the Information Needs in Diabetes Questionnaire and Patient Health Questionnaire-9 (PHQ-9), respectively. Multivariate linear regression analysis was performed. RESULTS: The participants were 64.8 years on average, and 46.6% were men. One hundred fifty-one (42.2%) had depressive symptoms (PHQ-9 ≥ 5). Participants had the least knowledge about "diabetes research," "acute complications," and "lifestyle adjustment." The sample had the highest levels of information needs about topics including "mental strain," "treatment/therapy," and "diabetes in everyday life." Compared to those without depressive symptoms, those experiencing depressive symptoms were less informed and had higher levels of need for further information. Controlling for covariates, higher levels of need for further information were significantly associated with greater depressive symptoms (B = 0.368, 95% CI, 0.155-0.582, P = .001). CONCLUSIONS: This study demonstrated areas that should be prioritized when meeting patients' information needs. It also showed the potential negative effect of unmet information needs on depression. These findings may help develop a more tailored intervention for people with T2D.

Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors.

BACKGROUND: Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE: This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS: Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS: The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS: Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.

The effects of smoking status on walking ability and health-related quality of life in patients with peripheral arterial disease.

BACKGROUND: Smoking is a leading risk factor for peripheral arterial disease (PAD), yet little is known about the interrelationships among smoking status, walking endurance, calf muscle tissue oxygenation, and quality of life in patients with PAD. OBJECTIVE: The aim of this study was to explore the differences in factors associated with walking endurance including walk distance, perceived walking ability, measures of skeletal muscle tissue oxygenation (StO2), claudication pain, peak oxygen consumption per unit time, and quality of life in smokers versus nonsmokers. METHODS: A total of 105 patients with PAD performed progressive, symptom-limited treadmill test. Ankle-brachial index was measured at baseline. Calf muscle tissue oxygenation measures were obtained during testing. The RAND Short Form-36 and Walking Impairment Questionnaire were used to measure health-related quality of life (HR-QoL). RESULTS: In the total sample (36 current smokers, 69 nonsmokers), smokers had steeper declines in StO2 from baseline to 2 minutes (42.3% vs 33%, P = .05) and shorter distance walked to onset of claudication pain (142.6 vs 247.7 m) than did nonsmokers (P < .0125), despite having no differences in ankle-brachial index, peak oxygen consumption per unit time, or any momentary measure of StO2 during walking. Smokers reported significantly lower HR-QoL on the Short Form-36 in several domains but no differences in the Walking Impairment Questionnaire measures. The smokers were younger than the nonsmokers; however, when age was entered as a covariate in the analyses, the results remained unchanged. CONCLUSIONS: These findings suggest that smokers have lower HR-QoL than do nonsmokers with PAD and that smoking confers risks for disrupted tissue oxygenation above those seen in patients who do not smoke.

Symptom Cluster Profiles in Adults with Chronic Obstructive Pulmonary Disease and Insomnia.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) and insomnia may experience multiple symptoms that can affect physical function, but little research has focused on symptom clusters in this population. OBJECTIVES: This study aimed to identify subgroups of people with COPD and insomnia based on a pre-specified symptom cluster and determine whether physical function differed in the subgroups. METHODS: This secondary data analysis included 102 people with insomnia and COPD. Latent profile analysis classified subgroups of individuals sharing similar patterns of five symptoms: insomnia, dyspnea, fatigue, anxiety, and depression. Multinomial logistic regression and multiple regression determined factors associated with the subgroups and whether physical function differed among them. RESULTS: Three groups of participants were identified based on the severity of all five symptoms: low (Class 1), intermediate (Class 2), and high (Class 3). Compared to Class 1, Class 3 showed lower self-efficacy for sleep and for COPD management and more dysfunctional beliefs and attitudes about sleep. Class 3 showed more dysfunctional beliefs and attitudes about sleep than Class 2. Class 1 showed significantly better physical function than Classes 2 and 3. CONCLUSIONS: Self-efficacy for sleep and for COPD management and dysfunctional beliefs and attitudes about sleep were associated with class membership. As physical function differed among subgroups, interventions to improve self-efficacy for sleep and for COPD management and minimize dysfunctional beliefs and attitudes about sleep may reduce symptom cluster severity, in turn enhancing physical function.

Nurse-led empowerment strategies for hypertensive patients with metabolic syndrome.

PURPOSE: The aim of this study was to compare the effect of a nurse-led empowerment-based intervention to that of standard care on metabolic syndrome risk factors, self-management behaviors, and walking activity in Korean hypertensive patients. METHODS: Using a quasi-experimental design, patients participated in an experimental group (N = 30) or control group (N = 22). The experimental group received eight weekly empowerment sessions, including lifestyle modification education, empowerment group discussions, and exercise training, while the control group received standard hypertension care. RESULTS: The experimental group had significantly improved metabolic syndrome symptoms and prevalence, empowerment scores, self-management behaviors, and walking (all p < 0.05). CONCLUSIONS: Findings from this study suggest that, in Korean hypertensive patients, empowerment interventions are more effective than standard care in improving metabolic syndrome risk factors, empowerment, self-management behaviors, and walking.