Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study.

BACKGROUND: Psychological distress is common in maintenance hemodialysis patients, and high psychological resilience can promote psychological well-being. The current research focuses on psychological resilience protective factors such as family resilience and social support. However, the trajectories of psychological resilience, family resilience, and social support over time and their longitudinal relationships in maintenance hemodialysis patients have not been fully explored yet. Therefore, this study aims to explore the longitudinal relationship between these factors. METHODS: Patients who received regular hemodialysis treatment for more than three months at dialysis centers of three tertiary hospitals in Zhejiang, China, were recruited from September to December 2020. A total of 252 patients who met the inclusion and exclusion criteria completed three follow-up surveys, including social support, family resilience, and psychological resilience assessments. A repeated measures ANOVA was used to explore differences in their respective scores at different time points. The cross-lagged analysis was performed in AMOS using the maximum likelihood method to examine the the reciprocal predictive relationships between these factors. RESULTS: Social support and psychological resilience remained relatively stable over time, whereas family resilience indicated a little increasing trend. According to the cross-lagged analysis, higher T1 social support predicted higher family resilience at T2 [ß = 0.123, 95% CI (0.026-0.244)]. Further, the effects of T2 social support to T3 family resilience [ß = 0.194, 95%CI (0.039-0.335)] and psychological resilience [ß = 0.205, 95%CI (0.049-0.354)] were significant. Finally, the effects of T2 family resilience to T3 social support [ß = 0.122, 95%CI (0.010-0.225)] and psychological resilience [ß = 0.244, 95%CI (0.119-0.359)] were also significant. CONCLUSIONS: The study showed that the directionality of the relationship appears to be from social support or family resilience to patients' psychological resilience but not vice versa. This finding reminds healthcare professionals to emphasize the vital role of social and family resources in providing appropriate support and interventions for maintenance hemodialysis patients to promote psychological resilience and mental health development.

Discrepancies in perceived family resilience between adolescents with chronic illness and parents: using response surface analysis to examine the relationship with adolescents' psychological adjustment.

BACKGROUND: This study aimed to explore discrepancies in adolescents with chronic illness and their parents' perceptions of family resilience, as well as the relationship between these differences and the psychological adjustment of adolescents with chronic illness. METHODS: A cross-sectional study was conducted. A total of 264 dyads of parents (77.7% mothers, mean age 41.60 years, SD = 6.17) and adolescents (48.5% girls, mean age 12.68 years, SD = 2.11) with chronic illness were recruited through convenience sampling from three children's hospitals in Wenzhou, Hangzhou, and Shanghai, China between June 2022 and May 2023. The Chinese version of the Family Resilience Scale and the Psychological Adjustment Scale, which are commonly used measures with good reliability and validity, were employed to assess family resilience and psychological adaption, respectively. The data were analyzed using polynomial regression and response surface analysis. RESULTS: Adolescents with chronic illness reported higher family resilience than their parents (t=-2.80, p < 0.05). The correlations between family resilience and adolescents' psychological adjustment reported by the adolescents (r = 0.45-0.48) were higher than parents (r = 0.18-0.23). In the line of congruence, there were positive linear (a1 = 1.09-1.60, p < 0.001) and curvilinear (a2=-1.38∼-0.72, p < 0.05) associations between convergent family resilience and adolescents' psychological adjustment. In the line of incongruence, when adolescents reported lower family resilience than parents, adolescents had a lower level of psychological adjustment (a3=-1.02∼-0.45, p < 0.05). Adolescents' sociability decreased when the perceived family resilience of parent-adolescent dyads converged (a4 = 1.36, p < 0.01). CONCLUSION: The findings highlighted the importance of considering the discrepancies and congruence of family resilience in the parent-child dyads when developing interventions to improve the psychological adjustment of adolescents with chronic illness. Interventions aimed at strengthening family communication to foster the convergence of perceptions of family resilience in parent-adolescent dyads were warranted.

Parent-adolescent family resilience and psychological adjustment in chronically ill adolescents: An actor-partner interdependence mediation model.

AIMS: This study explored the relationships between family resilience, dyadic coping and psychological adjustment among adolescents with chronic illnesses and their parents. The actor-partner interdependence mediation model was used to validate the mediating role of dyadic coping in the relationship between family resilience and psychological adjustment. DESIGN: This is a cross-sectional study. METHODS: A total of 318 parent-adolescents dyads were recruited from three paediatric hospitals in Wenzhou, Hangzhou, Shanghai city, China, between June 2022 and August 2023. The parents had a mean age of 41.62 years, and the adolescents had a mean age of 12.66 years. Participants independently completed a self-report questionnaire assessed family resilience, dyadic coping and psychological adjustment. Data analysis was conducted using the actor-partner interdependence mediation model. RESULTS: The findings suggest that in the actor effects, family resilience directly influenced psychological adjustment, and family resilience is related to psychological adjustment through positive dyadic coping. In the partner effect, parents' family resilience influenced adolescents' psychological adjustment through the parents' positive dyadic coping. Similarly, adolescents' family resilience influenced parents' psychological adjustment through both parents' positive dyadic coping and adolescents' negative dyadic coping. Additionally, there was a partner effect between parents' family resilience and adolescents' psychological adjustment. CONCLUSION: This study demonstrated the importance of developing effective dyadic interventions based on family resilience or positive dyadic coping strategies to improve the mental health of adolescents with chronic illnesses and their parents. IMPACT: The mediating role of dyadic coping in the relationship between family resilience and psychological adjustment among adolescents with chronic illnesses and their parents was demonstrated. Future psychosocial interventions should focus on increasing parents' positive dyadic coping strategies and improving adolescents' negative dyadic coping strategies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Resiliency process in the family after childhood leukaemia diagnosis: A longitudinal qualitative study.

AIMS: To construct a conceptual framework on the process of family resilience during the first year following childhood leukaemia diagnosis. DESIGN: A longitudinal qualitative interview study. METHODS: A longitudinal qualitative study following a grounded theory methodology was employed. Semi-structured interviews were conducted with parents of children with leukaemia in a general hospital. The participants were recruited through purposive and theoretical sampling and longitudinal engagement was achieved by conducting interviews at 1, 3, 6, and 12 months after the leukaemia diagnosis. The core category and categories were saturated following the enrolment of parents of children with leukaemia. Data collection and analyses were performed simultaneously. RESULTS: Sixteen parents of children with leukaemia participated. The core category of 'families living with childhood leukaemia' refers to the process of family resilience during the first year following childhood leukaemia diagnosis, which includes three phases: (1) destruction and resiliency period; (2) adjustment and consolidation period; and (3) growth and planning period. CONCLUSION: This study explored the dynamic, complex and continuous processes of resilience among families coping with childhood leukaemia during the first year following diagnosis. Further research should design tailored family interventions that characterise the different phases of family resilience, aiming to support family well-being, integrity and functioning. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Both families and healthcare professionals must create an enabling environment that supports families coping with difficulties. Understanding the different phases of family resilience allows healthcare professionals to provide holistic care that meets the demands of families with childhood leukaemia. IMPACT: Unique knowledge emerged about the family's resiliency process when facing childhood leukaemia, suggesting a family-led revolution in understanding and managing childhood leukaemia. Therefore, the development of phased, resilience-based family interventions is imperative. REPORTING METHOD: This study was reported using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: Patients contributed via study participation.

Development of a theory-based family resilience intervention program for parents of children with chronic diseases: A Delphi study.

BACKGROUND: Long-term illness exposes children with chronic diseases to a high risk of deterioration of physical and mental health. Developing an effective family resilience intervention program is a critical concern. OBJECTIVE: To develop a theory-based family resilience intervention program for parents of children with chronic diseases and provide a reference for clinical intervention. METHODS: A two-phased research design, guided by the Walsh family resilience process model, was employed to develop the intervention program. In phase 1, a scoping literature review was conducted to identify the possible elements of family resilience interventions. In phase 2, a three-round Delphi survey was conducted with experts (n = 14) using an online electronic survey to obtain their consensus on the intervention content. RESULTS: Three main components were identified: (1) strengthening family beliefs, (2) adjusting the family organization pattern, and (3) improving the family communication process. And 8 modules were developed: "introducing adversity and family resilience", "finding and strengthening positive family beliefs, and building confidence to live with the disease", "analyzing and adjusting family structure", "assisting families to increase and utilizing internal and external resources", "optimizing communication skills", "strengthening collaborative problem-solving capacity", "enhancing the family narrative ability", and "enhancing emotional expression". After 3-round Delphi, the findings indicated that the intervention program is applicable and feasible for parents of children with chronic diseases in China. CONCLUSION: The principal merit of this study lies in the development of a family resilience intervention program for parents of children with chronic diseases. The intervention's usability and efficacy should be investigated in future studies. IMPLICATIONS TO PRACTICE: Developing a family resilience intervention program is a critical first step toward providing effective care for parents of children with chronic diseases, and evaluating the program's feasibility and suitability in the target population is warranted.

Finding family resilience in adversity: A grounded theory of families with children diagnosed with leukaemia.

AIMS AND OBJECTIVES: To develop a conceptual framework that explores the process of building family resilience among Chinese families with children diagnosed with leukaemia. BACKGROUND: The diagnosis of childhood leukaemia has a devastating effect on the family. Nonetheless, some families were able to positively respond to the crisis. The process through which Chinese families bounce back has received little attention. DESIGN: Grounded theory. METHODS: This study used purposive and theoretical sampling to select 16 parents who agreed to participate in semistructured interviews after children were diagnosed with leukaemia. Data collection and analysis occurred simultaneously. Data were analysed through a process of open, axial and selective coding. The COREQ checklist was followed for reporting. RESULTS: A core category of 'finding family resilience in adversity' was generated. The core category was underpinned by a transition process between two fluid stages: (a) Disrupting the family system, informed by subcategories of negative emotional disturbances and challenges of the diagnosis and treatment journey; (b) Cultivating resilience in families, informed by subcategories of increasing positive attitudes; establishing new family routines; activating good support systems; and practising open family communication. CONCLUSIONS: The transition process from the disruption of the family system to the cultivation of family resilience is perceived as a complex family dynamic in response to childhood leukaemia. Our findings can form the basis for further research about resilience-based family interventions that promote family well-being during the early stages of a childhood leukaemia diagnosis. RELEVANCE TO CLINICAL PRACTICE: It is necessary for healthcare professionals to provide essential support for families to face the challenges of diagnosis and treatment to facilitate the successful transition to family resilience. By understanding the dynamic process of developing family resilience, healthcare professionals are able to focus on these families to provide holistic care that satisfies the specific demands of family members.

The resilient process of the family after diagnosis of childhood chronic illness: a qualitative meta-synthesis.

PROBLEM: Childhood chronic illness has a serious effect on the whole family. As there is yet little known about how the families adjust to the diagnosis of childhood chronic illness, this qualitative meta-synthesis aims to further our knowledge regarding the resilient process. ELIGIBILITY CRITERIA: A meta-synthesis review was conducted to explore the resilient process of the family after diagnosis of childhood chronic illness using nine electronic databases PubMed (MEDLINE), Web of Science, the Cochrane Library, SCOPUS, PsycINFO, CINAHL, Wan Fang, CBM, and CNKI from each database's inception to December 31,2020. Snowball sampling and manual search were performed to identify other relevant studies. SAMPLE: Seventeen qualitative studies met the inclusion criteria and were analyzed into meta-synthesis. RESULTS: Three key meta-themes were identified across the studies: (a) disintegration and vulnerability: emotional fluctuation and household chaos; (b) adjustment and adaptation: struggle with family needs; (c) recovery and reconstruction: growth and expectation. CONCLUSION: Family adjustment to childhood chronic illness presents a complex, multifaceted and dynamic process. Identifying characteristics of family processes provides some practical interventions for families with a chronically ill child. IMPLICATIONS: There is a need for all health professionals and social care services to be aware of the experience of family adjustment of children diagnosed with chronic illness. The specific intervention targeted at different periods of the family adjustment process is warranted to help families to recover from crises and deal better with challenges.

[Chromosomal structural abnormalities in men with semen abnormality and analysis of 19 cases of first-reported abnormal karyotype].

OBJECTIVE: To investigate the chromosomal structural abnormalities and pregnancy outcomes in men with semen abnormality. METHODS: We analyzed the karyotype of 3 095 male patients with semen abnormality spermatogenesis, performed pedigree analysis and provided reproduction guidance for those with chromosomal structural abnormalities. RESULTS: Of the 3 095 male patients with semen abnormality, 52 (1.68%) cases of chromosomal structural abnormalities were detected, including 28 cases of balanced translocation, 21 cases of Robertsonian translocation and 3 cases of chromosome inversion. There were 19 cases of rare abnormal karyotype first reported in the world. CONCLUSION: Reciprocal translocation is a main type of chromosomal structural abnormality in male patients with semen abnormality. An insight into the types of chromosomal abnormalities and analysis of the heredity of chromosomes in a family may help detect chromosomal abnormality carriers and provide scientific reproduction guidance.

Perceptions of adult patients with cancer towards telemedicine: A qualitative meta-synthesis.

Objective: This study aims to systematically identify, evaluate, and synthesize published qualitative research on the views and attitudes of adult cancer patients toward telemedicine and, consequently to better inform the future development of telemedicine technology and interventions. Methods: A meta-synthesis review was conducted to identify qualitative studies that reported adult cancer patients' perceptions toward telemedicine applications using nine electronic databases, including PubMed, MEDLINE, Web of Science, the Cochrane Library, PsycINFO, CINAHL, Wan Fang, VIP, and CNKI, from inception to November 2022. Quality appraisal was guided by the Joanna Briggs Institute's (JBI) Critical Appraisal Checklist for Qualitative Research. Data were synthesized using "thematic synthesis" to identify themes and concepts. Results: A total of 3518 articles were retrieved, of which 23 met the inclusion and exclusion criteria. These studies identified three key meta-themes and 11 key sub-themes: (1) Benefits of telemedicine: obtaining information and social support, maintaining the continuity of treatment, receiving professional assistance, having greater flexibility, and promoting physical and mental health; (2) Limitations of telemedicine: interference with normal life, privacy and security issues, auxiliary function issues, and increased psychological burden; (3) Expectations for future telemedicine: more personalized intervention, more specific and diverse information. Conclusions: The study showed that the benefits and limitations coexisted in the process of telemedicine application among adult cancer patients. It is necessary to develop personalized applications that are better suited to the needs and characteristics of adult cancer patients. Future telemedicine interventions should focus on information diversification and provide patients with more diverse and effective information. Systematic review registration: PROSPERO, CRD42022324528.

The characteristics of suicide attempters in Chinese patients: Comparison of adolescents, youths, middle-aged and elderly.

BACKGROUND: Potential risk factors for suicide differ by age group. Therefore, this study aims to investigate the characteristics of patients with suicide attempts according to age group and any the relevant risk factors. METHODS: This study retrospectively reviewed the medical records of attempted suicide patients who were admitted to the emergency departments (ED) of the First Affiliated Hospital of Wenzhou Medical University between January 1, 2017, and December 31, 2021. Demographic information and clinical characteristics were collected. The participants were divided into four age groups and the characteristics of each group were compared. RESULTS: A total of 834 participants were included in this study. Suicide attempts were more prevalent in females, and the gender difference decreased with age. Having religious belief and less educated suicide attempts were concentrated in the elderly groups. Adolescents suicide attempts were more likely to occur in the spring, autumn and during non-office hours. Mental disorders were the major motivation for suicide among adolescents, and interpersonal and social problems were more prevalent among youths. Psychiatric medication was the leading suicidal substances among adolescents, while pesticides and herbicides were more prevalent in adults. The history of psychiatric diagnosis was more common in adolescents, while the history of somatic disorder was more prevalent in the elderly. CONCLUSION: This study confirmed differences in the demographic and clinical characteristics of patients in different age groups. Therefore, it is necessary to construct individualized intervention strategies for each age group based on the characteristics of the patients in order to reduce suicide.

Influencing Factors of Psychological Resilience in Stroke Patients: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically review the current status and influencing factors of psychological resilience in stroke patients and to provide a theoretical basis for future personalized rehabilitation support and psychological interventions. METHOD: This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A comprehensive search of databases including PubMed, Web of Science, Medline, PsycINFO, CINAHL, Cochrane Library, CNKI, VIP, CMB, and WANGFANG was conducted from inception until November 22, 2023, resulting in the retrieval of 2099 studies. Literature screening and data extraction were performed by two independent evaluators based on pre-defined inclusion and exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software. RESULTS: The final review included 23 studies. The results showed that self-efficacy, hope, confrontation coping, avoidance coping, functional independence, quality of life, and social support were positively associated with psychological resilience. Conversely, anxiety, depression, and resignation coping were negatively associated with psychological resilience. CONCLUSIONS: Patients with stroke have a low level of psychological resilience, which was influenced by a variety of factors. However, longitudinal and large sample studies are needed to further confirm these findings. These results should be integrated into clinical practice for early assessment and targeted intervention in psychological resilience to assist patients in coping with the rehabilitation process and life changes after a stroke.

A prediction model for nonresponsive outcomes in critically ill patients with acute respiratory distress syndrome undergoing prone position ventilation: A retrospective cohort study.

OBJECTIVE: This study aimed to develop a reliable and effective nomogram model to identify high-risk populations with non-response to prone position ventilation (PPV) in acute respiratory distress syndrome (ARDS) patients. METHODS: This retrospective cohort study included 175 patients with ARDS undergoing PPV. An improvement of ≥ 20 mmHg in the PaO2/FiO2 after the first PPV was defined as a 'response'. For the construction of the model, all patients were randomly assigned to the train and validation cohort according to 2:1. Multivariate logistic regression was useed to develop the nomogram. The area under the receiver operating characteristic curve (AUC), decision curve and calibration curve were assessed to evaluate the efficiency, clinical utility and calibration of the model. RESULTS: The overall rate of non-response to PPV in ARDS patients was approximately 32.6 %. In the training cohort and validation cohort, the rate are 29.9 % and 34.5 % respectively. Murray score ≥ 2.5 (OR: 4.29), procalcitonin (PCT) ≥ 2 ng/mL (OR: 2.52), N-terminal pro-B-type natriuretic peptide (Nt-proBNP) ≥ 2000 pg/ml (OR: 2.44), and hemoglobin ≤ 90 g/L (OR: 2.39) were independently associated with the rate of non-response to PPV and combined in prediction model. The model demonstrated good predictive value with AUC of 0.817 and 0.828 in the train and validation cohort. Calibration curve showed good calibration and decision curve analysis indicated favorable clinical utility. CONCLUSIONS: This study constructed a risk prediction model for non-response to PPV, which demonstrated good predictive value and clinical utility. IMPLICATIONS FOR CLINICAL PRACTICE: Early identification of prone position response in ARDS is essential for timely alternative treatments, improving patient prognosis and healthcare efficiency. The predictive model included representative indicators of patients with ARDS, encompassing parameters such as the acute lung injury (Murray score), cardiac function (Nt-proBNP), infectious status (PCT), and hemoglobin levels.

Analyzing the Symptom Clusters Among Children With Acute Lymphoblastic Leukemia During Chemotherapy Based on Electronic Nursing Records.

BACKGROUND: Children with acute lymphoblastic leukemia often experience various physical and psychological symptoms during chemotherapy. Previous studies have used predetermined symptom inventories to analyze the complex relationships between these symptoms, which has certain limitations. OBJECTIVE: The aim of this study was to explore the dynamic changes in symptom clusters among children with acute lymphoblastic leukemia during chemotherapy using electronic nursing records. METHODS: Electronic nursing records for 2021 (N = 14 490) were obtained from a pediatric hematology department. A natural language processing tool was used to identify the presence of 46 symptoms in 3 chemotherapy phases of induction, consolidation, and maintenance. Incidence of symptom documentation was calculated by notes and patients, and principal component analysis and cluster analysis were performed for symptoms with an incidence above 15%. RESULTS: The most common symptoms included bleeding, cough, and vomiting. The number of symptom clusters in each chemotherapy period was 7, 6, and 4, respectively. There were upper gastrointestinal, respiratory system, lower gastrointestinal, skin-related, psychological, self-image disorder, and other discomfort symptom clusters in the induction period. Notably, the upper gastrointestinal, respiratory system, lower gastrointestinal, and skin-related symptom clusters persisted through the consolidation and maintenance periods. Neurological and other discomfort symptom clusters were observed during the consolidation period. CONCLUSION: Symptom clusters of children with acute lymphoblastic leukemia at various stages of chemotherapy showed a certain level of stability and dynamics, informing healthcare providers in developing continuous symptom management. IMPLICATIONS FOR PRACTICE: Medical staff should explore targeted intervention programs based on characteristics of symptom clusters at different chemotherapy stages, to improve the efficiency of symptom management and alleviate the symptom burden of children.

Alterations of the gut microbiome and plasma proteome in Chinese patients with adolescent idiopathic scoliosis.

The etiology of adolescent idiopathic scoliosis (AIS), the most common rotational deformity of the spine, is still unclear. Emerging evidence suggests that gut microbiota dysbiosis influences musculoskeletal diseases such as arthritis and osteoporosis. However, the alterations of the fecal microbiome in AIS remain unknown. Thus, the current study was conducted to explore the gut microbiota compositions of Chinese AIS patients. Microbiota communities in the feces of 51 AIS patients and 34 age- and sex-matched healthy individuals were investigated using 16S rRNA sequencing. Meanwhile, the changes in the plasma proteome were detected using tandem mass tag (TMT) labeling coupled with liquid chromatography-mass spectrometry (LC-MS). The relationship between gut microbiota and AIS clinical characteristics as well as the correlation between gut microbiota and the changes in plasma proteins were analyzed. The structure of the gut microbiota differed between the AIS and healthy groups, however, the richness was similar. The genera Prevotella, Gelria, and Desulfovibrio were enriched in the feces of AIS patients. In contrast, the abundance of Parasutterella, Tyzzerella, and Phascolarctobacterium was decreased in the AIS group. More remarkably, a positive correlation between the abundance of the fecal genera Prevotella and the Cobb angles of the AIS patients was observed. Moreover, the major differential plasma proteins related to AIS were Fibronectin 1 (FN1), voltage-dependent anion channel 1 (VDAC1), Ras homolog family member A (RHOA), and AHNAK nucleoprotein (AHNAK). Additionally, the positive correlations between fecal Prevotella and the expression of host plasma FN1 as well as the negative relationships between fecal Prevotella and the expression of host VDAC1 and AHNAK were confirmed. Elucidating these differences in the gut microbiota will provide a foundation to improve our understanding of the pathogenesis of AIS and to support potential therapeutic options based on modifying the gut microbiota.