Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis.

BACKGROUND: Depressive moods are commonly seen in patients who receive haemodialysis. This can cause a lack of compliance in their treatment procedures and increase the rate of hospitalization. This study aimed to investigate the relationship between social support and degree of depression in middle-aged and elderly patients undergoing haemodialysis and the predictors of depressive symptoms. METHODS: A cross-sectional correlational study was designed with a structured questionnaire survey. Patients over 40 years of age were included from five haemodialysis centres. Measures embraced a demographic and clinical characteristics questionnaire, the Centre for Epidemiologic Studies Depression Scale, and the Personal Resource Questionnaire 2000. Statistical analysis was performed using hierarchical multiple regression analysis. RESULTS: A total of 179 patients over 40 years of age were included from five haemodialysis centres in the analysis. The mean CES-D score was 19.0(12.3); the majority of participants (60.3%) had a CES-D score ≥ 15, indicating likely depressive status. The mean PRQ2000 score was 75.7(15.9). The proportional mean of the PRQ2000 was 72.11%, indicating moderate social support for participants in this study. Data disclosed that marital status, number of comorbidities, exercise behaviour, and social support could significantly predict depressive symptoms; total explanatory variance was 31.3%. CONCLUSION: Health care professionals should identify those at high risk of depressive symptoms when they provide care to the middle-aged and elderly patients undergoing haemodialysis. These findings may lead to greater insights into the nursing and rehabilitative care of patients treated by chronic maintenance haemodialysis.

Mediating effects of fatigue on the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis.

The aim of this study was to explore how hemodialysis patients' quality of life is related to sociodemographic data and depression as predicting variables, and how it is affected by fatigue as a mediating variable. Participants were 405 patients who has been receiving hemodialysis treatment regularly. SPSS Amos path analysis was used to explore the causal relationship and the mediating effect of fatigue among the variables of sociodemographic characteristics, depression, and quality of life. Unstandardized estimates determined that while sociodemographic characteristics were a significant predictor of fatigue, they were not directly related to quality of life. The results showed that depression and fatigue in patients receiving hemodialysis are important factors that affect patients' quality of life to a greater (fatigue) or lesser (depression) extent. Depression can affect patients' quality of life either directly or indirectly via fatigue. In this study, we demonstrated that fatigue plays an important role in the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis. The results of the study further suggest that comprehensive management programs should be applied with patients to reduce their fatigue, and ultimately to improve their quality of life.

Down-regulation of microRNA-155 attenuates retinal neovascularization via the PI3K/Akt pathway.

PURPOSE: We aimed to investigate the anti-angiogenic properties of miR-155 via in vitro and in vivo studies. METHODS: miR-155 was knocked down using lentivirus-mediated RNA interference. The proliferation, migration, and tube formation of human retinal microvascular endothelial cells (HRMECs) were measured using BrdU, Transwell, and Matrigel assays, respectively. An oxygen-induced retinopathy (OIR) model was induced using neonatal C57BL/6J pups. Anti-miR-155 was intravitreally injected on postnatal day 12, and the retinal non-perfused areas and extent of neovascularization were measured on postnatal day 18 using transcardiovascular fluorescein isothiocyanate (FITC)-dextran perfusion and retina sections. A laser-induced choroidal neovascularization (CNV) model was induced in adult C57BL/6J mice. To evaluate the leakage areas, fundus fluorescein angiography was performed on day 14 after anti-miR-155 intravitreal injection. The neovascularization area of the CNV model was also examined in confocal and retina section studies. The expression levels of SHIP1 and p-Akt (Thr308, Ser473, and Thr450) were evaluated both in vitro and in vivo. RESULTS: The expression of miR-155 was elevated in HRMECs after treatment with vascular endothelial growth factor (VEGF) and in neovascularized mouse model retinas. Anti-miR-155 lentivirus reduced the VEGF-induced proliferation, migration, and tube formation abilities of HRMECs. Anti-miR-155 attenuated retinal neovascularization in in vivo CNV and OIR models. In VEGF-treated HRMECs and retina neovascularization models, p-Akt (Ser473) was significantly upregulated, while SHIP1 was downregulated. Conversely, the inhibition of miR-155 restored the expression of SHIP1 and reduced the phosphorylation of effectors in the Akt (Ser473) signaling pathway. CONCLUSIONS: The results revealed that the downregulation of miR-155 attenuated retinal neovascularization via the phosphatidylinositol 3-kinase (PI3K)/Akt pathway.

The impact of depression on fatigue in patients with haemodialysis: a correlational study.

AIMS AND OBJECTIVES: To investigate the fatigue levels and important fatigue predictors for patients undergoing haemodialysis. BACKGROUND: Fatigue is a common symptom for haemodialysis patients. With its debilitating and distressing effects, it impacts patients in terms of their quality of life while also increasing their mortality rate. DESIGN: A descriptive correlational study. METHODS: Convenience sampling was conducted at six chosen haemodialysis centres in Southern Taiwan. Data were collected via a structured questionnaire from 193 haemodialysis patients. The scales involved in this study were socio-demographic details, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Scale for haemodialysis patients. Data analysis included percentages, means, standard deviations and hierarchical multiple regression analysis. RESULTS: The fatigue level for haemodialysis patients was in the moderate range. Results from the hierarchical multiple regression analysis indicated that age, employment status, types of medications, physical activity and depression were significant. Of those variables, depression had the greatest impact on the patients' fatigue level, accounting for up to 30·6% of the explanatory power. The total explanatory power of the regression model was 64·2%. CONCLUSION: This study determined that for haemodialysis patients, unemployment, increased age, taking more medications or lower exercise frequencies resulted in more severe depression, which translated in turn to higher levels of fatigue. Among all these factors, depression had the greatest impact on the patients' fatigue levels. RELEVANCE TO CLINICAL PRACTICE: Not only is this finding beneficial to future studies on fatigue as a source of reference, it is also helpful in our understanding of important predictors relating to fatigue in the everyday lives of haemodialysis patients. It is recommended that when caring for fatigued patients, more care should be dedicated to their psychological states, and assistance should be provided in a timely way so as to reduce the amount of fatigue suffered.

Early recovery experience of patients with injury in Taiwan.

PURPOSE: To fill out the gaps in the existing research on the early recovery experiences of patients who have suffered moderate to severe injuries. DESIGN: Exploratory phenomenology was applied in this study. METHODS: Data were collected at a hospital in Taiwan from a purposive sample of 14 participants who were interviewed before hospital discharge. Semi-structured and audio-taped interviews were conducted. Colaizzi's methods were applied to analyze data. Four criteria were applied to establish the rigors of this study. FINDINGS: The patients expressed that during the early stages following their injury, several aspects of the traumatic event caused them concern. Six themes were delineated: "experience of acute pain after the injury," "inability to fulfill daily needs," "concerns with impacts caused by the injury," "perceiving that time is needed to recover," "applying multiple methods to restore one's health," and "perceiving fate as the cause of the accident." CONCLUSIONS: The findings identify that injuries bring several problems for patients. Some culture-related issues such as Chinese diets, Chinese medicine, and karmic causation have emerged. Clinicians should better understand patient care needs in the early stages of recovery after an injury. CLINICAL RELEVANCE: Findings from this study could lead to new interventions, and finally improve care outcomes for patients with injuries.

[Vascular access management and education for hemodialysis patients].

Appropriate management and care of vascular access are very important to hemodialysis patient care. Access is the cornerstone of hemodialysis therapy. Vascular access with good function and few complications not only promotes hemodialysis therapy success but also facilitates the ability of patients to restore normalcy to life. Proper vascular access maintenance requires good cooperation between medical care personnel and patients. Nurses are responsible to apply their professional knowledge and technology in clinical practice and educate and encourage patients to take care of themselves. Patients are responsible to apply learned self-care knowledge to their daily life. Such cooperation is essential to enhancing the effectiveness of comprehensive care. This article provides an overview of vascular access issues in hemodialysis therapy, including related nursing assessment, management, and proper cannulation procedures. Enhancing patient self-care abilities and working together with patients on proper vascular access care can prolong vascular access site viability.

[Safe exercises for elderly diabetic patients with chronic complications].

Medical complications impair the ability of elderly diabetic patients to exercise independently, which often leads to increased medical costs. Detailed exercise guidance, in addition to encouragement, can help sustain and improve independent exercise abilities in this vulnerable population. Prior to adopting a exercise regimen, diabetic patients should receive a full physical examination and consider possible complications. Disease stage-appropriate exercise information can help patients self-manage their disease and exercise to achieve long-term benefits. This paper is a literature review that focuses on pre-exercise evaluation methodologies, exercise suggestions, and exercises recommended for diabetic patients with chronic complications. This review may serve as a reference for medical professionals responsible to provide exercise advice to elderly diabetic patients.

Self-care behaviour and related factors in older people with Type 2 diabetes.

AIM: The present study examined the factors related to self-care behaviour in type 2 diabetic patients aged > or =65 years. In addition, this study tested the effect of the important explanatory factors on self-care behaviour. BACKGROUND: Along with the development of an ageing society, diabetes occurs frequently among older people. Diabetes requires continual medical treatment, with patients responsible for self-care. Although the relationships among social support, depression and self-care have been widely studied, little is know about older diabetic patients, especially in Taiwan. DESIGN: A correlational design was adopted. In total, 165 patients recruited using convenience sampling were diabetic outpatients at three hospitals in southern Taiwan from January-March 2005. METHODS: The participants were interviewed using the Personal Resource Questionnaire 2000 (PRQ 2000), Diabetes Self-Care Scale and Taiwan Geriatric Depression Scale (TGDS). Data were analysed using descriptive statistics and multiple regression analysis. RESULT: Self-care behaviour scores were significantly influenced by different gender, education level, economic status and religious beliefs of older diabetic patients. Depression and self-care behaviour were negatively correlated. Social support, education and duration of diabetes significantly affected self-care behaviour, accounting for 35.6% of total variance. CONCLUSIONS. Social support plays a vital factor in contributing to the facilitation of self-care behaviour. These analytical findings demonstrate the importance of social support, education and duration of diabetes in determining self-care behaviour for diabetic older diabetic patients and serve as references for future studies of self-care behaviour in type 2 older diabetic patients. RELEVANCE TO CLINICAL PRACTICE: Implication for nurses highlights the significance of providing patients with social support that will enable them to have good support systems during their disease treatment to enhance self-care abilities and improve quality of life.

Correlates of depression in type 2 diabetic elderly patients: a correlational study.

OBJECTIVES: This aim of this study was to investigate depression and related factors in elderly patients (65 years) with type 2 diabetics. METHODS: The study utilized a descriptive-correlational design. Convenience sampling was applied to enroll 156 subjects, aged >or= 65 years from diabetic outpatient clinics at three hospitals in Kaohsiung. This study applied the Personal Resource Questionnaire 2000 (PRQ 2000), Taiwan Geriatric Depression Scale (TGDS), and a form for demographic data. RESULTS: (1) The mean index score for depression level was 26, indicating that study subjects had a low level of depression. The social support index score was 76. (2) Significant differences in TGDS scores existed for diabetes duration, diabetes complications, and treatment type. (3) Social support and regular exercise were significantly and negatively correlated with depression. (4) Social support and diabetes complications were significant correlates of depression and accounted for 25.9% of variance in depression. CONCLUSION: Analytical results may assist nurses in understanding depression and related factors for diabetic patients aged >or= 65. Therefore, this study could form a basis for caring older people with diabetes, and provide a reference for further research.