Promoting musculoskeletal health and preventing ill health.

Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.

Exploring health-related quality of life, exercise and alcohol use in adolescents with sickle cell disease and healthy siblings.

OBJECTIVE: This study explored the health-related quality of life (HRQL) and health behaviours of adolescents with sickle cell disease (SCD) and healthy siblings, drawing on Gap theory which suggests HRQL is the discrepancy between current and ideal selves. DESIGN: Twenty-three adolescents with SCD and 21 healthy siblings aged 13 to 17 years participated in eight focus groups. RESULTS: Thematic analysis identified three themes: learning to accept SCD, coping with SCD and influences on health behaviours. Adolescents appear to have normalised and adapted to SCD. Adolescents with SCD have learnt effective coping strategies, such as moderating engagement in exercise. Unlike heathy siblings, they were not encouraged to exercise by parents but were content with their level of participation. Both groups were influenced to exercise by role models or wanting to socialise, and influenced to drink alcohol by peers, but there was limited understanding of the potential negative impacts of alcohol on SCD. CONCLUSION: There does not appear to be a discrepancy between adolescents' current and ideal selves, providing optimism about their HRQL. Further consideration of engaging in healthy behaviours is needed, but it is important to strike a balance so that modifications to lifestyle do not impair HRQL.

A qualitative exploration of health-related quality of life and health behaviours in children with sickle cell disease and healthy siblings.

OBJECTIVES: This study explored the health-related quality of life (HRQL) and health behaviours of children with sickle cell disease (SCD) and healthy siblings, drawing on Gap theory, which suggests HRQL is the discrepancy between current and ideal selves. DESIGN: Thirty-two interviews, facilitated by children's drawings of their current and ideal selves were thematically analysed. RESULTS: Two themes were identified. First, limitations of SCD and adjusted expectations. Children with SCD report some discrepancy in HRQL as they would like to participate in more physical activity, but overall, they appear to have normalised their condition and adjusted their expectations in the context of the limits of their condition. Healthy siblings worry about their sibling and have greater expectations about engaging in adventurous activities and for their future. Second, coping with SCD. Children have limited social support, although children with SCD seek support from their mothers. They also modify health behaviours, like reducing exercise to help prevent and cope with sickle-related pain. CONCLUSION: Children have some discrepancies in their HRQL but adjusted expectations among children with SCD may reduce discrepancy. Adapting health behaviours may help to cope with SCD but it is important that reductions in physical activity do not impair HRQL.

Mental health and coping with fertility treatment cessation during the COVID-19 pandemic in the UK.

PURPOSE: This study examined experiences during the cessation of fertility treatment due to the COVID-19 pandemic, including levels of mental health, coping strategies used to manage uncertainty about treatment due to the pandemic, sources of support, and predictors of mental health. METHODS: One hundred and seventy-five participants in the UK completed an online survey. RESULTS: Half of the participants experienced clinical levels of anxiety and/or depression, and 20% reported suicidal feelings as a result of the uncertainty about treatment due to the pandemic. Support from friends, family and online forums were reported by more than half of participants, but support from fertility clinics or counsellors were reported by less than one quarter. The strategy used most frequently to cope with the uncertainty about treatment due to the pandemic was self-distraction, and this predicted reduced depression. However, self-blame, behavioral disengagement and venting predicted increased depression and self-blame, behavioral disengagement, and denial predicted increased anxiety. CONCLUSIONS: Fertility clinic communication and psychological support, such as counselling, which had substantially reduced during treatment cessation, could include some focus on personal coping, including what to avoid. Psychological support is likely to be more important now than ever. Despite resumption of treatment, the impacts of the period of cessation and of COVID-19 are likely to continue to reverberate.

Reiki practitioners' perceptions of the impact of the COVID-19 pandemic on the experience, practice and future of Reiki.

OBJECTIVES: This study examined the impact of the COVID-19 pandemic on the experience, practice and future of Reiki in the UK, including the personal impact of the pandemic on practitioners and their work, practitioner perceptions of the future of the profession and Reiki delivery, and practitioner experiences and views of distant Reiki in comparison to hands on or near the body treatments. METHOD: A qualitative study using semi-structured interviews was carried out with 10 Reiki practitioners. Interviews were recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Three themes were identified: adapting and growing with the challenges of COVID-19, Reiki for individual and community resilience, and moving from the mainstream hands on to lesser known distant Reiki. CONCLUSION: While the COVID-19 pandemic personally impacted Reiki practitioners, they focused on turning adversity into opportunity, to overcome a sense of disconnectedness and social isolation, by providing social support and promoting individual and community resilience. Practitioners focused on self-care, personal development and reaching out to the community. Personal Protective Equipment was perceived as necessary for infection control but a potential barrier to the client's experience of Reiki. They saw value in adapting their practice as part of the future of the profession by utilising new technology and distant Reiki healing, but were clear this could not replace in person contact.

Experiences of involuntary childlessness and treatment in the UK: what has changed in 20 years?

This study examined the financial, emotional and relationship impacts of involuntary childlessness and treatment, and the satisfaction with support from professionals. 796 participants in the UK completed an online survey based on a similar survey conducted in 1997. 55% of participants had to pay for at least part of their treatment. High levels of distress were experienced and 42% experienced suicidal feelings at least occasionally. Those most at risk of distress and suicidal feelings had experienced unsuccessful treatment outcomes, spent longer trying to conceive and reported some relationship strains. While 75% would like to have received counselling if it had been free, 45% only received such counselling and 54% of these had to fund some of it themselves. Although advances have been made in improving the availability of funded treatment and psychological support, involuntary childlessness and treatment continue to have financial, emotional and relationship consequences for many people. While counselling was generally reported to be useful, an approach involving all fertility clinic staff in the psychosocial care of clients is advisable.

Do-It-Yourself (DIY) Artificial Pancreas Systems for Type 1 Diabetes: Perspectives of Two Adult Users, Parent of a User and Healthcare Professionals.

The artificial pancreas system or an automated insulin dosing system has been the 'holy grail' for patients with type 1 diabetes and their caregivers who have over the years wanted to 'close the loop' between monitoring of glucose and delivery of insulin. The launch of the Medtronic MiniMed 670G system in 2017 and the subsequent release of the Tandem t:slim with Control-IQ system, the DANA RS pump compatible-CamAPS FX app and the more recent announcement of the Medtronic MiniMed 780G system have come as answers to their prayers. However, in the time taken to develop and launch these commercial systems, creative and ebullient parents of young patients with type 1 diabetes, along with other patients, technologists and healthcare professionals have developed mathematical models as software solutions to determine insulin delivery that in conjunction with compatible hardware have helped 'close the loop'. Under an umbrella movement #WeAreNotWaiting, they have, as a community, refined and disseminated technologies that are open source and ubiquitously available as do-it-yourself (DIY) closed-loop systems or DIY artificial pancreas systems (APS). There are presently three systems-OpenAPS, AndroidAPS and Loop. We present perspectives of two patients, parent of a patient, and their healthcare providers; the users spanning an age spectrum most likely to use this technology-a child, an adolescent in transitional care and a 31-yr old adult patient, highlighting how looping has helped them self-manage diabetes within the routine of their lives and the challenges they faced.

Resilience, stress and burnout in student midwives.

BACKGROUND: There is a lack of research on resilience in midwifery, yet this may be a factor that can help prevent burnout and intention to leave the profession. OBJECTIVES: To explore the relationship between perceived stress, resilience and burnout and the intention to leave midwifery within Midwifery students. DESIGN: A Quantitative study with a cross-sectional survey design. SETTING: A London University in the UK. PARTICIPANTS: 150 BSc student midwives, aged between 18 and 44, studying at University participated in this study. This included 72 students in year one, 26 in year two and 52 in year three. METHODS: Participants completed the Perceived Stress Scale, the Oldenburg Burnout Inventory and the Resilience Scale-14 to examine their self-reported stress levels, burnout (emotional exhaustion and disengagement) and level of resilience. Intentions to quit the profession were also measured. RESULTS: All variables were significantly correlated but in multiple regression analyses only stress predicted disengagement, and stress and year of study predicted emotional exhaustion. High stress and reduced resilience predicted intentions to quit midwifery. Resilience did not act as a moderator. Thus the findings suggest that resilience did not protect students from high levels of stress leading to burnout or wanting to quit, although resilience did help to reduce intentions to quit. CONCLUSION: Student stress levels are not moderated by resilience and resilience played no role in reducing burnout. However, resilience may help students to persevere in the profession rather than leaving their studies. In order to minimise burnout and stress we need to consider alternative ways of enhancing the current workforce to reduce the decline in midwives entering the profession.

Experiences and psychological distress of fertility treatment and employment.

Purpose: This study examined experiences and psychological distress about fertility treatment in people combining work and treatment. Methods: Five hundred and sixty-three participants in the UK completed an online survey asking about difficulties in combining work and treatment; workplace disclosure, support, absence and policy; and psychological distress about treatment. Results: Absence from work and perceptions that treatment has an impact on work and career prospects were reported by the majority of participants and this was related to the psychological distress of treatment. Around three quarters of participants disclosed to their employer and colleagues. The key reason for disclosure was needing to ask for absence from work and the main reason for non-disclosure was privacy. Workplace policy relating to managing fertility treatment and support from colleagues and their employer was related to reduced psychological distress but workplace policy was reported by less than one quarter of participants. Conclusion: Difficulties experienced in combining work and treatment suggest that support is needed. Specific workplace policy, guidance for supervisors and flexibility in fertility clinic times should help support employees during treatment and reduce psychological distress, thereby potentially influencing physical health and treatment outcomes.

Healthy eating beliefs and intentions of mothers and their adult children: An intergenerational transmission perspective.

This study examined the possible intergenerational transmission of eating beliefs and intentions between 60 mothers and their adult children. Maternal restrictive feeding practices were correlated with mothers' own healthy eating attitudes and subjective norms, and with their adult children's subjective norms. Mothers' beliefs and intentions were correlated with their adult children. Adult children's intentions to eat healthily were predicted by their attitudes and perceived behavioural control, and also by their mothers' intentions and perceived behavioural control. Mothers' own beliefs and intentions may be involved in shaping their children's beliefs and intentions into adulthood but their child feeding practices may have less of an influence.

Assessing the quality of life of children with sickle cell anaemia using self-, parent-proxy, and health care professional-proxy reports.

OBJECTIVES: The quality of life (QoL) of children with sickle cell anaemia (SCA) in the United Kingdom has not been examined, and a discrepancy measure based on Gap theory has rarely been used. This study investigated whether (1) child self-reports of QoL using a discrepancy measure (the Generic Children's QoL Measure; GCQ) are lower than those from healthy children, (2) proxy reports from parents and health care professionals are lower than child self-reports, and (3) demographic and disease severity indicators are related to QoL. DESIGN AND METHODS: An interdependent groups, cross-sectional design was implemented. Seventy-four children with SCA, their parent, and members of their health care team completed the GCQ. Demographic and disease severity indicators were recorded. GCQ data from healthy children were obtained from the UK Data Archive. RESULTS: Contrary to past research, when examining generic discrepancy QoL, children with SCA did not report a lower QoL than healthy children, and parent- and health care professional-proxy reports were not lower than child self-reports. Few of the demographic and disease severity indicators were related to QoL. CONCLUSIONS: Proxy reports may be used to gain a more complete picture of QoL, but should not be a substitute for self-reports. The explanation for the relatively high levels of QoL reported is not clear, but children with SCA may have realistic expectations about their ideal-self, place greater emphasis on aspects other than health in shaping their QoL, and define achievements within the limits of their illness. Future research should focus on psychological factors in explaining QoL. Statement of contribution What is already known on this subject? Children with sickle cell disease (SCD) generally have a reduced QoL compared with healthy children, but there appears to be no research measuring QoL in paediatric SCD in the United Kingdom. Proxy QoL reports from parents are often lower than child self-reports, but there is less research examining proxy reports from health care professionals. Previous research has measured paediatric QoL using measures of current health-related QoL, but this is not in line with the WHO's definition of QoL as the discrepancy between current state and expectations. What does this study add? Children with Sickle cell anaemia do not have an impaired discrepancy QoL; they may have realistic expectations about their ideal-self and define achievements within the limits of their illness. Health care professionals are able to gauge a SCA child's discrepancy QoL better than parents. The GCQ (a generic discrepancy measure of QoL) takes into account expectations about ideal QoL and does not emphasize health; it may be of use to Psychologists working with SCA children.

Employees' perceptions of the impact of work on health behaviours.

Research examining the impact of work on health behaviours has rarely provided a complete picture of the impact across health behaviours. Twenty-four employees were interviewed about their smoking, drinking, exercise and eating. Themes included the impact of the work environment, including policy, convenience and workplace cultural norms; business events effecting one's routine and again convenience and workplace cultural norms; being busy at work effecting time and energy for healthy behaviour; and work stress leading to health behaviours being used as coping responses on bad and good days. The impact of work is similar across health behaviours and is primarily detrimental.

A daily diary investigation of the impact of work stress on exercise intention realisation: can planning overcome the disruptive influence of work?

Using the theoretical context of the Theory of Planned Behaviour, this study examined whether work has a disruptive influence on people's ability to carry out their daily intentions to exercise, and whether daily planning helps overcome this. A daily questionnaire was completed by 42 employees for 14 days. A brief daily planning intervention was administered to half of the employees. Multilevel modelling was used to analyse the data. The moderating effects of daily perceived behavioural control (PBC), job demands and work-related anxiety and depression on the relationship between intention to exercise and subsequent behaviour were investigated, as well as the impact of the intervention. Intention and PBC predicted exercise. Job demands appeared to disrupt people's ability to carry out their daily exercise intentions. Contrary to expectation, people in the no intervention group were more likely to exercise. Furthermore, on low-demand days they were most successful in realising their exercise intentions (when they intended to exercise for longer), whereas people in the intervention group, on high-demand days were least successful in realising their exercise intentions. The intervention may have operated contrary to expectation by drawing attention to potential failure.

Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial.

The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data. The reports rated provider performance in asking, advising, assessing, and assisting with tobacco cessation compared with a clinic average and an achievable benchmark of care. During 12 months of follow-up, EHR-documented rates of advising, assessing, and assisting were significantly improved in the intervention clinics compared with the control clinics (p<.001). A higher case-mix index and presence of a clinic champion were associated with higher rates of referral to a state-level quitline. EHR-generated provider feedback improved documentation of assistance with tobacco cessation. Connecting physician offices to a state-level quitline was feasible and well accepted.

Increased sensitivity to warfarin after heart valve replacement.

BACKGROUND: The dosage requirement of warfarin to achieve a given international normalized ratio (INR) often varies considerably between the immediate postoperative period and long-term follow-up in patients with prosthetic heart valves, leading to INR instability. OBJECTIVE: To document the extent of warfarin sensitivity in a prospective study of patients receiving heart valve replacements. METHODS: Clinical and laboratory data regarding anticoagulation for 111 patients who received warfarin following heart valve replacement were collected during their hospital stay (induction period) and between 1 and 3 months after surgery (follow-up period). RESULTS: Mean patient age was 65.39 +/- 10.55 years (range 29-85), with 66 men. The mean INR value during the follow-up period was, on average, 0.21 higher than the induction period (2.81 +/- 0.5 vs 2.6 +/- 0.6; p = 0.007). The mean follow-up warfarin dose was 1.54 mg higher than the mean induction warfarin dose (5.09 +/- 2.03 vs 3.55 +/- 1.94 mg; p < 0.001). The warfarin dose index, which indicates relative sensitivity of warfarin, decreased from 1.16 to 0.65 (p < 0.001). Although the INR values during the induction and follow-up periods were similar, the dose requirement in the follow-up period was, on average, 43% higher than that of the induction period. CONCLUSIONS: Immediately after heart valve replacement, patients are more sensitive to warfarin and should receive a lower warfarin dose during the initial phase of oral anticoagulation treatment. This enhanced sensitivity decreases with time. Patients require frequent monitoring and are likely to need an increase in the warfarin dose to avoid insufficient anticoagulation during the early follow-up period.

Regional response of myocardial acceleration during isovolumic contraction during dobutamine stress echocardiography: a color tissue Doppler study and comparison with angiocardiographic findings.

BACKGROUND: Color tissue Doppler imaging permits noninvasive quantitation of regional wall motion. In experimental studies, a new marker, the slope of the isovolumic contraction wave, isovolumic acceleration (IVA) was more insensitive to ventricular loading conditions than myocardial velocities. This study compared the regional response IVA to dobutamine stress echocardiography to angiographic findings. METHODS: The Myocardial Doppler in Stress Echocardiography (MYDISE) study prospectively recruited 149 consecutive patients with chest pain for dobutamine stress tissue Doppler echocardiography prior to coronary angiography. This color tissue Doppler database was analyzed for IVA in 1,192 basal and mid segments at rest and again at peak stress. Angiographic findings were compared to IVA and peak systolic velocities (PSV) in corresponding cardiac segments. The diagnostic accuracy of IVA to predict coronary artery stenosis was determined using cut-off values for three representative segments and with the MYDISE diagnostic model including eight segments. RESULTS: Regional IVA increased in a dose-dependent manner during dobutamine infusion. The response was blunted in the supply territory of stenosed coronary artery branches. IVA performed slightly better than PSV as single marker for coronary artery stenosis. A diagnostic model incorporating IVA and PSV was 85-95% accurate (area under receiver operating characterstic curves). CONCLUSIONS: Regional changes of isovolumic acceleration during dobutamine stress echocardiography reflect regional wall motion and can be used to predict coronary artery stenosis with similar accuracy as a model based on systolic myocardial velocities. As a single marker, IVA performed better than myocardial velocities.

The impact of job strain on the predictive validity of the theory of planned behaviour: an investigation of exercise and healthy eating.

OBJECTIVES: This study examined the impact of the job strain model on exercise and healthy eating within the framework of the Theory of Planned Behaviour. DESIGN: Participants completed a questionnaire measuring the components of the Theory of Planned Behaviour and the job strain model. A follow-up questionnaire a week later measured behaviour. METHOD: The questionnaires were completed by e-mail. The initial questionnaire was completed by 331 employees, and 286 follow-up questionnaires were returned. RESULTS: Job demands affected exercise indirectly by lowering perceptions of behavioural control over exercise. However, variables from the job strain model were not related to exercise intentions or behaviour. In contrast, employees in passive jobs intended to eat more sweets and snack foods and employees in low strain jobs were more likely to realize their intentions to eat more sweets and snack foods. However, variables from the job strain model did not influence consumption of fruit and vegetables. CONCLUSIONS: While people may consider the impact of job strain on exercise whilst making decisions about whether or not to exercise, job strain has a more direct impact on healthy eating. However, job strain may only affect consumption of so-called 'high density' foods, rather than foods such as fruit and vegetables.

The role of perceived need within the theory of planned behaviour: a comparison of exercise and healthy eating.

OBJECTIVES: This study examined the effect of perceived need on exercise and healthy eating using the theory of planned behaviour (TPB). In addition, it investigated the determinants of perceived need. METHOD: Participants completed a questionnaire measuring components of TPB and perceived need. A follow-up questionnaire 1 week later measured behaviour. The questionnaires were completed by e-mail. The initial questionnaire was completed by 331 adults, and 286 follow-up questionnaires were returned. RESULTS: Perceived behavioural control was the main predictor of exercise intention and affective attitude was the main predictor of healthy eating intention. Perceived need significantly contributed to the prediction of healthy eating intention but not to exercise intention. Intention and perceived behavioural control predicted actual behaviour but perceived need did not. Reasons reported for the perception of needing to engage in both behaviours mainly focused on physical health and weight control. CONCLUSIONS: Reasons reported for low perceived need suggest that the concept of perceived need may be rather ambiguous, particularly in the case of exercise. Therefore, further research is needed to elucidate the role of perceived need in relation to a variety of health behaviours.

Impact of educational mailing on the blood pressure of primary care patients with mild hypertension.

OBJECTIVE: To assess the effectiveness of mailed hypertension educational materials. DESIGN: Prospective, randomized, controlled single-blind trial. SETTING: Primary care practice-based research network in which 9 clinics located in Portland, Oregon participated. PARTICIPANTS: Patients with mildly uncontrolled hypertension as defined as a last blood pressure of 140 to 159/90 to 99 mmHg from query of an electronic medical record database. INTERVENTIONS: Patients randomized to intervention were mailed 2 educational packets approximately 3 months apart. The first mailer included a letter from each patient's primary care provider. The mailer included a booklet providing an overview of hypertension and lifestyle modification and a refrigerator magnet noting target blood pressure. The second mailing also included a letter from the patient's primary care provider, a second educational booklet focused on medication compliance and home blood pressure monitoring, and a blood pressure logbook. The control group consisted of similar patients receiving usual care for hypertension. MEASUREMENTS AND MAIN RESULTS: Patients from each group were randomly selected for invitation to participate in a study visit to measure blood pressure and complete a survey (intervention n= 162; control n= 150). No significant difference was found in mean blood pressure between intervention and control patients (135/77 mmHg vs 137/77 mmHg; P=.229). Patients in the intervention arm scored higher on a hypertension knowledge quiz (7.48 +/- 1.6 vs 7.06 +/- 1.6; P=.019), and reported higher satisfaction with several aspects of their care. No significant difference was seen in the prevalence of home blood pressure monitoring ownership or use. CONCLUSIONS: In patients with mildly uncontrolled hypertension, educational mailers did not yield a significant decrease in blood pressure. However, significant improvement in patient knowledge, frequency of home monitoring, and satisfaction with care were demonstrated.