Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study.

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries.

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Effectiveness of Initiating Deep Vein Thrombosis Prophylaxis in Patients With Stroke: An Integrative Review.

Venous thromboembolism (VTE) is a frequent and potentially fatal complication of immobility caused by cerebrovascular disease. This review examines the efficiency of deep vein thrombosis (DVT) prophylaxis methods. Patients with stroke initiated on DVT prophylaxis were compared with those who did not have any prophylaxis. Integrative review research design was used and included articles from 2010 to 2016. Search terms such as "DVT prophylaxis" and "stroke" were used to identify scientific publications. Of 173 studies identified, 12 articles were included and rated using the Canadian Medical Association and Center for Evidence-Based Medicine Level of Evidence ranking system. Of DVT prophylaxis methods identified, intermittent pneumatic compression device was superior to antiembolic stockings. Current data showed that the stockings were insufficient in preventing VTE. Heparin and low-molecular-weight heparin were efficient chemoprophylaxis in reducing the incidence of VTE. The combination of chemical and mechanical DVT prevention is recommended.

Assessment of health care needs of older persons with type 2 diabetes mellitus

The global prevalence of diabetes by 2030 estimated an increase in number of people with diabetes. People who are 64 years of age will be 82 million in developing countries and 48 million in developed countries. The study aimed to assess the health care needs of older persons' physical, cognitive, functional and self-care abilities and determine relationship of these to their profiles. These assessments are the bases in designing modules for Diabetes Self-Management Education training module for Diabetes Educators. A descriptive correlational design was utilized to assess the health care needs of 100 young older persons. The Filipino Activities of Daily Living (Fil-ADL) and the Filipino Instrumental Activities of Daily living were utilized to assess the functional status of the older persons. The Montreal Cognitive Assessment (MOCA-P) and cognitive function exams were used to assess cognitive status while Mini- Nutritional Assessment (MNA) was used to assess nutritional status of the older persons. The Self-Care Inventory Revised (Sci-R) was used to assess self-care behaviors of older persons to diabetes management. Frequency and percentage were used to describe the health care needs of older persons, while mean and standard deviation were used in assessing knowledge and self-care abilities. Chisquare test for Association was utilized to determine relationship of the health care needs and the profile of the respondents. Study shows that most of the older persons are female, 66-70 years old, married and had primary education. The older persons' knowledge in diabetes is satisfactory, had a normal nutritional status, was functional in daily living activities (ADL), was functional in their instrumental activities of daily living (IADL), was normal of their cognitive status, and sometimes perform self-care abilities to diabetes management. There is significant relationship between knowledge, civil status and history of diabetes. Nutrition and cognitive status had significant relationship to their civil status, education and history of diabetes. The functional status of the older persons has significant relationship with history of diabetes. It is necessary to include the culture-based health care needs of older persons and to consider demography such as education and history of diabetes in designing the training module for diabetes educators.

Pressure ulcer prevention in acute care using the pressure ulcer bundle of care

@#<p style="text-align: justify;">A study was conducted to determine the effectiveness of the pressure ulcer bundle of care (PUB) in preventing pressure ulcers among patients in acute care. The pre and post-test quasi-experimental design was utilized to predict a model of preventing pressure ulcer in acute care setting. Thirty acute care patients with moderate risk for pressure ulcers were randomly selected to receive the following five PUB interventions: assessment of pressure ulcer risk, repositioning, head elevation, heel elevation, and frequent diet monitoring. Pressure ulcer risk was assessed using the Braden risk assessment scale before and after PUB interventions. This scale assesses important aspects of ulcer formation according to six subscales: sensory perception, moisture, mobility, physical activity, nutrition, and friction/shear. Profile of the patients according to age, sex, and length of hospital stay was described using frequency and percentage distribution. Bundle compliance, as measured by performance of the five interventions was described using mean scores and standard deviations. The t-test was used to determine the differences in pressure ulcer risk or occurrence between pre- and post-intervention phases. Multiple linear regression analysis was used to determine the relationship of Pressure Ulcer Risk Assessment  Scores (PURAS) to the PUB, and to identify the predictor(s)  of PURAS among the four interventions in the PUB. Statistical significance was considered at the .05 level. Pressure ulcer risk scores of patients improved significantly from "mild risk" to "not a risk" post-PUB (p=<0.001). Head elevation, heel elevation, and diet monitoring were found to be predictors of pressure ulcer risk scores after PUB interventions. Repositioning was not significantly associated with pressure ulcer risk scores of patients after PUB interventions. The three predictor model revealed the PUB interventions were able to account for 52% of the variance in pressure ulcer risk scores, which indicates a strong significant relationship between patients receiving PUB and their improvement in pressure ulcer risk. In conclusion, the pressure ulcer bundle of care intervention is effective in prevention of pressure ulcers in patients at risk. Nurses should adopt the provision of bundle of care intervention(s) to enhance patient safety and quality of care.</p>

Level of awareness and compliance in diabetes mellitus management among adolescents diagnosed with type-1 diabetes

@#<p style="text-align: justify;">The study aimed to determine the level of awareness and to assess compliance to Diabetes management of adolescents diagnosed with Type-1 Diabetes. A descriptive correlational type of research was utilized to gather information on the level of awareness and compliance of adolescents patients to diet, exercise and drug management suffering from Type-1 diabetes mellitus. The patients (n=20) were recruited from Institute for Studies on Diabetes Foundation Incorporated, Philippines. A purposive sampling was utilized to select twenty adolescents. A researcher-made questionnaire was utilized as the main instrument in gathering data. Focus group discussion was also done to further assess patient's level of awareness and compliance to diabetes management. Results showed that patients have a moderate level of awareness and some extent of compliance to diabetes. Patients have extreme awareness in diet management and moderate awareness in exercise and drug management. In terms of compliance, patients are compliant to some extent only, while drug management has the highest highest level of compliance, followed by exercise and diet. There is a low correlation between level of awareness and compliance in diabetes management (r=.32 p=0.15), indicating that the moderate level of awareness of patients to DM management is not related to their compliance. The results are limited only to the participants of the study. Further study using a larger population and different setting is recommended. Nurses taking care of adolescent patients with diabetes mellitus must understand the importance of health education. Health educations are valuable to increase level of awareness and extent of compliance of adolescents patients with Type-1 diabetes.</p>