The mediating role of sleep quality in the relationship between dispositional mindfulness and fatigue in Chinese nurses during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 epidemic in China, clinical nurses are at an elevated risk of suffering fatigue. This research sought to investigate the correlation between dispositional mindfulness and fatigue among nurses, as well as the potential mediation role of sleep quality in this relationship. METHODS: This online cross-sectional survey was performed from August to September 2022 to collect data from 2143 Chinese nurses after the re-emergence of COVID-19. The significance of the mediation effect was determined through a bootstrap approach with SPSS PROCESS macro. RESULTS: Higher levels of dispositional mindfulness were significantly negatively related to fatigue (r = -0.518, P < 0.001) and sleep disturbance (r = -0.344, P < 0.001). Besides, insufficient sleep was associated with fatigue (r = 0.547, P < 0.001). Analyses of mediation revealed that sleep quality mediated the correlation of dispositional mindfulness to fatigue (ß = -0.137, 95% Confidence Interval = [-0.156, -0.120]). CONCLUSIONS: In the post-COVID-19 pandemic era, Chinese nurses' dispositional awareness was related to the reduction of fatigue, which was mediated by sleep quality. Intervention strategies and measures should be adapted to improve dispositional mindfulness and sleep quality to reduce fatigue in nurses during the pandemic.

Association Between Obesity and Post-stroke Anxiety in Patients With Acute Ischemic Stroke.

Post-stroke anxiety (PSA) is serious psychosomatic comorbidity among patients with stroke, but whether obesity could be positively associated with PSA is currently unknown. The purpose of this study was to investigate the potential association between obesity and subsequent anxiety risk in patients with stroke. A total of 441 patients with acute ischemic stroke (AIS) onset were consecutively recruited within 7 days, and PSA and post-stroke depression (PSD) were evaluated by using a 14-item Hamilton anxiety scale (HAMA) and 17-item Hamilton depression scale (HAMD) at the end of 1-month follow-up. The odds ratio (OR) with 95% CI was estimated for the incidental PSA by using logistic regression analysis. The incidence of PSA was 25.85% at the end of 1-month follow-up, with a significant difference between patients with and without abdominal obesity. Relative fat mass (RFM) and abdominal obesity were significantly associated with an elevated risk of PSA, and the crude ORs were 1.04 (95% CI: 1.01-1.08) and 1.93 (95% CI: 1.11-3.34), respectively. Even after adjustment for obesity-related risk factors and PSA-related clinical measurements, the association remained to be pronounced with abdominal obesity. However, RFM (OR = 1.03, 95% CI: 0.99-1.06, P = 0.053) and abdominal obesity (OR = 1.31, 95% CI: 0.80-2.15, P = 0.280) were not significantly associated with an elevated risk of PSD. Abdominal obesity was independently associated with the PSA instead of PSD, which may help predict PSA risk in clinical practice. Further prospective clinical studies with a long follow-up duration are warranted to verify this finding.

Low vitamin D levels and the long-term functional outcome of stroke up to 5 years.

BACKGROUND AND PURPOSE: Previous studies have established that vitamin D was associated with stroke. The purpose of this study was to investigate the relationship between vitamin D and 5-year outcome of patients with stroke including acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) stroke. METHODS: Serum 25-hydroxyvitamin D levels were prospectively analyzed in patients admitted to the First Affiliated Hospital of Wenzhou Medical University from 2013 to 2015. Modified Rankin scale (mRS) was used to evaluate their 5-year functional outcome, and univariate and multivariate logistic regressions were applied to evaluate the effects of vitamin D on stroke outcome. RESULTS: In total, 668 patients diagnosed with stroke were recruited, and 420 completed the 5-year follow-up. Ninety-five patients experienced poor outcome in the 5 years since stroke onset. Vitamin D levels in patients with poor outcome showed significant differences compared to good outcome patients (p < .001). In multivariable logistic regression analysis, after adjusting the potential confounders, the 5-year functional outcome was significantly associated with vitamin D levels. Stroke patients with vitamin D levels less than 38.4 nmol/L had a higher risk for poor outcome compared with those with vitamin D level over 71.4 nmol/L at 5-year (odds ratio [OR] = 3.66, 95% confidence interval [CI] = 1.42-9.45, p = .007), which was consistent with AIS patients (OR = 6.36, 95% CI = 1.89-21.44, p = .003). CONCLUSION: Vitamin D level less than 38.4 nmol/L at admission is a potential risk biomarker for poor functional outcome at 5-year prognosis in AIS patients, which might provide new ideas for the prognostic assessment of stroke.

Prediabetes is associated with poor functional outcome in patients with intracerebral hemorrhage.

INTRODUCTION: The association between prediabetes and functional outcome in cerebrovascular diseases is controversial. No study has explored the relationship between prediabetes and functional outcome in intracerebral hemorrhage patients. Our study aimed to explore the association between prediabetes and functional outcome in intracerebral hemorrhage patients 1 month poststroke. METHODS: One hundred and fifty intracerebral hemorrhage patients were consecutively recruited within the first 24 hr after admission and were followed up for 1 month. Patients were divided into a diabetes mellitus group, a prediabetes group, and a nondiabetic group by fasting glucose levels, 2-hr postprandial blood glucose levels, and glycosylated hemoglobin levels. Patients with modified Rankin Scale scores >2 at 1 month were defined as having a poor functional outcome. RESULTS: The prediabetes group had a higher risk of poor functional outcome than the nondiabetic group in intracerebral hemorrhage patients (37.9% vs. 9.8%, χ2  = 11.521, p = .001). According to the logistic regression analyses, prediabetes was associated with a poor functional outcome in intracerebral hemorrhage patients after adjusting for confounding factors (odds ratio = 6.167, 95% confidence interval = 1.403-27.102, p = .016). CONCLUSIONS: Our findings show that prediabetes is associated with a poor functional outcome in intracerebral hemorrhage patients 1 month poststroke.

The effect of night shift on sleep quality and depressive symptoms among Chinese nurses.

PURPOSE: Night shift is associated with adverse physical and psychological health outcomes such as poor sleep quality and depressive symptoms. We aimed to compare sleep quality as well as depressive symptoms in nurses working night shifts to those working day shifts only and explore the association between sleep quality and depressive symptoms among nurses. PATIENTS AND METHODS: Eight hundred sixty-five nurses were enrolled in the current study. Sleep quality and depressive symptoms among nurses were evaluated by the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depressive Disorders Rating Scale (HADS), respectively. RESULTS: PSQI and HADS scores were both significantly higher in the nurses working night shifts (P<0.05) than in those working day shifts only. Besides, there was a positive correlation between PSQI and HADS scores. Binary logistic regression showed that night shift and poor sleep quality were independent risk factors of depressive symptoms among nurses. CONCLUSION: Higher rates of depression among Chinese nurses working night shifts may be associated with poor sleep quality induced by night shift.

High platelet-to-lymphocyte ratio are associated with post-stroke depression.

BACKGROUND: Post-stroke depression (PSD) is the most common psychological consequence among stroke patients, and inflammatory cytokines have cited as risk factors in PSD. We aimed to evaluate the predictive value of stratification of PLR (platelet-to-lymphocyte ratio), an inflammatory marker, in PSD patients. METHODS: A total of 363 acute ischemic stroke (AIS) patients were screened in the study and received 1-month follow-up. All of the patients were categorized into equal tertiles according to the number of patients and the distribution of PLR. PSD status was evaluated by 17-item Hamilton Depression Rating Scale at 1 month after stroke RESULTS: The optimal cut-off points of PLR were: (T1) 42.15-99.60, (T2) 99.72-127.92, (T3) 127.93-259.84. A total of 77 patients (21.2%) were diagnosed with PSD at 1-month follow-up. Significant differences were found between the PSD and non-PSD groups in PLR tertiles of patients (P < 0.001). After adjustment for conventional confounding factors, the odds ratio of PSD was 5.154 (95% CI, 1.933-13.739) for the highest tertile of PLR compared with the lowest tertile. In multiple-adjusted spline regression, continuously PLR showed linear relation with PSD risk after 95 (P < 0.001 for linearity). LIMITATIONS: We excluded patients with severe aphasia or serious conditions. In addition, the PLR was recorded only at admission, which limited us explore the correlation of the change of PLR over time with PSD CONCLUSIONS: Increased PLR at admission is a significant and independent biomarker to predict the development of PSD, and stratified PLR could strengthen the predictive power for PSD patients.