Relationship between comorbidity and health outcomes in patients with heart failure: a systematic review and meta-analysis.

BACKGROUND: The prevalence of heart failure (HF) is expected to rise due to increased survivorship and life expectancy of patients with acute heart conditions. Patients with HF and other multiple comorbid conditions are likely to have poor health outcomes. This study aimed to assimilate the current body of knowledge and to provide the pooled effect of HF patients' comorbid conditions on health outcomes. METHODS: A systematic search was performed using MEDLINE, EMBASE and CINAHL databases. Observational studies evaluating the relationship between comorbid conditions and the health outcomes of HF were included. The pooled effect sizes of comorbidity on the identified health outcomes were calculated using a random effects model, and the heterogeneity was evaluated using I2 statistics. RESULTS: A total of 42 studies were included in this review, and a meta-analysis was performed using the results of 39 studies. In the pooled analysis, the presence of a comorbid condition showed a significant pooled effect size in relation to the prognostic health outcomes: all-cause mortality (HR 1.31; 95% CI 1.18, 1.45), all-cause readmission (HR 1.16; 95% CI 1.09, 1.23), HF-related readmission (HR 1.13; 95% CI 1.05, 1.23), and non-HF-related readmission (HR 1.17; 95% CI 1.07, 1.27). Also, comorbidity was significantly associated with health-related quality of life and self-care confidence. Furthermore, we identified a total of 32 comorbid conditions from included studies. From these, 16 individual conditions were included in the meta-analyses, and we identified 10 comorbid conditions to have negative effects on overall prognostic outcomes: DM (HR 1.16, 95% CI 1.11, 1.22), COPD (HR 1.31, 95% CI 1.23, 1.39), CKD (HR 1.18, 95% CI 1.14, 1.23, stroke (HR 1.25, 95% CI 1.17, 1.31), IHD (HR 1.17, 95% CI 1.11, 1.23), anemia (HR 1.42, 95% CI 1.14, 1.78), cancer (HR 1.17, 95% CI 1.04, 1.32), atrial fibrillation (HR 1.25, 95% CI 1.01, 1.54), dementia (HR 1.19, 95% CI 1.03, 1.36) and depression (HR 1.17, 95% CI 1.04, 1.31). CONCLUSIONS: Comorbid conditions have significantly negative pooled effects on HF patient health outcomes, especially in regard to the prognostic health outcomes. Clinicians should carefully identify and manage these conditions when implementing HF interventions to improve prognostic outcomes.

The Influence of Gender Equity in Nursing Education Programs on Nurse Job Satisfaction.

(1) Background: One of the strategies to overcome the shortage of nurses is to minimize gender inequity in nursing culture, starting from the undergraduate education program. Although the number of men entering the nursing profession has increased over the years, the portion of male nurses remains low, particularly in Asian countries. Only a few studies have been conducted to identify gender inequity in nursing, and most of these studies used qualitative study design. Therefore, it is necessary to quantitatively identify gender equity in nursing education and the influence it has on nurse job satisfaction. (2) Methods: A total of 165 male nurses participated in this study. Validated questionnaires were used to assess gender equity in nursing education programs, nurse job satisfaction, nurse job esteem, and nursing professional pride. (3) Results: The mean score of gender equity in nursing programs was 62.6, showing a positive correlation with nurse job satisfaction, nurse job esteem, and nursing professional pride. Gender equity positively predicted nurse job esteem. (4) Conclusions: The gender equity in nursing education programs has positive predictive effects on the factors that influence male nurse job satisfaction. In order to increase nurse job retention, educators should incorporate strategies to minimize gender inequity.

Psychometric Evaluation of the Korean Version of Control Attitudes Scale-Revised.

BACKGROUND: Heart failure (HF) is a chronic heart condition that requires patients to adapt to the disease and maintain a high degree of self-management. Patients with HF commonly feel loss of control, which has a negative effect on their compliance to self-care, health-related quality of life, and health outcomes. To promote self-care behavior and to develop healthy coping mechanisms, it is important to understand individual HF patients' perceived control, a self-generated belief that one has the ability to bring forth desired outcomes. Currently, there is no valid and reliable Korean instrument available in measuring perceived control among patients with HF. OBJECTIVE: The objective of this study was to cross-culturally translate, adapt, and evaluate psychometric properties of the Korean version of Control Attitudes Scale-Revised (KCAS-R) in Korean patients with HF. METHODS: The KCAS-R was developed using a translation/back-translation process and an examination of semantic and conceptual equivalence. Reliability was assessed using Cronbach α to determine internal consistency, and item-total and interitem correlations were assessed to test item homogeneity. The construct validity was examined using exploratory factor analysis, confirmatory factor analysis, and testing hypotheses for known associations with self-efficacy, self-care confidence, and self-care. RESULTS: A convenience sample of 138 patients with HF were included for the psychometric testing of an 8-item KCAS-R. The Cronbach α for internal consistency was 0.835, and the item-total correlation was acceptable. The construct validity revealed a 2-factor structure accounting for 63.23% of the total variance. The KCAS-R was associated with higher levels of self-efficacy, self-care confidence, and self-care. In addition, patients with higher perceived control had less depression and anxiety compared with those with lower levels of perceived control. CONCLUSION: This study provided support for the satisfactory reliability and validity of the 8-item KCAS-R in measuring perceived control in Korean patients with HF.

Preditores de maus-tratos ao idoso relacionados a idosos e a seus cuidadores primários / Predictores de malos tratos a personas mayores relacionados con las personas mayores y sus cuidadores principales / Predictors for elder mistreatment related to older adults and their primary caregivers

Resumo Objetivos Identificar fatores preditivos de maus-tratos ao idoso relacionados a idosos e seus principais cuidadores e a relação entre formação profissional de saúde e identificação de maus-tratos. Métodos Estudo quantitativo e analítico. Os potenciais fatores de risco para maus-tratos relacionados a 40 idosos e seus cuidadores foram coletados por meio da observação de 12 profissionais de saúde e em uma associação de enfermeiras visitantes. O treinamento de profissionais de saúde na identificação de maus-tratos foi investigado. Estatística descritiva, teste exato de Fisher e análise de regressão linear múltipla foram usados para investigar as relações entre a ocorrência de maus-tratos ao idoso e fatores de risco relacionados ao idoso e ao cuidador, e os fatores preditivos para maus-tratos ao idoso. Resultados A dependência dos idosos em relação aos cuidadores e as condições crônicas de saúde dos cuidadores principais foram preditores de maus-tratos ao idoso. Os fatores de risco apresentados pelos cuidadores primários tendiam a afetar mais os maus-tratos ao idoso do que a dependência dos idosos. O número de treinamentos em maus-tratos ao idoso realizado pelos participantes, seu conhecimento sobre quem é responsável por notificar os maus-tratos ao idoso, o tipo de cuidador principal dos idosos e a condição crônica de saúde dos cuidadores foram os fatores correlacionados que afetaram os maus-tratos ao idoso. Conclusão As descrições de maus-tratos ao idoso das vítimas e perpetradores são difíceis de avaliar; portanto, recomenda-se a triagem mais ampla sob perspectiva dos profissionais de saúde. Futuras pesquisas de enfermagem devem explorar intervenções indiretas, como manipular os fatores de risco que os cuidadores primários representam, a fim de diminuir a ocorrência de maus-tratos ao idoso. Estudos futuros testando modelos de previsão de trajetória dentro de uma amostra maior e mais controlada devem ser conduzidos.

Resumen Objetivos Identificar factores predictivos de malos tratos a personas mayores relacionados con las personas mayores y sus cuidadores principales y la relación entre la formación profesional en salud y la identificación de malos tratos. Métodos Estudio cuantitativo y analítico. Los factores potenciales de riesgo de malos tratos relacionados con 40 personas mayores y sus cuidadores fueron recopilados mediante la observación de 12 profesionales de la salud y en una asociación de enfermeras visitantes. Se investigó la capacitación de profesionales de la salud en la identificación de malos tratos. Se utilizó la estadística descriptiva, la prueba exacta de Fisher y el análisis de regresión lineal múltiple para investigar las relaciones entre los casos de malos tratos a personas mayores y los factores de riesgo relacionados con personas mayores y su cuidador, y los factores predictivos de malos tratos a personas mayores. Resultados La dependencia de personas mayores con relación a los cuidadores y las condiciones crónicas de salud de los cuidadores principales fueron predictores de malos tratos a personas mayores. Los factores de riesgo presentados por los cuidadores principales tendían a afectar más los malos tratos a personas mayores que la dependencia de las personas mayores. El número de capacitaciones en malos tratos a personas mayores realizado por quienes participaron, sus conocimientos sobre quién es responsable de notificar los malos tratos a personas mayores, el tipo de cuidador principal de personas mayores y la condición crónica de salud de los cuidadores fueron los factores correlacionados que afectaron los malos tratos a personas mayores. Conclusión Las descripciones de malos tratos a personas mayores por parte de las víctimas y perpetradores son difíciles de evaluar; por lo tanto, se recomienda un triaje más amplio bajo la perspectiva de profesionales de la salud. Futuros estudios de enfermería deben investigar intervenciones indirectas, como manipular los factores de riesgo que los cuidadores principales representan, a fin de reducir los casos de malos tratos a personas mayores. Deben realizarse estudios futuros probando modelos de previsión de trayectoria dentro de una muestra más grande y más controlada.

Abstract Objectives To identify predictive factors for elder mistreatment (EM) related to older adults and their primary caregivers and the relationship between healthcare professional training and identification of EM. Methods This was a quantitative and analytic study. Potential risk factors for EM related to 40 older adults and their caregivers were collected through observation by 12 healthcare professionals and in a visiting nurses association. Training of healthcare professionals on EM identification was investigated. Descriptive statistics, Fisher's exact test, and multilevel regression analysis were used to investigate the relationships between the occurrence of EM and older adults and caregiver-related risk factors, and the predictive factors for EM. Results The older adults' dependency on caregivers and primary caregivers' chronic health conditions predicted EM. The risk factors the primary caregivers posed tended to affect EM more than the dependency older adults posed. The number of EM training the participants attended, their knowledge of who is responsible for reporting EM, the type of older adults' primary caregivers, and caregivers' chronic health condition were the correlating factors affecting EM. Conclusion Victims' and perpetrators' descriptions of EM are difficult to gauge; therefore, the broader screening of healthcare professionals' views is recommended. Future nursing research should explore indirect interventions, such as manipulating the risk factors primary caregivers pose, to decrease the occurrence of EM. A subsequent study testing Path prediction models within a bigger and more controlled sample are also warranted.

Evaluating the Prevalence and Incidence of Bronchiectasis and Nontuberculous Mycobacteria in South Korea Using the Nationwide Population Data.

Although the prevalence and incidence of bronchiectasis are rising worldwide, basic epidemiologic data have not been reported in Korea. Therefore, this study was conducted to investigate epidemiological characteristics of bronchiectasis and NTM (nontuberculous mycobacteria) pulmonary diseases in Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. The relative risks of prevalence and incidence after adjusting for demographic characteristics were evaluated by multivariate Poisson regression. The result of this study showed the prevalence and incidence rates of bronchiectasis and NTM to be epidemiologically similar to each other with a few slight differences, while the prevalence rate of bronchiectasis was not significantly different by gender, and its incidence rate was significantly lower in women than in men. Both the prevalence and incidence of NTM were significantly higher in women than in men. Both the prevalence and incidence rates of bronchiectasis and NTM were significantly lower in the age group below 40-49 years, and significantly higher in the age groups thereafter. As there were gender differences of bronchiectasis and NTM, gender-sensitive risk management should be available. In addition, since both bronchiectasis and NTM increase in prevalence and incidence after the age of 40-49, early detection and intervention strategies targeting the appropriate age group are needed.

Development and Validation of a Knowledge, Attitudes and Practices Questionnaire on COVID-19 (KAP COVID-19).

Given its highly contagious nature and an absence of a specific antiviral agent to this date, the key to controlling the spread of coronavirus disease 2019 (COVID-19) and decreasing the infection rate is adherence to preventive measures. It is essential to understand an individual's knowledge, attitudes and practices toward COVID-19 since public adherence to health guidelines relies heavily on these aspects. However, there is no validated instrument that evaluates knowledge, attitudes and practices toward COVID-19. Thus, this study aimed to develop and validate such tool. A questionnaire was developed based on international and national guidelines and a review of the literature. Initial items were evaluated by 10 experts to determine content validity. Exploratory factor analysis and reliability testing were conducted with a convenience sample of 229 nursing students. Based on the content, face validity and factor analysis, 34 items were selected. The Kaiser-Meyer-Olkin value of 0.735 indicated a highly acceptable score with a significant Bartlett's test of sphericity (p < 0.0001). The internal consistency coefficients indicated acceptable reliability of the tool (Cronbach's α = 0.75). The KAP COVID-19 is a valid instrument that can be used to evaluate knowledge, attitudes and practices toward COVID-19.

Poststroke Sleep Disorders: An Executive Summary.

BACKGROUND: Poststroke sleep disorders (PSSDs) are common manifestations that may lead to adverse outcomes that pose a negative impact on the daily lives of stroke survivors. However, PSSD is poorly understood in terms of etiology, assessment, treatment, and nursing management. The purpose of this executive summary is to provide an overview to broaden our understanding of PSSDs. METHOD: The electronic databases EMBASE, PubMed, CINAHL, Cochrane Library, and Google Scholar were searched to identify any available relevant studies. RESULTS: The 3 main sleep disorders among stroke survivors are sleep apnea, nighttime sleep disturbances, and excessive daytime sleepiness. The PSSD prevalence ranges from 13.2% to 94.0%. CONCLUSION: The causative mechanism seems to be multifactorial, but occurrence may differ depending on the stroke stage. Combined use of subjective and objective assessment methods may increase PSSD detection and early treatment.

Health behaviors of Korean female nursing students in relation to obesity and osteoporosis.

OBJECTIVES: It has been reported that young adults' dietary habits and health behaviors have significant effects on obesity and bone health. However, there is a lack of thorough understanding of the prevalence of unhealthy behaviors and potential relationships to obesity and osteoporosis among young females. METHODS: This cross-sectional study examined dietary habits, health behaviors, anthropometric measurements, and bone mineral density of 160 female nursing students. RESULTS: A relatively large number of students had vitamin D (n = 104, 65%) and calcium (n = 84, 52.5%) deficiencies but displayed excessive cholesterol (n = 86, 53.8%) and sodium (n = 137, 85.6%) intakes. Unhealthy dietary and health habits such as nighttime snacking, coffee drinking, low milk drinking, and lack of exercise were also noted. CONCLUSIONS: Despite their knowledge on health, a large portion of nursing students displayed unhealthy dietary habits and health. Tailored strategies and education to narrow the gap between health behavioral knowledge and practice are urgently needed.