Quality of life among mothers of preterm newborns in a Malaysian neonatal intensive care unit.

Background: As Quality of Life (QoL) becomes progressively vital in health care services, its importance in mother and child health is of no exception too. Quality of life among mothers with a premature newborn is an issue that has led to growing concerns in the health care system. Yet, despite the knowledge about mother's QoL being essential to family-centered planning on prematurity integrated healthcare, current evidence has been scant. Objective: To examine factors related to the QoL of mothers having preterm newborns hospitalized in the neonatal critical unit. Methods: A non-probability convenience survey was used in a public hospital in Malaysia, covering 180 mothers whose preterm newborns were hospitalized into level III Neonatal Intensive Care Unit (NICU) through the completion of a 26-questions survey of the World Health Organization Quality of Life (WHOQOL-BREF) and the 26-questions of Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU). The data were analyzed using descriptive statistics, bivariate analysis, and Pearson correlation coefficients. Result: The mean scores for mothers' quality of life were (M = 3.67, SD = 0.73) and maternal stress (M = 3.03, SD = 0.90) out of 5. A mother's occupation was found to be the only factor associated with the quality of life among mothers who have preterm newborns admitted to the NICU. Furthermore, maternal role change was found to have a moderate negative relationship with the quality of life (r = 0.310, p = 0.05). Conclusion: The findings of this study revealed that the main factors contributing to the mother's QoL during their preterm newborns' NICU admission were role change-related stress. Thus, to maintain a better QoL among this group of mothers during this traumatic period, a special nursing intervention program must be implemented immediately, right after the preterm newborns' admission, to relieve the mothers' stress which has been proven to have a direct effect on the mothers' QoL. The study results will alert healthcare providers, particularly neonatal nurses, on the need to support mothers psychologically in terms of role change. This is to ensure a better quality of life among mothers whose newborns were admitted to the NICU.

Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)-non-inferiority (peripheral arterial catheter) trial.

BACKGROUND: The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters. METHODS: We did a randomised, controlled, assessor-masked trial at ten Australian hospitals. Our hypothesis was CRBSI equivalence for central venous access devices and non-inferiority for peripheral arterial catheters (both 2% margin). Adults and children with expected greater than 24 h central venous access device-peripheral arterial catheter use were randomly assigned (1:1; stratified by hospital, catheter type, and intensive care unit or ward) by a centralised, web-based service (concealed before allocation) to infusion set replacement every 7 days, or 4 days. This included crystalloids, non-lipid parenteral nutrition, and medication infusions. Patients and clinicians were not masked, but the primary outcome (CRBSI) was adjudicated by masked infectious diseases physicians. The analysis was modified intention to treat (mITT). This study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12610000505000 and is complete. FINDINGS: Between May 30, 2011, and Dec, 9, 2016, from 6007 patients assessed, we assigned 2944 patients to 7-day (n=1463) or 4-day (n=1481) infusion set replacement, with 2941 in the mITT analysis. For central venous access devices, 20 (1·78%) of 1124 patients (7-day group) and 16 (1·46%) of 1097 patients (4-day group) had CRBSI (absolute risk difference [ARD] 0·32%, 95% CI -0·73 to 1·37). For peripheral arterial catheters, one (0·28%) of 357 patients in the 7-day group and none of 363 patients in the 4-day group had CRBSI (ARD 0·28%, -0·27% to 0·83%). There were no treatment-related adverse events. INTERPRETATION: Infusion set use can be safely extended to 7 days with resultant cost and workload reductions. FUNDING: Australian National Health and Medical Research Council.

Association Between Body Mass Index and Cardiometabolic Risks Among Malay Obese Adults.

Cardiometabolic risk (CMR) is a cluster of risk factors that may predict the occurrence of cardiovascular diseases and diabetes mellitus. This study investigated the association between CMR with body mass index (BMI) among obese adults. The CMRs, including waist circumference, systolic and diastolic blood pressure, blood glucose, total cholesterol, low-density and high-density lipoprotein, triglyceride, and high-sensitivity C-reactive protein (hs-CRP) level, were quantified in 82 obese adults. The findings indicate the highest correlation coefficient value ( r) was .618 between BMI and waist circumference; a weak correlation between mass index and systolic ( r = .276) and diastolic ( r = .311) blood pressure and hs-CRP ( r = .384); and a very weak correlation between BMI level and fasting blood glucose ( r = .069), total cholesterol ( r = .014), low-density lipoprotein (.013), high-density lipoprotein (-.154), and triglyceride (.173). Future strategies for CMR reduction among obese adults should focus on waist circumference and hs-CRP level.

Knowledge and Attitudes of Maintaining Bone Health among Post-Menopausal Women in Malaysia.

INTRODUCTION: Public awareness of osteoporosis is low among women in the developing countries. Health education was shown to be effective in improving knowledge and awareness on maintaining bone health. This study aims to identify the level of knowledge and attitudes among post-menopausal women in Malaysia on achieving bone health throughout the menopausal transition period. METHODS: A total of 116 post-menopausal female patients of orthopedic menopause clinic were recruited using a purposive sampling approach. Data on osteoporosis awareness and knowledge were collected using validated structured questionnaires Osteoporosis Prevention and Awareness Tool and Osteoporosis Attitude Knowledge Test. The chi-square test was used to determine the association between post-menopausal women's socio-demographic characteristics and their knowledge and attitude towards maintaining bone health. RESULTS: Participants' age ranged between 49 and 82 years (61.84, SD=7.87). The knowledge of osteoporosis varied significantly by age (p=0.014) and education (p=0.001) among the studied population. No significant diffrences were found for participants' attitude towards bone health. CONCLUSION: This study showed that the age and education levels have significantly different knowledge of bone health.

Prevalence and association between triglyceride level and lifestyle factors among Malay obese class I and II adults

Objective: Hypertriglyceridemia is an independent risk factor for cardiovascular diseases. This study aimed to determine the prevalence and association of triglyceride level and lifestyle factors among Malay obese class I and II adults. Method: This is a cross-sectional study of 65 Malay obese class I and class II adults aged 20-62 years (21 male, 44 female) from sub-urban areas of Malaysia. Overnight fasting venous blood samples were obtained to determine the triglyceride level (mmol/L). Subjects were classified into either normal or elevated triglyceride level groups based on the triglyceride level (normal < 1.6 mmol/L, elevated > 1.7 mmol/L). Unhealthy lifestyle behaviors, defined as smoking status, hours per day spent on sitting passively and sitting with active motion, and the amount of saturated fat, mono-unsaturated and polyunsaturated fat from dietary intake, were measured from 24-h dietary intake and physical activity recall. We compare the variables of unhealthy lifestyle behaviors between subjects with normal and elevated triglyceride level using independent samples t-test. Results: Among 65 obese class I and II adults, 16 subjects (24.6%) were found to have elevated triglyceride levels (mean ± standard deviation of body mass index 31.89 ± 3.29 kg/m2). There are significant differences between subjects having normal and elevated triglyceride level with gender, marital status, the number of children, smoking status, weight and monounsaturated fat intake (all P-values < .05). Conclusions: The findings of this study highlighted elevated triglyceride level in obese adults might be influenced by unhealthy lifestyle behaviors. We suggest that lifestyle modification intervention is appropriate to prevent cardiovascular disease among Malay obese class I and II adults

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Relationship between levels of thyroid stimulating hormone, age, and gender, with symptoms of depression among patients with thyroid disorders as measured by the Depression Anxiety Stress Scale 21 (DASS-21)

Objective: The aim of this study was to investigate the correlation between levels of depression symptoms and age, thyroid-stimulating hormone levels, and stressful life events of the participants. Method: Patients above 18 years old, with any thyroid disorders, and without psychiatric disorders were included in this study. All participants completed the Depression Anxiety Stress Scale 21 (DASS-21). The depression symptom score was calculated and interpreted as follows: less than 9: no depression; between 10 and 13: mild depression; between 14 and 20: moderate depression; between 21 and 27: severe depression, and more than 28: extremely severe depression. Results: The total number of participants in this study was 199. There was no correlation between age, thyroid stimulating hormone, and the DASS score. There was also no significant difference in the DASS-21 score between genders. However, there was a positive correlation between depression symptoms and stressful life events (r=0.201, n=199, p < 0.05). Conclusions: These findings would suggest that increased depression symptom scores correlate with increased stressful life events. A larger study should be undertaken to confirm these findings

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Fracture risk prediction in post-menopausal women with osteopenia and osteoporosis: preliminary findings

Objective: The study aims to identify the risk of obtaining a fracture among post-menopausal women with osteopenia and osteoporosis. Method: This work was a cross-sectional study involving a purposive sample of 87 post-menopausal women who attended the orthopedic and menopause clinics of Hospital Tengku Ampuan Afzan, Kuantan. The data were entered into the WHO fracture risk assessment tool (FRAX®) to predict major fracture and risk for hip fracture in 10 years' time. Results: The mean age of the respondents was 61.6 years (SD=7.9). Among the respondents, 50.6% had osteopenia and nearly half (48.3%) had osteoporosis. The mean number of menopausal years of the respondents was 11.9 (SD=8.5), ranging between 1 and 44 years. The FRAX findings indicated 9.7% major osteoporotic fracture probability and 3.5% hip fracture probability, which were denoted as high risk. A Pearson correlation coefficient was computed to assess the relationship between menopausal years and the FRAX major osteoporotic fracture probability. A significant positive correlation was found between the two, but the correlation was weak (r=0.581, n=87, p < 0.001). Conclusions: The present findings indicate that menopausal years have a positive correlation with the risk of obtaining a fracture

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Optimal timing for intravascular administration set replacement.

BACKGROUND: The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012. OBJECTIVES: The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death. SEARCH METHODS: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction. SELECTION CRITERIA: We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants. DATA COLLECTION AND ANALYSIS: Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours. MAIN RESULTS: We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult populations, arterial and venous administration sets, parenteral nutrition, lipid emulsions and crystalloid infusions. Most studies were at moderate to high risk of bias or did not adequately describe the methods that they used to minimize bias. All included trials were unable to blind personnel because of the nature of the intervention.No evidence was found for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.67 to 1.69; RR 0.67, 95% CI 0.27 to 1.70). Infrequent administration set replacement reduced the rate of bloodstream infection (RR 0.73, 95% CI 0.54 to 0.98). No evidence revealed differences in catheter colonization or infusate colonization with more frequent administration set replacement (RR 1.08, 95% CI 0.94 to 1.24; RR 1.15, 95% CI 0.70 to 1.86, respectively). Borderline evidence suggested that infrequent administration set replacement increased the mortality rate only within the neonatal population (RR 1.84, 95% CI 1.00 to 3.36). No evidence revealed interactions between the (lack of) effects of frequency of administration set replacement and the subgroups analysed: parenteral nutrition and/or fat emulsions versus infusates not involving parenteral nutrition or fat emulsions; adult versus neonatal participants; and arterial versus venous catheters. AUTHORS' CONCLUSIONS: Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.

Replacement of administration sets (including transducers) for peripheral arterial catheters: a systematic review.

AIMS AND OBJECTIVES: This article presents a systematic review of the evidence for the optimal interval for replacement of administration sets for peripheral arterial catheters. BACKGROUND: Peripheral arterial catheters are attached to administration sets, including transducers, which are changed routinely in some hospitals on the understanding that prolonged duration of administration sets use may cause a higher incidence of infection. DESIGN: Systematic review. METHODS: Medline, CINAHL, Scopus and the Cochrane Library were searched to access relevant studies published between 1966 and 2011. Inclusion criteria were quantitative studies of critically ill patients with peripheral arterial catheters that required administration sets for intra-arterial pressure monitoring and had a focus on administration sets duration of use. Studies were assessed for quality using either methodological quality assessments from Cochrane guidelines for systematic reviews for randomised controlled trials or with the Newcastle-Ottawa quality assessment scale for cohort studies. RESULTS: Six studies were selected for review. These included three randomised controlled trials (226 patients) and three cohort studies (219 patients). Cohort studies reported 1-4% catheter-related bloodstream infection and 0-8% infusate-related bloodstream infection when administration sets were changed every 48 hours. Two randomised controlled trials found no difference in infusate-related bloodstream infection (two days: 0%; four to eight days: 1·7%) and found no cases of catheter-related bloodstream infection in any group when administration sets were replaced every 24 or 48 hours. CONCLUSION: There is limited evidence on the optimum duration of administration sets used for peripheral arterial catheters. Large randomised trials of high quality are needed. RELEVANCE TO CLINICAL PRACTICE: This review provides clinicians with comprehensive information about the state of the evidence in relation to the duration of administration sets for peripheral arterial catheters to inform decision-making and further research.