Mobile Health Application-Based Interventions to Improve Self-management of Chemotherapy-Related Symptoms Among People with Breast Cancer Who Are Undergoing Chemotherapy: A Systematic Review.

BACKGROUND: Since the COVID-19 pandemic, there have been an increasing number of studies on using mobile health (mHealth) to support the symptom self-management of patients with breast cancer (BC). However, the components of such programs remain unexplored. This systematic review aimed to identify the components of existing mHealth app-based interventions for patients with BC who are undergoing chemotherapy and to uncover self-efficacy enhancement elements from among them. METHODS: A systematic review was conducted for randomized controlled trials published from 2010 to 2021. Two strategies were used to assess the mHealth apps: The Omaha System, a structured classification system for patient care, and Bandura's self-efficacy theory, which assesses sources of influence that determine an individual's confidence in being able to manage a problem. Intervention components identified in the studies were grouped under the 4 domains of the intervention scheme of the Omaha System. Four hierarchical sources of self-efficacy enhancement elements were extracted from the studies using Bandura's self-efficacy theory. RESULTS: The search uncovered 1,668 records. Full-text screening was conducted on 44 articles, and 5 randomized controlled trials (n = 537 participants) were included. Self-monitoring under the domain of "Treatments and procedure" was the most frequently used mHealth intervention for improving symptom self-management in patients with BC undergoing chemotherapy. Most mHealth apps used various "mastery experience" strategies including reminders, self-care advice, videos, and learning forums. CONCLUSION: Self-monitoring was commonly utilized in mHealth-based interventions for patients with BC undergoing chemotherapy. Our survey uncovered evident variation in strategies to support self-management of symptoms and standardized reporting is required. More evidence is required to make conclusive recommendations related to mHealth tools for BC chemotherapy self-management.

A Nurse-Led mHealth Self-Management Program (mChemotherapy) for Breast Cancer Patients Undergoing Chemotherapy: Study Protocol of a Randomized Controlled Pilot Study.

BACKGROUND: The global pandemic has caused breast cancer (BC) patients who are receiving chemotherapy to face more challenges in taking care of themselves than usual. A novel nurse-led mHealth program (mChemotherapy) is designed to foster self-management for this population. The aim of the pilot study is to determine the feasibility, usability, and acceptability of an mChemotherapy program for breast cancer patients undergoing chemotherapy. The objective also is to evaluate the preliminary effects of this program on adherence to app usage, self-efficacy, quality of life, symptom burden, and healthcare utilization among this group of patients. METHODS: This is a single-blinded randomized controlled pilot study that includes one intervention group (mChemotherapy group) and one control group (routine care group). Ninety-four breast cancer patients who commence chemotherapy in a university-affiliated hospital will be recruited. Based on the Individual and Family Self-management Theory, this 6-week mChemotherapy program, which includes a combination of self-regulation activities and nurse-led support, will be provided. Data collection will be conducted at baseline, week 3 (T1), and week 6 (T2). A general linear model will be utilized for identifying the between-group, within-group, and interaction effects. Qualitative content analysis will be adopted to analyze, extract, and categorize the interview transcripts. DISCUSSIONS: Breast cancer patients receiving chemotherapy are a population that often experiences a heavy symptom burden. During the pandemic, they have had difficulties in self-managing the side effects of chemotherapy due to the lack of face-to-face professional support. An mChemotherapy program will be adopted through a self-regulation process and with the provision of nurse-led real-time professional support for these patients. If proven effective, BC patients who engage in this program will be more likely to take an active role in managing their symptoms, take responsibility for their own health, and subsequently improve their self-efficacy and adherence to the use of the app.

Assessing quality of life using WHOQOL-BREF: a cross-sectional study on the association between quality of life and neighborhood environmental satisfaction, and the mediating effect of health-related behaviors.

BACKGROUND: Quality of life (QOL) is an important component in assessing people's health. Environmental quality can influence people's QOL in the physical health, psychological, social relationships and environment domains. QOL in the four domains, overall QOL and general heath of residents living in the Kowloon Peninsula of Hong Kong were assessed. The association between satisfaction with the neighborhood environment and QOL, and health-related behaviors which mediated the effect were investigated. METHODS: A sample of 317 residents completed a questionnaire which comprised the WHOQOL-BREF (Hong Kong version) to assess QOL, the International Physical Activity Questionnaire (IPAQ) to study physical activities, and questions on satisfaction with the neighborhood environment, health-related behaviors and socio-demographics. One-way ANOVA and linear regression were used to study the associations between environmental satisfaction and QOL in the four domains, overall QOL and general health, followed by assessing the relationships between environmental satisfaction and the potential health-related behavior mediators with regression tests. Mediation analysis was conducted using multiple linear regressions to study the effects of environmental satisfaction on QOL in the four domains, overall QOL and general health, as well as the potential mediating roles played by various health-related behaviors. A P-value of < 0.05 was considered as statistically significant. RESULTS: The residents had a relatively higher physical health mean score of 70.83 ± 12.69, and a lower environmental mean score of 61.98 ± 13.76. Moderate satisfaction with the neighborhood environment had a significant relationship with QOL in the psychological domain (ß = 0.170, P = 0.006), however, this effect was partially mediated by the non-smoking behavior of the residents (ß = 0.143, P = 0.022). CONCLUSIONS: Our residents had lower QOL in the physical health and psychological domains but similar QOL in the social relationships and environmental domains compared to other countries. Only QOL in the psychological domain could be predicted by the satisfaction with the neighborhood environment, and non-smoking status was a partial mediator of the effect of moderate environmental satisfaction on QOL in the psychological domain. Refrain from smoking seems to be able to lower the influence of neighborhood environment on people's QOL in the psychological domain to a certain extent.

Substitution of SF-36 by SF-12 Among Hong Kong Chinese Older Adults: Secondary Analysis of Randomized Controlled Trials.

PURPOSE: This study aims to examine the appropriateness of substituting the Short-Form 36 (SF-36) by its shortened version (SF-12) in measuring health-related quality of life (HRQoL) in older Chinese population. METHODS: Secondary analysis of two transitional care management programs, conducted from 2009 to 2012, were analyzed (n = 1188, aged 60-97). Participants were discharged patients with respiratory disease, type 2 diabetes, cardiac disease, and renal disease, and were classified according to number of chronic diseases. SF-36 was administered at baseline and 4-week follow-up. RESULTS: Both overestimations and underestimations of HRQoL by SF-12 were found. Most domain scores of SF-36 and SF-12 were highly correlated (Spearman correlation (ρ) > 0.85), with the exception of General Health (ρ = 0.64) and Vitality subscales (ρ = 0.82). Multiple linear regression adjusted for demographic characteristics showed that the four out of eight domains of SF-36 and SF-12 were equivalent in measuring the difference across numbers of chronic diseases (all p < 0.05). Paired sample t tests in 989 (83.2 %) who completed the SF-36 survey 4 weeks after baseline showed that SF-12 overestimated the 4-week changes in most of the domains. CONCLUSIONS: The use of the Chinese version of SF-12v2 for reporting the change over time in quality of life among medical patients after hospital discharge may need to be interpreted with caution. The SF-12 tends to underestimate the difference when compared with the SF-36.

Perceptions of utilizing a symptom self-management app for breast cancer patients receiving outpatient chemotherapy.

PURPOSE: Breast cancer (BC) patients who are undergoing outpatient chemotherapy encounter difficulties in symptom self-management at home. We have developed a mobile app with the support of self-regulation activities and nurse-led social service to empower self-management of BC patients during outpatient chemotherapy. The study aimed to explore the perceptions of breast cancer patients and nurses in utilizing an app with the functions of proactive nursing support and empowerment. METHODS: This is a qualitative study including group interviews with nurses and patients with breast cancer receiving outpatient chemotherapy. A total of eleven patients and five nurses were enrolled from August 2022 to October 2022. Thematic analysis was adopted to analyze the interview transcripts. Main themes and related sub-themes were drawn from the transcripts. RESULTS: Barriers (the lack of a contractual spirit) and facilitators (social support and native high-adherence) to app usage were identified. Following the six-week program, patients underwent various transformations such as improved health awareness and a tendency to pay more attention to psychological symptoms. This program also led to various changes in the nurses, including a transformation from taking the reactive emergency calls to a proactive approach of incorporating a self-regulation process and social support. CONCLUSIONS: The findings from the group interviews stressed the importance of integrating technology and nursing social support in facilitating patient symptom self-management.

Postoperative pain experience and barriers to pain management in Chinese adult patients undergoing thoracic surgery.

AIMS: The purpose of this study was (1) to explore postoperative pain experience among Chinese thoracotomy patients during hospitalisation; (2) to identify patient-related barriers to pain management; and (3) to explore how these barriers were related to patients' pain experience. BACKGROUND: Major thoracotomy causes severe pain and extreme stress for patients. Unrelieved postoperative pain leads to high risks of postoperative complications and chronic post-thoracotomy pain syndrome, compromising the quality of life for those patients. DESIGN: Cross-sectional design. METHODS: A tertiary general hospital in mainland China was selected for this study. A total of 94 patients undergoing scheduled major thoracotomy operations participated in the study. All patients completed Brief Pain Inventory-Chinese version, the Barrier Questionnaire-Taiwan Form Surgical version and a demographic questionnaire. RESULTS: Patients suffered moderate to severe pain and experienced extremely high interferences with daily activities after major thoracotomy operation. Patients reported the four highest barrier scores in the subscale of Barrier Questionnaire-Taiwan Form Surgical version were fear of tolerance, inhibition of wound healing, time intervals and distracting the physician from treating the disease. Patient's demographic data had no significant impact on their concerns about communicating pain and using of analgesics with exception of the subscale 'fatalism' of the Barrier Questionnaire-Taiwan Form Surgical version in patients with higher education levels or patients with 'non-farmer' occupation. However, there were no significant correlations indicated either between Barrier Questionnaire-Taiwan Form Surgical version score and pain severity or pain interference. CONCLUSIONS: Patients were underexposure of pain treatment after thoracotomy operation in the study, while patients' concerns about reporting pain and using analgesics had minimal impacts on their pain experience. RELEVANCE TO CLINICAL PRACTICE: Education approach for patients is inadequate to improve the status of unrelieved postoperative pain. Appropriate pain management regime together with attentive nursing care should be provided to achieve better pain relief for Chinese patients.

A qualitative study exploring the nurse telephone follow-up of patients returning home with a colostomy.

AIM: The aim of this study was to explore and describe the content of telephone intervention conversations conducted by an enterostomal nurse with patients discharged home with a colostomy. BACKGROUND: People discharged home with a new colostomy often encounter stoma-related difficulties. Postdischarge care with telephone follow-up by an enterostomal nurse is a helpful way to provide support for patients and ensure continuity of care. There is a paucity of studies reporting the content of telephone follow-up of colostomy patients. Information on the content of such follow-up is important in helping to formulate telephone call protocols that can help these patients. DESIGN: A qualitative exploratory study conducted in a university-based cancer centre in China. METHODS: The contents of 25 intervention phone calls to colostomy patients from January-August 2009 were subject to qualitative content analysis. RESULTS: Five themes emerged from the qualitative content analysis: 'education for stoma care', 'access to stoma care', 'encouraging stoma self-care', 'resuming normal living' and 'general postoperative problems'. CONCLUSIONS: Colostomy patients experienced stoma-related problems and difficulties after discharge, most of which could be effectively managed via telephone follow-up by an enterostomal nurse. The telephone follow-up satisfied patients' need for information and facilitated their adjustment to the permanent stoma. The findings suggested that patients had unmet needs after discharge and needed follow-up on returning home. RELEVANCE TO CLINICAL PRACTICE: This study provides important information to guide practice and education. The themes extracted from the qualitative content analysis provide a useful framework to guide the nurse in discussing care with the stoma patients and ensuring patients' adjustment to the permanent stoma. Further work can be done using this framework to develop protocols as standards of care and education materials when educating nurse specialists in stoma care.

Nursing education in China: past, present and future.

BACKGROUND: The development of nursing education in China is closely tied with the country's wider context, including the social, political and economic environment. EVALUATION: The source of information includes published materials accessible to the public and the authors' knowledge as content experts of the nursing situation in China. KEY ISSUES: Nursing in China is developing rapidly particularly in the last decade in quantity and quality terms. The education development of nursing is in line with the service development which aims at client-centred care adopting a holistic approach caring for clients at the preventive, curative and rehabilitative levels. CONCLUSIONS: Nursing education in China, both at the pre-registration and post-registration level, plays a key role in building a strong team of nurses to fulfil the health mission of the country. IMPLICATIONS FOR NURSING MANAGEMENT: Managers in nursing education need to continuously revise the curriculum to produce nurses who meet societal needs at present and for the future. At the same time, nurse managers in the service need to make best use of these nursing talents according to the nurses' competence and educational levels.

Parental Stress as the Mediator Between Symptom Burden and the Quality of Life of Chinese Children With Cancer.

BACKGROUND: Because of their cancer and treatment adverse effects, most pediatric oncology patients will experience 1 or more symptoms at one time that can seriously affect their quality of life. Because these children are attached to parents, their symptom burden directly influences the parental stress level and parental interpretations of their children's quality of life. OBJECTIVE: The aim of this study was to examine the association between child-reported symptom burden and the pediatric quality of life reported by children with cancer and their parents, and whether parental perceived stress mediates these relationships. METHODS: In a cross-sectional design, convenience sampling was used to recruit 80 parent-child dyads. Advanced statistical methods were adopted to analyze the mediating effects of parental stress between children's symptom burden and their quality of life. RESULTS: The results revealed that parental stress was the mediator in the relationship between child-reported symptom burden and children's quality of life reported by parents. The results also showed that parental stress was not a mediator in the relationship between child-reported symptom burden and their quality of life. This underscored the differences in interpretations of quality of life reported by children and their parents. CONCLUSION: Children's symptom burden is an important factor in predicting parental stress level and the quality of life reported by the children. Children's voice should be incorporated whenever possible. IMPLICATIONS FOR PRACTICE: The knowledge gained from this study will facilitate intervention development to enhance parents' abilities in stress management and symptom management for their children with the support of the nursing profession.

Symptom Burden of Children with Cancer and Parental Quality of Life: The Mediating Role of Parental Stress.

BACKGROUND: The aim of this study was to investigate the association between children's reported symptom burden and their parents' quality of life, and whether parents' perceived stress mediates this relationship. METHOD: this was a cross-sectional quantitative research study. Convenience sampling was used to recruit 80 pairs of parents and their children with cancer. Advanced statistical methods were used to analyse the mediating effects of parental stress between children's symptom burden and parents' quality of life. RESULTS: The results showed that parental stress was the mediator in the relationship between children's reported symptom burden and their parents' quality of life. CONCLUSIONS: Symptom burden was prevalent in Chinese children with cancer living in the community. Children's symptom burden is an important factor in predicting parental stress level, which simultaneously and directly lower parents' quality of life. The evidence in this study enlarges the knowledge base about the mediating effect of parental stress on the association between the symptom burden of children with cancer and their parents' quality of life. This evidence is crucial in paving the way for the development of interventions that improve the parental quality of life through stress-reduction programs.

Effects of Urban Green Space on Cardiovascular and Respiratory Biomarkers in Chinese Adults: Panel Study Using Digital Tracking Devices.

BACKGROUND: The health benefits of urban green space have been widely reported in the literature; however, the biological mechanisms remain unexplored, and a causal relationship cannot be established between green space exposure and cardiorespiratory health. OBJECTIVE: Our aim was to conduct a panel study using personal tracking devices to continuously collect individual exposure data from healthy Chinese adults aged 50 to 64 years living in Hong Kong. METHODS: A panel of cardiorespiratory biomarkers was tested each week for a period of 5 consecutive weeks. Data on weekly exposure to green space, air pollution, and the physical activities of individual participants were collected by personal tracking devices. The effects of green space exposure measured by the normalized difference vegetation index (NDVI) at buffer zones of 100, 250, and 500 meters on a panel of cardiorespiratory biomarkers were estimated by a generalized linear mixed-effects model, with adjustment for confounding variables of sociodemographic characteristics, exposure to air pollutants and noise, exercise, and nutrient intake. RESULTS: A total of 39 participants (mean age 56.4 years, range 50-63 years) were recruited and followed up for 5 consecutive weeks. After adjustment for sex, income, occupation, physical activities, dietary intake, noise, and air pollution, significant negative associations with the NDVI for the 250-meter buffer zone were found in total cholesterol (-21.6% per IQR increase in NDVI, 95% CI -32.7% to -10.6%), low-density lipoprotein (-14.9%, 95% CI -23.4% to -6.4%), glucose (-11.2%, 95% CI -21.9% to -0.5%), and high-sensitivity C-reactive protein (-41.3%, 95% CI -81.7% to -0.9%). Similar effect estimates were found for the 100-meter and 250-meter buffer zones. After adjustment for multiple testing, the effect estimates of glucose and high-sensitivity C-reactive protein were no longer significant. CONCLUSIONS: The health benefits of green space can be found in some metabolic and inflammatory biomarkers. Further studies are warranted to establish the causal relationship between green space and cardiorespiratory health.

Health-related quality of life in patients undergoing peritoneal dialysis: effects of a nurse-led case management programme.

AIM: This paper is a report of an examination of the effectiveness of a nurse-led case management programme in improving the quality of life of peritoneal dialysis patients in Hong Kong. BACKGROUND: Patients with end-stage renal failure need integrated health care to maintain a desirable quality of life. Studies suggest that transitional care using a nurse case management model has a positive effect for patients suffering from chronic diseases, but the results have not been conclusive. METHOD: Eighty-five patients participated in the study in 2005, 43 in the study group and 42 in the control group. Patients in the control group received routine hospital discharge services. Study group patients received a comprehensive education programme prior to discharge and standardized, 6-week nurse-initiated telephone follow-up. Kidney disease quality of life was measured for each patient at three time intervals: before the intervention, at completion of the 6-week intervention and 6 weeks after completion of the programme. RESULTS: Repeated measures analysis of variance, general linear model was carried out. Statistically significant within-group effects were found for symptoms/problems, effects of kidney disease, sleep, role-physical, pain, emotional wellbeing and social function. Statistically significant interaction effects were demonstrated for staff encouragement, patient satisfaction, sleep and social function. CONCLUSION: The nurse-led case management programme can be applied effectively to patients receiving peritoneal dialysis. The new model of care is particularly useful for enhancing patients' wellbeing in the transition from hospital to home.

Investigating the health profile of patients with end-stage renal failure receiving peritoneal dialysis: a cluster analysis.

AIM: To determine whether the patients with end stage renal failure can be differentiated into several subtypes based on five main variables. BACKGROUND: There is a lack of interventional research linking to clinical outcomes among the patients with end stage renal failure in Hong Kong and with no clear evidence of differences in terms of their clinical/health outcomes and characteristics. DESIGN: A cross-sectional survey. METHOD: Data were collected using a structured questionnaire. One hundred and fifty-three patients with end stage renal failure were recruited during 2007 at three renal centres in Hong Kong. Five main variables were employed: predisposing characteristic, enabling resources, quality of life, symptom control and self-care adherence. RESULTS: A cluster analysis yielded two clusters. Each cluster represented a different profile of patients with end stage renal failure. Cluster A consisted of 49.7% (n = 76) and Cluster B consisted of 50.3% (n = 77) of the patients. Cluster A patients, more of whom were women, were older, less educated, had higher quality of life scores, a better adherence rate and more had received nursing care supports than patients in Cluster B. CONCLUSIONS: We have identified two groupings of patients with end stage renal failure who were experiencing unique health profile. Nursing support services may have an effect on patient health outcomes but only on a group of patients whose profile is similar to the patients in Cluster A and not for patients in Cluster B. A clear profile may help health care professional make appropriate strategies to target a specific group of patients to improve patient outcomes. RELEVANCE TO CLINICAL PRACTICE: The identification of risk for future health-care use could enable better targeting of interventional strategies in these groups. The results of this study might provide health care professionals with a model to design specified interventions to improve life quality for each profile group.

What accounts for hospital readmission?

AIMS: This study was launched to address the knowledge gap regarding factors leading to readmission to hospital. BACKGROUND: Repeated hospital admission is an issue of concern for health care service providers. Research findings reveal that multiple factors can contribute to the phenomenon, but no study has examined the direct and indirect effects of these variables on hospital readmission. DESIGN: A survey conducted during the period from 2003-2005 in three hospitals in Hong Kong. METHODS: Patients who were readmitted to the same hospital within 28 days during the study periods were included. Data were collected using structured interviews. A structural equation model was employed to examine what factors will contribute to hospital readmission. RESULTS: The final model showed that subjective health outcome was the only significant variable that had a direct effect on readmission, and it had indirect effects on readmission mediating through the variables of age, income and satisfaction with care. CONCLUSIONS: A literature review reveals that none of the studies has recognised patients' subjective appraisal of their health condition as a significant variable to predict hospital readmission. Results did not find an association between evaluated and perceived need. In other words, patients who felt a higher need for hospital care were not necessarily sicker. It is possible that if patients can be empowered to manage their own health condition and make a fair appraisal of their well-being, unnecessary use of hospital services can be reduced. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence to support the notion that an effective transitional care programme needs to incorporate patients' own subjective assessment of health in the intervention and measurement of the outcome. We cannot solely use providers' judgment to measure health outcomes, for patients are active agents in seeking health care, and the use of services is to an extent self-selective.

Perceived Family Impact During Children's Hospitalization for Treatment of Acute Lymphoblastic Leukemia: A Cross-sectional Study.

BACKGROUND: Improved survival rates of acute lymphoblastic leukemia (ALL) in children are often associated with repeated and prolonged hospitalization, creating an immensely stressful situation for the family. OBJECTIVE: The aims of this study were to assess perceived family impact and coping during the child's hospitalization for ALL treatment and identify potential predictors of perceived family impact. INTERVENTIONS/METHODS: A total of 212 families with children hospitalized participated. The hospitalization impact and coping scales were used to assess perceived family impact and coping, respectively. RESULTS: The mean (SD) total score for perceived family impact was 88.11 (22.39); social impact received the highest average score. The mean (SD) total score for family coping was 39.02 (9.84). A significant decrease in family coping was associated with more readmissions. Predictors of perceived family impact were severity of the child's illness, total days of all admissions, and coping, accounting for 37% of the observed variance. CONCLUSIONS: Families were moderately affected by children's hospitalizations; social functioning was most affected. Families' perceived coping effectiveness decreased as the readmissions increased. The higher risk category a child's diagnosis is, the longer a child's hospitalization is, and the less perceived coping effectiveness, the higher family perceived impact. IMPLICATIONS FOR PRACTICE: The findings provide a direction for the development of family-centered supportive intervention programs. Nurses should be aware that the total days of admission and severity of a child's illness are significant factors associated with perceived family impact and likely justify special attention. Family coping enhancement interventions could alleviate perceived family impact.

Identifying patient readmission subtypes from unplanned readmissions to hospitals in Hong Kong: a cluster analysis.

It has been conjectured with regard to patient readmission patterns that there might be significant differences in patient characteristics, need factors, enabling resources, and health behavior. The aim of this study was to identify the profiles of readmitted patients in Hong Kong (n = 120) based on their predisposing characteristics, needs, health behavior, and enabling resources. All the readmitted patients were recruited to the study in three hospitals from 2003 to 2005. A cluster analysis yielded three clusters: Clusters 1, 2, and 3 constituted 27.5% (n = 33), 27.5% (n = 33), and 45.0% (n = 54) of the total sample, respectively. The study results show that community nurse services do affect the rate at which patients are admitted to hospital for a second time. The findings might help by providing important information that will enable health-care policy-makers to identify strategies to target a specific group of patients in the hope of reducing its readmission rate.

A Brief Hope Intervention to Increase Hope Level and Improve Well-Being in Rehabilitating Cancer Patients: A Feasibility Test.

This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3%). The mean age was 57.2 years (SD = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes (d = 0.49-0.74). The changes in present hope and depression scores were insignificant, with small effect sizes (d = 0.17-0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.

Influence of Urban Green Space and Facility Accessibility on Exercise and Healthy Diet in Hong Kong.

Background A cross-sectional study using a convenience sampling method was conducted to understand how green space and accessibility of common public open spaces in compact urban areas affect physical activity and healthy diets of residents. Methods A total of 554 residents completed a structured questionnaire on quality of life, physical activity level and healthy eating practice. Particularly, categories of physical activity and durations were obtained by using the short form Chinese International Physical Activity Questionnaire (IPAQ-C), then the Metabolic Equivalent of Task (MET)-minutes/week was calculated using the formulae (walking minutes × walking days × 3.3) + (moderate-intensity activity minutes × moderate days × 4.0) + (vigorous-intensity activity minutes × vigorous-intensity days × 8.0). The percentage of green space was calculated based on a spatial buffer with a 500 m radius from participants' geocoded addresses using a SPOT ('Satellite Pour l'Observation de la Terre' in French) satellite image-derived vegetation dataset. Parks, promenade and sports facilities were examples of open spaces. Results The sampled population who lived with green space averaged 10.11% ± 7.95% (ranged 1.56-32.90%), with the majority (90%) performing physical activities at medium and high levels. MET-minutes/week was significantly associated (Pearson r = 0.092; p < 0.05) with the green space percentage. Relatively active residents commonly used open spaces within the district for performing exercise, in particular, parks and promenades were mostly used by older residents, while sports facilities by the younger groups at age 25-44 and <25 years. Conclusions Current findings suggested promotion of exercise could be achieved by the design or redesign of built environment to include more parks accessible to the residents with the increase of vegetation.

Factors predicting perceived improved health after emergency room visits.

AIM: This study examines the key factors contributing to perceived improved health after emergency room (ER) visits. BACKGROUND: Perceived health is a subjective measure of health status. It is an important and useful concept in nursing and assessment of health services because it reflects the clients' own assessment of his/her health, which may have led to their subsequent health-seeking behaviour. METHODS: Secondary analysis of a main study which aimed at examining the effects of nurse follow-up on ER revisits using randomized-controlled trial. In this study, binary logistic regressions were conducted to identify factors associated with the dependent variable, perceived improved health 30 days after the index ER visit. Data were collected from 795 subjects and the sources of data were from medical records and telephone interviews. RESULTS: Gender, income, usual practice in managing minor illness, what to do other than attending the ER, nurse follow-up, general self-rated health, triage, considered other doctors on the day of index ER visit, times of attending general outpatient clinic and times of attending general practitioner were found to be significantly associated with perceived improved health 30 days after the index ER visit. CONCLUSION: Many of the variables identified in this study that predicted perceived improved health concurred with previous findings. What is of interest is that nurse follow-up but not multiple medical consultations helped enhance perceived improved health. We speculate that there was no continuity of care in the multiple medical consultations. Where as in the nurse follow-up, the nurse was able to follow through the care of individuals, monitor their progress and make appropriate referrals. This study shows that the nurse is an appropriate person to mediate the health needs of individuals and the healthcare system and to enhance health maintenance for individuals in the community without excessively using medical services. RELEVANCE TO CLINICAL PRACTICE: The nurses providing care during the transitional phase should not only include the traditional clinical or hospital system variables, but should also take into account the general health perception of patients, because these are the predictors of health services utilization and morbidity.

Community nursing services for postdischarge chronically ill patients.

OBJECTIVE: To examine community nursing services for patients with cardiovascular diseases, chronic respiratory diseases and other general medical conditions, making the transition from hospital to home. DESIGN: The original study design was a randomised controlled trial. This study is a secondary analysis of the hospital records documented by community nurses for the study-group patients. SAMPLE: The sample consisted of 46 subjects, randomly drawn from the main study group of the study. MEASUREMENTS: The community nursing records were analysed using the Omaha System. Self-reported health status and readmission data were retrieved from the data base of the original study. RESULTS: The three groups of patients experienced problems across the four domains in the Omaha System. Community nursing interventions did not differ greatly by disease groups. The primary purpose of home visits was observation, followed by treatment and procedures and health teaching. The community nurses in the study spent more effort providing health teaching to the respiratory group than to their counterparts. The outcome measures are self-reported health status and hospital readmission rates. For self-reported health status, significant differences were observed in the respiratory and cardiovascular group before and after community nursing services. For hospital readmission rate, no significant difference was found. CONCLUSIONS: To improve the well being of chronically ill patients, a comprehensive home intervention programme, emphasising continuous needs of monitoring and case management, is fundamental to producing desired, measurable effects. RELEVANCE TO CLINICAL PRACTICE: This paper adds the understanding of home-care services provided by community nurses to chronically ill patients. The scope of nursing services emphasises the significance of a positive, patient-centred, caring and appropriate client-practitioner relationship to improve the self-reported health of patients.