Attitudes toward depression among rural primary healthcare providers in hunan areas, China: a cross sectional study.

BACKGROUND: Mental health services are not sufficient for depression patients in rural areas of China, training in mental health knowledge for primary healthcare providers has been encouraged, but the effect of this encouragement has rarely been reported. METHODS: A cross-sectional survey was conducted in primary healthcare facilities that sought to include all the primary healthcare providers (registered physicians and nurses) in two cities in Hunan province, China by administering questionnaires that covered depression symptoms, typical depression cases, and the Revised Depression Attitude Questionnaire. RESULTS: In total, 315 primary healthcare providers agreed to participate in the study and finished the questionnaires, of which 12.1% had training in depression. In addition, 62.9% of the rural primary healthcare providers were able to recognize most general depression symptoms, and 8.3% were able to recognize all general depression symptoms. The primary healthcare providers in the survey held a neutral to slightly negative attitude towards depression as indicated by their professional confidence (mean scores 16.51 ± 4.30), therapeutic optimism/pessimism (mean scores 29.02 ± 5.98), and general perspective (mean scores 18.12 ± 3.12) scores. Fewer rural primary healthcare providers knew (28.3%) or applied (2.9%) psychological intervention in the clinic. CONCLUSIONS: Our study indicated that primary healthcare providers knew about general depression symptoms, but lacked psychological intervention skills and held low confidence in and pessimistic attitudes toward depression care. We therefore speculate that existing psychological training for primary healthcare providers is insufficient in quantity and quality, making the need to explore more effective types of training urgently.

Sexual dysfunction and activity avoidance in female kidney transplant patients.

Sexual dysfunction is common after kidney transplantation and has an adverse effect on patients' quality of life. This paper aims to evaluate the female sexual function, activity avoidance, and kidney function among a convenience sample of patients who had a kidney transplant. A cross-sectional study was conducted that included 250 patients had undergone a kidney transplant procedure >3 months ago, from multiple transplant centers and answered a self-reported sociodemographic questionnaire, the female version of the Arizona Sexual Experience Scale, and the Tampa Scale for Kinesiophobia-13. A correlation was found between sexual function and activity avoidance (r = .361, p < .001, n = 250) as well as between activity avoidance and kidney function (r = .198, p = .012, n = 250). Less education, having no child, post-transplant time for <36 months, and smoking (active and passive) were risk factors for female sexual dysfunction after kidney transplantation. The results suggest that physicians that the importance of recognize the relationship between fear of sexual activity and sexual function and that they should provide patients with more education and guidance on post-transplant sexual behaviors.

Job burnout and its influencing factors among newly graduated nurses: A cross-sectional study.

BACKGROUND: Burnout affects the quality of work and health of newly graduated nurses, increases the turnover rate among newly graduated nurses and leads to a shortage of nurses. Reducing job burnout among newly graduated nurses is critical. However, the factors that impact burnout among newly graduated nurses are currently not well known. OBJECTIVE: This exploratory study aims to identify the factors that influence burnout among newly graduated nurses in China. METHODS: We conducted a cross-sectional study of newly graduated nurses from 15 cities in 13 provinces in China. We used online questionnaires to conduct the survey and obtain the results in this study. A STROBE checklist was used to report the results. RESULTS: Of the 2400 questionnaires distributed, 2071 (86.29%) were returned. Job satisfaction, professional rank, hospital level, professional values and core competence were negatively correlated with burnout, while negative emotions were positively correlated with burnout. Women were more prone to burnout than men. CONCLUSIONS: Burnout among newly graduated nurses was divided into three dimensions based on the Maslach Burnout Inventory Scale. Our findings provided new evidence that newly graduated nurses had average levels of emotional exhaustion and depersonalisation and low levels of personal accomplishment. Job satisfaction, professional rank, hospital level, gender, professional values, negative emotions and core competence were predictors of job burnout among NGNs in China. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should pay attention to burnout management, standardise training about professional values, core competence and coping mechanisms and promote mental health and job satisfaction among newly graduated nurses.

Time management disposition and related factors among nursing managers in China: A cross-sectional study.

AIM: The purpose of this study was to gain a general overview of the time management disposition of clinical nursing managers in China and its related factors. BACKGROUND: Effective time management is important for managers to achieve organizational goals. However, there is a lack of big-sample research exploring the impact of psychological and socio-demographic characteristics on time management disposition. METHOD: The study adopted a cross-sectional and descriptive design; 531 nursing managers from seven regions of China were recruited. RESULTS: The nursing managers performed best on sense of time's value, followed by time monitoring ability and sense of time efficacy. Time management disposition was predicted by self-efficacy, SDS scores, managerial experience, the character strength of self-control and number of children. CONCLUSION: The "norm" level of the Chinese clinical nursing managers' time management disposition was at a favourable level, but these managers performed poorly in the aspect of time monitoring. It is recommended that actions be taken to improve nursing managers' time management disposition in order to maximize their time-use efficiency and enhance the quality of nursing management. IMPLICATIONS FOR NURSING MANAGEMENT: A greater understanding of nursing managers' time management disposition will provide a reference for subsequent actions to improve nursing managers' time management behaviour, which in turn will improve the quality and efficiency of nursing management.

Effect of peer support on health outcomes in patients with cardiac pacemaker implantation: A randomized, controlled trial.

The aim of this study was to examine the effect of a nurse-led telephone-based peer support program on health outcomes in patients after cardiac pacemaker implantation. Seventy six patients who received cardiac pacemaker implantation were recruited as participants and randomly assigned to either the peer support group or the usual care group. The usual care group received routine care and health education measures provided by nurses; the peer support group received telephone-based peer support. Health-related quality of life, self-care knowledge-attitudes-practice, postoperative anxiety and depression, compliance with attending scheduled follow-up visits, and the incidence of postoperative complications were evaluated at baseline and 6 months' postintervention for the two groups. The result showed that the interventions had a better effect on self-care knowledge-attitudes-practice, postoperative anxiety and depression, and compliance with attending scheduled follow-up visits in the peer support group than in the usual care group. This study confirms that telephone-based peer support improves self-care ability, compliance with attending scheduled follow-up visits, and reduces postoperative anxiety and depression more effectively than conventional nurse care among patients with cardiac pacemaker implantation.

A randomized study on the effect of modified behavioral activation treatment for depressive symptoms in rural left-behind elderly.

OBJECTIVE: To evaluate the effectiveness of a modified behavioral activation treatment (MBAT) intervention on reducing depressive symptoms in rural left-behind elderly. METHOD: This is a randomized study registered in Chinese Clinical Trial Registry (ChiCTR-IOR-17011289). Eighty rural left-behind elderly people who had a Geriatric Depression Scale (GDS) score between 11 and 25 were randomly assigned to the intervention (n = 40) and control group (n = 40). The intervention group received both MBAT and regular treatment for 8 weeks while the control group received regular treatment. Both groups were assessed with the GDS, Beck Anxiety Inventory (BAI), and Oxford Happiness Questionnaire (OHQ) at baseline, immediately post-intervention, and at 3 months post-intervention. RESULTS: There were a total of 73 participants that completed the intervention. The scores of GDS and BAI decreased significantly, but the scores of OHQ increased significantly in the intervention group after 8 sessions of MBAT (P < .01). The reduction in depression symptoms after the intervention was maintained at the 3-month follow-up. Significant differences in GDS, BAI, and OHQ scores were observed between the intervention group and the control group (P < .01). CONCLUSION: MBAT produced a significantly greater reduction in depressive symptoms than regular care in rural left-behind elderly. Clinical or methodological significance of this article: A modified behavioral activation (BA) psychotherapy can significantly reduce the recurrence and seriousness of depression symptoms in the left-behind elderly with mild to moderate depression. This study also suggests that further study of the MBAT as an intervention will provide a direction for the management of mental health in rural left-behind elders.

[Application of the index system for clinical evaluation of implementation effect: An example of vaginal delivery].

OBJECTIVE: In order to apply the index system for clinical evaluation of implementation effect in hospitals.
 Methods: A total of 862 patients with vaginal delivery from 9 hospitals were randomly divided into an clinical pathway group (n=496) and a control group (n=366). The patients in the control group received traditional treatment procedure while the patients in the clinical pathway group experienced procedure of the clinical treatment. The index system was used for clinical evaluation of implementation effect.
 Results: There were obvious advantages in 15 indicators in the clinical pathway group than those in the control group (P<0.05). The comprehensive score of the clinical pathway group was higher than the control group of the corresponding grade and nature of the hospital. The comprehensive score for secondary hospitals (Ci=0.7967) were higher than that for the tertiary hospitals (Ci=0.2033). The comprehensive score for the general hospitals (Ci=0.8948) were higher than that for the specialized hospitals (Ci=0.1052). As for clinical implementation effect, the secondary hospitals were better than the tertiary hospital, and the general hospitals were better than the specialized hospitals.
 Conclusion: The index system for clinical evaluation could quantify the implementation effect, and compare the implementation effect in different hospitals, which provides reference for the management of clinical pathway.

Rising Need for Health Education Among Renal Transplant Patients and Caregiving Competence in Care Providers.

BACKGROUND: Health education positively affects the efficacy of self-management and should be carried out according to the status of patients' needs, knowledge, and the competence of the primary caregivers. OBJECTIVES: This study was to investigate the needs of health education knowledge in transplant patients and the competence of the primary caregivers. METHODS: This is a cross-sectional study using a convenient sampling approach. Self-report questionnaires were applied to 351 renal transplantation patients and their primary caregivers. RESULTS: Three-hundred nine valid questionnaires were included in the analysis. The intensive care unit environment, stress coping strategies, the operation procedure, anesthesia and adverse reactions, and hand hygiene were the 5 most poorly understood aspects in health education. Stress coping strategies, at-home self-monitoring of health, pulmonary infection prevention, dietary needs, and anesthesia and other adverse reactions were the top 5 health education needs. Decision and self-efficacy were the weakest caregiving competence. Significant positive correlations were observed between health education knowledge level and caregiving competence in the primary caregivers. Marriage, education level, career, expense reimbursement, and residence significantly contributed to the health education demand questionnaire model, whereas gender, age, ethnic group, education level, career, and expense reimbursement significantly contributed to health education knowledge questionnaire model ( P < .05). CONCLUSION: The renal transplant patients and their primary caregivers need health education on the intensive care unit environment, stress coping strategies, the operation procedure, and anesthesia and other adverse reactions. The primary caregivers need training in decision-making and self-efficacy.

[Status for self-medication based on bibliometric study in China].

OBJECTIVE: To figure out problems through analyzing the status for self-medication in China and to provide references for further research.
 Methods: Papers related to self-medication were collected from Chinese journal net database, Wanfang database, VIP database and China biomedical literature database (CBMDisc). A literature metrology analysis was carried out by NoteExpress 2.0 and Excel.
 Results: A total of 161 papers were included in this study, while 33 papers belong to Hubei and Jiangsu Province, accounting for 20.50% of the total amount of the papers. 22 papers were from journals as follows: China Pharmacy, Medicine and Society and Chinese Journal of Pharmacoepidemiology, accounting for 13.67% of the total papers. 118 papers belong to research and experience discuss, accounting for 73.29% of all. The cooperation degree was 2.37, and 28 papers were funded. Domestic research reflected the current status of self-medication in our country. Although self-medication brought convenience for residents and reduce the burden on health system, it also brought a series of safety problems.
 Conclusion: Self-medication gradually catches the attention of the researchers. Some researchers have paid attention to self medication, but the evidence is at a low level. Researchers should strengthen cooperation with interagency and carry out experimental study to promote further development for self-medication.

Association Between Cytokines and Their Receptor Antagonist Gene Polymorphisms and Clinical Risk Factors and Acute Rejection Following Renal Transplantation.

BACKGROUND Acute rejection (AR) after renal transplantation affects both patient and graft survival. There is growing evidence of the genetic association between cytokine or its receptor antagonist and AR in solid organ transplantation. The objectives of this study were to investigate the role of recipient TNF ß, IL-10, IL-1ß, and IL-1 receptor antagonist (ra) gene polymorphism, as well as traditional clinical variables such as panel-reactive antibody (PRA) levels, donor type, and HLA mismatches in AR following renal transplantation. MATERIAL AND METHODS TNF ß (+252A/G), IL-10 (-592A/C), IL-1ß (-511C/T) and IL-1ra (86 bp VNTR) gene polymorphisms were determined in 195 renal allograft recipients with and without AR, using PCR. Both these genotypic variants and clinical risk factors were investigated for correlation with AR within the first year after renal transplantation. RESULTS Patients with increased pre-transplant PRA levels (P<0.001) and donor type (P=0.012) were prone to the development of AR. After adjusting for all variables of P<0.2, a PRA level >10% (OR=4.515, 95% confidence intervals=1.738-11.727, P=0.002) and the receipt of a graft from a donation after cardiac death (DCD) donor (OR=2.437, 95% confidence intervals=1.047-5.673, P=0.039) remained significantly associated with AR in a multivariate logistic regression analysis. No correlation could be found between recipients with an episode and absence of acute rejection and the gene polymorphisms of these cytokines investigated in the present study. CONCLUSIONS This study shows that the presence of increased pre-transplant levels of PRA and the receipt of a graft from DCD donor other than cytokine gene polymorphisms are significant risk factors for AR in renal transplantation. To reduce the occurrence of AR, clinicians should take necessary measures to lower the PRA levels and pay more attention to patients who received a graft from a DCD donor.

[Modification and evaluation of assessment of medication literacy].

OBJECTIVE: To translate and revise the Medication Literacy Assessment in English (MedLitRxSE-English) and evaluate its validity and reliability.
 Methods: We introduced MedLitRxSE-English from abroad. According to the principles of Brislin and culture adjustment, we revised it as a Chinese edition. Using random sampling method, from Oct, 2014 to Jan, 2015, 461 non-hospitalized patients from the outpatient departments of the top three hospitals in Changsha city were investigated. The reliability and validity of the scale was tested.
 Results: The test-retest reliability of the Chinese version for medication literacy scale was 0.885; the split reliability was 0.840; K-R was 0.820; the correlations between the assessment of medication literacy and the corresponding items were 0.427-0.587; the confirmatory factor analysis revealed overall good fit. Root mean square error of approximation (RMSEA), χ2/df, goodness of fit index (GFI) and comparative fit index (CFI) was 0.08, 3.06, 0.91 and 0.94, respectively. 
 Conclusion: The Chinese version for the assessment of medication literacy is in good reliability and validity, and it can be used to evaluate the medication literacy in our country.

Reporting among nurses and its correlation with hospital safety culture.

The aims of this study were to analyze the behaviors of nurses in China toward reporting safety events, the barriers to reporting, and the correlations of these aspects with hospital safety culture. A convenience sampling of 1125 nurses from 8 hospitals was performed. The perceptions of nurse managers and colleagues as well as reporting procedures played key roles in the barriers to safety event reporting. To increase the safety culture and facilitate reporting, attention should be paid to job satisfaction and recognition of nurses' stress.

Effect of social support and coping styles on the stress and mental health in relatives of patients with traumatic brain injury.

OBJECTIVE: To investigate the effect of social support and coping style on the stress and mental health in relatives of patients with traumatic brain injury. METHODS: The stress, mental health, social support and coping style were investigated in 300 relatives of patients with traumatic brain injury by Relative Stress Scale, Symptom Checklist-90, Social Support Rating Scale and Simplified Coping Style Questionnaire in Changsha City. RESULTS: The mental health problems in relatives of patients with traumatic brain injury were closely related to the levels of stress, the ways of coping and the social support. In addition to the direct eff ect of stress on mental health in relatives of patients, the ways of coping and social support functioned as a mediator in this regard. The value of mesomeric eff ect for coping styles and social support ranged from 23.6% to 43.0%, and social support had an advantage over the coping styles. CONCLUSION: Social support and coping styles should be considered in psychological nursing program to prevent and adjust the mental distress in relatives of patients with traumatic brain injury, which is beneficial to the treatment and recovery for patients.

[Relationship between the ischemic ST-T changes in ECG and the coronary artery diseases].

OBJECTIVE: To analyze the relationship between the ischemic ST-T changes in electrocardiogram (ECG) and the coronary artery diseases based on the perspective of diagnostics.
 METHODS: A total of 341 patients, who underwent coronary angiography in Department of Cardiology of Xiangya Hospital, Central South University from June 2013 to April 2014, were enrolled for this study. The internationally recognized diagnostic criteria for ischemic ST-T changes in ECG and the Judkins diagnostic criteria for coronary angiography were applied, respectively. The sensitivity and specificity of ECG were analyzed.
 RESULTS: There were more ischemic ST-T changes in women than that in men (P<0.01). Ischemic changes in coronary angiography were not significantly different between male and female patients (P>0.05). For ischemic diagnostic tests by ECG ST-T, the total sensitivity and specificity was 83.6% and 54.4%, respectively. The sensitivity and specificity was 82.3% and 68.0% or 85.0% and 28.2% in the male or female group, respectively. 
 CONCLUSION: Ischemic ST-T changes in ECG possess important value in the diagnosis of the coronary artery diseases. The sensitivity of ECG in the diagnosis of myocardial ischemia in women was higher than that in men, whereas the specificity of ECG in the diagnosis of myocardial ischemia in men was higher than that in women.

[Factors related to the length of hospital stay for cerebrovascular accident].

OBJECTIVE: To explore the factors related to the length of hospital stay for cerebrovascular accident and to provide the basis for health administrative department to formulate measures, and for clinical department to develop treatment guidelines. METHODS: We collected the medical record of the hospitalized cerebrovascular accident patients from 2008 to 2013 in the Third Xiangya Hospital, Central South University. The collected data included demographic information, disease characteristics, treatment information and health economics information. Then we analyzed the factors related to the length of hospital stay for cerebrovascular accident. SPSS 13.0 was used for statistical analysis and logistic regression and nonparametric rank sum test was performed. RESULTS: The length of stay in hospital was from one day to 513 days, with a median of 10 days. The length of stay for women was shorter than that of men (OR=0.869). The length of stay for the older patients was longer than that of younger patients (OR=1.158). The length of stay for patients who implemented a surgery was 1.686 times longer than those who were not implemented a surgery (OR=1.686). The length of stay for ischemic cerebrovascular patients was shorter than that of the hemorrhagic cerebrovascular patients (OR=0.275). The patients with new rural cooperative medical insurance or without health insurance usually stayed a short time in hospital. CONCLUSION: Sex, age, surgery, type of cerebrovascular accident and medicare type are the factors that affect the length of hospital stay for cerebrovascular accident.

[Early recognition of deteriorating patient program in department of cardiac surgery].

OBJECTIVE: To explore the application and the effect of early recognition of deteriorating patient program in department of cardiac surgery. METHODS: We used the early recognition of deteriorating patient program in the cardiac surgery groups, including cardiac surgeons, nurses in ward, ICU and operation rooms of the cardiac surgery department, and compared the satisfaction of nurses and doctors, handover time, handover score of critical patients, and rate of unplanned ICU admission before and after the intervention. RESULTS: After using the early recognition of deteriorating patient program, the satisfaction of doctors and nurses was increased, the handover time was lowered 0.56 min/time (t=2.22, P<0.05), the handover score of critical patients enhanced by 19.59 points (t=30.57, P<0.001), the rate of unplanned ICU readmission after the operation reduced by 4.8% (χ2=4.14, P<0.05). CONCLUSION: Early recognition of deteriorating patient program can improve the safety of cardiac patients, enhance the self-confidence of nurses and work efficiency.

The effect of health coaching on blood pressure control and disease self-management among patients in rural area in China: a randomized controlled trial.

The self-management education for patients with hypertension has not been widely provided in rural areas of China. Our study aimed to examine the effect of health coaching intervention on controlling BP and improving self-management skills among rural resident of ≤6 month-history of hypertension. A total of 102 participants were enrolled in the RCT. The control group received usual health guidance and follow-up management; the experimental group received health coaching and follow up management. The primary outcomes were the difference in changes of BP and mean self-management scores. The secondary outcomes included waist circumference, body mass index (BMI), and medication literacy. Participants in the experimental group showed a significantly greater improvement with respect to systolic BP and diastolic BP respectively (133.85 ± 4.74 mmHg vs 127.96 ± 5.42 mmHg;80.94 ± 5.52 mmHg vs 77.37 ± 4.44 mmHg, P < 0.05) and BMI (24.66 ± 2.19 kg/m2 vs 23.44 ± 2.05 kg/m2, P < 0.05) compared with the control group. A significant difference was also observed between the experimental and control groups in terms of self-management and medication literacy at both 3 and 6 months (P < 0.05). However, there was no significant difference in changes of waist circumferences between the two groups (22.6% vs 38.8%). In conclusion, for patients with diagnosed with hypertension within the last 6 months, health coaching maybe is an effective approach to control blood pressure and improve medication literacy and self-management skills.

Low body mass index and disease duration as factors associated with depressive symptoms of Chinese inpatients with chronic heart failure.

Depression is common in patients with chronic heart failure (CHF), and is associated with an increased risk of adverse health outcomes. There is a paucity of data on this subject from the developing countries. The aim was to examine the prevalence and related factors of depressive symptoms among Chinese inpatients with CHF. A cross-sectional study was conducted. PHQ-9 questionnaire was used to assess depressive symptoms. The overall prevalence of depressive symptoms was 7.5%. Low BMI (OR = 4.837, CI = 1.278-18.301, p = 0.02), disease duration 3-5 years (OR = 5.033, CI = 1.248-20.292, p = 0.023) and 5-10 years (OR = 5.848, CI = 1.440-23.744, p = 0.013) were risk factors for depressive symptoms, while being married (OR = 0.304, CI = 0.123-0.753, p = 0.010) was protective factor. We should pay more attention to patients without a spouse, with low BMI and whose disease duration is between 3 and 10 years in Chinese inpatients with CHF.

Environmental Enrichment during Gestation Improves Behavior Consequences and Synaptic Plasticity in Hippocampus of Prenatal-Stressed Offspring Rats.

Prenatal stress can result in various behavior deficits in offspring. Here we tested the effects of environmental enrichment during gestation used as a preventive strategy on the behavior deficits of prenatal-stressed offspring rats as well as the underlying structure basis. We compared the effect size of environmental enrichment during gestation on prenatal-stressed offspring to that of environmental enrichment after weaning. Our results showed that environmental enrichment during gestation partially prevented anxiety and the damage in learning and memory in prenatal-stressed offspring as evaluated by elevated plus-maze test and Morris water maze test. At the same time, environmental enrichment during gestation inhibited the decrease in spine density of CA1 and dentate gyrus neurons and preserved the expression of synaptophysin and glucocorticoid receptors (GRs) in the hippocampus of prenatal-stressed offspring. There was no significant difference in offspring behavior between 7-day environmental enrichment during gestation and 14-day offspring environmental enrichment after weaning. These data suggest that environmental enrichment during gestation effectively prevented the behavior deficits and the abnormal synapse structures in prenatal-stressed offspring, and that it can be used as an efficient preventive strategy against prenatal stresses.