A Social Media-Based Mindfulness Psycho-Behavioral Intervention (MCARE) for Patients With Acute Coronary Syndrome: Randomized Controlled Trial.

BACKGROUND: Psychological distress is common among patients with acute coronary syndrome (ACS) and has considerable adverse impacts on disease progression and health outcomes. Mindfulness-based intervention is a promising complementary approach to address patients' psychological needs and promote holistic well-being. OBJECTIVE: This study aims to examine the effects of a social media-based mindfulness psycho-behavioral intervention (MCARE) on psychological distress, psychological stress, health-related quality of life (HRQoL), and cardiovascular risk factors among patients with ACS. METHODS: This study was a 2-arm, parallel-group randomized controlled trial. We recruited 178 patients (mean age 58.7, SD 8.9 years; 122/178, 68.5% male) with ACS at 2 tertiary hospitals in Jinan, China. Participants were randomly assigned to the MCARE group (n=89) or control group (n=89). The 6-week intervention consisted of 1 face-to-face session (phase I) and 5 weekly WeChat (Tencent Holdings Ltd)-delivered sessions (phase II) on mindfulness training and health education and lifestyle modification. The primary outcomes were depression and anxiety. Secondary outcomes included psychological stress, HRQoL, and cardiovascular risk factors (ie, smoking status, physical activity, dietary behavior, BMI, blood pressure, blood lipids, and blood glucose). Outcomes were measured at baseline (T0), immediately after the intervention (T1), and 12 weeks after the commencement of the intervention (T2). RESULTS: The MCARE group showed significantly greater reductions in depression (T1: ß=-2.016, 95% CI -2.584 to -1.449, Cohen d=-1.28, P<.001; T2: ß=-2.089, 95% CI -2.777 to -1.402, Cohen d=-1.12, P<.001) and anxiety (T1: ß=-1.024, 95% CI -1.551 to -0.497, Cohen d=-0.83, P<.001; T2: ß=-0.932, 95% CI -1.519 to -0.346, Cohen d=-0.70, P=.002). Significantly greater improvements were also observed in psychological stress (ß=-1.186, 95% CI -1.678 to -0.694, Cohen d=-1.41, P<.001), physical HRQoL (ß=0.088, 95% CI 0.008-0.167, Cohen d=0.72, P=.03), emotional HRQoL (ß=0.294, 95% CI 0.169-0.419, Cohen d=0.81, P<.001), and general HRQoL (ß=0.147, 95% CI 0.070-0.224, Cohen d=1.07) at T1, as well as dietary behavior (ß=0.069, 95% CI 0.003-0.136, Cohen d=0.75, P=.04), physical activity level (ß=177.542, 95% CI -39.073 to 316.011, Cohen d=0.51, P=.01), and systolic blood pressure (ß=-3.326, 95% CI -5.928 to -0.725, Cohen d=-1.32, P=.01) at T2. The overall completion rate of the intervention (completing ≥5 sessions) was 76% (68/89). Positive responses to the questions of the acceptability questionnaire ranged from 93% (76/82) to 100% (82/82). CONCLUSIONS: The MCARE program generated favorable effects on psychological distress, psychological stress, HRQoL, and several aspects of cardiovascular risk factors in patients with ACS. This study provides clues for guiding clinical practice in the recognition and management of psychological distress and integrating the intervention into routine rehabilitation practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000033526; https://www.chictr.org.cn/showprojEN.html?proj=54693.

Effects of nurse-led self-care interventions on health outcomes among people with heart failure: A systematic review and meta-analysis.

AIM: To estimate the effects of nurse-led self-care interventions on people with heart failure (HF). BACKGROUND: Research evidence of the effects of nurse-led HF self-care interventions on patient outcomes is scant. DESIGN: A systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: Six databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies. METHODS: RCTs published in English that evaluated the impact of nurse-led HF self-care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA. RESULTS: Twenty-five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse-led self-care interventions improved QOL (SMD: .83, 95% CI: .50-1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49-2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24-1.38, low evidence) in people with HF. No significant effects were found in all-cause hospital readmission and all-cause emergency department visit. Research evidence on sleep quality, cardiac-related hospital readmission, cardiac-related emergency department visit and all-cause mortality remained unclear. CONCLUSIONS: Our review suggests that nurse-led HF self-care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well-designed RCTs are warranted to address the gaps identified in this review. RELEVANCE TO CLINICAL PRACTICE: The results indicated that nurse-led HF self-care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse-led self-care intervention could be integrated into current HF management practices.

Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross-sectional study.

AIMS AND OBJECTIVES: The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. BACKGROUND: Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country. DESIGN: A cross-sectional study design. METHODS: A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). RESULTS: Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach. CONCLUSION: Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. RELEVANCE TO CLINICAL PRACTICE: By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.

Effects of Telephone Consultation on Safety, Service Use, Patient Satisfaction, and Workload: Systematic Review and Meta-Analysis of Randomized Trials.

Objective: Telephone consultation (TC) is widely used for its easy access and convenience. This review aimed to assess the effects of TC including triage on safety, service use, patient satisfaction, and health professionals' workload to inform directions for future health service practice. Methods: CENTRAL, MEDLINE, Embase, CINAHL, ProQuest Dissertation & Theses (Health & Medicine), ClinincalTrials.gov, and International Clinical Trial Registry Platform were searched on April 7, 2022. The included were randomized controlled trials that compared TC with standard (face-to-face [F2F]) management or that by another group of call advisers. Cochrane methods were used to select eligible studies, assess the risk of bias, estimate summary effect measure, and grade evidence certainty. Meta-analysis was performed on important outcomes with moderate- or high-quality evidence. Results: Eight studies were included involving 40,002 participants. TC could increase call resolution-proportion of callers' concerns being addressed by telephone advice alone (two studies; high certainty) and reduce F2F contacts with doctors for the first consultation (two studies, moderate certainty) compared with standard management or TC by doctors. None of included studies reported increases in adverse events, including all-cause mortality, acute and emergency department visit, and hospitalization. There was inadequate evidence regarding the effects of TC on patient satisfaction and length of consultation. Conclusion: The findings support the benefits of TC on improving call resolution and reducing F2F contacts with doctors on the day of first management for regular day service; and TC by nurses can provide better effects than that by doctors for out-of-hours service.

Identifying the barriers and facilitators to implementation of ventilator bundle in the nepalese intensive care unit: A descriptive qualitative study.

BACKGROUND: A ventilator bundle is an effective preventive strategy against the development of ventilator-associated pneumonia (VAP). However, in clinical practice ventilator bundle implementation is poor. Understanding the barriers to ventilator bundle implementation in low- and middle-income countries can inform the development of effective implementation strategies to reduce the burden of VAP. OBJECTIVES: The primary objective of this study was to explore the barriers and facilitators of ventilator bundle implementation perceived by healthcare professionals (HCPs) working in intensive care units (ICU) in Nepal. The secondary objective was to prioritise the barriers when developing implementation strategies. METHODS: This study used a pragmatic approach comprising a series of methods to identify the implementation strategies: (i) Barriers and facilitators were explored using a qualitative study design. Twenty-one HCPs selected using the maximum variation sampling technique from a large tertiary hospital, completed semistructured interviews. All the interviews were recorded, transcribed word-by-word, and uploaded into NVivo for analysis using the thematic analysis approach. (ii) After analysis, nine participants were selecteded to determine the priority order of the barriers using a barrier identification and mitigation tool. RESULTS: The data analysis revealed five main themes and 19 subthemes that affected ventilator bundle implementation. The main themes were provider-related factors, organisational and practice-related factors, performances of work, environmental conditions, and patient-related factors. The common barriers were job insecurity, poor knowledge, negative attitude, insufficient equipment, and severity of patient disease. Common facilitators were educational training, equipment functioning, adequate staff, strong leadership, and organisational support. Finally, eight main barriers were prioritised to target the change. CONCLUSION: The barriers to implementing ventilator bundles in ICUs were identified. Focussing on addressing the prioritised barriers may aid in improving patient care and safety in ICUs. Results may guide HCPs in the development of implementation strategies to reduce the burden of VAP.

Household air pollution from solid fuel use and depression among adults in rural China: evidence from the China Kadoorie Biobank data.

BACKGROUND: Solid fuels are still widely used for cooking in rural China, leading to various health implications. Yet, studies on household air pollution and its impact on depression remain scarce. Using baseline data from the China Kadoorie Biobank (CKB) study, we aimed to investigate the relationship between solid fuel use for cooking and depression among adults in rural China. METHODS: Data on exposure to household air pollution from cooking with solid fuels were collected and the Chinese version of the World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF) was used to evaluate the status of major depressive episode. Logistic regression analysis was performed to investigate the association between solid fuel use for cooking and depression. RESULTS: Amongst 283,170 participants, 68% of them used solid fuels for cooking. A total of 2,171 (0.8%) participants reported of having a major depressive episode in the past 12 months. Adjusted analysis showed that participants who had exposure to solid fuels used for cooking for up to 20 years, more than 20 to 35 years, and more than 35 years were 1.09 (95% CI: 0.94-1.27), 1.18 (95% CI: 1.01-1.38), and 1.19 (95% CI: 1.01-1.40) times greater odds of having a major depressive episode, respectively, compared with those who had no previous exposure to solid fuels used for cooking. CONCLUSION: The findings highlight that longer exposure to solid fuels used for cooking would be associated with increased odds of major depressive episode. In spite of the uncertainty of causal relationship between them, using solid fuels for cooking can lead to undesirable household air pollution. Reducing the use of solid fuels for cooking by promoting the use of clean energy should be encouraged.

Genetic susceptibility in pneumoconiosis in China: a systematic review.

OBJECTIVE: Pneumoconiosis, encompassing coal workers' pneumoconiosis (CWP), silicosis and asbestosis, is one of the most common occupational diseases in China. Previous studies revealed significant associations between genetic variations and pneumoconiosis risk among individuals in different countries. With the known variability of genetic makeup between ethnicities, susceptibility to pneumoconiosis due to genetic differences is likely to be ethnicity-specific. The present review aimed at providing a comprehensive overview on the association between genetic polymorphisms and susceptibility of pneumoconiosis, specifically among people in China. METHODS: The literature search was performed in seven English and Chinese databases using keywords related to the review aim. An appraisal of the methodological quality of the included studies was conducted using the assessment tool derived from the Strengthening the Reporting of Genetic Association Studies (STREGA) statement. RESULTS: Forty-five studies were included in this review. Genotypes of specific genes which are associated with the risk of CWP, silicosis and asbestosis were reported. Our findings showed that genes encoding inflammatory cytokines have been examined extensively, and they demonstrated an association between these genes and pneumoconiosis risk. Gene-environment interactions in pneumoconiosis susceptibility were also reported by a number of studies. CONCLUSIONS: This review summarised the evidence demonstrating the association between genetic polymorphisms and pneumoconiosis susceptibility among people in China, and that various genotypes could modify their risk to develop pneumoconiosis. The findings prompt that identification of individuals at high pneumoconiosis risk through genetic screening and strategies limiting their exposure to dust could be a potential strategy for the control of this occupational disease in China.

Depressive and anxiety symptoms and illness perception among patients with acute coronary syndrome.

AIMS: To evaluate the features of depressive and anxiety symptoms and illness perception and their associations in patients with acute coronary syndrome (ACS). DESIGN: Secondary analysis of data from a cross-sectional study and baseline data from a randomized controlled trial. METHODS: From June to July 2019 and June to September 2020, patients with ACS in four public hospitals in China completed measurements of depressive and anxiety symptoms, illness perception, and sociodemographic and clinical characteristics. Data were analysed using univariate and multiple logistic regression analyses. RESULTS: This study included 510 participants (mean age, 61.0 ± 9.9 years; 67.8% male). The prevalence of depressive and anxiety symptoms was 66.3% and 56.5%, respectively. Total score of illness perception was 43.5 ± 9.1 and mean scores of each dimension ranged from 5.5 to 7.6, suggesting relatively negative illness perceptions. The top two perceived causes of illness were negative emotions or stress (27.3%) and dietary habits (25.5%) and 24.7% of participants were unaware of causes regarding their illness. After adjusting for potential confounders, a one-point increase in scores on illness perception regarding consequences and emotional response (range, 0-10) was related to a 22% increased probability of depressive symptoms. Every one-point increase in scores on illness perception related to emotional response, personal control and illness comprehensibility was associated with a 38% increased, 13% decreased and 9% decreased probability of anxiety symptoms, respectively. CONCLUSION: Depressive and anxiety symptoms are prevalent at high rates in patients with ACS. They have a relatively negative illness perception that is associated with the prevalence of depressive and anxiety symptoms. IMPACT: This study highlights the importance of screening for depressive and anxiety symptoms in patients with ACS, especially for those with negative illness perceptions. Targeted strategies are imperative to improve patients' health outcomes. NO PATIENT OR PUBLIC CONTRIBUTION: These details do not apply to this work.

Food frequency questionnaire for dietary assessment among adults at a risk of coronary heart disease: A mixed-methods study.

AIMS AND OBJECTIVES: To develop and psychometrically test a food frequency questionnaire for adults at risk of coronary heart disease (Cardio-FFQ). BACKGROUND: Comprehensive dietary assessment is critical for the prevention of cardiovascular disease, but appropriate instruments to perform this work are lacking. DESIGN: A sequential mixed-methods study followed the COREQ and STROBE guidelines. METHODS: This study was conducted between April 2016 and November 2017. It started with dietary history interviews (Phase 1) to identify candidate food items of the Cardio-FFQ, which validity and reliability were assessed (Phase 2) through expert consultation and four seasonal measurements, including test and retest with a 2-week gap every season. Physical activity and blood glucose and lipids were assessed seasonally, while another FFQ was administered during the fourth measurement. Content analysis was used to analyse verbatim interview transcripts, while descriptive and inferential analyses were used to simplify the Cardio-FFQ and examine its psychometric properties. RESULTS: Phase I involved 34 participants during their first onset of acute coronary syndrome and generated 176 candidate food items (consumed by at least three participants) under 12 food categories. These food items were simplified to form the 133-item Cardio-FFQ after discarding items with trivial contributions to food commonalities or between-person variance. Further analysis showed that the simplified questionnaire had satisfactory content validity, concurrent validity, convergent validity, predictive validity, known-group validity and test-retest reliability. CONCLUSION: The 133-item Cardio-FFQ is a valid and reliable tool for a comprehensive dietary assessment appropriate for adults at risk of coronary heart disease. RELEVANCE TO CLINICAL PRACTICE: Nurses may use the Cardio-FFQ to conduct a dietary assessment to better support people to commit to healthy diets, aiming to reduce the risk of coronary heart disease.

The effects of decision aids for genetic counselling among people considering genetic testing: A systematic review.

AIM: To assess the effectiveness of decision aids for genetic counsellees to improve their conflicts in decision-making and psychological well-being when considering genetic tests for inherited genetic diseases, and their knowledge about these tests and their genetic risks. DESIGN: Systematic review. DATA SOURCES: Six electronic databases (PubMed, MEDLINE, OVID Nursing, APA PsycINFO, EMBASE and CINAHL) were searched from inception to May 2022. REVIEW METHODS: Only randomised controlled trials that examined the effect of decision aids for information provision centring genetic testing on outcomes including decisional conflicts, informed choice making, knowledge on genetic risks or genetic tests, and psychological outcomes among participants who had undergone genetic counselling were included. Their risk of bias was assessed using the Version 2 of the Cochrane risk of bias tool for randomised trials. Results were presented narratively. The review was conducted according to the PRISMA checklist. RESULTS: Eight included studies examined the effect of booklet-based, computer-based, film-based or web-based decision aids on individuals considering genetic testing for their increased cancer risks. Despite contrasting findings across studies, they showed that decision aids enable genetic counsellees to feel more informed in decision-making on genetic tests, although most showed no effect on decisional conflict. Knowledge of genetic counsellees on genetic risks and genetic tests were increased after the use of decision aids. Most studies showed no significant effect on any psychological outcomes assessed. CONCLUSIONS: Review findings corroborate the use of decision aids to enhance the effective delivery of genetic counselling, enabling genetic counsellees to gain more knowledge of genetic tests and feel more informed in making decisions to have these tests. RELEVANCE TO CLINICAL PRACTICE: Decision aids can be used to support nurse-led genetic counselling for better knowledge acquisition and decision-making among counsellees. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution is not applicable as this is a systematic review.

Construct validity of advanced practice nurse core competence scale: an exploratory factor analysis.

BACKGROUND: Determining the core competence of advanced practice nurses is foundational for promoting optimal design and implementation of advanced practice nursing roles. Core competencies specific to the contexts of the advanced practice nurse in Hong Kong have been developed, but not yet validated. Thus, this study aims to assess the construct validity of advanced practice nurse core competence scale in Hong Kong. METHODS: We performed a cross-sectional study using an online self-report survey. Exploratory factor analysis was used to examine the factor structure of a 54-item advanced practice nurse core competence scale through principal axis factoring with direct oblique oblimin rotation. A parallel analysis was conducted to determine the number of factors to be extracted. The Cronbach's α was computed to evaluate the internal consistency of the confirmed scale. The STROBE checklist was used as reporting guideline. RESULTS: A total of 192 advanced practice nurse responses were obtained. Exploratory factor analysis led to the final 51-item scale with a three-factor structure, which accounted for 69.27% of the total variance. The factor loadings of all items ranged from 0.412 to 0.917. The Cronbach's alpha of the total scale and three factors ranged from 0.945 to 0.980, indicating robust internal consistency. CONCLUSION: This study identified a three-factor structure of the advanced practice nurse core competency scale: client-related competencies, advanced leadership competencies, and professional development and system-related competencies. Future studies are recommended to validate the core competence content and construct in different contexts. Moreover, the validated scale could provide a cornerstone framework for advanced practice nursing roles development, education, and practice, and inform future competency research nationally and internationally.

Impacts of ethical climate and ethical sensitivity on caring efficacy.

BACKGROUND: Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. RESEARCH AIM: This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy. RESEARCH DESIGN: This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. PARTICIPANTS AND RESEARCH CONTEXT: The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. RESULTS: Ethical climate was associated with caring efficacy (ß = 0.340, p < .001) and ethical sensitivity (ß = 0.197, p < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (ß = 0.860, p < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. CONCLUSIONS: The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.

Psychological Distress, Fear and Coping Strategies among Hong Kong People During the COVID-19 Pandemic.

The COVID-19 pandemic contributed to potential adverse effects on the mental health status of a wide range of people. This study aimed to identify factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Hong Kong. A cross-sectional online survey was conducted among general population in Hong Kong. Psychological distress was assessed using the Kessler Psychological Distress Scale; level of fear was evaluated using the Fear of COVID-19 scale; and coping strategies were assessed using the Brief Resilient Coping Scale. Multivariable logistic regression was used to identify key factors associated with these mental health variables. Of the 555 participants, 53.9% experienced moderate to very high levels of psychological distress, 31.2% experienced a high level of fear of COVID-19, and 58.6% showed moderate to high resilient coping. Multivariable logistic regression indicated that living with family members, current alcohol consumption, and higher level of fear were associated with higher levels of psychological distress; perceived stress due to a change in employment condition, being a frontline worker, experiencing 'moderate to very high' distress, and healthcare service use to overcome the COVID-19 related stress in past 6 months were associated with a higher level of fear; and perceived better mental health status was associated with a moderate to high resilient coping. This study identified key factors associated with distress, fear and coping strategies during the pandemic in Hong Kong. Mental health support strategies should be provided continuously to prevent the mental impact of the pandemic from turning into long-term illness. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-021-02338-7.

Development and evaluation of a multimedia intervention to promote cervical cancer prevention among South Asian women in Hong Kong.

Objective: The uptake of cervical cancer screening among South Asian ethnic minorities is low, rendering them at higher risk of developing cervical cancer. Interventions should, therefore, be developed to enhance their knowledge of this disease and its prevention. We developed and implemented a Health-Belief-Model-based and culturally sensitive multimedia intervention for South Asian women in Hong Kong, and evaluated its feasibility, acceptability and effectiveness using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework.Design: At post-intervention, a short survey was conducted to assess the participants' perceptions of the acceptability and effectiveness of the intervention. Focus group and/or telephone interviews with persons-in-charge of community organizations were conducted to collect feedback on the intervention's effectiveness and long-term sustainability.Results: The intervention was implemented successfully in partnership with 54 community organizations, of which 51 expressed a willingness to continue doing so at their centers. 1061 South Asian women received the intervention through attendance at the 51 health talks held. Over 90% of them agreed that the intervention was acceptable and effective.Conclusions: The intervention appeared to be feasible, and is potentially effective in enhancing participants' knowledge of cervical cancer and self-efficacy in undergoing screening.

Vasomotor symptoms, cardiovascular risk factors, and cardiovascular disease risk among Chinese postmenopausal women in Hong Kong.

Vasomotor symptoms are frequently reported by postmenopausal women and linked with unfavorable changes in cardiovascular risk factors, suggesting a likely association with cardiovascular disease (CVD) risk. This study aimed to investigate the characteristics of and associations between vasomotor symptoms, cardiovascular risk factors, and CVD risk among Chinese postmenopausal women. From March 2018 to August 2019, a convenience sample of 288 postmenopausal women who experienced natural menopause for ≥12 months were recruited from district centers of women associations in Hong Kong. We assessed vasomotor symptoms, cardiovascular risk factors, and CVD risk using questionnaires, anthropometric measures, and laboratory testing of fasting blood samples. Data were analyzed using bivariate correlation analyses and linear regression analyses. Over half of the participants experienced vasomotor symptoms (50.3 percent), and 23.3 percent had a high 10-year CVD risk. After adjusting for sociodemographic and clinical variables, flashing (ß = 0.270, P = .002) and sweating (ß = > -0.206, P = .018) were significantly associated with low-density lipoprotein cholesterol and flashing (ß = 0.229, P = .007) were significantly associated with total cholesterol. No statistically significant association was observed between vasomotor symptoms and CVD risk. Vasomotor symptoms were common and associated with several cardiovascular risk factors in Chinese postmenopausal women.

Advanced practice role delineation within Hong Kong: A cross-sectional study.

A career ladder for nurses, including several levels of nursing practice and specific roles for advanced practice nurses, was introduced in Hong Kong around the start of the 21st century. To date no studies have distinguished the practices of advanced practice nurses in Hong Kong. This cross-sectional study, conducted between November 2020 and March 2021, aims to identify and differentiate the practice patterns of advanced practice nurses by utilizing the Advanced Practice Role Delineation tool. A total of 191 responses were obtained. Three roles were identified: nurse consultant, advanced practice nurse, and advanced practice nurse in management. Among the five advanced practice nursing domains, nurses were most frequently involved in Education and in Direct Comprehensive Care activities, while least active in Research and in Publication and Professional Leadership. Identifying activities in various nursing roles helps to differentiate their responsibilities and provides new insights for role utilization and support. Although the role characteristics are shaped by country contexts, research evidence on practice patterns may be used to support international discussion and efforts to promote role clarity and effective role introduction and optimization.

Influenza-Associated Hospitalizations and Risk of Subsequent Heart Failure Hospital Admissions: A 20-Year Territorywide Registry Study in Hong Kong, China.

Little is known about the risk of hospitalization for cardiovascular disease after influenza infection in younger adults. In a territorywide Hong Kong, China, study using clinical registry data for 1997-2017, we examined the association between influenza-associated hospitalizations and the risk of subsequent hospitalization for heart failure (HHF) in 3 age groups: 18-44 years, 45-65 years, and >65 years. Exposure was defined as any infection with influenzavirus as a primary principal diagnosis for hospitalization, whereas the nonexposed control group comprised persons with hospitalizations for elective orthopedic surgery. Logistic regression was used to determine the risk of HHF within 12 months of hospital discharge for the exposed group versus the nonexposed group. Results showed that influenza-associated hospitalization in the preceding 12 months was associated with increased risk of subsequent HHF in all age groups (all P values < 0.001). Notably, the age group 18-44 years was found to have the highest elevated risk of HHF (adjusted odds ratio = 14.90, 95% confidence interval: 4.48, 49.58). In view of the relatively small number of subsequent HHF episodes in this age group, future studies are needed to confirm the elevated risk in this group and to explore the role of age in the relationship between influenza-associated hospitalization and subsequent HHF.

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

COVID-19: Factors associated with psychological distress, fear, and coping strategies among community members across 17 countries.

BACKGROUND: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. OBJECTIVES: We aimed to examine the extent and identify factors associated with psychological distress, fear of COVID-19 and coping. METHODS: We conducted a cross-sectional study across 17 countries during Jun-2020 to Jan-2021. Levels of psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale), and coping (Brief Resilient Coping Scale) were assessed. RESULTS: A total of 8,559 people participated; mean age (±SD) was 33(±13) years, 64% were females and 40% self-identified as frontline workers. More than two-thirds (69%) experienced moderate-to-very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (1.56 [1.29-1.90]), comorbidity with mental health conditions (3.02 [1.20-7.60]) were associated with higher levels of psychological distress and fear. Doctors had higher psychological distress (1.43 [1.04-1.97]), but low levels of fear of COVID-19 (0.55 [0.41-0.76]); nurses had medium to high resilient coping (1.30 [1.03-1.65]). CONCLUSIONS: The extent of psychological distress, fear of COVID-19 and coping varied by country; however, we identified few higher risk groups who were more vulnerable than others. There is an urgent need to prioritise health and well-being of those people through well-designed intervention that may need to be tailored to meet country specific requirements.

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial.

BACKGROUND: Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity. METHODS: The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients' diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention. DISCUSSION: This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients' adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings. TRIAL REGISTRATION: The trial is registered at ChiCTR.org.cn ( ChiCTR2000030011 ; date February 19, 2020).