| 1. |
- Albert, N.M., et al.
(författare)
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Exercise Factors Associated with 1-Year Mortality in Ambulatory Patients with Heart Failure
- 2013
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Ingår i: Journal of cardiac failure. - 1071-9164 .- 1532-8414. ; 19:8
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Konferensbidrag (refereegranskat)abstract
- Background: In prior research no differences have been found in 1-year mortality in pts with HF who participated in exercise interventions vs usual care. In HF-ACTION, over half of exercise pts were not fully adherent to the exercise intervention, even early into the trial. Understanding associations of exercise-related factors and 1-year mortality might lead to new interventions that promote exercise adherence. Methods. Using a prospective, correlational design, out-pts with chronic HF from 6 clinics completed questionnaires on demographics, comorbidites, and factors thought to be important in exercise capability and adherence (fatigue, depression, functional status, knowledge about exercise expectations, value of exercise, barriers/benefits of exercise, and exercise self-efficacy). Investigators provided 1-year survival data. Cox proportional hazards models were used to test for significance of the effects of variables of interest on survival. P-values for estimates of comparisons of hazard within levels of categorical variables were from tests based on z-statistics. If more than 2 categories, multiple comparisons were made to test for differences in the hazard ratios between each pair of categories. Continuous variables were categorized using cut scores. Results. Of the cohort of 492 pts (mean (SD) age 63 (± 13.6) yrs; LVEF 34.9% (± 14.8%); BMI 29.3 (± 6.73) kg/ml/m2; 40.3% ; male, 64.8%; Caucasian, 76.2%; married, 58.9%; NYHA-FC III/IV, 30.9%) 21 (4.2%) died within 1 year after enrollment. Only 46% reported exercising at a moderate-vigorous level. Pt characteristics associated with mortality were older age (p=0.037), no one to confide in (p=0.046) and NYHA-FC (p=0.001). Of exercise factors, mortality was reduced in pts with higher knowledge about exercise expectations (p=0.019), higher value for being active (p=0.002) and exercising (p=0.007), longer 6MWT distance (p=0.005), higher exercise self-efficacy (p=0.033) and reports of exercising at a moderate-vigorous level compared with no-infrequent exercise patterns (p=0.036). Conclusion. Among stable, out-pts with HF, many exercise-related factors were associated with 1-year mortality. Healthcare providers need to clearly communicate the value of exercise, explain details of moderate-vigorous exercise expectations and develop processes to increase self-efficacy for exercise to promote moderate-vigorous exercise behaviors and ongoing adherence to exercise.
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| 2. |
- Broström, Anders, et al.
(författare)
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Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients
- 2012
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 30:2, s. 107-113
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Tidskriftsartikel (refereegranskat)abstract
- Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.
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| 4. |
- De Maria, Maddalena, et al.
(författare)
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Cross-cultural assessment of the Self-Care of Chronic Illness Inventory : A psychometric evaluation
- 2021
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Ingår i: International Journal of Nursing Studies. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0020-7489 .- 1873-491X. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- Background: Self-care refers to behaviors that individuals adopt to prevent or maintain the stability of an illness (self-care maintenance), to monitor signs and symptoms (self-care monitoring), and to respond to signs and symptoms of an illness exacerbation (self-care management). A generic measure of self-care, the Self-Care of Chronic Illness Inventory, based on the Theory of Self-Care of Chronic Illness, was developed for use in individuals with any number and type of chronic conditions. Objective: The current study investigated the measurement equivalence of the Self-Care of Chronic Illness Inventory in individuals from three different cultural groups. We were interested in determining if Italians, Swedes, and Americans interpret the measure in a conceptually similar way. Methods: This cross-sectional study enrolled 1629 patients, 784 recruited in Italy, 438 in Sweden and 407 in the United States. Self-care (self-care maintenance, self-care monitoring and self-care management) was measured with the Self-Care of Chronic Illness Inventory. A multi-group confirmatory factor analytic approach was used to assess the equivalence of the measures across the three countries. Configural, metric, scalar and strict invariance were tested through a series of nested models where increasingly stringent equality constraints were posited. Results: Participants were mostly males (56.3%), older adults (69.8%) and had at least two chronic conditions. Results indicated that three out of four measurement equivalence levels were partially or totally supported in all three of the Self-Care of Chronic Illness Inventory scales. The partial scalar invariance level was reached for self-care maintenance [chi(2)(50)=63.495, p = 0.095; RMSEA =0.022, p = 0.999, 90% CI= 0.000 0.038; CFI =0.981; TLI =0.977; SRMR =0.036], self-care monitoring [chi(2) (22)=28.770, p = 0.095; RMSEA = 0.024, p = 0.978, 90% CI =0.000 0.046; CFI= 0.996; TLI=0.995; SRMR= 0.054], and self-care management [chi(2) (51)=91.334, p = 0.001; RMSEA =0.048, p = 0.576, 90% CI =0.031 0.063; CFI = 0.949; TLI= 0.937; SRMR = 0.047 ] scales. Conclusions: These findings suggest that patients in the three countries used an identical cognitive framework or mental model when responding and used the 1-5 Likert response scale in an almost identical way, almost without bias. In spite of sociocultural differences, patients in these countries seem to share the same fundamental view of self-care. The results of the Self-Care of Chronic Illness Inventory will be comparable in these countries. (C) 2019 Elsevier Ltd. All rights reserved.
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| 5. |
- Hjelm, Carina, et al.
(författare)
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The association between cognitive function and self-care in patients with chronic heart failure
- 2015
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Ingår i: Heart & Lung. - New York : Elsevier. - 0147-9563 .- 1527-3288. ; 44:4, s. 113-119
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To test the relationship between cognitive function and self-care in patients with heart failure after adjusting for the contribution of age, education, functional status, myocardial stress, sleep and depression. Further, the relationship between cognitive function and self-care was explored with depression and sleep as moderators.Background: Self-care can significantly impact functional capacity, well-being, morbidity, and prognosis in patients with heart failure (HF). However, self-care requires the cognitive ability to learn, perceive, interpret and respond. The influence of demographics and clinical symptoms on the relationship between cognition and self-care needs to be further understood.Design: Descriptive, cross-sectional study.Methods: The study included 142 patients with chronic HF (68% male, median age 72 years, 61% in NYHA II). Self-care was measured with the European Heart Failure Self-Care Behavior Scale. Cognitive function was evaluated with neuropsychological tests measuring global cognitive dysfunction, psychomotor speed, executive function, visual-spatial perception/construct, spatial performance, semantic and episodic memory.Findings: Psychomotor function (speed and attention) measured with the Trail Making A was the only dimension of cognitive function significantly associated with self-care. Neither depressive symptoms, nor sleep disturbances moderated the relation between cognitive function and selfcare.Conclusion: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care. A decrease in sustained attention and ability to carry out more than one task at a same time could lead to difficulties in self-care. Screening for psychomotor speed is therefore advocated for patients with HF.
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| 6. |
- Jaarsma, Tiny, et al.
(författare)
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Comparison of self-care behaviors of heart failure patients in 15 countries worldwide
- 2013
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 92:1, s. 114-120
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveClinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents.MethodsData on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale.ResultsIn all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries.ConclusionSelf-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide.Practice implicationsInterventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.
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| 10. |
- Jaarsma, Tiny, et al.
(författare)
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Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology
- 2021
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Ingår i: European Journal of Heart Failure. - : WILEY. - 1388-9842 .- 1879-0844. ; 23:1, s. 157-174
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Tidskriftsartikel (refereegranskat)abstract
- Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.
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