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- Jiang, Nan
(författare)
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Radiation-Induced Xerostomia in Chinese Patients with Head and Neck Cancer – An Explorative and Interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Radiation-induced xerostomia is a common oral complication of patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This can lead to a series of functional oral disorders, particularly dental caries, and ultimately negatively affect their oral health and health-related quality of life (HRQoL).Aims: The overall aim of this thesis was to understand the living experience of radiation-induced xerostomia and to determine the effects of an integrated supportive program based on multicomponent oral care strategies in Chinese patients with HNC.Methods: A qualitative descriptive study was conducted to describe how patients (13 men and 7 women) with HNC experienced radiation-induced xerostomia (Ⅰ). A cross-sectional study of patients (n=80) with HNC was conducted to accomplish the validation of the Chinese version of the xerostomia questionnaire (XQ) (Ⅱ). A randomized controlled trial (n=79) was conducted to determine the effect of an integrated supportive program (with a combination of face-to-face health education and coaching sections) on xerostomia, saliva characteristics (Ⅲ), oral health, and HRQoL (IV).Results: Five categories emerged from the manifest content of the interviews: communication problems, physical problems, psychosocial problems, treatment problems, and relief strategies. The meaning underlying these categories formed a theme, which was the latent content of the interview: Due to lack of information regarding xerostomia, patients had to find their own ways to deal with the problem (Ⅰ). The Chinese version of XQ was a unidimensional scale (1-factor solution explained 75.6 of the total variance) and had good psychometric properties with excellent internal consistency (Cronbach’s α of 0.95), test-retest reliability (intraclass correlation coefficient of 0.92), and good criterion-related validity and content validity (Ⅱ). The integrated supportive program showed significant inter-group differences in xerostomia (P=0.046), unstimulated saliva flow rate (P=0.035), plaque index (P=0.038), Oral Health Impact Profile-14 (P=0.002), and Functional Assessment Cancer Therapy-Head & Neck (P=0.001) over the 12-month follow-up, with better outcomes in the intervention group (Ⅲ & Ⅳ).Conclusion: This thesis contributes knowledge regarding the experiences of living with xerostomia from a patient perspective, noting that xerostomia has a profound impact on a patient's physical, psychological, and social quality of life. There is lack of assessment tools for xerostomia in the Chinese population, and the Chinese version of XQ proved to be a valid and simple self-administered tool to measure and monitor the xerostomia level in patients with HNC. The integrated supportive program with multicomponent oral care strategies demonstrated positive effects on relieving xerostomia, increasing unstimulated saliva flow rate, and improving their oral health and HRQoL. These findings provide a basis for improvement in the management of xerostomia and oral health of Chinese patients with HNC through the integration of oral care in nursing.
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- Shi, Linjun
(författare)
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Participation in everyday activities among children with intellectual disabilities in mainland China : The development, verification, and application of the Picture My Participation instrument
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Participation in everyday activities is seen as a main outcome of rehabilitation for children. ‘Picture My Participation’ (PMP) is a validated questionnaire for assessing participation in everyday activities by children with disabilities in low- and middle-income countries, but it is not yet available in simplified Chinese.Aims: The overall aims of this thesis were to validate a simplified Chinese version of Picture My Participation as a participation assessment tool, the PMP-C (simplified), and also to describe the attendance and involvement in everyday activities of children with IDs and their TD peers in rural and urban areas of mainland China as well as barriers and facilitators of participation from the perspectives of children and their primary caregivers.Methods: This thesis reports four studies conducted to carry out these aims. Studies I and II used a quantitative method with a cross-sectional instrument validation design to cross-culturally adapt the PMP-C (simplified) and explored its validity and reliability. Based on this, Study III used a cross-sectional design to compare the frequency and involvement of children with IDs and TD in everyday activities in rural and urban areas of mainland China. Meanwhile, Study IV used a descriptive and explorative design with an inductive qualitative content analysis approach to describe primary caregivers’ perceptions of barriers and facilitators related to participation in everyday activities among children with IDs in mainland China.Results: All items in the PMP-C (simplified) had excellent content and face validity. The internal consistency, reliability coefficient, and test-retest reliability of the subscale scores were excellent (Study I). The construct validity of the subscale scores extracted five subcomponents: organised activities, social activities, taking care of others, family life activities, and personal care and development activities (Study II). Children with IDs reported lower participation than children with TD in terms of their total scores for attendance and involvement but reported the same levels of involvement in the subcomponents taking care of others and family life activities as children with TD in urban areas. Concerning differences between urban and rural contexts, both children with TD and IDs in rural areas reported lower total scores for attendance and for all subcomponents except social activities than their urban counterparts. There was no significant difference in the total involvement score between rural and urban contexts for children with IDs; however, children with TD in urban areas reported higher involvement than their rural counterparts (Study III). Four categories of barriers to participation in everyday activities for children with IDs were identified: insufficient knowledge, attitudes, and skills in primary caregivers; ID-related characteristics of children; stigma and Chinese culture; and lack of societal support. Four categories describing facilitators were identified: the optimistic attitude of the primary caregiver, adequate family support; active school and policy environments, and enjoyable characteristics of children with IDs (Study IV).Conclusion: This thesis provides psychometric evidence that the PMP-C (simplified) is a valid and reliable measure of participation in mainland China and enable children with ID to have “a voice” and to report their own perspectives. The findings regarding ID–TD and urban–rural disparities in participation and the barriers and facilitators of participation among children with IDs offer important insights concerning environmental aspects when planning future intervention studies focused on promoting participation in mainland China.
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- Wang, Lan
(författare)
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A health coaching self-management programme for patients with Chronic Obstructive Pulmonary Disease : An explorative and interventional study
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of chronic morbidity and mortality and contributes to an increased economic and social burden on patients and families. Self-management education as one non-pharmacological treatment approach is highlighted in guidelines. Although self-management programmes have shown positive effects for COPD, lack of disease-specific self-management skills, high dropout rates, and poor attendance of participants are problems which should be taken under consideration. One way to cope with the problems is to use amore motivational approach which focuses on patients’ health decisions in cooperation with healthcare practitioners, combined with systematic and structured health coaching. However, there is a lack of such studies, which are needed to explore the effects of self-management on patients with COPD by health coaching, not least in China.Aims: The overall aim of this thesis was to explore sociodemographic and clinical factors influencing self-management and to test and evaluate a health coaching self-management programme for patients with COPD in China.Methods: The study’s design was explorative, prospective, and longitudinal, with both quantitative and qualitative approaches. Specifically, a quantitative method with a cross-sectional approach was used to explore the self-management status of patients with COPD and examine the associations with socio-demographic and clinical variables (I). Furthermore, a prospective randomized controlled trial was conducted to study the longitudinal effects of the health coaching self-management programme using a repeated-measures analysis of variance model of patients with COPD (II & III). A qualitative study implementing inductive content analysis was used to describe and explore participants’ experiences of the health coaching self-management programme of patients with COPD (IV).Results: High physical activity, high salary, and low age affected the self-management of patients with COPD most positively (I). The health coaching programme improved lung function, physical activity, quality of life, and self-management skills, as well as psychological status in both the short and long term (II & III). Participants expressed their experiences of the health coaching self-management programme as making them more aware of the importance of knowledge of the disease and their own responsibilities, taking action to maintain a healthy lifestyle, feeling supported by the programme, and being hindered by individual and programme limitations (IV).Conclusions: This thesis contributes to knowledge about the self-management skills of patients with COPD, which is low in China. A health coaching self-management programme with iterative interactions between patients and healthcare professionals represented a valuable and effective intervention designed to improve health-related outcomes. Moreover, low literacy, poor physical condition, and family and economic burdens should be taken into account in the development of future self-management programmes in China.
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- Wu, Yao, et al.
(författare)
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Global, regional, and national burden of mortality associated with short-term temperature variability from 2000–19 : a three-stage modelling study
- 2022
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Ingår i: The Lancet Planetary Health. - : Elsevier. - 2542-5196. ; 6:5, s. e410-e421
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000–19.Methods: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000–19. Temperature variability was calculated as the SD of the average of the same and previous days’ minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades.Findings: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901–2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2–4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7–5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3–10·4), followed by Europe (4·4%, 2·2–5·6) and Africa (3·3, 1·9–4·6).Interpretation: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. Funding: Australian Research Council, Australian National Health & Medical Research Council.
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| 6. |
- Zhao, Qi, et al.
(författare)
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Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019 : a three-stage modelling study
- 2021
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Ingår i: The Lancet Planetary Health. - : Elsevier. - 2542-5196. ; 5:7, s. e415-e425
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures.METHODS: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division.FINDINGS: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe.INTERPRETATION: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios.
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