Yan Shi

Background: Assessment of maternal readiness for discharge is critical. Higher level of discharge readiness can significantly improve maternal and family members’ depression and anxiety, and reduce the incidence of puerperal complications and neonatal diseases. Understanding how couples navigate and negotiate the challenges and demands of readiness for discharge after delivery has important implications for family health. This study aimed to investigate maternal readiness for hospital discharge and analyze the influencing factors under the dualistic perspective of the couple. Methods: A prospective questionnaire study was administered to 374 women using Maternal and spousal general information questionnaire, Maternal Readiness for Discharge Assessment Scale, and Relationship Satisfaction Scale. Results: Maternal readiness for hospital discharge was assessed with an average score of 177.17 ± 18.67. The total score of the Relationship Satisfaction Scale was 37.83 ± 1.90, and the total score of the spousal Relationship Satisfaction Scale was 36.25 ± 2.18. The results of the hierarchical linear regression equation modeling showed that maternal relationship satisfaction independently explained 8.9% of the total variance in readiness for discharge after controlling for the effects of maternal and spousal general information (p < 0.001), and spousal relationship satisfaction independently explained 10.3% of the total variance in readiness for discharge after controlling for the effects of maternal and spousal general information and maternal relationship satisfaction (p < 0.001). Conclusions: Higher levels of relationship satisfaction were associated with higher maternal readiness for discharge. The important predictive role played by couple intimacy satisfaction in readiness for discharge should be emphasized.

Objective: This study investigated the consistency and determined the optimal threshold values of three scales in the diagnosis of insomnia of ischemic stroke (IS) patients.Methods: Participants in this study consisted of 569 acute IS patients. All 569 patients completed the assessment of the three insomnia scales. Insomnia of IS patients were assessed by Pittsburgh sleep quality index (PSQI), Insomnia Severity Index (ISI), and Athens insomnia scale (AIS). Also, basic patient information, neurological function, and activities of daily living were assessed. General information was compared between the insomnia group and the no-insomnia group. Cronbach’s α coefficients, Cohen’s Kappa consistency, Receiver operating characteristic (ROC) curve and DeLong’s test analysis were used to analyze the reliability and diagnostic validity of PSQI, ISI, and AIS.Results: The PSQI and ISI showed high reliability with Cronbach’s α of 0.875 and 0.858, respectively, while the AIS had an α coefficient of 0.734, demonstrating acceptable reliability. The PSQI, ISI, and AIS showed outstanding diagnostic ability with an AUC of 0.960 (95% CI: 0.946, 0.974), 0.911 (95% CI: 0.882, 0.941), and 0.876 (95% CI:0.837, 0.916). The best diagnostic cutoffs for PSQI, ISI, and AIS are ≥9, ≥15, and ≥8.Conclusion: Each of the three questionnaires has advantages and disadvantages when assessing insomnia. In the evaluation of insomnia in IS patients, the best questionnaire selection should be made according to the purpose of clinical evaluation and considering the sensitivity and specificity.

Corrigendum: Prevalence and factors associated with hyperphosphatemia in continuous ambulatory peritoneal dialysis patients: a cross-sectional study

Background: Hyperphosphatemia remains a major complication in patients with Continuous ambulatory peritoneal dialysis (CAPD) leading to increased morbidity and mortality. However, phosphorus management still has many challenges.Objective: This study aimed to investigate the prevalence and factors of hyperphosphatemia among continuous ambulatory peritoneal dialysis patients in a tertiary public hospital in Shanghai, China.Methods: The single-center cross-sectional study recruited end-stage renal failure patients who received continuous ambulatory peritoneal dialysis (CAPD) for at least 3 months. The participants aged 18–80 years had undergone CAPD between 1 July 2021 and 30 May 2022, in Shanghai, China.The patients’ sociodemographic, clinical, and laboratory data were collected prospectively from medical records and via face-to-face interviews. A sample size of convenience decides the sample size. This study used the information-motivation-behavioral (IMB) skills model as a theoretical framework. The questionnaire included knowledge and behavior of diet and medication in patients with hyperphosphatemia of chronic kidney disease, self-efficacy for managing chronic disease, and social support rating scale. Univariate analysis and binary logistic regression were performed to identify the influencing factors of hyperphosphatemia by SPPS 27.0.Results: In total, 141 CAPD patients (73% hyperphosphatemia) were included in the final analysis. In logistic regression analysis, dialysis vintage (OR: 0.975, 95%CI: 0.957–0.993), dialysis exchanges (OR: 0.317, 95%CI: 0.131–0.768), urine output (OR: 0.997, 95%CI: 0.995–0.999), serum albumin (OR: 1.166, 95%CI:1.008–1.349), serum creatinine (OR: 1.005, 95%CI: 1.001–1.008), hyperphosphatemia knowledge behavior score (OR: 0.888, 95%CI: 0.797–0.991), and social support level (OR: 0.841, 95%CI:0.765–0.925) were the influencing factors of hyperphosphatemia.Conclusion: Hyperphosphatemia is a frequent complication in CAPD patients. Dialysis vintage, dialysis exchanges, urine output, serum albumin, serum creatinine, hyperphosphatemia knowledge behavior, and social support were the associated factors of hyperphosphatemia in CAPD patients. It is crucial for healthcare providers to maintain phosphorus balance among CAPD patients using phosphorus management strategies.

Objective: To examine the relationship between caregiver competence and health-related quality of life (HRQoL) among family caregivers of disabled elderly adults, and to evaluate the role of caregiver burden as a potential mediator of that relationship. Design: Cross-sectional study. Setting: Two general hospitals in Shanghai, China. Participants: Study participants were 135 family caregivers of disabled elderly adults listed on a roster for outpatient and emergency services utilisation from January to March 2022. Data analysis and outcome measures: We used stratified linear regression and structural equation model analysis. HRQoL was the main outcome, measured using the Medical Outcomes Study 36-Item Short form Health Survey. Caregiver competence was assessed using the Family Caregiver Task Inventory, and caregiver burden was assessed with the Zarit Burden Interview. Results: Caregivers of moderately and severely disabled elderly adults showed poorer scores in Physical Component Summary (F=20.463, p2 /df=1.175, p=0.261, NFI=0.970, RFI=0.949, IFI=0.995, CFI=0.995, GFI=0.963, TLI=0.992, AGFI=0.920, RMSEA=0.036). The total effect of Family Caregiver Task Inventory scores on HRQoL scores was −0.980, with a direct effect of −0.645. The mediating effect on HRQoL scores through the intermediate variable of caregiver burden scores was −0.335. Conclusions: Family caregivers’ HRQoL is closely related to caregiver difficulties and burdens. Early identification and targeted measures are needed to reduce the burden and problems in caregiving.

This study examined the association between post-stroke cognitive function and sleep status at 30 days post-stroke and evaluated the role of anxiety and depression as potential mediators of that association. The participants in this study were 530 acute ischemic stroke (IS) patients. Sleep disturbance at 30 days post-stroke was assessed by the Pittsburgh Sleep Quality Index. Basic patient information, cognitive function, depression, and anxiety status were assessed before discharge from the hospital. Stratified linear regression analysis models were fit to examine the associations between post-stroke sleep quality and the influencing factors. A structural equation model was developed to evaluate the role of anxiety and depression as potential mediators of sleep quality and cognitive function. At 30 days post-stroke, 58.7% of IS patients had sleep disturbance. Women and older IS patients were more likely to suffer poorer sleep quality (p < 0.05). A stratified linear regression analysis showed that the inclusion of cognitive function variables and indicators of depression and anxiety were statistically significant in predicting improvement in the sleep disturbance of AIS patients. Cognitive function, depression, anxiety, and sleep status were selected to construct a structural equation model. The total effect of cognitive function on sleep status was −0.274, with a direct effect of −0.097 and an indirect effect (through depression) of −0.177. The total effect of anxiety on sleep status was 0.235, with a direct effect of 0.186 and an indirect effect (through depression) of 0.049. IS patients often experience poor sleep quality. Depression in IS patients mediates two pathways: the pathway through which cognitive function affects sleep quality and the pathway through which anxiety affects sleep quality.

Objective To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients’ self-efficacy and self-management and changes in behaviour at, and following, hospital discharge. Design This study used a convergent mixed methods design. Participants Twenty-one participants with completed surveys and interviews at discharge and home follow-up were included in the analysis. Setting At a coronary care unit of a major hospital in Shanghai, China. Results Most participants (n=17) did not perceive they had sufficient education or ability to manage both conditions. More concerning was that most participants (n=16) reported low self-efficacy in the management of ACS symptoms. Three major themes were identified: self-management of ACS and T2DM represents a complex interplay between individual self-efficacy, knowledge and skills, as individuals navigate shifting self-management priorities due to perceived condition severity; the social environment is integral to lifestyle and behaviour change and managing multiple health conditions requires body and mind systems’ harmony. Conclusions The inpatient education received did not enhance participants’ confidence to manage either condition on discharge. While an unhealthy lifestyle was embedded within social roles and norms, some social activities, such as square dancing, positively influenced health behaviour. Culturally appropriate education for Chinese people with diabetes and ACS should contain information on maintaining mind and body harmony. Family members should be involved in formal education.

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.