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Jutterström L, Stenlund AL, Otten J, Lilja M, Hellström Ängerud K. Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study. Int J Qual Stud Health Well-being 2024; 19:2294512. [PMID: 38112175 DOI: 10.1080/17482631.2023.2294512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D). METHOD A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory. RESULT The analysis identified the core category "Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it." Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management. CONCLUSION Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.
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Affiliation(s)
- Lena Jutterström
- Department of Nursing, Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | | | - Julia Otten
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Mikael Lilja
- Unit of Research, Education and Development Department of Public Health and Clinical Medicine - Östersund Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 148] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Yuting Z, Xiaodong T, Qun W. Effectiveness of a mHealth intervention on hypertension control in a low-resource rural setting: A randomized clinical trial. Front Public Health 2023; 11:1049396. [PMID: 36935728 PMCID: PMC10014612 DOI: 10.3389/fpubh.2023.1049396] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Background Despite the increasing popularity of mHealth, little evidence indicates that they can improve health outcomes. Mobile health interventions (mHealth) have been shown as an attractive approach for health-care systems with limited resources. To determine whether mHealth would reduce blood pressure, promote weight loss, and improve hypertension compliance, self-efficacy and life quality in individuals with hypertension living in low-resource rural settings in Hubei, China. Methods In this parallel-group, randomized controlled trial, we recruited individuals from health-care centers, home visits, and community centers in low-resource rural settings in Hubei, China. Of 200 participants who were screened, 148 completed consent, met inclusion criteria, and were randomly assigned in a ratio of 1:1 to control or intervention. Intervention group participants were instructed to use the Monitoring Wearable Device and download a Smartphone Application, which includes reminder alerts, adherence reports, medical instruction and optional family support. Changes in the index of Cardiovascular health risk factors from baseline to end of follow-up. Secondary outcomes were change in hypertension compliance, self-efficacy and life quality at 12 weeks. Results Participants (n = 134; 66 in the intervention group and 68 controls) had a mean age of 61.73 years, 61.94% were male. After 12 weeks, the mean (SD) systolic blood pressure decreased by 8.52 (19.73) mm Hg in the intervention group and by 1.25 (12.47) mm Hg in the control group (between-group difference, -7.265 mm Hg; 95% CI, -12.89 to -1.64 mm Hg; P = 0.012), While, there was no difference in the change in diastolic blood pressure between the two groups (between-group difference, -0.41 mm Hg; 95% CI, -3.56 to 2.74 mm Hg; P = 0.797). After 12 weeks of follow-up, the mean (SD) hypertension compliance increased by 7.35 (7.31) in the intervention group and by 3.01 (4.92) in the control group (between-group difference, 4.334; 95% CI, 2.21 to -6.46; P < 0.01), the mean (SD) hypertension compliance increased by 12.89 (11.95) in the intervention group and by 5.43 (10.54) in the control group (between-group difference, 7.47; 95% CI, 3.62 to 11.31; P < 0.01), the mean (SD) physical health increased by 12.21 (10.77) in the intervention group and by 1.54 (7.18) in the control group (between-group difference, 10.66; 95% CI, 7.54-13.78; P < 0.01), the mean (SD) mental health increased by 13.17 (9.25) in the intervention group and by 2.55 (5.99) in the control group (between-group difference, 10.93; 95% CI, 7.74 to 14.12; P < 0.01). Conclusions Among participants with uncontrolled hypertension, individuals randomized to use a monitoring wearable device with a smartphone application had a significant improvement in self-reported hypertension compliance, self-efficacy, life quality, weight loss and diastolic blood pressure, but no change in systolic blood pressure compared with controls.
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Affiliation(s)
- Zhang Yuting
- Health Science Centre, Shenzhen University, Shenzhen, China
| | - Tan Xiaodong
- School of Public Health, Wuhan University, Wuhan, China
| | - Wang Qun
- Health Science Centre, Shenzhen University, Shenzhen, China
- *Correspondence: Wang Qun
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Zhang L, Wang J, Dove A, Yang W, Qi X, Xu W. Injurious falls before, during and after dementia diagnosis: a population-based study. Age Ageing 2022; 51:6964938. [PMID: 36580561 PMCID: PMC9799250 DOI: 10.1093/ageing/afac299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND the timing of incident injurious falls at different stages of dementia diagnosis is unclear. OBJECTIVES to identify when the occurrence of injurious falls begins to increase among individuals who are going to develop dementia, to explore the time point at which people living with dementia are at highest risk of injurious falls and to ascertain differences in fall-related factors pre- and post-dementia diagnosis. DESIGN this study included 2,707 participants with incident dementia and 2,707 1:1 matched (i.e. same birth year and sex) controls without dementia. METHODS dementia diagnosis and date of onset were identified from the National Patient Registry (NPR) and the Swedish Cause of Death Register following international criteria. Information on injurious falls and history of chronic disease was obtained from the NPR. Data were analysed using conditional Poisson regression and generalized estimating equation models. RESULTS compared with controls, the incidence of injurious falls among participants with dementia started to increase beginning 4 years pre-diagnosis (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI] 1.30-2.22), reaching a peak (IRR 3.73, 95% CI 3.16-4.41) in the year of dementia diagnosis. Heavy drinking, physically active and cardiometabolic diseases (CMDs) were associated with incident falls among those with dementia. CONCLUSION people with dementia have a higher incidence of injurious falls beginning 4 years leading up to diagnosis and peaking during the year of diagnosis. Older age, female, heavy drinking, physically active and CMDs may predict injurious falls among people with dementia.
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Affiliation(s)
| | | | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Weili Xu
- Address correspondence to: Weili Xu, Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Tianjin 300070, Heping, China; Aging Research Center, Department of Neurobiology, Karolinska Institutet, Tomtebodavägen 18A Floor 10, SE-171 65 Solna, Stockholm, Sweden.
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Li X, Wang S, Dunk M, Yang W, Qi X, Sun Z, Xu W. Association of life-course reproductive duration with mortality: a population-based twin cohort study. Am J Obstet Gynecol 2022; 227:748.e1-748.e13. [PMID: 35779587 DOI: 10.1016/j.ajog.2022.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although age at menopause has been linked to mortality, the association between the entire reproductive lifespan and mortality remains unclear. OBJECTIVE This study aimed to examine to what extent life-course reproductive duration is associated with all-cause mortality and explore the role of a healthy lifestyle and familial background in such an association. STUDY DESIGN A total of 11,669 women (mean age, 63.54 years) from the Swedish Twin Registry were followed for up to 19 years. Information on reproductive duration (the interval between ages at menarche and menopause) and lifestyle factors (including smoking, alcohol consumption, and physical activity; divided into unfavorable/intermediate/favorable) was collected on the basis of a structured questionnaire. Survival status was obtained from the Sweden Cause of Death Register. The data were analyzed using generalized estimating equation models, Laplace regression, and conditional logistic regression. RESULTS In the generalized estimating equation model, compared with those with ≤34 reproductive years, the odds ratio (95% confidence interval) of all-cause mortality was 0.79 (0.68-0.90) for those with ≥40 reproductive years, which prolonged survival time by 0.84 (0.24-1.43) years. Women with ≥40 reproductive years plus a favorable lifestyle (odds ratio, 0.28; 95% confidence interval, 0.23-0.35) were at a lower risk of all-cause mortality than those with <40 reproductive years plus an unfavorable lifestyle. An additive interaction between ≥40 reproductive years and a favorable lifestyle on all-cause mortality was observed (attributable proportion, 0.584; 95% confidence interval, 0.016-1.151). The odds ratios in conditional logistic regression and generalized estimating equation models did not differ significantly (P=.67). CONCLUSION A longer reproductive lifespan is associated with reduced all-cause mortality and prolongs survival by 0.84 years. A favorable lifestyle may amplify the beneficial effect of longer reproductive lifespan on mortality. Familial background does not account for the observed association.
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Affiliation(s)
- Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Shuqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Michelle Dunk
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden; Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Zhuoyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China.
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.
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Zhu Z, Li FR, Jia Y, Li Y, Guo D, Chen J, Tian H, Yang J, Yang HH, Chen LH, Zhang K, Yang P, Sun L, Shi M, Zhang Y, Qin LQ, Chen GC. Association of Lifestyle With Incidence of Heart Failure According to Metabolic and Genetic Risk Status: A Population-Based Prospective Study. Circ Heart Fail 2022; 15:e009592. [PMID: 35975661 DOI: 10.1161/circheartfailure.122.009592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether lifestyle factors are similarly associated with risk of heart failure (HF) for individuals with different metabolic or genetic risk status remains unclear. METHODS We included 464 483 participants from UK Biobank who were free of major cardiovascular disease or HF during baseline recruitment. Healthy lifestyle factors included avoidance of smoking, no obesity, regular physical activity, and healthy diet. Lifestyle was categorized as favorable (3 or 4 healthy lifestyle factors), intermediate (2 healthy lifestyle factors), and unfavorable (0 or 1 healthy lifestyle factor) lifestyles. Metabolic status was defined by the presence of hypertension, high total cholesterol, or diabetes at baseline. A weighted genetic risk score was created based on 12 single-nucleotide polymorphisms associated with HF. RESULTS Compared with favorable lifestyle, the multivariable-adjusted hazard ratios of HF were 1.79 (95% CI, 1.68-1.90) and 2.90 (95% CI, 2.70-3.11) for intermediate lifestyle and unfavorable lifestyle, respectively (Ptrend <0.0001). This association was largely consistent regardless of the presence of any single metabolic risk factor or the number of metabolic risk factors (Pinteraction ≥0.21). The association was also similar across different genetic risk categories (Pinteraction=0.92). In a joint analysis, the hazard ratio of HF was 4.05 (95% CI, 3.43-4.77) comparing participants who had both higher genetic risk and an unfavorable lifestyle with those having lower genetic risk and a favorable lifestyle. CONCLUSIONS Combined lifestyle was associated with incident HF regardless of metabolic or genetic risk status, supporting the recommendation of healthy lifestyles for HF prevention across the entire population.
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Affiliation(s)
- Zhengbao Zhu
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Fu-Rong Li
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine (F.-R.L.), Southern University of Science and Technology, China
- School of Public Health and Emergency Management (F.-R.L.), Southern University of Science and Technology, China
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China (F.-R.L.)
| | - Yiming Jia
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Yang Li
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Y.L.)
| | - Daoxia Guo
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
- School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases and School of Nursing (D.G.), Suzhou Medical College of Soochow University, China
| | - Jingsi Chen
- Department of Nutrition and Food Hygiene (J.C., J.Y., L.-Q.Q., G.-C.C.), Suzhou Medical College of Soochow University, China
| | - Haili Tian
- School of Kinesiology, Shanghai University of Sport, China (H.T.)
| | - Jing Yang
- Department of Nutrition and Food Hygiene (J.C., J.Y., L.-Q.Q., G.-C.C.), Suzhou Medical College of Soochow University, China
- Department of Clinical Nutrition, First Affiliated Hospital of Soochow University, Suzhou, China (J.Y.)
| | - Huan-Huan Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China (H.-H.Y.)
| | - Li-Hua Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Nantong University, China (L.-H.C.)
| | - Kaixin Zhang
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Pinni Yang
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Lulu Sun
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Mengyao Shi
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Yonghong Zhang
- Department of Epidemiology (Z.Z., Y.J., D.G., K.Z., P.Y., L.S., M.S., Y.Z.), Suzhou Medical College of Soochow University, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene (J.C., J.Y., L.-Q.Q., G.-C.C.), Suzhou Medical College of Soochow University, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene (J.C., J.Y., L.-Q.Q., G.-C.C.), Suzhou Medical College of Soochow University, China
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Yun J, Han K, Park Y, Han E, Lee Y, Ko S. Adherence to healthy lifestyle behaviors as a preventable risk factor for severe hypoglycemia in people with type 2 diabetes: A longitudinal nationwide cohort study. J Diabetes Investig 2022; 13:1533-1542. [PMID: 35474300 PMCID: PMC9943249 DOI: 10.1111/jdi.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION We investigated the associations between a combination of lifestyle factors and changes to these factors and the subsequent risk of severe hypoglycemia (SH) in type 2 diabetes patients. MATERIALS AND METHODS Individuals with adult type 2 diabetes who underwent consecutive 2-year interval health screening programs from 2009 to 2012 from the Korean National Health Insurance Service database were included and followed up until 2018. Information on history of smoking status, alcohol consumption and physical activity, as well as changes to these factors, was obtained. The primary outcome was incident SH. RESULTS Of the 1,490,233 type 2 diabetes patients, 30,539 (2.1%) patients developed SH. Current smokers and heavy drinkers had increased risk of SH, compared with non-smokers and non-drinkers, respectively (hazard ratio 1.28, 95% confidence interval 1.23-1.34; hazard ratio 1.22, 95% confidence interval 1.15-1.30). However, regular physical activity was associated with reduced SH risk (hazard ratio 0.79, 95% confidence interval 0.77-0.82). A combination of unhealthy lifestyle habits was associated with increased SH risk in a dose-dependent fashion (P for trend <0.001). Compared with participants without changes in their unhealthy lifestyles, participants who improved lifestyles had decreased risk of SH. CONCLUSIONS Greater adherence to healthy lifestyle factors and any improvement in unhealthy lifestyle habits were associated with a substantially lower risk of SH in individuals with type 2 diabetes.
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Affiliation(s)
- Jae‐Seung Yun
- Department of Internal MedicineCollege of MedicineSt. Vincent's HospitalThe Catholic University of KoreaSeoulKorea
| | - Kyungdo Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Yong‐Moon Park
- Department of EpidemiologyFay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockAZUSA
| | - Eugene Han
- Department of Internal MedicineDaegu Dongsan HospitalKeimyung UniversityDaeguKorea
| | - Yong‐ho Lee
- Department of Internal MedicineSeverance HospitalYonsei University College of MedicineSeoulKorea
| | - Seung‐Hyun Ko
- Department of Internal MedicineCollege of MedicineSt. Vincent's HospitalThe Catholic University of KoreaSeoulKorea
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Abbott L, Graven L, Schluck G, Lemacks J. A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample. Healthcare (Basel) 2022; 10:1536. [PMID: 36011193 PMCID: PMC9407851 DOI: 10.3390/healthcare10081536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.
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Affiliation(s)
- Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Lucinda Graven
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Glenna Schluck
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Jennifer Lemacks
- College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
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Wang Z, Yang W, Li X, Qi X, Pan KY, Xu W. Association of Sleep Duration, Napping, and Sleep Patterns With Risk of Cardiovascular Diseases: A Nationwide Twin Study. J Am Heart Assoc 2022; 11:e025969. [PMID: 35881527 PMCID: PMC9375484 DOI: 10.1161/jaha.122.025969] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Although sleep disorders have been linked to cardiovascular diseases (CVDs), the association between sleep characteristics and CVDs remains inconclusive. We aimed to examine the association of nighttime sleep duration, daytime napping, and sleep patterns with CVDs and explore whether genetic and early‐life environmental factors account for this association. Methods and Results In the Swedish Twin Registry, 12 268 CVD‐free twin individuals (mean age=70.3 years) at baseline were followed up to 18 years to detect incident CVDs. Sleep duration, napping, and sleep patterns (assessed by sleep duration, chronotype, insomnia, snoring, and daytime sleepiness) were self‐reported at baseline. CVDs were ascertained through the Swedish National Patient Registry and the Cause of Death Register. Data were analyzed using a Cox model. In the multiadjusted Cox model, compared with 7 to 9 hours/night, the hazard ratios (HRs) of CVDs were 1.14 (95% CI, 1.01–1.28) for <7 hours/night and 1.10 (95% CI, 1.00–1.21) for ≥10 hours/night, respectively. Compared with no napping, napping 1 to 30 minutes (HR, 1.11 [95% CI, 1.03–1.18]) and >30 minutes (HR, 1.23 [95% CI, 1.14–1.33]) were related to CVDs. Furthermore, a poor sleep pattern was associated with CVDs (HR, 1.22 [95% CI, 1.05–1.41]). The co‐twin matched control analyses showed similar results as the unmatched analyses, and there was no significant interaction between sleep characteristics and zygosity (P values >0.05). Conclusions Short or long sleep (<7 or ≥10 hours/night), napping, and poor sleep patterns are associated with an increased CVD risk. Genetic and early‐life environmental factors may not account for the sleep–CVD association.
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Affiliation(s)
- Zhiyu Wang
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam Public Health Amsterdam University Medical Center, Vrije Universiteit Amsterdam The Netherlands
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health Tianjin Medical University Tianjin China.,Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China.,Center for International Collaborative Research on Environment Nutrition and Public Health Tianjin China.,Aging Research Center, Department of Neurobiology, Health Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
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Khanjari S, Tehrani FJ, Feinn R, Wagner JA, Hashemi S, Abedini Z. Psychometric evaluation of the Persian version of the Heart Disease Fact Questionnaire (HDFQ) in people with diabetes in Iran. Diabetes Metab Syndr 2022; 16:102563. [PMID: 35809553 DOI: 10.1016/j.dsx.2022.102563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/12/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Public health and clinic-based educational strategies are desperately needed to stem the tide of death from heart disease among people with diabetes in low and middle-income countries. This study translated the Heart Disease Fact Questionnaire into Persian and evaluated its reliability and validity for use in Iran. METHODS Using rigorous translation methods, the 25-item scale was administered to Persian speakers with diabetes. The scale was evaluated for content validity, construct validity and reliability. RESULTS Participants were 268 patients with diabetes with mean age of 63.19 ± 16.61 years. The mean HDFQ score was 17.31 ± 5.11 (in the low range). Higher scores were associated with younger age, younger age of diabetes onset, higher education, higher employment position, family history of diabetes and hypertension, shorter diabetes duration, and adherence to home exercise regimens. Kuder-Richardson's reliability coefficient was good, i.e., 0.82. Confirmatory factor analysis showed that the factor loadings of all questions, except question number 25, were favorable, i.e., >0.3. Model fit indices were favorable: Chi-square statistic to degree of freedom ratio (χ2⁄df) = 1.82, Comparative fit index = 0.96, Tucker-Lewis Index = 0.96 and root mean square error = 0.06. CONCLUSION After removing item #25, the Persian heart disease fact questionnaire has good validity and reliability and can be used to inform and evaluate clinical and public health educational programs aimed at decreasing risk for heart disease among Persian speakers with diabetes.
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Affiliation(s)
- Sedigheh Khanjari
- School of Nursing and Midwifery, Nursing Care Research Center, Health Management, University of Medical Sciences, Iran.
| | - Fereshteh Javaheri Tehrani
- Community Health Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Velenjak St, Shahid Chamran Highway, Tehran, Iran.
| | - Richard Feinn
- Biomedical Sciences, Quinnipiac University, Frank H. Netter School of Medicine, 370 Bassett Rd, North Haven, CT, 06473, USA.
| | - Julie A Wagner
- Division of Behavioral Sciences and Community Health and Department of Psychiatry, UConn Schools of Dental Medicine and Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Sima Hashemi
- Department of Nursing, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.
| | - Zahra Abedini
- Department of Nursing, School of Nursing and Midwifery, University of Medical Sciences, Qom, Iran.
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