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Ojagbemi A, Bello T, Elugbadebo O, Alabi M, Owolabi M, Baiyewu O. Resilience in the first year of surviving a stroke in Nigeria. Aging Ment Health 2024:1-8. [PMID: 38779920 DOI: 10.1080/13607863.2024.2356873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES There is a knowledge gap on resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life (QoL) across the first poststroke year in Nigeria. METHOD Prospective observational study of 150 survivors of a first ever stroke. Resilience was ascertained at 3 time-points prospectively over 12 months using the 25-items Resilience Scale (RS). Depression and QoL were also assessed at baseline and follow-up, respectively using the centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Associations were investigated using regression models and presented as adjusted odds ratios (OR) and Wald test coefficients within 95% confidence intervals (CI). RESULTS Resilience improved across time points of measurement (p < 0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, alcohol use, and hypertension, higher resilience was associated with male sex (OR = 5.3, 95% CI= 1.7, 17.2), younger age (OR = 4.8, 95% CI = 1.5,15.7), and baseline hypertension (OR= 0.2, 95% CI ≤ 0.1,0.8). In similarly adjusted mixed effect linear regression analyses, higher resilience was associated with improvement in depression (months 12= -4.2, 95% CI= -5.6, -2.8) and quality of life (months twelve = 5.2, 95% CI = 2.2, 8.2) overtime. CONCLUSION Resilience, which was associated with better mental health and wellbeing of stroke survivors, was less likely with hypertension. Results suggest an important role for control of vascular risk factors as part of resilience interventions to promote poststroke recovery.
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Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Toyin Bello
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olufisayo Elugbadebo
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Morufat Alabi
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Division of Neurology, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Sun B, Wang N, Li K, Yang Y, Zhang F. The mediating effects of hope on the relationships of social support and self-esteem with psychological resilience in patients with stroke. BMC Psychiatry 2024; 24:340. [PMID: 38715019 PMCID: PMC11075303 DOI: 10.1186/s12888-024-05744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To explore the mediating effect of hope in the relationships between social support and self-esteem with psychological resilience among patients with stroke survivors in early rehabilitation. METHODS A cross-sectional study design was adopted. Data from a cross-sectional survey of 210 patients undergoing early stroke rehabilitation were analyzed using structural equation modeling. The variables of interest were measured using the Connor Davidson Resilience Scale, the Social Support Rating Scale, the Herth Hope Index, and the Self-Esteem Scale. This article reports according to the STROBE checklist. RESULTS A positive relationship was found between social support and psychological resilience (β1 = 0.548), which was mediated by hope (β2 = 0.114), and social support had significant direct effect on resilience (β3 = 0.434). A positive relationship was also found between self-esteem and psychological resilience (β4 = 0.380), which was mediated by hope (β5 = 0.200), and self-esteem had significant direct effect on resilience (β6 = 0.179). CONCLUSION According to the results of this study, some strategies can be incorporated into the rehabilitation process to enhance psychological resilience, such as cultivating individual personality characteristics and improving patients' social relationships. In the future, we need to explore methods for improving psychological resilience among patients with stroke in combination with their risk factors to improve their quality of life and reduce the incidence of post-stroke depression.
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Affiliation(s)
- Boru Sun
- Emergency Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Nan Wang
- Rehabilitation Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ke Li
- Surgery Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Yang
- Nursing Department, Shengjing Hospital China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, P.R. China.
| | - Fengjiao Zhang
- Teaching Group of Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, P.R. China.
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Tsai SJ, Li CC, Pai HC. Effects of a nurse-led therapeutic conversations intervention in stroke patient-family caregiver dyads: A randomized control trial. Int J Nurs Pract 2024:e13257. [PMID: 38570203 DOI: 10.1111/ijn.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 01/24/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Few studies have evaluated the effectiveness of family functional care interventions among stroke caregiver dyads. This study aimed to examine the effect of a nurse-led therapeutic conversation intervention on resilience, family function, self-efficacy in managing the disease, and quality of life (QoL) in stroke family caregiver dyads. AIMS This study aimed to examine the effect of a nurse-led therapeutic conversation intervention on resilience, family function, self-efficacy in managing the disease, and QoL in stroke-family caregiver dyads. DESIGN This study was a single-blind (evaluator) randomized controlled trial. The planned execution time was from August 2021 to December 2022, in the rehabilitation ward of a medical university hospital. METHODS A total of 82 dyads were included in this analysis. Dyads randomized to the intervention group received nurse-led therapeutic conversations intervention one at four weeks after the patient's hospitalization for a stroke. The family caregiver dyads of stroke survivors in the control group received routine care. An effectiveness analysis that included patients' resilience, self-efficacy, and patient-family caregiver dyads' family function and QoL was conducted at one month. We used the CONSORT Checklist for reporting parallel group randomized trials in this study. RESULTS The patients in the intervention group showed improvement in resilience and self-efficacy after one month. Furthermore, the effects on resilience (Cohen's d = 0.49) and self-efficacy (Cohen's d = 0.46) were significantly higher than in the control group. Family functioning was significantly higher in patient-family caregiver dyads in the intervention group than in the control group (Cohen's d = 0.55; Cohen's d = 0.50). However, no significant difference in QoL was found between patients and caregivers in either group. CONCLUSIONS The intervention was effective in promoting family functioning and can also promote patient resilience and self-efficacy in disease management. However, the intervention did not have a significant effect on the QoL of patient-family caregiver dyads.
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Affiliation(s)
- Su-Ju Tsai
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University School of Medicine, Taichung City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Chia-Chi Li
- Department of Nursing, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Hsiang-Chu Pai
- Department of Nursing, Chung Shan Medical University Hospital, Taichung City, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung City, Taiwan
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Wang Y, Xie H, Sun H, Ren L, Jiang H, Chen M, Dong C. Influencing Factors of Psychological Resilience in Stroke Patients: A Systematic Review and Meta-Analysis. Arch Clin Neuropsychol 2024:acad107. [PMID: 38324660 DOI: 10.1093/arclin/acad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To systematically review the current status and influencing factors of psychological resilience in stroke patients and to provide a theoretical basis for future personalized rehabilitation support and psychological interventions. METHOD This systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A comprehensive search of databases including PubMed, Web of Science, Medline, PsycINFO, CINAHL, Cochrane Library, CNKI, VIP, CMB, and WANGFANG was conducted from inception until November 22, 2023, resulting in the retrieval of 2099 studies. Literature screening and data extraction were performed by two independent evaluators based on pre-defined inclusion and exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software. RESULTS The final review included 23 studies. The results showed that self-efficacy, hope, confrontation coping, avoidance coping, functional independence, quality of life, and social support were positively associated with psychological resilience. Conversely, anxiety, depression, and resignation coping were negatively associated with psychological resilience. CONCLUSIONS Patients with stroke have a low level of psychological resilience, which was influenced by a variety of factors. However, longitudinal and large sample studies are needed to further confirm these findings. These results should be integrated into clinical practice for early assessment and targeted intervention in psychological resilience to assist patients in coping with the rehabilitation process and life changes after a stroke.
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Affiliation(s)
- Yuxin Wang
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Hongxia Xie
- School of Computing, Hangzhou City University, Hangzhou 310015, China
| | - Hongyu Sun
- School of Nursing, Peking University, Beijing 100191, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Meijia Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou 325035, China
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
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Zhou X, Wang Y, Zhou L. Social participation, resilience, and coping tendency in a sample of stroke survivors: a multi-centre cross-sectional study in China. J Rehabil Med 2024; 56:jrm12448. [PMID: 38175146 PMCID: PMC10785685 DOI: 10.2340/jrm.v56.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To investigate the association between resilience and social participation and examine the mediation of resilience on coping strategies and social participation. DESIGN A multi-centre cross-sectional study performed from April to July 2022. PARTICIPANTS The study sample comprised 239 stroke survivors (53.1% male). The mean age of participants was 65.4 years. METHODS The study was conducted at 3 neurorehabilitation centres in Shanghai, China. The Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P) was used to measure both objective and subjective social participation. Resilience was evaluated using the Connor-Davidson Resilience Scale (CD-RISC), while positive coping tendency was assessed using the Simplified Coping Style Questionnaire (SCSQ). Multivariate linear regression was employed, taking into account confounding factors. In cases where a significant interaction effect was observed, simple slope analysis was conducted to explore the relationship between positive coping tendency and social participation at different levels of resilience. RESULTS The mean scores of social participation frequency, restriction, and satisfaction were 21.80 ± 15.13, 38.92 ± 26.48, and 63.34 ± 22.35, respectively. Higher resilience level was independently associated with higher social participation frequency (B = 0.210, p < 0.001), less participation restriction (B = 0.584, p < 0.001), and higher participation satisfaction (B = 0.250, p < 0.001). Moreover, higher resilience was correlated with more positive coping tendency. More positive coping tendency was related to higher social participation frequency and less participation restriction, but not to social participation satisfaction. Furthermore, individuals at different resilience levels moderated the effect of positive coping tendency on social participation frequency. CONCLUSION This study underlines the importance of resilience as a potential intervention in enhancing both objective and subjective social participation in stroke survivors, and provides insights into increasing the efficacy of positive coping strategies on social participation.
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Affiliation(s)
- Xuan Zhou
- School of nursing, Naval Medical University, Shanghai, China.
| | - Ying Wang
- Department of nursing, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Lanshu Zhou
- School of nursing, Naval Medical University, Shanghai, China
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Zhang W, Ye M, Zhou W, Gao Y, Zhou L. Trajectory and predictors of family function in caregivers of stroke survivors: A longitudinal study of the first 6 months after stroke. J Adv Nurs 2024; 80:264-274. [PMID: 37395440 DOI: 10.1111/jan.15749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
AIMS This study aimed to investigate the trajectory and predictors of family function in caregivers of stroke survivors during the first 6 months after the first episode of stroke. DESIGN Longitudinal study. METHODS A total of 288 primary caregivers of patients with first-time stroke were recruited from seven tertiary hospitals in China between July 2020 and March 2021. The following characteristics were assessed by caregivers at hospitalization (T0) and at 1 month (T1), 3 months (T2) and 6 months (T3) after the stroke: family function, general self-efficacy, social support, coping style, caregiver burden, and sociodemographic and clinical data. RESULTS Family function scores among caregivers of stroke survivors were highest in the resolve dimension and lowest in the growth and adaptation dimensions within the first 6 months. The percentages of families with low functioning were 34.7%, 33.3%, 24.8% and 17.7% at T0, T1, T2 and T3, respectively. The generalized estimating equation model revealed that family function in caregivers increased over the first 6 months (Exp(B) = 1.415-2.689, p < .05). The following factors were identified as predictors of family functioning: caregiver's age, education, residential district, self-efficacy, social support utilization and caregiver burden. CONCLUSIONS Family function of caregivers of stroke survivors gradually increased during the first 6 months after stroke. However, some families demonstrated poor functioning. Caregivers' age, education, caregiver burden, self-efficacy and social support utilization could predict family function over time. IMPACT Empirical data on family function in families of stroke survivors are important for developing psychosocial interventions that can help families adapt to stroke. This study found that families of stroke survivors were likely to be dysfunctional in the first 6 months after stroke, particularly in family growth and adaptation. Therefore, reducing caregiver burden and promoting self-efficacy and social support utilization can help restore family functioning early after stroke. PATIENT OR PUBLIC CONTRIBUTION Stroke caregivers from seven hospitals in China were involved in this study and had the right to be informed of the main findings. A few patients were informed of the research results, who contributed to the dissemination.
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Affiliation(s)
- Wei Zhang
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Mingming Ye
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Wanqiong Zhou
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Yitian Gao
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
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Ventura S, Ottoboni G, Lullini G, Chattat R, Simoncini L, Magni E, Piperno R, La Porta F, Tessari A. Co-designing an interactive artificial intelligent system with post-stroke patients and caregivers to augment the lost abilities and improve their quality of life: a human-centric approach. Front Public Health 2023; 11:1227748. [PMID: 37808976 PMCID: PMC10551166 DOI: 10.3389/fpubh.2023.1227748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The motor disability due to stroke compromises the autonomy of patients and caregivers. To support autonomy and other personal and social needs, trustworthy, multifunctional, adaptive, and interactive assistive devices represent optimal solutions. To fulfill this aim, an artificial intelligence system named MAIA would aim to interpret users' intentions and translate them into actions performed by assistive devices. Analyzing their perspectives is essential to develop the MAIA system operating in harmony with patients' and caregivers' needs as much as possible. Methods Post-stroke patients and caregivers were interviewed to explore the impact of motor disability on their lives, previous experiences with assistive technologies, opinions, and attitudes about MAIA and their needs. Interview transcripts were analyzed using inductive thematic analysis. Results Sixteen interviews were conducted with 12 post-stroke patients and four caregivers. Three themes emerged: (1) Needs to be satisfied, (2) MAIA technology acceptance, and (3) Perceived trustfulness. Overall, patients are seeking rehabilitative technology, contrary to caregivers needing assistive technology to help them daily. An easy-to-use and ergonomic technology is preferable. However, a few participants trust a system based on artificial intelligence. Conclusion An interactive artificial intelligence technology could help post-stroke patients and their caregivers to restore motor autonomy. The insights from participants to develop the system depends on their motor ability and the role of patients or caregiver. Although technology grows exponentially, more efforts are needed to strengthen people's trust in advanced technology.
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Affiliation(s)
- Sara Ventura
- Department of Psychology, University of Bologna, Bologna, Italy
- Instituto Polibienestar, University of Valencia, Valencia, Spain
| | | | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Elisabetta Magni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Roberto Piperno
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessia Tessari
- Department of Psychology, University of Bologna, Bologna, Italy
- Alma Mater Research Institute for Human-Centered Artificial Intelligence, University of Bologna, Bologna, Italy
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Li Y, Wang Q, Liu XL, Hui R, Zhang YP. Effect of the physical rehabilitation program based on self-care ability in patients with acute ischemic stroke: a quasi-experimental study. Front Neurol 2023; 14:1181651. [PMID: 37360351 PMCID: PMC10288520 DOI: 10.3389/fneur.2023.1181651] [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: 03/07/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction It is the most practical goal of limb rehabilitation for stroke patients to make the upper limb, trunk, and lower limb joints link together as a whole and restore the ability to self-care. However, many previous studies focused on the single joint or single muscle group movement of stroke patients and did not integrate self-care ability training into the whole process of rehabilitation, which lacks accuracy, integrity, and systematization. Methods A quasi-experimental study was conducted in a tertiary hospital. Eligible patients were recruited according to the inclusion criteria and exclusion criteria and then divided into an experimental group (n = 80) and a control group (n = 80) by the medical district. The control group received the routine physical rehabilitation intervention. The experimental group adopted the physical rehabilitation program based on self-care ability led by the nurses specializing in stroke rehabilitation to carry out the multi-joint coordinated exercise based on the control group. The training time and frequency were the same in both groups (45 min per session, one session per day for three consecutive months). The primary outcome was myodynamia. Secondary outcomes were the modified Barthel Index (MBI) and Stroke Specific Quality of Life Scale (SS-QOL). The primary and secondary outcomes were assessed before the intervention and at 1 and 3 months of intervention. In this study, the TREND checklist was followed for non-randomized controlled trials. Results A total of 160 participants completed the study. The physical rehabilitation program based on self-care ability was better than the routine rehabilitation program. With the prolongation of intervention time, all outcomes improved gradually in the experimental group (P < 0.05), and the myodynamia of lower limbs recovered faster than that of upper limbs. In the control group, the myodynamia of the affected limb was not significantly improved (P > 0.05), with only a small increase in MBI and SS-QOL scores (P < 0.05). Conclusion The physical rehabilitation program based on self-care ability after stroke was beneficial for acute ischemic stroke patients and improved the patient's myodynamia, quality of life, and self-care ability within the third month.
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Affiliation(s)
- Ying Li
- Department of Nursing, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Qian Wang
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Xiao-Ling Liu
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Rong Hui
- Department of Nursing, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yin-Ping Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Yang M, Yang S, Dela Rosa RD, Cui LH. Development of family resilience models †. FRONTIERS OF NURSING 2023. [DOI: 10.2478/fon-2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Family resilience is not the sum of the individual psychological resilience of each of the family members, but the family itself as a unit of resilience research. The representative models of family stress tolerance theory mainly include McCubbin’s series of family stress tolerance models and Walsh’s family stress tolerance framework, which are widely used in the practice of family therapy. In the future, empirical studies on family resilience should be strengthened, measurement tools with high reliability and validity should be established, and the combination of family resilience theory and community-based practice should be promoted.
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Affiliation(s)
- Min Yang
- a School of Nursing, Binzhou Medical University , Binzhou, Shandong , China
| | - Shuang Yang
- b Department of Dermato-Venereal , Binzhou Medical University Hospital , Binzhou, Shandong , China
| | - Ronnell D Dela Rosa
- c School of Nursing, Philippine Women’s University , Manila , Philippines
- d College of Nursing and Midwifery, Bataan Peninsula State University , Bataan , Philippines
| | - Lu-Hai Cui
- a School of Nursing, Binzhou Medical University , Binzhou, Shandong , China
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Love MF, Brooks AN, Cox SD, Okpala M, Cooksey G, Cohen AS, Sharrief AZ. The effects of racism and resilience on Black stroke- survivor quality of life: Study protocol and rationale for a mixed-methods approach. Front Neurol 2022; 13:885374. [PMID: 36034272 PMCID: PMC9399920 DOI: 10.3389/fneur.2022.885374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Stroke, a life-threatening stressor, often negatively impacts stroke-survivor (SS) quality of life (QoL). Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, a significant stressor, occurs at structural, cultural, and interpersonal levels and contributes to health disparities for Black SS. Resilience, a dynamic process of positive adaptation to significant stress, is impacted by factors or resources both internal and external to the individual. This study aims to examine the effects of experiences of racism and resilience on Black SS QoL during early stroke recovery. This article presents the study protocol. Methods and analyses This will be a prospective observational mixed-methods study. Black community-dwelling adults who are within 4 weeks of a stroke will be eligible for inclusion. Baseline measures will include the exposure variables of experiences of racism and resilience. Covariates measured at baseline include sociodemographic variables (age, sex, marital status, education, income, health insurance, employment status, number of people in household, residential address), clinical variables (date and type of stroke, inferred Modified Rankin Scale, anxiety and depression screening), and psychosocial variables (COVID-19 stress, perceived stress, mindfulness). The outcome variable (QoL) will be assessed 6-months post-stroke. Multiple-level linear regression models will be used to test the direct effects of experiences of racism, and the direct and indirect effects of resilience, on QoL. Qualitative data will be collected via focus groups and analyzed for themes of racism, resilience, and QoL. Discussion Racism can compound the stress exerted by stroke on Black SS. This study will occur during the COVID-19 pandemic and in the aftermath of calls for social justice for Black Americans. Experiences of racism will be measured with instruments for both “everyday” discrimination and vigilance. Sociodemographic variables will be operationalized to assess specific social determinants of health that intersect with structural racism. Because of the long-standing history of racism in the United States of America (USA), cultural influences and access to resources are central to the consideration of individual-level resilience in Black SS. Study results may inform the development of interventions to support Black SS QoL through enhanced resilience.
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Affiliation(s)
- Mary F. Love
- College of Nursing, University of Houston, Houston, TX, United States
- *Correspondence: Mary F. Love
| | | | - Sonya D. Cox
- College of Nursing, University of Houston, Houston, TX, United States
| | - Munachi Okpala
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Gail Cooksey
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Audrey Sarah Cohen
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Anjail Z. Sharrief
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
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Zhang W, Ye MM, Gao YJ, Zhou LS. Dyadic profiles of family resilience among patients with first-episode stroke: A longitudinal study of the first 6 months after stroke. J Clin Nurs 2022. [PMID: 35864722 DOI: 10.1111/jocn.16458] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/11/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The importance of family resilience in the recovery of stroke patients has been demonstrated in numerous studies. However, little is known about post-stroke family resilience. AIMS To investigate the family resilience of stroke patients from a patient-caregiver dyadic perspective during the first 6 months after stroke. METHODS A total of 288 dyads of patients diagnosed with a first-episode stroke and their principal caregivers were recruited from neurology departments of 7 tertiary hospitals in Shanghai and Shangqiu, China. Family resilience and family function were assessed during hospitalisation and at 1, 3 and 6 months after stroke. K-means cluster analysis was used to identify different clusters of family resilience based on family resilience of patients and caregivers during hospitalisation. The STROBE guidelines for observational studies were followed. RESULTS Three clusters of family resilience were identified with distinct trajectories: cluster of high resilience (HR), cluster of low resilience (LR) and cluster of discrepant resilience (DR). The level of family function was consistently highest in cluster HR and lowest in cluster with LR at four time points. Most (69.8%) families fell into the cluster with low resilience and low family function. Characteristics such as the Rankin scores and education level of patients, education level of caregivers, family monthly income and living district were different among the three clusters. CONCLUSIONS We concluded that family resilience was linked to the family functioning of patients with a first-episode stroke, however, the levels of resilience in most families were low. Factors, including the education level, family income and stroke severity of patients were revealed to influence the family resilience and its development. RELEVANCE TO CLINICAL PRACTICE A resilience-focused approach to family-related treatment is beneficial for families. Therefore, understanding family resilience among stroke survivors is needed to inform the development of interventions for enhancing the recovery of stroke families.
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Affiliation(s)
- Wei Zhang
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Ming-Ming Ye
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Ya-Jing Gao
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Lan-Shu Zhou
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
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Zhang W, Zhou W, Ye M, Gao Y, Zhou L. Family resilience of stroke survivors within 6 months after a first-episode stroke: A longitudinal study. Front Psychiatry 2022; 13:968933. [PMID: 36311520 PMCID: PMC9606654 DOI: 10.3389/fpsyt.2022.968933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Family resilience is frequently recognized as a powerful determinant of family adaptation in chronic disease patients; understanding the family resilience of stroke patients and its predictors could help nurses develop interventions to assist patients in maintaining healthy family functioning. OBJECTIVE This study aimed to explore the trajectory of family resilience in the 6 months following stroke onset and examine the predictors of family resilience over time. METHODS A total of 288 first-episode stroke survivors were selected from seven hospitals in China from July 2020 to March 2021. Their family resilience, social support, self-efficacy, and medical coping style were assessed at hospitalization and 1, 3, and 6 months after stroke onset. The study was performed in accordance with the STROBE guidelines. RESULTS The mean levels of family resilience were between 95.52 ± 11.10 and 97.68 ± 9.68 within the first 6 months after a first-episode stroke, with a significant increase 3 months after the onset. Patient self-efficacy, social support, family atmosphere, and caregiver-patient relationship (sibling) were predictors of family resilience at all four time points. Baseline predictors of family resilience at 6 months included self-efficacy of the patients, subjective support, support utilization, family atmosphere, living district, medical bill payment methods, and caregiver-patient relationship (sibling). CONCLUSION Family resilience levels were low in stroke patients 6 months after the onset, and 3 months post-stroke onset was a critical period for family resilience of stroke patients. Nurses are recommended to pay particular attention to patients with low self-efficacy, perceived low support, poor utilization of available support, as well as those who are under the care of their siblings, self-pay, or live in a poor family atmosphere. Interventions aimed at improving the self-efficacy of patients and social support are potential approaches to enhance family resilience.
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Affiliation(s)
- Wei Zhang
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Wanqiong Zhou
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Mingming Ye
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Yitian Gao
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Department of Clinical Nursing, College of Nursing, Second Military Medical University, Shanghai, China
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Love MF, Wood GL, Wardell DW, Beauchamp JES. Resilience and associated psychological, social/cultural, behavioural, and biological factors in patients with cardiovascular disease: a systematic review. Eur J Cardiovasc Nurs 2021; 20:604-617. [PMID: 34223625 DOI: 10.1093/eurjcn/zvaa008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/27/2020] [Indexed: 01/25/2023]
Abstract
AIMS The aim of this systematic review of the literature is to synthesize the evidence regarding the associations between individual-level psychological, social/cultural, behavioral, and biological variables with resilience in patients with CVD. METHODS AND RESULTS A systematic search of PubMed, PsycINFO and CINAHL was conducted from database inception through March 2020. Studies with a quantitative research design were eligible for inclusion if published in English and focused on resilience among adults with CVD. Of the 788 articles retrieved, 34 studies (35 articles) were included in the review. Twenty-three studies focused on psychological factors, with findings of inverse relationships between resilience and depression, anxiety, and stress. Evidence regarding associations between resilience and social/cultural or behavioral variables was scarce. Four of the 6 studies regarding biological factors found low stress resilience in young adulthood was associated with early diagnoses of stroke, heart failure, and coronary heart disease. CONCLUSION Enhancing resilience may improve quality of life for CVD patients, but research is needed to further explore the complex relationships between resilience and associated variables. This research should prioritize under-represented groups (i.e. women and minority racial/ethnic groups), with the eventual goal of developing interventions to support resilience in CVD patients.
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Affiliation(s)
- Mary F Love
- University of Houston, College of Nursing, 14004 University Boulevard, Sugar Land, TX 77479, USA
| | - Geri LoBiondo Wood
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Cizik School of Nursing,, 6901 Bertner Avenue Houston, TX 77030, USA
| | - Diane Wind Wardell
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Cizik School of Nursing,, 6901 Bertner Avenue Houston, TX 77030, USA
| | - Jennifer E S Beauchamp
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Cizik School of Nursing,, 6901 Bertner Avenue Houston, TX 77030, USA
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Schäfer SK, Fleischmann R, von Sarnowski B, Bläsing D, Flöel A, Wurm S. Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study. BMJ Open 2021; 11:e049944. [PMID: 34187831 PMCID: PMC8245451 DOI: 10.1136/bmjopen-2021-049944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke. METHODS AND ANALYSIS The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1-5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models. ETHICS AND DISSEMINATION The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives. TRIAL REGISTRATION NUMBER NCT04704635.
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Affiliation(s)
- Sarah K Schäfer
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Dominic Bläsing
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases, Greifswald, Germany
| | - Susanne Wurm
- Institute for Community Medicine, Department of Social Medicine and Prevention, University of Greifswald Faculty of Medicine, Greifswald, Germany
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Zeng W, Wu X, Xu Y, Wu J, Zeng Y, Shao J, Huang D, Zhu Z. The Impact of General Self-Efficacy on Psychological Resilience During the COVID-19 Pandemic: The Mediating Role of Posttraumatic Growth and the Moderating Role of Deliberate Rumination. Front Psychol 2021; 12:684354. [PMID: 34248788 PMCID: PMC8261126 DOI: 10.3389/fpsyg.2021.684354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/21/2021] [Indexed: 01/31/2023] Open
Abstract
Purpose: This study used a moderated mediation model to explore the relationship between general self-efficacy (GSE) and psychological resilience (PR) and the associated mechanisms, the mediating role of posttraumatic growth (PTG), and the moderating role of deliberate rumination (DR) during the coronavirus disease 2019 (COVID-19) pandemic. Knowledge of the relationship between these four variables examined further understanding of the PR improvement mechanism of college students and even the general public. Methods: The college students who participated in this study came from an independent college in Guangdong Province, China. A total of 918 college students completed the survey, and the final data sample size was 881. SPSS 23.0 and PROCESS (version 3.3) were used to conduct Pearson's correlation analysis and hierarchical regression linear analysis on the data. Results: (1) The correlation analysis showed that GSE and PR were positively correlated and that PTG was positively correlated with GSE and PR. DR was positively correlated with GSE, PTG, and PR. (2) The results of mediation analysis showed that GSE had a direct predictive effect on DR, and PTG partially mediated the relationship between the two. (3) The results of moderating effect analysis showed that DR hindered the effect of GSE on PTG but enhanced the positive impact of PTG on PR. Conclusions: General self-efficacy can improve PR under the mediating influence of PTG. DR played a positive moderating role in the relationship between GSE and PTG, and played a negative moderating role in the relationship between PTG and PR. These results advance the understanding of the mechanism between GSE and PR.
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Affiliation(s)
- Wei Zeng
- School of Geography, South China Normal University, Guangzhou, China
| | - Xingrou Wu
- School of Geography, South China Normal University, Guangzhou, China
| | - Yanhua Xu
- College of Resource Environment and Tourism, Capital Normal University, Beijing, China
| | - Jiamin Wu
- School of Geography, South China Normal University, Guangzhou, China
| | - Yuqing Zeng
- School of Geography, South China Normal University, Guangzhou, China
| | - Jinlian Shao
- School of Geography, South China Normal University, Guangzhou, China
| | - Dongtao Huang
- School of Geography, South China Normal University, Guangzhou, China
| | - Ziqi Zhu
- Office of International Cooperation and Exchange, Dongguan University of Technology, Dongguan, China
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Li Y, Zhang W, Ye M, Zhou L. Perceived participation and autonomy post-stroke and associated factors: An explorative cross-sectional study. J Adv Nurs 2020; 77:1293-1303. [PMID: 33249635 DOI: 10.1111/jan.14670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/18/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To explore the level and associated factors of perceived participation and autonomy among stroke survivors in Shanghai, China. DESIGN Cross-sectional explorative study. METHODS From January to December 2018, 431 patients presenting at the neurology departments of three hospitals with a confirmed diagnosis of stroke were recruited. Impact on Participation and Autonomy Questionnaire, modified Rankin Scale, Self-efficacy for Managing Chronic Disease six-item Scale, Medical Coping Modes Questionnaire and Multidimensional Scale of Perceived Social Support were applied to measure their participation, physical function, self-efficacy, coping styles, and social support. RESULTS The average score of perceived participation and autonomy was 41.30 (SD 21.22); and 54.3%, 46.9%, 21.6%, and 7.7% of the participants reported poor participation in social relations, family role, autonomy indoors, and autonomy outdoors. Age, physical function, self-efficacy, friend support, and knowledge of stroke were predictors of post-stroke participation. Physical function and self-efficacy were the most relevant factors of nearly all domains of participation except autonomy outdoors, while predictors of autonomy outdoors were social support, resignation coping style, and knowledge of stroke. CONCLUSION The stroke patients experienced insufficient participation compared with previous studies in western countries. Patients' physical function and self-efficacy were particularly important and contributed to their participation, while the patient's age, perceived social support, coping styles, and knowledge of stroke also played a role in formulating participation. IMPACT The results may be used to provide nurses with a better understanding of the participation among stroke patients and assist them in promoting the post-stroke participation. Nurses should pay special attention to those with older age, worse physical function, lower self-efficacy, less support, little stroke-related knowledge, or who applied resignation coping style since those patients might experience lower participation in their daily life. It needs further studies to explore the causal effects of self-efficacy, coping styles, and social support on post-stroke participation.
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Affiliation(s)
- Yuxia Li
- Nursing School, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Nursing School, Second Military Medical University, Shanghai, China
| | - Mingming Ye
- Nursing School, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Head of Department: Clinical Nursing, Nursing School, Second Military Medical University, Shanghai, China
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Gray LA. Living the Full Catastrophe: A Mindfulness-Based Program to Support Recovery from Stroke. Healthcare (Basel) 2020; 8:healthcare8040498. [PMID: 33228109 PMCID: PMC7711731 DOI: 10.3390/healthcare8040498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/30/2022] Open
Abstract
Decades of research suggest that Mindfulness-Based Stress Reduction (MBSR) training supports a greater capacity to live with chronic medical conditions and contributes to lowering stress levels. This paper introduces a model for a Mindfulness-Based Recovery from Stroke (MBRfS) for promoting stroke recovery, informed by the lived experience of the author (a stroke survivor and certified MBSR instructor), the research literature regarding MBSR training, and the specific challenges of stroke recovery. Four themes emerged from the autoethnographic analysis that informed the proposed model: Readiness to accept the stroke event and the acquired brain injury, navigating uncertainties of stroke recovery with awareness and self-responsibility for outcomes, trusting the inherent wisdom of the body as a stroke recovery "teacher", and increased capacity to integrate complex emotions with self-compassion, and a sense of wholeness. A four-component MBRfS model is offered, which consists of an integration amongst a modified MBSR framework, emergent attitudinal themes, and insights from the autoethnographic vignettes. The MBRfS model offers a path for providing participants with a supportive experience within stroke recovery. Recommendations and suggestions for future studies are offered to support the development of MBRfS for stroke survivors and their caregivers, as well as contributing to healthcare providers.
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Affiliation(s)
- Lori A Gray
- Holistic Health Programs, Western Michigan University, Kalamazoo, MI 49008, USA
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