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Rodríguez-Alcázar FJ, Juárez-Vela R, Sánchez-González JL, Martín-Vallejo J. Interventions Effective in Decreasing Burden in Caregivers of Persons with Dementia: A Meta-Analysis. NURSING REPORTS 2024; 14:931-945. [PMID: 38651483 PMCID: PMC11036232 DOI: 10.3390/nursrep14020071] [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: 02/09/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction: Chronic non-communicable diseases, including diseases of mental origin such as Alzheimer's, affect all age groups and countries. These diseases have a major impact on the patient and their family environment. It is interesting that different questionnaires are measured in the same direction, given that different health questionnaires are used to measure caregiver burden. Objectives: To identify which type of intervention is the most appropriate to improve the health of the primary caregiver in patients with dementia. To understand the role played by the nurse within multidisciplinary teams and to know whether the different questionnaires used in the studies measure caregiver health in the same direction. Methods: A systematic search of the published and gray literature was carried out without restriction of the language used in the studies. Caregiver burden of patients with dementia, receiving an intervention to improve caregiver burden, was assessed. Standardized mean difference was used as the effect size measure, and there were possible causes of heterogeneity in the effect size. Results: In total, 1512 records were found, and 39 articles with 4715 participants were included. We found individual information with an effect of 0.48 (CI95%: 0.18; 0.79; I2 = 0%); group therapy with an effect of 0.20 (CI95%: 0.08; 0.31; I2 = 6%); workshops with an effect of 0.21 (CI95%: 0.01; I2 = 48%) and 0.32 (CI95%: 0.01; 0.54; I2 = 0%) when a nurse intervenes; respite care with an effect of 0.22 (CI95%: 0.05; 0.40; I2 = 66%); individual therapy with an effect of 0.28 (CI95%: 0.15; 0.4; I2 = 68%); and support groups with an effect of 0.07 (CI95%: 0; 0.15; I2 = 78%). Conclusions: The magnitude of the effects of the interventions has been low-moderate. Different instruments are not associated with the magnitude of the effect. The presence of nurses improves the effect of the intervention on caregivers when it is carried out in the form of workshops.
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Affiliation(s)
| | - Raúl Juárez-Vela
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, 26006 Logroño, Spain;
| | - Juan Luis Sánchez-González
- Department of Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Javier Martín-Vallejo
- Department of Statistics, Faculty of Medicine; University of Salamanca, 37007 Salamanca, Spain;
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Giulietti MV, Fabbietti P, Spatuzzi R, Vespa A. Effects of Mindfulness Based Interventions in Adults and Older Adults Caregivers of Patients with Early Stage Alzheimer's Disease: A Randomized Pilot Study. J Alzheimers Dis 2024; 97:1923-1930. [PMID: 38306028 DOI: 10.3233/jad-230284] [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] [Indexed: 02/03/2024]
Abstract
Background Many studies have highlighted the effect of training with mindfulness-based interventions (MBIs) on the psycho-physical rebalancing of patients suffering from various pathologies, and their families. Objective In this study, the effect of a training with mindfulness-based stress reduction (MBSR) on quality of life and emotion regulation (depression) was verified in caregivers (CGs) of patients affected by Alzheimer's disease at early stage (AD-P). Methods In this randomized controlled study, 22 CGs (age≥60 years) were treated with MBIs, in particular MBSR, and 22 CGs had no treatment. Tests (T0-T1 six months) included: SF 36-Quality of Life (QoL); Caregiver Burden Inventory (CBI); FACIT-Spiritual-Well-Being; Beck Depression Inventory (BDI); Everyday Cognition scales; and Mini-Mental State Examination (for AD-P). Results Significant differences emerged between T0 and T1 for CGs with MBSR in the following dimensions: Depression-BDI (p > 0.001), Burden CBI-Total (0.001), CBI-Time dependent burden (p < 0.001), CBI-Developmental burden (p < 0.001), CBI-Physical burden (p < 0.001); and pain (p = 0.002) all decreased; while CBI-Social burden (p = 0.004), QoL-Health Role Limitation (p < 0.000), QoL-Role-Limitation-Emotional-Problem (p < 0.000), QoL-Energy-fatigue (p < 0.000), QoL-Emotional Well-Being (p < 0.001), QoL-Social Well Being (p = 0.010), and QoL-General Health (p = 0.004) increased. The control group of untreated CG showed a significant worsening in the dimensions of Physical functioning (p = 0.036) and pain (p = 0.047). Conclusions AD-CGs treated with MBI reduced their burden and depression and experienced an improvement in all the dimensions of quality of life.
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Affiliation(s)
- Maria Velia Giulietti
- Department of Neurology, Scientific and Technological Area, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
| | - Paolo Fabbietti
- Biostatistical Center, INRCA-IRCCS National Institute of Science and Health on Aging, Ancona, Italy
| | | | - Anna Vespa
- Scientific and Technological Area, Department of Neurology, INRCA-IRCCS National Institute of Health and Science on Aging, Ancona, Italy
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Filleau C, Febvre-Richards E, Konig A, Fabre R, Mouton A, Sacco G. [Mindfulness meditation and art therapy for Alzheimer's patients and their caregivers]. SOINS. GERONTOLOGIE 2023; 28:27-34. [PMID: 37977762 DOI: 10.1016/j.sger.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Alzheimer's disease affects nearly three million people in France, and requires training for both healthcare professionals and caregivers. Our study underlines the value of supporting an adapted program based on mindfulness meditation, to reduce anxiety and stress for patients and their caregivers.
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Affiliation(s)
- Christelle Filleau
- Clinique gériatrique du cerveau et du mouvement, Centre hospitalier universitaire de Nice, France; Centre mémoire de ressources et de recherche, Centre de recherche Edmond et Lily Safra, Institut Claude-Pompidou, 10 rue Molière, 06100 Nice, France.
| | | | | | - Roxane Fabre
- Université Côte d'Azur, CoBTek, Nice, France; Département de santé publique, Centre hospitalier universitaire de Nice, France
| | - Aurélie Mouton
- Clinique gériatrique du cerveau et du mouvement, Centre hospitalier universitaire de Nice, France
| | - Guillaume Sacco
- Clinique gériatrique du cerveau et du mouvement, Centre hospitalier universitaire de Nice, France
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Kor PPK, Chou KL, Zarit SH, Gallagher D, Galante J, Wong SYS, Cheung DSK, Leung AYM, Chu LW. Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia. BMJ Open 2023; 13:e072410. [PMID: 37673447 PMCID: PMC10496708 DOI: 10.1136/bmjopen-2023-072410] [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] [Received: 02/03/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVES Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD. METHODS A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD. ETHICS AND DISSEMINATION This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER NCT05634317.
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Affiliation(s)
| | - Kee Lee Chou
- Department of Asian and Policy Studies, The Education University of Hong Kong, New Territories, China
| | - Steven H Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Dolores Gallagher
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel Y S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, China
| | | | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Sui Y, Kor PPK, Li M, Wang J. Effects of a Social Media-Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial. JMIR Form Res 2023; 7:e42861. [PMID: 36804167 PMCID: PMC9989915 DOI: 10.2196/42861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/16/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media-based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence. OBJECTIVE The aim of this study was to test the feasibility and preliminary effects of a social media-based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial. METHODS A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media-based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2). RESULTS The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention. CONCLUSIONS The findings support the feasibility and preliminary effects of social media-based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031.
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Affiliation(s)
- Yufang Sui
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Patrick Pui Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Mengli Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Jingjing Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Hatch S, Webber J, Rej S, Finlayson M, Kessler D. The effectiveness of mindfulness-based meditation treatments for late life anxiety: a systematic review of randomized controlled trials. Aging Ment Health 2022:1-11. [PMID: 35912637 DOI: 10.1080/13607863.2022.2102140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Older adults are interested in mindfulness-based interventions with a meditation component for late life anxiety. This review examined the effectiveness of existing mindfulness-based interventions with a meditation component. METHODS This systematic review was registered with the Joanna Briggs Institute on 2021-05-17, was guided by Joanna Briggs Institute methodology and followed the PRISMA framework. Peer-reviewed randomized control trials were reviewed. A systematic literature search was conducted, using the following databases: MEDLINE (Ovid), Embase, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL (EBSCO), and AMED. RESULTS Of 2709 studies screened, seven eligible randomized controlled trials were included representing 355 participants. Sample sizes ranged from 36 to 141. Mindfulness-based meditation interventions used varied. Regardless of the mindfulness-based meditation intervention used, a reduction in symptoms of anxiety in participants was reported post-intervention. Results are reported through narrative summary and tables. CONCLUSIONS Based on the emerging literature of randomized controlled trials, mindfulness-based interventions with a meditation component appear to be promising in reducing symptoms of anxiety in older adults. These findings demonstrate a need for further randomized controlled trials to guide clinical practice.
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Affiliation(s)
- Stacey Hatch
- Aging and Health Program, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jodi Webber
- Aging and Health Program, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Soham Rej
- Department of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Marcia Finlayson
- Aging and Health Program, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Dorothy Kessler
- Aging and Health Program, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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The ATENción Plena en Enfermedad de Alzheimer (ATENEA—Mindfulness in Alzheimer’s Disease) Program for Caregivers: Study Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10030542. [PMID: 35327020 PMCID: PMC8955639 DOI: 10.3390/healthcare10030542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
A person affected by Alzheimer’s disease (AD) gradually loses the ability to perform activities of daily living and becomes dependent on caregivers, thereby having a negative impact on the caregivers’ quality of life. There is evidence that suggests that interventions aimed at caregivers, such as mindfulness, may be effective at reducing this burden and emotional issues, such as depression and anxiety, and improving their quality of life. However, there is a lack of consistency in the findings and conclusions remain tentative. In addition, as neuropsychiatric symptoms (NPSs) of AD are major determinants of the caregiver’s burden, these interventions should examine the relationship between these symptoms and caregiver outcomes. Importantly, to improve the design of therapeutic interventions for caregivers and complement the treatment of AD, aspects related to occupational performance and the participation of people with AD and their caregivers should also be considered. Therefore, this study will aim to examine first, the effects of a mindfulness-based program designed for caregivers on NPSs of AD and caregivers’ anxiety and depression; second, the effects of this program on patients’ functional capacity, cognitive performance, executive functions, and quality of life, and on caregivers’ burden, quality of life, occupational balance, executive functions, psychological wellbeing, and self-compassion. We believe that the findings of this study will have significant implications for future healthcare strategies focused on improving the quality of life and wellbeing of caregivers.
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Kor PPK, Liu JYW, Chien WT. Effects of a Modified Mindfulness-Based Cognitive Therapy for Family Caregivers of People With Dementia: A Randomized Clinical Trial. THE GERONTOLOGIST 2021; 61:977-990. [PMID: 32886746 DOI: 10.1093/geront/gnaa125] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Family caregivers of people with dementia (PWD) experience high levels of stress resulting from caregiving. This study aimed to investigate the effects of a modified of Mindfulness-Based Cognitive Therapy (MBCT) for dementia caregiving. RESEARCH DESIGN AND METHODS 113 family caregivers of PWD were randomized to either the intervention group, receiving the 7-session modified MBCT for a period of 10 weeks with telephone follow-up or the control group, receiving the brief education on dementia care and usual care. The caregiving stress (primary outcome) and various psychological outcomes of caregivers and the behavioral and psychological symptoms of dementia (BPSD) in the care recipients were assessed and compared at baseline (T0), postintervention (T1), and at the 6-month follow-up (T2). RESULTS At both T1 and T2, the intervention group had a statistically greater improvement in stress (p = .02 and .03), depression (p = .001 and .04), anxiety (p = .007 and .03), and BPSD-related caregivers' distress (p = .003 and p = .04). A significant greater improvement was also demonstrated in mental health-related quality of life at T2 (p = .001) and BPSD of the care recipients at T1 (p = .04). The increased caregivers' level of mindfulness was significantly correlated with the improvement of various psychological outcomes at T1 and T2 with a correlation coefficient -0.64 to 0.43. DISCUSSION AND IMPLICATIONS The modified MBCT enhanced the level of mindfulness in the caregivers and was effective to reduce the caregivers' stress and promote their psychological well-being during a 6-month follow-up. Future research is recommended to further examine its effects on the varieties of psychological and behavioral outcomes of both caregivers and care recipients and their dyadic relationships, as well as explore its mechanism of action in facilitating dementia caregiving. CLINICAL TRIALS REGISTRATION NUMBER NCT03354819.
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Affiliation(s)
- Patrick Pui Kin Kor
- The Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Justina Y W Liu
- The Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
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Guo J, Luo J, Huang L, Yang J, Whittemore R. Adaptation and Feasibility Testing of a Coping Skills Training Program for Chinese Youth with Type 1 Diabetes. J Pediatr Nurs 2020; 54:e78-e83. [PMID: 32473824 DOI: 10.1016/j.pedn.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To adapt an evidence-based coping skills training program to the cultural context and healthcare system for youth with T1D in China, and to evaluate the feasibility, acceptability, and preliminary efficacy of the modified program. DESIGN AND METHODS A multiphase process was used based on a heuristic framework for program modification. This included information gathering, preliminary adaptation, and feasibility evaluation. RESULTS In Stage 1, the coping skills training protocol was translated and evaluated for relevance by the stakeholders (youth diagnosed with T1D, parents, and healthcare providers). Recommendations for revisions and culturally relevant scenarios were identified. In Stage 2, the program was adapted for youth with a wider age range. Scenarios and logistics of the program were changed, and a session on blood glucose management was added to enhance cultural relevance. In Stage 3, the feasibility of the modified program was evaluated with 15 youth participants diagnosed with T1D (mean age: 13.88 years). Problem-solving coping and the self-efficacy of the youth improved over time (p < .05). High attendance, engagement, and satisfaction were achieved. PRACTICE IMPLICATIONS The CST-China program has the potential to provide Chinese youth with T1D an interactive and engaging program to improve health outcomes. The adaptation process of a CST program can provide a reference for pediatric nurses to develop programs which are culturally relevant, acceptable to stakeholders, and aligned with the healthcare system in China. CONCLUSIONS A coping skills training program was systematically adapted and aligned to the healthcare system in China, with evidence of feasibility and acceptability in Chinese youth with T1D.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lingling Huang
- Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
| | - Jundi Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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