Development and effects of salutogenesis program for adolescents with moyamoya disease: A randomized controlled trial

BACKGROUND

Disease-specific interventions for management and health behavior implementation are needed to improve the health and quality of life of adolescents with moyamoya disease.

OBJECTIVE

This study aimed to develop a program for adolescents with moyamoya disease based on the salutogenesis theory, which focuses on the process of enhancing health through successful adaptation to external stressors, and to evaluate its effectiveness.

METHODS

A randomized controlled trial was performed according to the CONSORT guidelines. This preliminary research and experimental treatment were conducted at a Severance Hospital ward and outpatient clinic among 48 participants randomized into the intervention (seven sessions of salutogenesis program, n = 24) or the control group (one session of one-to-one moyamoya disease education program, n = 24) from September 6, 2018 to January 4, 2019. Changes in the following study outcomes were reported: "knowledge of moyamoya disease," "social support," "sense of coherence," "moyamoya disease health behavior," "stress," "depression," "subjective health status," "frequency of ischemic symptoms," and "quality of life".

RESULTS

The salutogenesis program improved the knowledge and social support of adolescents with illness-related problems and helped them attain healthy behaviors and stress reduction. It was confirmed to be effective in improving their quality of life.

CONCLUSIONS

The salutogenesis program for adolescents with moyamoya disease effectively improved the generalized resistance resources and sense of coherence in adolescents with moyamoya disease.

TRIAL REGISTRATION

Korean Clinical Research Information Service registry, KCT0006869.

The Moyamoya Health Behavior Scale for Adolescent Patients: Measurement Tool Development and Psychometric Evaluation

Clinical practitioners treating moyamoya disease recognize the need for a systematic approach to better manage the disease in adolescent patients with the disease. Methods: This study aimed to develop and evaluate the validity and reliability of a disease scale which measures the health-related behaviors of adolescents with moyamoya disease. Results: The final 12-item Moyamoya-HB Scale for adolescents was categorized by three sub-domains: implementation of treatment for moyamoya disease (four items); health promoting behavior for moyamoya disease (four items); and health coping behavior for moyamoya disease (four items). Overall, these factors explained 68.97% of the total variance. The results of the confirmative factor analysis supported the construct, convergent and discriminant validity of the three sub-domains. The Moyamoya-HB Scale for adolescents also demonstrated a concurrent validity with the Korean Adolescents’ Health Behaviors Tool (r = 0.59, p < 0.001). Reliability analysis showed an acceptable-to-high Cronbach’s alpha of 0.865 in total, and the subscales ranged from 0.800 to 0.841. Conclusions: Initial findings support the Moyamoya-HB Scale as a reliable and valid measure of health behaviors in adolescents with moyamoya disease.

[Factors Influencing Health Behavior Compliance in Adult Moyamoya Patients]

PURPOSE

The purpose of this study was to identify factors influencing health behavior compliance in adult patients with moyamoya.

METHODS

A descriptive correlation study was conducted to investigate the factors influencing health behavior compliance. Participants were 142 adult patients diagnosed with moyamoya disease who were hospitalized or visited an outpatient clinic in the Gyeonggi province. Data were collected from December 16, 2019 to April 14, 2020 using self-report questionnaires and analyzed using the IBM SPSS 26.0 Win software.

RESULTS

The hierarchical multiple regression analysis demonstrated that self-efficacy (β = .60, p < .001), social support (β = .13, p = .032), and age (β = .21, p = .005) affected the health behavior of adults with moyamoya disease. These 3 variables explained 62.0% of the variance of health behavior compliance, and the most influential factor was self-efficacy.

CONCLUSION

Based on the results of this study, it concludes that nursing interventions should be focused on self-efficacy and social support to improve health behavior compliance with adult patients diagnosed with moyamoya disease. For that, various strategies to enhance self-efficacy and social support should be developed and actively applied in the clinical setting for adult moyamoya patients.

Features and diversity of symptoms of moyamoya disease in adolescents: A cluster analysis

AIMS

The purpose of this study is to explore the symptoms experienced by adolescents with moyamoya disease and to identify the characteristics of each symptom cluster associated with moyamoya disease.

DESIGN

A retrospective and descriptive design, which is a secondary data analysis study based on electronic medical record data from hospitals.

METHODS

To assess the symptoms associated with moyamoya disease, a qualitative study was conducted on 12 adolescents, 12 caregivers and 12 experts on moyamoya disease. According to a qualitative study, 12 main symptoms (limb weakness, numbness, pins and needles, difficulty in speech, blurred vision, facial paralysis, hand tremors, involuntary movements, convulsions, dizziness, nausea/vomiting and headaches) were selected. Data were collected around these symptoms. The data collection was carried out through the Electronic Medical Record (EMR) data of 303 adolescents aged 13-19 who were diagnosed with moyamoya disease (ICD 10 Code: I67.5) between January 2010-December 2019 in a hospital in Seoul, South Korea. Cluster analysis was applied to identify symptom clusters with the hierarchical cluster agglomerative approach. We used the log-likelihood distance to measure the similarity of variables. Proximity between groups of variables was measured using the two-step method.

RESULTS

The physical symptoms experienced by adolescents with moyamoya disease were 'limb weakness' - the most common - followed by a 'headache,' 'difficulty in speech,' and 'nausea/vomiting.' A total of five symptom clusters were derived: cluster 1 was characterized by 'limb weakness'; cluster 2 participants were asymptomatic or experienced 'convulsions'; cluster 3 experienced 'difficulty in speech' and 'facial paralysis'; cluster 4 is prone to 'dizziness' and 'pins and needles'; and cluster 5 displays 'headaches' and 'nausea/vomiting'.

CONCLUSION

This study offers a multidimensional approach for identifying differences in clinical symptoms of moyamoya disease among adolescents.

IMPACT

These results will help provide interventions concerning the characteristics of the symptoms of moyamoya disease among adolescents.

Distribution of Intracranial Major Artery Stenosis/Occlusion According to RNF213 Polymorphisms

Intracranial major artery stenosis/occlusion (ICASO) is the major cause of ischemic stroke. Recent studies have suggested that variants of RNF213, a susceptibility gene for moyamoya disease (MMD), are also related to non-MMD ICASO. Regarding the predominant involvement of steno-occlusion on anterior circulation in MMD, we hypothesized that the ICASO distribution pattern (anterior/posterior) in non-MMD may differ according to RNF213 variants. This study analyzed 1024 consecutive Korean subjects without MMD who underwent computed tomography angiography (CTA) or magnetic resonance angiography (MRA). We evaluated four single nucleotide polymorphisms (SNPs) in the exon region of RNF213: 4448G > A (rs148731719), 4810G > A (rs112735431), 4863G > A (rs760732823), and 4950G > A (rs371441113). Associations between RNF213 variants and anterior/posterior ICASO were examined using multivariate logistic regression analysis. Anterior ICASO was present in 23.0% of study subjects, and posterior ICASO was present in 8.2%. The GA genotype of RNF213 4810G > A (adjusted odds ratio (AOR) [95% confidence interval (CI)], 2.39 [1.14–4.87] compared to GG; p = 0.018) and GA genotype of RNF213 4950G > A (AOR [95% CI], 1.71 [1.11–2.63] compared to GG; p = 0.015) were more frequent in subjects with anterior ICASO. The genotype frequency of RNF213 4863G > A differed significantly according to the presence of posterior ICASO. Further investigations of the functional and biological roles of RNF213 will improve our understanding of the pathomechanisms of ICASO and cerebrovascular disease.