STUDY OBJECTIVES:To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients. METHODS:Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale. RESULTS:Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly (P = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable. CONCLUSIONS:This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol.

Up to 50% of people living with HIV have some neurocognitive impairment. We examined associations of sleep and fatigue with self-reported cognitive problems in 268 adults living with HIV. Multivariate regression was used to examine associations between cognitive problems, self-reported sleep quality, actigraphy-measured total sleep time and wake after sleep onset, and fatigue severity. Poorer self-reported sleep quality (p < .001), short or long total sleep time (<7 or >8 vs. 7-8 hours, p = .015), and greater fatigue (p < .001) were associated with lower self-reported cognitive function scores after controlling for demographic and clinical characteristics. However, objective measure of wake after sleep onset was unrelated to self-reported cognitive function scores. Findings suggest that assessing and treating poor sleep and complaints about fatigue would be areas for intervention that could have a greater impact on improving cognition function than interventions that target only cognitive problems.

Sleep disturbance can contribute to negative health outcomes. However, sleep complaints have been under-recognized and undertreated in caregivers of ill family members. This systematic review describes the impact of family caregiving on sleep and summarizes factors associated with sleep disturbance in caregivers. A literature search using PubMed, MEDLINE, PsycINFO, and CINAHL databases yielded 22 relevant research articles on family caregivers of ill adults. Analyses revealed that up to 76% of caregivers reported poor sleep quality, and the proportion is considerably higher for female caregivers compared to male caregivers. Sleep measures indicated short sleep duration and frequent night awakenings. Characteristics of the care recipient, such as health status, and the caregiver's own health status and symptoms, such as depression, fatigue, and anxiety, were associated with sleep disturbance in caregivers. These factors may help clinicians identify caregivers at highest risk for developing sleep disturbance and guide the family toward additional support.

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies.

The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D's validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS. A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22-77 years) completed the CES-D. A Rasch model application was used to analyze the CES-D's rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning. CES-D scores were generally high and associated with several demographic and clinical variables. The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis. Removal of misfitting items resulted in minimal improvement in the CES-D's substantive and structural validity. CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups.

Background and aim: Pressure ulcers (PUs) and malnutrition represent a significant health problem for hospital inpatients. Satisfactory nutritional status is crucial for proper wound healing. Risk of malnutrition can be identified using standardized screening tools, such as the Nutritional Risk Screening (NRS) 2002. Objective: The objective of this study was to examine whether nutritional status based on the NRS 2002 is associated with PU in hospital inpatients. Design: The data for this cross-sectional analysis were based on 10 screening days between September 2012 and May 2014. All adult inpatients admitted to a medical or surgical ward on the screening days were evaluated for eligibility. Nursing students and ward nurses conducted the NRS 2002 initial screening and skin examinations for PU classification (Stages I-IV). A registered clinical dietician conducted all NRS 2002 final screenings. Results: The sample consisted of 651 patients, with mean age 62.9 years. Skin examinations indicated an 8% PU prevalence. Factors associated with PUs included age ≥ 70 years, low body mass index (BMI) and hospitalization in the medical department. Based on the initial screening, 48% were at 'Low risk' for malnutrition and 52% were at 'Possible risk'. After final screening, 34% of the sample was identified as 'At risk' for malnutrition. Patients identified at 'Possible risk' by the initial screening or 'At risk' by the final screening were more likely than patients at 'Low risk' to have a PU (OR = 2.58 and 2.55, respectively). Each of the three initial screening items was significantly associated PU, with 'Is BMI<20?' and 'Ate less past week?' having the strongest associations. Conclusion: Nutritional risk using the NRS 2002 is associated with the presence of PU in a mixed hospital population. The final screening had a slightly stronger association with PU compared to the initial screening.

Purpose

To explore the relationship between illness perceptions and self-reported general health of patients with chronic heart disease, using some core elements from the Common Sense Model.

Methods

Patients with heart failure (New York Heart Association [NYHA] Functional Class I-III) from five outpatient clinics in Eastern Norway were invited to participate in this cross-sectional study. Two research nurses collected socio-demographic data (age, sex, education and work status) and standardized questionnaires in structured interviews. Patients' self-reported general health was measured with the Euro-Qual Visual Analogue Scale (EQ-VAS), illness perceptions were measured with the 8-item Brief Illness Perception Questionnaire (BIPQ), and mood was assessed using the Hospital Anxiety and Depression Scale.

Results

Among the 220 patients who were recruited into this study (98% response rate), the mean age was 67.5 years (SD ± 12.5), and 65.9% were men. Patients were classified as NYHA Class I (8.7% with no activity limitations), Class II (47.6% with slight limitations), or Class III (43.8% with marked limitations). Mean EQ-VAS score was 58.8 (SD ± 21.0). Three of the eight perception of illness items (consequences, personal control and identity) were associated with the patients' general health rating, controlling for their NYHA Class, mood and other BIPQ items.

Conclusions

Our findings suggest that patients' perceptions of their illness have an independent and substantial relationship to the self-rated general health of patients with chronic heart failure. Peoples' illness perceptions are beliefs that have been shown to be modifiable in clinical interventions. Thus, targeted interventions aimed to modify these, such as patient education courses, ought to be developed and tested, as they may be helpful for improving perceived health status.

Objective

To evaluate the feasibility and efficacy of a home-based cognitive-behavioral training program for sleep during late pregnancy.

Methods

A nonrandomized quasiexperimental sample of nulliparous women who received the intervention during pregnancy (n=25) was compared with two control groups (n=76 and n=48) from other intervention studies at similar postintervention time points: approximately 1 month before childbirth and 1-2 months after childbirth. The home-based Sleep Enhancement Training System for Pregnancy consisted of 4 weeks of sound-enhanced audio relaxation programs, readings, and daily sleep diaries. Both control groups received dietary recommendations for improving sleep. Sleep duration (total sleep time) and sleep disruption (wake after sleep onset) were measured using wrist actigraphy for a minimum of 48 hours on consecutive weekdays.

Results

The intervention group had significantly longer sleep duration and less sleep disruption than both control groups, particularly at the postpartum assessment. Intervention participants slept an average of 430 (95% confidence interval [CI] 397-464) minutes during pregnancy compared with 420 (95% CI 403-438) and 417 (95% CI 395-439) minutes for the two control groups. At the postpartum assessment, the intervention group slept 446 (95% CI 415-478) minutes compared with 390 (95% CI 373-408) and 370 (95% CI 348-393) minutes for those in the control groups. In terms of sleep disruption, women in the intervention group had 16.1% (95% CI 11.9-20.2%) wake after sleep onset during pregnancy, whereas women in the control groups had 13.4% (95% CI 11.2-15.5%) and 20.4% (95% CI 17.7-23.0%). Postpartum, the intervention group had 20.3% (95% CI 16.4-24.1%) wake after sleep onset compared with 26.6% (95% CI 24.5-28.8%) and 28.7% (95% CI 26.0-31.5%) among women in the control groups. Participant feedback about the intervention was generally positive, although intervention adherence was variable.

Conclusion

This study provides evidence of the feasibility and efficacy of the Sleep Enhancement Training System for Pregnancy intervention for enhancing sleep that typically worsens during late pregnancy and after childbirth.

This study examines the psychometric properties of the Lee Fatigue and Energy Scales (visual analog version) using a Rasch model application. The relationship between fatigue and energy is also described for a convenience sample of 102 women with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who completed the Lee Fatigue and Energy Scales in the morning and evening. Both scales were assessed for internal scale validity, unidimensionality, and uniform differential item functioning in relation to morning and evening ratings. Analyses confirmed that both the Fatigue and Energy Scales demonstrated evidence of internal scale validity and unidimensionality. Mean fatigue measures were also higher in the evening than in the morning and mean energy measures were higher in the morning than in the evening (both p<0.001), indicating that time of day is an important consideration. Fatigue and energy measures were moderately correlated with each other in the morning but not in the evening. The concepts of energy and fatigue were inversely related, but not polar opposites in this sample. Fatigue and energy may therefore be distinct constructs that should not be used interchangeably, either in measurement or when interpreting outcomes for research or clinical purposes.

Background

People with morbid obesity (body mass index ≥40) may experience changes in their health after participating in a tailored patient education course. The aims of this study were to assess the changes in physical and mental health in persons with morbid obesity during the 2 years following an educational course and to explore possible socio-demographic, treatment, and personal predictors of physical and mental health outcomes.

Methods

In this prospective longitudinal cohort study, self-report questionnaire data were collected from people with morbid obesity at the beginning of mandatory educational courses while on a waiting list for gastric surgery and at two-year follow-up. Of the 185 who attended the courses, 142 (77%) volunteered to participate in the study, and the 59 with complete data at the two-year follow-up were included in the analysis. Physical and mental health were measured with the physical and mental component summary scores from the Short Form 12v2. Self-esteem was measured by the Rosenberg Self-Esteem Scale, and self-efficacy by the General Self-Efficacy Scale.

Results

The participants reported better physical health at two-year follow-up than at baseline. Mental health did not change significantly over time. Receiving surgical treatment during the study period predicted better physical health at two-year follow-up, even after controlling for physical health at baseline. Mental health at baseline was the only significant baseline predictor of mental health at follow-up. However, increasing self-esteem and self-efficacy over the two-year study period independently predicted better mental health at follow up after controlling for mental health at baseline.

Conclusion

Our study showed that people with morbid obesity on a waiting list for bariatric surgery improved their physical health during the 2 years after attending a tailored patient educational course. Improving self-esteem and self-efficacy may be important personal factors for maintaining mental health during this period.

Trial registration

NCT01336725 . Registered 14 April 2011.