Extent of heart failure self-care as an endpoint to patient education: a literature review

Background: In western countries the number of chronic heart failure (CHF) management programs has escalated in recent times. One key component of them is to teach self-care behaviours that enable affected individuals to monitor themselves and engage in lifestyles that improve their health status.
Aim: The aim of this article is to describe CHF self-care management and to review the literature which examines the effectiveness of patient education on patients’ performance of self-care behaviours.
Design/method: bibliographical databases were searched for papers published in English between 1982 to 2006. The search used the key words: heart failure, education, self-care and measures. Only randomized controlled trials (RCTs) were selected.
Results: Ten randomized controlled trials were selected that used education as an intervention and, in total, 1064 patients with CHF participated in these studies. The studies were heterogenous as to the sample population, the health outcomes measured, the education interventions, the expertise of the educator, and the length of time that was spent on teaching patients. No consistent patterns of implementation and specific evaluation of its impact were found, although three respective groups of investigators reported signifi cant differences in recurrent hospitalisation rates and mortality rates which were relative to usual care.
Conclusions: Teaching patients appropriate CHF self-care behaviours can significantly improve their health outcomes. Improvements in self-care were demonstrated in seven studies but only three had used validated instruments to measure such changes. This suggests that no firm conclusions can be drawn about changes in self-care practices.

Interrelationship between anxiety, lifestyle self-reports and fitness in a sample of Hong Kong University students

Although anxiety in university students has been well documented, the influence of lifestyle and fitness status in relation to anxiety has not been investigated from a cultural perspective previously. To make recommendations regarding the avoidance or management of anxiety in this anxiety-prone cohort that are rationally based, this preliminary investigation examined the interrelationship between anxiety, lifestyle self-reports and aerobic fitness in Hong Kong Chinese University students. The State Trait Anxiety Inventory (Form Y-2) and a lifestyle questionnaire were completed by 213 students. Female students were more anxious than male students. Subjects with high anxiety reported more deleterious lifestyle behaviours including higher salt consumption and lower levels of exercise; in addition to more frequent symptoms of anxiety such as headaches and daytime somnolence. The extremes of this sample were stratified into a low anxiety group ( n =17) and a high anxiety group ( n =14) to compare their fitness status. Although both groups had below normal aerobic capacity, the higher systolic blood pressure observed for the high anxiety group is consistent with signs of anxiety, or greater deconditioning in this group or both. The results of this study have highlighted anxiety as a concern in Hong Kong University students and identified some lifestyle and fitness correlates. Understanding lifestyle and pathophysiological correlates of anxiety in Hong Kong University students that may have a cultural basis, is a crucial step toward averting or managing anxiety when these students are studying either in Hong Kong or abroad.

Volunteering and well-being : do self-esteem, optimism, and perceived control mediate the relationship?

Volunteers play a vital role in modern societies by boosting the labor force within both the public and private sectors. While the factors that may lead people to volunteer have been investigated in a number of studies, the means by which volunteering contributes to the well-being of such volunteers is poorly understood. It has been suggested through studies that focus on the absence of depression in volunteers that self-esteem and sense of control may be major determinants of the increased well-being reported by volunteers. This is consistent with the homeostatic model of subjective well-being, which proposes that self-esteem, optimism, and perceived control act as buffers that mediate the relationship between environmental experience and subjective well-being (SWB). Using personal well-being as a more positive measure of well-being than absence of depression, this study further explored the possible mediating role of self-esteem, optimism, and perceived control in the relationship between volunteer status and well-being. Participants (N = 1,219) completed a 97-item survey as part of the Australian Unity Wellbeing project. Variables measured included personal well-being, self-esteem, optimism, and a number of personality and psychological adjustment factors. Analyses revealed that perceived control and optimism, but not self-esteem, mediated the relationship between volunteer status and personal well-being.

The self concepts and possible selves of problem gamblers : a qualitative exploration

The study investigated the self-concepts and possible selves of pathological gamblers. Six female egm users were recruited from a Victorian problem gambling counselling service. Three participants were currently gambling and three were not gambling. They were interviewed in-depth and using thematic analysis four dominant themes were identified. (1) Self-concepts tended to be consistent across all participants, (2) having a past self as being the dominant characteristics of possible selves coincided with greater possible selves clarity, (3) non-gambler’s had more elaborate and specific plans for how to create change than did gambler’s, and (4) non-gambler’s had more plans to become possible selves which address goals of intrinsic meaning, rather then having a general goal to ‘not gamble’. The findings are discussed in terms of implications for the cognitive theory of possible selves and suggestions for further research to investigate the utility of the constructs as a basis for a treatment modality.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Should I believe this? Reality monitoring of accounts of self-experienced and invented recent and distant autobiographical events

To examine personal and interpersonal reality monitoring, 240 participants wrote accounts of invented or self-experienced autobiographical events. Half the participants wrote about a distant event that happened before the age of 15 and half wrote about a recent event that happened after the age of 15. Using a yoked design, participants rated the qualitative details of their own accounts and the details of other participants’ accounts. Consistent with previous research, we found that self-experienced accounts contained more qualitative details than invented accounts, and that accounts of recent events contained more qualitative details than accounts of distant events. Participants rated their own accounts as more qualitatively detailed than other participants’ accounts, which suggests that they did not base their self-ratings solely on the written details. We discuss the practical and theoretical importance of our findings. Copyright # 2006 John Wiley & Sons, Ltd.

Body image and self-esteem across age and gender : a short-term longitudinal study

This study examined the relationship between body image and self-esteem across time and age for men and women. Participants were 150 men and 239 women aged between 20 and 86 years (M=59.73), recruited from the general population in Australia. They completed a questionnaire assessing self-esteem, body dissatisfaction, body importance, and a range of other domains of life satisfaction at baseline and 2 years later. Cross-sectionally, we found that higher self-esteem was associated with lower body dissatisfaction, but there was no consistent relationship between these variables across time for age and
gender. Women were more dissatisfied with their bodies than men; yet, men placed greater importance on their appearance than women, and also reported high levels of body dissatisfaction.

Relationship between inflammatory cytokines and self-report measures of training overload

It has been purported that inflammatory cytokines may be responsible for the aetiology of overtraining. The aim of the present study was to investigate the relationship between self-reported measures of overtraining and inflammatory cytokines. Eight elite male rowers were monitored in their natural training environment for 8 weeks prior to the 2007 Rowing World Championships. During this period of intense endurance training, self-report measures of overtraining and inflammatory cytokines (Interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, and Tumor Necrosis Factor (TNF)-) were assessed fortnightly. Consistent with previous findings, proinflammatory cytokines IL-1β and TNF- were significantly associated (p ≤ 0.05) with measures of depressed mood, sleep disturbances, and stress. Similarly, IL-6 was significantly associated (p ≤ 0.01) with measures of depressed mood, sleep disturbances, and fatigue. These results are consistent with previous hypotheses describing how overtraining may be caused by excessive cytokine release, and lend further support for a cytokine hypothesis of overtraining.

Body image and self-concept in adolescent girls [R]

Anorexia Nervosa has been recently recognized as one of the most common chronic illnesses that affects the female adolescent population today. Although there has been an abundance of research into eating disorders in a variety of fields, significant limitations within the research still exist. Since very early descriptions of the disorder, self-concept and body image have been identified as core components of the anorexia nervosa. However, research has been somewhat limited in that there have not been any consistent theoretical underpinnings for self-concept and body image within the eating disorders field. Furthermore, researchers have tended to adopt traditional inferential statistics and multivariate methods to assess the role of self-concept and body image. As a result there has been very little consistency in research results. The current paper summarizes the significant findings from a doctoral thesis that attempted to address current limitations in self-concept and body image literature within the field of eating disorders.

Educational and mental health implications of the multidimensional model of the self-concept for adolescent girls : comparison of clinical and non-clinical samples

The importance of a positive self-concept as an educational outcome and a facilitator of other desirable outcomes are well established within the education research field. Although the multidimensional and hierarchical model of the self-concept is widely accepted within the educational psychology, this perspective is not widely used within the mental health research. Hence, the purpose of the present investigation is to compare the psychometric properties of the short version of the Self-Description Questionnaire (SDQII-S) based on responses by a large sample of female adolescent high school students (N= 829) and a clinical sample of adolescent girls who have been diagnosed with anorexia nervosa (N= 75). The well-established psychometric properties of the longer version of the SDQII generalise well to both samples of adolescent girls, and analyses provided good support for the invariance of the factor structure across the two samples. Furthermore, analyses employing new structural equation modelling approaches to comparing the latent mean differences indicated that there were differences (although surprisingly small) between the two groups that were generally consistent with a priori predictions. The important educational and clinical implications of these results are discussed.

Fmoc-diphenylalanine self assembles to a hydrogel via a novel architecture based on π-π interlocked β-sheets

The self assembly of peptide hydrogelators that carry aromatic substituents can be modeled by a novel nanocylindrical architecture. The proposed model suggests that the nanocylinders are formed by anti-parallel β-sheets interlocked by the π-stacking interactions of fluorenyl groups and phenyl rings. This explanation is consistent with the structures observed in TEM and the data obtained by a variety of spectroscopic techniques.

Measurement issues in the evaluation of chronic disease self-management programs

Objectives: 

A systematic review of outcomes of chronic disease self-management interventions

Purpose
To carry out a systematic review of program outcomes used in the evaluation of group-based self-management interventions aimed at people with arthritis and other chronic conditions.

Methods
The systematic search was performed across databases MEDLINE, EMBASE, CINAHL, and PsycINFO. Both between-group and within-group effect sizes (ES) were calculated. Results were interpreted as small (ES ~ 0.2), medium (ES ~ 0.5), or large (ES ~ 0.8) effects.

Results
The majority of 18 included trials investigated the effectiveness of arthritis-specific interventions. Across most outcomes, small effects on course participants were shown. While effects on knowledge were large (between-group ES = 0.78), effects on clinical outcomes such as pain (ES = 0.10) were negligible to small.

Conclusions
This paper is consistent with other reviews in this area, suggesting that people with arthritis receive only marginal benefits from participating in chronic disease self-management interventions. When looking at the types of outcomes that trials are based on, however, alternative explanations for these results seem probable. As evaluations heavily rely on patient self-report, current approaches to program evaluation may not be sufficient to assess the intended impact of self-management education. An in-depth investigation of the types of outcomes assessed is provided in a separate paper.

Monitoring athletes through self-report: factors influencing implementation

Monitoring athletic preparation facilitates the evaluation and adjustment of practices to optimize performance outcomes. Self-report measures such as questionnaires and diaries are suggested to be a simple and cost-effective approach to monitoring an athlete’s response to training, however their efficacy is dependent on how they are implemented and used. This study sought to identify the perceived factors influencing the implementation of athlete self-report measures (ASRM) in elite sport settings. Semi-structured interviews were conducted with athletes, coaches and sports science and medicine staff at a national sporting institute (n = 30). Interviewees represented 20 different sports programs and had varying experience with ASRM. Purported factors influencing the implementation of ASRM related to the measure itself (e.g., accessibility, timing of completion), and the social environment (e.g., buy-in, reinforcement). Social environmental factors included individual, inter-personal and organizational levels which is consistent with a social ecological framework. An adaptation of this framework was combined with the factors associated with the measure to illustrate the inter-relations and influence upon compliance, data accuracy and athletic outcomes. To improve implementation of ASRM and ultimately athletic outcomes, a multi-factorial and multi-level approach is needed.

Fear of self, doubt and obsessive compulsive symptoms

BACKGROUND AND OBJECTIVES: Following observations in the literature that obsessions often contain or imply negative evaluative information about the self, Aardema et al. (2013) recently developed a measure of feared-self relevant to OCD. The current study aimed to provide further examination of the relevance of such feared self-beliefs to obsessive compulsive processes - in particular whether they partially underlie doubt in OCD-relevant situations. METHOD: Nonclinical participants (N = 463; 291 females; Mage = 25.17, SD = 7.47), were presented with three vignettes, related to washing, checking and non-OCD relevant themes, which assessed doubt through providing alternating sensory and possibility-based information. RESULTS: Higher levels of OCD symptoms and feared-self beliefs both significantly predicted both higher baseline levels of doubt and greater fluctuation in levels of doubt in both the contamination and checking scenarios, and to a much lesser extent in the control scenario. Feared-self beliefs did not predict fluctuation in doubt over-and-above OCD symptoms, consistent with a mediation model. LIMITATIONS: The main limitation was the use of a non-clinical sample, although this allowed sufficient participant numbers to test hypotheses. CONCLUSIONS: The findings provided further experimental support for reasoning processes in OCD, and suggested that feared self-beliefs may make individuals vulnerable to experiencing doubt. Additionally, these results suggested that individuals with high OCD symptoms and those with high feared self-beliefs are unable to recognise the improbable nature of possibility-based statements. Implications for treatment and theory are discussed.