Effect of a supportive-educational program, based on COPE model, on quality of life and caregiver burden of family caregivers of heart failure patients: a randomized clinical trial study

BACKGROUND

Heart failure (HF) is one of the most common and spreading diseases worldwide. As HF symptoms progress, it is affected the quality of life and the caregiver burden of the family. The present study aimed to determine the effectiveness of the supportive-educational program, based on the COPE (creativity, optimism, planning and expert advice) care model, on the quality of life and caregiver burden of family caregivers of HF patients.

METHOD

This clinical trial was conducted on 90 caregivers of HF patients admitted to Isfahan in 2021. The samples were divided into experimental (n = 45 people) and control (n = 45 people) groups based on random allocation (card method). The experimental group received problem-solving skills based on the four components of the COPE model in six sessions during one month. to collect data, the 36-Item Short Form Survey (SF-36) and the Zarit Burden Interview (ZBI) were used in two groups before, after and three months after the intervention.

RESULTS

There was a significant difference between the experimental and control groups regarding gender, but This confounding factor had no significant effect on the two components of quality of life and caregiver burden. There was a significant difference between the two groups in terms of the mean score of quality of life immediately(75.99),and three months after the intervention (78.78) (P < 0.05) and the mean score of care burden, immediately (16.60) and three months after the intervention (12.73) (P < 0.05).

CONCLUSIONS

One of the important duties of nurses is to implement educational-supportive programs for patients after the discharge of patients, These programs are family-oriented remotely for their caregivers.

TRIAL REGISTRATION

This study was registered by the Iranian Registry of Clinical Trials with decree code: IRCT20211128053202N1on 2022-02-20.

The effects of Lactobacillus delbrueckii and Lactobacillus rhamnosus on cytokines and their related molecules: An ex vivo study on patients with systemic lupus erythematosus

Objectives

This study aimed to assess the ex vivo impact of Lactobacillus delbrueckii (L. delbrueckii) and Lactobacillus rhamnosus (L. rhamnosus) on inflammatory and anti-inflammatory cytokines as well as their related molecules on the peripheral blood mononuclear cells (PBMCs) of systemic lupus erythematosus (SLE) patients.

Patients and methods

This study was conducted with 20 newly diagnosed SLE patients (18 females, 2 males; mean age: 33.3±12.4 years; range, 18 to 68 years) between September 2017 and September 2018. Extracted PBMCs from each patient were divided into 4 cell groups in our study. Three cell groups act as treatment groups receiving L. rhamnosus (107 CFU/mL), L. delbrueckii (105 CFU/mL) or a mixture of both, and one group act as our untreated control group in the absence of any probiotic agents. All cell groups were cultured in RPMI 1460 medium for 48 h. Then, total RNA was extracted, and cDNA was synthesized.

Results

The gene expression levels of forkhead box P3 (FOXP3), transforming growth factor beta (TGF-β), interleukin (IL)-6, IL-10, and IL-2 were evaluated by a quantitative real-time polymerase chain reaction. The results revealed that expression levels of FOXP3, TGF-β, IL-10, and IL-2 increased and the level of IL-6 decreased in probiotics-receiving groups compared to the control group. Lactobacillus delbrueckii and L. rhamnosus enhanced the expression of regulatory T cell-related molecules such as FOXP3 and IL-2 and also increased the expression of IL-10. These probiotics also reduced the expression of IL-6 as proinflammatory cytokines in the PBMCs of SLE patients.

Conclusion

The results of the present study show that these probiotics could be effective in regulating the balance of cytokine gene expression ex vivo , and due to their beneficial effects, they can be an intriguing option in the production of new complement drugs for SLE.

Predictors of Late Presentation for HIV among HIV-positive Tajik Migrants to the Russian Federation

Key messages

Structural factors are the strongest predictors of HIV late presentation among returned Tajik migrants to the Russian Federation. Further research is needed to explicate the causal pathways of the associations found in the present analysis.

Hepatitis C infection and other drug-related harms among inpatients who injected drugs in Turkey

Hepatitis C virus (HCV) is easily spread among those who share drug injection equipment. Due to the ease of contraction and growing prevalence of HCV in Eastern Europe, the aims of this study focused on describing risky injection practices as well as the prevalence of HCV, HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) who were admitted to public and private drug treatment centres in Turkey from 2012 to 2013. Other aims included identifying correlates of needle sharing and HCV infection. Of the 4694 inpatients who ever injected drugs and the 3914 who injected in the past 30 days, nearly all (98%) reported heroin as their drug of choice, the vast majority reported ever sharing a needle (73.4% and 79.3%), and the mean age at first injection was 23 years. Of current PWID, 51.9% were HCV-positive, 5.9% were HBV-positive and only 0.34% of lifetime PWID were HIV-positive. Predictors of increased needle sharing include younger age, being unemployed, having lesser education and reporting heroin as a drug of choice. Significant predictors of HCV infection included being 40 years or older, receiving treatment in the Mediterranean region of Turkey, reporting heroin as a primary substance, a longer duration of drug use and sharing needles. With this information, it is essential to improve access to clean injection equipment in Turkey, to focus on improving education on clean injection practices and to enhance efforts in testing and treating HCV-positive PWID.

Thrombocytopenia in HIV-infected patients, Islamic Republic of Iran

Thrombocytopenia is a blood dyscrasia common in AIDS patients that may result from increased viral load and diminished CD4 T lymphocytes. We evaluated the rate of thrombocytopenia [platelet count < 100 000/microL] in 170 HIV-infected patients [161 males and 9 females] from May 2000-April 2001 in Kermanshah, Islamic Republic of Iran. All except 7 females were injecting drug users. While 34 patients had thrombocytopenia, 3 had severe thrombocytopenia [platelet count < 20 000/microL]. Although prevalence was similar in various stages of HIV infection [18.5%-22.5%], severe thrombocytopenia was in patients with CD4 T cell count < 200 cells/microL. There were no other associated conditions. Mild thrombocytopenia is common in HIV-infected patients in our region.

Reduction of clinical tuberculosis in HIV-infected males with isoniazid prophylaxis

Isoniazid (INH) chemoprophylaxis has a positive impact on the development of clinical tuberculosis. Due to the increased prevalence of tuberculosis among HIV-infected individuals, we evaluated the effect of INH on the prevention of clinical tuberculosis in HIV-infected patients. We administered 300 mg of INH daily to 246 HIV-infected, tuberculin skin test-positive patients for 12 months. During 3 years of follow-up, 41 participants died and 94 were lost to follow up. Of the 111 patients followed for the 3 years, 12 developed tuberculosis which is lower than might be expected in an untreated group. INH prophylaxis appears to be an effective method to prevent clinical tuberculosis among HIV-infected, tuberculin skin test-positive patients.

Thrombocytopenia in HIV-infected patients, Islamic Republic of Iran

Thrombocytopenia is a blood dyscrasia common in AIDS patients that may result from increased viral load and diminished CD4 T lymphocytes. We evaluated the rate of thrombocytopenia (platelet count < 100 000/microL) in 170 HIV-infected patients (161 males and 9 females) from May 2000-April 2001 in Kermanshah, Islamic Republic of Iran. All except 7 females were injecting drug users. While 34 patients had thrombocytopenia, 3 had severe thrombocytopenia (platelet count < 20 000/microL). Although prevalence was similar in various stages of HIV infection (18.5%-22.5%), severe thrombocytopenia was in patients with CD4 T cell count < 200 cells/microL. There were no other associated conditions. Mild thrombocytopenia is common in HIV-infected patients in our region.