Abstract Background Methadone maintenance treatment (MMT) was implemented in mainland China since 2004. Numerous individual studies have investigated MMT retention but the overview still remains ...unclear. The aim of the study was to review MMT retention rates and predicting factors in mainland China during 2004–2012. Methods Chinese and English databases of literature were searched for studies reporting on retention rates and predicting factors in non-transfer MMT patients of fixed-site clinics in mainland China (2004–2012). Qualitative methods were used to synthesize the results. Results Nineteen studies were eligible for review, with sample size ranging from 29 to 3758. Retention rates varied between 30.0% at 6 months in Shanghai and 70.3% at 12 months in Xi'an. Predicting factors were non-treatment including sociodemographics (n = 14), support system and social function (n = 9), economic status (n = 2) and psychological status (n = 1), and treatment-related including drug use (n = 15), methadone use (n = 12), MMT clinics (n = 9), MMT participation (n = 7), awareness on MMT (n = 5) and HIV serostatus (n = 3). Methadone dose (n = 12) and age (n = 7) were the first two important specific factors. Conclusions In mainland China, MMT retention rates are heterogeneous and relatively lower, and predicting factors mainly focus on objective aspects. Future work should further explore subjective predicting factors regarding MMT retention.
Although many psychological factors have been associated with health-related quality of life (HRQoL), the mediator role of resilience between psychological predictors (i.e., coping styles and ...perceived social support) and HRQoL has rarely been explored in breast cancer survivors (BCSs).
A total of 231 BCSs participated in this cross-sectional survey. Pearson correlation was performed to analyze the relationships among coping styles (confrontation, avoidance, and resignation), perceived social support, resilience, and HRQoL. A multivariate linear regression analysis was applied to identify the psychological predictors of HRQoL and resilience, respectively. A structural equation modeling (SEM) was employed to examine the mediating role of resilience between coping styles, perceived social support, and HRQoL.
Perceived social support and resilience were positively associated with confrontation. Resilience was positively associated with perceived social support. HRQoL had positive correlations with confrontation/avoidance, perceived social support, and resilience. Resilience and resignation/avoidance were significant independent predictors of HRQoL, while resignation/confrontation and perceived social support were significant independent predictors of resilience. Confrontation/resignation, perceived social support, and resilience had significant direct effects on HRQoL; confrontation/resignation and perceived social support had significant direct effects on resilience; resilience had significant mediator roles between confrontation/resignation, perceived social support, and HRQoL.
Resilience was a significant mediator between coping styles, perceived social support, and HRQoL. A resilience-oriented intervention is recommended to alleviate the detrimental influences of low resilience on HRQoL, providing a new strategy for improving the health status of BCSs.
Breast cancer survivors experience altered body image and quality of life (QoL) due to the disease and its treatment. The multidimensional nature of body image and QoL makes their relationships ...complex. This study aimed to examine the associations between the two concepts in Chinese breast cancer survivors and test whether these associations are moderated by rural-urban residence.
A cross-sectional design was adopted. Breast cancer survivors were recruited via a convenience sampling method. Two validated questionnaires (the Body Image Self-Rating Questionnaire for Breast Cancer and 36-item Short-Form Health Survey) and questions assessing demographic and clinical covariates were administered. Multiple linear regressions were used to assess the relationship between body image and QoL domains and to examine the moderating effect of rural-urban residence.
In our sample of 354 breast cancer survivors, half (50.28%) lived in rural areas. After adjusting for demographic and clinical variables, better perception of body image-related sexual activity change, role change, and psychological change was significantly associated with better physical (β ranged from - 0.15 to - 0.11, p < 0.05) and mental (β ranged from - 0.46 to - 0.34, p < 0.001) well-being. Better perception of body image-related social and behavior change was significantly associated only with better mental well-being (β ranged from - 0.40 to - 0.33, p < 0.001). The association between body image and mental well-being was much stronger in urban subjects (b = - 0.38, p < 0.001) than in rural subjects (b = - 0.20, p < 0.001).
Our findings suggest that multidimensional body image is associated with physical and mental well-being in Chinese breast cancer survivors. Body image appears to play a larger role in urban breast cancer survivors' mental well-being. Our results indicate that incorporating interventions that address body image issues would be advantageous for survivorship care to enhance QoL in breast cancer survivors. Furthermore, rural-urban differences should be considered in the strategic design of survivorship care programs in rural and urban settings.
Breast cancer may impair health-related quality of life (HRQoL). We examined the mediating roles of perceived social support (PSS) and coping style (CS) in the relationship between resilience and ...HRQoL in newly diagnosed breast cancer patients.
Following a cross-sectional design, 431 patients completed a survey at two hospitals in Shaanxi Province, China. Four validated self-report measures assessed HRQoL, psychological resilience, PSS, and CS. A one-sample t-test analyzed differences between resilience, PSS, and CS in breast cancer patients and the corresponding norm. Multivariate linear regression analyzed the independent predictors of HRQoL. The mediating roles of PSS and CS between resilience and HRQoL were investigated using structural equation modeling (SEM).
Participants had significantly lower scores for resilience and PSS, and higher scores for the avoidance and resignation CSs than their corresponding norm. SEM analysis showed resilience had significant direct effects on PSS (Bs: 0.59, 95% CI 0.49, 0.68, P = 0.003), CS (confrontation: 0.53 (0.44, 0.62), P = 0.001; resignation: - 0.66 (- 0.74, - 0.57), P = 0.002), and HRQoL (Bs range from 0.44 to 0.63, P < 0.05). Resilience had significant indirect effects (Bs range from 0.09 to 0.27), and PSS and CS had significant direct effects on HRQoL (P < 0.05).
Newly diagnosed breast cancer patients had lower resilience and PSS, and higher negative CSs, suggesting that PSS and CS mediated the influence of resilience on HRQoL. A multimodal intervention program focusing on PSS and CS might improve the positive influences of resilience on HRQoL in breast cancer patients.
Abstract Purpose To examine effects of music therapy and progressive muscle relaxation training on depression, anxiety and length of hospital stay in Chinese female breast cancer patients after ...radical mastectomy. Methods A total of 170 patients were randomly allocated to the intervention group ( n = 85) receiving music therapy and progressive muscle relaxation training plus routine nursing care and the control group ( n = 85) receiving routine nursing care. Music therapy and progressive muscle relaxation training were performed twice a day within 48 h after radical mastectomy, once in the early morning (6a.m.–8a.m.) and once in the evening (9p.m.–11p.m.), for 30 min per session until discharged from the hospital. Results A general linear model with univariate analysis showed that the intervention group patients had significant improvement in depression and anxiety in the effects of group ( F = 20.31, P < 0.001; F = 5.41, P = 0.017), time ( F = 56.64, P < 0.001; F = 155.17, P < 0.001) and group*time interaction ( F = 6.91, P = 0.009; F = 5.56, P = 0.019). The intervention group patients had shorter length of hospital stay (12.56 ± 1.03) than that of the control group (17.01 ± 2.46) with statistical significance ( F = 13.36, P < 0.001). Conclusion Music therapy and progressive muscle relaxation training can reduce depression, anxiety and length of hospital stay in female breast cancer patients after radical mastectomy.
Although body image (BI) disturbance is a common problem that often contributes to poor health-related quality of life (HRQoL) among women with breast cancer following surgery, the mediating role of ...BI (as a self-perceptive factor) in the relationship between needs and HRQoL after controlling for socio-demographic factors remains unclear. The purpose of this study was to identify the mediating role of BI between post-surgery needs and HRQoL after controlling for socio-demographic factors among women with breast cancer. In this cross-sectional study, the primary outcome was HRQoL (as measured with the 36-item Short-Form Health Survey version 2 SF-36v2 and Functional Assessment of Cancer Therapy-Breast version 4.0 FACT-Bv4.0). The secondary outcomes included needs (measured in terms of needs importance NI and needs satisfaction NS) and BI. Structural equation modeling was used to identify the mediating role of BI between needs and HRQoL while considering socio-demographics. The 406 eligible patients reported poor HRQoL, and approximately half reported important unmet needs and poor BI. NI, NS, and socio-demographics had differing direct effects on BI and HRQoL, and contrasting indirect effects on HRQoL via BI. NI, NS, surgery type, presence of chronic disease, and BI explained 4% of the variance in the SF-36v2 physical component summary score; NI, NS, surgery type, residence, and BI explained 20% of the variance in the mental component summary score; and NI, NS, marital status, employment status, radiotherapy, and BI explained 33% of the variance in the FACT-Bv4.0 total score. After surgery, women with breast cancer have poor HRQoL and BI, and important unmet needs. BI mediates the relationship between needs and HRQoL after controlling for socio-demographics. The present findings provide information for developing comprehensive BI-based needs interventions and preparing targeted health-management programs for patients with breast cancer.
ObjectivesWomen with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, ...perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL.DesignCross-sectional design.SettingTwo tertiary level hospitals in Shaanxi Province, China.ParticipantsWomen newly diagnosed with breast cancer were recruited.Outcome measuresThe Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL.ResultsA total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=−0.067, p=0.024) and mental component summary (MCS) (b=−0.185, p<0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c′=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c′=0.194, p<0.001) and perceived needs importance (a=0.458, p<0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=−0.031; 95% CI −0.058 to –0.004) and the relationship between perceived needs satisfaction and MCS (a*b=−0.085; 95% CI −0.138 to –0.043).ConclusionFor women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.
Body image is a complex post-treatment concern among female patients with breast cancer, and various tools have been developed and applied to measure this multifaceted issue. However, these available ...tools were developed in other countries and only a few have been modified into Chinese versions. Furthermore, body-image evaluation instruments that are specific to Chinese mainland female patients with breast cancer have not been devised yet. Therefore, we developed the Body Image Self-rating Questionnaire for Breast Cancer for Chinese mainland female patients with breast cancer.
We performed two rounds of the Delphi technique and a cross-sectional pilot survey. Items were selected using a Likert scale (1-5) to determine ratings of importance (i.e., the significance of the item from experts' perspective; coefficients of variation ≤0.25), internal consistency reliability (Cronbach's α ≥ 0.70), convergent validity (hypothesized item-subscale correlations ≥0.40), and discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales). All decisions on items were made based on statistical analysis results, experts' recommendations, and in-depth discussion among researchers.
Twenty-five eligible experts completed the two Delphi rounds (mean age: 42.20 ± 8.90 years). Over half the experts were professors (56%, n = 14) or worked as clinical staff (68%, n = 17). Twenty (mean age = 49.55 ± 10.01 years) and 50 patients (mean age = 48.44 ± 9.98 years) completed the first- and second-round survey, respectively. Over half the patients had a tertiary education level, were married, and were employed. Regarding the revised questionnaire (comprising 33 items across seven subscales), the expert panelists' ratings of each item met the criteria (Kendall's W = 0.238, p < .001). Five subscales had a Cronbach's α value over 0.60 (range: 0.62-0.69) and two subscales were over 0.80 (range: 0.84-0.88). All items satisfied the criteria for convergent and discriminant validity.
The findings of this study provide evidence of a suitable tool for body image evaluation among Chinese mainland female patients with breast cancer. Studies with larger sample sizes should be conducted to validate this questionnaire in this patient population.
This study aimed to explore the bidirectional relationships between retention and health-related quality of life (HRQoL) in patients from mainland China receiving methadone maintenance treatment ...(MMT). This prospective cohort study recruited 1,212 eligible MMT patients from the two largest MMT clinics (one privately and another publicly funded) in Xi'an. This study started in March 2012 with a 2-year follow-up until March 2014. Retention was assessed by repeated terminations, past treatment duration, premature terminations, and follow-up treatment duration. HRQoL was evaluated using the Chinese (simple) short-form 36 health survey version 2 (SF-36v2) and the quality of life scale for drug addicts (QOL-DAv2.0). Linear and Cox regression analyses were used to explore relationships between retention and HRQoL. A general linear model was used to further examine the global effect of past treatment duration on HRQoL. Multivariate analyses showed that repeated terminations had no significant impact on HRQoL scores in MMT patients; however, past treatment time (year) influenced the SF-36v2PCS (P = 0.004): treatment for ≥4 years showed a lower SF-36v2PCS score (regression coefficient: -2.39; 95% confidence interval CI: -3.80, -0.97; P = 0.001) than treatment for <1 year. In addition, patients with an SF-36v2PCS score > 49 (hazard ratio: 0.83; 95% CI: 0.69, 0.98; P = 0.03) were 17% less likely to terminate MMT than those with scores of ≤49. In conclusion, retention and HRQoL tended to have a bidirectional relationship, which should be considered in the development of retention and health-management programs for patients with MMT.
To test psychometrics of the Short Form 36 Health Survey version 2 (SF-36v2) and the Quality of Life Scale for Drug Addicts (QOL-DAv2.0) in Chinese mainland patients with methadone maintenance ...treatment (MMT).
A total of 1,212 patients were recruited from two MMT clinics in Xi'an, China. Reliability was estimated with Cronbach's α and intra-class correlation (ICC). Convergent and discriminant validity was assessed using multitrait-multimethod correlation matrix. Sensitivity was measured with ANOVA and relative efficiency. Responsiveness was evaluated by pre-post paired-samples t-test and standardized response mean based on the patients' health status changes following 6-month period.
Cronbach's α of the SF-36v2 physical and mental summary components were 0.80 and 0.86 (eight scales range 0.73-0.92) and the QOL-DAv2.0 was 0.96 (four scales range: 0.80-0.93). ICC of the SF-36v2 two components were 0.86 and 0.85 (eight scales range: 0.72-0.87) and the QOL-DAv2.0 was 0.94 (four scales range: 0.88-0.92). Convergent validity was lower between the two instruments (γ <0.70) while discriminant validity was acceptable within each instrument. Sensitivity was satisfied in self-evaluated health status (both instruments) and average daily methadone dose (SF-36v2 physical functioning and vitality scales; QOL-DAv2.0 except psychology scale). Responsiveness was acceptable in the improved health status change (SF-36v2 except vitality scale; QOL-DAv2.0 except psychology and symptoms scales) and deteriorated health status change (SF-36v2 except vitality, social functioning and mental health scales; QOL-DAv2.0 except society scale).
The SF-36v2 and the QOL-DAv2.0 are valid tools and can be used independently or complementary according to different emphases of health-related quality of life evaluation in patients with MMT.
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