Poor adherence to treatment is common in patients on hemodialysis which may increase risk for poor clinical outcomes and mortality. Self management interventions have been shown to be effective in improving compliance in other chronic populations. The aim of this trial is to evaluate the effectiveness of a recently developed group based self management intervention for hemodialysis patients compared to standard care. This is a multicentre parallel arm block randomized controlled trial (RCT) of a four session group self management intervention for hemodialysis patients delivered by health care professionals compared to standard care. A total of 176 consenting adults maintained on hemodialysis for a minimum of 6 months will be randomized to receive the self management intervention or standard care. Primary outcomes are biochemical markers of clinical status and adherence. Secondary outcomes include general health related quality of life, disease-specific quality of life, mood, self efficacy and self-reported adherence. Outcomes will be measured at baseline, immediately post-intervention and at 3 and 9 months post-intervention by an independent assessor and analysed on intention to treat principles with linear mixed-effects models across all time points. A qualitative component will examine which aspects of program participants found particularly useful and any barriers to change. The NKF-NUS intervention builds upon previous research emphasizing the importance of empowering patients in taking control of their treatment management. The trial design addresses weaknesses of previous research by use of an adequate sample size to detect clinically significant changes in biochemical markers, recruitment of a sufficiently large representative sample, a theory based intervention and careful assessment of both clinical and psychological endpoints at various follow up points. Inclusion of multiple dependent variables allows us to assess the broader impact on the intervention including both hard end points as well as patient reported outcomes. This program, if found to be effective, has the potential to be implemented within the existing renal services delivery model in Singapore, particularly as this is being delivered by health care professionals already working with hemodialysis patients in these settings who are specifically trained in facilitating self management in renal patients.

To measure adherence levels with dietary restrictions in Irish patients with end-stage renal disease receiving haemodialysis and to explore the relationships between adherence with dietary sodium restrictions and health beliefs in relation to following these restrictions in this group. Non-adherence to medical regimes is an important healthcare issue and an ever-present problem, particularly in patients with a chronic illness. The literature revealed a lack of studies measuring adherence with the sodium component of the renal dietary restrictions and associated factors; despite the fact that adherence with sodium restrictions is essential to the optimal management of end-stage renal disease. Furthermore, despite increased emphasis on 'the patients' view' in healthcare no study to date has contextualised health beliefs and adherence in end-stage renal disease from an Irish perspective. A quantitative, descriptive, correlational design was employed using the Health Belief Model as a theoretical framework. A convenience sample (n = 79) was recruited from the haemodialysis units of a large hospital. Data were collected using self-report questionnaires. Data were analysed using descriptive and correlational statistics. Non-adherence with dietary restrictions was a problem among a proportion of the sample. Greater adherence levels with dietary sodium restrictions were associated with greater 'perceived benefits' and fewer 'perceived barriers.' For the Irish patient, beliefs in relation to following a low sodium diet significantly affected adherence levels with this diet. This is an important finding as delineating key beliefs, particularly key barriers, facilitates an increased understanding of non-adherence for nurses. RELEVANCE FOR CLINICAL PRACTICE: These findings have implications for the care of patients with end-stage renal disease in that they can provide guidance in terms of developing interventions designed to improve adherence.

Adherence is a major problem in patients with chronic kidney disease. Patients can be nonadherent with different aspects of their treatment, which includes medications, treatment regimens, and dietary and fluid restrictions. Although many lessons have been learned from adherence research, the evidence of how to modify adherence is somewhat mixed. To minimize nonadherence, interventions need to focus on both patient factors and the extent to which relationships and system problems compromise the patient's ability to adhere to medication and treatment plans. There continues to be a tendency to focus on the patient as the reason for problems with adherence, ignoring other factors such as the patient-health care provider relationships and the health care system that surrounds the patient. These latter factors can have a considerable effect on adherence. The nurse can develop a strong relationship of support with the patient, identify barriers, and offer strategies to help patients improve adherence.

OBJECTIVE: Self-efficacy is an important determinant of health behaviour and reflects a person's belief about their capability to complete a given task. The relationship between self-efficacy and fluid adherence has been investigated, although limited attention has been given to measurement issues. The purpose of this study was to develop a measure of situation-specific self-efficacy for constructive fluid intake behaviour in haemodialysis patients, the Fluid Intake Appraisal Inventory (FIAI). METHODS: Items were generated from an analysis of empirical studies available in the literature and exposed to an interpretability critique before haemodialysis patients confirmed sufficiency of each item. In a multi-centre study, data from 144 haemodialysis patients were collected regarding general self-efficacy, situation-specific self-efficacy, and estimated fluid consumption. Internal consistency, criterion-related validity, and structural validity were tested. RESULTS: The FIAI was found to have high internal consistency (Cronbach alpha 0.96) and the theoretical assumptions for criterion-related validity and known-group validity were supported. Structural validity was not confirmed, however, because the theoretically hypothesized four-factor model was not the prime structure. CONCLUSION: The FIAI was revealed to have satisfactory psychometric properties. The scale may be used in research or in clinical settings to study the mediating effects of self-efficacy or to modify haemodialysis patients' fluid-intake behaviour. Although this first validity study is promising, further validation focusing on reliability and cultural validity is needed.

OBJECTIVES: The study objective was to identify the factors that influence dietary adherence in Hispanic patients receiving maintenance hemodialysis and to determine the differences in dietary adherence between Hispanic and non-Hispanic patients. DESIGN: We performed a cross-sectional study using a descriptive-comparative design. SETTING: The study took place at hemodialysis centers at Winthrop-University Hospital, New York. PARTICIPANTS: The participants were adult patients of Hispanic descent receiving maintenance hemodialysis three times per week for 3 months or more and an equal number of age- and sex-matched non-Hispanic patients. INTERVENTION: Information was obtained by a questionnaire about knowledge of the diet, preferred language for education, consumption of potassium-(K(+)) and phosphorus-(PO(4)) containing foods, and adherence attitudes and behaviors. Serum albumin (SAlb), K(+), and PO(4) for the past 3 months were obtained from medical records and evaluated to assess dietary adherence. MAIN OUTCOME MEASURE: The main outcome measure was a mean SAlb of 3.2g/dL or greater, K(+) of 5.5 mEq/L or less, and PO(4) of 5.5 mg/dL or less. RESULTS: A total of 17 Hispanic and 17 comparison patients were included. Both groups were adherent to the diet because their mean levels of SAlb, K(+), and PO(4) were within acceptable limits. Dietary adherence was observed in 76% of the Hispanic patients for SAlb, 88% for K(+), and 65% for PO(4), whereas the rate of adherence was 59%, 88%, and 76%, respectively, for the comparison group. CONCLUSION: Both groups were adherent to the restrictions of the renal diet. More patients from both groups were adherent to K(+) than to PO(4) restrictions. Among the factors that probably influenced dietary adherence to the renal diet in this dialysis facility are knowledge of the renal diet, language, food frequency consumption, socioeconomic status, family support, and attitudes toward the renal diet. Patient education provided in Spanish with family involvement is an important element for promoting adherence among Hispanic patients receiving dialysis.

The research literature on self-care management for adults with end stage renal disease being treated with hemodialysis was reviewed to ascertain the current state of knowledge, identify gaps, and propose future research. Sixty-four studies were reviewed. Many studies focused on compliance and whether subjects were meeting predetermined values of outcome variables set by professionals. Self-care management of ESRD is multidimensional and warrants further research from the client professional, and health care system perspectives.

BACKGROUND Little is known about the impact of holiday and other special-event meals on patients with chronic medical conditions. It is possible that patients are less adherent with dietary restrictions during such meals. We sought to determine the impact of Super Bowl parties on nutritional parameters among hemodialysis patients. OBJECTIVE To determine the relationship between attending a Super Bowl party and subsequent change in serum phosphorus level, serum potassium level, interdialytic weight gain, and blood pressure. DESIGN Retrospective cohort study. SETTING Outpatient dialysis unit. PATIENTS One hundred twenty-two chronic hemodialysis patients. MAIN OUTCOME MEASURES Patients were asked whether they had attended a Super Bowl party. Serum phosphorus level, serum potassium level, interdialytic weight gain, and predialysis blood pressure at the hemodialysis treatment after the Super Bowl and at the hemodialysis treatment 1 month previously were obtained by chart abstraction. RESULTS The 15 patients who had attended a party had increased serum phosphorus levels (+0.5 mg/dL) and interdialytic weight gain (+1.1% of dry weight) from baseline. These increases were statistically significant (P values .005 and .02, respectively) compared with patients who did not attend a party. Attendees also had increased systolic blood pressure (+6 mm Hg) from baseline, but this was of marginal statistical significance compared with nonattendees (P =.14). Attending a party was not significantly associated with changes in serum potassium and diastolic blood pressure. CONCLUSIONS Attending a Super Bowl party is associated with adverse changes in several nutritional parameters. Although patients should not be discouraged from attending holiday and special-event meals, management of hemodialysis patients should include increased dietary counseling before holidays and special events and increased monitoring afterward.

BACKGROUND Despite the diversity of proposed theories, researchers are still unable to fully explain dietary compliance behaviours of dialysis patients. Dietary self-efficacy, a concept less studied in dialysis, has been linked to positive compliance outcomes in the chronic illness literature. Therefore, the aim of the present research was to determine how dietary self-efficacy is related to selected biochemical markers and self-reported behavioural outcomes in haemodialysis patients. METHODS 107 subjects participated in a cross-sectional study. Four questionnaires assessed dietary self-efficacy, compliance attitudes and behaviours, and staff-patient relationships. Laboratory outcomes were retrospectively obtained from patients' medical records and averaged for the previous 6 months. RESULTS Of the behavioural measures, only dietary self-efficacy was associated with laboratory outcomes. Dietary self-efficacy was also positively related to staff-patient relationships and to patients' self-reported assessment of compliance behaviours. Women had greater dietary self-efficacy than men. The number of family members living with the respondent was inversely related to dietary self-efficacy. CONCLUSIONS Results indicated that dietary self-efficacy determined both behaviours and laboratory outcomes. Patients with greater dietary self-efficacy had lower serum potassium and weight gain, showed favourable compliance attitudes and behaviours toward prescribed regimens and fostered better relationships with staff. Based on these findings we recommend an experimental approach to clarify whether maximizing dietary self-efficacy efforts is without psychological burden to patients and whether the positive effect of increased dietary self-efficacy is maintained in long-term dialysis patients.

OBJECTIVE This study sought to determine the effectiveness of a recently developed educational patient compliance program (A Taste for Life [1995]; Abbott Laboratories, Abbott Park, IL) on improving serum phosphate levels in patients receiving hemodialysis. DESIGN An ABA time series design was used. PARTICIPANTS/SETTING Eighty-one patients receiving hemodialysis participated. The experimental group consisted of 50 participants (mean [M]= 57.9 years of age; 92% African-American; 62% female) from a private freestanding dialysis unit (Kinston, NC). The control group consisted of 31 control participants (M = 58.2 years of age; 90% African-American; 48% female) from a separate private freestanding dialysis unit (Greenville, NC). INTERVENTION The experimental group took part in the educational patient compliance program directed at dietary and medical regimes. The program used educational materials, interactive educational modules, motivational posters, creative games and puzzles, videos, and an in-center achievement contest. The control group did not partake in the program, but received individual ongoing monthly therapy that involved nutrition counseling consistent with the National Renal Diet (American Dietetic Association, 1993) and instruction regarding use of phosphate binders. MAIN OUTCOME MEASURE Serum phosphate levels were monitored monthly for 1 year (ie, 3, 3, and 6 months during pretreatment, treatment, and posttreatment, respectively). RESULTS No statistically significant differences were found in serum phosphate levels between the two groups (P >.05). There was, however, a significant difference across time within groups. Mean serum phosphate levels significantly declined during the treatment period and further during the posttreatment period relative to the pretreatment baseline (P <.05). Results were not compared with a group of patients receiving hemodialysis who received no nutrition counseling. CONCLUSION The findings suggest that an educational compliance program is equally effective as standard individual ongoing counseling in affecting serum phosphate levels among patients with end-stage renal disease who receive hemodialysis. Results suggest that renal dietitians choose types of intervention within each patient's continuity of care that support individual success.

Depression is associated with increased cardiovascular risk in acute coronary syndrome (ACS) patients, but some argue that elevated depression is actually a marker of cardiovascular disease severity. Therefore, disease indices should better predict depression than established theoretical causes of depression (interpersonal life events, reinforcing events, cognitive distortions, type D personality). However, little theory-based research has been conducted in this area. In a cross-sectional design, ACS patients (n = 336) completed questionnaires assessing depression and psychosocial vulnerabilities. Nested logistic regression assessed the relative contribution of demographic or vulnerability factors, or disease indices or vulnerabilities to depression. In multivariate analysis, all vulnerabilities were independent significant predictors of depression (scoring above threshold on any scale, 48%). Demographic variables accounted for <1% of the variance of depression status, with vulnerabilities accounting for significantly more (pseudo R² = 0.16, χ²(change)= 150.9, df = 4, p < 0.001). Disease indices accounted for 7% of the variance in depression (pseudo R² = 0.07, χ² = 137.9, p < 0.001). However, adding the vulnerabilities increased the overall variance explained to 22%(pseudo R² = 0.22, χ² = 58.6, df = 4, p < 0.001). Theoretical vulnerabilities predicted depression status better than did either demographic or disease indices. The presence of these proximal causes of depression suggests that depression in ACS patients is not simply a result of cardiovascular disease severity.

BACKGROUND: While a healthy sexual life is regarded as an important aspect of quality of life, sexual counselling from healthcare providers for cardiac patients has received little attention in the literature. AIM: To document current practice and assess the needs of cardiac rehabilitation service providers in Ireland with regard to sexual assessment and management for patients. METHODS: Cardiac rehabilitation staff in all relevant centres in Ireland responded to a postal questionnaire. Sexual health management was assessed by a series of questions on current practice, staff attitudes, beliefs and perceived barriers to discussing sexual problems. RESULTS: Staff (N=60; 61% response rate) reported a lack of assessment and counselling protocols for addressing sexual health problems, with little or no onward referral system available. Results also suggest staff believe that patients do not expect them to ask about their sexual concerns. Barriers reported included an overall lack of confidence (45%), knowledge (58%) and training (85%). CONCLUSION: Development of guidelines, assessment protocols and training for cardiac rehabilitation staff are essential in the area of sexual health problems in order to improve the quality of services for patients with coronary heart disease.

BACKGROUND General practitioners (GPs) are often the first to assess mental health difficulties after acute coronary syndrome (ACS). AIMS To determine whether GPs observed an increase in mental health difficulties one-year post-hospitalisation for ACS. METHODS Postal survey. RESULTS GPs rated patients (n = 442) as having probable (GP assessed 10%) or definite (formally assessed 7%) mental health difficulties pre-hospitalisation. Post-hospitalisation the prevalence of probable cases increased significantly to 19%(OR = 4.3, 95% CI 2.1-10.2, P < 0.001). In multivariate analysis, only smoking at index hospitalisation was associated with being assessed as a new case of probable/formal mental health difficulties (RR = 2.1, 95% CI 1.3-3.4, P = 0.003). Forty-seven percent of cases were prescribed some medication for this problem. CONCLUSIONS GPs recorded a significant increase in mental health difficulties in ACS patients 12 months after hospitalisation, with smoking used as an indicator of new cases.

AIMS/HYPOTHESIS: The aim of this study was to test the construct validity of the Diabetes Quality of Life for Youth (DQOLY) questionnaire in a large representative sample of young people with type 1 diabetes mellitus. METHODS: The 52-item DQOLY questionnaire was completed by 2,077 adolescent individuals (aged 10-18 years) with type 1 diabetes. Participants were recruited from 22 paediatric diabetes centres in 18 countries across Europe, Asia and North America. HbA(1c) levels were determined once and analysed centrally. RESULTS: Exploratory factor analysis generated three possible measurement models of a revised questionnaire, two with four factors and one with six factors with all models indicating the presence of one satisfaction scale, but with many of the impact and worry scale items either double loading or not loading on any factors. Subsequent confirmatory analysis indicated that compared with the original DQOLY scales, the six-factor solution was the best-fitting model. CONCLUSIONS/INTERPRETATION: The DQOLY factor structure does not show construct validity in a large, diverse representative sample of young people with type 1 diabetes. However, a revised (short-form) version of the DQOLY is proposed that has improved construct validity, adequate internal consistency, and more precise and hypothesised association with HbA(1c). It is anticipated that this shorter version will enhance the acceptability and clinical utility of the measure, making it more feasible to introduce as part of routine care.

BACKGROUND The national Cardiovascular Health Strategy including specific plans for cardiac rehabilitation was launched in Ireland in 1999. A survey of cardiac rehabilitation services was conducted in 2003 to evaluate progress on service provision. AIM To establish levels of service provision, service formats and geographic distribution of cardiac rehabilitation services in 2003 and compare them with the status pre-Strategy (1998). METHOD All hospitals in Ireland (n = 39) admitting cardiac patients to a coronary or intensive care unit were surveyed by postal questionnaire. RESULTS All hospitals provided information and all reported providing Phase I cardiac rehabilitation. Seventy-seven per cent (30 of 39) provided Phase III rehabilitation in 2003 (i.e. outpatient cardiac rehabilitation services) compared with 29%(12 of 41) in 1998. Of those hospitals currently without programmes, 78%(seven of nine) had plans in place for programme establishment. All programmes had trained cardiac rehabilitation coordinators, multidisciplinary teams and multiple components as recommended in the Strategy. In 82% of hospitals, intervention was provided at Phase II (immediate post-discharge period) while 26% of hospitals provided intervention at Phase IV (long-term maintenance period). CONCLUSIONS There have been substantial achievements towards the Cardiovascular Health Strategy target of providing cardiac rehabilitation services for all relevant hospitals in Ireland over the past five years. Service provision of cardiac rehabilitation can benefit from collective efforts made across centres to encourage the prioritisation of cardiac rehabilitation in national health policy initiatives.

BACKGROUND The National Health Strategy envisages a health system incorporating patient views; and providing accessible, consultant-led dialysis services with patient choice of dialysis modality, in all regions. AIMS To describe patients' experiences of renal services against National Health Strategy objectives. METHODS Telephone interviews with 192 dialysis patients from three hospitals in the Eastern region. RESULTS One-quarter of participants (16% of haemodialysis [HD] and 46% of peritoneal dialysis patients) lived outside the Eastern region, and travelled there because dialysis was not available locally. Two-thirds (65%) had a choice of dialysis modality. High satisfaction with interpersonal care was observed (83-98% satisfaction). Dissatisfaction with physical environment included parking (39-56%), waiting areas (62-69%), HD unit space (74%). Regarding support services, dietary services were satisfactory (92-95%), with lower satisfaction ratings for social and financial support services (62%). CONCLUSIONS Structural and management issues must be addressed to advance a quality agenda for renal care in Ireland.

BACKGROUND Ethical approval of research projects is, appropriately, an essential prerequisite in health settings. AIMS This paper outlines difficulties encountered with procedures for gaining ethical approval for two multicentre surveys in Ireland. METHODS The experiences of two national surveys were documented. RESULTS Delays in processing ethics applications led to substantial delays in both surveys. Research ethics committees (RECs) assessed applications in an idiosyncratic manner. CONCLUSION In Ireland, there is currently no accepted mechanism for single location ethical approval for multicentre studies. Instead, they require separate approval from all participating centres. The challenges of this system of application to multiple committees are outlined in this paper, and possible solutions presented.

Few reports about methods of evaluating quality of life (QoL) among the thousands published since medical interest in the subject slowly began nearly 40 years ago are based upon theory. This paper, prepared in response to a request to furnish an exception (Meadows KA. Introduction to an Advanced Seminar: Assessing Health-Related Quality of Life. What can the Cognitive Sciences Contribute? Hull University, October 9, 2000) describes the origins of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL). This derives its cognitive aspects from theoretical studies of perception by Egon Brunswik, their extension to Social Judgment Theory (SJT) by Kenneth Hammond and the application of these ideas to QoL by the present authors and their colleagues.

BACKGROUND The first national survey of cardiac rehabilitation services was conducted. AIMS To establish levels of service provision, service formats, and geographic distribution of cardiac rehabilitation services in 1998. METHODS Public hospitals in the Republic (n=41) and Northern Ireland (n=12) which provide services to cardiac patients were surveyed. RESULTSl Response rate was 81%. Twelve centres (29%) in the Republic and nine (75%) in Northern Ireland provided cardiac rehabilitation. There was wide geographic variability in service provision. Most centres were unable to identify the proportion of eligible patient participation. Most programmes were established for less than five years. All programmes had multidisciplinary teams, multicomponent courses and co-ordinators. Additionally, 44% of hospitals without programmes had plans regarding programme establishment. CONCLUSIONS The findings highlight the underdeveloped but rapidly expanding nature of cardiac rehabilitation services in Ireland. They provide a baseline from which to address rehabilitation needs and to judge the success of the National Cardiovascular Health Strategy in addressing these needs.

OBJECTIVE It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families. RESEARCH DESIGN AND METHODS The study involved 2,101 adolescents, aged 10-18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA(1c) was analyzed centrally (normal range 4.4-6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires. RESULTS Mean HbA(1c) was 8.7%(range 4.8-17.4). Lower HbA(1c) was associated with lower impact (P < 0.0001), fewer worries (P < 0.05), greater satisfaction (P < 0.0001), and better health perception (P < 0.0001) for adolescents. Girls showed increased worries (P < 0.01), less satisfaction, and poorer health perception (P < 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P < 0.0001). Patients from ethnic minorities had poorer scores for impact (P < 0.0001), worries (P < 0.05), and health perception (P < 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores. CONCLUSIONS In a multiple regression model, lower HbA(1c) was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.

cicolini g., palma e., simonetta c.& di nicola m.(2012) Influence of family carers on haemodialyzed patients' adherence to dietary and fluid restrictions: an observational study. Journal of Advanced Nursing00(0), 000-000. doi: 10.1111/j.1365-2648.2011.05935.x ABSTRACT: Aim.  To determine the influence of a family carer on haemodialyzed patients''adherence'. Background.  There is extensive evidence showing that successful treatment of patients with end-stage renal disease is directly related to patients''adherence'. The parameters indicative of a good adherence are potassium and phosphate serum levels and the interdialytic weight gain. Haemodialyzed patients may have scarce adherence to food and fluid intake restrictions, and medications schedule. Design.  Case-control study carried out in a haemodialysis centre in Italy. Data sources.  The data were collected during 2010. Methods.  A total of 72 subjects with end-stage renal disease participated in the study. The subjects assisted by a family carer were identified as cases (n = 36), whereas those who did not have a family carer, as controls (n = 36). All subjects were followed up (4 months) and checked up regarding interdialytic weight gain, and serum levels of potassium and phosphate. Important differences in potassium and phosphate serum level and interdialytic weight gain between the two groups were evaluated separately using a repeated measures anova test. Results.  Participants in the case group showed significantly lower phosphate and potassium serum levels and a lower interdialytic weight gain during follow-up when compared to controls. Conclusions.  The presence of a family carer improves patients' adherence, particularly as far as phosphate levels are concerned, since phosphate intake plays a fundamental role in avoiding long-term complications in end-stage renal disease patients.

In this study, the development of the Posttraumatic Avoidance Behaviour Questionnaire (PABQ) is described and validated in 437 participants; PTSD patients (N = 75), clinical controls (patients with panic disorder with agoraphobia; PDA)(N = 50), and non-clinical traumatized controls (N = 312). Item reduction and exploratory factor analyses yielded 25 items reflecting seven factors. Internal consistency, test-retest reliability, convergent and discriminative validity of the PABQ proved adequate. In a second study, the PABQ showed to be sensitive to change due to exposure treatment outcome (N = 26).

This study is the first part of the validation of a French version of the Dutch Eating Behaviour Questionnaire (DEBQ), among a population of obese and normal-weight patients. The questionnaire was administered to 166 subjects. Construct validity was assessed by orthogonal factor analysis with a varimax procedure and reliability was measured by Cronbach's alpha coefficient. Results showed the presence of three major factors ("emotional","restrained" and "external eating") with loadings similar to those of the original questionnaire. A high internal consistency was found in the different scales. This study clearly demonstrates the factorial validity and the reliability of a French version of the DEQB.

AIM: This paper is a report of a study to develop and test the psychometric properties of a scale measuring nursing students' performance in de-escalation of aggressive behaviour. BACKGROUND: Successful training should lead not merely to more knowledge and amended attitudes but also to improved performance. However, the quality of de-escalation performance is difficult to assess. METHOD: Based on a qualitative investigation, seven topics pertaining to de-escalating behaviour were identified and the wording of items tested. The properties of the items and the scale were investigated quantitatively. A total of 1748 performance evaluations by students (rater group 1) from a skills laboratory were used to check distribution and conduct a factor analysis. Likewise, 456 completed evaluations by de-escalation experts (rater group 2) of videotaped performances at pre- and posttest were used to investigate internal consistency, interrater reliability, test-retest reliability, effect size and factor structure. Data were collected in 2007-2008 in German. FINDINGS: Factor analysis showed a unidimensional 7-item scale with factor loadings ranging from 0.55 to 0.81 (rater group 1) and 0.48 to 0.88 (rater group 2). Cronbach's alphas of 0.87 and 0.88 indicated good internal consistency irrespective of rater group. A Pearson's r of 0.80 confirmed acceptable test-retest reliability, and interrater reliability Intraclass Correlation 3 ranging from 0.77 to 0.93 also showed acceptable results. The effect size r of 0.53 plus Cohen's d of 1.25 indicates the capacity of the scale to detect changes in performance. CONCLUSION: Further research is needed to test the English version of the scale and its validity.

This study established the psychometric properties of the Chinese version of the Suicide Intent Scale (SIS) in a clinic- and community-based sample of 36 patients and 592 respondents, respectively. Results showed that the Chinese SIS demonstrated good inter-rater and test-retest reliability. Factor analysis generated three factors (Precautions, Planning, and Seriousness) explaining 92.9% of the total variance with high internal consistency. It was moderately correlated with depressive symptoms. Results suggest that the Chinese SIS is a reliable and valid instrument for use in assessing the extent of suicidal intention among subjects with deliberate self-harm in ethnic Chinese populations.

A low salt diet is beneficial for the whole population but has particular advantages for hemodialyis patients because of the role of salt restriction in the management of hypertension and interdialytic weight gain (IDWG). Education on dietary salt intake based on general healthy eating guidelines, such as the "DASH-sodium" diet, should be provided for staff, families, and carers as well as patients. Anuric hemodialysis patients will need to take in approximately 1 l of water for every 8 g salt consumed. Patients who restrict salt intake to <6 g/day, and drink only when thirsty, should gain no more than 0.8 kg/day. Those with significantly greater weight gains, but predialysis serum sodium close to or higher than the dialysate sodium, need further review of their salt intake. Attempts to restrict fluid intake in these patients will be futile. Patients with high interdialytic weight gain (IDWG) and low predialysis sodium should be assessed for other reasons for fluid intake, such as high blood glucose or social drinking. For patients with poor tolerance of fluid removal during dialysis, and those who are hypertensive in the absence of fluid overload, a salt intake 5 g/day or less may be required. Dietary advice for these patients should be customized to ensure that they do not become malnourished.

PURPOSE Recommendation of a low-sodium diet is the most common nonpharmacologic intervention used in patients with heart failure (HF). However, nonadherence to this recommendation is extremely high. There are no instruments available for the specific measurement of patients' perceptions of their barriers to, and attitudes toward, following a low-sodium diet. The purpose of this study was to evaluate the psychometric properties of a new instrument, the Dietary Sodium Restriction Questionnaire (DSRQ). Based on the Theory of Planned Behavior (TPB), the DSRQ assesses adherence through the use of 3 subscales. Each subscale represents a construct of the TPB: attitude, subjective norm, and perceived behavioral control. METHODS The sample consisted of 174 patients with HF (age 62.4 +/- 13.5 years, 56.1% were male, 83.8% were white, and 86.9% had New York Heart Association class II/III). Factorial validity was tested using principal component analysis. Reliability was tested using Cronbach's alpha to assess the internal consistency of the 3 subscales. Reliability was further evaluated with item-total correlations and inter-item correlations. RESULTS Principal component analysis of the DSRQ resulted in the extraction of 3 factors, each factor corresponding to a construct of the TPB. The 3-factor solution explained a total of 54.2% of the variance, with Attitude contributing 23.4%, Perceived Behavioral Control contributing 18.1%, and Subjective Norm contributing 12.7%. The Cronbach's coefficient alpha for each subscale was Attitude .88, Subjective Norm .62, and Perceived Behavioral Control .76. CONCLUSIONS The DSRQ is a valid and reliable tool for measuring patients' attitudes, beliefs, and barriers related to following a low-sodium diet in adult, white patients with New York Heart Association class II/III HF.

OBJECTIVE The numbers of older hemodialysis patients (OHPs) are increasing very rapidly worldwide, but few studies have focused on the compliance of OHPs. This study compared the compliance with, and the knowledge of, dietary restriction regimens between OHPs and younger hemodialysis patients (YHPs). Mortality was also compared between these two groups. PATIENTS AND SETTING A total of 160 patients who were registered at the Asan Medical Center (Seoul, Korea) participated in the study, 64 of whom were classified as OHPs (age >or=65 years), and 96 as YHPs (age <65 years). MAIN OUTCOME MEASURES Data were collected between September 2003 and February 2004. General characteristics and dietary knowledge of potassium, phosphorus, and sodium and fluid restrictions were assessed by personal interview. Dietary compliance was determined by measuring serum levels of these nutrients and interdialytic weight gain. Subjective global assessments were used to evaluate nutritional status. Both OHPs and YHPs were followed until May 2007 for mortality analysis. The data were analyzed with descriptive statistics, Student's t test, chi(2) test, and Spearman correlation using the SPSS statistical package (SPSS, Inc., Chicago, IL). RESULTS The OHPs had a lower appetite, lower physical activity, and lower educational level compared with the YHPs. Dietary compliance with phosphorus restriction and with sodium and fluid restriction was higher in the OHPs than in the YHPs (P <.01 and P <.05, respectively), whereas compliance with potassium restriction did not differ between groups. The knowledge scores concerning potassium (P <.05) and phosphorus (P <.01) restriction diets were lower in OHPs than in YHPs, whereas no differences were found for knowledge scores concerning sodium and fluid restriction diets. Mortality was higher in the OHPs than in the YHPs (P <.001). The OHPs with higher mortality had higher dietary compliance with sodium and fluid restriction (r = 0.248, P <.05), and lower nutritional status (r =-0.342, P <.05). CONCLUSIONS The OHPs were generally less knowledgeable and more compliant, and had a lower appetite and a higher mortality than the YHPs. Therefore, the current application of the same dietary education to both OHPs and YHPs may be problematic. Instead, developing age-specific strategies to increase dietary knowledge and nutritional intake is urgently needed to increase the survival rate of Korean hemodialysis patients.

OBJECTIVE To assess the utility of Leventhal's Self-Regulatory Model (SRM) to predict self-care behavior with regard to dietary, medication, and fluid regimes in end-stage renal disease (ESRD) patients. METHODS In a prospective study, ESRD patients treated via hospital-based haemodialysis (N=73) were screened for cognitive deficits and completed questionnaires that enquired about illness perceptions, coping strategies, knowledge of kidney disease, and psychological distress at Time 1. Physiological proxy measures of self-care behaviors regarding diet (serum potassium levels), fluid intake (mean and standard deviation of interdialytic weight gain), and medication (serum phosphate levels) regimes were collected 3 weeks later at Time 2. RESULTS Illness representations (emotional and timeline perceptions) predicted self-care behaviors with regard to diet and medication. Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions. Younger males were less likely to adhere to the fluid restrictions. CONCLUSIONS The SRM has predictive utility. Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients. A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population. Younger, male patients should be targeted for extra support with fluid restrictions.

Manchester Driver Behaviour Questionnaire (DBQ) is one of the most widely used instruments for measuring self-reported driving style and investigating the relationship between driving behaviour and accident involvement. In spite of the fact that Arab Gulf countries have a higher road accident fatality rate compared to European countries and USA, the DBQ has not been used in Arab countries so far. The aim of the present study was to investigate the factor structure of the DBQ, then to examine the relationships between the factors of the DBQ and accident involvement, and finally to compare DBQ scores between the two gulf countries: Qatar and United Arab Emirates (UAE). In this study, 1110 Qatari (263 females and 847 males) and 1286 UAE drivers (294 females and 992 males) filled a survey questionnaire including the DBQ and background information. The results showed that UAE drivers scored higher on almost all DBQ items than Qatari drivers. Surprisingly, only very small differences between men and women on the DBQ item scores were found in UAE. Factor analysis resulted in four factors, which were named as errors, pushing-speeding violations, lapses, and aggression-speeding violations. However, there were a number of differences in the factor structure of the DBQ in UAE and Qatar when compared to the theoretical four-factor structure of the DBQ. Reliabilities of some subscales were also questionably lower than in the original British data. Logistic regression analyses showed that errors, lapses, and aggression-speeding violations predicted accident involvement in Qatar but not in UAE after controlling the effect of the demographic variables (age, sex, and annual mileage).