Monira Alwhaibi Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Monira Alwhaibi, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11149, Saudi Arabia, Email malwhaibi@ksu.edu.saBackground: Depression and anxiety commonly coexist with asthma and may be associated with poorer health-related quality of life (HRQoL). This study examined their associations with HRQoL among US adults with asthma using nationally representative Medical Expenditure Panel Survey (MEPS) data.Methods: A cross-sectional study was conducted using 2017– 2022 data from the Medical Expenditure Panel Survey. Adults aged 18 years and older with asthma were categorized into four mutually exclusive groups: asthma only, asthma with depression, asthma with anxiety, and asthma with both depression and anxiety. HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12), which generates Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Multivariable linear regression analyses were performed to examine the associations between asthma groups and HRQoL after adjusting for the confounders while accounting for the complex survey design.Results: The study included 5743 adults with asthma, of whom 68.4% had asthma alone, 10.2% had depression, 11.7% had anxiety, and 9.6% had both depression and anxiety. HRQoL differed significantly across the four groups (both p < 0.0001), with the highest PCS (44.04) and MCS (51.26) scores in the asthma-only group and the lowest scores (37.67 and 37.54, respectively) among those with both depression and anxiety. After adjustment for potential confounders, asthma with anxiety (β = − 6.25, p < 0.001) and asthma with both depression and anxiety (β = − 10.63, p < 0.001) and asthma and depression (β = − 5.344, p < 0.001) were associated with lower MCS scores compared with asthma alone. Participants with both depression and anxiety also had significantly lower PCS scores (β = − 0.85, p < 0.001).Conclusions: Depression and anxiety were associated with poorer HRQoL among US adults with asthma, particularly mental HRQoL. Individuals with both conditions had the greatest impairment, highlighting the potential importance of incorporating mental health assessment into asthma care.Keywords: asthma, depression, anxiety, health-related quality of life, HRQoL, veterans RAND 12-item health survey, mental health
Jingjian Zhang,* Xiang Miao,* Qin Jia, Hai Zhou Department of Respiratory and Critical Care Medicine, Shidong Hospital of Yangpu District, Shanghai, 200438, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hai Zhou, Department of Respiratory and Critical Care Medicine, Shidong Hospital of Yangpu District, No. 999 Shiguang Road, Yangpu District, Shanghai, People’s Republic of China, Email bluefish8341@126.com Qin Jia, Department of Respiratory and Critical Care Medicine, Shidong Hospital of Yangpu District, No. 999 Shiguang Road, Yangpu District, Shanghai, 200438, People’s Republic of China, Email jiaqin1969@163.comAim: To examine the associations between pre-admission adherence to inhaled maintenance therapy and in-hospital antibiotic treatment duration and clinical outcomes among patients with chronic obstructive pulmonary disease (COPD) hospitalized for pneumonia.Methods: This single-center retrospective cohort (July 2022-July 2025) included 250 patients with COPD and pneumonia. Adherence during the preceding 12 months was assessed using the proportion of days covered (PDC). Patients were classified into high-adherence (PDC ≥ 80%, n = 96) and low-adherence (PDC < 80%, n = 154) groups. The primary outcome was antibiotic treatment duration. Multivariable regression and propensity score matching (PSM) were used to evaluate the associations.Results: Higher adherence was associated with shorter antibiotic treatment duration in the multivariable analysis (β = − 1.589 days, 95% CI: − 2.390 to − 0.789; P < 0.001). This association remained statistically significant after PSM (76 matched pairs; β = − 1.421 days, 95% CI: − 2.372 to − 0.470; P = 0.003). Associations with shorter time to clinical stability, shorter hospitalization, and lower hospital costs were also observed in the adjusted and matched analyses. However, associations with antibiotic escalation, treatment failure, and readmission were not statistically significant after matching.Conclusion: Higher pre-admission adherence to inhaled maintenance therapy was consistently associated with shorter antibiotic treatment duration among patients with COPD hospitalized for pneumonia. Associations with selected continuous clinical outcomes were also observed, whereas evidence for secondary binary outcomes was less conclusive. These observational findings do not establish causality.Keywords: chronic obstructive pulmonary disease, pneumonia, inhaled maintenance therapy, medication adherence, proportion of days covered
Yunzi Zhang,1 Hui Zhuo,2 Peiying Liu,3 Haiying Huang,4 Wenli Liang1 1School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Spine Surgery, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 3Department of Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 4Pediatric Hematology and Oncology Department, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of ChinaCorrespondence: Wenli Liang, Email liangwenli@gdpu.edu.cnPurpose: To identify distinct post-traumatic growth (PTG) profiles among mothers of children with acute leukemia (AL) during the induction remission phase and examine factors associated with profile membership.Patients and Methods: In this cross-sectional study, 223 mothers of children newly diagnosed with AL were recruited using convenience sampling at a tertiary specialized hospital in Guangzhou, China, between November 2021 and February 2023. Data were collected using a demographic information form, the Simplified Chinese Post-Traumatic Growth Inventory, Chinese Event Related Rumination Inventory, Social Support Rating Scale, and Simplified Coping Style Questionnaire. Because PTG may vary across its five dimensions, latent class analysis was used to identify distinct subgroups of mothers with different patterns of PTG. Univariate analysis and multinomial logistic regression examined factors associated with class membership.Results: Three profiles were identified: high-growth (n = 42, 18.8%), medium-growth (n = 155, 69.5%), and low-growth (n = 26, 11.7%). With the high-growth group as the reference, higher positive coping scores were associated with lower odds of medium-growth membership (OR = 0.890, 95% CI: 0.827– 0.958; P = 0.002). Higher deliberate rumination (OR = 0.906, 95% CI: 0.825– 0.994; P = 0.037), social support (OR = 0.881, 95% CI: 0.798– 0.972; P = 0.012), and positive coping (OR = 0.825, 95% CI: 0.742– 0.916; P < 0.001) were associated with lower odds of low-growth membership. Household income was not significantly associated with class membership after adjustment.Conclusion: Three distinct PTG profiles were identified among mothers of children with AL during the induction remission phase. Positive coping, deliberate rumination, and social support were differentially associated with PTG profile membership. These findings may inform individualized nursing interventions, with comprehensive support considered for the low-growth group and strategies to strengthen positive coping for the medium-growth group.Keywords: post-traumatic growth, parents, pediatric leukemia, social support, rumination, coping
Carme Santoyo-Medina,1,2 Montserrat Janer,1 Cristina Lidón-Moyano,2 Edwin Roger Meza-Murillo,1 Ingrid Galán,1 Xavier Montalban,1 Caritat Bagur-Calafat,2 Jaume Sastre-Garriga,1 Marta Amor-Barbosa2 1Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia, Vall D’Hebron University Hospital, Barcelona, Spain; 2Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional De Catalunya, Sant Cugat del Vallès, SpainCorrespondence: Carme Santoyo-Medina, Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain, Email carme_santoyo@uic.es; Caritat Bagur-Calafat, Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain, Email cbagur@uic.esBackground: Regular physical activity (PA) is recommended for people with multiple sclerosis (PwMS), yet long-term exercise adherence remains suboptimal. Exercise self-efficacy is a key patient-reported determinant of exercise initiation and maintenance, making its assessment relevant for both clinical practice and research. Although the Exercise Self-Efficacy Scale (EXSE; McAuley et al 1993) and the Exercise Self-Efficacy (ESE; Neupert et al 2009) have been previously used, validated Spanish versions are not available. This study aimed to translate, culturally adapt, and evaluate the measurement properties of the Spanish versions of the EXSE-McAuley (EXSE-Sp) and ESE-Neupert (ESE-Sp) in Spanish PwMS.Methods: The EXSE-McAuley and ESE-Neupert were translated and cross-culturally adapted into Spanish according to Beaton’s guidelines. Ninety-three Spanish PwMS completed both questionnaires twice, with a 7– 10-day interval between assessments at the end of their rehabilitation program. Structural validity, internal consistency, test–retest reliability, measurement error, and construct validity were evaluated following the COSMIN framework.Results: Both instruments demonstrated a unidimensional structure with adequate structural validity. Internal consistency was excellent for the EXSE-Sp (Cronbach’s α = 0.977) and good for the ESE-Sp (α = 0.896). Test–retest reliability was excellent (ICC = 0.992 and 0.969, respectively), with low measurement error (SEM = 2.83 and 1.20 points; Smallest Detectable Change [SDC] = 7.86 and 3.33 points, respectively). Construct validity was supported by the expected moderate positive correlation between the two scales (r = 0.56, p < 0.001), indicating that they assess related yet complementary aspects of exercise self-efficacy.Conclusion: The EXSE-Sp and ESE-Sp demonstrate good measurement properties and are suitable for assessing exercise self-efficacy in Spanish PwMS. These patient-reported measures may support clinical assessment, patient-centred rehabilitation planning, and evaluation of interventions targeting long-term PA participation.Graphical Abstract: Infographic titled, Patient Preference and Adherence and, Measurement properties of Spanish versions of two exercise self-efficacy scales in people with multiple sclerosis. Background. Regular physical activity improves health and quality of life in people with multiple sclerosis (PwMS), but long-term exercise adherence is often low. Exercise self-efficacy, the confidence to be active despite challenges, is a key factor influencing exercise initiation and maintenance. Two questionnaires have been used to measure exercise self-efficacy, but Spanish versions were not available. Aim. To translate, culturally adapt and evaluate the measurement properties of: EXSE, Exercise Self-Efficacy Scale by McAuley. ESE, Exercise Self-Efficacy by Neupert. in Spanish-speaking people with multiple sclerosis. Methods. Participants: 93 PwMS completed both questionnaires twice (test-retest) after a rehabilitation period. Translation and cross-cultural adaptation: Following Beaton’s guidelines. Test-Retest Interval: 7 to 10 days. Participants maintained their usual exercise routine. Measurement Properties Evaluated: Internal consistency. Test-retest reliability. Measurement error. Construct validity (structural, convergent and known-groups). Results. Internal consistency. Excellent consistency for EXSE-Sp and good consistency for ESE-Sp. EXSE-Sp Cronbach’s alpha 0.977. ESE-Sp Cronbach’s alpha 0.896. Minor floor effect and moderate ceiling effect for EXSE-Sp. No relevant floor or ceiling effects for ESE-Sp. Test-retest reliability. Excellent reliability for both scales. EXSE-Sp ICC (95 percent CI) 0.992 (0.987 to 0.995). ESE-Sp ICC (95 percent CI) 0.969 (0.954 to 0.980). Bland-Altman plots showed good agreement with no systematic bias. Measurement error. Low measurement error for both scales. SEM: EXSE-Sp 2.83; ESE-Sp 1.20. SDC: EXSE-Sp 7.86; ESE-Sp 3.33. Changes above the SDC are likely to represent true change beyond error. Structural validity. Both scales showed a unidimensional structure. EXSE-Sp 86.7 percent. ESE-Sp 55.5 percent. Good sampling adequacy (KMO 0.890 and 0.885; p less than 0.001). Construct validity. Convergent validity: Moderate correlation between scales (Spearman’s rho 0.56, p less than 0.001). Known-groups validity: No significant differences in scores across disability levels (EDSS groups). EXSE-Sp: p equals 0.253. ESE-Sp: p equals 0.637. Conclusion. The Spanish versions of the EXSE and ESE demonstrate strong measurement properties and are reliable tools to assess exercise self-efficacy in Spanish-speaking people with multiple sclerosis. These instruments can help identify individuals who may need additional support to stay active. They support personalized rehabilitation and the evaluation of exercise-based interventions. Their use may contribute to improving long-term physical activity participation and exercise adherence among people with multiple sclerosis. Clinical and research implications. Easy-to-use, patient-reported tools in routine clinical practice. Provide complementary information about confidence to exercise. Support tailored strategies to promote exercise adherence. Facilitate research and monitoring of intervention outcomes.An infographic summarizing methods and results for Spanish EXSE and ESE exercise self-efficacy scales in MS.Keywords: multiple sclerosis, exercise self-efficacy, exercise adherence, physical activity, patient-reported outcome measures, measurement properties
Alireza Savaroliaei,1 Alun C Jackson,2 Fatemeh Bahramnezhad31Ms. Student’s Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; 2The University of Hong Kong, Hong Kong, People’s Republic of China; 3Department of ICU Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, IranCorrespondence: Fatemeh Bahramnezhad, Email Bahramnezhad.f@gmail.comBackground: Persistent atrial fibrillation is associated with impaired quality of life and adverse health outcomes. Psychosocial factors, particularly social support and illness perception, may influence patients’ adaptation to the disease. However, the mediating role of illness perception in the relationship between social support and quality of life has not been adequately investigated.Objective: To examine the association between perceived social support and quality of life and whether this association operates indirectly through illness perception in patients with persistent atrial fibrillation.Methods: In this cross-sectional study, 150 patients with persistent atrial fibrillation were recruited from hospitals affiliated with Tehran University of Medical Sciences in 2025. Data were collected using the Multidimensional Scale of Perceived Social Support, Brief Illness Perception Questionnaire, and Atrial Fibrillation Effect on Quality of Life questionnaire. Mediation analysis was performed using PROCESS Macro Model 4.Results: Social support was positively associated with illness perception and quality of life (P< 0.001), with higher illness perception scores indicating a more threatening perception of illness. Illness perception was also positively associated with quality of life (P< 0.001) and partially accounted for the association between social support and quality of life (indirect effect = 0.091, 95% CI: 0.036– 0.144). The model explained 57.5% of the variance in quality of life.Conclusions: Social support and illness perception were significantly associated with quality of life in patients with persistent atrial fibrillation. These findings highlight the importance of considering patients’ perceived illness and social support when providing patient-centered care to support quality of life.Plain Language Summary: What’s New? Patients with persistent atrial fibrillation experience impaired quality of life accompanied by low perceived social support and high illness perception scores. Illness perception partially mediates the association between perceived social support and quality of life. Assessment of psychosocial factors should be incorporated into the care of patients with persistent atrial fibrillation to support better quality of life and improve patient outcomes. Keywords: atrial fibrillation, persistent atrial fibrillation, social support, illness perception, quality of life
