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Study on the status and countermeasures of disease self-management ability in chronic kidney disease patients in cold regions
Xinrui Wei, Chunlian Li, Hongmei Yu, Lingling Xu, Siwen Meng, Chun Xing, Qiang Gao, Guangming Chang, Yongchen Wang
2025, 5(1): 10-21. doi: 10.1515/fzm-2025-0002
Keywords: chronic kidney disease, self-management capacity, cross-sectional observational research, frigid regions
  Objective  Effective Chronic Kidney Disease (CKD) management is particularly important in cold regions of China, where climate and lifestyle factors play significant roles. However, there is a lack of relevant studies in this area. Therefore, the purpose of this study was: (1) to assess the status of self-management capacity in individuals with CKD in cold regions of China and analyze the factors influencing it; (2) to identify strategies to improve CKD management in primary care settings in these regions; and (3) to understand patients' attitudes toward eHealth services.  Methods  This was a regional, cross-sectional observational study. A questionnaire measuring CKD patients' self-management abilities was derived from the Perceived Kidney Disease Self-Management Scale, the Kidney Disease Behavioral Inventory (KDBI), and the Health Literacy Questionnaire. Data were collected from hospitalized CKD patients in Heilongjiang Province and analyzed using One-Way Analysis of Variance (ANOVA), Hierarchical Regression Analysis, and K-prototype cluster analysis.  Results  A total of 957 participants were tested. Of these, 70.64% had less than a bachelor's degree, and 56.27% had been diagnosed with hypertensive or diabetic nephropathy. The KDBI scale showed a lower overall score compared to the PKDSMS. Factors such as CKD stage 4 (F = 2.367, P = 0.042), last year's medical expenses (F = 3.974, P = 0.004), and poor self-rated health (F = 33.352, P < 0.01) were found to influence scores on both scales. The health literacy questionnaire revealed significant differences (P < 0.01) in health knowledge, except by sex. Additionally, healthcare expenditures and poor self-rated health were negatively associated with self-management capacity.  Conclusions  This study provides valuable insights into the self-management challenges faced by CKD patients in cold regions of China. Despite some difficulties in improving self-management, patients showed positive attitudes toward enhancing CKD management services in primary care and developing digital management tools. These findings offer useful references and recommendations for future clinical practice and research in this field.
Low ambient temperature and air pollution are associated with hospitalization incidence of coronary artery disease: Insights from a cross-sectional study in Northeast China
Rui Jiang, Lingling Xu, Yue Liu, Guangna Zhao, Chun Xing, Youyuan Li, Yongchen Wang
2023, 3(4): 232-241. doi: 10.2478/fzm-2023-0030
Keywords: meteorological changes, ambient temperature, air pollution, coronary heart disease, Poisson regression analysis
  Background   Previous studies have established a link between fluctuations in climate and increased mortality due to coronary artery disease (CAD). However, there remains a need to explore and clarify the evidence for associations between meteorological changes and hospitalization incidences related to CAD and its subtypes, especially in cold regions. This study aimed to systematically investigate the relationship between exposure to meteorological changes, air pollutants, and hospitalization for CAD in cold regions.   Methods   We conducted a cross-sectional study using hospitalization records of 86, 483 CAD patients between January 1, 2009, and December 31, 2019. Poisson regression analysis, based on generalized additive models, was applied to estimating the influence of hospitalization for CAD.   Results   Significant associations were found between low ambient temperature [-10℃, RR= 1.65; 95% CI: (1.28–2.13)] and the incidence of hospitalization for CAD within a lag of 0–14 days. Furthermore, O3 [95.50 μg/m3, RR = 12; 95% CI: (1.03–1.21)] and NO2 [48.70 μg/m3, RR = 1.0895% CI: (1.01–1.15)] levels were identified as primary air pollutants affecting the incidence of CAD, ST-segment-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) within the same lag period. Furthermore, O3 [95.50 μg/m3, RR = 1.12; 95% CI: (1.03–1.21)] and NO2 [48.70 μg/m3, RR = 1.0895% CI: (1.01–1.15)] levels were identified as primary air pollutants affecting the incidence of CAD, ST-segment-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) within the same lag period. The effect curve of CAD hospitalization incidence significantly increased at lag days 2 and 4 when NO2 and O3 concentrations were higher, with a pronounced effect at 7 days, dissipating by lag 14 days. No significant associations were observed between exposure to PM, SO2, air pressure, humidity, or wind speed and hospitalization incidences due to CAD and its subtypes.   Conclusion   Our findings suggest a positive correlation between short-term exposure to low ambient temperatures or air pollutants (O3 and NO2) and hospitalizations for CAD, STEMI, and NSTEMI. These results could aid the development of effective preparedness strategies for frequent extreme weather events and support clinical and public health practices aimed at reducing the disease burden associated with current and future abnormal weather events.