The purpose of this study was to review potential, physiological, hormonal and neuronal mechanisms that may mediate the sleep changes. This paper investigates the literatures regarding the activity of the hypothalamic-pituitary-adrenal (HPA) axis, one of the main neuroendocrine stress systems during sleep in order to identify relations between stress and sleep disorder and the treatment of stress-induced insomnia. Sleep and wakefulness are regulated by the aminergic, cholinergic brainstem and hypothalamic systems. Activation of the HPA and/or the sympathetic nervous systems results in wakefulness and these hormones including corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol or corticosterone, noradrenaline, and adrenaline, are associated with attention and arousal. Stress-related insomnia leads to a vicious circle by activating the HPA system. An awareness of the close interaction between sleep and stress systems is emerging and the hypothalamus is now recognized as a key center for sleep regulation, with hypothalamic neurontransmitter systems providing the framework for therapeutic advances. An updated understanding of these systems may allow researchers to elucidate neural mechanisms of sleep disorder and to develop effective intervention for sleep disorder.

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While acknowledging the limitations of this research due to the differences in BP and the participants' ages, meditation and yoga are demonstrated to be effective alternatives to pharmacotherapy. Given that BP decreased with the use of meditation and yoga, and this effect varied in different age groups, scientifically measured outcomes indicate that these practices are safe alternatives in some cases.

Aims and objectives:To examine the level of self-care behaviours among patients with diabetic foot ulcers and identify factors related to their self-care behaviours.Background: This study focused on the self-care behaviours of patients diagnosed with diabetic foot ulcers, a complication of diabetes. Design:A cross-sectional study design was adopted.Methods: From July-August 2018, 131 outpatients and inpatients with diabetic foot ulcers were given a survey questionnaire regarding self-care behaviours and expected related factors at two Korean hospitals. In this study, self-care behaviours were diabetes management and diabetic foot care. Demographic, disease-related and laboratory characteristics were collected. The data were analysed in terms of descriptive statistics, a t test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. STROBE checklist was used as the guideline for this study. Results:Moderate levels of self-care behaviours were found. The stepwise multiple regression analysis revealed that diabetes management was significantly related to perceived family support, experience of diabetic education, perceived stress, a problem-focused coping style, experience of hospitalisation and comorbidity. Furthermore, diabetic foot care was significantly associated with the experience of diabetic education, perceived family support, and serum level of erythrocyte sedimentation rate and haemoglobin A1C. Conclusions:Perceived family support was the main factor affecting diabetes management, and diabetic foot care was greatly affected by the experience of diabetic education. It is necessary to develop diabetes education programmes and nursing interventions to increase family support to improve the self-care behaviours of patients with diabetic foot ulcers.Relevance to clinical practice: Self-care behaviours among patients with diabetic foot ulcers are important, as they affect healing of the wound and the quality of life.Further development of family-based diabetes education or programmes is recommended to promote the self-care behaviours of patients with diabetic foot ulcers. K E Y W O R D S diabetes management, diabetic foot care, diabetic foot ulcers, self-care behaviour | 1713 KIM and Han S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Kim EJ, Han K-S. Factors related to self-care behaviours among patients with diabetic foot ulcers. J

Multiple social, psychological, and health-related factors were associated with quality of life.