Evaluating a Web-Based Coaching Program Using Electronic Health Records for Patients With Chronic Obstructive Pulmonary Disease in China: Randomized Controlled Trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the world, and it continues to increase in developing countries. The World Health Organization expects COPD to be the third most common cause of death in the world by 2020. Effective and continuous postdischarge care can help patients to maintain good health. The use of electronic health records (EHRs) as an element of community health care is new technology in China. OBJECTIVE: The aim of this study was to develop and evaluate a Web-based coaching program using EHRs for physical function and health-related quality of life for patients with COPD in China. METHODS: A randomized controlled trial was conducted from 2008 to 2015 at two hospitals. The control group received routine care and the intervention group received routine care with the addition of the Web-based coaching program using EHRs. These were used to manage patients' demographic and clinical variables, publish relevant information, and have communication between patients and health care providers. Participants were not blinded to group assignment. The effects of the intervention were evaluated by lung function, including percent of forced expiratory volume in 1 second (FEV1%), percent of forced vital capacity (FVC%), peak expiratory flow (PEF), maximum midexpiratory flow; St George's Respiratory Questionnaire (SGRQ); Modified Medical Research Council Dyspnea Scale (MMRC); and 6-Minute Walk Test (6MWT). Data were collected before the program, and at 1, 3, 6, and 12 months after the program. RESULTS: Of the 130 participants, 120 (92.3%) completed the 12-month follow-up program. There were statistically significant differences in lung function (FEV1%: F1,4=5.47, P=.002; FVC%: F1,4=3.06, P=.02; PEF: F1,4=12.49, P<.001), the total score of SGRQ (F1,4=23.30, P<.001), symptoms of SGRQ (F1,4=12.38, P<.001), the activity of SGRQ (F1,4=8.35, P<.001), the impact of SGRQ (F1,4=12.26, P<.001), MMRC (F1,4=47.94, P<.001), and 6MWT (F1,4=35.54, P<.001) between the two groups with the variation of time tendency. CONCLUSIONS: The Web-based coaching program using EHRs in China appears to be useful for patients with COPD when they are discharged from hospital into the community. It promotes the sharing of patients' medical information by hospital and community nurses, and achieves dynamic management and follow-up analysis for patients' disease. In addition, this program can postpone the decreasing rate of lung function, improve quality of life, decrease dyspnea, and increase physical capacity.

Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China.

BACKGROUND: Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients' quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR), which has been developed and validated in its English version, is needed for patients with COPD in China. METHODS: A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women), who met the inclusion and exclusion criteria, were enrolled in the study. Test-retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach's α. Content validity was examined using the Content Validity Index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). Besides, convergent validity and construct validity were also examined. RESULTS: The AIR-C (AIR-Chinese version) scale had high test-retest reliability (intraclass correlation coefficient =0.904) and internal consistency (Cronbach's α=0.914); the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89-1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, P<0.01), and there were significant correlations between the AIR-C and Clinical COPD Questionnaire (CCQ; r=0.44, P<0.01) and Activities of Daily Living Scale (ADLS; r=0.36, P<0.01). A two-factor model of general anxiety and panic symptoms in the AIR-C scale had the best fit according to Confirmatory Factor Analysis (CFA). CONCLUSION: The AIR-C scale had a good reliability and validity for patients with COPD and can be used as a user-friendly and valid tool for measuring anxiety symptoms among patients with COPD in China.

Psychometric properties of the Physical Activity Scale for the Elderly in Chinese patients with COPD.

BACKGROUND: For patients with COPD, physical activity (PA) is recommended as the core component of pulmonary rehabilitation, but there is lack of a validated questionnaire for assessing the PA effectively. AIM: To evaluate the reliability and validity of the Chinese version of Physical Activity Scale for the Elderly (PASE-C) in patients with COPD. METHODS: A cross-sectional study was conducted with 167 outpatients aged 60 years or older with COPD. Test-retest reliability and internal consistency were calculated by intraclass correlation coefficient (ICC) and Cronbach's coefficient α, respectively. Validity was evaluated by correlation with the International Physical Activity Questionnaire-Short (IPAQ-S), data of pedometer, Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), grip strength, and disease characteristics. RESULTS: The PASE-C had an excellent seven-day test-retest reliability (ICC=0.98) and an acceptable internal consistency (Cronbach's α=0.71). The content validity was supported by an item-content validity index, a scale-content validity index/universal agreement, and a scale-content validity index/average value of 0.70-1, 0.70, and 0.93, respectively. Concurrent validity was tested by correlation with IPAQ-S (r=0.651). Criterion validity was confirmed by correlation with the walking steps (r=0.611) and energy expenditure (r=0.493). For construct validity, PASE-C had correlations with SES6 (r=0.396), HADS for depression (r=-0.234), seven subscales of SF-36 (r=0.182-0.525), grip strength (r=0.341), and disease characteristics including the duration of COPD (r=-0.215), modified British Medical Research Council scale (r=-0.354), forced expiratory volume in one second as percentage of predicted (r=0.307), and Global Initiative for Chronic Obstructive Lung Disease grade (r=-0.264), with a good construct validity (all P<0.05). CONCLUSION: The PASE-C has acceptable reliability and validity for patients aged 60 years or older with COPD, and it can be used as a valid tool to measure the PA of patients with COPD in the People's Republic of China.

Demographic, health behavioral, and self-management abilities associated with disease severity among patients with chronic obstructive pulmonary disease: An exploratory study.

This study aimed to identify the association between demographic characteristics, health behaviors, self-management abilities, and disease severity among patients with chronic obstructive pulmonary disease (COPD). The study was conducted from January to December 2015 in 4 hospitals in China. The DOSE index was assessed by grade of dyspnea (D), airflow obstruction (O), current smoking status (S), and frequency of exacerbation in the last year (E). Self-management abilities were assessed by the COPD self-management scale. DOSE index associations with demographic characteristics, health behaviors, and self-management abilities were examined with multiple regression analysis. In total, 100 participants were recruited into the study. In univariate analysis, higher symptom management, lower daily life management, and lower self-efficacy in self-management abilities were significantly related to higher DOSE index. In multiple regression analysis, physical activity, body mass index, and gender were negatively related to DOSE index. The study highlighted the importance of physical activity, nutritional status, and gender difference in managing disease severity in COPD. Professional nurses should develop individualized intervention programs and specifically increase physical activity for men and poor nutritional status for patients with COPD.

Environmentally relevant concentrations of benzo[a]pyrene affect steroid levels and affect gonad of male scallop Chlamys farreri.

Sexually mature male Chlamys farreri were exposed to benzo[a]pyrene for 10 days at four concentrations at 0, 0.025, 0.5 and 10 µg/L. Fluctuations in sex steroids during the exposure period were observed, which indicated that sex steroids have a role in gamete development. Exposure to B[a]P altered levels of 17ß-estradiol, testosterone, and progesterone. Furthermore, B[a]P treatments induced oxidative stress in a dose-dependent manner on spermary of scallop and led to delayed development and damaged spermatid in germinal epithelium of spermary. Overall, B[a]P affected the steroid levels and induced gonadal toxicity at environmentally relevant concentrations.

Antioxidant responses in clam Venerupis philippinarum exposed to environmental pollutant hexabromocyclododecane.

The objective of this study was to assess the potential toxic effects of hexabromocyclododecane (HBCD) on tissues of clam Venerupis philippinarum using parameters of antioxidant defenses and oxidative stress. Antioxidant biomarkers including ethoxyresorufin-O-deethylase (EROD), glutathione S-transferase (GST), superoxide dismutase (SOD), and glutathione (GSH), as well as DNA damage and lipid peroxidation (LPO) in gills and digestive glands of V. philippinarum, were analyzed after a 1-, 3-, 6-, 10-, and 15-day exposure to seawater containing HBCD at environmentally related concentrations, respectively. The results showed that the activity of most antioxidant enzymes increased, and different trends were detected with exposure time extending. The oxidative stress could be obviously caused in the gills and digestive glands under the experimental conditions. This could provide useful information for toxic risk assessment of environmental pollutant HBCD.

Toxicity assessment of environmental pollutant phenanthrene in clam Venerupis philippinarum using oxidative stress biomarkers.

The objective of this study was to assess potential toxic effects of phenanthrene (PHE) on tissues of clam Venerupis philippinarum using parameters of antioxidant defenses and oxidative stress. Antioxidant biomarkers including ethoxyresorufin-O-deethylase (EROD), glutathione S-transferase (GST), superoxide dismutase (SOD), and glutathione (GSH), as well as DNA damage and lipid peroxidation (LPO) in gills and digestive glands of V. philippinarum, were analyzed after a 1-, 3-, 6-, 10- and 15-day exposure to seawater containing PHE at concentrations of 2, 10, 50 µg/L. The results showed that the activity of most antioxidant enzymes was induced throughout the exposure period, and different trends were detected with time of exposure. The oxidative stress could be obviously caused in the gills and digestive glands under the experimental conditions. Overall, our results show that digestive glands are more sensitive to marine environmental stressors than gills, and GSH is proposed as potential useful biomarker as it showed good correlation with the target contaminant. This could provide useful information for toxic risk assessment of environmental pollutant PHE.

Effects of benzo(a)pyrene on differentially expressed genes and haemocyte parameters of the clam Venerupis philippinarum.

In this study a suppression subtractive hybridisation method was employed to identify differentially expressed genes of the clam Venerupis philippinarum exposed to benzo(a)pyrene (BaP). Nineteen known transcripts and seven predicted proteins were found from the subtractive cDNA library of the clam, which could provide more sequence information for further study. Seven of the differentially expressed genes were selected for mRNA expression analysis. Real-time PCR analysis revealed that the expression level of the selected cDNAs of clams was up-regulated to varying degrees by different concentration of BaP. They are suggested as potential molecular biomarkers for polycyclic aromatic hydrocarbons (PAHs) pollution monitoring in aquatic ecosystems. In addition, haemocyte parameters were also measured, and a decrease of total haemocyte counts and suppression of antibacterial and bacteriolytic activities were detected in BaP-stressed clams. We suggest that the modulation of the expression of the selected genes caused by PAHs probably leads to the disturbance of the immune defense of the clam. Meanwhile, the adverse effects of PAHs on haemocyte parameters caused the suppression of the immune defense and susceptibility to infectious diseases. Therefore, it is inferred that PAHs pollutants could interact with components of the immune system and interferes with defense functions of the clam V. philippinarum.

Assessment of the toxicity of organochlorine pesticide endosulfan in clams Ruditapes philippinarum.

This study is aimed at evaluating the effects of endosulfan in clams (Ruditapes philippinarum). For this purpose, a study was performed on clams exposed to 0.005, 0.05 and 0.5µg/L endosulfan for 15 days. S ubsequently, the level of ethoxyresorufin-O-deethylase (EROD) activity, glutathione-S-transferase (GST) activity, glutathione (GSH) content, superoxide dismutase (SOD) activity, lipid peroxidation (LPO) and DNA strand break was determined in gills and digestive glands. Among the parameters, endosulfan caused significant changes in induction of EROD activity and oxidative stress in clams R. philippinarum. The exposure to endosulfan increased the concentration of EROD, GST, GSH, MDA and decreased the concentration of SOD. Moreover, according to the correlation analysis results, the EROD activity and GSH content in digestive gland as well as GST activity, LPO and DNA damage in both tissues had excellent correlation with endosulfan concentration. These results provided information on potential biomarkers that could be effectively applied to the biomonitoring of aquatic ecosystem in areas susceptible to persistent organochlorine compounds contamination, and also information on toxic effects.

Identification of genes differentially expressed in clams Ruditapes philippinarum in response to endosulfan after different exposure time.

This study reports molecular biomarkers potentially associated with resistance or sensitivity to the impact of endosulfan in clams, Ruditapes philippinarum. Genomic analysis was made applying suppression subtractive hybridization (SSH) to identify genes up- and down-regulated in calms exposed to 0.5 µg/L endosulfan for 1d and 10d. Results obtained from the SSH library revealed 360 different sequences regulated by endosulfan, which correspond to nine major physiological functions. To validate the expression profiles from SSH, 13 genes regulated by endosulfan were measured by quantitative real-time PCR. This study provides information for the characterization of potential molecular biomarker that may be used in future environmental monitoring and to investigate the mechanisms of stress to endosulfan in clams/marine invertebrates.