Determinants of longitudinal health-related quality-of-life change in children with asthma from low-income families: a report from the PROMIS® Pediatric Asthma Study.

BACKGROUND: How the longitudinal asthma control status and other socio-demographic factors influence the changes of health-related quality of life (HRQOL) among asthmatic children, especially from low-income families, has not been fully investigated. OBJECTIVES: This study aimed to describe the trajectories of asthma-specific HRQOL over 15 months and examine the effect of asthma control status on HRQOL by taking socio-demographic factors into consideration. METHODS: A total of 229 dyads of asthmatic children and their parents enroled in public insurance programs were recruited for assessing asthma control status and HRQOL over four time points of assessment. Asthma control status was measured using the Asthma Control and Communication Instrument, and asthma-specific HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System's Pediatric Asthma Impact Scale. Latent growth models (LGMs) were applied to examine the trajectory of HRQOL and the factors contributing to the changes of HRQOL. RESULTS: Unconditional LGM revealed that HRQOL was improved over time. Conditional LGM suggested that accounting for asthma control and participants' socio-demographic factors, the variation in the initial level of HRQOL was significant, yet the rate of change was not. Conditional LGM also revealed that poorly controlled asthma status was associated with poor HRQOL at each time point (P's < 0.05). Lower parental education was associated with lower baseline HRQOL (P < 0.05). Hispanic children had a larger increase in HRQOL over time (P < 0.01) than non-Hispanic White children. CONCLUSIONS: Vulnerable socio-demographic characteristics and poorly controlled asthma status affect HRQOL in children. This finding encourages interventions to improve asthma control status and HRQOL in minority children.

Membrane fluidity determines sensitivity of filamentous fungi to chitosan.

The antifungal mode of action of chitosan has been studied for the last 30 years, but is still little understood. We have found that the plasma membrane forms a barrier to chitosan in chitosan-resistant but not chitosan-sensitive fungi. The plasma membranes of chitosan-sensitive fungi were shown to have more polyunsaturated fatty acids than chitosan-resistant fungi, suggesting that their permeabilization by chitosan may be dependent on membrane fluidity. A fatty acid desaturase mutant of Neurospora crassa with reduced plasma membrane fluidity exhibited increased resistance to chitosan. Steady-state fluorescence anisotropy measurements on artificial membranes showed that chitosan binds to negatively charged phospholipids that alter plasma membrane fluidity and induces membrane permeabilization, which was greatest in membranes containing more polyunsaturated lipids. Phylogenetic analysis of fungi with known sensitivity to chitosan suggests that chitosan resistance may have evolved in nematophagous and entomopathogenic fungi, which naturally encounter chitosan during infection of arthropods and nematodes. Our findings provide a method to predict the sensitivity of a fungus to chitosan based on its plasma membrane composition, and suggests a new strategy for antifungal therapy, which involves treatments that increase plasma membrane fluidity to make fungi more sensitive to fungicides such as chitosan.

Study on the mitochondrial activity and membrane potential after exposing later stage oocytes of two gorgonian corals (Junceella juncea and Junceella fragilis) to cryoprotectants.

Coral reefs provide a valuable habitat for many economically valuable fish and invertebrates. However, they are in serious jeopardy, threatened by increasing over-exploitation, pollution, habitat destruction, disease and global climate change. Here, we examined the effect of cryoprotectant exposure on mitochondrial activity and membrane potential in coral oocytes in order to find suitable cryoprotectants towards their successful cryopreservation. According to the No Observed Effect Concentrations (NOECs), methanol was found to be the least toxic cryoprotectant whilst DMSO was the most toxic cryoprotectant. The results also demonstrated that there were no significant differences (p > 0.05) in ATP concentrations between Junceella juncea and Junceella fragilis after exposure to all concentrations of all cryoprotectants for 30 min. Using confocal microscopy, JC-1 (5,50,6,60-tetrachloro-1,10,3,30-tetraethyl-imidacarbocyanine iodide) staining indicated that the mitochondrial membrane potential of Junceella fragilis oocytes reduced after 1 M and 2 M methanol treatment and a loss of the mitochondrial distribution pattern and poor green fluorescence after 3M methanol treatment. Therefore, even oocytes that show no adverse effect of cryoprotectants on survival might suffer some more subtle impacts. The results obtained from this study will provide a basis for development of protocols to cryopreserve the oocytes of gorgonian corals.

Chitosan permeabilizes the plasma membrane and kills cells of Neurospora crassa in an energy dependent manner.

Chitosan has been reported to inhibit spore germination and mycelial growth in plant pathogens, but its mode of antifungal action is poorly understood. Following chitosan treatment, we characterized plasma membrane permeabilization, and cell death and lysis in the experimental model, Neurospora crassa. Rhodamine-labeled chitosan was used to show that chitosan is internalized by fungal cells. Cell viability stains and the calcium reporter, aequorin, were used to monitor plasma membrane permeabilization and cell death. Chitosan permeabilization of the fungal plasma membrane and its uptake into fungal cells was found to be energy dependent but not to involve endocytosis. Different cell types (conidia, germ tubes and vegetative hyphae) exhibited differential sensitivity to chitosan with ungerminated conidia being the most sensitive.

An evaluation of two decision-making scales for children with life-limiting illnesses.

PURPOSE: Annually, about 500,000 children are coping with life-limiting illnesses. Many of these children could benefit from pediatric palliative care which provides supportive services. These services can also aid parents in decision making. In order to measure the effect of pediatric palliative care programs on decision making, a valid and reliable tool must be identified. This study aims to validate the psychometric properties of the Decisional Conflict Scale (DCS) and the COMRADE instruments for children with life-limiting illnesses. METHODS: Analyses were conducted using survey data collected from 266 parents whose Medicaid enrolled children have life-limiting illnesses. RESULTS: Results of the analyses suggest that the DCS has better psychometric properties for measuring decision making within the population of children with life-limiting illnesses than the COMRADE. CONCLUSION: Pediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict.

Assistive devices and cerebral palsy: the use of assistive devices at school by children with cerebral palsy.

BACKGROUND: Although the importance of providing disabled children with assistive devices has always been highlighted, most studies in the field of assistive device research seek the participation of adult users or adult carers. Accordingly, the opinions of young users themselves seem to be overlooked. To start to address the gap, this study aimed to understand the children's perspectives regarding device use in school and to explore the factors related to their device utilization in this setting. METHODS: Semi-structured interviews were adopted as the main data collection instrument. A total of 44 participants were involved, including 15 Taiwanese children with cerebral palsy, aged between 8 and 15 years, 15 mothers and 14 teachers. RESULTS: The interview results show a high frequency of device use in school which can be attributed to children's willingness, teachers' attitudes, mothers' support, physical environmental factors and device-related features. CONCLUSIONS: The findings not only demonstrate the significance of child-environment interaction but also provide evidence that children's views may be different from those of adults because they are at a different developmental stage and act out different roles in their environment.

Assistive devices and cerebral palsy: factors influencing the use of assistive devices at home by children with cerebral palsy.

BACKGROUND: There is a growing awareness of the significance of gaining insights into device users' needs in their everyday usage in order to maximize the potential of assistive device intervention. However, current studies in this field are likely to focus more upon adult users' or adult carers' perspectives and, accordingly, the opinions of young users seem to be overlooked. In order to take the gap into consideration, this study aimed to explore the usability of assistive devices at home by children with cerebral palsy and consider the underlying factors related to the device usage in this setting mainly from the children's perspectives. METHODS: Semi-structured interviews were adopted as the main data collection instrument. A total of 30 participants were involved in the study, including 15 Taiwanese children with cerebral palsy and 15 mothers. RESULTS: The results showed a low frequency of device use at home by the participating children. Four factors leading to low device use at home were identified, including children's reluctance, mothers' perspectives, physical environmental barriers and device-related barriers. CONCLUSIONS: The results highlight the need, when considering the usability of assistive devices, to take into account three interactive factors, namely, the personal, device and environmental factors. They also demonstrate the importance of taking children's different developmental stages and unique personal experiences into consideration in understanding the influence of assistive device intervention for children with cerebral palsy.

Employment outcomes following spinal cord injury in Taiwan.

It is important to maximize vocational achievement following spinal cord injury. Despite this recognition, unemployment remains a prevalent problem and continues to challenge rehabilitation professionals. This study aimed to examine the employment status and determinants of employability for individuals with spinal cord injury in Taiwan. A cross-sectional survey was conducted. A total of 353 participants aged 18-65 years were recruited from four branches of the Association of People with Spinal Cord Injury. The results showed that, of the participants, 107 were employed at the time of the survey, with an employment rate of 30.3%. Logistic regression analyses indicated that individuals with a college degree or higher [odds ratio (OR)=3.03; 95% confidence intervals (CI): 1.30-7.07], aged 26-40 years (OR=8.51; 95% CI: 3.14-23.02) and 41-55 years (OR=3.06; 95% CI: 1.31-7.18), sustaining injury longer than 10 years (OR=9.89; 95% CI: 2.61-37.46), experiencing less functional limitations (OR=0.90; 95% CI: 0.86-0.95), and perceiving greater social support (OR=1.04; 95% CI: 1.01-10.7) were associated with higher likelihood of employment. Vocational rehabilitation services can use the results to target efforts toward those at risk of unemployment.

Establishing a cost estimation model for hypertension and its related diseases in Taiwan.

Chronic diseases are responsible for significant economic losses related to direct costs of medical care, as well as indirect costs arising from lost productivity. To optimize the use of limited health care resources, there is a need to establish a comprehensive index to establish the priorities for funding of health programs for chronic diseases. In this study, we applied the population attributable risk proportion (PAR) model to estimate the economic burden imposed by hypertension and its related diseases in Taiwan in 1991. Data were collected from published statistical reports and research reports. The estimated total economic cost of hypertension and associated diseases was 9.0 to 11.9 billion New Taiwan dollars (NTD) in 1991 (1 US dollar was equivalent to 27 NTD in 1991). Direct costs were the largest component of total expenditure (5.4-7.1 billion NTD), followed by morbidity costs (3.2 billion NTD), and mortality costs (0.4-1.5 billion NTD). Categorized by disease type, hypertensive diseases accounted for the largest share of costs (6.8-7.7 billion NTD), followed by cerebrovascular diseases (1.0-1.9 billion NTD). Disorders of arteries, arterioles, and capillaries accounted for the smallest share (41 million to 1 billion NTD). The method used in this study provides a satisfactory estimation of the economic burden imposed by hypertension and related diseases, and can be applied to other risk factors or diseases to show their separate economic impacts. The precision of such estimates can be greatly improved if health authorities establish more complete databanks to collect data on national expenditure for all types of health care services. This would, in turn, provide policy makers with more accurate data on which to base allocation of funding for chronic disease health care programs.

The relationship of excess body weight and health-related quality of life: evidence from a population study in Taiwan.

OBJECTIVE: Excess body weight is related to significant morbidity and mortality. However, less is known about the relationship of body weight to health-related quality of life (HRQOL), especially for Asian populations. We examined the relationship of excess weight and HRQOL in a general population sample from Taiwan. RESEARCH METHODS AND PROCEDURES: This cross-sectional study used a national representative sample (n = 14,221) from the 2001 Taiwan National Health Interview Survey. Body weight was categorized using body mass index (BMI in kg/m2) as normal (18.5-24.9), overweight (25-29.9), and obese (> or = 30). HRQOL was measured using the Taiwan version of the SF-36. We compared the body weight-HRQOL relationships by age, gender, and status of chronic condition, respectively. We especially used the Generalized Estimating Equations (GEE) to examine the relationships of BMI and HRQOL by taking into account the correlations of HRQOL within households. Four models were developed to adjust sequentially for sets of covariates: Model 1 with no adjustment; Model 2 adjusting for sociodemographic variables; Model 3 adding chronic conditions; Model 4 further adding smoking status. RESULTS: Unadjusted physical HRQOL was best for normal weight, worse for overweight, and worst for obese individuals. For unadjusted mental HRQOL, overweight subjects had at least as good mental domain scores of HRQOL as those with normal weight or obesity, depending on the subscales. As age increased, excess weight was associated with worse physical, but not mental HRQOL. Compared to men, women with excess weight showed a greater deficit in physical HRQOL. Multivariable analyses suggested that obesity was associated with worse physical HRQOL compared to overweight, which, in turn, was worse or comparable to normal weight. Specifically, in the model adjusting for demographic variables, the deficit in physical functioning and physical component scores for the obese vs normal weight were statistical significant (P < 0.05) and clinically important difference (effect size > or = 0.3). Both obesity and overweight were associated with higher mental component scores than normal weight, but the effect size was < 0.3. CONCLUSION: In Taiwan, excess weight was related to worse physical, but not mental HRQOL. The lack of impact of increased body weight on mental health status presents a potential challenge to preventing the increases in obesity. More research is needed to elucidate the mechanisms by which excess weight affects specific domains of HRQOL, and to develop effective prevention strategies.

Measuring validity of self-reported symptoms among people with HIV.

Symptoms are important indicators of health and treatment for people with HIV. Symptoms are measured by patient self-report, but there has been little attention to what is the best method of elicitation. We compared three methods (presence, frequency, and bother) commonly used to measure HIV self-reported symptoms. CD4+ T lymphocyte count and health-related quality of life (HRQL) scales were used to test validity in 160 people with HIV. The average number of symptoms reported was 15.2 (standard deviation 8.4). Correlation coefficients of summary symptom scores using the three methods ranged from -0.30 to -0.36 with HRQL score and from -0.19 to -0.20 with CD4 count (p<0.05). Correlation coefficients of seven specific symptom items with CD4+ counts and HRQL scores for the same concepts were small to moderate (-0.08 to -0.58, p<0.05). For the three methods, the correlation coefficients in general tended to be greater with frequency or bother than presence. However, the differences among the three methods were not statistically significant. We conclude that no single method is superior to the others.