Effectiveness of a Digital Decision Aid for Nutrition Support in Women with Gynaecological Cancer: A Comparative Study.

This study aimed to examine the effects of an animated Patient Decision Aid (PtDA) about dietary choices on decisional conflict and decision regret. A prospective, observational, two-group comparative effectiveness study was conducted with patients (n = 90) from a southern Taiwan oncology inpatient unit. Data included the Malnutrition Universal Screening Tool (MUST), laboratory results, 16-item Decisional Conflict Scale (sf-DCS), and 5-item Decision Regret Scale (DRSc). Data were collected at admission (T0), after the first-cycle of chemotherapy but before discharge (T1), and after the six-cycle chemotherapy protocol (T2) (around 3 months). Group A received standardized nutrition education and a printed brochure, while Group B watched a 10-minute information video during a one-on-one inpatient consultation and engaged in a values clarification exercise between T0 and T1. The percentage of women with a MUST score ≧1 in Group A sharply increased over time, but not in Group B. Decision aid usage significantly increased patients' hemoglobin and lymphocyte values over time (p < 0.05). The digital PtDA contributed to less decisional conflict and decision regret in at-risk patients and improved their nutritional well-being. Decision-aids help patients make healthcare decisions in line with their values, and are sustainable for use by busy clinicians.

Resilience, self-efficacy and diabetes distress on self-management behaviours in patients newly diagnosed with type 2 diabetes: A moderated mediation analysis.

AIM: To examine (1) the mediating role of self-efficacy between resilience and self-management behaviours and (2) the moderating role of diabetes distress on the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes. DESIGN: Cross-sectional design. METHODS: Totally, 195 patients newly diagnosed with type 2 diabetes for more than 5 months but less than 18 months were recruited from three endocrine clinics in Taiwan through convenience sampling. Self-reported questionnaires including demographic and disease characteristics, resilience, self-efficacy and self-management behaviours were used to collect data from October 2020 to May 2021. Moderated mediation analysis was performed by Hayes's PROCESS macro. RESULT: According to bootstrapping results, the indirect effect of resilience on self-management was significant, although the direct effect of resilience on self-management was not. Participants were categorized into with and without diabetes distress groups. The results of moderated mediation analysis indicated self-efficacy significantly correlated with self-management behaviours in participants without diabetes distress, although self-efficacy did not significantly correlate with self-management in participants with diabetes distress. CONCLUSION: The association of resilience with self-management behaviours was fully mediated through self-efficacy with diabetes distress moderating the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes. IMPACT: Improving resilience could enhance self-efficacy leading to possible improvement in self-management behaviour, although improving self-efficacy might not benefit self-management behaviours for those with high levels of diabetes distress. Healthcare providers need to first assess and address the diabetes distress before intervening to improve self-efficacy to enhance self-management behaviours in patients newly diagnosed with type 2 diabetes. PATIENT OR PUBLIC CONTRIBUTION: When designing this study, two patients newly diagnosed with diabetes were consulted about the importance of self-management behaviours for them personally.

Character Strengths Use in Diabetes Self-management Scale: Development and psychometric testing.

AIMS: To develop and psychometrically test Character Strengths Use in Diabetes Self-management Scale in people with type 2 diabetes. DESIGN: Cross-sectional design. METHODS: Based on literature reviews and examination by experts, a 20-item scale was developed and administered to 350 participants with type 2 diabetes who were enrolled from two endocrine clinics by convenience sampling in Taiwan. Item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), concurrent and predictive validity as well as reliability were used to examine the psychometric characteristics of the scale. Data were collected from November 2021 to March 2022. RESULTS: EFA and CFA supported a 12-item scale with three factors, namely learning proactively, taking on challenges and thinking positively, fit the data well. The total score of the 12-item scale significantly and positively correlated with diabetes-specific quality of life, and significantly and negatively correlated with baseline and 9-month haemoglobin A1c levels. Cronbach's α for overall scale and subscales ranged between .78 and .91. CONCLUSION: The 12-item Character Strengths Use in Diabetes Self-management Scale demonstrated satisfactory validity and reliability in people with type 2 diabetes. IMPACT: Nurses could apply this new scale to identify the degree of using character strengths in self-management in people with type 2 diabetes; accordingly, character strength-based interventions could be provided to improve self-management in such patients with diabetes. Furthermore, the 12-item Character Strengths Use in Diabetes Self-management Scale has the potential to be used to measure the effectiveness of strength-based interventions in people with Type 2 diabetes. PATIENT OR PUBLIC CONTRIBUTION: Five patients with type 2 diabetes were invited to take the original 20-item scale to evaluate the clarity, readability and comprehensiveness of the 20 items.

[Holistic Person-Centered Care for Individuals With Type 2 Diabetes Mellitus].

In 2022, the American Diabetes Association and the European Association for the Study of Diabetes emphasized that type 2 diabetes care is a person-centered holistic care concept. This article summarizes the concepts of holistic care for individuals with type 2 diabetes and proposes a complete model of the six-layer whole-person care circle for individuals with type 2 diabetes. This model treats individuals with type 2 diabetes as the core of care and adopts their specific needs, preferences, and values to design individualized care plans. The overall goal of care is to maintain quality of life and to avoid or delay complications. Management methods must be holistic. Based on people and comprehensive considerations, six circles of care are listed. The first layer is caregivers, taking into account the influence of the family and the community on the individual. The second layer is multi-professional and multi-disciplinary team care, which provides support to individuals with diabetes. The third layer emphasizes the need for the following thirteen principles in diabetes care: monitoring and screening for complications, behavior modification for healthy habits, monitoring and continuous assessment, reducing the risk of hypoglycemia, effective implementation and care organization, considering underlying physiological conditions, avoiding therapeutic inertia, considering social determinants of health, psychological factors, structured diabetes education, language proficiency, shared decision-making, and considering regional healthcare institutions and related resources. The fourth layer is the decision cycle of care, which applies the principles of care and conducts continuous and dynamic case management based on the decision cycle. The fifth layer is the healthcare network through which health providers provide hospital, long-term care, and primary clinics/ primary network care referrals based on the needs of individual with diabetes. The sixth layer leverages the chronic care model to construct a supportive healthcare system comprising organizational support, clinical information systems, delivery system design, decision support, self-management support, and community resources. This proposed model may provide a reference for constructing healthcare systems to care for patients with type 2 diabetes.

Determinants of fear of falling in older adults with diabetes.

OBJECTIVES: To identify the important determinants of FoF among older adults with diabetes in endocrine clinics based on demographic and illness characteristics, physical function and capability, psychosocial and cognitive factors. METHODS: A cross-sectional study was conducted on 240 older adults with Type 2 diabetes who were recruited by convenience sampling. Self-reported questionnaires, medical records as well as physical function and capability tests were used to collect the data. Multiple linear regression was used to identify the important determinants of FoF. RESULT: Diabetes distress, sarcopenia levels, TUG results, and HbA1c levels were significant determinants of FoF. These determinants uniquely explained 14%, 9%, 4%, and 2% of the variance in FoF respectively. CONCLUSION: Beside sarcopenia and dynamic balance being known as significantly associated with FoF in a general older population, diabetes distress and HbA1c levels should also be considered in designing interventions to improve FoF among older adults with diabetes.

Risk factors of falls and the gender differences in older adults with diabetes at outpatient clinics.

AIMS: To explore the risk factors of falls and the gender differences based on demographic and disease characteristics, physical capability, and fear of falling in older adults with diabetes visiting outpatient clinics in Taiwan. DESIGN: Cross-sectional design. METHODS: A total of 485 patients with type 2 diabetes aged between 65 and 80 years were recruited from three endocrine outpatient clinics in Taiwan. Demographic and disease characteristics, fall history in the previous one year and fear of falling were collected by a self-reported questionnaire. Calf circumference, handgrip strength, one-leg standing and time up-and-go tests were all performed to assess the physical capability of participants. Data were collected from May 2019 to May 2020. RESULTS: Female gender (OR = 1.75), handgrip strength (OR = 2.43) and fear of falling (OR = 3.38) were important risk factors of falls overall, although fear of falling (OR = 4.69) was the only important risk factor of falls in males, while handgrip strength (OR = 3.48) and fear of falling (OR = 2.86) were important risk factors of falls in females. The sensitivity of simultaneous screening handgrip strength and fear of falling were 85.7, 86.4 and 86.2 in males, females and older adults overall with diabetes, respectively. CONCLUSION: Fear of falling was an important risk factor of falls in both genders, especially in males. Handgrip strength was an important risk factor of falls specifically for females. By simultaneously screening fear of falling and handgrip strength, risk of falls in older adults with diabetes at outpatient clinics could be identified in a more timely manner. Impact Nurses could periodically and simultaneously assess fear of falling and handgrip strength of older adults with diabetes at outpatient clinics. For those are identified at risk of falls on either fear of falling or handgrip strength, nurses could provide corresponding interventions to reduce the fear of falling or improve muscle strength to prevent such falls.

Pathways of diabetes distress, decisional balance, self-efficacy and resilience to quality of life in insulin-treated patients with type 2 diabetes: A 9-month prospective study.

AIMS AND OBJECTIVES: To construct a path model addressing influences of diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin to quality of life (QoL) in insulin-treated patients with type 2 diabetes (T2DM). BACKGROUND: Insulin regimens more negatively impact QoL than oral medication treatments in patients with T2DM. Understanding the factors and influencing pathways associated with subsequent QoL will help nurses design timely interventions to improve QoL of insulin-treated T2DM patients. DESIGN: A 9-month prospective design was employed in this study. METHODS: Self-reported questionnaires were used to collect data from 185 insulin-treated T2DM patients. At baseline, diabetes distress and self-efficacy of injecting insulin were collected, while QoL, resilience and decisional balance of injecting insulin were collected 9 months later. Data were collected from February 2017 to February 2018. Structural equation modelling was used for analysis. This study was conducted based on the STROBE. RESULTS: Low baseline diabetes distress and high 9-month decisional balance of injecting insulin directly associated with high 9-month QoL. High baseline self-efficacy of injecting insulin and high 9-month resilience directly associated with high 9-month decisional balance of insulin injection and indirectly associated with high 9-month QoL. High baseline diabetes distress directly and indirectly associated with poor 9-month QoL. CONCLUSIONS: Diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin play different roles in associating with QoL in insulin-treated T2DM patients. RELEVANCE TO CLINICAL PRACTICE: Nurses could provide educational programs focusing on enhancing decisional balance of injecting insulin to improve QoL in insulin-treated patients. Improving self-efficacy of injecting insulin and resilience could be promising strategies to improve the decisional balance of injecting insulin. More timely assessment of diabetes distress and intervention might be powerful strategies to improve subsequent QoL in these patients.

Scale for Measuring Role Strain in Women With Diabetes: Development and Psychometric Testing of the Chinese Version.

BACKGROUND: Women with diabetes (type 1 and type 2) have excessive risk of developing cardiovascular disease compared with men with diabetes, so optimizing diabetes control is crucial for women to reduce this risk. Women with diabetes experience role strain, and a scale to measure role strain in the context of diabetes control could help healthcare providers improve diabetes control in women with diabetes. OBJECTIVE: The aims of the study were to develop a short-form scale for measuring role strain in Taiwanese women with diabetes and test its psychometric properties. METHODS: This study was conducted from October 2018 to May 2019 and used a cross-sectional design. Based on literature reviews and results of focus groups, a 28-item role strain scale was developed and administered to 519 women with diabetes in Taiwan. Item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability testing were used to examine the psychometric characteristics of the scale. RESULTS: A 9-item role strain scale including subscales for role guilt and role conflict, supported by exploratory factor analysis and confirmatory factor analysis, was produced. High role strain significantly correlated with high depression (r = 0.399, P < .001) and high hemoglobin A1c levels (r = 0.169, P < .001). The overall and subscale Cronbach's α ranged between 0.78 and 0.86, with test-retest reliability ranging between 0.64 and 0.81. CONCLUSIONS: The role strain scale for women with diabetes is reliable and valid and can be used to evaluate role strain in women with diabetes.

[Associations of Personality, Distress, Social Support With Self-Care Behaviors in Patients With Type 2 Diabetes].

BACKGROUND: The findings of recent studies indicate that self-care behaviors are significantly associated with diabetes-related distress and social support in patients with type 2 diabetes. Moreover, Big-Five personality traits are also considered to be associated with self-care behaviors and should be considered. PURPOSE: This study was designed to investigate the associations between Big-Five personality traits, diabetes-related distress, and social support and diabetes self-care behaviors in patients with type 2 diabetes. METHODS: A cross-sectional study design was conducted with 200 participants recruited by convenience sampling. A self-reported questionnaire was used to collect data on demographic and disease characteristics, Big Five personality indicators, diabetes-related distress, social support, and self-care behavior. Data were analyzed using percentage, mean and standard deviation, independent t-test, one-way ANOVA, Pearson's correlation test, and enter method multiple regression analysis. RESULTS: Social support was found to relate positively and significantly with self-care behavior, while no significant relationship was found between diabetes-related distress and self-care behaviors. Participants with high scores for extroversion, agreeableness, and conscientiousness tended to have better self-care behavior, while those with a high score for neuroticism tended to have poor self-care behaviors. The results of the enter method multiple regression analysis showed age and social support to be significant factors associated with self-care behaviors, explaining 19.5% of the variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Priority concern should be given to patient age and social support status when working to improve the self-care behaviors of patients with type 2 diabetes. As personality traits were found to be significantly associated with self-care behaviors, these should be included in the individual health education program.

Determinants for quality of life trajectory patterns in patients with type 2 diabetes.

PURPOSE: The purpose of the study was to identify quality of life (QoL) trajectory patterns and the determinants in patients with Type 2 diabetes (T2DM). METHODS: A longitudinal design was employed. Totally, 466 patients with T2DM recruited from five diabetic clinics in Taiwan were participants of this study. Demographic and disease characteristics, biomedical factors (HbA1c levels and body mass index), psychosocial factors (self-care behaviors, social support, resilience, diabetes distress), and QoL were collected at baseline. QoL was further measured every 6 months for four waves after baseline. Latent class growth analysis was used to identify QoL trajectory patterns. The multinomial logistic regression was further applied to explore the important determinants of different QoL trajectory patterns. RESULTS: The "steadily poor" (n = 27, 5.8%), "consistently moderate" (n = 174, 37.3%), and "consistently good" (n = 265, 56.9%) trajectory patterns were identified. The HbA1c levels (OR 2.16) and diabetes distress (OR 1.18) were important for determining participants in the "steadily poor" QoL trajectory pattern. HbA1c levels (OR 1.25) and diabetes distress (OR 1.14) were important for determining participants in the "consistently moderate" QoL trajectory pattern. CONCLUSIONS: To prevent development of relatively worse QoL trajectory patterns in patients with T2DM in a timelier manner, healthcare providers could regularly assess the QoL and provide intervention, especially for those with high HbA1c levels and high diabetes distress. Meanwhile, early intervention for decreasing HbA1c levels and diabetes distress may improve the trajectory development of QoL in patients with T2DM.

[Decision Cycle for Patient-Centered Glycemic Management in Type 2 Diabetes].

Effective glycemic control is crucial to achieving the ultimate goal of preventing complications and optimizing quality of life in patients with Type 2 diabetes. The American Diabetes Association and European Association for the Study of Diabetes recommend using the Decision Cycle for Patient-Centered Glycaemic Management as a model for caring for patients with Type 2 diabetes. This article describes the seven steps of this model. These steps are: (1) Assess key patient characteristics; (2) Consider specific factors that impact choice of treatment; (3) Shared decision-making to create a diabetes self-management education support plan; (4) Agree on a management plan; (5) Implement management plan; (6) Conduct regular monitoring and support; and (7) Review and agree on the management plan. Healthcare providers could apply these seven steps to help patients with Type 2 diabetes achieve optimal glycaemic management.

Quantifying PM2.5 from long-range transport and local pollution in Taiwan during winter monsoon: An efficient estimation method.

From autumn to the following spring, annually, the northeast monsoon transports PM2.5 (particles less than 2.5 µm in aerodynamic diameter) from the Asian continent to downstream areas. Naturally, this triggered a question: What are the contributions of PM2.5 from long-range transport (LRT) and local pollution (LP) at any downstream location? To answer that question, the present study developed an economical and efficient method that can easily estimate the contribution of PM2.5 from LRT (LRT-PM2.5) and PM2.5 from LP (LP-PM2.5). The method used PM2.5 and meteorological observation data in Taiwan from 2006 to 2015 and a short-term simulation from January to May in 2010. The analysis classified the data into three types of PM2.5 source patterns: LRT-Event (high concentration plume at the front edge of southward moving anticyclones/strong northeast wind), LRT-Ordinary (less concentration in common strong northeast wind), and LRT/LP Mix or Pure LP (PM2.5 was from both LRT and LP or from only LP under weak northeast wind). During the ten-year period, the average LRT-PM2.5 values at the northern tip of Taiwan were 31-39 µg m-3, 12-16 µg m-3, and 4-13 µg m-3 for the LRT-Event, LRT-Ordinary, and LRT/LP Mix or Pure LP patterns, respectively. The 10-year average LRT-PM2.5 and LP-PM2.5 contributions were approximately 70:30 in northern Taiwan, 50:50 in central Taiwan, and 30:70 in southern Taiwan for the LRT-Event pattern; 60:40 in northern and 40:60 in central and southern Taiwan for the LRT-Ordinary pattern; and 30:70 in northern and 25:75 in central and southern Taiwan for the LRT/LP Mix or Pure LP pattern. Interestingly, LRT-PM2.5 peaked in 2013 but has decreased annually since then, whereas LP-PM2.5 has roughly decreased in the past ten years.

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence-Based Practice.

BACKGROUND: Determining possible associated factors and the influencing pathways to hemoglobin A1C (HbA1C) levels and quality of life (QoL) will facilitate the development of effective interventions to improve the physical and psychosocial health of patients with type 2 diabetes mellitus (T2DM). OBJECTIVES: To test a hypothesized model that addressed the pathways among personal characteristics, social support, diabetes distress, and self-care behaviors to HbA1C and QoL. METHODS: A total of 382 adults with T2DM were recruited. Self-reported questionnaires and medical records were used to collect data regarding personal characteristics, diabetes distress, and social support at baseline. The self-care behaviors characters were collected 6 months later, as well as QoL and HbA1C levels 1 year later. RESULTS: The 12-month QoL directly affected 12-month HbA1C levels. The 6-month self-care behaviors directly affected 12-month QoL, and indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline diabetes distress directly affected 12-month QoL. Moreover, baseline diabetes distress indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline social support directly affected baseline diabetes distress and 6-month self-care behaviors. In addition, baseline social support indirectly affected 12-month QoL through baseline diabetes distress. Baseline social support also indirectly affected 12-month QoL through 6-month self-care behaviors. LINKING EVIDENCE TO ACTION: Enhancing QoL is important to improve HbA1C levels. Enhancing self-care behaviors is essential to improve subsequent HbA1C control and QoL. Reducing diabetes distress is crucial to improve subsequent QoL. Improving social support is suggested a favorable strategy to reduce diabetes distress and enhance subsequent self-care behaviors in patients with T2DM.

Longitudinal perceptions of the side effects of chemotherapy in patients with gynecological cancer.

PURPOSE: This study aimed to assess the incidence and difference of side effects among six courses of chemotherapy (C/T) in gynecological cancer patients. METHODS: The study period was from Sep. 2010 to Dec. 2011 at the Kaohsiung Veterans General Hospital in Taiwan. The treating protocols, courses, and drugs of C/T in patient were considered according to the different malignant cancers and clinical conditions. The patient data of age, marriage status, education, religion, and experiences of C/T were collected. The patients' or their families' reported side effects of C/T were recorded daily from the beginning of C/T to the 10th day after C/T in each cycle and every course of C/T. RESULTS: Total 89 patients enrolled into the study received total 450 courses of C/T. The mean age was 54.52 ± 11.02. Ovarian cancer was the most common malignant disease (64.0%). The most often combination of drugs used was Taxol and carboplatin (40.9%). Patients complained peripheral numbness of limbs, with the highest incidence of 58.6%. The side effects with incidence about 50% were decreased fatigue (55.0%) and hair loss (49.9%). Other side effects with different levels of incidence were also noticed, such as lack of appetite, changes in taste, and muscle ache. The incidences of peripheral limb numbness and hair loss were increased with following courses of C/T. The high incidence of fatigue did not show variation between different courses of C/T. CONCLUSION: This study revealed the incidence of side effects and occurrence timing during C/T in patients with gynecological cancer. These data provide substantial information to patients and their families to understand the potential side effects of C/T courses, which might increase their compliance in receiving adjuvant C/T. Relieving the side effects in C/T would be important to improve their quality of daily life and treatment willingness.

Associations of changes in psychosocial factors and their interactions with diabetes distress in patients with type 2 diabetes: a longitudinal study.

AIM: To assess the associations of changes in self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment and their interactions with changes in diabetes distress in patients with type 2 diabetes mellitus. BACKGROUND: Many patients with type 2 diabetes mellitus experience diabetes distress. Few longitudinal studies have investigated the associations of changes in various psychosocial factors with changes in diabetes distress in patients with type 2 diabetes mellitus. DESIGN: This study adopted a longitudinal design. Data were collected at baseline and 12 months later. METHODS: Overall, 304 patients with type 2 diabetes were recruited from four hospitals in southern Taiwan by convenience sampling. A self-report questionnaire and medical record were used to collect demographic data, clinical indicators, self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment, and diabetes distress. Data were collected from February 2014-March 2015. RESULTS/FINDINGS: An increase in resilience or diabetes self-efficacy significantly associated with a decrease in diabetes distress, whereas an increase in patient empowerment significantly associated with an increase in diabetes distress. The interactions between increase in patient empowerment and increase in self-management behaviours significantly associated with decrease in diabetes distress. CONCLUSION: Nurses could endeavour to improve the diabetes self-efficacy and resilience to reducing diabetes distress. Arbitrarily empowering patients may increase diabetes distress. Increasing self-care management behaviours and patient empowerment might need to be simultaneously addressed to reduce the diabetes distress in patients with type 2 diabetes.

[Disorder in life and the world: the illness experiences of women with diabetes in Taiwan].

BACKGROUND: The role of women is strongly associated with health behavior. Understanding the illness experiences of women with diabetes helps health professionals to provide appropriate health care to women with diabetes. PURPOSE: The purpose of this study was to explore the illness experiences of women with diabetes. METHODS: This study used interpretive ethnographic methods with in-depth interviews and field observations to obtain emic points of view from women who were diagnosed with diabetes. Agar's hermeneutic cycle was used to analyze the collected data. The participants were recruited under the principle of maximum variation. The inclusion criteria targeted women who: (1) had been diagnosed with diabetes for at least one year, (2) were able to speak Mandarin or Taiwanese, and (3) were willing to participate and have their sessions tape-recorded in a diabetes clinic in southern Taiwan. A total of 18 women with diabetes between 24 and 79 years of age were enrolled as participants. RESULTS: "Disorder in life and the world" was the main storyline elicited from participants. The four themes con-structed from this disorder were: (1) disorder of the body: reliance on medical care to understand the body, (2) disorder of life: shift from being in control of food to being controlled by food, (3) disorder of the family: sick person is perceived as incompetent, and (4) disorder of the self: controlling the body for the family. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Healthcare providers should recognize and make positive use of the potential of the cultural role of women to improve the ability of women to self-manage their diabetes. Additionally, perceiving the entire family as the client may improve the illness experience for Asian women with diabetes.

Impact of Type D Personality, Role Strain, and Diabetes Distress on Depression in Women With Type 2 Diabetes: A Cross-Sectional Study.

BACKGROUND: Women with diabetes face a significantly elevated risk of developing depression. Clarifying the factors associated with depression is critical to designing more timely interventions for this vulnerable population. PURPOSE: This study was developed to examine the impact of Type D personality, diabetes-care-related role strain, and diabetes-related distress on depression in women with Type 2 diabetes. METHODS: A cross-sectional design was used. Convenience sampling was used to recruit 298 women aged 20-64 years who had been diagnosed with Type 2 diabetes for over 6 months from three outpatient endocrine clinics in Taiwan. Demographic and disease characteristics and Type D personality (negative affectivity and social inhibition), diabetes-care-related role strain, and diabetes-related distress and depression status information were collected using self-reported questionnaires and medical records. The important factors of influence on depression were examined using hierarchical multiple regression. RESULTS: On the basis of the results of the hierarchical multiple regression analysis, age, negative affectivity, diabetes-care-related role strain, and diabetes-related distress were identified as significantly associated with depression, with negative affectivity explaining most (43.4%) of the variance in depression, followed by diabetes-care-related role strain and diabetes-related distress, which respectively explained 3% and 2.5% of the variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The negative affectivity associated with the Type D personality was shown to be more significantly associated with depression than diabetes-related psychosocial factors such as diabetes-related distress and diabetes-care-related role strain. Timely assessment of negative affectivity and the provision of brief mindfulness intervention to reduce negative affectivity may be useful in preventing depression in women with Type 2 diabetes, whereas addressing diabetes-related distress and diabetes-care-related role strain should not be neglected when providing comprehensive depression-preventing interventions to young women with diabetes.

Pinocembrin Reduces Keratinocyte Activation and Ameliorates Imiquimod-Induced Psoriasis-like Dermatitis in BALB/c Mice through the Heme Oxygenase-1/Signal Transducer and Activator of Transcription 3 Pathway.

Psoriasis is an autoimmune disease characterized by chronic skin inflammation and excessive keratinocyte proliferation. The itchy, scaly, and erythematous lesions present on psoriatic skin negatively affect patients' quality of life. Pinocembrin is a flavonoid present in propolis, fruits, and vegetables. It exerts neuroprotective effects and was used for treating ischemic stroke in a human clinical trial. However, the effects of pinocembrin on psoriasis have never been examined. In this study, we evaluated the effects of pinocembrin on human HaCaT keratinocytes and BALB/c mice with imiquimod- (IMQ-) induced psoriatic dermatitis. In interferon-γ- (IFN-γ-) activated HaCaT cells, pinocembrin reduced the expression of inflammatory cytokines, namely, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and keratinocyte proliferation markers, namely, keratin (K)16, K17, and Ki-67. The mechanism underlying these inhibitory effects involved the regulation of the heme oxygenase- (HO-) 1/signal transducer and activator of transcription (STAT) 3 pathway. In the IMQ-induced psoriatic dermatitis mouse model, the topical application of pinocembrin significantly ameliorated the Skin Psoriasis Area and Severity Index score, epidermal thickness, inflammation, hyperplasia, hyperkeratosis, and cluster of differentiation (CD) 4+ T-cell infiltration. Expression of the inflammatory cytokines and keratinocyte proliferation markers in dorsal skin was significantly decreased in the pinocembrin-treated group. Meanwhile, in lesional skin, the expression of HO-1 was upregulated, but that of phospho-STAT3 (pSTAT3) was downregulated. Collectively, our results indicated the therapeutic potential of pinocembrin. Additional studies are warranted to evaluate its clinical benefits in patients with psoriasis.

B cells are required for tumor-targeting Salmonella in host.

Systemic administration of Salmonella to tumor-bearing mice leads to the preferential accumulation within tumor sites and retardation of the tumor growth. Host factors including innate and adaptive immune responses influence Salmonella-induced antitumor activity. Antitumor activities of Salmonella are not only determined by the tumor regression but also by the host immune response. Herein, we demonstrated that B cells play an important role in the antitumor activity mediated by Salmonella. Body weight and survival of B cell-deficient mice were decreased compared with wild-type, CD8(+) cell-deficient, or CD4(+) cell-deficient mice after Salmonella administration. Although Salmonella accumulated within the tumors in B cell-deficient mice, the bacterial loads of healthy organs were higher than those in wild-type mice. The inflammation cytokine and bacteremia were found in B cell-deficient mice after Salmonella treatment. When Salmonella accumulated within the tumor, B cells inhibited the dissemination of Salmonella to other healthy organs. The depletion of host B cells resulted in a noticeably higher total number of Salmonella in the tumor and inhibited tumor growth. Meanwhile, B cell-depletive and B cell-adoptive transfer of serum experiments demonstrated that the natural antibody produced by B cell takes part in the control of Salmonella dissemination in tumor-bearing mice. In this study, we want to address the mechanisms of incorporating host immunoresponse as a way to augment the antitumor activities of Salmonella.

One-year efficacy and safety of the telehealth system in poorly controlled type 2 diabetic patients receiving insulin therapy.

OBJECTIVE: To evaluate the functionality of the telehealth system in poorly controlled type 2 diabetic (T2D) patients receiving insulin injections. MATERIALS AND METHODS: Sixty-four patients with glycosylated hemoglobin (HbA(1c)) values > 7% for more than 1 year were included. All patients underwent an intensive diabetes management program, including titration of insulin, blood glucose-self monitoring, and nutritional review, and 32 participated in the telehealth system. The major outcome was to evaluate the change of the HbA(1c) and body weight, the incidence of hospitalization, and hypoglycemic events. RESULTS: After 1-year management, patients receiving telehealth care had significantly improved HbA(1c) levels (9.5% ± 1.8% to 8.1% ± 1.2%; p < 0.01) without significant body weight gain. In contrast, the control group patients had no significant improvement in HbA(1c) levels but showed significant increase in body weight (66.8 ± 9.8 to 67.3 ± 10.0 kg; p < 0.01). No patient in the telehealth group was hospitalized during the follow-up period, but six patients in the control group were. Intergroup differences in hypoglycemic events were absent. CONCLUSION: The intensive diabetes management program with the telehealth system is a useful education method to improve blood sugar control and prevent hospitalization in poorly controlled T2D patients receiving insulin injections.