Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study.

BACKGROUND: The intricate balance between the advantages and risks of low-dose computed tomography (LDCT) impedes the utilization of lung cancer screening (LCS). Guiding shared decision-making (SDM) for well-informed choices regarding LCS is pivotal. There has been a notable increase in research related to SDM. However, these studies possess limitations. For example, they may ignore the identification of decision support and needs from the perspective of health care providers and high-risk groups. Additionally, these studies have not adequately addressed the complete SDM process, including pre-decisional needs, the decision-making process, and post-decision experiences. Furthermore, the East-West divide of SDM has been largely ignored. This study aimed to explore the decisional needs and support for shared decision-making for LCS among health care providers and high-risk groups in China. METHODS: Informed by the Ottawa Decision-Support Framework, we conducted qualitative, face-to-face in-depth interviews to explore shared decision-making among 30 lung cancer high-risk individuals and 9 health care providers. Content analysis was used for data analysis. RESULTS: We identified 4 decisional needs that impair shared decision-making: (1) LCS knowledge deficit; (2) inadequate supportive resources; (3) shared decision-making conceptual bias; and (4) delicate doctor-patient bonds. We identified 3 decision supports: (1) providing information throughout the LCS process; (2) providing shared decision-making decision coaching; and (3) providing decision tools. CONCLUSIONS: This study offers valuable insights into the decisional needs and support required to undergo LCS among high-risk individuals and perspectives from health care providers. Future studies should aim to design interventions that enhance the quality of shared decision-making by offering LCS information, decision tools for LCS, and decision coaching for shared decision-making (e.g., through community nurses). Simultaneously, it is crucial to assess individuals' needs for effective deliberation to prevent conflicts and regrets after arriving at a decision.

Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study.

BACKGROUND: People living with HIV/AIDS (PLWHA) are a vulnerable group who experience multiple physiological and psychological symptoms. A better understanding of unmet symptom management needs will allow researchers to design interventions that are more reflective of deficits in care and more effective at improving patient care. Few studies have focused on unmet needs for symptom management in PLWHA particularly in China. Factors influencing Chinese PLWHA symptom management needs are rarely discussed. AIM: The purpose of this study was to investigate the unmet needs for symptom management of PLWHA and how their symptom burden, HIV perceived stigma, and self-management capacity contributes to HIV-related self-management practices in Shanghai, China. DESIGN: Study participants were recruited from the outpatient and inpatient HIV/AIDS wards in an infectious hospital in Shanghai, China. Self-administered questionnaires were implemented and medical charts were reviewed. RESULTS: A total of 367 participants was recruited from April to September 2017. The results show that 53.1% (195 of 367) of participants presented at least one unmet symptom management need and that symptom burden, as well as perceived stigma, reduced self-management capacity, and no employment significantly affected unmet symptom management needs. CONCLUSION: The findings indicate that there is room for improvement in symptom management for Chinese PLWHA. Culturally appropriate interventions focusing on improving symptom burden, decreasing HIV perceived stigma, and enhancing self-management capacity can enhance symptom management in this population.

Life priorities in the HIV-positive Asians: a text-mining analysis in young vs. old generation.

HIV/AIDS is one of the most urgent and challenging public health issues, especially since it is now considered a chronic disease. In this project, we used text mining techniques to extract meaningful words and word patterns from 45 transcribed in-depth interviews of people living with HIV/AIDS (PLWHA) conducted in Taipei, Beijing, Shanghai, and San Francisco from 2006 to 2013. Text mining analysis can predict whether an emerging field will become a long-lasting source of academic interest or whether it is simply a passing source of interest that will soon disappear. The data were analyzed by age group (45 and older vs. 44 and younger). The highest ranking fragments in the order of frequency were: "care", "daughter", "disease", "family", "HIV", "hospital", "husband", "medicines", "money", "people", "son", "tell/disclosure", "thought", "want", and "years". Participants in the 44-year-old and younger group were focused mainly on disease disclosure, their families, and their financial condition. In older PLWHA, social supports were one of the main concerns. In this study, we learned that different age groups perceive the disease differently. Therefore, when designing intervention, researchers should consider to tailor an intervention to a specific population and to help PLWHA achieve a better quality of life. Promoting self-management can be an effective strategy for every encounter with HIV-positive individuals.

"Please Don't Make Me Ask for Help": Implicit Social Support and Mental Health in Chinese Individuals Living with HIV.

China faces a growing HIV epidemic; psychosocial needs of HIV-positive individuals remain largely unaddressed. Research is needed to consider the gap between need for mental healthcare and lack of sufficiently trained professionals, in a culturally acceptable manner. This study assessed explicit and implicit forms of social support and mental health symptoms in 120 HIV-positive Chinese. Explicit social support refers to interactions involving active disclosure and discussion of problems and request for assistance, whereas implicit social support refers to the emotional comfort one obtains from social networks without disclosing problems. We hypothesized and found using multiple linear regression, that after controlling for demographics, only implicit, but not explicit social support positively predicted mental health. Future research is warranted on the effects of utilizing implicit social support to bolster mental health, which has the potential to circumvent the issues of both high stigma and low professional resources in this population.

Psychometric properties of the World Health Organization Quality Of Life Assessment-Brief in methadone patients: a validation study in northern Taiwan.

BACKGROUND: Quality of life (QOL) is an important outcome measure in the treatment of heroin addiction. The Taiwan version of the World Health Organization Quality of Life assessment (WHOQOL-BREF [TW]) has been developed and studied in various groups, but not specifically in a population of injection drug users. The aim of this study was to analyze the psychometric properties of the WHOQOL-BREF (TW) in a sample of injection drug users undergoing methadone maintenance treatment. METHODS: A total of 553 participants were interviewed and completed the instrument. Item-response distributions, internal consistency, corrected item-domain correlation, criterion-related validity, and construct validity through confirmatory factor analysis were evaluated. RESULTS: The frequency distribution of the 4 domains of the WHOQOL-BREF (TW) showed no floor or ceiling effects. The instrument demonstrated adequate internal consistency (Cronbach's alpha coefficients were higher than 0.7 across the 4 domains) and all items had acceptable correlation with the corresponding domain scores (r = 0.32-0.73). Correlations (p < 0.01) of the 4 domains with the 2 benchmark items assessing overall QOL and general health were supportive of criterion-related validity. Confirmatory factor analysis yielded marginal goodness-of-fit between the 4-domain model and the sample data. CONCLUSIONS: The hypothesized WHOQOL-BREF measurement model was appropriate for the injection drug users after some adjustments. Despite different patterns found in the confirmatory factor analysis, the findings overall suggest that the WHOQOL-BREF (TW) is a reliable and valid measure of QOL among injection drug users and can be utilized in future treatment outcome studies. The factor structure provided by the study also helps to understand the QOL characteristics of the injection drug users in Taiwan. However, more research is needed to examine its test-retest reliability and sensitivity to changes due to treatment.

Chinese female immigrants english-speaking ability and breast and cervical cancer early detection practices in the New York metropolitan area.

BACKGROUND: Breast and cervical cancers are significant causes of mortality and morbidity for Asian women, and poor English-speaking ability is a barrier to cancer prevention practices. MATERIALS AND METHODS: This project tested relationships among English-speaking ability and early detection practices regarding to breast and cervical cancer among female Chinese immigrants. A descriptive cross-sectional survey was used. RESULTS: 175 female Chinese immigrants completed the survey in the breast cancer prevention section, and 35 of them also completed the cervical cancer prevention section. Some 63% of them had heard about the clinical breast exam (CBE), but only 54% had had a CBE. While 46% of the participants were aware of their need for a Pap smear, only 31% had heard about it and had undergone a pelvic exam. CONCLUSIONS: English-speaking ability was strongly associated with immigrant women's knowledge of female cancer early detection. Culturally and linguistic issues should be considered as the first step to access immigrant population in designing future education intervention.

"You must take the medications for you and for me": family caregivers promoting HIV medication adherence in China.

China is experiencing a rapid increase in the incidence of HIV infections, which it is addressing proactively with broad implementation of antiretroviral therapy (ART). Within a cultural context extolling familial responsibility, family caregiving may be an important component to promote medication adherence for persons living with HIV in China. Based on 20 qualitative interviews with persons living with HIV and their family caregivers and a cross-sectional survey with 113 adults receiving HIV care at Beijing's Ditan outpatient clinic, this mixed-methods study examines family caregivers' role in promoting adherence to ART. Building upon a conceptual model of adherence, this article explores the role of family members in supporting four key components enhancing adherence (i.e., access, knowledge, motivation, and proximal cue to action). Patients with family caregiving support report superior ART adherence. Also, gender (being female) and less time since ART initiation are significantly related to superior adherence. Since Chinese cultural values emphasize family care, future work on adherence promotion in China will want to consider the systematic incorporation of family members.

Research strategies: lessons learned from the studies of Chinese Americans and Korean Americans.

Given the increasing population of Asian Americans in the United States, there is an urgent need for culturally and linguistically sensitive and appropriate research to validate research findings, particularly with respect to health care. Although increasing attention is being focused on ethnic minority-group studies, few research reports concentrate on research strategies with respect to Asian American populations. This article describes the importance of language in culturally informed research for ethnic minorities and explores the paradigm for Asian American research methods. Finally, this article makes use of six research projects to discuss practical issues that help produce culturally and linguistically appropriate research on Asian American populations. Cultural diversity issues in patient care need to be included in the health care-related curriculum. Cultural interpretation programs should be facilitated in hospital settings.

Optimizing HIV care by expanding the nursing role: patient and provider perspectives.

AIM: This paper is a report of a study conducted to explore HIV healthcare services from the perspectives of both healthcare providers and patients in order to understand how to optimize HIV nursing care. BACKGROUND: In China, healthcare providers usually first diagnose HIV in a general hospital. Then, HIV-positive individuals are transferred to a specialist hospital. Between healthcare providers and healthcare institutions, there are many gaps in the process from diagnosis to treatment. METHODS: One focus group with six healthcare providers and 29 in-depth interviews with people living with HIV/AIDS were conducted during 2005. FINDINGS: Patients who were diagnosed with HIV in a general hospital often did not discuss their condition with a healthcare provider before being sent to a specialist hospital. Furthermore, since the patients had already been diagnosed, healthcare providers in the specialist hospital did not deal adequately with the disclosure process and emotional reactions to the diagnosis. They reported feeling overwhelmed in their role in providing healthcare services. Nurses reported that they were responsible for many 'non-nursing' tasks and did not have the opportunity to give the type of care they were trained to offer. CONCLUSION: Optimizing HIV care in China will involve establishing clear boundaries between general and specialist hospitals and a division of labour among healthcare providers that eases the burden of care and takes advantage of the full scope of practice that nurses are trained to provide.

Predictors of breast examination practices of Chinese immigrants.

Breast cancer is a significant threat to Chinese women living in the United States. The purposes of this study are, first, to examine the relationships among breast cancer risk knowledge, general cancer beliefs, and breast examination practices and, second, to determine the predictors of breast examination practices among Chinese women in New York. The study offers a descriptive approach that makes use of a correlation cross-sectional survey (N = 135). Five significant predictors are related to breast examination practices as a result of the study findings: age, acculturation, private insurance status, legal status, and length of stay in New York. Findings show that women who have regular breast examinations most likely belong to older generations, as compared with their younger peers. Study findings suggest that healthcare providers must become more culturally sensitive to the practices and needs of Chinese immigrants. Evidently, providing information regarding cancer prevention targeted for female Chinese immigrants can help increase use of cancer screening tests.

Crystal structure of the N-terminal domain of Geobacillus kaustophilus HTA426 DnaD protein.

The DnaD is one of the primosomal proteins that are required for initiation and re-initiation of chromosomal DNA replication in Gram-positive bacteria. The DnaD protein is composed of two major structural domains: an N-terminal oligomerization domain and a C-terminal ssDNA binding domain. Here, we report the crystal structure of the N-terminal domain (aa 1-128) of DnaD (DnaDn) of Geobacillus kaustophilus HTA426 at 2.3A resolution. The structure of DnaDn reveals an extended winged-helix fold, a typical double-stranded DNA binding motif as winged-helix proteins. DnaDn formed tetramers in the crystalline state, but the results of gel filtration chromatography further indicated that this domain of DnaD was a stable dimer in solution. The structural analysis of DnaDn may suggest the binding sites for DNA and DnaB, and an assembly mechanism for Gram-positive bacterial DNA replication primosome.

Breast cancer knowledge assessment in female Chinese immigrants in New York.

The purpose of this study was to examine the relationships between acculturation level and perceptions of health access, Chinese health beliefs, Chinese health practices, and knowledge of breast cancer risk. This descriptive, correlational cross-sectional study used a survey approach. The sample included 135 Chinese women from the New York City metropolitan area. Data were analyzed using correlational techniques and polytomous regression. There were no significant relationships between acculturation and health access, Chinese health beliefs, Chinese health practices, and breast cancer risk knowledge. Only "years of education," "marital status," and "household income" significantly predicted breast cancer risk knowledge level. The data indicate that women with a better knowledge of breast cancer risk are twice as likely to have higher income and have more education. The most knowledgeable women are less likely to be married and less likely to have partners compared to least knowledgeable group. Providers need to promote health knowledge and provide information about as well as access to preventive health practices to the immigrant population, given that acculturation to the new dominant society is inevitable.