Risk factors for cerebral palsy in children in Taiwan.

AIM: To determine the significant risk factors of cerebral palsy (CP) in Taiwanese children and the associations between infant-related and parent-related factors. METHOD: Data from 1 459 093 infants and their parents in Taiwan's national databases collected between 2009 and 2016 were used. The cohort with CP included children diagnosed with CP between birth and age 3 years; a total of 3254 children with CP were included in the final analysis. Hierarchical logistic regression models were used to estimate the odds ratio for the risk factors of CP. RESULTS: The hierarchical logistic regression models indicated that significant risk factors associated with CP are suburban location, low income, maternal and paternal diabetes mellitus, paternal substance abuse, paternal seizure disorder, male sex, birth by Cesarean section, singleton birth, low birthweight, being born extremely and very preterm, intraventricular hemorrhage, and periventricular leukomalacia, as well as tube feeding, ventilator use, and dopamine administration within 6 months of age. INTERPRETATION: In addition to common maternal and infant risk factors, we identified significant paternal risk factors associated with CP, including diabetes mellitus, seizure disorder, and substance abuse. The combination of maternal, paternal, and infant risk factors in CP holds great promise for early identification and intervention.

Mitochondrial Glutathione in Cellular Redox Homeostasis and Disease Manifestation.

Mitochondria are critical for providing energy to maintain cell viability. Oxidative phosphorylation involves the transfer of electrons from energy substrates to oxygen to produce adenosine triphosphate. Mitochondria also regulate cell proliferation, metastasis, and deterioration. The flow of electrons in the mitochondrial respiratory chain generates reactive oxygen species (ROS), which are harmful to cells at high levels. Oxidative stress caused by ROS accumulation has been associated with an increased risk of cancer, and cardiovascular and liver diseases. Glutathione (GSH) is an abundant cellular antioxidant that is primarily synthesized in the cytoplasm and delivered to the mitochondria. Mitochondrial glutathione (mGSH) metabolizes hydrogen peroxide within the mitochondria. A long-term imbalance in the ratio of mitochondrial ROS to mGSH can cause cell dysfunction, apoptosis, necroptosis, and ferroptosis, which may lead to disease. This study aimed to review the physiological functions, anabolism, variations in organ tissue accumulation, and delivery of GSH to the mitochondria and the relationships between mGSH levels, the GSH/GSH disulfide (GSSG) ratio, programmed cell death, and ferroptosis. We also discuss diseases caused by mGSH deficiency and related therapeutics.

The influence of psychosocial work environment, personal perceived health and job crafting on nurses' well-being: a cross-sectional survey study.

BACKGROUND: The World Health Organization urged governments to prioritize the health and work well-being of nursing staff by promoting a positive working environment. A safe and healthy physical and psychosocial work environment is a basic human right for nurses. Job crafting is a necessary skill when facing challenging working conditions. OBJECTIVES: This cross-sectional correlational research based on the Job Demands-Resources Model aimed to explore the correlation between psychosocial work environment and work well-being among nurses working in the intensive care unit (ICU) and determine whether personal perceived health could mediate the relationship and whether job crafting can moderate the mediating effect. The study hypothesized that: 1. The psychosocial work environment would impact nurses' work well-being; 2. Personal perceived health would play a role as a mediator in the relationship between psychosocial work environment and work well-being; 3. Job crafting would moderate the relationship between personal perceived health and work well-being. METHODS: A total of 655 registered nurses (RNs) from 7 ICUs in a teaching hospital in Beijing participated in this study. The RNs completed a battery questionnaire measuring their health, psychosocial work environment, well-being, and job crafting. PROCESS macros analysis was used to test mediating and moderating effects. RESULTS: Personal perceived health mediated the relationship between psychosocial work environment and work well-being (b = 0.012, 95% CI [0.008, 0.016]). The moderated mediated analysis revealed that job crafting moderated perceived health's impact on work well-being (b = -0.007, 95% CI [- 0.010, - 0.003]). CONCLUSION: A better psychosocial work environment with well-designed work organization and job content through job crafting could positively impact nurses' health and work well-being.

[Sleep Strategies for Shift Work Nurses].

To meet the demands of a 24/7 society, shift work is necessary. Shift work is outside the traditional regular 9-to-5 work schedule, is characterized by irregular working hours, and exists in various industries. However, this abnormal working time can disrupt the natural day and night rhythm, and if poorly adjusted, it can lead to shift work sleep disorder (SWSD). SWSD is associated with multiple health risks, including impaired cognitive function, increased risk of accidents, and various metabolic and cardiovascular diseases. The frontline nurses typically work shifts to provide comprehensive patient care. This article aims to discuss sleep physiology, apply existing literature to discuss the impact on nurses resulting from shift work, and further offer strategies to regulate sleep to promote physical and mental health. These strategies range from organizational interventions (e.g., optimizing shift schedules) to individual interventions (e.g., lifestyle changes) and the use of chronobiological techniques (e.g., light therapy) to promote the adjustment of circadian rhythms, etc.

Targeting EGFR in Combination with Nutritional Supplements on Antitumor Efficacy in a Lung Cancer Mouse Model.

Selenium (Se) and fish oil (FO) exert anti-epidermal growth factor receptor (EGFR) action on tumors. This study aimed to compare the anti-cancer efficacy of EGFR inhibitors (gefitinib and erlotinib) alone and in combination with nutritional supplements of Se/FO in treating lung cancer. Lewis LLC1 tumor-bearing mice were treated with a vehicle or Se/FO, gefitinib or gefitinib plus Se/FO, and erlotinib or erlotinib plus Se/FO. The tumors were assessed for mRNA and protein expressions of relevant signaling molecules. Untreated tumor-bearing mice had the lowest body weight and highest tumor weight and volume of all the mice. Mice receiving the combination treatment with Se/FO and gefitinib or erlotinib had a lower tumor volume and weight and fewer metastases than did those treated with gefitinib or erlotinib alone. The combination treatment exhibited greater alterations in receptor signaling molecules (lower EGFR/TGF-ß/TßR/AXL/Wnt3a/Wnt5a/FZD7/ß-catenin; higher GSK-3ß) and immune checkpoint molecules (lower PD-1/PD-L1/CD80/CTLA-4/IL-6; higher NKp46/CD16/CD28/IL-2). These mouse tumors also had lower angiogenesis, cancer stemness, epithelial to mesenchymal transitions, metastases, and proliferation of Ki-67, as well as higher cell cycle arrest and apoptosis. These preliminary results showed the Se/FO treatment enhanced the therapeutic efficacies of gefitinib and erlotinib via modulating multiple signaling pathways in an LLC1-bearing mouse model.

Early Intervention for Preterm Infants and Their Mothers: A Systematic Review.

This systematic review evaluates the efficacy of various early interventions on maternal emotional outcomes, mother-infant interaction, and subsequent infant outcomes during neonatal intensive care unit admission and postdischarge. Key interventions associated with outcomes in both the neonatal intensive care unit and postdischarge (ie, home) settings are summarized. A comprehensive search of peer-reviewed randomized controlled trials involving early interventions for infants and their mother published between 1993 and 2013 in the electronic databases PubMed, CINAHL, EMBASE, PsychINFO, and Cochrane was undertaken. Methodological quality was assessed using the PEDro scale to evaluate internal and external validity of the study. Twelve randomized controlled trials were included in the review, and all used some form of parenting education. The interventions had limited effects on maternal stress and mother-infant interaction and positive effects on maternal anxiety, depressive symptoms, and maternal coping. There were positive effects on infants' short-term outcomes for length of stay and breast-feeding rate. Positive and clinically meaningful effects of early interventions were seen in some physiological/psychological outcomes of mothers and preterm infants. It is important for nurses to foster close mother-infant contact and increase maternal competence during and after the infant's hospitalization period.

4-Acetylantroquinonol B Inhibits Osteoclastogenesis by Inhibiting the Autophagy Pathway in a Simulated Microgravity Model.

Astronauts suffer from 1-2% bone loss per month during space missions. Targeting osteoclast differentiation has been regarded as a promising strategy to prevent osteoporosis in microgravity (µXg). 4-acetylantroquinonol B (4-AAQB), a ubiquinone from Antrodia cinnamomea, has shown anti-inflammatory and anti-hepatoma activities. However, the effect of 4-AAQB on µXg-induced osteoclastogenesis remains unclear. In this study, we aimed to explore the mechanistic impact of 4-AAQB on osteoclast formation under µXg conditions. The monocyte/macrophage-like cell line RAW264.7 was exposed to simulated µXg (Rotary Cell Culture System; Synthecon, Houston, TX, USA) for 24 h and then treated with 4-AAQB or alendronate (ALN) and osteoclast differentiation factor receptor activator of nuclear factor kappa-B ligand (RANKL). Osteoclastogenesis, bone resorption activity, and osteoclast differentiation-related signaling pathways were analyzed using tartrate-resistant acid phosphatase (TRAP) staining, actin ring fluorescent staining, bone resorption, and western blotting assays. Based on the results of TRAP staining, actin ring staining, and bone resorption assays, we found that 4-AAQB significantly inhibited µXg-induced osteoclast differentiation. The critical regulators of osteoclast differentiation, including nuclear factor of activated T-cells cytoplasmic 1 (NFATc1), c-Fos, and dendritic cell-specific transmembrane protein (DC-STAMP), were consistently decreased. Meanwhile, osteoclast apoptosis and cell cycle arrest were also observed along with autophagy suppression. Interestingly, the autophagy inhibitors 3-methyladenine (3-MA) and chloroquine (CQ) showed similar effects to 4-AAQB. In conclusion, we suggest that 4-AAQB may serve as a potential agent against µXg-induced osteoclast formation.

Parent supervision attributes profile questionnaire (PSAPQ) for young children: psychometric properties of the Chinese version.

BACKGROUND: In China, thousands of children die from unintentional injury each year: the incidence rate of injury is from 19.4 to 64.3% which is the leading cause of mortality for children. An important factor to injury may be inadequate supervision. Thus, a linguistic and culturally appropriated, validated instrument to measure the supervision of children in Chinese primary caregiver is important and necessary. The purpose of this study was to translate and test the psychometric properties of the Chinese version of the Parent Supervision Attributes Profile Questionnaire (C-PSAPQ). METHODS: This is a two-phase study. In phase I, the C-PSAPQ was produced by for- and back-ward translation. A total of 296 primary caregivers of 3-6 years old children were invited to participate in the second phase of the psychometric study. In order to assess the reliability of the C-PSAPQ, internal consistency and test-retest methods were performed. Additionally, construct validity was examined by using confirmatory factor analysis (CFA). The averaged variance extracted (AVE) and Bootstrap were used to test the convergent and to discriminate validity. The concurrent validity was assessed by evaluating the association between the self-reported C-PSAPQ and naturalistic observations. RESULTS: The Cronbach's α and intraclass correlation coefficients were acceptable for the C-PSAPQ and four subscales. The CFA supported a 4-factor loading model; however, the convergent validity was not acceptable (AVE < .5 for two subscales). The concurrent validity was supported. CONCLUSIONS: Due to the unacceptable convergent validity of the C-PSAPQ, an exploratory factor analysis is needed to ensure that the same trait is measured by its indicators in different cultures.

From organisational support to second victim-related distress: Role of patient safety culture.

AIM: This cross-sectional correlation study aimed to explore the associations among patient safety culture, organisational support, second victim-related distress, absenteeism and turnover intentions in the registered nurses (RNs) by using structural equation modelling. BACKGROUND: Medical errors could cause RNs' second victim-related distress, which may either positively or negatively impact patient safety culture. METHOD: The Hospital Survey on Patient Safety Culture (HSOPSC) and Second Victim Experience and Support Tool (SVEST) were used to investigate 267 RNs who were involved in direct patient care and medical errors within the previous year in China. RESULTS: About half (45.3%) of nurses experienced psychological distress, and 26.6% of the nurses intended to leave. The model showed that 6 dimensions of patient safety culture have contributed to decreasing absenteeism and turnover intention via increased organisational supports and decreased second victim-related distress. CONCLUSION: The second victim-related distress may be relieved, and organisational support may be enhanced through improvements in patient safety culture. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies are needed to establish an environment where cooperation/cooperative relationships between the supervisor and the staff nurse can be ensured.

A prediction model of sleep disturbances among female nurses by using the BP-ANN.

AIM: To describe sleep disturbances and fatigue among female registered nurses in Beijing and to develop a prediction model for sleep disturbances. BACKGROUND: Chinese nurses are required to work rotating shifts on a weekly basis, which could negatively impact their sleep and well-being. METHOD: A total of 647 registered nurses participated in this study. Self-reported sleep-related data and selected physiological data were collected. Back propagation artificial neural networks was used to develop the prediction model by using the risk management and population health framework. RESULTS: Majority of them reported clinically significant poor sleep (69.4%) and fatigue (75.4%). A total of eight predictors were identified for sleep disturbances, and the top four normalized importance predictors are morning fatigue (100%), body mass index (30.5%), gastrointestinal symptoms (17.6%) and drinking caffeinated beverages at work (17.3%). The cross-entropy error was 206.58, and the model accounted for 77.6% of the variance in sleep disturbances. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: Female registered nurses in China experience clinically significant sleep disturbances. Morning fatigue severity along with seven significant influencing factors may be used to identify shift nurses who face a higher risk of sleep disturbances. The back propagation artificial neural networks model could be used as the foundation for health promotion interventions for registered nurses.

Psychometric evaluation of a Chinese version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema in women with gynaecological cancer surgery.

The prevalence of lower limb lymphoedema and its impact in gynaecological cancer patients is underestimated. However, a valid and reliable scale to measure lower leg lymphoedema in Taiwan has not been available. The purpose of the study was to translate the English version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema into a Chinese version (Lymph-ICF-LL-C), and evaluate the psychometric properties of the Lymph-ICF-LL-C in Taiwanese women with gynaecological cancer surgery. A total of 170 women with gynaecological cancer surgery were recruited to examine the Lymph-ICF-LL-C. The Lymph-ICF-LL-C shows satisfactory internal consistency (Cronbach's alphas ≥ 0.84) and stability test-retest reliability (Intraclass correlation coefficient ≥0.55-0.90) at a 2-week interval. Exploratory factor analysis showed that 68.53% of the total variance was explained by a five-factor solution. The concurrent validity of the Lymph-ICF-LL-C was evidenced by a significant correlation with a fatigue scale (r = 0.46, p < 0.01) and with the bilateral difference of lower limb circumference (r = 0.24-0.36, all p < 0.01). The Lymph-ICF-LL-C can be used for assessing the life impact of lower limb lymphoedema, allowing appropriate interventions to prevent further deterioration and complications.

Protective Effects of Rhodiola Crenulata Extract on Hypoxia-Induced Endothelial Damage via Regulation of AMPK and ERK Pathways.

Rhodiola crenulata root extract (RCE) has been shown to possess protective activities against hypoxia both in vitro and in vivo. However, the effects of RCE on response to hypoxia in the endothelium remain unclear. In this study, we aimed to examine the effects of RCE in endothelial cells challenged with hypoxic exposure and to elucidate the underlying mechanisms. Human umbilical vein endothelial cells were pretreated with or without RCE and then exposed to hypoxia (1% O2) for 24 h. Cell viability, nitric oxide (NO) production, oxidative stress markers, as well as mechanistic readouts were studied. We found that hypoxia-induced cell death, impaired NO production, and oxidative stress. These responses were significantly attenuated by RCE treatment and were associated with the activation of AMP-activated kinase and extracellular signal-regulated kinase 1/2 signaling pathways. In summary, we showed that RCE protected endothelial cells from hypoxic insult and suggested that R. crenulata might be useful for the prevention of hypoxia-associated vascular dysfunction.

Rhodiola crenulata extract counteracts the effect of hypobaric hypoxia in rat heart via redirection of the nitric oxide and arginase 1 pathway.

BACKGROUND: Rhodiola crenulata is traditionally used as a folk medicine in Tibet for preventing high-altitude illnesses, including sudden cardiac death (SCD). The cardio-protective effects of Rhodiola crenulata root extract (RCE) against hypoxia in vivo have been recently confirmed. However, the way in which RCE produces these effects remains unclear. The present study is designed to confirm the protective effects of RCE on the heart in acute hypobaric hypoxia exposure and examine the mechanisms by which this occurs. METHODS: Sprague-Dawley (SD) rats were pretreated with or without RCE and then exposed to a simulated altitude of 8000 m in a hypobaric hypoxia chamber for 9 h. The expression of cardiac arginase 1 (Arg-1) and endothelial nitric oxide synthase (eNOS) and the activity of associated signaling pathways was examined. RESULTS: Hypoxia reduced cardiac eNOS phosphorylation and increased Arg-1 expression, but both responses were reversed by RCE pre-treatment. In addition, RCE decreased the hypoxia-induced oxidative stress markers of reactive oxygen species (ROS) production, malondialdehyde (MDA) level, and protein carbonyl content. Furthermore, RCE protected cardiomyocytes from hypoxia-induced cardiac apoptosis and restored the phosphorylation level of AKT and p38 MAPK as well as the superoxide dismutase 2 (SOD2) content in hypoxic animals. CONCLUSION: The findings provide evidence that the effects of Rhodiola crenulata against altitude illness are partially mediated by modulation of eNOS and Arg-1 pathways in the heart.

In Vitro Anticancer Activity and Structural Characterization of Ubiquinones from Antrodia cinnamomea Mycelium.

Two new ubiquinones, named antrocinnamone and 4-acetylantrocamol LT3, were isolated along with six known ubiquinones from Antrodia cinnamomea (Polyporaceae) mycelium. The developed HPLC analysis methods successfully identified eight different ubiquinones, two benzenoids, and one maleic acid derivative from A. cinnamomea. The ubiquinones 1-8 exhibited potential and selective cytotoxic activity against three human cancer cell lines, with IC50 values ranging from 0.001 to 35.883 µM. We suggest that the different cytotoxicity levels were related to their chemical structures, especially the 4-hydroxycyclohex-2-enone ring and the presence of a free hydroxyl group in the side chain. The suppression by 4-acetylantrocamol LT3 stopped the cell cycle at the beginning of the G2-M phase thus making the cell cycle arrest at the sub-G1 phase as compared with control cells.

Neonatal ICU System Safety: A Pilot Test for Medication Error by Using Fuzzy Grey Relational Analysis.

This study analyzed risk factors for medication/near-miss errors in the neonatal intensive care unit by using Grey Relational Analysis based on self-incident reports from staff nurses. The ASSESS-ERR Medication System Worksheet was used. A total of 156 medication/near-miss errors were found across 5 stages of the medication use process. The order prescribing stage had the most errors. The highest systemic risk factors were critical drug information missing; environmental, staffing, and workflow problems; and lack of staff education.

Unintentional childhood injury: a controlled comparison of behavioral characteristics.

BACKGROUND: Childhood injury is a major public health problem around the world and those injuries have negative impacts on children and their families. The purpose of this study was to compare the behavioral characteristics between Chinese school-age children (6 to 11 years of age) with and without unintentional injuries and to identify behavioral risk factors for school-age children with unintentional injury. METHODS: This cross-sectional predictive study was conducted in five elementary schools in Daqing, China. The Achenbach Child Behavior Checklist (CBCL) was used to assess the children's behavioral characteristics. A total of 725 school-age children were screened. Of these, 116 children who had experienced unintentional injury in the past year were recruited as the study group, and 123 children who had not experienced an unintentional injury were randomly selected and assigned to the control group. RESULTS: The total scores of CBCL in the study group children were significantly higher than those in the control group. The significant behavior disorder predictors for unintentional injury in boys were schizoid behavior problem (OR = 2.43), anxiety/depression (OR = 2.76) and hyperactive (OR = 2.42). The predictors for unintentional injury in girls were anxiety/depression (OR = 2.12) and delinquent behavior (OR = 2.81). CONCLUSIONS: Children with behavior disorders are more likely to suffer from unintentional injuries. Teachers and pediatricians should identify the behavior disorders and assist parents to help children, thereby reducing the rate and severity of injuries.

Rhodiola crenulata extract regulates hepatic glycogen and lipid metabolism via activation of the AMPK pathway.

BACKGROUND: Metabolic syndrome may lead to many complications, such as nonalcoholic fatty liver disease (NAFLD). A natural and effective therapeutic agent for patients with NAFLD is urgently needed. In a previous study, we showed that Rhodiola crenulata root extract (RCE) regulated hepatic gluconeogenesis through activation of AMPK signaling. However, the manner in which RCE regulates hepatic lipid and glycogen metabolism remains unclear. The current study was conducted to investigate the effects of RCE on hepatic glycogen and lipid metabolism, as well as the mechanisms underlying such effects. METHODS: Human hepatoma HepG2 cells were treated with RCE for 6 h under high glucose conditions, after which glycogen synthesis, lipogenesis, and relative gene expression were examined. In addition, lipogenesis-related genes were investigated in vivo. RESULTS: RCE significantly increased glycogen synthesis and inhibited lipogenesis, while regulating genes related to these processes, including glycogen synthase kinase 3ß (GSK3ß), glycogen synthase (GS), fatty acid synthase (FAS), CCAAT/enhancer-binding protein (C/EBP), and sterol regulatory element-binding protein 1c (SREBP-1c). However, the effects caused by RCE were neutralized by compound C, an AMPK antagonist. Further studies showed that expression levels of lipogenic genes decreased at the protein and mRNA levels in the rat liver. CONCLUSIONS: Our results demonstrate that RCE regulates hepatic glycogen and lipid metabolism through the AMPK signaling pathway. These results suggest that RCE is a potential intervention for patients with NAFLD.

Effects of wheelchair Tai Chi on physical and mental health among elderly with disability.

A 12-week Wheelchair Tai Chi 10 Form (WTC10) intervention was conducted among elderly with disability to examine the effect of this WTC10 intervention on selected physical and mental health variables. Thirteen (age 87.23 ± 6.71) in the WTC10 intervention group and 15 (age 89.73 ± 6.31) in the control group completed the study. Independent t-tests and paired t-tests were employed to examine the differences between groups and within groups, respectively, at pretest and post-test. The WTC10 intervention group showed significant improvements in systolic and diastolic blood pressure, shoulder external rotation, left trunk rotation and total trunk rotation after the intervention. A 12-week WTC10 intervention had positive effects on blood pressure, range of motion at the shoulder and trunk, physical activity, and mental health among the elderly with disability. WTC10 is a feasible and safe exercise for the elderly with disability.

Effect of virtual reality on upper extremity function in children with cerebral palsy: a meta-analysis.

PURPOSE: To systematically examine the effect of virtual reality (VR) on upper extremity (UE) function in children with cerebral palsy (CP) and assess the association among VR effects and children's characteristics and an intervention protocol. METHOD: A systematic literature search was conducted in PubMed, CINAHL, Cochrane, and PsycINFO up to June 2013. Research studies involving children with CP that used VR as the intervention method and UE outcome measures were included. RESULTS: The search yielded 14 research articles, including 3 randomized controlled trials and 11 case series. Overall, VR provided a strong effect size (d = 1.00) when comparing pre- and postintervention. In subgroup analyses, younger children receiving home-based or laboratory-based VR and using an engineer-built VR system showed better improvement. CONCLUSIONS AND IMPLICATIONS: Virtual reality is a viable tool to improve UE function in children with CP. However, a more vigorous research design is needed to make a conclusive recommendation.

Depressive symptoms, sleep-wake features, and insomnia among female students: The role of rumination.

Depression symptoms are prevalent among nursing students, especially those in Asia. This study assessed the association between rumination and depression symptoms among female nursing students (N = 148) and the chain mediation role of sleep-wake indexes and insomnia symptoms. The data were collected from a battery of questionnaires and consecutive 7-day actigraphy data for analyzing sleep-wake indexes. About 54.1% of the participants had either mild or moderate depression symptoms. Most students (89.2%) had a delayed circadian phase, and circadian activity rhythm (CAR) was not ideal. The path mediation model underwent analysis using the PROCESS macros. The results showed that rumination in students is directly positively correlated with depressive symptoms (b = 4.831). Moreover, the association between rumination and depressive symptoms is sequent (moderating effect = 0.12, 95% CI [0.017, 0.410]). The proposed model in this study provides a foundation for improving educational programs on sleep hygiene and promoting mental wellness.