Symptom profiles in patients receiving maintenance hemodialysis and their association with quality of life: a longitudinal study.

PURPOSE: Many patients receiving maintenance hemodialysis experience one or multiple symptoms. Using a latent profile analysis to identify symptom profiles may provide insights for person-centered symptom management strategies. METHODS: This is a longitudinal study based on data from patients receiving maintenance hemodialysis at three hospitals in Shanghai, China. Of the 448 patients who completed the surveys at baseline (T1), 309 completed the 12-month follow-up survey (T2). Symptoms and quality of life were measured by the Chinese version of Kidney Disease Quality of Life 36 Short Form. The optimal classification of symptoms was identified using latent profile analysis. RESULTS: Five symptom profiles were identified: High (9.2%), Fatigue and Gastrointestinal (7.1%), Fatigue and Skin (10.7%), Skin (23.2%), and Low (49.8%). The high-symptom profile and the-fatigue-and-skin-symptom profile were associated with a lower level of physical functioning, a higher burden of kidney disease, and more negative effects of kidney disease than the low symptom profile at T1 and T2. Multivariate regression analysis showed that the high-symptom profile predicted a poorer physical functioning at T2, and the-fatigue-and-skin-symptom profile predicted a poorer physical functioning and higher burden of kidney disease at T2. CONCLUSION: Patients receiving maintenance hemodialysis reported unique symptom experiences which could be classified into different profiles. Patients reporting an overall high level of symptoms or a high level of fatigue and skin symptoms were more likely to have a poorer quality of life.

Subjective rather than objective patient death experiences link with physicians' and nurses' professional quality of life.

BACKGROUND: Patient deaths are impactful events for professional caregivers in both their professional and personal lives. The present study aims to explore how both subjective and objective patient death experiences are related to various aspects of professional quality of life (ProQOL) among physicians and nurses. METHODS: Secondary analyses of cross-sectional data were conducted, and 306 Chinese physicians and nurses whose most recent patient death experience was more than one month prior were included. Objective and subjective patient death experiences were measured based on the number of past patient deaths and the Accumulated Global Changes (AGC) subscale of the Professional Bereavement Scale, respectively. ProQOL was measured with the Professional Quality of Life Scale. Regressions were run following bivariate analyses. RESULTS: The number of past patient deaths was not significantly linked with any of the three ProQOL scores in either the bivariate analyses or regressions. Meanwhile, higher AGC scores were associated with higher burnout, secondary traumatic stress, and compassion satisfaction scores after participants' age, occupation (physician/nurse), department, work experience, job commitment, and sense of mission were controlled. CONCLUSION: Subjective rather than objective past patient death experiences link significantly with all three aspects of physicians' and nurses' ProQOL. The more professional caregivers think that they have been changed by all past patient deaths in their career, the more they experience burnout and secondary traumatic stress, but, the more satisfied they are with their job and the helping itself.

Estimating the value of sodium-glucose cotransporter-2 inhibitors within the context of contemporary guidelines and the totality of evidence.

AIMS: To comprehensively estimate the cost-effectiveness of sodium glucose cotransporter-2 (SGLT2) inhibitor usage in the management of type 2 diabetes mellitus (T2DM) at established clinical review points, incorporating the totality of proven health benefits. MATERIALS AND METHODS: This study considered the cardio- and reno-protective effects of SGLT2 inhibitors using the Cardiff type 2 diabetes model. Conventional cost-effectiveness evaluations were undertaken for eligible populations at relevant intensification points reflecting the 2022 guidelines versus the 2015 National Institute of Health and Care Excellence (NICE) guidelines; incremental cost-effectiveness ratio lifetime trajectories and timepoints for complete cost-offset were estimated for each pathway. Treatment effects, utility decrements and costs (applied additively and discounted at 3.5%) were sourced from the published literature. RESULTS: For all subpopulations on treatment pathways reflecting the NG28-2022 guidelines, SGLT2 inhibitor introduction was cost-effective, becoming cost-saving between 2 and 16 years post-initiation. Despite increases in pharmacy costs, predicted lifetime costs were lower than for pathways reflecting the NG28-2015 guidelines, driven by a reduction in heart failure hospitalization and chronic kidney disease costs. Incremental gains in quality-adjusted life years (ranging from 0.58-1.12) resulted in dominance for the updated NG28-2022 guidance in all scenarios. CONCLUSIONS: Our results show that SGLT2 inhibitors have the potential to lower healthcare costs while improving health outcomes in eligible patient subpopulations.

Trajectory of glycated haemoglobin over time, using real-world data, in type 2 diabetes patients with obesity on a U-100 basal-bolus insulin regimen.

AIMS: To identify patient clusters with poor glucose control among type 2 diabetes mellitus (T2DM) patients with obesity who are receiving basal-bolus insulin and to identify the potential therapeutic inertia factors associated with poor control. METHODS: Glycated haemoglobin (HbA1c) trajectories across a 3-year period were structured at 6-month intervals for a retrospective cohort of T2DM patients with obesity on basal-bolus insulin from the Veterans' Health Administration database. Based on each patient's longitudinal HbA1c features, an unsupervised clustering procedure was used to determine the numbers of clusters and associated trajectory patterns. Multinomial logistic regression was used to examine the association between HbA1c trajectory clusters and patient characteristics/treatment patterns. RESULTS: A total of 51 273 patients were included, of whom 11.2% were in a subgroup with persistent missingness of HbA1c values. For those with sufficient HbA1c observations, cluster analysis indicated six distinct HbA1c trajectories: stable low (35.8%); stable high (20.8%); descending low (10.5%); ascending low (10.2%); descending high (5.7%); and ascending high (5.7%). Being of Black ethnicity, not initiating noninsulin antihyperglycaemic agents (sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists or thiazolidinediones) or concentrated insulin, low adherence (measured by proportion of days covered), and reduced insulin prescription refills were factors associated with poorer HbA1c clusters; similar factors were associated with persistent HbA1c missingness. CONCLUSION: The present study found the potential for therapeutic inertia among a significant proportion of T2DM patients with obesity on basal-bolus insulin. Subgrouping T2DM patients based on HbA1c missingness and HbA1c trajectories can inform disease management strategies.

Patient engagement during the transition from nondialysis-dependent chronic kidney disease to dialysis: A meta-ethnography.

INTRODUCTION: Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis-dependent chronic kidney disease (CKD) to dialysis-dependent treatment. This systematic review employs meta-ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis-dependent CKD to dialysis. METHODS: A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta-ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of 'patient engagement' during the transition to dialysis. RESULTS: A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision-making and engagement in self-care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources. CONCLUSIONS: The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels. PATIENT OR PUBLIC CONTRIBUTION: The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future.

Small Zoom Mismatch Adjustment Method for Dual-Band Fusion Imaging System Based on Edge-Gradient Normalized Mutual Information.

Currently, automatic optical zoom setups are being extensively explored for their applications in search, detection, recognition, and tracking. In visible and infrared fusion imaging systems with continuous zoom, dual-channel multi-sensor field-of-view matching control in the process of synchronous continuous zoom can be achieved by pre-calibration. However, mechanical and transmission errors of the zoom mechanism produce a small mismatch in the field of view after co-zooming, degrading the sharpness of the fusion image. Therefore, a dynamic small-mismatch detection method is necessary. This paper presents the use of edge-gradient normalized mutual information as an evaluation function of multi-sensor field-of-view matching similarity to guide the small zoom of the visible lens after continuous co-zoom and ultimately reduce the field-of-view mismatch. In addition, we demonstrate the use of the improved hill-climbing search algorithm for autozoom to obtain the maximum value of the evaluation function. Consequently, the results validate the correctness and effectiveness of the proposed method under small changes in the field of view. Therefore, this study is expected to contribute to the improvement of visible and infrared fusion imaging systems with continuous zoom, thereby enhancing the overall working of helicopter electro-optical pods, and early warning equipment.

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China. / è¶ æœªæˆç†ŸåŒèƒŽå„¿ä¸´åºŠæ•‘æ²»ç»“å±€åŠå˜åŒ–åˆ†æžï¼šä¸€é¡¹å¹¿ä¸œçœå¤šä¸­å¿ƒå›žé¡¾æ€§ç ”ç©¶.

OBJECTIVES: To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China. METHODS: A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups. RESULTS: Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05). CONCLUSIONS: There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Patient-reported outcomes in a study of human regular U-500 insulin delivered by continuous subcutaneous insulin infusion or multiple daily injections in patients with type 2 diabetes.

Human regular U-500 insulin (U-500R) provides both basal and prandial coverage to people with diabetes. As part of the VIVID study, we studied patient-reported outcomes (PRO) of U-500R delivered by multiple daily injections (MDI, n = 211) and continuous subcutaneous infusion using a novel U-500R pump (CSII, n = 209). Treatment-Related Impact Measure for Diabetes (TRIM-D) for Diabetes Device (TRIM-DD) questionnaires were administered at weeks 0, 14 and 26. TRIM scores with effect sizes (ES) for within-group and between-group change were reported. All TRIM-D scores significantly improved from baseline for both groups (P < .001). The Diabetes Management domain had the greatest improvement, 16.3 (ES = 0.85) and 10.6 (ES = 0.51) for CSII and MDI, respectively. At the study end, the CSII group had significantly higher TRIM-D scores than the MDI group (P < .05). Most TRIM-DD scores had small within-group improvements and were not different between groups. People with type 2 diabetes on U-500R by either CSII or MDI reported improvement in PRO, particularly in Diabetes Management, Treatment Burden and Psychological Health domains, with greater improvement in the CSII group. In terms of delivery device and function, the CSII and MDI methods were similarly acceptable.

The cross-lagged association between depressive symptoms and health-related quality of life in patients receiving maintenance hemodialysis: a three-wave longitudinal study.

PURPOSE: To examine the cross-lagged relationship between depressive symptoms and health-related quality of life (HRQoL) in patients receiving maintenance hemodialysis. METHODS: A longitudinal, observational study was conducted in two public hospitals in Shanghai, China. The sample consisted of 204 patients at baseline (T1). Of these, 144 completed the 12-month follow-up survey (T2), and 135 completed the 24-month follow-up survey (T3). Depressive symptoms were assessed using the depression subscale of the Hospital Anxiety and Depression Scale, and HRQoL was assessed using the Kidney Disease Quality of Life 36 short form. Cross-lagged path analysis was used to examine the temporal relationship between depressive symptoms and domains of health-related quality of life. RESULTS: Lower levels of three out of five domains of HRQoL (physical functioning, burden of kidney disease, and symptoms of kidney disease) at T1 were associated with increases in depressive symptoms at T2. Moreover, higher depressive symptoms at T2 were associated with decreases in four domains of HRQoL (mental functioning, burden of kidney disease, symptoms of kidney disease, and effects of kidney disease) at T3. CONCLUSIONS: Patients who had poor HRQoL were more likely to report more subsequent depressive symptoms, which in turn predict lower HRQoL over time. It indicates a need to break this cycle in patients receiving maintenance hemodialysis.

Treatment Patterns and Outcomes, Before and After Humulin R U-500 Initiation, Among High-Dose Type 2 Diabetes Mellitus Patients in the United States.

OBJECTIVE: Severely insulin-resistant type 2 diabetes (T2D) patients face unique treatment challenges. Humulin R U-500 (U-500R) as insulin monotherapy with both basal/bolus properties addresses these challenges, although it remains understudied. This retrospective study compared real-world patient characteristics, treatment patterns, and outcomes before and after U-500R initiation. METHODS: Adults with T2D on dispensed doses of >180 units/d U-500R monotherapy (index date=first fill) with ≥9-month continuous enrollment both pre- and post-index date and ≥180 units/d insulin pre-index were identified using Veterans Health Administration data (January 1, 2014-January 30, 2017). Overall group was further stratified into elderly and 201 to 300 units dispensed total daily dose (dTDD) subgroups. Syringe and KwikPen users were separately analyzed as subcohorts. Treatment patterns (dTDD), insulin dosage (units/kg), proportion of days covered (PDC) with insulins, and outcomes (HbA1c and hypoglycemic events) were descriptively evaluated, with regression models used to confirm associations between exposure and outcomes. RESULTS: Among 951 U-500R initiators (overall group), mean dTDD (248.5 vs 392.1), percentage of patients with insulin dosage >2 units/kg (38.6% vs 88.1%), and mean PDC (73% vs 77%) significantly increased from the pre- to post-index periods (all P<.001). Changes in HbA1c (9.3% vs 8.5%; P<.0001) and hypoglycemia events per patient per year (2.1 vs 3.1, P<.0001) were statistically significant and confirmed by regression models (P<.0001). Subgroups (elderly, 492; 201 to 300 units, 148) and device subcohorts (syringe, 714; KwikPen, 244) showed similar trends. CONCLUSION: U-500R initiation was associated with significantly improved treatment compliance patterns and glycemic control, with modest increase in hypoglycemia events.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework.

Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen's d: 0.37-0.89), a small reduction in perceived barriers (Cohen's d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen's d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.

Acceptance and Commitment Therapy for psychological and behavioural changes among parents of children with chronic health conditions: A systematic review.

AIMS: To systematically identify the application of Acceptance and Commitment Therapy among parents of children with chronic health conditions and determine its effectiveness in parental psychological flexibility, psychological distress and parenting behaviour. DESIGN: Systematic review. DATA SOURCES: Nine databases (i.e. MEDLINE, PubMed, Embase, Cochrane Library, CINAHL, PsychINFO, Web of Science, China National Knowledge Infrastructure and WanFang Data) were systematically searched from inception to October 2019. REVIEW METHODS: Quality of studies was appraised by using the Joanna Briggs Institute critical appraisal checklist. Findings were synthesized narratively. This work was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. RESULTS: Eight studies involving 485 parents were included. Results indicated that Acceptance and Commitment Therapy significantly improved parental psychological flexibility and reduced psychological distress compared with usual care and waitlist, but was not significantly different from active treatments. Limited studies have provided very preliminary evidence that Acceptance and Commitment Therapy can significantly improve dysfunctional parenting behaviour than usual care and waitlist. High attrition rate at follow-up made the overall confidence of maintained effect relatively low. CONCLUSION: This review provides preliminary evidence that Acceptance and Commitment Therapy is beneficial for improving psychological flexibility, psychological distress and parenting behaviour among parents of children with chronic health conditions. Future studies with rigorous designs and large sample sizes are warranted to verify the evidence and explore its long-term efficacy. IMPACT: Acceptance and Commitment Therapy has been increasingly applied to parents of children with chronic health conditions. This review provides positive evidence of its effects on psychological and behavioural outcomes among these parents. This work will help healthcare professionals and researchers with their practice and further research.

Microbiome Links Cigarette Smoke-Induced Chronic Obstructive Pulmonary Disease and Dietary Fiber via the Gut-Lung Axis: A Narrative Review.

Existing comprehensive management strategies for COPD effectively relieve the symptoms of patients, delay the deterioration of lung function, and prevent the progression of COPD through various means and multidisciplinary interventions. However, there has been limited progress in therapies that address the underlying causes of COPD pathogenesis. Recent studies have identified specific changes in the gut and pulmonary microbiota in response to exposure to smoke that can cause or exacerbate CS-COPD by regulating the inflammatory immune response in the lungs through the gut-lung axis. As a convenient and controllable intervention, modifying the diet to include more dietary fiber can effectively improve the prognosis of CS-COPD. Gut microbiota ferment dietary fiber to produce short-chain fatty acids, which connect the microbial communities in the lung and gut mucosa across the gut-lung axis, playing an anti-inflammatory and immunosuppressive role in the lungs. Given that the effect of dietary fiber on gut microbiota was highly similar to that of quitting smoking on gut microbiota, we assume that microbiota might be a potential therapeutic target for dietary fiber to alleviate and prevent CS-COPD. This study examines the similarities between pulmonary and gut microbiota changes in the presence of smoking and dietary fiber. It also highlights the mechanism by which SCFAs link pulmonary and gut microbiota in CS-COPD and analyzes the anti-inflammatory and immunomodulatory effects of short-chain fatty acids on CS-COPD via the gut-lung axis.

Treatment Patterns, Adherence, and Persistence Associated With Human Regular U-500 Insulin: A Real-World Evidence Study.

OBJECTIVE | Human regular U-500 insulin (U-500R) is concentrated insulin with basal and prandial activity that can be used as insulin monotherapy. The goal of this study was to better understand treatment patterns (total daily dose [TDD] and concomitant medications), adherence, and persistence in real-world patients treated with U-500R. DESIGN AND METHODS | We selected patients from the Truven Health MarketScan database who initiated U-500R between 2010 and 2013. We collected data for three periods: pre-index (12 months before initiation), post-index (12 months after initiation or until a gap of ≥60 days in U-500R claims), and follow-up (12 months after post-index). Data were analyzed using descriptive statistics and a regression model as appropriate. RESULTS | We identified 1,582 patients who met the selection criteria. The median TDD of U-500R during the post-index period was 333 units/day, with 70.0% of patients using 300-400 units/day. During the post-index period, 74.1% of patients had U-500R claims that did not overlap with prescriptions for other insulins, interpreted as U-500R monotherapy. Among patients with ≥1 U-500R fill in the post-index period (n = 1,208), 54.4% had a medication possession ratio (MPR, a measure of adherence) ≥80%. Although 849 patients had a gap of ≥60 days in U-500R claims in the post-index period, 602 of those resumed U-500R in the follow-up period. Of the 733 patients who had no gap in U-500R claims in the post-index period, 286 had a gap of ≥60 days in claims in year 2, and 447 continued with U-500R treatment beyond 2 years. CONCLUSION | These results demonstrate that U-500R was commonly used as insulin monotherapy, with a median TDD >300 units/day. Compared with published, relevant studies of other insulins, U-500R showed similar or greater adherence and persistence rates. These new data may help guide clinical decision-making when choosing insulin therapy for patients requiring high doses of insulin.

Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008-2017.

BACKGROUND: An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province. METHODS: A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008-2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed. RESULTS: During 2008-2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival. CONCLUSIONS: Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.

Physical Activity Intensity and Biopsychosocial Correlates in Chinese Middle-Aged and Older Adults With Chronic Kidney Disease.

BACKGROUND: The study aims to characterize physical activity (PA) participation by intensity and examine the biopsychosocial correlates among middle-aged and older adults with CKD in China. METHOD: Data are examined from the 2011 China Health and Retirement Longitudinal Study. RESULTS: The percentages of participation in vigorous, moderate, and light activity among participants with CKD were 22.7%, 42.1%, and 76.3%, respectively. Participants were less likely to engage in vigorous and moderate PA if they were 70 years of age or older, not married/partnered, unemployed, lived in urban areas, had advanced disease stage, had heart disease, and/or experienced mobility limitations. The magnitude of associations between biophysical factors and PA participation was small for light PA. CONCLUSION: The higher the intensity of regular PA, the less likely older adults with CKD were to participate; Practitioners could consider the psychosocial characteristics of the older adults with CKD and facilitate their participation in PA.

Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients.

PURPOSE: The purpose of this study is to examine the effect of financial burden, using objective and subjective indicators, on the health-related quality of life (HRQOL) in lung cancer patients. METHOD: A total of 227 patients diagnosed with lung cancer (from the inpatient unit of the department of internal medicine-chest oncology, in Shanghai Chest Hospital, China) participated in the study. Financial information was measured by direct medical costs, direct nonmedical costs, healthcare-cost-to-income ratio, and perceived financial difficulty. HRQOL was measured using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. FINDINGS: Catastrophic health spending, defined as a healthcare-cost-to-income ratio of more than 40%, was reported in 72.7% of the participants, whereas 37.0% reported that healthcare costs exceeded annual household income. Financial difficulty was perceived in 83.7% of the participants. Patients whose healthcare costs exceeded their annual household income and who perceived financial difficulty reported a clinically meaningful difference in overall HRQOL (> 6 points on the FACT-L) compared with participants without catastrophic health spending or perceived financial difficulty. Healthcare costs did not show a significant effect on HRQOL. CONCLUSION: Healthcare costs exceeding total annual household income and perceived financial difficulty are associated with poorer HRQOL in lung cancer patients. Subjective indicator of financial burden has a stronger effect on quality of life than objective indicators. IMPLICATION: Health-cost-to-income ratio and perceived financial difficulty can be implied as objective and subjective indicators of financial burden to identify the patients who may need additional assistance. Communication on deciding on cost-effective treatments can be facilitated.

Hand-foot-mouth disease and use of steroids, intravenous immunoglobulin, and traditional Chinese herbs in a tertiary hospital in Shantou, China.

BACKGROUND: In contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-CDC), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management. Their use and therapeutic efficacies are, however, unclear. We aimed to describe their use in and the clinical outcomes of hospitalized HFMD cases. METHODS: A retrospective review of hospital medical records for HFMD cases during 2008-2016 was conducted in a medical school-affiliated tertiary hospital in Shantou, Guangdong, China. RESULTS: Hospitalized children with the discharge diagnosis of HFMD (n = 3778), comprising mild (58.4%), severe (41.5%), and very severe (0.1%) cases, were enrolled in the study. Steroids, IVIG, and antiviral TCH Lan-Qin were respectively prescribed in 60.5, 37.1, and 71.0% of cases. Most cases (99.8%) recovered and six died. Recovery rate was lower with the use of IVIG and higher with Lan-Qin (alone or in combination with steroid) in the mild cases (Ps < 0.05). Longer hospital stay was observed with steroid/IVIG with or without Lan-Qin in the severe cases (Ps < 0.05). CONCLUSIONS: This nine-year retrospective review shows 1) an increase in the incidence of HFMD as well as the use of steroids, IVIG, and TCH over time, 2) no significant advantage of using steroids and IVIG, either alone or in combination, in the management of mild HFMD cases, and 3) a higher recovery rate in mild HFMD cases with the use of antiviral TCH (Lan-Qin). Our findings need verification in a larger prospect study with cases from hospitals in other regions of China. Lan-Qin efficacy should be evaluated in randomized trials. Meanwhile, caution should be exercised in the extensive use of steroids and IVIG in HFMD management.

NS1 of H7N9 Influenza A Virus Induces NO-Mediated Cellular Senescence in Neuro2a Cells.

BACKGROUND/AIMS: The novel avian H7N9 influenza A virus has been detected in brain tissues and associated with central nervous system (CNS) symptoms in infected human and mice. Roles of its virulence factor, NS1 protein in influenza virus infected neuron has yet to be explored. METHODS: Nitric oxide (NO) release and inducible nitric oxide synthase (iNOS) expression in H7N9/NS1-expressed Neuro2a cells were detected by Griess test and western blotting. Cell proliferation rate of H7N9/NS1-expressing cells was recorded by Cell Counting Kit-8. Effects of H7N9/NS1 on cellular senescence were investigated by senescence-associated ß-galactosidase (SA-ß-gal) staining, immunofluorescent staining of phosphorylated heterochromatin protein 1γ (pHP1γ) and qPCR analysis of IL-6 and IL-8. RESULTS: H7N9/NS1 in Neuro2a cells and primary cultured mouse cortical neurons increased the expression of iNOS and boosted NO release. Neuro2a cells constitutively expressing NS1 displayed a reduced proliferative ability, enhanced SA-ß-gal staining, increased level of IL-6 and IL-8 and a typical punctuate structure of pHP1γ in nuclei. In addition, p38 MAPK was elevated in NS1-expressing Neuro2a cells. Reduced iNOS expression and subdued cellular senescence effect was found in p38 MAPK inhibitor-treated NS1-expressing Neuro2a cells. CONCLUSION: Our results suggest that H7N9/NS1 protein increases the iNOS expression and NO release in Neuro2a cells, which can induce cell growth arrest and cellular senescence.

Posttraumatic Stress Symptoms and Posttraumatic Growth in Children and Adolescents Following an Earthquake: A Latent Transition Analysis.

This study examined the transitions in classes of posttraumatic stress symptoms and posttraumatic growth in a sample of children and adolescents (N = 757), between 8 and 20 months after the 2013 Ya'an earthquake in China. Using latent profile analysis, three classes of symptoms (resilient, thriving, and struggling) were identified at 8 and 20 months after the earthquake. Latent transition analysis indicated that the majority of survivors remained in the same class during the period, while others showed a transition between different classes over time. The transition was mainly characterized by three paths: from struggling to resilient, and from thriving to either resilient or struggling. Of the survivors who were classified as thriving at 8 months, those transitioning to the struggling class at 20 months were more likely to experience higher levels of loss and injury compared with those transitioning to the resilient class (Cohen's d = 0.72) or remaining in the thriving class (Cohen's d = 0.36) at 20 months postearthquake. Survivors who remained stable in the struggling class were older than those who remained stable in the thriving class (Cohen's d = 0.41) or those who moved from thriving at 8 months to resilient at 20 months after the earthquake (Cohen's d = 0.39). It is recommended that clinicians consider the classes of posttraumatic stress symptoms and posttraumatic growth, and the potential development paths and associated factors, when implementing interventions for children and adolescents after a natural disaster.