Exploration of adaptation process and experience among the HIV/AIDS patients based on the comprehensive task-based adaptation model. / 基于综合任务模型探索HIV/AIDSæ‚£è€ çš„ç–¾ç— é€‚åº”è¿‡ç¨‹å’Œä½“éªŒ.

OBJECTIVES: Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) confront multiple difficulties during the disease adaptation process. Based on the comprehensive task-based adaptation model, this study aims to explore the process and experience of adapting to living with HIV among HIV/AIDS patients and to provide evidence for promoting the adaptation of this population. METHODS: With the design of the phenomenon study, we purposefully recruited 43 HIV/AIDS patients and conducted semi-structural interviews. The qualitative data was analyzed by Van Manen method. RESULTS: There were 1 307 significant quotes and 6 themes with 14 sub-themes. "The shadow comes along with the sunshine" was proposed to describe the process of adapting to life with HIV. Another 5 themes emerged to represent the tasks as follows: the direction of the mental anchor, the management of physical tasks, social network and support, the occupational dilemma and benefits, and the consideration of the future. CONCLUSIONS: The adapting process possesses both common and personalized characteristics. Future intervention development should address the integrality and interaction of the adaptation tasks, contributing to the positive adaptation outcomes of HIV/AIDS patients.

Ways of coping mediate the relationship between self-efficacy for managing HIV and acceptance of illness among people living with HIV.

AIM: The purpose of this study was to examine the relationship between self-efficacy for managing HIV and acceptance of illness and to identify the potential mediation effect of active coping and passive coping on this relationship. DESIGN: The study used a cross-sectional survey. METHODS: A sample of 555 people living with HIV were recruited from September-December 2018 in the HIV clinic of a tertiary general hospital in Changsha, China. Survey data were collected through face-to-face interviews that included measures of sociodemographic and HIV-related clinical characteristics, Acceptance of Illness Scale, the Simplified Coping Style Questionnaire and the Self-efficacy for Managing Chronic Disease Scale. Step-by-step linear regression models combined with bootstrap testing were used to test the relationships when controlling for gender and HIV diagnosis duration. RESULTS: Self-efficacy was positively related to acceptance of illness and this relationship was partially mediated by both active coping and passive coping. Acceptance of illness increased by 0.175 for every point increase in self-efficacy indirectly through active coping, while acceptance of illness decreased by 0.034 for every point increase in self-efficacy via passive coping. CONCLUSION: The findings highlighted the importance of self-efficacy for managing HIV and ways of coping, especially active coping, for illness acceptance. IMPACT: The findings suggested that interventions that improve confidence in managing HIV and active coping may enhance the illness acceptance of people living with HIV.

Patient safety culture and obstacles to adverse event reporting in nursing homes.

AIMS: To investigate patient safety culture and its relationship with obstacles to adverse event reporting in Chinese nursing homes. BACKGROUND: Reporting obstacles are related to high incidences and unreported rates of adverse events. Patient safety culture is also associated with adverse events. However, the relationship between reporting obstacles and patient safety culture in nursing homes is unclear. METHODS: A cross-sectional survey was conducted with a random sampling method among 549 staff members in six nursing homes using instruments of the Nursing Home Survey on Patient Safety Culture and the Adverse Event Reporting Obstacle Scale. The Pearson correlation coefficient, independent t tests, ANOVA tests and multivariate regression analysis were used. RESULTS: Patient safety culture in nursing homes was associated with facility ownership (p < .001), facility scale (p < .001), reporting management (p < .001), whether it was an integrated care institution (p = .006), frequency of concern about patient safety (p = .001), occurrence of adverse events in departments (p = .001) and a punitive atmosphere (p = .044). Adverse event reporting obstacles were negatively correlated with patient safety culture (p < .05). CONCLUSION: An improvement in patient safety culture was associated with a reduction in reporting obstacles in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT: A barrier-free adverse event reporting system should be built to reduce reporting obstacles and create a non-punitive patient safety culture in nursing homes.

The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust.

AIMS: To test a path model evaluating the influence of cultural competence of nurses on patient satisfaction and the mediating role of patient trust. BACKGROUND: In China, there has been an increase in medical disputes, which at times has resulted in physical assaults on healthcare providers. Enhanced patient satisfaction may reduce disputes and can perhaps be bolstered by the improved cultural competence of providers. DESIGN: A cross-sectional path analytic research design was used. METHODS: A random sample of 583 hospitalized patients recruited from six tertiary comprehensive hospitals in Changsha, China in 2016 completed a face-to-face structured questionnaire. Measures included the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set, the Wake Forest Physician Trust Scale, the Patient Satisfaction with Primary Nurses Scale and the Patient Overall Satisfaction with the Hospital Scale. RESULTS: Significant associations among cultural competence of nurses, patient satisfaction and patient trust were confirmed, and path analyses supported the proposed mediating role of patient trust. Furthermore, the cultural competence subscales of communication-positive behaviours, trust-building behaviours and shared decision-making were positively and significantly correlated with patient satisfaction. CONCLUSION: Findings suggest interventions should be designed to improve nurse's cultural competence, especially in the domains of communication-positive behaviours, trust-building behaviours and shared decision-making, and trust, to improve patient satisfaction.

[Status and influencing factors of rush poppers use and HIV infection among men who have sex with men in Changsha].

OBJECTIVE: To explore the relationship between use of rush poppers and HIV infection, and associated factors among men who have sex with men in Changsha. METHODS: A cross-sectional study was conducted in Changsha from April to December, 2014. Men who have sex with men who came for HIV counseling and testing services were invited to fill out a survey. A total of 608 MSM were finally recruited. The survey included socio-demographic characteristics, sexual roles, sexual behaviors in last 6 months and rush poppers use, HIV infection among MSM. After finishing the questionnaire, 5 ml blood was also drawn for HIV testing. Chi-square test or Fisher probabilities was used to compare usage of rush poppers and HIV antibody positive rate among MSM who had different characteristics and sexual behaviors. Multi-factor unconditioned logistic regression model was used to explore related factors about rush poppers use and HIV infection of MSM. RESULTS: Among 608 MSM, 29.8% (181) said they ever used rush poppers, and 13.3% (81 cases) were HIV positive. Among MSM who ever used rush poppers, 18.8% (34/181) were HIV positive; While among those who never used rush poppers, 10.5% (45/427) were HIV positive (χ(2)=7.65,P=0.006). Compared with MSM who had no For One Night sex in the last 6 months,OR (95% CI) value of MSM who had 6-10 times For One Night sexes in last 6 months to use rush poppers was 4.32 (1.77-10.57). Compared with MSM who self-identified as top,OR (95% CI) value of MSM who self-identified as bottom or versatile using rush poppers were 2.99 (1.53-5.86), or 3.60 (2.13-6.09). Compared with MSM who self-identified as top, OR (95% CI) value of MSM who self-identified as bottom or versatile to infect HIV were 3.19 (1.35-7.58), or 2.33 (1.12-4.85). Compared with MSM who used condoms at every anal sex,OR (95% CI) value of MSM who used condoms sometimes or never used to infect HIV were 1.93 (1.12-3.35) or 1.87 (0.64-5.50). Compared with MSM who never used rush poppers,OR (95% CI) value of MSM who ever used rush poppers to infect HIV was 1.88 (1.12-3.16). CONCLUSION: A large percentage of MSM population in Changsha used rush poppers, and HIV antibody positive rate among MSM was high. MSM who had more frequencies of For One Night sexes, self-identified as bottom or versatile were more likely to use rush poppers and more susceptible to HIV infection. In addition, MSM who had low frequency of condom use in the last 6 months in anal intercourse were more likely to infect HIV.

Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review.

PURPOSE: in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. METHODS: A literature search was conducted in PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid, and the Cochrane Library following the PRISMA-ScR statement. All original studies (n = 9) investigating transition interventions in CCSs were included. RESULTS: The current studies identified essential elements for transition programs, such as delivering knowledge, developing skills for coordination of care, and addressing psychosocial needs. However, the current transition interventions were generally in their infancy, and major deficits were found, including poorly reported intervention components and procedures, a limited number of relevant validated outcomes, and a failure to incorporate conceptual frameworks and international consensus statements. CONCLUSIONS: This scoping review mapped current evidence of transition interventions for CCSs and highlighted the paucity of data in this area. More high-quality and well-reported randomized controlled trials are needed for the enrichment and standardization of future transition interventions.

Status and factors associated with patient activation and its relationship with HIV clinic outcomes among Yi minority people living with HIV in Liangshan, China: a cross-sectional study.

Introduction: Patient activation is determined by an individual's knowledge, skills and confidence in managing his/her health. It is vital for people living with HIV (PLWH) to enhance their self-management skills and health outcomes, especially those from low- and middle-income regions, since they are at higher risk of worse health outcomes. However, literature from those regions is limited, especially in China. Objectives: This study aimed to explore the status and factors associated with patient activation among Yi minority PLWH in Liangshan, China and to determine whether patient activation is associated with HIV clinic outcomes. Methods: This cross-sectional study included 403 Yi minority people living with HIV in Liangshan between September and October 2021. All participants completed an anonymous survey measuring sociodemographic characteristics, HIV-related information, patient activation and illness perception. Multivariate linear regression and multivariate binary logistic regression were used to explore factors associated with patient activation and the association between patient activation and HIV outcomes, respectively. Results: The Patient Activation Measure (PAM) score was low (mean = 29.8, standard deviation = 4.1). Participants with negative illness perception, low income, and self-rated antiretroviral therapy (ART) effect based on self-perception were most likely to have a lower PAM score (ß = -0.3, -0.2, -0.1, respectively; all p < 0.05); those with having disease knowledge learning experiences and an HIV-positive spouse were more likely to have a higher PAM score (ß = 0.2, 0.2, respectively; both p < 0.001). A higher PAM score (AOR=1.08, 95% CI: 1.02, 1.14) was associated with viral suppression, mediated by gender (AOR=2.25, 95% CI: 1.38, 3.69). Conclusion: Low patient activation level among Yi minority PLWH impacts HIV care. Our findings indicate patient activation is associated with viral suppression for minority PLWH in low- and middle-income settings, suggesting that tailored interventions enhancing patient activation may improve viral suppression.

Perceptions toward antiretroviral therapy and delayed ART initiation among people living with HIV in Changsha, China: mediating effects of treatment willingness.

Introduction: Delayed antiretroviral therapy (ART) initiation is associated with poor HIV outcomes and a higher likelihood of HIV transmission. Methods: This cross-sectional study assessed the proportion of delayed ART initiation which was defined as initiating ART after 30 days of HIV diagnosis, and evaluated the pathways influencing ART initiation among adult PLWH in Changsha, China who were diagnosed between 2014 and 2022. Results: Of 518 participants, 37.8% delayed in initiating ART. Based on the theory of reasoned action (TRA), delayed initiation was indirectly associated with perceptions toward ART through the mediating pathway of patients' treatment willingness, with treatment willingness significantly being the full mediator. Discussion: The findings may guide the development of interventions to improve timely uptake of ART in people who are newly diagnosed with HIV.

Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis.

OBJECTIVE: HIV continues to be a global challenge. Key recommendations for HIV prevention and treatment are presented on rapid antiretroviral therapy (ART) initiation. However, several studies showed a high prevalence of delayed ART initiation. The aim of this systematic review and meta-analysis was to assess the prevalence of delayed ART initiation among HIV-infected patients globally. METHODS: This review summarised eligible studies conducted between January 2015 and August 2022 on the prevalence of delayed ART initiation in HIV-infected adults (age ≥ 15). Relevant studies were systematic searched through PubMed/Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases. Random-effects models were used to calculate pooled prevalence estimates. The heterogeneity was evaluated using Cochran's Q test and I2 statistics. Moreover, potential sources of heterogeneity were explored using univariate subgroup analysis. RESULTS: Data on the prevalence of delayed ART initiation was pooled across 29 studies involving 34,937 participants from 15 countries. The overall pooled prevalence of delayed ART initiation was 36.1% [95% confidence interval (CI), 29.7-42.5%]. In subgroup analysis, the estimated pooled prevalence decreased with age. By sex, the prevalence was higher among male patients (39.3%, 95% CI: 32.2-46.4%) than female (36.5%, 95% CI: 26.9-50.7%). Patients with high CD4 cell count were more likely to delay ART initiation than those with low CD4 cell count (>500cells/mm3: 40.3%; 201-500cells/mm3: 33.4%; and ≤200cells/mm3: 25.3%). CONCLUSIONS: Our systematic review and meta-analysis identified a high prevalence of delayed ART initiation. The prolonged time interval between diagnosis and treatment is a prevalent and unaddressed problem that should spur initiatives from countries globally. Further research is urgently needed to identify effective strategies for promoting the early ART initiation.

Sleep quality, social rhythms, and depression among people living with HIV: a path analysis based on social zeitgeber theory.

Background: People living with HIV frequently report sleep disturbances. The social zeitgeber theory, which proposes that stressful life events can interfere with sleep and even depression by destabilizing daily routines, provides new insights into identifying predictors of sleep disturbances and improving sleep in people living with HIV. Objective: To explain the pathways affecting sleep quality in people living with HIV based on social zeitgeber theory. Methods: A cross-sectional study was conducted to assess sleep quality, social rhythms, depression, social support, and coping styles from December 2020 to February 2021. The hypothetical model was tested and respecified by performing path analysis and a bias-corrected bootstrapping method using IBM AMOS 24 software. The report of this study followed the STROBE checklist. Results: A total of 737 people living with HIV participated in the study. The final model presented a good fit (goodness of fit = 0.999, adjusted goodness of fit index = 0.984, normed fit index = 0.996, comparative fit index = 0.998, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.030, chi-squared/degree of freedom = 1.646), explaining 32.3% of the variance in sleep quality among people living with HIV. Lower social rhythm stability was directly associated with poorer sleep quality, and depression mediated the relationship between social rhythms and sleep quality. Social support and coping styles affected sleep quality through social rhythms and depression. Limitation: The cross-sectional study design precludes making assumptions about causality among factors. Conclusion: This study validates and extends the applicability of the social zeitgeber theory in the HIV context. Social rhythms have direct and indirect effects on sleep. Social rhythms, sleep, and depression is not simply linked in a cascading sequence but is theoretically linked in a complex way. More studies are needed to explore the predictors of social rhythms, and interventions for stabilizing social rhythms have the potential to alleviate sleep disturbances and depression in people living with HIV.

Periodontal bone regeneration with a degradable thermoplastic HA/PLCL bone graft.

Strategic bone grafts are required to regenerate periodontal bone defects owing to limited self-healing. Current bioceramic particle or deproteinized bovine bone (DBB) products are not able to ideally meet clinical requirements, such as insufficient operability and slow degradation rates. Herein, a strong-interacted bone graft was designed and synthesized by modifying hydroxyapatite (HA) with a lactide-caprolactone copolymer (PLCL) to improve component homogeneity and mechanical properties. The physical-chemical analysis indicated that HA particles were homogenously distributed in HA/PLCL bone grafts, possessed outstanding thermoplasticity, and facilitated clinic operability and initial mechanical support. The in vitro study suggested that HA/PLCL bone graft degraded in a spatiotemporal model. Micropores were formed on the non-porous surface at the beginning, and interconnected porous structures were gradually generated. Furthermore, HA/PLCL bone grafts exhibited excellent biocompatibility and osteogenic ability as revealed in vitro cell culture and in vivo animal experiments. When applied to rat periodontal bone defects, the HA/PLCL bone graft showed a non-inferior bone regeneration compared to the commercial DBB. This study proposes a potential bone graft for periodontal bone repair with thermoplastic, spatiotemporal degraded, and osteogenic characteristics.

Perceived HIV risk and factors associated with condom use among women aged 40 and older: A cross-sectional survey.

Objectives: A noticeable increase in HIV-positive cases among women, particularly those of middle and old age, has been observed worldwide. This study aimed to describe women's perceived HIV risk, HIV/Acquired Immunodeficiency Syndrome (AIDS) knowledge, attitude, and sexual behaviors to determine factors associated with condom use among these women in Hunan, China. Methods: A cross-sectional study was conducted from July 2019 to August 2020 among 958 women aged 40 and older in four regions of Hunan, China. We collected data on sociodemographic characteristics, perceived HIV risk, HIV/AIDS knowledge and attitude, condom use, and sexual behaviors. Univariate and multivariate logistic regression were performed to identify factors related to condom use. Results: Out of 958 participants, 60.6% perceived no risk of HIV infection, and 46.8% reported they had never used a condom during their past sexual life. Those who were older, had lower monthly household income for family, had not received HIV education in the past year, were unwilling to use condoms, could not determine condom use during sexual activity, and had more negative attitudes towards HIV/AIDS and HIV-positive people were less likely to use condoms in their past sexual behaviors. Conclusions: In Hunan Province, most women aged 40 and older perceived themselves as having a low or no risk of HIV infection; their rate of condom use was low, and six factors were associated with condom use. It is imperative to strengthen HIV prevention and control programs among women aged 40 and above, particularly focusing on those who may use condoms infrequently or not at all.

Fibroblast ferroptosis is involved in periodontitis-induced tissue damage and bone loss.

Periodontitis causes inflammatory destructions of tooth-supporting tissue and constitutes a significant burden on public health. Failing to reserve the tissue damage and bone loss by any of the currently available therapies has left periodontitis uncurable thus far. Understanding the molecular mechanism in the inflammatory process is crucial to elucidating the pathogenesis and enlightening new therapeutic strategies for periodontitis. This study was to investigate whether and how ferroptosis, a newly-discovered form of cell death, was involved in the pathogenesis of periodontitis. Healthy and periodontitis human gingiva samples were collected and ligature-induced periodontitis murine models were constructed to investigate the role of ferroptosis in periodontitis. Single-cell RNA sequencing data was analyzed to identify the cell type that underwent ferroptosis. The susceptibility of human gingival fibroblasts to ferroptosis was investigated by in vitro cell cultures. We found that gingival fibroblasts undergo ferroptosis in periodontitis, and that periodontitis-induced tissue damage and bone loss were alleviated by inhibition of ferroptosis. Periodontitis-induced pro-inflammatory immune responses was featured by profound elevation of fibroblast-derived Interleukin-6, which was attenuated by ferroptosis inhibition. These results indicated fibroblast ferroptosis as a new clue to unveiling the cellular and molecular basis for periodontitis-induced tissue damage. Involvement of ferroptosis/Interleukin-6 signaling in the pathogenic process suggested a potential target for immunopharmacological approaches to curing periodontitis.

The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy.

HIV infection becomes a manageable disease, and self-management is one of the key indicators of achieving optimal health outcomes. Men who have sex with men (MSM) living with HIV face many psychosocial challenges when managing HIV infection, such as sexual minority pressure and HIV-related stigma. Higher perceived HIV-related stigma had been related to low self-management. However, the mechanisms underlying the association between HIV-related stigma and HIV self-management are unclear. Two possible mediators include social support and self-efficacy. This study aimed to examine the relationship between HIV-related stigma and HIV self-management among MSM living with HIV and to explore the single mediating effect of social support and self-efficacy and the chain mediating effect of these two variables on this relationship in China. Convenience sampling was used to recruit participants from the Center for Disease Control (CDC) in Changsha City, Hunan province, China. A total of 459 MSM living with HIV completed questionnaires regarding sociodemographic and disease-related information, HIV-related stigma, social support, self-efficacy, and HIV self-management. Descriptive statistics analysis, one-way ANOVA, independent t-tests, Pearson's bivariate correlation, and multiple regression were conducted using the SPSS v24.0. Process macro in SPSS was used to analyze the single and chain mediating effect among variables. Our findings showed that the indirect and total effect of HIV-related stigma on HIV self-management was significant, while the direct effect was not statistically significant. Social support and self-efficacy mediated the relationship between HIV-related stigma and HIV self-management, respectively. Moreover, the chain mediating model confirmed that the association between HIV-related stigma and HIV self-management was mediated by social support and self-efficacy sequentially. Future interventions focusing on improving HIV self-management among MSM living with HIV should consider a multi-faced approach.

The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV.

Background: Men who have sex with men (MSM) living with HIV suffer from psychosocial pressures and marginalization as a result of being HIV-positive and belonging to a sexual minority group, and self-injury or suicidal ideation are prevalent among this group. Studies have found that both perceived self-stigma and altered executive function is related to self-injury or suicidal ideation. However, the combined contribution of self-stigma and executive function to self-injury or suicidal ideation remains unclear, especially in MSM living with HIV. Therefore, this study is conducted to explore the mechanism of self-injury or suicidal ideation by hypothesizing that executive function plays a mediating role in the relationship between self-stigma and self-injury or suicidal ideation. Methods: We conducted a cross-sectional survey among 448 MSM living with HIV who were recruited in the HIV clinic of a tertiary general hospital in Changsha, China, from November 2021 to February 2022. A questionnaires survey was adopted to collect sociodemographic and disease-related information and data related to executive function (including working memory, inhibition, and task monitoring), self-stigma, and self-injury or suicidal ideation. Structural equation modeling and bootstrap testing were used to investigate the potential mediating role of executive function in the relationship between self-stigma and suicidal ideation. Results: The participants were aged 18-76 years. Those who had ever had self-injury or suicidal ideation accounted for 32.8% of the total. A higher level of self-stigma and poorer executive function were associated with more frequent self-injury or suicidal ideation (p < 0.01). The mediation model analysis showed a good fit (x 2/df = 1.07, p = 0.381). The direct effect of self-stigma on self-injury or suicidal ideation (ß = 0.346, p < 0.001) and the indirect effect of self-stigma via executive function (ß = 0.132, p < 0.001) were significant, with the indirect effect accounting for 27.6% of the total effect. Conclusions: This study demonstrates that executive function mediates the relationship between self-stigma and self-injury or suicidal ideation among MSM living with HIV. It suggests that future studies targeting enhancing executive function and decreasing self-stigma may reduce self-injury or suicidal ideation among MSM living with HIV.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus: A cross-sectional study.

Objectives: To explore the relationship between acceptance of illness and quality of life (QOL), and factors associated with acceptance of illness among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). Methods: Three hundred and one MSM were recruited from an HIV clinic between August and December 2018. The battery of measurements consisted of the Acceptance of Illness Scale, World Health Organization Quality of Life Questionnaire for HIV brief version, HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information. Pearson correlation test was used to examine the relationship between acceptance of illness and QOL. Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data (demographic and HIV-related clinical data) and HIV cognitive appraisal were associated with acceptance of illness levels. Results: Descriptive analysis showed the acceptance level among MSM living with HIV was moderate (Mean = 26.29, SD = 5.28). Those with a better acceptance of illness had a better QOL (r = 0.69, P < 0.01). In the multivariate ordinal logistic regression model, education level, threat appraisals (OR:1.09; 95%CI [1.06-1.13]), and controllability appraisals (OR: 0.82; 95%CI [0.71-0.94]) were significantly associated with acceptance of illness. Conclusions: Results showed acceptance level was moderate and had a positive correlation with QOL. High level of education, low threat appraisals and high controllability appraisals were related to high illness acceptance. This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

Polypharmacy, Medication-Related Burden and Antiretroviral Therapy Adherence in People Living with HIV Aged 50 and Above: A Cross-Sectional Study in Hunan, China.

PURPOSE: People living with HIV (PLWHIV) are susceptible to non-communicable diseases (NCDs) because of aging and infections. This means that the number of non-HIV medications increases, along with issues of polypharmacy and medication-related burden. The purpose of this study was to identify the current situation of polypharmacy and medication-related burden among PLWHIV aged 50 and above, as well as the relation between medication-related burden and antiretroviral therapy (ART) adherence. PATIENTS AND METHODS: A cross-sectional study was conducted with 185 participants recruited from two HIV clinics in Yuelu District Center for Disease Control (CDC) and Changsha First Hospital in Hunan, China. Participants filled questionnaires about comorbidities, polypharmacy, medication-related burden, ART adherence and sociodemographic characteristics. RESULTS: Among the participants, 40% were receiving polypharmacy, and PLWHIV, who were female (ß = 5.946; 95% CI = 1.354, 10.541), had a lower monthly income (ß = -4.777; 95% CI = -6.923, -2.632), and took more drugs (ß = 2.200; 95% CI = 1.167, 3.233) were more likely to report a higher level of medication-related burden. The score of ART adherence was negatively associated with medication-related burden (rs = -0.250 p = 0.001). CONCLUSION: The findings suggest that more attention should be paid to the issues of polypharmacy and targeted interventions should be developed to reduce medication-related burden among older PLWHIV.

Genetic and genomic nursing competency among nurses in tertiary general hospitals and cancer hospitals in mainland China: a nationwide survey.

OBJECTIVES: To explore genetic/genomic nursing competency and associated factors among nurses from tertiary general and specialist cancer hospitals in mainland China and compare the competencies of nurses from the two types of hospitals. DESIGN AND SETTING: A cross-sectional survey was conducted from November 2019 to January 2020, wherein 2118 nurses were recruited from 8 tertiary general hospitals and 4 cancer hospitals in mainland China. We distributed electronic questionnaires to collect data on nurses' demographics, work-related variables and genomic nursing competency. PARTICIPANTS: 2118 nurses were recruited via a three-stage stratified cluster sampling method. RESULTS: More than half (59.1%, 1252/2118) of the participants reported that their curriculum included genetics/genomics content. The mean nurses' genomic knowledge score was 8.30/12 (95% CI=8.21 to 8.39). Only 5.4% had always collected a complete family history in the past 3 months. Compared with general hospital nurses, slightly more cancer hospital nurses (75.6% vs 70.6%, p=0.010) recognised the importance of genomics, while there was no significant difference in the knowledge scores (8.38 vs 8.21, p>0.05). Gender (ß=0.06, p=0.005), years of clinical nursing (ß=-0.07, p=0.002), initial level of nursing education (ß=0.10, p<0.001), membership of the Chinese Nursing Association (ß=0.06, p=0.004), whether their curriculum included genetics/genomics content (ß=0.08, p=0.001) and attitude towards becoming more educated in genetics/genomics (ß=0.25, p<0.001) were significantly associated with the nurses' genomic knowledge score. CONCLUSION: The levels of genomic knowledge among mainland Chinese nurses in tertiary hospitals were moderate. The overall genomic competency of cancer hospital nurses was comparable to that of general hospital nurses. Further genomic training is needed for nurses in China to increase their genomic competency and accelerate the integration of genomics into nursing practice.

Prelimbic cortex miR-34a contributes to (2R,6R)-hydroxynorketamine-mediated antidepressant-relevant actions.

The ketamine metabolite (2R,6R)-hydroxynorketamine (HNK) has recently been suggested to exert fast-acting antidepressant-relevant actions and was proposed as an ideal next-generation antidepressant. However, the microRNA-mediated mechanism underlying its effects is still unknown. In the present study, we investigated the role of miR-34a in the prelimbic (PL) cortex during (2R,6R)-HNK-mediated antidepressant-like effects. Male (8-10 weeks old) C57BL/6J mice and primary hippocampal cultured neurons were employed. The tests of forced swimming, tail suspension, sucrose preference, and female urine sniffing were used as indices of depressive-like behaviors. (2R,6R)-HNK enhanced miR-34a levels in a time-dependent manner at 1, 24 h, and 3 days in vitro, in a time-dependent manner at 1 and 24 h, and in a dose-dependent manner at 10 and 30 mg/kg in PL. Pretreatment with NBQX or verapamil blocked (2R,6R)-HNK-enhanced miR-34a expression and NBQX pretreatment blocked AMPA-elevated miR-34a levels in vitro. AAV-miR-34a in PL produced antidepression-behavioral effects and rescued stress-induced depressive-like behaviors. Moreover, PL AAV-miR-34a increased the frequency and amplitude of miniature excitatory postsynaptic currents (mEPSCs) and potentiated evoked excitatory postsynaptic currents (EPSCs). Slices incubated with miR-34a mimic acutely enhanced the frequency and amplitude of mEPSCs in the PL. Intra-PL application of miR-34a rapidly produced antidepression-like effects and reversed stress-evoked depressive-like behaviors. Furthermore, intra-PL application of anti-miR-34a attenuated both systemic and local (2R,6R)-HNK-mediated antidepressant-like actions. Collectively, these results suggest that miR-34a in PL plays an antidepression-like role and contributes to the fast-acting antidepressant-relevant actions of (2R,6R)-HNK. The present study provides evidence for a miR-34a-dependent mechanism underlying the fast-acting antidepressant-like actions of (2R,6R)-HNK, indicating a novel role of PL miR-34a in antidepression.

Readiness for Hospital Discharge and Its Correlates Among People Living With HIV in Hunan, China: A Cross-sectional Study.

ABSTRACT: We aimed to (a) describe the readiness for hospital discharge in people living with HIV and (b) explore factors associated with readiness for hospital discharge. A cross-sectional survey was conducted at two infectious disease hospitals in Hunan, China, from May to November 2017. The readiness for hospital discharge scale (RHDS) was used to assess discharge readiness. The average item mean for the RHDS ranges from 0 to 10, and higher scores represent a higher level of readiness for hospital discharge. The mean score of the RHDS was 7.78 (95% confidence interval 7.586-7.968), and 27.6% of participants (n = 56/203) felt unready for discharge (RHDS <7). We found that older age, lack of medical insurance, lower self-rated health status, poorer quality of discharge teaching, and more severe depressive symptoms were significantly associated with a lower level of readiness for hospital discharge. Interventions are needed to improve readiness of people living with HIV for hospital discharge in Hunan, China, especially for those of advanced age, without medical insurance, with worse self-rated health status, and those with higher levels of depressive symptoms.