Improving mental health literacy using web- or app-based interventions: A scoping review.

Background: Given the rapid advancement in technology, the Internet has grown to play a significant role in the field of healthcare. Individuals can now access a profusion of easily available materials for self-management of their health. The purpose of this review is to describe Web/App-based interventions that are primarily or secondarily designed to improve mental health literacy (MHL) and to investigate the effectiveness of online interventions for improving mental health. Materials and Method: A scoping review was conducted by searching five databases: PsycINFO, EMBASE, PubMed, CINAHL, and Web of Science. The search was limited to peer-reviewed journals published in English between 2000 and 2022. Studies focusing on enhancements of MHL or its constituent components were included. Results: Twenty-four studies met the inclusion criteria. The interventions primarily targeted patients or individuals exhibiting symptoms of mental disorders, with a higher representation of female participants. All the interventions yielded positive outcomes. The included studies were categorized according to three themes: knowledge, attitude, and self-care skills. Although numerous studies have focused on knowledge improvement, research on interventions targeting self-care skills is scarce. Furthermore, existing literature on knowledge enhancement is limited in terms of the coverage of risk factors. Conclusion: This review indicates gaps in web/app interventions including limited evidence on risk factors, inconsistent help-seeking awareness, and inadequate self-care skills training. Further research is critically needed to address these deficiencies and promote comprehensive MHL.

Assessment of eHealth literacy to reduce financial toxicity and improve shared decision-making in cancer patients: A cross-sectional study.

Objectives: This study aimed to investigate the associations between eHealth literacy, preferences for financial decision-making, and financial toxicity (FT) in a sample of Chinese cancer patients. Methods: Eligible cancer patients were invited to participate in a cross-sectional survey from January to April 2021. Three measures (eHealth literacy scale, control preference scale, and COST) were used to analyze patients' eHealth literacy, decisional preferences, and FT, respectively. Wilcoxon signed-rank test and Kruskal-Wallis H test assessed the differences between population subgroups. Binary logistic and multivariate linear regression models were used to assess the relationships between eHealth literacy, decisional preferences, and FT. Results: A total of 590 cancer patients completed the questionnaire. We found that high FT was associated with poor ECOG performance, severe cancer stage, and longer cancer duration. Patients who preferred to adopt collaborative attitude toward decision-making showed a significantly higher eHealth literacy. However, there was an inverse relationship between eHealth literacy and a patient-driven attitude toward decision-making in female cancer patients. Regression analysis indicated that patients who were highly educated and actively employed might report a higher eHealth literacy. A significant relationship was found between high eHealth literacy and low FT. However, this relationship became insignificant when the background characteristics of cancer patients were taken into account. Conclusions: A relationship between enhanced eHealth literacy, preference for collaborative decision-making, and low risk of FT is identified. Practical implication: Interventions to improve patients' ability to use quality and reliable web-based information on cancer care should be encouraged.

Dioscorea nipponica Makino Relieves Ovalbumin-Induced Asthma in Mice through Regulating RKIP-Mediated Raf-1/MEK/MAPK/ERK Signaling Pathway.

Purpose: Dioscorea nipponica Makino (DNM) is a traditional herb with multiple medicinal functions. This study is aimed at exploring the therapeutic effects of DNM on asthma and the underlying mechanisms involving RKIP-mediated MAPK signaling pathway. Methods: An ovalbumin-induced asthma model was established in mice, which was further administrated with DNM and/or locostatin (RKIP inhibitor). ELISA was performed to detect the serum titers of OVA-IgE and OVA-IgG1, bronchoalveolar lavage fluid (BALF) levels of inflammation-related biomarkers, and tissue levels of oxidative stress-related biomarkers. The expression of RKIP was measured by quantitative real-time PCR, Western blot, immunohistochemistry, and immunofluorescence. HE staining was used to observe the pathological morphology of lung tissues. The protein expression of MAPK pathway-related proteins was detected by Western blot. Results: Compared with the controls, the model mice exhibited significantly higher serum titers of OVA-IgE and OVA-IgG1, BALF levels of IL-6, IL-8, IL-13, TGF-ß1, and MCP-1, tissue levels of MDA and ROS, lower BALF levels of IL-10 and IFN-γ, and tissue level of GSH. DNM relieved the allergic inflammatory response and oxidative stress in the model mice. DNM also recovered the downregulation of RKIP and the pathological injury of lung tissues in asthma mice. In addition, the Raf-1/MEK/MAPK/ERK pathway in the model mice was blocked by DNM. Silencing of RKIP by locostatin weakened the relieving effects of DNM on asthma through activating the Raf-1/MEK/MAPK/ERK pathway. Conclusion: DNM relieves asthma via blocking the Raf-1/MEK/MAPK/ERK pathway that mediated by RKIP upregulation.

A Network Pharmacology Approach to Reveal the Underlying Mechanisms of Rhizoma Dioscoreae Nipponicae in the Treatment of Asthma.

Background: In this study, network pharmacological methods were used to analyze the targets of Rhizoma Dioscoreae Nipponicae (RDN) and investigate the potential underlying mechanism of RDN in the treatment of asthma. Methods: Asthma-related targets were obtained from the GeneCards and DisGeNET databases. The bioactive components of RDN were obtained from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform database, and the targets of these compounds were predicted using the BATMAN-TCM database. The network of RDN component targets was constructed using Cytoscape. A protein-protein interaction (PPI) network was constructed in Cytoscape to determine the potential targets of RDN for the treatment of asthma. The hub genes of RDN in the treatment of asthma were screened using network topological parameters. Gene ontology (GO) and the KEGG pathways were analyzed. Molecular docking and in vivo experiments were performed to validate the network pharmacology results. Results: A total of four bioactive components and 55 targets were identified. The results of the enrichment analysis suggested that the treatment of asthma with RDN involved signaling pathways, such as those related to systemic lupus erythematosus, alcoholism, viral carcinogenesis, the cell cycle, prostate cancer, transcriptional misregulation in cancer, hepatitis B, thyroid hormone signaling, and PI3K-AKT signaling, as well as other signaling pathways. Molecular docking showed that the active components of RDN could stably bind to the predicted target. In vivo experiments showed that RDN could regulate the expression of target genes and inhibit the activation of the PI3K-AKT signaling pathway. Conclusion: To a certain extent, this study reveals the potential bioactive components and molecular mechanisms of RDN in the treatment of asthma and provides new insights for the development of new drugs for asthma.

Satisfaction With Patient Engagement and Self-Reported Depression Among Hospitalized Patients: A Propensity-Score Matching Analysis.

Background: Depression is common among hospitalized patients and poses a significant threat to their quality of life. Patient engagement (PE) in healthcare has been shown to be associated with positive health outcomes. However, the relationship between PE and depression among hospitalized patients, with and without chronic conditions, has not yet been explored. This study aimed to investigate the association between patients' satisfaction with PE and self-reported depression in Chinese public hospitals. Method: A multi-centered, cross-sectional survey was conducted in seven tertiary-level public hospitals in Guangdong province, China. Twelve items from a patient-centered care questionnaire and the Patient Health Questionnaire 2-item version were used were used to assess patients' satisfaction with PE and self-reported depression, respectively. Propensity score matching (PSM) approach was used to reduce selection bias and potential baseline differences between patients with and without chronic conditions. The relationship between satisfaction with PE and depression was assessed, using univariate and multivariate logistic regression analyses, respectively. Results: A total of 1,974 hospitalized patients participated in the survey. After the PSM procedure, 604 patients were assigned to the chronic condition group, and another 604 patients were successfully matched in the comparison group with no differences in sex, age, educational level, and PE-related characteristics. Univariate logistic regression analysis indicated that high satisfaction with PE-related approaches significantly decreased the probability of developing depressive status. Multivariate logistic regression analysis further indicated that, after adjusting all PE-related approaches, "patient education" and "involvement in discharge planning" could significantly decrease the probability of patients developing depression. Conclusions: Our results indicate that encouraging PE and improving patients' satisfaction with PE interventions in clinical practice led to improved mental health outcomes among hospitalized patients in China.

Urban-rural differences in financial toxicity and its effect on cancer survivors' health-related quality of life and emotional status: a latent class analysis.

OBJECTIVE: This study aimed to investigate the urban-rural differences in associations between financial toxicity (FT), physical health-related quality of life (HRQoL), negative emotional status, and the effect of patients' socioeconomic status and clinical and cost-related characteristics on the levels of FT in a sample of Chinese cancer survivors. METHODS: Data were obtained from a cross-sectional survey conducted by the oncology department at two tertiary level hospitals in China. The COmprehensive Score for financial Toxicity, Euroqol five-level instrument (EQ-5D), and Depression Anxiety Stress Scale - 21 (DASS-21) were used to measure patients' FT, physical HRQoL, and negative emotional status. A latent class analysis was used to identify patient subgroups with distinct symptom experiences based on self-reported data on symptom occurrence using the EQ-5D and DASS-21. RESULTS: Four distinct latent classes were identified: all low (47.6%); high physical and low psych (18.6%); low physical and high psych (17.1%); and all high (17.1%). Rural patients younger than 50 years showed a statistically significantly higher FT than urban patients. Rural patients who were male, highly educated, insured, first hospitalization, new cases, received surgery or immunotherapy, and had low cancer-related costs in all low classes showed a higher FT than urban patients. CONCLUSIONS: Rural patients with cancer suffered from higher FT than their urban counterparts, and the negative impact of psychological distress on FT was higher than that of physical HRQoL.

Investigating Medical Student's Preferences for Internet-Based Healthcare Services: A Best-Worst Scaling Survey.

Objective: This study aimed to investigate the importance of providing Internet-based healthcare services based on the preference of a sample of medical students in China. Methods: An online best-worst scaling (BWS) survey with Case 1 design was conducted. Balanced independent block design generated 12 choice task profiles for each participant to answer. Descriptive analysis was used to describe the respondents' characteristics; Multinomial and mixed logit regression methods were used to investigate the importance of Internet-based services based on respondents' preferences. Results: A total of 1,296 students completed the online survey and rated "Clinical Service," "Decision Aids," and "Public health" as the three most important services that should be provided through an Internet-based healthcare system. Providing "Medical Education" via the Internet was chosen as the least important service by the respondents. Subgroup analysis indicated that students studying clinical medicine and non-clinical medicine considered providing "Medical Education" and "Public Health," respectively, as more important services than others. Conclusions: This BWS study demonstrated that providing "Clinical Service," "Decision Aids," and "Public Health" through the Internet are the three most important services based on medical students' preferences in China. Further research is needed to investigate how to improve medical students' skills in using internet-based healthcare services in medical education programs.

Inpatients' Perception of Patient-Centered Care in Guangdong Province, China: A Cross-Sectional Study.

This study aimed to investigate the perceptions of patient-centered care (PCC) among inpatients in Guangdong Province (GD), China. Based on these perspectives, we sought to understand existing PCC practices in medical institutions and identify the impacts of inpatients' sociodemographic status on their perceived PCC. A self-developed PCC questionnaire was used to investigate inpatients' perceptions of PCC. A cross-sectional survey was conducted in nine tertiary-level hospitals across five cities in GD. Descriptive statistics was used to describe the levels of PCC in GD. The differences in PCC levels across different sociodemographic groups were assessed using analysis of variance and multivariate linear regression. Valid responses were provided by 1863 inpatients. The mean overall PCC score was 8.58 (standard deviation [SD] = 1.36); inpatients from the Pearl River Delta and eastern GD area reported significantly higher scores than those from western and northern GD area (P<.01). Inpatients from rural areas tended to report lower PCC scores than their urban counterparts. Among the PCC questionnaire sub-domains, inpatients scored highest and lowest in "patient experience" (mean = 8.96, SD = 1.34) and "medical insurance" (mean = 7.93, SD = 2.05), respectively. This study provided a comprehensive overview of inpatients' perceptions of PCC in the public healthcare system in GD, China. Our findings highlighted that a majority of inpatients were satisfied with the PCC in public healthcare system; however, a significant discrepancy between inpatients with different sociodemographic status remained.

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report.

BACKGROUND: An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis (ABPA). As ABPA is an allergic respiratory disease, immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators. However, eosinophilia in bronchoalveolar lavage fluid (BALF) has not been considered in the diagnostic criteria for ABPA. CASE SUMMARY: We present a case of ABPA in which the eosinophil count in peripheral blood was not increased, whereas the eosinophil percentage in BALF reached 60%. After antifungal and hormone therapy, imaging revealed very good resolution of lung infiltration. CONCLUSION: The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention, especially when the patient's clinical features lack specificity and the diagnostic parameters are negative.

The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study.

BACKGROUND: Although previous studies have shown that a high level of health literacy can improve patients' ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. OBJECTIVE: This study aims to assess the relationship between patients' eHealth literacy and their socioeconomic determinants and to investigate the association between patients' eHealth literacy and their SSDM and well-being. METHODS: The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients' eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients' background characteristics. RESULTS: A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM≥61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (ß=.22; P<.001) and well-being (ß=.26; P<.001) after adjusting for patients' demographic, socioeconomic status, lifestyle, and health status variables. CONCLUSIONS: This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients' depressive status may alter the relationship between eHealth literacy and SSDM.

The Relationship Between Decisional Regret and Well-Being in Patients With and Without Depressive Disorders: Mediating Role of Shared Decision-Making.

Background: The objectives of this study were two-fold: (1) to assess the relationship between patients' decisional regret and their well-being and (2) to examine the mediated effect of shared decision-making (SDM) on this relationship. Methods: A cross-sectional survey was conducted in five cities in Southern China. Patients were asked to fill out questionnaires assessing their decisional regret, SDM, subjective well-being, and depressive status. Mediation analysis was used to investigate the effect of SDM on the relationship between patients' decisional regret and their subjective well-being. Results: The findings showed significant direct negative effects of decisional regret on subjective well-being and SDM. For non-depressive patients, SDM exerted a significant and indirect effect on reducing the negative influence of decisional regret on subjective well-being. Conclusions: Findings suggest that implementation of SDM can decrease patients' decisional regret and improve their well-being; however, there is a need to examine their depressive status as part of routine healthcare.

A best-worst scaling survey of medical students' perspective on implementing shared decision-making in China.

BACKGROUND: The objective of this study was to ascertain the importance rankings of factors affecting the implementation of shared decision-making (SDM) in medical students in China and determine whether these factors were consistent across the respondents' individual characteristics. METHOD: Students studying clinical medicine were recruited from three medical universities in China. A cross-sectional online survey using best-worst object scaling with a balanced incomplete block design was adopted to investigate their preference towards implementing SDM in China. Count analysis, multinomial logit analysis and mixed logit analysis were used to estimate the preference heterogeneity of the SDM factors among respondents. RESULTS: A total of 574 medical students completed the online survey. The three most important factors for implementing SDM were trust and respect, (providing) high-quality medical information and multi-disciplinary collaboration. The mixed logit regression model identified significant heterogeneity in SDM preferences among respondents, and sub-group analysis showed that some heterogeneities varied in respondents by sex, study programs and their experience of visiting doctors. CONCLUSION: The importance rankings provide rich information for implementing SDM and facilitate the reform of education in medical schools in China. However, the heterogeneities in SDM preference need further explorations.

Psychometric Validation and Cultural Adaptation of the Simplified Chinese eHealth Literacy Scale: Cross-Sectional Study.

BACKGROUND: The rapid proliferation of web-based information on health and health care has profoundly changed individuals' health-seeking behaviors, with individuals choosing the internet as their first source of information on their health conditions before seeking professional advice. However, barriers to the evaluation of people's eHealth literacy present some difficulties for decision makers with respect to encouraging and empowering patients to use web-based resources. OBJECTIVE: This study aims to examine the psychometric properties of a simplified Chinese version of the eHealth Literacy Scale (SC-eHEALS). METHODS: Data used for analysis were obtained from a cross-sectional multicenter survey. Confirmatory factor analysis (CFA) was used to examine the structure of the SC-eHEALS. Correlations between the SC-eHEALS and ICEpop capability measure for adults (ICECAP-A) items and overall health status were estimated to assess the convergent validity. Internal consistency reliability was confirmed using Cronbach alpha (α), McDonald omega (ω), and split-half reliability (λ). A general partial credit model was used to perform the item response theory (IRT) analysis. Item difficulty, discrimination, and fit were reported. Item-category characteristic curves (ICCs) and item and test information curves were used to graphically assess the validity and reliability based on the IRT analysis. Differential item functioning (DIF) was used to check for possible item bias on gender and age. RESULTS: A total of 574 respondents from 5 cities in China completed the SC-eHEALS. CFA confirmed that the one-factor model was acceptable. The internal consistency reliability was good, with α=0.96, ω=0.92, and λ=0.96. The item-total correlation coefficients ranged between 0.86 and 0.91. Items 8 and 4 showed the lowest and highest mean scores, respectively. The correlation coefficients between the SC-eHEALS and ICECAP-A items and overall health status were significant, but the strength was mild. The discrimination of SC-eHEALS items ranged between 2.63 and 5.42. ICCs indicated that the order of categories' thresholds for all items was as expected. In total, 70% of the information provided by SC-eHEALS was below the average level of the latent trait. DIF was found for item 6 on age. CONCLUSIONS: The SC-eHEALS has been demonstrated to have good psychometric properties and can therefore be used to evaluate people's eHealth literacy in China.

Validation of the Toronto Empathy Questionnaire (TEQ) Among Medical Students in China: Analyses Using Three Psychometric Methods.

This study aimed to validate the simplified Chinese version of the Toronto Empathy Questionnaire (cTEQ) for use with the Chinese population. The original English version of the TEQ was translated into simplified Chinese based on international criteria. Psychometric analyses were performed based on three psychometric methods: classical test theory (CTT), item response theory (IRT), and Rasch model theory (RMT). Differential item functioning analysis was adopted to check possible item bias caused by responses from different subgroups based on sex and ethnicity. A total of 1296 medical students successfully completed the TEQ through an online survey; 75.2% of respondents were female and the average age was 19 years old. Forty students completed the questionnaire 2 weeks later to assess the test-retest reliability of the questionnaire. Confirmatory factor analysis supported a 3-factor structure of the cTEQ. The CTT analyses confirmed that the cTEQ has sound psychometric properties. However, IRT and RMT analyses suggested some items might need further modifications and revisions.

Doctor's Preference in Providing Medical Service for Patients in the Medial Alliance: A pilot Discrete Choice Experiment.

This cross-sectional survey study explored whether doctors in Guangdong, China preferred to provide extra healthcare services within the context of their medical alliances (MAs). Specifically, a discrete choice experiment (DCE) was conducted to investigate whether doctors preferred to provide extra services at low-tier hospitals within their MAs. A literature review, focus group interview, and expert group discussion resulted in three main attributes (i.e., working time, income, and hospital location) and corresponding levels, which were combined to create 24 profiles that were randomly presented to participants. A conditional logit model was then employed to calculate utility scores for all profiles. A total of 311 doctors completed the DCE questionnaire. The coefficients for each level within the three attributes were ordered and found to be statistically significant. Working time had the greatest influence on utility scores, increasing by one hour per week (beta = 1.4, odds ratio (OR) = 4.07, p < 0.001), followed by income, which increased by 30% per month (beta = 1.19, OR = 3.3, p < 0.001). The utility scores for all profiles ranged between -0.27 and 3.07. Findings indicated that participants made trade-offs with respect to providing extra services within their MAs. Furthermore, utility varied between different subpopulations.

Lysophosphatidic Acid is a Biomarker for Peritoneal Carcinomatosis of Gastric Cancer and Correlates with Poor Prognosis.

BACKGROUND: Peritoneal carcinomatosis (PC) is an important cause of morbidity and mortality among patients with gastric cancer. Thus, it is important to identify an ideal biomarker for PC. METHODS: Plasma and ascites samples were collected from gastric cancer patients with PC and a control group. Lysophosphatidic acid (LPA) levels were tested and analyzed. RESULTS: The plasma LPA levels of gastric cancer patients with PC were significantly higher than those in gastric cancer patients after radical resection (p = 0.046) and healthy volunteers (p < 0.001). Besides, plasma LPA levels were statistically lower after chemotherapy in gastric cancer patients with PC (p = 0.028). Furthermore, the ascites LPA levels were significantly higher in gastric cancer patients with peritoneal carcinomatosis than those in liver cirrhosis patients (p < 0.001). Moreover, ascites LPA levels were statistically lower after intraperitoneal chemotherapy injection than before (p < 0.001). In addition, the plasma LPA levels were significantly associated with serum CA125 levels (p = 0.032) and TNM stage in gastric cancer patients (p = 0.009). Individuals with plasma LPA levels >20,000 ng/mL had significantly worse overall survival (OS) than those with plasma LPA levels <20,000 ng/mL group (p = 0.006). In addition the group with ascites LPA levels >24,000 ng/mL showed significantly worse progression-free survival (PFS) and OS (p < 0.001 in PFS and OS). CONCLUSIONS: This study demonstrated that LPA levels in plasma and ascites may be useful diagnostic biomarkers for PC of gastric cancer and that higher levels are associated with poor prognosis.