The effects of Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes: a meta-analysis.

To explore the impact of the Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes(T2D) by a meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrance Library, EMBASE and four Chinese databases to identify RCTs that compared the Mediterranean diet with control diets in patients with T2D up to December 2021. The Risk of Bias of the included studies was assessed using the version 2 of the Cochrane risk-of-bias tools for randomized trials (ROB 2). Seven RCTs with 1371 patients met the eligibility criteria and entered into the meta-analysis. Compared to control diets, the beneficial effects of Mediterranean diet were not statistically significant in high-density lipoprotein (MD = 2.33; 95% CI: -0.27 to 4.92), low-density lipoprotein (MD = -2.34; 95% CI -5.67 to 0.99) and total cholesterol (MD = 2.60; 95% CI: -0.95 to 6.15). But Mediterranean diet led to reduce the level of diastolic blood pressure (MD = -1.20; 95% CI: -2.21 to -0.19) and systolic blood pressure (MD = -4.17; 95% CI: -7.12 to -1.22). Meanwhile, Mediterranean diet showed beneficial effects in glycemic control (HbA1[%]: MD = -0.39, 95% CI: -0.58 to -0.20; fasting plasma glucose: MD = -15.12, 95% CI: -24.69 to -5.55) and weight loss (BMI: MD = -0.71, 95% CI: -1.30 to -0.78; WC: MD = -1.69; 95% CI: -3.35 to -0.02) compared to the control diets. The meta-analysis presented evidence supporting the beneficial effects of the Mediterranean diet on blood pressure, glycemic control, and weight loss. However, the impact of the Mediterranean diet on the lipid profile was not found to be significant, warranting further verification. This Meta-analysis was registered on the INPLASY website (Registration number: INPLASY 202160096).

Relationship between family function, self-perceived burden and loneliness in patients with type 2 diabetes mellitus: a cross-lagged analysis.

AIMS: To explore the inter-predictive role and causal relationship between family functioning, self-perceived burden and loneliness in people with type 2 diabetes. METHODS: In this study, patients with type 2 diabetes admitted to two tertiary care hospitals in China were selected for an 8-month follow-up, and the patients' scores on the Family Functioning, Self-perceived Burden, and Loneliness scales were measured repeatedly at three time periods: during hospitalisation (T1), 1 month after discharge (T2), and 3 months after discharge (T3). RESULTS: The results showed that family function at the T1 time point had a negative predictive effect on self-perceived burden at the T2 time point, ß = - 0.43, P = 0.005. Loneliness at the T1 time point had a positive predictive effect on self-perceived burden at the T2 time point, ß = 0.08, P = 0.021. Unlike the pathway at time point T1, family functioning at time point T2 negatively predicted loneliness at time point T3, ß = - 0.32, P = 0.013. Loneliness at time point T2 positively predicted family functioning at time point T3, ß = 0.025, P = 0.013. Loneliness at time point T2 negatively predicted self-perceived burden at time point T3 (P = 0.011). CONCLUSIONS: The results of the cross-lagged analysis show that there is a mutually predictive and moderating relationship between family functioning and loneliness in patients with type 2 diabetes. Loneliness can predict the level of self-perceived burden at the next time point.

Identification of factors associated with fear of hypoglycemia using the capability, opportunity, motivation and behavior model in people with type 2 diabetes mellitus: a cross-sectional study.

AIMS: To examined the relationship between fear of hypoglycemia and certain variables in people with type 2 diabetes mellitus (T2DM) based on the Capability, Opportunity, Motivation, and Behavior model, combined with the context unique to people with diabetes to provide a basis for developing targeted nursing interventions. METHODS: In this cross-sectional study, 212 people with T2DM were recruited from February 2021 to July 2021. Data were collected using the Hypoglycaemia Fear Survey, Gold score, Patient Assessment of Chronic Illness Care (PACIC) scale and Diabetic Self-Management Attitudes Scale. Multiple linear regression analysis was performed to determine the predictors of fear of hypoglycemia using SPSS 26.0. RESULTS: The mean fear of hypoglycemia score was 74.88 ± 18.28 (range: 37.00-132.00). In people with T2DM, the frequency of blood glucose monitoring, the frequency of hypoglycemia in the past half-year, degree of understanding of hypoglycemia, impaired awareness of hypoglycemia, PACIC, and self-management attitude of diabetes were the influencing factors of fear of hypoglycemia (adjusted R2 = 0.560, F[21,190] = 13.800, P < 0.001). These variables explained 56.0% of the variance in the fear of hypoglycemia. CONCLUSIONS: The level of fear of hypoglycemia in people with T2DM was relatively high. In addition to paying attention to the disease characteristics of people with T2DM, medical staff should also pay attention to patients' own perception and handling ability of disease and hypoglycemia, attitude toward self-management behavior and external environment support, all of which have a positive effect on improving the fear of hypoglycemia in people with T2DM, optimizing the self-management level and improving quality of life.

The mediating effect of self-efficacy on the relationship between diabetes self-management ability and patient activation in older adults with type 2 diabetes.

OBJECTIVE: The aim of this study was to investigate the level of diabetes self-management ability in older patients with type 2 diabetes and analyse its relationship with patient activation. Besides, the mediating effect of self-efficacy on the relationship between the two was assessed in the study. METHODS: Using a cross-sectional design, 200 elderly patients with type 2 diabetes were recruited from the community of Yangzhou, China. The Patient Activation Measure (PAM), The Self-efficacy for Diabetes (SED), and The Summary of Diabetes Self-Care Activities Measure (SDSCA) were used in the questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. RESULTS: Pearson correlation analysis revealed a significant positive correlation (p< 0.01) between diabetes self-management ability and patient activation (r=0.312) and self-efficacy (r=0.367). Self-efficacy partially mediated the effect between patient activation and self-management ability in older patients with type 2 diabetes, and the mediating effect accounted for 49.33% of the total effect (p< 0.001). CONCLUSIONS: Older patients with type 2 diabetes in the community have a moderate level of self-management ability. Patient activation can improve patients' self-management ability through self-efficacy.

Mediation Effect of Self-Efficacy Between Health Beliefs and Glycated Haemoglobin Levels in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Purpose: To explore the mediating effect of self-efficacy in the relationship between glycated haemoglobin (HbA1c) levels and health beliefs in community elderly patients with type 2 diabetes. Patients and Methods: From January to March 2022, convenience sampling was adopted to investigate 200 elderly patients with type 2 diabetes in a community in Yangzhou, China. Data were collected using the Health Beliefs Questionnaire, Self-efficacy for Diabetes, and Medication Compliance Questionnaire. Laboratory parameters included HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density-lipoprotein cholesterol, and low-density-lipoprotein cholesterol levels. Correlation, linear regression, and mediation analyses were performed using SPSS 27.0. Results: HbA1c levels were higher in men (women vs men: 6.80% [6.08%, 7.73%] vs.7.30% [6.30%, 9.18%]) and employed (employed vs not employed vs retired: 7.60% [6.90%, 10.45%] vs 5.85% [5.40%, 6.95%] vs 7.10% [6.20%, 8.20%]) and low self-efficacy (low vs high: 13.1% [6.55%, 13.85%] vs 6.8% [6.10%, 7.70%]). HbA1c levels were negatively associated with health beliefs (r = -0.246) and self-efficacy (r = -0.240; p<0.01). Linear regression showed that perceived susceptibility, severity, benefit, and barriers, cues to action, and self-efficacy explained 50% of the variance in HbA1c levels after adjusting for sex and current work status. The mediation effect of self-efficacy was partial between health beliefs and HbA1c levels and accounted for 24.65% of the total effect (p < 0.001). Conclusion: Health beliefs influenced the improvement of self-efficacy in older patients with type 2 diabetes mellitus, which in turn could improve HbA1c control. Self-efficacy plays a partial mediating role between health beliefs and Hba1c levels in elderly patients with type 2 diabetes.

Evaluation of Application Effect of Self-Made Compression Cold Therapy in Postoperative Rehabilitation of Patients with Orthopedic Dyskinesia.

With the accelerated aging of the population, orthopedic injuries have become more collective. Among them, the incidence of ankle fractures remains high. Surgery is an effective way to treat ankle fractures by utilizing special surgical site, complex anatomical structure, and specific surgical methods. With surgical approach, it is easy for basis postoperative blood loss, pain, swelling, and other problems. After surgery, most patients suffer from symptoms of fear, increased pain sensitivity, and excessive irrational concerns about physical movement or activity. Compression cold therapy combines cold therapy with air pressure therapy to ease local exudation, constrict blood vessels, improve circulation, relieve pain, and control inflammation through the effects of low temperature and pressure. Application during the rehabilitation period can prevent joint swelling, reduce muscle soreness, and promote the functional recovery of limbs, which provides an effective guarantee for postoperative rehabilitation of patients with orthopedic dyskinesia. Based on this, it is very important to evaluate the application and effect of self-made compression cold therapy in postoperative rehabilitation of patients with orthopedic dyskinesia. This work proposes a one-dimensional deep convolutional neural network-based method; DenseNet for analyzing the rehabilitation effect of patients with orthopedic dyskinesia after ankle fracture surgery. The approach is to evaluate the rehabilitation effect of self-made compression cold therapy from the perspectives of feature reuse, attention mechanism, and feature decoupling. Experiments on the dataset show that the proposed neural network has better efficacy evaluation performance. The proposed systematic assessment based on the emerging deep learning network has great significance in healthcare domain, particularly in assessing applicability, side effects, and noninvasiveness of treatment methods.

Effects of a nurse-led peer support intervention for stroke survivors: protocol for a randomised controlled trial.

INTRODUCTION: Many stroke survivors have unmet psychosocial needs during the recovery phase following a stroke. There is emerging evidence that peer support interventions may play a valuable role in managing stroke. However, evidence regarding the effectiveness of peer support interventions on the psychosocial outcomes of stroke survivors is uncertain. This study aims to develop a nurse-led peer support intervention for stroke survivors based on the Person-Environment-Occupation-Performance Model and evaluate its effects on the psychosocial outcomes of stroke survivors. METHODS AND ANALYSIS: This is an assessor-blinded two-arm randomised controlled trial. A convenience sample of 120 stroke survivors will be recruited from two community centres and one rehabilitation unit in Yangzhou, a medium-sized city in eastern China, with 60 participants each in the intervention and control groups. The participants allocated to the intervention group will receive the nurse-led peer support intervention, which includes 6 weekly peer support sessions facilitated by a nurse and at least one peer facilitator. Participants randomised to the control group will receive the same dose of interpersonal interaction as intervention participants, including weekly individual face-to-face session for 6 weeks. The primary outcomes are social participation and participation self-efficacy. The secondary outcomes are psychosocial distress, social support, stigma towards disease, self-efficacy in managing chronic conditions and quality of life. Data will be collected at baseline, immediately after the intervention and 3 months after the intervention. A process evaluation will be conducted qualitatively and quantitively to examine the mechanism by which the intervention impacts the psychosocial outcomes of stroke survivors. All outcomes will be analysed following the intention to treat principle. Generalised Estimation Equation models will be used to assess the intervention effect. ETHICS AND DISSEMINATION: This protocol was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2021.196-T). All participants will be required to provide written informed consent. Results of the study will be disseminated through publication in peer-reviewed journals and presentation at local or international conferences. TRIAL REGISTRATION NUMBER: ChiCTR2100050853.

A Meta-Analysis of the Effectiveness of Telemedicine in Glycemic Management among Patients with Type 2 Diabetes in Primary Care.

Introduction: Telemedicine interventions are gradually being used in primary health care to help patients with type 2 diabetes receive ongoing medical guidance. The purpose of this study was to analyze the effectiveness of using telemedicine in primary health care for the management of patients with type 2 diabetes. Methods: A systematic search was conducted from database inception to August 2021 in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, CNKI, Wanfang Data, VIP, and CBM. Data extraction and quality assessment were performed for studies that met the inclusion criteria. The meta-analysis was performed using Review Manager 5.4 (Cochrane) and Stata v.16.0SE (College Station, TX, USA). Results: A total of 32 articles were included in this study. Analysis showed a reduction in glycated hemoglobin, fasting glucose, and postprandial glucose after the telemedicine intervention. Systolic blood pressure and self-efficacy improved significantly, but there was no significant improvement in weight, lipid metabolism, or diabetes awareness. Subgroup analysis based on the duration of intervention showed significant improvement in glycated hemoglobin at 6 months of intervention. Conclusions: Telemedicine interventions may help patients with type 2 diabetes to effectively control blood glucose and improve self-management in primary health care. There is only moderate benefit, and the benefit may not be sustained beyond 6 months. However, the evidence for the improvement in lipid metabolism is insufficient and further studies are needed.

Reliability and validity of the Chinese version of Oldenburg Burnout Inventory for Chinese nurses.

AIM: This study aims to develop a reliable and validate Chinese version of Oldenburg Burnout Inventory (OLBI). DESIGN: A cross-sectional validation design was adopted in this study. METHODS: After obtaining the copyright by contacting with the author, the original English OLBI was developed to Chinese by forward translation, back-translation, cultural adaptation and a pre-test (20 nurses). The Chinese OLBI and Maslach Burnout Inventory (MBI) were administered to 641 clinical nurses during July and August, 2020. Internal consistency (Cronbach's α coefficient), split reliability (split half coefficient), construct validity (confirmatory factor analysis) and criterion validity (comparison with MBI, using Pearson correlation analysis) were assessed. RESULTS: The Chinese OLBI included 16 items. Exploratory factor analysis extracted two factors with a cumulative contribution of 62.245%. Two-dimensional structure (exhaustion and disengagement) was confirmed. It has good internal consistency (Cronbach's α coefficient values of 0.905, 0.933 and 0.876 for the total questionnaire, exhaustion dimension and disengagement dimension, respectively), split half reliability (split half coefficient = 0.883, p < .01) and criterion validity (r = 0.873, p < .01). Pearson coefficients between 16 items and the scale varied from 0.479-0.765. An acceptable model fit (χ2 /df = 2.49, RMSEA = 0.068, TLI = 0.906, CFI = 0.922, SRMR = 0.061) was achieved.

Effects of peer support interventions on physical and psychosocial outcomes among stroke survivors: A systematic review and meta-analysis.

BACKGROUND: High level of unmet needs were reported by stroke survivors after hospital discharge. Peer support interventions may play a valuable role in the management of stroke, but the evidence is unclear. OBJECTIVES: To determine the effects of peer support interventions on physical and psychosocial outcomes of stroke survivors; and to identify the key characteristics of peer support interventions for stroke survivors.cv DESIGN: A systematic review and meta-analysis. REVIEW METHODS: Seven English databases and four Chinese databases were searched to identify eligible articles. Two reviewers screened the eligible studies, appraised the risk of bias, and extracted the data independently. Version 2 of the Cochrane risk-of-bias tool was used to evaluate the risk of bias for randomized controlled trials, while the Risk of Bias in Non-randomized Studies of Interventions tool was used for the quasi-experimental studies. The Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool was used to assess the quality of evidence. Meta-analyses were conducted using Review Manager 5.3, and narrative analyses were performed when meta-analysis was inappropriate. RESULTS: Eleven studies were included. Peer support interventions could improve the activities of daily living (MD = 15.53, 95% CI: 1.39 to 29.68; P = 0.03, I2 = 99%; very low quality of evidence), limb function, depression (SMD = -1.27, 95% CI: -2.18 to -0.36; P = 0.006, I2 = 91%; very low quality of evidence) and anxiety. Although pooled analysis showed that social participation (SMD= 0.74, 95% CI: 0.09 to 1.39; P = 0.03, I2 = 69%; low quality of evidence) and quality of life (SMD = 0.41, 95% CI: 0.09 to 0.73; P = 0.01, I2 = 0%; low quality of evidence) improved after peer support interventions, the studies which were not pooled due to insufficient data drew inconsistent results. CONCLUSIONS: Stroke survivors may benefit from peer support interventions to improve their physical and psychological outcomes. The evidence about the impact of peer support interventions on social participation and quality of life is very uncertain. It should be noted that the quality of evidence ranged from very low to low, thus highlighting the need for more research of higher quality to substantiate these findings.

Unraveling the Critical Role of Melt-Spinning Atmosphere in Enhancing the Thermoelectric Performance of p-Type Bi0.52Sb1.48Te3 Alloys.

Melt spinning has proven effective in maintaining chemical homogeneity and introducing multiscale microstructures that can reduce the lattice thermal conductivity and consequently enhance the thermoelectric performance of consolidated bulk materials. In this work, p-type Bi0.52Sb1.48Te3 bulk alloys are fabricated by melt spinning (MS) followed by subsequent plasma activated sintering (PAS). The influence of different MS atmospheres (air, Ar, N2, and He) on the morphologies of MS ribbons and the thermoelectric properties of MS-PAS bulk materials has been investigated systematically. Because of the relatively high thermal conductivity, a He atmosphere expedites the heat dissipation in the MS process and results in severe sublimation of tellurium and thus inferior thermoelectric performance. In contrast, an Ar atmosphere can essentially prevent heat loss of the fusant and suppress the sublimation of tellurium. Consequently, the corresponding Bi0.52Sb1.48Te3 sample (MS in Ar atmosphere) presents the highest peak ZT and average ZT values of 1.09 (at 340 K) and 0.81 (in 300-500 K), respectively. The average ZT of the sample prepared using an Ar atmosphere is almost three times the one prepared using a He atmosphere. This reflects the importance of using the appropriate atmosphere during the melt-spinning process. This result, which indicates that melt spinning in an Ar atmosphere is preferable to avoid heat loss, can also be extended to other materials.

Relationship between burnout and intention to leave amongst clinical nurses: The role of spiritual climate.

AIM: This study aims to identify the role that spiritual climate has in reducing burnout and intentions to leave amongst clinical nurses. BACKGROUND: Both shortages and the high turnover of nurses are challenging problems worldwide. Enhancing the spiritual climate amongst nurses can enhance teamwork, organisational commitment and job satisfaction and can play a role in reducing burnout and turnover intention. METHODS: A total of 207 clinical nurses working at a tertiary university hospital were included in this cross-sectional, single-site study. Independent-samples t test and ANOVA, Pearson correlation analysis and hierarchical regression analysis were used to explore the relationships amongst related factors. RESULTS: Most clinical departments showed a moderate spiritual climate (60.24 ± 0.82) with high job burnout (33.62 ± 0.28) and turnover intention (2.37 ± 0.57). A good spiritual climate was correlated with high job satisfaction (r = 0.412, p < 0.01), low burnout and turnover intention (r = -0.423, p < 0.01 and r = -0.292, p < 0.01, respectively). Spiritual climate could also indirectly influence nurses' job burnout and turnover intention (R2  = 10.31%). CONCLUSIONS: Different departments have different spiritual climates. The findings from this study indicate that spiritual climate may impact nursing burnout and turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Using a spiritual climate scale provides health care decision-makers with clear information about staff spirituality well-being. Interventions to improve spiritual climate can benefit teamwork in clinical departments.

The Dipeptide Pro-Gly Promotes IGF-1 Expression and Secretion in HepG2 and Female Mice via PepT1-JAK2/STAT5 Pathway.

It has been shown that IGF-1 secretion is influenced by dietary protein or amino acid. However, whether the dipeptides elicit regulatory effects on IGF-1 secretion remains largely unclear. Thus, this study aimed to investigate the effects of the dipeptide Pro-Gly on IGF-1 expression and secretion in HepG2 cells and mice, and explore the underlying mechanisms. The in vitro results indicated that Pro-Gly, but not Pro plus Gly, promoted the expression and secretion of IGF-1 in HepG2. Meanwhile, the expression of the peptide transporter 1 (PepT1) was elevated by Pro-Gly, whereas knockdown of PepT1 with siRNA eliminated the increase of IGF-1 expression induced by Pro-Gly. In addition, Pro-Gly activated JAK2/STAT5 signaling pathway in a PepT1-dependent manner. Furthermore, Pro-Gly enhanced the interaction between JAK2 and STAT5, and the translocation of phospho-STAT5 to nuclei. Moreover, inhibition of JAK2/STAT5 blocked the promotive effect of Pro-Gly on IGF-1 expression and secretion. In agreement with the in vitro results, the in vivo findings demonstrated that Pro-Gly, but not Pro plus Gly, stimulated the expression and secretion of IGF-1 and activated JAK2/STAT5 signaling pathway in the liver of mice injected with Pro-Gly or Pro+Gly acutely or chronically. Besides, acute injection of JAK2/STAT5 inhibitor abolished the elevation of IGF-1 expression and secretion induced by Pro-Gly in mice. Collectively, these findings suggested that the dipeptide Pro-Gly promoted IGF-1 expression and secretion in HepG2 cells and mice by activating JAK2/STAT5 signaling pathway through PepT1. These data provided new insights to the regulation of IGF-1 expression and secretion by the dipeptides.

Arginine reverses growth hormone resistance through the inhibition of toll-like receptor 4-mediated inflammatory pathway.

OBJECTIVE: Growth hormone stimulates growth by increasing insulin-like growth factor 1 expression and secretion. In the presence of insufficient nutrients, GH increases, whereas IGF-1 expression becomes severely suppressed, leading to GH resistance. This study aimed to explore the effect of arginine (Arg) on GH resistance during malnutrition and to describe its underlying mechanism. METHODS: C57BL/6J mice were injected intraperitoneally with Arg for 1h or subjected to caloric restriction with Arg supplement in drinking water for 18days. HepG2 cells were exposed to different Arg concentrations for 24h. Signaling pathway agonists/inhibitors, siRNA, and overexpression plasmids were used to investigate the underlying molecular mechanism. Liver-specific toll-like receptor (TLR4) knockout mice were utilized to clarify the role of TLR4 in Arg-induced IGF-I expression and secretion. RESULTS: Arg inhibited the TLR4 downstream pathway by binding to TLR4 and consequently activated Janus kinase 2/signal transducer and activator of transcription 5 signaling pathway. As a result, IGF-1 transcription and secretion increased. Arg activity was absent in liver-specific TLR4 knockout mice and was greatly suppressed in liver with overexpressed TLR4, suggesting that hepatic TLR4 was required and sufficient to induce GH resistance. By contrast, the mammalian target of rapamycin pathway was unnecessary for Arg activity. Arg not only significantly increased IGF-1 expression and secretion under acute fasting and chronic CR conditions but also attenuated body weight loss. CONCLUSIONS: Our results demonstrate a previously unappreciated pathway involving Arg that reverses GH resistance and alleviates malnutrition-induced growth restriction through the inhibition of TLR4-mediated inflammatory pathway.

Dietary protein-induced hepatic IGF-1 secretion mediated by PPARγ activation.

Dietary protein or amino acid (AA) is a crucial nutritional factor to regulate hepatic insulin-like growth factor-1 (IGF-1) expression and secretion. However, the underlying intracellular mechanism by which dietary protein or AA induces IGF-1 expression remains unknown. We compared the IGF-1 gene expression and plasma IGF-1 level of pigs fed with normal crude protein (CP, 20%) and low-protein levels (LP, 14%). RNA sequencing (RNA-seq) was performed to detect transcript expression in the liver in response to dietary protein. The results showed that serum concentrations and mRNA levels of IGF-1 in the liver were higher in the CP group than in the LP group. RNA-seq analysis identified a total of 1319 differentially expressed transcripts (667 upregulated and 652 downregulated), among which the terms "oxidative phosphorylation", "ribosome", "gap junction", "PPAR signaling pathway", and "focal adhesion" were enriched. In addition, the porcine primary hepatocyte and HepG2 cell models also demonstrated that the mRNA and protein levels of IGF-1 and PPARγ increased with the increasing AA concentration in the culture. The PPARγ activator troglitazone increased IGF-1 gene expression and secretion in a dose dependent manner. Furthermore, inhibition of PPARγ effectively reversed the effects of the high AA concentration on the mRNA expression of IGF-1 and IGFBP-1 in HepG2 cells. Moreover, the protein levels of IGF-1 and PPARγ, as well as the phosphorylation of mTOR, significantly increased in HepG2 cells under high AA concentrations. mTOR phosphorylation can be decreased by the mTOR antagonist, rapamycin. The immunoprecipitation results also showed that high AA concentrations significantly increased the interaction of mTOR and PPARγ. In summary, PPARγ plays an important role in the regulation of IGF-1 secretion and gene expression in response to dietary protein.

Using Prompted Voiding to Manage Urinary Incontinence in Nursing Homes: Can It Be Sustained?

OBJECTIVES: Studies reporting prompted voiding (PV) interventions were of short duration and were delivered by research personnel rather than nursing home staff. This study examined the effectiveness of the use of PV by nursing home staff in managing urinary incontinence among residents over a 6-month period. DESIGN: A randomized controlled trial. SETTING: Five nursing homes in Hong Kong. PARTICIPANTS: Data were collected from 52 nursing home residents who had been admitted to the facility for at least 6 months prior to the initiation of the study and whose incontinence had been stable over the 6-month period. INTERVENTION: The PV intervention was delivered by the staff for 6 months. All nursing home staff were trained to ensure that they would be able to correctly deliver the intervention before initiating the intervention. The control group received the usual care. MEASUREMENTS: Outcomes were defined in terms of wet episodes per day, incontinence rate per day, self-initiated toileting per day, and total continent toileting per day. Data were collected at baseline, 3 months postintervention (T1), and 6 months postintervention (T2). RESULTS: There were significant differences between the two groups in wet episodes per day, incontinence rate per day, and total continent toileting per day at 6 months post-intervention, with positive results found in the intervention group. A decrease of 9.1% was observed in the incontinence rate of the intervention group. CONCLUSIONS: PV was shown to have positive effects, although the effects in this study were not as powerful as those found in overseas studies. The intervention delivered by staff was sustainable for a 6-month period. Nursing home operators should promote better continence care through PV, as it is a sustainable noninvasive behavioral intervention that can be mastered by staff with training.

Toileting behaviours and lower urinary tract symptoms among female nurses: A cross-sectional questionnaire survey.

BACKGROUND: Unhealthy toileting behaviours exist among women, and lower urinary tract symptoms have a high prevalence and significant effects on quality of life. However, the relationship between toileting behaviours and lower urinary tract symptoms is unclear. OBJECTIVES: This study aimed to investigate the prevalence of lower urinary tract symptoms among female nurses, and the association between toileting behaviours and lower urinary tract symptoms. DESIGN: A cross-sectional stratified cluster sampling study. PARTICIPANTS: A total of 636 female clinical nurses from tertiary hospitals in Jinan (the capital city of Shandong Province, China). METHODS: The Toileting Behaviour-Women's Elimination Behaviours and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms scales were used to assess the participants' toileting behaviours and lower urinary tract symptoms, respectively. Multiple linear regression analysis was used to evaluate the association between toileting behaviours and lower urinary tract symptoms. RESULTS: Unhealthy toileting behaviours were common among the female nurses, with delayed voiding being the unhealthiest toileting behaviour, which was followed by place and position preference for voiding. Nearly 68% of the female nurses had at least one lower urinary tract symptom, nearly 50% had incontinence symptoms, 40% had filling symptoms, and 18% had voiding symptoms. Unhealthy toileting behaviours (premature voiding, delayed voiding, and straining to void) were positively associated with lower urinary tract symptoms. However, lower urinary tract symptoms were not significantly associated with voiding place or position preference. Among the control variables, being married or having a history of a urinary tract infection was associated with lower urinary tract symptoms. Having a higher income and regular menstrual period were negatively associated with lower urinary tract symptoms. Compared with vaginal delivery, caesarean delivery had a protective association with lower urinary tract symptoms. CONCLUSION: Lower urinary tract symptoms among female nurses should not be overlooked, because their prevalence among female clinical nurses exceeded that among the general population of women. These findings highlight the importance of avoiding unhealthy toileting behaviours (especially premature voiding, delayed voiding, and straining to void), as these unhealthy toileting behaviours were significantly associated with susceptibility to lower urinary tract symptoms.

The dipeptide Pro-Asp promotes IGF-1 secretion and expression in hepatocytes by enhancing JAK2/STAT5 signaling pathway.

It has been implicated that IGF-1 secretion can be regulated by dietary protein. However, whether the dipeptides, one of digested products of dietary protein, have influence on IGF-1 secretion remain largely unknown. Our study aimed to investigate the effects of the dipeptide Pro-Asp on IGF-1 secretion and expression in hepatocytes and to explore the possible underlying mechanisms. Our findings demonstrated that Pro-Asp promoted the secretion and gene expression of IGF-1 in HepG2 cells and primary porcine hepatocytes. Meanwhile, Pro-Asp activated the ERK and Akt signaling pathways, downstream of IGF-1. In addition, Pro-Asp enhanced GH-mediated JAK2/STAT5 signaling pathway, while inhibition of JAK2/STAT5 blocked the promotive effect of Pro-Asp on IGF-1 secretion and expression. Moreover, acute injection of Pro-Asp stimulated IGF-1 expression and activated JAK2/STAT5 signaling pathway in mice liver. Together, these results suggested that the dipeptide Pro-Asp promoted IGF-1 secretion and expression in hepatocytes by enhancing GH-mediated JAK2/STAT5 signaling pathway.

Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence.

AIMS AND OBJECTIVES: To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity. BACKGROUND: Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood. DESIGN: This was a cross-sectional community-based study. METHODS: We enrolled a sample of 305 women aged 40-65 years with stress urinary incontinence from three communities in a Chinese city between May-October in 2011. Data were collected on socio-demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self-reported questionnaire. Effects of stigma were analysed using path analysis. RESULTS: Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment-seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment-seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment-seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence. CONCLUSIONS: Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment-seeking attitudes through internalisation of social messages. RELEVANCE TO CLINICAL PRACTICE: Stigma reduction may help incontinent women to form positive treatment-seeking attitudes and engage them in treatment. Interventions should specifically target the self-stigma domains of social isolation and internalised shame in women with urinary incontinence to most efficiently increase their use of health care.

Disease stigma and intentions to seek care for stress urinary incontinence among community-dwelling women.

OBJECTIVES: Urinary incontinence (UI) threatens women's physical and mental health, but few women seek healthcare for their incontinence. Evidence is substantial that stigma may be associated with health service utilization for such diseases as mental illness, but sparse for UI. We examine the relationship between disease stigma and intentions to seek care for UI. DESIGN AND SETTING: A cross-sectional community-based study was used. A purposive sample of 305 women aged 40-65 years in a Chinese city who had stress urinary incontinence (SUI) was enrolled from May to October in 2011. MEASUREMENTS: Data were collected on socio-demographic characteristics, UI symptoms, disease stigma and intentions to seek care. RESULTS: Social rejection was positively linearly related to intentions to seek care for UI (ß=0.207; 95% CI=0.152, 0.784), indicating that more social rejection predicted stronger intentions to seek care. Significant curvilinear association between internalized shame and intentions to seek care was observed (ß=-0.169; 95% CI=-0.433, -0.047). Compared to women with the low and high levels of internalized shame, those with the moderate level of internalized shame reported stronger intentions to seek care. CONCLUSION: The impact of stigma on intentions to seek care varies by aspects and levels of stigma. Social rejection enhances intentions to seek care while internalized shame influences intentions to seek care in a quadratic way. The crucial step of targeted interventions will be to disentangle subgroups of SUI women with different aspects and levels of stigma.