Clinician perspectives on a culturally adapted patient decision aid concerning maintenance therapy for asthma.

BACKGROUND AND OBJECTIVE: Patients with persistent asthma often show poor adherence to inhaled corticosteroids (ICS). Shared decision-making can improve adherence rates in this population. Patient decision aids (PDAs) are tools to facilitate shared decision-making. To date, only one PDA, developed in a Canadian French-speaking population, exists for patients considering ICS maintenance therapy. This PDA has been culturally adapted in this study to contextualize to the needs of multi-ethnic Asian patients in Singapore. This study explored the views of local clinicians on the content, design and implementation of this newly-adapted PDA. METHODS: 24 clinicians, who were purposively sampled from polyclinics and a tertiary institution, were interviewed on the content, design and implementation of the PDA. The interviews were audio-recorded, transcribed and analyzed via thematic analysis. RESULTS: Clinicians generally accepted the design of the PDA. They suggested for the target users to be patients on Step 2 of GINA guidelines and the number of options to be reduced from four to two (do nothing or start inhaled corticosteroids). Moreover, they supported including a list of values for patients to select from given that Asian patients often do not articulate their values readily. The addition of more visual aids, the production of multilingual Asian editions and the involvement of nurses to administer the PDA was also suggested. CONCLUSION: The PDA was culturally-adapted with local clinicians' perspectives to target multi-ethnic Asian patients with persistent asthma (Step 2 GINA guidelines). The main changes include a list of values and addition of visual aids.

Transformation of a metaphor: semantic shift in a Cantonese term 'Chi Sin' denoting insanity.

OBJECTIVES: The historical evolution of the existing terms used to describe insanity may be able to shed light on the formation of stigma towards psychosis patients. In Hong Kong, a widely used Cantonese term for insanity 'Chi Sin' provides a unique example because of its neutral original sense, as it literally means misconnection in a network circuit. We attempt to trace the origin and subsequent evolution of the term 'Chi Sin' from its early use to the present day to understand how local Hong Kong people have attached increasingly negative connotations to this scientific term since the mid-20th century. METHODS: We sampled as many newspapers and magazines published in Hong Kong from 1939 to June 2014 as possible, and sampled 7 popular local movies from the 1950s and 1960s. We also searched all the newspapers published in Hong Kong, Macau, Taiwan, and Mainland China from January 1998 to June 2014, and searched several other local historical resources. RESULTS: In one early use of 'Chi Sin' in 1939, the term was only used in a technical sense to describe 'short circuiting'. We found that the development of the telephone system, the Strowger system, in Hong Kong is closely related to the evolution of the semantics of the term 'Chi Sin'. CONCLUSIONS: The original meaning of short circuitry of the term 'Chi Sin' is no longer used, and it has become a dead metaphor through repeated use with negative emotional connotations. This illustrates some of the factors facilitating the emergence of a metaphor with subsequent semantic drift.

Preliminary evidence on the measurement properties of the Chinese version of the Child Health Questionnaire, parent form (CHQ-pF50) and child form (CHQ-CF87).

UNLABELLED: The objective of this study was to evaluate the reliability and construct validity of the Chinese parent form (PF50) and child form (CF87) of the Child Health Questionnaire (CHQ). METHODS: To assess the construct validity and reliability of the Chinese versions, we invited 1099 parents of healthy children and 816 school children to complete the Chinese CHQ-PF50 and CHQ-CF87, respectively. RESULTS: Psychometric analysis on item convergent validity and discriminant validity showed > or = 99% rates of success for all 10 scales in the CF87 and > or = 94% for all but one scale in the PF50, the exception being general health scale (86%). We observed minimal floor effects for both questionnaires, but substantial ceiling effects for five scales in both the PF50 and CF87 (physical functioning, role-emotional/behavioral, role-physical, bodily pain and family activities). A substantially lower ceiling effect was observed for the physical scale and bodily pain in the CF87 (19% and 25%, respectively) relative to the PF50 (46% and 42%, respectively). The median alpha coefficient for CF87 and PF50 was 0.90 (range, 0.80-0.94) and 0.78 (range, 0.44-0.88), respectively. CONCLUSIONS: Our findings suggest that the Chinese CHQ-PF50 and CHQ-CF87 are robust and sufficiently reliable for group comparisons and perhaps also for use in other Chinese populations.

Gender difference in self-esteem of Hong Kong Chinese with cardiac diseases.

Self-esteem is an indicator of a person's subjective quality of life due to its close relationship to a person's behavioural competence, positive self-experience, and sense of self-actualization. The present study aimed to investigate the basis of self-esteem in people with cardiac diseases, according to gender, after their cardiac surgery. The findings showed that there were prominent gender differences in the subjects' self-esteem. Women (aged<60) showed statistically significant higher ratings in the importance of 11 life events importance and the satisfaction of three life events than men. The study also found cultural uniqueness: Hong Kong Chinese (both men and women) with cardiac diseases generally indicated that social (interpersonal) self-concept dimensions were more important than achievement (personal) self-concept dimensions in their life perception. These findings are noteworthy for setting optimum goals of rehabilitation apart from return to work.

Effect of exercise-based cardiac rehabilitation on mobility and self-esteem of persons after cardiac surgery.

This study adopted an experimental design with using a nonequivalent, posttest only control group to study the rehabilitation outcomes of 152 persons who received cardiac surgery. 37 subjects in a rehabilitation group participated in a 2-mo. exercise-based cardiac rehabilitation programme, and another 115 subjects who did not attend the programme formed the control group. The subjects' self-esteem was measured on the Adult Source of Self-esteem Inventory by Elvoson and Fleming, and their mobility skill was measured by a simple mobility test based on New York Heart Association Classification. Analysis of covariance (with covariance analysis of the subjects' age, years of education, occupational skill, and mobility skill) indicated that the experimental group scored higher on positive self esteem and showed significantly better improvement in mobility skill. The exercise-based cardiac rehabilitation programme positively affected physical and psychological outcomes. Also, subjects' self-esteem was significantly correlated with their mobility skills (r=.21, p<.05) among those aged under 60 years (n=96) but not among those aged 60 or above (n=53).

Characterization of the reaction rate coefficient of DNA with the hydroxyl radical.

Using agarose gel electrophoresis, we have measured the yield of single-strand breaks (SSBs) induced by 137Cs gamma irradiation in a variety of plasmid DNA substrates ranging in size from 2.7 kb to 38 kb irradiated in aerobic aqueous solution in the presence of the hydroxyl radical scavenger dimethyl sulfoxide (DMSO). Under these conditions DNA SSBs are caused mainly by the hydroxyl radical. Using the competition between DMSO and DNA for the hydroxyl radical, we have estimated the rate coefficient for the reaction of the hydroxyl radical with DNA. The results cannot be characterized by conventional steady-state competition kinetics. However, it is possible to describe the second-order rate constant for the reaction as a function of the scavenging capacity of the solution. The second-order rate constant increases with increasing scavenging capacity, rising from about 5 x 10(8) dm3 mol-1 s-1 at 10(5) s-1 to about 10(10) dm3 mol-1 s-1 at 10(10) s-1. This dependence of the second-order rate constant on the scavenging capacity appears to be more pronounced for larger plasmids.

Methylperoxyl radicals as intermediates in the damage to DNA irradiated in aqueous dimethyl sulfoxide with gamma rays.

Using agarose gel electrophoresis, we have measured the yields of DNA single-strand breaks (SSBs) for plasmid DNA gamma-irradiated in aerobic aqueous solution. Incubation after irradiation with the base damage repair endonucleases formamidopyrimidine-DNA N-glycosylase (FPG) or endonuclease III (endo III) results in an increase in the yield of SSBs. In the absence of dimethyl sulfoxide (DMSO) during irradiation, this increase is consistent with the yields of known substrates for FPG and endo III as determined by gas chromatography/mass spectrometry. After irradiation in the presence of 1 mol dm-3 DMSO, the increase in the yield of SSBs after enzyme incubation was further enhanced by a factor of about 5 to 7. The magnitude of this effect, the inability of acrylamide or oxygen to suppress it, and its attenuation by N,N,N',N'-tetramethylphenylenediamine (TMPD) or glycerol all suggest that the methylperoxyl radical (derived from DMSO) is involved as an intermediate. Reactions of the methylperoxyl radical (or some other species derived from it) do not result in strand break damage, but are responsible for DNA base damages which are recognized by FPG and endo III.

The ordered assembly of the phiX174-type primosome. I. Isolation and identification of intermediate protein-DNA complexes.

The phiX-type primosome was discovered during the resolution and reconstitution in vitro of the complementary strand DNA replication step of the phiX174 viral life cycle. This multienzyme bidirectional helicase-primase complex can provide the DNA unwinding and Okazaki fragment-priming functions at the replication fork and has been implicated in cellular DNA replication, repair, and recombination. We have used gel mobility shift assays and enhanced chemiluminescence Western analysis to isolate and identify the pathway of primosome assembly at a primosome assembly site (PAS) on a 300-nucleotide-long single-stranded DNA fragment. The first three steps do not require ATP and are as follows: (i) PriA recognition and binding to the PAS, (ii) stabilization of the PriA-PAS complex by the addition of PriB, and (iii) formation of a PriA-PriB-DnaT-PAS complex. Subsequent formation of the preprimosome involves the ATP-dependent transfer of DnaB from a DnaB-DnaC complex to the PriA-PriB-DnaT-PAS complex. The final preprimosomal complex contains PriA, PriB, DnaT, and DnaB but not DnaC. A transient interaction between the preprimosome and DnaG generates the five-protein primosome. As described in an accompanying article (Ng, J. Y., and Marians, K. J. (1996) J. Biol. Chem. 271, 15649-15655), when assembled on intact phiX174 phage DNA, the primosome also contains PriC.

The ordered assembly of the phiX174-type primosome. II. Preservation of primosome composition from assembly through replication.

Gel filtration chromatography was used to isolate both preprimosomal and primosomal complexes formed on single-stranded DNA-binding protein-coated phiX174 DNA by the combination of PriA, PriB, PriC, DnaT, DnaB, DnaC, and DnaG. The presence and relative amounts of primosomal proteins in these complexes were determined by Western blotting. Protein-DNA complexes isolated (i) after assembly in the presence of 10 microM ATP, (ii) after preprimosome movement in the presence of 1 mM ATP, (iii) after priming in the presence of the four ribonucleoside triphosphates, or (iv) after complementary strand DNA replication in the presence of the DNA polymerase III holoenzyme all had the same protein composition; preprimosomes contained PriA, PriB, PriC, DnaT, and DnaB, whereas primosomes included DnaG. The stable association of DnaG with the protein-DNA complex could be attributed partially to its ability to remain bound to the primers synthesized. In the absence of PriC, the efficiencies of priming and replication were reduced by one-third and one-half, respectively, even though PriC was not required for the formation of stable protein-DNA complexes on a 304-nucleotide-long single strand of DNA containing a primosome assembly site (Ng, J. Y., and Marians, K. J. (1996) J. Biol. Chem. 271, 15642-15648). We hypothesize that maintenance of the primosome on the replicated DNA may provide a mechanism to allow primosomes to participate in the resolution of recombination intermediates and intermediates formed during double strand break repair by permitting the re-establishment of a replication fork.

The difference that linear energy transfer makes to precursors of DNA strand breaks.

Using agarose gel electrophoresis, we have measured the yields of DN A single- and double-strand breaks (SSBs and DSBs) for plasmid DNA irradiated in aerobic aqueous solution with either 137Cs gamma rays or 4He ions with a mean LET of 94 or 150 keV micron-1. The presence of dimethyl sulfoxide (DMSO) resulted in a decrease in the yields of both SSBs and DSBs, with a greater decrease being apparent for gamma irradiation than for 4He-ion irradiation. Irradiation by 4He ions in the presence of N-(2-thioethyl)- 1,3-diaminopropane (WR-1065) resulted in a decrease in the yield of SSBs and a slightly larger decrease in the yield of DSBs. Together with results obtained previously, these observations suggest a substantial contribution to the formation of SSBs and DSBs by 4He ions by species containing at least two radicals and more than two radicals, respectively.

DNA repair by thiols in air shows two radicals make a double-strand break.

Using agarose gel electrophoresis, we have measured the yields of DNA single- and double-strand breaks (SSBs and DSBs) for plasmid DNA gamma-irradiated in aerobic aqueous solution. The presence during irradiation of either of the thiols cysteamine or N-(2-thioethyl)-1,3-diaminopropane (WR-1065) resulted in a concentration-dependent decrease in the yield of SSBs and a much greater decrease in the yield of DSBs. This large differential protective effect was not produced by thioethers or an alcohol of structural similarity to the two thiols, suggesting that repair of DSB radical precursors by thiols is more efficient than for SSB precursors. These observations suggest the existence of a diradical intermediate in the formation of DSBs. The results argue against a major contribution by a single radical mechanism involving interstrand radical transfer via hydrogen abstraction by a peroxyl intermediate, since the half-life of this radical transfer reaction appears to be significantly greater than the lifetime of the intermediate.