Nomogram for predicting electrocoagulation syndrome after endoscopic submucosal dissection of esophageal tumors.

BACKGROUND: Endoscopic submucosal dissection (ESD) was widely used for the removal of esophageal tumors, and post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) was one of the postoperative adverse events. The aim of this research was to develop and validate a model to predict electrocoagulation syndrome after endoscopic submucosal dissection of esophageal tumors. MATERIALS AND METHODS: Patients who underwent esophageal ESD in our hospital were retrospectively included. A predictive nomogram was established based on the results of multivariate logistic regression analysis, and bootstrapping resampling was used for internal validation. Besides, the clinical usefulness of the nomogram was evaluated using decision curve analysis (DCA) and clinical impact curve. RESULTS: A total of 552 patients who underwent esophageal ESD were included in the study, and the incidence of PPECS was 12.5% (69/552). Risk factors associated with PEECS (p < 0.1) were analyzed by multivariate logistic regression analysis, and the final model included four variables, namely gender, diabetes, tumor size and operation time. The predictive nomogram was constructed based on the above four variables, and the area under the ROC curve (AUC) was 0.811 (95% CI 0.767-0.855). The calibration curve of the nomogram presented good agreement between the predicted and actual probabilities. DCA showed that the model improved patient outcomes by helping to assess the risk of PEECS in patients compared to an all-or-no treatment strategy. In addition, the clinical impact curve of the model also indicates that the nomogram has a high clinical net benefit. CONCLUSION: In conclusion, we have developed a predictive nomogram for PEECS after ESD for esophageal tumors with good predictive accuracy and discrimination. This predictive nomogram can be effectively used to identify high-risk patients with PEECS, which will help clinicians in clinical decision-making and early intervention.

Effect of precision management scheme based on the best evidence summary on reducing catheter-associated urinary tract infection. / åŸºäºŽæœ€ä½³è¯æ®æ€»ç»“çš„ç²¾å‡†åŒ–ç®¡ç†æ–¹æ¡ˆå¯¹é™ä½ŽåŒ»é™¢å¯¼å°¿ç®¡ç›¸å ³å°¿è·¯æ„ŸæŸ“çš„æ•ˆæžœ.

OBJECTIVES: Catheter-associated urinary tract infection (CAUTI) is an important cause of prolonged hospital stay, which increases economic and medical burden for patients and hospitals, and it is a key focus of hospital infection prevention and control. However, there are currently few studies that convert evidence-based scientific evidence on CAUTI prevention and control into clinical applications and evaluation on its practical effects in combination with standardized infection ratio (SIR), the critical indicator of infection prevention and control. This study aims to establish a precision management plan for reducing the incidence of CAUTI, driven by the findings of a comprehensive evidence summary, to apply this plan across all the nursing units within the entire hospital, followed by a comparative analysis of CAUTI incidence, SIR, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff before and after the implementation of the precision management plan. METHODS: Based on a comprehensive review of the best evidence for preventing CAUTI, a precision management plan was meticulously developed through panel discussions and 2 rounds of expert consultations using Delphi technique. Subsequently, a historical control study was conducted to evaluate the plan's effectiveness. A total of 17 658 patients with indwelling urinary catheter in inpatient departments from January to December 2021 comprised the control group. These patients received standard nursing measures for CAUTI. Another 18 753 patients with indwelling urinary catheters in the inpatient departments from January to December 2022 comprised the intervention group, underwent the precision management scheme based on the best available evidence, to enhance CAUTI prevention. The incidence and SIR of CAUTI, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff were compared between the 2 groups. RESULTS: Compared with the control group, the incidence of CAUTI in the intervention group was significantly decreased (0.48‰ vs 1.12‰, χ2=20.814, P<0.001), SIR was decreased in the intervention group (0.55 vs 1.37); the average duration of indwelling urinary catheter for each patient was significantly decreased [(4.33±1.55) d vs (4.43±1.79) d, t=11.941, P<0.001]. The ratio of compliance rate of medical staff with strict hand hygiene protocols higher than 95% in the intervention group was significantly higher than that in the control group (93.3% vs 83.3%, χ2=5.822, P=0.016). CONCLUSIONS: The implementation of the precision management plan for reducing CAUTI based on a summary of the best available evidence on CAUTI prevention and control in patients with indwelling urinary catheters has found to be effective. This approach significantly reduces the incidence of CAUTI, reduces the average duration of indwelling urinary catheter, and enhances hand hygiene compliance among medical staff. It provides a scientific and efficient strategy for preventing and controlling CAUTI in the hospital, ultimately saving patients from unnecessary medical expense.

The influence of social constraints on the quality of life of hematopoietic stem cell transplantation survivors: The chain mediating effect of illness perceptions and the fear of cancer recurrence.

Objective: This cross-sectional correlational study aims to explore the relationship between social constraints and the quality of life of hematopoietic stem cell transplantation (HCT) survivors. Additionally, we also seek to demonstrate the chain mediating effect of illness perceptions and the fear of cancer recurrence on this relationship. Methods: Convenience sampling was employed in this study. A total of 232 HCT survivors were interviewed using the Social Constraints Scale, the Brief Illness Perception Questionnaire, the Fear of Cancer Recurrence Inventory (Short Form) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant. IBM SPSS 24.0 were used for data analyses, and PROCESS macro (Model 6) was used to examine the hypothesized chain mediation model. Results: A positive relationship between social constraints and quality of life verified the mediating effect of illness perceptions and the fear of cancer recurrence on this relationship. Social constraints affect the quality of life of HCT survivors via three pathways: the mediating role of illness perceptions, the mediating role of fear of cancer recurrence and the chain mediating effect of both factors. Conclusion: The chain mediating effect of illness perceptions and the fear of cancer recurrence on quality of life indicates that these two variables have important practical significance with respect to improving HCT survivors' physical and mental health. The study thus serves as a reference for health workers to improve HCT survivors' quality of life in the future.

Association between social support and medication literacy in older adults with hypertension.

Background: Reduced physical function and reduced social networks place older adults with hypertension at high risk for medication-related harm. Medication literacy is one of the preventable factors that affect the success of drug therapy for hypertension. However, little is known about the level of medication literacy and its influencing factors in older adults with hypertension. Objective: The purpose of this study was to investigate the levels of social support and medication literacy, and the association between them in older Chinese adult patients with hypertension. Methods: A total of 362 older adult patients with hypertension were investigated using a demographic characteristics questionnaire, the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP) and the Social Support Rating Scale (SSRS). Pearson correlation analysis, canonical correlation analysis (CCA) and hierarchical linear regression were used to analyse the relationship between social support and medication literacy. Results: Our results showed that the mean scores for the C-MLSHP and the SSRS for older adult patients with hypertension were 23.89 (SD = 4.66) and 39.22 (SD = 5.53), respectively. The results of the Pearson correlation analysis suggested that the score for social support was positively correlated with the score for medication literacy (r = 0.431, P < 0.01). The results of CCA demonstrate that older adult patients with hypertension who had more subjective (r s = 0.682) and objective support (r s = 0.817) performed better in knowledge (r s = 0.633), skills (r s = 0.631) and behavior literacy (r s = 0.715). Hierarchical linear regression indicated that two dimensions of subjective support (B = 0.252, P < 0.001) and objective support (B = 0.690, P < 0.001) in social support were found to be independent predictors of medication literacy (R2 = 0.335, F = 19.745, P < 0.001). Conclusion: Social support is positively associated with medication literacy in older Chinese adult patients with hypertension. The study highlights the importance of social support in promoting medication literacy among older adult patients with hypertension.

The Effects of Information-Seeking Behaviors on Risk Perception During the COVID-19 Pandemic: A Cross-Sectional Correlational Survey.

Background: The COVID-19 pandemic caused by the novel SARS-CoV-2 virus represents an ongoing public health challenge that necessitates a heightened need to understand people's risk perceptions as well as their information-seeking behavior. Objective: The aim of this study is to explore the impact of different information-seeking behaviors on people's risk perceptions during the COVID-19 pandemic. Methods: We employed convenience sampling in order to administer questionnaires to 3048 residents in Hunan Province, China. After screening the questionnaires for inclusion in the study, multiple linear regressions were then used to analyze the impact of the characteristics of respondents' information-seeking behavior on their risk perceptions. Results: From the 3048 distributed 2611 were included. New media (80.20%) was the most frequently used source of information seeking, and traditional media were participants' most trusted source of COVID-19 information. Statistics of COVID-19 were the type of information most frequently queried by respondents, and approximately 30.0% of them reported that most or all of the COVID-19 information they sought was negative. Approximately one in five respondents reported that they sought COVID-19 information more than 10 times per day. The results of our multivariate linear regression analysis showed that "seeking information from new media ", "level of trust in new media and local propaganda", "information content being about protective behaviors and personal related information", "proportion of negative information", and "frequency of information seeking" were positively associated, and "seeking information from traditional media" and "level of trust in traditional media" were negatively associated with people's risk perception of COVID-19. Conclusion: We find that specific types of channels of information acquisition and public trust in these information channels, their informational content, and proportion of negative information, as well as a frequency of information seeking all had an impact on risk perception during COVID-19.

Development and Validation of a Self-Quantification Scale for Patients With Hypertension.

Background: The self-management ability of patients with hypertension is poor, and self-quantification increases gradually with the development of electronics. Self-quantification for patients with hypertension has important implications for individual health. However, there is a lack of relevant scales at present, and we aim to develop a self-quantified scale for patients with hypertension. Methods: The instrument was developed based on protection motivation theory with literature review, a qualitative interview study and focus group discussions, and pilot testing. A total of 360 patients with hypertension were investigated using the scale. The psychometric properties of the scale were evaluated concerning validity and reliability employing internal consistency reliability, split-half reliability, test-retest reliability, content validity (S-CVI/Ave and I-CVI), and construct validity (exploratory factor analysis and confirmatory factor analysis). Results: The final scale had 30 items with seven sub-domains. The Cronbach's α for all domains was 0.900 with a range of 0.817-0.938. The split-half reliability coefficient for all domains was 0.743 with a range of 0.700-0.888. The test-retest reliability coefficient for all domains was 0.880 with a range of 0.849-0.943. The S-CVI/Ave for all domains was 0.922 with a range of 0.906- 0.950, and the I-CVI of each item was a range of 0.800-1.000. The result of confirmatory factor analysis of this scale showed that χ2/df was 2.499, RMSEA = 0.065, GFI=0.865, NFI=0.894, IFI=0.934, TLI=0.914, CFI=0.933, RFI=0.865. The Pearson's coefficients between the total scale and every domain were ranging from 0.347 to 0.695, and each domain ranged from 0.130 to 0.481. Conclusion: The scale has good validity and reliability and can be used as a self-quantification scale for patients with hypertension.

Mediating effect of ill perception on the relationship between social constraints and fear of cancer recurrence among adolescent and young adult survivors who underwent hematopoietic stem cell transplantation.

Objective: We aimed to investigate the effect of ill perception (IP) on the relationship between social constraints (SC) and fear of cancer recurrence (FCR) among adolescent and young adult survivors who underwent hematopoietic stem cell transplantation (AYA-HSCT survivors). Methods: A total of 135 AYA-HSCT survivors were interviewed using the social constraints scale, the brief illness perception questionnaire and the fear of cancer recurrence inventory (short form). Next, the mediating effect of IP on the relationship between SC and FCR was analyzed. Results: A total of 79.3% (107/135) of the interviewed AYA-HSCT survivors revealed that they had clinical FCR. Notably, FCR had a significant positive correlation with both SC (r â€‹= â€‹0.362, P â€‹< â€‹0.001) and IP (r â€‹= â€‹0.457, P â€‹< â€‹0.001). Moreover, IP accounted for 42.1% of the total mediating effect on the relationship between SC and FCR in AYA-HSCT survivors. Conclusions: Scientific management of FCR is one of the most common and unmet needs of AYA-HSCT survivors. Results of the present study indicate that SC has a direct effect on FCR in AYA-HSCT survivors, affirming the need for families and social networks for AYA-HSCT survivors to encourage greater expression. Also, health professionals should educate survivors and their families on the importance of cancer home care. They should also empower survivors and their families with professional information, as well as practical, interpersonal, and emotional support. Our results further show that IP partially affects the relationship between SC and FCR. Therefore, the development and implementation of targeted interventions is imperative to the improvement of survivors' IP.

Cost-effectiveness of Morse Fall Scale assessment in fall prevention care in hospitalized patients. / Morseè·Œå€’é‡è¡¨è¯„ä¼°åœ¨ä½é™¢æ‚£è€ é˜²è·Œå€’æŠ¤ç†ä¸­çš„æˆæœ¬æ•ˆæžœ.

OBJECTIVES: To analyze the cost-effectiveness of the Morse Fall Scale by clinical big data for nurses in the prevention of falls in hospitalized patients. METHODS: A total of 59 358 hospitalized patients, who came from the Third Xiangya Hospital of Central South University in 1 year before nurses were trained by the Morse Fall Scale, served as a control, including 26 862 males and 32 496 females. While the 66 203 hospitalized patients served as an observation group in 1 year after nurses were trained by the Morse Fall Scale, including 29 881 males and 36 322 females. The time spent by clinical nurses in the fall-risk assessment and the fall number were recorded in the 2 groups, and the relationship was analyzed between the Morse Fall Scale assessment and the clinical ending along with the labor cost of nursing. The cost-effectiveness was analyzed. In addition, the incidence of fall in the observation group was compared between the falling high-risk patients and the non-high-risk patients. RESULTS: The Morse Fall Scale showed that the incidences of fall in the observation group and the control group were 3.39/100 000 and 3.82/100 000,respectively, there was no significant difference between the 2 groups (U=0.807, P>0.05); the injury rates of falls of Grade 2 and above in the observation group and the control group were 27.30% and 20.00%, respectively, with no significant difference (χ2=0.345, P>0.05); but the labor cost was increased by 130 641.82 Chinses Yuan, and the incremental cost-effectiveness ratio was 43 547.27. However, the incidence of fall was significant higher in the falling high-risk patients by the assessment of the Morse Fall Scale than that in the non-high-risk patients (U=2.941, P<0.05). CONCLUSIONS: The evaluation of the Morse Fall Scale has a certain effect, but it is limited in the prevention of falls in adult hospitalized patients, and the cost-effectiveness analysis is not good. It is recommended to implement the intervention measures for high-risk patients after the assessment, which may improve the management level and efficiency of fall prevention.

Development and psychometric assessment of the public health emergency risk perception scale: Under the outbreak of COVID-19.

OBJECTIVE: Correctly understanding and evaluating the level of public risk perception toward public health emergencies not only helps experts and decision-makers understand the public's preventative health behaviors to these emergencies but also enhances their risk information communication with the public. The aim of this study was to develop a risk perception scale for public health emergencies and test its validity and reliability during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Guided by the theoretical model of risk perception, an initial scale was generated through literature review, group meetings, resident interviews, and expert consultation. A pretest and item screening were then conducted to develop a formal risk perception scale for public health emergencies. Finally, the reliability and validity of the scale were validated through a questionnaire survey of 504 Chinese adults. RESULTS: The final scale had 9 items. The content validity index of the scale was 0.968, and the content validity index of individual items ranged from 0.83 to 1.00. Three common factors, dread risk perception, severe risk perception, and unknown risk perception, were extracted for exploratory factor analysis, and together they explained 66.26% of the variance in the score. Confirmatory factor analysis showed that the model had a satisfactory fit, where χ 2/df = 1.384, the goodness-of-fit index (GFI) = 0.989, root mean square error of approximation (RMSEA) = 0.028, root mean square residual (RMR) = 0.018, comparative fit index (CFI) = 0.995, normed fit index (NFI) = 0.982, and non-normed fit index (NNFI) = 0.990. The correlations between dimensions ranged from 0.306 to 0.483 (P < 0.01). Cronbach's α was 0.793 for the total scale and ranged between 0.687 and 0.801 for the individual dimensions. The split-half coefficient was 0.861 for the total scale and ranged from 0.727 to 0.856 for induvial dimensions. The test-retest coefficient was 0.846 for the total scale and ranged from 0.843 to 0.868 for induvial dimensions. CONCLUSION: The developed scale for the risk perception of public health emergencies showed acceptable levels of reliability and validity, suggesting that it is suitable for evaluating residents' risk perception of public health emergencies.

Social Media Use, eHealth Literacy, Knowledge, Attitudes, and Practices Toward COVID-19 Vaccination Among Chinese College Students in the Phase of Regular Epidemic Prevention and Control: A Cross-Sectional Survey.

BACKGROUND: College students are at a high risk of being infected with COVID-19, and they are one of the key population clusters that should be vaccinated. The present study aimed to investigate the knowledge, attitudes, and practices (KAP) toward COVID-19 vaccination among Chinese college students, and to determine the relationships among social media use, eHealth literacy, and KAP toward COVID-19 vaccination among Chinese college students. METHODS: A cross-sectional survey was conducted by administering questionnaires to evaluate KAP toward COVID-19 vaccination, social media use, and eHealth literacy in one of the groups of Chinese college students. Multiple linear regression analysis was performed to determine the association among social media use, eHealth literacy, and KAP regarding COVID-19 vaccination. RESULTS: Among the 3,785 validated questionnaires collected from Chinese college students, male students accounted for 59.74%, and the mean age of the college students was (20.90 ± 3.14) years. More than four-fifths (83.43%) of the college students spent <2 h a week on social media, and the official and public social media were most common social media types. Additionally, the scores for KAP toward COVID-19 vaccination ranging from 0 to 48 among college students were high (39.73 ± 5.58), lowest for knowledge domain (3.07 ± 0.76), and the highest for practice domain (3.47 ± 0.63). Female college students who were in good health status and who spent more time browsing social media, frequently used official and public social media, rarely used aggregated social media, and had a relatively strong self-perception of eHealth literacy and information acquisition of eHealth literacy were more likely to have high levels of KAP regarding COVID-19 vaccination. CONCLUSIONS: Overall, Chinese college students have excellent KAP toward COVID-19 vaccination. Based on the findings of this study, we recommend that health counseling regarding COVID-19 vaccination should target male students and those with inferior health status. Dissemination of health education regarding COVID-19 vaccination should be purposely conducted, and cooperation with official and public social media platforms should be promoted. Finally, eHealth literacy, which is one of the predictors of the level of KAP regarding COVID-19 vaccination, should be emphasized.

Associations of COVID-19 Risk Perception, eHealth Literacy, and Protective Behaviors Among Chinese College Students Following Vaccination: A Cross-Sectional Study.

BACKGROUND: In spite of strict regulation of coronavirus disease 2019 (COVID-19) preventive measures and containment in China, there are still confirmed cases sporadically occurring in many cities. College students live in groups and have active social activities so that it will trigger a serious public health event once an infection event occurs. Thus, identifying the status and related factors of protective behaviors among them after receiving vaccination will be crucial for epidemic control. This study aimed to gather information on the protective behaviors and to identify the associations of COVID-19 risk perception, eHealth literacy, and protective behaviors for Chinese college students following vaccination. METHODS: A cross-sectional survey of college students engaged in protective behaviors post vaccination was conducted using the COVID-19 risk perception scale, eHealth literacy scale, and protective behaviors following vaccination questionnaire in one of the groups. Multiple linear regression analysis was used to confirm the correlation among the COVID-19 risk perception, eHealth literacy, and protective behaviors for Chinese college students. RESULTS: A total of 5,641 Chinese college students were included. Male students comprised 59.01% with an average age of (21.39 ± 2.75) years and most students rating their health as very good (44.85%) or pretty good (46.98%). A smaller percentage (13.76%) believed that they would likely or most likely be infected with COVID-19 after getting vaccinated. In addition, more than 1 in 10 (10.35%) college students had ever suspected to suffer from post-vaccination reactions following the COVID-19 vaccination. The mean score of protective behaviors was 26.06 ± 3.97. Approximately one-third (30.42%) of the students always or often did not wear a mask when going out. Some college students (29.25%) did not maintain distance of at least 1 m from others in social situations. Older female college students who were in good health and perceived as being at a low risk of getting infected with COVID-19, and those never suspected to suffer from post-vaccination reactions expected to engage in post-vaccination protective measures. Those with a higher level of perceived risk, severe risk perception and eHealth literacy, and a lower level of unknown risk perception were more likely to engage in further protective behaviors after getting vaccinated. CONCLUSIONS: Overall, the level of protective behaviors among the Chinese college students following vaccination could be improved, especially for male, younger college students in poor health. This study revealed the predictive effects of risk perception and eHealth literacy on protective behaviors, recommending that the negative and positive effects of risk perception should be balanced in epidemic risk management, and eHealth literacy promotion should also be emphasized for public health and social measures.

Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension.

Background: Studies have reported that medication literacy had a positive effect on medication adherence in patients with hypertension. However, little is known about the mechanism underlying this relationship in patients with hypertension. Objective: The purpose of this study was to investigate the mediating effect of self-efficacy between medication literacy and medication adherence. Methods: A total of 790 patients with hypertension were investigated using the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP), the Morisky Medication Adherence Scale-8 (MMAS-8) and the Medication Adherence Self-efficacy Scale-Revision (MASES-R). Hierarchical regression and the bootstrap approach were used to analyze the mediating effect of self-efficacy on the relationship between medication literacy and medication adherence. Results: A total of 60.9% of hypertensive patients were low adherent to their antihypertensive drug regimens. Self-efficacy had a significant positive correlation with medication literacy (r= 0.408, p < 0.001) and medication adherence (r = 0.591, p < 0.001). Self-efficacy accounts for 28.7% of the total mediating effect on the relationship between medication literacy and adherence to antihypertensive regimens for hypertensive patients. Conclusion: More than half of the hypertensive patients in the study were low adherent to antihypertensive regimens. Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. Therefore, it was suggested that hypertensive patients' medication adherence might be improved and driven by increasing self-efficacy. Targeted interventions to improve patients' self-efficacy should be developed and implemented. In addition, health care providers should also be aware of the importance of medication literacy assessment and promotion in patients with hypertension.

The Development and Psychometric Assessment of Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP).

OBJECTIVE: To develop the medication literacy scale for patients with hypertension, and to test the reliability and validity of the scale. METHODS: The initial draft of the scale was formulated based on the operationalization of medication literacy with four core elements of knowledge, attitude, skill, and practice, and was developed through procedures of literature review, interviews to hypertensive patients, and research group discussion. Expert panel meeting, interviews, and pre-test on the initial draft of the scale to 10 hypertensive patients, as well as a two iterations of expert feedback were used to form a primary medication literacy scale for pilot investigation and item selection. In this study, 260 patients with hypertension in Changsha city of China were purposively selected to conduct a pilot survey using the primary medication literacy scale. After item selection by a series of statistical analysis method and item re-wording according to patients' feedback, the scale was revised to form a formal investigation scale with four domains and 37 items. A formal investigation was carried out on 650 patients with hypertension selected purposively in a tertiary general hospital and two community health service centers in Changsha city of China. The reliability and validity of the scale were analyzed. RESULTS: Finally, the formal scale consists of four domains on knowledge, attitude, practice and skills, 11 sub-factors and 37 items in total. The scale-level content validity index (S-CVI/Ave) of this scale was 0.968, and the I-CVI for each item ranged from 0.833 to 1.000, indicating a good and acceptable content and face validity. The Cronbach's α coefficient was 0.849 for the overall scale and ranged from 0.744 to 0.783 for domains. The Pearson's correlation coefficients between domains and the total scale were ranging from 0.530 to 0.799. Besides, the Pearson's correlation coefficient among domains of the scale ranged from 0.157 to 0.439. The Spearman-Brown split-half reliability coefficient was 0.893 for the total scale and ranged from 0.793 to 0.872 for domains. The test-retest reliability coefficient of the total scale was 0.968 and ranged from 0.880 to 0.959 for domains. Four domains of knowledge, attitude, skill, and practice were identified through the exploratory factor analysis and confirmatory factor analysis from each domain. The total explained variation of domains for the overall scale was 51.420%. Eleven sub-factors for domains were extracted through respective exploratory factor analysis from each domain, and the total explained variation of sub-factors for its belonging domain were ranging from 56.111 to 64.419%. The confirmatory factor analysis showed the fit indices of the four-domain model were as follows (χ2/df=2.629, GFI=0.804, AGFI=0.777, RMR=0.012, IFI=0.746, RMSEA=0.066, PNFI=0.599, PCFI=0.689), which indicated an acceptable model fit. CONCLUSIONS: The medication literacy scale for hypertensive patients has good reliability and acceptable validity, which is suitable and acceptable for evaluating the medication literacy level of hypertension patients in China. In the future, further construct and model fit validation and English translation with appropriate adaptation of this whole scale are required, so that this scale can be further validated and applied worldwide.

The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study.

The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.

Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension.

Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.

[Clinical and laboratory analysis of a neonate with Down syndrome and a novel GATA1 gene mutation].

OBJECTIVE: To analyze the clinical and molecular biological characteristics of a neonate with myeloid proliferation related to Down syndrome (DS). METHODS: The neonate, who was suspected for Down syndrome, was analyzed in terms of clinical feature, peripheral blood cell morphology, fluorescence in situ hybridization (FISH), immunological classification and other laboratory tests. On hundred and fourteen leukemia-related genes were subjected to next-generation sequencing (NGS). RESULTS: Laboratory test revealed obvious abnormal liver function and coagulation function, anemia, and extreme leukocytosis. Cell smear indicated significantly increased progenitor cells, which conformed to proliferation of megakaryocytes. FISH showed trisomy 21. By NGS, c.220+dupT, a novel mutation, was identified in exon 2 of the GATA1 gene, which encodes a N-terminal activation domain and has a frequency of 95.8%. No mutation was identified among the remaining 113 genes. CONCLUSION: The neonate had DS and GATA1 gene mutation. High percentage of circulating blasts should be considered as transient myelodysplasia but not congenital leukemia.

Effect of peer support on health outcomes in patients with cardiac pacemaker implantation: A randomized, controlled trial.

The aim of this study was to examine the effect of a nurse-led telephone-based peer support program on health outcomes in patients after cardiac pacemaker implantation. Seventy six patients who received cardiac pacemaker implantation were recruited as participants and randomly assigned to either the peer support group or the usual care group. The usual care group received routine care and health education measures provided by nurses; the peer support group received telephone-based peer support. Health-related quality of life, self-care knowledge-attitudes-practice, postoperative anxiety and depression, compliance with attending scheduled follow-up visits, and the incidence of postoperative complications were evaluated at baseline and 6 months' postintervention for the two groups. The result showed that the interventions had a better effect on self-care knowledge-attitudes-practice, postoperative anxiety and depression, and compliance with attending scheduled follow-up visits in the peer support group than in the usual care group. This study confirms that telephone-based peer support improves self-care ability, compliance with attending scheduled follow-up visits, and reduces postoperative anxiety and depression more effectively than conventional nurse care among patients with cardiac pacemaker implantation.

Interactive Network Platform Improves Compliance and Efficacy of Subcutaneous Immunotherapy for Patients with Allergic Rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a common chronic inflammatory disease of nasal mucosa worldwide, and its symptoms seriously affect the lives of patients. Subcutaneous immunotherapy (SCIT) is an effective treatment for AR, but it is also associated with low patient compliance and difficulties in fully achieving therapeutic effects. OBJECTIVE: In this prospective randomized controlled study, we verified the effects of an interactive network platform named "U breath" in improving patient compliance and the efficacy of SCIT in patients with AR. METHODS: A total of 148 patients who received SCIT were recruited as participants and randomly assigned to either the standardized management (SM) or the interactive network platform management (INP) group. The SM group experienced the standard management SCIT process. The INP group experienced a new management approach based on an interactive network platform called "U breath". The compliance rate, combined symptom and medication score (CSMS), visual analogue scale score and the rhinoconjunctivitis quality of life questionnaire (RQLQ) results were evaluated at baseline and 1-year postintervention for the two groups. RESULTS: Within the first year of treatment, the INP group had a higher compliance rate than did the SM group, with a statistically significant difference (P<0.05). The INP group showed better clinical improvement than the SM group did in terms of the VAS score, and the RQLQ score except the sleep problems (P< 0.05). CONCLUSION: This study confirmed that the application of an interactive network platform is of great significance for improving patient compliance and the treatment effects of SCIT in patients with AR.

[Status for self-medication based on bibliometric study in China].

OBJECTIVE: To figure out problems through analyzing the status for self-medication in China and to provide references for further research.
 Methods: Papers related to self-medication were collected from Chinese journal net database, Wanfang database, VIP database and China biomedical literature database (CBMDisc). A literature metrology analysis was carried out by NoteExpress 2.0 and Excel.
 Results: A total of 161 papers were included in this study, while 33 papers belong to Hubei and Jiangsu Province, accounting for 20.50% of the total amount of the papers. 22 papers were from journals as follows: China Pharmacy, Medicine and Society and Chinese Journal of Pharmacoepidemiology, accounting for 13.67% of the total papers. 118 papers belong to research and experience discuss, accounting for 73.29% of all. The cooperation degree was 2.37, and 28 papers were funded. Domestic research reflected the current status of self-medication in our country. Although self-medication brought convenience for residents and reduce the burden on health system, it also brought a series of safety problems.
 Conclusion: Self-medication gradually catches the attention of the researchers. Some researchers have paid attention to self medication, but the evidence is at a low level. Researchers should strengthen cooperation with interagency and carry out experimental study to promote further development for self-medication.

Medication literacy status of outpatients in ambulatory care settings in Changsha, China.

Objective To assess medication literacy status and to examine risk factors of inadequate medication literacy of outpatients in ambulatory care settings. Methods Study participants were recruited randomly from outpatient departments in four tertiary hospitals (Xiangya Hospital of Central South University, Second Xiangya Hospital of Central South University, Third Xiangya Hospital of Central South University, People's Hospital of Hunan Province) in Changsha, Hunan, China, between October 2014 and January 2015. Medication literacy was assessed using the Medication Literacy Scale, Chinese version. Demographic and clinical data were collected using structured interviews. Multiple logistic regression analysis was used to estimate the independent effects of demographic and clinical factors on medication literacy. Results Of 465 participants, 425 (91.4%) produced valid responses for analysis. The mean medication literacy score was 8.31 (standard deviation = 3.47). Medication literacy was adequate in 131 participants (30.8%), marginally adequate in 248 (58.4%), and inadequate in 46 (10.8%). The risk of inadequate medication literacy was greater for older and unmarried patients but lower for more educated patients. Conclusion Many Chinese outpatients in ambulatory care have inadequate medication literacy. Greater age, low education, and unmarried status are important risk factors of inadequate medication literacy.