The Use of Multidimensional Nomial Logistic Model and Structural Equation Model in the Validation of the 14-Item Health-Literacy Scale in Chinese Patients Living with Type 2 Diabetes.

Objective: To evaluate the psychometric properties of the 14-item health literacy scale (HL-14) in patients living with type 2 diabetes mellitus (T2DM) in clinical setting. Methods: Cross-sectional study using item response theory and structural equation modeling (SEM) for testing the item difficulty and three dimensional-HL configurations was adopted in this study. Chinese patients living with T2DM admitted to endocrinology department of Huadong hospital were evaluated by the HL-14 including communication, functional and critical health literacy from August to December 2021. Results: The multidimensional random coefficients multinomial logistic model indicated the difficulty settings of the scale are appropriate for the study populations, and differential item functioning was not observed for sex in the study. SEM demonstrated that the three-dimensional configuration of the scale is good in the study population (x2/df=2.698, Comparative Fit Index = 0.965, Root Mean Square Error of Approximation = 0.076, standard residual mean root = 0.042). Conclusion: The HL-14 scale is a reliable and valid measurement, which can perform equitably across sex in evaluating the health literacy in Chinese patients living with T2DM. Moreover, the scale may help fill the gaps of multidimensional health literacy assessment and rapid screening of health literacy ability for clinical practice.

Self-Efficacy as Moderator and Mediator Between Medication Beliefs and Adherence in Elderly Patients with Type 2 Diabetes.

Purpose: Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes. Methods: This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence. Results: Self-efficacy for medication use acted as a moderator (B=-0.063, t=-2.215, p=0.028) and partial mediator (CItotal effect=4.5-16.63, p=0.001; CIindirect=1.524-5.323, p=0.014; CIdirect=2.151-11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence. Conclusion: Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.

Validation and psychometric properties of the self-efficacy for Appropriate Medication Use Scale in elderly Chinese patients.

Background Self-efficacy for appropriate medication use is an important construct when evaluating the optimal use of medications. However, no instrument that assesses this construct in elderly Chinese patients has been shown to have valid psychometric properties. Objective To investigate the psychometric properties of the Chinese version of the self-efficacy for Appropriate Medication Use Scale in elderly patients with type 2 diabetes. Setting Geriatric patients were recruited from the endocrinology department of a tertiary hospital in Shanghai, China. Method Self-efficacy was assessed by the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in subjects who were at least 65 years old. Exploratory and confirmatory factor analyses were used to develop a psychometrically sound model of the scale. Main outcome measures Internal and test-retest reliability; convergent and discriminant validity of the scale; model fit indices of the factor model. Results The two-factor model of the self-efficacy for Appropriate Medication Use Scale was not suitable for elderly patients with respect to both item factor loadings and model fit indices. Conceptually overlapping scale items emerged when the scale was used in these patients. The final model developed appeared to achieve an ideal model fit and presented acceptable convergent and discriminant validity. Conclusions This study presented a Chinese version of the self-efficacy for Appropriate Medication Use Scale with psychometrically sound properties that will enable pharmacists, nurses and physicians to prospectively evaluate the impact of medication self-efficacy on a variety of health outcomes in elderly patients with type 2 diabetes.

Ensiling of whole-plant hybrid pennisetum with natamycin and Lactobacillus plantarum impacts on fermentation characteristics and meta-genomic microbial community at low temperature.

BACKGROUND: The aim of the current research was to clarify the impacts of the ensiling of whole-plant hybrid pennisetum with natamycin and Lactobacillus plantarum on fermentation characteristics and the meta-genomic microbial community at low temperatures. RESULTS: During the ensiling process, lactic acid (LA) and lactic acid bacteria (LAB) significantly (P < 0.05) increased and acetic acid (AA), water-soluble carbohydrate (WSC), ammonia total nitrogen (NH3-N), and yeast significantly (P < 0.05) reduced in treatments as compared to controls. Different treatments and different ensiling days led to variations in the bacterial community at family and genus levels. The family Lactobacillaceae and genera Lactobacillus and Pediococcus are dominant communities in treatment silage. The family and genus levels bacterial ecology and fermentation quality were analyzed by principal component analysis (PCA). The PCO1, and PCO2 can be explained by 10.81% and 72.14% of the whole variance regularly, similarly in PCO1 and PCO2 can be explained 24.23% and 52.06% regularly. The core bacterial micro-biome operational taxonomic unit (OTU) numbers increased in treatments, as compared to controls, on different hybrid pennisetum ensiling days. CONCLUSIONS: The inoculation of L. plantarum alone and combined with natamycin influenced the fermentation quality and reduced undesirable microorganisms during the fermentation of hybrid pennisetum silage. Natamycin alone did not significantly enhance the concentration of organic acid but numerically enhanced in treatments group as compared to control. © 2020 Society of Chemical Industry.

Effects of natamycin and Lactobacillus plantarum on the chemical composition, microbial community, and aerobic stability of Hybrid pennisetum at different temperatures.

This study evaluated the effects of natamycin and Lactobacillus plantarum on the chemical composition, microbial community, and aerobic stability of Hybrid pennisetum at different temperatures. Different concentrations of natamycin (0.50 g L-1, 1.00 g L-1, and 1.50 mg L-1) significantly (p > 0.05) reduced the growth of undesirable microorganisms. During the ensiling periods the pH, ammonia nitrogen (NH3-N), acetic acid (AA), butyric acid (BA), aerobic bacteria (AB), and yeast were significantly (p > 0.05) reduced, while the lactic acid and lactic acid bacteria were significantly (p < 0.05) influenced in the SLP and SLNP groups as compared to the SP and SNP groups at high temperature (29-30 °C). During air exposure, water-soluble carbohydrate, ammonia nitrogen (NH3-N), lactic acid (LA), and acetic acid (AA) were not influenced, while pH and aerobic bacteria were significantly (p < 0.05) enhanced after three days (72 hours) of air exposure, and lactic acid bacteria were significantly (p > 0.05) reduced at ambient temperature (9-10 °C). It is concluded that the addition of L. plantarum CICC 20765 alone and in combination with natamycin reduced the content of AA, pH, NH3-N, BA, and undesirable microbial community, and enhanced the chemical composition, fermentation quality, and air exposure. Natamycin alone did not significantly enhance the organic acid profile but improved the air exposure. Furthermore, more effort is needed to evaluate the effects on silage preservation on a large scale and on animal performance.