Patient perceptions of empowerment processes, health outcomes and related factors in patients living with diabetes in Taiwan: a cross-sectional survey.

BACKGROUND: The aim was to examine the associations among empowerment processes, health outcomes, and related factors in patients living with diabetes. METHODS: This cross-sectional study analyzed a convenience sample of 144 patients with diabetes in Taiwan. Data were collected with questionnaires, HbA1C, blood pressure, and total cholesterol. FINDINGS: Empowerment processes were significantly associated with health outcomes, including self-care behaviors, quality of life, and HbA1C. Diabetes-related complications and treatment variables were associated with empowerment processes and health outcomes. CONCLUSIONS: To optimize the empowerment processes needed to promote the health of patients with diabetes, healthcare professionals should consider patient perceptions of empowerment processes and related factors.

Expression of Bcl2l1, Clcf1, IL-28ra and Pias1 in the mouse heart after single and repeated administration of chlorpromazine.

Several chlorpromazine (CPZ)-related deaths have been suspected in forensic autopsies but these are difficult to identify precisely because only low concentrations of CPZ can usually be detected. Patients on CPZ therapy exhibit various cardiovascular diseases, such as arrhythmia and cardiomyopathy. As our previous study revealed that CPZ administration affects the expression of immediate early genes that are induced before any other genes, we expected that CPZ probably affects the heart and, in particular, the gene expression in heart. CPZ changes tumor necrosis factor (TNF) production. After stimulation of TNF, the Janus kinase signal transducer and activator of transcription (JAK-STAT) signaling pathway is activated via TNF receptor (TNF-R), and the pathway participates in the regulation of cellular responses such as apoptosis [1]. We used semi-arrays to determine the JAK-STAT signaling pathway in a mouse cardiomyocyte cell line, HL-1, and real-time quantitative-PCR to determine whether the semi-array data applied in vivo in mouse heart after single and once-daily repeated (1-4weeks) low-dose (0.75mg/kg) or high-dose (7.5mg/kg) CPZ treatment. We found that expression of B cell lymphoma 2 like 1 (Bcl2l1), Cardiotrophin-like cytokine factor 1 (Clcf1), Interleukin-28 receptor alpha (IL-28ra) and Protein inhibitor of activated STAT-1 (Pias1) were significantly changed in vivo. All these genes are associated with apoptosis. The expression level of Bcl2l1 was elevated after a single high-dose CPZ treatment and after 1week of repeated high doses, but returned to baseline from week 2 to week 4. Clcf1 and IL-28ra expression increased from week 2 or 3 after low-dose CPZ treatment. Pias1 also increased from week 2 after low-dose CPZ treatment. Our results indicate that different doses of CPZ can induce distinct patterns of gene expression for preventing the apoptotic progression in mouse cardiomyocytes, suggesting that CPZ can affect cardiomyocytes via the JAK-STAT signaling pathway and that this might lead to cardiomyopathy. In addition, our data may help to clarify the pathophysiology of cardiomyopathy induced by CPZ and to diagnose cardiac sudden death following CPZ treatment.

Using the Health Belief Model to understand caregiver factors influencing childhood influenza vaccinations.

OBJECTIVE: This study applied the Health Belief Model to investigate factors in the decision by caregivers to vaccinate their children for influenza. DESIGN: Cross-sectional study. SAMPLE AND MEASUREMENTS: Purposive sampling obtained 2,778 useable responses to surveys of 33 public health centers and 40 medical institutions participating in vaccination programs in southern Taiwan. Data were collected using the Caregiver Demographics and Children's Health History Questionnaire, Children's Influenza Vaccination History Questionnaire, and a Health Belief Model Questionnaire. Multiple logistic regression was used to analyze predictors of influenza vaccinations in children. RESULTS: Predictors of vaccination revealed by logistic regression analysis included age, current employment, and residence of the caregiver as well as chronic disease, hospitalization, and influenza histories of the child. Other predictors revealed by the Health Belief Model were perceived susceptibility of the children to influenza, perceived benefits of vaccinations to children, perceived barriers to vaccinations, and cues to action. Eleven items in the model were also significant predictors of vaccination. CONCLUSIONS: The survey results can be used to develop strategies for increasing influenza vaccination rates.

Expression of C-fos, Fos-B, Fosl-1, Fosl-2, Dusp-1 and C-jun in the mouse heart after single and repeated chlorpromazine administrations.

Many cases of sudden chlorpromazine (Chl)-related deaths have been identified in forensic autopsies. Because Chl concentration detected in such cases is often low, identifying the cause of death can be difficult. Patients on Chl therapy exhibit arrhythmia and cardiomyopathy. Thus, Chl may affect the heart, particularly, gene expression there. Immediate early genes (IEGs) are expressed following stimulation. Using real-time quantitative-PCR, we investigated the mRNA expression of IEGs, including C-fos, Fos-B, Fosl-1, Fosl-2, Dusp-1 and C-jun, in the mouse heart after once-daily high-dose (7.5 mg/kg) or low-dose (0.75 mg/kg) of Chl single and repeated (1-4 weeks) injections. We showed that single high-dose Chl administration induced IEGs except C-jun. This induction was not observed after the repeated administration, and thus; suggested that the transcriptome is altered after repeated administration and tolerance is developed to Chl. Moreover, C-jun expression decreases after repeated administration. These results reflect that C-jun is down-regulated to avoid cardiomyopathy caused by the over stimulation of C-jun. In future, we intend to clarify the Chl-induced IEG cascade via IEGs in the mouse heart. Chl treatment can result in cardiovascular diseases. Investigation of the transcriptome in the heart after repeated Chl administration will aid in elucidating the patho-physiology of Chl-related cardiovascular diseases.