Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes: Cross-sectional survey study.

OBJECTIVE: The purpose of this study was to clarify the relationship between eHealth literacy, diabetic behavior rating, and caregiving burden among caregivers of children with type 1 diabetes mellitus (T1DM). METHODS: A questionnaire-based cross-sectional study of 143 primary caregivers of T1DM was conducted. Electronic health literacy was quantified using the Chinese version of the eHealth Literacy Scale (eHEALS). Their diabetic management behavior rating and caregiving burden were measured by Diabetes Behavior Rating Scale-Parent Version (DBRS-P) and Zarit Burden Interview (ZBI), respectively. Pearson correlation analysis was used to estimate the relationship between the above variables. RESULTS: Only 54 (37.76%) caregivers qualified by eHEALS scale, with a total score of 30.07 ± 4.54 out of 40. A positive correlation between DRBS-P scores and the scores of eHEALS (Pearson correlation coefficient r = 0.226, P = 0.007) and a negative correlation between ZBI and eHEALS scores (r = -0.166, P = 0.047) were observed. CONCLUSIONS: The eHealth literacy level of caregivers of children with T1DM in China remains to be improved. Caregivers with higher eHealth literacy had better diabetic management behaviors and less caregiving burden. IMPLICATIONS TO PRACTICE: This study suggests that hierarchical electronic health-based interventions should be designed according to the different levels of eHealth literacy of individuals, to enhance the ability of caregivers with different eHealth literacy levels to fully utilize eHealth resources to improve their daily disease management skills and reduce their burden when caring for T1DM children. In addition, improving eHealth literacy of caregivers for children with T1DM can be one of the important ways to enhance the effectiveness of electronic health-based programs designed for them.

Diabetes distress and disordered eating behaviors in youth with type 1 diabetes: the mediating role of self-regulatory fatigue and the moderating role of resilience.

BACKGROUND: Despite previous research on the association between diabetes distress and disordered eating behaviors (DEBs) among youth with type 1 diabetes (T1D), there is a lack of understanding regarding the underlying mechanisms. This study aimed to investigate the relationships between diabetes distress and DEBs, specifically examining whether self-regulatory fatigue mediated the relationship and whether resilience moderated this mediation. METHODS: A cross-sectional study was performed among youth with T1D recruited from two diabetes centers in Nanjing, China. Measurement instruments included the problem areas in the diabetes-5 scale, the diabetes strengths and resilience measure for adolescents, the self-regulatory fatigue scale, and the Chinese version of diabetes eating problem survey-revised. Mediation and moderated mediation analyses were conducted. RESULTS: A total of 185 youths with T1D were involved in the current study. The results indicated that diabetes distress positively predicted DEBs. Self-regulatory fatigue partially mediated the association between diabetes distress and DEBs, accounting for 50.88% of the overall effect. Additionally, the pathway from self-regulatory fatigue to DEBs was moderated by resilience. CONCLUSION: The current study examined whether self-regulatory fatigue mediated the relationship between diabetes distress and DEBs and whether resilience moderated the connection between self-regulatory fatigue and DEBs. These findings add to the theoretical basis of how diabetes distress influences DEBs and help guide the incorporation of diabetes distress, self-regulatory fatigue, and resilience into DEBs reduction programs for youth with T1D.

A high prevalence of disordered eating behaviors (DEBs) has been observed among youth with type 1 diabetes (T1D), leading to poor glycemic control, significant short- and long-term consequences, and an increased mortality risk. It is crucial to closely monitor DEBs in this population and identify factors that can be modified to develop targeted interventions. While previous studies have shown that diabetes distress, which refers to negative emotions specific to diabetes, is a positive predictor of DEBs, no research has examined how diabetes distress affects DEBs. Our cross-sectional study discovered a significant association between diabetes distress, self-regulatory fatigue, and an increased likelihood of experiencing DEBs. Furthermore, low resilience exacerbates this relationship, whereas high resilience weakens it. These findings highlight the importance of integrating resilience, self-regulatory fatigue, and diabetes distress in DEBs reduction programs among youth with T1D.

A Hypothesis on the Progression of Insulin-Induced Lipohypertrophy: An Integrated Result of High-Frequency Ultrasound Imaging and Blood Glucose Control of Patients.

AIMS: To put forward a scientific hypothesis about the progression of insulin-injection-induced lipohypertrophy (LH) according to the high-frequency ultrasonic imaging of insulin injection sites and the blood glucose control of patients. METHODS: A total of 344 patients were screened for LH by means of high-frequency ultrasound scanning. The results of their ultrasound examination were described in detail and categorized into several subtypes. Seventeen patients with different subtypes of LH were followed up to predict the progression of LH. To further verify our hypothesis, the effects of different types of LH on glycemic control of patients were observed by comparing glycated hemoglobin A1c (HbA1C) and other glycemic-related indicators. RESULTS: LH was found in 255 (74.1%) patients. According to the high-frequency ultrasonic imaging characteristics, LH can be categorized into three subtypes in general. Among all the LHs, the most common type observed was nodular hyperechoic LH (n = 167, 65.5%), followed by diffuse hyperechoic LH (n = 70, 27.5%), then hypoechoic LH (n = 18, 7.0%). At the follow-up after six months, all 10 patients with nodular hyperechoic LH had LH faded away. Of the five patients with diffuse hyperechoic LH, two had inapparent LH, and three had diffuse hyperechoic parts which had shrunk under ultrasound. No obvious changes were observed in the two cases of hypoechoic LH. Compared with the LH-free group, the mean HbA1C of the nodular hyperechoic LH group increased by 0.8% (9 mmol/mol) (95% CI:-1.394~-0.168, p = 0.005), that of the diffuse hyperechoic LH group increased by 2.0% (21 mmol/mol) (95% CI: -2.696~-1.20, p < 0.001), and that of the hypoechoic LH group increased by 1.5% (16 mmol/mol) (95% CI: -2.689~-0.275, p = 0.007). CONCLUSIONS: It was hypothesized that the earlier stage of LH is nodular hyperechoic LH. If nodular LH is not found in time and the patient continues to inject insulin at the LH site and/or reuse needles, LH will develop into a diffuse type or, even worse, a hypoechoic one. Different subtypes of LH may represent differences in severity when blood glucose control is considered as an important resolution indicator. Further studies are needed to confirm our hypothesis on the progression and reversion of insulin-induced lipohypertrophy.

The moderating role of informatization between country risks and international tourism: A cross-country panel analysis.

Informatization plays an increasingly important role in the tourism industry, while its effectiveness in alleviating tourism risks remains to be verified. This research aims to explore the effects of country risks on the international tourism and the moderating role of informatization between the two. This study firstly measures country risks based on the ICRG database, quantifies international tourism by tourism revenue, tourism expenditure, and tourist arrival, and calculates informatization level from informatization facilities, informatization applications, and informatization skills. A dynamic SYS-GMM model is then adopted to verify the research hypotheses based on the panel data of 138 countries from 2000 to 2019. The research results show that the composite country risk, political risk, economic risk, and financial risk all show a negative impact on the international tourism indicators regardless of different time periods, regions, or income levels. However, the effects are more obvious before the global financial crisis in 2008 and regions and countries with lower income levels. In addition, informatization is found to positively mitigate the adverse impacts of country risks on international tourism, especially for economic and financial risks. The research findings indicate the risk hedge potential of informatization in the tourism industry, which provides a profound reference for destination risk management.

Spatiotemporal effects of urban ecological land transitions to thermal environment change in mega-urban agglomeration.

Urban ecological land transitions (UELTs) have far-reaching effects on the thermal environment, but their dynamic effects in urban agglomerations remain poorly understood. This study defines the UELTs concept and quantifies its spatiotemporal effects and driving mechanisms on land surface temperature interdecadal variations (LSTIVs) in the Guangdong-Hong Kong-Macao Greater Bay Area using remote sensing, fuzzy overlay, shape-weighted landscape evolution index, and Geodetector methods. The results showed that UELTs shifted from degradation, increasing pressure, and decreasing vegetation proportion in the central city to scattered restoration, pressure relief, and increasing vegetation proportion in 2010-2020. LSTIVs simultaneously transitioned from rapid growth and contiguous expansion to reduction and dispersion. Moreover, the contribution of UELTs to LSTIVs increased by 19.49% from 2000 to 2020, and gradually shifted from being driven by dominant transition (isolating and adjacent degradation) (mean q = 0.58) to recessive transition (increased population and construction land pressure) (mean q = 0.62), where q is the determinant power. Interactions between edge-expansion and infilling restoration with the blue-green ratio (BGR; i.e., ratio of waterbodies to vegetation), habitat quality, and population layout had significant effects on LSTIVs. In addition, the relative magnitude of the effect of UEL restoration-degradation and BGR on LSTIVs was not fixed, but rather related to their interaction effect and the urban agglomeration development stage. Therefore, in addition to promoting an increase in UEL, optimizing the landscape structure of UEL (e.g., increasing aggregation and connectivity, adjusting BGR) and UEL distribution with other human factors are also crucial to reduce the urban thermal environment.

Off-pump versus on-pump coronary artery bypass grafting for octogenarians: A meta-analysis involving 146 372 patients.

There is an ongoing debate concerning the optimal surgical option of myocardial revascularization for octogenarians. The current meta-analysis aimed to compare clinical outcomes following off-pump coronary artery bypass grafting (OPCABG) or conventional coronary artery bypass grafting (CCABG) in octogenarians. PubMed, Cochrane, Web of Science, and EMBASE databases were searched to identify eligible studies from inception to March 2021. The analysis was performed using STATA 15.1. A literature search yielded 18 retrospective studies involving 146 372 patients (OPCABG = 44 522 vs. CCABG = 101 850). Pooled analysis showed a strong trend toward reducing mortality risk in the OPCABG group (odds ratio: 0.75, 95% confidence interval: 0.56-1.00, p = .05). However, it did not reach statistical significance. The sensitive analysis demonstrated that OPCABG was less likely to cause death than CCABG. There were comparable data in myocardial infarction, renal failure, deep sternal wound infection, and hospital stays between the two groups, although the incidence of stroke, atrial fibrillation, prolonged ventilation, and reoperation for bleeding was significantly lower in the OPCAGB group. OPCABG may be an effective surgical strategy for myocardial revascularization, especially in reducing the incidence of postoperative stroke, atrial fibrillation, prolonged ventilation, and reoperation for bleeding.

Resilience as a Mediator of the Association Between Perceived Stigma and Quality of Life Among People With Inflammatory Bowel Disease.

Background: Improving Quality of Life (QOL) is an essential objective in the management of inflammatory bowel disease. An accumulating body of research has been conducted to explore the association between perceived stigma and QOL among patients with chronic illness. Still, underlying mechanisms behind this pathway have not been thoroughly examined. Objective: To investigate (a) the effect of perceived stigma on QOL among patients with inflammatory bowel disease; and (b) the mediating role of resilience in the association between perceived stigma and QOL. Methods: This cross-sectional study included a convenient sample of patients diagnosed with inflammatory bowel disease from four tertiary hospitals in Jiangsu Province, China. Patients completed the Perceived Stigma Scale in Inflammatory Bowel Disease (PSS-IBD), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Inflammatory Bowel Disease Questionnaire (IBDQ). A bootstrapping analysis was implemented using the SPSS macro PROCESS. Results: A total of 311 patients with Cohn's disease and ulcerative colitis participated in this study, and 57.6% were men. The mean disease duration was 3.51 ± 1.04 years. Approximately 40% of the sample exceeded the criterion score for moderate stigma. Patients who perceived moderate or severe stigma reported lower QOL compared with those with mild stigma. After controlling for sociodemographic and clinical variables, we observed that perceived stigma was negatively associated with resilience. Moreover, resilience was found to mediate the relationship between perceived stigma and all aspects of QOL. Conclusions: These findings suggested that QOL of patients with inflammatory bowel disease was associated with perceived stigma and resilience and identified the mediating effects of resilience in the relationship between perceived stigma and QOL. Furthermore, this suggests that integrating intervention techniques to target resilience into the QOL improvement program of individuals with perceived stigma is possible.

Comparison of two health education intervention on tuberculosis prevention in schools / 中国学校卫生

Objective@#To compare the effectiveness of Internet plus mode with tradition education mode on tuberculosis prevention in schools,so as to provide the reference for reducing the risk of catching tuberculosis in schools.@*Methods@#Two junior and two senior high schools as well as two universities were selected from Baoding. The two same level schools were randomly divided into the traditional education group and the Internet plus group. All the students received 2-month TB health education intervention. Questionnaire survey was conducted before and after intervention. A total of 2 804 and 2 821 students were investigated before and after intervention respectively.@*Results@#The awareness rate of TB prevention and treatment core knowledge among the traditional education group and the Internet plus group before intervention was 47.5% and 47.8%, respectively (χ2=0.19, P>0.05). After intervention, the percentage of students with positive attitude and behavior regarding TB was 93.0% and 85.1% in the Internet plus group and the traditional model education group, respectively, including willingness to accept TB test (88.6% vs 81.5%), active reporting to school on TB diagnosis (96.4% vs 90.5%), no spitting in public, cover up when sneeze or cough (94.3% vs 90.6%), opening windows for ventilation (98.1% vs 95.7%), and willingness to share knowledge (98.7% vs 96.4%), active prevention of TB (86.3% vs 78.2%)(P<0.05).@*Conclusion@#Internet plus mode health education intervention shows more effectiveness on tuberculosis health education, compared with traditional health education.

Synergistic combination of two antimicrobial agents closing each other's mutant selection windows to prevent antimicrobial resistance.

Antimicrobial resistance seriously threatened human health. Combination therapy is generally an effective strategy to fight resistance, while some data on its effects are conflicting. To explore the reasons, the fractional inhibitory concentration indexes (FICIs) of three designed combinations against methicillin-resistant Staphylococcus aureus (MRSA) were determined using checkerboard method, and their minimal concentrations inhibiting colony formation by 99% (MIC99%s) and mutant prevention concentrations (MPCs) alone or in combinations including different proportions were first determined using agar plates. The results indicated that different proportions of a combination had presented different MPCs and mutant selection window (MSWs), and also showed that the smaller the FICIs of two agents in combinations were, the more probable their MSWs were to close each other. As two agents of a combination had different pharmacokinetic characters, the ratios of two agents in blood and infectious sites were likely different even though a specific proportion was administrated, which would lead to different effects preventing resistance. Thereby, these experimental results theoretically indicated that synergistic combination closing each other's MSWs had a great potency to prevent resistance according to the hypotheses of MSW and MPC, and deduced that in vivo synergistic validity of a combination was likely a key to prevent resistance. Moreover, a synergistic combination of roxithromycin/doxycycline with the FICIs of 0.26-0.50 and 0.28-0.38 respectively against MRSA 01 and 02 was obtained, and the MSWs of these two agents could be simultaneously closed each other in a certain range of proportions, but for others. Meanwhile, its effect preventing resistance needs to be further verified.