Associations of frailty, loneliness and the quality of life of empty nesters: A cross-sectional study in rural areas.

AIMS: To explore loneliness, in association with frailty, in explaining the quality of life (QOL) of empty-nest older adults in rural China. DESIGN: A cross-sectional questionnaire survey was conducted. METHODS: Data collection was performed from June to August 2017 in Changchun, the capital city of Jilin province, which consists of seven districts and three counties. In total, 304 older adults aged 60 years and above participated. The characteristics of older adults were evaluated in terms of frailty status, loneliness and the QOL. One-way and two-way analyses of covariance and the area under the receiver operating characteristic curves were used to explore the relationships of frailty, loneliness and the QOL. RESULTS: The one-way ANCOVA showed a significant difference among robust, prefrail and frail participants for loneliness. Moreover, an interaction effect of frailty with loneliness in determining the QOL was found. The receiver operating characteristic curves showed that loneliness and QOL could distinguish frail older adults, and the best cutoffs were 34.5 and 67.4, respectively. CONCLUSION: This study demonstrates a close relationship between frailty and loneliness, suggesting the need to simultaneously consider the two with regard to the QOL of empty-nest older adults in rural China.

Knowledge, attitudes, practices and information demand in relation to haze in China: a cross-sectional study.

BACKGROUND: Information on the effects of haze on health and corresponding knowledge, attitudes, and practices (KAP) will improve self-care ability against the ill effects of haze pollution and make environmental health policies more targeted and effective. In this study, we aim to determine the KAP and information demand in the context of haze and its effects on health. METHODS: A cross-sectional survey was conducted in Changchun, China, between October and November 2016. A purposive sample comprising four groups (college students, occupational population, traffic police, and elderly population) were investigated. Personal information and questions pertaining to KAP and information demand on haze pollution and health were collected through questionnaire. RESULTS: The questionnaire was completed by 888 residents. The awareness rate was 57.7% and varied significantly with education, exercise, and population group (p < 0.05). Among the four groups, college students scored the lowest in attitudes and practices, whereas traffic police scored the highest. Concerning the source of information demand, the elderly and traffic police preferred traditional information access (i.e., television and newspaper), whereas college students and the occupational population preferred new social media (i.e., mobile newspaper and social media sites). Regarding the most trusted department that releases information, all residents relied on the haze information released by the environmental protection department and meteorological department. The latest air quality was the most desired information of the residents. CONCLUSIONS: Changchun residents have a relatively high knowledge awareness rate. The elderly and less-educated residents are the targetable population for haze education. Education should be disseminated in such manner as to meet the needs of different people.

Napping on night-shifts among nursing staff: A mixed-methods systematic review.

AIMS: To synthesize research on the influence of night-shift napping on nurses. BACKGROUND: Shift work is common for hospital nurses. Various studies corroborate that shift work causes adverse health consequences for nurses. Night-shift napping is a countermeasure to address the adverse outcomes of shift work. DESIGN: A mixed-methods systematic review. DATA SOURCES: The literature search included the PubMed, Web of Science, Embase, PsycINFO and Cochrane Library electronic databases from inception to December 2017. Reference lists were hand searched. Only English articles were chosen. REVIEW METHODS: A sequential explanatory design and Cochrane's methods for integrating qualitative and implementation evidence in intervention effectiveness reviews. The Mixed Methods Assessment Tool and Cochrane Risk of Bias Tool were applied to assess the methodological quality of included studies. RESULTS: Twenty-two studies met our inclusion criteria. Many nurses experienced napping during their night-shift although no clear policy emerged. Napping is beneficial to the well-being of nurses and could improve their psychomotor vigilance and performance. However, the related studies are limited. The evidence on reducing sleepiness and fatigue was also insufficient and napping in nursing still faces challenges. CONCLUSION: Although research on this topic has just started, napping during night-shift is beneficial to nurses' health and performance. Research should further explore the long-term impact on of night-shift napping on nurses, people and organization using sound methodological designs. Managers should actively develop strategies to address night-shift napping barriers.

Factors influencing patient delay in individuals with haemorrhoids: A study based on theory of planned behavior and common sense model.

AIMS: This study aimed to describe the status of patient delay and examine related factors affecting patient delay in individuals with haemorrhoids in mainland China, based on theory of planned behaviour and common sense model. BACKGROUND: Studies on patient delay have mainly focused on cancer, tuberculosis and myocardial infarction, but studies on patient delay in individuals with haemorrhoids have yet to be conducted. Compared with other diseases, haemorrhoids are initially considered benign. However, if patients with haemorrhoids seek delayed medical assistance, they pay a large cost for worse symptoms because they fail to seek timely treatments compared with those who receive appropriate treatments at early stages. DESIGN: A cross-sectional study design was used. METHODS: The current study was performed on 306 patients with haemorrhoids from June - October 2017. Data were collected via a self-administered pencil-and-paper survey that consisted of a multi-item questionnaire. Stepwise logistic regression analysis was conducted to explore the factors of patient delay. RESULTS: Middle-aged participants were more than twice more likely to report patient delay than participants in other age groups. A high level of perceived self-efficacy, a high level of illness perceptions and perceived social impact were associated with prolonged delay. CONCLUSION: This study showed that patient delay is common among patients with haemorrhoids in China. The influencing factors of patient delay were middle-aged, illness perceptions, perceived self-efficacy, and perceived social impact.

The effectiveness of aromatherapy and massage on stress management in nurses: A systematic review.

AIMS AND OBJECTIVES: To assess the effectiveness of aromatherapy and massage on relieving stress in nurses. BACKGROUND: Nurses face uncommon levels of stress in medical settings. Stress has a negative impact on nurses' well-being and the organisation where they work. Aromatherapy and massage are important strategies for stress reduction. However, the effectiveness of aromatherapy and massage on relieving stress in nurses currently lacks understanding. DESIGN: Systematic review. METHOD: We performed a quantitative systematic review using Cochrane methods. We searched existing literature in the following databases: PubMed, PsycINFO, Embase, Web of Science and Cochrane Library, to examine any experimental design studies published from the earliest date available to August 2017 in English. Risk of bias per outcome was assessed. RESULTS: A total of 10 articles met the inclusion criteria, including aromatherapy (n = 4), massage (n = 4) and aromatherapy massage (n = 2). Most studies reported that aromatherapy and massage exert a beneficial effect on the stress of nurses. One study showed that the aromatherapy massage with music interventions has no effect on the stress of nurses. However, the number of the studies is limited and has high or unclear risk of bias. CONCLUSION: This review revealed that the evidence does not sufficiently prove that aromatherapy, massage and aromatherapy massage are effective for reducing job-related stress of nurses. We need to conduct high-quality studies to verify the effects of these interventions on nurses' stress levels in the future. Moreover, we need to integrate outcome measures of stress levels for developing more appropriate tools than the ones used as present. RELEVANCE TO CLINICAL PRACTICE: Nurses' stress has a negative impact on their own and organisation where they work. All available opportunities should be taken to reduce nurses' stress. It will be beneficial for nurse shortage.

Effects of cognitive behavioral therapy on people living with HIV and depression: A systematic review and meta-analysis.

The aim of this review is to examine the efficacy of cognitive behavioral therapy (CBT) on people living with HIV (PLWH) and depression. A literature search from five electronic databases was conducted, and articles published until July 2017 were collected. The inclusion criteria included randomized controlled trials (RCTs) of CBT that were conducted among PLWH with clinically relevant depression. Comprehensive Meta-Analysis 2 was used to obtain pooled results. Seven RCTs, with a total sample size of 388 participants, met the inclusion criteria. Compared with the control group, the CBT group had statistically significant, short-term improvements in depression (g = -0.486, 95% CI [-0.969 to -0.003], P = 0.048). A significant reduction in viral load was also observed at the long-term follow-up (g = -0.306, 95% CI [-0.573 to -0.040], P = 0.024), but no improvements were found in CD4. Results of this meta-analysis showed that CBT is effective in reducing depression symptoms in PLWH with comorbid depression for a short period of time. However, the findings of this review may not be generalized in the clinical field due to the small number of involved studies and the limited study sample. Thus, more robust and adequately powered studies are needed to further explore CBT interventions in PLWH with depression.

Evaluation of MESSAGE communication strategy combined with group reminiscence therapy on elders with mild cognitive impairment in long-term care facilities.

OBJECTIVE: This study aims to evaluate combined effects of MESSAGE communication strategy and group reminiscence therapy (GRT) on elders with mild cognitive impairment (MCI) in long-term care facilities in Changchun, China. METHODS: This study is a nonrandomized controlled trial. Subjects included 60 elders with MCI. Participants were divided into intervention (MESSAGE communication strategy combined with GRT) and control groups (without any intervention). Primary outcomes comprised cognitive function and quality of life of elderly people, as measured by the Beijing version of the Montreal Cognitive Assessment and the Chinese (mainland) version of Short-Form 36 Health Survey assessment. RESULTS: We observed significant changes in cognitive function with mean difference of 1.962 after 12 weeks (P = .000; 95% confidence interval [CI] = 1.341, 2.582), delayed memory dimension of 1.115 (P = .003; 95% CI = 0.417, 1.813). The intervention group exhibited the following improvements: general health of 14.731 (P = .000; 95% CI = 8.511, 20.951), mental health of 21.038 (P = .000; 95% CI = 17.301, 24.776), role-emotional of 26.925 (P = .003; 95% CI = 10.317, 45.533), and vitality of 14.231 (P = .000; 95% CI = 10.084, 18.377). CONCLUSIONS: Using a sample of Chinese elderly people with MCI and residing in long-term care facilities, we concluded that application of MESSAGE communication strategy combined with GRT resulted in improved cognitive function and quality of life.

Relationship between nurse psychological empowerment and job satisfaction: A systematic review and meta-analysis.

AIMS: This systematic review and meta-analysis aimed to synthesize and analyse studies that explored the relationship between the psychological empowerment and job satisfaction of nurses. BACKGROUND: Nurse turnover is an important cause of staff shortage. Job satisfaction is a major predictor of nurse turnover and is connected to the psychological empowerment of nurses. DESIGN: This systematic review and meta-analysis is based on the Joanna Briggs Institute guidelines. DATA SOURCES: A total of 1,572 articles on psychological empowerment and job satisfaction were retrieved from PubMed, PsycINFO, EMBASE and Web of Science. The articles were written in English and published before or by April 2017. METHODS: Studies on the relationship between psychological empowerment and job satisfaction were summarized. RESULTS: The majority of the included studies revealed that psychological empowerment and job satisfaction are significantly correlated. Only two studies showed that the two factors are not significantly correlated. The result of this meta-analysis is consistent with the results of most studies. One study reported that psychological empowerment partially mediates the structural empowerment and job satisfaction of school health nurses. Two studies, however, did not find that the mediating role of psychological empowerment between structural empowerment and job satisfaction. CONCLUSION: The results of this review provided evidence for the importance of psychological empowerment for the job satisfaction of among nurses. Exploring the correlation between psychological empowerment and job satisfaction can provide guidelines and recommendation for the development of strategies to promote nurse retention and alleviate nursing shortage.

Effect of multicomponent interventions on competence of family caregivers of people with dementia: A systematic review.

AIMS AND OBJECTIVES: This review aims to summarise and evaluate multicomponent interventions focused on improving the competence of family members of people with dementia (PwD) who undertake the caregiving tasks. BACKGROUND: Caregiver competence is essential for family members of PwD acting as caregivers. Competence affects the physical and mental health of both PwD and caregivers. Many kinds of multicomponent interventions are used to improve caregiver competence. DESIGN: A systematic review. METHODS: A literature search from six databases was conducted. Articles published until January 2017 were screened. Intervention studies that measured caregiver competence of family members of PwD as an outcome were included. The Oxford Center Evidence-based Medicine criteria and the Cochrane Handbook for Systematic Reviews of Interventions were used for quality assessment. RESULTS: Fifteen studies were included, and number of participants was 1096. The characteristics of the included studies and key findings were analysed. Multicomponent interventions may improve the family caregivers' competence. Caregivers in the intervention group were confident and skilful in managing their role. CONCLUSION: The intervention design, treatment content and length and intensity of the intervention varied in the included studies. Given that heterogeneity was high, combining these results via narrative synthesis is more appropriate than a meta-analysis. The current study provides recommendations regarding the formulation and implementation of interventions based on relevant literature. In view of existing research, researchers should conduct an in-depth study in this area and provide evidence-based interventions to support family members caring for PwD. RELEVANCE TO CLINICAL PRACTICE: The competence of family caregivers is essential for the life quality of PwD. To promote the health of the family caregiver and PwD, multicomponent interventions may be appropriate for nurses to practice.

Retirement planning and work-related variables in Chinese older nurses: A cross-sectional study.

AIM: To explore the situation of older nurses approaching retirement with regard to their retirement planning, and the relationship of their retirement planning behaviour with the job environment and job satisfaction under their current employment arrangements and other work-related variables. BACKGROUND: Nurse shortage has become a global phenomenon that can be alleviated by retaining older nurses in service. The Chinese government proposed the "Incremental Delay Retirement Age Policy." However, older nurses face delayed retirement but lack retirement plans. METHOD: A cross-sectional questionnaire survey was conducted among a convenience sample of older retiring nurses (n = 152; 84.92% response rate) recruited from every department of four large general hospitals in Changchun, Jilin Province from June to August 2016. RESULT: The majority of the respondents presented poor retirement planning (n = 122, 80.3%). The independent variables of information exchange with patients, teamwork and personal growth and development explained approximately 16.6% of the variance in retirement planning. Nurse-patient communication and personal growth and development can promote retirement planning, but teamwork is negatively related to retirement planning. CONCLUSION: Retirement planning by Chinese older nurses is related to certain work-related variables. However, many other work-related variables were not associated with retirement planning and require further research. Overall, Chinese older retiring nurses must improve their retirement planning practices.

Correlates of perceived stigma for people living with epilepsy: A meta-analysis.

OBJECTIVE: Epilepsy, one of the most common, serious chronic neurological diseases, is accompanied by different levels of perceived stigma that affects people in almost all age groups. This stigma can negatively impact the physical and mental health of people living with epilepsy (PLWE). Good knowledge of perceived stigma for PLWE is important. In this study, we conducted a meta-analysis to identify the correlates of perceived stigma for PLWE. METHODS: Studies on factors associated with perceived stigma for PLWE, including sociodemographic, psychosocial, and disease-related variables, were searched in PubMed, PsychINFO, EMBASE, and Web of Science. RESULTS: Nineteen variables (k>1) were included in the meta-analysis. For sociodemographic characteristics, findings revealed that the significant weighted mean correlation (R) for "residence" and "poor financial status" were 0.177 and 0.286, respectively. For disease-related characteristics, all variables of significance, including "seizure severity," "seizure frequency," "number of medicines," and "adverse event" (R ranging from 0.190 to 0.362), were positively correlated with perceived stigma. For psychosocial characteristics, "depression" and "anxiety" with R values of 0.414 and 0.369 were significantly associated with perceived stigma. In addition, "social support," "quality of life (QOLIE-31,89)," "knowledge," and "attitude," with R values ranging from -0.444 to -0.200 indicating negative correlation with perceived stigma. CONCLUSION: The current meta-analysis evaluated the correlates of perceived stigma for PLWE. Results can serve as a basis for policymakers and healthcare professionals for formulating health promotion and prevention strategies.

Differential gene expression in the endometrium on gestation day 12 provides insight into sow prolificacy.

BACKGROUND: Erhualian pigs, one of Chinese Taihu pig breeds, are known to have the largest recorded litter size in the world. A lower prenatal death rate is the major contributing factor to the prolificacy of Taihu pigs. Cross-breeding experiments have demonstrated that Taihu sows exhibit a strong maternal effect and that their large litter sizes are mainly caused by maternal genes. The growth and development of porcine embryos on gestation day (GD) 12 are dependent on histotroph secreted by endometrium. Embryonic loss of Taihu pigs on GD12 is lower than that of Western pigs. Here, endometrial samples were collected from pregnant Erhualian sows (parity 3) and Landrace × Large White (LL) sows (parity 3) on GD12. Digital gene expression profiling (DGE) was used to measure the gene expression in the endometrium of the two breeds. RESULTS: A total of 13,612 genes were differentially expressed between the two breeds (P < 0.001, FDR < 0.001). Gene Ontology (GO) analysis showed that the differential genes involved in reproduction and growth. Pathway analysis revealed that the differentially expressed genes significantly enriched in 24 KEGG pathways. Quantitative real-time RT-PCR confirmed the differential expression of eight genes. Analyses of the differentially expressed genes suggested possible reasons for the difference in embryonic survival ratio between the two breeds. Specifically, these findings point to a higher ratio of PGE2:PGF2α in the endometrium of Erhualian pigs, which facilitates the establishment and maintenance of pregnancy. We also suggest that the differences in the uterine environment lead to higher uterine capacity in Erhualian pigs. CONCLUSIONS: The DGE expression profiles of Erhualian and LL endometrium demonstrated differential expression of genes. Our results will increase understanding of the molecular mechanisms of the low rate of embryonic loss in Chinese Taihu pigs, facilitate the identification of major genes that affect litter size, and be valuable for porcine transcriptomic studies.

Hydrothermal Pretreatment of KOH for the Preparation of PAC and Its Adsorption on TC.

The environment has been heavily contaminated with tetracycline (TC) due to its excessive use; however, activated carbon possessing well-developed pores can effectively adsorb TC. This study synthesized pinecone-derived activated carbon (PAC) with high specific surface area (1744.659 cm2/g, 1688.427 cm2/g) and high adsorption properties (840.62 mg/g, 827.33 mg/g) via hydrothermal pretreatment methods utilizing pinecones as precursors. The results showed that PAC treated with 6% KOH solution had excellent adsorption properties. It is found that the adsorption process accords with the PSO model, and a large amount of C=C in PAC provides the carrier for π-πEDA interaction. The results of characterization and the isothermal model show that TC plays a key role in the adsorption process of PAC. It is concluded that the adsorption process of TC on PAC prepared by hydrothermal pretreatment is mainly pore filling and π-πEDA interaction, which makes it a promising adsorbent for TC adsorption.

A Scientometric Review: Biomass Gasification Study from 2006 to 2020.

Biomass gasification represents a significant way to produce energy from biomass. It features renewable properties and offers great potential for utilization. The application of biomass gasification products, design of the gasifier, type of biomass feedstock, gasification agents, and gasification parameters are key for the biomass gasification process. This work applies bibliometric approaches to provide a comprehensive and objective analysis of worldwide biomass gasification study trends over the period from 2006 to 2020 according to the Web Of Science core collection data. A total of 3222 articles associated with biomass gasification was retrieved, and its number grew annually. The subjects of study are diversified, primarily classified into "Energy & Fuels", "Engineering Chemical", and "Green Sustainable Science Technology". Moreover, Energy was a top published journal in the field of biomass gasification. Austrian contributors had the majority of publications, next to China and the USA. Liejin Luo from Xi'an Jiaotong University possessed the greatest H-index. Keyword evaluation showed that biomass gasification is a current hotspot, among which life-cycle assessment, sustainability, and deep processing of gasification products are future research directions. This work is predicted to offer further research interest in biomass gasification.

Selection of reference genes for studies of porcine endometrial gene expression on gestational day 12.

Comparing gene expression patterns in the endometrium on gestational day 12 (GD12) between Erhualian (ER) and Landrace×Large White (LL) pigs is helpful to understand the biological mechanisms of fecundity. Selecting genes that have stable expression levels as the internal standards in a comparative study is essential for identifying real gene-specific variation by quantitative RT-PCR (qRT-PCR). Five genes expressed in sow endometria on GD12 were evaluated for their suitability as internal control for relative quantification by qRT-PCR. These genes were beta-actin (ACTB), beta-2-microglobulin (B2M), phosphoglycerate kinase 1 (PGK1), RNA polymerase II polypeptide G (RPG), and ribosomal protein S20 (RPS20), which represent different functional classes. Our results indicated that ACTB, B2M, and PGK1 were not suitable as internal standards for normalization because of their huge variability between the two breeds. RPS20 and RPG were most stable, and the former is recommended to serve as the internal standard when the use of multiple housekeeping genes is unpractical.

A New Antitumor Direction: Tumor-Specific Endothelial Cells.

Targeting tumor blood vessels is an important strategy for tumor therapies. At present, antiangiogenic drugs are known to have significant clinical effects, but severe drug resistance and side effects also occur. Therefore, new specific targets for tumor and new treatment methods must be developed. Tumor-specific endothelial cells (TECs) are the main targets of antiangiogenic therapy. This review summarizes the differences between TECs and normal endothelial cells, assesses the heterogeneity of TECs, compares tumorigenesis and development between TECs and normal endothelial cells, and explains the interaction between TECs and the tumor microenvironment. A full and in-depth understanding of TECs may provide new insights for specific antitumor angiogenesis therapies.

Tanshindiol-C suppresses in vitro and in vivo hepatocellular cancer cell growth by inducing mitochondrial-mediated apoptosis, cell cycle arrest, inhibition of angiogenesis and modulation of key tumor-suppressive miRNAs.

PURPOSE: Hepatocellular carcinoma causes considerable mortality and no efficient chemotherapy is available. Novel molecules of plant origin may prove beneficial in the development of therapy of hepatocellular carcinoma. In this study we examined the anticancer effects of Tanshindiol-C (TC) against the hepatocellular carcinoma SNU-4235 cell line. METHODS: Proliferation rate of the SNU-2435 cells was determined by MTT assay. Apoptosis was confirmed by DAPI and annexin V/PI staining. Cell cycle analysis was performed by flow cytometry. MicroRNA expression was checked by qRT-PCR and protein expression by western blotting. The in vivo evaluation of TC was performed in xenografted mice models. RESULTS: TC inhibited the growth of the SNU-4235 cells and exhibited an IC50 of 20 µM. Investigation of the underlying mechanism revealed that TC triggered apoptotic death of the SNU-4235 cells which was also associated with enhancement of the expression of Bax and decrease in the expression of Bcl-2. TC also caused arrest of the cells in the G2/M phase of the cell cycle and also exerted angiogenitic effects. TC also enhanced the expression of the tumor suppressor microRNA-21, 222 and 31. In vivo evaluation of TC revealed that it could inhibit the tumor weight volume, suggestive of the anticancer potential of TC. CONCLUSIONS: In brief, tanshindiol-C exerts anticancer effects on hepatocellular carcinoma by induction of apoptosis and cell cycle arrest, along with inhibiting the angiogenesis and the expression of tumor suppressive microRNAs. TC could also inhibit the growth of the xenografted tumors and hence could prove to be a potential anticancer agent.

Differential microRNA Expression in Porcine Endometrium Involved in Remodeling and Angiogenesis That Contributes to Embryonic Implantation.

Background: In western swine breeds, up to 30% of embryonic losses occur during early pregnancy, and the majority of embryonic losses happens during implantation. In this period, maternal recognition of pregnancy begins to occur and blastocysts undergo dramatic morphologic changes. As with other species, changes in the uterine environment plays an important role in the process of embryo implantation in pigs. Erhualian (ER) pigs, one of the Chinese Taihu swine breeds, are known to have the highest litter size in the world. Experiments demonstrated that the greater embryonic survival on gestation day (GD) 12 in Chinese Taihu pigs is one important factor that contributes to enhanced litter size. This is largely controlled by maternal genes. In this study, endometrial samples were collected from pregnant Landrace×Large Yorkshire (LL) sows (parity 3) and ER sows (parity 3) on GD12 and the expression profiles of microRNAs (miRNAs) in the endometrium were compared between ER and LL using miRNA-seq technology. Results: A total of 288 miRNAs were identified in the pig endometrium, including 202 previously known and 86 novel miRNAs. The Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that highly abundant miRNAs might affect endometrial remodeling. Comparison between LL and ER sows revealed that 96 known miRNAs were differentially expressed between the two groups (including 78 up-regulated and 18 down-regulated miRNAs in ER compared to LL). Bioinformatics analysis showed that the target genes of some differentially expressed miRNAs were involved in pathways related to angiogenesis, proliferation, apoptosis, and tissue remodeling, which play critical roles in implantation by regulating endometrial structural changes and secretions of hormones, growth factors, and nutrients. Furthermore, the results demonstrated that insulin-like growth factor-1 protein expression was directly inhibited by miR-206. The lower expression of miR-206 in ER compared to LL might facilitate the angiogenesis of the endometrium during embryo implantation. Conclusions: The identified miRNAs that are differentially expressed in the endometrium of ER and LL pigs will contribute to the understanding of the role of miRNAs in embryonic implantation and the molecular mechanisms of the highest embryonic survival in Chinese ER pigs.

Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta-analysis.

WHAT IS KNOWN ON THE SUBJECT?: A growing body of qualitative and quantitative research has investigated the experiences of affiliated stigma for family members of PWMI. Some findings are contradictory and have not been considered systematically. WHAT DOES THE PAPER ADDS TO EXISTING KNOWLEDGE?: Family caregivers of PWMI may encounter affiliate stigma, but no systematic review or meta-analysis has been conducted to evaluate affiliate stigma among them. We identified eight variables significantly related to affiliate stigma among caregivers of PWMI. The findings can be used to help clinical practice to develop health promotion and prevention strategies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Affiliate stigma was prevalent among the family caregivers of PWMI and is important for clinicians to consider. Health-focused interventions for family caregivers can mediate the impact of affiliated stigma through provision of social support by practitioners, such as respite care based on the "Senses Framework," self-help groups and online support program. And the caregivers of PWMI might benefit from further support (e.g., psychoeducation) to improve their knowledge about mental illness. ABSTRACT: Introduction Many studies have investigated the correlates of affiliate stigma among family caregivers of people with mental illness (PWMI). Thus far, no systematic review or meta-analysis has been conducted to synthesize these results. Aims/Question This review aims to identify the correlates of affiliate stigma among family caregivers of PWMI. Method We searched four databases including PubMed, PsycINFO, EMBASE and Web of Science for studies that investigated the association of affiliate sigma with socio-demographic, psychosocial and disease-related factors. Results Twenty-two studies including 3,381 participants met the inclusion criteria. Eighteen variables were included for the meta-analysis. For disease-related characteristics, only "disease attribution" and "care time/day" were associated with affiliate stigma. For psychosocial characteristics, "support from others," "burden," "depression," "stress," "distress" and "face concern" were related to affiliate stigma. Discussion This review is the first to assess the association of affiliate stigma with other characteristics of interest. However, the findings are limited due to a very small number of studies. Researchers should conduct in-depth study in this area and improve the quality of the literature. Implications for practice Health-focused interventions for family caregivers such as respite care, self-help groups, online support program and psychosocial education can mediate the impact of affiliated stigma.

CagA increases DNA methylation and decreases PTEN expression in human gastric cancer.

Gastric cancer is one of the leading causes of cancer-associated mortality worldwide. Cytotoxin­associated gene A (CagA) has been reported to be associated with gastric diseases. Phosphatase and tensin homolog (PTEN) and tet methylcytosine dioxygenase 1 (Tet1) are important tumor­suppressor genes. The present study aimed to investigate the underlying functions of CagA in human gastric cancer, and to explore the associations between CagA, PTEN and Tet1 in gastric cancer. For that purpose, CagA overexpression and Tet1 interference recombinant lentiviral plasmids were constructed. Quantitative polymerase chain reaction (qPCR) was utilized to screen gene expression in HGC­27 human gastric cancer cells overexpressing CagA. qPCR and western blotting were used to detect gene and protein expression, respectively. In addition, the methylation status of PTEN was detected by methylation­specific PCR. The expression levels of PTEN, Tet1, apolipoprotein B mRNA editing enzyme catalytic subunit (APOBEC)3A, APOBEC3C and APOBEC3F were significantly decreased in the CagA overexpression group compared with in the negative control group in HGC­27 cells. Compared with in the negative control group, the mRNA and protein expression levels of PTEN were markedly decreased in cells with Tet1 interference. The decreased expression of PTEN was associated with increased methylation levels in the cells. In addition, the protein expression levels of PTEN were significantly decreased in HGC­27 cells when CagA was overexpressed. The expression levels of PTEN and Tet1 were also markedly decreased in CagA+ gastric cancer tissues compared with in non­cancerous tissues. The decreased expression of PTEN in CagA+ gastric cancer tissues was associated with increased methylation levels. In conclusion, overexpression of CagA significantly decreased the expression of PTEN, Tet1, APOBEC3A, APOBEC3C and APOBEC3F in human gastric cancer. In addition, CagA increased DNA methylation and decreased PTEN expression, which was reversed by Tet1 overexpression. The present study may facilitate future therapeutic approaches targeting human gastric cancer.