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Objective: Postoperative fasting following thoracoscopic surgery can cause intense thirst and oral discomfort. However, there is currently no research on ultraearly oral hydration (UEOH) in middle-aged or elderly patients after thoracoscopic surgery. The aim of this study was to investigate the effectiveness and safety of UEOH for improving oral discomfort after thoracoscopic surgery. Methods: This single-center prospective double-blind randomized controlled trial was conducted from April 2022 to November 2023. A total of 64 middle-aged and elderly patients who underwent the first thoracoscopic surgery on the day were enrolled at our institution. Postoperatively, in the Postanesthesia Care Unit (PACU), patients were randomly assigned at a 1:1 ratio to either the UEOH group or the standard care (SC) group. The primary outcome was the patient's thirst score at 6 h after surgery. Secondary outcomes included the incidence of postoperative oral discomfort; pain scores; the occurrence of adverse reactions such as nausea, vomiting, regurgitation and aspiration; anxiety scores on the first postoperative day; the time to first flatus; and recovery satisfaction scores. Results: The demographic and surgical characteristics were similar between the two groups. Patients in the UEOH group had lower thirst scores 6 h after surgery than did those in the SC group(16.1 ± 6.70 vs. 78.4 ± 8.42, P < 0.01). The incidence of postoperative oral discomfort (P < 0.01), anxiety scores on the first postoperative day (P<0.05), and time to first flatus (P<0.05) were better in the UEOH group. Additionally, the incidences of adverse reactions, such as postoperative nausea, vomiting, regurgitation and aspiration, were similar between the two groups (P>0.05). Conclusion: For middle-aged and elderly patients undergoing thoracoscopic surgery, the use of a modified UEOH protocol postoperatively can improve thirst and promote gastrointestinal recovery without increasing complications. Trial registration: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 07/12/2023 with the registration number ChiCTR2300078425. [ABSTRACT FROM AUTHOR]

Background: Neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) are closely related to the prognosis of patients with non‐small cell lung cancer, but their effect on extensive‐stage small cell lung cancer (ES‐SCLC) remains uncertain. Methods: This retrospective study was conducted in ES‐SCLC patients treated with first‐line atezolizumab or durvalumab and platinum‐etoposide. Clinical data from three hospitals were analyzed. Significant risk factors for survival were identified using descriptive statistics and Cox regression. Homogeneity was assessed using t‐tests or nonparametric tests. Kaplan‐Meier analysis revealed an association between high NLR level and median PFS and OS. Results: A total of 300 ES‐SCLC patients were included in the study. Cox regression analysis revealed that an elevated NLR level after the second treatment cycle (defined as NLRT2) was an independent prognostic factor for survival. Stratifying patients based on median NLRT2 showed significant differences in both PFS (HR: 1.863, 95% CI: 1.62–2.12, p < 0.001) and OS (HR: 2.581, 95% CI: 2.19–3.04, p < 0.001) between NLR ≥ 1.75 and NLR < 1.75 groups. mPFS and mOS were 8.2 versus 6.1 months and 13.7 versus 9.5 months, respectively. NLR was also associated with treatment efficacy and occurrence of irAEs. Further stratification based on NLR and irAEs showed that in the NLR < 1.75 group, patients with irAEs had prolonged mPFS and mOS. In the NLR ≥ 1.75 group, only mPFS showed a significant difference between patients with and without irAEs. Conclusion: NLRT2 and irAEs can predict the prognosis of ES‐SCLC patients with first‐line ES‐SCLC receiving PD‐L1 inhibitors combined with chemotherapy. [ABSTRACT FROM AUTHOR]

Objective. To analyze and evaluate the clinical value of hetrombopag in cancer therapy-induced thrombocytopenia (CTIT) caused by antitumor therapy for malignant tumors and to provide scientific evidence support for clinical application in the real-world setting. Methods. The clinical data of CTIT patients with advanced solid tumors who received hetrombopag were analyzed retrospectively. The proportion of patients with different characteristics who recovered platelet count to ≥75 × 109/L at day 14 and the effective rate of platelet elevation was compared by the χ2 test or Fisher exact probability method. P < 0.05 was considered statistically significant. Results. A total of 60 CTIT patients who received hetrombopag at our site from July 2021 to October 2022 were finally included in this study. The proportion of patients who achieved therapeutic effect within (7 ± 2) days after treatment was 26.7% (16/60), among which 20.0% (12/60) patients had platelet count recovered to ≥100 × 109/L, and 25.0% (15/60) patients had platelet count increase from baseline ≥50 × 109/L. Within (14 ± 2) days of treatment with hetrombopag, 66.7% (40/60) of patients achieved treatment response, of whom 56.7% (34/60) had platelet counts ≥100 × 109/L and 53.3% (32/60) had platelet counts ≥50 × 109/L increase from baseline. In addition, no treatment-related adverse events occurred during the treatment period. Conclusion. This retrospective study provides preliminary evidence that hetrombopag increases platelets in CTIT patients receiving antitumor therapy for advanced solid tumors. [ABSTRACT FROM AUTHOR]

Importance: Self-management of lifestyle behaviors is the recommended focus for interventions to address Type 2 diabetes. Habit formation is an effective approach to changing personal behaviors, but evidence of success for Type 2 diabetes is limited. Objective: To examine the feasibility and preliminary effectiveness of occupation-based habit formation interventions for improving diabetes self-management behaviors. Design: Single-subject design with multiple participants providing 4 wk of baseline data followed by 10 wk of intervention data. Setting: Individual telehealth sessions. Participants: Eight adults (ages 29–75 yr) with Type 2 diabetes, who had access to a telephone and who were not involved in other diabetes-related education or interventions voluntarily, enrolled into the study. Intervention: Participants engaged in 10 wk of habit formation intervention focused on four diabetes self-management domains: nutrition, blood glucose monitoring, medication management, and physical activity. Outcomes and Measures: Data gathered included findings on measures of diabetes self-care behaviors and habit formation. Results: There was a significant change in self-care behaviors for 6 of the 8 participants (p <.05 for 1 participant, and p <.01 for 5 participants). Group changes were statistically significant (p <.001). Habit strength significantly improved for all areas of diabetes self-management (p <.001 for nutrition, blood glucose monitoring, and medication management and p =.001 for physical activity). Conclusions and Relevance: Findings suggest that the occupation-based intervention was feasible and showed promise for developing self-management behaviors. What This Article Adds: Habits are considered foundational to occupations, yet application of the science of habit formation is often not well understood by occupational therapists. This study considered the theoretical components of habit formation that have been neglected by prior studies and demonstrates the feasibility and preliminary effect estimates of a habit formation intervention when used with people with Type 2 diabetes. The study findings suggest that an occupation-based habit formation intervention is feasible and shows promise for improving self-management behaviors for people with Type 2 diabetes. [ABSTRACT FROM AUTHOR]

The article discusses research which assessed interprofessional learner perceptions of a brief educational intervention tailored for opioid prescribing in older adults. The study evaluated pre- and post-intervention knowledge and confidence in medication safety and non-opioid treatment strategies. Findings revealed potential improvement of communication between providers and patients or their caregivers, as well as opportunity to educate caregivers and other providers.

Background: Colorectal cancer (CRC) screening rates remain low in Latino communities. We sought to determine the screening awareness and attitudes in Omaha, Nebraska. Methods: We interviewed 150 Latinos at an urban Federally Qualified Health Center, June-October 2017. Chi-square or Fisher-exact tests and multiple logistic regression models were used for data analysis. Results: Participants reported low educational attainment, low income, and limited access to insurance or a primary provider. Less than one-third of participants aged 50 + had ever heard of FOBT (32.6%) or colonoscopy (30.4%). For individuals 50+, access to a primary care provider (p =.03) and knowing the screening initiation age (p =.03) were associated with ever having a colonoscopy. Higher knowledge score was a strong predictor of any CRC screening. Discussion: Knowledge predicted screening, suggesting interventions should aim to educate this population regarding CRC screening guidelines and options and work with stakeholders to make CRC screening more accessible. [ABSTRACT FROM AUTHOR]

Interparental relationship is one of the substantial factors that affect children's mental well-being and emotional development in a family. Interparental conflicts are pervasive in most families, which may have adverse effects on children. However, interparental conflict in China received restricted attention, and social research about marital conflict has limited focus on children. A cross-sectional survey of 846 students was conducted to explore the correlations between interparental conflict and Chinese children's social anxiety and life adjustment. The results showed that more perceived threat, persistent and unresolved conflicts, older age, and lower coping efficacy were associated with increased social anxiety in children while paternal education of high school was related to lower social anxiety. Child-related and unresolved conflicts, greater intensity of the conflict, frequent conflict, and paternal education of college and above were associated with impaired children's life adjustment development. Perception of interparental conflicts was closely associated with children's social development. [ABSTRACT FROM AUTHOR]

Simple Summary: Smoking is the commonest cause of oral cavity squamous cell carcinoma (OC-SCC), but the cause of OC-SCC in nonsmokers is unknown. Our primary goal was to use metagenomic shotgun sequencing (MSS) to directly define the taxonomic composition and functional potential of oral metagenome in nonsmokers with OC-SCC. We found three bacterial phyla, one genus, and one species were enriched in OC-SCC while two phyla, five genera, and 18 species were enriched in controls. Pathways related to metabolism of flavin, biotin, thiamine, heme, sugars, fatty acids, peptidoglycans, and tRNA were more abundant in OC-SCC while those related to metabolism of nucleotides and essential amino acids were more abundant in controls. The MSS method achieved similar results to the commonly used 16S rRNA gene survey in compositional differentiation but differed greatly from prediction using 16S rRNA genes in functional differentiation of microbiomes in OC-SCC and controls. Objectives: Smoking is the commonest cause of oral cavity squamous cell carcinoma (OC-SCC), but the etiology of OC-SCC in nonsmokers is unknown. Our primary goal was to use metagenomic shotgun sequencing (MSS) to define the taxonomic composition and functional potential of oral metagenome in nonsmokers with OC-SCC. Methods: We conducted a case–control study with 42 OC-SCC case and 45 control nonsmokers. MSS was performed on DNA extracted from mouthwash samples. Taxonomic analysis and pathway analysis were done using MetaPhlAn2 and HUMAnN2, respectively. Statistical difference was determined using the Mann–Whitney test controlling false discovery rate. Results: There was no significant difference in age, sex, race, or alcohol consumption between OC-SCC and control patients. There was a significant difference in beta diversity between OC-SCC and controls. At the phylum level, Bacteroidetes and Synergistetes were overly represented in OC-SCC while Actinobacteria and Firmicutes were overly represented in controls. At the genus level, Fusobacterium was overly represented in OC-SCC compared with controls, while Corynebacterium, Streptococcus, Actinomyces, Cryptobacterium, and Selenomonas were overly represented in controls. Bacterial pathway analysis identified overrepresentation in OC-SCC of pathways related to metabolism of flavin, biotin, thiamin, heme, sugars, fatty acids, peptidoglycans, and tRNA and overrepresentation of nucleotides and essential amino acids in controls. Conclusions: The oral microbiome in nonsmoker patients with OC-SCC is significantly different from that of nonsmoker control patients in taxonomic compositions and functional potentials. Our study's MSS findings matched with previous 16S-based methods in taxonomic differentiation but varied greatly in functional differentiation of microbiomes in OC-SCC and controls. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (β=0.483, P<0.001), and negatively related to family resilience (β=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (β = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (β = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience–oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress. [ABSTRACT FROM AUTHOR]

Background: Anticipatory grief has been shown to be highly prevalent among family caregivers of patients with advanced illness. Qualitative study suggests that illness uncertainty may be one of the core characteristics of anticipatory grief, but it has not been confirmed in quantitative studies. Therefore, the purpose of this study was to explore the relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer and to determine the factors influencing anticipatory grief. Methods: This descriptive cross-sectional study used a convenience sampling method and recruited 254 inpatient family caregivers from the thoracic medicine ward of Liaoning Cancer Hospital & Institute in Shenyang, mainland China. Anticipatory grief (Anticipatory Grief Scale (AGS), illness uncertainty (Uncertainty in Illness Scale Family Caregiver Version) and sociodemographic information (Self-compiled general information questionnaire) were measured using validated self-report measures. Results: Chinese family caregivers of patients with advanced lung cancer had high levels of anticipatory grief (73.5 ± 16.1). The results of the correlation analysis showed a positive association between anticipatory grief and illness uncertainty (r = 0.580, P < 0.001). The final linear regression model with anticipatory grief as the dependent variable included four variables: illness uncertainty (β = 0.674, P < 0.001), lack of informativeness (β = − 0.168, P = 0.08), monthly income (β = 0.139, P = 0.006), and caregiving burden (β = − 0.196, P < 0.001). Conclusions: Illness uncertainty is probably an important factor affecting anticipatory grief. Excessive caregiving burden is associated with high levels of anticipatory grief. Improving illness uncertainty and caregiving burden may effectively reduce anticipatory grief among Chinese family caregivers. [ABSTRACT FROM AUTHOR]

There has been an increasing interest and enormous applications in three-dimensional (3D) printing technology and its prosthesis, driving many orthopaedic surgeons to solve the difficult problem of bony defects and explore new ways in surgery approach. However, the most urgent problem is without an effective prosthesis and standard treatment strategy. In order to resolve these problems, this study was performed to explore the use of a 3D-printed anatomically conforming pelvic prosthesis for bony defect reconstruction following tumor resection and to describe a detailed treatment flowchart and the selection of a surgical approach. Six patients aged 48-69 years who had undergone pelvic tumor resection underwent reconstruction using 3D-printed anatomically conforming pelvic prostheses according to individualized bony defects between March 2016 and June 2018. According to the Enneking and Dunham classification, two patients with region I+II tumor involvement underwent reconstruction using the pubic tubercle-anterior superior iliac spine approach and the lateral auxiliary approach and one patient with region II+III and three patients with region I+II+III tumor involvement underwent reconstruction using the pubic tubercle-posterior superior iliac spine approach. The diagnoses were chondrosarcoma and massive osteolysis. After a mean follow-up duration of 30.33 ± 9.89 months (range, 18-42), all patients were alive, without evidence of local recurrence or distant metastases. The average blood loss and blood transfusion volumes during surgery were 2500.00 ± 1461.51 ml (range, 1200-5000) and 2220.00 ± 1277.62 m l (range, 800-4080), respectively. During follow-up, the mean visual analogue scale (VAS) score decreased, and the mean Harris hip score increased. There were no signs of hip dislocation, prosthetic loosening, delayed wound healing, or periprosthetic infection. This preliminary study suggests the clinical effectiveness of 3D-printed anatomically conforming pelvic prostheses to reconstruct bony defects and provide anatomical support for pelvic organs. A new surgical approach that can be used to expose and facilitate the installation of 3D-printed prostheses and a new treatment strategy are presented. Further studies with a longer follow-up duration and larger sample size are needed to confirm these encouraging results. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the factors that influence nurses empathy towards patients and to explore its influence on effort–reward imbalance involving empathy. Background: Empathy is highly valued in nurse–patient relationships. However, currently, little evidence currently exists on the impact of work‐related stress measured by effort–reward imbalance and empathy. Design: An anonymous, cross‐sectional online survey using a sample of convenient was conducted. Methods: Convenient online sampling was conducted with select nurses from seven cities in Shandong province, China. The nurses worked in clinical settings in 10 different hospitals. Two questionnaires, for example the Effort‐Reward Imbalance Questionnaire and the Jefferson Scale of Physician Empathy, were used. Medians, percentages, related analysis and regression analysis were used to measure the relationship between Effort‐Reward Imbalance and empathy levels among nurses in China. In addition, this study adhered to the EQUATOR checklist, STROBE (see Supplementary file 1). Results: Among 1,077 participants, 26.5% stated experiencing an Effort‐Reward Imbalance, with a mean empathy score among Chinese nurses, was 109.78 ± 13.98. Multiple regression analysis revealed that females and head nurses had higher levels of empathy, and that those who had no experience learning about empathy‐related courses and an Effort‐Reward Imbalance ratio were negatively associated with empathy. Conclusions: Gender, department, position, experience learning about empathy‐related courses and Effort‐Reward Imbalance ratio were significant elements related to nurses' empathy levels. Relevance to clinical practice: As we all know, empathy can affect the relationship between nurse and patient. If nurses are in an Effort‐Reward Imbalance, they may have less empathy. It is advised to improve the reward level of nurses, so that the level of empathy towards patients is enhanced. [ABSTRACT FROM AUTHOR]

Background: PH domain and leucine‐rich repeat protein phosphatase 2 (PHLPP2) has been reported to be a potent tumor suppressor in many human cancers. However, PHLPP2 has not been fully researched as a putative clinical prognostic biomarker of lung cancer. Methods: The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases including data on 1383 non‐small cell lung cancer (NSCLC) patients were used to determine PHLPP2 expression. PHLPP2 expression was then examined by immunohistochemistry, and its clinical significance analyzed in 134 NSCLC patients, including 73 patients with adenocarcinoma and 81 with squamous cell carcinoma. Results: We found PHLPP2 expression to be less pronounced in NSCLC tissue samples than that in nontumoral lung tissues according to data taken from TCGA and GEO datasets; this outcome was further validated by immunohistochemistry assay. The low PHLPP2 expression level was found to be associated with the presence of lymph node metastasis (P = 0.003). Importantly, PHLPP2 was found to be an independent indicator of prognosis for overall (hazard ratio [HR] = 0.520, 95% confidence interval [Cl] = 0.327–0.827; P = 0.006) and disease‐free survival (HR = 0.489, 95% Cl = 0.308–0.775; P = 0.002) in patients with surgically‐resected NSCLC by multivariate analysis. Conclusion: Taken together, our findings show that PHLPP2 is a robust clinical marker for NSCLC survival and could serve as a potential therapeutic target. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and characteristics of unintentional injuries among 5 to 9 grades students for both urban and migrant children groups, and probe the major socio-demographic and psychosocial risk factors. Methods: A cross-sectional survey was conducted from May to June in 2013 with 2266 urban and 1770 migrant children among 5 to 9 grades from 13 schools in Yinzhou, Southeast China. Unintentional injuries and psychosocial factors were measured via self-administered questionnaires. Descriptive statistics and binary logistic regression were employed in data analysis. Results: The annual prevalence of unintentional injury in the past year was 38%. Compared with urban children, migrant children reported lower prevalence of sprains/fractures (15.5 vs. 18.7%), but higher in animal bites (15.7 vs. 9.6%), burns (20.7 vs. 16%), nonfatal drowning (6 vs. 2.7%), and unintentional injury (40.9 vs. 35.7%). Binary logistic regression analysis revealed that male, young age, attending migrant children school, scoring high in emotional symptoms, conduct problems or hyperactivity, with suicide ideation, and experiencing verbal maltreatment were associated with unintentional injury incidence in the past 12 months. Conclusions: The annual prevalence of unintentional injury among 5 to 9 grades schoolchildren in Yinzhou was high. Child unintentional injuries were associated with multi-level psychosocial factors. Although the direct correlation between migrant status and unintentional injuries was unobserved, migration could have an indirect relationship with injury. The findings could inform some implications for prevention strategies in urban area. [ABSTRACT FROM AUTHOR]

This study assessed the association between acculturation and unmet health needs among refugees. Based on data from the Refugee Health Needs Assessment Survey (n = 291) recently conducted in Omaha, Nebraska, Chi square tests and multivariate logistic regressions were estimated to examine how acculturation among refugees was related to their unmet health needs. Relative to refugees who had been in the U.S. for less than 3 years, refugees who had been in the U.S. for 3-5 years were more likely to report lack of health insurance coverage (AOR 2.87, 95% CI 1.19, 6.92) and delaying to see a health care provider due to cost during the 12 months prior to the survey (AOR 4.01, 95% CI 1.18, 13.67). Acculturation among refugees did not necessarily alleviate their unmet health needs. Addressing these needs calls for sustainable medical assistance to refugees that well go beyond the 8-month health insurance coverage currently provided to newly arrived refugees. [ABSTRACT FROM AUTHOR]

Abstract School-based health centers (SBHCs) have been suggested as potential medical homes, but may experience challenges implementing the patient-centered medical home (PCMH) model. It is currently unknown if there are PCMH variations among different types of SBHCs. The purpose of this study was to examine the associations between SBHC characteristics and PCMH capacity. Using 2013–2014 National Census of School-Based Health Centers data, SBHC PCMH Index scores were calculated and used as outcomes in linear regression models examining associations between PCMH capacity and SBHC characteristics. The mean PCMH capacity score for all SBHCs was 68.59%, with higher scores in the Comprehensive Care domain than in the Care Quality domain. Managed care arrangements, Medicaid PCMH initiatives, more funding sources, and higher patient billing activity were all positively associated with overall PCMH capacity. Having higher percentages of students who are members of racial/ethnic minority groups was negatively associated with overall PCMH capacity. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we examined the association between changes in leisure time physical activity (LTPA) preference (the extent to which participants liked or disliked certain types of physical activity) and the incidence of hypertension; we also assessed whether the association differed between urban and rural China. Methods: Based on longitudinal data from 2687 Chinese adults between 2004 and 2011, we performed multivariate logistic regressions were to assess the aforementioned association. We conducted stratified analyses to examine the urbanrural differences in this association. Results: The mean age was 40.0 (Standard Deviation = 12.5), and the mean BMI was 23.7 (Standard Deviation = 3.3). Adjusted estimates show that relative to respondents with no changes in LTPA preference, respondents who reduced preference were more likely to develop hypertension (OR = 1.92, 95% CI = 1.13-3.28). This association, however, was statistically significant among urban residents (OR = 2.19, 95% CI = 1.04-4.60), but not rural participants. Conclusions: Changes in LTPA preference and development of hypertension were significantly correlated, especially among urban Chinese. Hypertension prevention programs may identify the groups at elevated risk by examining levels and changes of LTPA preferences. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate changes in clinical outcomes for patients with type 2 diabetes (T2D) after a 3-month remote patient monitoring (RPM) program, and examine the relationship between hemoglobin A1c (HbA1c) outcomes and participant characteristics. The study sample included 955 patients with T2D who were admitted to an urban Midwestern medical center for any reason from 2014 to 2017, and used RPM for 3 months after discharge. Clinical outcomes included HbA1c, weight, body mass index (BMI), and patient activation scores. Logistic regression was used to estimate the likelihood of having a postintervention HbA1c <9% by patient characteristics, among those who had baseline HbA1c >9%. Most patients experienced decreases in HbA1c (67%) and BMI (58%), and increases in patient activation scores (67%) (P < 0.001 in all 3 cases) at the end of RPM. Logistic regression analyses revealed that among patients who had HbA1c >9% at baseline, men (odds ratio [OR] = 3.72; 95% confidence interval [CI], 1.43–9.64), those who had increased patient activation scores after intervention (OR = 1.05; 95% CI, 1.01–1.09), those who had higher baseline patient activation scores, and those who had a greater number of biometric data uploads during the intervention (OR = 1.02; 95% CI, 1.00–1.04) were more likely to have reduced their HbA1c to <9% at the end of RPM. RPM for postdischarge patients with T2D might be a promising approach for HbA1c control with increased patient engagement. Future studies with study designs that include a control group should provide more robust evidence. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine geographic and race/ethnic disparities in access to end of life care among elderly patients with lung cancer. The study sample consisted of 91,039 Medicare beneficiaries with lung cancer who died in 2008. The key outcome measures included the number of emergency room visits, the number of inpatient admissions and the number of intensive care unit (ICU) days in the last 90 days of life, hospice care ever used and hospice enrollment within the last 3 days of life. Medicare beneficiaries with lung cancer residing in rural, remote rural, and micropolitan areas had more ER visits in the last 90 days of life as compared to urban residents. Urban residents however, had more ICU days in the last 90 days of life and were more likely to have ever used hospice as compared to residents of rural, remote rural and micropolitan counties. Racial minority lung cancer patients had more ICU days, ER visits and inpatient days than non-Hispanic White patients, and also were less likely to have ever used hospice care or be enrolled in hospice in the last 3 days of life. Lung cancer patients with very low socioeconomic status (SES) were less likely to ever use hospice or be enrolled in hospice care in the last 3 days of life, as compared to those who had very high SES. Geographic, racial and socioeconomic disparities in end of life care call for targeted efforts to address access barriers for these groups of patients. [ABSTRACT FROM AUTHOR]

Acanthosis nigricans (AN) is a cutaneous marker associated with elevated risk of type 2 diabetes. This study assesses mother-father differences in perception of child's bodyweight and health by Mexican-American parents with AN-positive children. The study used medical records in conjunction with survey data collected between 2011 and 2012 for 309 Mexican-American children with AN in South Texas. Multivariate logit models were estimated to assess mother-father differences in perception of child bodyweight and health controlling for selected child- and parent-level covariates. About 91 % of the children in the sample were obese and 6.5 % were overweight. One fifth of mothers and 38.5 % of fathers in the sample expressed no concern of their children's bodyweight. After adjusting for selected explanatory variables at both the child and parent level, the odds for fathers, relative to mothers, to be concerned about child's bodyweight were 82 % lower (OR = 0.18, p < 0.05). Similar findings also hold for parental awareness of child's AN (OR = 0.19, p < 0.05). Among Mexican-American families with AN-positive children, the lack of concern over child's bodyweight, unawareness of AN, and misconception of child's health on the part of many parents, especially of fathers, constitutes a challenge to diabetes prevention. Health education programs targeting Mexican-American families with AN-positive children might be more cost effective to consider mother-father differences in perception of child health and bodyweight. [ABSTRACT FROM AUTHOR]

Background Although previous research has documented rural disparities in hospice use, limited data exist on the roles of geographic access in different types of end-of-life indicators among cancer survivors. Methods Medicare claims data were used to identify beneficiaries with colorectal cancer who died in 2008 (N = 34,975). We evaluated rural-urban differences in ER visits 90 days before death, inpatient hospital admissions ≤90 days before death, intensive care unit (ICU) use ≤90 days before death, hospice care use at any time, and hospice enrollment <3 days before death. Results About 60% of beneficiaries in rural areas lived in counties with the 2 lowest socioecomonic levels compared to only 5.3% of beneficiaries in metropolitan areas. After adjusting for demographic factors and comorbidities, beneficiaries in rural counties had a lower number of ICU days (RR = 0.65) and were less likely to ever use hospice (OR = 0.78) compared to those in metropolitan counties. Beneficiaries from racial/ethnic minority groups, those with lower socioeconomic status, and those with a higher comorbidity index were less likely to ever use hospice but they tended to use ER, inpatient care, and ICU. Conclusions Evidence for disparities due to geographic access and socioeconomic factors warrant increased efforts to remove systemic and structural barriers. Future research should focus on exploring and evaluating potential policy and practice interventions to improve the quality of life among elderly cancer survivors living in rural communities and those from socioeconomically disadvantaged backgrounds. [ABSTRACT FROM AUTHOR]

Older women have lower levels of physical functioning and higher associated health care costs than men after coronary artery bypass surgery (CABS). Clinical trials have demonstrated that interventions to increase physical activity levels can reduce the risk of recurrent cardiac events, reduce health care expenditures, prolong life, improve functional capacity, and increase quality of life in the elderly cardiac population. It is important for the patients, providers, health care payers, and policymakers to identify a cost-effective recovery intervention that has the potential to increase women's physical activity and functioning during their early recovery from CABS, especially in this time of limited health care resources. This home-based symptom management intervention has the potential to reduce the risk of recurrent cardiac events and health care cost by improving women's physical activity level after surgery. This information is vital to nursing leaders in making resource decisions regarding follow-up care of women who have had heart surgery. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the health‐related quality of life of nursing workers and influential factors. Background: Nursing workers are under great occupational stress. However, few population‐level studies of nursing workers' health conditions have been reported from China. Design This was a cross‐sectional study conducted in 12 medical institutions in east China between January and March 2015. Methods: Social‐demographic information, nursing workers' work‐related information and health‐related quality of life using the Chinese (mainland) version of the Short Form 36 health survey were collected by a self‐administrated questionnaire. Results: Nursing workers reported significantly lower scores of the vitality, mental health dimensions, and mental component summary of the Short Form 36 survey compared with general population reference values. They scored significantly higher for five other dimensions and comparably for the physical role dimension. Pre‐job training, families' positive attitudes to their job, and good relationships with clients were positively related with nursing workers' mental well‐being. Conclusion: To promote nursing workers' mental health, compulsory work‐related training, voluntary psychological counselling, and targeted legislation are needed. SUMMARY STATEMENT: What is already known about this topic? Shortages of professional medical staff in medical institution at all levels will not be quickly met, and nursing workers are thought to be an important supplement in China.Population‐level study on nursing workers' point of view of their work and health condition has been little reported in China. What this paper adds? Nursing workers were mentally vulnerable regarding their vitality and mental health scores.Job training, families' positive attitudes to their job, and good relationships with clients were all protective factors for nursing workers' mental well‐being. The implications of this paper: Compulsory work‐related training for nursing workers provided by intermediary companies can help promote nursing workers' well‐being.Voluntary psychological counselling provided by hospitals can also be helpful to build a supportive work environment for nursing workers.Governments need to regulate this market and protect nursing workers' rights and benefits by legislation. [ABSTRACT FROM AUTHOR]

Background: CD36 deficiency is closely associated with fetal/neonatal alloimmune thrombocytopenia, platelet transfusion refractoriness, and other hemorrhage disorders, particularly in Asian and African populations. There is a clinical need for rapid and high-throughput methods of platelet CD36 (pCD36) phenotyping to improve the availability of CD36 typing of donors and assist clinical blood transfusions for patients with anti-CD36 antibodies. Such methods can also support the establishment of databases of pCD36-negative phenotypes. Study Design and Methods: A sandwich enzyme-linked immunosorbent assay (ELISA) for CD36 phenotyping of human platelets was developed using anti-CD36 monoclonal antibodies. The reliability of the assay was evaluated by calculating the intra-assay and inter-assay coefficients of variation (CV). A total of 1,691 anticoagulant whole blood samples from healthy blood donors were randomly selected. PCD36 expression was measured using a sandwich ELISA. PCD36 deficiency was confirmed by flow cytometry (FC). Mutations underlying pCD36 deficiency were identified using polymerase chain reaction sequence-based typing (PCR-SBT). Results: The sandwich ELISA for pCD36 phenotyping had high reliability (intra-assay CV, 2.1–4.8%; inter-assay CV, 2.3–5.2%). The sandwich ELISA was used to screen for CD36 expression on platelets isolated from 1,691 healthy blood donors. Of these, 36 samples were pCD36-negative. FC demonstrated absence of CD36 expression on monocytes in three of the 36 cases. In the present study population, the frequency of CD36 deficiency was 2.13% (36/1,691), of which 0.18% (3/1,691) was type I deficiency and 1.95% (33/1,691) was type II deficiency. In addition, we used PCR-SBT to characterize the gene mutations in exons 3–14 of the CD36 gene in 27 cases of CD36 deficiency and discovered 10 types of mutations in 13 pCD36-negative samples. Conclusion: The present study describes the development and characterization of a highly reliable sandwich ELISA for high-throughput screening for pCD36 expression. This novel method is feasible for clinical applications and provides a useful tool for the establishment of databases of pCD36-negative phenotype donors. [ABSTRACT FROM AUTHOR]

This article investigates the reliability and validity of the Chinese version of the 7-item Fear of Cancer Recurrence Questionnaire (FCR-7). A total of 1,025 cancer patients were recruited and asked to complete the Chinese FCR-7, Fear of Progression Questionnaire—Short Form (FoP-Q–SF), 9-item Patient Health Questionnaire (PHQ-9), and 7-item General Anxiety Disorder Questionnaire (GAD-7). The internal consistency and test–retest reliabilities were examined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on random split-half samples. Overall relationships of FCR-7 with other psychological constructs were examined. The Chinese FCR-7 showed good internal consistency (Cronbach's alpha =.87), test–retest reliability (r =.90), and item–total correlations (range =.583–.872). The unitary factor structure was supported by the EFA and the CFA fit statistics (comparative fit index =.99, root-mean-square error of approximation =.039, 95% confidence interval [.01,.07]). The total score of FCR-7 was positively associated with FoP-Q–SF (r =.756, p <.01), PHQ-9 (r =.522, p <.01), and GAD-7 (r =.553, p <.01). Patients with low monthly income (p <.001) and family cancer history (p =.012) and those who had gone through chemotherapy (p =.001) tended to report higher fear of cancer recurrence (FCR). The FCR-7 has been translated and successfully culturally adapted into a Chinese version. It is a reliable and valid measurement for assessing FCR. The present study suggests that the Chinese version of the seven-item Fear of Cancer Recurrence Questionnaire is a reliable and valid measure for assessing patients' recurrence fears. Additionally, patients with low income and family cancer history and those who had gone through chemotherapy were more likely to report higher fears. Therefore, specific and flexible psychological interventions are needed for these high-risk populations. [ABSTRACT FROM AUTHOR]