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IntroductionBlood-based diagnostics and prognostics in sporadic Alzheimer's disease (AD) are important for identifying at-risk individuals for therapeutic interventions.MethodsIn three stages, a total of 34 leukocyte antigens were examined by flow cytometry immunophenotyping. Data were analyzed by logistic regression and receiver operating characteristic (ROC) analyses.ResultsWe identified leukocyte markers differentially expressed in the patients with AD. Pathway analysis revealed a complex network involving upregulation of complement inhibition and downregulation of cargo receptor activity and Aβ clearance. A proposed panel including four leukocyte markers - CD11c, CD59, CD91, and CD163 - predicts patients' PET Aβ status with an area under the curve (AUC) of 0.93 (0.88 to 0.97). CD163 was the top performer in preclinical models. These findings have been validated in two independent cohorts.ConclusionOur finding of changes on peripheral leukocyte surface antigens in AD implicates the deficit in innate immunity. Leukocyte-based biomarkers prove to be both sensitive and practical for AD screening and diagnosis.

BackgroundAlthough many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China.MethodsWe conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg).ResultsOverall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP.ConclusionsThis study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.

To explore the association between perceived stress and quality of life (QoL) and the mediating role of general self-efficacy and social support in this association. Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases suffered by pregnant women. Women with previous GDM may experience more medical-related stress and have a lower QoL than those without it. A multisite correlational study. Four hundred sixty-five women with previous GDM living in rural areas in China participated in this study from November 2017 to June 2019. The participants completed a set of self-reported socio-demographic questionnaires, the Perceived Stress Scale, the General Self-Efficacy Scale, the Social Support Rating Scale and the World Health Organization QoL assessment (Brief version). STROBE checklist was used as the guideline for this study. The mean QoL score was 13.97 (SD 2.07) for physical health, 13.75 (SD 1.98) for psychological health, 14.96 (SD 1.99) for social relations and 12.49 (SD 1.74) for environmental conditions. About 43.9% of women with previous GDM reported increased stress, which was negatively correlated with each of these QoL domains. Yet, the negative effect of perceived stress on QoL could be completely or partly mediated by better social support or general self-efficacy among this population. Nearly half of the women in the study living in rural China reported increased stress after delivery, and there is room to improve QoL in the environmental domain among women with previous GDM. Increasing general self-efficacy or social support can help these women avoid the negative effects of perceived stress on their QoL. These findings suggest that healthcare providers need to be cognizant of the importance of self-efficacy and social support for women with previous GDM in both enhancing QoL and reducing the negative impact of perceived stress on QoL.

Women with prior gestational diabetes mellitus (GDM) are at a higher risk of type 2 diabetes and other health issues after delivery. They may have a lower quality of life (QoL), experience more medical-related stress, and need more support than those without it. This study aimed to examine the six-month efficacy of an intensive lifestyle modification program on perceived stress, social support, and QoL among women with prior GDM in rural China. A total of 320 women with prior GDM were randomly assigned to an intervention group (n = 160) and a control group (n = 160). Participants in the intervention group received an intensive lifestyle modification (ILSM) program, including a series of six biweekly face-to-face sessions and five biweekly phone sessions delivered by trained local health workers. The control group received the usual care. Data about perceived stress, social support, QoL, and HbA1c were collected at baseline, at three months, and at six-month follow-ups. Generalized estimating equation analysis was used to assess the efficacy of the intervention. There were significant improvements in the psychological domain (β = 0.479 ± 0.153, p = 0.002) and environmental domain (β = 0.462 ± 0.145, p = 0.001) of QoL over six months; there were significant group effects (β = -0.718 ± 0.280, p = 0.010) and time effects (β = 0.453 ± 0.211, p = 0.032) in physiological domain, and there were significant group effects in the social relations domain (β = -0.669 ± 0.321, p = 0.037). The ILSM group had a more pronounced downward trend in HbA1c than the control group (β = -0.050 ± 0.026, p = 0.059). The ILSM program can help women with GDM improve their psychological and environmental domain of QoL. It can be recommended as a form of health promotion for improving QoL among women with prior GDM in rural primary care settings in developing countries.

Liger is a next generation adaptive optics (AO) fed integral field spectrograph (IFS) and imager for the W. M. Keck Observatory. This new instrument is being designed to take advantage of the upgraded AO system provided by Keck All-Sky Precision Adaptive-optics (KAPA). Liger will provide higher spectral resolving power (R∼4,000-10,000), wider wavelength coverage (∼0.8-2.4 µm), and larger fields of view than any current IFS. We present the design and analysis for a custom-made dewar chamber for characterizing the Liger opto-mechanical system. This dewar chamber is designed to test and assemble the Liger imaging camera and slicer IFS components while being adaptable for future experiments. The vacuum chamber will operate below 10-5 Torr with a cold shield that will be kept below 90 K. The dewar test chamber will be mounted to an optical vibration isolation platform and further isolated from the cryogenic and vacuum systems with bellows. The cold head and vacuums will be mounted to a custom cart that will also house the electronics and computer that interface with the experiment. This test chamber will provide an efficient means of calibrating and characterizing the Liger instrument and performing future experiments.

Liger is a next-generation near-infrared imager and integral fieldspectrograph (IFS) for the W.M. Keck Observatory designed to take advantage ofthe Keck All-Sky Precision Adaptive Optics (KAPA) upgrade. Liger will operateat spectral resolving powers between R$\sim$4,000 - 10,000 over a wavelengthrange of 0.8-2.4$\mu$m. Liger takes advantage of a sequential imager andspectrograph design that allows for simultaneous observations between the twochannels using the same filter wheel and cold pupil stop. We present the designfor the filter wheels and pupil mask and their location and tolerances in theoptical design. The filter mechanism is a multi-wheel design drawing from theheritage of the current Keck/OSIRIS imager single wheel design. The Ligermulti-wheel configuration is designed to allow future upgrades to the numberand range of filters throughout the life of the instrument. The pupil mechanismis designed to be similarly upgradeable with the option to add multiple pupilmask options. A smaller wheel mechanism allows the user to select the desiredpupil mask with open slots being designed in for future upgrade capabilities.An ideal pupil would match the shape of the image formed of the primary andwould track its rotation. For different pupil shapes without tracking we modelthe additional exposure time needed to achieve the same signal to noise of anideal pupil and determine that a set of fixed masks of different shapesprovides a mechanically simpler system with little compromise in performance.

BackgroundSelf-monitoring of blood glucose (SMBG) is a crucial tool for maintaining glycemic control in women with gestational diabetes mellitus (GDM). However, to date, little is known about the current status of SMBG engagement among women with GDM in China.ObjectiveTo describe the current status of SMBG engagement among women with GDM in China and identify its barriers and facilitators.Design and settingA mixed-methods design was conducted, comprising a cross-sectional survey and semi-structured interviews. The research data were collected in two tertiary hospitals in Hunan province, China.ParticipantsA total of 323 women with GDM completed the survey from March 2018 to October 2018, and 11 of them participated in the interviews.FindingIn total, 35.6% of the participants actively engaged in SMBG. The participants who had an advanced maternal age (95% CI 0.253-0.947), did not own glucose meters (95% CI 0.054-0.364), did not receive SMBG-related information from health professionals (95% CI 0.232-.987), or received less SMBG information in general (95% CI 0.137-0.52) were less likely to engage in SMBG. Insufficient SMBG information and low awareness of SMBG were also summarized as the main barriers in the interview findings. Facilitators of SMBG engagement included SMBG-related social support (95% CI 1.573-6.135) and health concerns related to themselves and the unborn infant.ConclusionAbout one-third of Chinese women with GDM engaged in SMBG. An accurate and complete description of how SMBG should be performed is needed from health professionals. Strategies to obtain more SMBG-related social support and a greater emphasis on health concerns are recommended to increase SMBG engagement among women with GDM in China.

BackgroundIn China, about 53.4 million women (11%) have type 2 diabetes (T2DM). Women with prior 2 (GDM) are at a high risk for T2DM. Postpartum lifestyle interventions have been effective in reducing T2DM for this population, but the evidence is limited to interventions provided in urban areas, despite the fact that a higher prevalence of undiagnosed T2DM was found in rural areas in China. The primary purpose of this proposed study is to examine the effect of a postpartum intensive lifestyle modification (ILSM) program on physiological health outcomes (T2DM development, insulin resistance, and weight-related variables), weight-related health behaviors (dietary intake and physical activity), and psychosocial outcomes (self-efficacy, perceived stress, social support, and health-related quality of life) compared to usual care at 3, 6, and 18 months post baseline assessment. The secondary outcomes are to identify potential mediators and moderators on change of physiological health outcomes.Methods/designA multi-site randomized clinical trial (RCT) will be conducted to examine the efficacy of an evidence-based Intensive Lifestyle Modification (ILSM) program compared with usual care for women with prior GDM living in rural areas in China. A total sample of 256 participants will be recruited in the study. The intervention consists of six bi-weekly in-person group sessions, five bi-weekly telephone consultation sessions, and three monthly telephone consultations to encourage behavior change. The usual care provided to the control group will utilize current clinical guideline and recommendations for T2DM prevention. Outcome measures include physiological variables (OGTT-2 h, HbA1c, weight, and waist circumference); weight-related health behavioral (dietary intake and physical activities); and psychosocial variables (self-efficacy and social support) at 3-, 6- and 18- month after baseline. We will also assess the potential cost-effectiveness of ILSM (net cost per T2DM case and per DALY averted) compared with usual care.DiscussionIf successful, this ILSM program can be adapted and used in rural areas as a blueprint for clinical guidelines to decrease T2DM by improving postpartum GDM care in China. Findings of this study are expected to make a significant contribution to public health practice and health policy related to T2DM prevention in China.Trial registrationChinese Clinical Trial Registry, ChiCTR1800015023 . Registered 1 March 2018 - Retrospectively registered, http://apps.who.int/trialsearch/default.aspx .

BACKGROUND: A community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits. OBJECTIVE: Was the question-listing intervention effective in reducing anxiety and increasing decision self-efficacy? METHODS: The organization surveyed patients on decision self-efficacy (273 respondents, 99% response rate) and anxiety (190, 68%) before and after question-listing interventions delivered from 2006 - 2011. We analyzed responses using two-sided paired t-tests at 5% significance and conducted linear regression to identify significant predictors of change. We examined predictors related to the patient (location, demographics, disease status and baseline decision self-efficacy and anxiety); the intervention (including interventionist case volume); and the visit (including type of doctor seen). RESULTS: Question-listing was associated with higher mean decision self-efficacy (2.70/3.43 pre/post, 1-4 min-max, P

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate safety-net clinics' responses to a novel community-wide Patient-Centered Medical Home (PCMH) financial incentive program in post-Katrina New Orleans.Data sources/study settingBetween June 2008 and June 2010, we studied 50 primary care clinics in New Orleans receiving federal funds to expand services and improve care delivery.Study designMultiwave, longitudinal, observational study of a local safety-net primary care system.Data collectionClinic-level data from a semiannual survey of clinic leaders (89.3 percent response rate), augmented by administrative records.Principal findingsOverall, 62 percent of the clinics responded to financial incentives by achieving PCMH recognition from the National Committee on Quality Assurance (NCQA). Higher patient volume, higher baseline PCMH scores, and type of ownership were significant predictors of achieving NCQA recognition. The steepest increase in adoption of PCMH processes occurred among clinics achieving the highest, Level 3, NCQA recognition. Following NCQA recognition, 88.9 percent stabilized or increased their use of PCMH processes, although several specific PCMH processes had very low rates of adoption overall.ConclusionsFindings demonstrate that widespread PCMH implementation is possible in a safety-net environment when external financial incentives are aligned with the goal of practice innovation.

Background: Sleep-related outcomes in people with diabetes are poor, which is closely linked to reducing the development of diabetes. Cognitive behavioral therapy (CBT) based intervention presents innovative solutions that can help improve sleep-related outcomes. Aim: This synthesis aims to assess the effectiveness of CBT-based intervention compared to controls in Randomized Controlled Trials (RCTs) for sleep-related outcomes among people with diabetes. Methods: Eight electronic databases were systematically searched: PubMed, EMBASE, Cochrane library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), and Wan Fang database. We examined CBT-based intervention's effectiveness on sleep-related outcomes in people with diabetes in RCTs identified in these databases from their inception to 1st November 2023, and updated on 15 January 2024. The risk of bias was assessed using the Cochrane Risk of Bias tool by two reviewers. The meta-analysis of included studies was conducted by RevMan 5.3 software. Results: Seven studies in total (n = 2633 participants) were included in this systematic review based on our inclusion criteria. The systematic review found CBT-based intervention significantly improved sleep quality (Pittsburgh Sleep Quality Index, PSQI scores) at immediate post-intervention [95% CI=(− 1.31 to -0.32), p = 0.001], six months [95% CI=(− 0.75 to − 0.22), p = 0.0003], and 12 months [95% CI=(− 0.72 to − 0.24), < 0.0001], compared to control groups. Furthermore, our findings demonstrated that six sessions [95% CI= (− 0.38 to − 0.13), p < 0.0001] or more than six sessions [95% CI=(− 1.76 to − 0.02), p = 0.05] of CBT-based intervention could improve sleep quality compared to controls (I2=0%). Interestingly, CBT-based intervention improves total sleep time at post-intervention in people with diabetes compared to the control group [95% CI= (− 0.57 to − 0.12), p = 0.003]. However, there was no significant that CBT-based intervention is beneficial to time to fall asleep [95% CI (− 1.89 to 0.43), p = 0.22] and sleep efficiency [95% CI (− 1.27 to 0.27), p = 0.20] after intervention, compared to control group. Conclusion: CBT-based intervention appears to have a beneficial effect on improving sleep quality and total sleep time among people with diabetes. CBT-based intervention could be considered a strategy among healthcare providers to enhance sleep quality and total sleep time for people with diabetes. More RCTs with rigorous designs and long-term follow-up are warranted to provide conclusive evidence of the CBT-based intervention on sleep-related outcomes and to explore the mechanisms by which the CBT-based interventions improve sleep-related outcomes. [ABSTRACT FROM AUTHOR]