Spiritual Connectivity Intervention for Individuals with Depressive Symptoms: A Randomized Control Trial

Depression is one of the most prevalent mental disorders worldwide. This study examined the effect of a spiritual connectivity intervention on individuals with depression in a randomized waitlist-controlled trial. Fifty-seven participants with mild or moderate depressive symptoms were randomly assigned to either the intervention group (n = 28) or the waitlist control group (n = 29). The intervention comprised eight weekly sessions focusing on divine connection, forgiveness and freedom, suffering and transcendence, hope, gratitude, and relapse prevention. The outcome measures included depressive symptoms, anxiety, hope, meaning in life, self-esteem, and social support. Participants completed self-administered questionnaires at baseline (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Repeated-measures ANOVA and one-way ANCOVA were used to compare the within-group and between-group differences in the changes in outcome variables. Participants in the intervention group showed significant improvements in depression, anxiety, spiritual experience, hope, self-esteem, and perceived social support after the intervention. Effect size statistics showed small to large differences (Cohen's d, 0.308 to -1.452). Moreover, 85.71% of participants in the intervention group also experienced clinically significant reductions in PHQ-9 scores from baseline to immediate post-intervention. This study highlights the effectiveness of a low-cost, accessible intervention suitable for community implementation by clergy and faith-based organizations.

The importance of transparency: Declaring the use of generative artificial intelligence (AI) in academic writing

The integration of generative artificial intelligence (AI) into academic research writing has revolutionized the field, offering powerful tools like ChatGPT and Bard to aid researchers in content generation and idea enhancement. We explore the current state of transparency regarding generative AI use in nursing academic research journals, emphasizing the need for explicitly declaring the use of generative AI by authors in the manuscript. Out of 125 nursing studies journals, 37.6% required explicit statements about generative AI use in their authors' guidelines. No significant differences in impact factors or journal categories were found between journals with and without such requirement. A similar evaluation of medicine, general and internal journals showed a lower percentage (14.5%) including the information about generative AI usage. Declaring generative AI tool usage is crucial for maintaining the transparency and credibility in academic writing. Additionally, extending the requirement for AI usage declarations to journal reviewers can enhance the quality of peer review and combat predatory journals in the academic publishing landscape. Our study highlights the need for active participation from nursing researchers in discussions surrounding standardization of generative AI declaration in academic research writing.

We Fear So We Judge: A Mediation Analysis on the Relations Among Ageing Anxiety, Ageism, and Ageist Microaggressions

Ageism remains an obstacle to building an age-friendly environment. Although the rise of ageist microaggressions (i.e., subtle discrimination) threatens older adults from maintaining well-being, the mechanism of ageist microaggressions remains understudied. The present study examined ageist microaggressions using a transactional model. Specifically, we examined whether ageing and death anxieties contribute to self-ageism and influence benevolent and hostile ageism. These ageist beliefs might lead to benevolent and hostile ageist microaggressions, respectively. Cross-sectional data from 214 Hong Kong middle-aged adults (Mage = 50.97) were obtained. The results from a structural equation model revealed that ageing anxiety, but not death anxiety, was a significant predictor of self-ageism, hostile ageism, and hostile ageist microaggressions. A revised model further suggested that benevolent and hostile ageism were predictive of hostile ageist microaggressions. The results highlight the importance of defying the conventional perception of ageing to reduce ageing anxiety, ageism and ageist microaggressions for an age-friendly society.

Revisiting Vaccine Hesitancy in Residential Care Homes for the Elderly for Pandemic Preparedness: A Lesson from COVID-19

Residents in residential care homes for the elderly (RCHEs) are at high risk of severe illnesses and mortality, while staff have high exposure to intimate care activities. Addressing vaccine hesitancy is crucial to safeguard vaccine uptake in this vulnerable setting, especially amid a pandemic. In response to this, we conducted a cross-sectional survey to measure the level of vaccine hesitancy and to examine its associated factors among residents and staff in RCHEs in Hong Kong. We recruited residents and staff from 31 RCHEs in July-November 2022. Of 204 residents, 9.8% had a higher level of vaccine hesitancy (scored ≥ 4 out of 7, mean = 2.44). Around 7% of the staff (n = 168) showed higher vaccine hesitancy (mean = 2.45). From multi-level regression analyses, higher social loneliness, higher anxiety, poorer cognitive ability, being vaccinated with fewer doses, and lower institutional vaccination rates predicted residents' vaccine hesitancy. Similarly, higher emotional loneliness, higher anxiety, being vaccinated with fewer doses, and working in larger RCHEs predicted staff's vaccine hesitancy. Although the reliance on self-report data and convenience sampling may hamper the generalizability of the results, this study highlighted the importance of addressing the loneliness of residents and staff in RCHEs to combat vaccine hesitancy. Innovative and technology-aided interventions are needed to build social support and ensure social interactions among the residents and staff, especially amid outbreaks.

Faith-Based Spiritual Intervention for Persons with Depression: Preliminary Evidence from a Pilot Study

Depression is a common, depleting, and potentially life-threatening disorder. This pilot study examined the feasibility and applicability, reported preliminary evidence for effectiveness, and explored the potential healing mechanisms of a faith-based spiritual intervention for people with depression. The intervention consisted of six weekly sessions focused on restoring a connection with the divine, forgiveness and freedom, suffering and transcendence, hope, gratitude, and relapse prevention. Seven adults with mild or moderate depressive symptoms were recruited. A qualitative evaluation was conducted via focus group discussions, and rating scales were administered at baseline, after the intervention, and at the 3-month follow-up. The mean difference scores of the treatment's effect over time were analyzed using Friedman's ANOVA. The themes identified by the focus group included the meaning of the spiritual intervention, the effect of involvement in a spiritual group, and the therapeutic components. The results indicated a significant decrease in the mean scores for depression (PHQ-9) after intervention and at the 3-month follow-up. Participants expressed their improvement in terms of increased knowledge about depression, enhanced coping mechanisms, and improved self-esteem. The preliminary evidence suggested that the faith-based spiritual intervention was effective in reducing depressive symptoms and also helped participants develop a greater sense of connection with themselves, others, and their environment.

How can we transform travel medicine by leveraging on AI-powered search engines?

A ChatGPT search engine with chatbot function offers travellers pre-, during and post-travel consultations. Users should critically evaluate information provided and assess source reliability. Integrating user feedback and reviews could enhance information quality. With responsible artificial intelligence (AI) development, leveraging travel medicine specialists’ expertise and AI-based search engines can transform travel medicine.

Development and validation of the caregiver needs and resources assessment

Introduction

Existing caregiver assessment tools were long criticized for focusing on the needs and burden while neglecting the importance of the resources. The current study aimed to develop a multidimensional and time-effective assessment tool that measures both needs and resources of non-paid family caregivers of older adults for screening and service-matching purposes.

Methods

Items of the Caregiver Needs and Resources Assessment (CNRA) were developed from extensive literature reviews and focus group interviews of family caregivers and social workers in the field. In addition, we collected 317 valid responses from family caregivers of older adults from local non-government organizations in examining the psychometric properties of the CNRA.

Results

The results revealed a 12-factor structure that fitted nicely into the conceptual frame of needs and resources domains. Need factors were positively associated with mental health symptoms, while resource factors were positively associated with peace in mind, meaning-making, and personal gain measures. The 36-item CNRA revealed good internal reliability and convergent validity.

Discussion

The CNRA has the potential to be used as a compact yet balanced assessment tool for understanding both the needs and resources of caregivers for human service professionals.

Amplifying research influence through the social network, open access publishing, and international collaboration: A mediation analysis on nursing studies literature

INTRODUCTION

Research impact and influence are commonly measured quantitatively by citation count received by research articles. Many institutes also use citation count as one of the factors in faculty performance appraisal and candidate selection of academic positions. Various strategies were recommended to amplify and accelerate research influence, particularly citation counts, by bringing research articles to a wider reach for potential readers. However, no prior empirical study was conducted to examine and valid effects of those strategies on nursing studies. This study examines and verifies the direct effects and mediation effects of some strategies, namely, the use of Twitter, international collaboration, the use of ResearchGate, and open access publishing, for amplifying the citation of research and review articles in nursing studies.

DESIGN

Cross-sectional study design.

METHODS

Articles published in top nursing journals in 2016 were identified in PUBMED and the citation metrics for individual articles until 2021 were extracted from Scopus. The primary outcome was the citation count of the article, while the tweet count on Twitter of the article was considered a mediator. The predictors included paper type, the total number of authors, the proportion of authors with a ResearchGate account in the article, funding support, open-accessed article, and the number of different countries stated in the authors' affiliation. A mediation analysis was conducted to examine the predictors' direct and indirect effects (i.e., via tweet count) on the citation count of the article.

RESULTS

A total of 2210 articles were included in this study, of which 223 (10.1%) were review articles. The median (IQR) number of Scopus citations, tweets, countries, and percentage of authors with ResearchGate accounts were 12 (6-21), 2 (0-6), 1 (1-1), and 75% (50%-100%) respectively. In the mediation analysis, tweet count, article type, number of countries, percentage of authors with a ResearchGate account, and journal impact factors in 2014 were positively associated with the Scopus citation count. The effects of article type, open access, and journals' impact factors in 2014 on Scopus citation count were mediated by the tweet count.

CONCLUSION

This study provides empirical support for some strategies researchers may employ to amplify the citation count of their research articles. The methodology of our study can be extended to compare research influence between entities (e.g., across countries or institutes).

CLINICAL RELEVANCE

The citation refers to the research work cited by peers and is one of the indicators for research impact. Higher citations implied the research work is read and used by others, therefore, understanding the associated factors with higher citations is critical.

Do caregiver interventions improve outcomes in relatives with dementia and mild cognitive impairment? A comprehensive systematic review and meta-analysis

Some reviews suggest benefits of nonpharmacological interventions for informal caregivers of people with dementia and mild cognitive impairment. These benefits may transfer to the care-recipients (CRs) through increased caregiving capability, reduced burden and depression among caregivers, and decreased negative mood contagion. However, large-scale review on these effects on the CRs is lacking. We searched PsycINFO, CINAHL with Full Text, MEDLINE, and PubMed from inception to end of 2020 and found 142 articles that reported randomized controlled trials (RCTs) of caregiver interventions using CR outcomes. Interventions were found to reduce neuropsychiatric symptoms (NPS) in general and behavioral and mood disturbance specifically, enhance cognition and quality of life, and delay institutionalization and mortality, with care coordination/case management, educational intervention with psychotherapeutic components (psychoeducation-b), and direct training of the CR (with caregiver involvement) being the more potent interventions. The kinds of benefit depend on the types of intervention. NPS was reduced by psychoeducation-b, care coordination/case management, and CR training. Cognition and quality of life were enhanced by CR training and care coordination/case management, respectively. Institutionalization was delayed by multicomponent interventions and respite (based on one study). However, the effects were generally small to very small. Together with existing findings on caregiver outcomes, a tripartite scaffolding model of caregiver support is proposed. The model is composed of three components: (a) care coordination/case management (i.e., enhanced usual care), (b) psychoeducation-b, and (c) CR training. Future directions in terms of developing consensual guidelines, a registry of intervention manuals, and family-centered programs with flexibility in delivery are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Path to normality: Assessing the level of social-distancing measures relaxation against antibody-resistant SARS-CoV-2 variants in a partially-vaccinated population

Introduction

Two years into the coronavirus 2019 (COVID-19) pandemic, populations with less built-up immunity continued to devise ways to optimize social distancing measures (SDMs) relaxation levels for outbreaks triggered by SARS-CoV-2 and its variants to resume minimal economics activities while avoiding hospital system collapse.

Method

An age-stratified compartmental model featuring social mixing patterns was first fitted the incidence data in second wave in Hong Kong. Hypothetical scenario analysis was conducted by varying population mobility and vaccination coverages (VCs) to predict the number of hospital and intensive-care unit admissions in outbreaks initiated by ancestral strain and its variants (Alpha, Beta, Gamma, Delta and Omicron). Scenarios were "unsustainable" if either of admissions was larger than the maximum of its occupancy.

Results

At VC of 65%, scenarios of full SDMs relaxation (mean daily social encounters prior to COVID-19 pandemic = 14.1 contacts) for outbreaks triggered by ancestral strain, Alpha and Beta were sustainable. Restricting levels of SDMs was required such that the optimal population mobility had to be reduced to 0.9, 0.65 and 0.37 for Gamma, Delta and Omicron associated outbreaks respectively. VC improvement from 65% to 75% and 95% allowed complete SDMs relaxation in Gamma-, and Delta-driven epidemic respectively. However, this was not supported for Omicron-triggered epidemic.

Discussion

To seek a path to normality, speedy vaccine and booster distribution to the majority across all age groups is the first step. Gradual or complete SDMs lift could be considered if the hybrid immunity could be achieved due to high vaccination coverage and natural infection rate among vaccinated or the COVID-19 case fatality rate could be reduced similar to that for seasonal influenza to secure hospital system sustainability.

Profiling vaccine believers and skeptics in nurses: A latent profile analysis

BACKGROUND

A tailored immunization program is deemed more successful in encouraging vaccination. Understanding the profiles of vaccine hesitancy constructs in nurses can help policymakers in devising such programs. Encouraging vaccination in nurses is an important step in building public confidence in the upcoming COVID-19 and influenza vaccination campaigns.

OBJECTIVES

Using a person-centered approach, this study aimed to reveal the profiles of the 5C psychological constructs of vaccine hesitancy (confidence, complacency, constraints, calculation, and collective responsibility) among Hong Kong nurses.

DESIGN

Cross-sectional online survey.

SETTINGS

With the promotion of a professional nursing organization, we invited Hong Kong nurses to complete an online survey between mid-March and late April 2020 during the COVID-19 outbreak.

PARTICIPANTS

1,193 eligible nurses (mean age = 40.82, SD = 10.49; with 90.0% being female) were included in the analyses.

METHODS

In the online survey, we asked the invited nurses to report their demographics, COVID-19-related work demands (including the supply of personal protective equipment, work stress, and attitudes towards workplace infection control policies), the 5C vaccine hesitancy components, seasonal influenza vaccine uptake history, and the COVID-19 vaccine uptake intention. Latent profile analysis was employed to identify distinct vaccine hesitancy antecedent subgroups.

RESULTS

Results revealed five profiles, including "believers" (31%; high confidence, collective responsibility; low complacency, constraint), "skeptics" (11%; opposite to the believers), "outsiders" (14%; low calculation, collective responsibility), "contradictors" (4%; high in all 5C constructs), and "middlers" (40%; middle in all 5C constructs). Believers were less educated, reported more long-term illnesses, greater work stress, higher perceived personal protective equipment sufficiency, and stronger trust in government than skeptics. They were older and had higher perceived personal protective equipment sufficiency than middlers. Also, believers were older and had greater work stress than outsiders. From the highest to the lowest on vaccination uptake and intention were believers and contradictors, then middlers and outsiders, and finally skeptics.

CONCLUSION

Different immunization programs can be devised based on the vaccine hesitancy profiles and their predictors. Despite both profiles being low in vaccination uptake and intention, our results distinguished between outsiders and skeptics regarding their different levels of information-seeking engagement. The profile structure reveals the possibilities in devising tailored interventions based on their 5C characteristics. The current data could serve as the reference for the identification of individual profile membership and future profiling studies. Future endeavor is needed to examine the generalizability of the profile structure in other populations and across different study sites. Tweetable abstract: Covid-19 vaccine hesitancy profiles of Hong Kong nurses (believers, sceptics, outsiders, contradictors and middlers) highlight the importance of tailored vaccine campaigns.

Preparation of Hard Tissues Like Bone or Cartilage for Shotgun Mass Spectrometry Analysis of the Proteome

Proteomic analyses of intervertebral discs (IVDs) reveal information for understanding the fundamentals of biological processes and pathogenesis but also provide insights for novel pharmaceutical development. Sensitive mass spectrometry techniques and bioinformatics have advanced the detection and identification of proteins from any sample. Due to the challenges of catastrophic sample-loss artifacts during hard-tissue extraction, however, many researchers have omitted the cartilage endplates of IVDs for protein extraction, analyzing only the cellular components of the annulus fibrosus and/or nucleus pulposus. The full proteomic picture of IVDs is compromised without extracting proteins from intact IVDs. Here, we describe a novel preparation method using snap-freeze grinding, which allows for mechanical disruption and customized chemical lysis of hard tissues such as bone or cartilage. This method replaces the time-consuming and insufficient conventional tissue homogenization methods. Sample loss and contamination could be minimized during proteolysis by using an in-solution protein digestion and desalting procedure. We demonstrate excellent proteome coverage with intact mouse IVDs by analyzing samples in a hybrid quadrupole time-of-flight tandem mass spectrometer. © 2021 Wiley Periodicals LLC.

Editor's Choice: Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey

BACKGROUND

A healthy healthcare system requires healthy healthcare workers. Protecting healthcare workers including nurses against COVID-19 is crucial, and vaccination could be a viable future option. However, vaccine hesitancy remains a global challenge. Nurses, as a trustworthy and creditable source of vaccine-related information, may build public confidence in vaccination. Hence, research on vaccine hesitancy among nurses is warranted.

OBJECTIVES

This study estimated nurses' influenza vaccination behaviors and intention to receive COVID-19 vaccine when available, and examined their corresponding 5C psychological antecedents (confidence, complacency, constraints, calculation, and collective responsibility). To investigate the impact of COVID-19-related work demands, the mediation effects of work stress on the association between work demands and COVID-19 vaccination intention were also examined.

DESIGN

Cross-sectional online survey SETTINGS: Nurses were invited to participate via the promotion of a professional nursing organization and by personal referrals during the COVID-19 outbreak in Hong Kong between mid-March and late April 2020.

PARTICIPANTS

1,205 eligible nurses (mean age = 40.79, SD = 10.47; 90% being female) were included in the analyses.

METHODS

Demographics, influenza vaccination, intention to have COVID-19 vaccine, the 5C vaccine hesitancy components, work stress and COVID-19-related work demands (insufficient supply of personal protective equipment, involvement in isolation rooms, and unfavorable attitudes towards workplace infection control policies) were reported in the survey.

RESULTS

The influenza vaccine uptake rate and the proportion intending to take COVID-19 vaccine were 49% and 63%, respectively. Influenza vaccination was associated with working in public hospitals and all 5C constructs (more confidence, more collective responsibility and less complacency, constraints, and calculation), whereas stronger COVID-19 vaccination intention was associated with younger age, more confidence, less complacency and more collective responsibility. COVID-19-related demands were associated with greater work stress, and hence stronger COVID-19 vaccination intention.

CONCLUSION

The potential uptake rate of COVID-19 vaccine among nurses was suboptimal to achieve herd immunity. The 5C constructs were useful in predicting influenza vaccination and, to a lesser extent, the intention to take COVID-19 vaccine. The uncertain attributes such as effectiveness, side effects, and effective duration of the COVID-19 vaccine may contribute to this discrepancy. With less work stress among nurses in the post-pandemic period, the intention to take COVID-19 vaccine will likely drop. The 5C constructs should be infused in vaccination campaigns. While a COVID-19 vaccine could be ready soon, the nursing profession may not be ready to accept it. More research work is needed to boost the uptake rate.

TWEETABLE ABSTRACT

Less than two-third of nurses intended to take COVID-19 vaccine when available. While a COVID-19 vaccine could be ready soon, nursing profession is not ready to accept it.

Physical activity promotion: precise matching of message frames and affect types

OBJECTIVE

Matching between affect orientations and message frames have been shown to enhance the persuasiveness of health messages. Based on a two-dimensional regulatory model (direction: approach/avoidance, valence: appetitive/aversive), this study examined whether a precise matching between affect and message frame would enhance physical activity (PA) attitudes, intentions, and behaviours.

DESIGN

Using a 2 (gain/loss frames) x 2 (positive/negative end-states) design, 147 college students were randomly assigned to one message-frame condition (gain-positive, gain-negative, loss-positive, or loss-negative). Four identified affect types (approach-positive, approach-negative, avoidance-positive, and avoidance-negative) were considered as matched, respectively, with the four message-frame conditions. The participants were subsequently grouped into fully-matched, direction-matched only, valence-matched only, or unmatched.

MAIN OUTCOME MEASURES

The immediate PA attitude and intention after the experiment and the PA attitudes, intentions, and behaviours at a two-week follow-up were reported.

RESULTS

Post-manipulation and follow-up intentions were greater in the fully-matched as compared with the unmatched group. Follow-up physical activity was more in the valence-matched than the unmatched group. No other differences were found across the matching types.

CONCLUSION

Findings partially supported the importance of a precise matching between affect orientations and message frames. The affect types may characterize an individual's sensitivity towards the corresponding regulatory information.

P14.48 Identification of subsets of IDH-mutant glioblastomas with distinct epigenetic and copynumber alterations and stratified clinical risks

BACKGROUND

IDH-mutant glioblastoma is classified by the 2016 CNS WHO as a group with good prognosis. However, the actual number of cases examined in the literature is relatively small. We hypothesize that IDH-mutant glioblastoma is not a uniform group and should be further stratified.

MATERIAL AND METHODS

We conducted methylation profiles and estimated copy number variations in 64 IDH-mutant glioblastomas.

RESULTS

Our results showed that 10.9%, 53.1%, and 35.9% of tumors belonged to Codel, G-CIMPhigh, and G-CIMP-low methylation subgroups, respectively. G-CIMP-low subgroup was associated with significantly worse OS as compared to G-CIMP-high (P=0.005) and Codel groups (P=0.009). CDKN2A deletion (37.5%) was the most common gene copy number variation, and was associated with G-CIMP-low subgroup (P=0.001). Other frequent copy number changes included MET (4.7%), CCND2 (17.2%), PDGFRA (14.1%), CDK4 (12.5%), and EGFR (12.5%) amplification. Both CDKN2A deletion (P=0.008) and MET amplification (P<0.001) were associated with poor OS in IDH-mutant glioblastomas. Combined epigenetic signatures and gene copy number variations separated IDH-mutant glioblastomas into Group 1 (Codel), Group 2 (GCIMP- high), Group 3 (G-CIMP-low without CDKN2A and MET alterations), and Group 4 (G-CIMP-low with CDKN2A/MET alteration). Survival analysis revealed Group 1 had a favorable OS (median survival: 41.3 months), while Groups 2 and 3 exhibited an intermediate OS (median survival: 20.6 and 21.8 months, respectively). Group 4 exhibited the worst OS (median survival: 8.4 months). Multivariable analysis confirmed the independent prognostic significance of our Groups.

CONCLUSION

IDH-mutant glioblastomas should be stratified for risk with combined epigenetic signature and CDKN2A/MET status and some cases have poor outcome.

Multi-centre study on cultural dimensions and perceived attitudes of nurses towards influenza vaccination uptake

This study explored how cultural values affected Health Belief Model (HBM) components and the influenza vaccine uptake among nurses across three Asian populations using a survey conducted in 2017 (N = 3971). The vaccination coverages were 33.5% (Brunei), 35.6% (Hong Kong) and 69.5% (Singapore). Three HBM components (perceived susceptibility, perceived benefits and cues to action) were positively associated with vaccination. A direct negative link and an indirect positive link via HBM were observed between collectivism and vaccination, whereas a negative indirect link via HBM between power distance and vaccination was observed. Cultural values, notably collectivism, advanced HBM to study nurses' vaccination.

Negotiations between health and social goals over the lifespan: The role of future time perspective

The interplay between health and social goals in relation to age and future time perspective was examined among 131 older and 131 younger adults via surveys and future time manipulations (limited, unchanged, and expansive). Being older was associated with weaker physical activity intentions and social activity intentions as mediated by a limited future time perspective. Physical activity intentions decreased in the limited condition and increased in the expansive condition, social activity intentions increased in all conditions, and preference toward health (over social) goals decreased in both the limited and expansive conditions. The results suggest that anticipated endings may become salient in all conditions and favor social goals, which are emotionally relevant.

Reverse Message-Framing Effects on Accelerometer-Assessed Physical Activity Among Older Outpatients With Type 2 Diabetes

It has been suggested that gain-framed messages are more effective than loss-framed messages in promoting low-risk health behaviors such as physical activity. Because of a heightened health concern and possible medical complications, older adults with type 2 diabetes (T2D) may consider physical activity to be risky. This study examined whether a reverse message-framing effect would be found among older adults with T2D. The participants included 211 sedentary and older adults with T2D recruited from an outpatient clinic. The participants were randomly assigned to receive either gain-framed or loss-framed messages and wore an accelerometer to monitor their physical activity for 2 weeks. The participants who received loss-framed messages were more physically active than those who received gain-framed messages (β = 0.13, p = .033). This loss-frame advantage might be attributable to the heightened perceived risks among older outpatients with T2D and the temporarily activated prevention-focused orientation in a clinical setting.

Radiofrequency Volumetric Reduction of the Palate: An Extended Follow-Up Study

OBJECTIVE: The goal was to evaluate the effect of radiofrequency (RF) of the palate on speech, swallowing, taste, sleep, and snoring 12 to 18 months after treatment.

METHODS: Twenty-two patients were evaluated by clinical examination, questionnaires, and visual analog scales. The patients with relapse of snoring were offered further RF treatment. RESULTS: After a mean follow-up of 14 months, no adverse effect was reported. Subjective snoring scores relapsed by 29% overall. Nine patients (41%) noted relapse of snoring from 2.1 ± 1.1 to 5.7 ± 2.7 ( P < 0.001). Eight of the patients underwent further RF treatment with a reduction of snoring from 5.8 ± 2.9 to 3.3 ± 3.1 ( P = 0.01).

CONCLUSION: The success of RF volumetric reduction of the palate diminishes with time, as with other surgical procedures of the palate. However, the minimal invasiveness of the RF provided a high patient acceptance for retreatment, and relapse of snoring can be improved.

Prediction of en-route complications during interfacility transport by outcome predictive scores in ED

OBJECTIVE

The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department.

DESIGN

This was a retrospective cohort study.

METHODS

All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves.

RESULTS

A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure.

CONCLUSION

None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.

Structure and validity of Family Harmony Scale: An instrument for measuring harmony

Culture plays a role in mental health, partly by defining the characteristics that are indicative of positive adjustment. In Chinese cultures, positive family relationships are considered central to well-being. The culturally emphasized characteristic of family harmony may be an important factor associated with psychopathology. This article presents the development and psychometric examination of the Family Harmony Scale (FHS), an indigenously developed 24-item instrument tapping family harmony in 17,461 Hong Kong residents from 7,791 households. A higher-order model with 1 second-order factor and 5 first-order factors fit the data well and showed factorial invariance across sex and participants in different family roles. A 5-item short form (FHS-5) was also developed, with 1 item from each first-order factor. The short scale showed, as expected, a single-factor structure with good fit. Both scales demonstrated high internal consistency, acceptable test-retest reliability, and good convergent and discriminant validity. The 24-item FHS was negatively associated with depressive symptoms after accounting for individual risk factors and general family function. Family harmony moderated the relationship between life stress and depressive symptoms such that those individuals who reported low family harmony had stronger associations between life stress and depressive symptoms. This study adds to the literature a systematically developed, multidimensional measure of family harmony, which may be an important psychological protective factor, in a large urban Chinese sample. The FHS-5 minimizes operational and respondent burdens, making it an attractive tool for large-scale epidemiological studies with Chinese populations in urban settings, where over half of China's 1.4 billion people reside.

The effects of CCR5 inhibition on regulatory T-cell recruitment to colorectal cancer

BACKGROUND

Regulatory T cells (Treg) are enriched in human colorectal cancer (CRC) where they suppress anti-tumour immunity. The chemokine receptor CCR5 has been implicated in the recruitment of Treg from blood into CRC and tumour growth is delayed in CCR5-/- mice, associated with reduced tumour Treg infiltration.

METHODS

Tissue and blood samples were obtained from patients undergoing resection of CRC. Tumour-infiltrating lymphocytes were phenotyped for chemokine receptors using flow cytometry. The presence of tissue chemokines was assessed. Standard chemotaxis and suppression assays were performed and the effects of CCR5 blockade were tested in murine tumour models.

RESULTS

Functional CCR5 was highly expressed by human CRC infiltrating Treg and CCR5(high) Treg were more suppressive than their CCR5(low) Treg counterparts. Human CRC-Treg were more proliferative and activated than other T cells suggesting that local proliferation could provide an alternative explanation for the observed tumour Treg enrichment. Pharmacological inhibition of CCR5 failed to reduce tumour Treg infiltration in murine tumour models although it did result in delayed tumour growth.

CONCLUSIONS

CCR5 inhibition does not mediate anti-tumour effects as a consequence of inhibiting Treg recruitment. Other mechanisms must be found to explain this effect. This has important implications for anti-CCR5 therapy in CRC.