Social isolation reinforces aging-related behavioral inflexibility by promoting neuronal necroptosis in basolateral amygdala.

Aging is characterized with a progressive decline in many cognitive functions, including behavioral flexibility, an important ability to respond appropriately to changing environmental contingencies. However, the underlying mechanisms of impaired behavioral flexibility in aging are not clear. In this study, we reported that necroptosis-induced reduction of neuronal activity in the basolateral amygdala (BLA) plays an important role in behavioral inflexibility in 5-month-old mice of the senescence-accelerated mice prone-8 (SAMP8) line, a well-established model with age-related phenotypes. Application of Nec-1s, a specific inhibitor of necroptosis, reversed the impairment of behavioral flexibility in SAMP8 mice. We further observed that the loss of glycogen synthase kinase 3α (GSK-3α) was strongly correlated with necroptosis in the BLA of aged mice and the amygdala of aged cynomolgus monkeys (Macaca fascicularis). Moreover, genetic deletion or knockdown of GSK-3α led to the activation of necroptosis and impaired behavioral flexibility in wild-type mice, while the restoration of GSK-3α expression in the BLA arrested necroptosis and behavioral inflexibility in aged mice. We further observed that GSK-3α loss resulted in the activation of mTORC1 signaling to promote RIPK3-dependent necroptosis. Importantly, we discovered that social isolation, a prevalent phenomenon in aged people, facilitated necroptosis and behavioral inflexibility in 4-month-old SAMP8 mice. Overall, our study not only revealed the molecular mechanisms of the dysfunction of behavioral flexibility in aged people but also identified a critical lifestyle risk factor and a possible intervention strategy.

Development and feasibility testing of an avatar-based education application for patients with acute coronary syndrome.

AIMS: To develop and evaluate an interactive, avatar-based education application, for improving patients' knowledge of, and response to, acute coronary syndrome (ACS) symptoms. BACKGROUND: A patient's ability to recognise and respond to the symptoms of ACS is imperative for seeking timely medical intervention. Innovative patient education interventions are needed to support patient education and patient self-care. METHODS: Participatory action research methods were used to engage consumers with cardiac and information technology (IT) experts to develop an avatar-based education application. The avatar-based education application was developed according to evidence-based guidelines. The effect on ACS knowledge was evaluated in a group of ten patients with ACS. RESULTS: In total, 10 consumers with ACS and 12 cardiovascular clinical and IT experts participated in the designing and development of the education application. An additional 10 consumers (mean age was 52.2 ± 10.4 years) were recruited for testing the feasibility of the application on improving ACS knowledge. A high level (87.3%) of satisfaction was reported with a 15.7% increase in the knowledge subscale score of the ACS Response Index and 25.7% increase in belief scores, while symptom recognition scores increased by 24.2%. CONCLUSION: An avatar-based application for heart attack education is feasible and has the potential to support patient education by enhancing engagement and improving health literacy. These outcomes will provide preliminary data for an effectiveness trial. RELEVANCE TO CLINICAL PRACTICE: Nurses frequently experience obstacles in providing patient education, such as health literacy and language barriers. Utilising avatar-based technology could potentially support the delivery of patient education. Involving consumers in the development these innovative educational tools is essential. Consumer participation in design has improved the engagement, satisfaction and outcomes of our app.

Value of Web-based learning activities for nursing students who speak English as a second language.

There is an increasing need to address the educational needs of students with English as a second language. The authors assessed the value of a Web-based activity to meet the needs of students with English as a second language in a bioscience subject. Using telephone contact, we interviewed 21 Chinese students, 24 non-Chinese students with English as a second language, and 7 native English-speaking students to identify the perception of the value of the intervention. Four themes emerged from the qualitative data: (1) Language is a barrier to achievement and affects self-confidence; (2) Enhancement intervention promoted autonomous learning; (3) Focusing on the spoken word increases interaction capacity and self-confidence; (4) Assessment and examination drive receptivity and sense of importance. Targeted strategies to promote language acculturation and acquisition are valued by students. Linking language acquisition skills to assessment tasks is likely to leverage improvements in competence.

Australia's health care reform agenda: implications for the nurses' role in chronic heart failure management.

INTRODUCTION: The importance of the nursing role in chronic heart failure (CHF) management is increasingly recognised. With the recent release of the National Health and Hospitals Reform Commission (NHHRC) report in Australia, a review of nursing roles in CHF management is timely and appropriate. AIM: This paper aims to discuss the implications of the NHHRC report and nursing roles in the context of CHF management in Australia. METHOD: The electronic databases, Thomson Rheuters Web of Knowledge, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched using keywords including; "heart failure", "management", "Australia" and "nursing". In addition policy documents were reviewed including statements and reports from key professional organisations and Government Departments to identify issues impacting on nursing roles in CHF management. RESULTS: There is a growing need for the prevention and control of chronic conditions, such as CHF. This involves an increasing emphasis on specialist cardiovascular nurses in community based settings, both in outreach and inreach health service models. This review has highlighted the need to base nursing roles on evidence based principles and identify the importance of the nursing role in coordinating and managing CHF care in both independent and collaborative practice settings. CONCLUSION: The importance of the nursing role in early chronic disease symptom recognition and implementing strategies to prevent further deterioration of individuals is crucial to improving health outcomes. Consideration should be given to ensure that evidence based principles are adopted in models of nursing care.

Chinese nurses' perceptions of heart health issues facing women in China: a focus group study.

BACKGROUND: China is in a state of rapid economic growth and epidemiological transition. Morbidity and mortality relating to heart disease in women have increased dramatically. OBJECTIVES: The aim of this study was to obtain the views of nurses regarding heart health issues for women in contemporary China. DESIGN: : This study used focus group interviews. SETTINGS: Convenience sampling was used to recruit nurses working in acute care hospitals in metropolitan China. METHODS: Five focus groups containing 28 female participants were conducted. Focus groups were moderated by 2 bilingual Chinese nurses, audiotaped, and analyzed using thematic analysis. RESULTS: Four themes emerged from the focus group data: (1) mixed perceptions of disease burden in women, (2) modern life impacts upon women's health, (3) need for focus on prevention and coordination, and (4) education and support are keys to driving healthcare improvements. CONCLUSIONS: Heart disease, as a significant health issue for women in China, is underappreciated among Chinese nurses.

Cardiovascular disease in Chinese women: an emerging high-risk population and implications for nursing practice.

BACKGROUND: Globally, cardiovascular disease (CVD) is the leading cause of death among women. In China, the burden of CVD is increasing at an alarming rate; yet, it is underestimated and has important primary, secondary, and tertiary prevention issues. AIM: This article seeks to document the issues surrounding the increased rate of CVD among Chinese women and describe the etiological factors and potential strategies to decrease the burden of disease. METHODS: The Medline, Current Information in Nursing and Allied Health Literature, Ovid, Science Direct, and Government Reports were searched using the key words heart disease, cardiovascular, ischemic heart disease, coronary, women, and Chin (China, Chinese). Articles were selected if they described epidemiological factors and/or interventions to address heart disease in Chinese women. FINDINGS: Rapid industrialization and urbanization in China have extended the life expectancy of the population, particularly among women. Social, political, and economic factors have caused lifestyle changes that have a direct bearing on health. Heart disease has become the most common cause of death among Chinese women and the second most common cause among men. Paradoxically, prevention and management strategies are sparse in relation to the high prevalence. A number of modifiable risk factors have been identified as major contributors of CVD and should be a focus of primary, secondary, and tertiary prevention. CONCLUSION: Cardiovascular disease is already a leading cause of death and disability among Chinese women. The high prevalence of risk factors and low rate of awareness, treatment, and control signal an urgent need for focusing on this issue in Chinese women. Strategies on individual, community, and government levels are recommended. Involving Chinese nurses in these strategies is essential.