Health-literacy, self-efficacy and health-outcomes of patients undergoing haemodialysis: Mediating role of self-management.

BACKGROUND: Health literacy, self-efficacy and self-management are known to influence health-related well-being. However, the precise influence of self-management, health literacy and self-efficacy on health outcomes in Asian countries is under-researched. OBJECTIVES: To examine the impact of health literacy and self-efficacy (independent variables) and self-management (mediator) on patients' health outcomes (dependent variable). DESIGN: An observational, cross-sectional design was conducted between 1 March 2022 and 31 August 2022. PARTICIPANTS: Outpatients receiving haemodialysis (n = 200) at a Taiwanese medical centre were assessed. MEASUREMENTS: The survey included demographic questions and standardised scales: the 3-item Brief Health Literacy Screen, the 8-item Perceived Kidney/Dialysis Self-Management Scale as a measure of self-efficacy, and the 20-item Haemodialyses Self-Management Instrument. Health outcomes were responses on the 12-item Short-Form Health Survey version 2 and clinical blood results from the past 3 months. RESULTS: Participants aged over 60 exhibited common comorbidities, with 34% showing low health literacy. Biochemical markers (e.g., haemoglobin and albumin) significantly correlated with physical and mental health scores. Mediating coefficients revealed that self-management significantly influenced associations between health outcomes, health literacy (ß = 0.31; p < 0.01), and self-efficacy (ß = 0.19; p < 0.01). IMPLICATIONS FOR PRACTICE: Self-management can modify the overall influence of health literacy and self-efficacy on patients' quality of physical and emotional health. When managing a chronic condition, 'knowing' how to self-manage does not always result in 'doing so' by the patient. Continuous monitoring and promoting self-management behaviours and support by nurses are crucial to enhance health outcomes.

Techniques to Study Common Root Responses to Beneficial Microbes and Iron Deficiency.

Iron (Fe) plays a central role in the vital processes of a plant. The Fe status of a plant influences growth and immunity, but it also dictates interactions of roots with soil microbiota through the production of Fe mobilizing, antimicrobial fluorescent phenolic compounds called coumarins. To adapt to low Fe availability in the soil, plants deploy an efficient Fe deficiency response. Interestingly, this Fe deficiency response is hijacked by root-colonizing microbes in the root microbiome to establish a mutually beneficial relationship. In this chapter, we describe how we cultivate plants and microbes to study the interaction between plants, beneficial rhizobacteria, and the plant's Fe deficiency response. We describe (a) how we study activity and localization of these responses by assessing gene-specific promoter activities using GUS assays, (b) how we visualize root-secreted coumarins in response to Fe deficiency and colonization by beneficial rhizobacteria, and (c) how we prepare our samples for metabolite extraction and reverse-transcriptase quantitative PCR to analyze the expression of marker genes.

The Association between Osteoporosis and Peripheral Artery Disease: A Population-Based Longitudinal Follow-Up Study in Taiwan.

Background: There are several possible links that have been used to claim that osteoporosis and peripheral artery disease (PAD) are associated; however, the solid evidence is not sufficient. This study aimed to use the Taiwan National Health Insurance Research Database (NHIRD) to determine if osteoporosis is associated with peripheral artery disease (PAD). Method: NHIRD records from 23 million patients were collected to recruit two matched cohort groups: 64,562 patients with and 64,562 patients without osteoporosis. To compare the crude hazard ratio (HR) and the incidence rate ratio between the two cohort groups for PAD, the Cox model was used. Result: With an adjusted HR of 1.18 (95% CI, 1.08-1.29), the osteoporosis cohort group had a significantly greater risk for PAD than the group without osteoporosis. The cumulative incidence of PAD in the cohort group was also statistically higher than it was in the group without osteoporosis (1.71% and 1.39%; p ≤ 0.0001, log-rank) over the 10-year follow-up period. In addition, the osteoporotic patients with ischemic stroke, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) had a significantly increased risk of PAD based on subgroup analysis. Conclusions: There was a positive association between osteoporosis and the development of PAD, as patients with osteoporosis had an increased incidence of PAD over time.

Metformin, Statin Use, and Female Colorectal Cancer: A Population-Based Cohort Study in Taiwan.

In the last few years, the incidence of colorectal cancer (CRC) in women has gradually increased. However, epidemiological studies on the relationship between type II diabetes mellitus (T2DM) and female CRC and the effect of metformin or statins on female CRC are insufficient. To determine their association, we conducted a population-based cohort study on women in Taiwan. We collected data on a total of 396,521 women aged 40 to 64 years old from 1 January 2007 to 31 December 2009 from the National Health Insurance Research Database. We followed up on all participants in the cohort until the occurrence of CRC, the date for all death, or 31 December 2015. Full development of CRC was identified using the International Classification of Disease (ICD), 9th Revision, code 153. We estimated hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using the Cox proportional hazards model. Both metformin (adjusted hazard ratio, aHR = 1.12; 95% CI: 0.934-1.335, p = 0.227) and statin (aHR = 1.03; 95% CI: 0.906-1.172, p = 0.645) use showed no association with female CRC in a multivariate analysis. The findings indicate that metformin and statin use showed no protective effect against female colorectal cancer (CRC). An additional randomized trial is necessary to investigate the effect of metformin and statin use in CRC prevention.

The association between coronary artery disease and osteoporosis: a population-based longitudinal study in Taiwan.

PURPOSE: This large population-based study is the first to analyze the association between coronary artery disease (CAD) and osteoporosis (OP) from the National Health Insurance Research Database (NHIRD) in Taiwan to determine if CAD is associated with OP. METHODS: Data from NHIRD, a national, population-based, retrospective, matched cohort study of 23 million patients, were collected to recruit two matched cohorts: with (n = 192,367) and without (n = 192,367) CAD. The Cox model was used to compare the incidence rate ratio and crude hazard ratio (HR) between the two cohorts for osteoporotic fracture and OP. RESULTS: The CAD cohort had a significantly increased risk for vertebral compression fracture, with an adjusted HR of 1.74 (95% CI, 1.60-1.89). The cumulative incidence of OP was also statistically higher in the cohort versus without CAD (11.6% vs. 5.6%; p ≤ 0.0001, log-rank) during the 10-year follow-up period. The Cox model showed a 2.04-fold increase in the incidence of OP in the CAD cohort, with an adjusted HR of 2.04 (95% confidence interval [CI], 1.99-2.08). CONCLUSIONS: A positive association exists between CAD and development of subsequent osteoporotic fracture and OP. Patients with CAD have a significantly increased risk of developing vertebral compression fracture and a higher incident rate ratio of OP. TRIAL REGISTRATION: IRB approval number: No. C108094 on February 19, 2020.

The Association between Hypertriglyceridemia and Colorectal Cancer: A Long-Term Community Cohort Study in Taiwan.

(1) Background: Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer deaths worldwide. It often diagnosed at advanced stages, and with increasing incidence at younger generation. CRC poses a heavy financial burden and a huge public health challenge nowadays. Lipoproteins and serum lipids may have an influence on carcinogenesis by making oxidative stress, inflammation, and insulin resistance. Dyslipidemia plays a potential role in the risk of CRC. The purpose of this study is to use nationally representative samples to determine epidemiologic characteristics of CRC in the Taiwanese population, and to evaluate the associations between baseline levels of lipid profile and their effect on risk of colorectal cancer (CRC) comprehensively and quantitatively. The control of dyslipidemia in primary and secondary prevention may reduce the disease burden of CRC. (2) Methods: This is a nationwide long-term community-based prospective cohort study. Data were retrieved from the nationwide population-based Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia (TwSHHH). Variables were estimated by the Cox proportional hazards model which was then further adjusted for age. We also calculated the relative ratios (RRs) of CRC for joint categories of serum cholesterol, triglyceride (TG), low-density lipoproteins cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) level, and to examine their combined effect and statistical interactions. (3) Results: Male, age, waist circumference, diabetes mellitus (DM), high TG, high cholesterol level, smoking history, and metabolic syndrome were proved to increase the risk of CRC. In addition, DM patients with a TG level ≥150 mg/dL and cholesterol ≥180 mg/dL had a 4.118-fold higher risk of CRC as compared with a TG level <150 mg/dL and cholesterol level <180 mg/dL, which was a significant difference (95% CI, 1.061−15.975; p = 0.0407). (4) Conclusions: Patients with DM should control TG and cholesterol level through diet, exercise, or taking medications more aggressively, not only for preventing cardiovascular disease, but also for first prevention of CRC. The study can be valuable for the clinicians and policy makers to implement more precisely goals about dyslipidemia management.

The Photosynthetic Bacterium Rhodopseudomonas palustris Strain PS3 Exerts Plant Growth-Promoting Effects by Stimulating Nitrogen Uptake and Elevating Auxin Levels in Expanding Leaves.

Rhodopseudomonas palustris strain PS3, a phototrophic bacterium, was originally isolated from a paddy field located in Taipei city, Taiwan, and showed positive effects on the growth of leafy vegetables. The aim of this study was to clarify the mechanism of the beneficial effects exerted by PS3 on plants. An ineffective R. palustris strain, YSC3, isolated from a paddy field located in Yilan County, was used as the negative control for comparative analyses. We cultivated non-heading Chinese cabbage (Brassica rapa var. chinensis) in 1/2 strength Hoagland hydroponic solution, in which nitrate is the main nitrogen source. We evaluated various plant physiological responses to inoculation with different bacterial inoculants. The N use efficiency (NUE) of PS3-inoculated plants was dramatically higher than that of YSC3-inoculated plants. The nitrate uptake efficiency (NUpE) was significantly elevated in plants treated with PS3; however, no excess nitrate accumulation was observed in leaves. We also noticed that the endogenous indole-3-acetic acid (IAA) levels as well as the cell division rate in the leaves of PS3-inoculated plants were significantly higher than those in the leaves of YSC3-inoculated plants. We examined the bacterial transcription of some genes during root colonization, and found that the expression level of IAA synthesis related gene MAO was almost the same between these two strains. It suggests that the elevated endogenous IAA in the PS3-inoculated plants was not directly derived from the exogenous IAA produced by this bacterium. Taken together, we deduced that PS3 inoculation could promote plant growth by enhancing nitrate uptake and stimulating the accumulation of endogenous auxin in young expanding leaves to increase the proliferation of leaf cells during leaf development.

Coumarin Communication Along the Microbiome-Root-Shoot Axis.

Plants shape their rhizosphere microbiome by secreting root exudates into the soil environment. Recently, root-exuded coumarins were identified as novel players in plant-microbiome communication. Beneficial members of the root-associated microbiome stimulate coumarin biosynthesis in roots and their excretion into the rhizosphere. The iron-mobilizing activity of coumarins facilitates iron uptake from the soil environment, while their selective antimicrobial activity shapes the root microbiome, resulting in promotion of plant growth and health. Evidence is accumulating that, in analogy to strigolactones and flavonoids, coumarins may act in microbiome-to-root-to-shoot signaling events. Here, we review this multifaceted role of coumarins in bidirectional chemical communication along the microbiome-root-shoot axis.

Tour leaders with detailed knowledge of travel-related diseases play a key role in disease prevention.

In Taiwan, group tours are a popular mode of international travel; hence, group tour leaders must ensure traveler safety and health. This study identified factors influencing tour leaders' willingness to recommend pretravel medical consultation and vaccination.A cross-sectional questionnaire survey was administered to tour leaders from January 2011 to December 2012. Multivariate logistic regression analyses were performed to estimate the odds ratios of having a positive attitude and willingness based on different knowledge scores of the tour leaders after adjustments for age, sex, education level, and seniority.Tour leaders with a more detailed knowledge of both travel-related infectious and noninfectious diseases demonstrated a higher willingness to receive vaccination. They believed that consultation at travel clinics before travel can improve travelers' health (P < .05).This study supports the importance and effectiveness on educating tour leaders' knowledge about travel-related diseases to improve health care for travelers.

Higher disappearance rate of anti-HBs in Taiwanese freshers neonatally vaccinated with recombinant yeast hepatitis B vaccine.

BACKGROUND & AIM: The aim of this study was to compare the long-term efficacy of infant recombinant yeast hepatitis B vaccine (Recombinant group) and infant plasma-derived one (Plasma group) in Taiwanese freshers. METHODS: Recruited were a total of 38 377 freshmen who underwent university entrance health examinations from 2003 to 2015. Subjects were assigned into two groups-plasma type and recombinant type, according to the national neonatal hepatitis B immunization program. The seroprevalences of hepatitis B surface antigen, antibody against hepatitis B surface antigen, and antibody against hepatitis B core antigen in each group and gender were calculated. Multivariate logistic regression analysis was performed to compare the efficacy of two groups. RESULTS: The HBsAg-positive rates in the plasma group and recombinant group were 1.5% and 0.3% respectively. The anti-HBs positive rates were 43.6% and 30.9%. The hepatitis B viral natural infection rates were 3.6% and 1.3%. Taking those who were born in July 1986-April 1992 as baseline group after adjustment for gender and age at hepatitis B markers checkup time, the efficacy of recombinant group in decreasing HBsAg positive rate, and decreasing hepatitis B virus natural infection rate was 71.0% (95% C.I.: 59.0-79.0%, P<.001) and 65.0% (95% C.I. 58.0-71.0%, P<.001) respectively. On the contrary, the seroprevalence of anti-HBs positive rate in recombinant group was 39.0% (95% C.I.: 36.0-42.0%, P<.001) lower than that of plasma group. (P<.001). CONCLUSION: Higher disappearance rate of anti-HBs was noted in recombinant group than in plasma group when the subjects reached their youth and young adulthood in Taiwan.

The Efficacy of a Family-Based Intervention Program on Childhood Obesity: A Quasi-Experimental Design.

The purpose of this quasi-experimental study was to assess the efficacy of a family-based (FB) weight-loss and behavior-modification intervention among overweight/obese children (age 9-11 years) and their parents in Taiwan. The intervention group (52 child-parent dyads) participated in an FB program for 7 weeks. The control group (55 child-parent dyads) received an educational pamphlet about obesity prevention. The children's body mass index (BMI) z-scores were the primary outcome variable. The parents' BMI, high-calorie (HC) food-intake behaviors, screen-related behaviors, and restrictions on children's consumption of HC foods and screen-related behaviors and the availability of HC foods at home were the secondary outcome variables. Outcome variables were measured at baseline (T0), at the end of the intervention (T1), and 4 weeks after the end of the intervention (T2). A linear mixed model was used to assess the efficacy of the FB program. Results indicated that the children's BMI z-scores decreased significantly more from T0 to T2 in the experimental group than in the control group. The decreases in parents' HC food-intake behaviors and availability of HC foods at home and the increase in parental restrictions on children's consumption of HC foods were significantly greater in the experimental than in the control group from T0 to T1 and T0 to T2. The FB program was effective in modifying parental behaviors and the weight of overweight/obese children in a Taiwanese population.

Promoting effects of a single Rhodopseudomonas palustris inoculant on plant growth by Brassica rapa chinensis under low fertilizer input.

Several Rhodopseudomonas palustris strains have been isolated from rice paddy fields in Taiwan by combining the Winogradsky column method and molecular marker detection. These isolates were initially screened by employing seed germination and seedling vigor assays to evaluate their potential as inoculants. To fulfill the demand in the present farming system for reducing the application of chemical fertilizers, we assessed the plant growth-promoting effects of the R. palustris YSC3, YSC4, and PS3 inoculants on Brassica rapa chinensis (Chinese cabbage) cultivated under a half quantity of fertilizer. The results obtained showed that supplementation with approximately 4.0×10(6) CFU g(-1) soil of the PS3 inoculant at half the amount of fertilizer consistently produced the same plant growth potential as 100% fertility, and also increased the nitrogen use efficiency of the applied fertilizer nutrients. Furthermore, we noted that the plant growth-promotion rate elicited by PS3 was markedly higher with old seeds than with new seeds, suggesting it has the potential to boost the development of seedlings that were germinated from carry-over seeds of poor quality. These beneficial traits suggest that the PS3 isolate may serve as a potential PGPR inoculant for integrated nutrient management in agriculture.