[Multimedia Health Education on Insulin Injection Skills for Patients With Type 2 Diabetes].

BACKGROUND: Multimedia health education may be applied to improve self-care behaviors in patients. However, the long-term effects of multimedia health education on insulin injection performance have been insufficiently studied. PURPOSE: To evaluate the effect of a multimedia insulin pen-injector health education intervention on patients in terms of their insulin injection skills and glycated hemoglobin level and the time spent by nurses on insulin injection education. METHODS: Using a randomized controlled trial and two-group repeated-measures study design, patients with type 2 diabetes who were novice users of a Lantus, Levemir, or Novomix pen injector were recruited. A total of 72 patients, comprising 36 in a control group and 36 in an experimental group, participated in the study. The participants' injection skills were photographed using a smart phone. RESULTS: Patients in the experimental group earned higher scores for attaching a new needle, removing air bubbles, selecting the required dose, selecting a suitable injection site (abdomen, arms, thigh, or buttocks), and injection performance skills than those in the control group. However, no significant differences were found between the two groups in terms of HbA1c levels at 13 weeks after discharge. The time spent by nurses on delivering health education to the experimental group was 0.38 times that of the time spent on the control group. CONCLUSIONS: Multimedia health education may not only enhance patients' self-injection skills but also save on human resources and nursing hours. The findings of this study may provide references for healthcare providers in educating patients with diabetes regarding self-administering insulin pen injections.

Predictors of Self-Efficacy in Administering Insulin Injection.

This study aimed to identify the predictors of self-efficacy in administering insulin injection among patients with type 2 diabetes. Using a cross-sectional survey, data were collected via purposive sampling from a metabolic ward of a medical center in Southern Taiwan. Participants were 72 patients with type 2 diabetes, who had started using Lantus, Levemir, or Novomix pen injectors. Data were collected from October 2013 to August 2014, using the Diabetes and Insulin Injection Knowledge Scale, Self-Efficacy in Administering Insulin Injection Scale, and photographs illustrating insulin injection skills. The findings indicated that "knowledge of diabetes and insulin injection," "insulin injection skills," "senior high school or above education," and "diabetes duration" were predictors of self-efficacy in administering insulin injection, which explained 41% of the total variance in self-efficacy. Health care professionals can design relevant strategies for improving patient self-efficacy in administering insulin injection, thereby increasing patients' insulin self-injection abilities.

Factors associated with quality of life in patients with diabetic hypoglycaemia.

AIMS AND OBJECTIVES: To identify determinants of quality of life among patients who had experienced hypoglycaemia and who were undergoing insulin treatment. BACKGROUND: Patients with diabetes receiving insulin treatment are at high risk for hypoglycaemia, which tends to affect their quality of life. DESIGN: With a cross-sectional and observational study design (see the STROBE checklist and Appendix S1). METHODS: One hundred and fifty patients with type 2 diabetes who had received insulin treatment and had experienced hypoglycaemia (<70 mg/dl) in the last 6 months were recruited. Data were collected from May 2016-February 2018 using the Knowledge of Hypoglycaemia Scale, Fear of Hypoglycaemia Scale, Social Support Scale and the simplified Taiwanese version of the Quality of Life Scale developed by the World Health Organization. RESULTS: Factors found to be associated with quality of life in patients with hypoglycaemia included having an educational level of senior high school or above, being on an insulin regimen only, engaging in regular exercise, diabetes complications, fear of hypoglycaemia and greater social support, which accounted for 28.5% of the total variance. CONCLUSIONS: During the process of glycaemic control, patients inevitably experience hypoglycaemic episodes. Therefore, healthcare providers should assist patients with disease management to improve their quality of life. Future studies should also recruit patients who claim to have experienced hypoglycaemic symptoms, rather than considering only those with blood glucose levels below 70 mg/dl, to expand the generalisability of the findings. Future studies may also focus on the management of hypoglycaemia in patients on an insulin regimen, and on examining the effect of health education programmes on prevention of hypoglycaemia. RELEVANCE TO CLINICAL PRACTICE: The present findings could provide a reference for healthcare providers to consolidate nursing care guidelines and to improve such patients' quality of life.

The Perinatal Biopsychosocial Consequences of Various Levels of Gestational Hyperglycemia.

This study was to compare biopsychosocial consequences among three groups of women with gestational hyperglycemia. We conducted a repeated-measures study at five time points among 132 women with gestational hyperglycemia. Women's physiological indicators and their psychosocial indicators were measured. There were 22.7% of participants had gestational diabetes mellitus (GDM), 11.4% had gestational impaired glucose tolerance (G-IGT), and 65.9% had mild gestational hyperglycemia (MGH). Women with GDM had higher fasting blood glucose and systolic/diastolic blood pressure than women with MGH. Women with GDM had higher diastolic blood pressure compared to women with G-IGT. Significant differences were found between the five time points regarding women's fasting blood glucose, diastolic blood pressure, depression, and health status. Health care providers should conduct early screening for predictors of metabolic syndrome in women with any degree of gestational hyperglycemia. Nursing interventions could be offered as early as the perinatal period to promote women's health.

First-time fathers' health status during the perinatal period.

BACKGROUND: For first-time fathers, the perinatal period is a critical period of stress and imbalance. Marital intimacy and social support may affect their stress and health status while they change their roles. AIM: This study was to explore the changes of and correlations among marital intimacy, social support, and health status and predictors of first-time fathers' health status during the perinatal period. METHODS: With a repeated measures study design, a total of 217 first-time fathers whose spouses were in the third trimester of pregnancy were recruited for the study. The Chinese Health Questionnaire, Marital Intimacy Scale, and Social Support Scale were employed to collect data at a medical center in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. RESULTS: The levels of marital intimacy and social support of first-time fathers during the perinatal period increased significantly with time. Meanwhile, the period of the first week after childbirth was a predictor of first-time father's health status. CONCLUSIONS: This study only tracked the first-time fathers' health status in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. Future studies could track them until one year after childbirth in order to explore the impact of the perinatal period on the couples and their babies. During the perinatal period, health care providers shall assess and provide needed interventions to first-time fathers as soon as possible to facilitate the first-time fathers to get ready for the role transition and to promote their health status.

The effectiveness of multimedia education for patients with type 2 diabetes mellitus.

AIMS: The aim of this study was to explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated haemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. BACKGROUND: Insulin therapy is recommended to facilitate the regulation of plasma glucose; however, patient's acceptance of insulin therapy is generally low. Healthcare providers should help them improve their knowledge of diabetes and insulin injection, as well as their insulin injection skills. DESIGN: A randomized repeated measures experimental study design. METHODS: The experimental (n = 21) and control (n = 21) groups received multimedia and regular health education programmes, respectively from October 2013-August 2014. Four structured questionnaires were used and videotapes were applied to demonstrate injection skills. RESULTS: Generalized estimating equations showed that the experimental group's scores were significantly higher than those of the control group for diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. On the other hand, an analysis of covariance revealed glycated hemoglobin (HbA1c) and creatinine levels did not differ significantly between the two groups. CONCLUSIONS: Implementation of a multimedia diabetes education programme could improve patients' diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. Healthcare providers should improve quality of patient care by providing multimedia diabetes health education.

Predictors of Hyperglycemic Women's Perinatal Health Status.

BACKGROUND: Hyperglycemic women face dramatic physiological and psychosocial changes during the perinatal period; however, studies examining hyperglycemic women's health are few, and limited to cross-sectional designs. PURPOSE: This study aimed to examine changes in hyperglycemic women's stress, social support, depression, and health status from pregnancy to 1 year postpartum, and to identify factors predicting hyperglycemic women's perinatal health. METHODS: Ninety-nine participants with positive results in a 50-g glucose challenge test were recruited in a medical center in southern Taiwan. A repeated measures study was conducted; measurements were made at 28 weeks of pregnancy, and 1 week, 6 weeks, 6 months, and 1 year after childbirth. The Social Support Scale, the Perceived Stress Scale, the Taiwanese Depression Questionnaire, and the Chinese Health Questionnaire were used. RESULTS: Compared with hyperglycemic women's depression at 28 weeks of pregnancy, significant decreases in mean depression scores were found at 1 week and 1 year postpartum. Hyperglycemic women's health status improved at 6 months and 1 year postpartum. Depression significantly predicted hyperglycemic women's perinatal health status. LINKING EVIDENCE TO ACTION: Stress and depression are associated with perinatal health status in hyperglycemic women. Healthcare providers should more closely assess stress and depression levels in hyperglycemic women from pregnancy to 1 year postpartum. Interventions promoting the psychological well-being of hyperglycemic women are required.

Outcomes for type 2 diabetes mellitus patients with diverse regimens.

AIMS AND OBJECTIVES: To compare the levels of self-care behaviour, social support and quality of life among type 2 diabetes mellitus patients who underwent three regimens: taking medicine, taking-medicine-while dieting and taking-medicine-while-dieting-with exercise. BACKGROUND: Diabetes treatment is a critical concern worldwide. However, studies on self-care behaviour, social support and quality of life based on diabetes patients' diverse regimens are few. DESIGN: This study was a cross-sectional design. METHODS: We enrolled 127 outpatients aged over 40 years who visited a metabolism clinic at a medical centre in Southern Taiwan. The Self-care Behaviour Scale, Social Support Scale and Quality of Life Scale were used to collect data. RESULTS: The results indicated that patients with a combined regimen of taking-medicine-while-dieting-with-regular exercise had the highest score at the levels of social support, self-care behaviour and quality of life. CONCLUSION: The study results could offer evidence-based knowledge for healthcare professionals to guide and promote social support, self-care behaviour and quality of life for people diagnosed with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE: These findings will help healthcare professionals to establish appropriate nursing strategies for type 2 diabetes patients who need to exercise regularly as part of their daily care to enhance their self-care behaviour, social support and quality of life.

Defective T cell chemotaxis to sphingosine 1-phosphate and chemokine CCL21 in idiopathic T lymphocytopenia.

T cell chemotaxis to sphingosine 1-phosphate (S1P) and the chemokines CCL21 and CCL5 was studied in ten adults with T lymphocytopenia, other immunological abnormalities (nine of ten), and frequent bacterial infections (seven of ten). Mean chemotactic responses to S1P of CD4 T cells from CD4 T lymphocytopenic patients and of CD8 T cells from CD8 T lymphocytopenic patients were significantly lower than those of healthy matched controls. Chemotaxis to CCL21 was lower than that of controls for CD4 T cells of three CD4 T lymphocytopenic patients and for CD8 T cells of three CD8 T lymphocytopenic patients, but none of the T cells of patients had diminished chemotaxis to CCL5. Defective T cell chemotactic responses to S1P and some chemokines may lead to subset-selective abnormal T cell trafficking and chronic T cell lymphocytopenia.

VPAC1 (vasoactive intestinal peptide (VIP) receptor type 1) G protein-coupled receptor mediation of VIP enhancement of murine experimental colitis.

Distinct roles of the two T cell G protein-coupled receptors for vasoactive intestinal peptide (VIP), termed VPAC1 and VPAC2, in VIP regulation of autoimmune diseases were investigated in the dextran sodium sulfate (DSS)-induced murine acute colitis model for human inflammatory bowel diseases. In mice lacking VPAC2 (VPAC2-KO), DSS-induced colitis appeared more rapidly with greater weight loss and severe histopathology than in wild-type mice. In contrast, DSS-induced colitis in VPAC1-KO mice was milder than in wild-type mice and VPAC2-KO mice. Tissues affected by colitis showed significantly higher levels of myeloperoxidase, IL-6, IL-1ß and MMP-9 in VPAC2-KO mice than wild-type mice, but there were no differences for IL-17, IFN-γ, IL-4, or CCR6. Suppression of VPAC1 signals in VPAC2-KO mice by PKA inhibitors reduced the clinical and histological severity of DSS-induced colitis, as well as tissue levels of IL-6, IL-1ß and MMP-9. Thus VIP enhancement of the severity of DSS-induced colitis is mediated solely by VPAC1 receptors.

Preferential enhancement of older human T cell cytokine generation, chemotaxis, proliferation and survival by lenalidomide.

Lenalidomide, an analog of thalidomide, modified responses of stimulated T cells from healthy young (ages 21-40 years) and old (≥ age 65 years) subjects. At 0.03 µM to 1 µM, lenalidomide enhanced generation of IL-2 and IFN-γ by T cell receptor-stimulated T cells of young subjects up to respective maximum increases of 17-fold and three-fold, but at 0.3 µM and 1 µM suppressed IL-17 generation. The same concentrations of lenalidomide enhanced IL-2 and IFN-γ generation by stimulated T cells of old subjects more, with greater respective maximal increases of up to 120-fold and six-fold, without suppressing IL-17 generation. Lenalidomide enhanced proliferation and suppressed apoptosis of stimulated T cells from old subjects, by IL-2-dependent mechanisms, and restored diminished T cell chemotactic responses to CCL21 and sphingosine 1-phosphate. The reversal of T cell abnormalities of immunosenescence by low concentrations of lenalidomide suggest a potential for improvement of immunity in the elderly.

Gender specificity of altered human immune cytokine profiles in aging.

Cytokine generation by T cells and monocytes was determined for 50 subjects aged 65 yr or older and concurrently studied young subjects individually matched to each old subject for sex, race, and national origin. Highly significant differences between cytokine levels of old and young subjects all were gender specific. For T cells stimulated with anti-CD3 plus anti-CD28 antibodies, mean ratios of IFN-gamma generation for healthy old to young subjects were 0.22 for men (P<0.001; n=15) and 3.35 for women (P<0.001; n=13), and those of IL-17 were 0.30 for men (P<0.001) and no difference for women. CD8 T cells were the source of high IFN-gamma in healthy old women. For old men with an inflammatory or immune disease (n=10), mean old to young ratios of T-cell-generated IFN-gamma and IL-17 increased with disease severity up to 5.78 and 2.97 (both P<0.01), respectively, without changes for old women with similar diseases (n=12). For differentiated LPS-stimulated monocytes, old to young ratios of TNF-alpha and IL-6 generation were high only in women with immune or inflammatory disease (2.38, P<0.05 and 1.62, P<0.01, respectively), whereas ratios of IFN-gamma-evoked IP-10 chemokine were low in all groups. Alterations in immune cytokine profiles with aging show significant gender specificity.

Human CD4- 8- T cells are a distinctive immunoregulatory subset.

Human CD4(-)8(-) T cells are a minor subset quantitatively but potentially important in immunity because they are predominantly distributed at body surfaces, and their number and activities increase in autoimmune diseases and decrease with aging. Distinguishing characteristics of CD4(-)8(-) T cells are found to include a unique profile of cytokines, including Serpin E1, which is not generated by other T cells, MIF, and TGF-beta. At 2-5% of the total in mixtures with CD4 + CD8 T cells, CD4(-)8(-) T cells enhance the generation of IFN-gamma and IL-17 by up to 12- and 5-fold, respectively, without contributing either cytokine or affecting cytokine production by NK/NKT cells. CD4(-)8(-) T cell-derived MIF is their major enhancer and TGFbeta their principal inhibitor of CD4 and CD8 T cell cytokine production. Decreases in CD4(-)8(-) T cell effects may diminish protective immunity in aging, whereas increases may augment the severity of autoimmune diseases.

Sphingolipid signaling and treatment during remodeling of the uninfarcted ventricular wall after myocardial infarction.

The sphingosine kinase (SphK)/sphingosine 1-phosphate (S1P) pathway, known to determine the fate and growth of various cell types, can enhance cardiac myocyte survival in vitro and provide cardioprotection in acute ex vivo heart preparations. However, the relevance of these findings to chronic cardiac pathology has never been demonstrated. We hypothesized that S1P signaling is impaired during chronic remodeling of the uninfarcted ventricle during the evolution of post-myocardial infarction (MI) cardiomyopathy and that a therapeutic enhancement of S1P signaling would ameliorate ventricular dysfunction. SphK expression and activity were measured in the remote, uninfarcted myocardium (RM) of C57Bl/6 mice subjected to coronary artery ligation. The mRNA expression of S1P receptor isoforms was also measured, as was the activation of the downstream S1P receptor mediators. A cardioprotective role for S1P(1) receptor agonism was tested via the administration of the S1P(1)-selective agonist SEW2871 during and after MI. As a result, the expression data suggested that a dramatic reduction in SphK activity in the RM early after MI may reflect a combination of posttranscriptional and posttranslational modulation. SphK activity continued to decline gradually during chronic post-MI remodeling, when S1P(1) receptor mRNA also fell below baseline. The S1P(1)-specific agonism with oral SEW2871 during the first 2-wk after MI reduced apoptosis in the RM and resulted in improved myocardial function, as reflected in the echocardiographic measurement of fractional shortening. In conclusion, these results provide the first documentation of alterations in S1P-mediated signaling during the in situ development of cardiomyopathy and suggest a possible therapeutic role for the pharmacological S1P receptor agonism in the post-MI heart.

Immunosuppressive human anti-lymphocyte autoantibodies specific for the type 1 sphingosine 1-phosphate receptor.

Anti-lymphocyte antibodies (Abs) that suppress T-cell chemotactic and other responses to sphingosine 1-phosphate (S1P), but not to chemokines, were found in a lymphopenic patient with recurrent infections. Lymphocyte type 1 S1P receptor (S1P(1)) that transduces S1P chemotactic stimulation was recognized by patient Abs in Western blots of T cells, S1P(1) transfectants, and S1P(1)-hemagglutinin purified by monoclonal anti-hemagglutinin Ab absorption. The amino terminus of S1P(1), but not any extracellular loop, prevented anti-S1P(1) Ab suppression of S1P(1) signaling and T-cell chemotaxis to S1P. Human purified anti-S1P(1) Abs decreased mouse blood lymphocyte levels by a mean of 72%, suppressed mouse T-cell chemotaxis to S1P in vivo, and significantly reduced the severity of dextran sodium sulfate-induced colitis in mice. Human Abs to the amino terminus of S1P(1) suppress T-cell trafficking sufficiently to impair host defense and provide therapeutic immunosuppression.

Characteristics and management of infectious industrial waste in Taiwan.

Infectious industrial waste management in Taiwan is based on the specific waste production unit. In other countries, management is based simply on whether the producer may lead to infectious disease. Thus, Taiwan has a more detailed classification of infectious waste. The advantage of this classification is that it is easy to identify the sources, while the disadvantage lies in the fact that it is not flexible and hence increases cost. This study presents an overview of current management practices for handling infectious industrial waste in Taiwan, and addresses the current waste disposal methods. The number of small clinics in Taiwan increased from 18,183 to 18,877 between 2003 and 2005. Analysis of the data between 2003 and 2005 showed that the majority of medical waste was general industrial waste, which accounted for 76.9%-79.4% of total medical waste. Infectious industrial waste accounted for 19.3%-21.9% of total medical waste. After the SARS event in Taiwan, the amount of infectious waste reached 19,350 tons in 2004, an increase over the previous year of 4000 tons. Waste minimization was a common consideration for all types of waste treatment. In this study, we summarize the percentage of plastic waste in flammable infectious industrial waste generated by medical units, which, in Taiwan was about 30%. The EPA and Taiwan Department of Health have actively promoted different recycling and waste reduction measures. However, the wide adoption of disposable materials made recycling and waste reduction difficult for some hospitals. It has been suggested that enhancing the education of and promoting communication between medical units and recycling industries must be implemented to prevent recyclable waste from entering the incinerator.

Regulation of the roles of sphingosine 1-phosphate and its type 1 G protein-coupled receptor in T cell immunity and autoimmunity.

The lipid mediator sphingosine 1-phosphate (S1P) and its type 1 G protein-coupled receptor (S1P1) affect mammalian immunity through alterations in thymocyte emigration, differentiation of T cell subsets, lymphocyte trafficking in lymphoid organs and other tissues, T cell-dendritic cell and T cell-B cell interactions, and cytokine generation. Recent attention to effects of the S1P-S1P1 axis on non-migration functions of lymphocytes includes delineation of a role in terminal differentiation and survival of Th17 effector cells and adaptive Treg cells of the CD4 T cell constellation, and a greater understanding of interactions of the S1P-S1P1 axis with immune cytokines in lymphocyte survival and activities. This breadth of involvement of the S1P-S1P1 axis in immune responses that often are altered in immunological diseases has provided many opportunities for novel therapeutic interventions. A spectrum of pharmacological and immunochemical agents is available that alter immunity by affecting either tissue and fluid concentrations of S1P or levels of expression and signaling activities of S1P1. Such agents have so far been beneficial in the settings of autoimmunity and rejection of transplanted organs, and are likely to become valuable constituents of combined drug programs.

Nuclear factor-kappaB-dependent reversal of aging-induced alterations in T cell cytokines.

Immunosenescence is characterized by decreases in protective immune responses and increases in inflammation and autoimmunity. The T helper (Th)17 subset of cluster-of-differentiation (CD)4 T cells, which is identified by its generation of interleukin (IL) -17, is implicated in autoimmune pathogenesis. To elucidate immunosenescent changes in Th17 cell cytokines, splenic CD4 T cells from 22- to 24-month-old (old) mice and 6- to 10-wk-old (young) mice were incubated on anti-CD3 plus anti-CD28 (anti-T cell antigen receptor) antibodies. After 96 h, T cells of old C57BL/6 and CBA mice generated up to 20-fold more IL-17 and up to 3-fold more IL-6 than those of young mice; T cells of young mice generated up to 5-fold more IL-21 than those of old mice; and no difference was found for IFN-gamma. At 24 h, cytokine mRNA levels paralleled 96 h cytokine concentrations. Naive CD4 T cells from old mice incubated on anti-T cell antigen receptor antibodies with transforming growth factor-beta, IL-1, IL-6, and IL-23 to induce de novo differentiation of Th17 cells had more IL-17 mRNA and produced more IL-17 than those of young mice. BAY11-7082 and the phytochemicals triptolide and butein suppressed nuclear concentrations of nuclear factor-kappaB and secreted levels of IL-17, IL-21, and IFN-gamma in parallel, with greater potency in Th17 cells from young than old mice. Pharmacological correction of altered generation of Th17 cell cytokines in immunosenescence represents a novel therapeutic approach to aging-induced inflammatory diseases.

Mass transfer of VOCs in laboratory-scale air sparging tank.

Volatilization of VOCs was investigated using a 55-gal laboratory-scale model in which air sparging experiments were conducted with a vertical air injection well. In addition, X-ray imaging of an air sparging sand box showed air flows were in the form of air bubbles or channels depending on the size of the porous media. Air-water mass transfer was quantified using the air-water mass transfer coefficient which was determined by fitting the experimental data to a two-zone model. The two-zone model is a one-dimensional lumped model that accounts for the effects of air flow type and diffusion of VOCs in the aqueous phase. The experimental air-water mass transfer coefficients, KGa, obtained from this study ranged from 10(-2) to 10(-3)1/min. From a correlation analysis, the air-water mass transfer coefficient was found to be directly proportional to the air flow rate and the mean particle size of soil but inversely proportional to Henry's constant. The correlation results implied that the air-water mass transfer coefficient was strongly affected by the size of porous media and the air flow rates.

Quality of life and its predictors for middle-aged and elderly patients with type 2 diabetes mellitus.

The purpose of this study was to explore the quality of life, and its predictors among middle-aged and elderly patients with Type 2 Diabetes Mellitus. 131 participants of age 40 or above were recruited from an outpatients department in one medical center in southern Taiwan. The study had a cross-sectional design; each participant was administered structured questionnaires, including the Diabetes Self-Care Behavior Scale, the Social Support Scale and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The results show that the predictors of patient's quality of life were diabetic self-care behaviors, economic status, and frequency of hospitalization, with a total variance of 21%. These findings can help health professionals to learn more about these patients. Furthermore, a suitable program and nursing interventions could be implemented to promote these patients' quality of life.