Process evaluation of a community-based diabetes prevention program in China: the Pathway to Health (PATH).

High prevalence of diabetes and prediabetes has emerged as a concern in China. The Pathway to Health Program was designed to prevent type 2 diabetes onset in prediabetic women in a north China urban community. This process evaluation of a randomized controlled trial analysed participant surveys at the 6- and 12-month assessment times, participant weekly logs, class attendance records and post-study participant focus group results. The reported levels of participant engagement in physical activity (PA)-related behaviors were higher than diet-related behaviors at the 6-month assessment. The engagement in both PA- and diet-related behaviors declined during the 6-month follow-up period. Step counts from the participants' pedometers indicated an increase in PA in the first 6 months of the intervention. Study participants expressed high levels of satisfaction with the intervention and increased their scores on diabetes-related knowledge. Conflicts with work and family responsibilities were the main barriers for missing health lessons, likely contributing to minimal weight loss. There was good fidelity in program implementation. Intensive lifestyle modification programs are difficult to sustain once the program is complete. A more structured 6-month follow-up phase may have provided needed support to enable participants to maintain their lifestyle changes.

Cultural adaptation of an evidence-based lifestyle intervention for diabetes prevention in Chinese women at risk for diabetes: results of a randomized trial.

Background: The prevalence of both obesity and type 2 diabetes has been on the rise in China. This randomized controlled trial was conducted to test the feasibility and effectiveness of an evidence-based diabetes prevention program in Yuci, Shanxi Province, China from 2012 to 2014. Methods: Women with pre-diabetes, ages 25-65 y, were assigned randomly to a comparison (n=75) or 6-mo lifestyle intervention condition (n=109). Weight, fasting glucose, hemoglobin A1c and self-reported diet and physical activity were measured at baseline, 6 mo and 12 mo. Results: All measures except fasting glucose improved favorably in both comparison and intervention participants at the 6- and 12-mo follow-ups. Participants in the intervention group lost more weight (-0.91 kg, p<0.05) and had a lower body mass index (-0.39 kg/m2, p<0.05) than the comparison group at follow-up. A total of 31.6% (31/98) and 16.2% (11/68) of the participants in the intervention and comparison groups, respectively, achieved the weight loss goal of 5% at follow-up. There was no significant group difference in outcome measures at the 12-mo follow-up. Participants in the intervention group also showed favorable changes in self-reported diet and physical activity measures. Conclusions: A lifestyle intervention to prevent diabetes in at-risk women in community health centers in China is feasible and acceptable but effect sizes were small.

A community-based cross-sectional survey of medication utilization among chronic disease patients in China.

OBJECTIVES: To determine medication use patterns and associated health outcomes in Chinese individuals with diabetes, hypertension or hyperlipidaemia. METHODS: This community-based cross-sectional study was done in a north China city of 300 000 people. Participants were recruited by poster and phone call through Community Health Centres. Data were collected on 638 Chinese individuals. Interviews were done to screen for disease and health behaviours. Fasting blood was collected and analyzed. KEY FINDINGS: Participants' average age was 52 years. Self-reported prevalence of type 2 diabetes, hypertension and hyperlipidaemia was 9.6, 29.9 and 20.5% respectively. Medication adherence was found among 88, 60 and 81.5% of individuals with diabetes, hypertension and hyperlipidaemia respectively. Treatment success, as defined by medication adherence and treatment to goal was achieved by 21, 23 and 10% of diabetic, hypertensive and hyperlipidaemic patients. CONCLUSIONS: A large proportion of individuals with chronic disease in this China-based study were not being successfully treated, putting them at high risk for poor health outcomes. In this urban China setting, healthcare services need to be strengthened in order to achieve better treatment outcomes among chronic disease patients. It is recommended that community pharmacists contribute to improving these outcomes through participation in patient education, medication reconciliation and disease state management.

A descriptive study of the progression of the Metabolic Syndrome in middle-aged Chinese population.

This longitudinal study investigated the prevalence of the Metabolic Syndrome (MetS) in middle-aged (44-56 years) men and women in China. The presence of the components of the MetS was determined in a cohort of 643 persons born in 1956, 1960-1961, and 1964 in Shanxi Province China in 2008 and 2012. The rate of MetS in 2008 was 51.63% (95% CI [44.73, 58.48]) and 37.15% (95% CI [32.56, 41.92]) and in 2012 was 50.23% (95% CI [43.35, 57.10]) and 46.26% (95% CI [41.46, 51.11]) for men and women, respectively. Increased blood glucose and triglycerides and decreased high-density lipoprotein for women, and blood glucose and triglycerides for men were the components responsible for the development of MetS from 2008 to 2012. MetS develops differently between men and women. From age 44 to 56, the rate is unchanged among men and increasing among women.

Communicating with patients and their families about palliative and end-of-life care: comfort and educational needs of nurses.

INTRODUCTION: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care. METHOD: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery. RESULTS: The number of years' experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk's ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk's ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication. DISCUSSION: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge.

Socioeconomic differences in the menopausal experience of Chinese women.

OBJECTIVE: This study explores the effect of employment status, occupation and education on menopausal symptoms experienced by women in an urban community in China. STUDY DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: Menopausal symptoms, medication/supplement use to relieve menopausal symptoms, sociodemographic variables. RESULTS: Risks for more burdensome menopausal symptoms include less education, non-white collar occupation and unemployment/retirement status. Being employed in a white collar occupation and having higher formal education were protective for hot flashes, dry skin/eyes, heart palpitations and insomnia and were associated with increased usage of medication to alleviate menopausal symptoms. CONCLUSIONS: As Chinese women age and continue working longer, they will spend increasing amounts of time postmenopausal and in the workplace. The development of worksite-based health programmes would be advantageous to female workers of menopausal age in China.

Severe vitamin D-deficiency and the health of North China children.

OBJECTIVES: To determine the health and nutritional status of rural Chinese children ages 12-24 months. METHODS: This study used a cross-sectional design with a longitudinal component. Anthropometry and blood chemistry were measured on each child twice (n = 250). Caretaker knowledge and behaviors that relate to the child's health and diet were evaluated by interview. RESULTS: Children were taken outdoors at an average age of 131.8 days. 65.3% of surveyed children had serum 25-OH-D levels less than 12 ng/ml in the spring. This declined to 2.8% in the fall. Mean blood lead levels were 15.7 +/- 11.0 microg/dl in the spring declining to 12.4 +/- 12.5 microg/dl in the fall (t = 6.47, P = 0.000). This still left 63.5 and 54.9% of the children with toxic blood lead levels in spring and fall. Rates of respiratory disease declined significantly from spring to fall. A summer outdoors remarkably improved vitamin D-deficiency and lead toxicity. However, nutritional status worsened as during the summer diet was unable to keep up with growth and increased nutritional demand. From spring to fall serum zinc declined from 0.77 +/- 0.19 to 0.66 +/- 0.21 microg/ml (t = 3.33, P = 0.001) and blood hemoglobin declined from 12.5 +/- 1.2 to 12.0 +/- 1.2 gm/dl (t = 4.07, P = 0.000). CONCLUSIONS: Northern climate and cloistering of children creates a host of health risks for north China children. Vitamin D-deficiency, lead poisoning and respiratory disease are significantly worse during the winter months. These children need vitamin D supplementation during the winter and improved overall nutritional status during the summer to maintain ideal growth and development.

Doing the month: rickets and post-partum convalescence in rural China.

OBJECTIVE: to analyse the health beliefs underlying the Chinese custom of 'doing the month', in particular mothers' perceptions of rickets. DESIGN: a qualitative approach was used. Four focus group discussions were tape recorded. Translated transcripts were analysed and coded. SETTING: Yuci District, rural Shanxi Province, China. PARTICIPANTS: eighteen young mothers with children aged between 12 and 24 months, five grandmothers aged between 48 and 55 years, five township clinic maternal and child health workers, and seven traditional medicine doctors. FINDINGS: Zuo yuezi (doing the month) is accepted by Chinese mothers as a time of respite and physical recovery. It is also burdensome to mothers, as cloistering indoors compromises both mother and baby's exposure to the sun, resulting in vitamin D deficiency and rickets. KEY CONCLUSIONS: in order to reduce the rates of rickets in children, it is important to promote a more balanced and health-enhancing form of zuo yuezi that maintains necessary vitamin D status of both the mother and her baby. By understanding this custom, medical professionals caring for pregnant and post-partum Chinese women in Western countries will be able to better serve their health needs.

Phase 2 clinical trial of three formulations of tetravalent live-attenuated dengue vaccine in flavivirus-naïve adults.

Sixteen dose formulations of our live-attenuated tetravalent dengue virus vaccines (TDV) were previously evaluated for safety and immunogenicity. Two of the sixteen candidate TDV formulations (Formulations 13 and 14) were selected for further evaluation. A new TDV formulation, Formulation 17, using a higher primary dog kidney (PDK) cell passage Dengue-1 virus (DENV-1) and a lower PDK cell passage DENV-4, was developed to optimize the neutralizing antibody response. All three formulations consist of combinations of 10exp3-5 pfu/dose of the four dengue vaccine virus serotypes. This double-blind, randomized trial in 71 healthy adult subjects evaluated vaccine safety, reactogenicity and immunogenicity. TDV's were given subcutaneously in the deltoid on Day 0 and 180 (6 months). Subjects were seen in clinic on Study Days 0, 10, 28, 180, 190 and 208 and filled out daily symptom diaries for 21 days after each vaccination. Formulation 13 was the most reactogenic, while both Formulations 14 and 17 were similar in reported reactions. Seventy-five percent, 31% and 31% of subjects were viremic on Day 10 after primary vaccination with Formulations 13, 14 and 17 respectively. Viremia was not detected in any subject following the second dose of vaccine. The immunogenicity endpoint was neutralizing antibody titer one month after the second vaccination. Thirty-six percent, 40% and 63% of vaccinated subjects developed tetravalent neutralizing antibodies after two doses of Formulations 13, 14 and 17, respectively. Formulation 17 was selected for further clinical evaluation based on this study.

A validation and short form of the Basic Character Inventory.

The Basic Character Inventory (BCI) contains 136 items, 17 lower-order personality factors and three higher-order personality factors derived from psychoanalytic theory: Oral, Obsessive Compulsion, and Hysteria. Previous research that investigated the BCI's psychometric properties examined small, special populations and did not use modern statistical methods to validate the BCI. The present study validates the BCI via confirmatory factor analyses using a large sample of 6,285 Norwegian nursing and teaching students. Reliability, convergent validity, and divergent validity of the BCI were also assessed. Results indicated general support for the original BCI factor structure in a reduced form of the BCI that possesses strong reliability and validity, and is suitable for use in time-limited measurement settings.

A study of the relationship between parental bonding, self-concept and eating disturbances in Norwegian and American college populations.

This study investigated the relationship between bonding patterns and self-concept, and the influence of these constructs on a measure of sub-clinical eating disturbances. Undergraduate students from the United States (N=166) and Norway (N=233) were given self-report questionnaires that included measures of parental bonding, locus of control, self-concept clarity, self-esteem, and disturbed cognitions associated with eating. A structural equation model showed the expected pattern, with bonding predicting self-concept and self-concept predicting eating disturbances. The model fit equally well for samples from both countries and for both genders. This model links the pattern of low care and overprotective parental bonding indicators mediated through a self-concept defined by a lack of self-understanding, low self-esteem, and external locus of control to increased risk of eating disturbances for college aged men and women.

Diagnosis of rickets and reassessment of prevalence among rural children in northern China.

BACKGROUND: Rates of rickets from 15.9 to 26.7% have been reported in China. METHODS: Combining the methods of epidemiology and the behavioral sciences, this study investigated the prevalence of rickets in children in rural Shanxi Province, China. A total of 250 children age 12-24 months were examined physically for the presence of rickets, blood was drawn for laboratory analysis, and X-rays were taken of each child's wrists. RESULTS: Vitamin D deficiency in the spring was found among 65.3% of children. Rickets diagnosis relying on clinical signs alone determined a rickets prevalence of 41.6%, declining to 17.0% in the fall after a summer of sun exposure (chi(2) = 8.356, P = 0.004). But an integrated diagnostic method exploiting clinical signs, X-ray and alkaline phosphatase levels found the prevalence of active rickets to be 3.7%. Furthermore, it was demonstrated that only five clinical signs reflect active rickets--wide wrists, frontal bossing, rachitic rosary, Harrison's sulcus, and bowed legs. CONCLUSIONS: The prevalence of active rickets in young children in northern China is lower than previously reported. Even in poor countries, simple tests such as X-rays and alkaline phosphatase can be added to physical examination to more accurately diagnose active rickets.

How effective are simulated molecular-level experiments for teaching diffusion and osmosis?

Diffusion and osmosis are central concepts in biology, both at the cellular and organ levels. They are presented several times throughout most introductory biology textbooks (e.g., Freeman, 2002), yet both processes are often difficult for students to understand (Odom, 1995; Zuckerman, 1994; Sanger et al., 2001; and results herein). Students have deep-rooted misconceptions about how diffusion and osmosis work, especially at the molecular level. We hypothesized that this might be in part due to the inability to see and explore these processes at the molecular level. In order to investigate this, we developed new software, OsmoBeaker, which allows students to perform inquiry-based experiments at the molecular level. Here we show that these simulated laboratories do indeed teach diffusion and osmosis and help overcome some, but not all, student misconceptions.

Phase II safety and immunogenicity study of type F botulinum toxoid in adult volunteers.

An aluminum hydroxide (alum)-adsorbed, purified, botulinum F toxoid (Bot F) vaccine was manufactured to be administered as a stand-alone monovalent vaccine or to be added to the current botulinum pentavalent toxoid vaccine to make a hexavalent vaccine. We conducted a phase II trial of the Bot F vaccine over 3 years in 144 healthy adult volunteers to identify one of three vaccination schedules that was safe and maximally immunogenic for adult volunteers. We vaccinated 116 volunteers 1-3 times with Bot vaccine, and 28 volunteers 1-3 times with a licensed, alum-adsorbed hepatitis B vaccine (Engerix-B) as a reaction control group. After 1 year, 42 Bot volunteers with low, mouse anti-toxin titers (<0.10 IU/ml) received a booster injection and were followed for an additional year. The Bot vaccine inoculated three times over 28-42 days was generally well tolerated and safe, whether injected by the subcutaneous (s.c.) or intramuscular (i.m.) route, although it caused significantly more local reactions than did the HBV vaccine. Two vaccination schedules of three primary injections over 42 days (days 0, 14 and 42 or days 0, 21 and 42) provided significantly better protective immunity (anti-toxin levels >0.02 IU/ml) than did vaccinations given over 28 days (days 0, 7 and 28). Vaccine reactogenicity and immunogenicity were similar over 42 days whether administered subcutaneously or intramuscularly. However, even the most immunogenic schedule left 7-16% of volunteers unprotected at day 56 and 33-42% of vaccinees unprotected at 1 year. The booster dose administered at 1 year induced high levels of protective serum anti-toxin in all persons assayed which persisted for at least one additional year. A more potent vaccine formulation will be required to protect more individuals after primary immunization.

Are oral, obsessive, and hysterical personality traits related to disturbed eating patterns? A general population study of 6,313 men and women.

In this study, we explored 3 psychodynamically defined personality traits as predictors of eating disturbances among men and women in the general population. The Basic Character Inventory (Torgersen, 1980) was used to measure oral, obsessive, and hysteria traits along with the Eating Disturbance Scale (Rosenvinge et al., 2001). Oral personality factors were the primary predictors of eating disturbances in both genders-both men and women with eating disturbances tended to score highly on measures of emotional instability, self-doubt, compliance, and sensitivity. In women, the presence of oral personality factors in addition to the absence of the obsessive factor Parsimony accounted for 16% of the variance in eating disturbances. In men, oral personality factors in addition to the presence of the hysterical factor Imagination accounted for 13% of the variance in eating disturbances. This last finding suggests that, in addition to oral characteristics, men with eating disturbances may exhibit dissociative traits and imaginative absorption.