Patient value co-creation behavior scale based on the DART model.

OBJECTIVES: Value co-creation focuses on customer participation and co-creates value with suppliers. Patients' support and cooperation can improve the quality of medical care. Value creation is closely related to participants' behavior. The DART (Dialogue, Access, Risk assessment, Transparency) model is widely used in commercial research because it defines and classifies value co-creation behavior clearly and systematically. However, there is little research using the DART model in the field of health care. This study aimed to develop and evaluate the psychometric properties of a scale measuring patient value co-creation behavior based on the DART model. STUDY DESIGN: The Delphi technique was used to determine the scale content with a panel of 17 experts. A cross-sectional survey was administered to 356 outpatients and inpatients of a hospital in Guangzhou, China. METHODS: Internal consistency reliability and composite reliability (CR) were used to estimate the scale's reliability. Validity was assessed using convergent and discriminant validity. RESULTS: Three rounds of expert consultation were completed before a final consensus was reached regarding scale content. The patient value co-creation behavior scale was composed of 23 items and 4 dimensions. The overall Cronbach's α was 0.934, and the CRs of the 4 DART dimensions were 0.843, 0.872, 0.911, and 0.884, respectively, showing satisfactory reliability. The average variance extracted ranged from 0.473 to 0.659, and the χ2 difference between constrained and free models was significant, indicating convergent and discriminant validity. CONCLUSIONS: The scale exhibited acceptable reliability and validity and could serve as an evaluation tool for patient value co-creation behavior.

The Reliability and Validity of Short Form-12 Health Survey Version 2 for Chinese Older Adults.

BACKGROUND: We assessed the information regarding the psychometric properties of the Short Form-12 Health Survey Version 2 (SF-12v2) among older adults in China. METHODS: A cross-sectional study was conducted on a stratified representative sample of older adults (≥60 years) residing in community and nursing home settings in 2017-18. Reliability was estimated using the internal consistency method. Validity was assessed using convergent and discriminant validity checks, factor analyses (including both exploratory and confirmatory factor analyses [EFA and CFA]), and "known groups" construct validity. RESULTS: The final sample comprised 1000 older adults (451 community-dwelling and 549 institutional). Cronbach's α was 0.81 for the Physical Component Summary (PCS) and 0.83 for the Mental Component Summary (MCS), showing satisfactory internal consistency for both. Most items were strongly correlated with their represented component (Spearman's correlation coefficient: 0.62-0.87), although the correlation of SF items with PCS was a bit stronger than that with MCS. A two-factor structure (physical and mental health) indicated by EFA jointly accounted for 68.50% of the variance and presented adequate goodness-of-fit indices (GFI=0.98, AGFI=0.92, RMSEA=0.08, 90% Cl RMSEA=0.06 to 0.11, NFI=0.98, and CFI=0.98) in CFA. Known-groups comparison showed that SF-12v2 summary scores did well in differentiating subgroups of older adults by age, marital status, and self-reported health problems (P≤0.05). CONCLUSION: SF-12v2 is a reliable and valid health-related quality of life instrument for Chinese older adults that works equally well with older adults under institutional care and community-based home care models.

Health-related quality of life and related factors among elderly persons under different aged care models in Guangzhou, China: a cross-sectional study.

PURPOSE: To analyze health-related quality of life (HRQoL) and related factors among elderly persons receiving community-based home care and institutional care in Guangzhou, a large city of mainland China. METHODS: A representative sample of 1600 subjects aged 60 years and over residing in communities and nursing homes was randomly selected through stratified sampling. The 12-item Short Form Health Survey version 2 (SF-12v2) was used to assess HRQoL. RESULTS: In total, 1014 elderly persons under different aged care models responded to the survey (response rate 63.4%) and 1000 were eligible for data analyses. Compared with the elderly receiving community-based home care or private institutional care, those in public institutional care had the lowest scores on the physical component summary (PCS, 36.89 ± 10.44) and the mental component summary (MCS, 47.16 ± 11.14). Number of chronic diseases, loneliness, and age were the most common significant factors (P < 0.05) affecting PCS and MCS. The interaction term between aged care model and number of chronic diseases significantly affected PCS (ß = - 0.165, P < 0.05), indicating a stronger association between these factors for participants receiving community-based home care than institutional care. The interaction term between aged care model and loneliness had a significant effect on MCS (ß = 0.189, P < 0.05), indicating a weaker association between loneliness and MCS for participants receiving community-based home care. CONCLUSIONS: This study found poor HRQoL among the elderly in Guangzhou. The main factors associated with the physical and mental HRQoL of elderly persons included number of chronic diseases, loneliness, age, and education level. It also revealed the moderating effects of aged care model on HRQoL, suggesting specific health management strategies for elderly in community-based home care and institutional care, respectively.

Long-term compulsive exercise reduces the rewarding efficacy of 3,4-methylenedioxymethamphetamine.

Although exercise has been known to regulate brain plasticity, its impact on psychostimulant reward and the associated mesolimbic dopamine system remained scarcely explored. A psychostimulant, 3,4-methylenedioxymethamphetamine (MDMA), is currently a worldwide abused drug of choice. We decided to examine the modulating effects of long-term, compulsive treadmill exercise on the hedonic value of MDMA in male C57BL/6J mice. MDMA-induced conditioned place preference (CPP) was used as a behavioral paradigm to indicate the reward efficacy of MDMA. We observed that sedentary control mice all demonstrated reliable MDMA-induced CPP with our conditioning protocol. Interestingly, pre-exposure to a treadmill exercise decreased the later MDMA-induced CPP in a running period-dependent manner. Specifically, mice undergoing a 12-week treadmill running exercise did not exhibit any approaching bias toward the MDMA-associated compartment in this CPP paradigm. Twelve weeks of treadmill running did not alter peripheral metabolism of MDMA 30min following single intraperitoneal injection of MDMA (3mg/kg). We further used microdialysis technique to study the underlying mechanisms for the impaired MDMA reward produced by the12-week exercise pre-exposure. We found that acute MDMA-stimulated dopamine release in nucleus accumbens was abolished in the exercised mice, whereas an obvious elevation of accumbal dopamine release was observed in sedentary control mice. Finally, the 12-week exercise program did not alter the protein levels of primary dopamine receptors, vesicular or membrane transporters in this area. We conclude that the long-term, compulsive exercise is effective in curbing the reward efficacy of MDMA possibly via its direct effect on reversing the MDMA-stimulated dopamine release in nucleus accumbens.

Prenatal exposure of bupropion may enhance agitation, anxiety responses, and sensitivity to cocaine effects in adult mice.

Major depression and dysthymia afflict a proportion of gravid and breast-feeding women. These women are frequently recommended on antidepressants to relieve their symptoms even if the drug effects on fetal growth and postnatal development are not completely known. In a previous study, we reported that prenatal bupropion exposure seemed to enhance the hedonic value of cocaine in adult mice. This study was undertaken to examine the dose-related effects for prenatal bupropion exposure on the stress susceptibility, cocaine-associated reinforcing property, and cocaine-induced behavioral sensitization in adult mice. Our results showed that various doses (ranging 12.5-50 mg/kg) of prenatal bupropion administration at the third trimester of pregnancy did not affect body weight of the adult mice. Bupropion administration at 50 mg/kg enhanced both ambulatory and rearing responses in the open field test. Moreover, bupropion administration (at 25 and 50 mg/kg) significantly decreased the numbers in open arm entry in the elevated plus maze test. Furthermore, prenatal bupropion treatment appeared to facilitate the cocaine-induced place preference in a sex-dependent manner. Finally, prenatal bupropion exposure (at 25 and 50 mg/kg) accelerated and elevated the development of cocaine-induced sensitization in locomotor activity. While the antidepressant and smoking-curbing effects of bupropion have been addressed in literature, we suggest that prenatal bupropion exposure could run a risk of enhancing individual's agitation, stress susceptibility and cocaine stimulating propensity in adulthood.