Development and validation of the health literacy environment scale for Chinese hospitals from patients' perspective.

Introduction: While the research on improving individual health literacy by promoting individual skills and abilities is increasing, less attention has been paid to the complexities of the healthcare environment that may influence patients' ability to access, understand, and apply health information and health services to make health decisions. This study aimed to develop and validate a Health Literacy Environment Scale (HLES) that is suitable for Chinese culture. Methods: This study was conducted in two phases. First, using the Person-Centered Care (PCC) framework as a theoretical framework, initial items were developed by using the existing health literacy environment (HLE) related measurement tools, literature review, qualitative interviews, and the researcher's clinical experience. Second, scale development was based on two rounds of Delphi expert consultation and a pre-test conducted with 20 hospitalized patients. Using 697 hospitalized patients from three sample hospitals, the initial scale was developed after item screening and its reliability and validity were evaluated. Results: The HLES comprised 30 items classified into three dimensions as follows: interpersonal (11 items), clinical (9 items), and structural (10 items) dimensions. The Cronbach's α coefficient of the HLES was 0.960 and the intra-class correlation coefficient was 0.844. The confirmatory factor analysis verified the three-factor model after allowing for the correlation of five pairs of error terms. The goodness-of-fit indices signified a good fit for the model (χ2/df = 2.766, RMSEA = 0.069, RMR = 0.053, CFI = 0.902, IFI = 0.903, TLI = 0.893, GFI = 0.826, PNFI = 0.781, PCFI = 0.823, PGFI = 0.705). The item-content validity index ranged from 0.91 to 1.00, and the scale-content validity index was 0.90. Conclusion: The HLES had good reliability and validity and provides a patient perspective tool for evaluating HLE and a new perspective for improving health literacy in China. That is, healthcare organizations make it easier for patients to access, understand, and use health information and service. Further studies about the validity and reliability of HLE should include other districts and different tiers or types of healthcare organizations.

Acute toxicity of eucalyptus leachate tannins to zebrafish and the mitigation effect of Fe3+ on tannin toxicity.

Fish ponds polluted by the black water of eucalyptus forests (formed by the complexation of eucalyptus tannins with Fe3+) have experienced fish deaths. However, the toxicity of the components of black water is still unclear. To study the acute toxicities of eucalyptus leachate tannins to fish, their changes in the presence of Fe3+, and the underlying mechanisms, the static bioassay test method was adopted for acute exposure testing of zebrafish. Zebrafish were exposed to three kinds of tannins, namely, tannic acid (TA), epigallocatechin gallate (EGCG) and tannins from fresh eucalyptus leaf leacheate (TFL), and to solutions of these tannins with different molar ratios of Fe3+, under both no-aeration and aeration conditions. The results showed that the 48 h LC50 values of TA, EGCG and TFL were respectively 92, 47, and 186 mg·L-1, under no aeration, and 171, 86, and 452 mg·L-1 under aeration. When Fe3+ at 2, 1, and 6 times the molar amount of tannin was added to LC100 solutions of TA, EGCG and TFL, zebrafish mortality in 24 h was reduced to 0-33%. Acute fish death in eucalyptus plantation areas is related to high concentrations of eucalyptus tannins in the water. However, with increasing dissolved oxygen and Fe3+ levels, the acute toxicity of tannins to fish can be reduced. Thus, the black water in eucalyptus plantation areas reflects a water quality phenomenon that reduces the acute toxicity of eucalyptus tannins to fish. The mechanism of tannin toxicity to fish may be related to the impairment of oxygen delivery by fish blood, but the mechanism needs further study. These results provide a scientific basis for the prevention and control of fish suffering from acute eucalyptus tannin poisoning in eucalyptus plantation areas and for the protection of water resources.

Production and characterization of human extracellular superoxide dismutase in the methylotrophic yeast Pichia pastoris.

Reactive oxygen species are associated with various diseases including cardiovascular diseases, neurological disorders, and pulmonary diseases. Extracellular superoxide dismutase (ECSOD) is an antioxidant enzyme secreted by cells to prevent overproduction of reactive oxygen species. We expressed an ECSOD gene isolated from a human aortic smooth muscle cDNA library in the methylotrophic yeast Pichia pastoris. A synthetic secretion cassette was constructed with the inducible promoter of the alcohol oxidase 1 gene (AOX1) and the yeast alpha-mating factor signal peptide. As much as 25% of the total protein was ECSOD in some transformants grown under inducing conditions. After 36 h of methanol induction, ECSOD was exported into the culture medium at a concentration of approximately 440 mg/L with an antioxidative activity of 760 +/- 20 U/mg ECSOD. Transformed yeast cells were more resistant to heat shock and H(2)O(2) oxidative stress, indicating that the human ECSOD expressed by P. pastoris had multiple biological functions. Our data suggest that the methylotrophic yeast inducible system is suitable for large-scale production of enzymatically active human ECSOD.