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.

Incidence and survival impact of pulmonary arterial hypertension among patients with systemic lupus erythematosus: a nationwide cohort study.

BACKGROUND: No population-based study has investigated the cumulative incidence of pulmonary arterial hypertension (PAH) in patients with newly diagnosed systemic lupus erythematosus (SLE) or the survival impact of PAH in this population. METHOD: We used a nationwide database in Taiwan and enrolled incident SLE patients between January 1, 2000, and December 31, 2013. The cumulative incidence of PAH in the SLE patients and the survival of these patients were estimated by the Kaplan-Meier method. Potential predictors of the development of PAH were determined using a Cox proportional hazards regression model. RESULTS: Of 15,783 SLE patients, 336 (2.13%) developed PAH. The average interval from SLE diagnosis to PAH diagnosis was 3.66 years (standard deviation [SD] 3.36, range 0.1 to 13.0 years). Seventy percent of the patients developed PAH within 5 years after SLE onset. The 3- and 5-year cumulative incidence of PAH were 1.2% and 1.8%, respectively. Systemic hypertension was an independent predictor of PAH occurrence among the SLE patients (adjusted hazard ratio 2.27, 95% confidence interval 1.59-2.97). The 1-, 3-, and 5-year survival rates of SLE patients following the diagnosis of PAH were 87.7%, 76.8%, and 70.1%, respectively. CONCLUSIONS: PAH is a rare complication of SLE and the majority of PAH cases occur within the first 5 years following SLE diagnosis. Systemic hypertension may be a risk factor for PAH development in the SLE population. The overall 5-year survival rate after PAH diagnosis was 70.1%.

Amiodarone and risk of liver cirrhosis: a nationwide, population-based study.

BACKGROUND: Liver cirrhosis is an uncommon but not rare side effect of amiodarone-induced hepatotoxicity. Patients with hepatitis B virus and hepatitis C virus infections are at a high risk for developing liver cirrhosis. However, the relationship between this treatment and risk of liver cirrhosis in high-risk chronic hepatitis B and chronic hepatitis C patients is unknown. PATIENTS AND METHODS: The present study identified amiodarone users (N=8,081) from the Taiwan National Health Insurance Research Database from 1997 through 2013. A total of 32,324 subjects with age, comorbidities, gender, and index date-matched non-amiodarone users were selected as controls (non-amiodarone cohort). The incidences of cumulative liver cirrhosis were compared between cohorts. Stratified Cox's regression hazard models were used to assess possible comorbidity-attributable risks for liver cirrhosis. RESULTS: The amiodarone cohort had a nonsignificant risk of liver cirrhosis compared with the non-amiodarone cohort, with a HR of 1.17 (95% CI: 0.93-1.47; P=0.1723). Patients with specific comorbid diseases, including type 2 diabetes mellitus, chronic hepatitis B, chronic hepatitis C, and heart failure, were probably at a high risk of developing liver cirrhosis. The use of statins was associated with a significant 42% reduction in the risk of liver cirrhosis. CONCLUSION: Patients in the amiodarone cohort had no excess risk of liver cirrhosis compared with patients in the non-amiodarone cohort. Long-term surveillance for liver toxicity in high-risk patients with amiodarone treatment is suggested.

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis patients-A prospective, randomized controlled trial.

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis (PD) patients were not known. We performed a prospective, randomized controlled trial enrolling 89 PD patients. After stratification by initial Staphylococcus aureus (SA) carrier status, patients were randomly assigned to receive daily 4% chlorhexidine care (intervention group) or normal saline (control group) at the exit site. Monthly, we cultured bacteria from the exit site and nasal swabs for 1 year. The SA colonization rates at exit site at 6 and 12 months were significantly lower in the intervention group than the control group (5.0% vs. 22.9%, p = 0.023 and 8.6% vs. 28.1%, p = 0.037 for 6 and 12 months, respectively). The Methicillin-resistant SA (MRSA) colonization rate at exit site at 6 months was similar (5.7% vs. 2.5%,p = 0.596) in control and intervention group, but significantly lower in the intervention group than the control group at exit site at 12months (0% vs. 12.5%, p = 0.047). The gram-negative bacilli (GNB) colonization rates were similar between the intervention and control groups at 6 and 12 months. Genotyping of all MRSA isolates showed ST (sequence type) 59 was the most predominant clone. In conclusion, chlorhexidine care at the exit site in PD patients may be a good strategy for SA and MRSA decolonization. TRIAL REGISTRATION: ClinicalTrials.gov NCT02446158.

Chlorella pyrenoidosa ameliorated L-NAME-induced hypertension and cardiorenal remodeling in rats.

PURPOSE: Hypertension is one of the main factors causing cardiovascular diseases. The aim of the study is to investigate the effects of Chlorella pyrenoidosa on blood pressure and cardiorenal remodeling in rats with N (ω)-nitro-L-arginine methyl ester hydrochloride (L-NAME)-induced endothelial dysfunction. METHODS: Rats were fed a diet containing L-NAME (40 mg/kg) with or without chlorella (4 or 8 %) for 5 weeks. We found that chlorella retarded the development of hypertension and cardiorenal remodeling during the 5-week experimental period. RESULTS: Although there was no difference in NO( x ) levels or plasma arginine concentrations, plasma and tissues ACE activities were significantly lower in the chlorella groups than in the L-NAME group. Moreover, tissue tumor necrosis factor-α concentrations and renal CYP4A expression were also lower in the chlorella group. CONCLUSION: These results suggest that chlorella might ameliorate the elevation of blood pressure and show cardiorenal-protective effects in nitric oxide-deficient rats, and one possible mechanism might be mediated by its ACE inhibitory activity.

Knowledge about and attitude toward enterovirus 71 infections: a survey of parents and teachers at kindergartens in Taiwan.

In 2008, we surveyed 690 parents and 104 teachers at kindergartens in Taiwan about their knowledge of and attitude towards enterovirus 71 infections. The accurate response rate for enterovirus infection characteristics was greater than 80% for specific symptoms, prevalent age group, and predominant infection season. Parents and teachers felt great anxiety and even panic about infection. Both groups perceived the impact of enterovirus infection to be worse than that of influenza.

Presynaptic adenosine A1 receptors modulate excitatory synaptic transmission in the posterior piriform cortex in rats.

The effect of adenosine on the fEPSP was examined in the lateral olfactory tract (Ia input) and associative tract (Ib input) of the rat piriform cortex. The fEPSP evoked in the Ia input showed paired-pulse facilitation, while that in the Ib input showed paired-pulse depression, suggesting a lower resting release probability in the Ia input. This was supported by results showing that MK801 blocked the NMDA receptor-induced fEPSP more rapidly in the Ib input than the Ia input. Adenosine caused dose-dependent inhibition of the fEPSP in both inputs, the sensitivity being higher in the Ib input. This effect was mimicked by the A(1) receptor agonist, CHA, and antagonized by co-application of the A(1) receptor antagonist, DPCPX, showing that adenosine was acting at A(1) receptors. Application of DPCPX alone caused an increase in the fEPSP, the increase being larger in the Ia input. DPCPX also caused paired-pulse depression in both inputs, and the paired-pulse ratio measured in its presence was very similar in both inputs. These results suggest there is a lower endogenous concentration of adenosine in the Ib sublayer than the Ia sublayer, which might account for the native difference in the resting release probability of the two inputs. The adenosine-induced inhibition of the fEPSP in both inputs was associated with a significant reduction in the rate at which MK801 blocked NMDA receptor-mediated fEPSP activity, suggesting a presynaptic location of the A(1) receptors. Blocking of N-, P/Q-type calcium channels occluded the inhibition by adenosine, indicating that they are downstream effectors of presynaptic A(1) receptor activation.