Predicting quantity of cannabis smoked in daily life: An exploratory study using machine learning.

BACKGROUND: Cannabis use is prevalent in the United States and is associated with a host of negative consequences. Importantly, a robust indicator of negative consequences is the amount of cannabis consumed. METHODS: Data were obtained from fifty-two adult, regular cannabis flower users (3+ times per week) recruited from the community; participants completed multiple ecological momentary assessment (EMA) surveys each day for 14 days. In this exploratory study, we used various machine learning algorithms to build models to predict the amount of cannabis smoked since participants' last report including forty-three EMA measures of mood, impulsivity, pain, alcohol use, cigarette use, craving, cannabis potency, cannabis use motivation, subjective effects of cannabis, social context, and location in daily life. RESULTS: Our best-fitting model (Gradient Boosted Trees; 71.15% accuracy, 72.46% precision) found that affects, subjective effects of cannabis, and cannabis use motives were among the best predictors of cannabis use amount in daily life. The social context of being with others, and particularly with a partner or friend, was moderately weighted in the final prediction model, but contextual items reflecting location were not strongly weighted in the final prediction model, the one exception being not at work. CONCLUSIONS: Machine learning approaches can help identify additional environmental and psychological phenomena that may be clinically-relevant to cannabis use.

Healing Wounds Efficiently with Biomimetic Soft Matter: Injectable Self-Healing Neutral Glycol Chitosan/Dibenzaldehyde-Terminated Poly(ethylene glycol) Hydrogel with Inherent Antibacterial Properties.

The high prevalence of acquiring skin wounds, along with the emergence of antibiotic-resistant strains that lead to infections, impose a threat to the physical, mental, and socioeconomic health of society. Among the wide array of wound dressings developed, hydrogels are regarded as a biomimetic soft matter of choice owing to their ability to provide a moist environment ideal for healing. Herein, neutral glycol chitosan (GC) was cross-linked via imine bonds with varying concentrations of dibenzaldehyde-terminated polyethylene glycol (DP) to give glycol chitosan/dibenzaldehyde-terminated polyethylene glycol hydrogels (GC/DP). These dynamic Schiff base linkages (absorption peak at 1638 cm-1) within the hydrogel structure endowed their ability to recover from damage as characterized by high-low strain exposure in continuous step strain rheology. Along with their good injectability and biodegradability, the hydrogels exhibited remarkable inhibition against E. coli, P. aeruginosa, and S. aureus. GC/DP hydrogels demonstrated high LC50 values in vivo using zebrafish embryos as a model system due to their relative biocompatibility and a remarkable 93.4 ± 0.88% wound contraction at 30-dpw against 49.1 ± 3.40% of the control. To the best of our knowledge, this is the first study that developed injectable glycol chitosan/dibenzaldehyde-terminated polyethylene glycol self-healing hydrogels for application in wound healing with intrinsic bacteriostatic properties against the three bacteria.

[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.

The Effects of Sequencing Strategies in Teaching Methods on Nursing Students' Knowledge Acquisition and Knowledge Retention.

Background: No existing research has determined which teaching sequence strategy is the best for nursing students. Purpose: To find out which sequence is most effective in knowledge acquisition and knowledge retention and to further verify knowledge acquisition between problem-based learning (PBL) and lecture-based learning (LBL). Methods: This was a quasi-experimental design with a comparison of two nursing student groups selected from students in their final program year who were invited to participate. Generalized estimating equation was used to compare Group I (LBL-PBL-clinical practicum) and Group II (PBL-LBL-clinical practicum) by using knowledge acquisition and knowledge retention as outcome variables. Findings: Fifty-six senior students joined this study. Group I was significantly better than Group II on both knowledge acquisition (ß = 7.05, p = 0.04) and knowledge retention (ß = 9.40, p = 0.03). Discussion: The sequence of LBL-PBL-clinical practicum or policy of allowing practicum and courses in the same semester might be the best strategy to enhance knowledge retention.

Risk factors for women with gestational diabetes mellitus developing type 2 diabetes and the impact on children's health.

AIM: The study aimed to explore the risk factors for progression to type 2 diabetes in women with gestational diabetes mellitus and the long-term impact of gestational diabetes mellitus on the health of their children. BACKGROUND: The occurrence of gestational diabetes mellitus in women is the strongest predictor of the development of type 2 diabetes in the future. DESIGN: A non-concurrent cohort and case-control study design and the guidelines for STROBE checklist were used for the study. METHODS: We reviewed medical records for the time period from the archives of the hospitals. The short-listed women and their children were invited to participate in a 'Women with gestational diabetes mellitus' research activity from November 2012-February 2016. Blood tests, physiological indicators and demographic questionnaires were applied for data collection. RESULTS: A total of 57 women and 57 children participated in the research activity. The risk factors for progression of gestational diabetes mellitus to type 2 diabetes included education level and the 1-h blood glucose level for the antepartum 100-g oral glucose tolerance test and the 2-h blood glucose level for the postpartum 75-g oral glucose tolerance test. However, these risk factors did not have a significant impact on the body mass index and body fat of the women's children. CONCLUSION: Healthcare providers should adopt a breadth of health education strategies to remind women with gestational diabetes mellitus to be aware of certain risk factors, and to urge them and their children to return for regular follow-up visits. RELEVANCE TO CLINICAL PRACTICE: Identification of the risk factors developing type 2 diabetes can make healthcare units incorporate the postpartum follow-up of gestational diabetes mellitus into their standard protocol and case managers continue to follow-up and manage the health of the women and that of their children to reduce adverse health of them.

The impact of prenatal depression and diabetes management self-efficacy on postpartum stress and depression in women with gestational diabetes mellitus.

AIMS: The study aimed to examine the impact of prenatal depression and diabetes management self-efficacy on postpartum stress and postpartum depression in women with gestational diabetes mellitus. BACKGROUND: Poor perinatal mental health is linked to various adverse pregnancy outcomes in women with gestational diabetes mellitus. DESIGNS: A predictive study design and the guidelines for the STROBE checklist were used for the study. METHODS: A total of 119 pregnant women with a positive 75 g-glucose challenge test were recruited at a medical centre. The Taiwanese depression questionnaire (TDQ), the diabetes management self-efficacy scale (DMSES) and the Hung postpartum stress scale (Hung PSS) were used for data collection at the 24th week of pregnancy and the first week after childbirth. RESULTS: Diabetes management self-efficacy was correlated with postpartum stress in women with gestational diabetes mellitus. Moreover, prenatal depression was a predictor of postpartum stress and postpartum depression, respectively, in women with gestational diabetes mellitus. CONCLUSIONS: Healthcare providers should assess those women's diabetes management self-efficacy and mood status during prenatal visits and offer the needed intervention to reduce the levels of postpartum stress and postpartum depression of those women after childbirth. RELEVANCE TO CLINICAL PRACTICE: A holistic care approach integrated diabetic care and mental health for women with gestational diabetes mellitus in a timely manner is warranted to promote perinatal mental health in women with gestational diabetes mellitus.

Mediating effect of social support on the relationship between illness concealment and depression symptoms in patients with pulmonary arterial hypertension.

BACKGROUND: Depression symptoms are common in patients with pulmonary arterial hypertension (PAH). Social support may mediate the effect of illness concealment on depression symptoms. OBJECTIVE: To examine the relationships between illness concealment, dimensions of social support, and depression symptoms and the mediating effect of the dimensions of social support on depression symptoms in PAH patients. METHODS: A cross-sectional design and convenience sampling were applied. Data were collected with three questionnaires and analyzed with hierarchical regression and the PROCESS macro. RESULTS: Ninety-seven participants were enrolled (mean age 50 ± 14 years). In total, 8% had a Patient Health Questionnaire (PHQ)-9 score ≥15. Hierarchical regression analysis showed that education level (ß = 0.28, p < 0.05), illness concealment (ß = 0.21, p < 0.05), and emotional support (ß = 0.29, p < 0.01) were determinants of depression symptoms. Emotional support mediated the relationship between illness concealment and depression symptoms. CONCLUSIONS: Emotional support can help patients reduce the effect of illness concealment on depression symptoms.

Beneficial effect of combinational methylprednisolone and remdesivir in hamster model of SARS-CoV-2 infection.

Effective treatments for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are urgently needed. Dexamethasone has been shown to confer survival benefits to certain groups of hospitalized patients, but whether glucocorticoids such as dexamethasone and methylprednisolone should be used together with antivirals to prevent a boost of SARS-CoV-2 replication remains to be determined. Here, we show the beneficial effect of methylprednisolone alone and in combination with remdesivir in the hamster model of SARS-CoV-2 infection. Treatment with methylprednisolone boosted RNA replication of SARS-CoV-2 but suppressed viral induction of proinflammatory cytokines in human monocyte-derived macrophages. Although methylprednisolone monotherapy alleviated body weight loss as well as nasal and pulmonary inflammation, viral loads increased and antibody response against the receptor-binding domain of spike protein attenuated. In contrast, a combination of methylprednisolone with remdesivir not only prevented body weight loss and inflammation, but also dampened viral protein expression and viral loads. In addition, the suppressive effect of methylprednisolone on antibody response was alleviated in the presence of remdesivir. Thus, combinational anti-inflammatory and antiviral therapy might be an effective, safer and more versatile treatment option for COVID-19. These data support testing of the efficacy of a combination of methylprednisolone and remdesivir for the treatment of COVID-19 in randomized controlled clinical trials.

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.

The symptoms, resourcefulness and quality of life in community-based patients with schizophrenia.

AIMS AND OBJECTIVES: To test Zauszniewski's resourcefulness and quality of life theory in community-based patients with schizophrenia. The objectives were to: (a) examine the relationship among psychotic symptoms, resourcefulness and quality of life, and (b) explore the determinants of quality of life. BACKGROUND: According to Zauszniewski's resourcefulness and quality of life theory, for patients, the skills constituting resourcefulness should centre on helping oneself or the use of resources to achieve their health. While the significant associations between resourcefulness and quality of life have been consistently delineated in published research, little is known about resourcefulness in patients with schizophrenia. DESIGN: A cross-sectional study design was used in this study. METHODS: A total of 120 patients were recruited with convenience sampling who received home care service and community rehabilitation programme. The participants were assessed with the Brief Psychiatric Rating Scale, the Resourcefulness Scale and the World Health Organization Quality of Life Scale-BREF. The psychotic symptoms were rated by the researchers with structured face-to-face interviews. Resourcefulness and quality of life were assessed through self-reporting. STROBE checklist was followed. RESULTS: The data were analysed using one-way analysis of variance, t test, Pearson's correlation coefficients and stepwise multiple regression analysis. Results showed that employment status and psychotic symptoms were correlated with resourcefulness, while employment status, psychotic symptoms and resourcefulness were correlated with quality of life. Resourcefulness and psychotic symptoms were the determinants of quality of life. CONCLUSION: Patients with employment and less psychotic symptoms had greater resourcefulness. In addition, patients with employment, less psychotic symptoms and greater resourcefulness had better quality of life. RELEVANCE TO CLINICAL PRACTICE: Community rehabilitation programmes should include supported employment, symptom management and resourcefulness skills training to enhance patients' resourcefulness and quality of life.

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.

The relationships among work stress, resourcefulness, and depression level in psychiatric nurses.

Psychiatric nurses are exposed to highly stressful work environments that can lead to depression over time. This study aimed to explore the relationships among work stress, resourcefulness, and depression levels of psychiatric nurses. A cross-sectional design with randomized sampling was used; 154 psychiatric nurses were recruited from six medical centers in Taiwan. Psychiatric nurses' work stress was found positively correlated with their depression level, and negatively related to resourcefulness. Work stress significantly predicted depression level. These results suggest that the hospital administrative units may develop training courses about resourcefulness skills to reduce psychiatric nurses' work stress, and improve their mental health.

Prenatal predictors for father-infant attachment after childbirth.

AIMS AND OBJECTIVES: This study aims to assess expectant fathers' social support, marital intimacy and health status during the third trimester of their partners' pregnancies. Further, we investigate the predictors of father-infant attachment after childbirth. BACKGROUND: Becoming a father is a transition. Research has focused more on mothers than on fathers, even though the philosophy of the maternal care system is about providing family-centred care. The psychological status of first-time fathers and the attachment they have to their infants have received little attention in the research. DESIGN: A repeated measures study design. METHODS: A total of 195 first-time fathers were recruited during the third trimester of their partners' pregnancies. During that time, they completed the Social Support Scale, the Marital Intimacy Scale and the Chinese Health Questionnaire. After childbirth, they completed the Paternal Attachment Inventory during the one-week postpartum period. RESULTS: The fathers who perceived more marital intimacy and support from their partners were more attached to their infants. Moreover, marital intimacy and partner support were important predictors for father-infant attachment. CONCLUSIONS: Future research is warranted to determine the prenatal predictors of father-infant attachment for high-risk families. RELEVANCE TO CLINICAL PRACTICE: The philosophy of maternal care is family oriented; for health professionals, pregnancy is an important time to provide information and counsel couples. Interventions should not only target the health and well-being of expectant mothers but should also actively invite fathers to participate in prenatal care with their partners to facilitate marital intimacy and father-infant attachment.

Postpartum psychosocial changes among experienced and inexperienced mothers in Taiwan.

PURPOSE: To compare differences in psychosocial changes among experienced and first-time mothers over 6 postpartum weeks. DESIGN: A trend research study design. METHOD: A cohort of 439 first-time mothers and 420 experienced mothers during the 6 postpartum weeks was recruited in southern Taiwan. Each participant was interviewed over the phone to complete the Hung Postpartum Stress Scale, the Social Support Scale, and the Chinese Health Questionnaire. FINDINGS: Concern about lack of social support was significantly higher in first-time mothers in the third week than in the first week. CONCLUSIONS: Postpartum stressors are different for inexperienced and experienced mothers, and these stressors vary in their importance over the 6 postpartum weeks, suggesting that the postpartum nursing needs of the two groups in 6 postpartum weeks may be different. IMPLICATION FOR PRACTICE: Knowledge and skills in mothering capability should be emphasized for first-time mothers, and physical exercises are needed for both groups of mothers.

Predictors of postpartum stress.

AIM: To predict important factors in women's postpartum stress. BACKGROUND: The transition to motherhood is often accompanied by stress, but research on predictors of postpartum stress is scant. DESIGN: A cross-sectional survey was used in the study. METHODS: Proportional stratified quota sampling based on births at 11 registered general hospitals and seven specialty clinics in the Kaohsiung area of southern Taiwan was used to obtain a high degree of representation. Eight hundred and fifty-nine women participated in the study within six weeks postpartum. The Hung postpartum stress scale, the social support scale and the 12-item Chinese Health Questionnaire were used in this study. RESULTS: Women with minor psychiatric morbidity, one or two children, junior college educational level, formula feeding for their infants, preference for an infant boy and a low level of social support were important predictors for women's postpartum stress. CONCLUSION: Our findings provide information and data for service planning and community care for the prevention and amelioration of postpartum stress. RELEVANCE TO CLINICAL PRACTICE: Postpartum women face a constellation of factors that could put them at risk for high levels of postpartum stress. Postpartum stress could significantly negatively impact women's health status. Nursing interventions should be tailored to decrease women's postpartum stress as a means of promoting postpartum women's pursuit of well-being.

Maternal satisfaction with postpartum nursing centers.

We explored predictors of women's satisfaction with postpartum nursing centers, which have become popular in Taiwan in recent years. After completing a consent form and demographic questionnaire, 401 women from different centers identified by proportional stratified quota sampling completed four questionnaires over the telephone after their fourth week postpartum. A high level of social support and low level of postpartum stress significantly predicted their satisfaction with the postpartum nursing centers. Future studies will be needed to determine whether, compared to traditional care at home, the postpartum nursing centers can help ease mothers' transition to parenthood and improve their childcare competence.

Taiwanese maternal health in the postpartum nursing centre.

AIM: To investigate the association between postpartum stress as well as social support and the general health status of women recently discharged from postpartum nursing centres where the ritual of Tso-Yueh-Tzu is followed. BACKGROUND: Taiwanese women stay in postpartum nursing centres to take care of their newborn babies and perform the traditional Chinese ritual of Tso-Yueh-Tzu, the custom of a postpartum month-long rest. DESIGN: A non-experimental research design was used in the study. METHODS: Two hundred and fifty-eight postpartum women who had stayed in postpartum nursing centres for at least 20 days were recruited at eight postpartum nursing centres in the Kaohsiung metropolitan area of southern Taiwan. They were administered the Hung Postpartum Stress Scale, the Social Support Scale and the Chinese Health Questionnaire. RESULTS: Women without minor psychiatric morbidity had higher social support, lower postpartum stress and longer length-of-stays in the postpartum care centre than women with minor psychiatric morbidity. Postpartum stress revolved around changes in body shape. A one-point increase in postpartum stress increased the likelihood that a mother would suffer minor psychiatric morbidity by 1.04 times; while giving birth to a boy decreased that likelihood by 0.51 times. CONCLUSIONS: This study found Tso-Yueh-Tzu as practised in postpartum nursing centres gave the postpartum women the opportunity to receive tangible support and, therefore, helped decrease postpartum stress and improved their general health. The greatest source of postpartum stress was concern over negative body changes. RELEVANCE TO CLINICAL PRACTICE: The postpartum nursing centre plays an important role in helping postpartum Taiwanese women observe the traditional ritual of Tso-Yueh-Tzu and in improving these women's general health. These centres may want to pay more attention to providing exercise that promotes body toning and relaxation.