Sorafenib is an antagonist of the aryl hydrocarbon receptor.

Sorafenib is an orally administered inhibitor of several tyrosine protein kinases. Treatment with sorafenib induces autophagy, which may suppress the growth of hepatocellular carcinoma (HCC) and other cancers. Aryl hydrocarbon receptor (AhR) is activated by xenbiotics and is involved in detoxification, but also plays other physiological roles. The following results were obtained. ITE and ß-NF are endogenous and synthetic AhR ligands, respectively. One µM sorafenib can strongly suppress baseline as well as 0.5 µM ITE- and 1 µM ß-NF-induced transcriptional activity of the aryl hydrocarbon response element (AHRE) in both human and mouse cells. Cytochrome p450 (CYP) 1A1 is mainly transcribed by activated AhR. Sorafenib (2-15 µM) strongly and dose-dependently suppressed baseline as well as 2 µM ITE- and 10 µM ß-NF-induced CYP1A1 mRNA and protein expression. Ligand-activated AhR translocates from the cytoplasm to the nucleus. While sorafenib was found to suppress AhR activity, the drug alone was able to induce AhR translocation into the nucleus. Sorafenib's antagonistic action on AhR was comparable to that of the known AhR antagonist CH-223191 in human liver and ovarian cell lines. In summary, we demonstrate that sorafenib is a potent AhR antagonist and likely endocrine disruptor of the AhR. Moreover, sorafenib offers potential benefit for diseases treatable through AhR suppression strategies. Further investigation is warranted into sorafenib's AhR antagonistic behavior.

Radical Scavenging and Antiproliferative Effects of Cordycepin-Rich Ethanol Extract from Brown Rice-Cultivated Cordyceps militaris (Ascomycetes) Mycelium on Breast Cancer Cell Lines.

The yield and efficacy of bioactive compounds from Cordyceps militaris fruiting bodies and its fermented grains usually vary with the strain used. In this study, we compared the antiproliferative, apoptotic, and antioxidative properties of ethanolic extracts of fruiting bodies and solid-stated fermented rice (FRE) from two wild-type strains of C. militaris applied to human breast cancer cell lines. We observed that FRE of the Zhangzhou strain (FRE-Z) produced a high level of cordycepin and exhibited comprehensive in vitro antioxidant activity against the oxidation of 2,2-diphenyl-1-picrylhydrazyl, superoxide, and hydroxyl radicals and low-density lipoprotein. Only FRE-Z exhibited dose-dependent inhibition of cell proliferation in MCF-7 (0.7 mg/mL) and MDA-MB-231 cells (1 mg/mL) after culturing for 24 h. The antiproliferative effects of FRE-Z were associated with an early stage of apoptosis induction at 4 h of treatment with 0.5 mg/mL FRE-Z in MCF-7 cells. The antiproliferative effect was determined to occur through p53 activation but not through the release of mitochondrial apoptosis-inducing factor or caspase-9 activation for an initial culture period of 16 h. In addition to a transient increase in cellular antioxidant enzyme, Cu/Zn superoxide dismutase was identified in MCF-7 cells after 2 h of treatment with FRE-Z. Therefore, FRE-Z, which exhibits various dose- and exposure time-dependent activities, has potential application in breast cancer chemoprevention.

Development and validation of the Taiwan Children's Health Literacy Test.

BACKGROUND: Currently, health literacy (HL) worldwide is measured primarily among adults from a medical perspective. A children's HL test from a health promotion perspective is needed. This study develops the Taiwan Children's Health Literacy Test (TCHL) targeted at Taiwanese sixth-graders. METHODS: HL indicators were identified through interviews of sixth-grade teachers, primary caregivers, and sixth-graders. They were used to develop a 25-item online test, which was finalized after pretesting and administered to a stratified random sample of 671 students across 29 sixth-grade classes. RESULTS: The response rate was 87.2% (585 participants). Cronbach's α was 0.60-0.78 for the HL subtests and 0.79 for the overall HL test. Correlation coefficients among subtests ranged from 0.49 to 0.87. The average proportion correct was 0.80 for overall HL. In item response theory analysis, the difficulty level ranged from -2.77 to -0.40, while the degree of discrimination was 0.44-2.65. Item information peaked when the ability value was approximately -1.8. Furthermore, HL scores had a significant positive correlation with health behaviors. CONCLUSIONS: Overall, the test was found to be reliable and valid, with a low level of difficulty for basic HL ability. The present results can be used as a reference by government health education units to investigate national HL in children.

Defining Taiwanese children's health literacy abilities from a health promotion perspective.

BACKGROUND: Health literacy is related to health inequality, health behaviors, and health status. Globally, health literacy has primarily focused on adults and has been based on the medical model. It is necessary to understand children's life experiences as they relate to health; thus, this study attempted to evaluate and describe the health literacy abilities of sixth-graders in Taiwan. METHODS: Interviews were conducted with 10 teachers and 11 caregivers, and focus groups were conducted with 32 children. Health literacy abilities corresponding to real-life situations were identified from life skills and the Taiwanese Curriculum Guidelines for health education. Three expert meetings were held to redefine children's health literacy using a health promotion perspective and confirmed indicators. RESULTS: An operational definition of three aspects of children's health literacy and 25 abilities was proposed: 11 functional health literacy abilities (e.g. understands the connection between personal health care behaviors and health); seven interactive health literacy abilities (e.g. obtains and understands information from various channels); and seven critical health literacy abilities (e.g. analyzes the relationship between personal needs and diet choices for a balanced diet). These indicators cover 10 health education categories. CONCLUSIONS: These findings highlight the importance of understanding Taiwanese children's health literacy, and the urgency of developing an appropriate measurement tool. The definition and indicators in this study were identified using a child-centered approach focusing on children's real-life experiences. The result serves as a solid basis for the development of the Taiwan Children's Health Literacy Scale, and provides information for the decision-making sector on health education.

Older Age, Low Socioeconomic Status, and Multiple Comorbidities Lower the Probability of Receiving Inpatient Rehabilitation Half a Year After Stroke.

OBJECTIVE: To determine the predictors of receiving inpatient rehabilitation during 7 to 12 months after stroke. DESIGN: Retrospective cohort study. SETTING: A nationally representative sample of 1 million National Health Insurance enrollees. PARTICIPANTS: Patients with new-onset stroke (N=13,828) were included. Studied participants were patients who received inpatient rehabilitation during 4 to 6 months after stroke. Patients who died within 1 year of the stroke event were excluded (n=488). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome variable of interest was the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke. The characteristics of both patients and medical care providers were investigated to determine their effect on patients receiving inpatient rehabilitation. RESULTS: Older patients, patients of low socioeconomic status, patients with Charlson Comorbidity Index ≥5, and patients who received outpatient rehabilitation during 4 to 6 months after stroke have a lower rate of receiving inpatient rehabilitation than do their counterparts. In addition, receiving inpatient rehabilitation during 7 to 9 months after stroke is a strong positive predictor of receiving inpatient rehabilitation during 10 to 12 months after stroke (odds ratio, 38.556; P<.0001). CONCLUSIONS: This study revealed that older age, lower socioeconomic status, and multiple comorbidities are negative predictive factors with a cumulative predictive power for the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke.

Association Between Physical Therapy and Risk of Coronary Artery Disease and Dyslipidemia Among Osteoarthritis Patients: A Nationwide Database Study.

OBJECTIVE: To provide empirical evidence on the effect of early physical therapy (PT) within the first year of osteoarthritis (OA) diagnosis on reduction in OA-related comorbidities in patients with OA. DESIGN: Retrospective cohort study. SETTING: The study was conducted using a nationally representative sample of 1 million National Health Insurance enrollees. PARTICIPANTS: Newly diagnosed patients with OA (N=13,545). One-to-one propensity score matching was used to match patients who received PT within the first year of OA diagnosis (PT group; n=3403) with an equal number of patients with OA who did not receive PT (non-PT group). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4-year cumulative risk of comorbidities including coronary artery disease (CAD), diabetes mellitus, dyslipidemia, osteoporosis, gastrointestinal tract ulcer, and renal failure was estimated. A Cox proportional hazards regression analysis was performed to identify the dose-response relation between the PT dosage and the risk of OA-related comorbidities. RESULTS: A total of 3403 patients (25.1%) received PT within the first year of OA diagnosis. The PT group had a significantly lower 4-year cumulative risk of dyslipidemia (P=.05) and a potentially lower 4-year cumulative risk of CAD (P=.09). After adjusting for other potential confounders, the Cox proportional hazards regression analysis showed that patients with OA who received a high PT dosage had a low risk of CAD and dyslipidemia. CONCLUSIONS: Patients with OA who received PT had a lower risk of OA-related comorbidities such as dyslipidemia or CAD.

Expanding school-district/university partnerships to advance health promoting schools implementation and efficacy in Taiwan.

In 2011, the Taiwan government expanded its support of school-district/university partnership programs that promote the implementation of the evidenced-based Health Promoting Schools (HPS) program. This study examined whether expanding the support for this initiative was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011 and 2013, a total of 647 and 1195 schools, respectively, complemented the questionnaire. Univariate analysis results indicated that the HPS implementation levels for six components were significantly increased from 2011 to 2013. These components included school health policies, physical environment, social environment, teaching activities and school-community relationships. Participant teachers also reported significantly greater levels of perceived HPS impact and HPS efficacy after the expansion of support for school-district/university partnership programs. Multivariate analysis results indicated that after controlling for school level, HPS funding and HPS action research approach variables, the expansion had a positive impact on increasing the levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Evaluation of the Health-Promoting School Supporting Network in Taiwan.

BACKGROUND: Taiwan has advocated health-promoting schools (HPS) since 2001 and established the Health-Promoting School Supporting Network (HPSSN) in 2005 to offer administrative support and consultation. Respondents' opinions about HPSSN and the relationship between these perceptions and HPS implementation were examined. METHODS: In 2011, 800 primary and middle schools were selected through stratified random sampling. School staff members (N = 656) in charge of HPS programs reported their impressions of the HPSSN's support. RESULTS: Respondents were most satisfied with consultants and schools' recognition of responsibilities and rules and their interactions with HPSSN administrators. They were least satisfied with the extent of their HPSSN consultant interaction and believed HPSSN provided insufficient resources to establish HPS. Respondents' consultant partnerships and satisfaction with HPSSN administration significantly predicted HPS implementation. Additionally, the predictive values of healthy policies and school-community relationships were greater than the other 6 HPS components. CONCLUSIONS: HPSSN positively influenced HPS implementation; however, consultant/school partnerships and school resource allocations must be improved.

Facilitating the implementation and efficacy of health-promoting schools via an action-research approach in Taiwan.

Taiwan launched its evidence-based health-promoting school (HPS) program via an action-research approach in 2010. The program featured a collaborative partnership between schools, local education authorities and university support networks. This study was focused on examining whether an HPS action-research approach was effective in advancing HPS implementation, perceived HPS impact and perceived HPS efficacy in Taiwan. In 2011, questionnaires were sent to 900 sample schools in Taiwan. A total of 621 schools returned the questionnaire, including 488 primary schools and 133 middle schools. The response rate was 69%. This study compared the difference in HPS implementation status, perceived HPS impact and perceived HPS efficacy between those schools that had implemented action-research HPS (138 schools) and those that had not (483 schools). The univariate analysis results indicated that the HPS implementation levels for components that included school health policies, physical environment, social environment, teaching activities and school-community relations were significantly higher in action-research schools than in non-action-research schools. Teachers in action-research schools reported significantly higher levels of HPS impact and HPS efficacy than non-action-research schools. The multivariate analysis results indicated that after controlling for school level and HPS funding, the HPS action-research approach was significantly positively related to greater levels of HPS implementation, perceived HPS impact and perceived HPS efficacy.

Effects of tooth scaling reminders for dental outpatients.

We investigated the effect of sending reminders for patients to attend appointments for tooth scaling. A total of 389 outpatients were assigned to three intervention groups (reminders sent by postcard, mobile-phone text message or telephone call) and one control group. Reminders accompanied by short health education messages were sent to patients in each of the intervention groups. The outpatient revisiting behaviour of the patients was monitored. Patients who were reminded to come in for tooth scaling were 2.6 (95% CI 1.3-5.4) to 2.9 (CI 1.1-7.8) times more likely to revisit compared to those who were not reminded. For every one point increase in the patient satisfaction score, patients were 3.8 (CI 1.2-11.6) times more likely to revisit. Patients with a high level of patient satisfaction and who had also received a reminder had the highest return rates (26%). Most patients (89-96%) had good feelings regarding the reminders; 65% of the patients agreed that reminders had enhanced their intention to revisit; 91% of patients hoped to continue to receive reminders concerning broader dental health information. A reminder combined with health education is an effective way of improving preventative dental visiting behaviour.

Hepatitis B immunity in adolescents and necessity for boost vaccination: 23 years after nationwide hepatitis B virus vaccination program in Taiwan.

The first universal hepatitis B vaccination program for newborns in the world was launched in Taiwan in July 1984. Most studies on the effectiveness of hepatitis B vaccination focused on the seroprevalence of HBs Ag among children under 14 years old. Only few studies focused on the seropositivity of anti-HBs among adolescents aged 15-18 years old. The present study aimed to evaluate the impact of the nationwide hepatitis B vaccination program on the immunity to HBV infection and the necessity of boost among adolescents. In this study including eight annual seroprevalence surveys from 2000 to 2007, 2342 college entrants (1589 15-year-olds in group I and 753 18-year-olds in group II) and 1851 university freshmen (18-year-olds in group III) participated. Subjects identified anti-HBs, HBs Ag and anti-HBc negative were given boost three doses of HBV vaccine. The HBs Ag seroprevalence was 11.6%, 3.5% and 1.0% for participants who were born before 1984, 1984-1986 and after 1986. The anti-HBs-seropositive rates were significantly higher in group II (83.1%) than in group I (53.0%) and group III (53.5%). All 572 participants who were seronegative for anti-HBs, HBs Ag and anti-HBc became anti-HBs-seropositive after catch-up vaccination. It is concluded that the anti-HBs-seropositive rate decreased to 50% in 15 years after vaccination, and boost vaccination was 100% effective. The necessity and age for boost among anti-HBs negative adolescents and the timing of the first immunization should be further evaluated.