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Background: Health literacy, self‐efficacy and self‐management are known to influence health‐related well‐being. However, the precise influence of self‐management, health literacy and self‐efficacy on health outcomes in Asian countries is under‐researched. Objectives: To examine the impact of health literacy and self‐efficacy (independent variables) and self‐management (mediator) on patients' health outcomes (dependent variable). Design: An observational, cross‐sectional design was conducted between 1 March 2022 and 31 August 2022. Participants: Outpatients receiving haemodialysis (n = 200) at a Taiwanese medical centre were assessed. Measurements: The survey included demographic questions and standardised scales: the 3‐item Brief Health Literacy Screen, the 8‐item Perceived Kidney/Dialysis Self‐Management Scale as a measure of self‐efficacy, and the 20‐item Haemodialyses Self‐Management Instrument. Health outcomes were responses on the 12‐item Short‐Form Health Survey version 2 and clinical blood results from the past 3 months. Results: Participants aged over 60 exhibited common comorbidities, with 34% showing low health literacy. Biochemical markers (e.g., haemoglobin and albumin) significantly correlated with physical and mental health scores. Mediating coefficients revealed that self‐management significantly influenced associations between health outcomes, health literacy (β = 0.31; p < 0.01), and self‐efficacy (β = 0.19; p < 0.01). Implications for Practice: Self‐management can modify the overall influence of health literacy and self‐efficacy on patients' quality of physical and emotional health. When managing a chronic condition, 'knowing' how to self‐manage does not always result in 'doing so' by the patient. Continuous monitoring and promoting self‐management behaviours and support by nurses are crucial to enhance health outcomes. [ABSTRACT FROM AUTHOR]

Our group have demonstrated that splenic B cells contributed to the CD4+CD25− naive T cells conversion into CD4+CD25+Foxp3− regulatory T cells without adding appended cytokines, named Treg‐of‐B cells which were potent suppressors of adaptive immunity. We like to investigate whether Treg‐of‐B cells could promote alternatively activated macrophage (M2 macrophages) polarization and alleviate inflammatory disease, psoriasis. In this study, we co‐cultured the bone marrow‐derived macrophages (BMDMs) with Treg‐of‐B cells under LPS/IFN‐γ stimulation and analyzed the M2‐associated gene and protein using qPCR, western blotting, and immunofluorescence staining. We also examined the therapeutic effect of Treg‐of‐B cell‐induced M2 macrophage for skin inflammation using imiquimod (IMQ)‐induced psoriatic mouse model. Our results showed that BMDMs co‐cultured with Treg‐of‐B cells upregulated typical M2‐associated molecules, including Arg‐1, IL‐10, Pdcd1lg2, MGL‐1, IL‐4, YM1/2 and CD206. In an inflammatory environment, TNF‐α and IL‐6 production by macrophages co‐cultured with Treg‐of‐B cells was decreased significantly. The molecular mechanism revealed that Treg‐of‐B cells promoted M2 macrophage polarization via STAT6 activation in a cell contact‐dependent manner. Moreover, the treatment with Treg‐of‐B cell‐induced M2 macrophages attenuated the clinical manifestations of psoriasis, such as scaling, erythema and thickening in the IMQ‐induced psoriatic mouse model. T cell activation in draining lymph nodes was decreased in the Treg‐of‐B cell‐induced M2 macrophage group after IMQ application. In conclusion, our findings suggested that Foxp3− Treg‐of‐B cells could induce alternatively activated M2 macrophages through STAT6 activation, providing a cell‐based therapeutic strategy for psoriasis. [ABSTRACT FROM AUTHOR]

3‐Methylhistidine (3MH) is an indicator of muscle catabolism. Subclinical protein malnutrition is an independent predictor of aortic stiffness (AS). We aimed to study the relationship between serum 3MH level and AS among patients undergoing maintenance hemodialysis (MHD). Carotid‐femoral pulse wave velocity was applied to measure AS of 110 MHD patients. Serum 3MH levels were analyzed using high‐performance liquid chromatography and mass spectrometry. AS was defined as cfPWV >10 m/s. Forty‐five (40.9%) patients were categorized as having AS. Multivariable logistic (odds ratio: 0.792, p < 0.001) and linear (β = −0.322, p < 0.001) regression analysis revealed that serum 3MH is an independent factor associated with AS among MHD patients. The diagnostic power of 3MH for AS in patients undergoing MHD was 0.691 (95% CI: 0.595–0.775, p = 0.0002). Low serum 3MH levels could be a potential biomarker related to AS among MHD patients. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV)-related disease remains a significant source of morbidity and mortality, and this underscores the need to increase HPV vaccination to reduce the burden of the disease. The objective of this study was to examine the association between the number of HPV vaccine doses and the risk of histologically confirmed preinvasive cervical disease and high-grade cytology.Methods: This retrospective matched cohort study used administrative data from Optum's Clinformatics DataMart Database to identify females aged 9 to 26 years who received 1 or more quadrivalent HPV vaccine doses between January 2006 and June 2015. Cases and controls were matched on region, age, sexually transmitted disease history, and pregnancy. All had a Papanicolaou test ≥1 year after the date of the matched case's final dose. Cox proportional hazards models were used to examine the association between the number of HPV vaccine doses and the incidence of preinvasive cervical disease and high-grade cytology. The Kaplan-Meier method was used to estimate the cumulative incidence rate at the 5-year follow-up.Results: The study included 133,082 females (66,541 vaccinated and 66,541 unvaccinated) stratified by the number of HPV vaccine doses and the vaccine initiation age. Among those aged 15 to 19 years, the hazard ratio (HR) for high-grade cytology for the 3-dose group was 0.84 (95% confidence interval [CI], 0.73-0.97), whereas the HRs for histologically confirmed preinvasive cervical disease for 1, 2, and 3 doses were 0.64 (95% CI, 0.47-0.88), 0.72 (95% CI, 0.54-0.95), and 0.66 (95% CI, 0.55-0.80), respectively.Conclusions: The receipt of 1, 2, or 3 doses of an HPV vaccine by females aged 15 to 19 years was associated with a lower incidence of preinvasive cervical disease in comparison with unvaccinated females, and this supports the use of any HPV vaccination in reducing the burden of the disease. [ABSTRACT FROM AUTHOR]

Adipocyte fatty acid binding protein is positively associated with atherosclerosis. Peripheral arterial disease is associated with an increased mortality in hemodialysis patients. This study aimed to evaluate the relationship between serum adipocyte fatty acid binding protein levels and peripheral arterial disease by ankle‐brachial index in hemodialysis patients. Among the 90 chronic hemodialysis recipients, 20 patients (22.2%) were in the low ankle‐brachial index group who had a higher prevalence of diabetes, hyperlipidemia, statin use, older age, higher body fat mass, higher serum adipocyte fatty acid binding protein level, and lower serum creatinine level compared with patients in the control group. After statistical analysis, body fat mass (P = 0.006) and creatinine level (P = 0.018) were shown to be the independent predictors of adipocyte fatty acid binding protein level. Serum adipocyte fatty acid binding protein (P = 0.021) was found to be positively associated with peripheral arterial disease in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Introduction: Leptin is an adipokine secreted from adipocytes that mediate lipid metabolism and inflammation. This cross‐sectional study investigated the relationship between serum leptin level and nutrition status evaluated by malnutrition‐inflammation score (MIS) among patients undergoing hemodialysis (HD). Methods: This study included 100 patients on HD. Nutritional status was based on MIS (malnutrition ≥7 points). Body composition, biochemistry data, and serum leptin level were evaluated. Findings: Of 100 subjects, 33 (33.0%) were categorized as having malnutrition. Compared with subjects in the well‐nourished group, those in the malnutrition group had on average an older age, longer HD duration, and lower height, weight, body mass index, waist circumference, body fat mass, serum triglyceride level, and creatinine level. Serum leptin levels were also significantly lower in the malnutrition group (P < 0.001), whereas C‐reactive protein (CRP) levels were higher (P = 0.002). Multivariable linear regression analysis revealed that HD duration (β = 2.06, P = 0.009), serum leptin level (β = −5.16, P < 0.001), CRP level (β = 3.33, P < 0.001), and albumin level (β = −1.95, P = 0.008) were factors independently associated with MIS. The discriminative power of serum leptin level to predict malnutrition was 0.834 (95% confidence interval: 0.747‐0.901, P < 0.001). Discussion: Low serum leptin level was associated with malnutrition, and serum leptin level may be a valuable marker for nutrition assessment in patients undergoing HD. [ABSTRACT FROM AUTHOR]

Background: Overtreatment is a common concern for patients with ductal carcinoma in situ (DCIS), but this entity is difficult to distinguish from invasive breast cancers in administrative claims data sets because DCIS often is coded as invasive breast cancer. Therefore, the authors developed and validated algorithms to select DCIS cases from administrative claims data to enable outcomes research in this type of data.Methods: This retrospective cohort using invasive breast cancer and DCIS cases included women aged 66 to 70 years in the 2004 through 2011 Texas Cancer Registry (TCR) data linked to Medicare administrative claims data. TCR records were used as "gold" standards to evaluate the sensitivity, specificity, and positive predictive value (PPV) of 2 algorithms. Women with a biopsy enrolled in Medicare parts A and B at 12 months before and 6 months after their first biopsy without a second incident diagnosis of DCIS or invasive breast cancer within 12 months in the TCR were included. Women in 2010 Medicare data were selected to test the algorithms in a general sample.Results: In the TCR data set, a total of 6907 cases met inclusion criteria, with 1244 DCIS cases. The first algorithm had a sensitivity of 79%, a specificity of 89%, and a PPV of 62%. The second algorithm had a sensitivity of 50%, a specificity of 97%. and a PPV of 77%. Among women in the general sample, the specificity was high and the sensitivity was similar for both algorithms. However, the PPV was approximately 6% to 7% lower.Conclusions: DCIS frequently is miscoded as invasive breast cancer, and thus the proposed algorithms are useful to examine DCIS outcomes using data sets not linked to cancer registries. Cancer 2018;124:2815-2823. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that patients with head and neck squamous cell carcinoma (HNSCC) with smoking cessation during curative chemoradiotherapy (CRT) had fewer complications and lower tumor progression risks. Methods: Sixty‐three patients with nonmetastatic HNSCC who were smokers at diagnosis (carbon monoxide [CO] breath concentrations ≥3 ppm) and underwent curative CRT were prospectively enrolled. Successful smoking cessation throughout CRT was confirmed by CO breath concentrations <3 ppm at CRT completion. Results: Forty‐one patients (65%) successfully discontinued smoking throughout CRT. With a median 33‐month follow‐up, patients with successful smoking cessation during CRT had significantly fewer, greater, and lower probabilities of grade ≥3 acute toxicities (P = .01), progression‐free survival (P = .03), and permanent gastrostomy or tracheostomy (P = .04), respectively, than those continuing smoking throughout CRT. In multivariate analysis, successful smoking cessation during CRT significantly reduced tumor progression risks (hazard ratio: 0.4, P = .05). Conclusion: Smoking cessation during curative CRT reduced treatment‐related toxicities and tumor progression risks in patients with HNSCC. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Peripheral neuropathy is a common diabetes complication that can increase fall risk. Regarding fall risk, the impact of pain management using tricyclic antidepressants (TCAs) or γ‐aminobutyric acid (GABA) analogs is unclear because these medications can also cause falls. This study investigates the impact of these drugs on fall and fracture risk in older diabetic peripheral neuropathy (DPN) patients. DESIGN: Historical cohort study with 1‐to‐1 propensity matching of TCA/GABA‐analog users and nonusers. SETTING: Nationally representative 5% Medicare sample between the years 2008 and 2010. PARTICIPANTS: After applying all selection criteria, 5,550 patients with prescription and 22,200 patients without prescription of TCAs/GABA‐analogs were identified. Both patient groups were then stratified for fall history and matched based on propensity of receiving TCAs/GABA‐analogs within each group. MEASUREMENTS: Patients were followed until the first incidence of fall or the first incidence of fracture during the follow‐up period (for up to 5 years). RESULTS: After matching, users and nonusers were largely similar. After covariate adjustment, TCA/GABA‐analog use was associated with a statistically significant increase in fall risk (adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 1.03‐1.20), but was not associated with fracture risk (adjusted HR = 1.09; 95% CI = 0.99‐1.19) in the conventional analysis. Treating TCA/GABA‐analog use as a time‐dependent covariate resulted in statistically significant associations of TCA/GABA‐analog use with both fall and fracture risk (HR = 1.26 [95% CI = 1.17‐1.36]; and HR = 1.12 [95% CI = 1.02‐1.24], respectively). CONCLUSION: Among older patients with DPN, GABA‐analogs or TCAs increase fall risk and possibly fracture risk. Use of these medications is therefore a potentially modifiable risk factor for falls and fractures in this population. [ABSTRACT FROM AUTHOR]

Anthropometric measurements, including body mass index (BMI), body weight and total fat mass are associated with the bone mineral density (BMD) in the general population. Compared to that in the general population, BMD was lower in dialysis patients. However, the association between anthropometric measurements and BMD is not well-established among peritoneal dialysis (PD) patients. To study this, we conducted a cross-sectional study in 48 chronic PD patients. Anthropometric parameters, biochemical data, and BMD measured by dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4) were collected. Among these PD patients, eight patients (16.7%) had osteoporosis and 22 patients (45.8%) osteopenia, while 18 patients were normal. Older age, decreased height, lower body weight, BMI, triceps skinfold thickness (TSF), mid-arm fat area (MAFA), and higher adiponectin levels were observed in our patients with lower lumbar T-scores. Height, body weight, waist circumference, BMI, body fat mass, TSF, mid-arm circumference, MAFA, and serum phosphorus levels were positively, while age, adiponectin levels were negatively correlated with lumbar BMD levels. According to our multivariate forward stepwise linear regression analysis, TSF ( R2 change = 0.080, P = 0.017) and body weight ( R2 change = 0.333, P = 0.002) were both correlated with low lumbar BMD. In conclusion, either TSF or body weight in our chronic PD patients was proved to be an independent predictor for osteolytic bone lesions. [ABSTRACT FROM AUTHOR]

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Objective To examine whether having a primary care physician ( PCP) is associated with reduced ethnic disparities for colorectal cancer ( CRC) screening and whether clustering of minorities within PCPs contributes to the disparities. Data Sources/Study Setting Retrospective cohort study of Medicare beneficiaries age 66-75 in 2009 in Texas. Study Design The percentage of beneficiaries up to date in CRC screening in 2009 was stratified by race/ethnicity. Multilevel models were used to study the effect of having a PCP and PCP characteristics on the racial and ethnic disparities on CRC screening. Data Collection/Extraction Methods Medicare data from 2000 to 2009 were used to assess prior CRC screening. Principal Findings Odds of undergoing CRC screening were more than twice as high in patients with a PCP ( OR = 2.05, 95 percent CI 2.03-2.07). After accounting for clustering and PCP characteristics, the black-white disparity in CRC screening rates almost disappears and the Hispanic-white disparity decreases substantially. Conclusions Ethnic disparities in CRC screening in the elderly are mostly explained by decreased access to PCPs and by clustering of minorities within PCPs less likely to screen any of their patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Hepatitis B virus Ag (HBsAg), a major antigen of hepatitis B virus (HBV), is also a vaccine component for prevention of HBV infection. Dendritic cells (DCs) of HBV carriers reportedly exhibit functional impairment. In this study, the aim was to investigate the effect of HBsAg on activation of human monocyte-derived dendritic cells (MD-DCs), and the subsequent signal transduction pathway. Treatment of MD-DCs with HBsAg resulted in enhanced cell surface expression of cluster of differentiation 80, CD83, CD86 and major histocompatibility complex class II, and increased interleukin (IL)-12 p40, IL-12p70, and IL-10 production. Furthermore, HBsAg treatment of MD-DCs with HBsAg resulted in enhanced T cell-stimulatory capacity and increased T cell secretion of interferon and IL-10. The pathway of MD-DCs activation by HBsAg was further investigated in the present study. Inhibition of nuclear factor (NF)-kappa B (κB) by helenalin and p38 mitogen-activated protein kinase (MAPK) by SB203580 prevented production of IL-12 p40, IL-12 p70, and IL-10. HBsAg also augmented MAPK phosphorylation. Thus, cytokine secretion of human MD-DCs by HBsAg is blocked by inhibition of the NF-κB and p38 MAPK pathways. Likewise, decreased inhibition of kappa B alpha concentrations and MAPK phosphorylation are critical for MD-DC maturation by HBsAg. These findings may provide a strategy for improving the prophylactic and therapeutic efficacy of vaccines and tumor therapies that utilize these pathways. [ABSTRACT FROM AUTHOR]

Objective. To determine whether racial/ethnic disparities in colonoscopy use vary by physician availability. Data Source. We used 100 percent Texas Medicare claims data for 2003-2007. Study Design. We identified beneficiaries aged 66-79 in 2007, examined racial/ethnic differences in colonoscopy use from 2003 to 2007, and estimated the percentage of white, black, and Hispanic beneficiaries who underwent colonoscopy by level of physician availability and area income. Principal Findings. For the 974,879 beneficiaries, colonoscopy use was higher in whites (40.7 percent) compared to blacks (35.0 percent) and Hispanics (28.7 percent, p < .001). For whites, increasing availability of colonoscopists and primary care physicians ( PCPs) was associated with higher colonoscopy use. For blacks and Hispanics, colonoscopy use was unchanged or decreased with increases in colonoscopist and PCP availability. In multilevel models, the odds of colonoscopy were 20 percent lower for blacks ( OR 0.80, 95 percent CI 0.79-0.82) and 32 percent lower for Hispanics ( OR 0.68, 95 percent CI 0.66-0.69) compared to whites; adjusting for availability of colonoscopists or PCPs did not attenuate racial/ethnic disparities. We found greater racial/ethnic disparities in areas with greater colonoscopist and PCP availability. Conclusions. Greater area availability of colonoscopists and PCPs is associated with increased use of colonoscopy in whites but decreased use in minorities, resulting in larger racial/ethnic disparities. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer. DESIGN: Retrospective cohort study. SETTING: The Surveillance, Epidemiology and End Results (SEER)–Medicare linked database. PARTICIPANTS: Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer. MEASUREMENTS: The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression. RESULTS: Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR)52.09, 95% confidence interval (CI=1.86–2.35); and to have received no chemotherapy for Stage 3 cancer (ARR=1.63, 95% CI=1.49–1.79). The rate of overall mortality (hazard ratio (HR)=1.33, 95% CI =1.31–1.36) and colon cancer-specific mortality (HR=1.23, 95% CI=1.19–1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia. CONCLUSION: Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders. [ABSTRACT FROM AUTHOR]

Although chronic hepatitis C patients have a lower frequency and functions of dendritic cells (DCs) than healthy subjects, little is known about the serial changes in frequency and functions of DCs following anti-viral treatment and the relationship with treatment outcomes. Twenty patients with hepatitis C virus genotype 1 receiving peginterferon (PEG-IFN) and ribavirin for 24 weeks were enrolled. The frequency and functions of DCs were assayed at baseline and 24 weeks post-treatment. Ten sex and age-matched healthy adults served as controls. Nineteen of the 20 chronic hepatitis C patients completed 24 weeks of combination therapy. Fifteen patients achieved rapid virologic response and 12 achieved sustained virologic response (SVR). The baseline frequency of peripheral blood myeloid DCs and plasmacytoid DCs was significantly lower in chronic hepatitis C patients than in healthy controls. In patients who achieved SVR, the frequency of DCs subsets at the end of follow-up increased to a level comparable to healthy controls. Although no functional defects of DCs was found in chronic hepatitis C patients in comparison with healthy controls, in patients without SVR had a lower CD83 expression and higher interleukin-10 production of DCs than SVR patients. The results suggest that low CD83 expression and high IL-10 production of DCs at the baseline may predict a poor virologic response to 24-week PEG-IFN plus ribavirin therapy in HCV genotype 1 patients. J. Med. Virol. 83:1212-1220, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Hepatitis B virus surface antigen (HBsAg) is a major antigen of hepatitis B virus (HBV). Dendritic cells (DC) of HBV carriers have been reported to exhibit functional impairment. In this study, the role of HBsAg on mice bone marrow-derived dendritic cells and immune responses in vivo was studied. The immune modulatory function of HBsAg was explored by using mice bone marrow-derived dendritic cells in vitro and also by examining an ovalbumin (OVA) specific immune response in vivo. Treatment of dendritic cells with HBsAg resulted in enhanced cell surface expression of cluster of differentiation (CD) 80, CD83, CD86, and major histocompatibility complex (MHC) class II, and enhanced production of interleukin (IL)-12 p40 and IL-12 p70. Treatment of dendritic cells with HBsAg resulted in decreased T cell secretion of IL-5 by OVA stimulation. In addition, the results showed stronger OVA-specific immunoglobulin (Ig) M and weaker IgG responses in mice sera when they had been immunized with OVA and co-injected with HBsAg. It was also found that the mice exhibited significant enhancement of anti-OVA IgG2a antibody (Ab), as well as marked inhibition of IgG1 Ab production. In cellular immune responses, IL-5 production was significantly decreased and interferon (IFN)-γ increased in the group co-injected with HBsAg. On the other hand, the induction of lymphoproliferative response to OVA stimulation in spleen cells was decreased in the HBsAg co-injected group. These results demonstrate that HBsAg can affect the differentiation of T helper (Th) cells, which might provide a strategy for improving its prophylactic and therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Our group have demonstrated that splenic B cells contributed to the CD4 + CD25 - naive T cells conversion into CD4 + CD25 + Foxp3 - regulatory T cells without adding appended cytokines, named Treg-of-B cells which were potent suppressors of adaptive immunity. We like to investigate whether Treg-of-B cells could promote alternatively activated macrophage (M2 macrophages) polarization and alleviate inflammatory disease, psoriasis. In this study, we co-cultured the bone marrow-derived macrophages (BMDMs) with Treg-of-B cells under LPS/IFN-γ stimulation and analyzed the M2-associated gene and protein using qPCR, western blotting, and immunofluorescence staining. We also examined the therapeutic effect of Treg-of-B cell-induced M2 macrophage for skin inflammation using imiquimod (IMQ)-induced psoriatic mouse model. Our results showed that BMDMs co-cultured with Treg-of-B cells upregulated typical M2-associated molecules, including Arg-1, IL-10, Pdcd1lg2, MGL-1, IL-4, YM1/2 and CD206. In an inflammatory environment, TNF-α and IL-6 production by macrophages co-cultured with Treg-of-B cells was decreased significantly. The molecular mechanism revealed that Treg-of-B cells promoted M2 macrophage polarization via STAT6 activation in a cell contact-dependent manner. Moreover, the treatment with Treg-of-B cell-induced M2 macrophages attenuated the clinical manifestations of psoriasis, such as scaling, erythema and thickening in the IMQ-induced psoriatic mouse model. T cell activation in draining lymph nodes was decreased in the Treg-of-B cell-induced M2 macrophage group after IMQ application. In conclusion, our findings suggested that Foxp3 - Treg-of-B cells could induce alternatively activated M2 macrophages through STAT6 activation, providing a cell-based therapeutic strategy for psoriasis., (© 2023 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.)