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The migratory endoparasitic phytonematodes Bursaphelenchus xylophilus is the causal agent of pine wilt disease and causes significant economic damage to pine forests in China. Effectors play a key role in the successful parasitism of plants by phytonematodes. In this study, 210 genes obtained by transcriptomics analyses were found to be upregulated in B. xylophilus infecting Pinus massoniana that were not functionally annotated nor reported previously in B. xylophilus infecting P. thunbergii. Among these differentially expressed genes, a novel effector, BxICD1, that could induce cell death in the extracellular space of Nicotiana benthamiana was identified. BxICD1 was upregulated in the early stages of infection, as shown by RT-qPCR analyses. In situ hybridization analysis showed that BxICD1 was expressed in the esophageal gland of nematodes. The yeast signal sequence trap system indicated that BxICD1 possessed an N-terminal signal peptide with secretion functionality. Using an Agrobacterium-mediated transient expression system, it was demonstrated that the cell death-inducing activity of BxICD1 was dependent on N. benthamiana brassinosteroid-insensitive 1-associated kinase 1 (NbBAK1). Finally, BxICD1 contributed to B. xylophilus virulence and migration in host pine trees, as demonstrated by RNAi silencing assays. These findings indicate that BxICD1 both induces plant cell death and also contributes to nematode virulence and migration in P. massonian. [ABSTRACT FROM AUTHOR]

Background: Peripherally inserted central catheters (PICCs) are used widely in patients with cancer, but catheter malposition often occurs. Objectives: This study aimed to provide a reference for clinically safe catheterization through multifactor analysis of malposition of PICCs in patients with cancer. Methods: The occurrence of PICC malposition in patients with cancer was retrospectively reviewed, and a multivariate logistic regression analysis was performed. Findings: Of 2,084 patients with PICCs, 170 cases (8%) of malposition occurred. The multivariate logistic regression analysis revealed that the risk of adverse events from malposition was higher in the right upper limb than in the left upper limb. The highest risk from malposition was cephalic vein puncture, followed by brachial vein puncture. The risk in the lower part of the elbow joint was higher than that in the upper part of the elbow joint. During PICC insertion, the left upper limb and upper part of the elbow joint should be selected for the puncture, and the basilic vein should be selected as the first-choice vein to reduce the incidence of malposition and adverse events. [ABSTRACT FROM AUTHOR]

Background: Adapting nursing interventions to suit the needs and culture of a new population (cultural adaptation) is an important early step in the process of implementation and dissemination. While the need for cultural adaptation is widely accepted, research-based strategies for doing so are not well articulated. Non-adherence to medications for chronic disease is a global problem and cultural adaptation of existing evidence-based interventions could be useful. Objectives: This paper aims to describe the cultural adaptation of an evidence-based nursing intervention to improve medication adherence among people living with HIV/AIDS and to offer recommendations for adaptation of interventions across cultures and borders. Site: The intervention, which demonstrated efficacy in a randomized controlled trial in North America, was adapted for the cultural and social context of Hunan Province, in south central China. Sources of data: The adaptation process was undertaken by intervention stakeholders including the original intervention study team, the proposed adaptation team, and members of a Community Advisory Board, including people living with HIV/AIDS, family members, and health care workers at the target clinical sites. Procedures: The adaptation process was driven by quantitative and qualitative data describing the new population and context and was guided by principles for cultural adaptation drawn from prevention science research. Results: The primary adaptation to the intervention was the inclusion of family members in intervention activities, in response to the cultural and social importance of the family in rural China. In a pilot test of the adapted intervention, self-reported medication adherence improved significantly in the group receiving the intervention compared to the control group (p = 0.01). Recommendations for cultural adaptation of nursing interventions include (1) involve stakeholders from the beginning; (2) assess the population, need, and context; (3) evaluate the intervention to be adapted with attention to details of the original studies that demonstrated efficacy; (4) compare important elements of the original intervention with those of the proposed new population and context to identify primary points for adaptation; (5) explicitly identify sources of tension between intervention fidelity and cultural adaptive needs; (6) document the process of adaptation, pilot the adapted intervention, and evaluate its effectiveness before moving to dissemination and implementation on a large scale. [ABSTRACT FROM AUTHOR]

Although the number of patients receiving antiretroviral (ARV) therapy in Central China is expanding, little is known about their medication adherence. The purpose of this study was to: (1) describe adherence prevalence among patients receiving free ARV in south central China; (2) identify factors associated with adherence; (3) compare 3 self-report measures of adherence in this population. A cross-sectional survey was conducted at seven free treatment sites in Hunan, Hubei, and Anhui Provinces. Adherence measures included direct questioning regarding the number of doses taken in the 7 days prior to interview, the Community Programs for Clinical Research on AIDS (CPCRA) Adherence Self-Report questionnaire, and a 7-day visual analogue scale. Subjects comprised all patients returning for monthly ARV follow-up at each site between April and July 2006. Among the 308 subjects, 244 (79%) lived in the countryside. One hundred seventy (55%) had been on ARV over 1 year. No regimen included a protease inhibitor. Two hundred forty-four (80%) reported taking more than 90% of prescribed doses in the previous 7 days. Sixty-four (20%) subjects reported missing at least 1 dose in that period. The three measures of self-reported adherence were highly correlated. On multivariate analysis, current heroin use (odds ratio [OR] = 2.5; 95% confidence interval [CI] 1,6, p = 0.05) and nonuse of reminders such as cell phone alarms, wall charts, or TV programs (OR 6; 95% CI 3, 11; p = 0.001) were associated with 90% or less adherence. Adherence to ARV in Central China is similar to elsewhere in the world. The 20% of subjects who reported taking 90% or fewer doses are of concern in view of the potential for non-nucleoside reverse transcriptase inhibitor resistance and lack of protease inhibitor back-up regimens. Substance abuse treatment will be an essential element of successful AIDS treatment in China. Prospective studies are needed to evaluate the efficacy of reminder devices to improve adherence in this population and to describe the prevalence and incidence of ARV resistance. [ABSTRACT FROM AUTHOR]

Abstract: We aimed to (a) describe the readiness for hospital discharge in people living with HIV and (b) explore factors associated with readiness for hospital discharge. A cross-sectional survey was conducted at two infectious disease hospitals in Hunan, China, from May to November 2017. The readiness for hospital discharge scale (RHDS) was used to assess discharge readiness. The average item mean for the RHDS ranges from 0 to 10, and higher scores represent a higher level of readiness for hospital discharge. The mean score of the RHDS was 7.78 (95% confidence interval 7.586-7.968), and 27.6% of participants (n = 56/203) felt unready for discharge (RHDS <7). We found that older age, lack of medical insurance, lower self-rated health status, poorer quality of discharge teaching, and more severe depressive symptoms were significantly associated with a lower level of readiness for hospital discharge. Interventions are needed to improve readiness of people living with HIV for hospital discharge in Hunan, China, especially for those of advanced age, without medical insurance, with worse self-rated health status, and those with higher levels of depressive symptoms., (Copyright © 2021 Association of Nurses in AIDS Care.)

Abstract: HIV self-testing (HIVST) could increase HIV testing. However, HIVST uptake rate among Chinese men who have sex with men (MSM) is low. We conducted qualitative interviews with 23 MSM, 4 workers from community-based organizations, and 7 officials from both provincial Centers for Disease Control and Prevention and affiliated city-level Centers for Disease Control and Preventions to explore facilitators and barriers of HIVST among Chinese MSM. Eight barriers were identified, including fear of being duped by a fake test, concern for cost, fear of disclosing sexual orientation, limited access, lack of consulting services, biosafety concerns, lack of policy support, and concern for lost opportunities to link men to care. Five facilitators were identified, including convenience, confidentiality, easy operation, partner HIV testing, and peers' influence. Officials and scholars should urgently address structural barriers and provide accessible, affordable, and high-quality HIVST services that are accompanied by counseling to develop culturally appropriate HIVST guidelines., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Association of Nurses in AIDS Care.)

Our cross-sectional study examined the prevalence of cognitive impairment among people living with HIV (PLWH) aged 60 years or older. The sample, composed of 250 PLWH, was recruited from 2 clinics in Hunan, China. Structured questionnaires guided face-to-face interviews, including items addressing demographic characteristics, regimens of antiretroviral therapy, and cognitive status as measured by the Montreal Cognitive Assessment. Findings revealed cognitive function of this population was significantly lower than that of uninfected individuals based on historical comparisons; 87.2% (n = 218) of PLWH in our study had cognitive impairment. Global cognitive function as well as the domains of language and orientation decreased with age. Global cognitive function was associated with sex and education, but not with antiretroviral therapy regimens. These findings support an urgent need to include routine screening for cognitive function in older PLWH and the need to consider the complexity of the evaluation process.

Consensus has been reached about the important role of partner notification (PN) for HIV prevention and control programs. We used a qualitative study to explore facilitators of and barriers to PN to understand reasons for disclosure and nondisclosure by people living with HIV in China. Our main goal was to identify information related to PN that may be unique to the Chinese cultural context. Of 41 participants who were interviewed, 33 had disclosed their HIV status to sexual partners. Facilitators for PN included preserving the integrity of the partnership, social support, and potential benefits of notification; barriers included perceived discrimination/stigma, possible negative consequences, and safety concerns. Participant physical health conditions, strength of the relationship, and concordant identification were found to be conditional factors of PN. Our findings provide information for a better understanding of PN in Chinese culture and offer a reference for developing more specific strategies to facilitate PN.

Nursing research in China is at an early stage of development and little is known about the practices of Chinese nurse researchers. This interview study carried out at a university in central China explores the informed consent practices of Chinese nurse researchers and the cultural considerations of using a western technique. Nine semistructured interviews were conducted in English with assistance and simultaneous translation from a Chinese nurse with research experience. The interviews were analyzed by one western and two Chinese researchers and major themes were identified. All participants endorsed informed consent as ethically required. Differences were noted between some of the informed consent practices typically recommended in the USA and those identified in this study, such as: recruitment using local and government officials, recruiting directly from medical records without special permission, family consultation in consent and consent control, and not revealing randomization to intervention groups receiving different treatments.