Background
To assess the impact of treatment delay on survival of oral/oropharyngeal cancer (OSCC).
Methods
We followed 5743 OSCCs between 2004 and 2009 from a population‐based screening program and ...ascertained death until the end of 2012.
Results
The hazard ratios (HRs) of mortality from OSCC were 1.46 (1.30‐1.65) and 1.18 (1.04‐1.33) in univariable and multivariable analyses, respectively, for treatment delay longer than 6 weeks compared with that shorter than 3 weeks. The corresponding figures were 1.12 (1.01‐1.24) and 1.00 (0.91‐1.11) for treatment delay between 3 and 6 weeks. Advancing age (1.01), higher stage (stage II: 1.84, stage III: 2.97, stage IV: 6.33), cancer in tongue (1.37), or hard palate (1.63) had higher HR of mortality (P < .05). However, treatment at medical center had a lower mortality (0.83, 0.75‐0.91) than local/regional hospital.
Conclusions
Treatment delay longer than 6 weeks for OSCCs detected via a population‐based screening program had unfavorable survival.
Metformin, as an AMP-activated protein kinase (AMPK) activator, can activate autophagy. A study showed that metformin decreased the risk of hepatocellular carcinoma (HCC) in diabetic patients. ...However, the detailed mechanism in the metformin-mediated anticancer effect remains an open question. Transcription factor CCAAT/enhancer-binding protein delta (CEBPD) has been suggested to serve as a tumor suppressor and is responsive to multiple anticancer drugs in HCC. In this study, we found that CEBPD and autophagy are involved in metformin-induced cell apoptosis in Huh7 cells. The underlying mechanisms in this process included a reduction in Src-mediated CEBPD protein degradation and an increase in CEBPD-regulated LC3B and ATG3 gene transcription under metformin treatment. We also found that AMPK is involved in metformin-induced CEBPD expression. Combined treatment with metformin and rapamycin can enhance autophagic cell death through the AMPK-dependent and AMPK-independent pathway, respectively. Taken together, we provide a new insight and therapeutic approach by targeting autophagy in the treatment of HCC.
Aims and objectives
To examine influencing factors of health‐related quality of life in primary family caregivers of people with schizophrenia receiving inpatient psychiatric rehabilitation services.
...Background
Families, particularly primary family caregivers, have become more important than ever in mental health care. Yet, research on health‐related quality of life among primarily family caregivers is limited.
Design
A correlational study design was used.
Methods
A convenience sample of 122 primary family caregivers participated in the study. Data were analysed with descriptive statistics, Pearson's product–moment correlation, t test, one‐way analysis of variance and a hierarchical multiple regression analysis.
Results
Primary family caregivers who were parents, older, less educated, and had a lower monthly household income, increased affiliate stigma and decreased quality of family‐centred care experienced poor health‐related quality of life. Particularly, monthly household income, affiliate stigma and quality of family‐centred care appeared to be the most critical determinants of health‐related quality of life.
Conclusions
Efforts to enhance satisfaction of life should focus on reducing affiliate stigma as well as increasing monthly household income and strengthening the quality of family‐centred care.
Relevance to clinical practice
Findings may assist in the development of culturally integrated rehabilitation programmes to decrease affiliate stigma and increase family engagement as a means of promoting quality of life for primary family caregivers living with people who have schizophrenia.
Impact of ambient pollution upon children's asthma may differ by sex, and exposure dose and timing. Psychosocial stress can also modify pollutant effects. These associations have not been examined ...for in utero ambient nitrate exposure.
We implemented Bayesian-distributed lag interaction models to identify sensitive prenatal windows for the influence of nitrate (NO
) on child asthma, accounting for effect modification by sex and stress.
Analyses included 752 mother-child dyads. Daily ambient NO
exposure during pregnancy was derived using a hybrid chemical transport (Geos-Chem)/land-use regression model and natural log transformed. Prenatal maternal stress was indexed by a negative life events score (high >2 vs. low ≤2). The outcome was clinician-diagnosed asthma by age 6 years.
Most mothers were Hispanic (54%) or black (29%), had a high school education or less (66%), never smoked (80%), and reported low prenatal stress (58%); 15% of children developed asthma. BDILMs adjusted for maternal age, race, education, prepregnancy obesity, atopy, and smoking status identified two sensitive windows (7-19 and 33-40 wk gestation), during which increased NO
was associated with greater odds of asthma, specifically among boys born to mothers reporting high prenatal stress. Cumulative effects of NO
across pregnancy were also significant in this subgroup (odds ratio = 2.64, 95% confidence interval = 1.27-5.39; per interquartile range increase in ln NO
).
Prenatal NO
exposure during distinct sensitive windows was associated with incident asthma in boys concurrently exposed to high prenatal stress.
Mass screening with abdominal ultrasonography (AUS) has been suggested as a tool to control adult hepatocellular carcinoma (HCC) in individuals, but its efficacy in reducing HCC mortality has never ...been demonstrated. This study aimed to assess the effectiveness of reducing HCC mortality by mass AUS screening for HCC based on a program designed and implemented in the Changhua Community‐based Integrated Screening (CHCIS) program with an efficient invitation scheme guided by the risk score. We invited 11,114 (27.0%) of 41,219 eligible Taiwanese subjects between 45 and 69 years of age who resided in an HCC high‐incidence area to attend a risk score‐guided mass AUS screening between 2008 and 2010. The efficacy of reducing HCC mortality was estimated. Of the 8,962 AUS screening attendees (with an 80.6% attendance rate), a total of 16 confirmed HCC cases were identified through community‐based ultrasonography screening. Among the 16 screen‐detected HCC cases, only two died from HCC, indicating a favorable survival. The cumulative mortality due to HCC (per 100,000) was considerably lower in the invited AUS group (17.26) compared with the uninvited AUS group (42.87) and the historical control group (47.51), yielding age‐ and gender‐adjusted relative mortality rates of 0.69 (95% confidence interval CI: 0.56‐0.84) and 0.63 (95% CI: 0.52‐0.77), respectively. Conclusion: The residents invited to community‐based AUS screening for HCC, compared with those who were not invited, showed a reduction in HCC mortality by ∼31% among subjects aged 45‐69 years who had not been included in the nationwide vaccination program against hepatitis B virus infection. (Hepatology 2014;59:1840–1849)
Aim. The purpose of this study was to assess gender effects on family demands, social support and caregiver burden as well as to examine contributing factors of caregiver burden in caring for family ...members with mental illness.
Background. Providing continued care and support for people with mental illness is demanding and challenging. Findings of earlier caregiving studies on the role of caregiver gender in response to caregiver burden and caregiving‐related factors have been inconsistent. Little research has been undertaken to examine gender effect on family demands, social support and caregiver burden in Taiwanese family caregivers of individuals with mental illness.
Design. Cross‐sectional, descriptive correlation design.
Methods. Data from 43 families, including at least one male and female family caregiver in each family, were analysed using descriptive statistics, principal component analysis and mixed linear modelling. Demographic data, Perceived Stress Scale, Perceived Social Support and Caregiver Burden Scale‐Brief were used to collect data.
Results. Female family caregivers perceived less social support and experienced higher degrees of caregiver burden compared with male family caregivers. In contrast, no significant gender effect was associated with family demands. Family caregivers with greater family demands and less social support experienced higher degrees of caregiver burden.
Conclusions. The results reinforced those of previously published studies that caregiver burden is highly prevalent among female family caregivers. Caregiver gender appears to be highly valuable for explaining family demands, social support and caregiver burden.
Relevance to clinical practice. Health care professionals should continue to collaborate with family caregivers to assess potential gender effects on available support and design gender‐specific interventions to alleviate caregiver burden.
Background:
Negative attitudes toward mental disorders are not only an interpersonal issue but also a concern of mental health care. Given that nursing students are future health care providers, it ...is pivotal to improve their attitudes toward individuals with mental disorders prior to their transition into clinical practice. However, research on nursing students’ attitudes in relation to schizophrenia in Taiwan remains unexplored.
Aim:
The aim of this article is to examine the correlates of attitudes toward individuals with schizophrenia among Taiwanese undergraduate nursing students.
Method:
A descriptive, correlational, and cross-sectional study was adopted. Self-reported questionnaires were conducted with a convenience sample of 306 Taiwanese undergraduate nursing students. Descriptive statistics, independent t tests, one-way analysis of variance, Pearson’s correlations, and a stepwise regression analysis were performed.
Results:
Nursing students expressed negative attitudes toward individuals with schizophrenia. Nursing students, who were female, had contact with individuals with mental disorders, and expressed greater empathy and personality traits held more favorable attitudes toward individuals with schizophrenia. The study found that empathy, personality traits, and academic year were the most crucial attributes contributing to attitudes of nursing students toward individuals with schizophrenia.
Conclusion:
Findings suggest that nursing education programs with empathy- and personality-tailored modules in mental health are pivotal to provide humanistic approaches with supportive attitudes regarding schizophrenia.
Caring for relatives with schizophrenia is complicated and has been associated with burden. Caregivers may also experience satisfaction, but these outcomes have not been simultaneously studied in ...family caregivers of relatives with schizophrenia.
The aim was to investigate the attributes of caregiver burden and satisfaction among individuals and families as well as the association of caregiver burden on caregiver satisfaction in the care of Taiwanese individuals with schizophrenia.
A cross-sectional, descriptive, correlational design was used. A convenience sample of 140 families (243 individual family caregivers) was recruited from two psychiatric hospitals in Taiwan. Participants were interviewed individually to complete questionnaires regarding pileup of demands, sense of coherence, mutuality, caregiver burden, and caregiver satisfaction. Linear mixed modeling was used.
Female caregivers, greater family demands, decreased sense of coherence, and lower mutuality were associated with higher levels of caregiver burden, whereas being siblings or close relatives and being friends of the affected individuals were associated with lesser self-reported burden. Satisfaction was positively associated with caregiver age, sense of coherence, and mutuality. Burden and satisfaction were not significantly related.
Caring for family members with schizophrenia is burdensome but can also be a source of satisfaction. Correlates of caregiver burden appeared to be somewhat distinct from those of caregiver satisfaction. Further research on negative and positive aspects of caregiving is warranted to broaden the understanding of caregiving experiences and design therapeutic interventions to mitigate caregiver burden and enhance the sense of satisfaction with caregiving.
Epidemiological research supports an association between maternal exposure to air pollution during pregnancy and adverse children's health outcomes. Advances in exposure assessment and statistics ...allow for estimation of both critical windows of vulnerability and exposure effect heterogeneity. Simultaneous estimation of windows of vulnerability and effect heterogeneity can be accomplished by fitting a distributed lag model (DLM) stratified by subgroup. However, this can provide an incomplete picture of how effects vary across subgroups because it does not allow for subgroups to have the same window but different within-window effects or to have different windows but the same within-window effect. Because the timing of some developmental processes are common across subpopulations of infants while for others the timing differs across subgroups, both scenarios are important to consider when evaluating health risks of prenatal exposures. We propose a new approach that partitions the DLM into a constrained functional predictor that estimates windows of vulnerability and a scalar effect representing the within-window effect directly. The proposed method allows for heterogeneity in only the window, only the within-window effect, or both. In a simulation study we show that a model assuming a shared component across groups results in lower bias and mean squared error for the estimated windows and effects when that component is in fact constant across groups. We apply the proposed method to estimate windows of vulnerability in the association between prenatal exposures to fine particulate matter and each of birth weight and asthma incidence, and estimate how these associations vary by sex and maternal obesity status in a Boston-area prospective pre-birth cohort study.
Although caregivers are a crucial support in the recovery of patients with schizophrenia, little is known about how mutuality is related to health-related quality of life within the dyadic (patient ...and caregiver) context. This study aimed to investigate the dyadic relationship between mutuality and health-related quality of life in patients with schizophrenia and caregivers.
A cross-sectional, correlational study was conducted with a sample of 133 dyads of patients with schizophrenia and caregivers. Structured questionnaires were used to collect data. Data were analyzed using descriptive statistics, paired sample
-tests, Pearson's product-moment correlations, and the Actor-Partner Interdependence Model.
Mutuality of patients was significantly higher than that of caregivers. Compared with caregivers, patients had significantly lower total scores for health-related quality of life. Patients' and caregivers' mutuality was related to their own health-related quality of life (actor effect) and their partners' health-related quality of life (partner effect).
Mutuality plays a critical role in health-related quality of life in dyads of patients with schizophrenia and caregivers. Viewing a dyad as a unit of nursing care reveals a promising approach for developing recovery-oriented modalities targeted at stimulating mutuality that may enhance health-related quality of life for both patients and caregivers.
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