Successful islet allotransplantation in diabetic rats immunosuppressed with FK506: A functional and immunological study

The effect of a novel immunosuppressive agent, FK506, on fresh islet allografts was evaluated in diabetic rats across major histocompatibility complex (MHC) barriers with respect to the transplantation (TR) site, islet source, treatment regimen, and antidonor antibody (Ab) titers of the recipients after TR. The functional periods of Wistar (Wi) islets transplanted under kidney capsule (KC) or intraportally (IPo) and of a mixture of Wi and Lewis (Le) islets under KC or IPo in nonimmunosuppressed ACI rat recipients were 6.9 ± 0.4 (n = 7), 6.4 ± 0.5 (n = 7), 5.6 ± 0.4 (n = 7), and 6.2 ± 0.4 (n = 5) days, respectively. FK506 treatment at 1 mg/kg/d intramuscularly (IM) for 2 weeks (protocol I) following islet TR under KC and IPo significantly prolonged the allograft function to more than 71.8 ± 11.3 (n = 10) and 161.7 ± 18.6 (n = 11) days, respectively. Additional treatment with FK506 at 1 mg/kg/wk (protocol II) further increased the islet survival under KC to more than 212.6 ± 22.3 (n = 8) days. With this FK506 treatment protocol, the Wi + Le mixed-islet allograft function was extended to more than 106.1 ± 10.5 (n = 7) and 167.9 ± 28.6 (n = 7) days under KC and IPo, respectively. Nephrectomy in 8 8 ACI rats with long-term-functioning Wi (n = 6) and Wi + Le (n = 2) islet allografts resulted in their return to hyperglycemia. Immunohistochemical staining showed abundant insulin-positive cells at the graft site, with small numbers of CD4- and CD8-positive cells present in the vicinity of the normal-appearing islets. Macrophages were not detected. The immunosuppressive effect of FK506 was further tested in ACI rats presensitized by a previous Wi islet TR. When the duration between the first and second TR under KC was 114.3 ± 20.5 days, protocol II treatment significantly prolonged the graft function to more than 152.9 ± 28.7 (n = 8) days. However, with a short duration of about 2 weeks between the two TRs, the same FK506 protocol achieved islet graft function of 14.0 ± 3.8 days (n = 7). Additional immunosuppression with cyclophosphamide did not further improve the survival time. Antidonor Abs detected in ACI recipients of Wi islet allografts were significantly lower in the FK506-treated animals compared with the nontreatment group. Wi and Le skin grafts performed in three ACI rats with long-term-functioning Wi islets IPo caused the rejection of the islet allografts. Skin grafts were also rejected in the first-set fashion. Six ACI recipients with long-term-functioning IPo Wi islet allografts were rendered hyperglycemic by streptozocin (STZ) injection. Long-term normoglycemia without further FK506 immunosuppression was achieved following retransplantation with fresh Wi islets IPo (n = 2), but not under KC (n = 2). The results of the present study indicate that FK506 was an effective immunosuppressant for islet allotransplantation in diabetic ACI rats across MHC barriers with islets from two donor strains, as well as in sensitized recipients whose antidonor activities had subsided. The efficacy of the immunosuppression was influenced by the FK506 treatment protocol and the site of the islet transplant. The results suggest that FK506 could be useful in clinical islet TR. © 1994

Effectiveness of smoking reduction intervention for hardcore smokers

© 2015 Lam et al.; licensee BioMed Central.Background: The prevalence and correlates of hardcore smokers, who have high daily cigarette consumption, no quitting history and no intention to quit, have been studied in several western developed countries, but no previous trials of smoking cessation have tested intervention effectiveness for these smokers. The current study examined if hardcore smokers can benefit from smoking reduction intervention to achieve cessation, and explored the underlying reasons. Methods: A posteriori analysis was conducted on data from a randomized controlled trial of smoking reduction intervention on 1,154 smokers who did not want to quit. Odds ratios of 7-day point prevalence of abstinence, smoking reduction by at least 50% and quit attempt at the 6-month follow-up comparing subgroups of smokers were analyzed. Results: In hardcore smokers, the odds ratio comparing the quit rate between the intervention and control group was 4.18 (95% CI: 0.51-34.65), which was greater than non-hardcore smokers (OR = 1.58, 95% CI: 0.98-2.54). The number needed to treat for hardcore and non-hardcore smokers was 8.33 (95% CI: 5.56-16.67) and 16.67 (95% CI: 8.33-233.64), respectively. In smokers who did not have quit attempt experience and those who smoked more than 15 cigarettes daily, the odds ratio comparing intervention and control group was 3.29 (95% CI: 0.72-14.98) and 1.36 (95% CI: 0.78-2.36), respectively. Conclusions: The a posteriori analysis provided pilot results that smoking reduction intervention may be effective to help hardcore smokers to quit and reduce smoking. Having no previous quit attempt was identified as more important than having large cigarette consumption in explaining the greater effectiveness of the intervention.published_or_final_versio

Development and validation of Chinese Health Literacy Scale for Diabetes

AIMS AND OBJECTIVES: To develop and to test the psychometric properties of the Chinese Health Literacy Scale for Diabetes. BACKGROUND: Patients with diabetes encounter many challenges when making health decisions in their daily lives, as they have access to many different kinds of health information. Health literacy issues are new topics in Chinese society. Without a valid and reliable instrument in Chinese, it is difficult to measure the level of health literacy and promote the concept of health literacy in Chinese societies. DESIGN: A methodological study with a sample of 137 patients with type 2 diabetes aged 65 years or older. METHOD: Chinese Health Literacy Scale for Diabetes was developed with reference to the revised Bloom's taxonomy model. Psychometric tests (content validity, item analysis, construct validity, discriminative ability and test-retest reliability) were conducted. Correlations between Chinese Health Literacy Scale for Diabetes and four relevant measures were tested. Cronbach's alpha and alpha if item deleted were calculated to assess internal consistency. RESULTS: Cronbach's alpha for Chinese Health Literacy Scale for Diabetes and its four subscales (remembering, understanding, applying and analysing) were 0.884, 0.885, 0.667, 0.654 and 0.717, respectively. The Chinese Health Literacy Scale for Diabetes was significantly correlated with the Diabetic Knowledge Scale (r = 0.398, p < 0.001), the Diabetic Management Self-Efficacy Scale (r = 0.257, p < 0.001), the Preschool and Primary Chinese Literacy Scale (r = 0.822, p < 0.001) and the Chinese Value of Learning Scale (r = 0.303, p < 0.001). It took an average of seven minutes to complete this 34-item instrument. CONCLUSION: The findings of this study support the Chinese Health Literacy Scale for Diabetes as a reliable and valid instrument for measuring the health literacy of Chinese patients with diabetes. RELEVANCE TO CLINICAL PRACTICE: We recommend that clinicians use this tool to assess patients' health literacy before conducting any kind of health promotion.postprin

Feasibility and effectiveness of a pilot outreach smoking cessation programme at smoking hotspots in Hong Kong

Parallel Session II: Prevention of Non-communicable DiseasesSince the enforcement of the smokefree legislation in 2007, more smokers have been gathering near some public rubbish bins at outdoor bus stops, outside office buildings and shopping malls to smoke. These “hotspots” provided an opportunity of publicizing and providing smoking cessation services to a large number of smokers and motivate them to quit. We aimed to promote smoking cessation at smoking hotspots and evaluate the feasibility and effectiveness of a pilot outreach approach. Out of the 26 smoking hotspots near shopping malls and commercial buildings, 10 hotspots with the great number of smokers were selected for the intervention from February to August 2009. Trained smoking cessation counsellors disseminated 2-page promotional leaflets and proactively delivered brief smoking cessation counselling (less than 5 minutes for each smoker) to smokers for 4 hours at each hotspot. We evaluated the programme by counting of smokers non-smokers 1 week before and 1 week after the intervention. We observed the smokers’ responses and behaviours when they were approached by the counsellors. In the observed 1,237 smokers at the 10 hotspots, the counsellors approached 751 (60.7%) smokers. 419 (55.8%) read or kept the promotional leaflets. 413 (55.0%) were willing to receive the brief on-site counselling. The intervention reduced the number of smokers at the hotspots by 7.8% (pre: 1,251, post: 1,154)) with 2.1% increase in non-smokers (pre: 5,004, post: 5,108). The proportion of smokers at hotspots reduced by 1.6% (95%CI 0.04%-3.1%, p=0.053) comparing 1 week before and after the intervention, whereas there was no significant difference in non-smokers (risk difference=1.6%, 95%CI -1.6%-4.7%, p=0.40). The outreach programme had a slightly positive impact to reduce the proportion of smokers at hotspots. The smoking hotpots are good locations for feasible and effective delivery of smoking cessation messages. Improvement in the approaching skills and incentives are needed.postprin

Secondhand smoke exposure and maternal action to protect children from secondhand smoke: Pre- and post-smokefree legislation in Hong Kong

Background: Smokefree legislation may protect children from secondhand smoke (SHS) in the home from smoking parent(s). We examined the effect of the 2007 smokefree legislation on children's exposure to SHS in the home and maternal action to protect children from SHS exposure in Hong Kong. Methods: Families with a smoking father and a non-smoking mother were recruited from public clinics before (2005-2006, n = 333) and after the legislation (2007-2008, n = 742) which led to a major extension of smokefree places in Hong Kong. Main outcomes included children's SHS exposure in the home, nicotine level in mothers' and children's hair and home environment, mothers' action to protect children from SHS, and their support to the fathers to quit. Results: Fewer mothers post-legislation reported children's SHS exposure in the home (87.2% versus 29.3%, p<0.01), which was consistent with their hair nicotine levels (0.36ng/mg versus 0.04ng/mg, p<0.01). More mothers post-legislation in the last month took their children away from cigarette smoke (6.3% versus 92.2%; p<0.01) and advised fathers to quit over 3 times (8.3% versus 33.8%; p<0.01). No significant change was found in the content of smoking cessation advice and the proportion of mothers who took specific action to support the fathers to quit. Conclusions: SHS exposure in the home decreased and maternal action to protect children from SHS increased after the 2007 smokefree legislation. Maternal support to fathers to quit showed moderate improvement. Cessation services for smokers and specific interventions for smoking families should be expanded together with smokefree legislation. © 2014 Chan et al.published_or_final_versio

Service learning in medical and nursing training: A randomized controlled trial

The purpose of this study was to explore the long term effect of a service learning project on medical and nursing students' knowledge in aging and their attitudes toward older adults. A total of 124 students were recruited and then randomized to intervention group (IG) and control group (CG). A pre-and-post-intervention design measured students' knowledge in aging (using modified Palmore's Fact on Aging Quiz) and attitudes toward older adults (using Kogan's Old People Scale). A total of 103 students completed all the activities and questionnaires. After the intervention, there were significant differences between the IG and CG on Palmore's mental health (MH) (P =.04), Palmore's total score (P =.02) and Kogan's negative attitudes toward older adults (P =.001). All students increased their positive attitude toward older adults after the intervention. However, both the IG and CG showed a decrease in positive attitudes 1 month after the interventon, and such decrease varied, depending on the programme which students attended. The current study showed that the 10-week service learning activities significantly increased medical and nursing students' overall knowledge of aging and their understanding of mental health needs in old age, and reduced their negative attitudes toward older adults. However, the effect is not long-lasting. On the other hand, its effect on positive attitudes toward older adults cannot be concluded. Periodic contacts with older adults via service learning activities may be needed to sustain attitude change toward older adults. © 2011 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial

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Bringing scientific rigor to community-developed programs in Hong Kong

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