Participation in Decision Making as a Property of Complex Adaptive Systems: Developing and Testing a Measure

Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores.We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them

Pioglitazone retrieves hepatic antioxidant DNA repair in a mice model of high fat diet

<p>Abstract</p> <p>Background</p> <p>Pioglitazone was reported to improve hepatic steatosis and necroinflammation in human studies. To investigate whether the hepato-protective effect of pioglitazone was associated with an improvement of antioxidant defense mechanism, oxidative DNA damage and repair activity were determined in a high fat diet model. Male C57BL/6 mice were respectively fed with a 30% fat diet, the same diet with pioglitazone 100 mg/kg/day, or a chow diet as control for 8 weeks. Tissue oxidative stress was indicated by malondialdehyde concentration. Oxidative DNA damage was detected by immunohistochemical 8-oxoG staining. Enzymatic antioxidant defense was detected by the real-time PCR of superoxide dismutase (<it>Sod1, Sod2</it>) and DNA glycosylase (<it>Ogg1, MutY</it>). Oxidative DNA repair was detected by immunohistochemical staining and western blotting of OGG1 expression.</p> <p>Results</p> <p>Our results show that hepatic steatosis was induced by a high-fat diet and improved by adding pioglitazone. Malondialdehyde concentration and 8-oxoG staining were strongly increased in the high-fat diet group, but attenuated by pioglitazone. Gene expressions of antioxidant defense mechanism: <it>Sod1, Sod2, Ogg1 </it>and <it>MutY </it>significantly decreased in the high-fat diet group but reversed by pioglitazone co-administration.</p> <p>Conclusion</p> <p>The attenuation of hepatic oxidative DNA damage by pioglitazone in a high-fat diet may be mediated by up-regulation of the antioxidant defense mechanism and oxidative DNA repair activity. The diminution of oxidative damage may explain the clinical benefit of pioglitazone treatment in patients with non-alcoholic fatty liver disease.</p

Evaluation of Oral Antiretroviral Drugs in Mice With Metabolic and Neurologic Complications

Antiretroviral (ART) drugs has previously been associated with lipodystrophic syndrome, metabolic consequences, and neuropsychiatric complications. ART drugs include three main classes of protease inhibitors (PIs), nucleoside analog reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Our previous work demonstrated that a high risk of hyperlipidemia was observed in HIV-1-infected patients who received ART drugs in Taiwan. Patients receiving ART drugs containing either Abacavir/Lamivudine (Aba/Lam; NRTI/NRTI), Lamivudine/Zidovudine (Lam/Zido; NRTI/NRTI), or Lopinavir/Ritonavir (Lop/Rit; PI) have the highest risk of hyperlipidemia. The aim of this study was to investigate the effects of Aba/Lam (NRTI/NRTI), Lam/Zido (NRTI/NRTI), and Lop/Rit (PI) on metabolic and neurologic functions in mice. Groups of C57BL/6 mice were administered Aba/Lam, Lam/Zido, or Lop/Rit, orally, once daily for a period of 4 weeks. The mice were then extensively tested for metabolic and neurologic parameters. In addition, the effect of Aba/Lam, Lam/Zido, and Lop/Rit on lipid metabolism was assessed in HepG2 hepatocytes and during the 3T3-L1 preadipocyte differentiation. Administration with Aba/Lam caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in leptin serum levels. Administration with Lop/Rit also caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in serum levels of total cholesterol, and HDL-c. Treatment of mice with Aba/Lam and Lop/Rit enhanced the lipid accumulation in the liver, and the decrease in AMP-activated protein kinase (AMPK) phosphorylation and/or its downstream target acetyl-CoA carboxylase (ACC) protein expression. In HepG2 hepatocytes, Aba/Lam, Lam/Zido, and Lop/Rit also enhanced the lipid accumulation and decreased phosphorylated AMPK and ACC proteins. In 3T3-L1 pre-adipocyte differentiation, Aba/Lam and Lop/Rit reduced adipogenesis by decreasing expression of transcription factor CEBPb, implicating the lipodystrophic syndrome. Our results demonstrate that daily oral administration of Aba/Lam and Lop/Rit may produce cognitive, motor, and metabolic impairments in mice, regardless of HIV-1 infection

Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan

AbstractEndometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities

Comprehensive Genotyping in Two Homogeneous Graves' Disease Samples Reveals Major and Novel HLA Association Alleles

BACKGROUND: Graves' disease (GD) is the leading cause of hyperthyroidism and thyroid eye disease inherited as a complex trait. Although geoepidemiology studies showed relatively higher prevalence of GD in Asians than in Caucasians, previous genetic studies were contradictory concerning whether and/or which human leukocyte antigen (HLA) alleles are associated with GD in Asians. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a case-control association study (499 unrelated GD cases and 504 controls) and a replication in an independent family sample (419 GD individuals and their 282 relatives in 165 families). To minimize genetic and phenotypic heterogeneity, we included only ethnic Chinese Han population in Taiwan and excluded subjects with hypothyroidism. We performed direct and comprehensive genotyping of six classical HLA loci (HLA-A, -B, -C, -DPB1, -DQB1 and -DRB1) to 4-digit resolution. Combining the data of two sample populations, we found that B*46:01 (odds ratio under dominant model [OR]  = 1.33, Bonferroni corrected combined P [P(Bc)]  = 1.17 x 10⁻²), DPB1*05:01 (OR  = 2.34, P(Bc) = 2.58 x 10⁻¹⁰), DQB1*03:02 (OR  = 0.62, P(Bc)  = 1.97 x 10⁻²), DRB1*15:01 (OR  = 1.68, P(Bc) = 1.22 x 10⁻²) and DRB1*16:02 (OR  = 2.63, P(Bc)  = 1.46 x 10⁻⁵) were associated with GD. HLA-DPB1*05:01 is the major gene of GD in our population and singly accounts for 48.4% of population-attributable risk. CONCLUSIONS/SIGNIFICANCE: These GD-associated alleles we identified in ethnic Chinese Hans, and those identified in other Asian studies, are totally distinct from the known associated alleles in Caucasians. Identification of population-specific association alleles is the critical first step for individualized medicine. Furthermore, comparison between different susceptibility/protective alleles across populations could facilitate generation of novel hypothesis about GD pathophysiology and indicate a new direction for future investigation

Reduced Neutrophil Count in People of African Descent Is Due To a Regulatory Variant in the Duffy Antigen Receptor for Chemokines Gene

Persistently low white blood cell count (WBC) and neutrophil count is a well-described phenomenon in persons of African ancestry, whose etiology remains unknown. We recently used admixture mapping to identify an approximately 1-megabase region on chromosome 1, where ancestry status (African or European) almost entirely accounted for the difference in WBC between African Americans and European Americans. To identify the specific genetic change responsible for this association, we analyzed genotype and phenotype data from 6,005 African Americans from the Jackson Heart Study (JHS), the Health, Aging and Body Composition (Health ABC) Study, and the Atherosclerosis Risk in Communities (ARIC) Study. We demonstrate that the causal variant must be at least 91% different in frequency between West Africans and European Americans. An excellent candidate is the Duffy Null polymorphism (SNP rs2814778 at chromosome 1q23.2), which is the only polymorphism in the region known to be so differentiated in frequency and is already known to protect against Plasmodium vivax malaria. We confirm that rs2814778 is predictive of WBC and neutrophil count in African Americans above beyond the previously described admixture association (P = 3.8×10−5), establishing a novel phenotype for this genetic variant

Retention and attrition of certified care assistants in the long-term care industry from the Taipei area: An interview survey

[[abstract]]Background/objectives The question, “do certified care assistants (CCAs), after finishing their training, devote themselves to the long-term care industry in accordance with the original expectations?”, is still unknown. Few studies have focused on CCAs who have left the long-term care industry. The purposes of this study were to identify the employment status of CCAs over the January 2000–July 2002 time period who had undergone a training program sometime in 1999 and to explore the factors affecting whether the CCAs stay or leave the long-term care industry in the Taipei area. Understanding retention and attrition of CCAs is important for developing the strategies of managing manpower in this industry. Design/setting/participants A descriptive survey design was conducted to telephone interview 826 CCAs who had trained during the 1999 certification training program in Taipei area. Three hundred and thirteen participants (an interview-completed rate of 38%) provided usable data. Methods A structured interview schedule was developed by authors for interview. Descriptive statistics and χ2 test were adopted to report the subjects’ characteristics and factors that influenced his/her intention to stay or leave this industry. Results One hundred and sixty-eight respondents (53.7%) had still stayed in this industry, while 145 respondents (46.3%) had left already. Major reasons for staying were personal interest in caring elderly, good financial benefits from the facility, and supportive leadership. In contrast, low wages, heavy workloads, long working hours, a high level of stress, and poor financial benefits were factors contributing to careers leaving this industry. Conclusions Many factors affected whether CCAs stayed or left, including personal factors, work-related factors, the welfare system, the managerial system, the leadership style and the work environment. However, the sequence of these factors and their importance were different between two groups. This study has significant implications for managing the manpower of the long-term care industry

Retention and attrition of certified care assistants in the long-term care industry from the Taipei area: An interview survey

[[abstract]]Background/objectives The question, “do certified care assistants (CCAs), after finishing their training, devote themselves to the long-term care industry in accordance with the original expectations?”, is still unknown. Few studies have focused on CCAs who have left the long-term care industry. The purposes of this study were to identify the employment status of CCAs over the January 2000–July 2002 time period who had undergone a training program sometime in 1999 and to explore the factors affecting whether the CCAs stay or leave the long-term care industry in the Taipei area. Understanding retention and attrition of CCAs is important for developing the strategies of managing manpower in this industry. Design/setting/participants A descriptive survey design was conducted to telephone interview 826 CCAs who had trained during the 1999 certification training program in Taipei area. Three hundred and thirteen participants (an interview-completed rate of 38%) provided usable data. Methods A structured interview schedule was developed by authors for interview. Descriptive statistics and χ2 test were adopted to report the subjects’ characteristics and factors that influenced his/her intention to stay or leave this industry. Results One hundred and sixty-eight respondents (53.7%) had still stayed in this industry, while 145 respondents (46.3%) had left already. Major reasons for staying were personal interest in caring elderly, good financial benefits from the facility, and supportive leadership. In contrast, low wages, heavy workloads, long working hours, a high level of stress, and poor financial benefits were factors contributing to careers leaving this industry. Conclusions Many factors affected whether CCAs stayed or left, including personal factors, work-related factors, the welfare system, the managerial system, the leadership style and the work environment. However, the sequence of these factors and their importance were different between two groups. This study has significant implications for managing the manpower of the long-term care industry

[[alternative]]A study of Perceived Nursing Work Environment among Nurses: An Example of Regional Teaching Hospitals in Taipei County

[[abstract]]本研究旨在探討護理人員對護理工作環境的認知。本研究採橫斷式問卷調查法，研究對象爲台北縣區域教學醫院服務滿三個月以上之護理人員，共回收1,461份（回收率89.5%）。研究工具爲Aiken及Patrician之護理工作環境指標量表。研究結果：(1)以因素分析萃取出：專業實務、專業發展、專業標準、人力與資源、醫護合作、行政主管支持、護理人員能力之七個構面，共解釋護理工作環境45.2%的變異量。(2)七個構面平均得分依序爲專業標準、行政主管支持、護理人員能力、醫護合作、專業發展、專業實務、人力與資源。運用護理工作環境指標量表評值台灣護理工作環境是很好的開端，建議未來針對不同層級醫院的護理人員進行工具信效度的測試，以了解護理工作環境的狀態，進而提供有效的環境改善措施以留任護理人員。[[abstract]]Objective: To examine the perceived nursing work environment among nurses of regional teaching hospitals in Taipei County. Methods: A cross-sectional survey was conducted for collecting data from 1,632 nurses who were met the criteria of selection. The respondents were 1,461 with a response rate of 89.5%. Measurements adapting from Aiken and Patrician's Revised Nursing Work Index (NWI-R) was used. Results: Seven factors were extracted and accounted for 45.2% variance of nursing work environment by factor analysis with an orthogonal rotation, such as professional practice, professional development, professional standard, staffing and resource adequacy, nurse-physician collaboration, supportive nurse manager, and nursing competence. The mean scores of the perceived nursing work environment arranged in order among nurses were professional standard, supportive nurse manager, nursing competence, nurse-physician collaboration, professional development, professional practice, staffing and resource adequacy. It is a good start to initiate investigation of perception of nursing work environment through the NWI-R in Taiwan. Future research is needed to evaluate the validity and reliability of the NWI-R among other nurses from different ownership hospitals and to understand the nursing work environment

Potential Effects of Antioxidant and Serum Cholesterol-Lowering Effects of Gynura bicolor Water Extracts in Syrian Hamster

Gynura bicolor (Roxb. and Willd.) DC (G. bicolor) is a dietary vegetable in the Far East. The aims of the present study were to investigate the antioxidant effects of the G. bicolor water extract (GBWE) and its ability to regulate the blood lipid and lipoprotein profiles. In this study, the pigment composition and antioxidant ability of the GBWE were analyzed. Syrian hamsters were fed a high-fat diet (HFD) and the GBWE for 12 weeks, and the blood lipid levels, lipoprotein profiles, and cholesterol metabolism-related enzyme levels were then examined. The results showed that the GBWE exhibited excellent 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging activity and ferrous-ion-chelating ability. The hepatic glutathione levels in the hamsters were increased after the administration of low (0.4 g/kg BW, GBWE-L) or high (0.8 g/kg BW, GBWE-H) levels of the GBWE. The GBWE-H-treated hamsters exhibited significantly decreased serum levels of total cholesterols (TC) and low-density lipoprotein-cholesterol (LDL-C) and significantly increased levels of lectin-cholesterol acetyltransferase (LCAT). These results showed that GBWE-H can reduce the total cholesterol and LDL-C levels in HFD-fed hamsters, and this reduction might be involved in the regulation of LCAT expression