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Background Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients’ use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. Objective The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. Methods Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders’ personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. Results The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (β=.12, 95% CI 0.02-0.22; P=.02). Conclusions This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.

specimens taken from the right forearm revealed non-specific superficial perivascular infiltration of inflammatory cells without spongiosis (Fig. 1b). Laboratory findings including aspartate aminotransferase and alanine aminotransferase were within normal limits and no eosinophilia was observed. Thus, one of the most apparent differential diagnoses was drug eruption, and all medications, including MMC therapy, were discontinued immediately.After discontinuation of all drugs and starting topical steroid therapy (betamethasone dipropionate; Shionogi & Co., Ltd., Osaka, Japan, for 3 days), the generalized erythema was remarkably improved with no recurrences. Neither patch tests nor druginduced lymphocyte stimulation tests (DLST) for all drugs, including MMC, were positive. However, from his clinical course, intravesical instillation of MMC was the leading candidate for the factor affecting his generalized erythema. Therefore, we performed a rechallenge test with intravesical instillation of MMC (5 mg, or half the previous dosage). After 24 h, generalized erythema had developed (Fig. 1c), and we considered that the rechallenge test was positive and immediately stopped MMC instillation. Topical steroid therapy resulted in prompt recovery to normal skin.In the present case, although DLST and patch test were negative, the patient's generalized erythema was assumed to be due to MMC treatment, as determined by rechallenge test. In general, the reliability of DLST in drug eruption is relatively low, and positive rates for the test have been reported to range from 60% to 70%. 2 Drug patch tests are positive in only 30-50% of patients with suspected drug eruption. 3 Therefore, from the present work, we conclude that a careful evaluation of clinical course, and in some cases also a rechallenge test, is very important for diagnosis of drug eruption.

Background Due to changes in family policy in China, pregnancy at advanced age (30 years old or above) is prevalent. Advanced maternal age is known to be related to a variety of negative health outcomes, including antenatal depression. Family relationship quality might be an important factor for antenatal depressive symptoms among Chinese women with advanced maternal age. However, the underlying mechanisms in which family relationship quality can affect antenatal depressive symptoms among this population and how positive psychological capital (PsyCap) intervenes in this impact are not clear. Objectives To describe the prevalence and demographic characteristics of antenatal depressive symptoms among Chinese pregnant women with advanced maternal age, and to explore the mediation effect of PsyCap in the associations between family relationship quality and antenatal depressive symptoms. Methods We conducted a cross-sectional survey at a tertiary hospital in China. A total of 192 women with maternal age of 30 years or older completed the questionnaires. Data on antenatal depressive symptoms, PsyCap, family relationship quality and demographic characteristics were collected. The multiple mediation models in SPSS’s PROCESS macro were used to test whether PsyCap mediated the relationship between family relationship quality and antenatal depressive symptoms. Results Approximately 28.6% of participants had antenatal depressive symptoms and 6.8% reported poor family relationship quality. Participants with higher education (p = .02) and better family relationship quality (p = .00) were less likely to have antenatal depressive symptoms. PsyCap collectively (β = 1.14, p < .05), or more specifically resilience (β = 0.61, p < .05) significantly mediated the relationship between poor family relationship quality and antenatal depressive symptoms. Discussion The relationship between family relationship quality and antenatal depressive symptoms can be mediated by PsyCap collectively or via resilience specifically. It is important to screen antenatal depressive symptoms among pregnant women with advanced age, especially those who have poor family relationship quality. Counseling and psychotherapy initiatives for resilience-enhancing training for pregnant women at advanced age may provide a promising target to break the link between poor family relationship quality and antenatal depressive symptoms.

BACKGROUND Effective patient-provider communication is the core of high-quality patient-centered care. Communication through electronic platforms such as web, patient portal, or mobile phone (referring as e-communication) has become increasingly important as it extends traditional in-person communication with less limitation of timing and locations, and has the potential to facilitate more effective interactions between patients and providers. However, little is known about the current status of patients’ use of e-communication with healthcare providers and whether the use is related to better perceived quality of care at the population level. OBJECTIVE This study was designed to explore the prevalence of, and factors associated with e-communication and effect of e-communication on patient perceived quality of care, using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. METHODS Data from 5,438 survey responders aged 18 years+ (mean=49.04 years, range=18-98) were included in the analysis. All variables were measured using self-report surveys. Logistic and linear regression analyses were used to explore responders’ profile characteristics related to use of e-communication and that use related quality of care. Descriptive sub-analyses for e-communication according to age groups were also performed. All analyses considered the complex design using the jackknife replication method. RESULTS The overall prevalence of the use of e-communication was 60%, with the lowest prevalence in older adults aged 65 years or above (17%), significantly lower than adults younger than 45 years old (41%) and adults aged between 45-65 years (42%) (p<.001). American adults who had some college (OR=3.14, 95% CI 1.52–6.48, p=.003) or college graduate+ (OR=4.14, 95% CI 2.04–8.39, p<.001), household income at or greater than $50,000 (OR=1.75, 95% CI 1.25–2.46, p=.002), or a regular provider (OR=1.93, 95% CI 1.43–2.61, p<.001) were more likely to use e-communication. In contrast, those who reside in rural area (OR=0.59, 95% CI 0.39–0.89, p=.014) were less likely to use e-communication. After controlling for demographic (e.g., age, gender, education, income, and comorbidity) and relationship factors (e.g., regular provider, communication quality, and trust a doctor), the use of e-communication was statistically significantly associated with better quality of care (β=0.13, 95% CI 0.01-0.25, p=.039). CONCLUSIONS Our findings on factors associated with e-communication and the positive association between e-communication and quality of care suggest that policy-level attention is needed to engage the socially disadvantaged (i.e., those with lower levels of education and income, without a regular provider, and living rural area) to maximize the use of e-communication and to support better quality of care among American adults. CLINICALTRIAL NOT APPLICABLE

Aims and ObjectivesTo (1) describe the socio‐demographic and behavioural characteristics of older adults who use wearable devices for physical activity monitoring and (2) explore whether wearable device use increases the possibilities of meeting physical activity guideline recommendations among older adults and older adults with known cardiovascular disease or risk.BackgroundFinding ways to increase physical activity and reduce cardiovascular disease risk among older adults is a public health priority. Wearable technology has great potential for promoting physical activity among older adults.DesignA secondary analysis of the national data.MethodsA nationally representative sample of older adults aged 65 years and older (mean age = 73.79 years, N = 1484) and a subsample of older adults with known cardiovascular disease or cardiovascular disease risk (mean = 74.32 years, N = 1098) was used in the analysis. All analyses were weighted to account for the complex survey design. This study was reported according to the STROBE checklist.ResultsThe overall prevalence of wearable device use among older adults and older adults with cardiovascular disease risk was 16% and 14%, respectively. Older adults with higher household incomes, better self‐rated health, and greater exercise enjoyment were more likely to use wearable devices. Compared with non‐users, older adult users were more likely to meet the recommended levels of moderate (55% vs. 31%) and strengthening activity guidelines (46% vs. 25%), but not of the sedentary behaviour guideline (69% vs. 62%). Similar findings were also seen in older adults with known cardiovascular disease or risk.ConclusionThe uptake of wearable devices in older adults, particularly those with known cardiovascular disease or risk is still low. The use of wearable devices is an important facilitator of physical activity. It is critical to provide individualised support for their engagement.Relevance to Clinical PracticeAge‐friendly design and individualised support are recommended to increase older adults' adoption of wearable devices to improve their physical health.Patient or Public ContributionNo patient or public contribution was involved in this study since we used publicly available data.

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Introduction: We monitored CSF (cerebrospinal fluid) for Th1/Th2 inflammatory cytokines in a patient with unexplained postoperative disturbance of consciousness after craniotomy and found that the level of IL-6 (Interleukin-6) concentrations was extremely high, meeting the traditional criteria for an inflammatory cytokine storm. Subsequently, the cerebrospinal fluid specimens of several patients were tested, and it was found that IL-6 levels were increased in different degrees after craniotomy. Previous studies have focused more on mild and long-term IL-6 elevation, but less on the effects of this short-term IL-6 inflammatory cytokine storm. Cerebrospinal fluid rich in IL-6 may play a significant role in patients after craniotomy. Objective: To explore the degree of IL-6 elevation and the incidence of IL-6 inflammatory cytokine storm in patients after craniotomy, as well as the effect of IL-6 elevation on brain. In this study, the levels and clinical manifestations of inflammatory factors in cerebrospinal fluid after craniotomy were statistically classified, and the underlying mechanisms were discussed preliminarily. Methods: CSF specimens of patients after craniotomy were collected, IL-6 level was measured at 1, 5 and 10 days after operation, and cognitive function was analyzed at 1, 10 and 180 days after surgery. Craniotomy mouse model, cerebrospinal fluid of patients with the appearance of IL-6 storm after craniotomy and IL-6 at the same concentration stimulation model were established. Behavioral tests, fluorescence in situ hybridization (FISH), pathological means, western blot, Elisa (enzyme-linked immune-sorbent assay) were performed for verification. Results: CSF from patients after craniotomy caused disturbance of consciousness in mice, affected neuronal damage in the hypothalamus, activation of microglia in the hypothalamus, and decreased expression of barrier proteins in the hypothalamus and brain. The large amount of interleukin-6 in CSF after craniotomy was found to be mainly derived from astrocytes. The IL-6 level in CSF after craniotomy correlated inversely with patients’ performance in MoCA test. Conclusion: High levels of IL-6 in the cerebrospinal fluid derived from astrocytes after craniotomy may lead to disruption of the brain-cerebrospinal fluid barrier, most notably around the hypothalamus, which might result in inflammatory activation of microglia to damage the hypothalamic neurons and impaired cognitive function/more gradual cognitive repairment in patients after craniotomy with the appearance of IL-6 storm.