Association of altitude and frailty in Chinese older adults: using a cumulative frailty index model.

Objective: The population is aging exponentially and the resulting frailty is becoming increasingly evident. We aimed to explore the association between altitude and frailty, and to identify associated factors for frailty. Methods: This is a community-based cross-sectional survey. 1,298 participants aged ≥60 years from three different altitudes were included in the study. To quantify frailty, we constructed a frailty index (FI) and a frailty score (FS). The FI was divided into non-frailty, prefrailty, and frailty. The Odds Ratios and confidence intervals (ORs, 95%CIs) were used to evaluate the association between altitude and FI and FS in multivariate ordinal logistic regression and linear regression. Results: There were 560 (53.1%) participants in the prefrailty and 488 (37.6%) in the frailty group. The FS increased with higher altitude (P for trend <0.001). Multivariate ordinal logistic regression analysis revealed an association between altitude and frailty, OR = 1.91 (95% CI: 1.38-2.64) in mid-high altitude and 2.49 (95% CI:1.40-4.45) in high altitude. The same trend of association was found in the univariate analysis. The FS increased by 1.69 (95% CI: 0.78-2.60) at mid-high altitude and 3.24 (95%CI:1.66-4.81) at high altitude compared to medium altitude. Conclusion: The study indicates that high altitude exposure is an associated factor for frailty in older adults. This association become stronger with higher altitudes. As a result, it is essential to conduct early frailty screening for residents living at high altitudes.

Development and testing of a questionnaire assessing knowledge, attitudes, and practices to prevent unplanned oral extubation.

BACKGROUND: The prevention of unplanned endotracheal extubation (UEE) is significant for the critical care of intensive care unit (ICU) patients. AIM: To develop a questionnaire to assess the knowledge, attitude, and practice (KAP) of the nurses regarding of the prevention of UEE in ICU patients with transoral endotracheal intubation (TEI) and to test the validity and reliability of the questionnaire. STUDY DESIGN: Items relevant to KAP were prepared following a literature review, and then screened using a Delphi expert consultation, pre-test, and factor analysis. The nursing staffs in four tertiary hospitals in Qinghai, Jiangsu, Gansu, and Shandong provinces were surveyed to test the reliability and validity of the questionnaire. RESULTS: The questionnaire contained 76 items, including 10, 37, and 29 in the dimensions of knowledge, attitude, and practice, respectively. The scale-level content validity index (S-CVI) of the questionnaire was 0.96. The results of exploratory factor analysis (EFA) showed that the Kaiser-Meyer-Olkin value was 0.956, indicating that the sample was adequate and suitable for factor analysis. The result of the Bartlett spherical test was significant (p < .001), indicating that the questionnaire was suitable for further EFA. A total of six common factors were extracted by EFA with a cumulative variance interpretation rate of 85.52%, indicating that the questionnaire had good structural validity. The Cronbach's alpha was 0.981 for the whole questionnaire; and was 0.966, 0.996, and 0.981 for the dimensions of knowledge, attitude, and practice, respectively. The test-retest reliability for the questionnaire was 0.843. CONCLUSIONS: The developed questionnaire has good reliability and validity and can be used as a scientific tool for the nursing leaders to prevent UEE in ICU patients with TEI. RELEVANCE TO CLINICAL PRACTICE: The instrument provides a theoretical reference for establishing preventive strategies and management programs in clinical practice.

Comparison of the prevalence of sarcopenia in geriatric patients in Xining based on three different diagnostic criteria.

BACKGROUND: Sarcopenia is an age-related decline in skeletal muscle mass, which depends on an assessment of muscle strength and muscle mass. The diagnostic definition of sarcopenia varies by region. AIM: To determine the optimal diagnostic criteria for sarcopenia in a plateau population. Cut off values for the components of diagnostic algorithms for sarcopenia in plateau populations should consider altitude. METHODS: One hundred and fifty subjects aged > 60 years attending a tertiary comprehensive hospital in the city of Xining (elevation: 2260 m) between October and December 2018 were enrolled. Handgrip strength, muscle mass, and physical performance were measured. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, Beijing criteria, and Lasha criteria. RESULTS: Across diagnostic criteria, there were significant differences in the prevalence of sarcopenia in the overall population and stratified by gender. The prevalence of sarcopenia measured by the AWGS 2019 or Lasha criteria was significantly higher in female compared to male subjects. In males, the prevalence of sarcopenia measured by the Beijing criteria was significantly higher in subjects who identified as Han compared to Minority. In females, there were no significant differences in the prevalence of sarcopenia by ethnicity according to any criteria. CONCLUSION: The Lasha criteria provided a lower prevalence of sarcopenia (males, 8.7%; females, 22.41%; overall, 14%) and were able to differentiate between males and females. The Lasha criteria are likely most appropriate for detection of sarcopenia in this plateau population. We recommend the Lasha criteria for detection of sarcopenia in Xining.

Health care worker occupational experiences during the COVID-19 outbreak: A cross-sectional study.

BACKGROUND: Health care workers treating coronavirus disease 2019 (COVID-19) patients experience burnout and stress due to overwork and poor working conditions. AIM: To investigate the work experiences of frontline health care workers in Wuhan city and Qinghai province, China, during the COVID-19 outbreak. METHODS: In this cross-sectional descriptive study, a self-reported questionnaire was designed to evaluate work experiences of medical staff throughout the course of the COVID-19 pandemic. A total of 178 health care workers responded to the questionnaire between February 19 and 29, 2020. Higher questionnaire dimen-sional score confirmed dimensional advantage. RESULTS: Of all dimensions evaluated by this questionnaire, the occupational value dimension had the highest mean score of 2.61 (0.59), followed by the support/security dimension score of 2.30 (0.74). Occupational protection scored lowest at 1.44 (0.75), followed by work environment at 1.97 (0.81). The social relationships dimension had an intermediate score of 2.06 (0.80). Significant differences in working conditions were observed across hospital departments, with the fever ward scoring lowest. Total scores also differed significantly across workplaces; the fever outpatient department scored lowest (P < 0.01). This phenomenon was likely due to the fact that work in the fever outpatient department, where many patients present to hospital, necessitates constant contact with a large number of individuals with insufficient provision of resources (such as protective equipment and social support). Medical workers in the fever outpatient department were burdened with a fear of COVID-19 infection and a lower sense of professional value as compared to workers in other hospital departments. Medical staff in Wuhan worked longer hours (P < 0.01) as compared to elsewhere. The mean support/security dimension score was higher for tertiary hospital as compared to secondary hospital medical staff as well as for Wuhan area as compared to Qinghai region staff (P < 0.01). Staff in Wuhan had a lower mean work environment score as compared to staff in Qinghai (P < 0.05). CONCLUSION: Medical staff treating COVID-19 patients in China report poor occupational experiences strongly affected by work environment, occupational protection and social relationships. Health care managers must address the occupational needs of medical staff by ensuring a supportive and safe work environment.

A correlation study between nursing staff's knowledge level of hospice care and the psychology, emotion and attitude towards deaths.

OBJECTIVE: We investigated the relationship between nursing staff's knowledge of hospice care and psychological states, including grief and attitude towards death. METHODS: From October 2018 to December 2018, a total of 1900 professional nursing staff of secondary and tertiary levels in Qinghai Province were chosen as the research subjects. Professional questionnaires were used to evaluate their knowledge level of Hospice Care (HC), psychological states, grief and attitude towards death, while the correlation between HC knowledge level and the latter three were analyzed. RESULTS: In Qinghai Province, the nursing staff had the highest scores in terms of knowledge levels of HC symptom control with a score of 4.48±1.65, and the lowest score of 1.79±1.12 in terms of knowledge levels of death education. In the Death Attitude Profile-Revised (DAP-R) scale, there was a negative correlation between fear of death, death avoidance, escape acceptance, and HC knowledge total score (P<0.05), while there was a positive correlation between natural acceptance and HC knowledge score (P<0.05). There was no statistical correlation between the total score of approach acceptance and HC knowledge (P>0.05). In the Grief Experience Questionnaire (GEQ) questionnaire, there were negative correlations between the total score of HC knowledge and body reaction, general grief response, seeking to explain and respond to special death forms (P<0.05). Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were negatively correlated with HC knowledge scores (P<0.05). CONCLUSION: There is a correlation between nursing staff's knowledge level of hospice care and the psychological state, partial grief and attitudes towards death. The improvement of levels of nursing staff's HC knowledge plays a positive role in maintaining their healthy psychological state, alleviating their grief and helping them to actively face death.

Sarcopenia in geriatric patients from the plateau region of Qinghai-Tibet: A cross-sectional study.

BACKGROUND: Sarcopenia is an age-related decline in skeletal muscle mass, which depends on an assessment of muscle strength and muscle mass. It has been reported that the prevalence of sarcopenia in non-hospitalized elderly people was 9.0%-18.5% in the lowland plains. However, epidemiological investigations of sarcopenia in plateau regions are limited. The city of Xining in Qinghai Province (altitude 2260 m) is the sole point of access to the Qinghai-Tibet plateau. We hypothesized that the diverse ethnicities or dietary habits of the people living in the plateau may influence the prevalence of sarcopenia. AIM: To investigate the prevalence and risk factors of sarcopenia in geriatric patients from the Qinghai-Tibet plateau region. METHODS: From October to December 2018, 150 hospitalized geriatric patients (72.4 ± 5.60 years) from Xining City (altitude 2260 m) in Qinghai Province were recruited. Collected data included demographics, history of fall, nutritional status, self-care ability, depression, handgrip, muscle mass, and 6-m gait speed. Sarcopenia was diagnosed based on the 2014 criteria of the Asian Working Group for Sarcopenia. RESULTS: The overall rate of sarcopenia was 20% (8.7 and 11.3% in men and women, respectively). Binary logistic regression analysis indicated that widowhood and a history of falling were associated with sarcopenia, while higher body mass index and beef and mutton consumption were protective. CONCLUSION: The prevalence of sarcopenia in hospitalized geriatric patients in the Qinghai-Tibet plateau region was higher than that in the plain region and in non-hospitalized geriatric people (reported elsewhere). Specific cultural features of the region, including ethnicity, brewed tea and ghee consumption, were not significantly associated with sarcopenia. Higher body mass index and consumption of beef and mutton were protective, while patients who were widowed or with a history of falling were at increased risk.

Predicting body weight by measuring weight underneath the buttock in supine position: A quantitative observation study.

BACKGROUND: Measuring body weight (BW) for bedridden patients often presents difficulty and challenge. OBJECTIVES: The present study aimed at providing a self-designed indirect method to predict BW by measuring weight underneath the buttock (WUB) of an individual in supine position, thereby providing an easy, safe and effective way of BW measurement for bedridden patients. METHODS: A total of 180 subjects participated in the present study and agreed to have their BW and WUB to be measured. BW was measured normally at the standing position through an electronic weighing machine without any special requirement. By placing the electronic weighing machine under the subject's buttock along with an additional hard board set under the electronic weighing machine, WUB was measured in subjects who were asked to assume a supine position in beds to simulate conditions of bedridden individuals. Measurement was repeated thrice to minimise the test error. RESULTS: Average BW (62.7 ± 11.7 kg) was 2.0 ± 0.1 (≈ 2) folds of WUB (31.4 ± 6.0 kg). Significant linear correlation was identified between BW and WUB in all subjects with a linear equation yielded (y= 1.8 x + 6.0). Further multiple regression analysis resulted in an equation of BW (kg) =-36.8 + 1.66*WUB (kg) + 29.0*height (m). Predicted BW (PBW) was calculated out based on the results described above: the multiple relationship (2 folds), the linear equation, and the multiple regression equation, and differed from the measured BW by 3.6 ± 2.8, 3.5 ± 2.7 and 4.2 ± 3.1 kg respectively. CONCLUSIONS: Predicting BW through WUB in supine position is effective and reliable because the latter can be easily measured and features a strong linear relationship with BW. This method provides clinical staff with remarkable benefits in BW determination for bedridden patients.

6MWT Performance and its Correlations with VO2 and Handgrip Strength in Home-Dwelling Mid-Aged and Older Chinese.

Six-minute walk test (6MWT) performance is more commonly used in clinic patients with chronic cardiopulmonary diseases but not in home-dwelling individuals of similar age, and its correlations with oxygen uptake (VO2) and muscle strength require further investigation. The current study determined the 6MWT performance of 106 home-dwelling residents (mean age of 62 years) in Suzhou, China. VO2 at a respiratory exchange ratio (R) of 1 was measured through graded cycling exercise tests on 46 participants. Handgrip strength of all participants was tested. 6MWT distance measured 543.4 ± 67.2 m (total work 351.0 ± 62.8 kJ) with similar distances ambulated each minute. Heart rate, blood pressure, and rate of perceived exertion scores significantly increased after 6MWT. VO2 at R = 1 reached 1238 ± 342 mL/min (18.6 ± 4.7 mL/kg/min), whereas handgrip strength totaled 29.8 ± 9.6 kg. 6MWT distance showed strong correlations with VO2 (r = 0.549, p ≤ 0.001) and handgrip strength (r = 0.359, p < 0.001). Aside from providing reference values for 6MWT performance (~543 m, ~559 m in males and ~533 in females) for home-dwelling Chinese residents, our results suggest that as a parameter of exercise endurance, 6MWT performance correlates with both aerobic capacity and muscle fitness.