Healthier Dietary Patterns Are Associated with Better Sleep Quality among Shanghai Suburban Adults: A Cross-Sectional Study.

BACKGROUND: More is to be explored between dietary patterns and sleep quality in the Chinese adult population. METHODS: A cross-sectional study including 7987 Shanghai suburban adults aged 20-74 years was conducted. Dietary information was obtained using a validated food frequency questionnaire. Adherence to a priori dietary patterns, such as the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet (MD), was assessed. Sleep quality was assessed from self-reported responses to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Logistic regression models adjusting for confounders were employed to examine the associations. RESULTS: The overall prevalence of poor sleep (PSQI score ≥ 5) was 28.46%. Factor analysis demonstrated four a posteriori dietary patterns. Participants with a higher CHEI (ORQ4 vs. Q1: 0.81, 95% CI: 0.70-0.95), DASH (ORQ4 vs. Q1: 0.70, 95% CI: 0.60-0.82) or MD (ORQ4 vs. Q1: 0.75, 95% CI: 0.64-0.87) had a lower poor sleep prevalence, while participants with a higher "Beverages" score had a higher poor sleep prevalence (ORQ4 vs. Q1: 1.18, 95% CI: 1.02-1.27). CONCLUSIONS: In Shanghai suburban adults, healthier dietary patterns and lower consumption of beverages were associated with better sleep quality.

Delirium Care by Intensive Care Unit Nurses: Focus Group Studies in a Medical Center of Southern Taiwan.

OBJECTIVES: Studies have identified many nursing interventions that can prevent delirium and fall accidents in clinical patients, detect and treat delirium early to prevent functional decline in the patient, shorten hospitalization duration, and lower the death rate. This study aimed to explore delirium care by intensive care unit (ICU) nurses in a medical center of southern Taiwan. METHODS: This study conducted 3 semistructured focus group interviews, each for a single medical ICU, involving groups of 6 to 8 nurses each. The nurses were recruited through purposive sampling. This research was approved by an institutional review board in the medical center of southern Taiwan from March 31, 2020, to January 30, 2021. The co-principal investigator described the purpose and process of this study to the participants before they provided their written informed consents. The interviews were conducted in the meeting room and were audiotape recorded. The recordings were transcribed and subject to content analysis to identify the themes of delirium care. RESULTS: For nursing interventions of delirium, satisfying the patient's physical needs: comfort care, massages, and early rehabilitation; and psychological care: being presence, communication, and ensuring familial support were included. In terms of environmental interventions for delirium, providing reorientation, music, light, belongings with sentimental value, and audiovisual equipment were included. However, according to the recruited medical ICU nurses, these nonpharmacological interventions, although effective, do not have long-lasting effects. Finally, nurses reported themselves as having been attacked by patients with delirium. Thus, they all agreed that restraining patients with delirium may be necessary, but restraining is a double-edged sword for ICU delirium patients. CONCLUSIONS: Research team suggests for future studies to extend their evidence-based findings of physical, psychological, and environmental care for ICU delirium patients toward integrating the efforts of various health care professionals.

Association between Metabolic Phenotypes of Body Fatness and Incident Stroke: A Prospective Cohort Study of Chinese Community Residents.

This study aimed to assess the association of body mass index (BMI)-based and waist circumference (WC)-based metabolic phenotypes with the risk of stroke among Chinese community residents. A total of 34,294 participants (mean ± standard deviation age: 56.05 ± 11.26 years) with no previous stroke diagnosis history were included in this cohort study. BMI-based metabolic phenotypes were classified into eight groups: metabolically healthy and normal weight (MHNW), metabolically healthy and underweight (MHUW), metabolically healthy and overweight (MHOW), metabolically healthy and obese (MHO), metabolically unhealthy and normal weight (MUNW), metabolically unhealthy and underweight (MUUW), metabolically unhealthy and overweight (MUOW), and metabolically unhealthy and obese (MUO). WC-based metabolic phenotypes were classified into four groups: metabolically healthy and normal WC (MHNWC), metabolically healthy and oversized WC (MHOWC), metabolically unhealthy and normal WC (MUNWC), and metabolically unhealthy and oversized WC (MUOWC). The association of these phenotypes with developing stroke events was examined using proportional hazards models. A total of 546 cases of first-stroke onset were recorded over a median follow-up time of 4.97 years. Compared with the reference group, the obesity phenotypes showed higher risks for stroke. The adjusted HRs (95% CIs) of MHUW, MHOW, MHO, MUNW, MUUW, MUOW, and MUO phenotypes were 1.01 (0.41, 2.49), 1.47 (1.09, 2.00), 1.33 (0.80, 2.22), 2.49 (1.87, 3.30), 3.92 (1.44, 10.72), 2.14 (1.64, 2.79), and 2.60 (1.91, 3.55), respectively. The adjusted HRs (95% CIs) of MHOWC, MUNWC, and MUOWC were 1.41 (1.02, 1.94), 2.25 (1.76, 2.87), and 2.16 (1.63, 2.87), respectively. The metabolic phenotypes defined by an alternative definition all showed significant positive associations (except for MHUW), with the adjusted HR ranging from 1.51 to 3.08 based on BMI and from 1.68 to 2.24 based on WC. The risk of stroke increased with the increase in metabolic abnormality numbers in different BMI and WC groups (all p trend < 0.001). The present study suggests that maintaining normal body weight or WC and improving metabolic health are of great significance in preventing cerebrovascular diseases.

Adherence to DASH Dietary Pattern and Its Association with Incident Hyperuricemia Risk: A Prospective Study in Chinese Community Residents.

Hyperuricemia represents a great burden on global public health, and it is important to provide effective guidance at the level of dietary patterns. We evaluated the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of hyperuricemia in a large-scale, community-based cohort in East China. In total, 45,853 participants that did not have either hyperuricemia nor gout were included and assigned a DASH dietary score based on their baseline dietary intake. They were then divided into five quintiles (Q1−Q5) according to their score, followed by cross-linkages with local health information systems and in-person surveys. Cox proportional hazards models were adopted to calculate hazard ratio (HR) and 95% confidence intervals (CIs). During a median follow-up of 4.54 years, 2079 newly diagnosed hyperuricemia cases were documented. Compared to the DASH Q1 group, the risk of incident hyperuricemia for the Q5 group was significantly reduced by 16% (HR: 0.84; 95% CIs: 0.72−0.97) in the adjusted model. The associations of DASH diet with hyperuricemia appeared stronger (P for interaction <0.001) among participants with 3−4 cardiometabolic diseases at baseline, compared with their counterparts. Our results suggest that the DASH diet could be taken into account in the recognition of risk population and the prevention of hyperuricemia.

Fish Consumption and Risk of Stroke in Chinese Adults: A Prospective Cohort Study in Shanghai, China.

Present studies on the association of fish consumption with risk of stroke have shown controversial results, and this association within the Chinese population remains unknown. We aimed to investigate the association between fish consumption and incidence of total stroke, ischemic stroke and hemorrhagic stroke among adults in China. We analyzed the data of 57,701 adults aged 20-74 years, with no history of stroke, in a prospective cohort study in Shanghai. Fish consumption was calculated from a food frequency questionnaire at baseline and divided into four categories (less than 300, 300-450, 450-600 and more than 600 g/week). Participant information was linked to health information systems in which stroke event information was collected up until 31 December 2021. The hazard ratios (HR) and 95% confidence intervals (CI) of the associations of fish consumption with risk of total stroke, ischemic stroke and hemorrhagic stroke were estimated using cox proportional hazards regression models. Dose-response relationships were estimated using restricted cubic spline analyses. During a median follow-up of 4.56 years, 807 newly developed stroke events were ascertained, including 664 ischemic stroke events and 113 hemorrhagic stroke events. Fish consumption of 300-450 g/week was associated with a reduced risk of total stroke (HR: 0.78, 95% CI: 0.64-0.94) and ischemic stroke (0.70 (0.57-0.88)) compared with fish consumption of less than 300 g/week, after adjustment for comprehensive covariates including sociodemographic characteristics, lifestyle, dietary patterns and disease histories. No significant association was found between fish consumption and hemorrhagic stroke. The findings of our study support the consumption level of fish recommended in the dietary guidelines.

Association between four nontraditional lipids and ischemic stroke: a cohort study in Shanghai, China.

BACKGROUND: The correlation between nontraditional lipids and ischemic stroke (IS) is inconsistent and controversial. This study aimed to examine the association of four nontraditional lipids with IS risk in Chinese adults. METHODS: This prospective community-based cohort study was performed in Songjiang District, Shanghai, China. The study began in 2016 and included 34,294 participants without stroke before the investigation. The association between nontraditional lipids (nonhigh-density lipoprotein cholesterol [non-HDL-C], total cholesterol/high-density lipoprotein cholesterol [TC/HDL-C], triglyceride [TG]/HDL-C, and low-density lipoprotein cholesterol [LDL-C]/HDL-C) and IS was studied with multivariate Cox regression models. The dose-response associations between these four serum lipids and IS were explored using restricted cubic spline (RCS) analysis. RESULTS: There were a total of 458 IS cases with 166,380 person-years of follow-up. Compared with the lowest tertiles, the highest tertiles of the nontraditional blood lipids showed greater IS risk after controlling for potential confounders. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were as follows: TC/HDL-C, 1.63 (1.28-2.07); TG/HDL-C, 1.65 (1.28-2.13); LDL-C/HDL-C, 1.51 (1.18-1.92); and non-HDL-C, 1.43 (1.13-1.81). The fully adjusted RCS curves presented a nonlinear relationship, and the risk increased when the TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C levels were > 3.47, > 0.92, and > 1.98, respectively. CONCLUSIONS: This community-based cohort study presents a positive association between the four nontraditional lipids and IS incidence. Maintaining relatively low lipid ratios can be beneficial for preventing stroke. Nontraditional lipids can be considered targets for managing blood lipids.

["Arrhythmia Reading": A Diverse Teaching Approach to Improve the Ability of 2 Year NPGY Nurses to Interpret and Manage Arrhythmias].

BACKGROUND: The author of this paper works in the critical care ward of an internal medicine department. During the study period, current trainees in a nurse post graduate year (NPGY) program joined our nurse team. While at our ward, they were required to demonstrate clinical nursing competencies in intensive care units in the facets of nursing knowledge, equipment use, prediction of emergencies, emergency response, and patient evaluation and management. The ability to interpret arrhythmias is critical to connecting and coordinating these competencies. However, arrhythmia interpretation is usually the most difficult skill for nurses to master. PURPOSE: This study was developed to improve the knowledge of NPGY trainees regarding arrhythmia interpretation, the accuracy of their arrhythmia interpretation and management, and their confidence in caring for patients with arrhythmia. RESOLUTION: The period of this study spanned from April 5th to June 18th, 2018. After surveying the current capabilities of the NPGY trainees to provide a reference for improvement, several teaching strategies were adopted. These strategies included: (1) provision of arrhythmia clinical scenarios; (2) establishment of multimedia teaching and interactive e-books; (3) development of memory strategies; and (4) mind mapping. RESULTS: The accuracy of the trainees' knowledge regarding arrhythmia interpretation increased from 52.5% pretest to 92.5% posttest, while their arrhythmia interpretation skill improved from 56.3% pretest to 92.5% posttest. Furthermore, their caring-for-patients-with-arrhythmia confidence score increased from 5.5 to 9.1. All of the objectives of this study were achieved. CONCLUSIONS: The diverse teaching approach employed in this study enhanced the ability of trainees to remember and recall relevant theories as well as improved their related practical skills. Furthermore, posttest, the trainees were significantly less nervous during encounters with patients with arrhythmia and demonstrated improved problem-solving abilities. Participation in this intervention significantly improved the confidence of trainees to serve as critical care nurses and to pursue a career in critical care nursing.

[Project to enhance accuracy of nursing assessments performed by medical and surgical ICU nursing staffs].

BACKGROUND: Some nurses do not have the skills necessary to evaluate general ICU patient condition and the meaning of laboratory data adequately. This can influence nursing care quality and patient safety. Between October 16th and 29th, 2009, this project employed a checklist to evaluate nursing assessment accuracy in medical and surgical ICUs. The unexpectedly low accuracy rate of two-thirds (63.4 percent) was caused by factors including poor nursing assessment cognizance, lack of experience performing nursing assessments, nursing assessment skills taught only to experienced nursing staff, and a lack of nursing assessment guidelines. PURPOSE: This project was designed to improve nursing assessment cognizance and accuracy among nursing staff. RESOLUTION: The authors: 1. Established formal nursing assessment guidelines; 2. made a CD-ROM to introduce nursing assessment basics; and 3. employed lectures and simulation exercises to teach nursing assessment skills. RESULTS: Nursing assessment accuracy improved significantly to 85.8 percent and actual nursing assessment cognizance scores ranged between 68.7 and 83.1. CONCLUSIONS: This project effectively improved nursing assessment accuracy and may be considered and referenced by relevant medical organizations.

Usefulness of the ratio of transmitral E wave velocity to isovolumic relaxation flow propagation velocity for predicting left ventricular end-diastolic pressure.

Transmitral E wave velocity was reported to be positively related to left ventricular (LV) filling pressure and negatively related to LV relaxation constant, and isovolumic relaxation flow propagation velocity (IRFPV) was proven recently to be negatively related to LV relaxation constant and independent of preload alterations. Therefore, the combination index, E/IRFPV, may eliminate the influence of LV relaxation and bring the LV filling pressure into focus. However, it is unknown whether E/IRFPV is a useful index in prediction of LV filling pressure. The aim of this study is to evaluate the correlation between E/IRFPV and LV end-diastolic pressure (LVEDP). Forty-three patients with suspected coronary artery disease who underwent a Doppler echocardiographic study and cardiac catheterization were included. LVEDP was determined by a micromanometer-tipped catheter. In a univariate analysis, LVEDP had a positive correlation with left atrial dimension, LV end-diastolic dimension, LV end-systolic dimension, the ratio of E to E wave propagation velocity (EPV) (r = 0.408, p = 0.007), the ratio of E to early diastolic mitral annular velocity (Ea) (r = 0.439, p = 0.003) and E/IRFPV (r = 0.686, p < 0.001). It had a negative correlation with diastolic blood pressure, E wave deceleration time, LV ejection fraction, EPV, Ea and IRFPV. After stepwise multiple linear regression analysis, only the E/IRFPV was the independent predictor of LVEDP (beta = 0.667, p < 0.001). In conclusion, E/IRFPV is a useful parameter in prediction of LVEDP.

The one-pot synthesis of dextran-based nanoparticles and their application in in-situ fabrication of dextran-magnetite nanocomposites.

The dextran-based nanoparticles containing carboxyl groups were synthesized by a one-pot approach, without using any organic solvents and surfactants. The resultant dextran-based nanoparticles was used as a host for the growing and organization of Fe(3)O(4) nanoparticles. The approach consists of the mixture of ferrous/ferric ions aqueous solution and host nanoparticles and subsequent coprecipitation of ferrous/ferric ions in basic medium. The magnetic nanocomposite material obtained was characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS), thermogravimetric analysis (TGA), X-ray diffraction techniques (XRD) and vibrating sample magnetometry (VSM). The data demonstrate that the carboxyls which can capture cationic ferrous/ferric by electronic interaction in the dextran-based hosts plays a crucial role in fabricating nanocomposites with a homogeneous spatial distribution of magnetite nanoparticles. The magnetic nanocomposites exhibit comparable saturation magnetizations to that of reported Fe(3)O(4) nanoparticles, and therefore display great potential in a large scope of biomedical fields.

Positive interference from contrast media in cardiac troponin I immunoassays.

Cardiac troponin I (cTnI) has been found to be a sensitive and reliable marker of myocardial damage, and elevated levels of cTnI can indicate high risk for acute coronary syndrome. To determine how to intervene in possible cases of acute coronary syndrome, cTnI levels must be measured by immunoassay. However, cTnI immunoassay results are prone to interference from many substances such as heparin and common drugs. The contrast media used in the coronary angiography might also interfere with results. To explore this possibility, we performed two in vivo and two in vitro studies. In the first in vivo study, we evaluated the effects of contrast media on cTnI immunoassays by collecting blood samples from 45 patients undergoing coronary angiography before and after the procedure. We used the Opus Magnum immunoassay system to measure cTnI levels. In the second in vivo study, we collected 25 blood samples from another group of patients also undergoing angiography at various times before and after the procedure to determine cTnI values by both the Opus Magnum and ACCESS systems. In the first in vitro study, 12 different contrast media were treated as samples to disclose the potential interference of measurement in the two assay systems. In the second in vitro study, we made sequential dilutions of iopromide (Ultravist; Schering) with serum to explore their potential for interfering with the detection of cTnI by the Opus Magnum and ACCESS assays. In the first in vivo study using the Opus Magnum assay, cTnI concentrations in samples taken after angiography were significantly higher at 5 minutes than at 30 minutes, and, at 60 minutes, all cTnI concentrations had dropped below the cutoff point. In the second in vivo study, we found a substantial difference in detection of cTnI by the Opus Magnum and ACCESS assays. All cTnI concentrations checked by ACCESS assay were below the cutoff value. In our first in vitro study, the Opus Magnum assay gave false positive results for all 12 contrast media; the ACCESS assay gave a positive result for only one contrast medium, poppy-seed oil (Lipiodol; Guebert). In our second in vitro study, we found that, in the Opus Magnum assay, the more concentrated the contrast medium, the higher the cTnI value, but not in the ACCESS assay. We conclude that contrast media may cause false-positive results in cTnI assays and that, when contrast media are being used for angiography, cTnI results, especially those based on samples taken within the first hour of the procedure, should be interpreted carefully.