Neurological manifestations of SARS-CoV-2 infection in children in Taiwan: A cross-section, multicenter study.

BACKGROUND: The SARS-CoV-2 virus has been a global public health threat since December 2019. This study aims to investigate the neurological characteristics and risk factors of coronavirus disease 2019 (COVID-19) in Taiwanese children, using data from a collaborative registry. METHODS: A retrospective, cross-sectional, multi-center study was done using an online network of pediatric neurological COVID-19 cohort collaborative registry. RESULTS: A total of 11160 COVID-19-associated emergency department (ED) visits and 1079 hospitalizations were analyzed. Seizures were the most common specific neurological symptom, while encephalitis and acute disseminated encephalomyelitis (ADEM) was the most prevalent severe involvement. In ED patients with neurological manifestations, severe neurological diagnosis was associated with visual hallucination, seizure with/without fever, behavior change, decreased GCS, myoclonic jerk, decreased activity/fatigue, and lethargy. In hospitalized patients with neurological manifestations, severe neurological diagnosis was associated with behavior change, visual hallucination, decreased GCS, seizure with/without fever, myoclonic jerk, fatigue, and hypoglycemia at admission. Encephalitis/ADEM was the only risk factor for poor neurological outcomes at discharge in hospitalized patients. CONCLUSION: Neurological complications are common in pediatric COVID-19. Visual hallucination, seizure, behavior change, myoclonic jerk, decreased GCS, and hypoglycemia at admission are the most important warning signs of severe neurological involvement such as encephalitis/ADEM.

A parsimonious and comprehensive screening tool for adult health behaviors.

BACKGROUND: A practical screening tool for early detection of unhealthy behaviors among adults to provide tailored care can have an important role in public health nursing. PURPOSE: To develop a screening tool with valid psychometric properties for adult health behaviors (AHBs). METHODS: A cross-sectional study was conducted between March 2018 and September 2019 in central-southern Taiwan. The AHBs development included qualitative and quantitative measurement of items based on literature reviews and expert opinion and exploration and confirmatory factor analysis. RESULTS: A total of 765 community adult participants: 377 women and 388 men, with a mean age of 39.3 (SD = 10.6), ranging from 20 to 64 years completed the AHBs screening tool. Analysis of the 23-items AHBs scale identified six dimensions - stress management, physical activity, health responsibility, life appreciation, healthy eating, and oral hygiene accounting for 67.3% of the variance. Total scale scores were significantly associated with a criterion variable of life satisfaction. CONCLUSION: The AHBs scale is a suitable screening tool that can be used to identify adults' unhealthy behaviors early, which is useful for public health nurses to conduct a regular assessment and initiate individualized health programs.

The health impact of an innovative summer camp for older adults: a pilot study using an interdisciplinary collaborative approach.

BACKGROUND: Healthy aging with dignity and aging in place are important for Taiwanese individuals. Although Taiwan did not experience COVID-19 outbreaks prior to May 2021, many older adults have been encouraged to stay at home since the beginning of the global pandemic in January 2020. Such shelter-in-place recommendations have resulted in significant lifestyle changes, limiting activities associated with aging with dignity such as exercise and community engagement. Few studies have explored how to promote or maintain holistic health practices and physical fitness in older adults residing in rural communities during the COVID-19 pandemic. This pilot study aimed to establish an interdisciplinary collaboration with community care workers (CCWs) and evaluate the impact of an innovative summer camp (ISC) program for older adults residing in rural areas. METHODS: A quasi-experimental pre-post-test design with an interdisciplinary collaborative approach was implemented. The ISC program was based on a standardized protocol of modified Baduanjin exercise combined with three recreational breathing games. Participants were recruited from three community centers around the western coastal region of Yunlin County between June and August 2020. The ISC program was designed and executed by a nurse-led health promotion research team that collaborated with trained CCWs for 90 min per day, five days per week, for 12 weeks. Participants and CCWs wore facemasks during all activities. Paired t-test was used to measure changes in physical biomarkers, pulmonary lung function, and health-related fitness changes. RESULTS: Sixty-eight participants completed the ISC program. The ISC program significantly improved the participants' physiological biomarkers and health-related fitness, including reduced body weight, waistline, and systolic blood pressure, and increased forced vital capacity, biceps arm flexion, and ability to sit and stand from a chair, step with a knee up in situ, and stand on one foot with eyes open. Most participants reported that they felt happy, satisfied, and hoped that this program would be continued in their community center. CONCLUSIONS: This interdisciplinary, collaborative ISC program improved physical biomarkers and health-related fitness in older adults. Despite limitations, results strongly suggested that primary healthcare providers and CCWs can employ the described ISC program to promote wellness in older adults.

The relationship of neuroimaging findings and neuropsychiatric comorbidities in children with tuberous sclerosis complex.

BACKGROUND/PURPOSE: To clarify the relationship between neuroimaging findings, neuropsychiatric comorbidities, and epilepsy in patients with tuberous sclerosis complex (TSC) in Taiwan. METHODS: Medical records from 32 patients with TSC were retrospectively reviewed, including mutational analysis, neuroimaging findings, electroencephalogram findings, and neuropsychiatric comorbidities. RESULTS: Of these patients, six (18.75%) were diagnosed to have autism spectrum disorders (ASD), and 10 (31.25%) were diagnosed to have attention-deficit-hyperactivity disorder. In the latter patients, there were no differences in the regional distribution of tuber burden. In addition to a high prevalence of cystic-like tubers, tubers in insular and temporal areas were associated with ASD. Nonsense mutations in the TSC2 gene group had a correlation with autistic behavior. In 26 (81.25%) patients with a history of epilepsy, infantile spasms and partial seizures were the predominant type of epilepsy. Most of them developed seizures prior to age 1 year. CONCLUSION: ASD is a common comorbidity in TSC. Cortical tubers in the temporal lobe and insular area were associated with ASD. The presence of cystic-like tubers on magnetic resonance imaging may also offer a structural marker for ASD in TSC.

Managing non-24-hour sleep-wake rhythm disorder with ramelteon in a 12-year-old girl with Pierre Robin sequence and developmental delay: a case report.

The author recently observed a case involving a 12-year-old sighted girl who exhibited symptoms typical of non-24-hour sleep-wake rhythm disorder (N24SWD). This disorder, more commonly found in blind individuals, presents a unique challenge when diagnosed in those with vision. Several interventions can be attempted, ranging from behavioral adjustments to light therapy. Although melatonin has been noted for its effectiveness in realigning the patient's sleep-wake cycle, the use of ramelteon, a melatonin receptor agonist, has seldom been reported in managing N24SWD. However, this case illuminates the potential of ramelteon as another therapeutic option for sighted individuals with N24SWD. Further study is suggested to determine the potential of ramelteon in managing this disorder among sighted individuals of varying age groups. CITATION: Huang C-H. Managing non-24-hour sleep-wake rhythm disorder with ramelteon in a 12-year-old girl with Pierre Robin sequence and developmental delay: a case report. J Clin Sleep Med. 2024;20(6):995-997.

The sleep problems in individuals with Rett syndrome and their caregivers.

LAY ABSTRACT: Sleep problems are common and impactful among individuals with Rett syndrome (RTT) and their caregivers. We examined the sleep patterns of 29 RTT patients and their primary caregivers using various assessment tools. The study found that a majority of the patients experienced sleep disturbances, with younger patients showing more sleep difficulties. Caregivers also reported poor sleep quality. The findings emphasize the need to address sleep problems in RTT management, as improving sleep quality can positively impact the well-being of individuals with RTT and their caregivers.

The clinical and sleep manifestations in children with FOXG1 syndrome.

FOXG1 syndrome is a rare neurodevelopmental disorder associated with severe cognitive dysfunction, autistic behavior, and early-onset hyperkinetic movement disorders. Patients have also been reported to experience sleep disturbances. However, these findings are mainly based on subjective caregivers' reports, and limited by small case numbers. Moreover, no studies using objective evaluation tools, such as actigraphy, have been reported. We analyzed the clinical and sleep manifestations of children with FOXG1 syndrome registered in the FOXG1 Research Foundation Patient Registry database. A total of 258 individuals with FOXG1 syndrome were included in this research. 132 (51.16%) had sleep disturbances. The more impaired of language acquisitions (absence of speech, OR: 3.99, 95%CI = 1.69-9.42, p = 0.002), hyperkinetic movement disorders (OR: 2.64, 95%CI = 1.34-5.20 p = 0.005) and feeding difficulties (OR: 2.81, 95% CI = 1.52-5.19, p = 0.001) were significantly associated with an increase in odds of sleep disturbance after adjusting for age, sex, and antiepileptic drugs. We also performed sleep studies on six individuals with FOXG1 syndrome using The Children's Sleep Habits Questionnaire (CSHQ), the Sleep Disturbance Scale for Children (SDSC), and 7-day data from Actiwatch. The Pittsburgh Sleep Quality Index (PSQI) and 7-day data from Actiwatch were also used to evaluate the sleep condition of their parents. The CSHQ scores revealed bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night-waking, and parasomnia. Sleep-wake transition disorders and disorders of initiating and maintaining sleep were also suggested by the SDSC scores. The children's actigraphy revealed short sleep durations, impaired sleep efficiency, longer wake after sleep onset, and frequent night-waking. All caregivers reported significantly higher PSQI scores, mildly declined sleep efficiency, and shorter total sleep duration. Sleep disturbances, especially in initiating and maintaining sleep, are common in individuals with FOXG1 syndrome and their caregivers. Sleep disorders in patients with FOXG1 syndrome and their caregivers should be investigated.

Factors Associated with Urinary 1-Hydroxypyrene and Malondialdehyde among Adults near a Petrochemical Factory: Implications for Sex and Lifestyle Modification.

BACKGROUND: The association between the biomarkers of environmental exposure, oxidative stress, and health-related behaviors in community residents living in an endemic viral hepatitis area and near petrochemical industrial complexes remains unclear. From a health promotion perspective, healthcare providers must know what to do for residents concerned about their health and living environment, especially for individual-level and modifiable risk factors. Therefore, we aimed to explore the factors associated with urinary 1-hydroxypyrene (1-OHP) and malondialdehyde (MDA). METHODS: A community-based, cross-sectional study was conducted between July 2018 and February 2019 in western coastal Yunlin County, Taiwan. All participants lived within a 10 km radius of a large petrochemical complex and did not work in the factory. This study was conducted with the local hospital through annual community health screening. Biological samples were collected and biomarkers determined and quantified in the central laboratory of the collaborating hospital. RESULTS: A total of 6335 adult residents completed the study. The mean age was 47.7 (SD = 16) years. Out of the total population, 56.4% were female, 30.1% had metabolic syndrome (MetS), and 16.8% and 14.3% had hepatitis B virus antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) positivity, respectively. The median 1-OHP and MDA level was 0.11 and 0.9 µg/g creatinine with an interquartile range of 0.07-0.18, and 0.4-1.5, respectively. The MDA levels correlated with specific diseases. The multivariable ordinal logistic regression model revealed that female sex, smoking, betel nut use, HBsAg, and anti-HCV positivity were associated with higher 1-OHP levels. In men, MetS was associated with higher 1-OHP levels and regular exercise with lower 1-OHP levels. High MDA levels were associated with smoking, betel nut users, HBsAg, and anti-HCV positivity. CONCLUSIONS: The findings highlight the importance of initiating individualized health promotion programs for residents near petrochemical factories, especially for adults with substance-use and cardiometabolic risk factors. Furthermore, it is crucial to provide further treatment to patients with viral hepatitis.

Microbial degradation of phenol in a modified three-stage airlift packing-bed reactor.

Phenol degradation was carried out by using a modified three-stage airlift packing-bed bioreactor. A laboratory-scale airlift packing-bed reactor, with hydrodynamic flexible packing material in the three-stage bioreactor, was constructed and operated for phenol removal from synthetic wastewater. The airlift packing-bed reactor successfully degraded phenol and lowered the chemical oxygen demand (COD) of wastewater. High COD removal was observed, and much lower sludge effluent was obtained in this investigation. This airlift bioreactor showed a superior hydrodynamics performance and broad operating conditions for phenolic material removal. Different operating modes were discussed to obtain the optimal condition for phenol degradation (i.e., hydraulic retention time [HRT] and gas flowrate of airlift). The HRT and feed phenol concentration of wastewater dominated the removal efficiency of phenol and COD. In this bioreactor, surface loading up to 2.84 g phenol/ m2 x d, almost 100% phenol removal, and over 90% COD removal was achieved. The lower operating cost combined with higher phenol-removal efficiency and a low sludge effluent concentration can be achieved by using this reactor for phenol wastewater treatment.

Catalytic wet peroxide oxidation of p-nitrophenol by Fe (III) supported on resin.

Fe(III) supported on resin (Fe(III)-resin) as an effective catalyst for peroxide oxidation was prepared and applied for the degradation of p-nitrophenol (PNP). Catalytic wet peroxide oxidation (CWPO) experiments with hydrogen peroxide as oxidant were performed in a batch rector with p-nitrophenol as the model pollutant. Under given conditions (PNP concentration 500 mg/L, H(2)O(2) 0.1 M, 80°C, resin dosage 0.6% g/mL), p-nitrophenol was almost completely removed, corresponding to an 84% of COD removal. It was found that the reaction temperature, oxidant concentration. and initial pH of solution significantly affected both p-nitrophenol conversion and COD removal by oxidation. It can be inferred from the experiments that Fe(III) supported on resin was an effective catalyst in the mineralization of p-nitrophenol. In an acidic environment of oxidation, the leaching test showed that there was only a slight leaching effect on the activity of catalytic oxidation. It was also confirmed by the aging test of catalysts in the oxidation.

Wet hydrogen peroxide catalytic oxidation of phenol with FeAC (iron-embedded activated carbon) catalysts.

This investigation aims at exploring the catalytic oxidation activity of iron-embedded activated carbon (FeAC) and the application for the degradation of phenol in the wet hydrogen peroxide catalytic oxidation (WHPCO). FeAC catalysts were prepared by pre-impregnating iron in coconut shell with various iron loadings in the range of 27.5 to 46.5% before they were activated. The FeAC catalysts were characterised by measuring their surface area, pore distribution, functional groups on the surface, and X-ray diffraction patterns. The effects of iron loading strongly inhibited the pore development of the catalyst but benefited the oxidation activity in WHPCO. It was found that the complete conversion of phenol was observed with all FeAC catalysts in oxidation. High level of chemical oxygen demand (COD) abatement can be achieved within the first 30 minutes of oxidation. The iron embedded in the activated carbon showed good performance in the degradation and mineralisation of phenol during the oxidation due to the active sites as iron oxides formed on the surface of the activated carbon. It was found that the embedding irons were presented in gamma-Fe(2)O(3), alpha-Fe(2)O(3), and alpha-FeCOOH forms on the activated carbon. The aging tests on FeAC catalysts showed less activity loss, and less iron leaching was found after four oxidation runs.

Sex and age differences in the association between anxiety disorders and narcolepsy: A nationwide population-based case control study.

BACKGROUND: To examine the association between narcolepsy and anxiety disorders. METHODS: This population-based, retrospective case-control study analyzed Taiwan's National Health Insurance Research Database between 2000 and 2013. We included narcoleptic patients aged at least 12 years, diagnosed according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 347. The cases and the propensity score-matched controls were selected in a 1:4 ratio. Each subject with anxiety disorders (ICD-9-CM code 300) was required to visit the outpatient clinic at least three times within a year. Multivariate logistic regression and interaction analyses were used to calculate the association between anxiety disorders and narcolepsy. RESULTS: This study enrolled 478 and 1912 subjects with and without narcolepsy, respectively. After adjusting for covariates, patients with anxiety disorders had an approximately 2.7 odds ratio of developing narcolepsy when compared to the control subjects (adjusted odds ratio [aOR)] = 2.7; 95% confidence interval [CI] = 1.699-4.344). Interaction analysis and subgroup analysis showed a higher incidence of previously diagnosed anxiety disorders in narcoleptic patients aged 12 to 17 years and female patients (aOR = 25.9; 95% CI = 15.194-42.896; aOR = 3.6; 95% CI = 1.818-7.062, respectively). LIMITATIONS: The narcolepsy and anxiety disorders were not distinguished by validated structural diagnostic instruments. CONCLUSIONS: The results of this study revealed higher comorbidity rates of anxiety disorders in narcoleptic patients. The incidence of previously diagnosed anxiety disorders was higher in narcoleptic patients aged 12 to 17 years and female patients.