Effectiveness of Companion Robot Care for Dementia: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Dementia and central nervous system degeneration are common problems in aging societies with regard to the number of people affected and total medical expenses. Socially assistive robotic technology has gradually matured; currently, most scholars believe it can be used as companions in long-term care facilities and to work as caregivers alongside staff to improve the social interaction and mental state of older adults and patients with dementia. Therefore, this study measured the effect of the duration of exposure to socially assistive robots in older adults with dementia. RESEARCH DESIGN AND METHODS: Seven databases were searched up to February 2019 through the consultation of appropriate Internet sites and the use of criteria lists recommended by relevant experts. Randomized controlled trials comparing socially assistive robot use with a control group in older adults with dementia and using at least one of the primary outcomes of agitation, depression, and quality of life were included. RESULTS: Thirteen randomized controlled trials were identified from 873 articles, 7 of which were included in the meta-analysis. The pooled effect estimate from 3 trials with 214 participants revealed that the pet-type robot improved patients' agitation level, with a standardized mean difference of -0.37 (95% CI: -0.64 to -0.10, p < .01) and no heterogeneity (I 2 = 0%). The results also revealed that length of each session and pet-type robot exposure time per week were associated with reduced depression levels (ß = -0.06, Q = 21.213, df = 1, p < .001 and ß = -0.019, Q = 7.532, df = 1, p < .01, respectively). However, the results for quality of life were nonsignificant. DISCUSSION AND IMPLICATIONS: Pet-type robot systems seem to be a potential activity in long-term care facilities for dementia care. Further research is warranted to establish a comprehensive intervention plan related to the use of pet-type robots.

Massage therapy for weight gain in preterm neonates: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: Weight gain is the main criterion for hospital discharge. This study measured the effectiveness of treating preterm neonates with massage therapy. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: Web of Science, Ovid-Medline, CINAHL, ProQuest, and PubMed (up to July 24, 2018). STUDY SELECTION: Randomized controlled trials involving preterm infants with very-low-birth weight or low-birth-weight that examined the effect of massage therapy, and at least one outcome assessing infants' weight change or weight gain. RESULTS: Pooled effect estimate from 15 trials with 697 participants showed that massage therapy improved daily weight gain by 5.07 g/day (95% CI 2.19-7.94, p = 0.0005). More benefits were observed when preterm neonates received moderate pressure massage (5.60 g/day, 95% CI 2.64-8.56, p = 0.0002) than when receiving light-pressure therapy (1.08 g/day, 95% CI 0.29-1.86, p = 0.007). CONCLUSIONS: Massage therapy is beneficial for preterm infant weight gain.

APOE Variant (rs405509) might Modulate the Effect of Sex and Educational Level on Cognitive Impairment Risk in a Taiwanese Population.

Education, sex, and the APOE-rs405509 variant are associated with Alzheimer's disease and cognitive performance. We investigated if the rs405509 TT, TG, and GG genotypes modulate the effect of sex and education on cognitive impairment in Taiwanese adults. Data on cognitive health (defined by Mini-Mental State Examination (MMSE) scores) and rs405509 were from Taiwan Biobank. Participants included 2105 men and 2027 women with a mean age of 64 years. Education below university level was significantly associated with lower MMSE scores. The odds ratios (ORs) were 1.82; 95% confidence interval (CI) 1.38-2.41 for senior high school, 3.39; 95% CI 2.50-4.59 for junior high school, and 11.94; 95% CI 9.91-15.50 for elementary school and below (p-trend < 0.05). The association between MMSE score and sex was significant only in the lowest educational group (elementary and below), with lower odds of having a low MMSE score in men compared to women (OR = 0.51; 95% CI 0.34-0.77). After stratification by rs405509 genotypes, this association was significant only among TT genotype carriers (OR = 0.481; CI = 0.253-0.915). In conclusion, a significant association between MMSE score and sex was observed in the lowest educational group, especially among carriers of rs405509 TT genotypes.

Genetic and Non-Genetic Factor-Adjusted Association between Coffee Drinking and High-Density Lipoprotein Cholesterol in Taiwanese Adults: Stratification by Sex.

Low high-density lipoprotein cholesterol (HDL-C) is a major risk factor for cardiovascular diseases (CVDs), the leading cause of global mortality. We aimed to determine the effect of coffee drinking and sex and their interaction, as well as rs1800588 and rs1800775 polymorphisms on HDL-C levels in Taiwanese adults. Data of 4262 men and 4813 women, aged 30-70 years, were retrieved from Taiwan Biobank. The interaction between sex and coffee drinking on HDL-C was significant (p = 0.0452). Coffee consumption was significantly associated with higher HDL-C levels in only women (ß = 0.81679; p = 0.0246). However, rs1800588 and rs1800775 variants were significantly associated with HDL-C in both sexes. In women, ß-values were 0.99080; p = 0.0059 and 3.16277; p < 0.0001 for rs1800588 CT and TT genotypes, respectively and -1.80954; p < 0.0001 and -2.81512; p < 0.0001 for rs1800775 AC and CC genotypes, respectively. In men, ß-values were 1.32430; p < 0.0001 and 3.24976; p < 0.0001 for rs1800775 CT and TT genotypes, respectively and -1.96232; p < 0.0001 and -2.71536, p < 0.0001 for the AC and CC genotypes, respectively. In conclusion, coffee drinking was significantly associated with higher high-density lipoprotein (HDL) levels in women but not men after adjusting for confounders including rs1800588 (LIPC) and rs1800775 (CETP) variants.

The Interaction between Sex and Hyperlipidemia on Gout Risk Is Modulated by HLA-B Polymorphic Variants in Adult Taiwanese.

The effects of genetic variants on the interaction between hyperlipidemia and sex have not been investigated among gout patients in Taiwan. Using Taiwan Biobank and the National Health Insurance Research Database (NHIRD), we examined hyperlipidemia, sex, and their relationship with gout among Taiwanese adults with the human leukocyte antigen B (HLA-B) genetic variants. Hyperlipidemia was present in 1437 patients with gout. Sex and hyperlipidemia had significant associations on gout risk, with hyperlipidemia showing a relatively stronger effect. Gout was present in men, with an odds ratio (OR) of 1.945 (95% confidence interval (CI) 1.568⁻2.411) compared to women, and in hyperlipidemic (OR = 4.032; 95% CI: 3.581⁻4.540) compared to non-hyperlipidemic patients. The interaction of sex and hyperlipidemia was significant for rs2523608 GG (p = 0.0402) and rs4713518 AA (p = 0.0003) genotypes. After stratification, hyperlipidemia remained a risk factor in women (OR = 4.735, 95% CI: 3.375⁻6.643) and men (OR = 3.640, 95% CI: 2.916⁻4.544) with rs2523608 GG genotype. The odds ratio in hyperlipidemic women and men with rs4713518 AA genotype was 7.454 (95% CI 5.103⁻10.888) and 3.585 (95% CI 2.854⁻4.503), respectively. Our study indicates that hyperlipidemia-sex interactions exist for gout risk in Taiwanese adults with rs2523608 GG and rs4713518 AA genotypes.

Identifying cut-off scores for interpretation of the Heart Failure Impact Questionnaire.

AIMS: Heart failure (HF) influences health-related quality of life. However, the factors that contribute to health-related quality of life remain unclear in Taiwan. We aim to identify the factors influencing health-related quality of life in HF patients. METHODS: Hospitalized HF (N = 225) patients were included from April 2011 to April 2014. Health-related quality of life was assessed by using the 36-Item Short-Form Health Survey (SF-36) and the Minnesota Living with Heart Failure Questionnaire. A new cut-off was conducted based on the combination of SF-36 and Minnesota Living with Heart Failure questionnaire. RESULTS: There were significant differences between good and poor quality groups on age, gender, education levels, occupational classification caregiver, New York Heart Association classes, and the numbers of comorbidities. The logistic regression analysis showed that the number of comorbidities was more than three and New York Heart Association class IV were significantly associated with health-related quality of life.

Outcome of Gamma Knife radiosurgery for trigeminal neuralgia associated with neurovascular compression.

We reviewed 130 patients from 1999 to 2012 to evaluate whether neurovascular compression (NVC) has prognostic value for pain relief in idiopathic trigeminal neuralgia (TN) treated by Gamma Knife radiosurgery (GKRS). Patients were assigned to one of the following groups based on NVC identified by MRI: no NVC, small vessel NVC, and large vessel (defined as part of the vertebrobasilar arterial system) NVC. Follow-up ranged from 4 to 14years. Primary outcome was pain graded by the Barrow Neurological Institute (BNI) pain scale. Successful pain control was defined asa score within Grade I-IIIb. Among the 130 patients, 53 had no neurovascular compression (group 1), 60 had a small vessel NVC (group 2), and 17 had a large vessel NVC (group 3). Successful pain control was 85% in group 1, 75% in group 2, and 88% in group 3 (X2=2.480, p=.289). Secondary outcome was new onset facial numbness which was 21% in group 1, 28% in group 2, and 35% in group 3 (X2=1.683, p=.431). NVC did not affect pain outcome for TN patients treated by GKRS. The lack of poorer response with large vessel NVC that has been reported in literature may be explained by treatment of multiple 4mm shots (as opposed to a single shot in 11/17 patients) to cover a larger compression area of the nerve root by a tortuous vessel.

Effects of Educational Intervention on State Anxiety and Pain in People Undergoing Spinal Surgery: A Randomized Controlled Trial.

Preoperative educational intervention for anxiety and pain affects patients undergoing spinal surgery. The effects, however, have never been examined using randomized controlled designs. To investigate the effects of education on anxiety and pain for patients undergoing spinal surgery, a randomized trial with block design was used. Patients were recruited from a medical center in central Taiwan. We invited 90 patients to participate in this study. Inclusion criteria were (a) age ≥20 years, (b) voluntary participation, (c) able to understand Taiwanese Mandarin Chinese or Taiwanese, and (4) no hearing or vision impairments after using aids. Patients (n = 86) undergoing lumbar spinal surgery were randomized into either an Intervention group (using educational intervention; n = 43) or a Control group (n = 43); four patients voluntarily dropped out after surgery (one in Intervention group; three in Control group). Patients had their anxiety (using the State-Trait Anxiety Inventory; STAI) and pain (using a visual analog scale) measured the day before surgery, 30 minutes before surgery, and the day after surgery. After controlling for demographics, the adjusted anxiety and pain levels were significantly lower for the Intervention group: mean STAI scores were 52.67 at baseline and 47.54 at 30 minutes before surgery (p < .001); mean pain scores were 6.07 at baseline and 5.28 on day after surgery (p < .001). Preoperative educational intervention is effective in informing patients undergoing spinal surgery that can lead to a reduction in pain, anxiety, and fear postoperatively.

Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis.

"Physical restraint" formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities. DESIGN: A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (ß: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (ß: -0.07, p < 0.001; ß: -0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers.

The effectiveness of clinical problem-based learning model of medico-jurisprudence education on general law knowledge for Obstetrics/Gynecological interns.

OBJECTIVE: The effective education method of medico-jurisprudence for medical students is unclear. The study was designed to evaluate the effectiveness of problem-based learning (PBL) model teaching medico-jurisprudence in clinical setting on General Law Knowledge (GLK) for medical students. MATERIALS AND METHODS: Senior medical students attending either campus-based law curriculum or Obstetrics/Gynecology (Ob/Gyn) clinical setting morning meeting from February to July in 2015 were enrolled. A validated questionnaire comprising 45 questions were completed before and after the law education. RESULTS: The interns attending clinical setting small group improvisation medico-jurisprudence problem-based learning education had significantly better GLK scores than the GLK of students attending campus-based medical law education course after the period studied. CONCLUSION: PBL teaching model of medico-jurisprudence is an ideal alternative pedagogy model in medical law education curriculum.

Comparing effects between music intervention and aromatherapy on anxiety of patients undergoing mechanical ventilation in the intensive care unit: a randomized controlled trial.

PURPOSE: Using patient-reported outcomes and physiological indicators to test the effects of music intervention and aromatherapy on reducing anxiety for intensive care unit (ICU) patients undergoing mechanical ventilation. METHODS: Patients with ICU admission duration >24 h were randomly assigned to a Music intervention group (n = 41), Aromatherapy group (n = 47), or Control group (rest only; n = 44). Each patient in the Music group listened to music; each patient in the Aromatherapy group received lavender essential oil massage on his/her back for 5 min; each patient in the Control group wore noise-canceling headphones. Anxiety was measured using the Chinese version of the Stage-Trait Anxiety Inventory (C-STAI) and the Visual Analogue Scale for Anxiety (VAS-A) at baseline, post-test, and 30-min follow-up. Heart rate, breathing rate, and blood pressure were measured every 10 min from baseline to the 30-min follow-up. RESULTS: The Music group had significantly better post-test VAS-A and C-STAI scores, and had lower heart rate and blood pressure than the Control group. The Aromatherapy group had significantly better VAS-A score and lower heart rate than the Control group. The 30-min follow-up showed that both Music and Aromatherapy groups had lower heart rate and blood pressure than the Control group. CONCLUSIONS: Music and aromatherapy interventions were both effective for ICU patients. The effects of music intervention were greater than that of aromatherapy; both interventions maintained the effects for at least 30 min.

Effects of Music Intervention on State Anxiety and Physiological Indices in Patients Undergoing Mechanical Ventilation in the Intensive Care Unit.

Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention ( n = 41) or control group ( n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures ( p < .02) and pre-post differences ( p < .03) except for diastolic blood pressure. Because of music intervention's low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient's mood should be monitored after the music intervention.

Association of single-nucleotide polymorphisms of high-mobility group box 1 with susceptibility and clinicopathological characteristics of uterine cervical neoplasia in Taiwanese women.

To date, no study associated the genetic polymorphisms of high-mobility group box 1 protein (HMGB1) with the development of uterine cervical cancer. We therefore conducted this study to investigate the associations of HMGB1 single-nucleotide polymorphisms (SNPs) with cervical carcinogenesis and clinicopathological characteristics of cancer patients. Five hundred two women, including 112 with invasive cancer, 85 with precancerous lesions of the uterine cervix, and 305 normal controls, were consecutively enrolled into this study. Analysis of HMGB1 SNPs was done by real-time polymerase chain reaction and genotyping. Our results found that the risk of susceptibility to cervical invasive cancer was 1.85 (95 % CI 1.12-3.04; p = 0.016) in women with TC and 1.99 (95 % CI 1.24-3.23; p = 0.005) in women with TC/CC after adjusting for age, using TT as a comparison reference in HMGB1 SNP rs1412125. In rs2249825, the increased risk was also seen for the development of cervical invasive cancer in women with CG [adjusted odds ratio (AOR) 2.04, 95 % CI 1.22-3.40; p = 0.006] or CG/GG (AOR 2.02, 95 % CI 1.22-3.32; p = 0.006) using CC as a comparison reference. An additional integrated in silico analysis confirmed that rs2249825 creates a binding site for v-Myb, which may affect HMGB1 expression. In conclusion, Taiwanese women with TC or TC/CC in HMGB1 SNP rs1412125 as well as CG or CG/GG in rs2249825 were susceptible to the development of cervical invasive cancer.

Personal History and Physical Examination in Judgment of Urinary Tract Infection in Children Aged 3 Months to 2 Years.

BACKGROUND: Pediatricians ubiquitously rely on urine analysis for diagnosing urinary tract infection (UTI) in young febrile children due to discrepancies in symptom presentation. This study aimed to identify the determinants of physical examination and personal history for diagnosing UTI. METHODS: Four hundred and ten patients aged between 3 months and 2 years presenting with a tympanic temperature of >38°C for >24 hours were requested to undergo urinary tests. Pediatricians completed patient record charts before the test results were generated, examined the final results of the tests, and compared the results with those reported in the medical records. Multivariate logistic regression analysis was performed to detect potential confounding factors. RESULTS: An age of <1 year [odds ratio (OR): 5.05; p < 0.01], female sex (OR: 2.117; p < 0.05), and the absence of throat redness (OR: 1.907; p < 0.05) were risk factors for UTI. Patients defecating ≤3 times/day (OR: 8.80; p < 0.05) were more likely to have pyuria than those who defecated >3 times/day. CONCLUSION: For febrile patients in the age group examined, the absence of throat redness and female sex were independent predictors of UTI. Moreover, the risk of UTI was higher in younger patients.

Risk of autistic disorder after exposure to general anaesthesia and surgery: a nationwide, retrospective matched cohort study.

BACKGROUND: Deficits of learning, memory and cognition have been observed in newborn animals exposed to general anaesthetics. However, conclusions from clinical studies conducted in humans to investigate the relationship between anaesthesia and neurodevelopmental disorders have been inconsistent. Autistic disorder is typically recognised earlier than other neurobehavioural disorders. Although certain genes apparently contribute to autistic disorder susceptibility, other factors such as perinatal insults and exposure to neurotoxic agents may play a crucial role in gene-environmental interaction. OBJECTIVE: This study was designed to investigate the association of exposure to general anaesthesia/surgery with autistic disorder. We hypothesised that exposure to general anaesthesia and surgery before 2 years of age is associated with an increased risk of developing autistic disorder. DESIGN: A retrospective matched-cohort study. SETTING: A medical university. Data from the National Health Insurance Research Database of Taiwan from 2001 to 2010 were analysed. PATIENTS: The birth cohort included 114,435 children, among whom 5197 were exposed to general anaesthesia and surgery before the age of 2 years. The 1 : 4 matched controls comprised 20,788 children. MAIN OUTCOME MEASURES: The primary endpoint was the diagnosis of autistic disorder after the first exposure to general anaesthesia and surgery. RESULTS: No differences were found in the incidence of autistic disorder between the exposed group (0.96%) and the unexposed controls (0.89%) (P = 0.62). Cox proportional regression showed that the hazard ratio of exposure to general anaesthesia and surgery was 0.93 [95% confidence interval (95% CI) 0.57 to 1.53] after adjusting for potential confounders. Age at first exposure did not influence the risk of autistic disorder. No relationship was found between the total number of exposures and the risk of autistic disorder. CONCLUSION: Exposure to general anaesthesia and surgery before the age of 2 years age at first exposure and number of exposures were not associated with the development of autistic disorder.

Increased plasma soluble CD40 ligand concentration in pelvic inflammatory disease.

BACKGROUND: The role of soluble CD40 ligand (sCD40L) in pelvic inflammatory disease (PID) remains unclear. We sought to determine whether sCD40L was an efficient serum marker as with WBC and CRP in PID patients. METHODS: Enzyme-linked immunosorbent assay was used to measure the plasma levels of sCD40L before and after routine protocol treatments in sixty-four PID patients and seventy healthy controls. RESULTS: The level of plasma sCD40L (pg/ml) was significantly elevated in PID patients (1632.83±270.91) compared to that in normal controls (700.33±58.77; p=0.001) and decreased significantly as compared to that in the same patients (928.77±177.25; p=0.0001) after they received treatment. The concentration of sCD40L was significantly correlated with the level of plasma C-reactive protein (CRP) in the blood (r=0.202, p=0.01, n=134). When the cutoff level of plasma sCD40L levels was determined to be 1612.26pg/ml based on ROC, the sensitivity, specificity, and the area under the curve of plasma sCD40L level for predicting PID were 0.26, 0.97, and 0.58 (95% confidence interval: 0.48-0.68), respectively, while the adjusted odds ratio (AOR) with their 95% CI of plasma sCD40L for PID risk was 7.09 (95% CI=1.14-43.87, p=0.03). CONCLUSIONS: The expression of plasma sCD40L was increased in patients with PID and detection of plasma sCD40L could be useful for the diagnosis of PID.

Correlation of plasma osteopontin and neutrophil gelatinase-associated lipocalin levels with the severity and clinical outcome of pelvic inflammatory disease.

OBJECTIVE: To investigate the correlation of two important inflammatory biomarkers, plasma osteopontin and neutrophil gelatinase-associated lipocalin (NGAL), with the severity and outcome of pelvic inflammatory disease (PID). MATERIALS AND METHODS: Sixty-one patients with PID, including 25 patients with tubo-ovarian abscess (TOA), were consecutively recruited. Their blood samples were tested for the concentrations of plasma osteopontin and NGAL using enzyme-linked immunosorbent assay. The associations of these biomarkers with TOA, length of hospitalization, and incidence of surgery were also analyzed. RESULTS: Plasma osteopontin level was significantly increased in PID patients with TOA compared to PID patients without TOA (median 107.77 ng/mL vs. 72.39 ng/mL, p = 0.004). However, there was no significant difference for plasma NGAL. If the cutoff level of plasma osteopontin was set at 81.1 ng/mL, there was a 76.0% sensitivity and a 24.0% false negative rate in predicting TOA in PID patients. Plasma osteopontin significantly correlated with length of hospital stay (r = 0.467, p < 0.001), and this correlation was better than that of NGAL. However, neither biomarker was associated with incidence of surgery. CONCLUSION: Plasma osteopontin has a better correlation with TOA and length of hospitalization compared to NGAL. If plasma osteopontin level falls below 81.1 ng/mL, PID patients will have about a 20% chance of developing TOA. Incorporating plasma osteopontin, but not NGAL, will allow for an adjuvant diagnostic biomarker for TOA and predictor of length of hospital stay.

Vegan diet and blood lipid profiles: a cross-sectional study of pre and postmenopausal women.

BACKGROUND: Vegan diet has been associated with lower risk of cardiovascular diseases and mortality, partly due to its effects on serum lipid profiles. Lipid profiles [high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and triglycerides (TG)] have not been fully elucidated either in pre and postmenopausal vegans or in ovo-lacto vegetarians. This study aimed to compare lipid profiles among vegans, ovo-lacto vegetarians and omnivores. METHODS: Demographic data and lipid profiles were obtained from the 2002 Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia. Multivariate linear regression analysis was used to examine factors significantly and independently associated with different categories of veganism and to estimate the ß value of lipid profiles in the dietary types. RESULTS: A total of 2397 premenopausal and 1154 postmenopausal participants who did not receive lipid lowering drugs were enrolled. Premenopausal vegans had significantly lower HDL-C and higher TG, LDL-C/HDL-C, total cholesterol (TC)/HDL-C and TG/HDL-C compared with omnivores. For postmenopausal women, vegans had lower TC while ovo-lacto vegetarians were observed with low HDL-C when compared with omnivores. Multivariate linear regression analyses showed that vegan and ovo-lacto vegetarian diets decreased HDL-C levels in premenopausal women (ß = -7.63, p = 0.001 and ß = -4.87, p = 0.001, respectively). There were significant associations between lower LDL-C and ovo-lacto vegetarian diets (ß = -7.14, p = 0.008) and also between TG and vegan diet (ß = 23.37, p = 0.008), compared with omnivorous diet. Post-menopausal women reported to have consumed either a vegan or an ovo-lacto vegetarian diet were at the risk of having low HDL-C unlike those that consumed omnivorous diets (ß = -4.88, p = 0.015 and ß = -4.48, p = 0.047). There were no significant changes in LDL-C in both pre and postmenopausal vegans. CONCLUSIONS: Vegan diet was associated with reduced HDL-C level. Because of its effects on lowering HDL-C and LDL-C, ovo-lacto vegetarian diet may be more appropriate for premenopausal women.

Inappropriate use of standard error of the mean when reporting variability of study samples: a critical evaluation of four selected journals of obstetrics and gynecology.

OBJECTIVE: The study was designed to investigate the frequency of misusing standard error of the mean (SEM) in place of standard deviation (SD) to describe study samples in four selected journals published in 2011. Citation counts of articles and the relationship between the misuse rate and impact factor, immediacy index, or cited half-life were also evaluated. MATERIALS AND METHODS: All original articles in the four selected journals published in 2011 were searched for descriptive statistics reporting with either mean ± SD or mean ± SEM. The impact factor, immediacy index, and cited half-life of the journals were gathered from Journal Citation Reports Science edition 2011. Scopus was used to search for citations of individual articles. The difference in citation counts between the SD group and SEM group was tested by the Mann-Whitney U test. The relationship between the misuse rate and impact factor, immediacy index, or cited half-life was also evaluated. RESULTS: The frequency of inappropriate reporting of SEM was 13.60% for all four journals. For individual journals, the misuse rate was from 2.9% in Acta Obstetricia et Gynecologica Scandinavica to 22.68% in American Journal of Obstetrics & Gynecology. Articles using SEM were cited more frequently than those using SD (p = 0.025). An approximate positive correlation between the misuse rate and cited half-life was observed. CONCLUSION: Inappropriate reporting of SEM is common in medical journals. Authors of biomedical papers should be responsible for maintaining an integrated statistical presentation because valuable articles are in danger of being wasted through the misuse of statistics.

Exposure to general anesthesia in early life and the risk of attention deficit/hyperactivity disorder development: a nationwide, retrospective matched-cohort study.

BACKGROUND: Postnatal exposure to anesthetics can cause neural apoptosis and degeneration in animals, but results from studies conducted on humans were discordant. Previous studies contained no information on the relationship between neurobehavioural disorders and anesthesia exposure in Asian children. We conducted a retrospective matched-cohort study in Taiwan to investigate the association of early life anesthesia exposure with risk of attention deficit/hyperactivity disorder (ADHD). METHODS: Data were obtained from the National Health Insurance Research Database of Taiwan. Children born between January 1, 2001 and December 31, 2005 were included. Each child with anesthesia exposure before 3 years of age was matched to four unexposed children. Observation was concluded on December 31, 2010. Proportional hazards regression was used to assess the association of anesthesia exposure with ADHD. Analyses were also made based on exposure number and age at the time of first exposure. RESULTS: This matched-cohort comprised of 16 465 children, among which 3293 were exposed to general anesthesia before age 3 years. The adjusted hazard ratio of developing ADHD was 1.06 (95% CI: 0.86,1.31) for general anesthesia exposure. The adjusted hazard ratio of developing ADHD for single and multiple exposures were 1.11 (95% CI: 0.88, 1.41) and 0.96 (95% CI: 0.71,1.31), respectively. No trend of increasing risk was noted based on age at the time of first exposure. CONCLUSIONS: Exposure to general anesthesia before 3 years of age was not associated with ADHD.