GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment.

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Combining polygenic risk scores and human leukocyte antigen variants for personalized risk assessment of type 1 diabetes in the Taiwanese population.

AIMS: To analyse the genome-wide association study (GWAS) data of patients with type 1 diabetes mellitus (T1D) in order to develop a risk score for the genetic effects on T1D risk and age at diagnosis in the Taiwanese population. MATERIALS AND METHODS: We selected 610 patients with T1D and 2511 healthy individuals from an electronic medical record database of more than 300 000 individuals with genetic information, analysed their GWAS data, and developed a polygenic risk score (PRS). RESULTS: The PRS, based on 149 selected single-nucleotide polymorphisms, could effectively predict T1D risk. A PRS increase was associated with increased T1D risk (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.72-2.55). Moreover, a 1-unit increase in standardized T1D PRS decreased the age at diagnosis by 0.74 years. Combined PRS and human leukocyte antigen (HLA) DQA1*03:02-DQA1*05:01 genotypes could accurately predict T1D risk. In multivariable models, HLA variants and PRS were independent risk factors for T1D risk (OR 3.76 [95% CI 1.54-9.16] and 1.71 [95% CI 1.37-2.13] for HLA DQA1*03:02-DQA1*05:01 and PRS, respectively). In a limited study population of those aged ≤18 years, PRS remained significantly associated with T1D risk. The association between T1D PRS and age at diagnosis was more obvious among males and patients aged ≤18 years. CONCLUSIONS: Polygenic risk score and HLA variations enable personalized risk estimates, enhance newborn screening efficiency for ketoacidosis prevention, and addresses the gap in data on T1D prediction in isolated Asian populations.

Cutoff Point of Mini-Balance Evaluation Systems Test Scores for Elderly Estimated by Center of Pressure Measurements by Linear Regression and Decision Tree Classification.

BACKGROUND: Understanding balance ability and assessing the risk of possible falls are very important for elderly rehabilitation. The Mini-Balanced Evaluation System Test (Mini-BESTest) is an important survey for older adults to evaluate subject balance, but it is not easy to complete due to various limitations of physical activities, including occasional fear of injury. A center of pressure (CoP) signal can be extracted from a force pressure plate with a short recording time, and it is relatively achievable to ask subjects to stand on a force pressure plate in a clinical environment. The goal of this study is to estimate the cutoff score of Mini-BESTest scores from CoP data. METHODS: CoP signals from a human balance evaluation database with data from 75 people were used. Time domain, frequency domain, and nonlinear domain parameters of 60 s CoP signals were extracted to classify different cutoff point scores for both linear regression and a decision tree algorithm. Classification performances were evaluated by accuracy and area under a receiver operating characteristic curve. RESULTS: The correlation coefficient between real and estimated Mini-BESTest scores by linear regression is 0.16. Instead of linear regression, binary classification accuracy above or below a cutoff point score was developed to examine the CoP classification performance for Mini-BESTest scores. The decision tree algorithm is superior to regression analysis among scores from 16 to 20. The highest area under the curve is 0.76 at a cutoff point score of 21 for the CoP measurement condition of eyes opened on the foam, and the corresponding classification accuracy is 76.15%. CONCLUSIONS: CoP measurement is a potential tool to estimate corresponding balance and fall survey scores for elderly rehabilitation and is useful for clinical users.

An Adapted Hybrid Model for Hands-On Practice on Disaster and Military Medicine Education in Undergraduate Medical Students During the COVID-19 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial impacts on all aspects of medical education. Modern health systems must prepare for a wide variety of catastrophic scenarios, including emerging infectious disease outbreaks and human and natural disasters. During the COVID-19 pandemic, while the use of traditional teaching methods has decreased, the use of online-based teaching methods has increased. COVID-19 itself and the accompanying infection control measures have restricted full-scale practice. Therefore, we developed an adapted hybrid model that retained adequate hands-on practice and educational equality, and we applied it with a group of undergraduate medical students participating in a mandatory disaster education course in a military medical school. Methods: The course covered the acquisition of skills used in emergency and trauma scenarios through designated interdisciplinary modules on disaster responses. Several asynchronous and synchronous online webinars were used in this one-credit mandatory disaster and military medicine education course. To allow opportunities for hands-on practice and ensure education equality, the students were divided into 15 groups, with 12 students in each group. The hands-on practice exercises were also recorded and disseminated to the students in the designated area for online learning. Results: A total of 164 3rd-year medical students participated in this mandatory disaster and military medicine course during the COVID-19 pandemic. The satisfaction survey response rate was 96.5%. The students were satisfied with the whole curriculum (3.8/5). Most of the free-text comments regarding the course represented a high level of appreciation. The students felt more confident in the knowledge and skills they gained in hands-on exercises than they did in the knowledge and skills they gained in online exercises. The students showed significant improvements in knowledge after the course. Conclusions: We demonstrated that this adapted hybrid arrangement provided an enhanced learning experience, but we also found that medical students were more confident in their knowledge and skills when they had real hands-on practice.

Multiple metal(loid)s bioaccessibility from cooked seafood and health risk assessment.

Seafood has been generally considered to be the main diet exposure source of metal(loid)s. We evaluated health risk of mercury (Hg), arsenic (As), cadmium (Cd), lead (Pb), chromium (Cr), nickel (Ni), copper (Cu), and zinc (Zn) through consumption of cooked seafood based on bioaccessibility, which was obtained by physiologically based extraction test method. Results showed that cooking practices could decrease metal(loid)s concentration from seafood (by 6.0-45.7%). Metal(loid)s release from seafood in this study followed the descending order of Hg > Zn > Ni > Cd > Pb > As > Cu > Cr. On average, cooking lowered the bioaccessibility of As, Hg, Cd, Pb, Ni, Cr, Cu, and Zn by 15.2, 26.1, 30.9, 30.7, 25.7, 31.2, 17.6, and 22.4%, respectively. Health risk calculation results showed that Cr, Ni, and Zn in seafood species in this study were within the human health benefits range. Hg, Cd, Pb, and Cu exposure from cooked seafood was within the safe dose. However, we found that there is a potential of having cancer (especially bladder and lung cancer) for people exposure to iAs from seafood based on bioaccessible contents the first time.

Assessment of Co-benefits of vehicle emission reduction measures for 2015-2020 in the Pearl River Delta region, China.

Vehicle emissions have become one of the key factors affecting the urban air quality and climate change in the Pearl River Delta (PRD) region, so it is important to design policies of emission reduction based on quantitative Co-benefits for air pollutants and greenhouse gas (GHG). Emissions of air pollutants and GHG by 2020 was predicted firstly based on the no-control scenario, and five vehicle emissions reduction scenarios were designed in view of the economy, technology and policy, whose emissions reduction were calculated. Then Co-benefits between air pollutants and GHG were quantitatively analyzed by the methods of coordinate system and cross-elasticity. Results show that the emissions reduction effects and the Co-benefits of different measures vary greatly in 2015-2020. If no control scheme was applied, most air pollutants and GHG would increase substantially by 20-64% by 2020, with the exception of CO, VOC and PM2.5. Different control measures had different reduction effects for single air pollutant and GHG. The worst reduction measure was Eliminating Motorcycles with average reducing rate 0.09% for air pollutants and GHG, while the rate from Updated Emission Standard was 41.74%. Eliminating Yellow-label Vehicle scenario had an obvious reduction effect for every single pollutant in the earlier years, but Co-benefits would descent to zero in later by 2020. From the perspective of emission reductions and co-control effect, Updated Emission Standard scenario was best for reducing air pollutants and GHG substantially (tanα=1.43 and Els=1.77).

The Development and Psychometric Properties of the Children's Sleep Assessment Questionnaire in Taiwan.

To develop and examine the validity and reliability of the Children's Sleep Assessment Questionnaire (CSAQ) for school-aged children in Taiwan. DESIGN AND METHODS: We used a cross-sectional study design with stratified random sampling. Pairs of children and parents were recruited from a school-based sample of third- and fourth-grade students, enrolling 362 child and parent pairs. The content validity, construct validity, convergent validity, internal consistency, and inter-rater reliability of the CSAQ were assessed. RESULTS: The CSAQ comprised three parts: sleep hygiene, sleep quality, and sleep disturbance. Sleep hygiene showed a moderate intra-class correlation coefficient (0.37-0.66) between children and parents. Results of exploratory factor analysis suggested a four-factor structure model for sleep quality with 64.9% of variance and a two-factor structure for sleep disturbance with 57.7% of variance. These two models also demonstrated good fit with the confirmatory factor analysis. CONCLUSIONS: The CSAQ is a valid and reliable instrument for assessing sleep problems in school-aged children. PRACTICE IMPLICATIONS: Both clinicians and researchers can use the CSAQ to screen or elucidate the children' sleep problems.

Psychometric Testing of Behavior Assessment for Children.

PURPOSE: The purpose of this study was to test the reliability and validity of the Behavior Assessment for Children (BAC) in a community of school-aged children in Taiwan. METHOD: A school-based sample comprising third grade and fourth grade students was recruited from Taichung City in Taiwan. The parents (n = 248) and teachers (n = 15) of these students completed structured questionnaires, including the Child Behavior Checklist (CBCL) and the proposed BAC. Content validity, concurrent validity, construct validity, internal consistency, and inter-rater reliability of the BAC were assessed. RESULTS: The BAC comprised three subscales (attention, emotion, and self-control) that included 17 items. The content validity index (CVI) score was 0.98. The result of the confirmatory factor analysis (goodness of fit = .90, root mean square of residual = .03, root mean square error of approximation = .06, and comparative fit index = .94) supported the construct validity of the three BAC subscales. The concurrent validity of the BAC subscales significantly correlated with the compatible CBCL subscales (r = .59-.78, p < .001). Cronbach α of the subscales of the BAC ranged from .78 to .92. The intraclass correlation coefficient between the parents and teachers ranged from .31 to .44, and the joint probability of agreement ranged from 31.4% to 92.2%. CONCLUSIONS: The BAC is a valid and reliable instrument for evaluating behavioral problems in school-aged children.

An Efficient and Facile Method for the Synthesis of Benzimidazoisoquinoline Derivatives via a Multicomponent Reaction.

Two series of benzimidazoisoquinoline and fused benzimidazoisoquinoline-benzimidazole derivatives have been synthesized using an efficient one-pot procedure. This process involves an intramolecular nucleophilic substitution reaction and provides facile access to two series of complexes and potentially interesting biologically active scaffolds.

Unsedated versus sedated gastrointestinal endoscopy: a questionnaire investigation in Wuhan, central China.

National data show that in China mainland unsedated gastrointestinal (GI) endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own decisions: the unsedated group (n=1000) and the sedated group (n=800). After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unsedated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference (P<0.01). Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% between the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% patients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure (P<0.01). In China, unsedated GI endoscopy is now widely accepted by the majority of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people's living standard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually accepted by more patients.

Assessing student nurses' learning needs for addressing patients' sexual health concerns in Taiwan.

BACKGROUND: Patients' health status may involve sexual issues and nursing education must prepare nurses to address patients' sexual health concerns. In Taiwan, nursing school curricula rarely include programs related to patients' sexuality or sexual health issues, and reflect conservative Asian attitudes toward sexuality. OBJECTIVES: Our aims were to determine Taiwanese student nurses' learning needs relative to addressing patients' sexual health concerns, and to gather information for curriculum development in sexual health education. DESIGN: Descriptive, correlational study. SETTING: Nursing school at a medical university in central Taiwan. PARTICIPANTS: 140 senior student nurses. METHODS: A 24-item instrument entitled "Learning Needs for Addressing Patients' Sexual Health Concerns" (LNAPSHC) was developed through 15 semi-structured interviews of senior nursing students, expert review, and comparative analysis of text and field notes. Content validity and reliability were evaluated using exploratory factor analysis to measure construct validity and Cronbach's alpha to measure internal consistency. Univariate and multivariate linear models were developed. RESULTS: Age, gender, and religion were not significant influences. Expressed learning needs included sexuality in health and illness, communication about patients' intimate relationships, and approaches to sexual health care. "Obtaining a comprehensive sexual health history" was the highest learning need. "Having sexual consultations with patients without embarrassment" was lower. Most participants recognized their role in sexuality-related health care, but their preparation and willingness to address it were limited. CONCLUSIONS: Our results indicated a gap between student nurses' positive perspectives on the role of nursing in sexual health care and their limited intention to provide it. Reported learning needs indicated that student nurses needed an effective curriculum to increase their ability and willingness to address patients' sexual health. Our results may help nursing educators develop curricula and clinical training to increase student nurses' competence in addressing patients' sexual health concerns.

An audiometer to monitor progressive hearing change in school-aged children.

OBJECTIVE: The purpose of this study was to develop a cost-effective and easy to use audiometer to monitor progressive hearing change in school-aged children. DESIGN: The hardware of the audiometer developed included a computer, an external sound blaster and a headphone. The hearing screening software was developed to control the pure tone sound level with modulability in the range of 0-45 dB HL at 1, 2, 4 and 0.5 kHz frequencies. Thirty sixth-grade children, aged 12-13 years old, were randomly divided into two groups for a hearing test in a conference room. Testing for one group was performed by a person with experience and the other group was examined by a graduate student who was not familiar with the device. After the hearing test, all children were immediately screened using a clinical diagnostic audiometer in a soundproof room by an audiologist. RESULTS: Most of the threshold dB values obtained by the audiometer in a conference room (55 ears, 93.2%) were significantly greater than those obtained by the clinical audiometer in a soundproof room. Most of the differences between these two measurements were within 5 dB (94.9%). Only 5.1% had a discrepancy within the maximum range of 10 dB. The correlation and intraclass correlation coefficients between the two measurements were 0.861 and 0.929, respectively. The results also indicated that the experience level of the screening personnel did not affect the testing. CONCLUSION: The newly developed audiometer is quite cost-effective and can be easily operated. The threshold dB values obtained by the audiometer developed in a conference room were comparable with the results of a clinical audiometer in a soundproof room. The audiometer developed could measure the hearing threshold values and, therefore, be useful in monitoring progressive hearing change in school-aged children.

Epidemiology and economic burden of rotavirus gastroenteritis in hospitals and paediatric clinics in Taiwan, 2005-2006.

Baseline estimates of rotavirus disease burden and epidemiology are useful for the evaluation of newly introduced rotavirus vaccination programs. Prospective, cross-sectional surveillance for acute gastroenteritis (AGE) was conducted in hospitals and outpatient paediatric clinics in Taiwan to assess the prevalence of rotavirus gastroenteritis and associated medical costs prior to rotavirus vaccine introduction. Faecal specimens were collected from 1130 children <5 years of age from December 2004 to June 2006. The year-round rate of rotavirus detection in faecal specimens was 46% for children seen in hospitals and 14% for children seen in paediatric clinics. In the winter season, the burden was higher, reaching a peak of 60% and 21% in hospitals and paediatric clinics, respectively. The rotavirus genotype distributions were 39% (G1), 34% (G9), 12% (G2), 15% (G3), and 0.3% (G5). Total medical and nonmedical costs were US $754 for a rotavirus hospitalisation and US $60 for an outpatient clinic visit. Parental work loss averaged 4.0 days per hospital visit and 1.3 days per paediatric clinic visit. These data show that rotavirus was associated with a substantial proportion of AGE medical visits and had considerable medical costs prior to rotavirus vaccine introduction.

The Chinese version of the Facts on Aging Quiz scale: reliability and validity assessment.

BACKGROUND: The use of health care services by older adults is increasing with the aging of the population. It is therefore essential that health care workers are current in their knowledge about gerontology; thus, educational programs regarding the care of elders are essential. Chinese-language assessments to measure knowledge about gerontology and aging and attitudes toward older adults are lacking. OBJECTIVE: This study was designed to measure the reliability and validity of a Chinese-language version of Palmore's facts on aging quiz (FAQ 1). METHOD: Cronbach's alpha, construct validity, content validity and convergent validity of the Chinese version of the FAQ 1 were assessed. A sample of 220 student nurses was recruited. Part of the sample (n=125; Group A) was comprised of experienced nurses who had returned to school for advanced degrees. The remaining 95 participants were first-year undergraduate students without prior work experience (Group B). The FAQ 1 was administered to all participants. The Chinese-language version of Kogan's Attitudes toward Older People (KAOP) was also administered to assess convergent validity of the FAQ 1. RESULTS: Cronbach's alpha of the FAQ was 0.68, content validity was 0.82, and construct validity and convergent validity were acceptable. Group A had more correct answers on each item than Group B, indicating that students with prior work experience with the elderly were more knowledgeable regarding older people and aging. CONCLUSIONS: Based on the results of the assessment, the Chinese version of FAQ 1 is a valid and reliable instrument for measuring students' or health care providers' knowledge about older people.

A Chinese version of Kogan's Attitude Toward Older People Scale: reliability and validity assessment.

BACKGROUND: Taiwan is facing the dilemma of a rapidly growing elderly population and there is a perceived need for greater gerontological education. Several universities have recently started providing elective gerontological certification programs. In order to provide useful and sufficient information to increase students' knowledge and attitudes, to develop a reliable and valid instrument is essential and helpful for faculty as well as the program director to pinpoint students' strengths and weaknesses. OBJECTIVE: To assess the reliability and validity of a Chinese version of Kogan's Attitudes toward Older People (KAOP) among medical and nursing students at a medical university. METHOD: A two-phase data collection design was used. Two weeks following the first completion, another KAOP form, was given. Content validity, construct validity, internal consistency, and stability reliability were assessed. The final sample consisted of 275 students. RESULTS: Scores were between 34 and 238. The study sample reported slightly positive attitudes (144.3+/-17.89), with half of the subjects (50.1%) above average. All of the 34 items were found to have significant item-to-total correlations (p<.05). Two factors were extracted, Appreciation and Prejudice. The Prejudice and Appreciation contributed 33.6% and 21.1% to the variance. The Cronbach's alpha was .82 for the total scale (.83 for Prejudice, .81 for Appreciation). Stability was 0.86 for Prejudice and 0.91 for Appreciation. CONCLUSIONS: The Chinese version of the KAOP can be considered reliable and valid scale for assessing the attitudes toward older people.

The costs and quality of operative training for residents in tympanoplasty type I.

CONCLUSION: A teaching hospital would incur more operation room costs on training surgical residents. OBJECTIVE: To evaluate the increased operation time and the increased operation room costs of operations performed by surgical residents. As a model we used a very common surgical otology procedure -- tympanoplasty type I. SUBJECTS AND METHODS: From January 1, 2004 to December 31, 2004, we included in this study 100 patients who received tympanoplasty type I in Taipei Veterans General Hospital. Fifty-six procedures were performed by a single board-certified surgeon and 44 procedures were performed by residents. We analyzed the operation time and surgical outcomes in these two groups of patients. The operation room cost per minute was obtained by dividing the total operation room expenses by total operation time in the year 2004. RESULTS: The average operation time of residents was 116.47 min, which was significantly longer (p<0.0001) than that of the board-certified surgeon (average 81.07 min). It cost USD $40.36 more for each operation performed by residents in terms of operation room costs. The surgical success rate of residents was 81.82%, which was significantly lower (p=0.016) than that of the board-certified surgeon (96.43%).

Balanced rhinoplasty in an Oriental population.

BACKGROUND: In Taiwan, augmentation rhinoplasty and double-eyelid blepharoplasty are the most popular aesthetic procedures. Although aesthetic concepts vary for different races, the current concept of nasal and facial beauty shows a tendency to correspond to that for white people. The authors present their 10-year experience with a simple and practical approach of simultaneous blepharoplasty and rhinoplasty. METHODS: This study enrolled 255 consecutive patients who underwent simultaneous rhinoplasty and blepharoplasty between January of 1996 and December of 2005. All were Chinese in ethnic origin. The patients in the series were predominantly women. Only 10 were men. Five of the cases involved congenital palpebral anomalies including congenital entropion, congenital ptosis, and Down syndrome. A total of 245 patients had an adequate follow-up period longer than 5 years. The patients' satisfaction and postoperative complications were recorded. RESULTS: Among the 245 patients receiving the balanced rhinoplasty, there were no cases of implant extrusion, displacement, or infection. Most of the patients (230/245 cases, 94%) were satisfied with their nasal and periocular shape. CONCLUSIONS: The authors believe that simultaneous blepharoplasty and rhinoplasty are a simple and reliable method for effecting better results for Asians.