Consistencies among miscellaneous scales for evaluation of post-stroke dysphagia.

PURPOSE: Post-stroke dysphagia (PSD) is the most common type of dysphagia. Stroke patients with sustained dysphagia have poorer outcomes. The severity of PSD is assessed using miscellaneous scales with unknown consistencies. We aim to investigate the consistencies among miscellaneous scales, which could aid in the assessment of PSD. METHODS: A total of 49 PSD patients were enrolled. Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), Ohkuma Questionnaire, Eating Assessment Tool-10, and Repetitive Saliva Swallowing Test were performed. FOIS was performed by physicians, and DSS was conducted by both the physicians and nurses; the physicians used either videofluoroscopy (VF) or videoendoscopy (VE) for evaluation; while, the nurses assessed PSD by observation and subjective judgment. RESULTS: When using VF (VF-DSS and VF-FOIS) as the gold standard for the evaluation, VE-FOIS (κ = 0.625, 95% CI 0.300-0.950, p < 0.001) has a substantial agreement with VF-FOIS, and VE-DSS (κ = 0.381, 95% CI 0.127-0.636, p = 0.007) has a fair agreement with VF-DSS. The weighted kappa of FOIS to DSS in VE (weighted κ = 0.577, 95% CI 0.414-0.740, p < 0.001) is not lower than that in VF (weighted kappa = 0.249, 95% CI 0.136-0.362, p < 0.001). CONCLUSION: For both DSS and FOIS, only VE has a statistically significant agreement with VF. Though VF has been viewed as the traditional gold standard of dysphagia screening, it has the limitations of being invasive and equipment dependent. For PSD, VE could be considered as a substitution when VF is not available or suitable.

Air Pollution Is Associated with Cognitive Deterioration of Alzheimer's Disease.

INTRODUCTION: Dementia is one of the major causes of disability and dependency among older people worldwide. Alz-heimer's disease (AD), the most common cause of dementia among the elderly, has great impact on the health-care system of developed nations. Several risk factors are suggestive of an increased risk of AD, including APOE-ε4, male, age, diabetes mellitus, hypertension, and low social engagement. However, data on risk factors of AD progression are limited. Air pollution is revealed to be associated with increasing dementia incidence, but the relationship between air pollution and clinical AD cognitive deterioration is unclear. METHODS: We conducted a case-control and city-to-city study to compare the progression of AD patients in different level of air-polluted cities. Clinical data of a total of 704 AD patients were retrospectively collected, 584 residences in Kaohsiung and 120 residences in Pingtung between 2002 and 2018. An annual interview was performed with each patient, and the Clinical Dementia Rating score (0 [normal] to 3 [severe stage]) was used to evaluate their cognitive deterioration. Air pollution data of Kaohsiung and Pingtung city for 2002-2018 were retrieved from Taiwan Environmental Protection Administration. Annual Pollutant Standards Index (PSI) and concentrations of particulate matter (PM10), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO) were obtained. RESULTS: The PSI was higher in Kaohsiung and compared with Pingtung patients, Kaohsiung patients were exposed to higher average annual concentrations of CO, NO2, PM10, and SO2. AD patients living in Kaohsiung suffered from faster cognitive deterioration in comparison with Pingtung patients (log-rank test: p = 0.016). When using multivariate Cox proportional hazards regression analysis, higher levels of CO, NO2, PM10, and SO2 exposure were associated with increased risk of AD cognitive deterioration. Among all these air pollutants, high SO2 exposure has the greatest impact while O3 has a neutral effect on AD cognitive deterioration. CONCLUSIONS: Air pollution is an environment-related risk factor that can be controlled and is associated with cognitive deterioration of AD. This finding could contribute to the implementation of public intervention strategies of AD.

Molecular Simulations of Laser Spike Annealing of Block Copolymer Lamellar Thin-Films.

We use molecular dynamics simulations to study the phase behavior of a coarse-grained lamella-forming A-b-B diblock copolymer under thin-film soft confinement for different heating cycle lengths, film thicknesses, and substrate-polymer affinities. This model describes the effect on thin-film morphology with a free surface (air-polymer interface) and a solid substrate. Our simulation results were first validated by showing that they capture changes for the order-disorder transition temperature with annealing conditions consistent with those found in laser spike annealing experiments, when the vertical lamella phase formed on neutral substrates. In addition, simulations with a substrate selective for a particular block revealed the formation of other phases, including a mixed vertical-horizontal lamella and a metastable island phase having horizontal but incomplete lamella layers. The nanoscale roughness features of this island phase, and hence its surface wettability, can be tuned with suitable choices of chemistry and annealing conditions.

Comparing Self-stigma Between People With Different Mental Disorders in Taiwan.

Internalized stigma (or self-stigma), one of the most painful effects of stigma, causes people with mental health problems profound negative consequences, for example, psychological adversity, demoralization, and feelings of hopelessness. However, knowledge about self-stigma in people with different mental disorders is insufficient. We hypothesized that people with different psychiatric diagnoses have different levels of self-stigma. Through convenience sampling, we used the Internalized Stigma of Mental Illness Scale to compare people diagnosed with schizophrenia (n = 161), depressive disorder (n = 98), bipolar disorder (n = 43), and anxiety disorder (n = 45) in southern Taiwan. We found that people with schizophrenia (mean, 2.09-2.30) and those with bipolar disorder (mean, 2.16-2.38) had significantly higher levels of self-stigma, except for the Stigma Resistance, than did those with anxiety disorder (mean, 1.74-1.87). Our results suggest that clinicians should use different interventions to reduce self-stigma for populations with different psychiatric diagnoses.

Effectiveness of using calligraphic activity to treat people with schizophrenia: a randomized controlled trial in Southern Taiwan.

Background: Prior research has shown preliminary evidence that calligraphy activity improves various body functions and decreases severity of psychotic symptoms in individuals with schizophrenia. However, major limitations of earlier studies include small and heterogeneous samples. The current large-scale randomized controlled trial examined effects of calligraphy activity on cognition (including attention), emotions, psychotic symptoms, quality of life, and mood in people with schizophrenia. Methods: One-hundred-and-fifty patients with schizophrenia were randomly allocated to the treatment group (receiving calligraphy activity) or the control group (receiving general activity), both of which lasted for 24 weeks (70 minutes per session; one session per week). Assessments were conducted at pretest, posttest, and three-month follow-up. The Montreal Cognitive Assessment, Chu's Attention Test, Depression, Anxiety, and Stress Scale, Positive and Negative Syndrome Scale, World Health Questionnaire on the Quality of Life-Brief Form, and Visual Analogue Scale were used. Results: Improved cognition and attention were found in both groups, although no group effects were shown. The treatment group appeared to show lower severity of positive symptoms at follow-up than posttest, whereas the control group appeared to show the opposite pattern. Improved mood was found in the treatment group. Conclusion: This study provides evidence regarding effects of calligraphy activity on increasing cognition and potentially decreasing severity of positive symptoms in patients with schizophrenia. Calligraphy activity can be incorporated in clinical occupational therapy and may be provided to supplement medication treatment. Trial Registration: ClinicalTrials.gov NCT03882619; https://clinicaltrials.gov/ct2/show/NCT03882619.

[Smoking and cigarette dependence among Taiwanese adolescent smokers: factors of influence].

BACKGROUND: The current literature in Taiwan on adolescent smoking behavior focuses primarily on epidemiological surveys. The literature outside of Taiwan is consistent in indicating that the experience of an individual with his or her first cigarette predicts consequent smoking behavior during adolescence. Smoking behavior has been associated with cigarette dependence. However the concept of smoking behavior differs from cigarette dependence, and their predictors may vary considerably. PURPOSE: The aims of this study were to examine predictors of regular smoking, cigarette dependence and attempts to quit amongst adolescent smokers. METHODS: Researchers conducted a cross-sectional survey in twelve senior high schools in central and southern Taiwan between November 2007 and May 2009. Participants (N = 370), all of who had smoked at least once during the preceding one-year period, completed a questionnaire. Logistic analyses and multiple regression were used to explore predictors of smoking behavior, cigarette dependence and quit attempts. RESULT: The sample included 306 "regular" smokers. In a multivariate logistic regression analysis, having friends who smoked significantly influenced regular smoking behavior. Parental nagging about participant smoking behavior was a protective factor inhibiting regular smoking. Multiple regression analysis found smoking amongst siblings and friends to be a significant predictor of cigarette dependence. Cigarette dependence was found to significantly influence the success of attempts to quit. CONCLUSION / IMPLICATIONS FOR PRACTICE: Family and peer groups were the most important factors of influence on adolescent smoking behavior. This finding suggests that nursing professionals should leverage family and peer support when planning and implementing smoking cessation programs.

Hospital admissions for respiratory system diseases in adults with intellectual disabilities in Southeast London: a register-based cohort study.

BACKGROUND: Intellectual disability (ID) carries a high impact on need for care, health status and premature mortality. Respiratory system diseases contribute a major part of mortality among people with ID, but remain underinvestigated as consequent morbidities. METHODS: Anonymised electronic mental health records from the South London and Maudsley Trust (SLaM) were linked to national acute medical care data. Using retrospective cohort and matched case-control study designs, adults with ID receiving SLaM care between 1 January 2008 and 31 March 2013 were identified and compared with local catchment residents for respiratory system disease admissions. Standardised admission ratios (SARs) were first calculated, followed by a comparison of duration of hospitalisation with respiratory system disease between people with ID and age-matched and gender-matched random counterparts modelled using linear regression. Finally, the risk of readmission for respiratory system disease was analysed using the Cox models. RESULTS: For the 3138 adults with ID identified in SLaM, the SAR for respiratory system disease admissions was 4.02 (95% CI 3.79 to 4.26). Compared with adults without ID, duration of hospitalisation was significantly longer by 2.34 days (95% CI 0.03 to 4.64) and respiratory system disease readmission was significantly elevated (HR=1.35; 95% CI 1.17 to 1.56) after confounding adjustment. CONCLUSIONS: Respiratory system disease admissions in adults with ID are more frequent, of longer duration and have a higher likelihood of recurring. Development and evaluation of potential interventions to the preventable causes of respiratory diseases should be prioritised.

Further psychometric evaluation of the self-stigma scale-short: measurement invariance across mental illness and gender.

BACKGROUND: This study cross-validated the factor structure of the Self-Stigma Scale-Short (SSS-S) in a cohort of patients with mental illness in southern Taiwan. The measurement invariance of the SSS-S factor structure across mental illness and gender was also examined. METHODS: The sample consisted of 161 patients with schizophrenia (51.6% males; mean age ± SD = 40.53 ± 10.38 years) and 189 patients with other mental illnesses (34.9% males; mean age = 46.52 ± 11.29 years). RESULTS: The internal reliability (total score: α = 0.948) and concurrent validity (r = 0.335 to 0.457 with Depression and Somatic Symptoms Scale; r = -0.447 to -0.556 with WHOQOL-BREF) of the SSS-S were both satisfactory, and the results verified that the factor structure in our Taiwan sample (RMSEA = 0.0796, CFA = 0.992) was the same as that of the Hong Kong population. In addition, the results supported the measurement invariance of the SSS-S across mental illness (ΔRMSEAs = -0.0082 to -0.0037, ΔCFAs = 0.000) and gender (ΔRMSEAs = -0.0054 to -0.0008, ΔCFAs = -0.001 to 0.000). CONCLUSION: Future studies can use the SSS-S to compare self-stigma between genders and between patients with different kinds of mental illnesses.

Psychometric evaluation of the internalized stigma of mental illness scale for patients with mental illnesses: measurement invariance across time.

BACKGROUND: The current investigation examined the psychometric properties of the Internalized Stigma of Mental Illness (ISMI) scale in a sample of patients with mental illness. In addition to the internal consistency, test-retest reliability, and concurrent validity that previous studies have tested for the ISMI, we extended the evaluation to its construct validity and measurement invariance using confirmatory factor analysis (CFA). METHODS: Three hundred forty-seven participants completed two questionnaires (i.e., the ISMI and the Depression and Somatic Symptoms Scale [DSSS]), and 162 filled out the ISMI again after 50.23±31.18 days. RESULTS: The results of this study confirmed the frame structure of the ISMI; however, the Stigma Resistance subscale in the ISMI seemed weak. In addition, internal consistency, test-retest reliability, and concurrent validity were all satisfactory for all subscales and the total score of the ISMI, except for Stigma Resistance (α = 0.66; ICC = 0.52, and r = 0.02 to 0.06 with DSSS). Therefore, we hypothesize that Stigma Resistance is a new concept rather than a concept in internalized stigma. The acceptable fit indices supported the measurement invariance of the ISMI across time, and suggested that people with mental illness interpret the ISMI items the same at different times. CONCLUSION: The clinical implication of our finding is that clinicians, when they design interventions, may want to use the valid and reliable ISMI without the Stigma Resistance subscale to evaluate the internalized stigma of people with mental illness.

The impact of implementing smoking bans among incarcerated substance users: a qualitative study.

This article reports a study evaluating the effects of implementing smoking bans among drug-using prisoners in Taiwan. Seventy-seven new entrants were recruited in May 2008. Six focus groups were conducted in a prison-based treatment center, the only prison with a total smoking ban in Taiwan. All the subjects were male and their average age was 37 years. Three general reactions to the ban were identified across all focus groups: (a) unfair/hypocritical policy; (b) being forced to stop smoking; and (c) finding ways to smoke anyway. Future studies should compare the effects of total versus partial smoking bans among drug abusers in prison to better explore policy options.

Smoking cessation program in outpatient clinics of Family Medicine Department in Taiwan: a longitudinal evaluation.

The Government of Taiwan has imposed a tobacco health tax of NT$5 (US$0.14) per pack of cigarettes since January 2002. The Department of Health has now begun to fund a smoking cessation program that provides nicotine-replacement therapy (NRT) and brief counseling by physicians in outpatient clinics. The purpose of the current study was to evaluate the smoking cessation program with a 3-year follow-up review implemented at outpatient clinics, which were run by the Family Medicine Department in a medical center, with a total of 772 adult participants. The abstinence rates were 99.7%, 49.2%, 37.7%, 30.2%, and 22.7%, at the 1-, 3-, 6-, 12-, and 36-month points, respectively. The frequency of clinic visits is a major factor predicting long-term cessation. The results indicate the need to pursue implementation and evaluation of multidisciplinary interventions in smoking cessation clinics with a longer follow-up, including the promotion of compliance to increase clinic visits and prevent relapse.

Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan.

AIMS: Diagnosing peripheral arterial disease (PAD) and recognizing its associated risk factors in diabetes is important due to high cardiovascular disease and limb loss risk. However, both traditional and nontraditional risk factors have seldom been analyzed in the same diabetic cohort. The aim of this study was to examine the traditional and nontraditional risk factors for PAD in elderly type 2 diabetic patients. METHODS: Five hundred and eighty type 2 diabetic subjects aged >or=60 years were cross-sectionally studied. Diagnosis of PAD was by ankle-brachial index (ABI) <0.90 on either leg. The association between traditional and nontraditional risk factors of PAD was analyzed. RESULTS: Among the confounders, age, diabetes duration, HDL cholesterol, albuminuria, CKD (chronic kidney disease), hsCRP and insulin use differed between patients with and without PAD. Multiple logistic regression revealed that only CKD, insulin use, albuminuria, elevated hsCRP level (>3mg/l) and low HDL cholesterol were independent risk factors. CONCLUSIONS: The findings of this study highlight the importance of monitoring nontraditional risk factors of PAD in diabetes. Implementing effective interventions to improve management of these risk factors may lower the risk for PAD.