Clinimetric Properties of the "FIND-NEEDS" to Screen Geriatric Conditions.

INTRODUCTION: Comprehensive geriatric assessment (CGA) is used to thoroughly assess and identify complex healthcare problems among older adults. However, administration of CGA is time-consuming and labor intensive. A simple screening tool with the mnemonic "FIND-NEEDS" was developed to quickly identify common geriatric conditions. The present study was to evaluate the clinimetric properties of the FIND-NEEDS. METHODS: The participants comprised first-visiting older adults aged 65 years and above (and who were able to communicate by themselves or with the help of a caregiver) who were assessed (October to December, 2021) using the FIND-NEEDS and CGA at geriatric outpatient clinics of a tertiary, referred medical center. The FIND-NEEDS was examined for its criterion-related validity and compared with the CGA results. Two types of scoring (summed score and binary score) of FIND-NEEDS and CGA were analyzed using Spearman correlation, sensitivity and specificity, and area under receiver operating characteristic curve (AUC). RESULTS: The mean age of the 114 outpatients was 78.3 ± 7.6 years, and 79 (69.3%) were female. The internal consistency was excellent when using all FIND-NEEDS items, and was acceptable when using domain scores. Exploratory factor analysis showed that most of the FIND-NEEDS domain scores had factor loadings higher than 0.3. Intercorrelations of binary scores between domains of FIND-NEEDS and CGA showed most domains were moderately correlated. The overall correlation of summed scores between FIND-NEEDS and CGA was high. The FIND-NEEDS summed score was moderately correlated with CGA score (r = 0.494; p < 0.001), and the binary score showed excellent correlation (r = 0.944; p < 0.001). When using the CGA score as the gold standard, the FIND-NEEDS showed excellent AUC (0.950), sensitivity (1.00), and specificity (0.90). DISCUSSION/CONCLUSION: The present study demonstrated that the FIND-NEEDS had acceptable clinimetric properties to screen for geriatric problems among older adults. Further in-depth assessment and care plan can then be conducted afterwards.

Oral administration of Lactobacillus plantarum JC7 alleviates OVA-induced murine food allergy through immunoregulation and restoring disordered intestinal microbiota.

PURPOSE: The incidence and prevalence of food allergy have sharply risen over the past several decades. Oral administration of probiotic stains has been proven as a safe and effective method to control food allergy. In this study, it aims to comprehensively investigate the anti-allergic effect of Lactobacillus plantarum JC7. METHODS: Balb/c mice were randomly divided into three groups and received OVA (20 µg/mouse, intraperitoneal injection), L. plantarum JC7 (2 × 108 CFU/mouse, intragastric administration) + OVA (20 µg/mouse, intraperitoneal injection) or 0.9% saline (intragastric administration) for 3 weeks. Body weight was monitored weekly, and allergic reactions were evaluated after challenge of OVA. Serum levels of OVA-specific immunoglobulins and various cytokines were tested using ELISA, and the cecum microbiota was analysed by 16S rRNA sequencing to explore the relationships between these indicators and OVA-induced food allergy. Western blotting was used to identify the expression levels of phosphorylated IκBα and nuclear factor kappa B p65. RESULTS: OVA-sensitised mice showed mitigation of respiratory manifestations, alleviation of lung inflammation and congestion, and the presence of an intact intestinal villus structure. Furthermore, OVA-specific immunoglobulin E (IgE), OVA-specific-IgG1, and plasma histamine levels were declined in mice treated with L. plantarum JC7 than in OVA-sensitised mice. In addition, interferon-γ (IFN-γ) and interleukin 10 (IL-10) levels were significantly increased, while IL-4 and IL-17A levels were clearly decreased in mice that had undergone oral administration of L. plantarum JC7, compared with OVA-sensitised mice. These findings indicated imbalances of T helper cell type 1 (Th1)/Th2 and regulatory T cells (Treg)/Th17, which were confirmed by quantitative polymerase chain reaction (PCR). Western blotting demonstrated that the expression levels of phosphorylated IκBα and nuclear factor kappa B p65 were significantly increased in OVA-sensitised mice, but these changes were partly reversed after treatment with L. plantarum JC7. Oral administration of L. plantarum JC7 increased the richness, diversity, and evenness of cecum microbiota, characterised by higher Bacteroidetes abundance and lower Firmicutes abundance. Additionally, the intestinal microbial community composition was significantly altered in the OVA-sensitised group, indicating a disordered intestinal microbiota that was restored by the oral administration of L. plantarum JC7. CONCLUSION: Overall, L. plantarum JC7 can prevent food allergy by rectifying Th1/Th2 and Treg/Th17 imbalances, combined with modifications of disordered intestinal microbiota.

Moonlighting glyceraldehyde-3-phosphate dehydrogenase (GAPDH) protein of Lactobacillus gasseri attenuates allergic asthma via immunometabolic change in macrophages.

BACKGROUND: The extra-intestinal effects of probiotics for preventing allergic diseases are well known. However, the probiotic components that interact with host target molecules and have a beneficial effect on allergic asthma remain unknown. Lactobacillus gasseri attenuates allergic airway inflammation through the activation of peroxisome proliferator- activated receptor γ (PPARγ) in dendritic cells. Therefore, we aimed to isolate and investigate the immunomodulatory effect of the PPARγ activation component from L. gasseri. METHODS: Culture supernatants of L. gasseri were fractionated and screened for the active component for allergic asthma. The isolated component was subjected to in vitro functional assays and then cloned. The crystal structure of this component protein was determined using X-ray crystallography. Intrarectal inoculation of the active component-overexpressing Clear coli (lipopolysaccharide-free Escherichia coli) and intraperitoneal injection of recombinant component protein were used in a house dust mite (HDM)-induced allergic asthma mouse model to investigate the protective effect. Recombinant mutant component proteins were assayed, and their structures were superimposed to identify the detailed mechanism of alleviating allergic inflammation. RESULTS: A moonlighting protein, glycolytic glyceraldehyde 3-phosphate dehydrogenase (GAPDH), LGp40, that has multifunctional effects was purified from cultured L. gasseri, and the crystal structure was determined. Both intrarectal inoculation of LGp40-overexpressing Clear coli and intraperitoneal administration of recombinant LGp40 protein attenuated allergic inflammation in a mouse model of allergic asthma. However, CDp40, GAPDH isolated from Clostridium difficile did not possess this anti-asthma effect. LGp40 redirected allergic M2 macrophages toward the M1 phenotype and impeded M2-prompted Th2 cell activation through glycolytic activity that induced immunometabolic changes. Recombinant mutant LGp40, without enzyme activity, showed no protective effect against HDM-induced airway inflammation. CONCLUSIONS: We found a novel mechanism of moonlighting LGp40 in the reversal of M2-prompted Th2 cell activation through glycolytic activity, which has an important immunoregulatory role in preventing allergic asthma. Our results provide a new strategy for probiotics application in alleviating allergic asthma.

Is coronavirus-related research becoming more interdisciplinary? A perspective of co-occurrence analysis and diversity measure of scientific articles.

The outbreak of coronavirus disease 2019 (COVID-19) has had a significant repercussion on the health, economy, politics and environment, making coronavirus-related issues more complicated and difficult to adequately address by relying on a single field. Interdisciplinary research can provide an effective solution to complex issues in the related field of coronavirus. However, whether coronavirus-related research becomes more interdisciplinary still needs corroboration. In this study, we investigate interdisciplinary status of the coronavirus-related fields via the COVID-19 Open Research Dataset (CORD-19). To this end, we calculate bibliometric indicators of interdisciplinarity and apply a co-occurrence analysis method. The results show that co-occurrence relationships between cited disciplines have evolved dynamically over time. The two types of co-occurrence relationships, Immunology and Microbiology & Medicine and Chemical Engineering & Chemistry, last for a long time in this field during 1990-2020. Moreover, the number of disciplines cited by coronavirus-related research increases, whereas the distribution of disciplines is uneven, and this field tends to focus on several dominant disciplines such as Medicine, Immunology and Microbiology, Biochemistry, Genetics and Molecular Biology. We also measure the disciplinary diversity of COVID-19 related papers published from January to December 2020; the disciplinary variety shows an upward trend, while the degree of disciplinary balance shows a downward trend. Meanwhile, the comprehensive index 2Ds demonstrates that the degree of interdisciplinarity in coronavirus field decreases between 1990 and 2019, but it increases in 2020. The results help to map the interdisciplinarity of coronavirus-related research, gaining insight into the degree and history of interdisciplinary cooperation.

[Community Innovation and Regional Sustainability: A Case Study on an Elder Social Survey Conducted by National Cheng Kung University].

National Cheng Kung University (NCKU) promotes university social responsibility and strives to ensure that all of its teaching staff and students engage in academics in a manner that incorporates both social awareness and social practice. The NCKU team has launched a series of social practice and research projects focused on accompanying and caring for older adults who live in the community, looking to establish a social practice model that bridges university teaching and research to practical community needs. The objective of this initiative is to develop an innovative model of social support and a new model for younger generations to work with older adults living in the community. The results of this survey project show better well-being in older adults to be associated with the following sets of traits: exercising regularly and lacking dental problems; engaging in daily laughter and holding positive aging perceptions; and having a higher subjective social status, more family support, and a sense of community attachment. The study results imply that multiple factors affect well-being in the context of caring for community-dwelling older adults and social development, especially during the current COVID-19 pandemic.

Generation and functional evaluation of a DNA vaccine co-expressing Cyprinid herpesvirus-3 envelope protein and carp interleukin-1 beta.

Cyprinid herpesvirus 3 (CyHV-3) infection in carp causes a fatal and highly contagious disease that results in huge economic losses in common and koi carp aquaculture worldwide. Thus the development of an effective vaccine to protect carp stocks against the CyHV3 virus is imperative. In this study, we immunized common carps with a DNA vaccine consisting of a plasmid that co-expresses the CyHV-3 envelope protein ORF25 and the carp IL-1ß gene in order to evaluate the adjuvant potential of IL-1ß. Our result shows that antibodies specific to ORF25 can be detected as early as one week after intramuscular injection of the DNA vaccine at low dosage. Moreover, the co-expression of IL-1ß can enhance the potency of the vaccine, as demonstrated by a higher antibody level after the third immunizations. Importantly, the DNA vaccine reduced mortality in carps when they were immunized prior to a CyHV-3 challenge, as compared to negative control groups. However, despite being able to induce higher neutralizing antibody titres, the co-expression of IL-1ß in the DNA vaccine did not significantly improve the overall survival of immunized fish following virus challenge. Furthermore, the DNA vaccine can protect carps from tissue damage and histopathological alteration caused by viral infection. These strongly suggests that the vaccine can efficiently elicit protective immunity against CyHV-3 infection. In conclusion, the DNA vaccine formulated with the pIRES-ORF25-IL-1ß DNA construct can protect carp against CyHV-3 infection and has potential applicability in the aquaculture industry.

Exploring factors influencing residents' health outcomes in long-term care facilities: 1-year follow-up using latent growth curve model.

PURPOSE: This study explored the residents' health outcomes of long-term care (LTC) facilities and examined the risk factors in individual and institutional levels during 1 year of admission. METHODS: The study included four stages of interviews with residents in 31 nursing homes and 64 residential care homes. Three hundred and twenty-five residents at baseline were interviewed, and 206 completed the interviews at follow-up. Five outcomes including residents' physical/mental functional status and subjective health status in Short Form-36 were analyzed using latent growth curve models (LGCMs). RESULTS: Only the physical component summary (PCS) had increased significantly. The most influential risk factors to outcomes were the intra-individual-level time-varying variables, including self-rated health and with/without tubing care. Some predictive inter-individual-level factors were also found. For institutional characteristics, small-sized homes (<49 beds) with low occupancy rates showed a lower growth rate in residents' mental component summary (MCS) and PCS over 1 year and private sector homes showed the most significant growth rates in MCS. CONCLUSIONS: The methodological strength using LGCMs provides a framework for systematically assessing the influence of risk factors from various levels on residents' outcomes and follow-up change. It is evident that factors in various levels all influenced residents' outcomes which support critical information for case mix and quality management in LTC facilities. Under the scenario of a surplus of institutional care in Taiwan, we suggest that institutions must focus more on residents' psychological well-being and care quality, especially in small-sized homes in relation to the outcomes of its residents.

[Relationship of the effectiveness of care management services and burdens of primary family caregivers].

BACKGROUND: In Taiwan, long-term care management centers hold primary responsibility for administering long-term care services, assisting with long-term care placements, and sharing the care burden with family caregivers in need. Research into the effectiveness of current care management services and the effectiveness of these services in reducing care burdens remains limited. PURPOSE: This study investigates the relationship among care management center service effectiveness, care management personnel, and burdens in relation to the provision of care services from the prospective of caregivers. METHODS: A purposive sampling method and structured questionnaire survey were used to conduct telephone interviews with 154 home caregivers who had been transferred from care management centers to homecare service centers. RESULTS: Participants expressed overall satisfaction with care management centers and with the services provided by these centers. Satisfaction toward the care managers' professional competence was associated with lower physical burden for caregivers. Participants' psychological and social burdens were associated with overall satisfaction with the care management centers and their satisfaction with the services provided by care managers. CONCLUSIONS: The implementation of care management services has improved satisfaction. However, center services remain inadequate to reduce the psychological and social burdens of caregivers. Greater focus on these two aspects will be critical to the successful implementation of the proposed intensive care management model and multiple services intervention in order to meet the complex care needs of home service recipients and their primary caregivers.

The Role of Place Attachment in the Relationship between Attitudes toward Aging and Subjective Well-Being among Community-Dwelling Older Adults in Taiwan.

Subjective well-being presents a societal challenge for vulnerable older adults. This study aims to investigate the mediating role of place attachment in the relationship between attitudes toward aging and subjective well-being among community-dwelling older adults in Taiwan. Two waves of investigations were conducted to examine the interplay between attitudes toward aging, subjective well-being, and place attachment among older adults. In Wave I, 1190 participants were enrolled, revealing predominantly younger cohorts with substantial educational levels. The subsequent Wave II involved 483 participants, maintaining continuity in characteristics. Subjective well-being remained moderate across waves, with prevalent positive attitudes toward aging. Place attachment scores indicated moderate to high associations. After controlling for demographics, structural equation modeling (SEM) in both waves revealed significant positive associations: attitudes toward aging influenced well-being, attitudes toward aging were positively associated with place attachment, and place attachment was positively related to well-being. Mediation testing confirmed the mediating role of place attachment in the relationship between attitudes toward aging and well-being. These findings underscore the important role of place attachment. It is evident that improving attitudes toward aging is an effective intervention which can lead to a better sense of well-being by enhancing place attachment to empower civil society.

Potential of Lactobacillus plantarum A56 in relieving food allergy through immunoregulation, antioxidation, and reshaping intestinal microbiota.

Food allergy is an abnormal immune reaction triggered by food protein antigens. Relevant studies have suggested that probiotic supplementation was with the potential to alleviate food allergy. This study aimed to explore the effects of Lactobacillus plantarum A56 on the alleviation of ovalbumin (OVA)-induced food allergy via immunomodulatory function, antioxidation, and modification of intestinal microbiota. Balb/c mice were sensitized with OVA (20 µg/mouse) by intraperitoneal injection for 3 weeks and accompanied by oral administration of L. plantarum A56 (109 CFU/mL), subsequently with orally challenged twice by OVA at 50 mg/mL for 1 week. The results showed that oral supplementation of L. plantarum A56 could effectively relieve allergic symptoms of mice, and decreased OVA-specific IgE and IgG1 concentrations. It also declined interleukin (IL)-4 level, raised interferon-γ (IFN-γ) in serum, and splenocyte supernatant, and the qPCR results were consistent with above results. Moreover, L. plantarum A56 treatment also fortified superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels, and reduced malondialdehyde (MDA) level in serum. The increased nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and forkhead box O1 (Foxo1) expression indicated that L. plantarum A56 exerted antioxidation through Nrf2-Foxo1 pathway. In addition, L. plantarum A56 treatment elevated Bacteroidetes richness, ASV/OTU number, species diversity, etc. Notably, Spearman correlation analysis indicated that Bacteroidetes displayed obviously negative correlation with IgE and IgG1, but Actinobacteria and Acidobacteria exhibited significantly positive correlation with IgG1 and IgE. Collectively, these results suggested that L. plantarum A56 could alleviate OVA-induced food allergy by regulating Th1/Th2 imbalance, antioxidation, and modulating intestinal microbiota.

Trajectories and predictors of functional decline of hospitalised older patients.

AIMS AND OBJECTIVES: To delineate the trajectories of functional status over four time points and to examine predictors of functional decline (FD) in hospitalised older patients. BACKGROUND: About 30-60% of the older patients develop new dependence in activities of daily living (ADL) during a hospital stay, which results in progressive disability after discharge. The functional trajectories and risk factors of FD among hospitalised older patients require identification. DESIGN: A cohort study. METHODS: The study consecutively recruited 273 patients aged 65 and older admitted to a medical centre in southern Taiwan. Functional trajectory, by ADL score, was observed at four time points: two weeks before admission, admission, discharge and three months after discharge. The ADL score two weeks before admission was used as a baseline functional status. RESULTS: Eighty-three (30·4%) patients experienced FD at three months after discharge. Functional trajectory as shown by ADL scores indicated that all 273 patients dropped steeply at admission and that two-thirds were gradually restored three months after discharge. Logistic regression revealed that the number of falls in the past year, Instrument Activities of Daily Living (IADL) status before admission, comorbidity and ADL decline between preadmission and discharge were significant predictors of FD three months after discharge. The ADL score decline during hospitalisation was the mediator of FD three months after discharge. CONCLUSIONS: Findings indicate that the ADL function of those hospitalised older patients who reported having fallen more often in the previous year had more comorbidity, had a lower IADL score, and had more ADL score decline before admission and discharge would continue to decline after discharge. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses can integrate the finding of this study with Comprehensive Geriatric Assessment to tailor intervention to restore older patient's physical function during hospitalisation.

Estimation of disability free life expectancy in non small cell lung cancer based on real world data.

To quantify the societal impact of disability in patients with non-small cell lung cancer (NSCLC), this study estimated the disability-free life expectancy (DFLE), loss-of-DFLE and explored their associations with quality-adjusted life expectancy (QALE) and loss-of-QALE. We interlinked national databases and applied a rolling-over algorithm to estimate the lifetime survival function for patients with NSCLC. Using the EuroQOL-5 Dimension (EQ-5D) and Barthel index (BI), we repeatedly measured the quality-of-life and disability functions of NSCLC patients who visited our hospital from 2011 to 2020. Age-, sex-matched referents were simulated from lifetables of the same calendar year of diagnosis. We categorized BI scores ≤ 70 as in need of long-term care and constructed linear mixed models to estimate the utility values and disability scores. We collected 960 cases and 3088 measurements. The proportions of measurements without disability at age 50-64 and in stage I-IIIa, 50-64 and stage IIIb-IV, 65-89 and stage I-IIIa and 65-89 and stage IIIb-IV were 97.3%, 89.3%, 94.8%,78.3%, corresponding to DFLEs of 15.3, 2.4, 6.8, 1.2 years and losses-of-DFLE of 8.1, 20.7, 4.0, 8.6 years, respectively, indicating that advanced stage had a stronger effect than old age. Survivors in advanced stages showed increased demands for assistance in almost all subitems. The DFLEs seemed to be approximate to the QALEs and the latter were shorter than the former due to discomfort and depression. From a societal perspective, future health technology assessment should consider the impact of lifetime duration of functional disability. Early diagnosis of NSCLC may decrease the burden of long-term care.

Approaching person-centered long-term care: The trajectories of intrinsic capacity and functional decline in Taiwan.

AIM: To examine the longitudinal trajectory of intrinsic capacity over a 3-year period among long-term care recipients in Taiwan, its association with functional decline and the onset of severe dependency. METHODS: A total of 9448 individuals aged ≥50 years utilizing home and community-based long-term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed-effects model to investigate their impact on activities of daily living and a Kaplan-Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes. RESULTS: The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory-dysfunction" (29.53%) and "all-dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from -16.94 to -6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all-dysfunction class. CONCLUSIONS: Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person-centered care approach in long-term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function-centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; 22: 516-522.

The Effect of Ageist Behaviors on Home Care Workers' Job Satisfaction and Retention in Long-Term Care.

OBJECTIVES: This study aimed to examine how intrinsic and extrinsic factors of job satisfaction affect home care workers' intention to stay and determine whether ageist behaviors moderate the relation between job satisfaction and intention to stay. METHOD: We recruited 380 participants to complete measures of job satisfaction, ageist behaviors, and intention to stay. RESULTS: Monthly wages, extrinsic and intrinsic factors, and positive and negative ageist behaviors were significantly related to home care workers' retention. Both positive and negative ageist behaviors negatively moderated the relation between job satisfaction and retention. CONCLUSION: Home care workers' retention may be increased by providing reasonable extrinsic rewards and enhancing the intrinsic nature of the job itself. Reducing negative ageist behaviors and increasing positive ones for those with low job satisfaction could be related to higher retention. The harmful effects of positive behaviors should be addressed. These findings could contribute to workforce retention in long-term care.

The Effects of in-Home Respite Care on the Burden of Caregivers in Taiwan.

The utilization rate of respite care in Taiwan is low, and past studies that evaluated the effects of in-home respite care on caregiver burden are few. This two-wave panel study used Taiwan's long-term care plan 1.0 database and included 2342 care recipient-caregiver dyads who used home services to examine the impact of in-home respite care on caregiver burden. Propensity score matching was used to select 323 in-home respite service users matched with 646 nonusers as control groups (1:2 matching). The mixed effect model was applied to estimate the effects of receiving in-home respite care on caregiver burden. Results showed that compared with those of nonusers, caregiver burden scores of service users decreased significantly after receiving in-home respite care for more than 14 days (adjusted B = -0.14, SE = 0.05). The government should prioritize increasing the number of days of in-home respite care for those in need to reduce the caregiver burden.

Multidimensional Determinants of Well-Being Among Community-Dwelling Older Adults During the Early Stage of the COVID-19 Pandemic in Taiwan.

Objectives: Due to the insufficient and inadequate policies on the psychological well-being of the aged population, we aimed to examine the multidimensional determinants of well-being during the early stage of the COVID-19 pandemic. Method: Data were collected from face-to-face interviews with1,232 participants aged 50 and older living in Southern Taiwan. We used multivariate logistic regression to examine the associations between demographics, the physical health, mental health, social ties domains, and well-being. Results: We found that (i) in physical health, no dental problems and exercise were related to better well-being; (ii) in mental health, stress and depression decreased well-being, but laughing every day, and a positive attitude toward aging had adverse effects; and (iii) in social ties, subjective social status, family support, and place attachment to the community were positively associated with well-being. Discussion: Our findings highlight the multidimensional needs at the individual and community levels for the Chinese population.

Rpl12p affects the transcription of the PHO pathway high-affinity inorganic phosphate transporters and repressible phosphatases.

The ribosomal protein Rpl12p of Saccharomyces cerevisiae is encoded by duplicated genes, RPL12A and RPL12B. The gene products possess an identical amino acid sequence. Yeast strain 6EA1, which lacks both genes, is viable but exhibits a very slow-growth phenotype. In this study, 6EA1 cells were transformed with plasmids carrying either RPL12A or RPL12B, and the transcriptional profiles of wild-type W303, 6EA1 and the transformed cells grown in synthetic complete medium were examined by microarray analysis. Transcription of PHO84, a gene encoding a high-affinity phosphate transporter, was drastically suppressed in 6EA1. PHO84 expression is induced under phosphate-limiting conditions. Therefore, cells were grown in low-phosphate medium and transcripts encoding the PHO pathway proteins were quantified by qRT-PCR. The high-affinity phosphate transporters and repressible phosphatases were suppressed, while PHO4, a PHO pathway transcription activator, was upregulated in 6EA1. Accordingly, phosphate transport and acidic phosphatase activities were significantly decreased in 6EA1. Addition of RPL12A or RPL12B to 6EA1 largely lessens these effects. We postulate that RPL12 has an extra-ribosomal function in modulating the transcription of genes that need Pho4p activation.

Functional and Cognitive Impairments Increased Risks of Outcomes of Healthcare Utilization in Patients With Stroke Receiving Home and Community-Based Care in Taiwan.

Aim: Stroke is a leading cause of disability; however, little is known about the outcomes of the utilization of long-term care (LTC) recipients in Taiwan. This study aimed to quantify the burdens of disease of stroke survivors receiving LTC by evaluating the outcomes of their utilization including mortality, readmissions, and re-emergency within 1 year after diagnoses of strokes. Methods: By interlinkages among the national mortality registry, LTC dataset (LTC-CM), and the National Health Insurance Research Dataset (NHIRD), the outcomes and the factors associated with receiving LTC up to 1 year were explored. Patients were aged 50 years and over with an inpatient claim of the first diagnosis of stroke of intracerebral hemorrhage (ICH) and ischemic stroke during 2011-2016. Outcomes of the healthcare utilization include rehospitalization and re-emergency. Results: There were 15,662 patients with stroke who utilized the LTC services in the dataset among the stroke population in NHIRD. Stroke survivors receiving LTC showed no difference in clinical characteristics and their expected years of life loss (EYLL = 7.4 years) among those encountered in NHIRD. The LTC recipients showed high possibilities to be rehospitalized and resent to emergency service within 1 year after diagnosis. Apart from the comorbidity and stroke severity, both the physical and mental functional disabilities and caregiving resources predicted the outcomes of the utilization. Conclusions: For stroke survivors, both severe functional impairments and cognitive impairments were found as important factors for healthcare utilizations. These results regarding reserving functional abilities deserve our consideration in making the decision on the ongoing LTC policy reform in the aged society of Taiwan.

Correlates of institutionalized senior veterans' quality of life in Taiwan.

BACKGROUND: Senior veterans living in government sponsored, long-term care (LTC) facilities, known as veterans' homes (VHs), are a special minority group in Taiwan. These seniors came from different provinces of mainland China during their teenage years at the end of civil wars in 1945. The situation of institutionalized senior veterans shares many characteristics with the concept of "total institution". Very little quality of life (QOL) research has involved senior veterans. This study aimed to explore the QOL and related factors of VH-dwelling senior veterans in Taiwan. METHODS: Chronic conditions and socio-demographic characteristics of 260 male VH residents were recorded. The Brief Form of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF, Taiwanese version); Short-Form 36; Inventory of Socially Supportive Behavior questionnaire; Geriatric Depression Scale-short form; Barthel Index; and instrumental activities of daily living were used. Data analyses including descriptive and inferred statistics were performed using SPSS, version 17. RESULTS: WHOQOL-BREF showed acceptable reliability in this study. Compared to Taiwanese male norms, WHOQOL-BREF physical, psychological, and social relationship domain scores were around the 25th percentile, and the environment domain was about the 75th percentile. Our participants scored low in all concepts of SF-36. Although these residents rated the social support of their children, relatives, friends, social and medical staff as low, they gave high satisfaction ratings to their social supports. On multiple stepwise linear regression analysis, depressive symptoms, number of chronic conditions, retired military rank, and relatives' support correlated with QOL in both the physical and psychological domains. Friends' support and depressive symptoms correlated with the social relationships domain. Friends' support and instrumental activities of daily living correlated with the environment domain. CONCLUSIONS: In general, institutionalized senior veterans' QOL was lower than Taiwanese male norms. Helping senior veterans to effectively improve their subjective mental health and social support, and controlling chronic disease appears to be critical to their QOL.

A longitudinal evaluation of residents' health outcomes in nursing homes and residential care homes in Taiwan.

PURPOSE: The role of nursing homes (NHs) and residential care homes (RHs) frequently overlaps in Taiwan, raising concerns about their level of care. This study aimed to investigate residents' health outcomes in NHs and RHs 1 year after admission. METHODS: This longitudinal study included four stages of face-to-face interviews with recruited residents. Five main outcome measures, residents' functional status, broad health status (SF-36), resident's/family's satisfaction toward institutions (RSQ), mortality, and relocation rates, were assessed by generalized estimating equations. RESULTS: The mean scores of ADL and RSQ of newly admitted NH residents were significantly lower, and mini-mental state examination (MMSE) scores higher than those of RH residents (P < 0.05). However, MMSE and RSQ showed no statistical difference between these two institutions over time. Moreover, scores for Physical Role, Emotional Role, and Mental Component Scales of SF-36 were significantly improved in NH residents than those of RH residents over time. The survival rate of RH residents was also statistically lower than that of NH residents (chi(2) = 6.2, P < 0.05) 1 year after admission. CONCLUSIONS: NH and RH residents in Taiwan experience significantly different trajectory outcomes in 1 year follow-up, suggesting that the placement for older people with long-term care needs should be constantly monitored.