Nursing Staff Presenteeism Scale: Development and psychometric test.

BACKGROUND AND OBJECTIVES: Nurses tend to exhibit higher rates of presenteeism compared to other professions. Presenteeism can cause the work performance of nurses to suffer, jeopardizing their own and their patients' safety and leading to decreased quality of care and increased risks of errors. However, there is a lack of a validated assessment tool for presenteeism in Taiwan. Thus, the purpose of this study was to develop a Nursing Staff Presenteeism Scale (NSPS). METHODS: To develop questionnaire items, participants from three medical centers in Taiwan were recruited. Through convenience sampling, 500 nurses who met the selection criteria were recruited from November 1, 2022 to January 18, 2023. The scale was developed based on a systematic literature review, a previous study, and expert consultation, and 50 items were initially generated. After removing three items that lacked discriminative power, the reliability and validity of the remaining 47 items were evaluated. An exploratory factor analysis was used to establish the construct validity. A confirmatory factor analysis and structural equation modeling for cross-validation were used to assess relationships of factors with items and the overall NSPS. RESULTS: The final scale consisted of 44 items assessed on a five-point Likert scale that loaded onto three different factors of physical or mental discomfort (18 items), work performance (15 items), and predisposing factors (11 items). These three factors were found to explain 63.14% of the cumulative variance. Cronbach's alpha for the overall final scale was 0.953. The item-to-total correlation coefficients ranged 0.443 to 0.795. CONCLUSIONS: The NSPS exhibited satisfactory reliability and validity. It can be applied to assess the level of presenteeism among clinical nurses and provide medical institutions with information regarding the causes of presenteeism, predisposing factors, and the impacts of presenteeism on their work performance to enhance the safety and quality of clinical care.

Effectiveness of health education and counseling on stages of change, decisional balance, and smoking cessation self-efficacy: A prospective self-control study.

OBJECTIVE: To examine the effectiveness of health education and counseling on the stages of change, decisional balance, and smoking cessations elf-efficacy in smokers with no intention of quitting. METHODS: A prospective self-controlled design was conducted between December 2020 and December 2022. The research period was divided into a control stage (first to fourth weeks) and an experimental stage (fifth to eighth weeks). Patients with coronary artery disease (CAD) and habitually smoked were recruited. Pearson correlation and a one-factor repeated-measurement analysis were performed to assess the effectiveness of the intervention. RESULTS: In total, 108 male CAD patients with a mean age of 58.1 years were recruited. After 4 weeks of the intervention, 55 (51%) exhibited behavior change (X 2 = 18.03, p = .001). The decisional balance and smoking cessation self-efficacy scores significantly improved in the experimental stage. No significant differences were observed in the control stage. CONCLUSIONS: Four weeks of health education and counseling could effectively improve participants' stage of change, decisional balance, and smoking cessation self-efficacy. PRACTICE IMPLICATION: Healthcare professionals can play key roles in helping CAD patients successfully quit smoking through individual education and counseling.

Comparative efficacy of exercise regimens on sleep quality in older adults: A systematic review and network meta-analysis.

The efficacies of various exercise modalities in improving older adults' sleep quality remain unclear. Therefore, in this study, network meta-analysis was performed by comparing the efficacies of various exercise regimens in improving sleep quality in this age group. Six electronic databases were searched for relevant studies between the date of database creation and August 13, 2021. Only randomized controlled trials reporting the effects of exercise on sleep quality in this population were included. Random-effects network meta-analysis based on a frequentist framework was conducted. In total, 35 trials involving 3519 older adults were included. Cognitive behavioral therapy for insomnia, muscle endurance training combined with walking, Tai chi, Baduanjin, resistance training combined with walking, and resistance training significantly improved sleep quality to a greater degree than did usual care (P < 0.05). Muscle endurance training combined with walking led to significantly higher sleep quality than did regimens involving sleep hygiene, Pilates, only walking, health education, resistance training, Taichi, resistance training combined with walking, or yoga. Muscle endurance training combined with walking was identified as the optimal exercise program (88.9%) for enhancing sleep quality in older adults. The results of this study support the claim that exercise can improve sleep quality in this population. PROSPERO registration number: CRD42020178209.

Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study.

AIMS: To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN: A cross-sectional nationwide study. METHODS: The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS: In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). CONCLUSIONS: Enhancing emergency training in LTCF can improve nurses' decision-making ability to refer LTCF residents to emergency treatment. IMPACT: What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision-making. 'Transfer timing' was most often considered in the decision-making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision-making ability and suitability of transferring residents for emergency treatment.

The association between psychological distress and angina pectoris: A population-based study.

BACKGROUND: Psychological distress is an undifferentiated combination of symptoms that may be related to the occurrence of angina pectoris (AP). However, few studies have investigated the relationship between psychological distress and AP, particularly in Asian populations. The purpose of this study was to examine the relationship between psychological distress and AP in Taiwanese adults. METHODS: We adopted a cross-sectional design to explore the data of the 2005-2008 Nutrition and Health Survey in Taiwan. In total, 2080 subjects (aged ≥ 19 years) responded to questionnaire interviews and underwent physical examinations. Each of the five dimensions of psychological distress (sleep disturbance, anxiety, hostility, depression, and feelings of inferiority) were scored (from 0-20) according to the Five-Item Brief Symptom Rating Scale (BSRS-5). A score ≥ 6 points indicated psychological distress. AP was evaluated using a modified Rose questionnaire. FINDINGS: In total, 102 subjects (3.6%) had AP, and 231 subjects (8.8%) had symptoms of psychological distress. After adjusting for the basic data, metabolism, and lifestyle covariates, the BSRS-5 total score was associated with AP (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.13-1.26, p < 0.001). Subjects with psychological distress had a higher risk of AP (OR = 2.97, 95% CI = 1.76-4.99, p < 0.001). CONCLUSIONS: The presence of AP is associated with psychological distress. Health care providers should therefore be aware of the impact of psychological distress on AP. Our study findings can serve as a reference for AP assessments. Large scale longitudinal studies are needed to confirm a causal relationship between psychological distress and AP.

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents.

BACKGROUND AND OBJECTIVES: Nurses serve as gatekeepers of the health of long-term care facility (LTCF) residents and are key members deciding whether residents should visit an emergency department (ED). Inappropriate decisions as to ED visits may result in ED overcrowding, excessive medical expenses, and nosocomial infections. Currently, there is a lack of effective tools for assessing the barriers and level of difficulty experienced by LTCF nurses. The purposes of this study were to develop a Patient Transfer Decision Difficulty Scale (PTDDS) and test its effectiveness. METHODS: This study randomly sampled LTCFs in Taiwan and surveyed two or three nurses in every institution selected. Registered return envelopes were provided for participants to return self-completed questionnaires. Three steps were used to develop the scale and items: in step I, the instrument was developed; in step II, psychometric testing was conducted, which entailed performing an exploratory factor analysis (EFA) to verify the construct validity and reliability of the developed items; and in step III, a confirmation study was conducted using a confirmatory factor analysis (CFA) and structural equation modeling to cross-validate the factors and items. RESULTS: The cumulative sum of variance explained by the measurement models of the three factors in the PTDDS was 63.54%.When deciding whether to transfer LTCF residents to EDs, the most pronounced barrier experienced by nurses were for judging the severity of "clinical episodes", which had an explanatory power of 37.49%. The second and third pronounced barriers and decision difficulty experienced by nurses were "communication and information" and "timing of the residents' emergency visits," which explained 16.81% and 9.24% of the variance, respectively. CONCLUSIONS: The cross-validation results obtained using the EFA and CFA showed favorable reliability and validity of the PTDDS. For future studies, this study recommends performing large-scale investigations of the level of decision difficulty and related factors experienced by nurses in LTCFs of varying levels and types.

A decline in the prevalence of angina pectoris: Data from the Nutrition and Health Survey in Taiwan.

BACKGROUND: Angina pectoris (AP) is one of common symptoms of heart disease. The prevalence of AP varies by genders, age and ethnics. This study aimed to estimate the AP prevalence in adults and its change between surveys. METHODS: Data was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) between 1993 and 1996, and between 2005 and 2008. Participants aged ≥19 years old and grouped according to sex and age range (19-44.9, 45-64.9, and ≥65 years). The national weight prevalence rates in three types of AP (possible, definite, and confirmed) were estimated and we also estimated its change between surveys. RESULTS: A total of 5031(1993-1996) and 4686 (2005-2008) adults were enrolled for this study. The aged-adjusted prevalence of possible, definite, and confirmed AP was 9.2%, 5.6%, and 2.1%, respectively, in 1993-1996, and 4.7%, 3.5%, and 1.1%, respectively, in 2005-2008. The age-adjusted prevalence of definite AP significantly declined from 5.6 (1993-1996) to 3.5 (2005-2008). Women had greater decline in the prevalence for possible (5.8% vs. 3.2%), definite (2.9% vs. 1.3%) and confirmed (1.6% vs. 0.5%) AP than men in both surveys. All AP prevalence rates increased by age in men in both surveys, however, the positive association between AP prevalence and age groups among women only was in 1993-1996. CONCLUSIONS: The AP prevalence significantly declined from 1993 to 1996 to 2005-2008. The AP prevalence in women was higher. The prevalence increased with age in men, but not in women. Continuous monitoring of AP prevalence is recommended to better understand the disease burden.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) experiences among COPD patients with comorbid gastrooesophageal reflux disease.

AIMS AND OBJECTIVES: To explore perceptions of experience exacerbations of chronic obstructive pulmonary disease among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease by focusing on unravelling how patients differentiate and react to symptoms of chronic obstructive pulmonary disease and gastrooesophageal reflux disease. BACKGROUND: While gastrooesophageal reflux disease has been suggested to be a risk factor for chronic obstructive pulmonary disease exacerbations, no study has explored perceptions of the symptoms leading up to severe exacerbation of chronic obstructive pulmonary disease events among chronic obstructive pulmonary disease patients with comorbid gastrooesophageal reflux disease. DESIGN: Qualitative design. METHODS: The analysis was performed in accordance with principles of Grounded Theory methodology. Data were collected via semi-structured interviews from 12 chronic obstructive pulmonary disease patients with endoscopy-diagnosed gastrooesophageal reflux disease who had experienced a chronic obstructive pulmonary disease exacerbation with hospitalisation. Appraisal and analysis using consolidated criteria for reporting qualitative research (COREQ) checklist were undertaken. RESULTS: The core category of this study was the ineffective management of exacerbation symptoms, which was associated with perceived symptoms pre-exacerbation which contained three overlapping categories of symptom presentation experienced, and chronic obstructive pulmonary disease-related coping strategies, high anxiety and a sense of helplessness in disease management. CONCLUSIONS: Patients with severe chronic obstructive pulmonary disease with comorbid gastrooesophageal reflux disease presented with some distinctly different atypical symptoms yet used common respiratory symptom management strategies. Patients and practitioners alike need to be more aware of the possibility of other symptoms such as nonspecific symptoms being clues of exacerbation onset for a more effective intervention. RELEVANCE TO CLINICAL PRACTICE: The medical community needs to educate patients to understand and manage not only chronic obstructive pulmonary disease but also gastrooesophageal reflux disease symptoms so that they are better able to identify the cause of their symptoms, treat them appropriately and seek out medical assistance when necessary.

Lowered obesity indicator cutoff points more effectively predict 5-year incidence of hypertension in premenopausal women.

OBJECTIVE: To compare proposed new cutoff points for four obesity indicators-waist-to-height ratio (WHtR), waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI)-with their current cutoff points to determine which are better standards predicting 5-year incidence of hypertension (HT) and diabetes mellitus (DM) among premenopausal women. DESIGN: Data were obtained from the 2002 and 2007 Survey on the Prevalence of HT, Hyperglycemia and Hyperlipidemia in Taiwan conducted by the Ministry of Health and Welfare, Taiwan. Premenopausal women were grouped based on the proposed cutoff points versus reference cutoff points for obesity indicators. PARTICIPANT: A total of 1466 premenopausal women aged between 20 and 57 years old were recruited. MAIN OUTCOME MEASURE: Five-year incidence of HT and DM. RESULTS: Our new obesity indicator cutoff points-WHtR 0.49, WC 74.7 cm, WHR 0.79 and BMI 22.3 kg/m2-were better predictors for 5-year HT incidence in premenopausal women compared with those of current standards, but were not significantly different for DM. Among the four obesity indicators, WHtR and WC were optimal for their 5-year predictive ability for HT and DM in premenopausal women. CONCLUSIONS: To avoid too many cutoff points for practitioners to adopt and memorize, the proposed new cutoff points were recommended preferentially to prevent the incidence of HT and DM in premenopausal women.

Effectiveness of a Tailored Lifestyle Management Program for Middle-Aged Women With Coronary Artery Disease: A Preliminary Study.

BACKGROUND: Coronary artery disease (CAD) is a leading cause of death in women. Many of the risk factors for CAD relate to lifestyle and thus may be influenced by lifestyle modification. However, middle-aged women often find it difficult to adjust their lifestyle behaviors. Thus, providing individualized treatment is crucial to reducing the risk and incidence of CAD in this population. PURPOSE: The aim of this study was to explore the effectiveness of a tailored lifestyle management program (TLMP) for middle-aged women with CAD. METHODS: An experimental design was employed. Thirty-five middle-aged women with CAD (with stenosis [> 50%] of at least one main artery as determined by cardiac catheterization examination results) were recruited. The 35 women were randomlyassigned to the experimental group (n = 17) or the control group (n = 18). Both groups received regular health education during their hospitalization. After discharge, the experimental group received the 12-week, home-based TLMP. A generalized estimating equation was used to examine the effects of the TLMP on metabolic and biomarker indicators for CAD. RESULTS: The average age of participants was 56.1 ± 5.6 years. No significant demographic differences were identified between the two groups. Compared with the control group, the experimental group had a significantly higher high-density lipoprotein level (B = 7.83, p < .001), a lower level of total cholesterol (B = -49.21, p = .04), and a lower waist circumference (B = -6.42, p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study suggests that using tailored interventions is an effective approach to improving high-density lipoprotein, total cholesterol, and waist circumference in middle-aged women with CAD. This result is expected to have important implications for women's healthcare, particularly in terms of preventing the incidence of CAD.

Predictors of coronary artery disease in middle-aged Taiwanese women at premenopause, postmenopause and after undergoing hysterectomy.

AIMS AND OBJECTIVES: To examine the predictors of coronary artery disease among middle-aged women at various menopausal statuses. BACKGROUND: Few studies have explored coronary artery disease predictors among middle-aged women at various menopausal statuses, particularly with the inclusion of women who underwent a hysterectomy. DESIGN: A cross-sectional design was adopted. METHODS: Two hundred and twenty-five middle-aged women who were waiting for catheterisation examinations because of possible coronary artery disease were selected. These patients were divided into premenopausal (n = 41), postmenopausal (n = 143) and women who had undergone a hysterectomy groups (n = 41). The differences in the risk factors for coronary artery disease between patients with coronary artery disease (catheterisation results showing stenosis of >50% in at least one major coronary artery) and those without coronary artery disease in the three groups were compared. RESULTS: The participants were aged 56·8 ± 5·9 years. In the premenopausal group, the odds of coronary artery disease among ever or current smokers was 8·46 times the odds of coronary artery disease for the never smokers. In the postmenopausal group, the odds of coronary artery disease among diabetes patients was 2·89 times the odds of coronary artery disease for those without diabetes. Each additional point on the Chinese Beck Depression Inventory-II increased the risk of coronary artery disease by 5%. In the hysterectomy group, each additional increase in 1 mmHg in systolic blood pressure increased the risk of coronary artery disease by 4%. CONCLUSIONS: Smoking, diabetes, depression and systolic blood pressure are predictors of coronary artery disease in middle-aged women at premenopause, postmenopause and after undergoing hysterectomy respectively. RELEVANCE TO CLINICAL PRACTICE: These results are beneficial for middle-aged women at various menopausal stages to effectively implement prevention of coronary artery disease. These findings were among women being evaluated for possible coronary artery disease, we suggest the need for further study in lager, longitudinal studies.

Cardiac Rehabilitation Prevents Recurrent Revascularization in Patients With Coronary Heart Disease: A POPULATION-BASED COHORT STUDY IN TAIWAN.

PURPOSE: To evaluate the effects of cardiac rehabilitation (CR) provided within the first 3 months of revascularization on reducing recurrent revascularization in patients with coronary heart disease in Taiwan. METHODS: In this population-based cohort study, we used the claims data of 1 million beneficiaries who were randomly selected from all beneficiaries enrolled in Taiwan's National Health Insurance program from 1996 to 2000. Between 2000 and 2007, 2838 patients underwent a first-event revascularization. Of these patients, 442 (15.6%) underwent CR within the first 3 months of admission for revascularization. The remaining 84.4% (n = 2396) served as the non-CR group. All the study patients were followed-up until the end of 2008 for any recurrent revascularization. A propensity score-adjusted Cox proportional hazard model was used to estimate the relative risk of recurrent revascularization associated with CR. RESULTS: During the 1- to 9-year follow-up, 69 patients (15.6%) in the CR group and 840 (35.1%) patients in the non-CR group experienced recurrent revascularization. The results of the propensity score-adjusted Cox proportional hazard regression analysis showed that CR was significantly associated with a reduced risk of recurrent revascularization with a hazard ratio of 0.48 (95% CI, 0.37 to -0.62). CONCLUSIONS: Cardiac rehabilitation within the first 3 months of revascularization is significantly associated with a reduced risk of recurrent revascularization. This preventive effect was more pronounced in men compared with other subgroups of patients.

Gastro-oesophageal reflux disease increases the risk of intensive care unit admittance and mechanical ventilation use among patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study.

INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is common among chronic obstructive pulmonary disease (COPD) patients and may have a deleterious effect on COPD prognosis. However, few studies have investigated whether GORD increases the risk of severe outcomes such as intensive care unit (ICU) admittance or mechanical ventilator use among COPD patients. METHODS: Propensity score matching by age, sex, comorbidities and COPD severity was used to match the 1,210 COPD patients with GORD sourced in this study to 2,420 COPD patients without GORD. The Kaplan-Meier method was used to explore the incidence of ICU admittance and machine ventilation with the log rank test being used to test for differences. Cox regression analysis was used to explore the risk of ICU admittance and mechanical ventilation use for patients with and without GORD. RESULTS: During the 12-month follow-up, GORD patients and non-GORD patients had 5.22 and 3.01 ICU admittances per 1000 person-months, and 4.34 and 2.41 mechanical ventilation uses per 1000 person-month, respectively. The log rank test revealed a difference in the incidence of ICU admittance and machine ventilation between the two cohorts. GORD was found to be an independent predicator of ICU admittance (adjusted hazard ratio (HRadj) 1.75, 95% confidence interval (CI) 1.28-2.38) and mechanical ventilation (HRadj 1.92, 95% CI 1.35-2.72). CONCLUSION: This is the first investigation to detect a significantly higher incidence rate and independently increased risk of admission to an ICU and mechanical ventilation use among COPD patients who subsequently developed GORD during the first year following their GORD diagnosis than COPD patients who did not develop GORD.

Treadmill Training Improves Forward and Backward Gait in Early Parkinson Disease.

OBJECTIVE: The aim of this study was to examine effects of treadmill training (TT) and lasting duration of training effects on forward walking (FW) and backward walking (BW) gait in Parkinson disease (PD). DESIGN: Twenty-six early PD patients undertook a 12-wk intensive TT program using FW. A repeated-measures design compared GAITRite-measured FW and BW gait before TT, within 1 wk, and at 4 and 12 wks after TT. RESULTS: Twenty-three PD patients, after completing TT, walked forward and backward with increased velocity, enlarged stride length, prolonged swing phase, and decreased double support phase; improvements occurred within 1 wk and remained at 4 and 12 wks after training (P < 0.01 or < 0.001). In addition, trends toward reduced posttraining swing time variability and stride length variability occurred in both directions and sustained for 12 wks. Posttraining FW and BW gait improvements were comparable. BW deficits, regardless of training, constantly exceeded FW deficits. Cadence did not differ before and after training in FW (P = 0.195) and BW (P = 0.229) and between FW and BW irrespective of TT (P = 0.124). CONCLUSIONS: A 12-wk TT program improves the 12-wk duration of FW and BW gait and can be considered a part of a rehabilitation strategy to overcome gait disturbances in early PD.

Lowered cutoff points of obesity indicators are better predictors of hypertension and diabetes mellitus in premenopausal Taiwanese women.

INTRODUCTION: In previous study, we found that in order to prevent MS in women aged <65 years, the cutoff points of obesity indicators should be lowered. OBJECTIVE: To investigate whether our proposed cutoff points of obesity indicators predict the occurrence of hypertension (HT), diabetes mellitus (DM), and hyperlipidemia in premenopausal women with greater sensitivity and specificity compared to reference cutoff points of obesity that are currently being used. METHODS: Using the database of the "2002 Survey on the Prevalence of Hypertension, Hyperglycemia and Hyperlipidemia in Taiwan" provided by the Bureau of Health Promotion, Taiwan as research material, data from 2270 premenopausal women aged 20-65 years were used for the analyses. The receiver-operating characteristic curves (ROC) of the body-mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were used to predict HT, DM, and hyperlipidemia. RESULTS: Obesity is not a good predictor of the occurrence of hyperlipidemia in premenopausal women aged <65 years. However, our proposed cutoff points had greater sensitivity and specificity than did the reference cutoff points. To prevent the risk of HT and DM in premenopausal women, the cutoff points of obesity indicators should be reduced. The proposed values are as follows: a WHR of 0.79; a WC of 74.7 cm; a WHtR of 0.49; and a BMI of 22.3 kg/m(2).

Weight change trajectory in women with breast cancer receiving chemotherapy and the effect of different regimens.

AIMS AND OBJECTIVES: To investigate the trajectory of weight change in Taiwanese women with breast cancer after starting chemotherapy and the impact of chemotherapy regimens on weight change while controlling for age, menopausal status, body mass index, lymph node involvement and changes in habits of dietary fat intake and exercise. BACKGROUND: Weight gain after adjuvant chemotherapy in women with breast cancer has negative impact on health outcomes. DESIGN: Longitudinal, clinical observational study. METHODS: Weights were repeatedly measured in 147 women with breast cancer stages I-III. Hierarchical linear modelling was used to analyse these longitudinal data. RESULTS: The overall pattern of weight change was a cubic form beginning with a mean of 56·9 kg before chemotherapy. It gradually increased to 59·4 kg at 8·5 months after the first chemotherapy followed by a decrease to 58·5 kg at 21·5 months. During the last 2·5 months, weight increased slightly and never returned to the initial level. After controlling for confounders, steeper weight change was observed among women receiving cyclophosphamide, methotrexate and fluorouracil. The highest weight gain in the cyclophosphamide, methotrexate and fluorouracil group was 2·9 kg (5%) vs. 0·9 kg (1%) in the anthracycline-based group. CONCLUSION: The trajectory of body weight change within two years after chemotherapy shows a trend of gradual ascent, followed by a small decline and a slight increase in the last 2·5 months. The chemotherapy regimen can predict the trend after controlling for other confounders; women on cyclophosphamide, methotrexate and fluorouracil have a steeper weight change. RELEVANCE TO CLINICAL PRACTICE: Nurses can inform women with breast cancer about the expected changes in body weight after chemotherapy to reduce their uncertainty. Future studies on effective interventions to minimise chemotherapy-induced weight gain are needed.

Profile of elderly with multiple physician visits: advocacy for tailored comprehensive geriatric assessment use in clinics.

AIM: The rapid growth of the elderly population has given rise to the need for better geriatric care. The present study explored the common conditions of elderly outpatients with multiple physician visits in order to develop feasible clinical indicators that can be rapidly administered for the evaluation of geriatric syndromes in outpatient settings. METHODS: The National Health Insurance Research Database (2008) was analyzed. Claims for elderly outpatients with more than two physician visits in the same day were retrieved. The primary diagnoses, types of prescriptions and comorbidities were cross-examined. RESULTS: The overall prevalence rate for elderly patients with multiple physician visits ranged from 28.41% to 39.40%, and which increased steadily with age. A maximum of seven physician visits in a single day was observed. The most common multiple physician visit was two visits per day, with a prevalence rate of 30.97%. The two most common accompanying conditions were hypertension (3.79%) and type 2 diabetes mellitus (3.68%). There was a greater relative increase in the prevalence of senile dementia and chronic obstructive pulmonary disease in older age groups. The three overall leading specialties were cardiology, internal medicine, and ophthalmology; however, rehabilitation medicine was the most common female-specific specialty. The most commonly prescribed medications were antihypertension drugs. The most prevalent comorbidity was type 2 diabetes mellitus and hypertension. CONCLUSION: We conclude that our data represent crucial information for the design of concise assessment metrics for application to the most chronic conditions in an effort to implement better geriatric healthcare.

Depression, antidepressants, and the risk of coronary heart disease: a population-based cohort study.

BACKGROUND: Evidence supporting a predictive role for depression in the pathgenesis of coronary heart disease (CHD) has mainly come from studies in Western countries. Conflicting data exist regarding the association between antidepressant use and the incidence of CHD. This population-based study tracked the risk of composite coronary events in a cohort with newly diagnosed depression compared to an age- and gender-matched cohort without depression. The association between antidepressant use and risk of coronary events in individuals with depression was also investigated. METHODS: In total, 39,685 individuals (7937 with depression and 31,748 without depression) aged 20-99 years selected from a random sample of 10(6) beneficiaries of the Taiwan National Health Insurance Program were followed up for up to 9 years with a median follow-up period of 8.76 years. Coronary events were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedure codes. Antidepressant use was identified using Anatomical Therapeutic Chemical classification codes. RESULTS: The multivariable-adjusted hazard ratio (HR) for newly detected coronary events was 1.49 (95% confidence interval (CI)=1.29-1.74, p<0.001) for individuals with depression compared to age- and gender-matched individuals without depression. Use of selective serotonin reuptake inhibitors and tricyclic antidepressants did not significantly impact the risk of the composite coronary events among individuals with depression. CONCLUSIONS: Depression is associated with an increased risk for CHD. No evidence supporting an association between antidepressants and coronary events was found.

Dietary supplementation and engaging in physical activity as predictors of coronary artery disease among middle-aged women.

AIM AND OBJECTIVES: To explore risk factors for coronary artery disease (CAD) among middle-aged women in Taiwan. BACKGROUND: Coronary artery disease is a leading cause of death among females. Risk factors for CAD vary due to differences in ethnicity, gender and age. However, few studies have documented risk factors among middle-aged women. DESIGN: We employed a cross-sectional, comparative study design. METHODS: Sixty-five middle-aged women who were suspected of having CAD and who received cardiac catheterisation were purposively sampled and divided into a CAD group (with at least one coronary artery with > 50% stenosis) and a control group, according to the results of catheterisation. Individual questionnaires regarding their medical history, blood test results, sociodemographic characteristics, metabolism, biomarkers and lifestyle risk factors were administered and quantified. RESULTS: The mean age of the 65 women (31 CAD and 34 controls) was 56·2 years. Within the CAD group, there was a greater incidence of women with a history of diabetes mellitus (DM), increased fasting blood glucose and increased diastolic blood pressure. Comparatively fewer women within the CAD category used dietary supplements or had a lower level of physical activity. After adjusting for other confounders, it was discovered that women who used dietary supplements (OR = 0·28; p = 0·04) and engaged in physical activities (OR = 0·16; p = 0·02) were less likely to develop CAD. CONCLUSIONS: Use of dietary supplements and engaging in physical activities can significantly predict the incidence of CAD among middle-aged women in Taiwan. RELEVANCE TO CLINICAL PRACTICE: Middle-aged women should be encouraged to take appropriate dietary supplements and engage in physical activity in order to prevent CAD.

Development of frailty indicators for the community-dwelling older adults.

BACKGROUND: Faster than anticipated increases in population, aging is making the issue of frailty among the elderly increasingly important. Despite general agreement that a frailty assessment is important for planning care for the older adults, a lack of consensus remains regarding the best methodology to use for frailty assessments. PURPOSE: The aim of this study was first to cross-examine results between perception of frailty and physical assessment outcomes then try to establish frailty indicators for elderly people in Taiwan. METHODS: This study used both qualitative and quantitative methods. From August to September 2010, researchers recruited a convenience sample of 10 community older adults from six different elderly centers in northern Taiwan. Qualitative in-depth interviews were conducted in Mandarin or Taiwanese and audiotaped. After the in-depth interview, researchers conducted a series of physical assessments on the participants. RESULTS: Ten elderly women were interviewed and assessed. The three themes identified by this study related to frailty perception included overall physical function performance, psychological health, and physiological health. These reflected the concept of successful aging. Participant frailty was compared with subjective perceptions to identify and/or check for consistency between qualitative and quantitative results. Although quantitative results revealed that participants were in fairly good health, there were many complaints about frailty during the qualitative interview. Better sensitive measures reflecting frailty changes are thus needed. CONCLUSIONS: These indicators can be considered as an integration of all maintained functions. We hope that results will provide better insights into understanding the process of frailty among the older adults.