The outcomes of thoracoscopic decortication between fungal empyema and bacterial empyema.

BACKGROUND: Fungal empyema is an uncommon disease and is associated with a high mortality rate. Surgical intervention is suggested in stage II and III empyema. However, there were no studies that reported the outcomes of surgery for fungal empyema. METHODS: This study is a retrospective analysis in a single institute. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. We separated the patients into a fungal empyema group and a bacterial empyema group according to culture results. We used 1:3 propensity score matching to reduce selection bias. RESULTS: There were 1197 empyema patients who received surgery. Of these, 575 patients showed positive culture results and were enrolled. Twenty-eight patients were allocated to the fungal empyema group, and the other 547 patients were placed in the bacterial empyema group. Fungal empyema showed significantly longer intensive care unit stay (16 days vs. 3 days, p = 0.002), longer median ventilator usage duration (20.5 days vs. 3 days, p = 0.002), longer hospital stay duration (40 days vs. 17.5 days, p < 0.001) and a higher 30-day mortality rate (21.4% vs. 5.9%, p < 0.001). Fungal empyema revealed significantly poorer 1-year survival rate than bacterial empyema before matching (p < 0.001) but without significant difference after matching. CONCLUSIONS: The fungal empyema patients had much worse surgical outcomes than the bacterial empyema patients. Advanced age and high Charlson Comorbidity Index score are independent predictors for poor prognosis. Prompt surgical intervention combined with the use of antifungal agents was the treatment choice for fungal empyema.

Evaluating caregivers' service quality perceptions: impact-range performance and asymmetry analyses.

BACKGROUND: This study aimed to analyze family caregivers' (FCs) dementia care service perceptions to identify the various attributes impacting FCs satisfaction and dissatisfaction. METHODS: This is a cross-sectional survey study using convenience sampling methods. A self-completion questionnaire was developed from the Service Quality scale and distributed using a convenience sampling method to family caregivers in community-based dementia care centers to determine their perceptions of service quality in dementia care. Both exploratory factor analysis and reliability analysis were conducted to confirm the validity and factor structure of the scale. This study employed Impact Range Performance Analysis (IRPA) and Impact Asymmetry Analysis (IAA) to analyze the data obtained from FCs across five attribute dimensions (Tangibles, Reliability, Responsiveness, Assurance, and Empathy). Priorities for service improvement were derived using a three-step analytical framework. RESULTS: This study reported that the overall perceived performance of service provided is high. The results indicated that practitioners should focus on attributes such as demand coordination, appropriate services, timely service, barrier-free environment, care-giving process, fire and safety compliance, professional knowledge, and reliable services, which have a higher range of impact on customer service and low impact-asymmetry and attribute performance scores. CONCLUSION: This study used expectation and perceived performance to suggest that the priorities for improvement and resource allocation in dementia care centers vary across different attributes. Thus, attentiveness toward satisfying user demand could improve patient care and caregiver satisfaction. The dimensions and attributes identified by our study can serve as basic data for future research on the long-term care system.

Patterns of home- and community-based services in older adults with dementia: an analysis of the long-term care system in Taiwan.

BACKGROUND: Understanding the specific characteristics of the patients with dementia is essential in developing services required to meet their needs. The purpose of this study was to investigate the patterns of use of home- and community-based services (HCBS) by patients with dementia and the factors influencing the utilisation of these services. METHODS: We analysed a dataset of patients with dementia receiving long-term care at a medical centre. All participating patients were required to complete a structured interview form every 6 months to assess their need for service utilisation. Between 2015 and 2018, a total of 822 patients fulfilled the criteria for dementia, and 737 people had assessment records, of whom 244 had used social services. Robust Poisson regression analyses were performed to estimate HCBS usage and the factors influencing service utilisation. RESULTS: The overall service utilisation rate was 33 %. Most patients used only one service, and assistive devices were used as the main service. Regarding the factors influencing service use, dementia concomitant with dependency increased the use of HCBS. These results suggest that patients with mild dependency might prefer to use community support services, whereas those with moderate to severe dependency being more likely to utilise in-home care services. CONCLUSIONS: This study provides empirical evidence regarding the use of long-term care resources by patients with dementia in the community. Providing customised HCBS, rather than a non-specialised service assumed to be suitable for every patient, is essential for ensuring good patient care. In addition, attention needs to be paid to patients with care needs who do not use HCBS.

Clinical features of tuberculosis and Bacillus Calmette-Guérin (BCG) -associated adverse effects in children: A 12-year study.

PURPOSE: To investigate the clinical feature of tuberculosis and BCG adverse effects in children and to examine whether delayed BCG vaccination changes the incidence of BCG osteomyelitis. METHODS: We analyzed patients younger than 18 years with tuberculosis or BCG-associated adverse effects from 2008 to 2019. We compared their clinical features, laboratory tests and outcomes. RESULTS: Totally 137 patients were collected, with 27% of pulmonary tuberculosis (PTB), 31% of extrapulmonary tuberculosis (EPTB) and 42% of BCG-associated adverse effects. The median age was older in PTB than EPTB group (17.1 vs 15.4 years; p = 0.015). More patients in EPTB group had fever than PTB group (55% vs 25%; p = 0.008). Compared with exclusively EPTB, more patients in EPTB plus PTB group had fever (78% vs 38%; p = 0.009), and had more systemic symptoms (67% vs 25%; p = 0.007), lower absolute lymphocyte count (1230 vs 1850/µL; p = 0.033), higher CRP level (5.62 vs 2.21 mg/dL; p = 0.024) and longer hospital stay (20 vs 11 days; p = 0.031). In BCG osteomyelitis group, the median time interval from vaccination to diagnosis was 16.4 months (IQR 15.0-20.2). Age at vaccination, either at birth or 5-8 month-old, did not affect the proportion of BCG osteomyelitis among children with BCG-associated adverse effects. CONCLUSION: Children with EPTB plus PTB had more fever, lower lymphocyte count and higher CRP. The median time interval from vaccination to diagnosis of BCG osteomyelitis was 16.4 months and the proportion of BCG osteomyelitis among children with BCG-associated adverse effects was not affected by delayed vaccination in this study.

Dental treatment procedures for periodontal disease and the subsequent risk of ischaemic stroke: A retrospective population-based cohort study.

AIM: To investigate the association between specific dental therapy for periodontal disease and the risk of ischaemic stroke. MATERIALS AND METHODS: We conducted a population-based cohort study that used data from the Taiwan National Health Insurance Research Database 2005 for the period of 2000-2013. Our observations focused on patients with the diagnoses of gingivitis or periodontitis with and without specific treatment and subsequent incidence of ischaemic stroke. Dental care services include dental scaling, intensive treatment (subgingival curettage and root planing) and tooth extraction. Multivariate Cox regression analysis was used to estimate the hazard ratios and corresponding 95% confidence intervals (95% CI). RESULTS: Compared with those in the gingivitis cohort, patients with periodontitis have a higher risk of ischaemic stroke and a lower survival rate of stroke over the 10-year follow-up period. After integrative dental care, both dental scaling and intensive treatment, the risk was reduced, especially in patients with periodontitis, while patients with periodontal disease may have an increased risk of stroke after tooth extraction therapy. CONCLUSIONS: Our study showed that periodontitis is a risk factor for ischaemic stroke. Both dental scaling and intensive treatment for periodontal disease are associated with a lower risk of further ischaemic stroke events.

The longitudinal relationship between mental health disorders and chronic disease for older adults: a population-based study.

OBJECTIVE: Although mental health disorders in older adults are common, their relationship with chronic disease and the influence of chronic disease on the development of mental health disorders over time is not well understood. This longitudinal study investigated the change in status of mental health disorders and chronic disease, as well as their interrelationships, over time. METHODS: Participants included community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Mental health disorders were scored using the Short Psychiatric Evaluation Schedule, and chronic disease(s) status was recorded during consecutive biennial data collection waves. The autoregressive latent trajectory model and parallel latent growth curve model were used for data analysis. RESULTS: The study findings suggest that in older people pre-existing mental health disorders and/or chronic disease(s) will predispose them to developing significantly more mental health disorders and/or chronic diseases respectively. The study findings also suggest that pre-existing mental health disorders can significantly contribute to the development of chronic disease over time, and that pre-existing chronic disease(s) significantly can contribute to the development of mental health disorders over time, indicating a reciprocal interrelationship. CONCLUSIONS: Our study findings suggest that it in addition to monitoring and treating chronic disease(s) in older people, it is also important to monitor and treat their mental health disorders. Doing so will result in overall better health outcomes and will facilitate a better quality of life as they age. Copyright © 2016 John Wiley & Sons, Ltd.

Trajectories of disability and their relationship with health status and social service use.

UNLABELLED: BACKGROUND/STUDY CONTEXT: This longitudinal study was conducted between 1994 and 2004 in a cohort of southern Taiwan community-living older residents. The study aims to explore the trajectories of disability and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and social service use predicted the different trajectories of disability. METHODS: Disability, chronic disease, depression, and social service usage data were collected over six waves. Clusters of disability were used to define a categorical response variable. Baseline levels and new occurrences of chronic disease and depression and the frequency of social service use during this period were chosen as the predictors of disability trajectories. RESULTS: Changes in levels of disability during the aging process were identified. Different trajectories clearly reflected heterogeneity within disability clusters and between surviving and nonsurviving respondents. This study highlighted that hypertension and depression were predictors of increased disability among both surviving and nonsurviving respondents, whereas diabetes was only found to be a strong predictor of increased disability for the nonsurviving respondents. In addition, this study found that use of social services such as personal care, homemaker-household, and physical therapy were significantly associated with an increase in disability, whereas use of recreational services seemed to be associated with a decrease in disability. CONCLUSIONS: These findings identify disability to be a highly dynamic process, which can be characterized into different trajectory clusters (e.g., no, mild, and major disability clusters). A greater awareness of these trajectories could be used to better target strategies to prevent and/or manage disabilities in an aging population.

Preoperative transarterial chemoembolization and resection for hepatocellular carcinoma: a nationwide Taiwan database analysis of long-term outcome predictors.

BACKGROUND: To explore long-term predictors of outcome after TACE and resection in a population of patients with hepatocellular carcinoma (HCC). METHODS: A total of 648 had received TACE before liver resection (TACE group) while 10,431 patients had received liver resection without TACE (LR group). Propensity scores were calculated by entering the patient data into a logistic regression model for predicting HCC outcomes. RESULTS: Compared to the LR group, the TACE group did not significantly differ in disease-free survival (DFS) (median, 17 months in the TACE group vs. 13 months in the LR group; P = 0.410) and overall-survival (OS) (median, 56 months in the TACE group vs. 54 months in the LR group; P = 0.777). The TACE group also showed that gender, liver cirrhosis, CCI score, hospital volume, and surgeon volume were independently associated with DFS while gender, CCI score and hospital level were independently associated with DFS/OS. CONCLUSIONS: This population-based cohort study provides compelling evidence that preoperative TACE does not significantly reduce DFS or OS in patients with resectable HCC. Moreover, long-term outcomes for these procedures are significantly associated with patient characteristics and hospital characteristics. Medical professionals and health care providers should carefully evaluate candidates for preoperative TACE in patients with resectable HCC.

Impulse oscillometry in patients with persistent post-COVID-19 symptoms: A retrospective study.

Introduction: Impaired lung function has been observed in patients following COVID-19 infection, with studies reporting persistent lung volume and diffusing capacity impairments. Some studies have demonstrated significantly higher small airway resistance in COVID-19 positive cases. This retrospective study aims to examine impulse oscillometry (IOS) data of patients with persistent symptoms after COVID-19 infection, focusing on the relationship between time and symptoms. Material and Method: The study analyzed data from adult patients with persistent symptoms who underwent IOS testing within and after 84 days from the diagnosis date. Result: The results showed that patients within 84 days and those between 31 and 84 days had higher small airway resistance values, indicating peripheral airway disease. Patients with dyspnea exhibited higher IOS values compared to those with cough symptoms, suggesting more significant impairment in the peripheral airways. Conclusion: The study highlights the importance of using comprehensive diagnostic tools like IOS to assess respiratory impairments in post-COVID-19 patients, particularly in the small airways. Understanding the relationship between time and symptoms can provide valuable insights for the treatment of peripheral airway dysfunction in post-COVID-19 patients.

Gender difference on the mediation effects of filial piety on the association between chronic obstructive pulmonary disease and depressive symptoms in older adults: A community-based study.

Filial piety is viewed as strong family support for older Chinese people, and strongly associated with depressive symptoms. It is unknown if there exists gender difference in the mediation effects of filial piety on the relationship between chronic obstructive pulmonary disease (manifested as lung function) and depression. We investigated whether filial piety mediates the association between lung function and depression in community-dwelling older men and women using the Healthy Aging Longitudinal Study in Taiwan (HALST). Community dwelling adults aged 65 and above were analyzed. Pulmonary function, depressive symptoms, and filial piety expectation (FPE) and receipt of filial piety (RFP) were collected. The interaction and mediation of filial piety between lung function and depression was analyzed. We found that in older men, forced expiratory volume in the first second (FEV1) was inversely correlated with depression (ß = -0.1281, p = 0.004) with no mediation effect of FPE. In older women, FEV1 was negatively associated with FPE, but FPE did not increase the risk of depression (ß = 0.0605, p = 0.12). In both older men and women, FEV1 was negatively associated with RFP, while RFP reduced the risk of depression (p< 0.001). In older women, the correlation between FEV1 was complete mediation of RFP. Results indicate that feelings of insufficient filial piety may increase the likelihood of depression, especially in elderly women with worse lung function. Although modest, the main mediation effect of filial piety was improvement of lung function in older subjects, which might decrease depression.

Meridian energy analysis may predict the prognosis of patients with advanced cancers receiving palliative care.

Background and aim: A better understanding of irreversible prognoses in palliative care is crucial for improving patients' quality of life and their sense of dignity. We examined whether measurements of meridian electrical conductance can noninvasively and objectively predict survival time in a hospice patient population. Experimental procedure: This was a single-center cohort study. Between 2019 and 2020, we measured skin conductance from 24 representative acupoints of 12 meridians on both sides of the body in 181 advanced cancer patients within 48 h of hospitalization and monitored their survival time. The Palliative Prognostic Score (PaP Score) was calculated for each patient, classifying them into one of three prognosis groups: Group A, B, or C. Factors associated with short-term and long-term survival were identified using multivariate regression analysis. Statistical differences in survival times were analyzed between the meridian electrical conductance measurements and PaP Scores. Results and conclusion: Analyses of the clinicopathological data from terminal cancer patients revealed that male sex, mean meridian electrical conductance measurements of ≤8.8 µA, and PaP Scores in Group C were independent predictors of short-term survival. Mean meridian electrical conductance measurements of ≤8.8 µA demonstrated good sensitivity (85.1%) and adequate specificity (60.6%) for short-term survival. A survival curve analysis revealed a mortality rate of 90.6% at 30 days among patients with meridian electrical conductance measurements of ≤8.8 µA. A mean meridian electrical conductance measurement of ≤8.8 µA can objectively assess short-term survival with advanced cancer and reduce nonbeneficial medical treatment.

Endoscopic subserosal dissection for a GI stromal tumor.

Video 1Endoscopic subserosal dissection was carried out to remove the subepithelial tumors.

Combining HAIC and Sorafenib as a Salvage Treatment for Patients with Treatment-Failed or Advanced Hepatocellular Carcinoma: A Single-Center Experience.

BACKGROUND: Hepatic arterial infusion chemotherapy (HAIC) has been proven to be an effective treatment for advanced HCC. In this study, we present our single-center experience of implementing combined sorafenib and HAIC treatment for these patients and compare the treatment benefit with that of sorafenib alone. METHODS: This was a retrospective single-center study. Our study included 71 patients who started taking sorafenib between 2019 and 2020 at Changhua Christian Hospital in order to treat advanced HCC or as a salvage treatment after the failure of a previous treatment for HCC. Of these patients, 40 received combined HAIC and sorafenib treatment. The efficacy of sorafenib alone or in combination with HAIC was measured in regard to overall survival and progression-free survival. Multivariate regression analysis was performed to identify factors associated with overall survival and progression-free survival. RESULTS: HAIC combined with sorafenib treatment and sorafenib alone resulted in different outcomes. The combination treatment resulted in a better image response and objective response rate. Moreover, among the patients aged under 65 years old and male patients, the combination therapy resulted in a better progression-free survival than sorafenib alone. A tumor size ≥ 3 cm, AFP > 400, and ascites were associated with a poor progression-free survival among young patients. However, the overall survival of these two groups showed no significant difference. CONCLUSIONS: Combined HAIC and sorafenib treatment showed a treatment effect equivalent to that of sorafenib alone as a salvage treatment modality used to treat patients with advanced HCC or with experience of a previously failed treatment.

Evaluation of a self-assessed screening test for masticatory ability of Taiwanese older adults.

OBJECTIVES: The aim of this study was to evaluate a screening test based on a food intake questionnaire to discriminate the masticatory ability of Taiwanese older adults with 20 and more natural teeth and at least 8 functional tooth units (FTUs) from the masticatory ability of those with fewer than 20 natural teeth and 8 FTUs. MATERIALS AND METHODS: The subjects were 2244 patients (mean age, 60.4±10.0 years) recruited from 23 counties and cities in Taiwan. Information about their demographic data, dentition, and masticatory ability was collected. Masticatory ability was measured for 23 food groups comprising 35 common Taiwanese foods, and receiver operation characteristic curve analysis was performed. RESULTS: The results showed that the final questionnaire included 14 food groups and a subject choosing 'difficult to eat' responses for 4 and more of these food groups had the same masticatory ability as individuals with fewer than 20 natural teeth and 8 FTUs. CONCLUSION: In conclusion, foods that are the most difficult to eat are not necessarily good discriminatory indicators. Hence, the 14-food group questionnaire can be considered the best screening test for masticatory ability of Taiwanese older adults in terms of the presence of 20 and more natural teeth and at least 8 FTUs.

Retrospective Evaluation of Discharge Planning Linked to a Long-Term Care 2.0 Project in a Medical Center.

BACKGROUND: Although there are several studies on discharge planning and long-term care systems in individual programs, research on the connection between discharge planning and the usage of long-term care is scanty. This study aims to evaluate the nature of the association between discharge planning (DP) and long-term care (LTC) and whether the utilization of LTC services improved after being discharged. METHODS: This was a single-center retrospective medical record review study. Secondary data analysis was conducted of DP-LTC participation data between 2018 and 2019. The objectives were to clarify the distinct characteristics of each part of the service to explore the utility rate by overall users and users with willingness and to determine the factors influencing their usage. Medical claims were used to identify inpatients receiving discharge services, and data were matched with LTC system engagement data (n = 2155). Backward stepwise regression was used to explore the attributes associated with each type of service use. RESULTS: A total of 94% (2042/2155) of inpatients expressed a perceived need for LTC services, of which 14% (285/2042) were users of LTC services after discharge. When assessed by case-mix system (CMS) and willingness to use services during hospitalization, inpatients had higher rates of service utilization after discharge. Using LTC services was most likely to be associated with obesity, disability, high CMS level, higher education, and women. CONCLUSION: The study confirms that the utilization of LTC services has improved under the integrated DP-LTC system. The gap between willing and actual users is worth considering. In the assessment stage, special attention should be paid to the service needs of persons with BMI ≥ 27 and disabilities. Future research with a larger sample could comprehensively evaluate the impact of integrated DP services on the use of LTC 2.0 service resources.

Important Factors Influencing Willingness to Participate in Advance Care Planning among Outpatients: A Pilot Study in Central Taiwan.

Advance care planning (ACP) and advance directives (ADs) ensure patient autonomy in end-of life care. The number of ADs made and followed in Taiwan is still lacking. This study aimed to determine the factors that influence the willingness to participate in ACP among outpatients in Taiwan. In this study, we conducted a cross-sectional survey based on convenient sampling methods. The questionnaire included questions about participants' basic sociodemographic information, knowledge of ACP, and awareness of ACP. A total of 198 adults who were outpatients of a family medicine clinic in an affiliated hospital in Taiwan were recruited. The associations between each variable were evaluated using the χ2 test. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the logistic regression method to examine the influence of each variable on willingness to participate in ACP. Being happy and being a healthcare professional were positively correlated with ACP participation. A lack of ACP knowledge (OR = 0.30 in model A and OR = 0.42 in model C), valuing "Reducing families' end-of-life decision-making burden" (OR = 2.53 in model B and OR = 2.65 in model C), and a "Belief in a good death" (OR = 4.02 in model B and OR = 4.10 in Model C) were the main factors affecting subjects' willingness to participate in ACP. Knowing which factors influence willingness to participate in ACP helps in the promotion of ACP. Continuously educating both the general public and healthcare professionals strengthens knowledge about the right to autonomy, about its associated laws, and about the ACP process, and thus, programs should be created to provide this education. Additionally, taking into account the differences between cultures can be helpful.

Clinical Outcome of Intraoperative Recurrent Laryngeal Nerve Monitoring during Thoracoscopic Esophagectomy and Mediastinal Lymph Node Dissection for Esophageal Cancer.

Mediastinal lymph dissection in esophagectomy for patients with esophageal cancer is important. The dissection of recurrent laryngeal nerve (RLN) lymph nodes could cause RLN injury, vocal cord palsy, pneumonia, and respiratory failure. This retrospective study aimed to evaluate the effects of intraoperative RLN monitoring in esophagectomy and mediastinal lymph node dissection in preventing RLN injury and vocal cord palsy. This study included 75 patients who underwent minimally invasive esophagectomy and mediastinal lymph node dissection for esophageal cancer with (38 patients) and without (37 patients) IONM at Changhua Christian Hospital from 2015 to 2020. The surgical and clinical outcomes were reviewed. Patients in the IONM group had more advanced clinical T status, shorter operation time (570 vs. 633 min, p = 0.007), and less blood loss (100 mL vs. 150 mL, p = 0.019). The IONM group had significantly less postoperative vocal palsy (10.5% vs. 37.8%, p = 0.006) and pneumonia (13.2% vs. 37.8%, p = 0.014) than that in the non-IONM group. IONM was an independent factor for less postoperative vocal cord palsy that was related to postoperative 2-year survival. This study demonstrated that IONM could reduce the incidence of postoperative vocal cord palsy and pneumonia.

Benefits and risks of low molecular weight heparin use on reproductive outcomes: A retrospective cohort study.

OBJECTIVE: Low molecular weight heparin (LMWH) has been given to reproductive-age women with various indications. This study aims to assess the benefits and risks of such use. MATERIALS AND METHODS: We retrospectively reviewed data (n = 204) between Jan 2016 and May 2019. Logistic regression analysis was conducted to evaluate the correlation between indications and reproductive outcomes. RESULTS: LMWH use had higher odds of live birth in women less than 30 years of age (OR: 4.98; 95% CI = 1.13-21.98; p = 0.034) and with protein S deficiency (OR: 3.90; 95% CI = 1.77-8.59; p = 0.001). For the subgroup of recurrent pregnant loss, LMWH use was only advantageous to women with protein S deficiency (OR: 2.45; 95%:1.01-5.97; p = 0.048). Risks such as preterm delivery, small-for-gestational-age, placental abruption, antepartum/postpartum hemorrhage were not significantly increased among subgroups. Women treated with LMWH and who had successful live births (n = 171) had a slightly increased risk of postpartum hemorrhage compared to controls (n = 8058) during this period in our institution (2.9% vs 1.2%, p < 0.001). CONCLUSION: LMWH administration produces a higher chance of live-birth to women younger than 30 years of age or with protein S deficiency. However, risk of postpartum hemorrhage is increased.

Socio-demographic and health-related factors associated with cognitive impairment in the elderly in Taiwan.

BACKGROUND: Cognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. It is especially important to better understand factors involving in cognitive decline for the countries where the older population is growing rapidly. The aim of this study was to examine the association between socio-demographic and health-related factors and cognitive impairment in the elderly in Taiwan. METHODS: We analysed data from 2119 persons aged 65 years and over who participated in the 2005 National Health Interview Survey. Cognitive impairment was defined as having the score of the Mini Mental State Examination lower than 24. The χ2 test and multiple logistic regression models were used to evaluate the association between cognitive impairment and variables of socio-demography, chronic diseases, geriatric conditions, lifestyle, and dietary factors. RESULTS: The prevalence of cognitive impairment was 22.2%. Results of multivariate analysis indicated that low education, being single, low social support, lower lipid level, history of stroke, physical inactivity, non-coffee drinking and poor physical function were associated with a higher risk of cognitive impairment. CONCLUSION: Most of the characteristics in relation to cognitive impairment identified in our analysis are potentially modifiable. These results suggest that improving lifestyle behaviours such as regular exercise and increased social participation could help prevent or decrease the risk of cognitive impairment. Further investigations using longitudinal data are needed to clarify our findings.