Dietary Characteristics of Elders with Frailty and with Mild Cognitive Impairment: Cross-Sectional Findings and Implications from the Nutrition and Health Survey in Taiwan 2014-2017.

It is unclear whether low dietary intake accompanied with multiple nutrient deficiencies or specific nutrient inadequacy is associated with geriatric syndrome. This study aimed to examine the nutrition inadequacy profiles associated with frailty and cognitive impairment (CI). With information from the Nutrition and Health Survey in Taiwan, 2014-2017, sex-specific nutrient intakes and intake per kg of body weight (BW) were estimated from 24-hour recall data for two age groups (65-74 years; ≥75 years) regarding the three frailty and three CI subgroups. Total energy intakes were significantly lower with the severity of both frailty and CI in analysis combining both gender and age groups, and in both the 65-to-74-year-old women or the over-75-year-old women. These trends were observed but not significant in either of the two age groups in men. Significantly lower levels of energy intake have been observed when age, sex, and sampling strata were adjusted. Intake levels of multiple nutrients also decreased with the severity of frailty and CI. A greater number of nutrient inadequacies for the frail and the CI was found in the 65-to-74-year-old group than the over-75-year-old age group. However, most of the associations between micronutrients and the two geriatric syndromes disappeared after energy adjustment. The remaining few did not show consistency across age-sex subgroups. In conclusion, frailty or CI was associated with low amounts of food consumption accompanied by multiple nutrient insufficiencies. Dietary intervention to ensure adequate total energy and multiple nutrient intakes should be trialed in the geriatric population to address both the causal and efficacy issues.

The Healthy Taiwanese Eating Approach is inversely associated with all-cause and cause-specific mortality: A prospective study on the Nutrition and Health Survey in Taiwan, 1993-1996.

BACKGROUND: Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan. METHODS: The study population included 2475 young and middle-aged adults (aged 18-65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis. RESULTS: A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47-0.87) for total mortality, and 0.52(0.28-0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities. CONCLUSION: Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan.

Prevalence of Postpartum Depression and Associated Predictors Among Taiwanese Women in a Mother-Child Friendly Hospital.

Postpartum depression (PPD) is a highly prevalent disorder characterized by increased vulnerability to morbidity and mortality. This study explores the predictors and prevalence of PPD among Taiwanese women. A total of 914 postpartum women was recruited from a mother-child-friendly hospital. These participants completed self-report questionnaires at 1 month postpartum, and their medical records were also examined for relevant information. Multivariate analyses were used to identify independent predictors of PPD. At 1 month postpartum, 18.8% had developed PPD. Multivariate analysis showed that the odds ratios for PPD were significantly lower among women who were breastfeeding, had more family support, and attended a postpartum care center, while those who were younger, primiparous, and who experienced gestational complications had a higher prevalence of PPD. Meanwhile, structural equation modeling showed that family support from partners, parents, and parents-in-law diminished depression scores through direct effects.

Burnout and metabolic syndrome among different departments of medical center nurses in Taiwan-Cross-sectional study and biomarker research.

OBJECTIVES: The cross-sectional study aimed to analyze the association between burnout, work-related factors, and metabolic syndrome (Mets) in nurses from several departments of a tertiary hospital in Taiwan. Exploring biomarkers could provide for prevention. METHODS: Demographic data were obtained through a written questionnaire and include the following information: gender, age, education level, psychosocial and work situations, such as departments, working hours, work shift, depression, and sleep time. Burnout was evaluated according to the Chinese Burnout inventory, Mets was evaluated according to the criteria of the National Cholesterol Education Program of Taiwan-Treatment Panel for Adults III (NCEP-ATP III). RESULTS: A total of 1758 nurses participated with a median age of 35.2 years. The prevalence of burnout and Mets was 6.4% and 13.84%, respectively. The results showed that burnout induced higher risk of Mets, odds ratio (OR) 1.70 (95% confidence interval, 1.04-3.05). Other factors, such as out-patient nurses, seniority (4-10 and >10 years), working hours (51-59 h/wk), nigh shift, Brief Symptom Rating Scale-5 (score 10-14 and ≧15), poor self-rated health status, and inadequate sleep time, led to higher risk of Mets. Biomarkers research showed that Glycated hemoglobin (Hba1c) was significantly associated with burnout nurses (OR = 24.72, P < .001), but thyroid-stimulating hormone and free thyroxin were not. CONCLUSIONS: Results suggested positive associations between burnout and Mets in nurses. For nurses with higher seniority, long hours of work, night shifts, poor physical and mental conditions, and poor lifestyle habits in different departments, strategies are needed to prevent burnout and Mets.

A correlation study of fear of cancer recurrence, illness representation, self-regulation, and quality of life among gynecologic cancer survivors in Taiwan.

OBJECTIVE: The purpose of this study was to examine the correlations among fear of cancer recurrence (FCR), illness representation (IR), self-regulation (SR), and quality of life (QOL) in gynecologic cancer survivors. MATERIALS AND METHODS: A cross-sectional study was conducted with 287 participants recruited from a medical center in northern Taiwan. Four questionnaires, the Assessment of Survivor Concerns (ASC), the Brief Illness Perception Questionnaire (BIPQ), the Self-Regulation Questionnaire (SRQ), and the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire-Core 30-item (EORTC QLQ-C30), were used to assess FCR, IR, SR, and QOL respectively. Data pertaining to socio-demographic characteristics and self-reported medical status was also collected from the participants. Stepwise regression analysis was performed to identify predictors of QOL. RESULTS: The results showed that FCR (r = -.21, P < .01) and IR (r = -.44, P < .01) was negatively correlated with global QOL subscale of the EORTC QLQ-C30. SR, IR, and health status in the self-reported medical status explained 39% of the variance in global QOL, with SR of the largest. CONCLUSIONS: Our findings provided valuable information to healthcare professionals about the ability of SR to affect QOL and negative impacts of FCR and IR on gynecologic cancer survivors.

Reduced medication use and improved pulmonary function with supplements containing vegetable and fruit concentrate, fish oil and probiotics in asthmatic school children: a randomised controlled trial.

Dietary pattern changes may be one of the key factors associated with increasing asthma prevalence. Observational studies have found negative associations between fruit, vegetable and fish consumption and risk of asthma. Experimental studies have also shown that probiotics can modulate the immune system. However, each dietary component exhibits a modest effect. The objective of the present study was to investigate the joint effect of multiple beneficial dietary components on asthma. We designed a 16-week school-based double-blind placebo-controlled randomised trial. The supplement group received fruit plus vegetable concentrate, fish oil and probiotics (FVFP supplement), while the control group received placebos. A total of 192 asthmatic children aged 10-12 years were recruited from elementary schools in metropolitan Taipei. Pulmonary function, medication usage, Paediatric Asthma Quality of Life Questionnaire (PAQLQ) score and the Childhood Asthma Control Test score were evaluated at baseline, and at weeks 8 and 16. Compared with the placebo group, the supplement group showed significant improvement in pulmonary function parameters (91 v. 178 ml for forced vital capacity (FVC), 40 v. 107 ml for forced expiratory volume in 1 s (FEV1) and 1·6 v. 4·8 % for FEV1:FVC ratio; all P values < 0·01) and had a significantly reduced proportion of those using short-acting inhaled bronchodilators and inhaled corticosteroids. However, the PAQLQ score and the Childhood Asthma Control Test score were not significantly different between the two groups, possibly because the majority of the children were treated routinely. FVFP supplements reduced medication use and improved pulmonary function in asthmatic children. The present study supports an adjuvant intervention with a combination of fruit, vegetable, fish and probiotic foods.

[Applying the human dignity ideals of Confucianism and Kant to psychiatric nursing: from theory to practice].

Literature articles and clinical observation suggest disease and environmental factors as primary causes of the low self-esteem and stigmatization that typify most psychiatric patients. These patients are at risk of injury when subjected to inappropriate physical restraint. Hospital staffs, including nurses, are in immediate and close contact with psychiatric patients. Mencius's and Kant's thoughts on human dignity can enhance reflections on clinical nursing practices. Mencius's belief that preserving life is not the most desirable thing and death is not the most hated thing can help nurses realize the human dignity of psychiatric patients by understanding that, as an unrighteous act is more detestable than death, the meaning and value of righteousness are greater than life itself. In light of Kant's views on human dignity, nurses should treat patients as goals rather than means. Exploring such ideas can raise nursing quality, restore a positive sense of humanity to psychiatric patients, and develop nursing values and meaning to a higher plane.

Risk of asthma associated with energy-dense but nutrient-poor dietary pattern in Taiwanese children.

Childhood asthma has rapidly increased over the past few decades, possibly due to changes in lifestyle and dietary patterns. We aimed to determine associations between dietary patterns and asthma in schoolchildren in Taiwan. The Nutrition and Health survey in Taiwan Elementary School Children was carried out by using a multi-staged complex sampling design. A total of 2,082 elementary school children with complete data on dietary, lifestyle, demographics and asthma were included in the analysis. We used a Chinese version of the International Study of Asthma and Allergies in Childhood questionnaire to generate an asthma symptom score and to define asthma outcomes. Dietary intake was assessed by a food frequency questionnaire. Reduced rank regression (RRR) was used to identify the dietary pattern associated with the asthma symptoms score. Asthma outcomes included; current asthma, current severe asthma, nocturnal cough, exercise-induced wheeze and asthma ever. The RRR-derived dietary pattern was characterized by high consumption of fast foods, high-fat snacks, candy, and cheese; and low consumption of fruit, vegetables and rice. The RRR-derived dietary pattern was associated with an increased risk of current asthma (OR [95% CI]) (2.42 [1.19-4.93] for Q4/Q1, p-for-trend=0.01), current severe asthma (3.21 [1.11-9.25] for Q3/Q1, 4.45 [1.59-12.5] for Q4/Q1; p-for-trend=0.003), and nocturnal cough (1.79 [1.06-3.05] for Q2/Q1, 1.74 [1.02-2.97] for Q3/Q1, 1.82 [1.07-3.11] for Q4/Q1; p-for-trend=0.049). Our results suggest that a diet with a high intake of fat and simple sugars and low intake of fruit, vegetables and rice is associated with an increased risk of asthma in Taiwanese children.

Trends in hyperuricemia and gout prevalence: Nutrition and Health Survey in Taiwan from 1993-1996 to 2005-2008.

Hyperuricemia is a recognized risk factor for cardiovascular disease. This study investigated trends in uric acid levels, hyperuricemia and gout among adults in Taiwan from 1993-1996 to 2005-2008, using data collection from, Nutrition and health surveys in Taiwan (NAHSIT) conducted in 1993-1996 and 2005-2008. Information on food frequency, medical history, physical measures and fasting blood parameters were analyzed. Mean uric acid levels decreased between 1993-1996 and 2005-2008 in both genders (6.77 vs 6.59 mg/dL in men and 5.33 vs 4.97 mg/dL in women) and the prevalence of hyperuricemia declined from 25.3% to 22.0% in men (p<0.0001) and from 16.7% to 9.7% in women (p<0.0001). However, the prevalence of gout (self-reported) increased (4.74% vs 8.21% in men and 2.19% vs 2.33% in women, p<0.0001). Reduced rank regression was used to identify dietary patterns that explained significant amounts of variance in uric acid. Frequency of consumption of lean meat, soy products and soymilk, milk, eggs, vegetables, carrots, mushrooms, fruit and coffee were negatively associated with hyperuricemia, whereas consumption of organ meats, bamboo shoots, and soft drinks were positively associated with hyperuricemia. The dietary factor score (DFS) composed of the frequency of above food items decreased from -5.40 to -6.00 between the two surveys (p<0.0001). In conclusion, uric acid levels and prevalence of hyperuricemia both declined, whilst self-reported gout increased between 1993-1996 and 2005-2008. Changes in dietary patterns may in part explain the decrease in uric acid levels between the two national surveys.

The expression pattern of heterogeneous nuclear ribonucleoprotein R in rat retina.

The heterogeneous nuclear ribonucleoproteins (hnRNPs) play important roles in DNA repairing, cell signaling, telomere biogenesis, and in regulating gene expression at both transcriptional and translational levels. In the present study, we demonstrated that the expression of hnRNP-R1 and hnRNP-R2 is developmentally regulated in rat retina. The neural specific isoform hnRNP-R2 is expressed in 7-day postnatal rat retina, but not in the adult retina. The positive immunohistochemistry signal of hnRNP-R1 is extensively distributed in the outer plexiform layer, inner nuclear layer and ganglion cell layer of rat retina. Double staining experiments showed that the positive signal of hnRNP-R1 is distributed in ON-type bipolar cells and localized in the cytoplasm, dendrites and axon terminals. In addition, the hnRNP-R1 distribution is regulated in rat retina during circadian. The present investigation suggests that hnRNP-R may play roles in retinal development and light-elicited cellular activities.

Localization of zinc in the outer retina of carp: a light- and electron-microscopic study.

Many lines of evidence suggest that zinc may play an important neuromodulatory role in the central nervous system, including the retina. In this work, localization of zinc in the outer retina of carp was studied, using the silver amplification method, by light and electron microscopy. Reaction products (silver grains) were widely distributed throughout the retina, including photoreceptors, the outer and inner nuclear layers (ONL and INL), the ganglion cell layer (GCL), as well as in both outer and inner plexiform layers (OPL and IPL). Generally, staining for zinc was stronger in the outer retina than in the inner retina, and grains were aggregated with the greatest density in the OPL and the outer limiting membrane (OLM). Silver precipitates were also detected in the inner segments, axons, but not outer segments of photoreceptors. At the ultrastructural level, zinc was localized to myoid regions, mitochondria in the inner segments, internuclear space and nuclei of photoreceptors. In addition, silver grains were found in the terminals of photoreceptors, cone pedicles, and rod spherules, as well as in some processes in the OPL, which might be dendrites of horizontal cells. The presence of zinc in the terminals of photoreceptors suggests that zinc might be released from photoreceptor terminals and play modulatory roles in the outer retina.

The expression and distribution of neural salient serine/arginine-rich protein 1 in rat retina.

Neural salient serine/arginine-rich protein 1 (NSSR1) expression has been found in mouse cerebral neurons, cerebellar Purkinje cells, pyramidal neurons and granule cells of dentate gyrus and regulates the pre-mRNA splicing of genes important for neural functions. In this study, we demonstrated that NSSR1 is expressed in rat retina and extensively distributed in the outer and inner plexiform layers. Double staining experiments showed that NSSR1 distributed mainly in ON-type bipolar cells and localized in the dendrites, somata and axon terminals. The result suggests that NSSR1 may play important roles in retinal function, possibly via regulating the neural-specific alternative splicing of genes.

Modulation by melatonin of glutamatergic synaptic transmission in the carp retina.

Melatonin is involved in a variety of physiological functions through activating specific receptors coupled to GTP-binding protein. Melatonin and its receptors are abundant in the retina. Here we show for the first time that melatonin modulates glutamatergic synaptic transmission from cones to horizontal cells (HCs) in carp retina. Immunocytochemical data revealed the expression of the MT1 receptor on carp HCs. Whole-cell recordings further showed that melatonin of physiological concentrations potentiated glutamate-induced currents from isolated cone-driven HCs (H1 cells) in a dose-dependent manner, by increasing the efficacy and apparent affinity of the glutamate receptor. The effects of melatonin were reversed by luzindole, but not by K 185, indicating the involvement of the MT1 receptor. Like melatonin, methylene blue (MB), a guanylate cyclase inhibitor, also potentiated the glutamate currents, but internal infusion of cGMP suppressed them. The effects of melatonin were not observed in cGMP-filled and MB-incubated HCs. These results suggest that the melatonin effects may be mediated by decreasing the intracellular concentration of cGMP. Consistent with these observations, melatonin depolarized the membrane potential of H1 cells and reduced their light responses, which could also be blocked by luzindole. These effects of melatonin persisted in the presence of the antagonists of receptors for dopamine, GABA and glycine, indicating a direct action of melatonin on H1 cells. Such modulation by melatonin of glutamatergic transmission from cones to HCs is thought to be in part responsible for circadian changes in light responsiveness of cone HCs in teleost retina.

Expression of glycine receptor and transporter on bullfrog retinal Müller cells.

The expression of the glycine receptor (GlyR) alpha1, alpha2 and beta subunits and glycine transporter (GlyT) on Müller cells was studied in bullfrog retina using double immunofluorescence labeling and confocal scanning microscopy. Double labeling of glial fibrillary acidic protein (GFAP), a specific marker for Müller cells, and the GlyR subunits showed that almost all Müller cells moderately expressed GlyR alpha1 and weakly GlyR beta, whereas no immunoreactivity for GlyR alpha2 was observed. The labeling for GlyR alpha1 and GlyR beta appeared in somata, major processes, endfeet and branchlets of the Müller cells. Müller cells were also GlyT1-labeled. Consistent with previous electrophysiological results, these findings suggest that Müller cells may be involved in modulation of glycinergic transmission by reciprocal interactions with retinal neurons through GlyR and GlyT.