Pictogram-based method of visualizing dietary intake.

BACKGROUND: Pictograms have been shown by many studies to be an effective way of conveying information. An easy-to-understand pictorial description is essential for communication of dietary intake in the computer era. OBJECTIVES: We proposed a novel approach that represents textual descriptions of dietary intake into a pictorial representation with the concept of pictograms. The computational implementation in terms of a web-based tool was investigated on how well the pictograms carry their intended message. METHODS: 1) We investigated how well the pictograms are comprehended in terms of subjects' accuracy rate and response time. In the study (n = 90), pictorial variants with three types of food images (black-and-white sketch, colored sketch, and colored photograph) were tested. 2) We also investigated how well subjects were able to select the standard food size among various food portions with the use of the tool. A comparison was made against the current standard of an educational session taught by a registered dietitian. We recruited 86 university students who were asked to select a standard size out of five different size categories. Three types of shapes were used. The bowl is the container that is widely used in the participants' country. The pork strip was to represent foods with elliptical cross-section. The apple was used to represent a baseball-like size and shape. RESULTS: Two pictograms with black-and-white food image were low of less than 50% in accuracy rate. The rest of the twenty-seven pictograms derived from portions of the nine foods were well understood with high accuracy rates (above 85%). Participants in using the tool without the dietitian's session was better than participants in the dietitian education session in selecting a standard portion size of an apple (p < 0.0001; p = 0.0009 after adjustment for gender and age). The rate of correct bowl and pork strip size estimates were similar between the two conditions (p > 0.05). CONCLUSION: The development of pictograms could be used as a computational visual aid for comprehending and identifying dietary intake. Broader investigation is required for considering the effectiveness of the pictograms on recall, measurement, or estimation as well as for further evaluation in the clinical practice.

Application of three-dimensional body scanner: observation of prevalence of metabolic syndrome.

BACKGROUND AND AIMS: This retrospective cross-sectional study correlates blood pressure, blood glucose, lipid and uric acid levels with anthropometric measurements. METHODS: A total of 3975 visitors to the Department of Health Management were randomly selected to participate in this cross-sectional study. Whole body three-dimensional (3-D) laser scans were used to obtain anthropometric measurements. A health index (HI) was also designed based on anthropometric parameters. Subjects were defined as having metabolic syndrome when three of the following criteria were met: obesity (BMI of at least 30 kg/m(2); or a WHR of over 0.9 for males and 0.85 for females); triglyceride of at least 150 mg/dl; high-density lipoprotein (HDL)-cholesterol below 35 mg/dl for males and 39 mg/dl for females; fasting sugar levels of at least 110 mg/dl and hypertension. RESULTS: Of 3975 subjects, 341 (8.6%) met the criteria for diabetes mellitus (DM); of these, 32.8% were diagnosed with hypertension. This proportion exceeded 18% of the subjects had normal glucose levels. Of the 3975 subjects, 658 (16.6%) met the criteria for metabolic syndrome. Proportionally, more male subjects than female subjects were diagnosed with metabolic syndrome (18.5% vs 14.7%). Of these, central obesity, elevated triglyceride and low HDL-cholesterol were the main factors in men, while fasting glucose, hypertension and central obesity were the main factors in women. This investigation found that larger proportions of subjects with impaired glucose tolerance (41.1%) and DM (64.2%) than of subjects with normal glucose subjects, suffered from metabolic syndrome (9.5%). CONCLUSIONS: 3-D body scanning is useful in correlating pertinent factors with metabolic syndrome, these factors include central obesity, hyperglycemia, dyslipidemia, hyperuricemia and hypertension.

Levels of interferon-gamma and interleukin-2 receptor-alpha for bronchoalveolar lavage fluid and serum were correlated with clinical grade and treatment of pulmonary tuberculosis.

OBJECTIVE: We investigated possible correlations for interferon-gamma (IFN-gamma) and soluble interleukin-2 receptor-alpha (sIL-2R-alpha) levels in bronchoalveolar lavage fluid (BALF), and clinical grade of pulmonary tuberculosis (TB), which is determined by factors such as extent of pulmonary involvement, fever and loss of body weight. DESIGN: In order to explore these correlations and address associated questions, BALF was collected from 45 patients presenting with active pulmonary TB and 14 healthy controls. Repetitive BALF was collected in 17 patients after 3 months of anti-tuberculosis chemotherapy. The epithelial lining fluid (ELF) levels for IFN-gamma and sIL-2R-alpha were measured using enzyme-linked immunosorbent assay (ELISA) after standardization with urea. RESULTS: Patients with higher-grade pulmonary TB (i.e., with more advanced pulmonary involvement, fever or body weight loss), revealed significantly higher ELF levels for IFN-gamma and sIL-2R-alpha compared to those with lower grade pulmonary TB. Similar results were also determined for sIL-2R-alpha serum levels, but not for IFN-gamma serum levels. After anti-tuberculosis chemotherapy the elevated cytokine levels for ELF and serum significantly decreased in accordance with radiographic improvement. CONCLUSIONS: ELF levels of IFN-gamma and sIL-2R-alpha were correlated with disease grading of pulmonary TB and decreased after anti-tuberculosis chemotherapy.

Pulmonary function and spinal characteristics: their relationships in persons with idiopathic and postpoliomyelitic scoliosis.

OBJECTIVE: To identify what influence the various features of spinal deformity have on pulmonary function in persons with idiopathic and the postpoliomyelitic scoliosis. DESIGN: Prospective, cohort, observational study with clinical and radiologic evaluations. SETTING: Hospital-based rehabilitation units. PATIENTS: Forty-four patients with idiopathic scoliotis and 16 with postpoliomyelitic scoliotis. Each group was divided into subgroups: normal and abnormal pulmonary function. INTERVENTION: Clinical and radiologic evaluation of spinal deformity, full pulmonary functional test and respiratory muscle strength were performed. Presence of dyspnea on exertion and low back pain (LBP) was recorded. MAIN OUTCOME MEASURES: Pulmonary function: spirometry, lung volume test, and diffusing capacity. Respiratory muscle strength: maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Presence of dyspnea on exertion (DOE), and LBP were also recorded. Characteristics of spinal deformity: direction of convexity, uppermost vertebra, number of involved vertebrae, Cobb angle, the apical vertebra, degree of rotation at the apical vertebra, type of scoliotic curve, and presence of balanced spine and pelvic obliquity. Chi-square analyses and Mann-Whitney U test for between-groups comparisons. Spearman's rho correlation coefficient to determine the existence and magnitude of a relationship. RESULTS: We found significant differences between the idiopathic and postpoliomyelitis groups in the degree of rotation at the apical vertebra, MIP, average percentage of predicted vital capacity, residual volume/total lung capacity, presence of double or triple curves, pelvic obliquity, and DOE. Between the idiopathic scoliotis subgroups we found significant differences in the uppermost vertebra and number of vertebrae in the scoliotic curve. Between the subgroups of the postpoliomyelitis group were significant differences in the location of the apical vertebra and the uppermost vertebral body of scoliotic curve. In the idiopathic group, pulmonary function was mostly related to scoliotic angle, number of vertebrae in the scoliotic curve, location of the uppermost vertebra, and the patients' age; MIP and MEP were negatively related to the scoliotic angle and degree of rotation of apical vertebra. In the postpoliomyelitis group, pulmonary function was mostly related to scoliotic angle, kyphotic angle, location of the uppermost vertebra of the scoliotic curve, and age. CONCLUSION: No single factor can predict the severity of impairment in scoliotic patients' pulmonary function. In both groups, severity of pulmonary impairment was related to the combined features of the spinal deformity. However, uppermost vertebra, scoliotic angle, and patient's age may play important roles influencing pulmonary function in both groups.

Implementation of whole body scanner for determining somatotype index at Chang Gung Memorial Hospital.

BACKGROUND: Body mass index (BMI) and waist-hip ratio (WHR) using 1-dimensional circumference data have been proven to be highly related to blood pressure and total cholesterol; these 2 indices have been widely used as health indicators in preventive diagnosis and health examination. Sophisticated software, which allows calculation of the triangular mesh related to the body surface in 3D space, is capable of computing the circumference, width, sectional surface, volume, and surface area of the body. METHODS: Chang Gung Whole Body Scanner (CGWBS) was used to capture 3D whole body surface images. In this study, the human body was divided into 10 segments consisting of the head, breast, wrist, hip, upper arm, forearm, hand, thigh, calf, and foot. Five independent assessments were made on a total of 32 anthropometric sites, including 12 circumferences, 3 widths, 3 profile areas, 7 surface areas, and 7 volumes. In this study, the somatotype index (SI) was computed through anthropometric data after 1,323 subjects were investigated. Correlation analysis was used to describe the relationship between BMI, WHR, SI, and anthropometric data. One-way analysis of variance (ANOVA) and Duncan's multiple range tests were used to examine differences between examination variables across sex and SI groups. RESULTS: This study found 4 somatotypes from anthropometric data. SI determined by CGWBS has better correlation with anthropometry than WHR or BMI. Of the 644 male subjects, 155 were in the ectomorph group, 232 in the semi-mesomorph group, 136 in the full-mesomorph group, and 121 in the endomorph group. Of the 679 female subjects, 160 were in the ectomorph group, 235 in the semi-mesomorph group, 168 in the full-mesomorph group, and 116 in the endomorph group. CONCLUSION: The results show that SI has great potential to perform precise somatotype classification.

New quantitative and qualitative measures on functional mobility prediction for stroke patients.

The purpose of this study was to explore whether we could provide supportive laboratory evidence for clinical observations that a stroke patient has lost functional mobility/locomotion capability based on dynamic balance responses (centre of pressure, COP sway patterns) and motor control activities (EMG patterns) during the motor task of sit-to-stand. A computerized controlled dynamic postural control assessment system was developed and used in this study. Various dynamic balance indices were introduced and derived from COP sway patterns expressed in four domains (i.e. space, time, force, and frequency). Motor control was assessed by multi-channel surface electromyography of each side of the lower limb during the same motor task. The functional mobility capability was evaluated using a traditional FIM method. Fourteen stroke patients with right hemiplegia and nine healthy elderly were recruited as the experimental and control groups respectively. Muscle activity was recorded for quadriceps, hamstrings, anterior tibialis, and triceps surae muscles and used for analysis. Centre of pressure sway patterns and ground reaction forces were registered. All signals were synchronized at 'seat-off'. Surface electromyographic patterns of activities recorded during sit-to-stand and dynamic balance indices computed from centre of pressure sway patterns were categorized and compared with the functional mobility scores. The results show that both the motor control patterns and dynamic balance indices correlated well to the extent of mobility impairment evaluated using the traditional FIM method. An important conclusion for rehabilitation medicine is that the functional mobility capability of stroke patients may be quantified analytically using dynamic balance indices and visualized graphically through EMG motor patterns.

Design and assessment of an adaptive intermittent cervical traction modality with EMG biofeedback.

An intermittent cervical traction modality with closed-loop traction force control based on EMG biofeedback was developed and used for clinical study. This system consists of a EMG scanner, on-line self-adjusted traction force controller, audio/video alarm system, real time therapeutic status display, computer interface hardware, and control software. Twenty-four subjects with diagnosed cervical radiculopathy and muscle spasm symptom who were randomly divided into two groups served as subjects in this study. The control and experimental groups were treated with conventional open loop and new EMG biofeedback closed loop traction control protocols respectively. The results of this study indicate that the average reductions in paraspinal EMG signal during traction after 7 weeks treatment for experimental and control groups were 71 and 50 percent, respectively (p < 0.001). These results not only support the clinical use of intermittent, sitting traction to produce cervical paraspinal muscle relaxation, but also revealed that the average myoelectric activity of cervical paraspinal muscle during traction was reduced as traction force increased over the 7-week duration of traction treatment. Through EMG biofeedback traction force control, muscle injury, neck soreness, or pain after traction may be avoided.

Ergonomic analysis of working posture in nursing personnel: example of modified Ovako Working Analysis System application.

A postural analysis system was developed using a biomechanical approach to identify low back pain related working postures of nursing personnel. The Ovako Working Analysis System (OWAS) was modified for doing postural recording. Chaffin's biomechanical model was used to calculate the associated work stress on the L5/S1. The system was applied to examine the working postures of 64 nurses of 16 departments. The frequency distribution of the trunk showed 15.9% of the 8,629 observed postures were bending more than 15 degrees. Based on the calculated stress, 17.0% of the observed postures generated forces higher than the recommended action limit of the National Institute for Occupational Safety and Health (NIOSH). In addition to patient transfers, potentially health hazardous postures were identified in nursing tasks of inspection, nursing techniques, instrumentation, physical examination, taking inventory, and documentation.

Epidemiology of low back pain in Chinese nurses.

This epidemiological study analyzed risk factors for low back pain (LBP) in nursing personnel in a 5000-bed medical center in the Republic of China. Of the 3212 eligible nursing personnel, 3159 (98.3 per cent) responded to the mail survey. Risk factors for LBP were age, stature, body weight, duration of work, work habits, and sitting posture. The lifetime prevalence of LBP was 77.9 per cent. The primary cause of LBP was lifting heavy objects. Muscle strain was the most common diagnosis. For LBP treatment, the nurses' first choice was physical therapy and rehabilitation.

Epidemiology of low back pain in the nurses of Chang Gung Memorial Hospital.

Low back pain (LBP) caused by heavy workload or unsuitable work postures not only bothers a great number of persons but also presents a great challenge to the medical profession. This study attempts to analyze the related factors of LBP in nurses from the view of epidemiology, so as to offer a reference in the designing/redesigning of nurses' work and training programs. In this study, 3,212 nurses were surveyed in November 1991. Only 3,159 copies of the questionnaire were valid for investigation; of these, 89.8% were from registered nurses, 6% were from nursing assistants, and 4.2% were from head nurses. Among them, 82.2% were still single, 17.8% were married. Their average age was 25.2 +/- 3.9 years, and they had worked in nursing for an average of 3.9 +/- 3.6 years. Those who worked in the Taipei area and the neurological department were more aware of "low back health care," as well as those who were head nurses and those who had graduated from university. Head nurses had better postures in their daily activities than staff nurses. Head nurses and nurses working in ICUs, and those who were married and had borne children or had a history of abortion had higher incidence of LBP. The risk factors of LBP were related to the age, height, body weight, duration of work, working habits and sitting posture. LBP occurs as frequently as 77.9% in the nursing profession. The causes of LBP were mostly induced by lifting heavy objects (65%) and prolonged sitting (39%). For LBP treatment, physical therapy was the nurses' first choice, and operation was the last choice.