Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study.

BACKGROUND: Both sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls. METHODS: A comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison. RESULTS: The mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls. CONCLUSIONS: Early detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.

Preventing functional decline in hospitalized older adults in medical ward: a best practice implementation project.

INTRODUCTION AND OBJECTIVES: Functional decline frequently occurs in older adults in hospitals. The aim of this project was to promote evidence-based strategies for physical activity to prevent functional decline in hospitalized older adults in a medical center in southern Taiwan. METHODS: This project was guided by the JBI Evidence Implementation Framework. Seven audit criteria were derived from a JBI evidence summary and a baseline audit involving 25 nurses and 30 hospitalized older adults was conducted to compare current practice with best practice recommendations. The JBI Getting Research into Practice (GRiP) tool was used to identify barriers to implementation, and strategies were developed to overcome those barriers. A follow-up audit was conducted to measure any changes in compliance. RESULTS: After implementing the strategies, the pass rate of nursing staff improved in the physical activity knowledge test, rising from 56% to 88%. Compliance of nursing staff with providing physical activity instructions using evidence-based guidelines to hospitalized older adults reached 80%. The incidence of functional decline among hospitalized older adults decreased from 36.7% to 20%. CONCLUSIONS: The results of this best practice implementation project suggest that initiating physical activity as early as possible for hospitalized older adults once their medical condition has stabilized can help prevent functional decline. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A171.

The Relationship Between Bullying and Risk of Suicide Among Adolescents During the COVID-19 Pandemic in Indonesia.

Objectives: Although adolescents appear less vulnerable to coronavirus disease (COVID-19), the side effects of this pandemic can still be devastating. Bullying and suicidality are significant global issues with detrimental effects on young people, particularly during school closure. This study aimed to identify the relationship between bullying and suicide risk among adolescents in Indonesia during the COVID- 19 pandemic. Methods: A cross-sectional study was conducted on adolescents aged 14-18 years in May 2020 in Bandung, Indonesia, using a webbased closed survey. The Adolescent Peer Relations Instrument and the Suicide Behavior Questionnaire-Revised were used to measure bullying and risk of suicide. Multinomial logistic regression analysis was performed. Results: This study included 268 participants in 2020 and 175 participants in 2019. In 2020, the prevalence of perpetrators and victims of bullying combined was 74.6%. Meanwhile, in 2019, the prevalence of perpetrators and victims of bullying combined was 82.9%. Risk of suicide increased from 26.1% in 2019 (before the COVID-19 pandemic) to 36.5% in 2020 (during the first wave of the COVID-19 pandemic). The risk of perpetrators and suicide victims was higher than that of perpetrators and victims alone (odds ratio [OR]=4.0, 95% confidence interval [CI]=1.5-6.6 vs. OR=1.3, 95% CI=1.0-2.9 and OR=1.6, 95% CI=1.1-2.8, respectively). Conclusion: Bullying can enhance the likelihood of suicide among adolescents in Indonesia, and the risk was highest for the combination of victims and perpetrators. It is very important to provide early risk prediction for youths with bullying behavior and improve the knowledge and understanding of families and schools regarding the negative effects of bullying behavior.

On practicing magicine, from wonder to care: A systematic review of studies that apply magic in healthcare.

RATIONALE: Magic, traditionally perceived as entertainment, has been increasingly employed in healthcare to enhance health and well-being. Despite its potential benefits across various dimensions of health, including biological, psychological, and social, a comprehensive review highlighting its broad applications in healthcare remains unexplored. OBJECTIVE: This study aims to explore the diverse uses of magic within healthcare, progressing from entertainment to integral medical care, termed "magicine." METHODS: This systematic review adopted a narrative synthesis approach, and an extensive database search was conducted including Embase Classic & Embase, MEDLINE (Ovid), Scopus, the Cochrane Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and CINAHL (EBSCOhost), from the earliest records to 22 June 2023. Potential applications of magic in healthcare were explored with an unrestricted search strategy. A quality assessment was conducted using the Mixed Methods Appraisal Tool. (Registration: PROSPERO number CRD42023417122.) RESULTS: This review identified 82 journal articles, including 11 randomized controlled trials, four quasi-experimental designs, 10 pre-experimental designs, five qualitative studies, three mixed methods studies, two observational studies, five review articles, and 42 commentaries. The review resulted in the conception of "magicine ennead" - nine diverse areas where magic can be applied in healthcare including physical rehabilitation, cognitive training, psychotherapy, humor therapy, distraction therapy, social skills, health education, doctor-patient relationships, and surgical techniques. These applications demonstrate the potential of magic to enhance health outcomes for the general population and improve the clinical practice of healthcare professionals. CONCLUSIONS: Magic in healthcare shows potential for varied applications, and a deeper understanding of these applications could lead to optimized and cost-efficient intervention programs. Given the heterogeneity and varied methodological quality of the current research, future studies necessitate the adoption of rigorous designs with active controls.

Tongue pressure during swallowing is an independent risk factor for aspiration pneumonia in middle-aged and older hospitalized patients: An observational study.

AIM: To evaluate oral frailty features present in hospitalized older patients with aspiration pneumonia. METHODS: We enrolled hospitalized patients aged ≥50 years and classified them into three groups: the community-acquired, aspiration, and non-community-acquired pneumonia groups. Oral frailty was defined as meeting three or more criteria from the following: choking, and decreased occlusal force, masticatory function, tongue-lip motor function, tongue pressure, and tongue pressure during swallowing. RESULTS: Of 168 patients enrolled, the incidence of aspiration pneumonia was 23.9% (17/71) in patients admitted with pneumonia as the primary diagnosis. The occlusal force and masticatory function were significantly poorer and tongue pressure and tongue pressure during swallowing were significantly lower in the aspiration pneumonia group than in the other two groups. A higher number of chronic comorbidities, poor oral health, and lower tongue pressure during swallowing were significantly associated with aspiration pneumonia. A tongue pressure during swallowing of <10.32 kPa might be a cutoff point for predicting the risk of aspiration pneumonia. CONCLUSIONS: Hospitalized patients aged ≥50 years with multiple comorbidities, poor oral hygiene, and oral frailty during swallowing are at a higher risk of developing aspiration pneumonia, especially when their tongue pressure during swallowing is <10.32 kPa. Aspiration pneumonia is a preventable disease. Healthcare professionals should incorporate tongue pressure measurements or other screening tools into routine clinical practice to facilitate the early detection of this condition and intervention. Geriatr Gerontol Int 2024; 24: 351-357.

[Reflections on the Design of English-Medium Instruction Courses in Nursing].

In line with the Taiwan government's 2030 bilingual national policy, nursing education must emphasize the importance of enhancing English proficiency, developing international competitiveness, and fostering global literacy. English is used as the medium of instruction (EMI) in nursing education with the main goal of conveying professional knowledge and skills through effective communication and linguistic awareness. The achievement of this goal may be enhanced by the use of artificial intelligence (AI) technology and software to assist teachers and students improve their linguistic awareness. EMI curricula provide to students of different nationalities opportunities to learn and appreciate multicultural perspectives, allowing them to practice respect for different cultural perspectives, cooperate in international learning environments, and build global competence.

Herpes zoster associated with stroke incidence in people living with human immunodeficiency virus: a nested case-control study.

BACKGROUND: The incidence of stroke is increasing among younger people with human immunodeficiency virus (HIV). The burden of stroke has shifted toward the young people living with HIV, particularly in low- and middle-income countries. People infected with herpes zoster (HZ) were more likely to suffer stroke than the general population. However, the association of HZ infection with the incidence of stroke among patients with HIV remains unclear. METHODS: A nested case-control study was conducted with patients with HIV registered in the Taiwan National Health Insurance Research Database in 2000-2017. A total of 509 stroke cases were 1:10 matched to 5090 non-stroke controls on age, sex, and date of first stroke diagnosis. Logistic regression models were used to estimate the odds ratio and 95% confidence intervals (CI) of stroke incidence. RESULTS: The odds ratio of stroke was significantly higher in the HIV-infected population with HZ (adjusted odds ratio [AOR]: 1.85, 95% CI: 1.42-2.41). A significantly increased AOR of stroke was associated with hypertension (AOR: 3.53, 95% CI: 2.86-4.34), heart disease (AOR: 2.32, 95% CI: 1.54-3.48), chronic kidney disease (AOR: 1.82, 95% CI: 1.16-2.85), hepatitis C virus infection (AOR: 1.49, 95% CI: 1.22-1.83), hyperlipidemia (OR: 1.41, 95% CI: 1.12-1.78), and treatment with protease inhibitors (AOR: 1.33, 95% CI: 1.05-1.69). CONCLUSIONS: Our findings suggest that HZ concurrent with HIV may increase the risk of stroke. The incidence rates of stroke were independent of common risk factors, suggesting strategies for early prevention of HZ infection among people living with HIV.

Association between sleep health and intrinsic capacity among older adults in Taiwan.

Although the association between poor sleep quality and frailty has been previously reported, the relationship between sleep health and intrinsic capacity (IC) remains largely unknown. We aimed to examine the association between sleep health and IC among older adults. This was a cross-sectional study, and 1268 eligible participants completed a questionnaire collecting information on demographic, socioeconomic, lifestyle, sleep health, and IC. Sleep health was measured by the RU-SATED V2.0 scale. High, moderate, and low levels of IC were defined using the Integrated Care for Older People Screening Tool for Taiwanese. The ordinal logistic regression model estimated the odds ratio and corresponding 95% confidence interval. Low IC was significantly associated with age of 80 years or above, female, currently unmarried, uneducated, currently not working, financially dependent, and having emotional disorders. A one-point increase in sleep health was significantly associated with a 9% reduction in the odds of poor IC. An increase in daytime alertness was related to the greatest reduction in poor IC (aOR, 0.64; 95% CI, 0.52-0.79). In addition, the subitems sleep regularity (aOR, 0.77; 95% CI, 0.60-0.99), sleep timing (aOR, 0.80; 95% CI, 0.65-0.99), and sleep duration (aOR, 0.77; 95% CI, 0.61-0.96) were associated with a reduced OR of poor IC but with marginal statistical significance. Our findings showed that sleep health across multiple dimensions is related to IC, particularly daytime alertness in older adults. We suggest developing interventions to improve sleep health and prevent IC decline, which is crucial in causing poor health outcomes.

[Superstitious Beliefs Among Healthcare Providers: A Concept Analysis].

Evidence-based practice is a problem-solving approach to healthcare delivery that reflects the best current scientific evidence. When healthcare providers face unexpected changes in a patient's condition or uncontrollable situations during care delivery, they may have less confidence or feel fearful / anxious about the care process and result. As people, healthcare providers may hold beliefs regarding the effect of external, supernatural forces on events, which may lead to superstitious beliefs and behaviors. Also, superstitious beliefs may be adopted by healthcare providers as a mechanism to cope with stress, anxiety, and uncertainty in situations where standard medical practices offer no ready solution. Although superstitious beliefs may help ease anxiety and feelings of failure in healthcare providers, this issue and the effects of these beliefs on medical staff behavior have not been adequately studied. The concept analysis strategy of Walker and Avant (2019) was applied in this study to define this concept and to examine (1) healthcare providers' loss of environment control and domination of irrationality in decision making, (2) the lack of objective evidence to explain cause-and-effect relationships in health-related situations, and (3) how unverified true or false claims become a compliance criterion among healthcare providers. Typical, borderline, and contrary cases were used to explain the concept of superstition in medical staff. The antecedents and possible consequences of healthcare providers holding superstitious beliefs were identified and the empirically addressed measurement tools were evaluated. This analysis may be used to improve the understanding of healthcare workers regarding superstitious beliefs. The results are expected to benefit clinical practice, facilitate further research, and enhance healthcare quality.

Short-term effects of Chlorhexidine mouthwash and Listerine on oral microbiome in hospitalized patients.

Introduction: Chlorhexidine (CHX) and essential oil containing mouthwashes like Listerine® can improve oral hygiene via suppressing oral microbes. In hospitalized patients, CHX mouthwash reduces the incidence of ventilator-associated pneumonia. However, CHX use was also associated with increased mortality, which might be related to nitrate-reducing bacteria. Currently, no study determines oral bacteria targeted by essential oils mouthwash in hospitalized patients using a metagenomic approach. Methods: We recruited 87 hospitalized patients from a previous randomized control study, and assigned them to three mouthwash groups: CHX, Listerine, and normal saline (control). Before and after gargling the mouthwash twice a day for 5-7 days, oral bacteria were examined using a 16S rDNA approach. Results: Alpha diversities at the genus level decreased significantly only for the CHX and Listerine groups. Only for the two groups, oral microbiota before and after gargling were significantly different, but not clearly distinct. Paired analysis eliminated the substantial individual differences and revealed eight bacterial genera (including Prevotella, Fusobacterium, and Selenomonas) with a decreased relative abundance, while Rothia increased after gargling the CHX mouthwash. After gargling Listerine, seven genera (including Parvimonas, Eubacterium, and Selenomonas) showed a decreased relative abundance, and the magnitudes were smaller compared to the CHX group. Fewer bacteria targeted by Listerine were reported to be nitrate-reducing compared to the CHX mouthwash. Discussion: In conclusion, short-term gargling of the CHX mouthwash and Listerine altered oral microbiota in our hospitalized patients. The bacterial genera targeted by the CHX mouthwash and Listerine were largely different and the magnitudes of changes were smaller using Listerine. Functional alterations of gargling CHX and Listerine were also different. These findings can be considered for managing oral hygiene of hospitalized patients.

[Detection of Fever Using Continuous Skin Temperature Monitoring in Hospitalized Older Adults].

BACKGROUND: The continuous monitoring of body surface temperature has been proven to help detect potential fever events in hospitalized patients. However, the efficacy of using body surface temperature to detect fever in older adults remains unclear due to the relatively low and slower-to-change body surface temperature in this population. PURPOSE: This study was designed to investigate 1) the relationship between changes in body surface and routine tympanic temperatures, 2) the correlation between body surface temperature measurement frequency and detection of fever, and 3) the factors related to the incidence of fever in hospitalized older adults. METHODS: A prospective study was conducted on 33 hospitalized older adults aged 65 years or older who were suspected to have or diagnosed with an infection in an infectious disease and medical ward at a medical center in southern Taiwan from March to November 2020. Demographic, routine tympanic temperature, and heart rate data were collected by reviewing the participants' medical records. Body surface temperatures were monitored continuously using HEARThermo every 10 seconds until one of the following conditions were met: hospital discharge, no fever for three continuous days, and HEARThermo was removed. Descriptive analysis was used to compare the variations in body surface temperature and routine tympanic temperature measurements. Pearson correlation was used to analyze the correlation between different measurement frequencies and fever events. Finally, mixed effects logistic regression was used to analyze the factors significantly related to fever events. RESULTS: Seven hundred and twenty routine body temperature measurements were taken, with 209 (29.0%) fever events detected in 23 (69.7%) of the participants. The body surface temperatures were more closely correlated with tympanic temperatures during fever events than non-fever events (r = .260, p < .001). More fever events were detected using body surface temperature monitoring frequencies of every 10 seconds and every 1 minute. After controlling for demographic factors, the results of the mixed effect model indicate that body surface temperature and heart rate are significant factors related to fever events in hospitalized older adults (odds ratio, OR: 1.74, p < .001; OR: 1.11, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The continuous monitoring of body surface temperature may improve the detection of fever events in hospitalized older adults. The application of wearable devices and cloud platforms may further facilitate the real-time assessment and care capabilities of nurses, thus reducing their workload and improving care quality.

Efficacy of brief behavioural therapy for insomnia in older adults with chronic insomnia: a systematic review and meta-analysis from randomised trials.

BACKGROUND: chronic insomnia is a highly prevalent and persistent health concern among older adults, and it has significant adverse effects on cognitive function and physical health. OBJECTIVES: the study aimed to evaluate the efficacy of a brief 4-week behavioural therapy for insomnia (BBTi) on insomnia remission in older adults with chronic insomnia. DESIGN: a systematic review and meta-analysis were conducted. SUBJECTS: adults aged 60 years or older. METHODS: eight electronic databases were systematically searched through the end of March 2022. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. RESULTS: four randomised controlled trials (190 subjects) were included. The mean age of the participants was 69.06 (65.10-71.65), and 29.9% (27.3-32.3%) were male. Older adults who received the BBTi showed a significant insomnia remission (standardised mean differences, -1.07; 95% confidence interval, -1.43 to -0.71; I2, 0%). Sleep parameters measured by actigraphy revealed that in older adults, the BBTi program significantly improved total sleep time, wake after sleep onset (WASO), sleep onset latency (SOL) and sleep efficacy (SE) compared to the controls. For the subjective sleep parameters measured the by sleep diary, older adults who received BBTi obtained a more effective improvement in WASO, SE and SOL. The overall risk of bias was mostly low or of some concern due to the difficulty of blinding participants and assessors. CONCLUSIONS: a 4-week BBTi program can be considered an effective and nonselective intervention for insomnia remission among older adults with chronic insomnia and thereby has the potential to ameliorate WASO, SE and SOL.

Cold application for pain and anxiety reduction following chest tube removal: A systematic review and meta-analysis.

AIM AND OBJECTIVES: To conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after chest tube removal (CTR). BACKGROUND: The act of removing the chest tube often causes pain among cardiothoracic surgery patients. Most guidelines regarding CTR do not mention pain management. The effects of cold application on reducing pain and anxiety after CTR are inconsistent. DESIGN: Systematic review and meta-analysis. METHODS: We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomised controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration's tool was used to assess the risk of bias, Review Manager 5.4 was used to conduct the meta-analysis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used for assessing certainty of evidence (CoE). RESULTS: Ten RCTs with 683 participants were included in the meta-analysis. The use of cold application could effectively reduce pain and anxiety after CTR. The subgroup showed that a skin temperature drops to 13°C of cold application was significantly more effective for the immediate reduction in pain intensity after CTR compared with control group. The GRADE methodology demonstrated that CoE was very low level. CONCLUSION: Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. Skin temperature drops to 13°C or lasts 20 min of cold application were more effective for immediate reduction of pain intensity following CTR. RELEVANCE TO CLINICAL PRACTICE: In addition to pharmacological strategy, cold application could be used as evidence for reducing pain intensity and anxiety level after CTR.

Relationships Among Trajectories of Sleep Disturbance, Depression, and Antiretroviral Therapy in Persons Newly Diagnosed with HIV: A One-and-a-Half-Year Observational Longitudinal Study.

Purpose: Sleep disturbance is one of the most prevalent symptoms among persons living with HIV (PLWH). However, the trajectory of sleep patterns in persons newly diagnosed with HIV remains underrecognized. The current study aimed to estimate the trajectory of sleep quality and its associated factors among newly diagnosed PLWH. Patients and Methods: A prospective study was conducted in the outpatient clinic of a medical center in southern Taiwan from January 2015 to December 2017. Our primary outcome was sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Participants completed the questionnaire at baseline and at four follow-up interval visits: at 3-6, 6-9, 9-12 and 12-15 months. A generalized equation estimation (GEE) model was applied to analyze the relationships among poor sleep quality, depression and antiretroviral therapy among persons newly diagnosed with HIV. Results: A total of 217 PLWH were included. The mean age of the sample was 29.3 years, and males (98.6%) were predominant. A total of 56.2% of HIV-infected persons were considered to have poor sleep quality at baseline. After controlling for the confounding effects of demographic characteristics, the following factors increased the risk of poor sleep quality: older age (ß= 0.07, CI: 0.03-0.11, p=0.001), level of depression (ß= 0.32, CI: 0.27-0.37, p<0.001) and detectable viral load (ß= 0.61, CI: 0.04 - 1.18, p= 0.037). However, there was no significant difference in BMI, CD4 counts, HIV viral load, disclosure status, or highly active antiretroviral therapy (HAART) regimen. Conclusion: Our results demonstrate that one in two persons with newly diagnosed HIV had poor sleep quality. Being older, having higher levels of depression, and having detectable HIV viral loads were identified as risk factors for developing poor sleep quality in persons living with HIV.

Effect of 0.12% Chlorhexidine Oral Rinse on Preventing Hospital-Acquired Pneumonia in Nonventilator Inpatients.

BACKGROUND: Nonventilator hospital-associated pneumonia (NV-HAP) is a nosocomial infection with a multifactorial etiology that is particularly prevalent in individuals with poor oral health. PURPOSE: This study was designed to determine the effect of a 0.12% chlorhexidine gluconate oral rinse intervention on oral health and on reducing NV-HAP in inpatients. METHODS: A randomized, double-blind, and triple-arm clinical trial was conducted on a sample of 103 patients aged ≥ 50 years. Using the blocking sample method, patients were randomly assigned into three groups. These included Group A, using an oral rinse solution of 0.12% chlorhexidine; Group B, using Listerine; and Group C, using a standard saline oral rinse. In addition to routine hospital-associated pneumonia preventative nursing care, the participants used the oral rinse solutions twice a day with a period of at least 9 hours between each use. Oral health, the degree of bacterial exposure, and the clinical pneumonia index scale were evaluated in each of the groups at baseline (first day), on Intervention Days 3 and 7, and at discharge. The clearance rate was calculated by dividing the number of bacteria cleared by the total frequency of oral bacteria in the collected culture × 100%. RESULTS: Each arm of the study was composed of 34-35 participants, with an average hospitalization duration of 7.5 days. There was no incidence of NV-HAP or any changes in clinical pulmonary infection score among the three groups. Group A achieved a more significant improvement in oral health assessment tool scores between baseline and discharge than either Group B or C ( p = .03), particularly in the tongue, gums, and tissues; saliva; and oral cleanliness subscales. In addition, Group A reported higher clearance rates for Staphylococcus (100.00% vs. 66.67% vs. 66.67%, respectively), Escherichia coli (100.00% vs. 60.00% vs. 66.67%, respectively), and Pseudomonas aeruginosa (75.00% vs. 46.30% vs. 25.00%, respectively) than Groups B and C. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Although the results do not provide evidence supporting the use of a 0.12% chlorhexidine oral rinse as better in terms of preventing NV-HAP in middle-aged and elderly inpatients, nursing supervision was found to have an overall positive effect on oral health. The use of oral rinse with 0.12% chlorhexidine for nonventilated patients with poor oral health may be recommended.

The impact of physical pain and depression on sleep quality in older adults with chronic disease.

AIMS AND OBJECTIVES: This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease. BACKGROUND: Sleep quality is a common problem in older adults that may be affected by physical and mental status. DESIGN: A cross-sectional correlational design was employed. METHODS: The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively. RESULTS: Of the 120 older adults (age >65 years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain. CONCLUSION: Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease. RELEVANCE TO CLINICAL PRACTICE: The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population.

Efavirenz Is Not Associated with an Increased Risk of Depressive Disorders in Patients Living with HIV: An 11-Year Population-Based Study in Taiwan.

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan's National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars-NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79-3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04-2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21-1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51-6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

Differences in Sleep Disorders between HIV-Infected Persons and Matched Controls with Sleep Problems: A Matched-Cohort Study Based on Laboratory and Survey Data.

OBJECTIVES: Sleep disturbances are prevalent problems among human immunodeficiency virus (HIV)-infected persons. The recognition of comorbid sleep disorders in patients with HIV is currently hampered by limited knowledge of sleep-related symptoms, sleep architecture, and types of sleep disorders in this population. We aimed to compare the differences in sleep-related symptoms and polysomnography-based sleep disorders between HIV-infected persons and controls. METHODS: The study evaluated 170 men with a Pittsburgh sleep quality index scores greater than 5, including 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (±3.0 years) and BMI (±3.0 kg/m2). For all participants, an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or chi-square tests. RESULTS: HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p < 0.001) and suspected rapid eye movement behavior disorder (25.0% vs. 4.8%, p < 0.01) than controls. Sleep-disordered breathing was less common in HIV-infected persons than in controls (56.8% vs. 87.3%, p < 0.001). The mean percentage of rapid eye movement sleep was higher among HIV-infected patients than among controls (20.6% vs. 16.6%, p < 0.001). Nocturia was more common in HIV-infected persons than in controls (40.9% vs. 22.2%, p = 0.02). CONCLUSIONS: Psychological disturbances and sleep-disordered breathing can be possible explanations of sleep disturbances in HIV-infected persons in whom sleep-disordered breathing is notable. Further studies are warranted to examine the underlying factors of rapid eye movement behavior disorder among HIV-infected persons with sleep disturbances.

Clinical Limitations of Tissue Annexin A2 Level as a Predictor of Postoperative Overall Survival in Patients with Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the second common cause of cancer-related death in Taiwan. Tumor recurrence is frequently observed in HCC patients receiving surgical resection, resulting in unsatisfactory overall survival (OS). Therefore, it is pivotal to identify effective prognostic makers, so that intensive surveillance or adjuvant treatments can be applied to predictively unfavorable patients. Previous studies indicated that Annexin A2 (ANXA2) was an effective prognostic marker in several cancers, including HCC. However, the prognostic value of ANXA2 in Taiwanese HCC patients remains unclear, where a great proportion of patients had chronic hepatitis B with liver cirrhosis. Here, ANXA2 was highly expressed in HCC tissues compared with para-neoplastic noncancerous tissues. Furthermore, high ANXA2 expression in HCC tissues independently predicted shorter OS. In subgroup analysis, however, ANXA2 expression could not effectively predict OS in the following subgroups: female, age > 65 years old, Child-Pugh classification B, hepatitis B virus surface antigen negative or anti-hepatitis C antibody positive, alcoholism, tumor number >1, presence of micro- or macrovascular invasion, absence of capsule, non-cirrhosis and high alpha-fetoprotein. In conclusion, ANXA2 expression in HCC tissues could predict postoperative OS. However, the predictive value was limited in patients with specific clinical conditions.