Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study.

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.

Factors Affecting the Ability of People With Diabetes to Avoid Hypoglycemia.

BACKGROUND: Hypoglycemia is recognized as a limiting factor in diabetes management. Fear of experiencing hypoglycemia may lead to lower quality of life, impaired glycemic control, and emotional distress, all of which impair the ability of patients to self-manage their diabetes effectively. Problem solving is central to diabetes self-management and may help patients achieve effective self-care of their disease. PURPOSE: The aim of this study was to investigate the ability of people with diabetes to avoid hypoglycemia and to explore associated factors. METHODS: A cross-sectional, descriptive design was used for the study. Data were collected using a demographic and disease characteristics datasheet, the Hypoglycemic Problem Solving Scale, and the Disease-Associated Negative Mood Scale. RESULTS: Three hundred thirteen participants were recruited, with a mean age of 55.49 years. The average item score for the questions on hypoglycemic problem-solving ability was 2.43 (SD = 0.75). In comparing Hypoglycemic Problem Solving Scale subscales, participants scored highest on the problem orientation subscales and lowest on the problem-solving skills subscales. Multiple regression analysis revealed that being younger and unmarried and having a higher level of education, a diagnosis of Type 1 diabetes, and a lower negative mood score were each significantly associated with greater problem-solving ability as regards hypoglycemic events. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: We suggest that patients with diabetes, especially those who are older or with lower levels of education, receive disease-related psychological interventions and that healthcare professionals teach problem-solving abilities in conjunction with hypoglycemia management.

Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study.

AIMS AND OBJECTIVES: To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. BACKGROUND: Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. DESIGN: The descriptive phenomenological method was used. METHODS: Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6 months, (iv) being at least 20 years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. RESULTS: The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. CONCLUSIONS: The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene appropriately, discuss self-monitoring of blood glucose results with patients and track these results.

Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model.

BACKGROUND: Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. PURPOSE: The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. METHODS: This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. RESULTS: Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. CONCLUSIONS: The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and perceived benefits of adherence to treatment were found to predict adherence rates. Patient education should be enhanced to reduce the risks of rejection and increase adherence rates to improve outcomes.

Assessing the impact of diabetes on quality of life: validation of the Chinese version of the 19-item Audit of Diabetes-Dependent Quality of Life for Taiwan.

OBJECTIVE: To examine the reliability and validity of the Chinese version of the 19-item Audit of Diabetes-Dependent Quality of Life for Taiwan (ADDQoL-CnTW). METHODS: Linguistic validation procedures for patient-reported outcome measures were used to translate the Taiwan version from the original 19-item UK-English ADDQoL. The psychometric properties of the ADDQoL-CnTW were evaluated in a convenience sample, recruited from outpatient facilities, of 260 patients diagnosed with diabetes mellitus. RESULTS: The forced one-factor solution supported one general 19-item factor with all items loading above 0.43, accounting for 51.5% of the variance, although the results of confirmatory factory analysis did not strictly adhere to a one-factor structure. Using Kaiser's Criterion, exploratory factor analysis identified four sub-dimensions but the pattern of loading also confirmed the presence of a large general factor with 11 of 19 items loading ≥0.4 on the first component, accounting for 49.73% of the variance. Internal consistency for the entire scale was 0.94. Convergent and discriminant validity were suggested by a stronger correlation of average weighted impact (AWI) scores with the overview Diabetes-specific QoL item than with the Present QoL item. The Present QoL item correlated better with the World Health Organization Quality of Life-BREF(TW) dimension scores than the Diabetes-specific QoL scores or the AWI scores. Insulin-treated patients reported significantly more negative AWI scores and Diabetes-specific QoL scores than those treated with tablets and/or diet, demonstrating known-groups validity. CONCLUSIONS: The ADDQoL-CnTW revealed excellent internal consistency reliability, and showed evidence of validity for use in Taiwanese people with diabetes.

Associations between sleep duration and type 2 diabetes in Taiwanese adults: A population-based study.

BACKGROUND/PURPOSE: Research on the association between sleep duration and type 2 diabetes in an adult community population has been relatively scarce. The objective of this study was to analyze the association between sleep duration and the risk of diabetes in Taiwanese adults. METHODS: Secondary data analysis was based on the database of Nutrition and Health Survey in Taiwan between 2005 and 2008. A stratified three-staged probability sampling method was used to create a cross-sectional research design and 1533 participants (733 men, 800 women, between 19 years and 64 years of age) were selected in this study. Logistic regression models were conducted to estimate the effect of sleep duration for type 2 diabetes patients. RESULTS: The average sleep duration for all participants in this study was 7.2 ± 1.4 hours, with 35.1% of the participants having a sleep duration less than 7 hours. After controlling related confounders, such as age, sex, body mass index, abdominal circumference, total cholesterol levels, sleep disturbances, and hypertension, the risk of having diabetes for participants with ≤ 5 hours sleep was 2.04-fold (95% confidence interval, 1.05-3.95) higher than for participants with 7-8.9 hours of sleep. In particular, the risk of having diabetes for young adults (between 19 years and 44 years of age) with ≤5 hours of sleep was 5.24-fold (95% confidence interval, 1.17-23.47) higher than for young adults who reported 7-8.9 hours of sleep. CONCLUSION: Our results show that a short sleep duration was associated with a higher prevalence of diabetes and this correlation was particularly strong in young adults.

The relationship between insomnia with short sleep duration is associated with hypercholesterolemia: a cross-sectional study.

AIM: To examine the association between insomnia with short sleep duration and hypercholesterolemia in Taiwanese adults. BACKGROUND: Previous studies mostly focused on the association between sleep duration and hyperlipidemia, but the results were not consistent. Besides, very few studies extensively examined the association between insomnia and hypercholesterolemia. This study hypothesized that insomnia with short sleep duration is associated with hypercholesterolemia. DESIGN: Secondary data analysis. This study analysed the latest database of the cross-sectional Nutrition and Health Survey in Taiwan which was released on 2011 (data collected between 2005-2008) and collected data using stratified three-staged probability sampling design. METHODS: This study analysed 1533 participants aged between 19-64 (733 males and 800 females) and used logistic regression model to calculate the odds ratio and the 95% confidence interval of insomnia with short sleep duration to hypercholesterolemia. Controlled confounders included age, gender, sample weight, body mass index, waist circumference, fasting plasma glucose, hypertension and diabetes. RESULTS: Insomnia with 5-6 hours of sleep duration was significantly associated with hypercholesterolemia. The odds ratio of mild insomnia or moderate/severe insomnia with 5-6 hours of sleep duration to hypercholesterolemia was higher, compared with the reference group (without insomnia and >6 hours of sleep duration). CONCLUSION: Insomnia with short sleep duration was associated with increased odds of hypercholesterolemia. Caregivers in clinical practice should watch out for the effect brought by this novel factor.

The development of a questionnaire measure of diabetes-related distress in Chinese-speaking patients: the Diabetes-Related Distress Questionnaire (DRDQ).

PURPOSE: To develop and evaluate the reliability and validity of a Diabetes-Related Distress Questionnaire for Chinese-speaking patients with diabetes. METHODS: The Diabetes-Related Distress Questionnaire (DRDQ) included 11 quality-of-life questions translated from a Diabetes, Attitudes, Wishes, and Needs study and four native items developed by researchers based on patients' experiences. A sample of 981 Chinese-speaking patients with diabetes in Taiwan was invited to complete the questionnaire. RESULTS: A minimum of 4.2 % of patients used each response option for each item. Exploratory factor analysis suggested a two-factor structure, representing treatment-related distress (factor 1) and progression-related distress (factor 2). The mean loading of items on their corresponding factor was high (0.60), while the mean loading on the other factor was low (0.10). A confirmatory factor analysis confirmed a single structure of the DRDQ (root-mean-square error of approximation = 0.063, comparative fit index = 0.93). The Cronbach's alpha was 0.89 for the DRDQ scale, 0.87 for the factor 1, and 0.68 for the factor 2. As expected, people with insulin-treated and HbA1c > 7 % reported significantly greater negative scores than their counterparts on the total score and all items of the DRDQ, with the exception of item 2. A moderate effect size was demonstrated between insulin known groups (ranging from 0.14 to 0.46) and between HbA1c known groups (ranging from 0.08 to 0.87). CONCLUSIONS: The DRDQ is a psychometrically sound instrument that can be used to assess diabetes-related distress in Chinese-speaking patients in Taiwan.

Risk of Type 2 Diabetes in Patients With Nonapnea Sleep Disorders in Using Different Types of Hypnotics: A Population-Based Retrospective Cohort Study.

There has been insufficient evidence on whether exposure to hypnotics affects the risk of type 2 diabetes (T2DM). The aim of this study was to examine patients with nonapnea sleep disorders using zolpidem, benzodiazepines (BZDs), or a combination of both, and their risk of T2DM. This was a population-based retrospective cohort study using data from 1997 to 2011. Data from the Taiwan National Health Insurance Research Database were employed for this study. A total of 45,602 patients with nonapnea sleep disorders and use of hypnotics were identified as the study cohort. The control cohort comprised 40,799 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of hypnotics on risk of T2DM. The overall incidence of T2DM was 20.1 per 1000 person-years for patients using zolpidem, which was significantly higher than that of the control group (11.9 per 1000 person-years). Overall, patients with nonapnea sleep disorders using zolpidem had a higher risk of T2DM compared with patients not using zolpidem and the control cohort (adjusted hazard ratio [HR] = 1.41, 95% confidence interval [CI] = 1.35-1.48). We also observed a significantly higher risk of T2DM in patients with both zolpidem and BZD use (adjusted HR = 1.77, 95% CI = 1.64-1.91) than that of those without zolpidem use and BZD use. Compared with patients not using hypnotics, patients using zolpidem had a higher risk of developing T2DM; the risk was particularly pronounced in those using both zolpidem and BZDs.

[The perspectives on palliative nursing education].

The numbers of people who suffer from age-related and chronic diseases have been increased worldwide. This has lead to an increased emphasis in the medical community on end of life care. This paper references the processes followed overseas in developing palliative care education programs as well as the domestic experiences promoting the hospitalization, home care, and "share care" models of palliative care. Particular emphasis is given to considerations of cultural diversity in palliative care. The aim of this paper is to elaborate on the prevalent clinical end-of-life care issues that are faced in Taiwan, to cultivate core capabilities in end-of-life care, to elicit the current status and development of formal nursing education, and to promote continuing education in palliative care. Kern formulated a six-step approach to curriculum development in education and the details has been discussed . Finally, this paper reflects on the current bottlenecks, challenges, and expectations related to palliative care curriculum development in order to help medical professionals further put humanistic and social care into practice, increase ethical reflection in end of life care and nursing competency, and encourage the creation of localized textbooks / multimedia e-teaching materials. The fostering of "patient-centered, family unit and the social-cultural contexture" for palliative care professionals and the ability to respond to the needs of terminal patients and patients with chronic diseases are critical to increasing the quality of Taiwan healthcare.

[Centennial retrospective on the evolution and development of nursing education in Taiwan].

Nursing education in Taiwan has developed significantly over the past one hundred years. Throughout the first half of the 20th century, nursing education in Taiwan ended at the high school level. However, over the most recent 50 years, this level has been gradually raised, and nursing doctoral programs are now offered today. Changes in the nursing profession over the past century have been influenced by social and political factors, war, the health care policies, and national education policies. Areas of nursing education that have presented key challenges to change and innovation include the nursing faculty, curriculum, teaching materials, and quality of teaching. Today, key future goals for nursing education in Taiwan are: Raising the entry level of generic nursing education from junior high to the high-school level, improving the curricula for master's and doctoral students, cultivating advanced practice nurses, improving the quality of nursing faculties, and establishing a mechanism to ensure the consistent quality of nursing education.

Effectiveness of interactive discussion group in suicide risk assessment among general nurses in Taiwan: a randomized controlled trial.

The evidence of suicide prevention training for nurses is scarce. Strategies to enhance general nurses' ability in suicide risk assessment are critical to develop effective training programs in general medical settings. This study was aimed to examine the effectiveness of an interactive discussion group in a suicide prevention training program for general nurses. In this randomized study with two groups of pre-post study design, the sample was recruited from the Medical, Surgical, and Emergency/Intensive Care Sectors of a 2000-bed general hospital via stratified randomization. Among the 111 nurses, 57 participants randomly assigned to the control group received a two-hour baseline suicide gatekeeper lecture, and 54 participants assigning to the experimental group received an additional five-hour group discussion about suicide risk assessment skills. Using a case vignette, the nurses discussed and assessed suicide risk factors specified in a 10-item Chinese SAD PERSONS Scale during a group discussion intervention. The findings revealed that the nurses achieved significant and consistent improvements of risk identification and assessment after the intervention without influencing their mental health status for assessing suicide risks. The result suggested an effective approach of interactive group discussion for facilitating critical thinking and learning suicide risk assessment skills among general nurses.

The prevalence and determinants of impaired fasting glucose in the population of Taiwan.

BACKGROUND: A current prevalence and relevant risk factors for impaired fasting glucose (IFG) have been reported by various ethnic groups and countries. By contrast, nationwide data for the incidence of IFG in Taiwan have not been presented in the past 15 years. The aim for this manuscript was to estimate the prevalence of IFG and associated risk factors in the population of Taiwan. METHODS: For this cross-sectional research, we used a nationally representative sample (N = 2604) obtained from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT), and adopted a stratified multistage sampling design. The tools employed for data collection included questionnaire interviews, anthropometry measurements, and laboratory analysis. RESULTS: The prevalence of IFG among adults in Taiwan is 35.8% (a fasting glucose level between 100 and 125 mg/dl is considered abnormal). An estimated number of people with IFG is 6.5 million. A higher prevalence of IFG is observed in men younger than 65 years compared to women. However, this trend is reversed for the elderly population. The factors significantly associated with IFG include the following: sex, age, overweight (27 > BMI ≥ 24), obesity (BMI ≥ 27), waist circumference (men ≥ 90 cm, women ≥ 80 cm), hypertension, and hyperlipidemia. CONCLUSIONS: IFG among adults in Taiwan is a health concern that requires attention. We recommend targeting the younger population, especially overweight and obese men between the ages of 19 and 40 years, to provide applicable healthy lifestyle counseling and services. Furthermore, appropriate screening of elderly people is required to detect undiagnosed IFG cases and provide early intervention and treatment.

The quality of life of adults with type 2 diabetes in a hospital care clinic in Taiwan.

PURPOSE: To assess the impact of diabetes on quality of life (QoL) and identify major determinants affecting that impact using a multiple regression model. METHODS: This was a cross-sectional design. The audit of diabetes-dependent quality of life (ADDQoL) was administered to assess QoL. RESULTS: A sample of 256 outpatients with type 2 diabetes was recruited. A negative impact of diabetes was observed on all life domains. The first three most impacted life domains were 'future', 'freedom to eat', and 'self-confidence'. 'Freedom to eat' was also the domain the most frequently impacted in five previous ADDQoL studies conducted in Singapore, UK, India, the United States, and Slovakia. Factors negatively associated with some domain scores were younger age (future), being male (close personal relationship and sex life), more education (leisure activities, future, dependence, and freedom to drink), low income (leisure activities), having more diabetic complications (do physically and sex life), treatment with insulin (finances and living conditions), and higher HbA1c (freedom to drink). CONCLUSION: QoL is impaired in patients with diabetes, especially for the 'freedom to eat' domain, indicating that an intervention to improve dietary freedom might be a good way of improving QoL. Greater negative impact of diabetes on QoL was associated with being younger, male, more educated with low income, more diabetes complications, higher HbA1c, and using insulin. These need to be considered in responding to patients' individual needs.

Trends of ABC control 2006-2011: a National Survey of Diabetes Health Promotion Institutes in Taiwan.

AIMS: To understand the trends of ABC control in 5 years interval in Taiwan. METHODS: We compared two waves of nationwide surveys (n=7541 and n=5599, mainly type 2 diabetes) to examine the trends of ABC control across 5 years in accredited Diabetes Health Promotion Institutes in Taiwan. RESULTS: The percentages of subjects who had HbA1c lower than 7% (A), both SBP and DBP lower than 130/80 mmHg (B), and total cholesterol lower than 160 mg/dl or LDL cholesterol lower than 100mg/dl (C) increased by 6.5% (from 32.4% to 34.5%), 22.0% (from 30.9% to 37.7%), and 57.8% (from 35.3% to 55.7%), respectively, with a resulting total ABC attainment rate from 4.1% to 8.6%. A subgroup of 720 diabetic subjects who participated in both surveys showed the same pattern of changes in B and C but had a slight deterioration of glycemic control. Logistic regression analysis revealed that diagnosis of type 1 diabetes, lower BMI and individuals not requiring insulin were independently associated with attainment of ABC goals in 2006 and 2011. An accountabilities examination revealed that annular tests of HbA1c, BP and lipids were all above 90% in both surveys. CONCLUSIONS: We observed an improvement of individual and overall attainments of ABC goals across 5 years in Taiwan owing to recent implementation of several diabetes care models and initiatives. We anticipate that these improvements will translate into reductions of both macrovascular and microvascular complications.

[Challenges and strategies for nursing education in Taiwan from a public health needs perspective].

An increasingly elderly population and prevalence of chronic health problems have transformed the healthcare landscape in Taiwan and necessitated a shift in the focus of healthcare toward chronic rather than acute illnesses. This is a challenge to the domestic healthcare system, which was initially designed to address and cure primarily acute illness. Traditional nursing education and training programs are no longer adequate to meet current population healthcare needs. The first part of this article highlights the challenges posed by changing healthcare needs, e.g., the rise in prevalence of age-related chronic conditions and the increased acuity of hospitalized patients. Such developments are making new demands and expectations of nurses in terms of education, skills and roles. The second part of this article explores the weaknesses of current nursing education. Recommendations for the future include: making high school graduation a minimum requirement for entering nursing college and university programs, restructuring the nursing master's education program to prepare advanced nurse practitioners, redesigning curriculum content, and teaching approaches based on public healthcare needs. Upgrading clinical competencies and increasing nursing school faculty numbers are issues of the most immediate priority.

Psychological resistance to insulin therapy in adults with type 2 diabetes: mixed-method systematic review.

AIM: This paper is a report of a review that aimed to describe the phenomenon of psychological resistance to insulin therapy from the perspective of adults with type 2 diabetes mellitus. BACKGROUND: Although the benefits of insulin for people with diabetes who are poorly controlled by oral agents have been established, delay in transition to insulin treatment is common. An understanding of the barriers to insulin from the client's viewpoint provides information to facilitate appropriate and effective care. DATA SOURCES: Searches were carried out between 1999 and 2009 using computerized databases, three in English language and one in Chinese. REVIEW METHODS: Review design was a mixed-method systematic review, and data abstraction and synthesis were undertaken by thematic synthesis. Reviewed articles were restricted to adults with type 2 diabetes and published in English or Chinese. RESULTS: Sixteen articles were included. For adults with type 2 diabetes, psychological resistance to insulin therapy could be explained by five themes. Three themes were categorized as cognitive appraisal, including 'people do not see the necessity for insulin and actively seek ways to control blood sugars without insulin', 'people have a holistic view of the consequences of insulin' and 'people see insulin therapy as less feasible'. Two themes were categorized as emotional reactions: 'people see insulin as a source of fear/anxiety', and 'the necessity to start insulin therapy has a very negative connotation for them and is associated with dysfunctional emotions'. CONCLUSION: Psychological resistance to insulin therapy can result from a range of personal viewpoints involving cognitive appraisal and/or emotional reactions.

The dilemma of diabetic patients living with hypoglycaemia.

AIMS: To examine the impact of the threat of hypoglycaemic episodes on people with diabetes in Taiwan. BACKGROUND: Intensive diabetes treatment in people with diabetes helps them to achieve better glycaemic control. However, it also causes more frequent hypoglycaemic episodes and has an impact on their overall quality of life. Hypoglycaemia is accompanied by various distressing symptoms which may cause excessive fear, affecting decision making in hypoglycaemic management. DESIGN: Purposive sampling and in-depth, face-to-face interviews were used to collect data. METHODS: Semi-structured interviews were conducted from July 2008-January 2009 with 17 individuals treated with insulin who had previous hypoglycaemic episodes. Data were analysed using qualitative content analysis. RESULTS: Four themes were generated from the analysis, 'inability to control fluctuations in health', 'challenges to interpersonal relationships', 'facing the disease alone' and 'finding a balance between competing symptoms'. CONCLUSIONS: Hypoglycaemia is a major health issue for many people with diabetes. Understanding individuals' experiences with hypoglycaemic episodes should help practitioners become more fully involved in promoting self-management. We identified key areas that health care providers should address, including concerns about patient education and professional support for people with diabetes experiencing hypoglycaemia, to enhance problem solving skills for them and their families. RELEVANCE TO CLINICAL PRACTICE: We recommend that health care providers make proper use of support groups for family caregivers or other important individuals in the lives of people with diabetes to provide education, clarification, support and guidance. In addition, health care providers also need to provide clients with hypoglycaemia-related emotional support, while enhancing diabetes self-management and problem-solving skills.

[Issues related to quality of life measures for persons with dementia].

The rising population of elderly worldwide has led to an increasing number of people with dementia. Managing and providing quality care for people with dementia has thus become a priority public health issue in developed countries. Dementia is a gradually degenerative disease. In the absence of a cure, improving, maintaining or maximizing quality of life is becoming the primary goal of nursing care for patients with this disease. Quality of life is an important outcome index of medical care and can be a criterion for making health economics decisions. The fact that dementia is a disease that presents steadily declining cognitive function has led to numerous challenges and debates regarding the optimal concepts and methodologies to be used to measure quality of life in those with dementia. This paper reviews relevant debates on these issues and makes suggestions that may serve as guides to monitoring / studying quality of life in dementia patients.

[Palliative care for persons with dementia].

Dementia is irreversible. Although currently available drugs are typically able to ameliorate symptoms and slow down its progress, there is yet no known cure for this disease. The inevitable consequence of dementia is the gradual deterioration of the condition until final decline into the end of life stage. The priority care plan for patients with end stage dementia, therefore, must focus on palliative care that provides for a comfortable and high as possible quality of life. However, dementia is rarely looked upon as an end-stage disease. In 2009, the Taiwan National Health Insurance began reimbursing the costs of hospice care for patients with end stage dementia. This paper discusses end stage dementia cases in which patients received inappropriate interventions during their final days as well as the barriers faced in developing countries to providing palliative care. This paper also suggests strategies to promote quality of care and quality of life in people with end of life dementia.