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J Clin Med ; 7(12)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30486496


BACKGROUND: Chronic kidney disease (CKD) is a global health threat affecting approximately 10% of the adult population worldwide. Multimorbidity is common in CKD, but its impacts on disease outcomes are seldom investigated. METHODS: This prospective cohort analysis followed patients, who were part of a multidisciplinary CKD care program, for 10 years. We aimed to determine the impact of multimorbidity on renal outcomes. RESULTS: Overall, 1463 patients with stage 3⁻5 CKD were enrolled and stratified by the number of comorbidities. Mean follow-up time was 6.39 ± 1.19 years. We found that stage 3⁻5 CKD patients with at least three comorbidities at enrollment initiated dialysis earlier (hazard ratio (HR): 2.971) than patients without comorbidities. Risk factors for multimorbidity included old age, smoking, and proteinuria. CONCLUSIONS: By analyzing the number of comorbidities, a simple and readily applicable method, we demonstrated an association between multimorbidity and poor renal outcomes in stage 3⁻5 CKD patients. In addition to current guideline-based approaches, our results suggest an urgent need for tailored CKD care strategies for high-risk groups.

Int J Med Sci ; 14(8): 735-740, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28824308


Objective: It has been uncertain that low protein diet for patients with chronic kidney disease (CKD) may predispose to malnutrition. The study aimed to investigate the effects of low protein diet on body composition of CKD patients and analyze the influence of age. Methods: Patients with glomerular filtration rate less than 45 mL/min/1.73m2 including 103 elderly (70.7 ± 6.9 years old) and 56 non-elderly (49.8 ± 9.1 years old) CKD patients were enrolled. All patients were educated by dietitians to take low protein diet and were followed up regularly every three months. Their demographic data, underlying disease and body mass index (BMI) were reviewed and recorded. Results of body composition measurement and laboratory tests were collected every three months for one year. Results: At baseline, the distribution of body composition was similar in non-elderly patients between non-low and low protein groups. In the elderly, patients in low protein group had higher fat and lower muscle percentage. In one-year follow-up, non-elderly patients did not present significant changes in their BMI, serum albumin level and body compositions in both protein groups. Non-low protein group in elderly patients had significant decrease in BMI and estimated glomerular filtration rate (eGFR) after 12 months (both p< 0.05). Determination in body composition showed decrease in fat and increase in muscle component. In low protein group, their BMI was decreased and eGFR was not influenced. Fat component was decreased and muscle percentage was increased in one-year follow-up. Conclusions: In elderly CKD patients, low protein diet maintained good nutritional status and muscle mass was preserved.

Composição Corporal/fisiologia , Falência Renal Crônica/dietoterapia , Obesidade/dietoterapia , Insuficiência Renal Crônica/dietoterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Progressão da Doença , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Obesidade/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia
Sci Rep ; 7: 46293, 2017 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-28425494


Recent studies have indicated that tree carbon accumulation in subtropical forests has been negatively affected by global change phenomena such as warming and drought. However, the long-term effect of nitrogen addition on plant carbon storage remains poorly understood in these regions. In this study, we conducted a 10-year field experiment examining the effect of experimental N addition on plant growth and carbon storage in a subtropical Chinese fir forest. The N levels were 0 (control), 60, 120, and 240 kg ha-1 yr-1, and the N effects on tree carbon were divided into stand and individual levels. The results indicated that tree carbon storage at the stand scale was not affected by long-term N addition in the subtropical forest. By contrast, significant impacts of different tree size classes on carbon sequestration were found under different N treatments, which indicated that the amount of plant carbon sequestration was significantly enhanced with tree size class. Our findings highlight the importance of community structure and growth characteristics in Chinese fir forests, in which individual size but not additional N regulates tree carbon sequestration in this subtropical forest.

Sequestro de Carbono , Florestas , Nitrogênio/metabolismo , Árvores/crescimento & desenvolvimento , Árvores/metabolismo , Clima Tropical , Cunninghamia , Ecossistema
AoB Plants ; 2016 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-28011455


Heat waves in combination with drought are predicted to occur more frequently with climate warming, yet their interactive effects on crop carbon and water balance are still poorly understood. Hence, research on the capacity of crops to withstand and recover from the combined stress is urgently needed. This study investigated the effects of drought and heat wave on a crop species as well as the recovery from the combined stress. Seedlings were grown in growth chambers under two soil water conditions (i.e. well watered and drought stress) at ambient temperature (26°C) for 10 days. Afterwards, half of the seedlings were exposed to a 7-day 42°C heat wave. All the drought-stressed seedlings were then rehydrated upon relief of the heat wave. Leaf gas exchange, the maximum carboxylation capacity (V cmax), plant growth, relative chlorophyll content and leaf water potential were examined during the experimental period. The heat wave reduced leaf gas exchange rates, V cmax and relative chlorophyll content, while it had no impacts on leaf water potential. In contrast, drought stress led to greater reductions in leaf gas exchange rates, growth and water potential than heat wave alone. Seedlings underwent a greater degree of stress in the combination of drought and heat wave than under the single drought treatment. The recovery of leaf gas exchange from drought stress lagged behind the water potential recovery and was delayed by heat wave. Our results show that drought stress had a predominant role in determining plant physiological responses and the negative impacts of drought stress were exacerbated by heat wave. The greater stress in the combination of drought and heat wave translated into the slower recovery of leaf gas exchange. Therefore, drought combined with heat wave may induce greater risks on crops under future climates.

J Neurosci Nurs ; 45(6): 370-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24217147


Parkinson disease (PD) is a progressive neurological condition, usually occurring among older individuals. Along with increasing handicaps in daily life, patients with PD also face problems with psychosocial adjustment. This study explored the experiences of older Taiwanese individuals at different stages of PD. Qualitative design with in-depth interviews was conducted with participants being treated at the neurology outpatient department in a teaching hospital in northern Taiwan. The study included nine men and six women, aged 65-80 years, with PD at stages 1-4. Comparative analysis of the interviews revealed four themes: ignorance of symptoms, loss of control, gradual deterioration, and a deep sense of helplessness. In stage 1, symptoms were not significant at the onset of PD. For most participants, others first detected the symptoms, rather than themselves. During stage 2, although they could still care for themselves, they became very anxious when the effects of medication disappeared and their reactions slowed before they took the next dose. During stage 3, the physical capacity of the body decreased gradually and affected the patient's participation in social activities. In stage 4, older patients gradually became dependent on others in their daily lives. They were upset and worried that the symptoms would worsen and make them become a burden for their children. By understanding the perceptions of elderly patients at different stages of PD, this study has organized the key care requirements into four stages. These include the following: (1) provide more information on the disease in stage 1, (2) increase guidance on regular medication usage and establish a support system in stage 2, (3) highlight the importance of a safe living environment and encourage participation in support groups in stage 3, and (4) assist patients to find the meaning of life and value of existence in stage 4.

Adaptação Psicológica , Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Doença de Parkinson/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Medo , Feminino , Enfermagem Geriátrica/métodos , Humanos , Solidão , Masculino , Doença de Parkinson/enfermagem , Pesquisa Qualitativa , Comportamento Social , Taiwan
Hu Li Za Zhi ; 55(1): 94-8, 2008 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-18270938


This report describes the nursing experience of using the life review approach to help an elderly stroke patient reduce his feelings of powerlessness. The nursing care lasted between March 14th and May 24th, 2006. In the study of the nursing process, the author uses Gordon's assessment tools to gather subjective and objective information to establish the nursing problems, including activity intolerance, swallowing impairment, high risk of falling down, and powerlessness. Aiming at the nursing problem of powerlessness, the author makes use of the oral history method to conduct a life review of the client. Through the process of life reviewing, the client expressed acceptance of his life, reduced his feelings of powerlessness, and achieved the integration of his ego with his life. This case report might serve as a reference in guiding nurses to provide appropriate nursing interventions in helping clients with similar problems to obtain inner peace and reduce their feelings of powerlessness.

Acidente Vascular Cerebral/enfermagem , Idoso , Humanos , Masculino , Acidente Vascular Cerebral/psicologia