Risk factors and incidence of repeat osteoporotic fractures among the elderly in Taiwan: a population-based cohort study.

The incidence of osteoporotic fracture (OF), a condition that leads to higher morbidity and mortality in the elderly, is increasing yearly worldwide. However, most studies of OF have focused on the epidemiology of initial fractures, mainly in female and white populations. This study aimed to explore the incidence and the risk factors for repeat osteoporotic fracture (ROF) in Taiwan.We performed a retrospective cohort study using the Taiwan National Health Insurance Database (NHIRD) from 1995 through 2011. Individuals aged 65 years or older who experienced an initial OF were included. The patients were followed until death, the end of registration in the NHIRD, ROF occurrence, or the end of the study period (December 31, 2011), whichever occurred first. The incidence of ROF over ≥ 5 years after the initial fracture was analyzed, and the risk factors for ROF were assessed using Cox proportional hazards models. The incidence rates of ROF were 950.5, 321.4, 158.7, 92.8, and 70.2 per 1000 person-years among subjects in their first, second, third, fourth, and fifth years after the initial OF, respectively. Nearly 45% of the subjects sustained a ROF in the first year after OF. ROF risk increased with age and Charlson Comorbidity Index (CCI) score. Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications. The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

[A concept analysis of stress].

Stress formation, which depends on an individual's perception of a situation, can lead to changes in physiology, emotions, or behavior, and cause damage to one's physical and/or mental health. Nurses can help their patients reduce the impact of stress by teaching some essential stress attributes. Applying concept analysis, the authors provide information on definition, critical attributes, antecedents, and consequences, and presents both references for empirical research and construct demonstration examples. The article concludes with a discussion of potential applications to nursing practices.

Differences in COPD patient care by primary family caregivers: an age-based study.

BACKGROUND: Because Taiwan has the fastest aging rate among developed countries, care for the elderly is becoming more prominent in the country. Primary family caregivers play an important role in patient health and health promotion behavior. Chronic obstructive pulmonary disease (COPD), an age-related disease, is a major public health problem with high morbidity and mortality and can be a long-term burden for family members; however, little attention has been given to the differences in COPD care between elder caregivers and other caregivers. This study aimed to investigate the differences between elder family caregivers and non-elder family caregivers caring for COPD patients in Taiwan, including caring behavior, caregiver response, and caring knowledge. METHODS: This cross-sectional study was conducted between March 2007 and January 2008; 406 primary family caregivers of COPD patients from the thoracic outpatient departments of 6 hospitals in north-central Taiwan were recruited to answer questionnaires measuring COPD characteristics, care behavior, caregiver response, and COPD knowledge. All questionnaires, which addressed caregiver knowledge, care behaviors, and care reactions, were shown to have acceptable validity and reliability, and the data were analyzed using univariate and generalized linear model techniques. RESULTS: The elder caregivers group had 79 participants, and the non-elder caregivers comprised 327 participants. The COPD-related knowledge scale results were positively correlated with the family caregiver caring behavior scale, suggesting that better COPD-related knowledge among family caregivers may result in improved caring behavior. After adjusting for all possible confounding factors, the elder caregivers had significantly lower COPD-related knowledge than the non-elder caregivers (P<0.001). However, there were no significant differences in the family caregiver caring behavior scale or the caregiver reaction assessment scale between the two groups. CONCLUSIONS: Elder family caregivers require increased education regarding medications and preventive care in COPD patient care.

Postoperative sedation after major surgery with midazolam or propofol in the ICU: effects on amnesia and anxiety.

BACKGROUND: Propofol and midazolam are commonly used in the ICU to alleviate physical and psychological disturbances in consequence of anxiety. This study was conducted to assess and compare the impact of postoperative sedation after major surgery with midazolam or propofol on amnesia and anxiety in conscious patients under intensive care. METHODS: One hundred and two adult patients irrespective of sex and age, receiving thoracic, abdominal or other major truncal surgery necessitating close care at the ICU, were randomly allocated into midazolam or propofol group. Prior to surgery, all patients were subjected to evaluation of the levels of anxiety and amnesia, which was repeated on the following morning with the level of anxiety and the level of amnesia assessed just before and 30 min after cessation of midazolam or propofol medication, respectively. RESULTS: There were no significant differences between the two groups regarding gender, age, types of analgesics used, and anxiety. In both groups, the levels of anxiety (P < 0.001) and amnesia (P < 0.001) were improved significantly over the following day. Midazolam had more pronounced effects on amnesia than propofol (P < 0.001). There were no significant differences between the two groups in the pre- or post-drug anxiety (P = 0.189). CONCLUSIONS: Both midazolam and propofol are effective amnesic and anxiolytic drugs. Midazolam tends to have more favorable effects on amnesia. It is speculated that combination of propofol and midazolam may give better results for treating critically ill ICU patients, the confirmation of which necessitates further study.