[Post COVID-19 Pandemic Care for HIV Caregivers].

The COVID-19 pandemic that swept the world in 2020 has highlighted the dangers and challenges posed by infectious diseases and encouraged healthcare providers to further re-think the stigma of epidemic and pandemic diseases. HIV infection was reclassified as a chronic disease in Taiwan after highly active antiretroviral therapy was introduced in the country. Because HIV infection is related to behavior, people living with HIV are often affected by a negative social image that is influenced by multiple stereotypes and the general stigma toward AIDS. In Taiwan, this stigma is deeply influenced by Eastern philosophy and Confucian culture, making the context and effect of stigma different from Western countries. The current "U=U" concept of HIV treatment holds that someone under treatment for HIV with an undetectable HIV viral load cannot sexually transmit the virus to others. Therefore, in the post-pandemic era, HIV medical care personnel should apply evidence-based-care thinking. This article describes HIV stigma in the context of Confucianism, U=U as the leading concept of HIV treatment, and the recommended approach to care for HIV healthcare practitioners in the post-COVID-19 era. Reducing HIV stigma will enable Taiwan to achieve the ' Three Zeros' of zero discrimination, zero infection, and zero death advocated by the Joint United Nations Program on HIV/AIDS for ending the AIDS epidemic by 2030.

The mediating effects of leisure engagement on relationships between caregiving stress and subjective wellbeing among family caregivers of persons with cognitive impairment: A cross-sectional study.

Family caregivers of persons with cognitive impairment experience changes in reductions in leisure engagement, which can decrease their subjective wellbeing (leisure satisfaction, negative affect and positive affect). We recruited 100 dyads of patients with cognitive impairment and family caregivers by convenience sampling from outpatient memory clinics and daycare centers in northern Taiwan. Hierarchical regression analysis tested the mediating effects of leisure engagement on the relationship between caregiving stress and subjective wellbeing. Results indicated that the restorative experience of event/tourism activities (ß = 0.23, p < .05) significantly mediated between caregiving stress and leisure satisfaction. In addition, the only significant mediator between caregiving stress and negative affect was leisure barriers (ß = 0.21, p < .05). Both of the regression models explained 27% of the variance. Future development of leisure interventions should focus on reducing leisure barriers and providing event and tourism activities to the dyads. (146 words).

A Highly Selective and Sensitive Fluorescent Chemosensor for Detecting Al3+ Ion in Aqueous Solution and Plant Systems.

The solubilized form of aluminum, Al3+, is present under acid soil conditions and toxic to both animals and plants. Detecting and quantifying Al3+ is vital for both chemistry and biology. A new Schiff-based fluorescent turn-on sensor (probe L) for the selective detection of the Al3+ ion was synthesized by coupling 2-hydroxy-1-naphthaldehyde and 2-aminoisoindoline-1,3-dione, and the structure was characterized by nuclear magnetic resonance spectra. The probe L exhibited an excellent selective and sensitive response to the Al3+ ion over other metal ions in DMSO-H2O (1:9 v/v). Fluorescence quantification revealed that probe L was promising for the detection and accumulation of Al3+. Treating rice seedlings with Al3+ at 25⁻200 µM inhibited their growth. Al3+ treatment produced reactive oxygen species in rice roots. Practical applications of the fluorescent probe for the quantification of Al3+ in water samples and rice seedlings are demonstrated. Detecting the Al3+ ion with the probe L is easy and a potential alternative to existing analytical methods. The method can be used for detecting the Al3+ content of aqueous solution and plant systems. The novel fluorescent probe L has good potential for monitoring Al3+ content in the environment and biological systems.

Effects of Al Addition on Microstructures and Mechanical Properties of CoCrFeMnNiAlx High Entropy Alloy Films.

CoCrFeMnNiAlx (x = 0, 0.07, 0.3, 0.6, 1.0, 1.3) high-entropy alloy films (HEAFs) were processed by co-sputtering of CoCrFeMnNi alloy and Al targets. The effects of Al content on the microstructures and mechanical properties of HEAFs were studied. The XRD results indicated that the crystalline structure changed from the single face-centered cubic (FCC) phase for x = 0 and 0.07 to duplex FCC + body-centered cubic (BCC) phases for x = 0.3 and 0.6, and eventually, to a single BCC phase for x = 1.0 and 1.3, which agreed with the corresponding selected-area electron diffraction patterns. Also, nanotwins were observed in the FCC phase. Mechanical properties of films were studied using nanoindentation and micropillar compression tests. The hardness increased from 5.71 GPa at x = 0 to 8.74 GPa at x = 1.3. The compressive yield strength increased from 1.59 GPa to 3.73 GPa; however, the fracture strain decreased from 20.91% (no fracture) to 13.78% with the increasing Al content. Both nanotwins and BCC phase contributed to the strengthening effects for CoCrFeMnNiAlx HEAFs. Also, compared to the bulk CoCrFeMnNiAlx counterpart, the film exhibited much higher hardness and strength because of the much smaller grain size and the presence of nanotwins.

Predictors of postoperative falls in the first and second postoperative years among older hip fracture patients.

AIMS AND OBJECTIVES: To explore risk factors for a single fall and multiple falls in the first and second postoperative years among older hip fracture patients. BACKGROUND: Older hip fracture patients have a high probability of falling again after a fall incident. Risk factors for postoperative falls among older hip fracture patients in Taiwan remain to be confirmed. DESIGN: Secondary analysis. METHODS: Data collected from control groups of two clinical trials conducted during 2001-2004 and during 2005-2009 were selected. Overall, 181 older adults who underwent hip fracture surgery were assessed at predischarge and postdischarge. Participant data were collected through home visits. RESULTS: Decline in unaffected limb quadriceps muscle endurance was a crucial predictor of a single fall in the first postoperative year for older hip fracture patients. Advanced age and more severe depressive symptoms were the crucial predictor for multiple falls. Engagement in activities of daily living was the crucial predictor for falls during the first to second postoperative years among older hip fracture patients. CONCLUSION: In Taiwan, postoperative falls that occur within 1-2 years of a hip fracture are associated with a high incidence of single and multiple falls in older people. The crucial predictors of falls in the first and second year after a hip fracture include unaffected limb quadriceps endurance, age, depression status and postdischarge activities of daily livings in older people. RELEVANCE TO CLINICAL PRACTICE: The identified factors associated with subsequent falls within one and two years of a hip fracture should be incorporated into clinical strategies and taught in nursing courses. Early postoperative lower extremity muscular endurance rehabilitation must be provided. Furthermore, as part of the healthcare plan before hospital discharge, it must be ensured that the community where the older adults live has nutritional education, cognitive screening and psychological support.

Family caregivers' sleep disturbance and its associations with multilevel stressors when caring for patients with dementia.

OBJECTIVE: We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD). METHODS: For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD-FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs' neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs' distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale - Short Form, and sleep disturbance by the General Sleep Disturbance Scale. RESULTS: FCGs' most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs' sleep disturbance was predicted by their physical fatigue, their depressive symptoms, and the synergistic effect of physical fatigue and depressive symptoms in the final model, explaining 57.8% of the variance. CONCLUSIONS: This study supports the model that development of caregivers' sleep problems may depend on their depression, fatigue, and the synergistic effects of these two variables. These findings suggest that clinicians should educate FCGs about self-care and offer strategies for dealing with a cluster of symptoms when maintaining sleep hygiene.

Changes in decisional conflict and decisional regret in patients with localised prostate cancer.

AIMS AND OBJECTIVES: To identify the changes and associated factors in decisional conflict and regret in patients with localised prostate cancer up to six months postprimary treatment. BACKGROUND: Various treatments of differing qualities can be used for patients with localised prostate cancer; these treatments may cause conflicts in treatment decision-making and post-treatment regret. DESIGN: A quantitative longitudinal study. METHODS: A total of 48 patients were recruited from a 3700-bed medical centre in northern Taiwan and assessed at pretreatment and one and six months post-treatment. Demographic characteristics, clinical information and results from the psychosocial adjustment to illness scale, decisional conflict scale and decision regret scale were collected. Data were analysed based on the generalised estimating equations models. RESULTS: The overall decisional conflict substantially improved over time. However, the feeling of being less informed was high and did not improve considerably during the study period. Education level, decision preferences and psychosocial adjustment were associated with decisional conflict and influenced decision-making. The feeling of ineffective decision-making and decisional regret was low, post-treatment. Psychosocial adjustment was associated with effective decision-making and decisional regret. CONCLUSION: In patients with localised prostate cancer, decisional conflict reduced considerably up to six months post-treatment. Moreover, the patients were satisfied with their treatment decision-making and believed that they had made the correct choice up to six months post-treatment. However, patients may have experienced feelings of being less informed pre- and post-treatment, particularly those with lower education levels, a preference for passive roles, or inferior psychosocial adjustment. Consequently, health professionals must provide adequate medical information and psychosocial intervention to help patients in the decision-making process. RELEVANCE TO CLINICAL PRACTICE: Nurses and healthcare providers must provide localised prostate cancer patients with adequate information and psychosocial intervention to reduce decisional conflict.

Joint predictability of health related quality of life and leisure time physical activity on mortality risk in people with diabetes.

BACKGROUND: Reduced health related quality of life (HRQOL) has been associated with increased mortality in individuals with diabetes. In contrast, increased leisure time physical activity (LTPA) has been associated with reduced mortality. The aim of this study was to investigate the combined relationship of HRQOL and LTPA on mortality and whether high levels of LTPA are associated with reduced risk of mortality in adults with diabetes and inferior HRQOL. METHODS: We analyzed data from a national sample of adults (18 years or older) with self-reported physician-diagnosed diabetes, who participated in the 2001 National Health Interview Survey in Taiwan (N = 797). A total of 701 participants had complete Short Form 36 (SF-36) and LTPA data and were followed from 2002 to 2008. Participants were divided into 3 groups based on their LTPA: (1) a regularly active group who reported 150 or more min/week of moderate-intensity activity; (2) an intermediately active group who reported engaging in LTPA but did not meet the criterion for the "regular" category; and (3) an inactive group who reported no LTPA. The physical component summary (PCS) and mental component summary (MCS) scores were dichotomised at the median (high vs. low) (PCS = 45.11; MCS = 47.91). Cox proportional-hazards models were used to investigate associations between baseline characteristics and mortality. RESULTS: After 4,570 person-years of follow-up, 121 deaths were recorded and the crude mortality rate was 26.5 per 1,000 person-years. Both PCS scores and LTPA were significant predictors of mortality, whereas no significant relationship was observed between MCS and mortality. After adjustment for other factors, participants with low PCS who reported no LTPA had a hazard ratio (HR) for mortality of 4.49 (95% CI = [2.15-9.36]). However, participants with low PCS who were active (including intermediate and regular LTPA) had a HR for mortality of 1.36 (95% CI = [0.64-2.92]). CONCLUSIONS: Our results show a significantly increased mortality risk of diabetes associated with reduced HRQOL in individuals who report no LTPA. Engaging in LTPA may be associated with improved survival in participants with diabetes with poor self-rated physical health status.

Joint predictability of physical frailty/pre-frailty and subjective memory complaints on mortality risk among cognitively unimpaired older adults.

The aim of the present study was to investigate how frailty/pre-frailty in combination with subjective memory complaints predicts all-cause mortality in community dwelling cognitively unimpaired older adults. There were 1904 community-dwelling cognitively unimpaired persons aged 65 years or older who participated in the 2013 Taiwan National Health Interview Survey with a 5-year follow-up. Frailty was determined based on the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMC). In this study, 11.9% of participants had both frailty/pre-frailty and SMC. A total of 239 deaths were recorded after 9009.5 person-years of follow-up. After adjustment for other factors, compared with participants who were physically robust with no SMC, participants who reported either SMC alone (HR = 0.88, 95% CI = 0.60-1.27) or were frail/pre-frail alone (HR = 1.32, 95% CI = 0.90-1.92) had no significantly increased mortality risk. However, coexisting frailty/pre-frailty and SMC was associated with a significantly increased hazard ratio for mortality of 1.48 (95% CI = [1.02-2.16]). Our results highlight the high prevalence of co-occurring frailty/pre-frailty and SMC and that this co-occurrence is associated with an increased risk of mortality among cognitively unimpaired older adults.

Risk and Protective Profile of Men Who Have Sex With Men Using Mobile Voluntary HIV Counseling and Testing: Latent Class Analysis.

BACKGROUND: Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored. OBJECTIVE: The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups. METHODS: A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators-multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases-and three protective indicators-experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing. RESULTS: Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19%), highest protection (n=121, 11.89%), and low risk and low protection (n=722, 70.92%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ≥40 years of age (odds ratio [OR] 2.197, 95% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95% CI 2.272-18.482; P<.001), and a CD4 count ≤349/µL (OR 17.50, 95% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95% CI 1.033-6.277; P=.04). CONCLUSIONS: LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ≥40 years old. These results could be applied to tailor HIV prevention and testing programs.

Skin-Inspired Tactile Sensor on Cellulose Fiber Substrates with Interfacial Microstructure for Health Monitoring and Guitar Posture Feedback.

Skin-inspired flexible tactile sensors, with interfacial microstructure, are developed on cellulose fiber substrates for subtle pressure applications. Our device is made of two cellulose fiber substrates with conductive microscale structures, which emulate the randomly distributed spinosum in between the dermis and epidermis layers of the human skin. The microstructures not only permit a higher stress concentration at the tips but also generate electrical contact points and change contact resistance between the top and bottom substrates when the pressure is applied. Meanwhile, cellulose fibers possessing viscoelastic and biocompatible properties are utilized as substrates to mimic the dermis and epidermis layers of the skin. The electrical contact resistances (ECR) are then measured to quantify the tactile information. The microstructures and the substrate properties are studied to enhance the sensors' sensitivity. A very high sensitivity (14.4 kPa-1) and fast recovery time (approx. 2.5 ms) are achieved in the subtle pressure range (approx. 0-0.05 kPa). The device can detect subtle pressures from the human body due to breathing patterns and voice activity showing its potential for healthcare. Further, the guitar strumming and chord progression of the players with different skill levels are assessed to monitor the muscle strain during guitar playing, showing its potential for posture feedback in playing guitar or another musical instrument.

Flexible Hybrid Electronics Nanofiber Electrodes with Excellent Stretchability and Highly Stable Electrical Conductivity for Smart Clothing.

In this paper, a side-by-side, dual-nozzle electrospinning process was used to prepare a flexible hybrid electronics (FHE) material with excellent stretchable properties. A highly stable electrical conductivity was also imparted to the resulting membrane electrodes using silver nanoparticles (AgNPs) and carbon-based nanomaterials of different structures. The AgNP/carbon-based nanomaterials were coated onto bicomponent polymer nanofibers (composed of polyurethane (PU) and polyvinylidene difluoride (PVDF)) on the nanofiber membrane. The FHE nanofiber electrodes were finally integrated into clothing designed to accurately measure human body sensing signals (e.g., electrocardiography (ECG) and electromyography (EMG) signals). To effectively increase the high electrical conductivity, a polymer-type dispersant (polyisobutylene-b-poly(oxyethylene)-b-polyisobutylene, a triblock copolymer) was used to effectively and stably disperse AgNPs with different particle sizes and carbon-based nanomaterials with different geometric dimensions (e.g., zero-dimensional carbon black, one-dimensional carbon nanotubes, and two-dimensional graphene) through non-covalent adsorption. Moreover, the bicomponent PVDF-PU nanofibers were immersed in a mixed dispersant of AgNPs and carbon-based nanomaterials at low concentrations, and thermal post-treatment was conducted to improve the electrical conductivity. The AgNP/graphene oxide (GO) nanofiber electrode exhibited a continuous phase with a stable material microstructure after 5000 repetitions of 50% tension-tension fatigue testing. The waveform pattern obtained from the proposed AgNP/GO nanofiber electrode was compared with those of traditional ECG and EMG electrodes. The nanofiber web electrode treated with organic/inorganic mixed dispersants and verified via tests of its electrical and fatigue properties was found to be suitable for long-term ECG and EMG monitoring, and it has excellent potential in wearable smart sensors.

The excess mortality risk of diabetes associated with functional decline in older adults: results from a 7-year follow-up of a nationwide cohort in Taiwan.

BACKGROUND: Diabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. The aim of this study was to examine how diabetes in combination with different levels of functional decline affects 7-year mortality in older adults. METHODS: We analyzed data from a nationally representative sample of people aged 65 years and over, participating in the 2001 National Health Interview Survey in Taiwan. A total of 1873 participants were followed through 2002-2008, of whom 286 (15.3%) had a history of diabetes confirmed by a medical professional. Participants were divided into three functional status groups: (1) high functioning-no limitations involving activities of daily living (ADLs), instrumental activities of daily living (IADLs), or physical functioning; (2) low functioning-limitations in one or more ADLs; (3) middle functioning-all participants in between groups 1 and 2. RESULTS: The crude mortality rate was 52.7 per 1,000 person-years in those with diabetes and 34.1 per 1,000 person-years in those without diabetes. After adjustment for other factors, diabetes alone was not associated with an increased mortality risk in those with high functioning. However, diabetes alone had a hazard ratio (HR) for mortality of 1.90 (95%CI = [1.02-3.53]) in those with middle functioning and 3.67 (95%CI = [1.55-8.69]) in those with low functioning. The presence of diabetes and one or more other chronic conditions was associated with a HR for mortality of 2.46 (95%CI = [1.61-3.77]) in those with middle functioning and 4.03 (95%CI = [2.31-7.03]) in those with low functioning. CONCLUSIONS: Our results indicate that diabetes is not associated with increased mortality in those with high functioning. There was a gradient effect of functional decline on mortality in individuals with diabetes. Additionally, among participants with other chronic conditions, functional decline was associated with a greater burden of mortality in older adults with diabetes. These findings highlight the critical importance of the prevention of cardiovascular disease morbidity and the maintenance of functional abilities in order to reduce mortality risk in older adults with diabetes.

Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality?

OBJECTIVES: The main aim of this study was to examine how physical activity in combination with physical frailty and cognitive impairment affects risk of mortality in older adults. STUDY DESIGN: A national sample of community-dwelling Taiwanese aged 65 years or older (n=2678) was followed for 5 years. MAIN OUTCOME MEASURES: Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. The Mini-Mental State Examination was used to assess cognitive impairment. Information on self-reported physical activity was collected at baseline. The study cohort was followed until the date of death or the end of the study period (31 December 2018). Deaths were confirmed by the computerized data files of the National Register of Deaths. RESULTS: A total of 417 deaths were recorded after 12415.2 person-years of follow-up. After adjustment for other factors, compared with active participants who were physically robust with normal cognition, inactive participants who were with either frail/pre-frail or cognitively impaired had hazard ratios for mortality of 2.65 (95% CI=[1.88-3.74]) and 3.09 (95% CI=[2.08-4.59]), respectively. Inactive participants with coexisting frailty/pre-frailty and cognitive impairment had the highest hazard ratio for mortality of 3.85 (95% CI=[2.73-5.45]). Being active was associated with a mortality reduction of 31%, 38%, and 42% in physically robust participants with normal cognition, those who were frail/pre-frail only, and those with cognitive impairment only, respectively. CONCLUSIONS: Having a physically active life style has beneficial effects on survival in older persons with either frailty/pre-frailty or cognitive impairment.

A population study on the association between leisure time physical activity and self-rated health among diabetics in Taiwan.

BACKGROUND: There is strong evidence for the beneficial effects of physical activity in diabetes. There has been little research demonstrating a dose-response relationship between physical activity and self-rated health in diabetics. The aim of this study was to explore the dose-response association between leisure time physical activity and self-rated health among diabetics in Taiwan. METHODS: Data came from the 2001 Taiwan National Health Interview Survey (NHIS). Inclusion criteria were a physician confirmed diagnosis of diabetes mellitus and age 18 years and above (n = 797). Self-rated health was assessed by the question "In general, would you say that your health is excellent, very good, good, fair, or poor?" Individuals with a self perceived health status of good, very good, or excellent were considered to have positive health status. RESULTS: In the full model, the odds ratio (OR) for positive health was 2.51(95% CI = 1.53-4.13), 1.62(95% CI = 0.93-2.84), and 1.35(95% CI = 0.77-2.37), for those with a total weekly energy expenditure of > or = 1000 kcal, between 500 and 999 kcal, and between 1 and 499 kcal, respectively, compared to inactive individuals. Those with duration over 10 years (OR = 0.53, 95%CI = 0.30-0.94), heart disease (OR = 0.50, 95%CI = 0.30-0.85), and dyslipidemia (OR = 0.65, 95% CI = 0.43-0.98) were less likely to have positive health than their counterparts. After stratified participants by duration, those with a duration of diabetes < 6 years, the adjusted OR for positive health was 1.95(95% CI = 1.02-3.72), 1.22(95% CI = 0.59-2.52), and 1.19(95% CI = 0.58-2.41) for those with a total weekly energy expenditure of > or = 1000 kcal, between 500 and 999 kcal, and between 1 and 499 kcal, respectively, compared to inactive individuals. In participants with a duration of diabetes > or = 6 years, total energy expenditure showed a gradient effect on self-perceived positive health. The adjusted OR for positive health was 3.45(95% CI = 1.53-7.79), 2.77(95% CI = 1.11-6.92), and 1.90(95% CI = 0.73-4.94) for those with a total weekly energy expenditure of > or = 1000 kcal, between 500 and 999 kcal, and between 1 and 499 kcal, respectively, compared to inactive individuals. CONCLUSIONS: Our results highlight that regular leisure activity with an energy expenditure -- 500 kcal per week is associated with better self-rated health for those with longstanding diabetes.

[Sleep disturbance and associated factors amongst family caregivers of dementia patients].

BACKGROUND: In Taiwan, eighty-five percent of dementia patients are cared for by family caregivers (FCGs), who have indicated insomnia to be a prevalent personal health problem. PURPOSE: The aim of this study was to explore sleep disturbance and associated factors among FCGs caring for dementia patients. METHODS: A purposive sample of 180 dementia patient dyads and their FCGs was recruited from northern Taiwan. Dementia patients neuropsychiatric symptoms were assessed using the Chinese Neuropsychological Inventory (CNPI). FCG distress, depressive symptoms, and sleep disturbance were assessed using the CNPI Caregiver Distress Scale, Center for Epidemiological Studies-Depression Scales, and Lee's General Sleep Disturbance Scale, respectively. RESULTS: Sleep disturbance was reported as interfering with the daily lives of 13.3% of FCGs. The hierarchical regression model indicated (1) relationships between patients and FCGs and (2) FCG depressive symptoms as two significant predictors of sleep disturbance in FCGs, explaining 45.8% of variance. FCG depressive symptoms represented the most significant single predictor - contributing 31% of variance. CONCLUSIONS: Sleep disturbance in FCGs is predicted by the patient-FCG relationship and FCG depressive symptoms. To better care for FCGs of dementia patients, nurses should assess patients behavioral problems, FCG distress, and FCG depressive symptoms. Nurses may also better allocate social resources based on the specific relationships between FCGs and their dementia patients. In addition, nurses should redirect FCG attention toward positive thinking in order to alleviate depressive symptoms and decrease sleep disturbance.

Combined effects of frailty status and cognitive impairment on health-related quality of life among community dwelling older adults.

OBJECTIVES: The aim of the present study was to investigate the combined association of frailty/pre-frailty and cognitive impairment with health related quality of life (HRQOL) among community dwelling older adults. METHODS: Data came from a cross-sectional study of community-dwelling older adults aged 65 years or older, who participated in the 2013 National Health Interview Survey in Taiwan. Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. The Mini-Mental State Examination was used to assess cognitive function. HRQOL was measured using the European Quality of Life-5 Dimensions questionnaire (EQ-5D) that assesses three levels of functioning for the dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Poisson regression models were performed to estimate prevalence ratios (PR) and 95 % Confidence Intervals (95 % CI) for health problems in all EQ-5D domains. RESULTS: In this study, 11.0 % of participants aged 65 years and older had co-occurring frailty/pre-frailty and cognitive impairment. After adjustment for other factors, compared with participants who were physically robust with normal cognition, participants with co-occurring frailty/pre-frailty and cognitive impairment had PRs of 10.38 (95 % CI 7.56-14.26), 9.66 (95 % CI 6.03-15.48), 9.37 (95 % CI 6.92-12.68), 3.04 (95 % CI 2.53-3.64), and 5.63 (95 % CI 3.83-8.28) for reporting problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, respectively. CONCLUSIONS: There is a high prevalence of co-occurrence of frailty/pre-frailty and cognitive impairment in older adults, and this co-occurrence was strongly associated with self-reported health problems across all EQ-5D domains.

Sensitivity and specificity of the Clock Drawing Test, incorporating Rouleau scoring system, as a screening instrument for questionable and mild dementia: scale development.

OBJECTIVE: The objective of this study was to validate the Rouleau scoring system for the Clock Drawing Test (CDT) in northern Taiwan, a non-English speaking area, to increase its generalization by detecting subjects with questionable dementia (QD) from normal controls (NC) and subjects with mild dementia (AD). The system consists of two parts: a 10-point scoring and error types. A cross-sectional design was used. One hundred and sixteen subjects were recruited from a memory disorder clinic (n=40 NC; n=34 QD; n=42 AD). Reliability and validity were estimated, the predictive accuracy was calculated using the receiver operating characteristic (ROC) curve analysis, and the error types were counted. RESULTS: The results indicated that most of the error types committed were conceptual deficiencies and graphic difficulties; more errors were found in the command condition (CDT-command) than in the copy condition (CDT-copy); 15% of the subjects drew smaller clock circles in CDT-command, which did not relate to any other errors. No small clock was found in CDT-copy because a pre-dawn circle was provided. The inter-rater reliability of the Rouleau scoring system was .87 and .83 for the CDT-command and -copy, respectively, while the discriminate accuracy of the scoring system was relatively low in detecting QD vs. NC, QD vs. AD, but somewhat better in distinguishing AD vs. NC groups for the areas under the ROC curves was equal to .72 for the CDT-command, and .73 for the CDT-copy. Visuospatial construction and executive functioning explained the largest score variance of the CDT in both conditions, while depressive symptoms were not significantly associated with the CDT performance. CONCLUSION: The CDT using the Rouleau scoring system has been validated in mild AD subjects in Taiwan; however, to screen for QD sufferers, alternative scoring systems emphasizing hands or combining CDT with different neuropsychological tests such as the Clinical Abilities Screening Instrument are recommended.

Frailty and health care use among community-dwelling older adults with diabetes: a population-based study.

PURPOSE: The aims of this study were to investigate the prevalence of frailty and its relationship with health care use among community-dwelling older adults with diabetes. METHODS: We analyzed data from a nationally representative sample of people aged 65 years and above (n=3,203) participating in the 2013 National Health Interview Survey in Taiwan. A total of 719 participants had a history of self-reported physician-diagnosed diabetes. The presence of frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. FRAIL scores range from 0 to 5 and are categorized as frail (3-5), pre-frail (1-2), and robust (0). Participants were asked whether they had been hospitalized or had visited an emergency department in the past year. RESULTS: Among community-dwelling older adults with diabetes, 9.4% of participants were frail and 35.3 % were pre-frail. After adjustment for other factors, being frail was significantly associated with hospitalization during the past year (OR =5.31, 95% CI =1.87-15.10), whereas being pre-frail was not associated with hospitalization. Both being pre-frail and frail were significantly associated with emergency department visits during the past year (OR =2.64, 95% CI =1.35-5.17 and OR =4.05, 95% CI =1.31-12.49, respectively) after adjustment for other factors. CONCLUSION: Our results highlight the high prevalence of frailty in community-dwelling older adults with diabetes. Furthermore, being frail is associated with a greater burden of hospitalizations and emergency department visits.

Associations between the metabolic syndrome and its components, watching television and physical activity.

OBJECTIVE: To examine the associations between watching television and physical activity with the metabolic syndrome and its components. STUDY DESIGN: Cross-sectional study. METHODS: This study was conducted among 358 subjects recruited from the Department of Health Management of Chang Gung Medical Centre in Linkou. After adjustment for gender, age and body mass index (BMI), the odds ratios (ORs) of the metabolic syndrome and its components were analysed for relative daily energy expenditure groups and time spent watching television categories. RESULTS: After adjustment for gender, age and BMI, the OR of the metabolic syndrome in the most active subjects compared with the least active subjects was 0.27 [95% confidence interval (CI)=0.08-0.88; P=0.030]. There was inconclusive evidence of an association between watching television for more than 20h/week and presence of the metabolic syndrome (OR=2.99; 95% CI=0.83-10.84; P=0.095). CONCLUSIONS: Physical activity was a significant protective factor for presence of the metabolic syndrome and low levels of high-density-lipoprotein cholesterol. Watching television was positively associated with greater odds of high levels of triglycerides and fasting glucose. This study emphasized the importance of reducing the time spent watching television and increasing the level of physical activity for prevention of the metabolic syndrome.