The Effect of a Tele-Health Intervention Program on Home-Dwelling Persons with Dementia or MCI and on Their Primary Caregivers during the Stay-at-Home-Order Period in the COVID-19 Pandemic Outbreak: Evidence from Taiwan.

BACKGROUND: The Taiwanese government implemented a stay-at-home order that restricted all community-based health promotion activities for the elderly by shutting down all community care centers from May 2021 to August 2021 to control the spread of COVID-19. Community-based dementia care centers were barely able to provide dementia care services during that period. METHODS: The data used in this study were collected from a community-based dementia care center that was able to continue their dementia care services through a Tele-Health intervention program. The difference-in-differences methodology was applied to evaluate the effects of the Tele-Health intervention program on home-dwelling persons with dementia or mild cognitive impairment and on their primary caregivers during the COVID-19 pandemic. RESULTS: The Tele-Health intervention program significantly increased the well-being of the participants and their primary caregivers, but the negative correlations between the Tele-Health intervention program and family functioning were also found to be significant. CONCLUSIONS: The significant substitution (negative) effects between the Tele-Health intervention program and family functioning raises the concern that promotion of the Tele-Health intervention program comes at the potential cost of a loss of family functioning. Policymakers should be cautious when considering the Tele-Health intervention program in response to pandemics and demographic transitions.

[Factors Associated With Oral Health Status and Oral Hygiene Behavior in Patients With Stroke].

BACKGROUND: Studies have shown that oral health is closely related to systemic diseases. Poor oral hygiene may lead to dental caries and periodontal disease and also increase the risk of cardiovascular disease. Patients with stroke have a possibility of recurrence, and good oral health is expected to benefit their general health. Nevertheless, nursing research exploring the oral health and oral hygiene behaviors of stroke patients has been rare. PURPOSE: To explore the factors significantly associated with oral health status and oral hygiene behaviors in patients with stroke. METHODS: A cross-sectional research design with convenient sampling was used. Information on health promoting behaviors and oral health status was collected in a teaching hospital in southern Taiwan. A multivariate linear regression model was applied to explore the factors associated with oral health status in patients with stroke. RESULTS: One hundred and eight-five patients with stroke were enrolled in this study. The average number of real teeth was 11.3 and the average score for oral health status was 4. The univariate analysis showed that being 65 years of age or older, having an education level below primary school, having a lower Barthel index score, having a higher modified Rankin scale score, not brushing and flossing, not having a regular tooth cleaning, having a lower of health promotion score, and having insufficient water intake levels were all associated with a worse oral health status. The stepwise regression analysis showed that factors affecting oral health status include health promotion behaviors, age, tooth brushing, and water intake, which, together, accounted for 28.5% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings indicate that oral health status, oral hygiene behaviors, and health promoting behaviors are inadequate among patients with stroke. Clinicians should promote health-related behaviors early to their patients with stroke, specifically in terms of implementing proper oral hygiene behaviors in daily routine care.

G-CSF enhances the therapeutic potency of stem cells transplantation in spinal cord-injured rats.

Aim: The therapeutic effects of human wisdom teeth-derived neuronal stem cell (tNSC) cotreatment with granulocyte-colony-stimulating factor (G-CSF) were evaluated for contusion-induced spinal cord injury in rats. Materials & methods: 7 days after contusion, tNSCs were transplanted to the injury site and followed by G-CSF cotreatment for 5 days. Behavioral deficits were evaluated by the Basso, Beattie and Bresnahan test. The injury site was collected for immunohistochemistry analysis. Results: The Basso, Beattie and Bresnahan test significantly improved in the cotreated group compared with the tNSCs or G-CSF single treatment groups. However, inflammation indices did not differ among the three groups. In vitro experiment demonstrated that tNSCs express both G-CSF and its relevant receptor. G-CSF enhanced tNSC proliferation and neurotrophins secretion in vitro. Conclusion: This study demonstrated that G-CSF enhances neurotrophins secretion of tNSCs, and might help improving functional recovery from spinal cord injury in rats if they were given together.

Psychometric properties of the Chinese version of the attitudes towards cardiopulmonary resuscitation with defibrillation (ACPRD-C) among female hospital nurses in Taiwan.

INTRODUCTION: Nurses are often the first responders to in-hospital cardiac emergencies. A positive attitude towards cardiopulmonary resuscitation with defibrillation may contribute to early cardiopulmonary resuscitation and rapid defibrillation, which are associated with enhanced long-term survival. The aim of this study was to translate and adapt the 31-item attitudes towards cardiopulmonary resuscitation with defibrillation and the national resuscitation guidelines (ACPRD) instrument into Chinese and to evaluate its psychometric properties in a sample of Taiwanese hospital nurses. METHODS: The ACPRD instrument was translated into Chinese using professional translation services. Content validity index based on five experts to refine the translated instrument. The final instrument was applied to a sample of 290 female nurses, recruited from a regional hospital in southern Taiwan, to assess its internal consistency, factor structure, and discriminative validity. RESULTS: The Chinese ACPRD instrument showed good internal consistency (Cronbach's alpha=0.87). Seven factors emerged from the factor analysis. The instrument showed good discriminative validity and were able to differentiate the attitudes of nurses with more experience of defibrillation or cardiopulmonary resuscitation from those with less experience. Nurses working in emergency ward or intensive care unit also showed significantly higher overall scores compared to those working in other units. CONCLUSION: The Chinese ACPRD demonstrated adequate content validity, internal consistency, sensible factor structure, and good discriminative validity. Among Chinese-speaking nurses, it may be used as a tool for assessing the effectiveness of educational programs that aim to improve their confidence in performing cardiopulmonary resuscitation with defibrillation.

A Reversible Isolated Lesion in the Splenium of Corpus Callosum in a Patient with Probable Neuroleptic Malignant Syndrome -- Case Report.

PURPOSE: A reversible isolated lesion in the splenium of the corpus callosum (SCC) is rare. We present such a case in a young female patient with neuroleptic malignant syndrome (NMS) and elaborate on its proposed pathophysiology and the possible differential diagnoses. CASE REPORT: A 28-year-old female was on neuropsychiatric treatment (clozapine) for schizoaffective disorder. NMS was diagnosed based on the clinical presentation of fever, mental status change (with disorientation and visual hallucination), generalized muscular rigidity (catatonic signs), tremor, and markedly increased creatine phosphokinase (1824 U/l) after 10-day administration of clozapine. The SCC lesion had a "boomerang" appearance and high signal intensity on the initial T2-weighted, T2 fluid attenuated inversion recovery, and diffusion-weighted magnetic resonance images, and decreased apparent diffusion coefficient values. The follow-up magnetic resonance imaging 12 weeks later showed complete resolution of the SCC lesion. CONCLUSION: A reversible isolated SCC lesion is a distinct clinicoradiological syndrome of varied etiology. The changes may occur in certain psychiatric patients with NMS and most patients with epilepsy and encephalitis. The etiological mechanism remains uncertain and enigmatic, but the neurological course and outcome are good.

Predicting 7-day survival using heart rate variability in hospice patients with non-lung cancers.

BACKGROUND: A simple and accurate survival prediction tool can facilitate decision making processes for hospice patients with advanced cancers. The objectives of this study were to explore the association of cardiac autonomic functions and survival in patients with advanced cancer and to evaluate the prognostic value of heart rate variability (HRV) in 7-day survival prediction. METHODS: A prospective study was conducted on 138 patients with advanced cancer recruited from the hospice ward of a regional hospital in southern Taiwan. Information on functional status and symptom burden of the patients was recorded. Frequency-domain HRV was obtained for the evaluation of cardiac autonomic functions at admission. The end point of the study was defined as the survival status at day 7 after admission to the hospice ward. Multivariate logistic regression analyses were performed to evaluate the independent associations between HRV indices and survival of 7 days or less. RESULTS: The median survival time of the patients was 20 days (95% CI, 17-28 days). Results from the multivariate logistic regression analysis indicated that the natural logarithm-transformed high-frequency power (lnHFP) of a value less than 2 (OR = 3.8, p = 0.008) and ECOG performance status of 3 or 4 (OR = 3.4, p = 0.023) were significantly associated with a higher risk of survival of 7 days or less. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve was 0.71 (95% CI, 0.61-0.81). CONCLUSIONS: In hospice patients with non-lung cancers, an lnHPF value below 2 at hospice admission was significantly associated with survival of 7 days or less. HRV might be used as a non-invasive and objective tool to facilitate medical decision making by improving the accuracy in survival prediction.

Association between frequency domain heart rate variability and unplanned readmission to hospital in geriatric patients.

BACKGROUND: An accurate prediction of unplanned readmission (UR) after discharge from hospital can facilitate physician's decision making processes for providing better quality of care in geriatric patients. The objective of this study was to explore the association of cardiac autonomic functions as measured by frequency domain heart rate variability (HRV) and 14-day UR in geriatric patients. METHODS: Patients admitted to the geriatric ward of a regional hospital in Chiayi county in Taiwan were followed prospectively from July 2006 to June 2007. Those with invasive tubes and those who were heavy smokers, heavy alcohol drinkers, on medications that might influence HRV, or previously admitted to the hospital within 30 days were excluded. Cardiac autonomic functions were evaluated by frequency domain indices of HRV. Multiple logistic regression was used to assess the association between UR and HRV indices adjusted for age and length of hospitalization. RESULTS: A total of 78 patients met the inclusion criteria and 15 of them were readmitted within 14 days after discharge. The risk of UR was significantly higher in patients with lower levels of total power (OR = 1.39; 95% CI = 1.04-2.00), low frequency power (LF) (OR = 1.22; 95% CI = 1.03-1.49), high frequency power (HF) (OR = 1.27; 95% CI = 1.02-1.64), and lower ratios of low frequency power to high frequency power (LF/HF ratio) (OR = 1.96; 95% CI = 1.07-3.84). CONCLUSION: This is the first study to evaluate the association between frequency domain heart rate variability and the risk of UR in geriatric patients. Frequency domain heart rate variability indices measured on admission were significantly associated with increased risk of UR in geriatric patients. Additional studies are required to confirm the value and feasibility of using HRV indices on admission as a non-invasive tool to assist the prediction of UR in geriatric patients.

Association between cardiovascular autonomic functions and time to death in patients with terminal hepatocellular carcinoma.

CONTEXT: A better time-to-death (TTD) prediction can facilitate decision-making processes related to plans for providing effective end-of-life care for patients in hospice wards. OBJECTIVE: To explore the association of cardiovascular autonomic functions with TTD in patients with terminal hepatocellular carcinoma. METHODS: A prospective study was conducted with 33 patients with hepatocellular carcinoma recruited from the hospice ward of a regional hospital in Chiayi county, Taiwan. Serum creatinine, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, blood urea nitrogen (BUN), and serum albumin were measured on the admission day. Cardiovascular autonomic functions were evaluated by frequency-domain measures of heart rate variability (HRV) on admission. RESULTS: TTD was significantly associated with total spectrum power (TP) (r=0.55, P=0.001) and high frequency (HF power) (r=0.44, P=0.010) of HRV measurement. The accuracy of within-one-week TTD prediction was 67% for TP and HF power. The accuracy of within-two-week TTD prediction was 82% for TP and 73% for HF. In addition, TTD of the patients was also significantly associated with serum creatinine (r=-0.42, P=0.015), serum albumin (r=-0.46, P=0.007), and BUN (r=-0.44, P=0.010). CONCLUSION: This is the first study to evaluate the association between cardiovascular autonomic functions and TTD in patients with terminal hepatocellular carcinoma. The inclusion of HRV measurement in prognostic models may improve accuracy in TTD prediction and, hence, facilitate medical decision making in hospice care.

Alteration of cardiovascular autonomic functions by vegetarian diets in postmenopausal women is related to LDL cholesterol levels.

This study was designed to test the hypothesis that alteration of cardiovascular autonomic functions by vegetarian diets in healthy postmenopausal women is related to lipid metabolism. A total of 70 healthy postmenopausal women not on hormone therapy participated in this study: 35 were vegetarians (mean age 55.0 years) and 35 were omnivores (mean age 55.1 years). Cardiovascular autonomic functions and baroreflex sensitivity were evaluated by specific frequency-domain measures of heart rate variability (HRV) and arterial blood pressure fluctuation. The vegetarians had statistically significant lowered blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, and fasting glucose levels compared with the omnivores. The vegetarians exhibited a significant higher total power, low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.15-0.4 Hz) of HRV and increased baroreflex sensitivity measures [Brr(LF) and Brr(HF)] compared with the omnivores. Total power, LF and HF of HRV, Brr(LF), and Brr(HF) were significantly and negatively correlated with LDL-cholesterol concentrations (P < 0.01). We concluded that the increases of cardiac vagal activity and baroreflex sensitivity by vegetarian diets in postmenopausal women are inversely related to LDL-cholesterol levels.

Effects of long-term vegetarian diets on cardiovascular autonomic functions in healthy postmenopausal women.

The incidence of cardiovascular disease is higher in postmenopausal women than in premenopausal women. We hypothesized that long-term vegetarian diets might modulate cardiovascular autonomic functions measured by frequency-domain techniques in healthy postmenopausal women. A total of 35 healthy vegetarians (mean age +/- SEM 55.0 +/- 1.3 years) who had been vegetarians for > or =2 years and 35 omnivores (55.1 +/- 1.4 years) participated in this study. These subjects were all postmenopausal without hormone replacement therapy. Fluctuations in arterial blood pressure and heart rate variability were diffracted into low-frequency (0.04 to 0.15 Hz) and high-frequency (0.15 to 0.4 Hz) segments. Cardiovascular autonomic functions and baroreflex sensitivity were evaluated by specific frequency-domain measures. The vegetarians had statistically lower systolic and diastolic blood pressure, and lower serum total cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting blood sugar, and hemoglobin levels compared with the nonvegetarians. They also exhibited a significantly higher high-frequency power of heart rate variability and increased baroreflex sensitivity than did omnivores. No statistical differences were found in the low-frequency/high-frequency ratio or percentage of low frequency of heart rate variability between the 2 groups. In conclusion, in addition to the lower blood pressure and lipid concentrations in vegetarians, long-term vegetarian diets may facilitate vagal regulation of the heart and increase baroreflex sensitivity in healthy postmenopausal women, without increasing the sympathetic modulations of the cardiovascular system.

Age-related changes in cerebral hemodynamics and their correlations with cardiac autonomic functions.

OBJECTIVES: This study was designed to evaluate the correlations between cerebral hemodynamics and cardiac autonomic functions in aging process using transfer function techniques. METHODS: Arterial blood pressure (ABP), middle cerebral artery flow velocity (MCAFV) detected by transcranial Doppler sonography and electrocardiogram were recorded simultaneously in 20 young (27.5 +/- 0.9 years) and 20 middle-old-aged (54.3 +/- 1.5 years) healthy volunteers. Variability of ABP, MCAFV and heart rate (HR) were diffracted into very low (VLF, 0.016-0.04 Hz), low (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) components. Cerebral vasomotor reserve was quantified by specific ABP-MCAFV transfer function measurements. RESULTS: The young group had significantly higher LF transfer phase and HF transfer magnitudes of ABP-MCAFV transfer function; higher HF powers of HR variability; and higher baroreflex sensitivity than those of the middle-old-aged group. LF phase and HF magnitude of ABP-MCAFV transfer function were positively correlated with HF powers of HR variability. DISCUSSION: Although aging process is not obviously associated with changes in the static values of ABP, MCAFV and HR in this study, it is accompanied by significant declines in cerebral vasomotor reserve, cardiac vagal activity and baroreflex sensitivity. Besides, age-related changes in cerebral vasomotor reserve are positively related to those in cardiac vagal activity.

Effects of different classes of antihypertensive drugs on cerebral hemodynamics in elderly hypertensive patients.

BACKGROUND: This study was designed to estimate the effect of different classes of antihypertensive drugs on cerebral hemodynamics in elderly stroke-free, nondiabetic hypertensive patients by applying frequency-domain techniques. METHODS: A total of 60 hypertensive patients divided into treatment groups of 15 unmedicated (HT), 15 nifedepine sustained release form (CCB), 15 atenolol (BB), and 15 valsartan (AIIA), and 15 age-matched healthy volunteers (CON) were studied prospectively. Variability of arterial blood pressure (ABP) and middle cerebral artery flow velocity (MCAFV) detected by transcranial Doppler sonography were diffracted into very-low frequency (VLF, 0.016 to 0.04 Hz), low frequency (LF, 0.04 to 0.15 Hz), and high frequency (HF, 0.15 to 0.4 Hz). Cerebral hemodynamics was quantified by the ABP-MCAFV transfer function. RESULTS: The ABP and MCAFV were statistically different between CON and HT groups, but not significantly different among CON, CCB, BB, and AIIA groups. The LF phase and HF magnitude in the HT, CCB, and BB groups were significantly attenuated than in those of the CON group, but not statistically different between the AIIA and CON groups. There was no statistical difference in VLF and LF transfer magnitude among the five groups. CONCLUSIONS: Although cerebral vasomotor reserve and cerebral blood flow are impaired in unmedicated hypertensive patients, the cerebral autoregulatory response was preserved both in controlled and uncontrolled hypertension. Nifedipine, atenolol, and valsartan are all effective as monotherapy to control ABP and restore cerebral blood flow. Valsartan has the effect to normalize the changes in cerebral vasomotor reserve to a level similar as in age-matched healthy subjects.

Effect of angiotensin II receptor antagonism on cerebral vasomotor reserve in humans.

Angiotensin II receptor antagonists have been reported to modulate cerebrovascular flow in animals. We applied frequency-domain techniques to explore whether angiotensin II receptor activity plays a role in cerebrovascular dynamics in humans. Essential hypertensive patients with (AIIA, n = 10) and without (HT, n = 10) an angiotensin II receptor antagonist (Volsartane) and healthy with matched (CON, n = 10) and younger (YOUNG, n = 10) ages were enrolled. They underwent measurement of middle cerebral artery flow velocity (MCAFV) by transcranial Doppler ultrasound and noninvasive beat-to-beat arterial blood pressure (ABP). Fluctuations in ABP and MCAFV were diffracted into high-frequency (HF, 0.15-0.4 Hz), low-frequency (LF, 0.04-0.15 Hz), and very low-frequency (VLF, 0.016-0.04 Hz) components. The mean age did not statistically significantly differ among the CON, HT, and AIIA groups. HT had significantly higher mean ABP, lower LF fluctuations of ABP and MCAFV, but similar ABP-MCAFV transfer magnitude compared with CON. HF transfer magnitude of AIIA was significantly higher than those of HT and CON, but similar to that of YOUNG. We conclude that the elderly with chronic essential hypertension has a suppressive effect on cerebral vasomotor reserve, in which angiotensin II receptor activity may play an active role.