HuR promotes triglyceride synthesis and intestinal fat absorption.

Triacylglyceride (TAG) synthesis in the small intestine determines the absorption of dietary fat, but the underlying mechanisms remain to be further studied. Here, we report that the RNA-binding protein HuR (ELAVL1) promotes TAG synthesis in the small intestine. HuR associates with the 3' UTR of Dgat2 mRNA and intron 1 of Mgat2 pre-mRNA. Association of HuR with Dgat2 3' UTR stabilizes Dgat2 mRNA, while association of HuR with intron 1 of Mgat2 pre-mRNA promotes the processing of Mgat2 pre-mRNA. Intestinal epithelium-specific HuR knockout reduces the expression of DGAT2 and MGAT2, thereby reducing the dietary fat absorption through TAG synthesis and mitigating high-fat-diet (HFD)-induced non-alcoholic fatty liver disease (NAFLD) and obesity. Our findings highlight a critical role of HuR in promoting dietary fat absorption.

A Novel Retrograde AAV Variant for Functional Manipulation of Cortical Projection Neurons in Mice and Monkeys.

Retrograde adeno-associated viruses (AAVs) are capable of infecting the axons of projection neurons and serve as a powerful tool for the anatomical and functional characterization of neural networks. However, few retrograde AAV capsids have been shown to offer access to cortical projection neurons across different species and enable the manipulation of neural function in non-human primates (NHPs). Here, we report the development of a novel retrograde AAV capsid, AAV-DJ8R, which efficiently labeled cortical projection neurons after local administration into the striatum of mice and macaques. In addition, intrastriatally injected AAV-DJ8R mediated opsin expression in the mouse motor cortex and induced robust behavioral alterations. Moreover, AAV-DJ8R markedly increased motor cortical neuron firing upon optogenetic light stimulation after viral delivery into the macaque putamen. These data demonstrate the usefulness of AAV-DJ8R as an efficient retrograde tracer for cortical projection neurons in rodents and NHPs and indicate its suitability for use in conducting functional interrogations.

Circuit-specific gene therapy reverses core symptoms in a primate Parkinson's disease model.

Parkinson's disease (PD) is a debilitating neurodegenerative disorder. Its symptoms are typically treated with levodopa or dopamine receptor agonists, but its action lacks specificity due to the wide distribution of dopamine receptors in the central nervous system and periphery. Here, we report the development of a gene therapy strategy to selectively manipulate PD-affected circuitry. Targeting striatal D1 medium spiny neurons (MSNs), whose activity is chronically suppressed in PD, we engineered a therapeutic strategy comprised of a highly efficient retrograde adeno-associated virus (AAV), promoter elements with strong D1-MSN activity, and a chemogenetic effector to enable precise D1-MSN activation after systemic ligand administration. Application of this therapeutic approach rescues locomotion, tremor, and motor skill defects in both mouse and primate models of PD, supporting the feasibility of targeted circuit modulation tools for the treatment of PD in humans.

An ultra-compact promoter drives widespread neuronal expression in mouse and monkey brains.

Promoters are essential tools for basic and translational neuroscience research. An ideal promoter should possess the shortest possible DNA sequence with cell-type selectivity. However, whether ultra-compact promoters can offer neuron-specific expression is unclear. Here, we report the development of an extremely short promoter that enables selective gene expression in neurons, but not glial cells, in the brain. The promoter sequence originates from the human CALM1 gene and is only 120 bp in size. The CALM1 promoter (pCALM1) embedded in an adeno-associated virus (AAV) genome directed broad reporter expression in excitatory and inhibitory neurons in mouse and monkey brains. Moreover, pCALM1, when inserted into an all-in-one AAV vector expressing SpCas9 and sgRNA, drives constitutive and conditional in vivo gene editing in neurons and elicits functional alterations. These data demonstrate the ability of pCALM1 to conduct restricted neuronal gene expression, illustrating the feasibility of ultra-miniature promoters for targeting brain-cell subtypes.

Comparison of four screening methods for sarcopenia among community-dwelling older adults: A diagnostic accuracy study.

This study aimed to compare the diagnostic values of SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls), SARC-Calf (SARC-F combined with calf circumference), CC (calf circumference), and the Yubi-wakka (finger-ring) test for screening for sarcopenia in community-dwelling older adults. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used as a standard reference. A total of 209 participants were enrolled, and 40.7% were identified as sarcopenia. The sensitivity, specificity, and AUC were respectively 54.1%, 70.2%, and 0.687 for SARC-F; 76.5%, 73.4% and 0.832 for SARC-calf, 86.7%, 82.4%, and 0.906 for CC in men, and 85.5%, 63.3%, and 0.877 for CC in women. Relative to the "bigger," a significant association between sarcopenia and the Yubi-wakka test ("just fits" OR: 4.1, 95% CI: 1.57-10.98; "small" OR: 27.5, 95% CI: 10.14-74.55) was observed. The overall accuracy of CC was better than SARC-Calf for sarcopenia screening.

Impact of an Educational Program on Improving Nurses' Management of Fever: An Experimental Study.

BACKGROUND: Despite a public information campaign "To Break the Myth of Fever", nurses continued to overtreat fever. This study hypothesized that the campaign lacked the detailed rationale essential to alter nurses' attitudes and behaviors. AIM: To evaluate the effect of the educational program on nurses' knowledge, attitudes, and behaviors related to fever management. DESIGN: A randomized experimental design using a time series analysis. METHODS: A random sample of 58 medical/surgical nurses was evenly divided into an intervention and a control group. The intervention group received an educational program on fever and fever management. Both groups completed a pretest and four posttests using investigator-developed instruments: a questionnaire on knowledge and attitudes about fever management and a fever treatment checklist to audit charts. RESULTS: The intervention group had markedly higher knowledge scores and reduced use of ice pillows at all four posttests, as well as lower use of antipyretics overall, except for the first posttest, despite no sustained change in attitude. CONCLUSIONS: An educational program for fever management can effectively improve clinical nurses' knowledge and attitudes about fever management.

Validation of Screening Tools for Predicting the Risk of Functional Decline in Hospitalized Elderly Patients.

BACKGROUND: Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d' Evaluation du Risque de Perte d'Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward. METHODS: A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily living (ADL), and screening instruments. The Barthel Index was used to measure functional disability. Functional decline was defined as a decline of at least five points on the Barthel Index 30 days after discharge compared to that at pre-admission. RESULTS: Patients had a mean age of 77.7 years, with 55.7% being female. Functional decline was observed in 39.1% of all patients. The best cutoff point, sensitivity, specificity, and area under the receiver operating characteristic curve were 2.5, 96.1%, 52.5%, and 0.751 for ISAR-HP; 1.5, 83.1%, 62.5%, and 0.761 for VIP; and 4.75, 89.6%, 54.2%, and 0.758 for SHERPA, respectively. CONCLUSIONS: All three instruments showed moderate diagnostic accuracy as indicated by their best cutoff points. Therefore, the results presented herein can guide health care professionals in selecting the appropriate assessment tool for predicting functional decline among hospitalized elderly patients in a clinical setting.

[Reflections on the Prospective Professional Competency of Taiwan Public Health Nurses].

Societal ageing, the rising prevalence of chronic diseases, and the COVID-19 pandemic have changed the global healthcare environment dramatically. These challenges have significantly burdened community medical and healthcare systems and complicated the work of public health nursing. As an important care provider on the frontlines of primary care, public health nurses (PHNs) must keep up with the current state of the medical environment and statistical data interpretation, scientific data translation, community resource sharing, and telehealth applications. These demands have greatly impacted the traditional routines and existing professional core competencies of PHNs. Discussions among 12 Taiwanese public healthcare experts and the definition of public health nursing capacity from World Health Organization were considered in this review. In addition to reflecting on social changes and the professional development of public health nursing, eight prospective recommendations were provided in this review to enhance the professional competence of PHNs and better prepare them for future changes in the health environment and primary healthcare. The suggestions provide a reference for updating the position statement of PHNs.

Effectiveness of Self-administered Acupressure for Family Caregivers of Advanced Cancer Patients With Insomnia: A Randomized Controlled Trial.

BACKGROUND: Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer. OBJECTIVE: The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer. METHODS: Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation. RESULTS: Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups. CONCLUSIONS: Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs. IMPLICATIONS FOR PRACTICE: Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.

The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university.

PURPOSE: To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). DESIGN AND METHODS: A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews. FINDINGS: A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up. PRACTICE IMPLICATIONS: This screen model can be used in early detection for undergraduates with HRDP from large general samples.

Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study.

BACKGROUND: Action observation therapy and mirror therapy, two promising rehabilitation strategies, are aimed at enhancing the motor learning and functional improvement of stroke patients through different patterns of visual feedback and observation. OBJECTIVE: This study investigated and compared the treatment effects of the action observation therapy, mirror therapy, and active control intervention on motor and functional outcomes of stroke patients. METHODS: Twenty-one patients with subacute stroke were recruited in this study. All patients were randomly assigned to the action observation therapy, mirror therapy, or active control intervention for 3 weeks. Outcome measures were conducted at baseline, immediately after treatment, and at 3-month follow-up. The primary outcome was the Fugl-Meyer Assessment, and secondary outcomes included the Box and Block Test, Functional Independence Measure, and Stroke Impact Scale. Descriptive analyses and the number of patients whose change score achieved minimal clinically important difference were reported. RESULTS: Both the action observation therapy and active control intervention showed similar improvements on the Fugl-Meyer Assessment, Box and Block Test, and Stroke Impact Scale. Moreover, the action observation therapy had a greater improvement on the Functional Independence Measure than the other 2 groups did. However, the mirror therapy group gained the least improvements on the outcomes. CONCLUSION: The preliminary results found that the patients in the action observation therapy and active control intervention groups had comparable benefits, suggesting that the 2 treatments might be used as an alternative to each other. A further large-scale study with at least 20 patients in each group to validate the study findings is needed. This trial is registered with NCT02871700.

Estimating the survival of elderly patients diagnosed with dementia in Taiwan: A longitudinal study.

BACKGROUND: Dementia is characterized by prolonged progressive disability. Therefore, predicting mortality is difficult. An accurate prediction tool may be useful to ensure that end-of-life patients with dementia receive timely palliative care. PURPOSE: This study aims to establish a survival prediction model for elderly patients with dementia in Taiwan. METHODS: Data from the 2001 to 2010 National Health Insurance Research Database in Taiwan were used to identify 37,289 patients with dementia aged ≥65 years for inclusion in this retrospective longitudinal study. Moreover, this study examined the mortality indicators for dementia among demographic characteristics, chronic physical comorbidities, and medical procedures. A Cox proportional hazards model with time-dependent covariates was used to estimate mortality risk, and risk score functions were formulated using a point system to establish a survival prediction model. The prediction model was then tested using the area under the receiver operating characteristic curve. RESULTS: Thirteen mortality risk factors were identified: age, sex, stroke, chronic renal failure, liver cirrhosis, cancer, pressure injury, and retrospectively retrieved factors occurring in the 6 months before death, including nasogastric tube placement, supplemental oxygen supply, ≥2 hospitalization, receiving ≥1 emergency services, ≥2 occurrences of cardiopulmonary resuscitation, and receiving ≥2 endotracheal intubations. The area under the receiver operating characteristic curves for this prediction model for mortality at 6 and 12 months were 0.726 and 0.733, respectively. CONCLUSIONS: The survival prediction model demonstrated moderate accuracy for predicting mortality at 6 and 12 months before death in elderly patients with dementia. This tool may be valuable for helping health care providers and family caregivers to make end-of-life care decisions.

Sleep Pattern and Predictors of Sleep Disturbance Among Family Caregivers of Terminal Ill Patients With Cancer in Taiwan: A Longitudinal Study.

BACKGROUND: Sleep disturbance commonly has a negative impact on the well-being of family caregivers (FCs) of terminally ill patients with cancer. The effect of sleep disturbance on FCs has not been explored through long-term follow-up studies in Taiwan. OBJECTIVE: The purposes of this study were to (1) identify the trajectory of sleep quality of FCs of terminally ill patients with cancer in Taiwan and (2) examine the determinants of sleep disturbance through a longitudinal follow-up until patient death. METHODS: A prospective, longitudinal study was conducted among 95 FCs of terminally ill patients with cancer. The FCs' sleep quality was measured subjectively by using the Pittsburgh Sleep Quality Index and objectively by wearing a wrist actigraphy for 48 hours each month during the 6-month follow-up assessments. The trajectory and determinants of sleep quality were identified using a generalized estimation equation approach. RESULTS: The FCs' sleep quality significantly decreased as the patient's death approached. Family caregivers who were women or older, had a relative with a longer survival period after diagnosis, reported higher levels of depression and fatigue, and provided lower levels of assistance to their relatives experienced more sleep disturbance. CONCLUSION: The sleep quality of Taiwanese FCs significantly deteriorated as the death of the terminally ill patients with cancer approached. Early detection of the FCs' sleep disturbance, increasing their self-awareness of sleep problems, and providing nonpharmacological interventions and psychosocial support may be helpful for FCs to improve their quantity and quality of sleep.

A "Sit Less, Walk More" Workplace Intervention for Office Workers: Long-Term Efficacy of a Quasi-Experimental Study.

OBJECTIVE: This study tested the maintenance outcomes of a 3-month Sit Less, Walk More (SLWM) workplace intervention for office workers compared with usual care at 12 months from the baseline. METHOD: A quasi-experimental study was conducted in two workplaces. The intervention group (n = 51) received multi-component intervention and the comparison group (n = 50) received newsletters only. The outcomes of the study (self-reported psychosocial, physical activity, sitting, and lost productivity; objectively measured cardiometabolic biomarkers) were compared at baseline, 3, and 12 months. RESULTS: Generalized estimating equations analyses found that the intervention group had significant improvements in self-regulation for sitting less and moving more (P = 0.017), walking (P = 0.003), weight (P = 0.013), waist circumference (P = 0.002), and insulin (P = 0.000) at 12 months compared with the comparison group. CONCLUSION: The SLWM intervention was effective in improving self-regulation, walking, and some cardiometabolic biomarkers in office workers.

Short-Term Efficacy of a "Sit Less, Walk More" Workplace Intervention on Improving Cardiometabolic Health and Work Productivity in Office Workers.

OBJECTIVE: The aim of this study was to test the short-term efficacy of the Sit Less, Walk More (SLWM) workplace intervention. METHODS: This was a quasi-experimental design. A total of 99 office workers from two workplaces participated in this study. The 12-week intervention included five components: monthly newsletters, motivational tools, pedometer challenge, environmental prompts, and walking route. The comparison group received monthly newsletters only. RESULTS: Generalized estimating equation analyses showed that the intervention group demonstrated significant improvements in weight (P = 0.029), waist circumference (P = 0.038), diastolic blood pressure (P < 0.001), walking (P < 0.001), moderate-intensity physical activity (P = 0.014), and total physical activity (P = 0.003) relative to the comparison group. A significant improvement in lost-productivity was observed in both groups (P = 0.003 to 0.008). CONCLUSIONS: The SLWM workplace intervention can improve worker health and lost-productivity.

An integrative review: work environment factors associated with physical activity among white-collar workers.

The purpose of this review is to synthesize the research evidence for the role of the work environment-workplace physical activity policies and resources and job strain factors-in explaining physical activity in white-collar workers. White-collar workers are at risk for developing a sedentary lifestyle, which contributes to all-cause mortality. Understanding how work environment can influence worker physical activity is important for the development of effective interventions. We reviewed 15 research articles that describe the relationship between work environment factors and physical activity in predominantly white-collar workers. Relatively consistent evidence was found for the effects of supportive workplace policies and resources. Weak evidence was found for the effects of job strain. Both work environment factors have the potential to influence physical activity but require further exploration to fully understand their contribution to physical activity in white-collar workers. Limitations and implications are discussed.

Work environment and psychosocial factors affecting physical activity among Taiwanese information technology professionals: a structural equation modeling approach.

OBJECTIVE: To examine the relationships among work environment, psychosocial factors, and physical activity (PA) among information technology (IT) professionals. METHODS: This was a cross-sectional survey of 576 IT professionals from three IT companies in Taiwan. Structural equation modeling was used to test a theoretically supported model using social cognitive theory, incorporating variables from the demand-control model. RESULTS: Higher levels of PA were positively associated with supportive workplace environments, positive outcome expectations, and self-efficacy for PA. Self-efficacy partially mediated the effects of supportive workplace environments on PA. Job strain had an indirect effect on PA through self-efficacy. The final model accounted for 31% of the variance in PA. CONCLUSIONS: Work environment and psychosocial factors are both important. Workplace PA interventions directed toward individuals' self-efficacy and outcome expectations in the context of supportive environments may be useful.

Translation and psychometric properties of the Chinese version of the perceived workplace environment scale in Taiwanese information technology professionals.

BACKGROUND: The six-item Perceived Workplace Environment Scale (PWES) is a self-report instrument designed to measure employees' perceptions of the extent to which their workplace environment supports employee physical activity. A Chinese version is needed to facilitate workplace physical activity research in Chinese speaking countries. OBJECTIVES: This paper describes the translation process and the psychometric properties of the newly translated Chinese version of the PWES (PWES-C). METHODS: The PWES in English was translated into Chinese using a modified committee approach with the consideration of cross-cultural equivalence. Psychometric properties were examined by a cross-sectional survey of 466 male and 109 female Taiwanese information technology (IT) professionals from three IT companies in northern Taiwan. RESULTS: Content validity of the newly translated PWES-C was supported by a panel of experts. Internal consistency reliability was high (Cronbach's alpha=0.88), and no significant ceiling and floor effects were observed for the PWES-C. Construct validity was supported by examining the factor structure of the PWES-C using a confirmatory factor analysis, and the results suggest a single-factor structure. CONCLUSIONS: The PWES-C is a reliable and valid measure of perceived workplace physical activity environments in Taiwanese IT professionals. The scale could be used by employers to document employees' perception of the workplace environment.

ROS-mediated p53 induction of Lpin1 regulates fatty acid oxidation in response to nutritional stress.

The p53 protein is activated by stress signals and exhibits both protective and death-promoting functions that are considered important for its tumor suppressor function. Emerging evidence points toward an additional role for p53 in metabolism. Here, we identify Lpin1 as a p53-responsive gene that is induced in response to DNA damage and glucose deprivation. Lpin1 is essential for adipocyte development and fat metabolism, and mutation in this gene is responsible for the lypodystrophy phenotype in fld mice. We show that p53 and Lpin1 regulate fatty acid oxidation in mouse C2C12 myoblasts. p53 phosphorylation on Ser18 in response to low glucose is ROS and ATM dependent. Lpin1 expression in response to nutritional stress is controlled through the ROS-ATM-p53 pathway and is conserved in human cells. Lpin1 provides a critical link between p53 and metabolism that may be an important component in mediating the tumor suppressor function of p53.

Occupational health nursing practice, education, and research in Taiwan.

This article describes occupational health nursing practice, education, research, and future perspectives in Taiwan. It also provides a brief overview of major occupational health and safety problems, laws and regulations, and organizations in Taiwan.