Care needs assessment of older Chinese individuals with dementia of Hong Kong.

Using the Care Needs Assessment Pack for Dementia (CarenapD), the care needs of older Hong Kong Chinese individuals with dementia were investigated in the present study. A convenience sample of 197 community-dwelling older adults with dementia, with a mean age of 77, was examined. Among the participants, 71 were classified with a Clinical Dementia Rating (CDR) score of 1 (mild impairment), 100 with a CDR score of 2 (moderate impairment), and 26 with a CDR score of 3 (severe impairment). CarenapD, consisting of 57 activity/behavioural items, was used to evaluate the status of care needs as 'No', 'Met' or 'Unmet' in seven domains of functioning. The results suggested that the care needs of participants with increasing severity of cognitive impairment became diversified and evident in activities related to complex and instrumental daily living tasks, social interaction, thinking and memory, and behaviour and mental state. Unmet care needs were identified in 10 items that are mainly associated with social interaction, memory, and mental state. Formal service providers are suggested to formulate support services that are appropriate to address the care needs for persons with dementia and family carers.

Measuring sensory processing patterns of older Chinese people: psychometric validation of the adult sensory profile.

The Adult Sensory Profile (ASP) evaluates the sensory experiences of adults in the categories of auditory, visual, taste/smell, touch, movement, and activity level. It generates four sensory processing patterns including low registration, sensation seeking, sensory sensitivity, and sensation avoiding. This study examined the psychometric properties of the Chinese version of ASP (ASP-CV) for older Hong Kong Chinese adults. Ninety-six participants with normal cognitive functioning and 33 participants with dementia were recruited. All participants were involved in the investigation of internal consistency and construct validity. One sub-sample from each group was selected for test-retest reliability and inter-rater reliability respectively. The ASP-CV demonstrated excellent inter-rater reliability and test-retest reliability (r = 0.91-0.99 and 0.76-0.88 respectively), and satisfactory internal consistency (alpha = 0.58-0.72). The construct validity of ASP-CV was supported by the known-groups method, in which participants with dementia differed significantly from their healthy counterparts in the patterns of 'low registration' (F(1, 127) = 9.69, p = 0.002), 'sensory sensitivity' (F(1, 127) = 4.63, p = 0.033), and 'sensation avoiding' (F(1, 127) = 15.87, p < 0.001). In conclusion, ASP-CV is reliable and valid to measure sensory processing functions of older Hong Kong Chinese people. Further studies are suggested to examine the factor structure of and the equivalence of self-report and proxy report of ASP-CV.

Reversible cholestasis and cholangitis induced by biliary drainage and infusion in the rat.

To develop a rat model of ascending cholangitis, we constructed a controllable and accessible biliary drainage and infusion system. We first modified a reversible cholestasis model of the rat and then induced ascending cholangitis by administration of Escherichia coli into the proximal choledochostomy tube. After biliary infusion of E. coli, the liver, choledochostomy tube and bile were all positive for E. coli, but no bacteria grew in rats receiving biliary infusion of normal saline. Retrograde cholangiography of the initial choledochostomy ensured that the tube end was in the right position in the proximal common bile duct. The patency of the tube-tube choledochocholedochostomy was confirmed by a cholangiogram on day 90. Thirty days after the tube-tube choledochocholedochostomy, the livers of the experimental animals did not differ from the control livers. The tube-tube choledochocholedochostomy model not only provides reproducible, reliable, reversible cholestasis, but creates a sustainable and accessible biliary infusion system. This can be used for long-term investigations of repeated cholangitis and recurrent cholestasis.

Changes in nitrate and nitrite content of four vegetables during storage at refrigerated and ambient temperatures.

The nitrate and nitrite contents of four kinds of vegetables (spinach, crown daisy, organic Chinese spinach and organic non-heading Chinese cabbage) in Taiwan were determined during storage at both refrigerated (5 +/- 1 degrees C) and ambient temperatures (22 +/- 1 degrees C) for 7 days. During storage at ambient temperature, nitrate levels in the vegetables dropped significantly from the third day while nitrite levels increased dramatically from the fourth day of storage. However, refrigerated storage did not lead to changes in nitrate and nitrite levels in the vegetables over 7 days.

Clear cell eccrine porocarcinoma with extensive cutaneous metastasis and peripheral lymphocyte dysfunction.

An 81-year-old woman came to our clinic (Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan) with multiple erythematous, indurated papules over the left side of her face. Two years earlier, the patient had a skin biopsy done at a similar anatomical area with the histopathological diagnosis of Bowen's disease. After reviewing surgical specimens and confirming no systemic involvement, clear cell eccrine porocarcinoma with extensive cutaneous metastasis has been diagnosed. In addition, the peripheral blood lymphocyte function of the patient was evaluated. The expression of interleukin-2 receptors on lymphocytes after stimulation is abnormal compared with the age-matched normal control and a patient with cutaneous squamous cell carcinoma. This clinical manifestation of eccrine porocarcinoma is exceptional, and lymphocyte dysfunction in this patient has probably contributed to extensive cutaneous metastasis.

Addressing the informational needs of healthcare professionals in dementia care: an explorative study in a Chinese society.

Many healthcare professionals in Hong Kong are now working in dementia care, but little is known about their informational needs in this area. This study explored the level of knowledge about dementia that healthcare professionals perceived themselves as having, and the informational needs of dementia care. 320 respondents, who were primarily nurses, social workers, and rehabilitation therapists, completed a questionnaire designed for this study. While 65% reported having sufficient knowledge of dementia, only 40% expressed having adequate knowledge of dementia-related services. Respondents who had relevant clinical experience demonstrated a significantly higher self-perceived knowledge level of dementia (p=0.000) and dementia-related services (p=0.000). The respondents ranked information leaflets (68%), the mass media (65%), and workshops (53%) as the three popular sources for obtaining dementia-related information. Similar to their western counterparts, over 75% of respondents expressed the need to lean more about clinical management and service provisions for people with dementia and their families. To enhance the knowledge of healthcare professionals about dementia care, it is recommended that healthcare professionals be encouraged to participate in continuing education programmes, and that education/resource centres for dementia care be developed to address the learning needs of local practitioners.

Snoezelen for dementia.

BACKGROUND: Snoezelen, multi-sensory stimulation, provides sensory stimuli to stimulate the primary senses of sight, hearing, touch, taste and smell, through the use of lighting effects, tactile surfaces, meditative music and the odour of relaxing essential oils (Pinkney 1997). The clinical application of snoezelen has been extended from the field of learning disability to dementia care over the past decade. The rationale for its use lies in providing a sensory environment that places fewer demands on intellectual abilities but capitalizes on the residual sensorimotor abilities of people with dementia (e.g. Buettner 1999, Hope 1998). Practitioners are keen to use snoezelen in dementia care, and some encouraging results have been documented in the area of promoting adaptive behaviours (e.g. Baker, Long 1992, Spaull 1998). However, the clinical application of snoezelen often varies in form, nature, principles and procedures. Such variations not only make examination of the therapeutic values of Snoezelen difficult, but also impede the clinical development of snoezelen in dementia care. A systematic review of evidence for the efficacy of snoezelen in the care of people with dementia is therefore needed to inform future clinical applications and research directions. OBJECTIVES: This review aims to examine the clinical efficacy of snoezelen for older people with dementia. SEARCH STRATEGY: "Snoezelen", "multi-sensory", "dement*", "Alzheimer*", "randomized control/single control/double control" were used as keywords to search seven electronic databases (e.g. MEDLINE, PsyLIT). The list of trials was compared with those identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group. SELECTION CRITERIA: All RCTs in which Snoezelen or multi-sensory programmes were used as an intervention for people with dementia were included in the review. Trial data included in the review were restricted to those involving people aged over 60 years suffering from any type of dementia, except one subject of Baker's study was aged below 60 years. DATA COLLECTION AND ANALYSIS: Only two RCTs fulfill the inclusion criteria for this systematic review. Two reviewers independently extracted the data from these two inclusion studies. Quantitative synthesis of the comparable data from the two trials was performed. MAIN RESULTS: Two trials were included. Both Baker (and Kragt examined the short-term values of snoezelen on the behaviours of people with dementia. Although the pooled results were insignificant, the trend was in the direction of favouring treatment (hence a negative value of the SMD). The standardized mean difference (SMD) was -1.22, with a 95% confidence interval (CI) (-4.08, 1.64). Kragt's result, weighted 47%, was significant in favour of treatment, with a SMD of -2.77 and a 95% CI (-4.24, -1.29). During the snoezelen session, Kragt's subjects presented significantly fewer apathetic behaviours (t=-8.22, p<0.01), fewer restless behaviours (t=-3.00, p=0.01), fewer repetitive behaviours (t=-.822, p<0.01), and fewer disturbances (t=-4.91, p<0.01). Baker's result was slightly not in favour of the treatment, with a SMD of 0.16 and a 95% CI (-0.41, 0.73). The control subjects touched objects/equipment more appropriately within the activity sessions than the subjects who participated in snoezelen sessions (F(1,47)=5.96, p=.001). Kragt did not examine the carryover and long-term effects of snoezelen, so only Baker's results were analysed. Baker used the Behavioural and Mood Disturbance scale (BMD), the REHAB, the CAPE and MMSE to assess patients mood, behaviour and cognition after (but not immediately after) four treatment sessions and eight treatment sessions. Some assessments were carried at home, some at day hospital. There were many subscores and mostly there were no differences between treatment and control. The following significant differences were found with benefit in favour of snoezelen compared with control after four sessions: apathy ezelen compared with control after four sessions: apathy score of the BRS (CAPE) (MD -3.00, 95%CIs -5.87 to -0.13, P=0.04), after eight sessions: mood score of the BRS (CAPE) (MD -2.60, 95%CIs -4.92 to -0.28, P=0.03), total score of the BRS (CAPE) (MD -6.92, 95%CIs -13.13 to -0.7, P=0.03), speech skills of the REHAB (MD 1.46, 95%CIs 0.01 to 2.82, P=0.03), psychomotor subscore of the cognitive assessment scale of CAPE (MD -3.12, 95%CIs -5.31 to -0.93, P<0.01). REVIEWER'S CONCLUSIONS: Two trials were reviewed. Although both studies examined the short-term values of snoezelen on people with dementia, it is not feasible to draw a firm conclusion at this stage, for two main reasons. Firstly, very limited data were available for analysis, thus limiting data inference and generalization. Secondly, different methodology and control conditions were adopted in the two trials. Such variations not only require a careful interpretation of results but also make the comparison of results across studies less valid. Hence, there is an urgent need for more systematic and scientific research studies to examine the clinical value of snoezelen for people with dementia. To our knowledge, there are four RCTs currently in progress. It is hoped that the data and results of these trials will enrich the systematic review of snoezelen for dementia in the next update.

Active learning of geriatric rehabilitation: deliberations of an undergraduate occupational therapy programme.

Occupational therapists working in geriatric rehabilitation must possess skills of self-directed learning and critical thinking, but conventional teaching-learning strategies are limited in acquiring the said skills. This action research aimed at developing in students an ability for active learning and problem solving. An inquiry-based learning (IBL) methodology was introduced to two geriatric-related subjects of an undergraduate occupational therapy (OT) programme. Students worked on four real-life problems in tutorials and participated in service learning. Lectures were carefully structured to consolidate theoretical knowledge generated from the problems. This study was evaluated qualitatively through interviews of both students and clinical educators, and reflective journals. Students found the problems and service learning stimulating enough to encourage active learning and develop basic study skills. Likewise, clinical educators noted students to be more competent when working with geriatric clients than former students who learned through a conventional curriculum. However, the IBL methodology was stressful in areas related to consistency of teaching-learning strategies across curriculum, workload and time constraints. Curriculum review, development of resource files and provision of systematic support are some of the recommendations to the challenges encountered. To conclude, the IBL approach provides appropriate learning environments that foster in students a self-directed learning attitude in the study of geriatric rehabilitation.

Empowering individuals with early dementia and their carers: an exploratory study in the Chinese context.

This article discusses an early dementia program developed for sufferers and family carers in a Chinese context. Instead of replicating formats of similar programs developed in Western countries, this program considered cultural issues and caring values that are unique to Chinese people. Its main objective was to empower sufferers and carers through educational activities and support programs. Observations and interviews were used for program evaluation. The program creates a "win-win" situation in which both parties experienced pleasurable feelings and developed a close relationship. It also highlights the values of "meaningful occupation" in dementia care. Furthermore, the program broadens our understanding of needs and concerns of sufferers and carers at early stages, which are deemed important to develop continuous dementia programs along the disease course.

Lay interpretation of dementia.

Dementia is a relatively "new" disease in the medical field. Over the past few decades, neurologists, geriatricians, psychologists, and sociologists were keen to determine the causes of dementia. The prevalent picture of the scientific and theoretical causation of dementia, however, overshadows the lay perspective of dementia. To get a better understanding of the latter aspect, this study examined family carers' knowledge of dementia and how they made sense of the disease. Individual interviews were completed with 18 family carers. The interview data were analyzed based on grounded theory, which is characterized by a constant comparative method of analysis (Glaser & Strauss, 1967). This method of analysis is inductive in nature and allows the construction of a theory of the lay interpretation of dementia. The study revealed family carers' limited knowledge of dementia might be related to medical professionals' inadequate explanations of the multifaceted dimensions of dementia. Hence, the family carers tended to use external events and personal experiences to explain the occurrence of dementia. Findings suggested that the development of a lay understanding of dementia was a means for family carers to gain control of this abstruse disease and served as an adaptive strategy to cope with the loss experienced during the caring process. The study indicates a definite need for health care professionals to form partnerships with family carers in order to develop good dementia care.

Effect of Jindangwon on streptozotocin-induced diabetes.

The inhibitory effects of the traditional herbal medicine Jindangwon (JDW) on streptozotocin (ST)-induced diabetic mellitus were studied using the ST-treated diabetic model. Glucokinase activity of pancreatic islets was severely impaired by ST treatment. However, when ST-treated islets were treated with 1 mg/ml of JDW, the enzyme activities of glucokinase and hexokinase were protected, glucose-6-phosphatase was not. When the effects of JDW on ST-induced ATP/ADP ratio of islets were assayed, JDW was effective in restoring of ATP/ADP ratio. In addition, ST decreased the enzyme activities of PDH, while JDW had a protective effect on the enzyme. ST-induced cGMP accumulation was significantly inhibited by JDW treatment. Furthermore, ST-induced nitrite formation was significantly inhibited by JDW treatment. JDW also showed the suppressed nitrite production in ST-treated pancreatic islet cells. When the islets (200/condition) were treated with ST (5 mM for 30 min), and then JDW was added to the ST-treated cells, 1.0 mg/ml of JDW showed the activated and recovered aconitase activity in pancreatic islet cells. When the effect of ST on the gene expression of pancreatic GLUT2 and glucokinase were examined, the level of GLUT2 and glucokinase mRNA in pancreatic islets was significantly decreased. However, JDW protected and improved the expression of protein and genes, indicating that JDW is effective on ST-induced inhibition of gene expression of GLUT2, glucokinase and proinsulin in islets. These results suggested that JDW is effective in this model to treat ST-induced diabetes.

Heterogeneity of epidermal growth factor binding kinetics on individual cells.

Binding of fluorescein-conjugated epidermal growth factor (EGF) to individual A431 cells at 4 degrees C is measured by a quantitative fluorescence imaging technique. After background fluorescence and cell autofluorescence photobleaching corrections, the kinetic data are fit to simple models of one monovalent site and two independent monovalent sites, both of which include a first-order dye photobleaching process. Model simulations and the results from data analysis indicate that the one-monovalent-site model does not describe EGF binding kinetics at the single-cell level, whereas the two-site model is consistent with, but not proved by, the single-cell binding data. In addition, the kinetics of binding of fluorescein-EGF to different cells from the same coverslip often differ significantly from each other, indicating cell-to-cell variations in the binding properties of the EGF receptor.

The Enantiospecific Synthesis of an Isoxazoline. A RGD Mimic Platelet GPIIb/IIIa Antagonist.

A convergent, large-scale, chiral synthesis of isoxazoline 1 has been achieved in 37% overall yield and >99.6% optical purity, starting from L-asparagine and 4-cyanobenzaldehyde. Hofmann reaction of N(alpha)-n-Boc-L-asparagine with iodosobenzene diacetate provides optically pure N(alpha)-n-Boc-L-alpha,beta-diaminopropionic acid (8) in 75% yield. A process of lipase resolution-base catalyzed epimerization gives the single enantiomer 5. Reaction of acid 5 with amine 9 in the presence of thionyl chloride forms the framework of 1. A Pinner reaction of intermediate 4 in methyl acetate or anisole, followed by an amidination with ammonium acetate, gives optically pure product 1.

Severity of hyperammonemic encephalopathy correlates with brain ammonia level and saturation of glutamine synthetase in vivo.

Correlation among in vivo glutamine synthetase (GS) activity, brain ammonia and glutamine concentrations, and severity of encephalopathy was examined in hyperammonemic rats to obtain quantitative information on the capacity of GS to control these metabolites implicated in the etiology of hepatic encephalopathy. Awake rats were observed for neurobehavioral impairments after ammonium acetate infusion to attain a steady-state blood ammonia concentration of 0.9 (group A) or 1.3 mumol/g (group B). As encephalopathy progressed from grade III to IV, brain ammonia concentration increased from 1.9 to 3.3 mumol/g and then decreased to 1.3 mumol/g on recovery to grade III. In contrast, brain glutamine concentration was 26, 23, and 21 mumol/g, respectively. NH(4+)-infused rats pretreated with L-methionine DL-sulfoximine reached grade IV when brain ammonia and glutamine concentrations were 3.0 and 5.5 mumol/g, respectively; severity of encephalopathy correlates with brain ammonia, but not glutamine. In vivo GS activity, measured by NMR, was 6.8 +/- 0.7 mumol/h/g for group A and 6.2 +/- 0.6 mumol/h/g for group B. Hence, the in vivo activity, shown previously to increase with blood ammonia over a range of 0.4-0.64 mumol/g, approaches saturation at blood ammonia > 0.9 mumol/g. This is likely to be the major cause of the observed accumulation of brain ammonia and the onset of grade IV encephalopathy.

Characterization of a new genotype II hepatitis delta virus from Taiwan.

Three genotypes of HDV, which may be associated with different clinical pictures and epidemiological patterns, have been identified. In contrast to Type I and Type III HDV, both of which have multiple isolates, Type II HDV so far includes only a single isolate (Japan-1) from a low prevalence area (Japan). Recently, Type II has been reported to be the predominant genotype in Taiwan, which is also a low prevalence area, and is associated with less aggresive disease than Type I. However, the sequence and structure of these viruses have not been characterized. The complete characterization of a second member (Taiwan-3 isolate) of the Type II HDV from Taiwan is reported. These two Type II HDV isolates (Taiwan-3 and Japan-1) have 93.8% nucleotide homology and 89.3% amino acid homology, respectively. These shared sequences establish the common characteristics of Type II viruses. Sequence comparisons of various HDV genotypes show that the autocatalytic region of the RNA is relatively conserved between Type I and Type II (88.5-95.6% homology) but is significantly divergent in Type III (76.8-80.3% homology). The hypervariable region (nucleotides 1602-658) of RNA, however, is heterogeneous (64.9-73.0%) among all three genotypes. The delta antigen sequence is also very heterogeneous (64.9-73.0%). Most strikingly, the C-terminal sequence (19 amino acids) of the large delta antigen is almost completely different in each of the three genotypes. The heterogeneity in this region of three HDV genotypes may be a basis for their different biological properties, and the nucleotide sequences of this region can be used to differentiate the different genotypes of HDV. The consensus sequence in the four previously identified conserved domains of HDV RNA is defined more precisely.

Double-negative (L3T4-, Lyt2-) thymocytes of autoimmune lpr/lpr mice are resistant to down-regulation of DNA synthesis by a thymic stromal cell product.

The murine autosomal recessive gene, lpr, induces a progressive lymphadenopathy and lupus-like autoimmune syndrome characterized by the accumulation of immature, dull Thy 1.2+, TCR+, L3T4-/Lyt 2- (double-negative, DN) T cells in peripheral lymphoid organs. Previous studies demonstrated that the thymic microenvironment is required for the generation of the abnormal, peripheral DN T cells, while a more recent report linked the lpr gene defect with a failure of thymocytes to express a functional form of the Fas antigen, which mediates apoptosis. Thus, the lpr gene defect apparently prevents lpr thymocytes from responding to the ordered sequence of differentiation and proliferation signals involved in normal thymocyte maturation and selection. We compared the responses of thymocytes from C57BL/6 +/+ (normal) and congenic C57BL/6 lpr/lpr (lpr) mice to a thymic stromal cell product which down-regulates DNA synthesis in vitro. The results indicate that (a) thymic stromal cells from lpr mice produce a factor that can down-regulate DNA synthesis as efficiently as that from normal mice, even at an age when massive lymphadenopathy is present, (b) mitogen-stimulated thymocytes of normal, but not lpr, mice are sensitive to the inhibitory factor, (c) normal DN thymocytes are the cellular target of the inhibitory factor, which acts at some postmembrane receptor-ligand binding event during mitogen-stimulated proliferation, and (d) IL-4-dependent DN thymocyte proliferation seems to be the main target of the inhibitory factor.

Mutation of p53 gene in hepatocellular carcinoma in Taiwan.

To elucidate the role of p53 mutation in hepatocarcinogenesis in Taiwan, a hepatitis B viral infection hyperendemic area, exons 5 to 8 of the p53 gene in the tumor tissue of 61 hepatocellular carcinomas were amplified and sequenced. A total of 20 cases (32.8%) were found to have mutations; 36.6% (15 of 41) for the hepatitis B surface antigen positive group and 25.0% (5 of 20) for the hepatitis B surface antigen negative group. The corresponding normal liver showed no mutation. The mutation is widely distributed throughout exons 5 to 8. Only 4 cases (6.6%), all positive for hepatitis B surface antigen, had a specific hot spot mutation at codon 249 with G to T transversion. Our results show that scattered point mutations in p53 are not uncommon in hepatocellular carcinoma samples from Taiwan and may be important in the development of this cancer. However, the aflatoxin related specific mutation seems much less related to the genesis of hepatocellular carcinoma in Taiwan.

Hypersensitivity pneumonitis by a cool-mist vaporizer: a detailed microbiologic and immunologic study.

A patient with hypersensitivity pneumonitis caused by a contaminated cool-mist vaporizer was evaluated. A detailed microbiologic and immunologic study was done, and a Pseudomonas species was isolated as the possible causative organism by inhalational provocative and serologic tests.

Diazacholesterol-induced ichthyosis in the hairless mouse. Assay for comparative potency of topical retinoids.

Although the new synthetic retinoids are effective when administered systemically, they have not been shown to be effective as topical agents. We compared the topical activity of six synthetic retinoids (two arotinoids, etretinate, all-trans- and 13-cis-tetrazole-retinamide, isotretinoin, and tretinoin) on tail skin in the diazacholesterol-fed mouse model of ichthyosis. Responses were assessed clinically and by measurement of stratum corneum thickness. Although the arotinoids dramatically reduced scaling, they were toxic at concentrations above 0.1%, as was etretinate at 1.0% or greater. Lower concentrations were effective without producing local or systemic toxic reactions. Clinical responses were paralleled by equivalent decrements in stratum corneum thickness, which also permitted quantitative comparisons. The order of potency for the retinoids was as follows: arotinoids, etretinate, tetrazole-retinamides, tretinoin = isotretinoin, vehicle. These results demonstrate that (1) the synthetic retinoids hold promise as topical agents; (2) irritation is not an absolute requirement for topical retinoid activity; and (3) the diazacholesterol-fed mouse offers a new assay of topical retinoid potency in a well-defined animal model of ichthyosis.