The benefits of leisure activities on healthy life expectancy for older people with diabetes.

PURPOSE: The purpose of this study is to examine whether leisure activities can help reduce years lived with disability and increase healthy life expectancy of diabetics aged 50 years and above. METHODS: Analysis was based on five waves of follow-up survey data (Taiwan Longitudinal Study of Aging, TLSA) from 1996 to 2011. A total of 5131 participants aged 50 years and above in 1996 were included in the analysis, and gender, leisure activity participation, and diabetes mellitus were used as primary variables to examine the variation trend in health status in the participants. The health status in the various waves of surveys was measured using the activities of daily living scale, and nondisabled was defined as healthy. A multivariate logistic regression model was used to calculate the life expectancy (LE) and healthy life expectancy (HLE) of the people aged 50 years and above. RESULTS: The diabetes older people with a high frequency of leisure activities have longer HLE than those with lower activity frequency. Using 50-year-old diabetic women as an example, the LE (HLE) of those with six or more leisure activities and those with three or fewer leisure activities was 30.40 (25.34) and 24.90 (20.87), respectively. The LE (HLE) of men with the same conditions was 24.79 (22.68) and 20.30 (18.45), respectively. CONCLUSIONS: This study used life expectancy and healthy life expectancy as markers to evaluate health benefits and provided evidence that leisure activities can help extend the life span and maintain the health status of middle-aged and older diabetics.

Pholiota nameko Polysaccharides Protect against Ultraviolet A-Induced Photoaging by Regulating Matrix Metalloproteinases in Human Dermal Fibroblasts.

Ultraviolet-A (UVA) exposure is a major cause of skin aging and can induce oxidative damage and accelerate skin wrinkling. Many natural polysaccharides exhibit a UV protective effect. In research on Pholiota nameko polysaccharides (PNPs), a natural macromolecular polysaccharide (4.4-333.487 kDa), studies have shown that PNPs can significantly decrease elastase activity to protect against UVA-induced aging in Hs68 human dermal fibroblasts. Cellular experiments in the present study indicated that PNPs can protect against UVA-induced oxidative damage in Hs68 cells by inhibiting the production of reactive oxygen species. Furthermore, PNPs significantly attenuated UVA-induced cell aging by decreasing the protein expression of matrix metalloproteinase 1, 3, and 9. Pretreatment of Hs68 cells with PNP-40, PNP-60, and PNP-80 before UVA irradiation increased protein expression of tissue inhibitor metalloproteinase 1 by 41%, 42%, and 56% relative to untreated cells. In conclusion, this study demonstrates that PNPs are a natural resource with potentially beneficial effects in protecting against UVA-induced skin aging.

Prescription patterns and dosages of antiepileptic drugs in prevalent patients with epilepsy in Taiwan: A nationwide retrospective cross-sectional study.

OBJECTIVE: To evaluate the prescription patterns and prescribed daily dose (PDD)/defined daily dose (DDD) ratios of antiepileptic drugs (AEDs) in prevalent patients with epilepsy in Taiwan. MATERIALS AND METHODS: A nationwide retrospective cross-sectional study was conducted for prevalent patients with epilepsy in 2016 using the Taiwanese National Health Insurance Research Database. The prescription records of AEDs of all prevalent patients with epilepsy were retrieved. The mean PDDs and PDD/DDD ratios of AEDs in adult patients were obtained to evaluate dosing adequacy. A chi-square test and two-sample t test were used to analyze the differences in AED prescription patterns and dosages, respectively, among patients with different ages, sexes, comorbidities, and therapeutic approaches. RESULTS: A total of 118,937 prevalent patients with epilepsy were enrolled. The predominant therapeutic approach was monotherapy, especially in the elder adults, accounting for 82.9% of elder adult patients with epilepsy. The proportion of AED monotherapy was higher in patients with dementia (78.9%) and stroke (80.6%). The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%); however, oxcarbazepine (22.8%) was substituted for carbamazepine (3.9%) as monotherapy for patients aged 0-17 years. Among adult patients with epilepsy, the PDD/DDD ratio of each AED in monotherapy was less than 1.00. The mean PDD of each AED was higher in polytherapy than in monotherapy (p < 0.01), except for lacosamide. The mean PDDs of all evaluated AEDs in monotherapy were lower in elder adult patients than in younger adult patients, most of which reached statistical significance (p < 0.001). CONCLUSIONS: In Taiwan, valproic acid was the most prescribed AED for prevalent patients with epilepsy. The mean PDDs of most AEDs were lower than the DDDs developed by the World Health Organization.

Analysis of trends and factors determining initial antiseizure medication choice for epilepsy in Taiwan.

PURPOSE: To evaluate the current trends and factors associated with the first anti-seizure medications (ASMs) prescribed for epilepsy in Taiwan. METHODS: Data for patients with epilepsy were collected from the National Health Insurance Research Database, a population-based claims database. We selected patients with newly diagnosed epilepsy from 2013 to 2016. Multivariate logistic regression was used to examine the factors associated with the selection of newer ASMs for the first prescription. RESULTS: A total of 73,891 patients with newly diagnosed epilepsy were eligible for the study, and the annual incidence was approximately 0.79 per 1,000 people. The five ASMs most prescribed for monotherapy were valproic acid, phenytoin, levetiracetam, gabapentin, and oxcarbazepine, accounting for nearly 90% of all ASMs. Valproic acid was the most-prescribed ASM (more than 30%), and levetiracetam has replaced phenytoin as the second choice since 2015. Factors associated with the selection of newer ASMs for the first prescription were patients' year of diagnosis, gender, socioeconomic level, and previous or existing comorbidities and the profiles of the care providers (accreditation level, service volume, geographic location, and degree of urbanization of the surrounding area). CONCLUSION: The data indicated that the trends in ASMs first prescribed for patients in Taiwan accorded with most of the international epilepsy treatment guidelines. However, there were some differences between our results and those in developed countries. In addition, we observed a large urban-rural disparity in the administration of ASMs.

A propositional AI system for supporting epilepsy diagnosis based on the 2017 epilepsy classification: Illustrated by Dravet syndrome.

PURPOSE: The 2017 epilepsy and seizure diagnosis framework emphasizes epilepsy syndromes and the etiology-based approach. We developed a propositional artificial intelligence (AI) system based on the above concepts to support physicians in the diagnosis of epilepsy. METHODS: We analyzed and built ontology knowledge for the classification of seizure patterns, epilepsy, epilepsy syndrome, and etiologies. Protégé ontology tool was applied in this study. In order to enable the system to be close to the inferential thinking of clinical experts, we classified and constructed knowledge of other epilepsy-related knowledge, including comorbidities, epilepsy imitators, epilepsy descriptors, characteristic electroencephalography (EEG) findings, treatments, etc. We used the Ontology Web Language with Description Logic (OWL-DL) and Semantic Web Rule Language (SWRL) to design rules for expressing the relationship between these ontologies. RESULTS: Dravet syndrome was taken as an illustration for epilepsy syndromes implementation. We designed an interface for the physician to enter the various characteristics of the patients. Clinical data of an 18-year-old boy with epilepsy was applied to the AI system. Through SWRL and reasoning engine Drool's execution, we successfully demonstrate the process of differential diagnosis. CONCLUSION: We developed a propositional AI system by using the OWL-DL/SWRL approach to deal with the complexity of current epilepsy diagnosis. The experience of this system, centered on the clinical epilepsy syndromes, paves a path to construct an AI system for further complicated epilepsy diagnosis.

Characterization and Antioxidant Activities of Yellow Strain Flammulina velutipes (Jinhua Mushroom) Polysaccharides and Their Effects on ROS Content in L929 Cell.

Yellow strain Flammulina velutipes, which is known as Jinhua mushroom in Taiwan, has become popular among customers due to its distinct texture that is utterly different from white strain F. velutipes. However, there has been little study on the physicochemical properties, antioxidant activities, and biological functions of yellow strain F. velutipes polysaccharides (FVYs). The specific aims of this study are to evaluate and compare the physicochemical properties, antioxidant activities, and biological functions of FVYs and white strain F. velutipes polysaccharides (FVWs) in order to select the strain appropriate for cosmetic ingredient. The FVYs and FVWs were prepared by fractional precipitation (40%, 60%, and 80%). According to the results, FVY-80 showed the greatest antioxidant activities based on 2,2-diphenyl-1-picrylhydrazyl (DPPH) (IC50 = 2.22 mg/mL) and 2,2' -azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS) radical assay (IC50 = 2.04 mg/mL). None of the fractions exhibited cytotoxicity toward L929 cell under a concentration of 500 µ g/mL. FVY-80 significantly reduced the reactive oxygen species (ROS) content in L929 cell by 55.96%, as compared with the H2O2-induced L929 cell, according to the dichloro-dihydro-fluorescein diacetate (DCFH-DA) assay. In conclusion, we suggest that FVY-80 is the best source for a cosmetics ingredient.

Inhibition of LPS-Induced Oxidative Damages and Potential Anti-Inflammatory Effects of Phyllanthus emblica Extract via Down-Regulating NF-κB, COX-2, and iNOS in RAW 264.7 Cells.

Phyllanthus emblica is an edible nutraceutical and functional food in the Asia area with medicinal and nutritive importance. The fruit extract of P. emblica is currently considered to be one of the effective functional foods for flesh maintenance and disease treatments because of its antioxidative and immunomodulatory properties. We examined the antioxidant abilities of the fruit extract powder by carrying out 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging, iron reducing power, and metal chelating activity analysis and showed excellent antioxidative results. In 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, the result showed that the samples had no cytotoxic effect on RAW 264.7 cells even at a high concentration of 2 mg/mL. To investigate its immunomodulatory function, our estimation was to treat it with lipopolysaccharide (LPS) in RAW 264.7 cells to present anti-inflammatory capacities. The extract decreased reactive oxygen species (ROS) production levels in a dose-dependent manner measured by flow cytometry. We also examined various inflammatory mRNAs and proteins, including nuclear factor-κB (NF-κB), inducible nitric oxide synthases (iNOS), and cyclooxygenase-2 (COX-2). In quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blotting assay, all three targets were decreased by the extract, also in a dose-dependent manner. In conclusion, P. emblica fruit extract powder not only lessened antioxidative stress damages, but also inhibited inflammatory reactions.

Dexmedetomidine reduces lipopolysaccharide induced neuroinflammation, sickness behavior, and anhedonia.

BACKGROUND: Peripheral innate immune response may induce sickness behavior through activating microglia, excessive cytokines production, and neuroinflammation. Dexmedetomidine (Dex) has anti-inflammatory effect. We investigated the effects of Dex on lipopolysaccharide (LPS)-induced neuroinflammation and sickness behavior in mice. MATERIALS AND METHODS: BALB/c mice were intraperitoneally (i.p.) injected with Dex (50 ug/kg) or vehicle. One hour later, the mice were injected (i.p.) with Escherichia coli LPS (0.33 mg/kg) or saline (n = 6 in each group). We analyzed the food and water intake, body weight loss, and sucrose preference of the mice for 24h. We also determined microglia activation and cytokines expression in the brains of the mice. In vitro, we determine cytokines expression in LPS-treated BV-2 microglial cells with or without Dex treatment. RESULTS: In the Dex-pretreated mice, LPS-induced sickness behavior (anorexia, weight loss, and social withdrawal) were attenuated and microglial activation was lower than vehicle control. The mRNA expression of TNF-α, MCP-1, indoleamine 2, 3 dioxygenase (IDO), caspase-3, and iNOS were increased in the brain of LPS-challenged mice, which were reduced by Dex but not vehicle. CONCLUSION: Dexmedetomidine diminished LPS-induced neuroinflammation in the mouse brain and modulated the cytokine-associated changes in sickness behavior.

Applying importance-performance analysis to patient safety culture.

PURPOSE: The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. DESIGN/METHODOLOGY/APPROACH: The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. FINDINGS: The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. ORIGINALITY/VALUE: Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

Short-term results of vagus nerve stimulation in pediatric patients with refractory epilepsy.

BACKGROUND: Vagus nerve stimulation (VNS), an alternative method to manage patients with medically intractable epilepsy, has shown favorable results in reducing seizure relapse and improvements in quality of life. In 1997, the U.S. Food and Drug Administration approved the use of this device as an adjunctive therapy for intractable seizure in adults and adolescents older than 12 years of age. METHODS: We present a preliminary study of pediatric patients, who suffered from medically intractable seizure and underwent VNS implantation after observation of the baseline seizure frequency. Classification of epileptic syndrome, seizure patterns, age of onset, seizure frequency reduction and adverse effects were recorded. RESULTS: Patients who underwent VNS implantation included four adolescents and four children. The follow-up duration ranged from 9-33 months. All the patients were responders after the beginning of the stimulation. Five of the eight patients responded to VNS with a seizure frequency reduction rate > 50%, and four of the eight patients experienced a ≥ 90% seizure reduction. No significant adverse effects were noted in all patients during the observation period. CONCLUSION: The effective management of medically intractable seizure remains challenging to most clinical physicians. In addition to ketogenic diet and epilepsy surgery, VNS provides an alternative way to manage this issue. Our results suggest that VNS is well tolerated in pediatric patients, and is a favorable and safe method of treating intractable seizure in common clinical practice.

Trends in the use of antiepileptic drugs in Taiwan from 2003 to 2007: a population-based national health insurance study.

PURPOSE: The aim of this study was to evaluate the prevalence of prescription and use of antiepileptic drugs (AEDs) for the treatment of epilepsy and other indications in a nationwide population using a prescription database. MATERIALS AND METHODS: AED prescription data were collected from the National Health Insurance Research Database (NHIRD) in Taiwan for a 5-year period (2003-2007). Patients prescribed AEDs at least two times from 2003 to 2007 were selected for the study from a random sample that included approximately 600,000 people. RESULTS: The prevalence of AED use (per 1000 inhabitants) increased from 12.6 in 2003 to 13.8 in 2007. The prevalence of newer AED use increased progressively from 1.0 in 2003 to 3.8 in 2007, but the prevalence of older AED use decreased during this time (11.6-10). Carbamazepine and valproic acid were the most common AEDs used. Among the newer generation of AEDs, gabapentin was the most frequently used. Newer AEDs were used primarily to treat pain disorders. The primary class of drugs used to treat epileptic disorders was older AEDs. CONCLUSION: An increase in the use of AEDs was observed over a 5-year period in data collected from NHIRD. This might implicate the use of newer compounds at clinical practice not only increased in the treatment of epilepsy, but also in the conditions other than epilepsy especially pain disorders.

Antiepileptic drug utilization in Taiwan: analysis of prescription using National Health Insurance database.

OBJECTIVE: The objective of this study was to analyze and evaluate antiepileptic drug (AED) utilization among adults in Taiwan. METHODS: A random sample of 167,377 patients from the National Health Insurance (NHI) reference database was used. Prescription records were retrieved for all patients prescribed AEDs during 2004. The prescribed daily dose/defined daily dose (PDD/DDD) ratio was used to assess the adequacy of AED dosing. RESULTS: Seventy-one percent (n=518) of patients used only one AED, while 29% (n=212) used more than two AEDs in 2004. For monotherapy, the most frequent regimens included carbamazepine (41.9%), followed by phenytoin (27.3%) and valproic acid (17.8%). For polytherapy, the most commonly used combination was valproic acid and carbamazepine. For adults, the mean PDD/DDD ratio for each AED used for either monotherapy or polytherapy was less than 1.00. Additionally, adult patients treated with more than one AED during 2004 in Taiwan took each drug in higher dose than patients using the same AED in monotherapy. CONCLUSION: In Taiwan antiepileptic drug therapies appear to be still dominated by the first generation drugs. The mean dosages of most antiepileptic drugs were lower than that of WHO suggested.

Prevalence of treated epilepsy in western medicine among the adult population in Taiwan: a study conducted using antiepileptic drug prescription data.

OBJECTIVE: To determine the prevalence of treated epilepsy in the Taiwan in 2004 using prescription data from the National Health Insurance (NHI) research database and to compare this rate with estimates from other prevalence studies. METHODS: A cohort was extracted from a group of antiepileptic drug (AED) users who met two inclusion criteria: (1) use of AED more than once and International Classification of Disease (ICD) codes indicating epilepsy or (2) use of AEDs except clonazepam for more than 90 days without ICD codes of epilepsy. RESULTS: In total, 559 AED users were included. The estimated crude prevalence of AED use was 0.42% of the adult population (0.4% for women and 0.45% for men), and 72% of the cohort (n=400) used only one AED. CONCLUSION: Our estimate of prevalence of treated epilepsy through the NHI system has much larger coverage of population with more credible registration system, and appears to be closer to the truth than two previous small-scaled community-based studies in Taiwan.

Comparative study of children's self-concepts and parenting stress between families of children with epilepsy and asthma.

The purpose of the present study was to conduct a comparative study on families of children with epilepsy and asthma with regard to the variables of children's self-concepts and parenting stress. While past research has indicated higher rates of behavioral problems in children with epilepsy, behavioral problems were associated primarily with children's self-concept. How an individual assesses his or herself impacts significantly upon self conceptualization and the attainment of a stable concept about oneself as an individual is a critical development factor during an individual's cognitive development stage. Nevertheless, specific factors related to such have not previously been well delineated. Forty-eight children, 8 to 13 years of age with epilepsy, and 54 children in the same age range with asthma were investigated for this study. Parents of subjects were also involved in this study. The self-concepts of subject children were assessed using the Harter's Self-Perception Profile for Children (SPPC). Parenting stress was measured using Abidin's Parenting Stress Index (PSI)/long form. Children's demographic variables and illness severity were also measured as potential risk factors. Results showed significant differences between the two groups in terms of self-concept and parenting stress, with epileptic children returning significantly lower self-concept scores in 3 SPPC subscales. Demographic variables and illness conditions were not found to be effective predictors of parenting stress. Level of parenting stress was revealed to be significantly associated with children's self-concept in the epilepsy group. Results suggest that parents of children with epilepsy will benefit from coping strategies that may help lower parenting stress levels and influence positively upon children's self-concept. In addition to providing regular drug therapy, providing further support is needed.

Parenting stress in parents of children with epilepsy and asthma.

The purposes of this study were to identify differences in parenting stress between 2 samples and examine the factors associated with parenting stress. An asthma sample was selected to contrast with the epilepsy sample because both medical conditions are chronic episodic conditions that require daily medication. Data from 49 parents of epileptic children and 54 parents of asthmatic children were examined in this study. Samples were conducted in a hospital pediatric clinic. Parental stress was measured using Abidin's Parenting Stress Index-long form. There were 2 major domains in the Parenting Stress Index: parent domain and child domain. The parent domain included 7 subscales, and the child domain included 6 subscales. Overall, results showed that parental stress was higher in the epilepsy group. Significant differences were found in 7 subscales: adaptability, demanding, hyperactivity/distractibility, role restrictions, depression, relationship to spouse, and parental health. Possible explanations for a higher level of parenting stress in the epilepsy group were discrimination, poor child adaptation, the threat of unpredictability of the seizures, and neurological dysfunction. The causes of higher levels of parenting stress in the asthma group were limitation of activities and parental health condition. These differences should be considered when psychosocial care is offered. Results also showed that demographic variables (gender, age, and family social economic status), age at onset, and condition severity were not effective predictors for parenting stress.

Depressive symptoms following ischemic stroke: a study of 207 patients.

Depression is a frequent and important problem for patients who have experienced strokes. The purpose of this study was to assess the prevalence of depressive symptoms, their clinical correlations, and the effects of depressive symptoms on stroke recovery. A consecutive cohort of 207 ischemic stroke patients with a mean age of 64 years, were studied for ascertaining any correlation between potential risk factors and the incidence of post-stroke depression (PSD). Depressive symptoms were relatively common (34.3% Hamilton depression rating scale > 10), but the prevalence of severe depression (HDRS > 17) was only 7.7%. Patients with depressive symptoms were more likely to be female, have a family history of depression, and a poor functional outcome. There were no significant differences between depressive symptoms and age, marital status, location of stroke lesion, and duration after stroke onset. Our findings indicate that depressive symptoms occurred in about one third of post stroke patients. There is a negative correlation between depressive symptoms and functional status of the patients.