Walking Interventions and Sleep Quality of Persons Living With Dementia and Their Family Caregivers: Effects of Different Walking Companions.

PURPOSE: To examine the effect of walking interventions on sleep quality of persons with dementia (PWD) and their caregivers (dyads), and how different companions affect results. METHOD: Forty-five dyads were divided into three groups: a control group and two experimental groups (one with a care attendant, one with a family caregiver). The two experimental groups engaged in 120 minutes of walking per week for 24 weeks. RESULTS: A significant improvement in sleep quality was observed among PWD in the family caregiver group (Wald χ2 = 4.55, p = 0.033), whereas there was no improvement in the care attendant group. A slight improvement in sleep quality of family caregivers was also found. CONCLUSION: Findings suggest the importance of creating individualized walking activity plans for dyads, incorporating trust and rapport-building strategies to improve sleep quality. [Journal of Gerontological Nursing, 50(8), 46-56.].

The Experiences of Migrant Care Workers in Long-term Care Facilities: A Scoping Review.

The employment of migrant care workers provides a remedy to face the challenges of increased demand for care of older adults. A scoping review aimed to identify, categorize, and summarize the existing knowledge about migrant care workers' working experiences in long-term care facilities. Identifying gaps in the literature can inform future research. Five electronic databases were searched in April 2024 in addition to a manual search for articles published in English. Forty-five articles were reviewed. A few studies described migrant care assistants' main tasks as assisting physical care and care assistants' characteristics grouped into personal and acquired qualities to provide good quality care. Migrant care workers experienced work satisfaction, achievement, adaptability and adjustment, organizational support, work burden, sense of loneliness, low wages, low social status, and loss of profession. They faced challenges involving inadequate knowledge of palliative care, communication and language barriers, cultural and religious differences, and health concerns. Friendly and discriminatory relationships were found between migrant care workers and stakeholders. Existing evidence regarding the experiences of migrant care workers in delivering palliative care to dying residents or facilitating death preparation is limited. Additionally, there is a notable absence of data from the perspectives of employers and residents on discrimination issues. Further research is necessary to investigate these areas.

Development and psychometric properties of a friendly dietary function assessment scale for home-dwelling people with dementia.

BACKGROUND: Mealtime difficulties related to cognitive functioning negatively impact a patient's life during the various stages of dementia, and they typically cause a burden and stress on family caregivers. Most people with dementia live at home alone or are cared for by informal caregivers, typically their spouses or other family members. However, no suitable screening tools for home-dwelling patients with dementia have been developed, nor have measurements focused on executive and self-eating functions. This study aimed to develop and evaluate the psychometric properties of the Dietary Function Assessment Scale (DFAS) for community-dwelling persons with dementia. METHODS: A mixed-method design was used to develop the instrument. Methods included a comprehensive literature review to identify the item pool and an expert panel to assess the initial item pool. We performed convenience sampling of 190 home-dwelling people with dementia for psychometrical evaluation. The psychometric properties tests included item and factor analyses, criterion-related validity testing, internal consistency reliability testing, and defining the optimal cut-off values. The study was conducted from 2018 to 2019. RESULTS: Items were generated based on an extensive literature review and pre-existing scales related to mealtime and executive functions in persons with dementia. The S-CVI/Ave of the DFAS was 0.89. A Principal Component factor analysis demonstrated seven items, with a two-factor structure accounting for 56.94% of the total variance. The two extracted factors were Self-eating ability and Dietary executive function. The confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = -0.528, p < 0.01). The reliability of Cronbach's alpha internal consistency was 0.74, and McDonald's Omega coefficient was 0.80; the optimal cut-off value of 13 points with an AUC of 0.74 was established to determine poor dietary functioning in persons with dementia. CONCLUSION: The DFAS was simple, user-friendly, and a valid and reliable instrument to assess dietary functioning in community-dwelling persons with dementia. This short scale can be helpful for caretakers, who can use it to identify the dietary needs of home-dwelling persons with dementia and improve their care and eating experience.

Genetic Profile of the Parasitic Varroan Mite Varroa destructor (Arachnida: Mesostigmata: Varroidae) in Taiwan: a New Taiwanese Haplotype Intermediate Between the Highly Virulent Russian and Less Virulent Japanese Types Identified in the Honey Bee Host Apis cerana.

The Modern beekeeping industry is being challenged by the varroan mite and its transmitted pathogens. Various types of Varroa destructor exhibit different levels of virulence toward honey bees, but only the Japanese (J) and Russian (R) types were found to infect Apis mellifera. Type R was more highly virulent against A. mellifera in comparison with type J. Examining the genetic profile of Varroa species is therefore of crucial importance in apiary management. In this study, maternally inherited mitochondrial cytochrome oxidase I (COI) and bisexual nuclear internal transcribed spacer (ITS) sequences of V. destructor individuals from Taiwan were determined. All 168 COI sequences observed in populations obtained from A. mellifera were identical and belonged to type J, with one base difference to that of populations collected from A. cerana; the new type is named 'T type' (Taiwan type). ITS sequences of V. destructor and its sister species V. jacobsoni were identical. A network analysis based on 611 COI sequences compiled from references indicated the presence of 27 haplotypes in V. destructor. Epidemic history and relationship analyses of V. destructor showed that the basal haplotypes were those from A. cerana and many R-extending haplotypes infesting A. mellifera involving amino acid substitutions. Calibration dating based on COI analysis revealed that V. destructor differentiated from its sibling lineage (occurring in Sri Lanka) prior to 1.3 million years ago (Mya). The ancestral haplotype retention and drift in V. destructor that occurred locally during 0.10-0.64 Mya might be relevant to its host A. cerana, which had been isolated geologically. The highly virulent type R was spreading quickly and could gradually outcompete the common and less virulent type J. Type T, being intermediate between types R and J, ought to be studied to better understand the pathogenic mechanism of V. destructor in A. mellifera. Moreover, for areas where type R does not occur, such as Taiwan, quarantine requirements are crucial for reducing invasion risks.

Composition and Dynamics of Hexapod Communities on Yushan Bamboo (Yushania niitakayamensis) in the Subtropical Montane Areas of Taiwan.

Plant communities that colonize high-elevation zones generally have short growing seasons which lead to specialized adaptations in such zones. In montane areas of Taiwan, Yushan bamboo (YB, Yushania niitakayamensis) is dominant at elevations ranging from 2500 to 3300 m and grows in a grassland-like open habitat. In this study, hexapods were collected from YB bimonthly between 2009 and 2012 by using a sweeping net. The composition of and several bioindices for the hexapods were determined, and multivariate analyses were conducted to explore the dynamics and seasonal distribution of the hexapods. A total of 32,000 individuals belonging to 11 orders and 113 families were collected, with adult individuals being collected more frequently in warmer seasons (from June to October). Of the sampled individuals, 90% belonged to the orders Collembola (42%), Hemiptera (35%), and Hymenoptera (13%). The number of individuals belonging to Hemiptera were stable in all seasons, and the number of hymenopteran wasps was influenced by temperature and exhibited a stable dynamic pattern. The number of individuals belonging to Collembola fluctuated dramatically. The multivariate analyses revealed that the collected hexapods could be divided into two major family groups according to survey season (i.e., summer and winter groups). Several families were collected only in summer, but a few were collected only in winter. Eigenvalues obtained from a principal component analysis revealed that the families Chironomidae, Delphacidae, Entomobryidae, Hypogastruridae, Sminthuridae, and Thripidae (all dominant) were the major contributors to the winter group. These families were abundant all year, although some were more abundant during winter. The three dominant orders Collembola, Hemiptera, and Hymenoptera, each of which has a distinct community structure and dynamic pattern, may have their own adaptive mechanisms in the subtropical regions of Taiwan. Hemiptera individuals, which feed on YB, were most abundant in the adult stage in summer and in the nymphal stage in winter. The abundance of parasitic hymenopteran wasps, which had stable dynamic patterns, was associated with that of their host insects and temperature. The drastic fluctuations in the abundance of Collembola may have been caused by abiotic factors, such as precipitation and microhabitat factors. The early onset of spring and the late onset of winter might also affect the dynamics of the studied hexapods.

Cognitive Decline Related to Diet Pattern and Nutritional Adequacy in Alzheimer's Disease Using Surface-Based Morphometry.

Dietary pattern (DP) results in nutrition adequacy and may influence cognitive decline and cortical atrophy in Alzheimer's disease (AD). The study explored DP in 248 patients with AD. Two neurobehavioral assessments (intervals 13.4 months) and two cortical thickness measurements derived from magnetic resonance images (intervals 26.5 months) were collected as outcome measures. Reduced rank regression was used to assess the groups of DPs and a linear mixed-effect model to explore the cortical neurodegenerative patterns. At screening, underweight body mass index (BMI) was related to significant higher lipid profile, impaired cognitive function, smaller cortical thickness, lower protein DP factor loading scores and the non-spouse caregiver status. Higher mini-mental state examination (MMSE) scores were related to the DP of coffee/tea, compared to the lipid/sugar or protein DP group. The underweighted-BMI group had faster cortical thickness atrophy in the pregenual and lateral temporal cortex, while the correlations between cortical thickness degeneration and high HbA1C or low B12 and folate levels were localized in the medial and lateral prefrontal cortex. The predictive model suggested that factors related to MMSE score were related to the caregiver status. In conclusion, normal or overweight BMI, coffee/tea DP group and living with a spouse were considered as protective factors for better cognitive outcomes in patients with AD. The influence of glucose, B12 and folate on the cortical degeneration was spatially distinct from the pattern of AD degeneration.

Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study.

BACKGROUND & AIMS: Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. METHODS: A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. RESULTS: There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (ß = -.06, P < 0.001) and MNA (ß = -.1, P < 0.001). A BMI of 22-23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. CONCLUSIONS: In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.

[The Relationship Between Diet Nutrition Knowledge and Demographic Characteristics in Family Caregivers of Patients With Dementia].

BACKGROUND: Although the general-care knowledge of family caregivers related to dementia had been studied, little attention has been given to understanding the knowledge of caregivers related to dementia diet nutrition. This knowledge is important to help caregivers handle the eating and nutrition problems of people with dementia (PwD). PURPOSE: The purpose of this study was to explore the dementia diet nutrition knowledge of family primary caregivers and to analyze whether demographic characteristics of caregivers and/or the dementia stages of PwD have a relationship with dementia diet nutrition knowledge. METHODS: A descriptive and cross-sectional study using a questionnaire survey was conducted. A total of 220 primary family caregivers of people with dementia were recruited. RESULTS: Results showed that the average total score for the 13 questions on diet nutrition knowledge was 71.85%. Moreover, only 28.2% of the participants answered the question "Malnutrition is a significant risk during the early stage of dementia" correctly. In addition, the findings showed significant differences in the diet nutrition knowledge of participants based on education level (F = 3.989, p < .05) and the use of foreign (non-Taiwanese) caregivers (t = -2.919, p < .01). CONCLUSIONS: The participants had sufficient overall diet nutrition knowledge of dementia. However, they lacked knowledge in specific areas. Family caregivers with higher levels of education and those who hired foreign caregivers had better knowledge scores. The results may be used as a reference for nurses providing dementia dietary education. It is recommended that special attention be given to dietary education when patients are at the early onset phase of the disease and when caregivers have a lower level of education in order to improve the overall quality of dementia dietary care in the community.

Cognitive Function and Quality of Life in Community-Dwelling Seniors with Mild Cognitive Impairment in Taiwan.

The aims of this study were to examine the relationships between overall cognitive function and the quality of life (QOL) domains, and to compare the differences in these by age, gender, and educational level in community-dwelling seniors in Taiwan. A cross-sectional study was conducted, with the participants screened and recruited from Southern Tainan. The Saint Louis University Mental Status Examination was used to screen the cognitive status of the participants. A total of 144 seniors participated in this study were assessed using the Taiwanese version of WHOQOL-BREF. The results showed that the participants performed better in the cognitive domains of "figure identification" and "orientation" while they performed poor in "delayed recall" and "immediate paragraph recall". No significant relationship between cognitive function and overall QOL, but a positive relationship between cognitive function and the physical health domain of QOL was found. The findings of this study provide valuable information for community healthcare providers.

Evolution of entecavir-resistant hepatitis B virus during entecavir and adefovir dipivoxil combination therapy.

The emergence of entecavir (ETV) resistance is rare, particularly in a longitudinal study. The aim of the present study was to characterize the evolution of ETV-resistant variants during antiviral therapy using entecavir monotherapy followed by ETV-adefovir dipivoxil (ADV) combination therapy. The study included a prospective cohort of 53 consecutive chronic hepatitis B (CHB) patients. During the 60-month period of ETV therapy, 2 patients exhibited ETV resistance and their medical records were comprehensively reviewed. A total of 25 consecutive serum samples were regularly collected from the 2 patients. All the samples were used to characterize the evolution of the polymerase gene mutations using pyrosequencing. The linkage of the variants was analyzed from 87 reverse transcriptase sequences of 3 selective samples using clone sequencing. The 2 patients presented with viral breakthrough during ETV monotherapy. In patient A, the rtL180M, rtS202G and rtM204V mutant variants were detected using pyrosequencing prior to virological breakthrough. Although the viral load declined following the administration of ADV, the ETV-resistant variants were persistently dominant in the viral populations. In patient B, the rtL180M, rtM204I and rtM204V mutants were present in ~70, 30 and 10% of the viral populations, respectively, at the time of study entry. In addition, rtT184F was present in ~20% of the viral population during virological breakthrough, at month 24. The rtL180M, rtT184F and rtM204V were predominant during the combination treatment. Clonal analysis further revealed that the rtS202G or rtT184F was in all cases co-localized with rtL180M and rtM204V in any single virus isolate clone. The results of the present study indicate that the addition of ADV therapy with ETV for treating ETV-resistant mutation may not inhibit the replication of ETV-resistant variants that developed previously in lamivudine-treated CHB patients.