Angela Shin-Yu Lien

Characteristics of traditional Chinese medicine use in children with asthma: a nationwide population‐based study

Asthma is a chronic inflammatory airway disease accounting for severe morbidity and mortality in children. To determine the characteristics of traditional Chinese medicine (TCM) used to treat pediatric asthma, we conducted a nationwide population‐based study by analyzing a cohort of one million randomly sampled patients from the beneficiaries of the National Health Insurance Program in Taiwan from 2002 to 2010. Children under 18 years of age with newly diagnosed asthma (ICD‐9‐CM code: 493, N = 45 833) were enrolled, and 57.95% (N = 26 585) of them had used TCM. The number of TCM users was significantly more than that of non‐TCM users in school‐age children. The most commonly prescribed TCM formula is Ding‐chuan‐tang, or Xing‐ren (Semen Armeniacae Amarum) for the single herb. Our study is the first to reveal characteristics and prescription patterns of the use of TCM in children with asthma. Further research is needed to elucidate the efficacy and safety of these Chinese herbal products.

A nationwide population-based study of traditional Chinese medicine usage in children in Taiwan

OBJECTIVES To characterize the application of traditional Chinese medicine (TCM) among pediatric patients. DESIGN AND SETTING This study examined data sets from the National Health Insurance Research Database in Taiwan. Two cohorts, each with one million patients who were randomly sampled from the beneficiaries of the National Health Insurance Program from January 1 to December 31 in 2005 or 2010, were chosen for analysis. Children had at least one TCM outpatient clinical record were defined as TCM users, whereas children who had no TCM outpatient records were defined as non-TCM users. MAIN OUTCOME MEASURES The demographic data, treatment modalities and the disease distributions of the pediatric TCM users were analyzed from two randomly sampled cohorts. RESULTS Overall, 22% and 22.5% of the children used TCM in 2005 and 2010, respectively. The utilization rate of TCM increased with age. Herbal remedies were the most commonly used therapeutic approach, followed by manipulative therapy and acupuncture. There was an increasing trend of using herbal remedies (increased from 65.6% to 74.4%) and acupuncture (increase from 7.5% to 11.4%), but there was a markedly decreased use of manipulative therapies from 25.6% to 12.3% from 2005 to 2010. There is an obvious increasing use of TCM due to diseases of the digestive system, skin/subcutaneous tissue and genitourinary system from 2005 to 2010. A further comparison of the prevalence rates between TCM and non-TCM visits indicated that allergic rhinitis, dyspepsia, injury and musculoskeletal diseases, as well as menstrual disorders, were the main diseases that children tended to visit TCM clinics in Taiwan. CONCLUSIONS Our nationwide population-based study revealed the high prevalence and specific usage patterns of TCM in the pediatric population in Taiwan. The results of this study should provide valuable information for physicians, parents and the government concerning pediatric healthcare.

Aerosol Distribution During Open Suctioning and Long-Term Surveillance of Air Quality in a Respiratory Care Center Within a Medical Center

BACKGROUND: The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning. METHODS: The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patients head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers. RESULTS: This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers. CONCLUSIONS: RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings.

Integration of diffusion of innovation theory into diabetes care.

The acceptance for innovation by Rogers

A Systematic Review and Meta-Analysis of the Effect of Lifestyle Modification on Metabolic Control in Overweight Children

Childhood obesity is associated with type 2 diabetes mellitus. We aimed to determine the effects of lifestyle modification programs on fasting plasma glucose (FPG) levels in overweight children. We queried six relevant electronic databases and manually searched for studies published before December 2016. Overweight/obese children who underwent a lifestyle modification for more than 6 months were included. A total of 3923 children from eight randomized controlled trials (RCTs) were included. Compared with the control group, the lifestyle modification group had significantly lower FPG levels by 1.3 mg/dL. The mean differences were significantly decreased for both secondary outcomes; BMI z-score decreased by 0.16 units and insulin levels decreased by 2.4 mU/L. The metaregression showed that the follow-up duration was associated with FPG levels and BMI and insulin levels and half year is a suitable follow-up duration for this population. This study showed that lifestyle modification programs may be effective in reducing the FPG levels of overweight/obese children. Further high-quality RCTs with longer follow-up periods are needed to evaluate the long-term effect of this complementary approach for diabetes mellitus prevention on overweight/obese children.

Transformation of Sexual Expression in Taiwanese Women After Treatment for Gynecological Cancer.

Background: Understanding the sexual experience of women after gynecological cancer is important for nurses caring for this population. Sexual experience should be studied within women’s sociocultural context because it influences the construction of sex. However, the sexual experience of Chinese women after gynecological cancer has not been examined qualitatively. Objective: The aim of this study is to explore the sexual experience of Taiwanese women after treatment for gynecological cancer. Methods: Data for this phenomenological study were collected during in-depth, semistructured interviews with 11 women purposively recruited from outpatients of the gynecological clinic of a medical center in northern Taiwan. Interview data were analyzed using the Colaizzi method. Results: Data analysis yielded 4 themes: (1) suffering from sexual changes and difficulties, (2) judgments and uncertainty about the appropriateness of sexual behavior, (3) maintenance and transformation of sexual expression, and (4) reinterpretation and reaffirmation of feminine value. Conclusions: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate Chinese and Asian clients about women’s sexual expression during and after cancer treatment. Implications for Practice: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate women about possible alternative ways of sexual expression during and after cancer treatment.

Diabetes related fatigue sarcopenia, frailty

The rationale of diabetes related fatigue syndrome and interventions.