Bih-Shya Gau

The effectiveness of exercise on improving cognitive function in older people: a systematic review.

Background: The well-documented physical benefits of exercise and the value of exercise for improving mental health have raised the profile and role of exercise in healthcare. However, studies evaluating the effects of exercise on neurocognitive function have produced equivocal results. Purpose: This study was designed to examine the effectiveness of exercise on improving cognitive function in older people. Methods: Researchers used a narrative synthesis approach in this review and conducted a computer-based search in MEDLINE, CINAHL, Cochrane Library, and Airiti Library (Chinese) from 2006 to 2009 using the search terms exercise, physical activity, and cognition. Research quality appraisal was rated using Consolidated Standards of Reporting Trials criteria. Result: This review included 12 medium- to high-quality randomized controlled trials. Most studies examined used a 60-minute exercise regimen scheduled three times per week that was continued for 24 weeks. Of the 12 studies, 8 revealed that exercise can improve cognitive function. Five studies focused on healthy older people and three studied older people who had impaired cognition at baseline. Analysis of the studies showed simple, one-component exercise as better for older people with cognitive impairment and multicomponent exercise as better for those without such impairment. Conclusions/Implications for Practice: This systematic review demonstrated that an exercise regimen of 6 weeks and at least 3 times per week for 60 minutes had a positive effect on cognition. Whether multicomponent exercise is significantly more effective in improving cognitive function, particularly in healthy older people, should be tested using larger trials with more rigorous methodology.

Measuring knowledge of patients with congenital heart disease and their parents: validity of the ‘Leuven Knowledge Questionnaire for Congenital Heart Disease’

Background: Patients with congenital heart disease (CHD) and their parents need to have sufficient knowledge on their condition, treatment, medication, and preventive measures. The Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD) was developed to comprehensively measure the level of knowledge in patients with CHD. Aims: This study aimed to translate the LKQCHD into Chinese and to test its validity to be used in patients with CHD and their parents. Method: Questionnaire translation was guided by a three-step linguistic validation method. Evidence based on test content and on relation with other variables was obtained. For test content, we included five experts in CHD and research methods. Furthermore, the instrument was tested in 89 pairs of adolescents with CHD and their parents. Results: We found a high item-level content validity index (>0.78 in all except two items), high scale-level content validity index (>0.90), high free-marginal multirater Kappa (>0.75), and low average proportion of missing values (0.49% in adolescents; 0.51% in parents), showing an excellent content validity. The hypothesized positive correlations between parental knowledge and parental educational level and between patient’s knowledge and patient’s age, as well as the hypothesis that parents have more knowledge than their children, were confirmed. This provides validity evidence based on relation with other variables. Conclusions: The Chinese version of the LKQCHD is valid to assess the level of knowledge in patients with CHD and their parents.

An evaluation of disease knowledge in dyads of parents and their adolescent children with congenital heart disease.

Background:Congenital heart disease (CGHD) can be considered a chronic disease for many patients. To adopt a healthy lifestyle and to avoid complications, patients with CGHD and their parents need to have good knowledge of the heart defect and its consequences. Objective:The aims of this study were to evaluate patient and parental knowledge of CGHD and to explore the related factors of their respective disease knowledge. Methods:This study included 116 dyads of adolescents with CGHD (43.1% male adolescents; aged 12–18 years) and one of their parents (79.3% mothers; median age, 46 years). All participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease, and then we calculated a correct rate score to determine the overall disease knowledge of the respondents. Results:The correct rate score was 38.8% for adolescents with CGHD and 51.4% for parents (t = 7.69; P < .001). The only determinant of knowledge in parents was their educational level (standardized estimate = 6.160, P < .001). In adolescents, knowledge was determined by age (standardized estimate = 2.242, P = .002) and parental knowledge (standardized estimate = 0.311, P < .001). Conclusions:Although parents have significantly greater disease knowledge than their children do, the level of knowledge in both parents and adolescents is suboptimal. Because parents’ knowledge influenced their adolescents’ knowledge, educational interventions should target both adolescent patients and parents. Transition programs can play a pivotal role in this respect.

A Model Linking Uncertainty, Post-Traumatic Stress, and Health Behaviors in Childhood Cancer Survivors

PURPOSE/OBJECTIVES To consolidate the literature and provide a model to explain the links among uncertainty, post-traumatic stress syndrome, and health behaviors in adolescent and young adult childhood cancer survivors. DATA SOURCES A systemic review of related literature and theory was used for the proposed model. The literature pertaining to the Uncertainty in Illness Theory, childhood cancer late effects, post-traumatic stress, and health behaviors was reviewed and critiqued from three data sets from 1979-2007: MEDLINE, PsycInfo, and CINAHL. Key words used for the search were uncertainty and post-traumatic stress as well as health behaviors, including smoking, alcohol use, unsafe sex, sunscreen use, and physical inactivity. DATA SYNTHESIS Childhood cancer survivors living with chronic uncertainty may develop a new view of life and, as a result, adopt more health-promotion behaviors and engage in less health-risk behaviors. However, survivors living with chronic uncertainty may generate symptoms similar to post-traumatic stress disorder and, therefore, adopt fewer health-promotion behaviors and engage in more health-risk behaviors. CONCLUSIONS The uncertainty that pervades the childhood cancer experience can lead to the development of symptoms that resemble those of post-traumatic stress. The symptoms can interfere with the adoption of healthy lifestyle behaviors and avoidance of health-risk behaviors. IMPLICATIONS FOR NURSING The theoretically derived model outlined in this article can be used to guide clinical interventions and additional research into the health behaviors of childhood cancer survivors.

Effects of prone and supine positioning on gastric residuals in preterm infants: A time series with cross-over study

BACKGROUND Few studies have examined the effect of body position on gastric residuals at different time points in feeding preterm infants. Further, the results of previous studies are inconsistent. OBJECTIVES To describe the changing pattern of gastric residuals over time in the prone and supine position and to examine the effects of position on gastric residuals at different feeding volumes in preterm infants. DESIGN A randomized, time series with cross-over study. SETTING A neonatal intensive care unit affiliated with a medical center in central Taiwan. PARTICIPANTS 35 preterm infants who were asymptomatic for gastroesophageal reflux, other gastrointestinal diseases or other significant morbidities of any kind other than prematurity. METHODS Infants were randomly assigned to the following treatments: 3h in a supine position followed by 3h in a prone position, or vice versa. Measurements of gastric residual volume were taken by syringe at 30, 60, 90, 120 and 150 min following feeding when the enteral intake was set at 50 or 100ml/kg/day. RESULTS The rate of decrease of gastric residuals in the prone and supine positions was fastest during the first half an hour post-feeding according to measurements taken at 30, 60, 90, 120 and 150 min at feeding volumes of 50 and 100ml/kg/day (p<001). Gastric residuals were significantly lower in the prone than in the supine position at the five measurement points. CONCLUSIONS Placing preterm infants in the prone position for the first half an hour post-feeding and then changing the position according to the behavior cues of the infants is suggested. This result contributes to a better understanding of the relationships between time, position, and gastric residuals; it could also help health care professionals to provide efficient feeding as well as perform the appropriate positioning of preterm infants.

Integrative traditional Chinese medicine therapy reduces the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus

ETHNOPHARMACOLOGICAL RELEVANCE Life-long insulin is the standard treatment for type 1 diabetes mellitus (T1DM). The role of traditional Chinese medicine (TCM) in T1DM is still not clear. The aim of this study is to explore the prescription pattern of TCM and its impact on the risk of diabetic ketoacidosis (DKA) in patients with T1DM. MATERIALS AND METHODS We retrieved samples from the registry for catastrophic illness patients from the National Health Insurance Research Database (NHIRD). Based on a frequency (1:4) matched case-control design, patients with T1DM in 2000-2011 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with T1DM was analyzed. The incidence of DKA and the annual costs of emergency visits and hospitalizations were evaluated for all causes. RESULTS Overall, 416 subjects were TCM users, whereas a total of 1608 matched subjects were classified as non-TCM users. The most common Chinese herbal formula and single herb is Liu-wei-di-huang-wan (Six-ingredient pill of Rehmannia) and Huang-qi (Radix Astragali; Astragalus membranaceus (Fisch.) Bunge, Astragalus membranaceus var. mongholicus (Bunge) P.K.Hsiao), respectively. Compared with non-TCM users, we found a 33% reduction in DKA incidence for all TCM users (aHR 0.67, 95% CI 0.56-0.81, p <0.000) and a 40% reduction for users receiving TCM treatment for more than 180 days (aHR 0.58, 95% CI 0.41-0.82, p <0.01). There were no significant differences between TCM users and non-users in the frequency and medical costs of emergency visits and hospitalizations. CONCLUSIONS Integrative TCM use may reduce the risk of DKA in patients with T1DM. Our results suggest that TCM may have a substantial positive impact on the management of TIDM.

Clinical applicability of the World Health Organization Quality of Life Scale Brief Version (WHOQOL‐BREF) to mothers of children with asthma in Taiwan

AIMS This study examined the clinical applicability of the World Health Organization Quality of Life Scale brief version (WHOQOL-BREF) to mothers of children with asthma in Taiwan. BACKGROUND The WHOQOL-BREF scale has been culturally adapted for Taiwan and applied to a variety of ill and healthy subjects in hospitals and the community and to the general population in the 2001 National Health Interview Survey in Taiwan. Its application to explore the QOL of mothers of children with asthma in Taiwan allows future cross-population comparisons. DESIGN A cross-sectional survey. METHODS Internal consistency, test-retest reliability; content validity, criterion-related validity and discriminant validity were assessed. A total of 229 mothers participated in the study. RESULTS The WHOQOL-BREF showed acceptable psychometric properties. Internal consistency of 0.63-0.84, content validity r = 0.39-0.65 (p < 0.01) and criterion-related validity r = 0.28-0.65 (p < 0.05) were reported. Discriminant validity was also found, especially in the domain of physical health. Issues of QOL for mothers, especially in the realm of physical health need more support and attention from health professionals. CONCLUSIONS This study supports the clinical applicability of the WHOQOL-BREF scale as a measure of QOL of mothers of children with asthma. Future studies to compare the QOL measured by WHOQOL-BREF in female caregivers of children with other chronic health conditions are suggested. RELEVANCE TO CLINICAL PRACTICE Our findings show that mothers are hardly ever free from the strains of the daily-care of an asthmatic and bear the uncertainties for the unending illness. The health care team is responsible for providing collaborative care approaches in hospital, home and school health care settings for children with asthma and their mothers.

Meta-prediction of MTHFR gene polymorphism-mutations, air pollution, and risks of leukemia among world populations

The major objective of this study was to examine the association between Methylenetetrahydrofolate Reductase (MTHFR) polymorphisms and the risk of various types of leukemias across the lifespans of children and adults by using the meta-predictive techniques. The secondary objective was to examine the interactions among epigenetic risk factors (including air pollution), MTHFR polymorphisms, and the risks of developing leukemia. We completed a comprehensive search of 6 databases to find 54 studies (10,033 leukemia cases and 15,835 controls) for MTHFR 677, and 43 studies (8,868 cases and 14,301 controls) for MTHFR 1298, published from 1999 to 2014. The results revealed that, in European populations; childhood populations; children from Europe, East Asia, and America; and children with acute lymphocytic leukemia (ALL), MTHFR 677 polymorphisms (both TT and CT types together and individually) are protective, while CC wildtype was leukemogenic. In addition, MTHFR 1298 polymorphisms were protective against ALL and acute myeloid leukemia in European children, and in chronic myeloid leukemia in all adults worldwide and American adults. Air pollution played a role in the increased polymorphisms of MTHFR 677 genotypes in childhood leukemia.

Prevalence of impaired fasting glucose and analysis of related factors in Taiwanese adolescents

To determine the prevalence of impaired fasting glucose (IFG) in Taiwanese adolescents and important related variables.

Moderating Effect of Psychosocial Factors for Dyspnea in Taiwanese and American Heart Failure Patients

Background: Dyspnea is the most common and distressing symptom of heart failure (HF). Evidence from empirical studies has shown that multiple factors apart from pathophysiological changes may influence this symptom. Purpose: This study explored the moderating effect of psychosocial factors between clinical characteristics and dyspnea in patients with HF. To assess the potential effects of cultural background, this study also compared differences in psychosocial factor moderating effects between HF patients in Taiwan and the United States. Methods: We recruited patients with HF from outpatient clinics in Taiwan and the United States. Data were collected at clinics and research centers. Dyspnea was measured using the modified pulmonary function status and dyspnea questionnaire. Psychosocial factors considered were depression, anxiety, perceived control, and perceived social support. These factors were measured using the Brief Symptom Inventory, Revised Control Attitudes Scale, and Multidimensional Scale of Social Support Scale, respectively. Multiple regressions with interaction effect analysis tested the moderator effects across these two groups. Results: Ninety-seven Taiwanese (mean age = 66.2 ± 12.1 years; 76% male; 28% NYHA [New York Heart Association] III/IV) and 96 American (mean age = 61.6 ± 11.7 years; 74% male; 42% NYHA III/IV) patients participated. In Taiwanese patients, only perceived social support (B = .08, p = .034) moderated the relationship between clinical variables and dyspnea. In American patients, depression (B = .75, p = .028) and anxiety (B = .85, p = .041) were moderators of the relationship between clinical status and dyspnea severity. Conclusions/Implications for Practice: Depression, anxiety, and perceived social support moderated the relationship of clinical characteristics with dyspnea in Taiwanese and American HF patients, respectively. Attention to these psychosocial factors may improve dyspnea status in HF patients. Symptom management should include a focus on patients’ psychological distress and social perspectives.