Cheryl Chia-Hui Chen

Playful bottle: a mobile social persuasion system to motivate healthy water intake

This study of mobile persuasion system explores the use of a mobile phone, when attached to an everyday object used by an everyday behavior, becomes a tool to sense and influence that behavior. This mobile persuasion system, called Playful Bottle system, makes use of a mobile phone attached to an everyday drinking mug and motivates office workers to drink healthy quantities of water. A camera and accelerometer sensors in the phone are used to build a vision/motion-based water intake tracker to detect the amount and regularity of water consumed by the user. Additionally, the phone includes hydration games in which natural drinking actions are used as game input. Two hydration games are developed: a single-user TreeGame with automated computer reminders and a multi-user ForestGame with computer-mediated social reminders from members of the group playing the game. Results from 7-week user study with 16 test subjects suggest that both hydration games are effective for encouraging adequate and regular water intake by users. Additionally, results of this study suggest that adding social reminders to the hydration game is more effective than system reminders alone.

The diet-aware dining table: observing dietary behaviors over a tabletop surface

We are what we eat. Our everyday food choices affect our long-term and short-term health. In the traditional health care, professionals assess and weigh each individuals dietary intake using intensive labor at high cost. In this paper, we design and implement a diet-aware dining table that can track what and how much we eat. To enable automated food tracking, the dining table is augmented with two layers of weighing and RFID sensor surfaces. We devise a weight-RFID matching algorithm to detect and distinguish how people eat. To validate our diet-aware dining table, we have performed experiments, including live dining scenarios (afternoon tea and Chinese-style dinner), multiple dining participants, and concurrent activities chosen randomly. Our experimental results have shown encouraging recognition accuracy, around 80%. We believe monitoring the dietary behaviors of individuals potentially contribute to diet-aware healthcare.

Trajectory and determinants of the quality of life of family caregivers of terminally ill cancer patients in Taiwan

BackgroundFamily caregiving is common and important in Taiwanese culture. However, the combination of anticipated loss, prolonged psychological distress, and the physical demands of caregiving can seriously compromise the quality of life (QOL) of a family caregiver (FC). The effect of caring for a dying cancer patient on a FC’s QOL has been explored in western countries—primarily with small sample sizes or short-term follow-ups—but has not yet been investigated in Taiwan. Therefore, the purposes of this study were to: (1) identify the trajectory of the QOL of FCs of terminally ill cancer patients in Taiwan; and (2) investigate the determinants of the QOL of FCs, in a large sample and with longer follow-ups, until the patient dies.MethodsA prospective, longitudinal study was conducted among 167 FCs. Trajectory and determinants of FCs’ QOL were identified by a generalized estimation equation (GEE).ResultsCaregiving for a terminally ill cancer patient extracts a toll from a FC’s QOL and causes it to deteriorate significantly over time. The results from the multivariate GEE analysis indicated that this deterioration of a FC’s QOL reflects the patient’s increasing distress from symptoms, the gradual loss of confidence in caregiving and an increased subjective caregiving burden on the FC as the patient’s death approaches, and a weaker psychological resource (i.e., sense of coherence) of the FC.ConclusionTaiwanese FCs’ QOL deteriorated significantly as the patient’s death approached. This study contributes to the family caregiving literature by using longitudinal data to confirm that the available psychological resource of a FC and the ‘appraisals of caregiving’ are more salient in determining a FC’s QOL than the patient’s/FC’s characteristics and the caregiving demands.

Brushing Teeth With Purified Water to Reduce Ventilator-Associated Pneumonia

Background:Oral care may decrease the development of ventilator-associated pneumonia (VAP) and improve oral hygiene. However, little evidence is available to guide the development of oral care protocols. The practical effect of toothbrushing on VAP development and oral health and hygiene improvement is inconclusive. Purpose:This study evaluated the effects in postneurosurgical, intensive care unit patients of brushing teeth twice daily with purified water on VAP rates and oral health or hygiene. Methods:This study conducted a randomized controlled pilot trial. Patients consecutively admitted to the surgical intensive care unit at a suburban hospital in 2007 were invited to participate if they met two inclusion criteria: (a) under ventilator support for at least 48 to 72 hours and (b) no current pneumonia. Upon obtaining informed consent, subjects were randomized into experimental and control groups. Both groups received usual hospital care, that is, daily oral care using cotton swabs. The experimental group additionally received a twice-daily oral care protocol of toothbrushing with purified water, elevating the head of the bed, and before-and-after hypopharyngeal suctioning. The control group also received twice-daily mock oral care (elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning). VAP was defined by a clinical pulmonary infection score of > 6. Oral hygiene and health was assessed after conclusion of the intervention. Results:Patients (N = 53) were predominantly male (64.2%), mean age was 60.6 years old, and most had received emergency surgery (75.5%). After 7 days of toothbrushing with purified water, cumulative VAP rates were significantly lower in the experimental (17%) than in the control (71%; p <.05) group. The experimental group also had significantly better scores for oral health (p <.05) and plaque index (p <.01). Conclusion/Implication for Practice:Findings suggest that, as an inexpensive alternative to existing protocols, toothbrushing twice daily with purified water reduces VAP and improves oral health and hygiene.

Functional trajectory 6 months posthospitalization: a cohort study of older hospitalized patients in Taiwan.

Background: Although it is well-recognized that hospitalization often precipitates functional decline in older patients, there have been few studies to examine these functional changes carefully over multiple points in time. Objective: To describe functional trajectory during and 6 months posthospitalization and to ascertain the predictors that signal different classes of functional trajectory, using latent class analysis. Methods: A cohort study was conducted on 286 older hospitalized patients who were admitted to five surgical-medical units at a tertiary medical center in Northern Taiwan. Results are reported of 241 participants who completed all four scheduled assessments during hospitalization (within 48 hr after admission and before discharge) and 3 and 6 months postdischarge. Functional trajectory was measured using the Barthel index over four time points, and decline was defined as a reduction on the Barthel index scores. Demographics, comorbidities, visual impairment, medications taken, cognitive status, nutritional status, oral health, depressive symptoms, social support, surgical diagnosis, and length of stay were assessed as the predictors of functional trajectory classes. Results: Most (74.3%) participants developed functional decline during hospitalization, and 32.0% had persistent functional impairment at 6 months posthospitalization. Three functional trajectory classes (good, moderate, and poor) were identified, and gender, age, comorbidities, cognitive status, nutritional status, oral health status, and length of stay were associated with different trajectory classes. Conclusion: Visualizing different classes of functional trajectory and studying predictors that signal such differences during and posthospitalization help practitioners understand how function changed and the possible ways to intervene.

A Smart Kitchen for Nutrition-Aware Cooking

The paper discusses a kitchen that intelligently senses cooking activities and provides realtime nutritional information helps facilitate healthy cooking by letting family cooks make informed decisions. It creates opportunities to embed pervasive computing in a smart kitchen to facilitate healthy cooking.

A Framework for Studying the Nutritional Health of Community-Dwelling Elders

BackgroundEnsuring nutritional health for elders has been shown to reduce healthcare costs and enhance quality of life. Studies, however, have shown that malnutrition is present in 2% to 51% of community-dwelling elders, depending on the definition used and the population studied. An empirically tested framework for studying nutritional health in community-dwelling elders is not yet available. ObjectiveTo test the goodness-of-fit exhibited by the framework of nutritional health among community-dwelling elders based on the Roy Adaptation Model using structural equation modeling (SEM). MethodsA population-based study investigated 243 elders dwelling in public housing. Demographics, polypharmacy, chronic illness, oral health, depressive symptoms, functional status, and satisfaction with social support were assessed to test their relation with nutritional health according to the propositions of the Roy Adaptation Model and scientific evidence. ResultsThe SEM analysis indicated that functional status, oral health, depressive symptoms, and satisfaction with social support affect nutritional health directly. Oral health, depressive symptoms, functional status, and satisfaction with support mediated the effects of age, ethnicity, education, and number of medications and chronic illnesses on nutritional health. The model accounted for 35% of the variance in nutritional health and demonstrated a good fit with the data and with the values for Bentlers Comparative Fit Index (0.94) and χ2 (1.76). ConclusionsThe propositions of the Roy Adaptation Model were supported, and the findings showed that this framework of nutritional health among community-dwelling elders could serve as a theoretical and empirical base for future inquiry.

Clinical events occurrence and the changes of quality of life in chronic haemodialysis patients with dry weight determined by echocardiographic method.

The maintenance of circulating blood volume within an optimal range is necessary for haemodialysis patients to avoid circulating complications, including over‐hydration and dehydration. Inferior vena cava diameter (IVCD) estimation is a non‐invasive method to obtain a well correlation with the intravascular fluid status, and it may get a reliable ideal dry weight (DW) for chronic haemodialysis patients. We try to analysis the life quality changes and circulating complication in chronic haemodialysis patients who adjust DW with this tool in comparing with the traditional method. A total of 100 chronic haemodialysis patients, ranging from 26 to 77 years old, were involved in this study. They are randomly divided into study (n = 50) and control group (n = 50). All of them received the IVCD estimation by echocardiography every month for 3 months. The patients in the study group adjusted the DW with the IVCD estimated by echocardiographic method, however, patients in the control group with the traditional method. The quality of life (QOL) was evaluated with the short form 36 questionnaire (SF‐36) in the beginning and the end of the study. The scores of physical functioning (PF), role limitation‐physical (RP), general health (GH) and role limitation‐emotional (RE) have much improvement in the patients of the study group than those in the control group. Besides, the occurrence of clinical events due to circulating complications during the study period showed significant reduction in the extents of hypotension, gastrointestinal upset, discontinuation of haemodialysis, muscular cramps, tinnitus, headache and chest discomforts with electrocardiographic changes; and these effects, especially, are significant in the patients with over‐dehydrated status, which with the IVCD < 8 mm/m2 detected by echocardiographic method. The study demonstrated that ideal DW estimated by echocardiographic method not only improved the QOL but also reduced the circulating complications during haemodialysis for chronic haemodialysis patients.

Effects of a modified Hospital Elder Life Program on frailty in individuals undergoing major elective abdominal surgery.

To test the effects of a modified Hospital Elder Life Program (mHELP) on frailty.

Patterns of cognitive change in elderly patients during and 6 months after hospitalisation: A prospective cohort study

BACKGROUND The extent and patterns of cognitive change regularly occurring in elderly patients who experience prolonged hospitalisation have not been well examined. OBJECTIVE To describe patterns of cognitive change during and 6 months after hospitalisation and to identify prognostic factors associated with different patterns of changes. DESIGN A prospective cohort study. SETTING Five med-surgical units at a tertiary hospital in Taipei, Taiwan. PARTICIPANTS Patients ≥65 years old without preexisting profound cognitive impairment (Mini-Mental State Examination score ≥20) and with an expected hospital length of stay >5 days were drawn from consecutive admissions. Of 351 patients, 82.9% (138 women, 153 men, mean age=71.6 years) completed all four scheduled assessments. METHODS Cognition was measured by the Mini-Mental State Examination at 4 times: admission, discharge, and 3 and 6 months post-discharge. Possible prognostic factors at admission included demographics, comorbidities, number of medications, serum haemoglobin, length of hospital stay, and surgery. RESULTS Four cognitive-change patterns with a high prevalence of decline were identified by cluster analysis. The worsening then improve group (n=47) had a deep V-shape with a mean fluctuation of 3.9 points on the Mini-Mental State Examination, and the low continuous group (n=83) had little change. Both the start high and decline (n=66) and start low and decline (n=95) groups showed persistent and accelerated declines, with baseline cognitive scores of 29.1 and 25.5 points, respectively. Predictor variables at admission for different patterns of cognitive change were age, total education (years), cardiovascular comorbidities, number of medications, functional and nutritional status, depressive symptoms, surgical treatment, and haemoglobin level <12 g/dL. CONCLUSIONS Cognitive decline during and after hospitalisation shows four heterogeneous patterns of change. Different patterns of change were predicted by age, education, cardiovascular comorbidities, number of medications, functional and nutritional status, depressive symptoms, surgical treatment, and haemoglobin level <12 g/dL, most of which are potentially modifiable factors.