Chia-Yi Wu

Sleep quality among community-dwelling elderly people and its demographic, mental, and physical correlates

Background: Sleep quality is an important predictor of well being in the elderly. However, the effects of depression and physical activity on sleep quality among elderly are less clear. Methods: One hundred older individuals who met the inclusion criteria were randomly sampled from a Taipei district elderly residential list. Door‐to‐door interviews were conducted. Sleep quality (the outcome variable), physical activity and depression symptoms were measured by the Pittsburgh Sleep Quality Index (PSQI), Physical Activity Scale for the Elderly (PASE), and Taiwanese Depression Questionnaire (TDQ), respectively. Logistic regression was performed to examine the relationship between the above major variables. Results: A half of the elderly had short sleep onset (<15 minutes) but reported poor sleep quality (PSQI > 5). Twenty‐two percent of community‐dwelling elders used psychoactive medication for sleep. The prevalence of depressive disorders (TDQ ≥ 19) was 7%. Although both physical activity and depression were significantly associated with sleep quality in the univariate analysis, only depression remained significant after adjusting for age, gender, education, marital status, and chronic illness confounders in logistic regression (OR = 1.31, 95% confidence interval = 1.12–1.52). Conclusion: Elderly depression symptoms was the only factor significantly associating with poor sleep quality after adjustment. Higher level of physical activity was associated with better sleep quality in univariate analysis but not in multivariate analysis, which considered the factor of elderly depression symptoms in the elderly. The role of physical activity in late life potentially influence sleep quality but may have less significance compared with depression. Therefore, we suggest the need for more future research to investigate the relationship between elderly peoples sleep and physical activity.

Dynamic functional modules in co-expressed protein interaction networks of dilated cardiomyopathy

BackgroundMolecular networks represent the backbone of molecular activity within cells and provide opportunities for understanding the mechanism of diseases. While protein-protein interaction data constitute static network maps, integration of condition-specific co-expression information provides clues to the dynamic features of these networks. Dilated cardiomyopathy is a leading cause of heart failure. Although previous studies have identified putative biomarkers or therapeutic targets for heart failure, the underlying molecular mechanism of dilated cardiomyopathy remains unclear.ResultsWe developed a network-based comparative analysis approach that integrates protein-protein interactions with gene expression profiles and biological function annotations to reveal dynamic functional modules under different biological states. We found that hub proteins in condition-specific co-expressed protein interaction networks tended to be differentially expressed between biological states. Applying this method to a cohort of heart failure patients, we identified two functional modules that significantly emerged from the interaction networks. The dynamics of these modules between normal and disease states further suggest a potential molecular model of dilated cardiomyopathy.ConclusionsWe propose a novel framework to analyze the interaction networks in different biological states. It successfully reveals network modules closely related to heart failure; more importantly, these network dynamics provide new insights into the cause of dilated cardiomyopathy. The revealed molecular modules might be used as potential drug targets and provide new directions for heart failure therapy.

Evaluation of smoking status identification using electronic health records and open-text information in a large mental health case register.

Background High smoking prevalence is a major public health concern for people with mental disorders. Improved monitoring could be facilitated through electronic health record (EHR) databases. We evaluated whether EHR information held in structured fields might be usefully supplemented by open-text information. The prevalence and correlates of EHR-derived current smoking in people with severe mental illness were also investigated. Methods All cases had been referred to a secondary mental health service between 2008-2011 and received a diagnosis of schizophreniform or bipolar disorder. The study focused on those aged over 15 years who had received active care from the mental health service for at least a year (N=1,555). The ‘CRIS-IE-Smoking’ application used General Architecture for Text Engineering (GATE) natural language processing software to extract smoking status information from open-text fields. A combination of CRIS-IE-Smoking with data from structured fields was evaluated for coverage and the prevalence and demographic correlates of current smoking were analysed. Results Proportions of patients with recorded smoking status increased from 11.6% to 64.0% through supplementing structured fields with CRIS-IE-Smoking data. The prevalence of current smoking was 59.6% in these 995 cases for whom this information was available. After adjustment, younger age (below 65 years), male sex, and non-cohabiting status were associated with current smoking status. Conclusions A natural language processing application substantially improved routine EHR data on smoking status above structured fields alone and could thus be helpful in improving monitoring of this lifestyle behaviour. However, limited information on smoking status remained a challenge.

Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients.

Abstract Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the temporal association between polypharmacy and renal outcomes is rarely addressed and recognized. We investigated the association between cardiovascular (CV) polypharmacy and the risk of acute kidney injury (AKI) in elderly patients. We used the Taiwan National Health Insurance PharmaCloud system to investigate the relationship between cumulative CV medications in the 3 months before admission and risk of AKI in the elderly at their admission to general medical wards in a single center. Community-dwelling elderly patients (>60 years) were prospectively enrolled and classified according to the number of preadmission CV medications. CV polypharmacy was defined as use of 2 or more CV medications. We enrolled 152 patients, 48% with AKI (based upon Kidney Disease Improving Global Outcomes [KDIGO] classification) and 64% with CV polypharmacy. The incidence of AKI was higher in patients taking more CV medications (0 drugs: 33%; 1 drug: 50%; 2 drugs: 57%; 3 or more drugs: 60%; P = 0.05) before admission. Patients with higher KDIGO grades also took more preadmission CV medications (P = 0.04). Multiple regression analysis showed that patients who used 1 or more CV medications before admission had increased risk of AKI at admission (1 drug: odds ratio [OR] = 1.63, P = 0.2; 2 drugs: OR = 4.74, P = 0.03; 3 or more drugs: OR = 5.92, P = 0.02), and that CV polypharmacy is associated with higher risk of AKI (OR 2.58; P = 0.02). Each additional CV medication increased the risk for AKI by 30%. We found that elderly patients taking more CV medications are associated with risk of adverse renal events. Further study to evaluate whether interventions that reduce polypharmacy could reduce the incidence of geriatric AKI is urgently needed.

Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register.

BACKGROUND Mental disorders are widely recognized to be associated with increased risk of all-cause mortality. However, the extent to which highest-risk groups for mortality overlap with those viewed with highest concern by mental health services is less clear. The aim of the study was to investigate clinical risk assessment ratings for suicide, violence and self-neglect in relation to all-cause mortality among people receiving secondary mental healthcare. METHOD A total of 9234 subjects over the age of 15 years were identified from the South London and Maudsley Biomedical Research Centre Case Register who had received a second tier structured risk assessment in the course of their clinical care. A cohort analysis was carried out. Total scores for three risk assessment clusters (suicide, violence and self-neglect) were calculated and Cox regression models used to assess survival from first assessment. RESULTS A total of 234 deaths had occurred over an average 9.4-month follow-up period. Mortality was relatively high for the cohort overall in relation to national norms [standardized mortality ratio 3.23, 95% confidence interval (CI) 2.83-3.67] but not in relation to other mental health service users with similar diagnoses. Only the score for the self-neglect cluster predicted mortality [hazard ratio (HR) per unit increase 1.14, 95% CI 1.04-1.24] with null findings for assessed risk of suicide or violence (HRs per unit increase 1.00 and 1.06 respectively). CONCLUSIONS Level of clinician-appraised risk of self-neglect, but not of suicide or violence, predicted all-cause mortality among people receiving specific assessment of risk in a secondary mental health service.

The impact of quality and quantity of social support on help-seeking behavior prior to deliberate self-harm

OBJECTIVE Little is known about use of formal or informal help-seeking resources prior to deliberate self-harm (DSH) outside Western settings. The aim of the study was to investigate help-seeking behavior and correlates of this prior to self-harm in an East Asian setting. METHODS Over a year period, consecutive attendees at a general hospital emergency room in Taiwan with DSH were asked about prior medical contact and informal help-seeking in the month prior to DSH. Self-reported social support/network was measured using the Close Persons Questionnaire. RESULTS The mean age of the 209 participants was 35.2 years (S.D.=13.3), with three times more women (75.6%) than men. Nearly half had made medical contact (47.1%) or sought informal help (54.1%) within the month prior to DSH. After adjustment, higher level of confiding and practical support were associated with seeking informal help (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06-1.23; OR 1.17, 95% CI 1.04-1.32, respectively). Prior medical contact was negatively associated with higher social network outside the home (OR 0.91, 95% CI 0.85-0.98). CONCLUSION Social support/network potentially modifies help-seeking behavior prior to DSH. Quality rather than quantity of social support was associated with seeking informal support, with the reverse pattern associated with prior medical contact.

Risk Factors of Internet Addiction among Internet Users: An Online Questionnaire Survey.

Backgrounds Internet addiction (IA) has become a major public health issue worldwide and is closely linked to psychiatric disorders and suicide. The present study aimed to investigate the prevalence of IA and its associated psychosocial and psychopathological determinants among internet users across different age groups. Methods The study was a cross-sectional survey initiated by the Taiwan Suicide Prevention Center. The participants were recruited from the general public who responded to the online questionnaire. They completed a series of self-reported measures, including Chen Internet Addiction Scale-revised (CIAS-R), Five-item Brief Symptom Rating Scale (BSRS-5), Maudsley Personality Inventory (MPI), and questions about suicide and internet use habits. Results We enrolled 1100 respondents with a preponderance of female subjects (85.8%). Based on an optimal cutoff for CIAS-R (67/68), the prevalence rate of IA was 10.6%. People with higher scores of CIAS-R were characterized as: male, single, students, high neuroticism, life impairment due to internet use, time for internet use, online gaming, presence of psychiatric morbidity, recent suicide ideation and past suicide attempts. Multiple regression on IA showed that age, gender, neuroticism, life impairment, internet use time, and BSRS-5 score accounted for 31% of variance for CIAS-R score. Further, logistic regression showed that neuroticism, life impairment and internet use time were three main predictors for IA. Compared to those without IA, the internet addicts had higher rates of psychiatric morbidity (65.0%), suicide ideation in a week (47.0%), lifetime suicide attempts (23.1%), and suicide attempt in a year (5.1%). Conclusion Neurotic personality traits, psychopathology, time for internet use and its subsequent life impairment were important predictors for IA. Individuals with IA may have higher rates of psychiatric morbidity and suicide risks. The findings provide important information for further investigation and prevention of IA.

Validation of the Chinese SAD PERSONS Scale to predict repeated self-harm in emergency attendees in Taiwan

BackgroundPast and repeated self-harm are long-term risks to completed suicide. A brief rating scale to assess repetition risk of self-harm is important for high-risk identification and early interventions in suicide prevention. The study aimed to examine the validity of the Chinese SAD PERSONS Scale (CSPS) and to evaluate its feasibility in clinical settings.MethodsOne hundred and forty-seven patients with self-harm were recruited from the Emergency Department and assessed at baseline and the sixth month. The controls, 284 people without self-harm from the Family Medicine Department in the same hospital were recruited and assessed concurrently. The psychometric properties of the CSPS were examined using baseline and follow-up measurements that assessed a variety of suicide risk factors. Clinical feasibility and applicability of the CSPS were further evaluated by a group of general nurses who used case vignette approach in CSPS risk assessment in clinical settings. An open-ended question inquiring their opinions of scale adaptation to hospital inpatient assessment for suicide risks were also analyzed using content analysis.ResultsThe CSPS was significantly correlated with other scales measuring depression, hopelessness and suicide ideation. A cut-off point of the scale was at 4/5 in predicting 6-month self-harm repetition with the sensitivity and specificity being 65.4% and 58.1%, respectively. Based on the areas under the Receiver Operating Characteristic curves, the predictive validity of the scale showed a better performance than the other scales. Fifty-four nurses, evaluating the scale using case vignette found it a useful tool to raise the awareness of suicide risk and a considerable tool to be adopted into nursing care.ConclusionsThe Chinese SAD PERSONS Scale is a brief instrument with acceptable psychometric properties for self-harm prediction. However, cautions should be paid to level of therapeutic relationships during assessment, staff workload and adequate training for wider clinical applications.

Pathways to Care and Help-Seeking Experience Prior to Self-Harm: A Qualitative Study in Taiwan

Background: Help-seeking behavior may protect people from harming themselves. However, few studies have discussed how and why people access lay or professional help prior to self-harm. Purpose: This study explored the subjective experiences of individuals with deliberate self-harm in terms of help-seeking behavior and medical care pathways. Methods: Researchers performed qualitative in-depth interviews and content analysis and used a sampling grid to recruit participants. Twenty emergency attendees between the ages of 18–55 years were interviewed on their help-seeking pathways and experiences using a standardized topic guide. Results: Participants identified friends, family members, healthcare personnel, and their own initiative as the primary medical care pathways. Analysis showed help-seeking experiences significantly related to the physician–patient relationship, social support, and treatment adherence. These factors were also identified as prominent themes related to medical help-seeking behavior. Conclusions: Supportive attitudes and continuous care from formal and informal sources of help may facilitate help-seeking behavior, whereas negative influences from close friends or relatives may trigger a self-harm episode. Medication stockpiling and the negative aspects of close relationships should be addressed and minimized to raise the effectiveness of self-harm or suicide prevention efforts.

The severity of initial acute kidney injury at admission of geriatric patients significantly correlates with subsequent in-hospital complications.

Acute kidney injury (AKI) is associated with higher hospital mortality. However, the relationship between geriatric AKI and in-hospital complications is unclear. We prospectively enrolled elderly patients (≥65 years) from general medical wards of National Taiwan University Hospital, part of whom presented AKI at admission. We recorded subsequent in-hospital complications, including catastrophic events, incident gastrointestinal bleeding, hospital-associated infections, and new-onset electrolyte imbalances. Regression analyses were utilized to assess the associations between in-hospital complications and the initial AKI severity. A total of 163 elderly were recruited, with 39% presenting AKI (stage 1: 52%, stage 2: 23%, stage 3: 25%). The incidence of any in-hospital complication was significantly higher in the AKI group than in the non-AKI group (91% vs. 68%, p < 0.01). Multiple regression analyses indicated that elderly patients presenting with AKI had significantly higher risk of developing any complication (Odds ratio [OR] = 3.51, p = 0.01) and new-onset electrolyte imbalance (OR = 7.1, p < 0.01), and a trend toward more hospital-associated infections (OR = 1.99, p = 0.08). The risk of developing complications increased with higher AKI stage. In summary, our results indicate that initial AKI at admission in geriatric patients significantly increased the risk of in-hospital complications.