Yu-Hsia Tsai

Effectiveness of individualised intervention on older residents with constipation in nursing home: a randomised controlled trial.

AIMS AND OBJECTIVES To develop and examine the effectiveness of individualised intervention to reduce constipation among older adults in nursing homes. BACKGROUND In long-term care facilities, approximately 60-80% of the residents have symptoms of constipation. Constipation may lead to haemorrhoids, faecal impaction, ulcers, intestinal bleeding and can also lead to a decrease in quality of life. Although a high prevalence of constipation in older adults can be seen, there is a lack of empirical evidence for delivering interventions based on individual risk factors of constipation. Many factors cause constipation but the risk factors are different for each individual. DESIGN A prospective, randomised control trial conducted in northern Taiwan. METHODS Nursing home residents (n = 43) were randomly assigned to either the control group or the experimental group. The control group received no extra care from the researcher while the experimental group received an individualised intervention and an eight-week follow-up. Participants were assessed using the Bristol Stool Form Scale, the Patient Assessment of Constipation Symptoms, types and dosages of laxative, and bowel sound observations. Data were taken at baseline, four weeks as well as eight weeks after the intervention. RESULTS The participants in the experimental group had a significantly higher increase in the frequency of defecation (group effect, p = 0·029) and in bowel sounds (interaction effect, p = 0·010) compared to those in the control group. However, the two groups did not differ significantly in symptoms and the severity of the constipation symptoms, Bristol Stool Form and use of laxatives. CONCLUSIONS The results of this trial suggest that the individualised intervention may be appropriate for decreasing constipation among nursing home residents and encourage further study and confirmation. RELEVANCE TO CLINICAL PRACTICE Using individualised intervention to enhance the self-care ability related to constipation among older adults is recommended.

The association between sleep duration and overweight or obesity in Taiwanese adults: A cross-sectional study.

BACKGROUND/OBJECTIVE The effect of eating habits and sedentary lifestyle on obesity has been extensively examined and supported; however, few studies have examined the association of sleep duration with obesity in Taiwan. To redress this gap, this study investigated the association of sleep duration with overweight and obesity in community-dwelling Taiwanese adults. METHODS A cross-sectional study was performed using the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT). A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of the association of sleep duration with overweight and obesity. Nightly sleep duration was divided into three groups: >6 to <9h (normal), ≤6h (short), and ≥9h (long). RESULTS A total of 1548 adults aged 20-64 years were examined in this study. The adjusted ORs of obesity for short and long sleep duration relative to a normal sleep duration were 1.31 (95% CI 1.01, 1.76) and 1.64 (95% CI 1.04, 2.61), respectively. No significant association of sleep duration with overweight was observed. CONCLUSIONS The present study suggests that both short and long sleep duration are associated with obesity risk.

Mediating effects of burden on quality of life for caregivers of first-time stroke patients discharged from the hospital within one year

BackgroundCaregiver burden may be either a predictor or an outcome of caregiver quality of life (QoL). Patient or caregiver factors that directly affect caregiver QoL, predictors that are simultaneously shared with caregiver burden and QoL, and factors that affect caregiver QoL through caregiver burden are not well understood. This study explored predictors of caregiver QoL and identified whether caregiver burden is a mediator for caregivers of first-time stroke patients.MethodsThis is a cross-sectional study. We recruited first-time stroke patients who had been discharged from the hospital within 1 year. We screened caregivers with two major inclusion criteria: age > 20 years old and being the family member who provides the most patient-care hours out of all family caregivers. Caregiver burden (Caregiver Strain Index, CSI), QoL (Caregiver Quality of Life Index, CQLI), and patient and caregiver characteristics were assessed with structured questionnaires. Multiple-regression and bootstrap analysis were conducted for data analysis.ResultsA total of 126 caregivers completed the questionnaires. Higher caregiver burdens, lower caregiver education level, lower self-rated health, lower monthly family income, and spouses who were responsible for medical fees were significant predictors of lower caregiver QoL. Poor self-rated health and monthly family income of

Association between sleep disorders and injury: a nationwide population-based retrospective cohort study

666 USD or below were the strongest predictors of caregiver QoL. Spouses who were responsible for medical fees and lower monthly family income had direct negative effects on caregiver QoL, but these factors exhibited no indirect mediating effect between caregiver characteristics and QoL through caregiver burden as a mediator. Caregiver education level at or below elementary school and poor or fair self-rated-health had direct negative effects on caregiver QoL, which were mediated by caregiver burden.ConclusionsOur study indicated predictors of caregiver QoL and the relationships with caregiver burden among first-time stroke survivors in the early stage. Caregivers’ financial factors affected caregiver QoL directly. Caregivers’ poor self-rated health and lower education level negatively affected caregiver QoL indirectly through caregiver burden as a mediator. Interventions to make appropriate policies for financial subsidies, to enhance caregivers’ health and to provide tailored stroke-related education through multidisciplinary cooperation may effectively promote caregiver QoL.

Physical fitness exercise versus cognitive behavior therapy on reducing the depressive symptoms among community-dwelling elderly adults: A randomized controlled trial

Background The evidence is insufficient for the association between the exposure of sleep disorders and the risk of injury. The aim of this study was to examine the association between patients with sleep disorders and the risk of injury. Methods This was a population-based retrospective cohort study using Taiwan National Health Insurance Research Database from 2005 to 2010. A total of 15 109 patients with sleep disorders were identified as the study cohort. The non-sleep disorders control cohort comprised 29 955 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of sleep disorders on the risk of injury. Results The overall incidence of injury was 77.03 per 1000 person-years for patients with sleep disorders, which was significantly higher than that of the control cohort (60.63 per 1000 person-years). Overall, patients with sleep disorders had a higher risk of injury compared with control cohort (adjusted HR=1.27, 95% CI 1.26 to 1.28). Comparing to the control cohort, patients with insomnia had a 12% higher risk for injury (adjusted HR, 1.12 (95% CI 1.01 to 1.41)). Conclusions Comparing to patients with non-sleep disorders, patients with sleep disorders had a higher risk of injury and the risk was particularly pronounced in those who had insomnia.