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Introduction: Integrating assistive technology (AT) into occupational therapy (OT) education is critical to educating students to utilize AT to enhance individual independence. This study aims to describe the development of a science, technology, engineering, arts, and mathematics (STEAM)-based AT curriculum in OT and evaluate its effectiveness using the Kirkpatrick model. Methods: An 18-week STEAM-based AT curriculum was created with lectures, hands-on activities, and a simulation exam. A one-group pretest–posttest observational study was undertaken with 40 undergraduate students to gauge its effectiveness. Their professionalism was evaluated using a multidimensional checklist, whereas a satisfaction survey gathered their feedback on the curriculum experience. Results: Level 1: Participants reported high satisfaction (mean = 4.61, SD = 0.36), with a 97.5% agreement. Level 2: 95% (n = 38) passed the AT curriculum exam. Level 3: Therapists and patients expressed satisfaction with participants' AT skills (therapists: t (39) = 12.22, p < 0.001; patients: t (39) = 8.84, p < 0.001). Level 4: Participants showed significant improvement in professionalism (t (39) = 16.45, p < 0.001). Lastly, using the Kirkpatrick model, the STEAM-based AT curriculum passed the evaluation. Conclusions: The STEAM-based AT curriculum in OT enhances professionalism and potentially boosts patient satisfaction with AT services provision. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop two pictorial tools for assessing the attitudes of Taiwanese male senior high school students with intellectual disabilities toward sexually offensive behavior, focusing on cognitive distortion and victim empathy. A total of 181 male high school students at special education schools participated in this study. The validity and reliability were examined using exploratory factor analysis and Cronbach's alpha coefficient. For the cognitive distortion scale, 18 items grouped into three factors, rationalization, denial, and victim blaming, and explained 69.72% of the variance; for the victim empathy scale, 12 items grouped into two factors, the victim's feelings when the offensive behavior is perpetrated by another, and the victim's feelings when the offensive behavior is perpetrated by oneself, and explained 68.00% of the variance. The reliability was.96 for the cognitive distortion scale and.93 for the victim empathy scale. In conclusion, the two scales developed in this research were found to be reliable and valid tools for evaluating male students' attitudes toward sexually offensive behavior, and can also be used as reference material for courses in sex education. [ABSTRACT FROM AUTHOR]

Background: Health care industriesmust consider their sustainable development, and employee well-being is a crucial environmental, social, and governance indicator that should be prioritized. During events such as the COVID-19 pandemic, information transparency is a concern for health care workers. Authentic leaders can build trust by openly sharing their thoughts and feelings. Understanding how authentic leadership affects employee well-being through job stress and how emotional intelligence reduces job stress is essential for health care workers. Purposes: This study investigated the effect of authentic leadership on employee well-being and considered the mediating role of job stress and moderating role of emotional intelligence in this effect. Methodology/Approach: A time-lagged survey of 452 full-time health care workers (comprising nurses, allied health professionals, and administrative workers) from a general hospital in Taiwan was conducted. Findings: Authentic leadershipwas positively associatedwith employee well-being, and job stressmediated the effects of authentic leadership on employee well-being. Among the employees who perceived leadership to be authentic, those with higher emotional intelligence felt less job stress. Conclusion: From the perspective of conservation of resources theory, authentic leadership was identified as a crucial factor influencing how health care workers reduce job stress and improve theirwell-being. Emotional intelligence was identified as essential in enhancing the effects of authentic leadership on reducing the job stress of health care workers. Practice Implications: Organizations should promote authentic interactions between leaders and followers and provide training for developing authentic leadership. They should also provide training to improve their employees' emotional intelligence. [ABSTRACT FROM AUTHOR]

Importance: Coloring is popular with preschool children and reveals their developmental state. However, interpreting coloring performances is challenging because descriptive and subjective evaluations are commonly used with large variations. Objective: To develop a scoring method to objectively quantify children's coloring skills. Design: Colored blank train templates were analyzed using four indicators (entropy, complexity, coloring outside the lines, and unexpected blank areas) to form a summed score. Setting: Kindergarten in a urban city (Tainan, Taiwan). Participants: Two hundred thirty-nine typically developing children ages 3 to 6 yr. Outcome and Measures: A newly developed method to assess coloring skill on the basis of a colored picture of a train. Results: The summed score exhibited good internal consistency (Cronbach's α =.80), discriminative validity (p =.04), convergent validity (rs =.66 and.59 with age and visual–motor integration), and acceptable factorial validity (comparative fit index =.99, standardized root-mean-square residual =.04, and root-mean-square error of approximation =.13). Moreover, three coloring patterns (mature, transitional, and immature) were identified. Conclusions and Relevance: The new method provides objective, reliable, and valid scores representing coloring skills in typically developing children. In addition, the coloring patterns can be recognized. This method can be used to facilitate comparisons of children's coloring skills with peers and provide valuable insight into children's development. Plain-Language Summary: This study proposes a new method to objectively quantify children's coloring skills with sound reliability and validity in typically developing children. The method can be used to evaluate children's coloring skills and patterns to shed light on their developmental stages. This study proposes a method to facilitate comparisons of children's coloring skills with peers that can provide valuable insights into children's development. [ABSTRACT FROM AUTHOR]

Background: Sedentary activities are not conducive to the health benefits of elderly residents living in nursing homes. This study explored the effect of a 12-week elastic band resistance exercise (EBRE) on physical function, depression and quality of life (QOL) among the elderly in nursing homes. Methods: A single-blind experimental design. Eighty elderly from three nursing homes in the south of Taiwan were selected and assigned to the control group (40) and the experimental group (40). The experimental group intervened with regular EBRE for 12weeks. The control group maintained the original lifestyle and activity. Physiological status, depression and QOL were assessed using tools and instruments with reliability and validity at weeks 4, 8, and 12 during the study period. Results: After the 12-week EBRE intervention, the grip strength, one of the physiological indicators, was significantly improved at weeks 4, 8 and 12 (p < 0.05) with the experimental group. The measured blood oxygen saturation, heart rate, respiratory rate and blood pressure were non-affected. Self-reported depression and QOL were improved (p < 0.001) significantly at week 12. Conclusion: Early intervention of EBRE is an effective method to improve grip strength and QOL and to reduce depression for the elderly living in nursing homes. The results provide empirical evidence for incorporating EBRE into regular activity in nursing homes. [ABSTRACT FROM AUTHOR]

Background: The relationship between the use of multiple medications and the risk of chronic kidney disease (CKD) warrants investigation. The aim of this study was to examine the association between polypharmacy and CKD. Methods: A population-based case-control study was conducted using data from the Taiwanese National Health Insurance Research Database. Medication use was assessed from 2002 to 2003, and newly diagnosed CKD using the International Classification of Disease, 9th revision, Clinical Modification (ICD-9 CM) from 2004 to 2011 was analyzed. Propensity score analysis was used to recruit 3,249 cases and 3,249 controls through random selection. The risk of CKD was compared among individuals who used less than five medicines per day and those who used more than five medicines per day. Results: A dose-response relationship was observed between the number of medications used and the risk of CKD. Propensity score analysis showed an increased risk of CKD among patients who used five to nine medicines per day (odds ratio (OR), 1.90; 95% CI, 1.69--2.14) and those who used more than ten medicines per day (OR, 3.06; 95% Cl, 3.61--2.60). Nevertheless, the use of ICD codes to identify CKD may result in misclassification bias. The severity of renal impairment was not assessed. Non-adherence and over-the-counter drugs were not accounted for. Conclusion: In a nationwide study, polypharmacy was found to be associated with CKD in the older population, and this trend persisted after propensity score matching. There was a positive correlation between the number of medications used and the incidence of CKD. [ABSTRACT FROM AUTHOR]

Background: Stroop Color Word Test (SCWT) is often adopted to evaluate processing of cognitive function or interference. This study addressed whether different indices of Stroop interference (SI) significantly distinguished Chinese-speaking Alzheimer's disease (AD) persons from control counterparts, and whether SCWT interference errors changed in AD persons of different severity. Methods: Forty native speakers of Mandarin Chinese, including 20 AD persons and 20 controls, participated in this study. All of the participants took SCWT, and their performance was computed for eight SI indices. Different conditions, response types, and AD errors were also examined. Results: Our findings revealed significant group differences in terms of raw scores, response types, and most SI scores. We additionally contributed to SCWT performance by AD persons of different severity. SCWT performance of very mild AD persons was slightly impaired in the incongruous condition, while the mildly-demented persons were more severely impaired in all of the conditions. Conclusion: SI indices in the current study are proven to be helpful in distinguishing AD persons from controls. Moreover, dementia exerts a certain impact on AD SCWT performance. It is thus suggested that AD persons be given help with appropriate application of SCWT, and that SCWT interference errors be adopted as a diagnostic tool in future treatment. [ABSTRACT FROM AUTHOR]

Importance:Reablement is a person-centered and goal-oriented rehabilitative intervention to optimize people's chances to live independently. Objective: To investigate the effects of a reablement intervention on performance of instrumental activities of daily living (IADLs) in three aspects (i.e., actual performance, ability, and self-perceived difficulty) for patients with stroke. Design: A single-blinded, randomized crossover study. Setting: Participants' home and community. Participants: Twenty-seven patients with stroke. Interventions: Each participant received two interventions (IADL reablement and health education). Each intervention was administered for 6 wk. All participants were randomly assigned to one intervention and then received the other intervention after a 4-wk washout period. Outcomes and Measures: Outcomes of actual performance and self-perceived difficulty were derived from the Frenchay Activities Index (FAI) and the difficulty dimension of the Participation Measure–3 Domains, 4 Dimensions (PM–3D4D), respectively. Outcomes of ability were measured with the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Canadian Occupational Performance Measure Performance score (COPM Performance). Results: No statistically significant differences were found in the three aspects between the IADL reablement and health education (ps =.148–.570). Compared with the health education, the IADL reablement showed better improvements on the FAI, LIADL, COPM Performance, and difficulty dimension of the PM–3D4D with trivial to small effect sizes (ds = 0.17–0.45). Conclusions and Relevance: Our results reveal that the IADL reablement has the potential to increase the frequency of IADL administration, enhancing the capability to perform IADLs and reducing the self-perceived difficulty of carrying out IADLs. Plain-Language Summary: The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. An IADL reablement intervention may be useful for improving the ability to carry out IADL tasks at home and in the community. The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study was to investigate the relationship between specific subtests of the Mini-Mental State Examination-Second Edition (MMSE-2) and activities of daily living (ADL) functions in people with dementia. Methods: A cross-sectional design study was conducted to collect data from two teaching hospitals in northern Taiwan between March 2019 and March 2020. One hundred and twenty-five people with dementia were recruited and assessed with the MMSE-2, Barthel Index (BI), Self-Perceived Difficulty Scale, Ability Scale, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL) once. Results: The subtests of registration, language, MMSE-2: Standard Version total score, story memory, processing speed, and MMSE-2: Expanded Version (MMSE-2: EV) total score of theMMSE-2were significantly correlated with the BI, Self-Perceived Difficulty Scale, and Ability Scale (r = .31-.35, p < .001). In addition, the subtests of orientation,MMSE-2: Brief Version total score, and visual-constructional ability were significantly correlated with the Ability Scale (r = .32-.33, p < .001). All, except for registration subtest, were significantly correlated with the Lawton IADL (r = .29-.57, p < .001). The registration and language subtests were two important predictors of the BI, while the processing speed subtest was the only predictor for the Self-Perceived Difficulty Scale and Ability Scale. The MMSE-2: EV total score was an important predictor of the Lawton IADL. Conclusions: The overall findings from our study demonstrates that the relationship between the MMSE-2 and ADL functions is not simply general, but that specific aspects of the MMSE-2 do in fact correlate more significantly and strongly with certain ADL functions. The findings of this study could help with the early detection of people with dementia and may provide useful information for early interventions to maintain patients' independence. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 (COVID-19) pandemic, early warning scores (EWS) have been used to help emergency physicians with triage. This study aimed to evaluate the threemost used EWSs: Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), and National EarlyWarning Score (NEWS), based on the in-hospital mortality of geriatric patients with COVID-19. Methods: This retrospective, single-center study included geriatric patients hospitalized for COVID-19 from May 2021 to July 2021 at the MacKay Memorial Hospital. Patients who (i) presented with out- of-hospital cardiac arrest (OHCA), (ii) were transferred fromother hospitals, and (iii) hadmissing demographic data were excluded. The area under the receiver operating characteristic curve (AUC) was calculated to predict the in-hospital mortality rate associated with each EWS. Results: The study included 135 patients, of whom24 (17.8%) died. Themedian age of the included patients was 74.44 years, and 53% of them were men. Of the selected EWSs, MEWS (AUC = 0.761) exhibited the highest prognostic value, with a cutoff value of 3.5. Furthermore, NEWS (AUC = 0.758) and REMS (AUC = 0.736) exhibited good prognostic value. Conclusion: We validated the three most used EWSs, and MEWS performed well in predicting the in-hospital mortality of geriatric patients with COVID-19 using basic parameters. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection is a global problem, and older patients are more likely to develop advanced liver disease. Direct-acting antiviral treatments (DAA) have revolutionized the paradigm of HCV treatment and made its elimination possible. However, hematological and biochemical changes have rarely been discussed. Methods: This was a retrospective observational study of enrolled patients who received DAA for chronic HCV between Aug 2018 and Mar 2020. Patients were divided into two groups: younger < 65 years and older 65 years. The HCV genotype, changes in biochemistry and hematologic data before and after treatment, and sustained virologic response at 12 weeks after cessation of drug administration were recorded. Results: Of the 226 enrolled patients, 130 (57.5%) belonged to the younger group and 96 (42.5%) to the older group. Most patients had HCV genotype 2 infections (54.4%), and older patients tended to have genotype 2 infections (70.7% vs. 42.3%). The older patients had significantly lower hemoglobin, platelet, albumin, and BUN levels initially. After treatment, the platelet count and BUN levels significantly improved in older patients. Older patients had higher fibrosis-4 (FIB-4) scores than younger patients before and after treatment. After treatment, the FIB-4 score in the older group showed a significant change (3.90 vs. 2.67; p = 0.001), but the younger group did not (1.97 vs. 1.75; p = 0.05). Conclusion: Older patients tended to have genotype 2 infections. After DAA treatment, the improvements in platelet count and albumin level were better in older patients than in younger patients. Improvement in FIB-4 was also significant in the older population. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Venetoclax, in combination with a hypomethylating agent or low-dose cytarabine, is approved for the treatment of acute myeloid leukemia (AML) in elderly patients or in those who are ineligible for intensive chemotherapy. The aim of our study was to investigate whether the venetoclaxcontaining regimen improved the survival of elderly AML patients in Taiwan. Patients and methods: Thirty-two elderly patients ( 60 years) diagnosed with AML at our hospital from January 2018 to October 2022 were retrospectively enrolled. Clinical characteristics and molecular profiles of the patients were captured by chart review. All statistical analyses were calculated by using MedCalc Statistical Software. Results: The median overall survival (OS) of our entire cohort was 4.0 months (95% confidence interval, 1.13–33.3 months). Patients receiving venetoclax-containing regimens or the best available therapy (BAT) had median OS of 33.3 months and 1.5 months, respectively (p < 0.001). The response rate of the venetoclax-containing regimen was 68.8% (11/16). Three patients treated with venetoclax underwent allogeneic peripheral blood stem cell transplantation and remained in remission at the last follow-up. Patients aged 75 years or older who were treated with venetoclax-containing regimens had better survival when compared to those who received BAT (11.3 months vs. 0.4 months, p = 0.018). Multivariate analysis showed that elderly AML patients aged 75 years or younger and those receiving venetoclaxcontaining regimens were 2 independent good prognostic factors for OS. Conclusion: Venetoclax-based regimens prolonged the survival of elderly AML patients in Taiwan, even in those aged 75 years or older. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is an important nutrient for maintaining cardiovascular, endocrine, immune, and nervous system health. Body mass index (BMI) is one of the factors influencing vitamin D levels. We aimed to study the factors that play a role in the outcomes and prognoses of critically ill patients. Method: This study was conducted at four teaching hospitals in Northern Taiwan between August 2018 and July 2020. A total of 1421 critically ill patients admitted to the intensive care units (ICUs) were eligible for assessment. Patients were classified into two groups based on serum 25(OH)D levels: sufficiency ( 20 ng/ml) and insufficiency (< 20 ng/ml); and into four groups according to BMI: underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obesity (BMI 30). Statistical analyses were performed, and a p-value < 0.05 indicated a significant difference. Results: More than half (57.9%) of the critically ill ICU patients had vitamin D deficiency (VDD); and VDD lengthened ICU stay by 2.5 days in vitamin D-deficit patients as compared to that in vitamin D-sufficient patients. Patients with obesity had a 4.2-day longer ICU stay (16.7 days) than that of the BMI < 30 group (12.5 days), which was significant (p = 0.009). They also had the lowest vitamin D levels (17.3 ng/mL) and the highest 90-day mortality rate (17.3%) compared to the other BMI groups. Conclusion: In caring for critical patients, physicians need to pay more attention to vitamin D levels and BMI factors, which may impact their outcome prediction. [ABSTRACT FROM AUTHOR]

Background: Residents in nursing homes are generally highly dependent on others, and unplanned hospitalizations often have major impacts on their physical and cognitive functions. The purpose of this study was to investigate the factors that affect the unplanned hospitalization of nursing home residents. Methods: This retrospective cohort study enrolled 98 residents from a nursing home affiliated with a regional hospital in northern Taiwan. A chart review was performed to transcribe variable data, including demographic characteristics, health status, nutritional status, and the length and frequency of unscheduled transfers to the hospital. Results: A total of 64.3% of the residents experienced one or more unplanned hospitalization. The major causes of unplanned hospitalization were cerebrovascular accident, congestive heart failure, and pneumonia. The factors affecting the unplanned hospitalization of residents were a Barthel index of 20 and the use of a nasogastric or urinary catheter. Conclusion: Strengthening the management of nursing homes and developing preventive guidelines for treating residents with poor ability to perform activities of daily living or using invasive devices are crucial. By implementing preventive measures early and improving the quality of monitoring care, nursing homes can reduce the incidence of unplanned hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the association between famotidine treatment and severity, as well as mortality, for patients with COVID-19. In addition, to investigate whether this association was changed in cases of concomitant treatment with corticosteroids, remdesivir, clarithromycin, low molecular weight heparin, or statin. Material and methods: This is a retrospective cohort study conducted by analyzing electronic medical records of 171 hospitalized patients into the Infectious DiseaseWard of a 2068-bed tertiary care medical center, with laboratory-confirmed COVID-19 between May 01, 2021 and August 31, 2021. Patients were classified as receiving famotidine if they were treated with oral drug, at any dose, within ± 7 days of COVID-19 screening and/or hospital admission. Famotidine use was extracted directly fromthe electronic medical record. Results: Current study failed to identify famotidine as a protective factor associated with a significant reduction in the risk of in-hospitalmortality (odds ratio 1.573, 95%confidence interval (CI) 0.464--5.325, p = 0.467) or a significant reduction in the risk of ICU admission (odds ratio 0.547, 95%confidence interval (CI) 0.286--1.045, p = 0.068).However, non-significant trend towards a lower rate of ICU admission in association with famotidine prescription was observed. Conclusions: The results of this study reflect the real-world use of famotidine does not reduce the risk of in-hospital-mortality or ICU admission of hospitalized COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak presents challenges to the emergency care system. Advanced age is a risk factor formortality. This study aimed to investigate whether the shock index (SI) is an early pre- dictor of adverse outcomes in geriatric patients with COVID-19. Methods: Patients aged ≤ 60 yearswith COVID-19 betweenMay 1, 2021, and February 1, 2022,were in- cluded in a retrospective cohort study. These patients were divided into two groups based on ICU ad- mission. Variables were compared for the two groups. The receiver operating characteristic analysis of the SI and age--SI (ASI) was used to detect deteriorating outcomes early. Results: In total, 156 patients were included, and the mean age was 68.52 ± 7.25 years. ICU admission, intubation, andmortality were recorded in 46 (29.49%), 32 (20.51%), and 16 (10.26%) patients, respec- tively. Themean body weight, pulse rate, respiratory rate, pulse oximetry, SI, and ASI were significantly different between the two groups (p = 0.018, 0.032, 0.007, < 0.001, 0.004, and 0.007, respectively). CRP, LDH, ALT, ferritin, D-dimer, and sodiumlevels were significantly associated with ICU admission. Regard- ing ICU admission, intubation, and mortality, the areas under the curve (AUC) of the SI and ASI showed acceptable discrimination. The predictive power of the ASI was significantly higher than that of the SI for mortality (AUC difference, 0.088 ± 0.036 (95% CI 0.017--0.160); p = 0.016). Conclusion: The ASI is a useful triage tool for mortality prediction in geriatric patients with COVID-19. The SI and ASI can be used in conjunction with vital signs, oxygen saturation, and laboratory biomarkers for the early detection of ICU admission. [ABSTRACT FROM AUTHOR]

Background: This study explored the relationship between handgrip strength (HGS) and pulmonary function, respiratory muscle strength, and cardiopulmonary endurance in older adults. Methods: We recruited 128 community-dwelling older adults. Correlations between HGS, pulmonary function parameters, respiratory muscle strength, and cardiopulmonary endurance were analyzed. Results: Forced vital capacity (r = 0.180, P <.05), maximum voluntary ventilation (r = 0.180, P <.05), and 2-minute step test (r = 0.204, P <.05) were weakly correlated with HGS. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) had moderate correlations with HGS (r = 0.431 for MIP, 0.492 for MEP, P <.001). Conclusion: HGS was correlated with pulmonary function, respiratory muscle strength, and cardiorespiratory endurance. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, all trainees (first-year residents (R1) and postgraduate year two (PGY2)) can apply for second-year residents (R2) physician level since 2021. However, there is no data to assess whether PGY2 will be equal in ability to R1 when dealing with intensive care situations. Therefore, we aimed to evaluate trainees' Accreditation Council for Graduate Medical Education (ACGME) core competencies in the PGY period and intensive care core competencies before achieving R2 status. We also examined the correlation between the two. Methods: We retrospectively collected PGYs' examination scores on a small-scale objective structured clinical examination and evaluated the old PGY1 or PGY2 scores from the intensive care simulation-based education (SBE) workshop for PGY2 and R1 trainees about three months before the R2 classification. The study period was 2018 to 2020. Results: A total of 71 trainees (58 R1 and 13 PGY2) attended the intensive care SBE workshop. There was no significant differences in average simulation total scores among 2018 to 2020 (p = 0.172). A comparison of the test scores of R1 in internal medicine (n = 23) with PGY2 (n = 13) in 2020 revealed no significant difference (n = 0.884). Furthermore, the total scores for PGY's ACGME core competencies were positively correlated with the total scores for R1 or PGY2 simulation performance in intensive care (r = 0.580, p < 0.001). Conclusion: Our findings revealed no significant difference between PGY2's and R1's average simulation total scores. Thus, these trainees have the competencies required to move on to R2. The PGY's ACGME core competencies are also positively correlated with intensive care simulation performance score in the future. [ABSTRACT FROM AUTHOR]

Quality of life is an important outcome for people with cancer throughout their cancer trajectory. Having a valid and reliable instrument to measure the quality of life is critical. This cross-sectional study examined the psychometric properties of the Taiwanese version of the Hospice Quality of Life Index among patients with advanced cancer in Taiwan. There were 3 phases: (1) translation of the Hospice Quality of Life Index from English to Mandarin, (2) pilot testing among 30 targeted participants, and (3) field testing to examine validity and reliability. The results of confirmatory factor analysis indicated that the original factor structure of the Hospice Quality of Life Index did not fit the data. After 5 items were deleted from the original questionnaire, principal factor extraction with oblique rotation for exploratory factor analysis yielded 3 subscales: Social/Spiritual Well-Being, Psychological Well-Being, and Functional/Physiological Well-Being. For convergent validity, the small to moderate strength of associations showed shared variance with the Memorial Symptom Assessment Scale. The internal consistency was supported by Cronbach α ranging from 0.77 to 0.86. This study shows early evidence that the quality of life of people with advanced cancer can be appropriately assessed by the Taiwanese Hospice Quality of Life Index. [ABSTRACT FROM AUTHOR]

Taiwan is a leading country regarding bariatric surgery in Asia-Pacific. Since 2010, the Taiwan Society for Metabolic and Bariatric Surgery (TSMBS) has been accountable for the national evolution of bariatric surgery and inaugurated a national database accordingly. This study aimed to analyze the bariatric surgery trends and progress in Taiwan from 2010 to 2021. The TSMBS database was collected on the basis of structured inquiries filled out by bariatric surgeons in Taiwan. All patients involving bariatric surgery were included. The data were stratified with the following objectives, including the types of bariatric procedures, demographic characteristics, and perioperative variables. A nationwide database was comprehensively analyzed and evaluated to determine the trends in the applications of the procedure. Data of 30,026 patients were enrolled. A 2.5-fold increase was observed in bariatric procedures, from 1218 in 2010 to 3005 in 2021. Within 12 years, female accounts for 61.8 %. The revisional rate was 3.40 % during the exploration stage (2010–2013), 2.77 % during the maturity stage (2013–2018), and 5.10 % during the expansion stage (2019–2021). The top five of primary bariatric surgery is sleeve gastrectomy (SG, 63.05 %), gastric clipping surgery (GC, 11.17 %), Roux-en-Y gastric bypass (RYGB, 9.34 %), one anastomosis gastric bypass (OAGB, 8.80 %), and sleeve plus surgery (SG plus, 4.43 %). The trends and progress of Taiwan's bariatric surgery within recent decades are presented in this article. Taiwan's bariatric surgery case number has increased steadily from 2010 to 2021. Amongst all, SG has become the most dominant procedure since 2011 while OAGB takes up second place in 2020. • Taiwanis the pioneer of bariatric surgery in the Asia Pacific since the late 20th century. • To comprehensively demonstrate a panorama of Taiwan's bariatric surgery development. • Several factors influencing the ebb and flow of various bariatric surgery procedures in Taiwan are discussed. • The trends of Taiwan's bariatric surgery may provide an insight of the evolvement of bariatric surgery in Asian population. [ABSTRACT FROM AUTHOR]

Background: This short term structured, multimodal, home-based, self-help program was designed to reduce frailty of elderly type 2 diabetes mellitus (T2DM) patients, and detect the major predictors of frailty status improvement. Method: This study recruited T2DM patients aged 65 years and older from the DM shared care center in a regional hospital who were frail or prefrail according to Fried Frailty Phenotype. Short term (12 weeks) home-based intervention including an elastic band low resistance exercise, a smart bracelet monitored walking exercise, and nutrition consultation was conducted. Change of frailty status, functional outcomes, body composition and metabolic indices after intervention were analyzed. A logistic regression was applied to determine the predictive factors associated with frailty status improvement. Results: 81 participants were enrolled after they were fully consented. After 12 weeks' intervention, 60 participants completed the program. Since two participants with incomplete data were excluded, there were 58 remaining in the analysis. They were on average 71.7 ± 4.9 years old and 22 persons (36.7%) were male. 46 (79.3%) of them were prefrail and 12 (20.7%) were frail. The average duration between the pre-test and the post-test was 107.1 ± 25.6 days. The average incidence of home-based exercise was 1.4 ± 1.1 times a week. Fried Frailty Phenotype, handgrip strength, muscle quality, HbA1c, and symptomatic hypoglycemic episodes significantly improved. Initial poorer frailty status was the major predictor (OR = 104.446, 95% CI = 7.551-1444.726, p = 0.001) of frailty status improvement. Conclusions: Short term structured, multimodal, interdisciplinary, home-based, self-help program is effective in reducing frailty status among elderly T2DM patients. [ABSTRACT FROM AUTHOR]

Background: Despite anticoagulant therapy, patients with atrial fibrillation are still at high risk of ischemic stroke. This study aimed to determine the effect of known pre-stroke atrial fibrillation on the pre-stroke prescription rate of oral anticoagulants, as well as the factors affecting the prescription. Methods: This registry-based prospective cohort study included patients with known atrial fibrillation before stroke who were hospitalized between December 1, 2012, to December 31, 2016. We analyzed the use of oral anticoagulants before the onset of index-stroke and stratified patients according to their therapeutic and non-therapeutic anticoagulant status. Results: Of the 511 acute ischemic stroke patients with atrial fibrillation, 243 (47.6%) were known to have atrial fibrillation before stroke. Only 40 (16.5%) of 243 patients received therapeutic anticoagulation therapy. Patients therapeutic on anticoagulation were more likely to have a lower NIHSS score (7.4 ± 6.6 vs. 10.8 ± 8.4, p = 0.01), shorter length of hospital stay (13.1 ± 9.7 vs. 18.8 ± 13.6, p = 0.01), and higher rates of good functional outcomes at discharge (40% vs. 25.1%, p = 0.01) and at 90 days (60% vs. 39.4%, p = 0.02). Lower CHA2DS2VASc score (3.5 ± 2 vs. 4 ± 1.5, p = 0.01), younger age and male gender were associated with the use of therapeutic anticoagulants before stroke. Conclusion: In patients with atrial fibrillation, oral anticoagulant therapy after the era of non-vitamin K antagonist oral anticoagulants was still underutilized before the onset of stroke. This underused is associated with increased stroke severity and disability. [ABSTRACT FROM AUTHOR]

Importance: Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions. Objective: To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL. Design: Cross-sectional, repeated observation, test–retest. Setting: Elementary schools in Taiwan. Participants: We recruited 25 lower-grade children for the examination of test–retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility. Outcomes and Measures: Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale. Results: The CAM-CHL demonstrated good to excellent test–retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children. Conclusions and Relevance: The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure. This study supports the use of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) as an outcome measure with acceptable psychometrics for the comprehensive evaluation of the handwriting legibility of school-age children. [ABSTRACT FROM AUTHOR]

Friendship networks are relevant to adolescent weight status and lifestyle, but little is known about their relationship in an East Asian setting. Using a longitudinal cohort of Taiwanese adolescents, we studied how weight status and lifestyles might influence friendship. Simultaneously considering the influence of friendship networks, we further examined the effects of peers' lifestyles on the body weight status of adolescents. Data were retrieved from the first three waves of the Taiwan Youth Project (N = 2409; 51 % boys). Participants were asked to nominate their friends at school and to report their lifestyle factors (e.g. sleep habits, internet use, and athletic performance). Weight status was proxied by body mass index calculated from self-reported weight and height. Stochastic actor-based modeling was used for the friendship network analyses. Considering network structure, adolescents selected friends based on similarities in weight status (β = 0.147 [standard error = 0.044], p < 0.001) and lifestyle factors, such as athletic performance (β = 0.181 [0.034], p < 0.001), internet use (β = 0.156 [0.039], p < 0.001), and social jetlag (β = 0.055 [ ± 0.022], p < 0.05). In the behavior dynamics model, we did not observe any peer influence on changes in adolescents' weight status. These findings suggest a pervasive homophilic friendship selection explained by weight and lifestyle-based similarities, despite no evidence of peer influence on weight status. Stakeholders and care providers of adolescent health should be aware of the social network processes that underlie weight problems. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study identified developmental patterns of handwashing habit formation during childhood and examined their associations with later COVID-19 preventive practices. METHODS: We used data from the Taiwan Birth Cohort Study, which included 11,254 adolescents with complete data on childhood handwashing behavior and age-15 COVID-19 survey items. Bias-adjusted 3-step latent class analysis was used to test study hypotheses. RESULTS: The rates of handwashing and mask-wearing during the pandemic were 63.8% and 93.8%, respectively. Five distinct patterns of handwashing habit formation were identified: early formation (14.89%), delayed formation (17.73%), gradual formation (42.98%), inconsistent formation (9.78%), and nonformation (14.62%). Compared with adolescents with an early formation pattern of handwashing habits, those with other patterns exhibited lower odds ratios (ORs) of handwashing during COVID-19; these ORs were 0.67 (95% confidence interval [CI], 0.49-0.85), 0.60 (95% CI, 0.44-0.77), 0.29 (95% CI, 0.08-0.49), and 0.21 (95% CI, 0.01-0.40) for those with delayed formation, gradual formation, inconsistent formation, and nonformation patterns, respectively. Moreover, relative to that of adolescents with the early formation pattern, mask-wearing was less common among adolescents with gradual formation, inconsistent formation, and nonformation patterns, with ORs of 0.54 (95% CI, 0.16-0.92), 0.50 (95% CI, 0.03-0.96), and 0.26 (95% CI, 0.00-0.65), respectively. CONCLUSIONS! The early formation of hygienic habits is associated with higher adherence to pandemic preventive practices among adolescents. Our findings suggest that interventions to promote hygienic behaviors can start as early as age 3 through the introduction of healthy habits such as handwashing. [ABSTRACT FROM AUTHOR]

Background: The complication of donor site in skin grafting often acts as a causing factor for extended treatment period. The elderly individuals tend to be afflicted by impaired wound healing. Herein, we presented the outcome of skin regrafting in the elderly patients. Methods: Patients who aging over 60 had anterior thigh split-thickness skin grafting (STSG) donor sites as part of any reconstructive surgery were included. In experimental group, the over-harvest skin back was replaced on the donor site in island type, and Alleyvn (Smith & Nephew) was put upon the regrafting skin as fixation. In the control group, the donor site was only covered by Alleyvn (Smith & Nephew). Variables extracted included demographics, intra-operative data and post-operative outcomes. Vancouver scar scale (VSS) was used to evaluate scar condition in donor site in post-operative 3 months. Results: Twenty-six patients with 15 re-grafting versus 11 non-regraftingwere analyzed. Therewas a significantly shorter in the healing time of donor site in the re-grafting group than the non regrafting group (28.33 vs. 39.91, p = 0.03). All the parameters of VSSwere significant difference between regrafting versus non-regrafting groups, for the mean scores of vascularity (0.36 ± 0.34 vs. 1.64 ± 0.61, p < 0.01), pigmentation (0.52 ± 0.31 vs. 1.98 ± 0.44, p < 0.01), pliability (0.48 ± 0.26 vs. 1.49 ± 0.51, p < 0.01), height (0.23 ± 0.20 vs. 0.98 ± 0.39, p < 0.01). Conclusions: Compared with artificial dressing only, immediate regrafting of over-harvest skin on the donor site in STSG is a reliable method to provide faster healing time and better scar formation in the elderly. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of a 12-week board game intervention for seniors with mild cognitive impairment (MCI) in improving cognitive functioning and scores on the instrumental activities of daily living (IADL) scale. Methods: A single-blind randomized controlled trial was conducted to collect data from a long-term care facility in central Taiwan. Sixty-eight MCI seniorswere recruited and randomized into a board game group (trial group) and a health promotion group (control group). Participants in both groups received a 2-hour intervention once a week for 12 weeks, with the trial group receiving 12 weeks of board games and the control group receiving 12 weeks of health promotion activities. Before and after the intervention, the primary assessment was conducted using the Saint Louis University Mental Status Exam, Contextual Memory Test, and Trail Making Test part-A; the secondary assessment was conducted using the IADL scale. Results: The results of the primary assessment indicated that the participants in the trial group showed significant differences in immediate recall and delayed recall compared to the control group (p < 0.01). The results of the secondary assessment indicated that participants in the trial group differed significantly (p < 0.01) only on the item of using the telephone compared to the control group. Conclusions: Compared to the health-promoted MCI seniors, those who participated in the board game had significant improvements in memory (immediate recall and delayed recall), but not in IADL (except for using the telephone). [ABSTRACT FROM AUTHOR]

Background: Following acute ischemic stroke in patients with atrial fibrillation, the risk of stroke recurrence is relatively high. The purpose of this study is to determine the factors that influence the risk of recurrent stroke. Methods: In this registry-based prospective cohort study, we included patients with acute ischemic stroke and atrial fibrillation whowere admitted consecutively fromDecember 1, 2012, to December 31, 2016. Patients were divided into 2 groups based on stroke recurrence. We tried to identify factors predicting stroke recurrence and evaluate the impact of treatment on recurrent ischemic events. Results: A total of 511 patients (mean age, 76 years; 262 women) was analyzed. During the follow-up period, 58 patients (11.4%) had at least one ischemic event. The diameter of the left atrium in the recurrence group is larger (in millimeters) (39.6 ± 8.2 vs. 35.9 ± 6.9, p < 0.001), and is more likely to have left atrial enlargement (n = 32, 55.2% vs. n = 143, 31.6%, p = 0.001). Patients who received inappropriately low doses (n = 16, 27.6%) and who did not receive oral anticoagulation treatment (n = 25, 43.1%) were significantly higher in the recurrence group (p < 0.001). Surprisingly, the stroke severity at baseline in the recurrence group was less severe and the hospital stay was shorter. Conclusion: Our study suggests that patients who have left atrial enlargement and receiving inappropriate low dose or not receiving oral anticoagulant treatment were associated with increased risk of recurrent stroke in patients with atrial fibrillation. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore factors influencing Taiwanese older adults' end-of-life (EOL) care preferences. A cross-sectional questionnaire survey was conducted in 2 geriatric wards of a veterans' hospital. Fifty-five older adults aged 65 years or older were included. Structured questionnaires were used to collect data regarding demographic characteristics, EOL care preferences, stages of change for advance care planning behaviors, and reluctance to burden others. The study revealed that nearly 60% of the participants preferred to let their spouses, adult children, or health care professionals make the decisions. Furthermore, 83.6% of the participants lived with their family members and were moderately to severely disabled with a certain degree of dependence on their family members. Sex, independence, discussion of advance care planning with family members, and completion of advance directives were significantly correlated with EOL care preferences. The regression model showed that the participants' discussion of advance care planning with their family members influenced their EOL care preferences. The results demonstrate that family is an essential consideration for older adults choosing EOL care. Accordingly, because Chinese culture focuses on family harmony, improving communication between older adults and their family members is crucial for promoting advance care planning. [ABSTRACT FROM AUTHOR]

This study explores relationships between Taiwanese Sign Language (TSL) and Chinese reading comprehension with 65 deaf adults/youth (study 1: ages 14–50 years) and 27 deaf children (study 2: ages 6–13 years). Significant relationships were found between scores on two tests measuring TSL tasks. In study #1, the TSL tasks (measured by Taiwan Sign Language Comprehension Test, TSLCT) on story and syntax comprehension predicted more of the variance than vocabulary on Chinese reading comprehension. In study #2, TSL tasks measuring vocabulary (using Taiwanese Sign Language Receptive Skills Test, TSL-RST) predicted more of the variance than syntax and story comprehension on Chinese reading comprehension but were not significant. Results are interpreted utilising Cummins' Linguistic Interdependence Theory and Threshold Hypothesis. Limitations, future research and educational implications are provided. [ABSTRACT FROM AUTHOR]

Before 2010, guidelines recommended adenosine 6, 12, and a repeat dose of 12 mg for paroxysmal supraventricular tachycardia (PSVT). After 2010, these doses were reduced to two. This study aims to outline adenosine using trend from 2000 to 2012 in Taiwan emergency departments (EDs). This was an ecological study. PSVT were drawn from one million individuals of the National Health Insurance Database. The χ2 test was used to determine an association between different adenosine doses and other antiarrhythmic drugs (OADs), including verapamil, diltiazem, amiodarone, digoxin, and labetalol. There were 3361 PSVT visits from 2000 to 2012; 834 (24.8%) did not receive an antiarrhythmic drug, and 2527 (75.2%) did, either adenosine with/without OADs or OADs alone. The use of an OAD was significantly different between the adenosine 6–18 mg and 19 + mg groups. Most PSVT episodes converted with adenosine within 18 mg, and the success conversion rate was 62.2%. It could be up to 65.2% if they received more. Of the patients who did not have their PSVT reverted with< 18 mg, 37.8% could have been successfully treated with more doses. The necessity of using the 3rd dose of adenosine is needed to be further explored. [ABSTRACT FROM AUTHOR]

Importance: The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns' performance. Objective: To develop a pediatric occupational therapy–specific Mini-CEX and examine its psychometrics. Design: Stage 1 had a retrospective design; Stage 2 had a prospective design. Setting: Pediatric occupational therapy unit in a hospital in Taiwan. Participants: Thirty-four occupational therapy interns were evaluated with the Mini-CEX (physician version), and 57 were evaluated with the occupational therapy–specific Mini-CEX. Outcomes and Measures: The occupational therapy–specific Mini-CEX was developed with seven items on a 9-point scale categorized into three levels (unsatisfactory, satisfactory, highly satisfactory). Results: In Stage 1, the frequency of Mini-CEX (physician version) items receiving a rating of not applicable ranged from 1.9% to 88.1%. In Stage 2, the frequency of occupational therapy–specific Mini-CEX items receiving a rating of not applicable ranged from 3.5% to 31.6%. With the theme of evaluation taken into consideration, the frequency of not-applicable ratings was 0% to 8.8%. For the occupational therapy–specific Mini-CEX, content validity (item-level content validity index = 1, scale-level content validity index = 1) and internal consistency (Cronbach's α =.93) were excellent. The interns' scores on the second evaluation were significantly higher than those on their first evaluation, indicating good discriminant validity. Conclusions and Relevance: The occupational therapy–specific Mini-CEX appears to be reliable and valid, and it is appropriate for evaluating interns' skills and attitudes in pediatric occupational therapy practice. What This Article Adds: The results support the development of the occupational therapy–specific Mini-CEX and its application in pediatric internship training. The results of this study support the development of the occupational therapy–specific Mini-CEX and its application in evaluating interns' skills and attitudes in pediatric occupational therapy practice. [ABSTRACT FROM AUTHOR]

Background: Both Flexi-Bar and Multi-Component exercises can improve an individual's physical fitness and musculoskeletal discomfort. However, determining which is more effective in enhancing the physical fitness, and musculoskeletal discomfort of older adults remains controversial. Objective: This study aims to investigate differences in the effectiveness of Flexi-Bar and Multi-Component exercises in improving the frailty, physical fitness, and musculoskeletal discomfort of older adults after 12 weeks of intervention. Methods: A single-blind randomized controlled trial was conducted to collect data in central Taiwan. Participants were randomly assigned into a Flexi-Bar group (FB group) and a Multi-Component exercise group (MCE group). Participants in the FB group performed a 60-minute Flexi-Bar exercise every week for 12 consecutive weeks; participants in the MCE group performed a 60-minute Multi-Component exercise everyweek for 12 consecutiveweeks. Before and after the intervention, the assessmentwas conducted using the Kihon Checklist, Senior Fitness Test, and Nordic Musculoskeletal Questionnaire. Results: A total of 80 participants (16 males) were recruited (age = 75.7 ≥ 7.3 years). The results showed that the improvements of the FB group participants in the 2-minute step test, back scratch test, and number of body parts with discomfort were more significant than those of the participants in the MCE group. Conclusion: This study found that the cardiopulmonary function, upper body flexibility, and musculoskeletal discomfort of the FB group participants improved more significantly than those in the MCE group. This finding indicated that a Flexi-Bar exercise was a more effective intervention for older adults than a Multi-Component exercise. [ABSTRACT FROM AUTHOR]

Background: The use of statin has been encouraged in elderly high-risk patients; nevertheless, the prescription rates of statin have been shown to decline with age. Despite the current Taiwan lipid guidelines has been issued, the status for management of dyslipidemia among elderly high-risk patients in Taiwan remained unclear. The present study was aimed to investigate the prescription rates of highintensity statin (HIS)/ezetimibe and LDL-C goal attainment rates among elderly high-risk patients in a tertiary medical center. Methods: Between July 2018 and August 2019, 208 high-risk patients with suboptimal serum LDL-C levels, including 70 elderly patients (age ≥ 65 years) and 138 non-elderly patients (age < 65 years) received lipid-lowering therapy (LLT) and observation for a 12-month follow-up. The prescription rates of any statins/HIS/ezetimibe, the percentages of LDL-C reduction, and LDL-C goal attainment rates at 12-month follow-up were compared between elderly and non-elderly high-risk patients. Results: The serum LDL-C levels at baseline/12-month among elderly and non-elderly high-risk patients were respectively 128.8 ± 36.3/80.7 ± 46.3 and 138.5 ± 52.3/78.1 ± 37.0 mg/dL, with respectively LDL-C reductions of 34.1% and 39.6% at 12-month follow-up. The prescription rates of any statins/HIS/ezetimibe at 12-month follow-up in elderly and non-elderly high-risk patients were respectively 88.9%/68.3%/47.6% and 96.6%/72.7%/60.7%. The LDL-C goal attainment rates at 12-month follow-up in elderly and non-elderly high-risk patients were respectively 68.3% and 73.3%. All observed study outcomes were comparable between groups without significant statistical differences. Conclusion: Our findings highlight that the elderly high-risk patients in Taiwan received similar aggressive strategy of LLT with similar LDL-C attainment rates compared with non-elderly high-risk patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the prevalence of frailty and its associated factors among older patients (≥ 65 years) admitted to the hospital through the emergency room. Methods: This was a cross-sectional analytical study. The sample comprised 367 patients (≥ 65 years) admitted to various wards in King Saud University Medical City (KSUMC) between November 2020 and February 2021. The study adopted the FRAIL scale consisting of five domains (fatigue, resistance, ambulation, illness, and loss of weight). Results: The study showed that the prevalence rates of pre-frailty and frailty were 41.1%, and 51.8% respectively. In addition, there were significant differences between robust health, pre-frail, and frail older patients regarding age (p = 0.027), weight (p = 0.030), gender (p = 0.002), monthly income (p = 0.000), educational qualification (p = 0.001), history of medication (p = 0.024), and polypharmacy (p = 0.001). The results of the multivariate logistic regression revealed that older patients' age was a significant predictor of frailty among hospitalized old patients in KSUMC (p = 0.001). Conclusion: The study concluded that therewas a high prevalence rate of frailty among older patients (≥ 65 years) hospitalized in KSUMC. In addition, age was significantly associated with frailty among older patients. Further studies are needed to explore the impact on mortality and morbidity for frail patients admitted in various medical wards. [ABSTRACT FROM AUTHOR]

Background: Geriatric patients with COVID-19 have had poor clinical outcomes globally, especially during the first wave of the pandemic. In Taiwan, the first wave of the COVID-19 pandemic occurred from May to July 2021. This retrospective study aimed to compare the characteristics and outcomes between geriatric and younger patients with COVID-19 infection. Methods: A total of 257 confirmed COVID-19 cases who were hospitalized from May to June 2021 were included. Their characteristics and outcomes, including in-hospital mortality, use of mechanical ventilation, and hospital stay, were collected for analysis. Results: There were 98 elderly patients (aged ≥ 65 years, median, 72.5 (interquartile range, 69.0-78.0) years) and 159 younger patients (aged < 65 years, median 55.0 (46.0-60.0) years). The elderly patients had a significantly higher Charlson comorbidity score (4.0 (3.0-5.0) vs. 1.0 (1.0-2.0), p < 0.001), and significantly higher D-dimer, procalcitonin, ferritin, and creatinine levels, but lower albumin level than the younger patients. The elderly group also had higher in-hospital mortality (7.1% vs. 1.9%, p < 0.05), were more likely to develop severe disease (83.7% vs. 67.9%, p < 0.01), and had a longer hospital stay (15.0 (11.0-23.0) vs. 12.0 (9.0-16.5) days, p < 0.001). Nevertheless, the elderly patients did not have a higher risk of using high-flow nasal cannulas (17.3% vs. 15.1%, p = 0.63) or mechanic ventilation (23.5% vs. 17.0%, p = 0.20). Conclusion: Elderly COVID-19 patients had significant higher risks of severe disease, mortality, and longer duration of hospitalization, possible due higher rates of comorbidities and pro-inflammatory status. [ABSTRACT FROM AUTHOR]

Background: SARS-CoV-2 infection initially occurred in December 2019 and spread rapidly into a pandemic. The aims of this study were to assess the efficacy of measures taken to minimize intra-hospital transmission of COVID-19 at our hospital. Methods: An outdoor fever screening station and outdoor COVID-19 screening station were initially set up to isolate people with suspected COVID-19 infection from those within the hospital. Another outdoor outpatient department (OPD) was set up later in the pandemic for people visiting the hospital following 14 days of quarantine, during the next 15 to 30 days, or residents from high incidence areas. Rogers' model of diffusion of innovations was applied to the promotion of COVID-19 vaccination. Results: From 18March 2020 to 17 April 2020, 10 newly confirmed cases at our hospital were detected at the outdoor COVID-19 screening station, and no health careworkers (HCWs) in the hospital contracted COVID-19. From May 2021 to November 2021 during the outbreak in Taiwan, therewere 191 confirmed cases and 2 HCWs had COVID-19. Promoting COVID-19 vaccination led to 98.2% of employees receiving two doses by November 2021 and zero COVID-19 infection in HCWs fromJune to the end of November 2021. Conclusion: Having outdoor fever and COVID-19 screening stations and an "outdoor OPD" service to isolate patients suspected of or at risk of COVID-19 were effective strategies to minimize the risk of intra-hospital transmission. Promotion using Rogers' model resulted in nearly all employees receiving two doses of COVID-19 vaccine. [ABSTRACT FROM AUTHOR]

Importance: Theory of mind (ToM) and executive function (EF) are often used to explain social interaction deficits in children with autism spectrum disorder (ASD), but no behavioral studies have specifically examined their relationship. Objective: To investigate the cognitive correlates of social interaction in daily contexts by ToM as well as cool and hot EFs among children with ASD. Design: Cross-sectional study. Setting: Teaching hospitals, clinics, and developmental centers. Participants: One hundred thirty-two children with ASD and their caregivers. Outcomes and Measures: Measurements included the Vineland Adaptive Behavior Scales, Theory of Mind Task Battery, Dimensional Change Card Sort, and Children’s Gambling Task, respectively, for children’s daily social interaction, ToM, cool EF, and hot EF. Pearson’s correlation analyses and three hierarchical regression models were conducted to identify the significant predictors of daily social interaction while controlling for verbal comprehension, measured using the Verbal Comprehension Index (VCI) of two Wechsler scales. Results: ToM and cool EF were significant cognitive predictors of social interaction in daily contexts in children with ASD whose verbal comprehension was average or above average. Conclusions and Relevance: Our results suggest that ToM and cool EF are predictors of social interaction in daily contexts when considering children’s verbal comprehension. Hot EF was not a significant predictor, contrary to our hypothesis. This behavioral study fills a research gap by enhancing the understanding of important cognitive correlates of social interaction in daily contexts for children with ASD to improve evaluation and intervention planning with this population. What This Article Adds: This study identified two cognitive predictors, ToM and cool EF, of social interaction in daily contexts for children with ASD. In addition to verbal comprehension, occupational therapy practitioners should assess ToM and cool EF to inform more comprehensive evaluation and intervention planning to improve social interaction in daily contexts for children with ASD. [ABSTRACT FROM AUTHOR]

Importance: The Brief Pain Inventory (BPI) is one of the most widely used measures to assess pain and related impacts among patients with low back pain (LBP). However, its test–retest reliability and minimal detectable change (MDC) have rarely been examined in patients with LBP, interfering with its utility. Objective: To investigate the test–retest reliability and MDC of the BPI among patients with LBP. Design: Repeated assessments design with a 1-wk interval. Setting: Department of Physical Medicine and Rehabilitation in a hospital in Taiwan. Participants: Fifty-four patients with stable LBP conditions. Outcomes and Measures: The BPI has two subscales—Intensity and Interference—that assess pain intensity and pain interference, respectively. Their test–retest reliability was examined using the intraclass correlation coefficient (ICC), and MDCs were calculated. Results: The ICCs of the Intensity and Interference subscales were.62 and.76, respectively. The MDC values for the two subscales were 2.57 and 2.34, respectively. For the four Intensity items, the average-pain score had a higher ICC (.60) than scores on the other items (worst, least, and current pain, which had ICCs of about.40). Conclusions and Relevance: The results suggest that although the BPI is a commonly used measure of pain intensity and pain interference among patients with LBP, caution should be exercised in interpreting the Intensity subscale score and its item scores. What This Article Adds: The BPI is widely used to assess pain and related impacts on daily occupation and functioning among patients with LBP. This study provides information regarding its test–retest reliability. Moreover, the MDC values provide clinicians and researchers with the thresholds for determining real improvement (beyond random measurement error). Although the Brief Pain Inventory is a commonly used pain intensity and pain interference measure for patients with low back pain, this study suggests that caution should be exercised in interpreting the Intensity subscale score and its item scores. [ABSTRACT FROM AUTHOR]

Importance: A child's independent mobility, environments, and mastery motivation are critical factors during early development. Objective: To examine the effectiveness of ride-on car (ROC) training with a standing (ROC–Stand) or a sitting posture (ROC–Sit) in enhancing children's mastery motivation and decreasing parenting stress levels. Design: Randomized controlled trial (RCT) with a multiple pretest–posttest design. Setting: Hospital-based environment in northern Taiwan. Participants: Thirty-nine children with disabilities ages 1 to 3 yr were randomly assigned to ROC–Stand (n = 16), ROC–Sit (n = 12), or conventional therapy (control; n = 11). All groups received 2-hr training sessions two times a week for 12 wk and then a 12-wk follow-up period that involved only regular therapy. Measures: Assessments included the Revised Dimensions of Mastery Questionnaire–Chinese version and the Parenting Stress Index. Results: All groups showed significant changes in social persistence with adults, mastery pleasure, and general competence after the intervention. The two ROC training groups showed a significantly greater decrease in parenting stress than the control group. In addition, increased general competence of the ROC–Stand group also strongly correlated with decreased parent–child dysfunctional interaction. Conclusions and Relevance: This RCT verifies the effectiveness of ROC training and offers a novel approach to increase children's mastery motivation and decrease parenting stress. What This Article Adds: Providing a large amount of active, exploratory experiences with goal-directed, moderately challenging tasks and cooperation with caregivers may result in the greatest benefits to young children with motor disabilities. This study supports the effects of ride-on car training with conventional therapy to improve mobility, psychosocial function, and play performance of young children with motor disabilities. [ABSTRACT FROM AUTHOR]

Background: Recurrent falls are more likely to cause injuries and disabilities than single falls. Purpose: This study investigated the incidence and risk factors of recurrent falls among inpatients. Methods: We analyzed inpatient fall data from the anomaly event notification database and electronic medical records of a hospital. We collected data regarding 1059 inpatients who had fallen during their hospital stay. Among these inpatients, 390 (36.83%) had fallen within the previous year. Results: Inpatients in the orthopedics and neurology wards were at a higher risk of recurrent falls than those in surgical wards; inpatients who were physically dependent were at a higher risk of recurrent falls than those who were physically independent; inpatients with poor vision were at a lower risk of recurrent falls than those without this issue; and inpatients who were using antidepressants were at a higher risk of recurrent falls than those who were not using antidepressants. Conclusion: The risk of recurrent falls is highly correlated with ward type, physical independence, self-perceived good vision, and use of antidepressants. [ABSTRACT FROM AUTHOR]

This pilot study investigated a manualized lifestyle-based intervention, Physically Active Lifestyle Modification (PALM) program, designed to increase physical activity in the daily life routines of Taiwanese older adults and improve their quality of life. Thirty older adults who attended a Senior Citizens Learning Camp in Taiwan participated in the program. Quantitative measures and qualitative interviews were employed to study the intervention's effect on quality of life and to capture participants' subjective experiences in the program. Results revealed significant improvement in both physical and mental component summary of the RAND 36-Item Short Form Health Survey. Interview data revealed 4 key themes: change in action, self-awareness of occupational pattern, acquisition of health information, and social participation. [ABSTRACT FROM AUTHOR]

Importance: Caregiver rating scales often give an unclear picture of the actual self-care performance of preschool children with autism spectrum disorder (ASD). Objective: To assess self-care performance among preschool children with ASD using two standardized instruments. Design: Cross-sectional study. Setting: Clinics, hospitals, and early intervention centers in Tainan, Taiwan. Participants: Sixty children with ASD (ages 48–71 mo). Outcomes and Measures: The Standard Version of the Childhood Autism Rating Scale–Second Edition, the Assessment of Motor and Process Skills (AMPS), and the Chinese version of the Pediatric Evaluation of Disability Inventory (PEDI–C). Results: About 53.3% of children with ASD scored below 1.5 logits for AMPS motor skills and below 1 logit for AMPS process skills, indicating difficulties performing activities of daily living tasks. The average PEDI–C self-care normative standard scores were moderately low (between −1 and −2 SDs), indicating poor self-care performance. The correlations between the two measures were also low (rs =.27–.44). Overall, the results for 36 children were consistent with AMPS and PEDI–C scores; however, those for 24 children (40.0%) were discrepant. Conclusions and Relevance: These findings have implications for how preschool children with ASD perform their self-care activities and suggest that more than half of preschool children with ASD have a need for occupational therapy interventions that target self-care skills. Occupational therapy practitioners can work with preschool children with ASD and their families to help them improve their self-care performance. What This Article Adds: Many children with ASD need occupational therapy interventions that target self-care skills. Both the AMPS and the PEDI–C provide valuable information from different perspectives on the self-care performance of preschool children with ASD. The findings from this cross-sectional study have implications for how preschool children with ASD perform their self-care activities and suggest that more than half of preschool children with ASD have a need for occupational therapy interventions that target self-care skills. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether age plays a crucial role in the oral cancer prognosis. We aimed to compare the clinicopathological parameters, outcomes, and trends of patients aged ≥ 65 years (middle age, MA) and <65 years (old age, OA) with oral squamous cell carcinoma (OSCC). Methods: Data of 862 OSCC patients who underwent surgery at the Taipei MacKay Memorial Hospital between 1997 and 2017 were obtained. The patients were divided into MA and OA groups. Tumor size, nodal invasion, tumor location, radiotherapy status, pathological features, and prognosis were compared. The chi-square test was used for statistical analysis. We calculated the hazard ratios and 95% confidence intervals of all-cause mortality risk between the two groups. Results: Significant differences were noted in sex, tumor location, and survival rate between the groups. Sex, late-stage cancer, positive nodal invasion, and moderate differentiation significantly increased the mortality risks in the OA group compared to those in the MA group. In addition, OA group patients without diabetes mellitus (DM), perineural invasion, lymphovascular invasion, recurrence, secondary primary cancer, and distant metastases also showed a higher mortality risk than other patients. Conclusion: Aging could be a predictive prognostic factor for OSCC, particularly for tumor location and survival rate. Radiotherapy after surgery could increase the survival rate of OA patients with nodal invasion. [ABSTRACT FROM AUTHOR]

• Obesity exhibits various phenotypes and may have various effects on cancer risk. • We defined metabolic healthy obesity using the stricter criteria. • Metabolic healthy obesity may cause a modest increase in the risk of cancer. Many cancers are caused by overweight; however, cancer risk varies among individuals with obesity. Few studies are addressing the relationship between metabolic obesity phenotypes and cancer. This study investigates the association between metabolically healthy overweight (MHOW) or metabolically healthy obesity (MHO) and cancer incidence. In a nationwide, representative community-based prospective cohort study, 5734 Taiwanese adults were classified into eight phenotypes according to body mass index (underweight <18.5; normal weight 18.5–23.9; overweight 24–26.9; and obese ≥27 kg/m2) and metabolic status (healthy/unhealthy). Participants with healthy cardiometabolic blood profiles included in the metabolic syndrome criteria and an absence of hypertension, diabetes, and hyperlipidemia were considered metabolically healthy. We used the Cox proportional hazards models to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (95% CI). During 73,389 person-years of follow-up, 428 incident cancers were identified. Compared to the participants with metabolically healthy normal weight, participants with MHOW (adjusted HR 1.39, 95% CI, 0.90–2.13) or MHO (adjusted HR 1.07, 95% CI, 0.51–2.22) had a tendency toward a higher risk of cancer. These associations were stronger in MHOW (adjusted HR 1.77, 95% CI, 1.09–2.86) or MHO (adjusted HR 1.39, 95% CI, 0.66–2.93) participants younger than 65 years. This study was the first to investigate the impact of metabolic obesity phenotype on the incidence of cancer in the Taiwanese population. Even in the absence of metabolic abnormalities, overweight, and obesity may cause a modest increase in the risk of developing cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: The role of end-expiratory lung volume (EELV) during a spontaneous breathing trial (SBT) in patients who were tracheostomized and on prolonged mechanical ventilation is unclear. This study aimed to assess EELV during a 60-min SBT and its correlation with weaning success. METHODS: Enrolled subjects admitted to a weaning unit were measured for EELV and relevant parameters before and after the SBT. RESULTS: Of the 44 enrolled subjects, 29 (66%) were successfully liberated, defined as not needing mechanical ventilation for 5 d. The success group had fewer subjects with chronic kidney disease (41% vs 73%, P = .044), stronger mean ± SD maximum inspiratory pressure (41.6 ± 10.4 vs 34.1 ± 7.1 cm H2O; P = .02) and mean ± SD maximum expiratory pressure (46.9 ± 11.7 vs 35.3 ± 16.9 cm H2O; P = .01) versus the failure group. Toward the end of the SBT, the success group had a significant increase in the mean ± SD EELV (before vs after: 1,278 ± 744 vs 1,493 ± 867 mL; P = .040) and a decrease in the mean ± SD rapid shallow breathing index (83.8 ± 39.4 vs 66.3 ± 29.4; P = .02), whereas there were no significant changes in these 2 parameters in the failure group. The Cox regression analysis showed that, at the beginning of SBT, a greater difference between EELV with a PEEP of 0 cm H2O and with a PEEP of 5 cm H2O was significantly correlated to a higher likelihood of weaning success. Toward the end of the SBT, a greater EELV level at a PEEP of 0 cm H2O was also correlated with weaning success. Also, the greater difference of EELV at a PEEP of 0 cm H2O between the beginning and the end of the SBT was also correlated with a shorter duration to weaning success. CONCLUSIONS: The change in EELV during a 60-min SBT may be of prognostic value for liberation from prolonged mechanical ventilation in patients who had a tracheostomy. Our findings suggest a model to understand the underlying mechanism of failure of liberation from mechanical ventilation in these patients. [ABSTRACT FROM AUTHOR]

• English as a neutral language could be a language of connecting and/or excluding. • Mandarin was used as a language for converging and connecting. • Vietnamese as a language of divergence became a language of connecting. • Accommodation to others often came from international students. • Accommodation should also come from local students and internationalised universities. This study examines Vietnamese students' experiences of language choice practices in intercultural interactions with their local Taiwanese peers. Data were gathered from semi-structured interviews with students from five different Taiwanese universities where both English and Mandarin Chinese are used as mediums of instruction and communication. Findings suggest that the students frequently used English as a language of neutrality to communicate with local students, which either connected them with or disconnected them from their peers. They, whereas, considered Mandarin as a language of convergence, which helped them to get closer to their Taiwanese friends. They also occasionally made use of Vietnamese—a language of divergence—to a small extent to connect with their local peers. As international students seem to be the ones who often put more effort into addressing the linguistic and cultural gaps and improving the communication effectiveness compared with their local counterparts, it is recommended that local students should play a more proactive role in using proper accommodation strategies to connect with international students. Internationalised universities should also contribute to building a healthy and inclusive intercultural environment for international and local students and facilitating respectful and effective intercultural interactions among them. [ABSTRACT FROM AUTHOR]

Background: Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery. Objective: The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing. Methods: The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22. Results: Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (β = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP. Conclusions: Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management. [ABSTRACT FROM AUTHOR]