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The coronavirus disease 2019 (COVID-19) pandemic has had substantial impacts, including disruptions in routine vaccinations. In Taiwan, COVID-19 was relatively controllable, and the reduction in routine vaccinations was not profound. The impact of the pandemic on vaccination remained unclear. We collected vaccination uptake data at our hospital and analyzed the weekly trends of different vaccines. We calculated the monthly number of vaccinations and compared consumption before and during the COVID-19 pandemic (year 2019 vs years 2020 and 2021). Except for self-paid pneumococcal conjugate vaccines (PCV13), a mild (14.6%

Objectives The purpose of this study is to determine the relationship between depressive symptoms and nutritional status in the frail older adults. Methods This study uses a cross-sectional, descriptive, and correlational design. A questionnaire was used to collect demographic data, and the Taiwan International Physical Activity Questionnaire Form Geriatric Depression Scale-Short Form Charlson Comorbidity Index, and Mini-Nutritional Assessment Short-Form were used to measure depression and nutritional status, respectively. Data were analyzed by independent-t tests, chi-square tests, spearman correlations, and multiple linear regressions. Results Of the total of 94 frail older adults, 17 (18.09%) had depressive symptoms (GDS > 5). The average MNA-SF score was 11.38 (SD = 2.45), 31 (32.98%) participants had a risk of malnutrition and 12 (12.77%) were malnourished. Participants’ reports of dissatisfaction with their lives (72.1%) and feeling terrible about their lives (58.14%) were associated with a risk of malnutrition. Elderly age, multiple comorbidities, and high level of depressive symptoms were at increased risk of malnutrition. Conclusion When clinicians are faced with a high-risk group, such as elderly patients with multiple comorbidities and depressive symptoms, they should perform an immediate assessment of nutritional status. If a risk of malnutrition is found, adequate nutrition and health care should be provided.

With the increasing competition in contemporary enterprise, sustainable human resource management is a powerful resource for workplace mental health. On the basis of job demands-recourses theory and conservation of resources theory, this study examined the relationship between empowering leadership and employees’ proactive work behavior. It also explored how job design inspires employees to be embedded in their work and to exhibit proactive work behavior. In addition, the research probed the mediating roles of job characteristics and job embeddedness in a serial mediation model within an integrated model. Data were collected from 461 employees of three- to five-star hotels through stratified random sampling. Results indicated that (1) empowering leadership has positive influences on job characteristics and proactive work behavior, (2) job characteristics have a positive influence on job embeddedness, (3) job embeddedness has a positive influence on proactive work behavior, (4) job characteristics mediate the effect of empowering leadership on proactive work behavior, (5) job embeddedness mediates the effect of empowering leadership on proactive work behavior, and (6) job characteristics and job embeddedness jointly mediate the effect of empowering leadership on proactive work behavior by bootstrapping analyses. Accordingly, this study suggests that promoting sustainable human resource management is needed for human health and organizational value at work, both of which enable empowering leadership to improve proactive work behavior via job characteristics and job embeddedness. The theoretical and managerial implications of empirical findings are also discussed.

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

BACKGROUND A combination of physical and cognitive training appears to be the effective intervention to improve cognitive function in older adults with mild cognitive impairment (MCI). Computing technology such as virtual reality (VR) may have the potential to assist rehabilitation in shaping brain health. However, little is known about the potential of VR-based physical and cognitive training designed as an intervention for cognition and brain activation in elderly patients with MCI. Moreover, whether a VR program designed around functional tasks can improve their instrumental activities of daily living (IADL) requires further investigation. AIM This study investigated the effects of 12 weeks of VR-based physical and cognitive training on cognitive function, brain activation and IADL and compared the VR intervention with combined physical and cognitive training. DESIGN A single-blinded randomized controlled trial. SETTING Communities and day care centers in Taipei, Taiwan. POPULATION Older adults with mild cognitive impairment. METHODS Thirty-four community-dwelling older adults with MCI were randomized into either a VR-based physical and cognitive training (VR) group or a combined physical and cognitive training (CPC) group for 36 sessions over 12 weeks. Participants were assessed for their cognitive function (global cognition, executive function and verbal memory) and IADL at pre- and postintervention. Changes in prefrontal cortex activation during the global cognition test were also captured by functional near-infrared spectroscopy (NIRS) to identify the potential mediating pathway of the intervention. RESULTS Both groups showed improved executive function and verbal memory (immediate recall). However, only the VR group showed significant improvements in global cognition (P

Background Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. Methods We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. Results Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). Conclusions The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.

Background. The model of interhemispheric competition after stroke has been established for the upper but not for the lower extremity. Repetitive transcranial magnetic stimulation (rTMS) of the brain has been shown to modulate cortical excitability. Objective. The purpose of this study was to investigate the effects of rTMS followed by task-oriented training on cortical excitability and walking performance in individuals with chronic stroke. Methods. A total of 24 patients with average Fugl-Meyer lower limb scores of 17.88 ± 5.27 and average walking speeds of 63.81 ± 18.25 cm/s were randomized into an experimental group and a control group. Participants received rTMS (experimental group) or sham rTMS (control group) followed by task-oriented training (30 minutes) for 10 sessions over 2 weeks. Repetitive TMS was applied at a 1-Hz frequency over the leg area of the motor cortex of the unaffected hemisphere for 10 minutes. Outcomes, including motor-evoked potential (MEP), lower-extremity Fugl-Meyer score, and gait performance, were measured before and after training. Results. Decreased interhemispheric asymmetry of the amplitude of the MEP was noted after rTMS and task-oriented training. Improvement in spatial asymmetry of gait was comparable with increased symmetry in interhemispheric excitability. Motor control and walking ability were also significantly improved after rTMS and task-oriented training. Conclusions. rTMS enhances the effect of task-oriented training in those with chronic stroke, especially by increasing gait spatial symmetry and corticomotor excitability symmetry.

BACKGROUND: Falls are a major problem for people with Parkinson's disease (PD). Many studies indicate that more than 50% of people with PD have difficulty in turning that may lead to falls during daily activities. The aims of this study were to identify the relationship between turning performance and falls, and to determine the factors that influence turning performance. METHODS: This study examined 45 patients with idiopathic PD (Hoehn and Yahr stage 1-3) using a battery of tests, including 180° turn time, balance, and muscle strength. The levels of disease severity and freezing of gait were also measured. The number of falls in the past 6 months was recorded. RESULTS: Sixteen out of forty-five participants experienced falls in the past 6 months. A receiver operating characteristic curve showed that turn time was highly related to falls [more affected side: sensitivity = 0.81, specificity = 0.79, area under the curve (AUC) = 0.83; less affected side: sensitivity = 0.88, specificity = 0.76, AUC = 0.83]. The most important factor influencing turn time was balance ability (both sides: p = 0.000) according to the regression model. Correlations between turn time and dynamic balance were further established with reaction time, movement velocity, endpoint excursion, and maximal excursion of the LOS (limits of stability) test. CONCLUSION: The time needed to complete a 180° turn during the SQT (step/quick turn) test is a good index to differentiate fallers from non-fallers in persons with PD. Turn time is most influenced by balance. Furthermore, balance control, especially in an anterior or sideways direction, is important for turning performance. Language: en