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Objectives: Long sleep duration predicts adverse health outcomes in older adults. Impaired cardiac autonomic control (CAC) is a potential pathomechanism that links this relationship; however, the causal relationship between long sleep duration and CAC remains unclear. This study aimed to determine the temporal relationship between long sleep duration and poor CAC. Methods: This is a community‐based, fixed‐cohort, follow‐up study that recruited community‐dwelling older adults aged ≥ 65 years. Self‐reported sleep duration was categorized as short (≤ 5 h), mid‐range (6–7 h), and long (≥ 8 h). Participants with short or long sleep duration were defined as cases. CAC was measured using heart rate variability (HRV), and cases were classified using cutoffs defined by the lowest quintiles of four HRV parameters. Non‐case participants for sleep duration or CAC at baseline were followed. Binary and multinomial logistic regression analyses were conducted to examine baseline variables that predicted incident CAC decline and changes in sleep duration, respectively. Results: A total of 772 individuals were recruited, with a mean follow‐up period of 5.8 ± 1.7 years. In multivariable analyses, long sleep duration at baseline predicted a higher risk of cardiac vagal control decline in the follow‐up visit (odds ratio: 1.86, 95% confidence interval: 1.00–3.44). Conversely, all HRV parameters at baseline failed to predict changes in sleep duration at the follow‐up visit. Conclusions: Long sleep duration seems to precede the decline in CAC in community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Aim: To assess heart rate variability (HRV) as a measure to assess job stress and sleep quality among nurses in the post‐COVID‐19 period. Background: The COVID‐19 pandemic significantly affected nurses, with heightened job stress and impaired sleep quality impacting their well‐being and effectiveness in patient care. HRV could offer insights for supporting strategies in the pandemic aftermath. Design: A quantitative cross‐sectional study. Methods: This study involved 403 clinical nurses recruited from a teaching hospital in Taiwan. Data on job stress, work frustration, sleep quality and HRV were collected and analysed. Results: Among the nurses surveyed during the COVID‐19 pandemic, 72.7% reported poor sleep quality (PSQI = 9.369). Job stress emerged as a strong predictor of work frustration. High stress levels and poor sleep quality were correlated with significantly decreased HRV, indicating a potential physiological impact of stress on the nurses' health and well‐being. Conclusions: HRV is a valuable and cost‐effective measure for monitoring and managing nurses' well‐being in the post‐COVID‐19 era. Targeted interventions can be implemented to support nurses' overall performance and promote their well‐being by identifying those at high risk of job stress and poor sleep quality. Summary statement: What is already known about this topic? The COVID‐19 pandemic significantly impacted medical care capacity, leading to heightened physical and mental distress among frontline nurses. This has resulted in a marked increase in job stress, presenting a significant challenge to occupational health.The substantial changes in the medical environment caused by the pandemic are likely to induce job stress, which, in turn, can detrimentally affect sleep quality. This aspect is crucial, as sleep quality is a key determinant of nurses' ability to deliver optimal medical care to patients. What this paper adds? Job stress significantly impacts nurses' sleep quality and is a key predictor of work frustration, surpassing the sole influence of work frustration.The study highlights a significant link between high stress levels, reduced sleep quality and decreased heart rate variability in nurses. It further reveals that nurses with moderate COVID‐19‐related anxiety show heightened heart rate variability, indicating sympathetic nervous system activation to maintain alertness in emergency medical situations. The implications of this paper: Moderate anxiety as a positive factor: moderate levels of anxiety among nurses can contribute to maintaining alertness, reducing errors and lowering the risk of contracting COVID‐19.HRV as a monitoring and management measure: heart rate variability is a valuable and cost‐effective measure for monitoring and managing the health of nurses in the post‐COVID‐19 era. By identifying nurses with high work stress and poor sleep quality, targeted interventions can be implemented to support their overall performance and promote their well‐being.Targeted interventions for improved well‐being: the implementation of specific interventions aimed at supporting nurses' overall performance and enhancing their well‐being is crucial in maintaining a high standard of patient care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiopulmonary exercise testing (CPET) is a unique diagnostic tool that assesses the functional capacity of the heart, lungs, and peripheral oxidative system in an integrated manner. However, the clinical utility of CPET for evaluating interstitial lung disease (ILD) remains uncertain. The objective of this study was to determine the predictive value of CPET for mortality in subjects with ILD. METHODS: We prospectively enrolled subjects with ILD who underwent CPET at a tertiary medical center in Taiwan and followed up their survival status for 12 months. Mortality prediction was based on comparing CPET parameters between subjects who survived and those who died. We further analyzed CPET parameters that showed significant differences using receiver operating characteristic curves to identify their optimal cutoff values. RESULTS: A total of 106 newly diagnosed subjects with ILD underwent CPET, and the 1-y mortality rate was 7.5%. Six CPET variables were found to be significant predictors of mortality: peak oxygen consumption, oxygen pulse, end-tidal partial pressure of carbon dioxide, heart rate recovery 1 min after CPET, minute ventilation to carbon dioxide output slope, and functional aerobic impairment. We calculated a summed score by adding the number of CPET variables that exceeded their cutoff values. Subjects with a summed score of 6 had a 1-y survival rate of only 25%, whereas subjects with scores of 0-5 had a survival rate of 98%. CONCLUSIONS: In conclusion, the summed score represents a useful tool for screening patients with ILD who can undergo a CPET to determine their prognosis. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common sustained atrial arrhythmia. Accurate detection of the timing and possibility of AF termination is vital for optimizing rhythm and rate control strategies. The present study evaluated whether the ventricular response (VR) in AF offers a distinctive electrocardiographic indicator for predicting AF termination. Methods: Patients experiencing sustained paroxysmal AF for more than 3 h were observed using 24‐h ambulatory Holter monitoring. VR within 5 min before AF termination (VR 0–5 min, BAFT) was compared with VR observed during the 60th to 65th min (VR 60–65 min, BAFT) and the 120th to 125th min (VR 120–125 min, BAFT) before AF termination. Maximum and minimum VRs were calculated on the basis of the average of the highest and lowest VRs across 10 consecutive heartbeats. Results: Data from 37 episodes of paroxysmal AF revealed that the minimum VR0–5 min, BAFT (64 ± 20 bpm) was significantly faster than both the minimum VR120–125 min, BAFT (56 ± 15 bpm) and the minimum VR60–65 min, BAFT (57 ± 16 bpm, p <.05). Similarly, the maximum VR0–5 min, BAFT (158 ± 49 bpm) was significantly faster than the maximum VR120–125 min, BAFT (148 ± 45 bpm, p <.05). In the daytime, the minimum VR0–5 min, BAFT (66 ± 20 bpm) was significantly faster than both the minimum VR60–65 min, BAFT (58 ± 17 bpm) and minimum VR120–125 min, BAFT (57 ± 15 bpm, p <.05). However, the mean and maximum VR0–5 min, BAFT in the daytime were similar to the mean and maximum VR120–125 min in the daytime, respectively. At night, the minimum, mean, and maximum VR0–5 min, BAFT were similar to the minimum, mean, and maximum VR120–125 min, respectively. Conclusions: Elevated VR rates during AF episodes may be predictors for the termination of AF, especially during the daytime and in patients with nondilated left atria. These findings may guide the development of clinical approaches to rhythm control in AF. [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]

Objective: This study aimed to examine the effects of binaural beat music (BBM) on sleep quality, heart rate variability, and depression in older people with poor sleep quality in a long‐term care institution. Methods: A single‐blind randomized controlled trial design was employed, and 64 older participants with poor sleep quality were recruited from a long‐term care institution in Taiwan. Participants were randomized into the BBM group or control group and received 14 days of intervention. During the intervention period, participants in the experimental group listened to 20 min of Taiwanese Hokkien oldies embedded with BBM once in the morning and afternoon three times a week. Participants in the control group only listened to Taiwanese Hokkien oldies. Questionnaires and heart rate variability analysis were used to assess participants' sleep quality, heart rate variability, and depressive symptoms. Results: Significant improvements were observed in sleep quality, along with an increase in heart rate variability means of heart rate and normal sinus beats, and a decrease in low‐frequency normalized units and depression severity in the BBM group after the intervention. In the control group, effects on sleep quality were inconsistent, heart rate variability showed significant improvements in some autonomic nervous function regulation, and depression severity was significantly decreased. Furthermore, the BBM group showed a significant improvement in sleep quality and a significant reduction in sympathetic nervous activity compared with the control group. Conclusion: This study demonstrates that 14 days of BBM intervention, a non‐invasive intervention, could improve sleep quality and depression in older people with poor sleep quality in long‐term care institutions. Geriatr Gerontol Int 2024; 24: 297–304. [ABSTRACT FROM AUTHOR]

Objectives. Current approaches via physiological features detecting aberrant driving behaviour (ADB), including speeding, abrupt steering, hard braking and aggressive acceleration, are developing. This study proposes using machine learning approaches incorporating heart rate variability (HRV) parameters to predict ADB occurrence. Methods. Naturalistic driving data of 10 highway bus drivers in Taiwan from their daily routes were collected for 4 consecutive days. Their driving behaviours and physiological data during a driving task were determined using a navigation mobile application and heart rate watch. Participants' self-reported data on sleep, driving-related experience, open-source data on weather and the traffic congestion level were obtained. Five machine learning models - logistic regression, random forest, naive Bayes, support vector machine and gated recurrent unit (GRU) - were employed to predict ADBs. Results. Most drivers with ADB had low sleep efficiency (≤ 80%), with significantly higher scores in driver behaviour questionnaire subcategories of lapses and errors and in the Karolinska sleepiness scale than those without ADBs. Moreover, HRV parameters were significantly different between baseline and pre-ADB event measurements. GRU had the highest accuracy (81.16-84.22%). Conclusions. Sleep deficit may be related to the increased fatigue level and ADB occurrence predicted from HRV-based models among bus drivers. [ABSTRACT FROM AUTHOR]

Restorative landscapes provide people with the opportunity to experience nature. This pilot study aimed to determine whether cultural differences affect psychological and physiological responses to restorative landscapes. Two populations, one in Taiwan and one in Sweden, were experimentally compared by showing them photos of restorative landscapes from each country. The results showed that restorativeness was affected more by photos of the restorative landscape in Sweden than in Taiwan. The results showed that restorativeness in terms of psychological and physiological responses was affected. A significant variation in heart rate was observed between the populations: Taiwanese participants experienced higher heart rates when viewing unfamiliar and novel scenery when compared to Swedish participants. No significant differences between the populations were observed regarding attention capacity, working memory, and muscle tension. The psychological and physiological responses to the two countries' distinctive restorative landscapes may have implications for designing such landscapes in urban green spaces. [ABSTRACT FROM AUTHOR]

(1) Background: Snoring is a cardinal symptom of obstructive sleep apnea (OSA) and has been suggested to potentially increase sympathetic activity. On the other hand, sleep itself usually leads to a decrease in sympathetic activity. Heart rate variability (HRV) analysis is a non-invasive technique used to assess autonomic nervous system function. However, there is limited research on the combined impact of sleep and snoring on sympathetic activity in individuals with OSA, particularly during the first hour of sleep (non-rapid eye movement sleep). The current study aims to investigate the net effect of sleep and snoring on sympathetic activity and explore factors that might contribute to increased sympathetic activity in individuals with OSA during the first hour of sleep. (2) Methods: The participants were referred from the outpatient department for OSA diagnosis and underwent whole-night polysomnography (PSG). Electrocardiogram (EKG) data from the PSG were downloaded for HRV analysis. HRV measurements were conducted in both the time and frequency domain, including the root mean square of successive differences between normal heartbeats (RMSSD) and the ratio of the absolute power of the low-frequency (LF) band (0.04–0.15 Hz) to the absolute power of the high-frequency (HF) band (0.15–0.4 Hz) (LF/HF ratio), respectively. (3) Results: A total of 45 participants (38 men and 7 women) were included in the analysis. The RMSSD gradually increased from 0–5 min to 50–60 min (p = 0.024), while the LF/HF ratio decreased (p < 0.001) during the first hour of sleep (non-rapid eye movement sleep). The LF/HF ratios of the "S" (snoring) episodes were compared with those of the pre-S episodes. An elevated LF/HF ratio during the S episode was associated with the first snoring episode occurring more than 20 min after lying down to sleep (Odds ratio, OR = 10.9, p = 0.004) and with patients diagnosed with severe OSA (OR = 5.01, p = 0.045), as determined by logistic regression. (4) Conclusions: The study observed an increase in the value of RMSSD and a decrease in the value of the LF/HF ratio during the first hour of sleep for patients with OSA. Higher LF/HF ratios were associated with the first occurrence of snoring while lying down for more than 20 min and with patients with severe OSA. [ABSTRACT FROM AUTHOR]

Fatigue is a prevalent subjective sensation, affecting both office workers and a significant global population. In Taiwan alone, over 2.6 million individuals—around 30% of office workers—experience chronic fatigue. However, fatigue transcends workplaces, impacting people worldwide and potentially leading to health issues and accidents. Gaining insight into one's fatigue status over time empowers effective management and risk reduction associated with other ailments. Utilizing photoplethysmography (PPG) signals brings advantages due to their easy acquisition and physiological insights. This study crafts a specialized preprocessing and peak detection methodology for PPG signals. A novel fatigue index stems from PPG signals, focusing on the dicrotic peak's position. This index replaces subjective data from the brief fatigue index (BFI)-Taiwan questionnaire and heart rate variability (HRV) indices derived from PPG signals for assessing fatigue levels. Correlation analysis, involving sixteen healthy adults, highlights a robust correlation (R > 0.53) between the new fatigue index and specific BFI questions, gauging subjective fatigue over the last 24 h. Drawing from these insights, the study computes an average of the identified questions to formulate the evaluated fatigue score, utilizing the newfound fatigue index. The implementation of linear regression establishes a robust fatigue assessment system. The results reveal an impressive 91% correlation coefficient between projected fatigue levels and subjective fatigue experiences. This underscores the remarkable accuracy of the proposed fatigue prediction in evaluating subjective fatigue. This study further operationalized the proposed PPG processing, peak detection method, and fatigue index using C# in a computer environment alongside a PPG device, thereby offering real-time fatigue indices to users. Timely reminders are employed to prompt users to take notice when their index exceeds a predefined threshold, fostering greater attention to their physical well-being. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between bedtime and cardiac autonomic function in older adults. This cross-sectional study included community-dwelling older adults aged ≥ 65 years. Self-reported bedtime was categorized as early (< 21:30), intermediate (21:30–22:30), and late (> 22:30). Cardiac autonomic function was evaluated by HRV. The lowest tertiles for each HRV parameter were defined as unhealthy indicators. A total of 3,729 individuals participated, with mean age of 76.3 ± 6.6 years. After controlling for various covariates, late bedtime was associated with a lower risk for unhealthy total power [Odds ratio (OR) = 0.74; 95% confidence interval (CI) = 0.59–0.93] and low frequency power (OR = 0.69, 95% CI = 0.55–0.87) than intermediate bedtime. In contrast, early bedtime was correlated with a higher risk of poor total power (OR = 1.23, 95% CI: 1.05–1.45) and high frequency power (OR = 1.18, 95% CI = 1.00–1.39). When further specifying sleep duration and physical disability into the regression models, the inverse association between late bedtime and unhealthy HRV remained; however, the association between early bedtime and HRV disappeared. Accordingly, we concluded that in terms of cardiac autonomic function, early bedtime in older adults is not necessarily beneficial for their health outcomes, whereas late bedtime may not be detrimental. Abbreviations: ADL: activity of daily living; BMI: body mass index; CI: confidence interval; GARS: the Groningen Activity Restriction Scale; HADS: The Hospital Anxiety and Depression Scale; HF: high frequency power; HRV: heart rate variability; LF: low frequency power; LF/HF: low frequency to high frequency ratio; OR: odds ratios; TP: total power. [ABSTRACT FROM AUTHOR]

Background: A high resting heart rate (HR) has been associated with an increased risk of diabetes mellitus. This study explored the association between initial in-hospital HR and glycemic control in patients with acute ischemic stroke (AIS) and diabetes mellitus. Methods: We analyzed data from 4,715 patients with AIS and type 2 diabetes mellitus enrolled in the Chang Gung Research Database between January 2010 and September 2018. The study outcome was unfavorable glycemic control, defined as glycated hemoglobin (HbA1c) ≥ 7%. In statistical analyses, the mean initial in-hospital HR was used as both a continuous and categorical variable. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. The associations between the HR subgroups and HbA1c levels were analyzed using a generalized linear model. Results: Compared with the reference group (HR < 60 bpm), the adjusted ORs for unfavorable glycemic control were 1.093 (95% CI 0.786–1.519) for an HR of 60–69 bpm, 1.370 (95% CI 0.991–1.892) for an HR of 70–79 bpm, and 1.608 (95% CI 1.145–2.257) for an HR of ≥ 80 bpm. Even after adjusting for possible confounders, the HbA1c levels after admission and discharge among diabetic stroke patients increased significantly in the subgroups with higher HRs (p < 0.001). Conclusions: High initial in-hospital HR is associated with unfavorable glycemic control in patients with AIS and diabetes mellitus, particularly in those with an HR of ≥ 80 bpm, compared with those with an HR of < 60 bpm. [ABSTRACT FROM AUTHOR]

Exposure to bright morning light (BML) entrains the master circadian clock, modulates physiological circadian rhythms, and reduces sleep–wake disturbances. However, its impact on the autonomic nervous system at night remains unclear. Here, we investigated the effects of BML exposure on parasympathetic nervous system (PSNS) and sympathetic nervous system (SNS) activity at night in elderly women. This nonrandomized controlled pilot study included female participants aged ≥ 60 years who were diagnosed with a type of dementia or cognitive disorder, excluding individuals with pacemakers. The treatment group was exposed to 2500 lx of BML, whereas the control group was exposed to 200 lx of general lighting. We measured heart rate variability to quantify ANS activity. The treatment group displayed significant increases in high-frequency (HF) power (Roy's largest root = 1.62; p < 0.001) and nonsignificant decreases in normalized low-frequency (LF%) power. The corresponding nonsignificant decreases in the low-frequency/high-frequency (LF/HF) ratio and cognitive function were correlated with PSNS activity (Roy's largest root = 1.41; p < 0.001), which improved severe dementia. BML exposure reduced SNS activity and enhanced PSNS activity at night in female participants, which improved cognitive function. Thus, BML therapy may be a useful clinical tool for alleviating cognitive decline. [ABSTRACT FROM AUTHOR]

Objective: Generalized anxiety disorder (GAD) and sleep-disordered breathing (SDB) share similar symptoms, such as poor sleep quality, irritability, and poor concentration during daily activities. This study aims to investigate the proportion of undiagnosed SDB and its impacts on anxiety severity and autonomic function in newly diagnosed, sedative-free GAD patients. Methods: This prospective case-control study included newly diagnosed GAD patients and control participants with matched age, sex, and body mass index (BMI) in Taiwan. All participants completed questionnaires for sleep and mood symptoms and a resting 5-min heart rate variability (HRV) examination during enrollment. The participants also used a home sleep apnea test to detect SDB. An oxygen desaturation index (ODI) ≥ 5 was considered indicative of SDB. Results: In total, 56 controls and 47 newly diagnosed GAD participants (mean age 55.31 ± 12.36 years, mean BMI 23.41 ± 3.42 kg/m²) were included. There was no significant difference in the proportion of undiagnosed SDB in the control and sedative-free GAD groups (46.43 vs. 51.06%). Sedative-free GAD patients with SDB scored significantly higher on Beck Anxiety Inventory (23.83 ± 11.54) than those without SDB (16.52 ± 10.61) (p < 0.001). Both control and sedative-free GAD groups with SDB had worse global autonomic function than the control group without SDB, as evidenced by the HRV results (p < 0.05 for all). Conclusion: Average age 55 years and mean BMI 23 kg/m² patients with GAD and matched controls had an undiagnosed SDB prevalence of approximately 50%. SDB correlated with worsening anxiety severity and reduced cardiac autonomic function. Moreover, age and BMI were considered major risk factors for predicting undiagnosed SDB. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the efficacy of aromatherapy in relieving the stress of nursing staff working in different departments during COVID-19. A total of 26 nursing staff from Taiwan were recruited for this study. Bergamot essential oil was diffused for over a four-week period in four different hospital departments. We assessed heart rate variability indicators, Nurse Stress Checklist, and Copenhagen Burnout Inventory before and after the intervention. The results of the analysis showed that during a high workload period, aromatherapy had no significant effect on regulating physical stress. Subjective measurements showed a significant impact on work concern and personal fatigue. Moreover, there were large differences among the four departments; the aromatherapy treatment had a weak effect on those with a heavy workload, whereas those with a lighter workload showed a stronger effect. Finally, this study provides practical results about aromatherapy stress reduction applied during the pandemic on first-line medical staff. [ABSTRACT FROM AUTHOR]

Taiwan currently faces an aging population and an increased mortality rate caused by cardiovascular disease. Therefore, preventing cardiovascular disease and constantly tracking people's physiological conditions are very important. Photoplethysmography (PPG) can be used to instantaneously monitor and measure the physiological information of each person. Compared with using electrocardiography, measurement using PPG is less expensive and more convenient. However, PPG has high susceptibility to motion artifacts. To analyze the physiological information in PPG signals with higher accuracy, the negative effects of motion artifacts on PPG signals must first be eliminated. In this study, the independent components of PPG signals were separated by independent component analyses (i.e., of the PPG noises and signals) to separate raw signals from motion artifacts. Subsequently, the PPG signals contained in the independent components were selected and the frequency spectrum was used to analyze the locations of the PPG signal components. Next, to eliminate motion artifacts, a multi-bandpass filter that the raw signals could pass through was specifically designed for this study. In our experiment, motion artifacts were created using two types of finger movements: random finger shaking and rapid finger shaking. In this study, research results included the waveforms of the filtered PPG signals in the frequency and time domains, independent ingredients after the separation of independent components, and the measurements of the heart rate. [ABSTRACT FROM AUTHOR]

Nature and health researchers have often suggested that nature induces better psychological and physical health responses than urban environments, especially with healthy ecosystems in nature. However, research that has empirically documented the daily benefits of physical and psychological health in rural landscapes is scarce. This study explores how rural landscapes could provide better health benefits than the built environment in daily life. The research involved on-site data collection with a set of psychological indicators (e.g., restorativeness, preference, emotion) and physical indicators (e.g., brain waves, heart rate) to compare the rural and the built environments. A total of 169 subjects took part in the study. We analyzed health indicators through analysis of variance to show the difference in water landscapes in rural areas relative to the built environment after the participants experienced the environments. The results showed that subjects could release stress and felt a greater sense of restorativeness, pleasure, and arousal in rural areas than in the built environment. Subjects preferred the rural landscape more than the built environment. To conclude, this study explains the rural landscape and its health-related benefits in Taiwan. [ABSTRACT FROM AUTHOR]

INTRODUCTION: High G training is a part of strenuous and high-intensity sports. Recently, a novel parameter, being the cardiac force index (CFI), was introduced to investigate the relationship with the G tolerance during the centrifuge. Walking CFI on the ground could be applied to predict the level of G tolerance under the gradual onset rate among military flight cadets. The aim of this study was set to reconfirm the potential model between the walking CFI and G tolerance. METHODS: We organized this cross-sectional study in August 2023; 24 subjects were recruited from the aeromedical personnel training program in Taiwan. Before the centrifuge training, they wore the non-invasive BioHarness 3.0 devices (Zephyr Technology Corporation, Annapolis, MD, USA) to collect the heart rate (HR) and activity data during the 200-meter walk. Walking CFI was generated from the formula: CFI = weight × activity/HR. Relaxed G tolerance (RGT) and straining G tolerance (SGT) were examined during the gradual onset run of initial high G training (Onset rate: 0.1G/sec). A regression model between the walking CFI and G tolerance was established by the SPSS 24.0 software. RESULTS: Of these subjects, the average data of age, height, and weight were 31.25 years, 170.75 cm, and 72.75 kg. The mean of the RGT and SGT were 5.42G and 8.27G. There were between four and 13 subjects at the RGT ≥6.0G and SGT ≥8.0G, respectively. Subjects with the RGT more than 6.0G, and the SGT more than 8.0G, had a significantly higher walking CFI than the others. We also found that each increment of the 10 walking-CFI unit increased the RGT by 1.65G and the SGT by 0.70G. DISCUSSION: In this small study, it appeared that walking CFI could assist in the estimation of the G tolerance before the training began again. However, some reports revealed that the G tolerance became various and different every day. It is necessary to collect more data to assess the validity and stability of this algorithm used to predict the G tolerance. We also hope that this finding will further be used to monitor the G performance before the flight mission. Learning Objectives 1. To understand the physiological challenges and responses during the G load. 2. To develop the model of G tolerance estimation before the training by using the new cardiac parameter. [ABSTRACT FROM AUTHOR]

In this research, a risk assessment model was developed that concurrently considers the location and physiological risk factors for fall accidents in workers at construction sites. In terms of location risk, data on 1683 occupational fall accidents involving 1718 worker casualties in the construction industry were collected for the period 1996–2016 from the Institute of Labor, Occupational Safety and Health (ILOSH), Taiwan. Next, the locations of these fall accidents were identified and defined as hazardous areas, with each area assigned a fall-risk level based on the average number of occupational accidents per year. In terms of physiological risk, the thermal hazard evaluation model, Recommended Alert Limits/Recommended Exposure Limits (RALs/RELs), developed by the National Institute for Occupational Safety and Health (NIOSH), USA was used in this study. This model uses metabolic heat and wet bulb globe temperature (WBGT) to recommend hourly rest/work times for workers. Using WBGT and one hour as the basic unit of time, varying degrees of metabolic heat, defined as metabolic heat loading severity (MHLS), were obtained. An optical heart rate (HR) sensor was applied in this study to measure HR, which was subsequently converted to a metabolic heat value using the Malchaire J metabolic heat evaluation model. Next, metabolic heat loading risk level was evaluated based on the MHLS. Finally, the location-based fall-risk level was multiplied by the MHLS, generating a risk evaluation model for fall accidents. The evaluation results identify the real-time fall-risk level of each worker and, if needed, suggest actions to be taken to mitigate the elevated risks of fall accidents identified by the model. • Hazardous zones are considered based on historical reports in Taiwan. • Assess the risk of body fatigue based on metabolic heat load. • Develop the risk model based on hazardous areas and metabolic heat loading. • A model to evaluate the real-time fall-risk for workers at construction sites. [ABSTRACT FROM AUTHOR]

It is still unknown whether long-term inhalation of indoor air pollutants from ambient essential oil is associated with increased cardiopulmonary events. We recruited 200 healthy homemakers to conduct a prospective observation study in Northern Taiwan. We measured heart rate (HR), systolic blood pressure (SBP), diastolic BP (DBP), peak expiratory flow rate (PEFR), and indoor air pollutants four times per year for each participant between 2008 and 2018. Moreover, a questionnaire related to essential oil usage, home characteristics, and health status was filled out with each participant. The association between essential oil usage and cardiopulmonary health was determined using mixed-effects models. The mixed-effects models showed a significant association between essential oil usage and adverse cardiopulmonary effects including increased HR and BP and decreased % predicted PEFR among participants with heavy use of essential oils. No significant association between essential oils usage and adverse cardiopulmonary effects was observed among participants without essential oils usage or participants with mild use of essential oils (less than one hour per day). We concluded that exposure to indoor air pollution related to essential oils was associated with adverse cardiopulmonary effects among participants with essential oil usage more than one hour per day. [ABSTRACT FROM AUTHOR]

Taiwan currently faces an aging population and a rise in mortality rate caused by cardiovascular disease. Therefore, the prevention of cardiovascular disease and the constant tracking of physiological information are crucial. Photoplethysmography (PPG) is used to instantaneously measure and monitor a person's physiological information. Compared with electrocardiography, PPG measurements are more convenient and less expensive. However, PPG is more susceptible to the effects of motion artifacts. To accurately analyze the physiological information contained in PPG signals, the negative effects of motion artifacts on PPG signals must first be eliminated. In this study, independent component analysis was employed to separate independent components (i.e., PPG signals and noise) from raw signals with motion artifacts. Subsequently, independent components containing PPG signals were selected and the locations of the PPG signal components in the frequency spectrum were analyzed. Next, the raw signals were passed through a multi-bandpass filter specifically designed for this study to eliminate motion artifacts. Motion artifacts were created for an experiment using two types of finger movements: vertical and horizontal finger movements. From the independent component analysis of the independent components, the waveforms of the filtered PPG signals in the time and frequency domains were acquired, which were then compared with the results of heartbeat measurement. [ABSTRACT FROM AUTHOR]

Obesity is a risk factor of cardiovascular disease-related mortality and may be associated with changes in the autonomic nerve activity. Nurses working shifts and caring for patients are under great mental and physical pressure, and research has proven that these can negatively affect the body. The objective of this study was to examine the influence of obesity in nurses on their heart rate variability (HRV) and determine whether age or shift type moderates this influence. A questionnaire survey and HRV measurements were conducted on nurses at a hospital in Taiwan during a routine employee health checkup. HRV analysis was conducted using a noninvasive HRV monitor for five minutes. A total of 242 nurses with a mean age of 28.98 ± 6.56 years were enrolled in this study. An overly large waist circumference (WC) had a negative impact on high frequency (HF), low frequency (LF), and standard deviation of normal-to-normal interval (SDNN), while an overly high body mass index (BMI) had a negative impact on very low frequency (VLF) and SDNN. The interaction term "overly large WC × age" had a negative impact on HF (β = − 0.21 , p = 0.010) and LF (β = − 0.18 , p = 0.030), whereas the interaction term "overly high BMI×age" had a negative impact on HF (β = − 0.27 , p = 0.001), LF (β = − 0.19 , p = 0.023), and VLF (β = − 0.17 , p = 0.045). The interaction terms "overly large WC × shift type" and "overly high BMI × shift type" did not influence any HRV parameters. As age increased, so did the degree to which the HF and LF of nurses with an overly large WC were lower than normal, and so did the degree to which the HF, LF, and VLF of nurses with an overly high BMI were lower than normal. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of mindful walking practice on the exercise capacity of patients with chronic obstructive pulmonary disease (COPD). Design: A randomised controlled trial with four repeated measurements. Setting: Outpatient departments of a medical centre in northern Taiwan. Participants: Patients with mild to severe COPD. Intervention: The control group received usual care, whereas the mindful walking group received usual care plus undertook a mindful walking practice. Outcome measures: The main outcome was the six-minute walk distance. And the Global Initiative for Chronic Obstructive Lung Disease classification, dyspnoea, heart rate variability and interoceptive awareness were control factors. Results: Compared with the control group (n = 40), the mindful walking group (n = 38) achieved a significantly longer six-minute walk distance (longer by 45.57 m; P = 0.04). The interaction effect of the six-minute walk distance significantly increased on Week 4 (P = 0.01), Week 8 (P = 0.002) and Week 12 (P = 0.02). Participants in Global Initiative for Chronic Obstructive Lung Disease class A exhibited significantly improved six-minute walk distance compared with those in class D (P = 0.001). Moreover, scores on the emotional awareness scale of interoceptive awareness were significantly associated with the six-minute walk distance (P = 0.02). Conclusion: The eight-week mindful walking practice improved the exercise capacity of patients with COPD, and its effect was sustained for at least four weeks after the end of the practice. This study suggest that this practice improved COPD symptoms, reduced COPD risk and increased the interoceptive awareness of this population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a 12-week breathing-based leg exercises program on quality of life under stabilizing heart rate variability and reducing fatigue in regular hemodialysis patients. Design: Randomized controlled trial. Setting: A 94-bed hemodialysis department at a medical center in northern Taiwan. Participants: Eighty-six patients with end-stage renal disease undergoing hemodialysis were recruited and randomly assigned to the ExBr or control groups. Interventions: The breathing-based leg exercises program comprised abdominal breathing and low-intensity leg exercise, including leg lifts, quadriceps femoris contraction and knee flexion, and lasted for 15 minutes at one time, three times a week for 12 weeks. Main measure: Data was collected by using the World Health Organization quality of life assessment-brief, physiological signal recorder for heart rate variability and hemodialysis-related fatigue scale at baseline and on Week 4, Week 8, and Week 12. Results: Average (standard deviation) age was 53.70 (10.04) years in the ExBr group and 61.19 (10.19) years in the control group. The linear mixed model with adjusted age, creatinine, heart rate variability and fatigue revealed that the ExBr group had significantly higher quality of life than did the control group (P = 0.01), especially on Week 12 (P = 0.04). Fatigue was significantly correlated with quality of life (P < 0.001). Conclusion: This study supported the benefits of the continued breathing-based leg exercises during hemodialysis for at least 12 weeks, which improved the quality of life of patients with end-stage renal disease and did not affect the stability of their vital signs. [ABSTRACT FROM AUTHOR]

Background: A burn scar is a type of hypertrophic scar that can cause significant clinical symptoms, discomfort, and post-burn scar (PBS) syndrome in up to 77% of patients with burn injuries. Medication and rehabilitation are rarely effective at managing patient discomfort, and both laser and surgical interventions are postponed until the scar stabilizes and discomfort is tolerable. Objectives: The present study was conducted to investigate the effectiveness of auricular acupuncture among burn victims from the Formosa Color Dust Explosion in Taiwan. Methods: We enrolled 31 victims of the 2016 Formosa Color Dust Explosion who met the study inclusion criteria. The intervention involved placement of magnetic beads over the auricular Shenmen and Subcortex acupoints on one ear. Patients performed selfmassage five times per day, and both magnet beads were removed between the fifth and seventh days during the sessions. Several evaluation tools were used to assess clinical symptoms: the visual analogue scale for pain assessment, Burn Man Itch Scale for perceived patient itchiness, 5-D Pruritus Scale for sleep quality, and heart rate variability (HRV) for effects on the autonomic nervous system. Results: The clinical symptoms were significantly decreased following the intervention, but the effect did not endure. The normal-to-normal heart rate interval, heart rate analysis abnormalities, and very low frequency heart rate were significantly decreased among patients with abnormal HRV (SD < 40) following treatment. Conclusion: Stimulation of the auricular Shenmen and Subcortex acupoints may effectively reduce pain, itchiness, and sleep disturbances among patients with PBS syndrome. [ABSTRACT FROM AUTHOR]

Medically unexplained symptoms (MUS) are persistent bodily symptoms without known pathology. An unofficial term has recently emerged in Taiwan to accommodate MUS: autonomic imbalance (AI). AI literally refers to disturbances of the autonomic nervous system (ANS) that innervates vital organs. However, AI is variously conceptualised by different parties. This study intends to investigate what is in the name of AI. It draws on available databases and in‐depth interviews with AI sufferers and Western and Chinese medicine physicians. Some physicians research ANS functions through heart rate variability measurements. Research findings show that physicians regard AI as a convenient term for clinical communication and a euphemistic substitute for MUS or even psychiatric diagnoses. It is not a 'real thing'. However, AI sufferers treat AI as a bona fide disease, only that it has not been officially classified. AI is therefore an unfaithful translation, or an uncontrolled equivocation, of MUS. The paper concludes by discussing the implications of treating AI as an equivocation. These implications include the limitations of the current diagnostic criteria, the necessity to rethink the dichotomy of mind and body, and the underlying realities exposed or masked by 'diagnosis'. [ABSTRACT FROM AUTHOR]

Background: Alteration of cardiac autonomic function may underlie the link between hypnotics use and the risk for cardiovascular morbidity and mortality. This study aimed to examine the relationship between the various characteristics of benzodiazepine receptor agonists (BzRAs) and heart rate variability (HRV).Methods: A community-based survey using the cohort from the Yilan Study, Taiwan was conducted. Older adults aged 65 and older were randomly selected to participate from August 2013 to November 2016. Cardiac autonomic function was evaluated using HRV, and the lowest quartiles of HRV parameters were defined as unhealthy. Those who used BzRAs as a sleep aid were defined as BzRA hypnotic users. The characteristics of BzRA use were further detailed and included the half-life, drug compound, frequency of use, and cumulative daily equivalent dosage.Results: Of all participants, 379 (14.5%) were BzRA hypnotic users. After controlling for covariates, BzRA hypnotic users had a higher risk for unhealthier HRV than non-users. Among all BzRA hypnotic users, those who only used benzodiazepines (BZDs), used short half-life BzRAs, and used the middle tertile of daily cumulative BZD equivalent had a higher risk for poor total power (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.07-4.16), high frequency (OR: 3.43, 95% CI: 1.07-10.97), and high frequency (OR: 2.94, 95% CI: 1.35-6.42), respectively, than their counterparts.Conclusions: BzRA hypnotics are linked with poor cardiac autonomic function. Various characteristics of BzRA hypnotics showed an independent pattern of association with cardiac autonomic function. [ABSTRACT FROM AUTHOR]

This descriptive study aimed to explore the physiological factors that determine tolerance to exertion during high-intensity interval effort. Forty-seven young women (15–28 years old) were enrolled: 23 athletes from Taiwan national or national reserve teams and 24 moderately active females. Each participant underwent a maximal incremental INC (modified Bruce protocol) cardiopulmonary exercise test on the first day and high-intensity interval testing (HIIT) on the second day, both performed on a treadmill. The HIIT protocol involved alternation between 1-min effort at 120% of the maximal speed, at the same slope reached at the end of the INC, and 1-min rest until volitional exhaustion. Gas exchange, heart rate (HR), and muscle oxygenation at the right vastus lateralis, measured by near-infrared spectroscopy, were continuously recorded. The number of repetitions completed (Rlim) by each participant was considered the HIIT tolerance index. The results showed a large difference in the Rlim (range, 2.6–12.0 repetitions) among the participants. Stepwise linear regression revealed that the variance in the Rlim within the cohort was related to the recovery rates of oxygen consumption (V˙O2), HR at the second minute after INC, and muscle tissue saturation index at exhaustion (R = 0.644). In addition, age was linearly correlated with Rlim (adjusted R = −0.518, p < 0.0001). In conclusion, the recovery rates for V˙O2 and HR after the incremental test, and muscle saturation index at exhaustion, were the major physiological factors related to HIIT performance. These findings provide insights into the role of the recovery phase after maximal INC exercise testing. Future research investigating a combination of INC and HIIT testing to determine training-induced performance improvement is warranted. [ABSTRACT FROM AUTHOR]

Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013.The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18–2.76]) and 1.45 (95% CI [0.67–3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment. [ABSTRACT FROM AUTHOR]

Purpose: To explore the state of mental treatment, heart rate variability (HRV), level of aggressive behavior, and their relationships among hospitalized patients with schizophrenia. Design and Methods: This study adopted a follow‐up design and convenience sampling. Thirty‐three subjects completed the questionnaire, and their HRV indices were measured. Findings: Patients' psychiatric symptoms showed a significant downward trend after hospitalization (P =.003). The standard deviation of the normal‐to‐normal intervals in the morning was significantly correlated with overall aggression, physical aggression, and verbal aggression. Practice Implications: HRV can be regularly monitored among inpatients with schizophrenia with a risk of high aggression as an indicator of possible aggressive behavior. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of acupuncture in helping antihypertensive drugs lower the hypertension of elderly patients in home health care. Design: Randomized controlled trial. Setting: Subjects were recruited from Branch of Linsen, Chinese Medicine, and Kunming, Taipei City Hospital, Taipei, Taiwan. Subjects: A total of 70 participants with hypertension in home health care were assigned randomly to the acupuncture group (35 participants) or the control group (35 participants). Interventions: The acupuncture group received antihypertensive drugs plus acupuncture twice a week for 12 weeks, and the control group received antihypertensive drugs only. Acupuncture points SP10, SP6, LR3, ST36, and LI4 were used bilaterally. Each acupuncture treatment session lasted 30 min. All the subjects were instructed not to alter their diet, physical activity, or use of drugs. Outcome measurements: Blood pressure (BP), heart rate variability, and the Constitution in Chinese Medicine Questionnaire (CCMQ) were assessed at baseline and at 6 and 12 weeks from the baseline between 9 am and 10 am in all subjects. Results: A total of 31 participants in each group completed the study. Within-group differences were observed in systolic BP (SBP) (p < 0.001), diastolic BP (p < 0.001), standard deviation of normal sinus beat intervals (SDNN) (p = 0.01), low frequency (p = 0.05), high frequency (p = 0.01), total power (TP) (p = 0.01), percentage of successive intervals that differ by more than 50 msec (PNN50) (p = 0.01), qi deficiency (p = 0.003), blood stasis (p = 0.02), and qi depression (p = 0.03) constitution. Significant between-group differences were observed in SBP (p = 0.001), SDNN (p = 0.008), and TP (p = 0.04). Conclusions: This study suggested that in the home health care hypertension population, antihypertensive drugs plus acupuncture may be more beneficial in lowering BP and in regulating autonomic nervous system activity than drugs alone. A longer follow-up and larger sample size should be considered in future studies to reveal the precise effect of acupuncture followed by evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: Pelvic ring fracture is often combined with other injuries and such patients are considered at high risk of mortality and complications. There is controversy regarding the gold standard protocol for the initial treatment of pelvic fracture. The aim of this study was to assess which risk factors could affect the outcome and to analyze survival using our multidisciplinary institutional protocol for traumatic pelvic ring fracture. Material and methods: This retrospective study reviewed patients who sustained an unstable pelvic ring fracture with Injury Severity Score (ISS) ≥ 5. All patients were admitted to the emergency department and registered in the Trauma Registry System of a level I trauma center from January 1, 2008, to December 31, 2017. The annular mortality rate after the application of our institutional protocol was analyzed. Patients with different systems of injury and treatments were compared, and regression analysis was performed to adjust for factors that could affect the rate of mortality and complications. Results: During the 10-year study period, there were 825 unstable pelvic ring injuries, with a mean ISS higher than that of other non-pelvic trauma cases. The annual mortality rate declined from 7.8 to 2.4% and the mean length of stay was 18.1 days. A multivariable analysis showed that unstable initial vital signs, such as systolic blood pressure < 90 mmHg (odds ratio [OR] 2.53; confidence interval [CI] 1.11–5.73), Glasgow Coma Scale < 9 (OR 3.87; CI 1.57–9.58), 24 > ISS > 15 (OR 4.84; CI 0.85–27.65), pulse rate < 50 (OR 11.54; CI 1.21–109.6), and diabetes mellitus (OR 3.18; CI 1.10–9.21) were associated with higher mortality. No other specific system in the high Abbreviated Injury Scale increased the rates of mortality or complications. Conclusion: Poor initial vital signs and Glasgow Coma Scale score, higher ISS score, and comorbidity of diabetes mellitus affect the mortality rate of patients with unstable pelvic ring fractures. No single system of injury was found to increase mortality in these patients. The mortality rate was reduced through institutional efforts toward the application of guidelines for the initial management of pelvic fracture. [ABSTRACT FROM AUTHOR]

Introduction: Heart rate recovery (HRR) is a marker of parasympathetic activity recovery after exercise, and it is associated with cardiovascular mortality and total mortality. Impaired renal function is also associated with cardiac mortality. The aim of this study was to investigate the association between HRR after exercise and renal function in patients referred for a treadmill exercise test. Patients and methods: This cross-sectional study was conducted at a regional hospital in southern Taiwan. Patients who completed a symptom-limited treadmill exercise test from January 2015 to February 2018 were recruited. Before the treadmill exercise test, patients were asked to complete a questionnaire on the past disease history and lifestyle factors. Serum creatinine measurement within two years prior to or after the date of the treadmill exercise test of the patients was also obtained from the medical records for these patients. Estimated glomerular filtration rate (eGFR) was calculated. Simple and multiple linear regression analyses were performed to investigate the association between one-minute HRR and eGFR. Results: A total of 2,825 patients completed the treadmill exercise test, and serum creatinine measurement was identified from medical records for 2,153 patients (76.2%). Multiple linear regression analysis revealed that a lower eGFR was significantly associated with lower one-minute HRR (P< 0.001), adjusting for other significant independent factors, including age, waist circumference, type 2 diabetes mellitus, and smoking. Conclusions: In this cross-sectional observational study, a lower eGFR was significantly and independently associated with decreased one-minute HRR, suggesting that parasympathetic activity recovery after exercise could be impaired by a decrease in renal function. [ABSTRACT FROM AUTHOR]

Backgroud/purpose: Deep pressure input is used to normalize physiological arousal due to stress. Third molar extraction is an invasive dental procedure with high stress for the patient, and an alleviation strategy is rarely applied during tooth extraction. In the present study, we investigated the effects of deep pressure input on autonomic responses during the procedures of third molar extraction in healthy adolescents.Methods: A randomized controlled crossover design was used for adolescents who were allocated to experimental and control groups that received intervention with or without deep pressure input, respectively. Autonomic indicators, namely the heart rate, percentage of low-frequency heart rate variability (LF-HRV), percentage of high-frequency heart rate variability (HF-HRV), and low-frequency/high-frequency heart rate variability ratio (LF/HF-HRV), were assessed at the baseline, during molar extraction, and in the posttreatment phase.Results: The results indicated that third molar extraction caused significant autonomic parameter changes in both groups; however, differential response patterns were observed between two groups. In particular, application of deep pressure input in the experimental group was associated with higher HF-HRV and lower LF/HF-HRV during third molar extraction compared with those in the control group.Conclusion: LF/HF-HRV measurement revealed balanced sympathovagal activation in response to deep pressure application. The present study suggests that the application of deep pressure alters the response of HF-HRV and facilitate maintaining sympathovagal balance during third molar extraction. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects that listening and not listening to music had on pain relief, heart rate variability (HRV), and knee range of motion in total knee replacement (TKR) patients who underwent continuous passive motion (CPM) rehabilitation. We adopted a single-group quasi-experimental design. A sample of 49 TKR patients listened to music for 25 min during one session of CPM and no music during another session of CPM the same day for a total of 2 days. Results indicated that during CPM, patients exhibited a significant decrease in the pain level (p < .05), an increase in the CPM knee flexion angle (p < .05), a decrease in the lowfrequency/high-frequency ratio (LF/HF) and normalized LF (nLF) of the FHRV (p < .01), and an increase in the normalized HF (nHF) and standard deviation of all normal-to-normal intervals (SDNN; p < .01) when listening to music compared with no music. This study demonstrated that listening to music can effectively decrease pain during CPM rehabilitation and improve the joint range of motion in patients who underwent TKR surgery. [ABSTRACT FROM AUTHOR]

Background Brugada syndrome (BrS) is a heritable sudden cardiac death (SCD) disease with male predominance. Information on gender difference of BrS remains scarce. Aim To investigate the gender difference of BrS in Han Chinese. Design We consecutively enrolled 169 BrS patients (153 males and 16 females) from Han Chinese in Taiwan from 1998 to 2017. Methods Clinical characteristics, electrocardiographic parameters and SCN5A mutation status were compared between genders. Results The percentage of family history of SCD in females was slightly higher (31.3% vs. 15%, P  =   0.15). Females exhibited longer QTc (457.8 ± 33.0 vs. 429.5 ± 42.1 ms, P  <   0.01). Regarding cumulative event occurrence by age, Mantel-Cox test showed females had earlier age of onset of first cardiac events (SCD or syncope) than males (P  =   0.049), which was mainly attributed to syncope (P  <   0.01). Males with SCD exhibited longer QRS duration (114.2 ± 26.8 vs. 104.8 ± 15.3 ms, P  =   0.02) and QTc (442.5 ± 57.4 vs. 422.9 ± 28.8 ms, P  =   0.02). Males with syncope exhibited longer PR interval (181.2 ± 33.7 vs. 165.7 ± 27.1 ms, P  =   0.01), whereas females with SCD or syncope had a trend towards slower heart rates (69.1 ± 9.6 vs. 82.2 ± 16.3 bpm, P  =   0.10) than female with no or mild symptoms. There was no difference in the percentage of SCN5A mutation between genders. Conclusion Gender difference is present in BrS. Females have longer QTc and suffer from syncope earlier than males. Risk of SCD in males is associated with boarder QRS complex and longer QTc, whereas risk of syncope is associated with longer PR interval in males and slower heart rate in females. [ABSTRACT FROM AUTHOR]

Background: Heart rate variability (HRV), a non-invasive measurement of the sympathetic-vagal balance, has been demonstrated as a predictor of long-term survival in various patient populations. However, its predictive value in patients with end-stage renal disease (ESRD) has not been evaluated in a long-term follow-up study.Methods: Prospective data collected for 41 patients with chronic hemodialysis (age 59 ± 10 years, men 51.3%, diabetes mellitus 31%, and duration of dialysis 64 ± 50 months) who underwent a 5-minute electrocardiogram (ECG) recording as a baseline for frequency domain HRV analysis.Results: During a median follow-up of 150.2 months from 2003 to 2014, 15 (35.7%) patients died (3 due to cardiac causes and 12 due to non-cardiac causes). The Cox proportional hazards model suggested that the low frequency versus high frequency signal (LF/HF) of a high ratio for the HRV and diabetes mellitus were two independent predictors of mortality (hazard ratios 3.028 and 3.494; p = 0.033 and 0.022, respectively). Less reduction in MAP during dialysis showed borderline significance of long-term survival than those with larger drop (p = 0.058).Conclusion: A short ECG recording and an analysis of the frequency domain of the HRV is clinically predictive of the long-term survival of patients with chronic hemodialysis. [ABSTRACT FROM AUTHOR]

Qigong is a gentle exercise that promotes health and well-being. This study evaluated the acute physiological and psychological effects of one session of qigong exercise in older practitioners. A total of 45 participants (mean age, 65.14 years) were recruited. Meridian electrical conductance, State-Trait Anxiety Inventory (STAI), heart rate variability (HRV), and Short Form 36 (SF-36) were evaluated and compared before and after one session of qigong exercise. The results revealed that the electrical conductance of all meridians, except spleen and bladder meridians, increased significantly (p<0.05). Compared with baseline values, upper to lower body ratio and sympathetic/vagal index were significantly improved and closer to 1 (p=0.011 and p=0.007, resp.). STAI-S and STAI-T scores decreased significantly (p<0.001 and p=0.001, resp.). The RR interval of HRV decreased significantly (p=0.035), a significant positive correlation was observed between kidney meridian electrical conductance and SF-36 physical scores (r=0.74, p=0.018), and a positive correlation was observed between pericardium meridian electrical conductance and SF-36 mental scores (r=0.50, p=0.06). In conclusion, one session of qigong exercise increased meridian electrical conductance, reduced anxiety, and improved body and autonomic nervous system balance. These findings provide scientific evidence for acute physiological and psychological effects of qigong exercise in older practitioners. [ABSTRACT FROM AUTHOR]

Backgrounds: The aims of the present study were to determine the associations and sex-specific relationships between extreme sleep duration and cardiac autonomic control in a cohort of older individuals.Methods: A community-based survey was conducted in Yilan City, Taiwan. Community-dwelling older adults aged ≥65 were randomly selected to participate. Extreme sleep durations were defined as either short sleep (≤5 hours) or long sleep (≥8 hours). Cardiac autonomic control was evaluated using the parameters of frequency-domain analysis of heart rate variability.Results: Of 1,721 participants, 58.7% were female. In multiple logistic regression analyses, short sleep duration did not correlate with any of the unhealthier parameters of heart rate variability. In contrast, long sleep duration was associated with elevated risk for poor high-frequency values (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.34-2.50) and the unfavorable low-frequency values (OR: 1.44, 95% CI: 1.05-1.97). When stratified by sex, the associations between extreme sleep duration and poor heart rate variability were more robust in males.Conclusions: Poor cardiac autonomic control may underlie the link between extreme sleep duration and adverse health outcomes in older adults. A sex-specific relationship between poor cardiac autonomic function and extreme sleep duration also was found. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study has been to evaluate the occupational heat exposure of 12 workers at 5 plants in a subtropical country.Material and Methods: The heat stresses and strain on workers in 5 plants were assessed by the International Organization for Standardization (ISO) 7243 index (wet bulb globe temperature - WBGT) and the ISO 7933 index (maximum allowable exposure time - Dlim).Results: Results indicated that 42% of the subjects (5 workers) surpassed the WBGT limits. According to the Dlim, 42% of the subjects could not continue working in the hot environments. The relationships between the various heat stress indices and the WBGT index were also correlated. However, further studies from different heat environments and more subjects should be performed.Conclusions: The sensitive dependence of skin temperature on meteorological and physiological indices for each subject was clearly observed. Obviously, the heart rate response to metabolic rate was much greater than that caused by environmental heat alone. The exponential relationship between workers' duration-limited exposure time, predicted by various estimated criteria, and WBGT were also found. Int J Occup Med Environ Health 2017;30(3):379-395. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study was to investigate the effects of a 12-week yoga program on heart rate variability (HRV) and depressive symptoms in depressed women. Methods: This was a randomized controlled trial. Twenty-six sedentary women scoring ≥14 on the Beck Depression Inventory-II were randomized to either the yoga or the control group. The yoga group completed a 12-week yoga program, which took place twice a week for 60 min per session and consisted of breathing exercises, yoga pose practice, and supine meditation/relaxation. The control group was instructed not to engage in any yoga practice and to maintain their usual level of physical activity during the course of the study. Participants' HRV, depressive symptoms, and perceived stress were assessed at baseline and post-test. Results: The yoga group had a significant increase in high-frequency HRV and decreases in low-frequency HRV and low frequency/high frequency ratio after the intervention. The yoga group also reported significantly reduced depressive symptoms and perceived stress. No change was found in the control group. Conclusions: A 12-week yoga program was effective in increasing parasympathetic tone and reducing depressive symptoms and perceived stress in women with elevated depressive symptoms. Regular yoga practice may be recommended for women to cope with their depressive symptoms and stress and to improve their HRV. [ABSTRACT FROM AUTHOR]

Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention (n = 41) or control group (n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures (p < .02) and pre–post differences (p < .03) except for diastolic blood pressure. Because of music intervention’s low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient’s mood should be monitored after the music intervention. [ABSTRACT FROM AUTHOR]

Summary: Measurement of bone turnover markers is an alternative way to determine the effects of exercise on bone health. A 10-week group-based step aerobics exercise significantly improved functional fitness in postmenopausal women with low bone mass, and showed a positive trend in reducing resorption activity via bone turnover markers. Introduction: The major goal of this study was to determine the effects of short-term group-based step aerobics (GBSA) exercise on the bone metabolism, bone mineral density (BMD), and functional fitness of postmenopausal women (PMW) with low bone mass. Methods: Forty-eight PMW (aged 58.2 ± 3.5 years) with low bone mass (lumbar spine BMD T-score of −2.00 ± 0.67) were recruited and randomly assigned to an exercise group (EG) or to a control group (CG). Participants from the EG attended a progressive 10-week GBSA exercise at an intensity of 75-85 % of heart rate reserve, 90 min per session, and three sessions per week. Serum bone metabolic markers (C-terminal telopeptide of type 1 collagen [CTX] and osteocalcin), BMD, and functional fitness components were measured before and after the training program. Mixed-models repeated measures method was used to compare differences between the groups ( α = 0.05). Results: After the 10-week intervention period, there was no significant exercise program by time interaction for CTX; however, the percent change for CTX was significantly different between the groups (EG = −13.1 ± 24.4 % vs. CG = 11.0 ± 51.5 %, P < 0.05). While there was no significant change of osteocalcin in both groups. As expected, there was no significant change of BMD in both groups. In addition, the functional fitness components in the EG were significantly improved, as demonstrated by substantial enhancement in both lower- and upper-limb muscular strength and cardiovascular endurance ( P < 0.05). Conclusion: The current short-term GBSA exercise benefited to bone metabolism and general health by significantly reduced bone resorption activity and improved functional fitness in PMW with low bone mass. This suggested GBSA could be adopted as a form of group-based exercise for senior community. [ABSTRACT FROM AUTHOR]

Purpose: Characteristics of the distressed (Type D) personality include negative affectivity (NA) and social inhibition (SI), which are associated with an increased risk of major adverse cardiac events and mortality among patients with coronary artery disease (CAD). The aims of this study were to examine: (1) the correlation of NA and SI with psychological characteristics, heart rate variability (HRV) indices, and lipids profiles and (2) the differences in psychological characteristics, HRV indices, and lipid profiles between patients with CAD with Type D personality and those with non-Type D personality. Method: A cross-sectional study was conducted on 168 patients with CAD. The Taiwanese 14-item Type D Scale, Chinese Hostility Inventory-Short Form, Beck Depression Inventory-II, Beck Anxiety Inventory, and Anger Rumination Scale were administered to all of the participants. The raw signals of electrocardiograms were recorded over a 5-min baseline resting period and then transformed to HRV indices representing short-term cardiac autonomic activations. Lipid profiles were acquired from patients' medical records. Results: NA was positively correlated with hostility, depression, anxiety, and anger rumination. With respect to pathophysiological mechanisms for CAD with Type D personality, NA was negatively correlated with standard deviation of all normal-to-normal intervals (SDNN) and total power of HRV and positively correlated with total cholesterol. SI was positively correlated with suppressive hostility behavior and anger rumination; however, SI was not significantly correlated with expressive hostility behavior, or HRV indices and lipid profiles. Conclusion: Pathophysiological mechanisms leading to higher rates of adverse outcomes in CAD in individuals with Type D personalities may involve cardiac autonomic imbalance and lipid dysregulation. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic schizophrenia often show negative emotional responses because of cognitive impairment. Multisensory stimulation therapy has been shown effective in improving cognitive and emotional functions in cognitively impaired patients with dementia. However, very few studies have applied this multisensory intervention to patients with chronic schizophrenia. Furthermore, it is not known whether a dose--response relationship exists between the frequency and efficacy of this intervention. Purpose: The objective of this study was to evaluate the relationship between the effects and dose--response of the multisensory intervention on patientswith chronic schizophrenia in a mental rehabilitation hospital. Methods: A crossover study design with a sample size of 60 was conducted. Participants were divided equally between an experimental group and a control group. The experimental group received the intervention in a multisensory stimulation room. Six sessions of the 30-minute sensory intervention were conducted on experimental group participants, who were allowed to select their preferred stimulants. In contrast, the control group received routine care only. After a 2-week washout period, participants in the experimental group were reassigned to the control group, and those in the control group were reassigned to the experimental group. Standardized questionnaires were applied to evaluate psychotic symptoms, emotional responses, and well-being of all participants. The NeXus-4 model wireless biofeedback system was used to measure the psychological--physiological parameters of participants at baseline and after the first, third, and sixth sessions of the multisensory intervention. A generalized estimating equation model was used to analyze the effects of the intervention Results: Although multisensory stimulation therapy had no significant effect on psychotic symptoms and well-being, this intervention may improve the negative emotional reactions of patients. In particular, the intervention significantly reduced the subjective anxiety level of participants and stabilized their objective respiratory and heart rates. Moreover, a positive correlation was found between the efficacy of the treatment and the frequency of the intervention. Conclusions/Implications for Practice: Evidence from this study validated the multisensory stimulation therapy protocol. Therefore, this protocol may be incorporated into clinical interventions to improve quality of care and to alleviate the negative emotions of patients with chronic schizophrenia. [ABSTRACT FROM AUTHOR]

Background Metabolic syndrome (MetS) has been reported to cause considerable psychoneuroimmunology (PNI) disturbances such as, psychological distress, autonomic nervous imbalance, and impaired immune function. Associations among these psychoneuroimmunology (PNI) factors and their integrated effects with MetS and risk components of MetS necessitate further exploration. Objective This study investigated associations among psychoneuroimmunological factors, their integrated effects with MetS and risk components of MetS. Methods This was a cross-sectional study. Participants were recruited from two health management centers at a medical center in Northern Taiwan. Demographics and data on psychological distress (e.g., perceived stress and depression) were collected using self-reported questionnaires. Heart rate variability (HRV) and C-reactive protein values (CRP) were measured to evaluate participants’ autonomic nervous function and immune reaction. The risk components of MetS (e.g., elevated blood pressure, impaired fasting glucose, dyslipidemia, and abdominal obesity) were identified according to the Taiwan-specific definition of MetS and were determined based on participants’ health examination profiles. Results A total of 345 participants with complete data were included for data analysis. Compared with healthy controls, participants with MetS exhibited higher depression scores (11.2 ± 8.5 vs. 8.7 ± 7.0), higher CRP values (2.1 ± 2.5 vs. 0.7 ± 1.0), and lower HRV (total power: 758.7 ± 774.9 vs. 1064.4 ± 1075.0). However, perceived stress in participants with MetS did not significantly differ from that of their healthy counterparts ( p > 0.05). Univariate analyses indicated that associations among psychoneuroimmunological factors and MetS risk components were statistically heterogeneous: a) perceived stress and depression were significantly associated only with high blood glucose ( p < 0.05); b) CRP was significantly associated with all MetS risk components ( p < 0.05); and c) HRV was significantly associated with high triglycerides and high fasting blood glucose ( p < 0.05). Multivariate analysis indicated that the integrated effects of depression, CRP, and HRV were significantly associated with MetS ( p < 0.01) after controlling for age and education level. Conclusions Higher depression scores, higher CRP values, and lower HRV are independently and additively associated with MetS and risk components of MetS. Accordingly, a multidisciplinary approach to alleviating psychological distress, immune dysfunction, and autonomic nervous imbalance is recommended for promoting well-being in people with subclinical metabolic abnormalities or MetS to minimize downstream health consequences. [ABSTRACT FROM AUTHOR]

Fine particulate matter (PM 2.5) has been reported to be associated with increased risk of chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, studies on whether long-term exposure to PM 2.5 negatively impacts the survival of patients with ESRD are very limited. To conduct this study, we linked Taiwan Air Quality-Monitoring Database (TAQMD) and the National Health Insurance Research Database (NHIRD) by zip-code. A retrospective population-based cohort of 34,088 adult patients initiating dialysis over six months was formed. Cox proportional regression models were used to estimate the risk of mortality in dialysis patients per 10-μg/m3 increase of PM 2.5 and by PM 2.5 levels divided into quintiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between PM 2.5 and mortality. The adjusted hazard ratio (aHR) per 10-μg/m3 increase of PM 2.5 for mortality was 1.11 (95% confidence interval [CI] = 1.08–1.13). When analyzing PM 2.5 exposure divided into quintiles, patients with mean PM 2.5 exposure over 29.33 μg/m3, including level III (aHR 1.00, 95% CI = 0.94–1.07), level IV (aHR 1.09; 95% CI = 1.03–1.16), and level V (HR 1.11; 95% CI = 1.05–1.19), were at stepwise higher risks of mortality compared with level I. Spline analysis showed a non-linear concentration-response function between PM 2.5 and mortality, with the lowest mortality aHR identified at a mean PM 2.5 of 26 μg/m3, followed by a concentration interval with a gradual increase of aHR, and finally a steep rise of mortality risk when mean PM 2.5 exceeded 37 μg/m3. Individuals with older age, those were male, with selected comorbidities, and with low socioeconomic status (SES) were at higher mortality risk. Male and non-diabetics participants were more sensitive to the effect of a 10-μg/m3 of PM 2.5 increase on mortality than their counterparts. In conclusion, long-term exposure to PM 2.5 exceeding a threshold was observed to be associated with increased risk of mortality among dialysis patients. [Display omitted] • Asia's first dialysis-population-based cohort study on PM 2.5 -mortality association. • Positive PM 2.5 -mortality relation per 10-μg/m3 increase in Taiwan's dialysis patients. • Non-linear dose-mortality relation in dialysis patients with long-term PM 2.5 exposure. • A PM 2.5 threshold (26 μg/m3) after which mortality in dialysis patients increases. [ABSTRACT FROM AUTHOR]

Background/purpose: Deep pressure input is used to normalize physiological arousal due to stress. Wisdom tooth surgery is an invasive dental procedure with high stress levels, and an alleviation strategy is rarely applied during extraction. In this study, we investigated the effects of deep pressure input on autonomic responses to wisdom tooth extraction in healthy adults.Methods: A randomized, controlled, crossover design was used for dental patients who were allocated to experimental and control groups that received treatment with or without deep pressure input, respectively. Autonomic indicators, namely the heart rate (HR), percentage of low-frequency (LF) HR variability (LF-HRV), percentage of high-frequency (HF) HRV (HF-HRV), and LF/HF HRV ratio (LF/HF-HRV), were assessed at the baseline, during wisdom tooth extraction, and in the posttreatment phase.Results: Wisdom tooth extraction caused significant autonomic parameter changes in both groups; however, differential response patterns were observed between the two groups. In particular, deep pressure input in the experimental group was associated with higher HF-HRV and lower LF/HF-HRV during extraction compared with those in the control group.Conclusion: LF/HF-HRV measurement revealed balanced sympathovagal activation in response to deep pressure application. The results suggest that the application of deep pressure alters the response of HF-HRV and facilitates maintaining sympathovagal balance during wisdom tooth extraction. [ABSTRACT FROM AUTHOR]