Pingtung Christian Hospital

ABSTRACTThe long‐term cumulative impact of metabolic syndrome (MS) on cognitive decline remains uncertain. This study investigated how changes in MS status over 10 years relate to cognition and whether sex modifies this relationship. A total of 766 participants (mean baseline age: 54 years) from the Kaohsiung Atherosclerosis Longitudinal Study were enrolled. MS was defined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria for Asian populations. Participants were categorized into four groups based on changes in MS status over the 10‐year follow‐up: never MS, ever MS, new MS, and persistent MS. Cognition was assessed using the Chinese version of the Montreal Cognitive Assessment (MoCA). Multivariate regression models were adjusted for age, sex, education, smoking status, physical activity, alcohol consumption, anxiety and depression. The results showed that participants with persistent MS had lower MoCA scores (β = −0.08, adjusted p = 0.020) compared to those who never had MS, with impairments primarily in the memory and language domains. This adverse effect was observed only in women (β = −0.12, adjusted p = 0.004), while no significant association was found in men (β = −0.03, adjusted p = 0.628). Individuals with nonpersistent MS (either ever or new MS) did not show significant cognitive decline compared to those who never had MS. This study demonstrates that persistent MS over a decade is linked to cognitive decline, with a more pronounced effect in women. These findings highlight the importance of early MS intervention in midlife, particularly for women, to reduce the risk of cognitive deterioration later in life.

Background: Cancer continues to cause major morbidity and mortality in low- and middle-income countries thereby contributing to unmet palliative care services. Palliative care among cancer patients aims to improve quality of life (QoL). This study was conducted to assess the QoL of cancer patients in palliative care. Methods: Through a descriptive and cross-sectional design, 158 cancer patients in palliative care services were assessed using the World Health Organization QOL-BREF tool which is a validated and reliable tool to assess QoL. The participants were assessed in four domains of QoL, namely physical, psychological, environment health, and social relationships. We also assessed individual’s overall perception to QoL and satisfaction with their health. Results: A total of 158 patients were interviewed with a mean age of 53 years and majority were females 102 (64.6%). The results show a significant positive correlation between the overall QoL and overall satisfaction and the scores of the physical and psychological domains, with r > 0.4 ( P < 0.001). Higher education ( P < 0.05), being on palliative chemotherapy ( P < 0.05) and longer duration of cancer ( P < 0.05) were associated with better QoL. Morphine was found to be a significant negative predictor affecting both the physical domain (β = −9.24; P = 0.045) and Q1 (β = −0.53; P < 0.05), but not psychological domain and overall satisfaction of health. Conclusion: Physical and psychological domains are the major determinants of overall QOL and satisfaction. The effectiveness of palliative care services in maintaining the overall QoL requires comprehensive supportive care.

A 52-year-old male, a property broker known for his fast-paced lifestyle, presented with a history of severe chest discomfort immediately after consuming a large slice of bread (Figure 1) in his rush to get to work. He exhibited a type A personality, had no comorbidities, and did not take any regular medications. Since then, he has experienced ongoing chest pain accompanied by a sensation of the bread being lodged in his chest. Six hours later, his incarcerated sensation started to decrease after massive water and milk consumption. However, the chest pain still persisted. His gastroduodenoscopy showed a 3.5-cm ulcer in the middle esophagus (Figure 2). His chest symptoms gradually improved after a week treatment with sucralfate 1 g four times daily. The decision to use sucralfate instead of proton pump inhibitors was based on its direct action on the ulcer, forming a protective film that could prevent further deterioration of the esophageal ulcer. A compression ulcer produced by incarcerated bread might occur, possibly due to compression-related ischemia of the mucosa. A bread-related esophageal ulcer tends to occur at middle esophagus, the anatomical narrowing site behind left atrium. Esophageal ulcers can arise from various factors, including reflux esophagitis, viral infections, or medication use.1-3 In this case, the mechanical obstruction caused by the bread likely contributed to the development of the ulcer given the sequence of events. In the literature, there have been reports of fatality and laceration caused by bread crust and bagel, respectively.4, 5 The autopsy of the former case revealed perforation at the upper end of the esophagus with a mediastinal abscess.4 In the latter case, a barium-swallow exam indicated a 4-cm mucosal tear extending from the upper esophagus to the cricopharyngeal muscle.5 However, the patient survived with conservative medical treatment involving narcotic analgesics, antacids, and intravenous hydration. All authors contributed equally to the review of data, drafting of manuscript, and approval of final version. The study was funded by research foundation of An Nan Hospital (grant numbers: ANHRF112-09 and ANHRF112-45), China Medical University, Taiwan and Ping Tung Christian Hospital Research Fund (grant number: PS 113005). The authors declare no conflicts of interest. Informed consent was taken from patient for clinical image submission.

Pingtung is a county in Taiwan that covers a large area and a population marked by significant cultural diversity. Healthcare programs in the county must take geographical and cultural needs into consideration to create a person-centered, friendly-care model for the county's older adult residents. This study was designed to explore the experiences of community nurses in Pingtung County caring for adults in the community and identify related core competency needs. A focus group research method was used, and community nurses were recruited to participate in focus group discussions. Each focus group included 10 to 12 nurses, and each session lasted about 120 minutes. The interview data were recorded, transcribed, content analyzed, and rigorously controlled. The two discussion sessions organized for this study were both held on August 9, 2012, with a total of 12 head nurses and 13 registered nurses participating. The researchers identified the following six themes: 1. Training of cross-cultural community care and systemic care capabilities; 2. Cultivation and improvement of professional capabilities; 3. Improving capabilities of evidence implementation and innovative ideas; 4. Promoting evidence implementation and self-identity; 5. Leadership management transformation and organizational reengineering; 6. Optimizing dementia care and creating a more patient-friendly atmosphere. Community nurses play an important role in maintaining and improving public health. Special needs such as aging, multiculturalism, geographical characteristics, and dementia requires that systematic care provided be sensitive to cultural characteristics, work to improve evidence-based application capabilities, and strengthen leadership and management.

This study aims to develop a nutrition education intervention to promote healthy eating, and to evaluate the effectiveness of this intervention on healthy eating knowledge, attitude and behaviour among elementary students. A quasi-experimental study was conducted in two elementary schools in Taiwan. The intervention course design included simulation videos, lectures, and the after-school learning worksheet designed for parental involvement. A total of 4 courses along with 4 simulation videos were given to the intervention group. The four course themes were Sugar patrol, Balanced Diet during the Mid-Autumn Festival, Rainbow Fruit and Vegetables, and Smart Dine Out. The study recruited 35 3rd grade students for the intervention group and 30 for the control group. Data were collected from the pre- and post-test questionnaires. The nutrition intervention had significant effects on improving participants’ knowledge about tips for making healthy choices and the necessity of balanced diet, and on attitude toward healthy eating. There was no significant improvement in participants’ healthy eating behaviours. This nutrition education intervention, which utilized simulation videos and encouraged parental involvement, could be recommended for teaching practice in elementary schools to improve healthy eating knowledge and attitude among students.

BackgroundDengue virus serotype 2 (DENV-2) was the major serotype in the 2015 dengue outbreak in Taiwan, while DENV-1 and DENV-3 were dominant between 2005 and 2014. We aimed to investigate whether DENV-2 contributed to disease severity and mortality in the outbreak in Kaohsiung city, Taiwan.MethodsWe collected serum samples from dengue patients to detect the presence of DENV and determine the serotypes by using quantitative reverse transcription-polymerase chain reaction. Our cohorts comprised 105 DENV-1-infected cases and 1,550 DENV-2-infected cases. Demographic data, DENV serotype, and comorbidities were covariates for univariate and multivariate analyses to explore the association with severity and mortality.ResultsThe results suggested that DENV-1 persisted and circulated, while DENV-2 was dominant during the dengue outbreak that occurred between September and December 2015. However, DENV-2 did not directly contribute to either severity or mortality. Aged patients and patients with diabetes mellitus (DM) or moderate to severe chronic kidney disease (CKD) had a higher risk of developing severe dengue. The mortality of dengue patients was related to a higher Charlson comorbidity index score and severe dengue. Among DENV-2-infected patients and older patients, preexisting anti-dengue IgG, DM, and moderate to severe CKD were associated with severe dengue. Moreover, female sex and severe dengue were associated with a significantly higher risk of death.ConclusionsOur findings highlight the importance of timely serological testing in elderly patients to identify potential secondary infections and focus on the meticulous management of elderly patients with DM or moderate to severe CKD to reduce dengue-related death.