AIMS AND OBJECTIVES:This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease.BACKGROUND:Sleep quality is a common problem in older adults that may be affected by physical and mental status.DESIGN:A cross-sectional correlational design was employed.METHODS:The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively.RESULTS:Of the 120 older adults (age >65 years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain.CONCLUSION:Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease.RELEVANCE TO CLINICAL PRACTICE:The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population.

Hepatocellular carcinoma (HCC) is the second common cause of cancer-related death in Taiwan. Tumor recurrence is frequently observed in HCC patients receiving surgical resection, resulting in unsatisfactory overall survival (OS). Therefore, it is pivotal to identify effective prognostic makers, so that intensive surveillance or adjuvant treatments can be applied to predictively unfavorable patients. Previous studies indicated that Annexin A2 (ANXA2) was an effective prognostic marker in several cancers, including HCC. However, the prognostic value of ANXA2 in Taiwanese HCC patients remains unclear, where a great proportion of patients had chronic hepatitis B with liver cirrhosis. Here, ANXA2 was highly expressed in HCC tissues compared with para-neoplastic noncancerous tissues. Furthermore, high ANXA2 expression in HCC tissues independently predicted shorter OS. In subgroup analysis, however, ANXA2 expression could not effectively predict OS in the following subgroups: female, age > 65 years old, Child–Pugh classification B, hepatitis B virus surface antigen negative or anti-hepatitis C antibody positive, alcoholism, tumor number >1, presence of micro- or macrovascular invasion, absence of capsule, non-cirrhosis and high alpha-fetoprotein. In conclusion, ANXA2 expression in HCC tissues could predict postoperative OS. However, the predictive value was limited in patients with specific clinical conditions.

AIM:To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation.DESIGN:Prospective cohort design.METHODS:The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation.RESULTS:Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation.CONCLUSION:Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice.IMPACT:The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care.

Visual and empirical assessments do not enable the early detection of wound deterioration or necroses. No suitable objective indicator for predicting poor wound-healing is currently available. We used infrared thermography to determine the association between wound temperature and pressure-wound healing. We examined patients with grades 2–4 pressure ulcers from a medical center in southern Taiwan and recorded the temperatures of the wound bed, periwound, and normal skin using infrared thermographic cameras. A total of 50 pressure ulcers and 248 infrared-thermography temperature records were analyzed. Normal skin temperature was not related to pressure ulcer wound healing. In a multivariate analysis, higher malnutrition universal-screening-tool scores were associated with poor wound-healing (p = 0.020), and higher periwound-temperature values were associated with better wound-healing (p = 0.028). In patients who had higher periwound-skin temperature than that of the wound bed, that result was also associated with better wound-healing (p = 0.002). Wound-bed and periwound temperatures differed significantly with the grade of the pressure ulcer, and a high periwound temperature was positively correlated with wound healing. Infrared thermography can objectively serve as indicators for assessing pressure-ulcer healing.

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan’s National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars—NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79–3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04–2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21–1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51–6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

Surface engineering via alloying opens up a new route to tune the strength of an alloy film, thus it is critical to determine an optimal alloy addition. Here, the effect of varying the content of extremely dilute manganese oxide (MnO), namely 0.04, 0.10 and 0.17%, on microstructure stability and reliability of electroless plated colloidal Cu alloy thin films upon annealing is studied. An intermediate MnO content (0.10%) noticeably gives the best performance in terms of stabilizing Cu grains and enhancing film reliability against thermal stressing. Transmission electron microscopy and secondary ion mass spectroscopy reveal that the strengthening mechanism is related to interfacial segregation of MnO (serving as a barrier) and grain-boundary segregation of MnO (pinning and stabilizing Cu grains). However, the stabilization of Cu grains by the segregation of MnO are both missing from the other two films with MnO additions of 0.04% and 0.17%, and an identical annealing thus leads to their premature failure. Thin-film properties of adhesion strength, residual stress, surface energy, and MnO segregation tendency are comprehensively studied elucidating the strengthening mechanism.

"Sweet poison: seizures in two patients with Coriaria intermedia poisoning." Clinical Toxicology, 59(6), pp. 533–534

Background: Health literacy has become the best predictor of healthcare status. However, two-thirds of health providers are unaware of patients' health literacy. Thus, the aim of the study is to investigate factors related to Chinese-speaking nurses' knowledge and experience of health literacy. Methods: This cross-sectional study used a web-based survey. A total of 430 nurses were recruited by stratified sampling from different levels of hospitals and community health centers in Taiwan. Primary outcome measure by Health Literacy Knowledge and Experience. Results: The participants' overall health literacy knowledge was limited; the correct responses were 51%. The education level of the participants, job category, working years, and having attended in-service patient education programs were the predictors of knowledge of health literacy (p < 0.05); Institute, job category, and having attended in-service patient education programs were the predictors of experience of health literacy (p < 0.01). Conclusions: Participants' education levels and In-service patient education programs are beneficial factors to improve nurses' knowledge of health literacy. Furthermore, nursing education should emphasize on how to identify individuals' health literacy and using readable healthcare materials to improve health education.

Introduction: The purpose of this study was to predict the 10-year risk of fracture among people living with HIV (PLWH) using FRAX (TM), and to determine the risk factors related to a high probability of fractures. Methodology: This study consisted of 288 subjects aged 40 years and above. The ten-year probability of major osteoporotic fractures (MOF) and hip fractures was assessed using the FRAX (TM) algorithm with bone mineral density (BMD) data. A logistic regression was used to determine risk factors related to a high probability of major osteoporotic fracture and hip fracture. Results: The median 10-year probability of fracture was 3.7% (IQR 2.2-6.2) for MOF and 0.8% (IQR 0.3-2.5) for hip fractures. In addition to old age, previous fracture history, and low T-scores, HCV co-infection was associated with a higher risk of hip fractures in PLWH (AOR: 4.3, 95% CI: 1.29-14.33). Old age and low T-scores were also associated with a high probability of MOF. Conclusions: HCV co-infection among PLWH is associated with a higher risk of hip fracture. Sustained efforts in terms of pharmacologic and non-pharmacologic interventions in PLWH are necessary to prevent osteoporotic fractures, especially in those with HCV co-infections. (C) 2020 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.

Healthcare workers (HCWs) are recommended to measure their body temperature every 8 hours to reduce the risk of cross infections during the COVID-19 pandemic in Taiwan. However, temperature reporting accuracy among HCWs is difficult to attain due to busy working schedules and high chances of human errors. This study describes the application of a continuous temperature monitoring system (HEARThermo Care AI.) based on the Internet of Things (IoT) among HCWs in hospitals during the COVID-19 outbreak. A prospective cohort study was conducted among HCWs in a major tertiary hospital in southern Taiwan. HCWs participated in this study wore HEARThermo, an innovative wearable device used to measure body surface temperature and heart rate every 10s, to continue monitoring their body surface temperature and heart rate during working hours. The HEARThermo Care AI. system combined with the routine body temperature measurement flow were used to automatedly notify the manager about the HCWs with fever risks. The completion rate of body temperature measurements was calculated as the number of HCWs using the continuous temperature monitoring system divided by the number of HCWs on duty. A total of 52 HCWs (medical doctors, nurses, and interns) working in the medical ward between April 22 and June 30, 2020, voluntarily participated. The completion rate of body temperature measurements increased from 77.7% to 85% among HCWs in hospitals using HEARThermo Care AI. system. All the HCWs who received warning messages were reconfirmed by their managers and found they had discomforts at that time. The application of the continuous temperature monitoring system serves as a solution to early identify HCWs suspected of having discomforts during the COVID-19 pandemic.

Object. To compare the provision and effectiveness of dispatcher-assisted cardiopulmonary resuscitation (DACPR) in rural and urban areas. Methods. Patients with out-of-hospital cardiac arrest (OHCA) were prospectively registered in Taichung. The 29 districts of Taichung city were divided into urban and rural areas based on whether the population density is more than 1,000 people per square kilometer. Prehospital data were collected according to the Utstein-style template, and telephone auditory records were collected by a dispatch center. Results. 2,716 patients were enrolled during the study period. 88.4% OHCA occurred in urban areas and 11.6% in rural areas. 74.9% after dispatcher assistance, laypersons performed CPR in urban areas and 67.7% in rural areas (p=0.023). The proportion of laypersons continued CPR until an emergency medical technician’s (EMT) arrival was higher in the urban areas (59.57% vs 52.27%, p=0.039). Laypersons continued CPR until an EMT’ arrival would increase the chance of return of spontaneous circulation in urban and rural areas, with adjusted odds ratio (aOR) of 1.02, 95% confidence interval (CI) of 0.82–1.27, and aOR of 1.49, 95% CI of 0.80–2.80, respectively. Continued laypersons CPR until the EMT’ arrival also improved survival with favorable neurological function, with aOR of 1.16, 95% CI of 0.61–2.20 in urban areas and aOR of 2.90 95% CI of 0.18–46.81 in rural areas. Conclusion. Bystanders in urban areas exhibited higher ratio of acceptance of DACPR. However, after DACPR intervention, prognosis improvement was considerably higher in rural areas than in urban areas.

Aim and Objectives To investigate factors related to self-management and predictors of self-management in older adult patients with type 2 diabetic nephropathy. Background Diabetic patients suffer many comorbidities during their lifetime, and the process of self-management is complex. Self-management and an integrated care experience are extremely important for older adults with diabetic nephropathy. Design A cross-sectional correlation design was adopted. Methods A total of 123 older patients were enrolled in the study from June 2016 to November 2017. Data collection involved a demographic questionnaire, the Patients' Experience of Integrated Care Questionnaire and the Partners in Health Scale to measure the integrated care experience and self-management. Data analysis included descriptive statistics, independent t tests, Pearson product-moment correlation and multiple linear regression. The methods are consistent with the STROBE criteria (Data S1). Results The results showed that the majority of the sample was female (56.9%). The average age was 77 years old. Stepwise regression analysis showed that re-admission during the past year (p < .001), physical function (p < .001) and integrated care experience (p < .001) are predictors of self-management in older adult patients with type 2 diabetic nephropathy and explained 42.8% of the variation in self-management behaviour. Conclusion The results can be used to enhance the awareness of clinicians of the importance of an integrated care experience and self-management among older patients with type 2 diabetic nephropathy. Clinicians also should pay attention to physical function and the integrated care experience to promote self-management. Relevance to Clinical Practice Studies on the integrated care experience and self-management of diabetic neuropathy in older adults are limited in Taiwan. The results of this study provide valuable information to support the importance of integrated care among this specific population.

TaN in conjunction with adhesive Ta is a key barrier component of Cu-Damascene structure. However, the limited scalability and stability of TaN pose a dire need of an alternative molecularly thick (<= 1 nm) barrier. To this end, the feasibility of anodizing 2-nm-thick Ta films with a mild ethanol based solution, rather than the commonly used strongly acidic (aggressive) chemical electrolytes, to enhance the formation of (3-aminopropyl) trimethoxysilane (APTMS) monolayer barrier is studied. Performing the anodization in an H2O-containing (1%) ethanol solution results in a prompt oxidization of the Ta film surface into fully passive Ta(2)O(5)layer with extremely smooth topography, subsequently facilitating the growth of a fully oriented monolayer serving triply as a seed adsorber (for electroless Cu plating), barrier and adhesion promoter. Using Ta (pristine)/Cu [and Ta (pristine)/SAM/Cu] as a control, Ta (anodized)/SAM/Cu exhibits markedly higher adhesion strength (25.2 vs <1 MPa) and resistance against thermal failure (>500 vs 425 degrees C) of Cu. H2O is heavily involved in the anodization efficiency of the Ta films and is the key underlying factor deciding orientation ordering and barrier capacity of the monolayer fabricated. This is related to H2O-enhanced surface hydroxylation and Ta(2)O(5)passivation of Ta.

Among human immunodeficiency virus (HIV)-infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention. This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis. A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis. Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (beta = 0.23,P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11-1.86), male gender (aIRR 11.14, 95% CI 4.16-29.79), a history of STIs (aIRR 1.39, 95% CI 1.21-1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy >= 85% ([aIRR] 0.77, 95% CI 0.61-0.98;P < .001) were associated with a reduced risk of repeat syphilis. The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.

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

In contrast to previous metallization studies that primarily use sputtering to fabricate self-forming Cu-alloy thin films with metallic solutes >= 1 at.%, this work examines the feasibility of electroless plating to fabricate Cu films and nanowires that incorporate only 0.1% of MnO. Both surface and grain-boundary segregations of MnO inclusions are observed from secondary ion mass spectrometry (SIMS) and transmission electron microscopy (TEM). The mechanism of self-strengthening of Cu against electrical and thermal stressing involving dual segregation of MnO will be discussed, and the benefit of the extremely dilute metallurgical systems over conventional sputter deposited Cu-alloy systems minimizing residual resistivity components will be presented. (C) 2019 Elsevier B.V. All rights reserved.

Objective: To determine the incidence of and factors associated with neurological disorders in a large Taiwanese cohort of HIV-infected persons with free access to highly active antiretroviral therapy (HAART). Design: A retrospective population-based cohort study was conducted using the National Health Insurance Research Database for the years 2000–2010. Methods: We identified 13,316 HIV-positive persons from 2000 through 2010. We used direct standardization to calculate age-adjusted and sex-adjusted incidence rates based on the 2000 World Health Organization world standard population. Factors associated with neurological disorders were analyzed using a Cox proportional hazards model. Results: The standardized incidence of neurological disorders among HIV-infected persons increased from 22.16 per 1000 person-years in 2000 to 25.23 per 1000 person-years in 2010. Cognitive disorders increased significantly from 0.36 per 1000 person-years in 2001 to 7.44 per 1000 person-years in 2010 (trend P < 0.001). The rate of neurological disorders increased with age ≥55 years [adjusted hazard ratios (AHRs) 2.54, 95% confidence interval (CI): 1.89 to 3.40], hypertension (AHR 1.41, 95% CI: 1.12 to 1.76), substance abuse (AHR 1.65, 95% CI: 1.36 to 2.02), opportunistic infection (AHR 1.76, 95% CI: 1.47 to 2.11), syphilis (AHR 1.27, 95% CI: 1.10 to 1.47), and emergency department visits >5 (AHR 2.41, 95% CI: 1.96 to 2.97). The incidence of neurological disorders was negatively associated with adherence to HAART (adherence ≥85% AHR: 0.79, 95% CI: 0.64 to 0.97). Conclusions: The rising incidence of cognitive disorders among HIV-positive persons highlights the need to provide routine neurological evaluations at clinical visits. Receiving HAART with adherence ≥85% contributes to a reduced risk of neurological disorders.

It has become popular for men who have sex with men (MSM) to use mobile-phone geosocial networking applications (mobile apps) to find sex partners. A cross-sectional online survey was conducted in Taiwan to compare the sexual and substance-use behaviors of MSM seeking sex partners through the internet and mobile apps. Of the 1060 participants, 65.8% used the internet via computer and 37.7% used a mobile app to find sexual partners, while 30.3% used recreational drugs or alcohol in the previous 6 months. MSM who exclusively used mobile apps to seek sex partners were significantly more likely than MSM seeking sex via computer to be older, to have used recreational drugs or alcohol, and to have sex with HIV-positive partners. Additionally, using mobile apps to seek sex partners was significantly associated with having sex with online partners through either mobile apps or computer-based internet use (adjusted odds ratio (AOR), 7.12 [3.87-13.11]), self-reporting as HIV-positive (AOR, 2.24 [1.12-4.12]), using recreational drugs (AOR, 1.67 [1.21-2.32]), having disclosed HIV status to sexual partners (AOR, 1.44 [1.03-2.02]), and having sex with HIV-positive partners (AOR, 1.81 [1.06-3.10]). In conclusion, the mobile apps may serve as a feasible platform for HIV-positive MSM to find other HIV-positive partners.

OBJECTIVE:Positive prevention interventions for patients living with the HIV include the early detection and treatment of sexually transmitted infections (STIs). This study aimed to determine the incidence of selected STIs, including syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis, in a population-based cohort of individuals living with HIV.METHODS:Clinical data from 2000 to 2010 were obtained from the Taiwan National Health Insurance Research Database identified 15,123 patients with HIV infection. The incidence rates were standardized by age and sex using the direct method that was based on the 2000 World Health Organization world standard population.RESULTS:The overall rate ratio of STI episodes significantly increased [rate ratio: 34.0, 95% confidence interval (CI): 24.3 to 47.6, P < 0.01]. After an HIV diagnosis, 15.9% of patients with HIV had at least 1 of these 5 STIs. An incidence rate of 503.0 STI episodes/10,000 person-years (PYs) (95% CI: 487.1 to 519.5) was detected during the 11-year follow-up period. The most common STIs after an HIV diagnosis were syphilis (381.9 episodes/10,000 PYs; 95% CI: 368.0 to 396.3), followed by genital warts (138.9 episodes/10,000 PYs; 95% CI: 130.6 to 147.6). The incidence of STIs varied significantly according to gender. In women, the annual incidence of STIs remained stable. However, the annual incidence of syphilis, genital warts, and chlamydial infection increased in young men.CONCLUSIONS:An increase in STIs among HIV-positive persons highlights the need to identify the causal factors of these co-infections. Routine STI screenings and early preventive interventions against STIs in HIV-infected persons are crucial.

Results: The incidence of cervical neoplasia was four times higher in the HIV-infected women than in the general population [standardized incidence ratio 4.0, 95% confidence interval (CI) 2.16–6.95]. The most increased risk was noted in HIV-infected women aged 40–59 years. Receipt of HAART was associated with a significantly reduced risk of cervical neoplasia (0.20, 0.05–0.77). The most evident protective effect was noted in adherent to HAART at least 85%, and those treated with HAART for more than 3 years (0.01, 0.00–0.47).