Assessment of patient safety culture during COVID-19: a cross-sectional study in a tertiary a-level hospital in China

Purpose

The aims of this study are to (1) evaluate physicians and nurses' perspectives on patient safety culture amid the COVID-19 pandemic and (2) integrate the emotional exhaustion of physicians and nurses into an evaluation of patient safety culture to provide insights into appropriate implications for medical care.

Design/methodology/approach

Patient safety culture was assessed with the Chinese version of the Safety Attitudes Questionnaire. Confirmatory factor analysis was conducted to validate the structure of the data (i.e. reliability and validity), and Pearson's correlation analysis was performed to identify relationships between safety-related dimensions.

Findings

Safety climate was strongly associated with working conditions and teamwork climate. In addition, working conditions was highly correlated with perceptions of management and job satisfaction, respectively. It is worth noting that the stress and emotional exhaustion of the physicians and nurses during this epidemic were high and needed attention.

Practical implications

For healthcare managers and practitioners, team-building activities, power of public opinions, IoT-focused service, and Employee Assistance Programs are important implications for inspiring the patient safety-oriented culture during the period of the COVID-19 pandemic.

Originality/value

This paper considers the role of emotional state into patient safety instrument, a much less understood but equally important dimension in the field of patient safety.

Using the Apriori Algorithm to Explore Caregivers' Depression by the Combination of the Patients with Dementia and Their Caregivers

Purpose

The purpose of this study was to identify the caring scenarios that result in severe depression in caregivers caring for dementia patients.

Patients and Methods

A cross-sectional study with 1111 dementia patients and their caregivers in Taiwan from October 2015 to January 2020 was conducted. Gender, age, type of dementia, clinical dementia rating, walking ability, mood symptoms, behavioral symptoms, and psychological symptoms were the variables from the dementia patients. Age, relation to the patient, employment, type of primary care, frequency of care, mood symptoms, and the score from the Center for Epidemiologic Studies Depression Scale were the variables from the caregivers. A comprehensive viewpoint of both dementia patients and their caregivers was evaluated by the Apriori algorithm to find the attributes resulting in different caregiving depressions.

Results

Forty-seven rules were found with 18 rules of mild depressive symptomatology, 17 rules of moderate depressive symptomatology, and 12 rules of severe depressive symptomatology. A total of 7 general rules were summarized to be the severe depressive symptomatology. The results showed that an unemployed or retired caregiver with the mood symptoms such as helplessness, anger, emotional liability, or anxiety who took care of AD patients or AD patients with a moderate severity would have severe depression. Increased care frequencies (≥6 days per week) and multiple mood problems from caregivers result in severe depression. The composition of adult children, patients' aggression, and caregivers' helplessness as well as the combinations of male patients aged 75-84 years with the caregiver's mood of helplessness or nervousness and hopelessness were highly associated with severe depression.

Conclusion

For those caring for AD patients, severe depression was associated with the combination of different parameters to constitute each of these seven scenarios. Unlike previous studies which often evaluated one or two variables related to caregiver's depression, this study provided a more comprehensive viewpoint that enabled the collaborative team to efficiently identify and manage different scenarios by summarizing the rules of caregivers with severe depression from a systematic viewpoint.

Association Between Caregivers' Burden and Neuropsychiatric Symptoms in Female Patients with Alzheimer's Disease with Varying Dementia Severity

Purpose

This study examined the attributes causing higher burdens for caregivers caring for female patients with Alzheimer’s disease by analyzing a combination of various variables, including demographic data, dementia severity, and neuropsychiatric symptoms.

Patients and Methods

This study included 99 female patients with Alzheimer’s disease who were cared for by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Neuropsychiatric symptoms used in this study included affections (9 types), behavior symptoms (9 symptoms), and psychological symptoms (3 symptoms). The Apriori algorithm was employed to identify association rules that reveal the relationships among demographic data, dementia severity, neuropsychiatric symptoms, and caregivers’ burden.

Results

A total of 185 rules were determined, including 51 rules with little or no burden, 108 rules with mild to moderate burden, and 26 rules with moderate to severe burden. The major findings are as follows. Neuropsychiatric symptoms were associated with varying degrees of caregivers’ burden among female patients aged 75 to 84 years with mild dementia. Crying spells and aggression were specifically associated with a moderate to severe burden. Delusion was associated with a mild to moderate and moderate to severe burden. Dysthymia and depression were associated with little or no burden to moderate to severe burden.

Conclusion

Clinicians can provide early interventions to reduce the burden of caregivers caring for female patients with Alzheimer’s disease and can refer caregivers for timely assistance to reduce their burden.

Characteristics Predicting a High Caregiver Burden in Patients with Vascular Cognitive Impairment: Using the Apriori Algorithm to Delineate the Caring Scenario

Purpose

The aim of this study was to elucidate the factors and caring scenarios associated with a moderate to severe care burden in the caregivers of patients with vascular cognitive impairment (VCI).

Patients and Methods

This cross-sectional study included 158 patients with VCI and their caregivers who were managed by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Gender, age, clinical dementia rating, walking ability, behavioral symptoms, and psychological symptoms were the variables from the patients with VCI. Age, marital status, relation to the VCI patient, education, employment status, help of key activities, type of primary care, frequency of care, ZBI (Zarit burden interview) caregiving burden, and caregiver's mood were the evaluated variables for the caregivers. The Apriori algorithm was used to identify the attributes that resulted in different caregiving burdens from a comprehensive viewpoint of both VCI patients and their caregivers.

Results

A total of 1193 rules were identified with 1134 rules belonging to caregivers with a mild to moderate burden and 59 rules belonging to caregivers with a moderate to severe burden. Seven general rules were created based on a summary of these 59 rules. The results showed that an employed female caregiver who was taking care of her husband alone for ≥6 days per week, and who was helping with all key activities was likely to experience a moderate to severe burden when the patient had VCI. Moreover, if the caregiver had a relatively low education level and expressed an abnormal mood during the assessment, this increased the likelihood of the caregiver having a moderate to severe burden.

Conclusion

The caregiver's gender, relation to the care recipient, education level, mood status, employment status, and care loading were associated with a higher burden of care for caregivers of patients with VCI. Therefore, a dementia care team should provide personalized training for caregivers about the disease, care skills for specific behaviors and psychological symptoms of dementia (BPSD), and strategies to cope with their own feelings. Caregivers should also be referred to appropriate social resources, such as support groups or respite care.

[Reference values and growth curves of weight/length, body mass index, and ponderal index of Chinese newborns of different gestational ages]

Objective: To establish the reference values and growth curves of weight/length, body mass index, and ponderal index for Chinese newborns with gestational ages of 24 to 42 weeks, in order to provide a reference for the assessment of body proportionality and nutritional status at birth. Methods: Cross-sectional study design was applied. From June 2015 to November 2018, a total of 24 375 singleton live birth newborns with gestational ages of 24 to 42 weeks from 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha, and Shenzhen were selected, excluding those impacting the establishment of the reference values. The generalized additive model for location, scale, and shape (GAMLSS) was employed to establish percentile (P₃, P₁₀, P₂₅, P₅₀, P₇₅, P₉₀, P₉₇) reference values and growth curves of weight/length, body mass index, and ponderal index for male and female newborns with gestational ages of 24 to 42 weeks. The established growth standards in this study were compared with the standards from the 1988 Chinese data, the INTERGROWTH project, and the USA reference values. Results: A total of 24 375 newborns with 12 264 preterm newborns (7 042 males and 5 222 females) and 12 111 full-term newborns (6 155 males and 5 956 females) were included in this study. The percentile reference values and growth curves of weight/length, body mass index, and ponderal index were obtained for male and female newborns with gestational ages of 24 to 42 weeks. Weight/length of males in all gestational ages at P₁₀, P₅₀ and P₉₀ was 0 to 0.2 kg/m higher than that of females, and body mass index of males in all gestational ages at the P₁₀, P₅₀ and P₉₀ was 0.1 to 0.3 kg/m² higher than that of females. The established growth curves of weight/length and body mass index at the upper percentile and ponderal index at both upper and lower percentiles were greatly different from those of the 1988 Chinese data, which, for example, reported the difference ranges at P₉₀ as -1.09 to 0.40 kg/m for weight/length, -1.19 to 0.92 kg/m² for body mass index, and -0.64 to 0.81 kg/m³ for ponderal index. The established weight/length curves were generally consistent with the reference values from the INTERGROWTH project with a difference of -0.17 to 0.20 kg/m at P₅₀, while being 0.02 to 0.40 kg/m lower at P₉₀ and 0.13 to 0.41 kg/m higher at P₁₀ than that of the INTERGROWTH reference values at gestational ages of ≤32 weeks. The established body mass index curves differed from that of the USA reference values with a difference of -0.47 to 0.17 kg/m² at P₅₀, while being 0.53 to 1.10 kg/m² lower at gestational ages of ≥37 weeks but 0.17 to 0.45 kg/m² higher at gestational ages of ≤28 weeks than that of the USA reference values at P₉₀. Conclusion: The establishment of the new standardized growth reference values of weight/length, body mass index, and ponderal index for Chinese newborns by different gestational ages are useful for clinical practice and scientific research.

Gender difference in the perceptions of the patient safety culture: a case from a medical center in Taiwan

Purpose

Gender difference exists in the perception of the patient safety culture in healthcare organizations. A case from a medical center in Taiwan is presented to examine how different genders perceive the patient safety culture in practice from 2014 to 2017.

Design/methodology/approach

A longitudinal study using the data from 2014 to 2017 is conducted quantitatively. Mann–Whitney U test and one-way analysis of variance are employed for analyses.

Findings

The results showed that female nurses had significantly higher emotional exhaustion than male nurses in 2015 and 2016 indicating male nurses had better fatigue recovery than their female counterparts. In addition, male nurses felt a higher degree of fatigue in 2016 and 2017 than those in 2015 statistically. In contrast, female nurses felt more stressful in 2016 and 2017 than those in 2014 statistically. Female nurses had higher emotional exhaustion in 2016 and 2017 than those in 2014 and 2015 statistically.

Practical implications

To sum up, female nurses were more stressful than before, and their recovery was also relatively poor particularly in 2016 and 2017. There is a need to reduce the degree of fatigue for female nurses in this medical center through employee assistance programs, mindfulness-based stress reduction programs, building up female nurses' positive currency and setting up their appreciative inquiry. In contrast to female nurses, male nurses recovered better from fatigue. This might encourage hospital management to deploy male nurses more effectively in this medical center.

Originality/value

The results enable the hospital management to know there is a gender difference in this case hospital. More attention on female nurses is required.

Patient safety in Work Environments: Perceptions of Pediatric Healthcare Providers in Taiwan

BACKGROUND

Extensive research on the link between the organizational characteristics of the work environment and patient safety in a healthcare organization has been conducted; yet, only a few studies have concentrated on care providers in a pediatric unit.

OBJECTIVES

To determine the correlation between different work environment factors impacting patient safety in a pediatric care unit from the perspective of registered nurses working in these units.

DESIGN

Cross-sectional design.

DATA SOURCES AND METHODS

The study was conducted with 155 registered nurses from a pediatric unit in a medical center in Taiwan with the Chinese version of the Safety Attitudes Questionnaire (SAQ) 2014-2017.

RESULTS

Teamwork climate, higher job satisfaction, and better working conditions are linked to positive perceptions of patient safety culture. Emotional exhaustion is negatively related to most dimensions of patient safety.

CONCLUSION

Teamwork climate, job satisfaction, working conditions, and emotional exhaustion were identified as critical factors impacting the patient safety climate.

IMPLICATIONS FOR NURSING OR HEALTH POLICY

Investments to improve teamwork climate, job satisfaction, and working conditions and reduce emotional exhaustion may have a positive effect on patient safety in pediatric care units.

Understanding critical demographic variables affecting patient safety culture from nurses' viewpoints

Purpose

The purpose of this study is to identify critical demographic variables that would significant influence each dimension of patient safety culture. Understanding nurses' attitudes toward patient safety is important for healthcare organizations to relentlessly improve medical quality and services for patients.

Design/methodology/approach

The internal survey data sets in 2015 and 2016 from nurses' viewpoints are used. Linear regression with forward selection is applied where nine demographic variables are the input variables, while each dimension of the Chinese version of safety attitudes questionnaire (SAQ) is the dependent variable.

Findings

Supervisor/manager is the most essential demographic variable that has significant impacts on six dimensions. Experience in organization is the other critical demographic variable.

Practical implications

Nurses who are in charge of supervisors/managers are more satisfied in six of eight dimensions. Nurses who have much experience in an organization tend to have less satisfaction in three dimensions. Therefore, hospital management should enhance the leader's effectiveness in engaging their subordinates' commitment.

Originality/value

The results enable the hospital management to pay much attention to two major demographic variables, namely supervisor/manager and experience in organization, in order to improve the patient safety culture based on the Chinese version of SAQ in this hospital. Moreover, supervisor/manager is a more critical demographic variable for nurses due to larger absolute values of standardized coefficients by linear regression with forward selection.

[Timing of permanent tooth emergence and its association with physical growth among children aged from four to seven years in nine cities of China]

Objective: To investigate the timing of permanent tooth emergence and its association with physical growth among children aged 4-7 years in 9 cities of China, and to analyze the trend of permanent teeth development. Methods: According to a stratified cluster sampling design, a cross-sectional survey on the timing of permanent tooth emergence children aged 4-7 years was carried out in 9 cities (Beijing, Harbin and Xi'an in northern China; Shanghai, Nanjing and Wuhan in central China; Guangzhou, Fuzhou and Kunming in southern China) from June to October in 2015. A total of 37 973 children (19 035 boys and 18 938 girls) were recruited and were divided into different age groups (4.0-<4.5, 4.5-5.0, 5.0-5.5 and 6.0-<7.0 years of age). The situation of the exfoliation of primary teeth and the eruption of permanent teeth were investigated. Height and weight were measured using the standardized methods. Z-scores of physical growth indicators were calculated using the growth standards for Chinese children in 2009. Probit regression analysis was used to determine the median and percentile age of transition from deciduous to permanent teeth. Chi-square test was used for comparison of categorical data and t test was used for comparison of measurement data between boys and girls, urban and suburban as well as among different ages and regions. Meanwhile, the data from the national survey on physical growth and development of children under 7 years of age in 9 cities of China in 1995 were used to analyze the trends of the permanent teeth development. Results: The rate of transition from deciduous to permanent teeth in 37 973 children aged 4-7 years was higher with age, which was 0.6% (42/7 568) in 4.0-<4.5 years of age group, 30.3% (2 295/7 583) in 5.5-<6.0 years of age group, and 74.5% (5 680/7 627) in 6.0-<7.0 years of age group. The rates of transition from deciduous to permanent teeth in boys were all lower than those of girls except for children aged 4.0-<4.5 years (all P<0.01). The rate of transition from deciduous to permanent teeth in urban children was higher than that in suburban children for older than 5.5-6.0 years of age group in boys and older than 4.5-5.0 years of age group in girls, which was 74.2% (1 427/1 924) in urban boys aged 6.0-<7.0 years and 69.2% (1 305/1 885) in suburban boys aged 6.0-<7.0 years (χ(2)=11.446, P<0.01). The age of transition from deciduous to permanent teeth was 6.00 (95%CI: 5.98-6.01) years and the range of the 3-97 percentile was 4.88-7.11 years of age. The median permanent tooth emergence age of girls was lower than that of boys (5.94 vs. 6.06 years) and the median age of urban children was lower than that of suburban children (5.94 vs. 6.05 years). The median permanent tooth emergence age of southern Chinese children (6.05 years) was higher than that of northern (5.97 years) and central Chinese children (5.97 years). The weight for age Z-scores (WAZ), height for age Z-scores (HAZ) and body mass index for age Z-scores (BMIZ) of children with transition from deciduous to permanent teeth (0.35±1.17, 0.32±1.00, 0.23±1.16) were significantly higher than those of children without transition from deciduous to permanent teeth (0.03±1.13, 0.03±1.02, 0.04±1.13, t=20.81,21.67,12.09, all P<0.05). In comparison with the data in 1995, data in 2015 showed that the rate of transition from deciduous to permanent teeth was higher, for example, the rate of urban boys aged 6.0-<7.0 years group was 63.8% (1 146/1 796) in 1995, and increased to 74.2% (1 427/1 924) in 2015 (χ(2)=46.748, P<0.01). The median permanent tooth emergence age decreased by 0.24 years in 2015 as compared with that in 1995. Conclusions: The development of permanent teeth is earlier in girls than in boys, earlier in urban children than in suburban children and slightly delay in southern children than in central and northern Chinese children. In addition, the development of permanent teeth, which is related to the physical growth, slightly accelerate in China during the past 20 years.

[Survey on the stunting of children under seven years of age in nine cities of China]

Objective: To survey the children under 7 years of age in nine cities of China for a better understanding of the current situation of childhood stunting. Methods: According to a stratified cluster sampling design, a cross-sectional survey on children under 7 years of age was carried out in 9 cities (Beijing, Harbin and Xi'an in northern China; Shanghai, Nanjing and Wuhan in central China; and Guangzhou, Fuzhou and Kunming in southern China) from June to November in 2016. A total of 110 499 children were recruited. Height of children was evaluated using the growth standards for Chinese children (2009 edition) .Children with height less than the 3rd percentile of the growth standards were considered as stunting, and children with height between the 3rd and 10th percentiles of the growth standards were considered as relatively short stature. Chi-square test was used for comparison between data of boys and girls, urban and suburban, as well as among different ages and regions. Results: Totally 113 084 children under 7 years of age should be investigated and actually 110 499 children were investigated, with a rate of 97.7%. The prevalence of stunting was 1.9% (2 141/110 499) among all the children. The prevalence of stunting in urban children (1.6%, 904/55 524) was lower than that in suburban children (2.3%, 1 237/54 975, χ(2)=56.246, P<0.01). The gender difference in stunting prevalence was not statistically significant (1.9% (1 121/57 921) in boys and 1.9% (1 020/52 578) in girls, χ(2)=0.003, P=0.965). The prevalence of stunting decreased with age for children younger than 3 years, from 1.8% (312/17 080) in 0-<1 year of age group to 1.2% (168/13 740) in 2-<3 years of age group, but increased to 2.2% (240/11 073) at 6-<7 years group. Comparison among different regions showed that the stunting prevalence in southern region was higher than those in the central and northern regions (0.9% (193/20 374) in northern urban, 0.8% (154/18 486) in central urban, and 3.3% (557/16 664) in southern urban children), showing a statistical significance (χ(2)=437.736, P<0.01); 1.1% (241/21 924) in northern suburban, 1.4% (227/16 775) in central suburban and 4.7% (769/16 276) in southern suburban children, showing a statistical significance (χ(2)=646.533, P<0.01). In urban areas, the difference between the central and northern regions showed no statistical significance (χ(2)=1.429, P=0.232) and the stunting prevalence of central Chinese children was slightly higher than that of northern Chinese children in suburban areas (χ(2)=5.130, P=0.024). Among the nine cities, the stunting prevalence of Guangzhou (6.1%, 613/10 019) was higher than those of other cities (χ(2)=1 559.64, P<0.01). Among the stunting children, 78.4% (1 679/2 141) were classified as borderline or mild and only 7.2% (154/2 141) were classified as severe. The prevalence of relatively short stature was 5.2% (5 721/110 499). Conclusions: The prevalence of stunting among children under 7 years of age in nine cities of China is low and most of the stunting children were classified as mild; the prevalence of stunting in suburban children is higher than that in urban children; the gender difference show no statistical significance; and the prevalence of stunting in southern Chinese children is higher than those in central and northern Chinese children.

[Progress of interruption of schistosomiasis transmission in Jiangsu Province]

Schistosomiasis was once heavily endemic in Jiangsu Province. Following the control efforts for several decades, schistosomiasis was almost eradicated in all endemic counties in Jiangsu Province in 1980, and transmission control was achieved in the province in 2011. According to the principle of "implementing the control measures with adaptation to local circumstances and guiding the control programs with classified interventions", an integrated strategy with emphasis on the management of both infectious sources and snails has been recently employed for schitsosomiasis control in Jiangsu Province. In addition, a sensitive and highly effective surveillance system has been built and the application of novel techniques and information construction has been intensified to effectively interrupt the transmission of schistosomiasis in the Province. Transmission interruption of schistosomiasis was achieved in all endemic counties in Jiangsu Province. The paper summarizes the endemic situation of schistosomiasis, progress of schistosomiasis control, and major schistosomiasis control measures implemented during the stage of transmission interruption in Jiangsu Province.

What Role Does Patient Gratitude Play in the Relationship Between Relationship Quality and Patient Loyalty?

The environment in health care organizations is becoming increasingly competitive. Therefore, to improve patient return rates, health care organizations need to examine how to enhance the physician-patient relationship. In particular, the role of patient gratitude on the physician-patient relationship in health care organizations is still ambiguous. The specific role of patient gratitude in the medical service industry needs to be identified. Therefore, this study aimed to investigate physician-patient interactions with reference to relationship marketing and to further understand the relationships among relationship quality, patient gratitude, and patient loyalty. The potential effects of patient gratitude on the physician-patient relationship were examined by testing mediation effect. The results demonstrated that patient gratitude had a notable effect on the association between relationship quality and patient loyalty. To improve the physician-patient relationship in the medical service industry, health care managements should not ignore the 3 relationship quality tactics perceived by patients, specially the role of the potential effect of patient gratitude on relational building.

Care Needs of Community-Residing Male Patients with Vascular Cognitive Impairment

PURPOSE

The aim of this study was to identify the care needs of male patients with vascular cognitive impairment (VCI) and their caregivers.

PATIENTS AND METHODS

This cross-sectional study enrolled 389 male patients with VCI and their caregivers who were cared for by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Fifteen care needs consisting of most of quality measures for people living with dementia and their caregivers were developed by the care team. Through face-to-face evaluations, individualized care needs were collected. The Apriori algorithm was used to identify care bundles for the patients and their caregivers.

RESULTS

Six basic care needs for patients and their caregivers were identified, including appropriate schedule of activities, regular outpatient follow-up treatment, introduction and referral of social resources, referral to family support groups and care skills training, care for the mood of the caregiver, and health education for dementia and behavioral and psychological symptoms of dementia. Compared to subjects with all dementia subtypes from the previous studies, care for the mood of the caregiver was an important and frequent care need for the male patients with VCI and their caregivers. A comparison among the study and similar studies was made to highlight the strength of this study concentrating on the precise selection of care needs.

CONCLUSION

Collaborative dementia care teams should monitor for caregivers' depression and include this care need into the care bundle when assessing male subjects with VCI.

A magneto-microfluidic platform for fluorescence immunosensing using quantum dot nanoparticles

This study reports the online fluorescent detection of carcinoembryonic antigen (CEA) and α-fetoprotein (AFP) biomarker proteins in microfluidic channels using functional nanoparticles. Functional magnetic nanoparticles labeled with two antibodies were predeposited on separated microfluidic channels. Antigens were passed through each microfluidic channel to react with the respective antibodies. Two types of fluorescent nanoparticles labeled with antibodies were then used to detect and confirm antigens in the immunocomplex. Results indicate that online fluorescent detection of proteins can provide advantages for real-time monitoring and diagnostic applications. The running time was less than 20 min for each trial. The detection limits of CEA and AFP were found to be 0.6 and 0.2 pg ml^-1. These detection limits are lower than those of ELISA. The linear ranges of CEA and AFP detection were from 1.8 pg ml^-1 to 1.8 ng ml^-1 and from 0.68 pg ml^-1 to 0.68 ng ml^-1 for two deposition zones in a magnetic sandwich immunoassay. The linear ranges of this method are wider than those of ELISA and those of most other methods. The measurements of CEA and AFP in serum samples from this method differed from ELISA results by 11% and 9.4%, respectively. The detection limit of online detection has achieved the same range as those of previous offline detection. This method has a good potential for automation and multichannel analysis to increase the throughput with some modifications in the future. The proposed method can provide simple, fast, and sensitive online detection for biomarkers.

[Development of primary teeth among infants and toddlers in nine cities of China in 2015]

Objective: To investigate the status of the development of primary teeth and to identify the development patterns among infants and toddlers in nine cities of China in 2015. Methods: Healthy children aged 1-<36 months were investigated by across-sectional survey and retrospective studies, which was carried out in 9 cities (Beijing, Harbin and Xi'an in northern China; Shanghai, Nanjing and Wuhan in central China; and Guangzhou, Fuzhou and Kunming in southern China) from June to October in 2015. Subjects (n=103 995) were divided into 14 age groups (1-<2, 2-<3, 3-<4, 4-<5, 5-<6, 6-<8, 8-<10, 10-<12, 12-<15, 15-<18, 18-<21, 21-<24, 24-<30, 30-<36 months). There were 150-200 boys and girls respectively in each group of urban and suburb areas in each city. The eruption status and the number of primary teeth were examined by the trained child health care physician or pediatrician on the spot. The timing of primary teeth eruption of children was retrospectively surveyed using a questionnaire. The prevalence of primary teeth was calculated and χ(2) test was used for comparison of categorical data. Probit regression analysis was used to determine the median and percentile age of eruption of primary teeth. Results: Totally 103 995 children aged 1-<36 months were investigated. There were 52 346 children in urban areas (boys 26 228, girls 26 118) and 51 649 children in suburb areas (boys 25 912, girls 25 737). The eruption rate of primary teeth in children under 2 years became higher with age and the difference among each age group was statistically significant (χ(2)=85 913.868, P<0.01), which was 0.3% (22/7 450) in 3-<4 months group, 43.0% (3 227/7 503) in 6-<8 months group and 99.9% (7 441/7 446) in 15-<18 months group. The eruption age of primary teeth was 6.6 months (95%CI: 6.5-6.7 months), and the range of the 3rd to 97th percentile was 4.1-10.6 months. The eruption ages of primary teeth in urban and suburb areas children were 6.6 months (95%CI: 6.5-6.7 months) and 6.6 months (95%CI: 6.5-6.7 months) respectively. The eruption age of primary teeth was earlier in boys (6.4 months, 95%CI: 6.3-6.5 months) than that in girls (6.7 months, 95%CI: 6.6-6.8 months). The median eruption age of primary teeth was earlier in northern China (6.2 months) than that in central (6.7 months) and southern China (6.9 months). The eruption rate of primary teeth became higher with age, showing that the median number of primary teeth was 2 in 8-<10 months group, 8 in 12-<15 months group and 20 in 30-<36 months group. Conclusions: The timing of eruption of primary teeth was similar between urban and suburb areas children and that of the boys was slightly earlier than that of the girls. There were slight differences among different regions in the eruption timing of primary teeth. The range of the 3rd to 97th percentile in the eruption age of primary teeth was 4.1-10.6 months and the number of primary teeth followed the regular development pattern with age.

Performance of Arma chinensis reared on an artificial diet formulated using transcriptomic methods

An artificial diet formulated for continuous rearing of the predator Arma chinensis was inferior to natural prey when evaluated using life history parameters. A transcriptome analysis identified differentially expressed genes in diet-fed and prey-fed A. chinensis that were suggestive of molecular mechanisms underlying the nutritive impact of the artificial diet. Changes in the diet formulation were made based on the transcriptome analysis and tested using life history parameters. The quantity of pig liver, chicken egg, tuna fish, biotin, nicotinamide, vitamin B6, thiamine, riboflavin, vitamin C, L-glutamine, and sucrose was reduced, and wheat germ oil, calcium pantothenate and folic acid were increased. Ecuadorian shrimp was added as a partial substitute for tuna fish. Several parameters improved over six generations, including increased egg viability, and decreased egg and adult cannibalism. Additionally, several parameters declined, including longer developmental times for 2nd-5th instars, and decreased nymphal weights. The improvements in life history parameters support the use of transcriptome analyses to help direct formulation improvements. However, the decline in some parameters suggests that additional information, e.g., proteomic data, may be useful as well to maximize diet formulations.

Association between patients with dementia and high caregiving burden for caregivers from a medical center in Taiwan

Background

Based on a person-centered care, the relationships between people with dementia and caregivers should be interconnected. There is a need to study what attributes would contribute a higher caregiving burden from a comprehensive viewpoint of care recipients and caregivers.

Methods

Apriori algorithm is performed with 12 variables for antecedents and caregiving burden for the consequent from the self-built database of a medical center in Taiwan. The minimum support, minimum confidence, and lift of Apriori algorithm are set to 5%, 90%, and > 1, respectively.

Results

Thirty-two rules that satisfy the threshold values are found. Our findings show that clinical dementia rating of care recipients, type of dementia of care recipients, and age of caregivers are not the attributing variables to affect the caregiving burden. In contrast, the highest burden results from a female spouse or a sole caregiver. Moreover, the burden is associated with the type of primary care, frequency of care, and help of key activities.

Preventing arteriovenous shunt failure in hemodialysis patients: a population-based cohort study

Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients. 95 971 people under hemodialysis were followed in a claims database in Taiwan. Aspirin reduced vascular access failure rate and did not increase major bleeding rate. Clopidogrel, Aggrenox, and warfarin might increase major bleeding rate. SUMMARY: Background Dialysis adequacy is a major determinant of survival for patients with end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives This study evaluated the impacts of different drugs on the vascular access failure rate of an arteriovenous fistula or an arteriovenous graft and the rate of major bleeding in hemodialysis patients. Patients and methods We studied patients with end-stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for thrombectomy or percutaneous angioplasty. Major bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. The adjusted odds ratios between person-quarters with or without antiplatelet or oral anticoagulant use were calculated using a generalized estimating equation. Results The odds ratio of vascular access failure was 0.21 (0.11-0.39) for aspirin, 0.76 (0.74-0.79) for clopidogrel, 0.67 (0.59-0.77) for dipyridamole, 0.67 (0.53-0.86) for Aggrenox and 0.96 (0.90-1.03) for warfarin. The highest odds ratio for intracerebral hemorrhage was 5.33 (1.25-22.72) in younger patients using Aggrenox. The highest odds ratio for gastrointestinal bleeding was 1.34 (1.10-1.64) for clopidogrel. Conclusion Antiplatelet agents, but not warfarin, might reduce the vascular access thrombosis rate. The gastrointestinal bleeding rate was increased in the group using clopidogrel. Aggrenox should be used with caution in young individuals because it might increase the rate of intracerebral hemorrhage.

Using The Apriori Algorithm To Classify The Care Needs Of Patients With Different Types Of Dementia

PURPOSE

To elucidate specific combinations of care needs for people living with dementia (PLWD) and their caregivers according to specific subtypes of dementia.

PATIENTS AND METHODS

A cross-sectional study at memory clinics in Changhua Christian Hospital, Taiwan, was conducted. Five hundred and eight people living with dementia and their caregivers joined the dementia collaborative care model. The care team established 15 care needs containing most of quality measures for PLWD and their caregivers. Individualized care plans including different combinations of care needs were addressed through face-to-face assessments. Apriori algorithm was used to find specific combinations of care needs for particular groups of PLWD and their caregivers.

RESULTS

This study identified the basic care needs of PLWD and caregivers including appropriate scheduling of activities, regular outpatient follow-up treatment, introduction and referral of social resources, referral to family support groups and care skills training, and health education for dementia and behavioral and psychological symptoms of dementia. Patients with Alzheimer's dementia required more care to prevent traffic accidents and getting lost, while patients with vascular dementia required more care to prevent falls. The older (≥75 years old) PLWD were associated with more needs of fall prevention and care for the mood of the caregiver, especially in the female patients with mild Alzheimer's dementia (CDR = 1).

CONCLUSION

Bundling the needed care needs might be a more effective means to care for a wide variety of patients with dementia.

[Clinical characteristics of silent pheochromocytoma]

Objective: To summarize the clinical characteristics of silent paraganglioma. Methods: A total of 247 pheochromocytoma cases in Peking University First Hospital between January 1993 and December 2015 were analyzed retrospectively.The cases were divided into two groups according to whether they had hypertension: non-silent group (193 cases) and silent group (53 cases), then the clinical characteristics between the groups were compared, and the clinical features of silent pheochromocytoma were reviewed. Results: There were 53 silent pheochromocytoma cases in this study, which accounted for 21.5% (53/247), and imaging was the main way to find the tumor. Forty-one in 53 cases (77.4%) located in adrenal gland, in which 31 cases (75.6%) were benign and 2.3-8.0 cm in diameter, while 10 cases (24.4%) were malignant and 3.5-12.0 cm in diameter. Twelve in 53 cases (22.6%) located in extra-adrenal tissue, in which 4 cases were benign and 2.0-5.5 cm in diameter, while 8 cases were malignant and 5.0-10.5 cm in diameter. With the tumor diameter increased, the malignant rate increased: 1 in 8 cases in diameter<3 cm, 2 in 12 cases in diameter 3-5 cm, 15 in 33 cases in diameter>5 cm were malignant. There was no significant difference in age, sex, tumor location, benign or malignant rate between the two groups (all P>0.05). Compared with the non-silent group, the proportion of tumor size≥5 cm in silent group was significantly higher (62.3% vs 45.9%, P=0.034), and the incidence of hyperglycemia and the concentrations of norepinephrine and epinephrine were lower (all P<0.05) in silent group.Misdiagnosis was common in silent group, and up to 35.8% (19/53) had not been diagnosed correctly before operation. Twenty-one in 53 (39.6%) silent pheochromocytoma cases occured severe intra-operative blood pressure fluctuation. Conclusions: Silent pheochromocytoma was not uncommon and imaging was the main way to find it. The tumor size was always big and misdiagnosis was common, especially extra-adrenal tumors. Therefore, regardless of the adrenal or extra-adrenal tumors, especially in diameter>3.0 cm but with normal blood pressure, the possibility of silent pheochromocytoma should be considered. In order to reduce misdiagnosis and intra-operative blood pressure fluctuations, preoperative diagnosis and preparation, as well as intra-operative monitoring should be fully made.