Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes

OBJECTIVES

Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes.

METHOD

A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed.

RESULTS

The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group.

CONCLUSIONS

The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength.

The reciprocal regulation loop of Notch2 pathway and miR-23b in controlling gastric carcinogenesis

Gastric carcinoma is one of the most common malignancies and the third highest cause of global cancer-related death. Notch2 receptor intracellular domain (N2IC), the activated form of Notch2 receptor, enhances gastric carcinogenesis. MicroRNAs (miRNAs) act as either oncogenes or tumor suppressors in tumorigenesis and cross-talk with Notch pathways. Herein, microRNA-23b (miR-23b) was identified as a Notch2 receptor-related miRNA and its role in gastric carcinogenesis was investigated. Levels of miR-23b in stomach adenocarcinoma samples were down-regulated, whereas those of Notch2 receptor, v-ets erythroblastosis virus E26 oncogene homolog 1 (Ets1), and E2F1 transcripts were up-regulated. Results also showed that N2IC down-regulated miR-23b expression in gastric cancer cells through up-regulating E2F1. The miR-23b inhibited gastric tumorigenesis including growth, viability, epithelial-mesenchymal transition, and abilities of colony formation, migration, invasion, and tumorsphere formation. Mechanistically, miR-23b suppressed tumor progression and pluripotency gene expression and affected tumorsphere ultra-structure in gastric cancer cells via targeting Notch2 receptor or Ets1. Furthermore, miR-23b diminished the xenografted tumor growth and lung metastasis of SC-M1 gastric cancer cells through Notch2 pathway. Our results suggest that Notch2 pathway and miR-23b interplay in a reciprocal regulation loop in gastric cancer cells and this axis plays an important role in gastric carcinogenesis.

Injection of Human Cord Blood Cells With Hyaluronan Improves Postinfarction Cardiac Repair in Pigs

Recent clinical trials using autologous bone marrow or peripheral blood cells to treat myocardial infarction (MI) show controversial results, although the treatment has a good safety profile. These discrepancies are likely caused by factors such as aging, systemic inflammation, and cell processing procedures, all of which might impair the regenerative capability of the cells used. Here, we tested whether injection of human cord blood mononuclear cells (CB-MNCs) combined with hyaluronan (HA) hydrogel improves cell therapy efficacy in a pig MI model. A total of 34 minipigs were divided into 5 groups: sham operation (Sham), surgically induced-MI plus injection with normal saline (MI+NS), HA only (MI+HA), CB-MNC only (MI+CB-MNC), or CB-MNC combined with HA (MI+CB-MNC/HA). Two months after the surgery, injection of MI+CB-MNC/HA showed the highest left ventricle ejection fraction (51.32%±0.81%) compared with MI+NS (42.87%±0.97%, p<.001), MI+HA (44.2%±0.63%, p<.001), and MI+CB-MNC (46.17%±0.39%, p<.001) groups. The hemodynamics data showed that MI+CB-MNC/HA improved the systolic function (+dp/dt) and diastolic function (-dp/dt) as opposed to the other experimental groups, of which the CB-MNC alone group only modestly improved the systolic function (+dp/dt). In addition, CB-MNC alone or combined with HA injection significantly decreased the scar area and promoted angiogenesis in the infarcted region. Together, these results indicate that combined CB-MNC and HA treatment improves heart performance and may be a promising treatment for ischemic heart diseases.

SIGNIFICANCE

This study using healthy human cord blood mononuclear cells (CB-MNCs) to treat myocardial infarction provides preclinical evidence that combined injection of hyaluronan and human CB-MNCs after myocardial infarction significantly increases cell retention in the peri-infarct area, improves cardiac performance, and prevents cardiac remodeling. Moreover, using healthy cells to replace dysfunctional autologous cells may constitute a better strategy to achieve heart repair and regeneration.

Yin Yang 1 is a target of microRNA-34 family and contributes to gastric carcinogenesis

Gastric cancer is the second leading cause of cancer-related death worldwide. Herein, we investigated the role of transcription factor Yin Yang 1 (YY1), a multi-functional protein, in tumorigenesis of gastric cancer cells. Results showed that YY1 contributed to gastric carcinogenesis of SC-M1 cells including growth, viability, and abilities of colony formation, migration, invasion, and tumorsphere formation. Levels of pluripotency genes CD44, Oct4, SOX-2, and Nanog were also up-regulated by YY1 in SC-M1 cells. Additionally, the 3'-untranslated region (3'-UTR) of YY1 mRNA was the target of microRNA-34 (miR-34) family consisting of miR-34a, miR-34b, and miR-34c. Overexpression of miR-34 family suppressed carcinogenesis through down-regulation of YY1 in NUGC-3 gastric cancer cells scarcely expressing miR-34 family. Alternatively, knockdown of miR-34 family promoted tumorigenesis via up-regulation of YY1 in SC-M1 and AZ521 gastric cancer cells with higher levels of miR-34 family. The miR-34 family also affected tumorsphere ultra-structure and inhibited the xenografted tumor growth as well as lung metastasis of SC-M1 cells through YY1. Expressions of miR-34a and miR-34c in gastric cancer tissues of patients were lower than those in normal tissues. Taken together, these results suggest that miR-34 family-YY1 axis plays an important role in the control of gastric carcinogenesis.

Fibrocyte trafficking in patients with chronic obstructive asthma and during an acute asthma exacerbation

BACKGROUND

Fibrocytes express several chemokine receptors (CCR7 and CXCR4) that regulate their recruitment and trafficking into tissue-damage sites in response to specific chemokine gradients (CCL19 and CXCL12).

OBJECTIVE

We investigated whether these chemoattractants and S100A9, through the receptor for advanced glycation end-products (RAGE; ie, its receptor), are involved in fibrocyte trafficking in patients with chronic obstructive asthma (COA) and during an acute exacerbation (AE) in patients without airflow obstruction (Asthma AE group).

METHODS

We collected peripheral blood from 14 asthmatic patients with normal pulmonary function, 14 patients with COA, 11 patients in the Asthma AE group, and 14 healthy subjects. Isolated circulating fibrocytes were used for migration assay. Expression of CCR7, CXCR4, S100A9, and RAGE in fibrocytes was measured by using flow cytometry. CCL19 and CXCL12 expression in bronchial tissues was determined by using immunohistochemistry and RT-PCR.

RESULTS

There were higher numbers of circulating fibrocytes in patients in the Asthma AE group and patients with COA. The expression of CXCL12 in bronchial tissues and CXCR4 in circulating fibrocytes was higher in the Asthma AE group and, to a lesser extent, in patients with COA. The expression of CCL19 in bronchial tissues and CCR7 in fibrocytes was higher in patients with COA. CXCL12/CXCR4 and CCL19/CCR7 enhanced fibrocyte transmigration in the Asthma AE group and in patients with COA, respectively. The upregulated expression of S100A9 and RAGE in fibrocytes of patients in the Asthma AE group and those with COA contributes to the enhanced basal migratory motility of fibrocytes.

CONCLUSION

The CXCR4/CXCL12 axis contributes to chemotaxis of fibrocytes in patients in the Asthma AE group, whereas the CCR7/CCL19 axis plays an important role in patients with COA. S100A9 enhances the basal migratory motility of fibrocytes from patients in the Asthma AE group and patients with COA.

Downregulation of tumor suppressor MBP-1 by microRNA-363 in gastric carcinogenesis

Gastric carcinoma is one of the most common malignancies and the second most lethal cancer worldwide. The mechanisms underlying aggressiveness of gastric cancer still remain obscure. c-Myc promoter binding protein 1 (MBP-1) is a negative regulator of c-myc expression and ubiquitously expressed in normal human tissues. It is produced by alternative translation initiation of α-enolase gene. Both MBP-1 and α-enolase are involved in the control of tumorigenesis including gastric cancer. MicroRNAs (miRNAs) are involved in tumorigenesis and could have diagnostic, prognostic and therapeutic potential. In this study, whether miRNAs modulate tumorigenesis of gastric cancer cells through targeting MBP-1 was evaluated. We found that miR-363 targets 3'-untranslated region of human MBP-1/α-enolase messenger RNA. The exogenous miR-363 promotes growth, viability, progression, epithelial-mesenchymal transition and tumorsphere formation of SC-M1 gastric cancer cells through downregulation of MBP-1, whereas the knockdown of endogenous miR-363 suppresses tumorigenesis and progression of SC-M1 cells via upregulation of MBP-1. The miR-363/MBP-1 axis is also involved in the control of carcinogenesis in KATO III and SNU-16 gastric cancer cells. Furthermore, miR-363 induces the xenografted tumor growth and lung metastasis of SC-M1 cells through MBP-1 in vivo. Taken together, these results suggest that miR-363 plays an important role in the increment of gastric carcinogenesis via targeting MBP-1.

Impact of action cues, self-efficacy and perceived barriers on daily foot exam practice in type 2 diabetes mellitus patients with peripheral neuropathy

AIMS AND OBJECTIVES

To identify the effects of health belief model factors on daily foot-exam practice among diabetes mellitus patients with peripheral neuropathy.

BACKGROUND

Daily foot exams are one of the most important self-care behaviours that prevent the occurrence of diabetic foot ulcers and subsequent amputation. Although daily foot exams were under-practiced in patients with peripheral neuropathy, few studies have explored modifiable social-psychological factors related to daily foot exams.

DESIGN

A cross-sectional survey was used to collect the data.

METHODS

A total of 277 patients with diabetes and peripheral neuropathy were recruited from two hospitals in northern Taiwan. The Family APGAR and Diabetic Foot Ulcer Health Belief Scale (DFUHBS) were used to measure family support and health belief factors respectively. Data on foot-exam practice, perceived self-efficacy and action cues were collected through the use of structured questionnaires. The data were analysed using logistic regression.

RESULT

The regression model revealed that select action cues (recommendations from family, friends, or health professionals), perceived self-efficacy and perceived barriers interactively influenced the participants' daily foot-exam practice.

CONCLUSION

Factors related to daily foot-exam practice were identified. Specifically, action cues played a significant role in motivating daily foot-exam practice in this group.

RELEVANCE TO CLINICAL PRACTICE

This study recognises modifiable factors that influence the daily foot-exam practice of patients with diabetes and peripheral neuropathy. Using the findings of this study, health professionals can design interventions that aim to modify the above factors as a means to promote daily foot-exam practice.

Misperception among rural diabetic residents: a cross-sectional descriptive study

AIMS

To evaluate the self-perception of diabetes control associated with physical indicators and with practicing exercise and a healthy diet, among rural residents.

BACKGROUND

It remains unclear whether a subject's self-perception of diabetes control increases its deleterious effects.

DESIGN

Cross-sectional, correlational.

METHODS

We recruited 715 participants from 18 primary healthcare centres in the rural regions of Chiayi County, Taiwan. Data were collected between 1 January 2009-30 June 2010. Logistic regression was conducted to identify the determinant factors associated with perceptions of diabetes control.

RESULTS

A high percentage of participants overestimated their fasting blood glucose and HbA1 C status. Total cholesterol, triglyceride, low density lipoprotein cholesterol, blood pressure, and waist circumference exceeded the medical standard in the 'feel good' group, and many did not adopt a healthy diet and undertake physical activity. The final logistic regression model demonstrated that residents with diabetes who exercised frequently had normal fasting glucose, and normal HbA1 C tended to perceive 'feel good' control.

CONCLUSION

Misperception and unawareness of diabetes control were prevalent among rural residents. Addressing misperceptions among rural residents with diabetes and increasing their knowledge of professional advice could be important steps in improving diabetes control in an elder population.

Exacerbation of oxidative stress-induced cell death and differentiation in induced pluripotent stem cells lacking heme oxygenase-1

Embryonic stem cells (ESCs) are promising donor sources in cell therapies for various diseases. Although low levels of reactive oxygen species (ROS) are necessary for the maintenance of stem cells, increased ROS levels initiate differentiation and cell damage. We and others have previously demonstrated that heme oxygenase (HO)-1, a stress response protein with antioxidative and anti-inflammatory properties, plays critical protective functions in cardiovascular and other diseases. However, the functions of HO-1 in ESCs remain to be elucidated. Our goal was to investigate the roles of HO-1 in ESC survival and differentiation. Due to the lack of HO-1-deficient ESCs, we used Oct3/4, Sox2, c-Myc, and Klf4 retroviruses to reprogram mouse embryonic fibroblasts into induced pluripotent stem (iPS) cells of different HO-1 genotypes. These iPS-HO-1 cells exhibited characteristics of mouse ESCs (mESCs) and formed teratomas that were composed of cell types of all 3 germ layers after injected into severe combined immunodeficiency mice. In response to oxidant stress, iPS-HO-1(-/-) cells accumulated higher levels of intracellular ROS compared with D3 mESCs or iPS-HO-1(+/+) cells and were more prone to oxidant-induced cell death. Spontaneous differentiation experiments revealed that Oct4 levels were significantly lower in iPS-HO-1(-/-) cells after leukemia inhibitory factor withdrawal and removal of feeders. Further, during the course of spontaneous differentiation, iPS-HO-1(-/-) cells had enhanced Erk1/2 phosphorylation, which has been linked to ESC differentiation. By the loss-of-function approach using iPS-HO-1(-/-) cells, our results demonstrate that a lack of HO-1 renders iPS cells more prone to oxidative stress-induced cell death and differentiation.

Expression of anti-neuroexcitation peptide III of scorpion Buthus martensii Karsch BmK ANEP III in plants

Anti-neuroexcitation peptide III of Buthus martensii Karsch (BmK ANEP III) has better anti-epileptic and anticonvulsive effects in the test animal models. The present study is aimed at developing transgenic tomato and tobacco lines overproducing the ANEP III protein. Using the molecular cloning technique, the plant expression vector pBI-ANEP III was constructed successfully. The ANEP III expression cassette included a double CaMV 35S promoter with omega enhancers, the ANEP III gene with the Kozak sequence, the ER retention signal and the NOS terminator. Recombinant plasmids were transferred into Agrobacterium tumefaciens EHA105 by freeze-thaw transformation methods. By the Agrobacterium-mediated leaf disc transformation method, tobacco (Nicotiana tabacum) and tomato (Lycopersicum esculentum) lines were transformed. Transformants were screened and confirmed by PCR, RT-PCR and western blotting analysis. It was demonstrated that the ANEP III gene was successfully expressed in the genomic DNA of transgenic plants. The ANEP III protein was detected by immunofluorescence analysis, and the results confirmed the high amount of ANEP III protein, being 0.81 and 1.08% of total soluble proteins in transgenic tobacco and tomato. The study of plants with high expression levels of ANEP III has an important theoretical and practical significance and provides valuable information for establishing a new, economical and effective system for industrial protein production.

Skin delivery of short hairpin RNA of indoleamine 2,3 dioxygenase induces antitumor immunity against orthotopic and metastatic liver cancer

Liver cancer is one of the most malignant cancers in the world and has a high rate of metastasis. Therefore, development of a novel therapy for liver cancer is a critical issue. Indoleamine 2,3-dioxygenase (IDO) is known as a negative immune regulator in dendritic cells. Our previous study demonstrated that skin delivery of IDO short hairpin RNA (shRNA) induced antitumor immunity in subcutaneous bladder and colon tumor models. Because the immunological environment is quite different between skin and liver, it is essential to evaluate whether skin delivery of IDO shRNA is an effective treatment in metastatic and orthotopic animal tumor models. In the present study, IDO shRNA inhibited tumor growth in subcutaneous, metastatic and orthotopic liver tumor models. The cytotoxicity of splenocytes was significantly elevated in mice treated with IDO shRNA in the orthotopic and metastatic tumor models. Interleukin (IL)-12 and interferon (IFN)-gamma mRNA expression were upregulated while IL-10 was downregulated in the inguinal lymph nodes, which were collected from IDO shRNA-treated mice. Similar results were observed in the spleens of mice inoculated with IDO shRNA by gene gun. The results indicate that skin administration of IDO shRNA is an effective therapy in orthotopic and metastatic liver cancer animal models. Indoleamine 2,3-dioxygenase shRNA might be a potential new treatment for liver cancer in the future.

Microalgal biomass production and on-site bioremediation of carbon dioxide, nitrogen oxide and sulfur dioxide from flue gas using Chlorella sp. cultures

The growth and on-site bioremediation potential of an isolated thermal- and CO₂-tolerant mutant strain, Chlorella sp. MTF-7, were investigated. The Chlorella sp. MTF-7 cultures were directly aerated with the flue gas generated from coke oven of a steel plant. The biomass concentration, growth rate and lipid content of Chlorella sp. MTF-7 cultured in an outdoor 50-L photobioreactor for 6 days was 2.87 g L⁻¹ (with an initial culture biomass concentration of 0.75 g L⁻¹), 0.52 g L⁻¹ d⁻¹ and 25.2%, respectively. By the operation with intermittent flue gas aeration in a double-set photobioreactor system, average efficiency of CO₂ removal from the flue gas could reach to 60%, and NO and SO₂ removal efficiency was maintained at approximately 70% and 50%, respectively. Our results demonstrate that flue gas from coke oven could be directly introduced into Chlorella sp. MTF-7 cultures to potentially produce algal biomass and efficiently capture CO₂, NO and SO₂ from flue gas.

Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial

AIM

To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults. Background.  Fear of falling is a major health problem among community-dwelling older persons. The prevalence of this fear ranges from 29% to 77%, indicating the importance of developing effective strategies to reduce fear of falling among elderly adults.

METHODS

Data were collected from January to December 2007. A randomized controlled trial with three groups (control, cognitive-behavioural and cognitive-behavioural with Tai Chi). Participants were assessed at baseline for demographic data, falls-related history, and fear of falling. Data on these variables plus falls, mobility, social support behaviour and satisfaction, and quality of life were also collected at 2 and 5 months after interventions.

RESULTS

Participants in the three groups differed significantly in both measures of fear of falling (F = 20·89, P < 0·001; F = 6·09, P < 0·001) and mobility (F = 30·33, P < 0·001), social support behaviour and satisfaction (F = 3·32, P < 0·05 and F = 6·35, P < 0·001, respectively), and quality of life (F = 16·66, P< 0·001). In addition, participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores (P < 0·001) and higher mobility (P < 0·001), social support satisfaction (P < 0·01) and quality of life (P < 0·001) than the cognitive-behavioural alone and control groups at 5 months. The three groups did not differ significantly in falls.

CONCLUSION

The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility, to manage their fear of falling and to increase their quality of life.

Quality of life in Parkinson's disease patients: validation of the Short-Form Eight-item Parkinson's Disease Questionnaire (PDQ-8) in Taiwan

PURPOSE

This study sought to evaluate the Chinese version of the eight-item Parkinson's Disease Questionnaire (PDQ-8), through standard psychometric techniques.

METHODS

A cross-sectional study was conducted on 100 Parkinson's disease patients attending a Movement Disorders Unit. Neurologists' assessments were based on Hoehn and Yahr, Schwab and England and Unified Parkinson's Disease Rating Scales. Patients' self-evaluations included the Taiwanese Depression Questionnaire, the 39-item Parkinson's Disease Questionnaire (PDQ-39) and PDQ-8, pain, and Pittsburgh Sleep Quality Index. Analyses for internal consistency, inter-rater reliability, and construct validity were performed.

RESULTS

There was no evidence of floor or ceiling effects. The alpha coefficient was 0.81. Correlation of social support and bodily discomfort with the PDQ-8 was modest (0.46 and 0.36, respectively). PDQ-8 convergent validity with the PDQ-39 was very high (r = 0.96), and known-groups validity proved satisfactory.

CONCLUSIONS

The results of this study suggest the PDQ-8 is a valid and reliable disease-specific health-related quality-of-life instrument for Parkinson's disease in Taiwan when used independently of the PDQ-39.

A combination of the metabolic enzyme inhibitor APO866 and the immune adjuvant L-1-methyl tryptophan induces additive antitumor activity

Many types of malignant cells have a higher nicotinamide adenine dinucleotide (NAD) turnover rate than normal cells, as well as the ability to escape immune responses. Indoleamine 2,3-dioxygenase (IDO) is reported to be a negative immune regulator. Overexpression of IDO in dendritic cells is observed in tumor-draining lymph nodes. IDO-expressing dendritic cells suppress T-cell activation and promote immune tolerance. The nicotinamide phosphoribosyl transferase (NAMPT) inhibitor APO866 (also called FK866 or WK175) selectively inhibits tumor growth through intracellular NAD depletion. The IDO-specific inhibitor L-1-methyl-tryptophan (L-1MT) activates immune responses and reduces tumor volume in murine tumor models. We combined L-1MT and APO866 treatments and tested their antitumor effects in the murine gastric and bladder tumor models. In immune-competent mice, a combination of APO866 and L-1MT had a better therapeutic effect than did either L-1MT or APO866 alone. The intracellular level of NAD was suppressed by APO866 but not L-1MT. However, an additive inhibitory effect on tumor growth was not observed in tumor-bearing immune-deficient mice. The new strategy of combining a metabolic inhibitor and an immune adjuvant induced a potent therapeutic effect.

[Fatigue and related factors in patients with Parkinson's disease]

BACKGROUND

While fatigue ranks as one of the most common symptoms of Parkinson's disease (PD), few studies on PD-related fatigue have been done in Taiwan.

PURPOSE

The purpose of this study was to explore PD fatigue and fatigue-related factors.

METHODS

A descriptive and correlation study design was used. Using purposive sampling, we recruited 100 subjects from a medical center in northern Taiwan. Data were analyzed using Pearson product-moment correlation, independent t-test, chi-square test, one way ANOVA, multiple regression and logistic regression.

RESULTS

Results showed that: (1) about 46% of participants reported fatigue symptoms; (2) UPDRS (Unified Parkinson's Disease Rating Scale) total score, Hoehen and Yahr stage (H&Y), daily L-dopa dose (mg), quality of sleep and depression symptoms each correlated positively with level of fatigue. The Schwab and England score (SES) correlated negatively with level of fatigue; (3) depression inclination explained 45.0% of variance in fatigue among subjects; (4) depression inclination was a significant fatigue predictor (OR = 5.357, 95% CI = 2.27-12.65) among participants.

CONCLUSION

Fatigue associated with PD is a common and under-appreciated problem. The present study confirms UPDRS total score, HYS, daily L-dopa dose (mg), quality of sleep, depression symptoms and SES to correlate positively with level of fatigue. Assessment of fatigue should be part of the routine evaluation procedures used with PD patients to promote healthcare quality.

Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing

BACKGROUND

Several approaches have emerged for measuring self-reported fear of falling. A comparison of measurement scales' psychometric properties is needed for researchers to choose the proper scale for their study.

OBJECTIVES

To compare the psychometric properties of the Falling Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC) and the Geriatric Fear of Falling Measurement (GFFM).

DESIGN

Secondary analysis using baseline and 8-week data from a randomized, controlled trial on fall and fear of falling prevention.

SETTINGS

Rural area northeast of Taiwan with assessments conducted in participants' homes.

PARTICIPANTS

Population-based sample of 168 community-dwelling older adults aged 60 and older.

METHODS

During a home visit, a nurse administered the Tinetti Mobility Scale, and asked about the FES, ABC, GFFM, WHOQOL, falls, chronic illnesses and medicines taken.

RESULTS

Baseline internal consistency measured using Cronbach's alpha was 0.98 for the FES, 0.96 for the ABC and 0.88 for the GFFM. Baseline concurrent validity between the FES, ABC and GFFM measured using a correlation coefficient was 0.88 (FES vs. ABC), -0.55 (FES vs. GFFM), and -0.57 (ABC vs. GFFM), respectively, p<.001. All three instruments scores were significantly correlated at baseline with physical performance tests and WHOQOL. The GFFM demonstrated responsiveness to change at 8 weeks.

CONCLUSIONS

The FES, ABC and GFFM demonstrated strong internal consistency reliability. The GFFM had stronger associations with physical and psychosocial functioning and may be more appropriate for studies focused on improving all aspects of fear of falling. Both FES and ABC instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively non-frail older community-dwelling adults. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population.

Individualized programme to promote self-care among older adults with asthma: randomized controlled trial

AIM

This paper is a report of a trial to examine the effectiveness of individualized self-care education programmes in older adults with moderate-to-severe asthma.

BACKGROUND

Asthma is a common chronic disease in adults and a major cause of frequent work absences, emergency room visits, and hospitalization. The results of studies of self-care education programmes have been largely supportive and suggest that they have positive outcomes for people with asthma. However, for older people with asthma, the effectiveness of computer-aided, self-learning video programmes has been controversial.

METHODS

Older adult patients with asthma (N = 148) were randomly assigned to one of three groups: usual care, individualized education, or individualized education with peak flow monitoring, and followed for 6 months. Data were collected from January to December 2006. The variables studied included demographic data, asthma self-care competence, asthma self-efficacy, and asthma self-care behaviour. FINDINGS. Patients in both individualized education groups reported higher asthma self-care competence scores (F = 334.06 and 481.37, P < 0.001) and asthma self-care and self-efficacy scores (F = 104.08 and 68.42, P < 0.001) than patients in the usual care group. In addition, patients who received individualized education with peak flow monitoring had statistically significantly higher asthma self-care behaviour and self-efficacy scores (P < 0.001) and asthma control indicators (P = 0.025) than the education alone group. No differences were found among the three groups in unscheduled health service usage.

CONCLUSION

Our results suggest that individualized education helps older people with asthma to enhance their self-care behaviours, manage their disease, and increase their quality of life.

Self-care behavior of adult asthma patients

The purpose of this study was to identify factors potentially associated with asthma self-care behavior among adult asthma patients. A correlational descriptive study was conducted with a convenience sample of 220 adults identified as having moderate-to-severe asthma and receiving outpatient care at a medical center in northern Taiwan. Participants were interviewed by questionnaires. The study found that asthma self-care behaviors were predicted by 5 factors: (1) younger age, (2) not smoking history, (3) better social support, (4) better knowledge, and (5) better skills regarding asthma self-care, accounting for 51.5% of the total variance. The study also showed that the initial model could be modified to obtain a recursive model with good fit. Determinant factors identified by the analysis highlight the need to educate adult asthma patients about self-care to minimize mortality and promote their quality of life.

[A project to revise the patient needs rank assessment scale for discharge planning]

A comprehensive discharge planning assessment tool facilitates the provision of services that meet individual needs thus also facilitating the implementation of high-quality discharge planning. This project used a medical center in northern Taiwan as an example, applied interviews and the questionnaire method, and found that the sensitivity and specificity of existing rank assessment scales were all lower than the standard of 70%, too low to provide accurate screening for classification of needs. In revising the assessment items of, "The Patient Needs Rank Assessment Scale for Discharge Planning, a quantified score was set for the degree of need for each rank, to compute the cut point of each rank with the appropriate sensitivity and specificity. The results show that sensitivity and specificity after revision of the assessment scale all exceeded 70%. As far as satisfaction in clinical usage was concerned, personnel sought to match assessment standards with clinical patients'needs and accurately screened three grades of patient need. Initially, the increase in satisfaction was of clear statistical significance (p < .05). This showed that revision of, "The Patient Needs Rank Assessment Scale for Discharge Planning" can be applied to achieve accurate screening of patient need grades.