Exploration of Inflammatory Biomarkers and Psychological Cardiovascular Disease Risk Factors Among Community Dwelling Adults: A Gender Comparison Study

Patients with rheumatic disease (RD) are at high risk for cardiovascular disease (CVD), which is the leading non-communicable chronic disease cause of death worldwide. Inflammatory biomarkers and psychological health status are reliable predictors of CVD in patients with RD. The primary aim of this study was to compare the inflammatory biomarkers and psychological CVD risk factors (CRFs) between a group of community-dwelling adults with RD and CRFs and a group of their peers with CRFs only. The secondary aim of this study was to analyze and compare the collected data by gender in the RD group. Data were collected and analyzed from 355 participants, with the 135 participants with physician-diagnosed RD assigned to the RD group and the remainder (n = 220) assigned to the comparison group. The measures used included a demographic datasheet, medical information, serum homocysteine (Hcy) levels, high sensitive C-reactive protein (hs-CRP) levels, and depression and global sleep-quality scale scores. The RD group had higher ratios of hypertension and depression diagnoses than the comparison group. The gender analysis of the RD group found significantly more-severe sleep disturbances in women than men and a significantly higher mean value of Hcy in men than women. The women in the RD group were significantly older, less educated, and less employed than their male counterparts and thus may be presumed to at higher risk of health illiteracy. Gender-tailored interventions to modify the risk factors of CVD identified in this study for patients with RD are recommended.

Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial

We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.

[Community Innovation and Regional Sustainability: The Practice of Time Banking at Fooyin University]

The need for health literacy in the context of older adult healthcare has increased significantly with population aging. Employing innovative models of social service delivery will be necessary to effectively integrate academic, medical, and community resources to address diverse healthcare needs. The project of university social responsibility supported by Fooyin University is a comprehensive program that employs a time bank model and cultivates community. The Fooyin Time Bank leverages reciprocity to cultivate sustainable manpower to satisfy community needs. The five strategies of the Fooyin Time Bank include: 1) strengthen the awareness of the time bank in community volunteers, 2) cultivate seed members to initiate the time bank, 3) adapt the mutual help model to meet local individual needs, 4) promote the online platform system of the time banking infrastructure and diversities of resource exchange, and 5) emphasize the key role of community and supplementary role of university to enhance sustainability. The Fooyin Time Bank coordinates with government agencies, private companies, and academic institutions to bolster the sustainability of its networks. In addition, faculties and students participate in the community to create a social climate of mutual help, inter-generational aged care, and social welfare.

Outcomes of a walking exercise intervention in postpartum women with disordered sleep

AIM

Good sleep quality is essential to physical and mental-health-related quality of life. The purpose of this study was to evaluate the effects of a walking exercise in relieving sleep quality, fatigue, and depression in new mothers during the postpartum period.

METHODS

This quasi-experimental study was conducted at a teaching hospital in southern Taiwan. One hundred and four eligible postpartum women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score ≧16) were assigned to either the experimental group (n = 50) or the control group (n = 54) according to their individual preferences. The participants in the experimental group participated in a 12-week stride walking exercise intervention. The control group did not receive any exercise intervention. The PSQS, Postpartum Fatigue Scale, and Edinburgh Postnatal Depression Scale were used to assess outcomes.

RESULTS

Repeated measures ANOVA demonstrated that the experimental group participants perceived milder physical symptoms associated with sleep inefficiency at 4-week posttest (F = 7.25, p < 0.01) than their control group peers. However, no significant differences were found between two groups in terms of either fatigue or depression at 4-week and 12-week posttest.

CONCLUSION

Significant improvement in the physical symptoms associated with sleep inefficiency was observed. The findings may be used to encourage postpartum women with disordered sleep to incorporate 20-30 min of stride walking into their regular routine to improve sleep quality.

The clinically crucial predictors of depression in women with systemic autoimmune diseases

The researchers' aim of this study was to identify and quantify the useful, clinically crucial predictors of depression in Taiwanese women with systemic autoimmune diseases (SADs). We used a cross-sectional method. A total of 241 Taiwanese women with SADs between 21 and 85 years of age participated in the study. Analysis revealed that the strongest predictors of depression in participants were: perceived stress, fatigue, mental health, physical health, chronic-disease-related comorbidities, self-perceived SAD severity, and social support. The model used in the present study explained 70.9% of the variance in the depression.

[Non-Pharmacological Interventions for Pregnancy-Related Sleep Disturbances]

Most women experience the worse sleep quality of their life during pregnancy and the early postpartum period. Although pregnancy typically accounts for a relatively short part of a woman's life, the related sleep disturbances may have a significant and negative impact on her long-term health. Approximately 78-80% of pregnant women experience sleep disturbances, including interruptions in deep sleep, decreased total sleep time, poor subjective sleep quality, frequent night waking, and reduced sleep efficacy. Sleep disturbances during pregnancy start during the first trimester and become prevalent during the third trimester. Related factors include physiological and psychosocial changes and an unhealthy lifestyle. As non-pharmacological interventions have the potential to improve sleep quality in 70% to 80% of patients with insomnia, this is the main approached that is currently used to treat pregnancy-related sleep disturbances. Examples of these non-pharmacological interventions include music therapy, aerobic exercise, massage, progressive muscle relaxation, multi-modal interventions, and the use of a maternity support belt. The efficacy and safety of other related non-pharmacological interventions such as auricular acupressure, cognitive therapy, tai chi, and aromatherapy remain uncertain, with more empirical research required. Additionally, non-pharmacological interventions do not effectively treat sleep disturbances in all pregnant women.

Effects of Qigong Exercise on Biomarkers and Mental and Physical Health in Adults With at Least One Risk Factor for Coronary Artery Disease

Current medical technology permits the early detection of risk factors for coronary artery disease (CAD) in adults, and interventions are available to prevent CAD-related morbidity and mortality. The goal of this study was to determine the effectiveness of a Qigong exercise intervention in improving biomarker levels and mental and physical health outcomes in community-dwelling adults diagnosed with CAD risk factors, in a southern Taiwanese city. Participants were randomly assigned to an experimental ( n = 84) group that participated in a 60-min Qigong group session 3 times per week for 3 months or a control ( n = 61) group that did not receive the intervention. Self-perceived mental and physical health assessed with the Chinese Health Questionnaire-12, and body fat percentage were measured at baseline and 6, 12, and 16 weeks. Blood samples were collected at baseline and 12 weeks for analysis of lipid profiles, high-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin (HbA1c), and fasting plasma sugar. Linear mixed model analyses revealed that experimental participants had significantly improved perceived mental and physical health and body fat percentage compared to the control group at 6 and 12 weeks but not 16 weeks. The lipid profiles were significantly more improved in the Qigong group than in the control group at 12 weeks. Qigong exercise, however, had no significant effects on hs-CRP, HbA1c, or fasting plasma sugar. Findings suggest that Qigong exercise improves a limited number of CAD risk factors in community-dwelling adults aged 40 years and over.

Development of the model of health for older adults

AIMS

This study aimed to explore the pertinent health indicators and to form a model of health for older adults.

BACKGROUND

Health assessment and early detection are foundations for health promotion. Finding essential health indicators for older adults can better reflect the health status of this population and efficiently detect their health problems in a timely and economical manner.

METHODS

This study had two phases. Data were collected from July 2008 to January 2009. Phase I began with sending evaluation surveys to a panel of ten professional experts to generate health indicators for older adults. Phase II was a preliminary determination of the extent of health predictions using these indicators by conducting a descriptive survey involving a stratified random sample of 55 community-dwelling older adults.

RESULTS

The ten experts had fairly high agreement on the representativeness and importance of the proposed health model for older adults. The predictability of the health of older adults in the three domains (physical health, psychological health and social-economic health), four constructs (activities of daily living, physical status, emotional health and social engagement), and 47 indicators in this model was 84·50%.

CONCLUSION

Results of this study could be used for making health policy and/or to set the goals for intervention. In addition, nurses who care for the older adults may use the health indicators to plan and control the given quality of care. The researchers may further examine the effects of study programmes for health promotion.

[Using alternative therapies in treating sleep disturbance]

Sleep disturbance is a common health problem among adults, and enhancing sleep quality is an issue of significant importance to healthcare providers. As sleep quality worsens into insomnia, individuals may seek assistance from medication. However, sedative hypnotic drugs pose potentially adverse effects. Also, most medical treatments (e.g., positive pressure assistant ventilators) represent invasive interventions that must be prescribed by physicians. Non-pharmacological alternative therapies are commonly recommended and adopted by community nurses. Alternative therapies for sleep disturbance included exercise, cognitive behavior therapy, multiple strategies, music, and acupressure. In general, moderately intensive walking exercise is the intervention most recommended by professionals to help patients deal with sleep disturbance. Therefore, it is suggested that future researchers devise sleep quality promotion strategies that are suitable for home practice in order to apply the findings and spirit of research already done in this area.

[Nursing knowledge: the evolution of scientific philosophies and paradigm trends]

Different aspects of philosophy are derived from different paradigms that contain various main points, some of which are repeated or overlap. Belief and practice are two components of a paradigm that provide perspective and framework and lead to nursing research. Changes in healthcare have popularized empirical and evidence-based research in the field of nursing research. However, the evidence-base study approach has given rise to a certain level of debate. Until now, no standard paradigm has been established for the nursing field, as different professionals use different paradigms in their studies. Such provides certain limitations as well as advantages. The quantitative aspects of a nursing paradigm were developed by Peplau and Henderson (1950) and Orem (1980). Such remained the standard until 1990, when Guba and Parse proposed qualitative viewpoints in contextual features. Therefore, the nursing paradigm has made great contributions to the development of knowledge in nursing care, although debate continues due to incomplete knowledge attributable to the presentation of knowledge and insight within individually developed paradigms. It is better to apply multiple paradigms to different research questions. It is suggested that better communication amongst experts regarding their individual points of view would help nursing members to integrate findings within the global pool of knowledge and allow replication over multiple studies.

[Scientific and holistic therapy perspectives on Qigong practice for elders with cardiovascular disease risk factors]

The ratio of older adults with chronic illnesses has increased due to increased average life spans. The incidence of cardiovascular diseases among older adults has reached 33.26%, becoming the leading chronic disease and second most significant cause of mortality among older adults. Statistics show that the largest proportion of expenditures on prescription pharmaceuticals in the National Health Insurance goes toward the treatment of cardiovascular diseases. In addition, complications resulting from cardiovascular diseases result in burdens of care that impact seriously on the individual, their family, and society. Studies have supported physical activity as the most important behavior in reducing cardiovascular disease risk factors. Qigong, a traditional Chinese therapeutic activity, uses gentle movements of extremities and control of breathing to improve health, enhance vitality and enable bodies, emotion, and spirit to reach optimal performance. Evidence-based research supports the argument that Qigong improves cardiovascular-respiratory function and lipid profile, decreases blood sugar, and relieves anxiety and depression. We suggest developing a safe, convenient, and simple Qigong exercise regimen for older adults at higher risk of cardiovascular diseases to extend their life expectancy and quality of life.

Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial

BACKGROUND

Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind-body interaction should be tested to enhance the mental health of older adults.

OBJECTIVE

To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status.

DESIGN

Cluster randomized trial.

SETTINGS

Eight senior activity centers, southern Taiwan.

PARTICIPANTS

A sample of 139 participants was recruited, and 128 of them completed the study.

INCLUSION CRITERIA

(1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 +/- 6.23 years, and the average number of chronic illness was 0.83 +/- 0.90. The average BI score of the participants was 99.92 +/- 0.62, and the mean SPMSQ score was 9.90 +/- 0.30.

METHODS

Participants were randomly assigned into either the experimental (n=62) or the control (n=66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group.

RESULTS

Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p<.05).

CONCLUSIONS

After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.

Drug profiling: a new scientific contribution to law enforcement operations in Viet Nam

Since 1995 heroin sample comparisons have been carried out in Viet Nam to establish links between wholesalers and retailers. To that end, the physical and chemical characteristics of samples are analysed: their colour, the packaging material, including fingerprints, diacetylmorphine (heroin) content and the composition of some main alkaloids. At the beginning of 2002, having acquired expertise on impurity profiling and with the support of new instruments, the Institute of Forensic Sciences of Viet Nam introduced the routine impurity profiling of seized heroin and methamphetamine and later undertook to explain that process to national law enforcement bodies. Since then, 375 heroin and 29 methamphetamine samples have been analysed for major and minor impurities. Substances detected in the analysis of illicit heroin include diacetylmorphine, morphine, codeine, 06-monoacetylmorphine and acetylcodeine as well as adulterants such as paracetamol and caffeine. Since methamphetamine impurity profiling began, 29 samples have so far been analysed, and some samples have been grouped through the application of cluster analysis. In the case of heroin, impurity profiling has established a link between two major trafficking groups suspected of obtaining heroin from the same source of production. Analysis has also revealed a link between one wholesaler and several retailers in one region. In addition, impurity profiling provides new information on the preparation and production of some methamphetamine and fake Ecstasy tablets.

Group sequential test strategies for superiority and non-inferiority hypotheses in active controlled clinical trials

In a group sequential active controlled clinical trial, the study hypothesis may be a superiority hypothesis that an experimental treatment is more effective than the active control therapy or a non-inferiority hypothesis that the treatment is no worse than the active control within some non-inferiority range. When it is necessary to plan for testing the superiority and the non-inferiority hypotheses, we propose an adaptive group sequential closed test strategy by which the sample size is planned for testing superiority and is to be increased for showing non-inferiority given that it is deemed more plausible than superiority based on the observed sample path during the course of the trial. The proposed adaptive test strategy is valid in terms of having the type I error probability maintained at the targeted alpha level for both superiority and non-inferiority. It has power advantage or sample size saving over the traditional group sequential test designed for testing either superiority only or non-inferiority only.

Evaluation of a combination drug with multiple doses in unbalanced factorial design clinical trials

Flexibilities for sample size allocation are often demanded for achieving multiple study objectives in combination drug trials. The global tests of Hung, Chi and Lipicky are extended for analysis of unbalanced factorial design trials to test the hypothesis that at least one of the non-zero dose combinations of two drugs is more effective than the respective component doses. When the dose combinations have heterogeneous effect sizes, an unbalanced design may induce greater power than the balanced design. An adjusted p-value approach is proposed for testing the individual dose combinations under the condition that the maximum type I error probability is protected.

Modification of sample size in group sequential clinical trials

In group sequential clinical trials, sample size reestimation can be a complicated issue when it allows for change of sample size to be influenced by an observed sample path. Our simulation studies show that increasing sample size based on an interim estimate of the treatment difference can substantially inflate the probability of type I error in most practical situations. A new group sequential test procedure is developed by modifying the weights used in the traditional repeated significance two-sample mean test. The new test has the type I error probability preserved at the target level and can provide a substantial gain in power with the increase of sample size. Generalization of the new procedure is discussed.

Use of two-stage test statistic in the two-period crossover trials

For two-period crossover trials where the residual carryover can only exist in the presence of treatment effect, Willan (1988, Biometrics 44, 211-218) recommended use of the maximum test statistic that chooses the analysis with the larger test statistic corresponding to the parallel analysis and the crossover analysis. We construct two alternative two-stage test procedures, based on Grizzle's approach, that maintain the actual type I error rate at the desirable level. The power, accuracy, and precision of the analysis based on the modified two-stage procedures are compared to those based on the parallel analysis, crossover analysis, and the maximum test statistic.

Large sample tests for binary outcomes in fixed-dose combination drug studies

Several test statistics are developed for testing the hypothesis that the combination of two drugs at a fixed-dose regimen is more effective than both of the single drugs used alone with respect to a dichotomous response variable. The response probability, logit, and arcsine-root scales are considered. The power function and the significance level are derived for large samples. For the sample size per group of 20 or greater, the power and type I error rate can be accurately calculated using the large sample power function when the response probability ranges from 0.2 to 0.8. These tests have similar power behaviors. In small samples, the large sample power functions of two of the tests can severely underestimate the type I error rate while overestimation can occur with one other test. The utilities of these tests are extended to unbalanced sample size cases. Generally speaking, there is a loss of power with unequal sample size allocation, but the loss is not severe.

The behavior of the P-value when the alternative hypothesis is true

The P-value is a random variable derived from the distribution of the test statistic used to analyze a data set and to test a null hypothesis. Under the null hypothesis, the P-value based on a continuous test statistic has a uniform distribution over the interval [0, 1], regardless of the sample size of the experiment. In contrast, the distribution of the P-value under the alternative hypothesis is a function of both sample size and the true value or range of true values of the tested parameter. The characteristics, such as mean and percentiles, of the P-value distribution can give valuable insight into how the P-value behaves for a variety of parameter values and sample sizes. Potential applications of the P-value distribution under the alternative hypothesis to the design, analysis, and interpretation of results of clinical trials are considered.

Global tests for combination drug studies in factorial trials

To test the hypothesis that there are some studied dose combinations more effective in treating a disease than their respective component doses of two drugs, Hung, Chi and Lipicky proposed two alpha-level tests for normally distributed data. This paper extends the utilities of these tests to the outcome variable that has variance as a function of its mean, such as with a binomially distributed outcome, and to incomplete factorial design settings where some cells are not studied. I explore the impacts of excluding cells from study on the power performances of these tests.

Efficacy evaluation for monotherapies in two-by-two factorial trials

For factorial clinical trials in which two monotherapy treatments under study can interact only in the presence of treatment effects for each treatment, the always-pooled test statistic using data from all four groups has a correct size in detecting the simple effect of an individual treatment used alone. However, this test statistic may have an unbounded bias in estimation of the simple effect. The never-pooled test statistic that uses only data from the treatment group not receiving the other treatment has poor precision for estimating the simple effect. Two alternative test statistics under consideration are the two-stage statistic involving a preliminary test of treatment interaction and the maximum test statistic taking the larger of the always-pooled and the never-pooled statistics. The power, bias, and mean square error of all four tests are compared. When negative interactions exist, the two-stage and maximum statistics are generally superior to the always-pooled statistic and compare reasonably well with the never-pooled statistic; the maximum statistic seems slightly more favorable than the two-stage statistic. The two-stage statistic is the best choice when a treatment interaction can be large.

Two-stage tests for studying monotherapy and combination therapy in two-by-two factorial trials

Two-stage testing involves a preliminary test of a nuisance parameter prior to testing a main hypothesis. In a two-by-two factorial trial, the treatment interaction is the nuisance to the inference about the efficacy of one of the treatments given alone. In comparing a combination therapy to both of its component therapies, the nuisance parameter is the difference in the component effects. When the preliminary test is an integral part of inference about the main parameter, the actual level of significance for the two-stage test procedure can be much higher than the desired nominal level. If one places no restriction on the value of the nuisance parameter, then any two-stage test with its significance level properly controlled has undesirable properties. This applies to comparative studies of combination agents relative to the component agents. When the interaction with an ineffective treatment is null, two-stage testing may have some power advantage for assessing monotherapy efficacy.

Testing for the existence of a desirable dose combination

We consider the problem of studying several dose combinations of two drugs for a therapeutic endpoint in a multilevel factorial clinical trial. Two test statistics are constructed to test whether there exists at least one dose combination that is more effective than its component doses. Their distributions involve nuisance parameters quantifying the mean differences among the doses of the two component drugs. It is shown that their power functions achieve maxima as all the nuisance parameters approach infinity in absolute value. The significance levels of the two tests are derived and two alpha-level tests are proposed. Tables are given to provide the alpha-level critical values for these tests and to gain insights into their power performances.

On identifying a positive dose-response surface for combination agents

This article concerns construction of a confidence surface for tangential slopes of the dose-response surface of a combination therapy to identify where response increases as a function of drug dosage. This approach extends to the assessment of the effectiveness of the combination therapy.

Multidimensional data format specification: a generalization of the American College of Radiology-National Electric Manufacturers Association standards

Multidimensional image data are becoming increasingly common in biomedical imaging. Three-dimensional visualization and analysis techniques based on three-dimensional image data have become an established discipline in biomedicine. Some imaging problems generate image data of even higher dimensions. It often becomes necessary, rather than just convenient, to consider the higher-dimensional data as a whole to adequately answer the underlying imaging questions. Despite this established need for convenient exchange of image and image-derived information, no exchange protocols are available that adequately meet the needs of multidimensional imaging systems. This paper describes an exchange protocol that has been designed after careful consideration of the common requirements of methodologies for visualization and analysis of multidimensional data. It is based on and is a generalization of the widely accepted American College of Radiology-National Electrical Manufacturers Association (ACR-NEMA) standards specified for two-dimensional images. It is implemented and actively being used in a data-, application-, and machine-independent software environment, being developed in the authors' department, for the visualization and analysis of multidimensional images.

Surface and volume rendering in three-dimensional imaging: a comparison

Many surface rendering techniques are currently available for the three-dimensional display of structure data captured by imaging devices. Comparatively fewer volume rendering techniques are also available for the same purpose. The relative performance of these two methodologies in visualization tasks has been a subject of much discussion recently. Although it is very desirable to establish, based on observer studies, objective guidelines stating the relative merits of the two methodologies even for specific situations, it is impossible to conduct meaningful observer studies that take into account the numerousness of the techniques in each methodology, and within each technique, the numerousness of the parameters and their values that control the outcome of the technique. Our aim in this article is to compare the two methodologies purely on a technical basis in an attempt to understand their common weaknesses and disparate strengths. The purpose of this article is twofold--to report a new surface rendering technique and to compare it with two volume rendering techniques reported recently in the literature. The bases of comparison are: ability to portray thin bones; clarity of portrayal of sutures, fractures, fine textures, and gyrations; smoothness of natural ridges and silhouettes; and computational time and storage requirements. We analyze the underlying algorithms to study how they behave under each of these comparative criteria. Our conclusion is that, at the current state of development, the surface method has a slight edge over the volume methods for portrayal of information of the type described above and a significant advantage considering time and storage requirements, for implementations in identical environments.