ADHD Family Support Group: A Hospital-based Model in Taiwan

Attention deficient hyperactive disorder (ADHD) is one of the most common childhood psychiatric disorders worldwide. In Taiwan, its prevalence is estimated at between 7.5% and 9.9%, however, according to analysis of the National Health Insurance dataset, as few as 20% seek medical help for the condition. This action research project consisted of forming a hospital-based ADHD family support group and evaluating how well it functioned. First, the formation of a hospital-based family support group in central Taiwan was announced by newspaper, following a news report on 21 August 2008 of a local teacher tying a hyperactive child to a chair. After attending lectures or receiving services at this hospital, some parents and teachers asked to participate in the ADHD support group. A family support group was organized in 2011 and the research team helped appl y for publ i c educati on fundi ng from pharmaceutical companies like Eli Lily and Janssen. In January 2013, to evaluate the group’s functioning and the program results, we identified core leaders in the group and started interviewing them using an oral history approach. One child psychiatrist, eight family members, and two patients were selected for interviews. This family support group has demonstrated high motivation and efficiency in addressing its members’ concerns, as well as convincing therapeutic benefits. There is a need for pragmatic solutions that cannot be satisfied by purely scientific or therapeutic public discourse. For this reason, the family support group needed autonomy to respond to their own needs and to develop a new sense of identity

A common link between clinical practice and research:the ADHD model for Central Taiwan

This study aimed to describe a research model regarding the Attention Deficit Hyperactive Disorder (ADHD) in Central Taiwan based on the strategy of routine data collection from clinical practice. Therefore, a prospective study with naturalistic observation was used. Modeling study was developed in clinical evaluation and treating for the ADHD children at Department of Psychiatry, Chung Shan Medical University Hospital in Central Taiwan. For all new patients, their first visit information were collected, including sociodemography, ADHD symptom scale, family support, academic performance, enuresis, severity of disability, mother depression, blood pressure(BP), heart rate(HR), weight, height, help-seeking behavior. After the clinical interview, patients were arranged to be assessed by the Neuropsychological test such as Continuous Performance Test (CPT). During the follow-up period, many variables (messages for the side effects, BP, HR, Weight, Height, CPT, ADHD symptom scale) were recorded. Finally, the ADHD clinical–based research model was contributed using all variables into many studies such as the ADHD comorbidity study, family study, sleep study, assessment tool development and treatment outcome study. The results had shown a several ADHD related papers have been published from this model. New treatment strategies emerged from the findings of studies. This is a feasible model for combining clinical practice with research to produce international publications. Clinical benefits of this model include creating culture-specific knowledge from the clinicians’ own clinical practice, focusing essential processes on cost-effective patient retreatment, and maintaining ongoing relationships with patients. In conclusions, our experience shows the clinical practice based longitudinal study is feasible and the results can nurture the quality of clinical practice vice versa

Methylphenidate Use and Infectious Diseases in Children With Attention Deficit and Hyperactivity Disorder:A Population-Based Study

Objective: Children with attention deficit hyperactivity disorder (ADHD) have more visits to the emergency department (ED) due to injuries than those without ADHD. However, no study has investigated whether children with ADHD have more ED visits or hospitalizations due to infectious diseases (IDs) and whether methylphenidate (MPH) treatment may reduce the risk. Method: The incidence of ID-related ED visits or hospitalizations was defined as the main outcome. The Cox regression and conditional Poisson regression models were calculated to estimate hazard ratios (HRs) in the population level and relative risks for the self-controlled case series design, respectively. Results: Children with ADHD had higher rates of emergency visits (HR = 1.25, 95% CI: 1.23~1.27) and hospitalizations (HR = 1.28, 95% CI: 1.26~1.31) due to IDs than those without ADHD. In the ADHD subgroup, those who received MPH treatment have a reduced risk of emergency visits (HR = 0.10, 95% CI: 0.09~0.10) and hospitalizations (HR = 0.73, 95% CI: 0.71~0.75), compared to those without treatment. The risk of ID-related emergency visits decreased to 0.21 (95% CI: 0.21~0.22); and hospitalizations decreased to 0.71 (95% CI: 0.69~0.73). Within self-controlled analysis, it is demonstrated that compared with non-MPH exposed period, children with ADHD had significantly decreased risks for infection-related emergency visits (RR = 0.73, 95% CI: 0.68~0.78) or hospitalizations (RR = 0.19, 95% CI: 0.17~0.21) during MPH-exposed periods. Conclusions and Relevance: This is the first study that reported an increased risk of ID-related healthcare utilizations in children with ADHD compared to those without, and that such risks may be significantly reduced in ADHD children that received MPH treatment.</p

Pendekatan Lean Manufacturing Untuk Meningkatkan Efisiensi Dalam Proses Produksi Dengan Menggunakan Value Stream Mapping Pada CV. Indospice

CV. INDOSPICE merupakan Perusahaan yang bergerak pada produksi pala, untuk terus mengoptimalkan kinerja produktifitasnya dan meningkatkatkan laba Perusahaan dengan berusaha menurunkan biaya, meningkatkan kualitas dan tepat waktu dalam pengiriman ke pelanggan. Penelitian ini bertujuan untuk mengetahui berbagai bentuk pemborosan (waste) apa saja yang sering terjadi sehingga dapat meningkatkan efisiensi produksi, karena itu diperlukan suatu pendekatan lean manufacturing. Lean Manufacturing merupakan sebuah pendekatan untuk meminimisasi pemborosan yang terjadi dalam proses produksi melalui value stream mapping untuk meningkatkan efisiensi. Metode yang digunakan dalam penelitian ini adalah deskriptif yang dilakukan dengan meneliti analisa pekerjaan dan aktifitas pada suatu obyek. Hasil penelitian menunjukan bahwa dalam proses produksi yang terjadi masih terdapat bentuk pemborosan berupa proses yang berlebih dan penggunaan mesin yang belum optimal. Untuk itu perlu upaya untuk meningkatkan efisisen berupa penambahan mesin penggiling pala dan pengadaan teknologi modern agar pengerjaan menjadi lebih cepat

Feasibility of Tomotherapy-Based Image-Guided Radiotherapy to Reduce Aspiration Risk in Patients with Non-Laryngeal and Non-Pharyngeal Head and Neck Cancer

PURPOSE: The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk. RESULTS: Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1-48 months), all patients were able to resume normal oral feeding without aspiration. CONCLUSION AND CLINICAL RELEVANCE: IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis

Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit

<p>Abstract</p> <p>Background</p> <p>Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patientsThe purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan.</p> <p>Methods</p> <p>We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV) in an intensive care unit (ICU) from the year 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded.</p> <p>Results</p> <p>There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33%) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (<it>p </it>< 0.01 for all). The overall ICU mortality rate was 88% (53 of 60 patients), and was not significantly different for patients with IFIs (85%) and those without IFIs (90%, <it>p </it>= 0.676).</p> <p>Conclusion</p> <p>There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.</p

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019