Associations between walking parameters and subsequent sleep difficulty in older adults:a 2-year follow-up study

Purpose: This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults. Methods: A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later. The 5-item Athens Insomnia Scale (AIS-5) was used to measure sleep difficulty. Frequency, duration, and speed of outdoor walking were self-reported. Walking speed was assigned a metabolic equivalent value (MET) from 2.5 to 4.5. Total walking volume in MET-h/week was calculated as frequency × duration × speed. Negative binomial regressions were performed to examine the associations between volume and components of walking with subsequent sleep difficulty with covariates of age, sex, education, marital status, living arrangement, smoking, alcohol consumption, mental health, Charlson Index, exercise (excluding walking), and sleep difficulty at baseline. Results: Participants with low walking volume had a higher level of sleep difficulty 2 years later compared with those with high walking volume (incident rate ratios = 1.61, p = 0.004). When speed, frequency, and duration of walking were simultaneously entered into 1 model, only walking speed was significantly associated with subsequent sleep difficulty (after the model was adjusted for covariates and baseline sleep difficulty). Sensitivity analyses showed that walking duration emerged as a significant predictor among 3 walking parameters, with 2-year changes of sleep scores as dependent variable. Conclusion: Total amount of walking (especially faster walking and lasting for more than 20 min) is associated with less subsequent sleep difficulty after 2 years among older adults

The impact of SARS on hospital performance

© 2008 Chu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Factorsassociated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan

[[abstract]]Background Although advance directives (AD) have been implemented for years in western countries, the concept of AD is not promoted extensively in eastern countries. In this study we evaluate a program to systematically conduct advance care planning (ACP) communication for hospitalized patients in Taiwan and identify the factors associated with AD completion. Methods In this retrospective evaluation of a clinical ACP program, we identified adult patients with chronic life-limiting illness admitted to Taipei City Hospital between April 2015 and January 2016. Trained healthcare providers held an ACP meeting to discuss patients’ preference regarding end-of-life care and AD completion. A multiple logistic regression was performed to determine the factors associated with the AD completion. Results A total of 2878 patients were determined to be eligible for ACP during the study, among which 1798 (62.5%) completed ACP and data was available for 1411 patients (49.1%). Of the 1411 patients who received ACP communication with complete data, the rate of AD completion was 82.6%. The overall mean (SD) age was 78.2 (14.4) years. Adjusting for other variables, AD completion was associated with patients aged ≥ 85 years [adjusted odds ratio (AOR) = 1.80, 95% CI 1.21–2.67], critical illness (AOR = 1.17, 95% CI 1.06–1.30), and social workers participating in ACP meetings (AOR = 1.74, 95% CI 1.24–2.45). Conclusion The majority of inpatients with chronic life-limiting illness had ACP communication as part of this ACP program and over 80% completed an AD. Our study demonstrates the feasibility of implementing ACP discussion in East Asia and suggests that social workers may be an important component of ACP communication with patients

Factors associated with potentially harmful antibiotic prescription during pregnancy: A population-based study

[[abstract]]Rationale, aims and objectives: Inappropriate antibiotic prescriptions during pregnancy may adversely affect the fetus. There were few studies on factors associated with antibiotic prescriptions potentially harmful to the fetus. Methods: This was a population-based cross-sectional study using data from National Health Insurance Research Database. We calculated the frequency of antibiotic prescription according to the status of pregnancy, type of infections, characteristics of patients, doctors and medical institutions. According to the British National Formulary, sulfonamides, trimethoprim, tetracycline and quinolones were classified as antibiotics potentially harmful to the fetus. A multivariate logistic regression analysis was performed to evaluate the independent effect of various characteristic on antibiotic prescriptions, during pregnancy, potentially harmful to the fetus. Results: Among the 19 464 pregnant subjects, 6554 (33.67%) received antibiotic prescriptions during pregnancy. Antibiotic prescriptions potentially harmful to the fetus accounted for 6.31% of all antibiotic prescriptions during pregnancy. Pregnant women aged <20 years, in their first trimester, and who were presenting with urogenital infections had the highest risks of receiving antibiotic prescriptions potentially harmful to the fetus. Non-gynaecologists, doctors aged 39-49 or ≥50 years, and doctors at clinics had higher risks of prescribing antibiotics potentially harmful to the fetus. Conclusions: Measures to improve the quality of practices should include efforts to increase awareness of antibiotic prescription guidelines for the treatment of infections in the pregnant population

Physician and patient characteristics affecting repeat use of abdominal ultrasound: A nationwide population-based study

Abstract Background: Ultrasound is a useful and popular imaging modality. Our aim was to assess the association between the use and repeat use of abdominal ultrasound and diagnosis, physicians, and hospital characteristics according to a Taiwanese national database. Methods: The Taiwan National Health Insurance database contains data for approximately 22,134,270 insured individuals during 2004e2005 (&gt;98% of the population in Taiwan). Patients who were scanned with abdominal ultrasound once or more during that period were identified. Associations between physicians, hospital characteristics, diagnoses, and repeat use of abdominal ultrasound were analyzed. Logistic regression with generalized estimating equations was used. Results: A total of 2,319,164 abdominal ultrasound scans were performed (approximately 6.42% of the population in Taiwan). Among these, 38.34% received repeat examinations. Multiple logistic regression analysis showed that gastroenterologists [odds ratio (OR) ¼ 1.07], male physicians, physicians younger than 40 years of age, and physicians in medical centers were more likely to use repeat abdominal ultrasound. The analysis also showed that male patients, older patients, patients with liver and biliary disease (OR ¼ 1.17), and patients with other abdominal disease (OR ¼ 1.37) were more likely to receive repeat abdominal ultrasound. Conclusion: Our study shows that the use and repeat use of abdominal ultrasound is very high and is related to diagnosis and physician and hospital characteristics

UBM image of an eye.

<p>UBM shows the structure of angle. However, it can not demonstrate the structure behind the lens. Thus anterior chamber depth or lens thickness can not be derived.</p

A-scan ultrasonography image along the optical axis of an eye.

<p>Peaks correspond to cornea (C), anterior lens (AL) surface, posterior lens (PL) surface, and retina (R). Anterior chamber depth (ACD), lens thickness (LT) and axial length can be derived from A-scan ultrasonography.</p