Taiwanese Experiences: Elders with Dementia in Two Different Adult Day Service (ADS) Environments

Background: Researchers have demonstrated that adult day services (ADS) benefit elders with dementia and their caregivers, but they have also observed infantilization that diminishes personhood. Many ADS are socially constructed as places for incompetent elders, where clients are labeled as child-like dependents. Most ADS research has been performed in Western society; little is known about ADS in Asian countries. The Taiwanese Government seeks to expand ADS availability to meet the needs of an aging population; researchers must examine their ADS environments and practices to inform program development and expansion that supports respectful elder care.

Objectives: Elders’ experiences of daily life were examined within the physical and social environments of one social and one medical model ADS in Taiwan. The ecological model and place rules informed our research framework.

Methods: Ethnographic data were analyzed for themes reflecting our framework with attention to physical and social environment and staff–client interactions.

Results: The social model center included unique environmental features, such as a temple, indicating the purpose of different areas. Staff treated clients like family, sometimes to clients’ detriment, providing limited privacy and demanding compulsory activity participation. The medical model center with nurse's station and institutional furniture reflected a hospital-like environment and fostered a patient–nurse relationship. Staff inattention actually created opportunities for autonomy among some clients.

Conclusion and discussion: Physical features and social interactions within Taiwanese ADS reflected infantilization similar to that seen in the US and uniquely embedded within a traditional cultural background. Our findings reveal a tension between physical and social care features reflecting Eastern traditions of respect for elders and western traditions of institutional care.     

Temporal variation in risk factors and prevalence rate of depression in urban population: does the urban environment play a significant role?

Urban environment has now been recognized as significant risk factor of depression; however, there remains a gap in the literature regarding specific stressors associated with urbanization. Therefore, the present study is designated to examine the strength of association between urban environment and depression in temporal manner, and to identify significant risk factors. A household survey based on a questionnaire was conducted in 2003 and 2013, covering 1326 and 1965 households, respectively, from 12 wards of Delhi, India, to procure household-level data. Prevalence of depression was measured using the Centre for Epidemiologic Studies Depression Scale. The individual response rate within participating households was 88.3% in 2003, while it was 82.7% in 2013. During the period of study, the percentage of depressed people increased from 30.9% (2003) to 33.4% (2013). At the univariate level, significant confounders that were associated with depression were being female, unmarried and underemployed. The risk of being depressed due to inaccessibility to basic facilities reduced by ? 1.5%, while fear of crime and reducing social support recorded a phenomenal increase of 31.1% and 14.4%, respectively, during the period of study. Within domain analysis, after adjusting for confounding factors, indoor noise pollution (OR 3.04, p < 0.001), overcrowding (OR 2.35, p < 0.001), increasing crime (OR 1.72, p < 0.001), less supportive neighbours (OR 1.16, p < 0.001) and lacking park/playground (OR 1.12, p < 0.001) remained significantly associated with being depressed. This study confirms an association between the urban environment and depression across a range of domains. This study highlights the need to intervene on both physical and social features of urban centres to promote mental well-being.     

How can we Improve the Physical and Social Environment of the School to Promote Student Resilience? Evidence from the Resilient Children and Communities Project in China

Debate on the relationship between mental health and environment is of long standing. Resilience, as a core aspect of mental health promotion, has been described as the interaction between risk and protective factors present in the environment (Rutter, 1987). Central to the concept is that protective factors — those factors in the individual or the environment that enhance an individual's ability to resist problems and deal with life's stresses — can be fostered and promoted. The paper specifies aspects of the school environment in a holistic, or ecological setting, drawing on a multi-strategy health promotion project in primary schools in Hefei and Nanjing in China. A prospective intervention study design was used to collect data in pre-intervention and post-intervention phases, and to analyse it to establish the effectiveness of the intervention in improving the health-promoting environment in Chinese primary schools. The results indicate a significant intervention effect on the physical and social school environment in primary schools, and these results can be used in forthcoming comprehensive work to improve school mental health and well-being.     

Interaction between the MTHFR C677T polymorphism and traumatic childhood events predicts depression

Childhood trauma is associated with the onset and recurrence of major depressive disorder (MDD). The thermolabile T variant of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) is associated with a limited (oxidative) stress defense. Therefore, C677T MTHFR could be a potential predictor for depressive symptomatology and MDD recurrence in the context of traumatic stress during early life. We investigated the interaction between the C677T MTHFR variant and exposure to traumatic childhood events (TCEs) on MDD recurrence during a 5.5-year follow-up in a discovery sample of 124 patients with recurrent MDD and, in an independent replication sample, on depressive symptomatology in 665 healthy individuals from the general population. In the discovery sample, Cox regression analysis revealed a significant interaction between MTHFR genotype and TCEs on MDD recurrence (P=0.017). Over the 5.5-year follow-up period, median time to recurrence was 191 days for T-allele carrying patients who experienced TCEs (T+ and TCE+); 461 days for T− and TCE+ patients; 773 days for T+ and TCE− patients and 866 days for T− and TCE− patients. In the replication sample, a significant interaction was present between the MTHFR genotype and TCEs on depressive symptomatology (P=0.002). Our results show that the effects of TCEs on the prospectively assessed recurrence of MDD and self-reported depressive symptoms in the general population depend on the MTHFR genotype. In conclusion, T-allele carriers may be at an increased risk for depressive symptoms or MDD recurrence after exposure to childhood trauma.     

An event-related examination of neural activity during social interactions

Social exclusion is known to cause alterations in neural activity and perceptions of social distress. However, previous research is largely limited to examining social interactions as a unitary phenomenon without investigating adjustments in neural and attentional processes that occur during social interactions. To address this limitation, we examined neural activity on a trial-by-trial basis during different social interactions. Our results show conflict monitoring neural alarm activation, indexed by the N2, in response to specific exclusionary events; even during interactions that are inclusionary overall and in the absence of self-reported feelings of social pain. Furthermore, we show enhanced attentional activation to exclusionary events, indexed by the P3b, during exclusionary, compared with inclusionary, interactions, and this P3b activation was associated with self-reported social distress following prolonged social exclusion. Finally, both the N2 and P3b showed larger amplitudes in the earlier stages of exclusion compared with later stages, suggesting heightened early sensitivity for both components. Together, these findings provide novel insights into the dynamic neural and perceptual processes of exclusion that exist during social interactions and the relationship between discrete events within interactions and the more general contexts of the social interactions.     

Network participation for unpromoted female dentists in relation to psychosocial support

Studies have shown that female unpromoted general practice (GP) dentists have a taxing work situation with many problems related to their psychosocial work environment. This study aims to describe: 1) the participation of this group in organized network activity (support groups) in a region (Scania) in Sweden, 2) the sense of support compared with another organization and with a nationwide sample of GP dentists, and 3) the covariation of network participation with support. All unpromoted female dentists within the Public Dental Health Service (PDHS) in Scania received a questionnaire and 94% responded. Those participating in network activity ≥4 times a year constituted 12% of respondents. Cooperation between colleagues was lower than in the nationwide sample. Support from the PDHS was experienced as weak. It was not possible to explain why female unpromoted GP dentists participated ≥4 times a year, while those who felt lonely in their work were to a higher degree participants in a network. Almost 9 out of 10 reported being strengthened by the network both as a person and in a professional role. The female dentist was three times more likely to participate in a network if she had a male head of clinic. The main findings are a paucity of inter‐colleague contact and a lack of association between support and network participation. The many affirmative comments indicated that network participation might be a good coping strategy for unpromoted female GP dentists.     

Laterality of central venous sampling: lack of effect on the accuracy of intraoperative parathyroid hormone monitoring

Background

The purpose of this study was to determine if laterality of internal jugular vein (IJV) sampling affects the accuracy of intraoperative parathyroid hormone (PTH) monitoring during parathyroidectomy for primary hyperparathyroidism.

Methods

In this study, 109 patients underwent parathyroidectomy (82 with unilateral disease, 27 with multigland disease). PTH samples were taken from both the left and the right IJV at these time points: preincision (baseline) and then at 5, 10, and, in selected patients, 20 minutes after excision. The Miami criterion was used to determine operative success.

Results

In all 109 patients combined, the mean decreases in intraoperative PTH levels were 73.8 ± 22.2% for the left IJV and 71.9 ± 23.0% for the right IJV (P = .22). The Miami criterion was met in 105 patients: in 100 (95%) left IJV samples and 99 (94%) right IJV samples (P = 1.00).

Conclusions

No difference was found in the accuracy of intraoperative PTH monitoring between patients' left and right IJV samples. Central venous laterality did not affect fulfillment of the Miami criterion.