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.     

Recognizing syntactic errors in Chinese and English sentences: Brain electrical activity in Asperger's syndrome

This study investigates electroencephalographic (EEG) oscillatory activity in the brain for bilingual participants with Asperger's syndrome (AS) and bilingual healthy control participants during visual recognition of syntactic errors in traditional Mandarin Chinese (native) and English (foreign) sentences. Reading performance is similar for the two groups in both languages. While reading Mandarin Chinese, the control group showed a left-hemispheric specialization within the 400–600 ms interval in delta synchronization. However, delta synchronizations were widely distributed in all scalp regions and lasted longer than 600 ms in the AS group. One possible interpretation of our data is the hypothesis that the AS group has more difficulty in brain organization of semantic and syntactic processes than the control group when reading their native language, because Chinese syntactic structure requires more work to be done by the perceiver. Nevertheless, other brain mechanisms (e.g., top-down regulation), can partially compensate for this difficulty, allowing AS subjects to attain the same level of response activity as the controls.     

Transradial Szabo Technique for Intervention of Ostial Lesions

Objectives: The aim of our study is to assess the feasibility and safety of transradial intervention (TRI) of coronary ostial lesions using the Szabo technique. Background: When performing TRI of coronary ostial lesions, precise stent positioning is of paramount importance. TRI has experienced increasing popularity in the U.S.; however, utilization of the Szabo technique has not been systematically evaluated in this setting. We report the results of ostial stent deployment using the Szabo technique for 2 experienced TRI operators and centers. Methods: This was a retrospective analysis of 40 consecutive patients who underwent PCI from April 2009 to September 2011. All patients who underwent PCI via the transradial route with the Szabo technique for ostial lesions performed by experienced transradial operators (>200 cases/yr) were included. Results: In our study of 40 patients with 41 coronary ostial lesions, overall procedural success rate was 100%. Stent dislodgement was seen in 1 patient. Clinical follow up was 100%, with a mean duration of 292.7±200 days. Target lesion revascularization (TLR) was seen in 2 patients (5%). One patient had an episode of transient ischemic attack (TIA) at 33 days after PCI; another experienced subacute stent thrombosis at 81 days while on dual antiplatelet therapy. MACE was 7.5% overall. Conclusion: In our study, treatment of coronary ostial lesions with the Szabo technique via TRI is associated with a high procedural success rate and a low MACE of 7.5%. (J Interven Cardiol 2012;25:447-451).     

The immune aspect in neuropathic pain: Role of chemokines

Neuropathic pain is a pathological symptom experienced worldwide by patients suffering with nervous system dysfunction caused by various diseases. Treatment of neuropathic pain is always accompanied by a poor response and undesired adverse effects. Therefore, developing a novel “pain-kill” drug design strategy is critical in this field. Recent evidence demonstrates that neuroinflammation and immune response contributes to the development of neuropathic pain. Nerve damage can initiate inflammatory and immune responses, as evidenced by the upregulation of cytokines and chemokines. In this paper, we demonstrated that different chemokines and chemokine receptors (e.g., CX3CL1/CX3CR1, CCL2/CCR2, CCL3/CCR1, CCL4/CCR5 and CCL5/CCR5) serve as mediators for neuron–glia communication subsequently modulate nociceptive signal transmission. By extensively understanding the role of chemokines in neurons and glial cells in nociceptive signal transmission, a novel strategy for a target-specific drug design could be developed.     

Évaluation du statut nutritionnel chez les patients présentant un glioblastome en récidive

Introduction

Nutritional status is a major clinical parameter in multiple cancers. Indeed, nutritional status is a prognostic factor and a predictor of response and toxicity to treatments in breast and lung cancers for instance. To our knowledge, in patients suffering from malignant primary brain tumors, nutritional status has been poorly investigated.

Methods

Nutritional status of 26 glioblastoma patients relapsing after a first line of treatment was studied. The body mass index (BMI), the prognostic inflammatory and nutritional index (PINI) and the instant nutritional score (INS) were assessed.

Results

The BMI was abnormal in 12 patients, two were malnourished while 10 were overweight. The BMI was not correlated to age of patients. Overweight status did not impact patient survival but it was associated with reduced performance status. The PINI was abnormal in three patients. Finally, the INS was abnormal in 24 patients, noted 2 (n = 22) or 4 (n = 4).

Conclusions/discussion

Our results were not in favor of systematic nutritional support in patients with recurrent glioblastoma after a first line of treatment. Being overweight does not influence prognosis but may influence performance status. Steroid therapy and chemotherapy (inducing sodium and water retention and lymphopenia) weaken the relevance of BMI and INS for nutritional assessment in patients with recurrent glioblastoma. Further studies using additional nutritional tests in larger, independent and prospective cohorts of patients are warranted to obtain more details.     

Efficacy of therapeutic play for pediatric brain tumor patients during external beam radiotherapy

Objective

External beam radiotherapy (EBRT) is frequently used to improve disease control for pediatric brain tumor patients. However, to facilitate the radiotherapy (RT) procedure, “forced” type interventions including conscious sedation or general anesthesia are frequently used to manage patients’ fear and anxiety. The aim of this study was to investigate the effects of therapeutic play (TP) in reducing anxiety for pediatric brain tumor patients treated by EBRT.

Methods

Between April 1st and September 30th, 2009, 19 young brain tumor patients, aged 3–15 years and recommended for RT, were recruited: ten to a control group and nine to the study intervention group. The study group was introduced with TP during EBRT. The Beck Youth Anxiety Inventory and the Faces Anxiety Scale were used to evaluate patients’ psychological levels of anxiety. The heart rate variability and salivary cortisol concentrations were used to indicate the patients’ physical levels of anxiety. Both the psychological and physiological tests were administered to all subjects before and after the RT procedure.

Results

The study group had significantly lower anxiety scores and expressed fewer negative emotions than did the control group before EBRT.

Conclusions

TP can not only improve the quality of medical services but can also reduce costs and staffing demands. In addition, it can help lower young patients’ anxiety and fear during medical procedures. As a result, it further decreases the potential negative impacts of hospitalization on these young patients.     

The development of a multimedia online language assessment tool for young children with autism

This study aimed to provide early childhood special education professionals with a standardized and comprehensive language assessment tool for the early identification of language learning characteristics (e.g., hyperlexia) of young children with autism. In this study, we used computer technology to develop a multi-media online language assessment tool that presents auditory or visual stimuli. This online comprehensive language assessment consists of six subtests: decoding, homographs, auditory vocabulary comprehension, visual vocabulary comprehension, auditory sentence comprehension, and visual sentence comprehension. Three hundred typically developing children and 35 children with autism from Tao-Yuan County in Taiwan aged 4–6 participated in this study. The Cronbach α values of the six subtests ranged from .64 to .97. The variance explained by the six subtests ranged from 14% to 56%, the current validity of each subtest with the Peabody Picture Vocabulary Test-Revised ranged from .21 to .45, and the predictive validity of each subtest with WISC-III ranged from .47 to .75. This assessment tool was also found to be able to accurately differentiate children with autism up to 92%. These results indicate that this assessment tool has both adequate reliability and validity. Additionally, 35 children with autism have completed the entire assessment in this study without exhibiting any extremely troubling behaviors. However, future research is needed to increase the sample size of both typically developing children and young children with autism and to overcome the technical challenges associated with internet issues.