Stroke survivors suffer from various physical, emotional, and cognitive impairments. These changes are dynamic and depend on multiple factors, including underlying diseases, baseline brain function ...and pathology, the site of the stroke and the post‐stroke inflammation, neurogenesis as well as the subsequent remodeling of the neuro‐network. First we review the structural and pathological changes of the brain in stroke survivors with diabetes mellitus, which may lead to post‐stroke cognitive dysfunction. Second, we provide evidence of hyperglycemia, diabetes mellitus, hypoglycemia, and their relationship with post‐stroke cognitive impairment (PSCI) and post‐stroke dementia (PSD). In addition to conventional biomarkers, such as HbA1c, we also provide other novel tools to predict PSCI/PSD, such as glycemic variability, receptor for advanced glycation end products, and gut microbiota. Finally, we attempt to provide some modifying methods for glycemic control, focusing on the prevention of PSCI/PSD.
PSD and PSCI impose heavy burdens on patients, families, and society. However, cognitive function after stroke is dynamic and dysfunction is often overlooked. Impaired fasting glucose, prediabetes, type 2 DM, hypoglycemia, and glycemic variability may lead to cognitive dysfunction after stroke via various mechanisms and pathways. There is emerging evidence regarding the association between different DM medications and cognitive functions. However, their relationship with the PSCI/PSD warrants further investigation.
Pathogen populations in estuarine areas are dynamic, as they are subject to multiple natural and anthropogenic challenges. Heavy rainfall events bring instability to the aquatic environment in ...estuaries, causing changes in pathogen populations and increased environmental sanitation and public health concerns. In this study, we investigated the effects of heavy precipitation on the occurrence of pathogens in the Puzi River estuary, which is adjacent to the largest inshore oyster farming area in Taiwan. Our results indicated that Vibrio parahaemolyticus and adenovirus were the most frequently detected pathogens in the area. There was a significant difference (Mann-Whitney U test, p < 0.01) in water quality parameters, including total coliform, Escherichia coli, water temperature, turbidity, salinity, and dissolved oxygen, between groups with and without V. parahaemolyticus. In addition, the detection rate was negatively correlated with the average daily rainfall (r2 > 0.8). There was no significant difference between water quality parameters and the presence/absence of adenovirus, but a positive correlation was observed between the average daily rainfall and the detection rate of adenovirus (r2 ≥ 0.75). We conclude that heavy precipitation changes estuarine water quality, causing variations in microbial composition, including pathogens. As extreme weather events become more frequent due to climate change, the potential impacts of severe weather events on estuarine environments require further investigation.
The aim of the present study was to investigate the relationship between care burden and motivation of COVID-19 vaccine acceptance among caregivers of patients who have experienced a stroke and to ...explore the mediating roles of social media use, fear of COVID-19, and worries about infection in this relationship.
A cross-sectional survey study with 172 caregivers of patients who had experienced a stroke took part in a Taiwan community hospital. All participants completed the Zarit Burden Interview, Bergen Social Media Addiction Scale, Worry of Infection Scale, Fear of COVID-19 Scale, and Motors of COVID-19 Vaccine Acceptance Scale. Multiple linear regression model was applied to construct and explain the association among the variables. Hayes Process Macro (Models 4 and 6) was used to explain the mediation effects.
The proposed model significantly explained the direct association of care burden with motivation of COVID-19 vaccine acceptance. Despite the increased care burden associated with decreased vaccine acceptance, problematic social media use positively mediated this association. Moreover, problematic social media use had sequential mediating effects together with worry of infection or fear of COVID-19 in the association between care burden and motivation of vaccine acceptance. Care burden was associated with motivation of vaccine acceptance through problematic social media use followed by worry of infection.
Increased care burden among caregivers of patients who have experienced a stroke may lead to lower COVID-19 vaccines acceptance. Moreover, problematic social media use was positively associated with their motivation to get COVID-19 vaccinated. Therefore, health experts and practitioners should actively disseminate accurate and trustworthy factual information regarding COVID-19, while taking care of the psychological problems among caregivers of patients who have experienced a stroke.
Objective
One in five patients with rheumatoid arthritis (RA) rely on surgery to restore joint function. However, variable response to disease‐modifying antirheumatic drugs (DMARDs) complicates ...surgical planning, and it is difficult to predict which patients may ultimately require surgery. We used machine learning to develop predictive models for the likelihood of undergoing an operation related to RA and which type of operation patients who require surgery undergo.
Methods
We used electronic health record data to train two extreme gradient boosting machine learning models. The first model predicted patients’ probabilities of undergoing surgery ≥5 years after their initial clinic visit. The second model predicted whether patients who underwent surgery would undergo a major joint replacement versus a less intensive procedure. Predictors included demographics, comorbidities, and medication data. The primary outcome was model discrimination, measured by area under the receiver operating characteristic curve (AUC).
Results
We identified 5,481 patients, of whom 278 (5.1%) underwent surgery. There was no significant difference in the frequency of DMARD or steroid prescriptions between patients who did and did not have surgery, though nonsteroidal anti‐inflammatory drug prescriptions were more common among patients who did have surgery (P = 0.03). The model predicting use of surgery had an AUC of 0.90 ± 0.02. The model predicting type of surgery had an AUC of 0.58 ± 0.10.
Conclusions
Predictive models using clinical data have the potential to facilitate identification of patients who may undergo rheumatoid‐related surgery, but not what type of procedure they will need. Integrating similar models into practice has the potential to improve surgical planning.
Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate ...the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic.
A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden.
The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19.
Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.
To translate and cross-culturally adapt the Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A) for use in Taiwan and to validate their internal consistency, construct ...validity, measurement invariance, and convergent validity in Taiwanese young adults.
The GDT and GADIS-A were translated into traditional (unsimplified) Chinese characters and culturally adapted according to standard guidelines. A sample of 608 Taiwanese university students were recruited online. All participants completed the GDT, GADIS-A, Internet Gaming Disorder Scale – Short Form (IGDS9-SF), and Depression Anxiety Stress Scale-21 (DASS-21). Internal consistency was assessed using Cronbach's α and McDonald's ω. Factor structure was examined using Confirmatory Factor Analysis (CFA). Measurement invariance in gender was assessed by three nested models in CFA. Convergent validity was determined by calculating Pearson's r among the GDT, GADIS-A, IGDS9-SF, and DASS-21.
The GDT and GADIS-A showed adequate internal consistency (both α and ω = 0.90). The CFA results supported a one-factor structure for the GDT and a two-factor structure for the GADIS-A. Measurement invariance across gender was supported for both the GDT and GADIS-A. The convergent validity of the GDT and GADIS-A were acceptable.
The Chinese versions of the GDT and GADIS-A are valid and reliable tools that can be used to assess gaming disorder in Taiwanese young adults. Measurement invariance across genders was supported for both tools. The convergent validity of the GDT and GADIS-A were also satisfactory.
•The International Classification of Diseases 11th Revision (ICD-11) defines gaming disorder (GD).•Gaming Disorder Test (GDT) is developed using ICD-11 diagnostic criteria.•Gaming Disorder Scale for Adolescents (GADIS-A) is also developed using ICD-11.•Both GDT and GADIS-A can assess GD concept with good validity.•GDT is unidimensional and GADIS-A is two-factor structure.
Abstract
Background
Insomnia and suicidal thoughts are two of the negative impacts that have been caused by the COVID-19 pandemic. Identifying the factors that contribute to these psychological ...problems may help develop strategies to sustain the mental health of the public. The present study examined the psychosocial impacts caused by the COVID-19 pandemic among different populations in Taiwan, and investigated the relationships between these psychosocial variables, insomnia, and suicidal thoughts.
Methods
Between September 2020 and May 2021, online questionnaires including psychometrically validated scales were distributed to a convenience sample of outpatients (
n
= 205), healthcare workers (HCWs) (
n
= 500), and individuals in the general population (
n
= 1200) in Taiwan to collect data regarding their insomnia severity, suicidal thoughts, fear of COVID-19, trust of information, and resilience. Multivariate logistic regression methods were used to identify variables associated with suicidal thoughts and insomnia.
Results
Greater fear of COVID-19 was significantly associated with suicidal thoughts: odds ratios (ORs) with 95% confidence interval (CI) = 1.155 (1.002–1.330) for outpatients; 1.127 (1.035–1.228) for HCWs; and 1.100 (1.130–1.222) for those in the general population. Higher resilience was significantly associated with lower insomnia: OR (95% CI) = 0.819 (0.725–0.926) for outpatients; 0.803 (0.728–0.887), for HCWs; 0.829 (0.785–0.875), and for those in the general population. In addition, there was a statistically significant association between insomnia diagnosis and greater fear of COVID-19 among HCWs (OR 95% CI = 1.102 1.062–1.144) and those in the general population (OR 95% CI = 1.079 1.053–1.106). Among outpatients, there was a statistically significant association between suicidal thoughts and lower trust of information (OR 95% CI = 0.794 0.646–0.976), while among those in the general population there was a statistically significant association between suicidal thoughts and higher insomnia severity (OR 95% CI = 1.175 1.13–1.222). A statistically significant association was also found between insomnia diagnosis and higher suicidal thoughts among those in the general population (OR 95% CI = 3.455 2.338–5.106).
Conclusions
Trust of information, fear, and resilience were important factors for suppressing suicidal thoughts and insomnia among the three study populations. Health policies that monitor psychological status and build resiliency of the public are recommended to help develop tailored strategies for different populations affected by the COVID-19 pandemic.
This study explores the toxic effect of TCE at different depths of sub-surface soil and underpins microbial community-level suitable carbon (C)-sources that provided directionality to the in situ ...biostimulation effort via augmentation strategy for effective TCE remediation in soil. The impacts on resident microbial communities and their functional profiles that govern the TCE biodegradation process were identified. Highly contaminated PW01 soil (9 m depth) had severely limited microbial diversity and was enriched in Proteobacteria and Firmicutes. The abundance of TCE degradation-associated genera was observed in all contaminated samples, and the abundance of TCE-degradation-related taxa were positively correlated with soil TCE contamination levels. Community-level metabolic activity associated with the utilization of diverse external C-sources was directly influenced by TCE concentration and soil depth. Multivariate data analysis revealed that the functional genus, TCE concentration, and selected available C substrate uptake capacity correlated in soil samples. Pearson’s correlation tests revealed that C sources such as L-arginine, phenylethylamine and γ-hydroxybutyric acid utilization trait exhibited significant positive correlations with chloroalkane and chloroalkene degradation pathway abundance. Ultimately, depth and TCE contamination level-associated soil microbiota and their most preferred C-source understanding could add to facilitate effective biostimulation via external nutrient amendment for efficient in situ TCE degradation.
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•TCE concentration increased with soil depth and altered microbial diversity.•TCE stress enhanced Firmicutes and Proteobacteria abundance.•Depth and TCE concentration altered microbial community metabolic profiles.•TCE biodegradation prospects assessed based on functional microbes.•Biostimulation strategy was identified using Ecoplate based-C source utilization.
Hepatitis C virus (HCV) infection-induced oxidative stress is a major risk factor for the development of HCV-associated liver disease. Sulforaphane (SFN) is an antioxidant phytocompound that acts ...against cellular oxidative stress and tumorigenesis. However, there is little known about its anti-viral activity. In this study, we demonstrated that SFN significantly suppressed HCV protein and RNA levels in HCV replicon cells and infectious system, with an IC50 value of 5.7 ± 0.2 μM. Moreover, combination of SFN with anti-viral drugs displayed synergistic effects in the suppression of HCV replication. In addition, we found nuclear factor erythroid 2-related factor 2 (Nrf2)/HO-1 induction in response to SFN and determined the signaling pathways involved in this process, including inhibition of NS3 protease activity and induction of IFN response. In contrast, the anti-viral activities were attenuated by knockdown of HO-1 with specific inhibitor (SnPP) and shRNA, suggesting that anti-HCV activity of SFN is dependent on HO-1 expression. Otherwise, SFN stimulated the phosphorylation of phosphoinositide 3-kinase (PI3K) leading Nrf2-mediated HO-1 expression against HCV replication. Overall, our results indicated that HO-1 is essential in SFN-mediated anti-HCV activity and provide new insights in the molecular mechanism of SFN in HCV replication.
The Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) is a consistent and comprehensive instrument to assess symptoms of specific internet-use disorders including those related to ...gaming, shopping, pornography use disorder, social networks use and gambling considering criteria in the eleventh revision of the International Classification of Diseases (ICD-11). However, to date, there is little evidence supporting instruments assessing major types of specific internet use disorders in Thailand. The aim of this present study was to assess the psychometric properties of the ACSID-11 among Thai young adults.
A total of 612 participants were recruited. A confirmatory factor analysis (CFA) examined construct validity of the ACSID-11. Cronbach's α and McDonald's ω were used to assess reliability of the ACSID-11. Pearson correlations examined relationships between ACSID-11 domains and Internet Gaming Disorder Scale-Short Form (IGDS9-SF) scores.
The CFA supported validity of the Thai version of the ACSID-11 and a four-factor structure. Specific domains of the Thai ACSID-11, particularly gaming, were positively and significantly correlated with IGDS9-SF scores.
Data indicate that the Thai version of the ACSID-11 is a valid and reliable instrument to assess major types of specific internet use disorders. Additional studies are needed to further examine the validity and reliability of the Thai ACSID-11.
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