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Background: N6-methyladenosine (m6A) modification of messenger RNA (mRNA) is crucial for liquid-liquid phase separation in mammals. Increasing evidence indicates that liquid-liquid phase separation in proteins and RNAs affects diabetic cardiomyopathy. However, the molecular mechanism by which m6A-mediated phase separation regulates diabetic cardiac fibrosis remains elusive. Methods: Leptin receptor-deficient mice (db/db), cardiac fibroblast-specific Notch1 conditional knockout (POSTN-Cre × Notch1flox/flox) mice, and Cre mice were used to induce diabetic cardiac fibrosis. Adeno-associated virus 9 carrying cardiac fibroblast-specific periostin (Postn) promoter-driven small hairpin RNA targeting Alkbh5, Ythdf2, or Notch1, and the phase separation inhibitor 1,6-hexanediol were administered to investigate their roles in diabetic cardiac fibrosis. Histological and biochemical analyses were performed to determine how Alkbh5 and Ythdf2 regulate Notch1 expression in diabetic cardiac fibrosis. NOTCH1 was reconstituted in ALKBH5- and YTHDF2-deficient cardiac fibroblasts and mouse hearts to study its effects on mitochondrial fission and diabetic cardiac fibrosis. Heart tissue samples from patients with diabetic cardiomyopathy were used to validate our findings. Results: In mice with diabetic cardiac fibrosis, decreased Notch1 expression was accompanied by high m6A mRNA levels and mitochondrial fission. Fibroblast-specific deletion of Notch1 enhanced mitochondrial fission and cardiac fibroblast proliferation and induced diabetic cardiac fibrosis in mice. Notch1 downregulation was associated with Alkbh5-mediated m6A demethylation in the 3'UTR of Notch1 mRNA and elevated m6A mRNA levels. These elevated m6A levels in Notch1 mRNA markedly enhanced YTHDF2 phase separation, increased the recognition of m6A residues in Notch1 mRNA by YTHDF2, and induced Notch1 degradation. Conversely, epitranscriptomic downregulation rescues Notch1 expression, resulting in the opposite effects. Human heart tissues from patients with diabetic cardiomyopathy were used to validate the findings in mice with diabetic cardiac fibrosis. Conclusions: We identified a novel epitranscriptomic mechanism by which m6A-mediated phase separation suppresses Notch1 expression, thereby promoting mitochondrial fission in diabetic cardiac fibrosis. Our findings provide new insights for the development of novel treatment approaches for patients with diabetic cardiac fibrosis. [ABSTRACT FROM AUTHOR]

Cardiac fibrosis is a common consequence of different types of cardiac injury. Reprogramming of lipid metabolism has a key role in cardiac fibrosis. Multiple lipid categories have been shown to exert diverse effects in cardiac fibrosis. Several pharmacological interventions targeting lipid metabolism reprogramming and ferroptosis are under investigation for the management of cardiac fibrosis. Cardiac fibrosis is a critical pathophysiological process that occurs with diverse types of cardiac injury. Lipids are the most important bioenergy substrates for maintaining optimal heart performance and act as second messengers to transduce signals within cardiac cells. However, lipid metabolism reprogramming is a double-edged sword in the regulation of cardiomyocyte homeostasis and heart function. Moreover, lipids can exert diverse effects on cardiac fibrosis through different signaling pathways. In this review, we provide a brief overview of aberrant cardiac lipid metabolism and recent progress in pharmacological research targeting lipid metabolism alterations in cardiac fibrosis. [ABSTRACT FROM AUTHOR]

m6A epitranscriptomic modification plays a novel role in diabetes mellitus. m6A epitranscriptomic modification in coding and noncoding RNAs plays a key role in pathogenesis of diabetic microvascular complications. m6A epitranscriptomic modifying enzymes (writers, erasers, and readers) targeted epigenetic drugs may be a promising approach for management of diabetes mellitus and diabetic microvascular complications. N6-methyladenosine (m6A) modifications are modulated by m6A methyltransferases, m6A demethylases, and m6A-binding proteins. The dynamic and reversible patterns of m6A modification control cell fate programming by regulating RNA splicing, translation, and decay. Emerging evidence demonstrates that m6A modification of coding and noncoding RNAs exerts crucial effects that influence the pathogenesis of diabetic microvascular complications that include diabetic cardiomyopathy, diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, and diabetic dermatosis. In this review, we summarize the roles of m6A modification and m6A modification-related enzymes in diabetic microvascular complications and discuss potential m6A modification-related enzyme-targeting therapeutic strategies. [ABSTRACT FROM AUTHOR]

The traditional biomedical care approach has been unsatisfactory to meet the complex needs of seniors with long‐term multimorbidity and irreversible disability, particularly for those living in residential LTC facilities. This study aimed to develop and evaluate the effectiveness of an 8‐week biopsychosocial‐spiritual (BPS‐S) group intervention with the attempt to enhance quality of life (QoL) and meaning in life among senior residents with disability. This single‐blind randomized controlled trail was conducted in eight residential LTC facilities. The primary outcome, 'participants' overall and subdomain QoL', and the secondary outcome, 'meaning in life', were repeatedly assessed, including four time points: before, mid‐ and post‐intervention, and at a 1‐month follow‐up. A generalized linear mixed model (GLMM) was used to assess between‐group differences over time. The post‐intervention differences indicated significant higher improvement on senior residents' overall and all 4 domains of QoL, as well as their meaning in life, between the baseline and both times of post‐intervention and 1‐month follow‐up. On the other hand, participants' family QoL have improved immediately in the midst of intervention. This study provides preliminary evidence to support the feasibility and effectiveness of an 8‐week BPS‐S group therapy. We recommend the BPS‐S be integrated into routine institutional care activities to help maximize senior residents' own capacity for self‐healing, achieve a state of harmonious balance between body, mind, social and spiritual relationships; and in turn, enhance holistic health of this group. [ABSTRACT FROM AUTHOR]

Background: Approximately 50% of residents living in institutions have insufficient fluid intake, and 20%–30% experience dehydration. Implementing strategies that effectively increase fluid intake is crucial to preventing dehydration-related complications and reducing complications and comorbidities in this population. Purpose: This study was designed to explore the effects on fluid intake and hydration status of a hydration game-based learning program in institutional residents. Methods: A single-blind, cluster, randomized controlled trial was conducted. Sixty-four subjects from five long-term care facilities in northern Taiwan were randomly assigned to either an experimental or control group. The experimental group received a 40-minute game-based hydration care program intervention twice weekly for 8 weeks. The control group received routine care. The data obtained were analyzed using generalized estimating equation analysis to verify changes in observed variables in the two groups at 4 and 8 weeks (during and immediately after the intervention). Results: The results showed a significant improvement in fluid intake in the experimental group at 4 and 8 weeks (p =.002 and p <.001, respectively). In terms of dehydration-related indicators, although total body water was significantly improved at 8 weeks in the experimental group (p =.009), no significant improvement was found in urine-specific gravity. In terms of signs of possible urinary tract infection, the experimental group showed significant improvement in urine leukocytes (p =.029) and nitrites (p =.004) at 8 weeks. Conclusions/Implications for Practice: The findings of this study support the positive effects of applying the concept of uncertain rewards and game-based learning in institutional group activities. Specifically, the interventions increased social interaction and enhanced enjoyment of drinking. The findings call for nursing professionals at institutions to offer similar hydration game-based learning programs as part of residents' daily activities to improve fluid intake. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. Design: The study employed a descriptive research, prospective longitudinal study design. Method: The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017–May 2018. Obtained data were analysed using an independent t test, one‐way ANOVA and logistic regression approach. Results/findings: The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30‐day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30‐day emergency room visit. Conclusion: Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. Impact: Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30‐day readmission rate. Family‐centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision‐making. [ABSTRACT FROM AUTHOR]

Cardiac fibroblasts play a pivotal role in cardiac fibrosis by transformation of fibroblasts into myofibroblasts, which synthesis and secrete a large number of extracellular matrix proteins. Ultimately, this will lead to cardiac wall stiffness and impaired cardiac performance. The epigenetic regulation and fate reprogramming of cardiac fibroblasts has been advanced considerably in recent decades. Non coding RNAs (microRNAs, lncRNAs, circRNAs) regulate the functions and behaviors of cardiac fibroblasts, including proliferation, migration, phenotypic transformation, inflammation, pyroptosis, apoptosis, autophagy, which can provide the basis for novel targeted therapeutic treatments that abrogate activation and inflammation of cardiac fibroblasts, induce different death pathways in cardiac fibroblasts, or make it sensitive to established pathogenic cells targeted cytotoxic agents and biotherapy. This review summarizes our current knowledge in this field of ncRNAs function in epigenetic regulation and fate determination of cardiac fibroblasts as well as the details of signaling pathways contribute to cardiac fibrosis. Moreover, we will comment on the emerging landscape of lncRNAs and circRNAs function in regulating signal transduction pathways, gene translation processes and post-translational regulation of gene expression in cardiac fibroblast. In the end, the prospect of cardiac fibroblasts targeted therapy for cardiac fibrosis based on ncRNAs is discussed. Assumption of cardiac fibroblasts targeted biotherapy by epigenetic regulation. Precise medicine targeting noncoding RNAs may be a promising therapeutic approach to regulate biological activities of cardiac fibroblasts and pathogenesis of cardiac fibrosis. [Display omitted] • MicroRNAs regulate fate determination of cardiac fibroblasts. • LncRNAs played a crucial role in fate determination of cardiac fibroblasts. • CircRNAs regulate of cardiac fibroblasts fate determination. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the effectiveness of spaced retrieval for improving hyperphagia in patients with dementia in residential care settings. Background Although 10-30% of patients with dementia have hyperphagia, most studies have focused on eating difficulties. Only a few studies have focused on hyperphagia. Various memory problems cause hyperphagia in patients with dementia. Spaced retrieval, a cognitive technique for information learning, can be used as a training method to improve memory loss. Recent studies showed that patients who received the training successfully memorised information learned in the training and correctly applied it to their daily lives. Study design Single-blind experiments were performed. Methods The 97 subjects with dementia were recruited from seven institutions. All research participants were stratified into three groups according to cognitive impairment severity and Hyperphagic Behavior Scale scores and then randomly assigned to the experimental and control groups. The experimental group received a six-week one-by-one spaced retrieval training for hyperphagia behaviour. The control group received routine care. Results After the intervention, the frequency and severity of hyperphagia in the patients with dementia, and food intake were significantly lower in the experimental group than in the control group. However, body mass index did not significantly differ. Conclusion Our results suggest that the spaced retrieval training could decrease the frequency and severity of hyperphagia in patients with dementia. The content of this training programme is consistent with the normal manner of eating in daily life and is easy for patients to understand and perform. Therefore, it can be applied in residents' daily lives. Relevance to clinical practice This study confirms the efficacy of the spaced retrieval training protocol for hyperphagia in patients with dementia. In future studies, the follow-up duration can be increased to determine the long-term effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

The article discusses the challenges of professional caregiver manpower in long-term care and describes intergenerational learning on ageism and caregiving.

Aims To explore the long-term effects of standardized and individualized spaced retrieval combined with Montessori-based activities on the eating ability of residents with dementia. Background Eating difficulty is common in residents with dementia, resulting in low food intake, followed by eating dependence, weight loss and malnutrition. Design A single-blinded and quasi-experimental design with repeated measures. Methods Ninety residents with dementia from four veterans' homes in Taiwan took part in this study. The intervention consisted of spaced retrieval combined with Montessori-based activities. Twenty-five participants in the standardized group received 24 intervention sessions over 8 weeks. Thirty-eight participants in the individualized group received tailored intervention sessions. The number of intervention sessions was adjusted according to the participant's recall responses in spaced retrieval. Twenty-seven participants in the control group received no treatment. The Chinese version of the Edinburgh Feeding Evaluation in Dementia was used, and eating amounts and body weight were measured pre-test, posttest and at 1-, 3- and 6-month follow-ups. Data were collected between July 2008-February 2010. Repeated measures of all dependent variables for the three groups were analysed by the linear mixed model. Results The standardized and individualized interventions could significantly decrease the scores for the Chinese version of the Edinburgh Feeding Evaluation in Dementia and increase the eating amount and body weight over time. Conclusion Trained nurses in institutions can schedule the standardized or individualized intervention in usual activity time to ameliorate eating difficulty and its sequels. [ABSTRACT FROM AUTHOR]

Aim To examine the long-term effects of fixed/individualized spaced retrieval combined with Montessori-based activities on nutritional status and body mass index and nutritional improvement's moderating effect on depressive symptoms for people with dementia during a specific follow-up period. Background The decrease in food intake, often combined with poor nutrition, may induce depressive symptoms in people with dementia. Design A single-blind, quasi-experimental study with repeated measures. Methods Twenty-five fixed group participants received spaced retrieval combined with Montessori-based activities over 24 sessions. Thirty-eight individualized group participants received the same intervention with different sessions, which was adjusted according to each participant's learning response. Twenty-seven control group participants just received routine care. The Chinese version of the Mini-Nutritional Assessment and Cornell Scale for Depression in Dementia scores and body mass index were recorded at pre-test, posttest and 1-, 3- and 6-month follow-ups. Data were collected between July 2008-February 2010. Results The Mini-Nutritional Assessment scores and body mass index of the fixed and individualized groups could be significantly increased over time. Additionally, the Cornell Scale for Depression in Dementia scores could be significantly reduced as a result of the improvement of the Mini-Nutritional Assessment scores arising from the individualized intervention. Conclusion The depressive symptoms of residents with dementia could be moderated by the individualized intervention through nutritional improvement. Trained clinical nurse specialists can use this individualized intervention for residents with dementia who also have poor nutrition and depressive symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Background: Prenatal maternal stress is associated with adverse birth outcomes. Few studies have been published on the effectiveness of relaxation techniques focusing on women with preterm labour. Objects: The object of this study was to examine the effectiveness of a relaxation training program on pregnancy outcomes in women experiencing preterm labour. Design: A single-blinded, controlled clinical trial was used. Settings: The study was conducted in two hospitals. Both of the study hospitals located in northern Taiwan are also large teaching hospitals and share the same treatment protocols of preterm labour. Participants: Inclusion criteria were being pregnant and diagnosed with preterm labour, singleton, hospitalized at time of entry into the study, at gestation between 20 and 34 weeks, and having a cervical dilatation of less than 3cm. Exclusion criteria were if they had one or any combination of the following: antepartum hemorrhage, infection, hypertension, gestational diabetes mellitus, or immunologic disease. Methods: The experimental group (n =68) participants received a mini mp3 player containing a 13-min relaxation audio program, which they were instructed to follow daily, while the control group (n =59) received only routine prenatal care. Pregnancy outcomes were obtained from medical charts after each woman gave birth. Results: Survival analysis demonstrated that the experimental group had a significant pregnancy prolongation compared to the control group (p =0.048). Participants receiving the relaxation training program had a significant lower proportion of extreme preterm birth, a higher rate of not being admitted to a NICU, and a lower rate of stay days within 30 days when compared with the control group. No significant differences were found on pregnancy outcomes in terms of the rate of preterm birth, low birth weight, Apgar score at 1 and 5min, mode of birth, and perinatal mortality between the two groups. Conclusions: Relaxation training for women with preterm labour is effective in delaying of delivery and enhancing positive pregnancy outcomes. This relaxation intervention is cost-effective, noninvasive, and easily applicable in women with preterm labour. [Copyright &y& Elsevier]

chuang l.-l., lin l.-c., cheng p.-j., chen c.-h., wu s.-c. & chang c.-l. (2012) Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour. Journal of Advanced Nursing 68(1), 170-180. Abstract Aim. This paper is a report of an experimental study of the effects of relaxation-training programme on immediate and prolonged stress responses in women with preterm labour. Background. Hospitalized pregnant women with preterm labour experience developmental and situational stress. However, few studies have been performed on stress management in such women. Methods. An experimental pretest and repeated post-test design was used to compare the outcomes for two groups in northern Taiwan from December 2008, to May 2010. A total of 129 women were randomly assigned to an experimental ( n = 68) or control ( n = 61) group. The experimental group participants were instructed to listen daily to a 13-minute relaxation programme. Measurements involved the stress visual analogue scale, finger temperatures, State Trait Anxiety Inventory, Perceived Stress Scale and Pregnancy-related Anxiety. Two-way analysis of variance and hierarchical linear modelling were used to analyse the group differences. Results. Compared with those in the control group, participants in the experimental group showed immediate improvements in the stress visual analogue scale scores and finger temperatures. The State Trait Anxiety Inventory-State subscale score for the experimental group was significantly lower than that for the control group ( P = 0·03). However, no statistically significant differences for the Perceived Stress Scale and Pregnancy-related Anxiety scores were found between the experimental group and the control group. Conclusions. The relaxation-training programme could improve the stress responses of women with preterm labour. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prevalence of heart failure is increasing among older adults. Most heart failure patients experience distressing symptoms that lead to decreased physical functioning, poor quality of life, and a high incidence of rehospitalization. Health education about heart failure self-care (HFSC) is very important during hospitalization for these patients. However, lack of ongoing follow-up after discharge makes evaluation and disease management difficult. This is a significant problem in Taiwan. PURPOSE: This study was undertaken to determine if participants with heart failure who were managed under the HFSC program had fewer distressing symptoms, better functional status, improved quality of life, and reduced hospital and emergency readmission rates compared with control group participants. METHODS: This study used a quasi-experimental design with a control group that received usual care and an intervention group that received usual care plus the HFSC program. Twenty-seven participants were recruited from 2 cardiac general wards at 1 medical center in Taipei City, Taiwan, and were randomized into intervention (n = 14) and control (n = 13) groups. RESULTS: : After 3 months, there were significant differences in symptom distress (p < .01), 6-minute walk test results (p < .01), and quality of life (using Short Form 36, Taiwan version, p < .05) between the HFSC and control groups but no significant differences in hospital readmission and emergency department visits. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The HFSC program for patients with heart failure improved their heart failure symptoms and resulted in increased functional status and better quality of life. HFSC is a workable program in the clinical environment. Advanced nurse practitioners can use HFSC methods and principles to provide improved education and follow-up to heart failure patients. [ABSTRACT FROM AUTHOR]

Aims. To investigate the efficacy of applying a Montessori intervention to improve the eating ability and nutritional status of residents with dementia in long-term care facilities. Background. An early intervention for eating difficulties in patients with dementia can give them a better chance of maintaining independence and reduce the risk of malnutrition. Methods. An experimental crossover design was employed. Twenty-nine residents were chosen from two dementia special care units in metropolitan Taipei. To avoid contamination between participants in units using both Montessori and control interventions, two dementia special care units were randomly assigned into Montessori intervention (I1) and routine activities (I2) sequence groups. A two-period crossover design was used, with 15 residents assigned to Montessori intervention sequence I (I1, I2) and 14 residents assigned to Montessori intervention sequence II (I2, I1). On each intervention day, residents were given their assigned intervention. Montessori intervention was provided in 30-min sessions once every day, three days per week, for eight weeks. There was a two-week washout period between each intervention. Results. There was a significant reduction in the Edinburgh Feeding Evaluation in Dementia score for the Montessori intervention period but not for the routine activities period, while the mean differences for the Eating Behavior Scale score, self-feeding frequency and self-feeding time were significantly higher than those of the routine activities period. Except for the Mini-Nutritional Assessment score post-test being significantly less than the pre-test for the routine activities period, no significant differences for any other variables were found for the routine activities period. Conclusion. This study confirms the efficacy of a Montessori intervention protocol on eating ability of residents with dementia. Adopting Montessori intervention protocols to maintain residents' self-feeding ability in clinical practice is recommended. Relevance to clinical practice. Montessori-based activities could provide caregivers with an evidence-based nursing strategy to deal with eating difficulties of people with dementia. [ABSTRACT FROM AUTHOR]

Objectives To construct a training protocol for spaced retrieval (SR) and to investigate the effectiveness of SR and Montessori-based activities in decreasing eating difficulty in older residents with dementia. Methods A single evaluator, blind, and randomized control trial was used. Eighty-five residents with dementia were chosen from three special care units for residents with dementia in long-term care facilities in Taiwan. To avoid any confounding of subjects, the three institutions were randomized into three groups: spaced retrieval, Montessori-based activities, and a control group. The invention consisted of three 30-40 min sessions per week, for 8 weeks. Results After receiving the intervention, the Edinburgh Feeding Evaluation in Dementia (EdFED) scores and assisted feeding scores for the SR and Montessori-based activity groups were significantly lower than that of the control group. However, the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group, which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes. In terms of the effects of nutritional status after intervention, Mini-Nutritional Assessment (MNA) in the SR group was significantly higher than that of the control group. Conclusion This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability. A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Several behaviourally observed tools have been developed to assess pain among cognitively impaired older people with communication difficulty. However, no adequate pain observation instrument is available for this group in Taiwan. Objective: The study was undertaken to translate the French version of the Doloplus-2 scale into Chinese and to evaluate the psychometric properties and the clinical feasibility of the translated instrument. Design: A prospective, descriptive design was used. Settings: Five dementia special care units in the Northern Taiwan were used. Participants: Two hundred and forty-one residents with dementia and 14 registered nurses in charge of these residents were recruited. Methods: The Doloplus-2 scale was translated into Chinese using the back-translation technique and pilot testing was performed to determine the comprehensibility and the initial psychometric characteristics. Internal consistency and inter-rater reliability were evaluated by Cronbach's alpha and intra-class correlation coefficient, respectively. Based on the known correlated validity model, the association between C-Doloplus-2 and empirically supported correlates of pain such as the past pain history, the presence of pain related condition, functional disability, agitation and depression were examined using Pearson's correlation coefficient for validating the construct validity. Furthermore, factor structure was investigated using Principal Components Analysis. Results: The internal consistency was adequate for the total scale (alpha 0.74) and the subscales (alpha range 0.67–0.87). The intra-class correlation coefficient of the total scale was 0.81 and of the subscales ranged from 0.60 to 0.81. The association between pain latent variable and disability or depression was demonstrated, partially supporting the construct validity. Three factors were extracted to confirm the original three-dimensional structure perfectly, accounting 65% of the total variance. Conclusions: The psychometric qualities of Chinese Doloplus-2 were supported. Further research is needed to assess the clinical value of the translated scale performed in the institutions. [Copyright &y& Elsevier]

Aims. The purpose of this study was to explore the characteristics of and the contexts related to sexual behaviours among institutionalised residents with dementia. Background. Institutionalised residents with dementia are frequently unable to manage their sexual needs properly resulting in caregivers having a more conservative and passive attitude toward residents with dementia than those with higher cognitive status. Design. A grounded theory study. Methods. The participants in this study were institutionalised older people with dementia and their formal caregivers. Data were collected using in-depth, face-to-face interviews of 12 formal caregivers and by observing 12 institutional older people with dementia for three days. All observations were recorded and interview data were tape recorded and transcribed verbatim. Results. The results indicated that the predisposing factors included having opportunity, presence of a cooperative target and personal space without privacy. The sexual expressions of institutionalised older people with dementia included: physically intimate touch, sexual expression without touching others and sexual talk. Responses by individuals to sexual behaviour from another resident included neutral response, negative response and positive response. Conclusion. To provide better care, it is recommended that an inventory regarding sexual expression for clinical and research usage be constructed from the research results. Relevance to clinical practice. The findings of this study can provide the basis to develop on-the-job training programmes for sexual education of residents with dementia in institutions. Regular seminars on sexual care for the residents with dementia might be beneficial for managing sexual issues among residents and to decrease caregivers’ burden. [ABSTRACT FROM AUTHOR]

In the process of cardiac fibrosis, the balance between the Wnt/β-catenin signalling pathway and Wnt inhibitory factor genes plays an important role. Secreted frizzled-related protein 3 (sFRP3), a Wnt inhibitory factor, has been linked to epigenetic mechanisms. However, the underlying role of epigenetic regulation of sFRP3, which is crucial in fibroblast proliferation and migration, in cardiac fibrosis have not been elucidated. Therefore, we aimed to investigate epigenetic and transcription of sFRP3 in cardiac fibrosis. Using clinical samples and animal models, we investigated the role of sFRP3 promoter methylation in potentially enhancing cardiac fibrosis. We also attempted to characterize the underlying mechanisms using an isoprenaline-induced cardiac fibrosis mouse model and cultured primary cardiac fibroblasts. Hypermethylation of sFRP3 was associated with perpetuation of fibroblast activation and cardiac fibrosis. Additionally, mitochondrial fission, regulated by the Drp1 protein, was found to be significantly altered in fibrotic hearts, contributing to fibroblast proliferation and cardiac fibrosis. Epigenetic modification of sFRP3 promoter methylation also influenced mitochondrial dynamics, linking sFRP3 repression to excessive mitochondrial fission. Moreover, sFRP3 hypermethylation was mediated by DNA methyltransferase 3A (DNMT3A) in cardiac fibrosis and fibroblasts, and DNMT3A knockdown demethylated the sFRP3 promoter, rescued sFRP3 loss, and ameliorated the isoprenaline-induced cardiac fibrosis and cardiac fibroblast proliferation, migration and mitochondrial fission. Mechanistically, DNMT3A was shown to epigenetically repress sFRP3 expression via promoter methylation. We describe a novel epigenetic mechanism wherein DNMT3A represses sFRP3 through promoter methylation, which is a critical mediator of cardiac fibrosis and mitochondrial fission. Our findings provide new insights for the development of preventive measures for cardiac fibrosis. DNA methyltransferase DNMT3A causes upregulation of sFRP3 methylation levels in cardiac fibrosis and cardiac fibroblasts. Subsequently, sFRP3 downregulation promotes cardiac fibroblast proliferation, migration and mitochondrial fission. DNA methyltransferase DNMT3A repressed sFRP3 to facilitate cardiac fibroblast activation and cardiac fibrosis. [ABSTRACT FROM AUTHOR]

Aims Mechanosensitive (MS) ion channels play a key role in heart development, physiology, and disease. However, little is known about the molecular mechanisms of the MS non-selective cationic channel Piezo family in cardiac fibrosis. Methods and results Mice were treated with ISO/Ang-II/TAC to induce cardiac fibrosis. AAV9 carrying POSTN promoter-driven small hairpin RNA targeting YTHDF1 , and Piezo2 were administered to ISO mice to investigate their roles in cardiac fibrosis. RNA-seq, single-cell sequencing, and histological and biochemical analyses were performed to determine the mechanism by which YTHDF1 regulates Piezo2 expression in cardiac fibrosis. Piezo2 was reconstituted in YTHDF1 -deficient cardiac fibroblasts (CFs) and mouse hearts to study its effects on CF autophagy and fibrosis. Piezo2 but not Piezo1 expression increased in experimental cardiac fibrosis and TGF-β1-induced CFs. Fibroblast-specific Piezo2 deficiency ameliorated fibroblast activation and autophagy and inhibited cardiac fibrosis. Mechanistically, Piezo2 up-regulation was associated with elevated m6A mRNA levels. Site-specific m6A modifications at peak_26355 were crucial for regulating the binding of YTHDF1 to Piezo2 mRNA and inducing Piezo2 translation. Notably, Piezo2 epitranscriptomic repression ameliorated experimental cardiac fibrosis. Conclusions We demonstrated a novel epitranscriptomic mechanism through which YTHDF1 recognizes Piezo2 and controls cardiac fibroblast autophagy and fibrosis through m6A-dependent modulation. Our findings provide new insights for the development of preventive measures for cardiac fibrosis. [ABSTRACT FROM AUTHOR]

Background The disability policy in Taiwan has traditionally emphasized residential care in large institutions and, more recently, medium-sized group homes. This paper compares the relative costs, services provided and outcomes between the traditional institutions, medium-sized group homes and new small-scale community living units that were launched in 2004 in Taiwan. Materials and Methods Cross-sectional analysis was used to investigate the three current residential service models. A total of 248 participants with intellectual disabilities were interviewed, including all residents from the existing 25 small residential units and purposively sampled respondents from the other two residential models. Results Outcomes for the Taiwanese participants were consistent with the existing literature on deinstitutionalization from Western societies. Small homes provided better subjective and objective quality of life than both medium-sized community-based units and traditional institutions. Conclusion Participants living in small residential homes experienced better outcomes at lower cost than persons living in medium-sized group homes or institutions. [ABSTRACT FROM AUTHOR]

Background Taiwanese family carers of people with intellectual disabilities not only suffer from long-term stress but also need to cope with social difficulties. The aim of this study is to evaluate the quality of life (QOL) among family carers of people with intellectual disabilities. Materials and methods A census interview survey was conducted in Hsin-Chu City in Taiwan and included the primary family caregivers of 792 adults with intellectual disability who were living with their families. The survey packet contained the WHOQOL-BREF Taiwan-version scale with four core domains and the activities of daily life/instrumental activities of daily life (ADL/IADL) scales. Results The mean score for ‘physical’ was highest and that for ‘environment’ was lowest. The strongest predictors of caregivers QOL were the caregiver's health status, their family income and the level of severity of the intellectual disability of the adult. Conclusions The results of the study support the need to expand services and individualize support to families of adults with intellectual disability living in family homes. [ABSTRACT FROM AUTHOR]

A simple and specific method based on gas chromatography–selected ion monitoring-mass spectrometry (GC–SIM-MS) for the analysis of in vivo metabolism of 2,5-dimethoxy-4-ethylthiophenethylamine (2C-T-2) in rats is described. Three male rats were administered 20 mg/kg of 2C-T-2 by intra-peritoneal injection, and 24 h urine fractions were collected before and after the administration for analysis. After acidic hydrolysis of the urine samples, the metabolites were liquid–liquid extraction and analyzed by a quadruple mass spectrometer in the selected ion monitoring mode. The findings show that four metabolites of 2-(4-ethylthio-2,5-dimethoxyphenyl)-ethanol (Mw: 242), 4-ethylthio-2,5-dimethoxyphenyl acetic acid (Mw: 256), 1-acetoamino-2-(2-hydroxy-4-ethylthio-5-methoxyphenyl)-ethane (Mw: 269) and 1-acetoamino-2-(2-methoxy-4-ethylthio-5-hydroxyphenyl)-ethane (Mw: 269) are present and the metabolic pathway for 2C-T-2 in the rat is proposed. [Copyright &y& Elsevier]

lin l.c., wang s.c., chen s.h., wang t.g., chen m.y. & wu s.c. (2003) Journal of Advanced Nursing 44(5), 469–478 Efficacy of swallowing training for residents following stroke The presence of dysphagia is associated with an increased risk of mortality, malnutrition, dehydration, compromised pulmonary function, and disability. Appropriate swallowing training can establish optimal nutritional status and eliminate or reduce the risk of developing medical complications associated with swallowing impairment. The aim of this study was to examine the functional swallowing and nutritional outcomes of swallowing training in institutionalized stroke residents with dysphagia. A quasi-experimental parallel cluster design was used. Seven institutions with similar bed sizes were selected. All subjects in the experimental group received a structured swallowing training programme. The subjects in the experimental group ( n = 40) received 30 minutes of swallowing training each day for 6 days per week for 8 weeks. The control group ( n = 21) did not receive any training. After swallowing training, mean differences in volume per second, volume per swallow, mid-arm circumference and body weight between pre- and post-training of the experimental group were significantly higher than for the control group, while mean differences in neurological examination and choking frequency during meals for the experimental group were significantly lower than in the control group. This study used objective timed swallowing tests, a swallowing questionnaire, and a neurological examination to evaluate the effects of swallowing training. However, videofluroscopy is generally considered the best method for evaluating the pharyngeal and esophageal stages of swallowing, and introducing this technique is recommended for future studies. Furthermore, it is recommended that nursing professionals should conduct swallowing training protocols in stroke patients to help prevent aspiration from dysphagia. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the prevalence of impaired swallowing in residents at long-term care facilities (LTCFs) in Taiwan. DESIGN: A chart review, a structured questionnaire completed at interview, a neurological examination, and a timed swallowing test were used to assess impairment and to gather demographic data. SETTING: Nine skilled nursing facilities and nine intermediate-care facilities in metropolitan Taipei. PARTICIPANTS: One thousand two hundred twenty-one conscious and unconscious residents with a mean age of 77.07. MEASUREMENTS: Impaired swallowing was defined when a subject met two or more of the following criteria: self-report of swallowing difficulty, a score of 2 or more derived from a swallowing questionnaire combined with a neurological examination investigating symptoms and signs of impairment, and coughing/choking during a timed swallowing test or a measured swallowing rate (volume swallowed per second) below the 10th percentile as derived from a gender-based study of an older community in Taipei. RESULTS: Of the 1,221 subjects, 356 (29.2%) were fed by tube. The prevalence rates for impaired swallowing as estimated were 97.5% and 31.9% for tube-fed and non-tube-fed subjects respectively, whereas the overall prevalence for tube-fed and non-tube-fed subjects altogether was 51.0%. CONCLUSIONS: The findings may serve to increase awareness of this problem among healthcare professionals in LTCFs. Further research is contemplated to investigate whether early identification makes a difference in treatment choices and outcomes. [ABSTRACT FROM AUTHOR]

Provides information on a study which tested the effectiveness of acupressure in enhancing the quality of sleep of institutionalized residents. Methods; Results; Conclusions.

Presents information on a study conducted on hospitalized acquired immune deficiency syndrome (AIDS) patients in Taiwan. Details on method used for the study; How sample size was determined; Results of the study conducted on the healthcare needs of patients with aids.

Aims: To identify key factors influencing institutional nurses' self‐perceived competencies in spiritual care. Background: In the past decade, interest in spiritual care has been increasing; however, in long‐term care facilities, limited knowledge is available about nurses' competencies in spiritual care. Methods: The cross‐sectional study was conducted with 202 nurses in 11 long‐term care facilities. Data were collected in a survey using the Spirituality and Spiritual Care Rating Scale, the Nurse Spiritual Care Therapeutics Scale, the Spiritual Care Competence Scale and demographic questions. Data were analysed using stepwise linear regression. Results: Study findings revealed that nurses' perceptions of spirituality and spiritual care, frequency of spiritual care provision and self‐satisfaction with the spiritual care given all significantly predicted overall spiritual care competence, which together explain 58% of the total variance. Conclusions: Improving nurses' perceptions of spirituality and spiritual care and encouraging the performance of spiritual care may be an effective pathway to enhance the spiritual care competence of institutional nurses. Implications for Nursing Management: Additional continuing education on spiritual care topics and the establishment of clear guidance and support from institutional administrators are required to enable nurses to deal with spiritual issues as they arise and improve the quality of holistic care. [ABSTRACT FROM AUTHOR]

Accumulating evidence has shown that aerobic glycolysis is essential for the establishment and maintenance of the fibrotic phenotype, so treatments targeting glycolytic reprogramming may become an important strategy to reduce fibrosis. Here, we reviewed current evidence on the glycolytic reprogramming in organ fibrosis, new dynamics of the epigenetic landscape. Epigenetic regulation of the expression of specific genes involved mediates glycolytic reprogramming, thereby affecting fibrosis progression. A comprehensive understanding of the interplay between aerobic glycolysis and epigenetics holds great promise for the treatment and intervention of fibrotic diseases. This article aims to comprehensively review the effect of aerobic glycolysis on organ fibrosis, and to elucidate the relevant epigenetic mechanisms of glycolytic reprogramming in different organs. [Display omitted] • DNA methylation-mediated glycolysis reprogramming in organ fibrosis. • RNA methylation-mediated glycolysis reprogramming in organ fibrosis. • Noncoding RNA-mediated glycolysis reprogramming in organ fibrosis. • Histone modification-mediated glycolysis reprogramming in organ fibrosis. [ABSTRACT FROM AUTHOR]

The pathogenesis of cardiovascular diseases (CVDs) is intricate, with liquid-liquid phase separation (LLPS) considered a crucial regulatory mechanism. Epigenetics is closely intertwined with cardiovascular diseases, involving mechanisms such as DNA methylation, histone modifications, and non-coding RNAs (ncRNAs) that play pivotal roles in cardiovascular disease progression and regression. It is known that specific proteins and mRNAs associated with epigenetic modifications exhibit LLPS characteristics, influencing cardiovascular diseases. Consequently, targeting epigenetic modifications to modulate LLPS emerges as a promising strategy for cardiovascular diseases treatment. This review delves into the regulatory impact of liquid-liquid phase separation on cardiovascular diseases, with a specific focus on the epigenetic landscape. The current study sought to investigate the relationship between epigenetic landscape and phase separation in cardiovascular diseases development, as well as their therapeutic implications. [Display omitted] • Liquid-liquid phase separation regulation of cardiovascular diseases. • Liquid-liquid phase separation and epigenetic interactions in cardiovascular diseases. • Epigenetic regulation of targeted liquid-liquid phase separation for cardiovascular diseases. [ABSTRACT FROM AUTHOR]

N6-methyladenosine (m6A) modification is closely related to cardiac fibrosis. As the most common and abundant form of mRNA modification in eukaryotes, m6A is deposited by methylases ("writers"), recognized and effected by RNA-binding proteins ("readers"), and removed by demethylases ("erasers"), achieving highly dynamic reversibility. m6A modification is involved in regulating the entire biological process of target RNA, including transcription, processing and splicing, export from the nucleus to the cytoplasm, and enhancement or reduction of stability and translation. Programmed cell death (PCD) comprises many forms and pathways, with apoptosis and autophagy being the most common. Other forms include pyroptosis, ferroptosis, necroptosis, mitochondrial permeability transition (MPT)-dependent necrosis, and parthanatos. In recent years, increasing evidence suggests that m6A modification can mediate PCD, affecting cardiac fibrosis. Since the correlation between some PCD types and m6A modification is not yet clear, this article mainly introduces the relationship between four common PCD types (apoptosis, autophagy, pyroptosis, and ferroptosis) and m6A modification, as well as their role and influence in cardiac fibrosis. [Display omitted] • Programmed cell death: a novel hallmark of cardiac fibrosis. • m6A regulation of programmed cell death in cardiac fibrosis. • m6A regulation of apoptosis in cardiac fibrosis. • m6A regulation of autophagy in cardiac fibrosis. • m6A regulation of pyroptosis in cardiac fibrosis. [ABSTRACT FROM AUTHOR]

Aims. To demonstrate the principles and application of Mokken scaling. Background. The history and development of Mokken scaling is described, some examples of applications are given, and some recent development of the method are summarised. Design. Secondary analysis of data obtained by cross-sectional survey methods, including self-report and observation. Methods. Data from the Edinburgh Feeding Evaluation in Dementia scale and the Townsend Functional Ability Scale were analysed using the Mokken scaling procedure within the 'R' statistical package. Specifically, invariant item ordering (the extent to which the order of the items in terms of difficulty was the same for all respondents whatever their total scale score) was studied. Results. The Edinburgh Feeding Evaluation in Dementia scale and the Townsend Functional Ability Scale showed no violations of invariant item ordering, although only the Townsend Functional Ability Scale showed a medium accuracy. Conclusion. Mokken scaling is an established method for item response theory analysis with wide application in the social sciences. It provides psychometricians with an additional tool in the development of questionnaires and in the study of individuals and their responses to latent traits. Specifically, with regard to the analyses conducted in this study, the Edinburgh Feeding Evaluation in Dementia scale requires further development and study across different levels of severity of dementia and feeding difficulty. Relevance to clinical practice. Good scales are required for assessment in clinical practice and the present paper shows how a relatively recently developed method for analysing Mokken scales can contribute to this. The two scales used as examples for analysis are highly clinically relevant. [ABSTRACT FROM AUTHOR]

In this study, we used Andersen's Behavioral Model with the family as a unit of analysis to examine the patterns of awareness and utilization of social services by families with at least one adult with intellectual disabilities. Face-to-face interview questionnaires were conducted with primary family caregivers in Hsinchu City, Taiwan in 2004. Data were collected on adults' and caregivers' predisposing, enabling, and need variables as well as awareness and utilization of formal social services. A total of 792 interviews were completed, making a response rate of 94.2%. Multivariate logistic regression analysis was used to identify potential predictors of social service awareness and utilization. We found awareness and utilization to be mostly associated with predisposing and enabling variables including caregiver's socioeconomic status, family connection with social networks, and family participation in related groups or associations. Younger caregivers were more likely to access formal assistance, while adults whose families were more connected into social networks were more likely to be aware of in-kind and voucher services, e.g., in-home services including respite and home care, and vocational services such as sheltered workshops, and bus voucher services. [Copyright &y& Elsevier]

The chiral separation of (±)-methamphetamine, (±)-methcathinone, (±)-ephedrine and (±)-pseudoephedrine by means of β-cyclodextrine modified capillary electrophoresis is described. The distribution of enantiomers in clandestine tablets and urine samples were identified. Several electrophoretic parameters such as the concentration of β-cyclodextrin, temperature, the applied voltage and the amount of organic solvent required for successful separation were optimized. The method, as described herein, represents a good complementary method to GC–MS for use in forensic and clinical analysis. [Copyright &y& Elsevier]

[Display omitted] • m6A modification of inflammation in cardiovascular disease. • Key role of inflammation in cardiovascular disease. • m6A epitranscriptomic opens a new charter in inflammatory cells. Cardiovascular disease is currently the number one cause of death endangering human health. There is currently a large body of research showing that the development of cardiovascular disease and its complications is often accompanied by inflammatory processes. In recent years, epitranscriptional modifications have been shown to be involved in regulating the pathophysiological development of inflammation in cardiovascular diseases, with 6-methyladenine being one of the most common RNA transcriptional modifications. In this review, we link different cardiovascular diseases, including atherosclerosis, heart failure, myocardial infarction, and myocardial ischemia–reperfusion, with inflammation and describe the regulatory processes involved in RNA methylation. Advances in RNA methylation research have revealed the close relationship between the regulation of transcriptome modifications and inflammation in cardiovascular diseases and brought potential therapeutic targets for disease diagnosis and treatment. At the same time, we also discussed different cell aspects. In addition, in the article we also describe the different application aspects and clinical pathways of RNA methylation therapy. In summary, this article reviews the mechanism, regulation and disease treatment effects of m6A modification on inflammation and inflammatory cells in cardiovascular diseases in recent years. We will discuss issues facing the field and new opportunities that may be the focus of future research. [ABSTRACT FROM AUTHOR]

Although hospice or palliative care for patients with advanced dementia has been implemented for more than 30 years, few studies have investigated the prognostic predictors of 6-month mortality in these patients. Prognostication has been a major obstacle, and 6-month prognostic predictors for patients with advanced dementia are still considered elusive. To better understand the dying trajectories of patients with advanced dementia, we performed a longitudinal prospective cohort study to investigate the predictors of 6-month mortality for residents with advanced dementia in long-term care facilities in Taiwan. Prospective cohort study. This study took place in 32 long-term care facilities selected from northern, central, and southern Taiwan. The study included 320 residents with advanced dementia. Measurements were obtained after determining study eligibility; the participants underwent follow-up assessments once every 3 months for 6 months or died during follow-up. The assessments included demographic characteristics, health and medical status characteristics, and death-related information. The Kaplan-Meier survival function estimation and the Cox proportional hazards model were used to estimate the survival rate and predict the prognostic factors. Baseline data from 320 residents with advanced dementia in long-term care facilities were obtained. The mean age was 82.7 years and 61.6% were female. The 6-month survival rate was 78.1%. The major cause of death was multiple organ failure related to pneumonia. The 6-month prognostic predictors were pneumonia (adjusted hazard ratio, 5.56; 95% confidence interval, 2.46–12.6; p -value <.001), reduction in nutrient intake >25% (adjusted hazard ratio, 5.05; 95% confidence interval, 2.37–10.8; p -value <.001), oxygen dependency (adjusted hazard ratio, 2.58; 95% confidence interval, 1.51–4.39; p -value =.001), treatment for electrolyte abnormalities (adjusted hazard ratio, 2.14; 95% confidence interval, 1.10–4.14; p -value =.025), severe pressure injuries (adjusted hazard ratio, 2.04; 95% confidence interval, 1.13–3.67; p -value =.018), and long-term indwelling urinary catheters (adjusted hazard ratio, 1.80; 95% confidence interval, 1.09–2.96; p -value =.021). Our results identified six prognostic predictors of 6-month mortality among residents with advanced dementia in Taiwan. These predictors may serve as risk assessment indicators for nursing staff who provide clinical care and can enable the identification of patients in recognized terminal decline, thereby allowing access to hospice palliative services. [ABSTRACT FROM AUTHOR]

Aim: To determine whether acupressure can prevent or relieve the adverse drug reactions (ADRs) of anti‐tuberculosis drugs. Background: People receiving drug treatment for TB often experience ADRs that may cause them to stop taking their medication. Acupressure is a form of traditional Chinese medicine that can be applied to alleviate or prevent disease symptoms. Design: A double‐blinded, repeated‐measures clinical trial in hospitals in Taiwan was carried out from April 2015 – May 2017. Methods: Convenience sampling was used to select 32 people (15 for the experimental group and 17 for the control group) aged >20 years who were taking anti‐tuberculosis drugs. The people were randomized to receive 4‐week of true acupressure and 4‐weeks of sham acupressure. Acupressure therapy was given by a researcher in all cases. Both groups received treatment once per day on weekdays, with 15 min for each acupressure session. Outcomes (gastrointestinal irritation and adverse skin reactions) were assessed according to the people feedback and the physicians' recordings during the treatment course, and during monthly follow‐up visits for 6 months thereafter. Results: Both groups typically experienced gastrointestinal irritation and adverse skin reactions within 2 months of beginning anti‐tuberculosis drug treatment. The 4‐weeks intervention involving relevant acupressure points successfully relieved both types of side effects in both immediate and delayed manner. Conclusions: When correctly implemented, acupressure can prevent and relieve the ADRs of anti‐tuberculosis drugs, and motivate people to complete their treatment course. [ABSTRACT FROM AUTHOR]

Aim: The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self‐education about dementia care among nurses working in different wards. Methods: This was a descriptive cross‐sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self‐report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16‐item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. Results: The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Conclusions: Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276–285. [ABSTRACT FROM AUTHOR]

Epigenetics indicates that certain phenotypes of an organism can undergo heritable changes in the absence of changes in the genetic DNA sequence. Many studies have shown that epigenetic patterns play an important role in the lung and lung diseases. Pulmonary fibrosis (PF) is also a type of lung disease. PF is an end-stage change of a large group of lung diseases, characterized by fibroblast proliferation and massive accumulation of extracellular matrix, accompanied by inflammatory injury and histological destruction, that is, structural abnormalities caused by abnormal repair of normal alveolar tissue. It causes loss of lung function in patients with multiple complex diseases, leading to respiratory failure and subsequent death. However, current treatment options for IPF are very limited and no drugs have been shown to significantly prolong the survival of patients. Therefore, based on a systematic understanding of the disease mechanisms of PF, this review integrates the role of epigenetics in the development and course of PF, describes preventive and potential therapeutic targets for PF, and provides a theoretical basis for further exploration of the mechanisms of PF. [Display omitted] • DNA methylation regulation of pulmonary fibrosis. • Histone modifications regulation of pulmonary fibrosis. • Non-coding RNA regulation of pulmonary fibrosis. [ABSTRACT FROM AUTHOR]

Dysregulated mitochondrial metabolism occurs in several pathological processes characterized by cell proliferation and migration. Nonetheless, the role of mitochondrial fission is not well appreciated in cardiac fibrosis, which is accompanied by enhanced fibroblast proliferation and migration. We investigated the causes and consequences of mitochondrial fission in cardiac fibrosis using cultured cells, animal models, and clinical samples. Increased METTL3 expression caused excessive mitochondrial fission, resulting in the proliferation and migration of cardiac fibroblasts that lead to cardiac fibrosis. Knockdown of METTL3 suppressed mitochondrial fission, inhibiting fibroblast proliferation and migration for ameliorating cardiac fibrosis. Elevated METTL3 and N6-methyladenosine (m6A) levels were associated with low expression of long non-coding RNA GAS5. Mechanistically, METTL3-mediated m6A methylation of GAS5 induced its degradation, dependent of YTHDF2. GAS5 could interact with mitochondrial fission marker Drp1 directly; overexpression of GAS5 suppressed Drp1-mediated mitochondrial fission, inhibiting cardiac fibroblast proliferation and migration. Knockdown of GAS5 produced the opposite effect. Clinically, increased METTL3 and YTHDF2 levels corresponded with decreased GAS5 expression, increased m6A mRNA content and mitochondrial fission, and increased cardiac fibrosis in human heart tissue with atrial fibrillation. We describe a novel mechanism wherein METTL3 boosts mitochondrial fission, cardiac fibroblast proliferation, and fibroblast migration: METTL3 catalyzes m6A methylation of GAS5 methylation in a YTHDF2-dependent manner. Our findings provide insight into the development of preventative measures for cardiac fibrosis. [Display omitted] • Augmentation of mitochondrial fission in cardiac fibrosis, but not mitochondrial fusion and biogenesis. • LncRNA-GAS5 played a crucial role in cardiac fibroblasts proliferation and migration and mitochondrial fission. • METTL3 mediated m6A methylation of LncRNA-GAS5 via an YTHDF2-dependent manner. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study aimed to evaluate the level of care quality received by disabled older patients residing at home vs. those residing in institutions. Background. Taiwan has an aging society and faces issues of caring for disabled older patients, including increasing needs, insufficient resources and a higher economic burden of care. Design. Retrospective study extracting patient data from Taiwan's National Health Insurance database. Methods. We enrolled 76,672 disabled older patients aged 65 years and older who resided at home or institutions and had submitted claims for coverage of National Health Insurance for home care received for the first time between 2004-2006. Propensity score matching was applied to create a home-care group and an institutional-care group with 27,894 patients each. Indicators of care quality (emergency services use, hospitalisation, infection, pressure ulcers, death) within the first year were observed. Results. The home care group had significantly higher emergency services use, fewer hospital admissions and fewer infections, but had significantly higher occurrence of pressure ulcers. The institutional-care group had significantly lower time intervals between emergencies, fewer deaths, lower risk of emergencies and lower pressure ulcer risk. Males had significantly higher emergency services use than females, and higher risk of hospital admission and death. Conclusions. Care quality indicators for elder care are significantly different between home care and institutional care. The quality of home care is associated with higher emergency services use and pressure ulcer development, and institutional care is associated with number of infections and hospitalisations. Relevance to clinical practice. Care quality indicators were significantly different between home-care and institutional-care groups and were closely associated with the characteristics of individual patients' in the specific settings. Nursing capabilities must be directed towards reducing unnecessary care quality-related events among high-risk disabled older patients. [ABSTRACT FROM AUTHOR]

Objectives: To examine adherence to relaxation guided imagery in women experiencing preterm labor as well as predictors influencing adherence. Methods: This study used a longitudinal follow-up approach. Each of the 57 participating women received a mini-MP3 player containing a 13-minute relaxation guided imagery audio program that they were instructed to follow daily until giving birth. Follow-up interviews were conducted weekly. A generalized estimating equation was used to predict adherence. Results: The total adherence rate was 58%. Higher adherence was predicted by the presence of at least a college degree ( p=0.006), greater perceived stress ( p=0.006), a higher risk of preterm delivery ( p<0.001), and greater relaxation effects ( p=0.028). Older maternal age was associated with lower adherence ( p=0.001). In addition, adherence decreased significantly over time ( p<0.001). Adherence was not related to marital status, employment, parity, the baseline level of anxiety, or hospitalization. Conclusions: Pregnant women with a high risk for preterm birth and greater perceived stress showed higher adherence to relaxation guided imagery. For women with a lower adherence to relaxation guided imagery, health care professionals may consider individual preferences regarding relaxation techniques. [ABSTRACT FROM AUTHOR]

Aims. To study the effect of a music programme during lunchtime on problem behaviour among institutionalised older residents with dementia. Background. Symptoms of dementia among older people include depression, problems with memory, insomnia and problem behaviours. Problem behaviour has been identified by families and nurses as the greatest challenge that needs to be addressed. Several studies have found that music therapy can reduce problem behaviours among dementia sufferers and, based on this finding, music has been recommended for incorporation as part of dementia management. Design. This study used a quasi-experimental design with an eight-week time series follow-up. The intervention was background music when residents had their lunch meal. Methods. A purposive sampling technique was used. Forty-one participants were selected from an institution housing residents with dementia located in a city in Taiwan. Results. The mean age of participants was 81·68 (SD 6·39) years old. The mean score for Mini-Mental State Examination (MMSE) was 10·66 (SD 6·85). The mean of Barthel Activity of Daily Living score was 56·83 (SD 38·12). The results showed that the music programme reduced, significantly, physical and verbal aggressive behaviour among the older residents with dementia. The study identified that there was a one-week time lag between the implementation of the music programme and a significant effect on the residents. Conclusions. The results from this study suggested that music is able to reduce the degree of problem behaviours among the older residents with dementia and this helps to ease work-load of nurse aides and nurses during meal times. Relevance to clinical practice. The results may serve as a reference for the future treatment of problem behaviour among the older with dementia. [ABSTRACT FROM AUTHOR]

Background: No studies have ever been conducted concerning menstrual experiences among women with an intellectual disability in Taiwan. Materials and Methods: An in-depth interview was conducted at three public institutions and perceptions and experiences regarding menstruation were elicited from 55 women aged 21–65 years. Results: The participants knew about menstrual blood and could recognize the experiences of period pain and its link to femininity. The women’s management of menstruation played a big part in their institutionalized life, where they had relatively limited choice and autonomy. Positive feelings towards the menstrual cycle were experienced by some participants; however, many had negative attitudes towards sexual activities or parenting, even though they knew the association between menstruation and pregnancy. Conclusions: Although these women’s experiences of perimenstrual symptoms are quite similar to those of women without intellectual disability, their menstrual management, interpretations and attitudes to menses are influenced by their institutional life and by the society at large. [ABSTRACT FROM AUTHOR]

wu h.s., wu s.c., lin j.g. & lin l.c. (2004) Journal of Advanced Nursing 45(3), 252–259 Effectiveness of acupressure in improving dyspnoea in chronic obstructive pulmonary disease Patients with chronic obstructive pulmonary disease (COPD) suffer from dyspnoea in their daily life and this may be increased by anxiety. Acupressure may promote relaxation and relieve dyspnoea. Thus, it is appropriate to explore the effectiveness of acupressure on dyspnoea in patients with COPD. To compare outcomes of acupressure using sham acupoints on different meridians and ganglionic sections with that using true acupoints, in patients with COPD who are living at home. Patients diagnosed with COPD were selected from a medical centre and three regional hospitals in Taipei. A randomized block experimental design was used. Using age, sex, pulmonary function, smoking, and steroid use as matching factors, 44 patients were randomly assigned either to a true acupoint acupressure or a sham group. The true acupoint acupressure group received a programme to decrease dyspnoea. Those in the sham group received acupressure using sham pressure points. Both acupressure programmes consisted of five sessions per week lasting 16 minutes per session, extending over 4 weeks for a total of 20 sessions. Before acupressure was initiated and at the conclusion of the 20th session, the Pulmonary Functional Status and Dyspnoea Questionnaire-modified scale and the Spielberger State Anxiety scale were administered, and a 6-minute walking distance test was performed. Physiological indicators of oxygen saturation and respiratory rate were measured before and after every session. The results of this study showed that the pulmonary function and dyspnoea scores, 6-minute walking distance measurements, state anxiety scale scores, and physiological indicators of the true acupoint acupressure group improved significantly compared with those of the sham group. The findings suggest that acupressure can be used as a nursing intervention to improve dyspnoea in patients with COPD. [ABSTRACT FROM AUTHOR]

Background: The quality of pain management in hospitalized older adult patients with dementia is a crucial issue in healthcare. The knowledge and beliefs of nurses are known to predict their pain management intentions toward this particularly vulnerable patient population. Purpose: This study was designed to evaluate the reliability and validity of the Chinese version of the Knowledge and Beliefs About Pain in Elderly Patients With Dementia (KBPED-C) questionnaire using a sample of hospital nurses. Methods: A cross-sectional study was conducted. The 17-item KBPED-C was distributed between September 2013 and August 2014 to 350 nurses working at a hospital in northern Taiwan. Consistency assessment was conducted using Cronbach's alpha, and construct validity was examined using principal component analysis. Three hundred five nurses (19 men and 286 women) were enrolled using convenience sampling. Results: The mean age of the participants was 30.8 ± 5.8 years. The Cronbach's alpha for internal consistency was.86. The item–total correlation was acceptable. The observed content validity was strong, with a content validity index of.86. Construct validity testing revealed a four-factor structure that accounted for 55.2% of the total variance. The four factors of the KBPED-C questionnaire were "general beliefs about pain and aging," "pain management in the workplace," "knowledge about pain management in older adult patients with dementia," and "beliefs about pain in older people." Conclusions/Implications for Practice: This preliminary validation study showed the high acceptability, reliability, and validity of the KBPED-C for hospital nurses. Future studies may use this questionnaire to explore the beliefs and knowledge of nurses regarding pain in older adult patients with dementia. [ABSTRACT FROM AUTHOR]