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Background: Small cohort studies have shown rapid pleurodesis protocol's (RPP) effectiveness and capacity to expedite pleurodesis for malignant pleural effusion (MPE). This study intends to evaluate the effectiveness of the RPP in inducing pleurodesis in patients with pleural effusions from either malignant or benign etiologies., Methods: In this single-center, retrospective cohort study spanning 2 decades, we assessed patients with recurrent symptomatic chronic noninfectious pleural effusion, both benign and malignant. Post-RPP, chest tubes were removed when fluid output dropped below 150 mL/d, and patients were discharged with daily indwelling pleural catheter (IPC) drainage. Exclusion criteria included nonexpandable lung and active pleural infection. Treatment success was defined as IPC removal on reduced output (<50 mL) on 3 consecutive drainages and radiologic effusion resolution. Recurrence was defined as the occurrence of pleural effusion requiring additional pleural procedures postsuccess. Duration outcome was expressed as median with IPC placement as time zero., Results: Of the 210 patients studied, 72% had MPE, and 28% had benign effusions. The median hospital stay was 4 days post-RPP. Treatment was successful in 177 (84%) patients within a median of 12 days, with no significant differences between MPE and benign cases. Nine patients (5%) experienced recurrence within a median of 152 days. Complications included hemothorax in 4 (1.9%) and empyema in 2 (1%). The thirty-day mortality rate was 9%, with a median survival time of 245 days postprocedure., Conclusion: The RPP combines the benefit of chemical pleurodesis and IPC and appears to be a reasonable option for patients with recurrent and symptomatic pleural effusion., Competing Interests: Disclosure: There is no conflict of interest or other disclosures., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Short-term airway stent placement (stent evaluation) has been employed to evaluate whether patients with excessive central airway collapse (ECAC) will benefit from tracheobronchoplasty. Although retrospective studies have explored the impact of stent placement on ECAC, prospective randomized controlled trials are absent., Methods: This was a randomized open-label trial comparing patients receiving airway stent placement and standard medical treatment (intervention group) versus standard medical treatment alone (control group) for ECAC. At baseline, patients' respiratory symptoms, self-reported measures, and functional capabilities were assessed. Follow-up evaluations occurred 7 to 14 days postintervention, with an option for the control group to crossover to stent placement. Follow-up evaluations were repeated in the crossover patients., Results: The study enrolled 17 patients in the control group [medical management (MM)] and 14 patients in the intervention group. At follow-up, 15 patients in the MM crossed over to the stent group, resulting in a total of 29 patients in the combined stent group (CSG). Subjectively (shortness of breath and cough), 45% of the CSG exhibited improvement with the intervention compared with just 12% in the MM. The modified St. George Respiratory Questionnaire score in the CSG improved significantly from 61.2 at baseline to 52.5 after stent placement (-8.7, P = 0.04). With intervention, the 6-minute walk test in CSG improved significantly from 364 meters to 398 meters (34 m, P < 0.01). The MM did not show a significant change in the St. George Respiratory Questionnaire score or 6-minute walk test distance., Conclusion: Short-term airway stent placement in patients with ECAC significantly improves respiratory symptoms, quality of life, and exercise capacity., Competing Interests: Disclosure: There is no conflict of interest or other disclosures., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Disclosure: There is no conflict of interest or other disclosures.

Objective: To evaluate performance of the ABC (Age, Biomarkers, Clinical history)-bleeding risk score in estimating major bleeding risk in Chinese patients with atrial fibrillation (AF) on oral anticoagulation (OAC) therapy in real-world practice., Methods: Data were collected from the Chinese Atrial Fibrillation Registry study (CAFR). Patients were stratified into low-, medium-, and high-risk groups based on ABC-bleeding risk score with 1-year major bleeding risk (<1%, 1-2%, and > 2%) and modified HAS-BLED score (≤1, 2, and > 2 points). Cox proportional-hazards (Cox-PH) models were used to determine the association of major bleeding incidence with bleeding scores. Harrell's C-index of the two scores were compared. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) at 1 year were employed to evaluate the reclassification capacity. The calibration curve was plotted to compare the predicted major bleeding risk using ABC-bleeding risk score with the observed annualized event rate. The decision analysis curves (DCA) were performed to show the clinical utilization of two scores in identifying major bleeding events., Results: The study included 2,892 AF patients on OAC therapy. After the follow-up of 3.0 years, 48 patients had major bleeding events; the incidence of a bleeding event in the low-, medium-, and high-risk groups according to ABC-bleeding risk score was 0.31% (reference group, HR = 1.00),0.51% (HR = 1.83, 95%CI: 0.91-3.69, P = 0.09), and 1.49% (HR = 4.92, 95%CI: 2.34-10.30, P < 0.001), respectively. Major bleeding incidence had an independent association with growth differentiation factor 15 (GDF-15) level (HR = 2.16, 95%CI: 1.27-3.68, P = 0.005) after adjusting components of the HAS-BLED score and cTnT-hs level. The ABC-bleeding score showed a Harrell's C-index of 0.67 (95%CI: 0.60-0.75) in estimating major bleeding risk, which was non-significant compared to the modified HAS-BLED score (0.67 vs. 0.63; P = 0.38). NRI and IDI also revealed comparable reclassification capacity of ABC-bleeding risk score compared with HAS-BLED score (14.6%, 95%CI: -10.2%, 39.4%, P = 0.25; 0.2%, 95%CI -0.1 to 0.9%, P = 0.64). Cross-tabulation of the two scores showed that the ABC-bleeding score outperformed the HAS-BLED score in identifying patients with a high risk of major bleeding. The calibration curve showed that the ABC-bleeding risk score overestimated the observed major bleeding risk. DCA did not show any difference in net benefit when using either of the scores., Conclusion: This study verified the value of the ABC-bleeding risk score in assessing major bleeding risk in Chinese patients with AF on OAC therapy in real-world practice. Despite the overestimation of major bleeding risk, ABC-bleeding score performed better in stratifying patients with a high risk than the modified HAS-BLED score. Combining the two scores could be a clinically practical strategy for precisely stratifying AF patients, especially those at a high risk of major bleeding, and further supporting the optimization of OAC treatment., Competing Interests: This study was sponsored by Roche Diagnostics (Shanghai). Roche Diagnostics (Shanghai) Limited was allowed to review the study protocol and comment on the final version of the manuscript as well as contributed to the design, conducting, and statistical analysis of the study. Under the authors’ direction, medical writing support was provided by Xue Wu of Roche Diagnostics (Shanghai) Limited. C-YP was employed by Roche Diagnostics (Shanghai) Limited. J-ZD received lecture fees from Johnson and Johnson. C-SM received lecture fees and honoraria from Bristol-Myers Squibb, Pfizer, Johnson and Johnson, Boehringer-Ingelheim, and Bayer. The construction of CAFR was supported by grants from Bristol-Myers Squibb, Pfizer, Johnson and Johnson, Boehringer Ingelheim, and Bayer. The handling editor declared a shared affiliation with several of the authors Y-FW, CJ, LH, XD, C-HS, D-YL, R-BT, J-ZD, C-SM at the time of review., (Copyright © 2022 Wang, Jiang, He, Pu, Du, Sang, Long, Tang, Dong and Ma.)

Introduction: Lung cancer screening criteria should select candidates with minimal cardiopulmonary comorbidities who are fit for curative lung cancer resection., Methods: We retrospectively analyzed 728 patients with lung cancer for screening eligibility using the U.S. Preventive Services Task Force (USPSTF) 2013 criteria (n = 370). If ineligible for screening, they were further assessed for eligibility using the USPSTF 2021 (n = 121) and National Comprehensive Cancer Network group 2 (NCCN gp 2) (n = 155). Comparisons of cardiopulmonary comorbidities between patients selected by the different lung cancer screening criteria were performed. Excluding missing data, a similar comparison was done between USPSTF 2013 (n = 283) and PLCOm2012 (risk threshold ≥1.51%) (n = 118)., Results: Patients eligible for USPSTF 2021 and NCCN gp 2 had lower rates of airflow obstruction (forced expiratory volume in 1 s [FEV1]/forced vital capacity <0.7) compared with those in USPSTF 2013 (55.4% and 56.8% versus 70.5%). Both USPSTF 2021 and NCCN gp 2 groups had less severe airflow obstruction; only 11.6% and 12.9% of patients, respectively, had percent-predicted FEV1 less than 50% versus 20.3% in the USPSTF 2013 group. Comparing USPSTF 2013 and PLCOm2012 revealed no significant differences in age or the rate of airflow obstruction ( p = 0.06 and p = 0.09 respectively). Nevertheless, rates of percent-predicted FEV1 less than 50% and diffusing capacity of the lungs for carbon monoxide less than 50% were lower in the PLCOm2012 group compared with those in the USPSTF 2013 group (22.3% versus 10.2% and 32.6% versus 20.0%), respectively., Conclusions: The USPSTF 2021 qualifies an additional group of screening candidates who are healthier with better lung reserve, translating to better surgical candidacy but potentially more overdiagnosis. The PLCOm2012, with its better accuracy in selecting patients at risk of cancer, selects an older group with chronic obstructive pulmonary disease but with good lung reserve and potentially less overdiagnosis., (© 2022 The Authors.)

Importance: In 2021, the US Preventive Services Task Force (USPSTF) broadened its age and smoking pack-year requirement for lung cancer screening., Objectives: To compare the 2021 USPSTF lung cancer screening criteria with other lung cancer screening criteria and evaluate whether the sensitivity and specificity of these criteria differ by race., Design, Setting, and Participants: This study included 912 patients with lung cancer and 1457 controls without lung cancer enrolled in an epidemiology study (INHALE [Inflammation, Health, Ancestry, and Lung Epidemiology]) in the Detroit metropolitan area between May 15, 2012, and March 31, 2018. Patients with lung cancer and controls were 21 to 89 years of age; patients with lung cancer who were never smokers and controls who were never smokers were not included in these analyses. Statistical analysis was performed from August 31, 2020, to April 13, 2021., Main Outcomes and Measures: The study assessed whether patients with lung cancer and controls would have qualified for lung cancer screening using the 2013 USPSTF, 2021 USPSTF, and 2012 modification of the model from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012) screening criteria. Sensitivity was defined as the percentage of patients with lung cancer who qualified for screening, while specificity was defined as the percentage of controls who did not qualify for lung cancer screening., Results: Participants included 912 patients with a lung cancer diagnosis (493 women [54%]; mean [SD] age, 63.7 [9.5] years) and 1457 control participants without lung cancer at enrollment (795 women [55%]; mean [SD] age, 60.4 [9.6] years). With the use of 2021 USPSTF criteria, 590 patients with lung cancer (65%) were eligible for screening compared with 619 patients (68%) per the PLCOm2012 criteria and 445 patients (49%) per the 2013 USPSTF criteria. With the use of 2013 USPSTF criteria, significantly more White patients than African American patients with lung cancer (324 of 625 [52%] vs 121 of 287 [42%]) would have been eligible for screening. This racial disparity was absent when using 2021 USPSTF criteria (408 of 625 [65%] White patients vs 182 of 287 [63%] African American patients) and PLCOm2012 criteria (427 of 625 [68%] White patients vs 192 of 287 [67%] African American patients). The 2013 USPSTF criteria excluded 950 control participants (65%), while the PLCOm2012 criteria excluded 843 control participants (58%), and the 2021 USPSTF criteria excluded 709 control participants (49%). The 2013 USPSTF criteria excluded fewer White control participants than African American control participants (514 of 838 [61%] vs 436 of 619 [70%]). This racial disparity is again absent when using 2021 USPSTF criteria (401 of 838 [48%] White patients vs 308 of 619 [50%] African American patients) and PLCOm2012 guidelines (475 of 838 [57%] White patients vs 368 of 619 [60%] African American patients)., Conclusions and Relevance: This study suggests that the USPSTF 2021 guideline changes improve on earlier, fixed screening criteria for lung cancer, broadening eligibility and reducing the racial disparity in access to screening.

Objective: To determine the benefits of preoperative breathing exercises on hospital length of stay (LOS), pneumonia, postoperative pulmonary complications (PPC), 6-minute walk distance (6MWD), forced expiratory volume in 1 second (FEV 1 ), and health-related quality of life (HRQOL) in patients undergoing surgical lung cancer resection., Data Sources: PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were comprehensively searched from inception to March 2021., Study Selection: Only studies including preoperative inspiratory muscle training (IMT) and/or breathing exercises compared with a nontraining control group were included. The meta-analysis was done using Cochrane software for multiple variables including LOS, pneumonia, PPC, 6MWD, FEV 1 , mortality, and HRQOL., Data Extraction: Two authors extracted the data of the selected studies. The primary outcomes were LOS and PPC., Data Synthesis: A total of 10 studies were included in this meta-analysis, 8 of which had both IMT and aerobic exercise. Pooled data for patients who performed preoperative breathing exercises, compared with controls, demonstrated a decrease in LOS with a pooled mean difference of -3.44 days (95% confidence interval [CI], -4.14 to -2.75; P<.01). Subgroup analysis also demonstrated that LOS was further reduced when breathing exercises were combined with aerobic exercise (χ 2 , 4.85; P=.03). Preoperative breathing exercises reduce pneumonia and PPCs with an odds ratio of 0.37 (95% CI, 0.18-0.75; P<.01) and 0.37 (95% CI, 0.21-0.65; P<.01), respectively. An increase in 6MWD of 20.2 meters was noted in those performing breathing exercises (95% CI, 9.12-31.21; P<.01). No significant differences were noted in FEV 1 , mortality, or HRQOL., Conclusions: Preoperative breathing exercises reduced LOS, PPC, and pneumonia and potentially improved 6MWD in patients undergoing surgical lung cancer resection. Breathing exercises in combination with aerobic exercise yielded greater reductions in LOS. Randomized controlled trials are needed to test the feasibility of introducing a preoperative breathing exercise program in this patient population., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: In patients with clinical N1 disease, minimally invasive surgery (MIS) has potentially better perioperative outcome compared to open thoracotomy. Additionally, whether adjuvant or neoadjuvant chemotherapy produces the best long-term survival is still debatable., Methods: We queried The National Cancer Database for patients with clinical N1 NSCLC who underwent surgical resection between 2010 and 2014. Comparison between patients receiving MIS and patients who underwent open thoracotomy was done using an intention-to-treat analysis. Comparison was also done among neoadjuvant, adjuvant chemotherapy, and only surgery. Proportional hazard models were used to evaluate the effects of surgical approach and timing of chemotherapy on overall survival., Results: A total of 1440 and 3942 patients underwent MIS and open thoracotomy respectively. MIS achieved better surgical margins (90.0% versus 88.6%) and shorter length of stay (6.5 ± 6.5 versus 7.3 ± 6.4 d, P ≤ 0.01) compared to open thoracotomy. There were no differences in 30-day and 90-day mortality, nor readmission rates. Neoadjuvant and adjuvant chemotherapy were administered to 13.5% and 57.2% of patients respectively. There was no significant difference in the 5-year overall survival between MIS and open thoracotomy (46% versus 46% P = 0.08). There was significantly better 5-year overall survival in neoadjuvant and adjuvant chemotherapy versus only surgery, but no difference between neoadjuvant and adjuvant chemotherapy (48% versus 47% versus 44%, P < 0.01)., Conclusions: In clinical N1 NSCLC, MIS does not compromise oncological quality or overall survival when compared to open thoracotomy. Overall survival improved in patients treated with chemotherapy but there is no difference when given as neoadjuvant versus adjuvant chemotherapy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Phenylephrine has been administered endobronchially for airway bleeding during bronchoscopy as an alternative to epinephrine. Topical phenylephrine, often used in nasal surgery as a vasoconstrictor agent has been linked to cardiovascular morbidity., Objective: To evaluate the safety of bronchoscopic instillation of phenylephrine during bronchoscopy., Methods: We retrospectively reviewed patients who received endobronchial phenylephrine in our endoscopy suite. We compared the changes in blood pressure and heart rate before and after endobronchial phenylephrine administration. The safety of endobronchial phenylephrine was assessed with regards to the changes in hemodynamics and acute cardiovascular event, and 30-day mortality. Acute cardiovascular complications included acute coronary syndrome, aortic dissection, tachyarrhythmias, pulmonary edema and stroke., Results: We identified 30 patients who received endobronchial phenylephrine 100mcg/ml with a mean total volume of 6.5 ± 10.6 ml. They were given mainly for balloon dilation and cryobiopsy procedure (96.7%). On excluding patients who received concurrent IV pressor, there was a statistically significant increase of mean arterial pressure (MAP) by 12 ± 21 mmHg, p = 0.01 within 30 min of endobronchial phenylephrine compared to procedure day MAP baseline. There was 27% of patients with more than 20% increase in their MAP but none of the patients had MAP more than 140 nor the occurrence of acute cardiovascular event. There was no significant change in the patients' heart rate following endobronchial phenylephrine., Conclusion: In our review, endobronchial phenylephrine with dose comparable to IV administration can cause significant raise in MAP but their absolute levels did not go beyond 180/120 mmHg nor resulted in acute cardiovascular complications., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Tracheobronchial colonization by Pseudomonas aeruginosa ( PA ) has been shown to negatively impact outcomes in cystic fibrosis and bronchiectasis. There is uncertainty whether the same association is prevalent in chronic obstructive pulmonary disease (COPD), especially in the outpatient setting. Our objective was to determine (1) whether PA isolation is associated with mortality and (2) changes in exacerbation and hospitalization rates within a longitudinal cohort of COPD outpatients., Methods: Pseudomonas aeruginosa colonization was ascertained in monthly sputum cultures in a prospective cohort of COPD patients from 1994 to 2014. All-cause mortality was compared between patients who were colonized during their follow-up period ( PA + ) and those who remained free of colonization ( PA - ); Cox proportional hazards models were used. Exacerbation and hospitalization rates were evaluated by 2-rate χ  2 and segmented regression analysis for 12 months before and 24 months after PA isolation., Results: Pseudomonas aeruginosa was isolated from sputum in 73 of 181 (40%) patients. Increased mortality was seen with PA isolation: 56 of 73 (77%) PA +   patients died compared with 73 of 108 (68%) PA - patients ( P  = .004). In adjusted models, PA +   patients had a 47% higher risk of mortality (adjusted hazard ratio = 1.47; 95% confidence interval, 1.03-2.11; P  = .04). Exacerbation rates were higher for the PA +   group during preisolation (15.4 vs 9.0 per 100 person-months, P  < .001) and postisolation periods (15.7 vs 7.5, P  < .001). Hospitalization rates were higher during the postisolation period among PA +   patients (6.25 vs 2.44, P  < .001)., Conclusions: Tracheobronchial colonization by PA in COPD outpatients was associated with higher morbidity and mortality. This suggests that PA likely contributes to adverse clinical outcomes rather than just a marker of worsening disease., (© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: The diagnosis of COPD in patients hospitalized for AECOPD can be confirmed by spirometry showing obstruction or radiographs showing emphysema. The evidence for COPD is sometimes absent or contradicts this diagnosis. The inaccurate attribution of the exacerbation to COPD can lead to suboptimal care and worse outcome., Objectives: We determined if the presence of tests that confirm the diagnosis of COPD has any implications on the course of the hospitalization and readmission rate., Methods: We selected subjects hospitalized between 2012 and 2014 for AECOPD. We divided them into four hierarchical, mutually exclusive groups based on the presence of tests that confirm the diagnosis of COPD: spirometry (COPD SPIRO ), radiology (COPD RAD ), clinical diagnosis (COPD CLIN ), and no COPD by spirometry (NotCOPD). We compared the presentation, hospital course, outcome, and readmission rate between the four groups., Results: We identified 974 subjects: COPD SPIRO 22%, COPD RAD 24%, COPD CLIN 46% and 7% NotCOPD. The vital signs, use of respiratory support, admission to the MICU, and length of stay were similar between the groups. The age, gender, BMI, presence of comorbidities, and readmission rate were different between the groups. The NotCOPD group had the highest BMI (38 kg/m 2 ), comorbidities, and 30-day all-cause readmission (17%). Logistic regression showed that serum creatinine and presence of any comorbidity were the independent predictors of 30-day all-cause readmission., Conclusion: COPD was confirmed by spirometry or radiographs in half of the subjects hospitalized for AECOPD. The presence of confirmation did not influence the hospital course. The presence of confirmation was associated with different readmission rate, but was accounted for by the presence of comorbidities.

Background: The incidence of depression is very common among patients with post-acute coronary syndrome (ACS) and leads to adverse outcomes., Aims: The aim of this meta-analysis was to detect risk factors for depression among patients with ACS and to provide clinical evidence for its prevention., Methods: The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to search the PubMed, Web of Science, EMBASE, and EBSCO databases from January 1996 to March 2018. Data that met the inclusion criteria were extracted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of post-ACS depression., Results: A total of 30 articles met the inclusion criteria, and 25 risk factors were found to be associated with depression. The top 5 risk factors are as follows: antidepression treatment (OR, 4.25; 95% CI, 3.41-5.31), housewife status (OR, 4.17; 95% CI, 1.83-9.53), history of depressive disorders (OR, 3.52; 95% CI, 2.69-4.61), widow status (OR, 2.34; 95% CI, 1.05-5.21), and history of congestive heart failure (OR, 2.03; 95% CI, 1.04-3.97). The authors also found that a married status, high education level, and employment are protective factors., Conclusion: Clinical personnel should be alerted with regard to the high risk factors of depression, including female gender, low education level, unmarried status, living alone, unemployed status, unhealthy lifestyle, and complications such as cardiovascular, respiratory, and metabolic diseases. In particular, staff should pay attention to a history of previous depression, be concerned with the psychological condition of the patient, and monitor and perform early interventions to reduce the incidence of depression.

Purpose: To study the incidence and epidemiology of Behcet's disease in Taiwan., Methods: This retrospective cohort study was conducted using the nationwide reimbursement database in Taiwan. One million registered beneficiaries of the Taiwan National Health Insurance system in 2000 were randomly selected. All medical claims of these persons were collected. The definition of having Behcet's disease was based on diagnostic codes. Persons who had incomplete registry data or diagnoses prior to 2001 were excluded. Annual incidence between 2001 and 2011 was calculated and risk factors for incidence were explored using the Cox proportional regression model. Characteristics of patients with Behcet's disease with and without uveitis were compared., Results: A total of 236 newly diagnosed patients with Behcet's disease were found between 2001 and 2011. The average incidence was 2.40 cases per 100,000 person-years (ranging from 1.29 to 3.53). Female patients and those aged between 40 and 65 years were at the highest risk of Behcet's disease. Only 18.2% of the patients had also suffered from uveitis. The subspecialties of doctors making initial diagnoses and the number of prescribed immunomodulatory agents differed significantly between the patients with and without uveitis (p < 0.001 and <0.05, respectively)., Conclusion: Incidence of Behcet's disease was not high in Taiwan and relatively few of the patients developed uveitis. Patients of working age or who were female were more likely to have Behcet's disease. However, age of onset and clinical severity differed between patients with and without uveitis.

Background: Mothers with lifelong care responsibilities might involuntarily be non-employed or work part-time, both of which are defined as "underemployment." This study aimed to investigate who these underemployed mothers are and what are the factors associated with such employment hardship when having a child with intellectual disability (ID)., Method: An interview survey was conducted in 2011 in two local authorities of Taiwan on 876 working-age mothers with a child with intellectual disability; 514 of them were working part-time/non-employed and chosen as participants of this study., Results: The mothers with a younger child with intellectual disability, a higher level of education, a lower level of family income and more family members with disabilities were more likely to be underemployed compared with the mothers who were voluntarily working part-time/non-employed., Conclusions: The underemployed mothers were more likely to have financial difficulty and heavy caregiving loads; their employment hardship should be of concern for policymakers., (© 2017 John Wiley & Sons Ltd.)

A 61-year-old man was evaluated for a 2 month history of cough and dyspnea without relevant exposures other than pyrethrin containing insecticidal sprays he used while grooming dogs almost daily. High Resolution Computed Tomography (HRCT) of the chest demonstrated a Non-Specific Interstitial Pneumonia (NSIP) pattern. Pulmonary function testing revealed an isolated mildly reduced diffusion capacity. Bronchoalveolar lavage (BAL) results confirmed the presence of foamy histiocytes, lymphocytes, and polymorphonuclear cells consistent with ongoing exposure. Open lung biopsy showed poorly formed granulomas and bronchiolitis. He was advised to avoid exposure to pyrethrin. While he declined to stop grooming dogs, on follow-up, his symptoms had improved with use of a P100 mask and better ventilation to protect himself when using the pet sprays. We conclude that sustained exposure to pyrethrin containing sprays in the pet grooming industry may be a risk factor for a novel occupation related hypersensitivity pneumonitis. ("Pet Groomer's Lung"). Am. J. Ind. Med. 60:141-145, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: Pax8 and peroxisome proliferator-activated receptor gamma 1 gene (Pax8-PPARγ1) are important factors in tumors. Several studies have suggested that follicular thyroid cancer may arise from Pax8- PPArγ1 rearrangement. In order to have a better understanding of the association between Pax8-PPARγ1 rearrangement and follicular thyroid cancer, we conducted the presenmt meta-analysis., Materials and Methods: The information was extracted from PubMed, EMBASE and Web of Science. Statistic analysis was performed with Stata12.0 software. Odds ratios (ORs) were calculated using a fixed-effects model. We also performed heterogeneity and publication bias analyses., Results: Nine studies including 198 follicular thyroid cancer patients and 268 controls were considered eligible. The frequency of Pax8-PPARγ1 rearrangement was significantly higher in the follicular thyroid cancer group than in the control group, with a pooled OR of 6.63 (95%CI=3.50-12.7). In addition, through subgroup analysis, the OR between Pax8-PPARγ1 rearrangement and follicular thyroid cancer was 6.04 (95%CI = 3.18-11.5) when using benign tumor tissues as controls. The OR for the method subgroup was 9.99 (95% CI =4.86-20.5) in the RT-PCR., Conclusions: The final results demonstrated that Pax8-PPARγ1 rearrangement has significant association with follicular thyroid cancer.

Background: The universal breadwinner model means both parents are employed; while the universal caregiver model implies that the father's hours of caregiving are equal or higher to those of the mother. This study aims to examine the hypothesis that the universal caregiver model is more related to the overall well-being of mothers of children with intellectual disabilities than the universal breadwinner model., Methods: Face-to-face interview surveys were conducted in 2011 in Taiwan with 876 working-age mothers who had an offspring with intellectual disabilities. The survey included 574 mothers living with their husbands who became our participants., Results: Both anova and regression analyses indicated that, compared with mothers in the universal breadwinner group, mothers in the universal caregiver group had higher levels of maternal marital and family life satisfaction, but not of work satisfaction and quality of life., Conclusions: An incentive policy is critical for supporting the fathers involved in lifelong caregiving and to promote the mothers' quality of life., (© 2015 John Wiley & Sons Ltd.)

Purpose: To investigate the incidence and risk factors for developing ocular hypertension or glaucoma needing treatment among uveitis patients in Taiwan., Methods: The nationwide database-derived retrospective cohort study was designed using Taiwan's National Health Insurance Research Database. From 1 million representative samples randomly selected from the beneficiaries of the National Health Insurance program, all patients with a diagnosis of uveitis were identified. Only newly onset uveitis patients who were diagnosed after January 1, 2002 and had no prior diagnosis of glaucoma were included in the study, and were followed up until December 31, 2008 or the last day that they were covered by the program. A patient was defined as having glaucoma as soon as both a diagnosis of glaucoma or ocular hypertension as well as a claim for medical or surgical treatment of glaucoma was found. Risk factors for developing glaucoma at the time of, or after the uveitis incidence were evaluated and discussed., Results: Initially, 5757 newly diagnosed uveitis patients were enrolled in the study. Of these patients, 488 (8.5%) were also diagnosed with glaucoma at the time of uveitis incidence. Patients aged 17 to 64 years, of male sex and diagnosed with anterior uveitis were more likely to have glaucoma at the time of the uveitis incidence. Among the remaining 5269 patients, 351 (6.7%) patients developed glaucoma during the follow-up period. Significant risk factors included increasing age, having been diagnosed with anterior uveitis, having more than an average number of ophthalmic claims within the first 3 months, and complications with corneal edema. A stratified analysis showed that having a history of receiving intraocular surgery is also a risk factor for the development of glaucoma among adult patients., Conclusions: The development of glaucoma in uveitis patients is noteworthy and is associated with several demographic and clinical factors. To minimize the visual impairment caused by uveitis-related glaucoma, clinicians should pay more attention to those uveitis patients who are at high risk for developing glaucoma.

Studies comparing the sexual attitudes of men and women with intellectual disabilities (ID) have been limited. A mixed-methods approach was employed to explore attitudes toward sexuality among men and women with ID in Taiwan and to ascertain the disparities between attitudes among men and women with ID. First, fifty-six men and forty-four women with mild and moderate ID completed a face-to-face interview survey. After this, focus groups were conducted for men and women with ID. Results indicated that women with ID were more likely to have negative attitudes toward parenting and non-reproductive sexual behavior than their male counterparts. Qualitative data indicated that men and women with ID had different sexual attitudes and experiences and were subject to different expectations from people around them. Both men and women with ID had very limited opportunities to develop romantic relationships and a healthy sexual identity. Sexual rights awareness and practice should be matters of concern for this group of adults and women with ID in particular.

Importance: Medication persistence is an important factor for treatment effect in patients with glaucoma. Evaluating risk factors for refill discontinuation might be helpful for improving persistence and preventing blindness in patients with glaucoma., Objectives: To estimate the persistence rate with topical glaucoma medication 2 years after diagnosis and evaluate risk factors for nonpersistence among patients in Taiwan with open-angle glaucoma and ocular hypertension., Design, Setting, and Participants: A retrospective population-based study using claims data from the National Health Insurance Research Database. One million patients were randomly selected from the registered beneficiaries of the National Health Insurance Research Database in 2000. All patients with newly diagnosed open-angle glaucoma and ocular hypertension were included and followed up until December 31, 2008. Patients were included in the analysis only if they had follow-up data for more than 2 years after diagnosis., Main Outcomes and Measures: Nonpersistence was defined as the patient not refilling any topical glaucoma medication for more than 90 days. Patient characteristics, prescription-related clinical factors, and physician and hospital characteristics were identified and considered in the analysis. The rate of persistence was estimated and risk factors for nonpersistence were investigated using Cox proportional regression models., Results: A total of 3134 patients were identified and observed in the study. After a 2-year follow-up, 759 patients (24.2%) persisted with their glaucoma medications. Multivariate analysis showed that patients' living or working areas (P < .001), number of glaucoma medications (P < .001), prescription of pilocarpine hydrochloride (adjusted ratio of persistence = 0.72; 95% CI, 0.59-0.88) or prostaglandin analogs (adjusted ratio of persistence = 2.04; 95% CI, 1.82-2.33), the year in which glaucoma diagnosis was made (adjusted ratios of persistence for patients whose condition was diagnosed after 2004 = 1.18; 95% CI, 1.09-1.27), sex of the main physicians (adjusted ratios of persistence for male ophthalmologists = 0.82; 95% CI, 0.74-0.90), treatment in hospitals (P < .001), and continuity of care index (P < .001) were associated with patients' persistence with glaucoma medications., Conclusions and Relevance: The rate of persistence for glaucoma medications is low in Taiwan, although health care costs, including the cost of medication, are mostly covered by the nationwide health insurance system. This study suggests that factors other than cost, such as physician-patient relationship and patient education, may play an important role in the persistence of topical glaucoma medication.

More than 20% of chronic hepatitis C (CHC) patients receiving interferon-alpha (IFN-α)-based anti-hepatitis C virus (HCV) therapy experienced significant depression, which was relieved by treatment with fluoxetine. However, whether and how fluoxetine affected directly the anti-HCV therapy remained unclear. Here, we demonstrated that fluoxetine inhibited HCV infection and blocked the production of reactive oxygen species (ROS) and lipid accumulation in Huh7.5 cells. Fluoxetine facilitated the IFN-α-mediated antiviral actions via activations of signal transducer and activator of transcription (STAT)-1 and c-Jun amino-terminal kinases (JNK). Alternatively, fluoxetine elevated peroxisome proliferator-activated receptor (PPAR) response element activity under HCV infection. The inhibitory effects of fluoxetine on HCV infection and lipid accumulation, but not production of ROS, were partially reversed by the PPAR-β, -γ, and JNK antagonists. Furthermore, fluoxetine intervention to the IFN-α-2b regimen facilitated to reduce HCV titer and alanine transaminase level for CHC patients. Therefore, fluoxetine intervention to the IFN-α-2b regimen improved the efficacy of anti-HCV treatment, which might be related to blockades of ROS generation and lipid accumulation and activation of host antiviral JNK/STAT-1 and PPARβ/γ signals., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The four main models of long-term care (LTC) for older people in Taiwan are institutional care, community and home-based care, live-in migrant care and family care. This study aims to examine the factors associated with the four above-mentioned LTC models, using the Andersen model as its framework for analysis. Data were from the 2005 National Taiwanese Health Interview Survey ( n  = 30,680), and in this study, 592 over 65-year-old persons who require personal care in daily life were included. The findings showed that the majority of older people with care needs lived with family and were cared only by their family. The second largest group was those older people who were cared by migrant care workers, and the third group used institutional care. Only a very small proportion used community/home-based care services. If older people had intensive care needs, they either hired migrant care workers or used institutional care, depending on social and economic backgrounds. Multinomial logistic regression results showed that the way how disabled older people use different LTC models was affected by three components of the Andersen model: their needs (level of ADL and IADL), predisposing factors (age, education) and enabling factors (family networks). Results suggest that there is a need for LTC policies in Taiwan to provide more available and accessible community/home-based care services, particularly for older people with intensive care needs, in order to support their 'ageing in place' and to decrease the use of migrant care workers.

Background: Little is known about how middle-aged and older women with intellectual disability (ID) cope with life transitions such as perimenopause and postmenopause., Method: A mixed methods approach was employed to explore the attitudes toward and experiences of menopause among women with ID and their family carers in one city in Taiwan., Results: A survey found that how the carers perceived the level of menopausal symptoms in their female family members with ID was affected by their attitudes toward menopause; and carer age and education were significant factors associated with carer menopausal attitudes. The results of in-depth interviews indicated the carers' gender, age, kinships with the women with ID, and the carers' own menopausal experiences were related to how the carers felt about the menopausal transition of the women with ID., Conclusions: Both quantitative and qualitative findings show that little attention has been paid to either the menopausal transition experiences or the wellbeing of women with ID.

Purpose: This study aimed to investigate the incidence and prevalence of uveitis in Taiwan, and then analyzed the risk factors related to uveitis using multivariate regression., Design: Population-based cohort study using medical claims data., Participants: We randomly selected 1 000 000 residents from the Taiwan National Health Insurance Research Database. All participants with correct registry data (96%) were included in the study. The study period was from 2000 to 2008., Methods: All types of uveitis were identified using the International Classification of Diseases, 9th revision, Clinical Modification diagnostic codes. The annual incidence and cumulative prevalence of uveitis were calculated. A univariate and a multivariate Poisson regression were used to determine the risk factors associated with uveitis., Main Outcome Measures: The first diagnosis of uveitis noted during the study period., Results: The annual cumulative incidence rate of uveitis ranged from 102.2 to 122.0 cases per 100 000 persons over the study period, and the average incidence density was 111.3 cases per 100 000 person-years (95% confidence interval, 108.4-114.1). The cumulative prevalence was found to have increased from 318.8 cases per 100 000 persons in 2003 to 622.7 cases per 100 000 persons in 2008. Anterior uveitis was the most common location and accounted for 77.7% of all incident cases, which was followed by panuveitis, posterior uveitis, and intermediate uveitis. Multivariate regression analysis showed that males, the elderly, and individuals who lived in an urban area had higher incidence rates for uveitis., Conclusions: The epidemiology of uveitis in Taiwan differs from most previous studies in other countries. The incidence of uveitis in Taiwan has increased significantly recently. The elderly and individuals living in urban areas are the populations that are most commonly affected by uveitis. These findings are consistent with suggestions found in several recent studies., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

EDSM, an endostatin-derived synthetic polypeptide, contains the amino acids 6-48 of endostatin from its N-terminus, which could inhibit human umbilical vein endothelial cell (HUVEC) migration and tumor growth. To increase the targeted delivery of EDSM to tumors and further enhance its antiangiogenic activity, the RGD sequence (Arg-Gly-Asp) was introduced into EDSM and two peptides were obtained: EDSM-X with RGD on the N-terminus of EDSM and EDSM-Y with RGD on the C-terminus. Both modified peptides showed a significant antiangiogenic activity in the HUVEC migration assay, the HUVEC tube formation assay, and the murine aortic ring formation assay in vitro. In agreement with the in-vitro data, EDSM-X and EDSM-Y also showed a significant antitumor activity in vivo. From the cell adhesion assay, it was confirmed that the molecular target of the modified peptides on HUVECs was integrin αvβ3, rather than integrin α5β1. Furthermore, EDSM-Y exhibited more potent antiangiogenic activity and antitumor activity than EDSM-X in vitro and in vivo, and this phenomenon was attributed to the difference in the two modified peptides in their three-dimensional structure modeling and their molecular dockings with integrin αvβ3.

Background: Whether employed and nonemployed mothers of children with intellectual disability (ID) have different experiences with reconciliation between care and work has rarely been explored., Method: A survey was conducted in a county in Taiwan and 487 mothers aged younger than 65 and having a child with ID were interviewed face to face at their homes to explore whether there are different factors related to the reconciliation between care and work among employed and nonemployed mothers., Results: Except for the common ground of mothers' health and care demands, logistic regression revealed work flexibility and care support were important for employed mothers. In contrast, the success of reconciliation for nonemployed mothers was determined by their individual characteristics (i.e., age, marital status, family income)., Conclusions: Reconciliation policies for mothers with different employment statuses need to use different strategies.

Aim: Different eukaryotic expression vectors were selected in this research, and then we respectively cloned and constructed recombinant plasmids contained HBX gene or its different fusion forms with GFP. We are aimed to explore the influence of the HBX protein with different structure on its intracellular localization., Methods: Flag-HBX gene was amplified from pcDNA3.0-HBX plasmid in our laboratory, cloned into pMD-18T vectors, sequenced.and then subcloned into different vectors. After right sequenced, respective recombinant plasmids of pFlag- HBX-IRES2-EGFP, pEGFP-C3-Flag-HBX and pFlag-HBX-EGFP-N3 were transiently transfected into hepatoma HepG-2 cells. The intra-cellular localizations and distributions of HBX protein were examined by indirect immunofluorescence., Results: Three different Flag-HBX eukaryotic expression vectors were successfully constructed. After transfection of them into HepG2 cells respectively, indirect immunofluorescence demonstrated that HBX protein fused with GFP in different forms show distint intra-cellular distribution characteristics., Conclusion: We have provided significant experimental evidences for research of the role of HBX protein in the development of hepatocellular carcinoma, and especially the references for explanation of the outcomes in vitro transfection experiments.

Setting: The deterioration of immunity in cancer patients may be associated with a higher incidence of tuberculosis (TB)., Objective: Despite several previous studies on cancer and TB, no population-based investigation has been published. We performed a nationwide population-based study to investigate the incidence of active TB among cancer patients, and the cancer-type specific risk factors related to TB., Designs: This nationwide population-based retrospective cohort study was based on data obtained from the Taiwan National Health Insurance Database. A total of 16,487 cancer patients and 65,948 controls matched for age and sex were recruited., Results: The incidence of TB per 100,000 person-years was 339 in the cancer patients and 202 in the controls, which gives a crude incidence rate ratio of 1.68 (95%CI 1.42-1.98). The hazard ratio (HR) was 1.67 (95%CI 1.42-1.96) after adjusting for age, sex and comorbidity. Cox regression showed that cancers of the aerodigestive tract, including oral, nasopharyngeal and oesophageal and lung cancer (HR 3.09, 95%CI 2.42-3.94) and haematological cancers, including non-Hodgkin's lymphoma and leukaemia (HR 3.22, 95%CI 1.98-5.22), were significant risk factors for TB., Conclusion: Cancer patients have a higher incidence of TB than controls. Patients with aerodigestive tract, lung and haematological cancers are especially vulnerable to TB.

Background: This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID)., Method: In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained standardised scales to assess carer self-reported depressive symptoms, social support, caregiving burden and disease and health, as well as adult and carer sociodemographic information. Multiple linear regressions were used to identify the factors associated with high depressive symptoms in carers., Results: Between 64% and 72% of these carers were classified as having high depressive symptoms. The factors associated with carer self-reported depressive symptoms were carer physical health, social support and caregiving burden; overall, the carer self-reported physical health was a stronger factor associated with depressive symptoms than their physical disease status. The level of the adult with ID's behavioural functioning and the carer age, marital status, employment status, education level and the family income level were not significantly associated with carer depressive symptoms., Conclusions: The factors identified in this study as correlating with self-reported depressive symptoms suggest that researchers and mental health professionals should collaborate to help improve the physical health and social support networks of the most vulnerable older female family carers. This should reduce depressive symptoms directly among this high-risk group., (© 2010 The Authors. Journal of Intellectual Disability Research © 2010 Blackwell Publishing Ltd.)

The effects of caregiving on mothers of adults with intellectual disability was examined by determining whether there are differences in quality of life and related factors between mothers with different employment status. Study participants were 302 working-age mothers who had adult children with intellectual disability based on the 2008 census survey on intellectual disability carried out in Hsinchu, City, Taiwan. Results revealed that nonemployed mothers are more likely to have a lower level of health status, including the WHOQOL Physical Health domain, than are mothers employed fulltime. Multiple regression analysis showed that mothers' quality of life was significantly determined by the availability of a person with whom they could share care work, family income, social support, and employment status.

Varicella zoster virus (VZV) causes varicella, and may reactivate to cause herpes zoster later in the life of the host. It has been previously observed that exposure to VZV may boost the host's latent immunity. Health-care workers who are frequently exposed to ill patients ought to receive a protective effect. We investigated the incidence of herpes zoster among health-care workers and the general population in Taiwan to see whether such a protective effect exists among health-care workers against herpes zoster. This nationwide population-based retrospective cohort study was based on data obtained from the Taiwan National Health Insurance Database. In total, 7744 health-care workers, including 168 dermatologists and pediatricians, and 695 188 general adults were recruited for the study. Health-care workers in the age groups 20-29, 30-39 and 40-49 years were found to have a significant higher herpes zoster incidence compared to the general adults (P < 0.001, 0.011 and <0.001, respectively). Both logistic regression and Cox regression showed that dermatologists, pediatricians, and other medical professionals have a higher herpes zoster incidence than the general population (odds ratio [OR] = 1.36, 95% confidence interval [95% CI] = 0.63-2.90, hazards ratio [HR] = 1.35, 95% CI = 0.64-2.82 in dermatologist and pediatrician groups, and OR = 1.39, 95% CI = 1.23-1.58, HR = 1.38, 95% CI = 1.22-1.56 in other medical professionals). The incidence of herpes zoster is higher among health-care workers and it can be clearly concluded that no protective effect against herpes zoster exists for health-care workers in Taiwan.

Background: Little account has been taken of quality of life (QoL) among family carers of adults with an intellectual disability (ID) and family carers of adults with a mental illness (MI), particularly the female ageing carers' perceived stigma. We explore whether there are differences in the significant predictors of female ageing family carers' QoL between family carers of adults with ID and family carers of adults with MI and aim to examine the effect of these differences in stigma on carer QoL between the two groups., Methods: A structural survey interview was administered to 350 female family carers supporting persons with ID and 66 female carers supporting persons with MI; the carers were aged 55 years and older, and the interviews were carried between July 2006 and April 2007 at the carers' homes in a county in Taiwan. The survey package contained standardised scales to measure the carer's stigma, social support, QoL and health as well as adult and carer socio-demographic data., Results: The results highlight that in both groups the ageing female family carers' health and social support were strongly associated with the level of their QoL even though there was also a strong effect of carers' perceived stigma on their QoL. Contrary to previous findings, ageing female family carers of adults with MI had a higher level of QoL compared with the carers of adults with ID. Hierarchical regressions show a stronger effect of perceived stigma on the carer QoL among the family carers of adults with MI than among the carers of adults with ID., Conclusions: This study suggests that attempts to improve these female older family carers' health and social support must include their lifelong unmet needs in terms of how to cope with the perceived stigma associated with their position.

Background: Perimenstrual syndrome (PMS) among women with an intellectual disability (ID) has not been investigated in Taiwan. This study explores the prevalence/severity of PMS experienced by women with ID who are institutionalised., Method: Ninety two female residents aged 15 to 54 at six public institutions completed a structured interview between June and November 2006, together with the Moos Menstrual Distress Questionnaire (MMDQ)., Results: Strong significant differences were detected between the participants' physical, emotional, behavioural, and psychological changes during the perimenstrual and remainder phases in all domains other than Arousal. Cramps, hot flushes, affection, orderliness, excitement, and bursts of energy/activity were most prevalent during the perimenstruum (>50%). The participants' unique characteristics and cultural context were associated with the various domains of the PMS., Conclusions: Special attention should be paid in future to ascertain whether these experiences and perceptions of PMS are common among all women with ID.

No previous research has examined the importance of both individual and environmental factors for predicting caregivers' menstrual attitudes. To explore the predictors of female caregivers' attitudes towards menstruation and the help they give to women with intellectual disabilities, we conducted a cross-sectional questionnaire survey which was completed by 725 female workers from 12 institutions in Taiwan. The Menstrual Attitudes Questionnaire (MAQ) and a structured questionnaire were used. Logistic regression analysis revealed that individual characteristics such as age and education were significantly associated with menstrual attitudes of female caregivers working with institutionalized women with intellectual disabilities. Furthermore, the environmental context, such as the frequency of discussions with colleagues, training in menstrual management care and the level of difficulty when giving help in menstruation management, was important for improving caregivers' menstrual attitudes. This study contributes to the existing literature by determining both individual and environmental predictors of caregivers' menstrual attitudes.

This paper investigates the determinants of traditional Chinese medicine (TCM) and acupuncture utilization for cancer patients who are simultaneously having conventional Western medical treatments. This study used five leading cancers in Taiwan, namely cervical, breast, lung, liver and colorectal cancers. A total of 2499 cancer patients were interviewed, of which 2034 had full information and were analysed. Logistic regressions were used for both TCM and acupuncture. The results showed that type of cancer and cancer duration determine the utilization for alternative treatments. While socio-economic factors also affect choice of alternative medicine, the magnitude differs by types of alternative treatment and cancer. Compared with men and older patients, women and younger patients tend to prefer alternative medicine, and patients from south have higher preference for alternative medicine, which could be a reflection of local culture. Our results are useful for the government to determine higher users of TCM and acupuncture among cancer patients, and make policies to suit these patients' needs.

In this paper, we used data from the 2004 Survey of Family Income & Expenditure of Taiwan to show that the problem of the crowding-out effects of tobacco and alcohol in a country with low expenditure can still be serious. Most studies that have investigated this issue have focused on developing countries with a high expenditure share on tobacco or alcohol, and have often overlooked the effects in countries with a low expenditure on such goods. After controlling for the endogeneity of tobacco and alcohol expenditure, and the possibility that households with a zero expenditure on tobacco and alcohol may result from a corner solution rather than abstention, we found that the lowest income households are still most vulnerable to tobacco and alcohol expenditures despite an overall low expenditure in Taiwan. Even higher income households may suffer a lower standard of living due to such expenditure. In addition, some goods and services may be perceived differently by households with different levels of income and this may be caused by the difference in composition across broad expenditure categories. Our results suggest that the government ought to tackle the problem of smoking and drinking outside the realm of health, since these expenditures may harm the country's standard of living even when there is high income.

Background: This study examines the effects and associated factors of respite care, which was legislated as a community service for adults with an intellectual disability (ID) in Taiwan in 1997., Method: A total of 116 family carers who live with an adult with ID and have utilised the respite care program were surveyed using standardised measures., Results: The results suggest that the most notable effects of respite care include improvement in the carers' social support and life satisfaction, and relief of psychological stress and overall burden of care. The factors associated with these effects include the way the participants have used the respite care and the users' individual characteristics., Conclusions: How families used the respite care, whether the carers practised a religion, and where the families resided, were the most significant factors in determining the effectiveness of the respite. Suggestions are made for making access to information about the program more widely available, and for extending the availability and duration of the service.

Objective: Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate treatments for them. This study evaluated the efficacy of in-home intervention, based on cognitive behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs)., Methods: Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavioral management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms., Results: CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments., Conclusion: This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement.