International Journal of Gerontology

Mass Gathering Emergency Medicine: A Review of the Taiwan Experience of Long-distance Swimming Across Sun-Moon Lake

2010-06-01

Summary: Once a year during the festival of Sun-Moon Lake in Nan-Tou County, Taiwan, a long-distance swimming mass gathering (LDSMG) event takes place. This event, in which participants swim an estimated 30 km, is very popular; the total number of spectators and participants at the 2002 festival was 15,189. This study, the first pertaining to the LDSMG, aimed to review the effect of the environmental factors at this particular mass gathering event, with mass being defined here as more than 1,000 people, upon the event's patient presentation rate (PPR). This was done to provide improved medical services at this event in future years The study also aimed to collect patient data from the two medical stations (one upstream and one downstream) and analyze the differences between them. In 2002, the number of patients requiring first aid treatment was determined from data gathered on-site. A total of 63 presented at on-site medical stations (PPR, 4.15 per 1,000 attendees), where 14 patients presented to a downstream medical station and 49 to an upstream medical station. The mean age of the patients was 35.46 ± 15.14 years; ages ranged from 1 to 65 years. Forty-nine of the patients (78%) were male. Fifty-nine patients were treated with medication (3.88 per 1,000 attendees), and two were taken to hospital (0.13 per 1,000 attendees). Injuries sustained included trauma (71%), such as impact, fall, sprain, stabbed laceration and burn, hypothermia (5%), and foreign bodies (3%). The PPR at the LDSMG was related to factors including the presence or absence of seating, whether the event was outdoors or indoors, mobility of the crowd, whether the activity was contained within a boundary, attendance figures, and humidity level. The weather, particularly the relative humidity (81%), was also positively correlated with an increase in the number of presentations at the medical stations.

Factors Associated With Leisure Participation Among the Elderly Living in Long-term Care Facilities

2010-06-01

Summary: Background: A lack of participation in leisure activities often leads to depression in the elderly. This study investigated the factors impacting leisure participation among the elderly living in long-term care facilities. Methods: This cross-sectional study recruited 309 individuals older than 65 years from six long-term care facilities located in the Taipei area. Structured in-person questionnaires were administered to assess their demographic characteristics, general self-rated health status, leisure constraints, and leisure participation. Results: The average frequency of leisure participation was 27.20 ± 12.48 points. The top five most popular leisure activities were watching television, walking, chatting, reading, and participating in religious activities. Elderly subjects who tended to be female, have religious beliefs, have a high school education level, be married, perceive themselves in better health, demonstrate better cognitive function and have higher scores on activities of daily living and instrumental activities of daily living scales were more likely to participate in leisure activities (p < 0.05). In contrast, those who were older, had stayed in the facility for a longer time period and had more leisure constraints were less likely to participate in leisure activities (p < 0.05). Overall, the predictive factors for leisure participation included religious beliefs, educational level, cognitive skill, instrumental activities of daily living score, depression, personal inner constraints, and structural constraints. The entire model was significant (F = 11.03, p < 0.001). Conclusion: Based on the self-reported interests, health status and level of cognitive skill of elderly residents, long-term care facilities should arrange appropriate leisure activities to prevent depression and to improve quality of life.

Correlation Between Arterial Stiffness Index and Arterial Wave Pattern and Incidence of Stroke

Cheuk-Sing Choy, David Yen-Ju Wang, Tu-Bin Chu, Wai-Mau Choi, Hung-Yi Chiou — 2010-06-01

Summary: Background: Although there are several extensive studies on stroke risks and prevention, stroke has remained one of the top ten causes of death in Taiwan for many years. The key factor is a lack of an effective and non-invasive screening tool for stroke risk. The arterial stiffness index (ASI), which measures artery distensibility and is correlated with arthrosclerosis, is gaining popularity nowadays for stroke risk assessment. In our study, we investigated the relationship between stroke and ASI as well as other noninvasive screening tools such as the ankle brachial index (ABI) and arterial wave pattern. Methods: This community-based prospective study was conducted between August 2005 and June 2006. The control group consisted of 629 volunteer adults above 30 years of age living in the northern Taipei area. The stroke group consisted of 266 newly diagnosed stroke patients. Participants completed a structured questionnaire, and blood samples were collected. In addition, a validated oscillometric automated digital blood pressure device was used to measure the participant's ASI, ABI and arterial wave pattern. The odds ratio was then computed to evaluate the association between each factor and stroke. Results: Our study showed that abnormal ASI (ASI < 70) was associated with a six times higher risk of stroke. Even after adjustment, the adjusted odds ratio was still 1.8. We also found a significant association between stroke and both ABI and arterial wave pattern (odds ratios, 2.15 and 2.98, respectively). In addition, when we employed ASI and arterial wave pattern together, the adjusted odds ratio for stroke was 1.87. The odds ratio increased significantly to 10.53 when all three factors were taken into consideration. Conclusion: Our study showed that ASI, arterial wave pattern and ABI are correlated with stroke risk. In addition, when all these factors are taken into consideration, they create a synergistic effect in evaluating the risk of stroke risk.

Middle-aged Subjects With Habitual Low-speed Cycling Exercise Have Greater Mononuclear Cell Responsiveness Against Human Hepatitis B Virus Surface Antigen

Kuen-Chang Hsieh, Yu-Yawn Chen, Tsong-Rong Jang, Yu-Jen Chen — 2010-06-01

Summary: Background: Whether middle-aged people with habitual cycling exercise (HCE) at low intensity in the morning have higher immunity against hepatitis B virus than sedentary controls (SCs) is a health issue in the elderly. Methods: Conditioned media (CM) were prepared by stimulating isolated human peripheral blood mononuclear cells (MNC) with phytohemagglutinin (PHA) or assessment of their inhibitory effects on hepatitis B surface antigen expression in human hepatoma Hep3B cells. Results: With the percent of maximal oxygen uptake at about 45.52% and percent of maximal heart rate at about 68.58% during a cycling exercise program in the present study, we considered HCE as an aerobic and a low to moderate exercise for the elderly. The concentrations of secreted cytokines such as interferon gamma, tumor necrosis factor a and interferon alpha were higher in the MNC-CM from the HCE group than from the SC group. The inhibitory rates of MNC-CM of the HCE group against hepatitis B surface antigen expression were higher than that of the SC group. In the same stimulating concentration of PHA (10 μg/mL), the relative hepatitis B surface antigen expression in MNC-CM of the HCE group was 64.7% versus 81.5% of the SC group. The reduction in inhibitory rates in cytokine neutralization experiments suggests crucial roles of these cytokines for the inhibitory effect of HCE-PHA-MNC-CM against hepatitis B surface antigen expression. Conclusion: The results reveal that the immune response of MNC, which are stimulated by PHA to suppress hepatitis B surface antigen expression, is greater in middle-aged subjects with low-speed HCE than in sedentary subjects.

Self-assessed Impairment of Masticatory Ability and Lower Serum Albumin Levels Among Community-dwelling Elderly Persons

2010-06-01

Summary: Background: Serum albumin is considered a key nutrient that is significantly related to general health among elderly persons. The aim of the present study was to determine the relationship between masticatory ability and serum albumin levels in the elderly. Methods: A total of 768 persons were enrolled in the study. Data on background factors and the self-assessed masticatory ability were collected by means of questionnaires. An intraoral examination was performed to examine the pattern of occluding pairs of natural teeth, and blood samples were collected from the cutaneous vein to measure serum albumin levels. A forward stepwise multivariate logistic model was constructed with serum albumin levels as the dependent variable and the self-assessed masticatory ability as the principal independent variable, to adjust for potential confounding variables. Results: Sex, current employment status, social interaction, and self-assessed masticatory ability were retained in the final model, and they were significantly associated with serum albumin levels. The odds ratios for lower levels of serum albumin (≤ 40 g/L) were 1.88 for males, 1.70 for non-working status, 1.55 for low social activity status, and 1.43 for the self-assessed impairment of masticatory ability. Conclusion: A weak, statistically significant relationship may exist between self-assessed impairment of masticatory ability and lower levels of serum albumin in the elderly living independently.

Ruptured Aortic Aneurysm Presenting as a Stridor

Feng Lin, Chang-Chih Chen, Yu-Jang Su, Yen-Chun Lai, Wen-Han Chang — 2010-06-01

Summary: Stridor is an abnormal, high-pitched, whining breathing sound caused by a blockage in the throat or larynx that is usually heard in children. We describe an unusual case of an 81-year-old man brought to our emergency department with sudden onset of dyspnea and shortness of breath. Stridor could be heard without a stethoscope. We found a huge mass over the left upper chest on chest radiography, suggesting an aortic aneurysm. We believed that these symptoms were caused by a huge thoracic aortic aneurysm with trachea/bronchi compression. Chest computed tomography confirmed the diagnosis.

Extracorporeal Membrane Oxygenation-assisted Cardiopulmonary Resuscitation for an In-hospital Cardiac Arrest Patient

Shih-Fen Tseng, Yu-Jang Su, Ding-Kuo Chien, Shuo-Hsueh Chang, Wen-Han Chang — 2010-06-01

Summary: Extracorporeal membrane oxygenation (ECMO) is used as a resuscitative tool for cardiogenic shock or cardiac arrest patients in the emergency department. It provides a better outcome for an in-hospital cardiac arrest (IHCA) patient, even if the patient has received prolonged cardiopulmonary resuscitation. We present the case of a 44-year-old female IHCA patient who presented to the emergency department with sudden onset of chest pain and cold sweating. Cardiac arrest occurred approximately 20 minutes after she arrived at the emergency department. Spontaneous heart beating returned immediately after cardiopulmonary resuscitation, and the patient was then supported by quickly applying ECMO. Thereafter, primary percutaneous transluminal coronary angioplasty was performed by a cardiologist. The patient received ECMO support for a total of 12 days. There were no major complications noted during the hospital stay. In conclusion, the use of ECMO to support cardiopulmonary function during cardiopulmonary resuscitation can improve the chance of survival in cases of IHCA that have better central nervous function after being weaned from ECMO. Shorter cardiopulmonary resuscitation duration and less organ damage may predict a better outcome in these patients.

Obturator Hernia

Ho-Hsing Lin, Chi-Wen Juan, Bau-Tein Chew, Jui-Ho Chao — 2010-06-01

Summary: The obturator hernia is a rare form of internal hernia that often presents with a confusing clinical picture. The diagnosis is usually made at laparotomy for small bowel obstruction. It often occurs in elderly, emaciated women. We present a case of obturator hernia in an 89-year-old female. This problem is usually resolved only by surgery. A delay in diagnosis of internal hernia may result in a high probability of morbidity and mortality. Plain abdominal radiography and computed tomography are the most appropriate early diagnostic tools for an obturator hernia. Prompt diagnosis and surgery could have a good clinical result and reduce the mortality rate. Emergency physicians should be alert to the possibility of an obturator hernia.