Effects of integrated care with case management and nutritional counselling for frail older adults with nutritional risk in the primary care setting

BACKGROUND

The effects of integrated care with case management and nutritional counselling for frail patients with nutritional risk are unclear.

OBJECTIVES

To assess the impact of the integrated care model for frail patients with nutritional risk in the primary care setting.

METHODS

This was a retrospective observational study. We enrolled 100 prefrail or frail patients according to Clinical Frailty Scale (CFS) aged ≥ 60 years with nutritional risk from the geriatric clinic. We implemented the frailty intervention model, including integrated care with comprehensive geriatric assessments (CGA), case management, and nutritional counselling by the dietitian. We obtained measures of CGA components, physical performance, body mass index (BMI), and daily caloric intake before and after the 2-month care program. We used the Wilcoxon signed-rank test to analyse differences after the care program and applied multiple linear regression to determine the predictive factors for CFS improvement.

RESULTS

Among the 100 patients (mean age, 75.0 ± 7.2 years; females, 71.0%; frail patients, 26%), 93% improved their CFS status, and 91% achieved > 80% of recommended daily caloric intake after the care program. The Mini Nutritional Assessment Short-Form significantly improved after the program. BMI and daily caloric intake increased significantly after nutritional counselling. The post-test short physical performance battery (SPPB) significantly increased with a faster 4 m gait speed. Baseline poor CFS was a significant predictor for CFS improvement.

CONCLUSIONS

Integrated care with case management and nutritional counselling for prefrail and frail patients with nutritional risk in the primary care setting may improve physical performance and nutritional status.

Time trend of substance use among adolescent students in Taiwan, 1991-1996

The purpose of this study was to determine the prevalence and time trend of cigarette, alcohol, and illicit substance use among adolescent students in Taiwan, from 1991 through 1996. Subjects were selected through a two-stage random-sampling procedure. In the first stage, the strata were based on the type of school: middle school (13-15 years), high school (16-18), vocational school (16-18), and junior college (first 3 years only, 16-18). In the second stage, the strata were based on grade: one class each for 1st, 2nd, and 3rd grades were randomly selected from each type of school. Students were guaranteed anonymity before the questionnaire was administered. About 12,000 students from 100 schools participated each year in 1991 and 1994-1996. In 1993, 8,320 students from 65 schools participated. The prevalence of smoking and drinking decreased between 1991 and 1994, and then increased between 1994 and 1996. In 1996, the prevalence of illicit substance use was 15.4% for smoking, 16.7% for drinking, and 1.5% for illicit substance use. The rate of illicit substance use was lowest among high school students, followed by middle school students, and higher among students in vocational schools and junior colleges. The percentage of smokers and drinkers who had started early (at age 12 or earlier) rose every year. The prevalence of smoking and drinking habits among girls increased consistently during the study period. The most commonly abused substance was amphetamine. However, in 1996, sniffing glue became more prominent among middle school students, and flunitrazepam became the second most commonly abused substance among high school students.

Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan

The adulteration by synthetic therapeutic substances of traditional Chinese medicines has been reported on various occasions and has been a public health concern in Taiwan over the past several years. A large-scale effort was initiated in 1992 to screen traditional Chinese medicines that were suspected of adulteration with synthetic therapeutic substances. The term "adulteration" refers to traditional Chinese medicines that are tested and found to contain chemical substances not prescribed or labeled as part of the intended use. A total of 2,609 samples were collected by eight major general hospitals in Taiwan. Samples were collected through physicians' referrals during patients visits. The samples were analyzed by hospital pharmacists following the established standard procedures in comparison to references by thin-layer chromatography. An average of 23.7% (n = 618) of the samples collected from the eight hospitals were adulterated. Four samples with either a rheumatoid or an antiinflammatory indication contained six different kinds of adulterants. More than half (52.8%) of the adulterated traditional Chinese medicines contained two or more adulterants. The sources of adulterated samples and their claimed indications, as well as the most frequently detected synthetic therapeutic substances, are presented in this report. The controversies regarding the combination of synthetic therapeutic substances and traditional Chinese medicines without adequate labeling should be resolved through regulatory actions for better safety of drug use.