Dyspnea in pregnancy is common. It can result from adaption to body changes in pregnancy and also from complications therein. Understanding the mechanisms of change in the respiratory system during pregnancy helps with the differential diagnosis of dyspnea in normal pregnancy as opposed to pathological dyspnea.

Background: Stress is considered a crucial trigger for physical and mental illness. Stress reduction is a known long-term benefit of regular Hatha yoga practice. The efficacy of a single-session Hatha yoga class on stress reduction is not currently known. Purpose: This study investigated the comparative effectiveness of a single 90-minute Hatha yoga class and an 8-week, 90-minute-class-per-week course. Methods: We used a quasiexperimental design and recruited 63 female community residents in New Taipei City aged 40–60 years. Participants were randomly divided into an experimental group (n = 30) and a control group (n = 33). The experimental group received the 8-week Hatha yoga course. The control group received no intervention. The Perceived Stress Scale (PSS) and heart rate variability (HRV) assessed stress reduction effectiveness. Chi-square, independent t test, paired t test, and generalized estimating equations were used for data analysis. Results: After a single 90-minute class of Hatha yoga, experimental group PSS scores were significantly less than those of the control group (p = .001). Although experimental group HRV (low-frequency norm and high-frequency norm) had improved, these changes were not statistically significant (p = .059). PSS scores for the single 90-minute class and 8-week course did not significantly differ (p = .157) and HRV of statistics is significant (p = .005). Generalized estimating equations analyzed changes in the effectiveness over time of stress reduction (HRV and PSS) after the Hatha yoga intervention. Results showed the postintervention HRV and PSS of the experimental group decreased significantly (p < .001) more than the control group. Conclusions/Implications for Practice: Our findings support the position that regular, long-term practice of Hatha yoga provides clear and significant health benefits. Participation in a single 90-minute Hatha yoga class can significantly reduce perceived stress. Doing Hatha yoga regularly can reduce perceived stress even more significantly.

Objective: To identify risk factors for traumatic brain injuries (TBIs) during falls in older Taiwanese people. Participants: Case patients consisted of 113 patients aged 60 years or older with a moderate/severe TBI due to a fall. Two control groups: (1) 339 older patients with a soft-tissue injury; and (2) 113 with a mild-TBI due to a fall. Proxies were required to provide information for a considerable number of patients. Design: Matched case-control study. Settings: The emergency departments of 3 general hospitals. Measures: Sociodemographic, lifestyle behavior, chronic condition, medication use, functional abilities, and fall-related characteristics. Results: When patients with a soft-tissue injury were assigned to the control group, men were 2.06-fold more likely to have a moderate/severe TBI than women. Subjects who took antiarrhythmics within 4 hours of a fall were 2.59-fold more likely to have a moderate/severe TBI than those who took none. Subjects who were negotiating stairs and getting in/out of the bed/chair were 3.12-fold and 2.97-fold, respectively, more likely to have a moderate/severe TBI than those who fell while walking. Falling backward and sideways was 4.07-fold and 2.30-fold, respectively, more likely to cause a moderate/severe TBI than falling forward. When patients with a mild-TBI were assigned to the control group, results were similar, with the exception that the effect of antiarrhythmic use became nonsignificant and subjects who took 2 or more medications were 3.07-fold more likely to have a moderate/severe TBI than those who took none. Conclusion: Avoiding a head impact during a backward or sideways fall, reducing unnecessary use of polypharmacy and antiarrhythmics, and maintaining safety during stair negotiation and bed/chair transfer may protect an elderly person from a severe brain injury.

Background: The shock index (SI) predicts short-term mortality in trauma patients. Other shock indices have been developed to improve discriminant accuracy. The authors examined the discriminant ability of the SI, modified SI (MSI), and reverse SI multiplied by the Glasgow Coma Scale (rSIG) on short-term mortality and functional outcomes. Methods: The authors evaluated a cohort of adult trauma patients transported to emergency departments. The first vital signs were used to calculate the SI, MSI, and rSIG. The areas under the receiver operating characteristic curves and test results were used to compare the discriminant performance of the indices on short-term mortality and poor functional outcomes. A subgroup analysis of geriatric patients with traumatic brain injury, penetrating injury, and nonpenetrating injury was performed. Results: A total of 105 641 patients (49±20 years, 62% male) met the inclusion criteria. The rSIG had the highest areas under the receiver operating characteristic curve for short-term mortality (0.800, CI: 0.791–0.809) and poor functional outcome (0.596, CI: 0.590–0.602). The cutoff for rSIG was 18 for short-term mortality and poor functional outcomes with sensitivities of 0.668 and 0.371 and specificities of 0.805 and 0.813, respectively. The positive predictive values were 9.57% and 22.31%, and the negative predictive values were 98.74% and 89.97%. rSIG also had better discriminant ability in geriatrics, traumatic brain injury, and nonpenetrating injury. Conclusion: The rSIG with a cutoff of 18 was accurate for short-term mortality in Asian adult trauma patients. Moreover, rSIG discriminates poor functional outcomes better than the commonly used SI and MSI.

SummaryIntroductionMortality of trauma patients is strongly associated with Injury Severity Score (ISS). However, the interaction between ISS and age has not been studied extensively. We evaluated ISS in different age groups in relation to mortality rate.Materials and methodsThis was a retrospective review of 955 trauma patients who visited Mackay Memorial Hospital during January–December 2009. Age, sex, emergency department (ED) stay time, hospital stay time, out-of-hospital cardiac arrest, in-hospital cardiac arrest, ED survival rate, emergency operation, and mortality were analyzed. Patients were separated into two groups by age below or above 65 years, and hospital courses and mortality rate were compared.ResultsNine hundred and fifty-five trauma patients visited our ED in 2009: 212 in the aged group (99 male patients; 46.7%) and 743 in the young group (472 male patients; 63.5%). The mean age of the elderly group was 77±8 years (mean±standard deviation), and 38±16 years in the young group. Mean ISS was 12±12 in the elderly group and 10±13 in the young group. The mean ED stay time was 2.9±3.8 hours for the elderly group and 3.0±4.6 hours for the young group. One hundred and sixty-three patients were admitted and the mean hospital stay time was 12.7±13.6 days in the elderly group, whereas 559 patients were admitted and the mean hospital stay time was 9.9±13.7 days in the young group (p=0.018). The mortality rate among hospitalized patients was 3.1% in the elderly group and 2.9% in the young group. On receiver operating characteristic curve analysis, the optimal cut-off ISS for mortality rate among young patients (area under the curve: 0.899) and elderly patients (area under the curve: 0.782) was 17 (sensitivity: 81.3%; specificity: 88.7%) and 14 (sensitivity: 80%; specificity: 82.3%), respectively.ConclusionThe elderly group seemed to have no significant difference from the younger group for mortality rate, ED stay time and hospital stay time. In the elderly group, lower ISS predicted a higher mortality than in the younger group