Depression and anxiety between nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic

AIM

This study investigated the levels of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic. We also explored the potential causes of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the pandemic.

BACKGROUND

The COVID-19 pandemic has had a considerable impact on long-term care facilities. The high infection and mortality rates for COVID-19 have resulted in an increased workload for caregivers.

INTRODUCTION

The COVID-19 pandemic exposed caregivers working in long-term care facilities to higher risks of anxiety and depression. Additionally, the high risk of infection in the work environment and concerns about spreading COVID-19 to family members and long-term care facility residents led to various forms of stress among caregivers.

METHODS

The present study was a cross-sectional study. Questionnaires were used to investigate depression and anxiety among regarding nurses and nursing assistants working in long-term care facilities during the pandemic.

RESULTS

The depression and anxiety levels of the nurses were higher than nursing assistants, but had no statistically significant difference (p = 0.551). The factors influencing levels of depression and anxiety in nurses contained facility affiliation and experience working. In terms of nursing assistants, age, marital status, and facility affiliation were correlated with the levels of depression and anxiety.

DISCUSSION

The pandemic has severely impacted caregivers. In the process of implementing pandemic prevention measures and providing care for COVID-19 patients, safeguarding the psychological health of caregivers is also essential.

CONCLUSION

The levels of depression and anxiety in nurses were higher than in nursing assistants working in long-term care facilities during the pandemic.

IMPLICATION FOR NURSING AND HEALTH POLICY

Long-term care facilities managers are recommended to enhance the education and training process for caregivers. Managers are also recommended to ensure provision of sufficient amounts of pandemic prevention equipment and resources.

Comparison between sodium-glucose cotransporter 2 inhibitors and dipeptidyl peptidase 4 inhibitors on the risk of incident cancer in patients with diabetes mellitus: A real-world evidence study

AIMS

Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) have been demonstrated to be associated with cancer cell mechanisms. However, whether they increase the risk of cancer remains unclear. Thus, this study aimed to determine the association between SGLT-2i use and the incidence of cancer in patients with diabetes mellitus (DM) in Taiwan.

MATERIALS AND METHODS

This retrospective cohort study was based on the Taiwan National Health Insurance database. The study population comprised patients with DM, and those who first used SGLT-2is during 2016-2018 were assigned to the study group. Greedy propensity score matching was performed to select patients who first used dipeptidyl peptidase 4 inhibitors (DPP-4is), and these patients were assigned to the control group. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for cancer risk in the study and control groups; this model was adjusted for demographic characteristics, DM severity, comorbidities and concomitant medication use.

RESULTS

After controlling for relevant variables, the SGLT-2i cohort (aHR = 0.90, 95% CI = 0.87-0.93) had a significantly lower risk of developing cancer than the DPP-4i cohort, particularly when the SGLT-2i was dapagliflozin (aHR = 0.91, 95% CI = 0.87-0.95) or empagliflozin (aHR = 0.90, 95% CI = 0.86-0.94). Regarding cancer type, the SGLT-2i cohort's risk of cancer was significantly lower than that of the DPP-4i cohort for leukaemia, oesophageal, colorectal, liver, pancreatic, lung, skin and bladder cancer.

CONCLUSIONS

SGLT-2i use was associated with a significantly lower risk of cancer than DPP-4i use.

Factors Associated With Influenza Vaccination During Pregnancy: A Real-World Evidence-Based Study

Pregnant women are at increased risk of influenza-related complications. However, the rate of influenza vaccination among pregnant women in Taiwan is low. By analyzing real-world data in this study, we investigated the factors associated with influenza vaccination during pregnancy in Taiwan. This study was a cross-sectional study. We collected real-world data from 2 databases in Taiwan: the Birth Certificate Database and the National Health Insurance Research Database. The study population was pregnant between October 2014 and December 2016 in Taiwan. The multivariate logistic regression was performed to identify factors associated with influenza vaccination, including maternal sociodemographics, trimester, comorbidities, and health-care utilization. The vaccination rate of among pregnant women was 8.2%. Factors significantly associated with a high likelihood of influenza vaccination were age between 30 and 34 years (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.10-1.19), second trimester (OR: 1.80; 95% CI: 1.75-1.85), income equal to or exceeding NT$ 38 201 (OR: 1.92; 95% CI: 1.86-1.99), hypertension (OR: 1.16; 95% CI: 1.05-1.29), cardiovascular disease (OR: 1.29; 95% CI: 1.17-1.42), autoimmune disease (OR: 1.47; 95% CI: 1.38-1.58), and chronic pulmonary disease (OR: 1.24; 95% CI: 1.18-1.31). A low level of urbanization, at least 1 hospitalization in the previous year, and the presence of pregnancy complications (eg, gestational diabetes, preeclampsia, and placenta previa) were associated with a lower likelihood rate of influenza vaccination. The influenza vaccination rate among pregnant women in Taiwan was low. Age, gestational age, income level, urbanization level, hypertension, cardiovascular disease, autoimmune disease, chronic pulmonary disease, and pregnancy complications may be associated with influenza vaccination among pregnant women.

Risk of herpes simplex virus infection in solid organ transplant recipients: A population-based cross-sectional study

BACKGROUND

Herpes simplex virus (HSV) is an opportunistic infection antigen in solid organ transplant (SOT) recipients. However, this phenomenon has received limited attention from epidemiologists. Our study aims to determine the HSV infection risk in SOT recipients.

METHODS

This was a nationwide population-based cross-sectional study based on the National Health Insurance Research Database from 2002 to 2015. We used propensity score matching to avoid selection bias and analyzed the association between HSV infection and SOT recipients with multiple logistic regression analysis.

RESULTS

At a 3-year follow-up, SOT recipients had a higher risk of developing HSV, with an adjusted odds ratio (aOR) of 3.28 (95% confidence interval (CI), 2.51-4.29). Moreover, at 6-month, 1-year, and 2-year follow-ups, SOT recipients also had an increased risk of HSV than general patients with aORs of 3.85 (95% CI, 2.29-6.49), 4.27 (95% CI, 2.86-6.36), and 3.73 (95% CI, 2.74-5.08), respectively. In the subgroup analysis, lung transplant recipients (aOR = 8.01; 95% CI, 2.39-26.88) exhibited a significantly higher chance of HSV among SOT recipients, followed by kidney transplant recipients (aOR = 3.33; 95% CI, 2.11-5.25) and liver transplant recipients (aOR = 3.15; 95% CI, 2.28-4.34).

CONCLUSION

HSV can develop at any time after organ transplantation. SOT recipients had a higher risk of HSV infection than the general population at 6 months, 1 year, 2 years, and 3 years after transplantation, with the highest chance at 1 year after. In addition, the patients who underwent lung transplantion were at higher risk for HSV infection than liver or kidney transplant recipients.

Association between early-life antibiotics use and the risk of attention-deficit/hyperactivity disorder: A real-world evidence study

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Recently, children using antibiotics showed an increased incidence of neurodevelopmental disorders.

AIMS

The purpose of this study was to investigate the association between antibiotics use and the risk of ADHD in children.

STUDY DESIGN

Population-based retrospective cohort study.

SUBJECTS

The Taiwan National Health Insurance Research Database was used to collect data of children. Prevalence of antibiotics use was analyzed in the children (age, <2 years) included in this study. There were 1,601,689 children included in this study between 2004 and 2012.

OUTCOME MEASURES

The risk of developing ADHD was estimated using the Cox proportional hazards model.

RESULTS

71.25 % of children used at least one antibiotic, and the mean follow-up period was 7.07 years. After controlling for other related influencing factors, children who used antibiotics had a 1.12 times higher risk of ADHD than those who did not. The risk of ADHD increased through the use of penicillin and cephalosporin regardless of the duration of antibiotics use.

CONCLUSIONS

Antibiotics use in children-especially penicillin and cephalosporin-was associated with a higher risk of ADHD.

Associations between neonatal jaundice and autism spectrum disorder or attention deficit hyperactivity disorder: Nationwide population based cohort study

BACKGROUND/PURPOSE

Neonatal jaundice might result brain insults. Both autistic spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are developmental disorders, which might result from early brain injury at neonatal period. We aimed to explore the association between neonatal jaundice treated with phototherapy and the ASD or ADHD.

METHODS

This retrospective nationwide population cohort study was based on a nationally representative database of Taiwan, and neonates born from 2004 to 2010 were enrolled. All eligible infants were divided into 4 groups, without jaundice, jaundice with no treatment, jaundice with simple phototherapy only and jaundice with intensive phototherapy or blood exchange transfusion (BET). Each infant was follow-up until the date of incident primary outcomes, death, or 7-year-old, whichever occurred first. Primary outcomes were ASD, ADHD. Using cox proportional hazard model to analyze their associations.

RESULTS

In total, 118,222 infants with neonatal jaundice were enrolled, including diagnosed only (7260), simple phototherapy (82,990), intensive phototherapy or BET (27,972 infants). The cumulative incidences of ASD in each group was 0.57%, 0.81%, 0.77%, and 0.83%, respectively. The cumulative incidences of ADHD in each group was 2.83%, 4.04%, 3.52% and 3.48%, respectively. Jaundice groups were significantly associated with ASD, ADHD, or either one, even after all other extraneous maternal and neonatal variables were adjusted. After stratification, the associations were still existed in subgroup with birth weights ≥2500 grams and in male subgroup.

CONCLUSION

Neonatal jaundice correlated with the ASD and ADHD. The associations were significant in infants of both sexes and with birth weights larger than 2500 grams.

The association between non-alcoholic fatty liver disease and atopic dermatitis: a population-based cohort study

Background

In previous studies, it was reported that non-alcoholic fatty liver disease (NAFLD) incidence and prevalence increased in children with atopic dermatitis. Nevertheless, the actual association between the two diseases has not been fully proven in large-scale studies, and real-world evidence is missing. The objective of this nationwide, longitudinal cohort study was to evaluate the association between NAFLD and atopic dermatitis.

Methods

The National Health Insurance Research Database in Taiwan was utilized in this study. Patients with records of NAFLD diagnosis were recruited as the experimental group, and patients having less than three outpatient visits or one inpatient visiting record due to NAFLD were excluded from the study design. Non-NAFLD controls were matched based on a 1:4 propensity score matching. Potential confounders including age, gender, comorbidity, and medical utilization status were considered as covariates. The risk of future atopic dermatitis would be evaluated based on multivariate Cox proportional hazard regression.

Results

Compared with people without NAFLD, a decreased risk of atopic dermatitis in NALFD patients had been observed (aHR = 0.93, 95% CI 0.87-0.98). The trend was especially presented in young NAFLD patients. In patients younger than 40 years old, a 20% decreased risk of atopic dermatitis was reported (aHR = 0.80, 95% CI 0.70-0.92).

Conclusion

People with NAFLD were not associated with an increased risk of atopic dermatitis. Conversely, a 0.93-fold risk was noted in NAFLD patients, compared with NAFLD-free controls. Future studies are warranted to evaluate further the mechanism regarding the interplay between the inflammatory mechanisms of NAFLD and atopic dermatitis.

High risk of osteoporosis and fracture following solid organ transplantation: a population-based study

Background

Osteoporosis and fractures increase morbidity and mortality rates after solid organ transplantation (SOT), but few studies have analyzed the risk of osteoporosis and related fractures after SOT. In this retrospective cohort study, we investigated the risk of osteoporosis and fractures in different SOT recipients.

Methods

This study was a retrospective cohort study using a nationally representative database in Taiwan. We collected the data of SOT recipients and used the propensity score matching method to obtain a comparison cohort. To reduce bias, we excluded patients who had been diagnosed with osteoporosis or fracture before inclusion. All participants were followed up until the date of diagnosis as having a pathological fracture, death, or the end of 2018, whichever occurred first. The Cox proportional hazards model was used to investigate the risk of osteoporosis and pathological fracture in SOT recipients.

Results

After adjustment for the aforementioned variables, SOT recipients were observed to have a higher risk of osteoporosis (hazard ratio (HR) = 1.46, 95% confidence interval (CI): 1.29-1.65) and fracture (HR: 1.19, 95% CI: 1.01-1.39) than the general individuals. Among the different SOT recipients, the highest risk of fractures was noted in heart or lung transplant recipients, with a HR of 4.62 (95% CI: 2.05-10.44). Among the age groups, patients aged >61 years had the highest HRs for osteoporosis (HR: 11.51; 95% CI, 9.10-14.56) and fracture (HR: 11.75, 95% CI: 8.97-15.40).

Conclusion

SOT recipients had a higher risk of osteoporosis and related fractures than the general population, with the highest risks observed in patients receiving heart or lung transplants, older patients, and patients with CCI scores of >3.

The Correlation between Metformin Use and Incident Dementia in Patients with New-Onset Diabetes Mellitus: A Population-Based Study

The evidence of metformin's effect on dementia is conflicting. This study investigates the association between metformin use and the risk of dementia among patients with diabetes mellitus (DM). This study included patients with new-onset DM between 2002 and 2013. We divided the patients into patients who used metformin and patients who did not. Two models were used to assess metformin use: the cumulative defined daily dose (cDDD) of metformin use and the intensity of metformin use. This study with 3-year and 5-year follow-ups investigated the risk of dementia among patients with DM who used metformin. At the 3-year follow-up, patients who received cDDD < 300 had an odds ratio (OR) of developing dementia of 0.92 (95% confidence interval [CI] = 0.89-0.96); patients who used metformin at intensities <10 and 10-25 DDD/month had ORs of 0.92 (95% CI: 0.87-0.97) and 0.92 (95% CI: 0.85-1.00), respectively. Metformin use at cDDD 300-500 (OR = 0.80, 95% CI = 0.56-1.15) or >500 (OR = 1.48, 95% CI = 0.48-4.60) or at an intensity >25 DDD/month (OR = 0.84, 95% CI = 0.60-1.18) were not associated with an incident of dementia. There were similar results at the 5-year follow-up. Patients with a low intensity of metformin use had a lower risk of dementia. However, higher doses of metformin with higher intensity exhibited no protective role in dementia. Prospective clinical trials are warranted to evaluate the actual underlying mechanisms between metformin dosage and the risk of dementia.

Effects of individual and neighborhood social risks on diabetes pay-for-performance program under a single-payer health system

BACKGROUND

Enrollment in and adherence to a diabetes pay-for-performance (P4P) program can lead to desirable processes and outcomes of diabetes care. However, knowledge is limited on the potential exclusion of patients with individual or neighborhood social risks or interruption of services in the disease-specific P4P program without mandatory participation under a single-payer health system.

OBJECTIVE

To investigate the impact of individual and neighborhood social risks on exclusion from and adherence to the diabetes P4P program of patients with type 2 diabetes (T2D) in Taiwan.

METHODS

This study used data from Taiwan's 2009-2017 population-based National Health Insurance Research Database, 2010 Population and Housing Census, and 2010 Income Tax Statistics. A retrospective cohort study was conducted, and study populations were identified from 2012 to 2014. The first cohort comprised 183,806 patients with newly diagnosed T2D, who had undergone follow up for 1 year; the second cohort consisted of 78,602 P4P patients who had undergone follow up for 2 years after P4P enrollment. Binary logistic regression models were used to examine the associations of social risks with exclusion from and adherence to the diabetes P4P program.

RESULTS

T2D patients with higher individual social risks were more likely to be excluded from the P4P program, but those with higher neighborhood-level social risks were slightly less likely to be excluded. T2D patients with the higher individual- or neighborhood-level social risks showed less likelihood of adhering to the program, and the person-level coefficient was stronger in magnitude than the neighborhood-level one.

CONCLUSIONS

Our results indicate the importance of individual social risk adjustment and special financial incentives in disease-specific P4P programs. Strategies for improving program adherence should consider individual and neighborhood social risks.

The Incidence of Myocarditis Following an Influenza Vaccination: A Population-Based Observational Study

BACKGROUND AND OBJECTIVE

Recently, studies have pointed to a link between coronavirus disease 2019 vaccinations and myocarditis. Myocarditis following an influenza vaccine has been sporadically reported. However, it is not known whether this adverse event occurs among elderly individuals who have received influenza vaccines. We used a population-based database and a self-controlled case-series design to estimate the incidence of myocarditis following an influenza vaccination.

METHODS

Data were extracted from Taiwan's National Health Insurance Research Database. The study population consisted of elderly people aged ≥ 65 years who had de novo myocarditis, which required hospitalization, within 6 months after receiving an influenza vaccination between 2003 and 2017. The first 1-7, 1-14, and 1-42 days after vaccination were defined as risk intervals, and the other periods were defined as control intervals. Poisson regression was used to calculate the incidence rate ratio for myocarditis between the risk and control periods.

RESULTS

Within 180 days following a vaccination, 191 people were hospitalized for myocarditis among 19,678,904 people. In comparison with control intervals, the incidence rate ratios of an admission for myocarditis for days 1-7, 1-14, and 1-42 were 0.80 (95% confidence interval 0.36-1.81), 0.72 (95% confidence interval 0.39-1.32), and 0.73 (95% confidence interval 0.50-1.05), respectively. Subgroup analyses by sex, age, Charlson Comorbidity Index scores, and comorbidities did not yield significant differences in the incidence rate ratio.

CONCLUSIONS

Regardless of the post-vaccination time and underlying baseline characteristics, the incidence risk of myocarditis is not significantly increased in the elderly following an influenza vaccination.

Bidirectional Association Between Psoriasis and Nonalcoholic Fatty Liver Disease: Real-World Evidence From Two Longitudinal Cohort Studies

Background

Association between nonalcoholic fatty liver disease (NAFLD) and future psoriasis has not yet been confirmed, although the two diseases partially share a common pathogenesis pathway. Studies have revealed an association between psoriasis and subsequent NAFLD; however, these studies were limited to small sample sizes and a cross-sectional study design. Hence, the main objective of this population-based longitudinal cohort study was to evaluate the bidirectional association between psoriasis and NAFLD.

Methods

Data were retrieved from Taiwan’s National Health Insurance Research Database. Patients with new-onset NAFLD and psoriasis were respectively enrolled in two cohorts. For each comparison cohort, propensity-score-matched controls with no record of NAFLD or psoriasis were selected. An adjusted hazard ratio (aHR) was applied to evaluate subsequent risks.

Results

The risk of patients with new-onset NAFLD developing psoriasis was statistically significant, with an HR of 1.07 (95% CI, 1.01–1.14). For younger patients with NAFLD, the risk of developing psoriasis was 1.3-fold higher. The risk of patients with new-onset psoriasis developing NAFLD in the future was 1.28-fold higher than that of patients without psoriasis (95% CI, 1.21–1.35), and patients in younger psoriasis subgroups below the age of 40 years were at a higher risk than those in older subgroups, with an aHR of 1.55 (95% CI, 1.40–1.71).

Conclusion

Evidence supports a bidirectional association between NAFLD and psoriasis, especially in patients below the age of 40 years. The correlation between the two diseases and the subsequent risk of disease development should be considered when caring for patients.

A comparison of central compartment atopic disease and lateral dominant nasal polyps

BACKGROUND

The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population.

METHODS

This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed.

RESULTS

Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p < 0.01) and histopathologic profiles (57.0 vs 17.3, p < 0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: -31.82 vs -22.66, p < 0.01; MCT: -233.06 vs -191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups.

CONCLUSION

Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD.

Antidepressants Usage and Risk of Pneumonia Among Elderly Patients With the Parkinson's Disease: A Population-Based Case-Control Study

The patients with Parkinson's disease (PD) are associated with a higher risk of pneumonia. Antidepressants exert an anticholinergic effect in varying degrees and various classes of antidepressants also can produce a different effect on immune function. The relationship between the risk of pneumonia and the use of antidepressants among elderly patients with PD is unknown. The study investigated the risk of pneumonia associated with the use of antidepressants in elderly patients with PD. This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 551,975 elderly patients with PD between 2002 and 2018. To reduce the potential confounding caused by unbalanced covariates in non-experimental settings, we used propensity score matching to include older patients without pneumonia to serve as the comparison. The antidepressants in the study included tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin, and norepinephrine reuptake inhibitors (SNRIs). The conditional logistic regression was used to investigate the association between antidepressants and pneumonia. Control variables in the study included sex, age, income level, urbanization, Charlson comorbidity index score, and comorbidities related to pneumonia. In terms of TCAs users, compared with patients not receiving TCAs, current users had a lower risk of incident pneumonia (adjusted odds ratio [aOR] = 0.86, 95% CI = 0.82–0.90) and recent users (aOR = 0.83, 95% CI = 0.80–0.87). In terms of MAOIs users, current users had a lower risk of incident pneumonia (aOR = 0.88, 95% CI = 0.83–0.93), recent users (aOR = 0.89, 95% CI = 0.85–0.93). In terms of SSRIs users, current users had a higher risk of incident pneumonia (a OR = 1.13, 95% CI = 1.01–1.17), recent users (aOR = 1.01, 95% CI = 1.06–1.13), and past users (aOR = 1.19, 95% CI = 1.17–1.21). In terms of SNRIs users, past users had a higher risk of incident pneumonia (aOR = 1.07, 95% CI = 1.03–1.10). The incident pneumonia is associated with the use of individuals of different classes of antidepressants. The use of TCAs (such as, amitriptyline and imipramine) had a lower odds of incident pneumonia. The use of MAOIs (such as, selegiline and rasagiline) had a lower odds of pneumonia during recent use. The use of SSRIs (such as, fluoxetine, sertraline, escitalopram, paroxetine, and citalopram) and SNRIs (such as, milnacipran, and venlafaxine) had a higher odds of incident pneumonia.

Correlation between long-term use of metformin and incidence of NAFLD among patients with type 2 diabetes mellitus: A real-world cohort study

BACKGROUND AND AIMS

Studies have demonstrated that the short-term use of metformin benefits liver function among patients with type 2 diabetes mellitus (T2DM). However, few studies have reported on the effects of long-term metformin treatment on liver function or liver histology. This study investigated the correlation between metformin use and the incidence of nonalcoholic fatty liver disease (NAFLD) among patients with T2DM.

METHODS

This population-based study investigated the risk of NAFLD among patients with T2DM who received metformin treatment between 2001-2018. Metformin users and metformin nonusers were enrolled and matched to compare the risk of NAFLD.

RESULTS

After 3 years, the patients who received <300 cDDD of metformin and those with metformin use intensity of <10 and 10-25 DDD/month had odds ratios (ORs) of 1.11 (95% confidence interval [CI] = 1.06-1.16), 1.08 (95% CI = 1.02-1.13), and 1.18 (95% CI = 1.11-1.26) for NAFLD, respectively. Moreover, metformin users who scored high on the Diabetes Complications and Severity Index (DCSI) were at high risk of NAFLD. Patients with comorbid hyperlipidemia, hyperuricemia, obesity, and hepatitis C were also at high risk of NAFLD.

CONCLUSION

Patients with T2DM who received metformin of <300 cDDD or used metformin at an intensity of <10 and 10-25 DDD/month were at a high risk of developing NAFLD. The results of this study also indicated that patients with T2DM receiving metformin and with high scores on the DCSI were at a high risk of developing NAFLD.

Risk of Pneumonia is associated with Antipsychotic Drug Use among older patients with Parkinson's Disease: A Case-control Study

Objective: To investigate the risk of pneumonia associated with the use of antipsychotic drugs in older-adult patients with Parkinson's disease (PD) in Taiwan. Methods: This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 51,158 older patients with PD for the period between 2001 and 2016. To reduce the potential confounding caused by unbalanced covariates in nonexperimental settings, we used propensity score matching to include older patients without pneumonia to serve as the control group. Results: Compared with patients who had never taken antipsychotics, current (adjusted odds ratios [aOR] =1.63, 95% confidence interval [CI] = 1.51-1.75), recent (aOR = 1.63, 95% CI = 1.52-1.74), and past (aOR = 1.89, 95% CI = 1.80-2.00) users of antipsychotics had a higher risk of incident pneumonia. Among typical and atypical antipsychotics, haloperidol and clozapine were associated with higher risks of incident pneumonia, respectively. By contrast, aripiprazole was not associated with a higher risk of pneumonia. Conclusion: Older patients with PD receiving typical antipsychotics or atypical antipsychotics had a higher risk of pneumonia. Among these antipsychotics, clozapine had the highest risk of pneumonia. Clinicians should pay attention to the risk of pneumonia in older patients with PD who receive typical antipsychotics and atypical antipsychotics.

Prognosis and clinicopathologic features in patients with gastric stump cancer after curative surgery

Background

Gastric stump ("remnant") cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial.

Methods

From January 1988 to December 2012 at a single medical centre in Taiwan, 105 patients with gastric stump cancer, including 85 with previous peptic ulcer disease and 20 with previous gastric cancer, were analyzed for clinicopathologic characteristics and overall survival (os).

Results

The 5-year os rates for patients with gastric stump cancer and with primary gastric cancer were 51.2% and 54.5% respectively (p = 0.035). Analysis of clinicopathologic characteristics indicated that, compared with patients having primary gastric cancer, those with gastric stump cancer had more lymph node metastasis (p < 0.001) and had been diagnosed at a more advanced stage (p = 0.047). Multivariate analysis with os as an endpoint showed that age [p = 0.015; hazard ratio (hr): 2.300; 95% confidence interval (ci): 1.173 to 4.509], tumour size (p = 0.037; hr: 1.700; 95% ci: 1.031 to 2.801), stromal reaction (p = 0.021; hr: 1.802; 95% ci: 1.094 to 2.969), and pathologic N category (p = 0.001; hr: 1.449; 95% ci: 1.161 to 1.807) were independent predictors in gastric stump cancer. The os rates for patients with gastric stump cancer who previously had gastric cancer or peptic ulcer disease were 72.9% and 50.0% respectively (p = 0.019). The Borrmann classification was more superficial (p = 0.005), lymph node metastases were fewer (p = 0.004), and staging was less advanced (p = 0.025) in patients with gastric stump cancer who previously had gastric cancer than in their counterparts who previously had peptic ulcer disease.

Conclusions

Survival is poorer in patients with gastric stump cancer who previously had peptic ulcer disease than in those who previously had primary gastric cancer. Patients with gastric stump cancer who previously had gastric cancer and could receive curative gastrectomy tended to have a better prognosis because of a more superficial Borrmann classification. Regular follow-up in patients who have undergone gastric surgery is recommended for the early detection of gastric stump cancer.

Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study

This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability.

PURPOSE

To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting a propensity score-matched (PSM), nationwide, population-based cohort study.

METHODS

Data from Taiwan's National Health Insurance Research Database were used in this study. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. The GEE logit was used to estimate the relative risks of death and hospitalization after influenza vaccination. Adjusted odds ratios (aORs) were used to estimate relative risk.

RESULTS

The matching process yielded a final cohort of 272 896 elderly individuals with a disability (136 448 individuals in each cohort). In multivariate GEE analyses, aOR (vaccinated vs. unvaccinated) and 95% confidence interval (CI) of death were 0.70 (0.68-0.72). The aORs (95% CIs) of hospitalization for influenza and pneumonia, respiratory diseases, respiratory failure, heart disease, hemorrhagic stroke, and ischemic stroke were 0.98 (0.95-1.01), 0.96 (0.94-0.99), 0.85 (0.82-0.89), 0.96 (0.93-0.99), 0.85 (0.75-0.97), and 0.89 (0.84-0.95), respectively. The length of stay and medical expenditure exhibited greater reduction in vaccinated elderly individuals with a severe and very severe disability than in unvaccinated elderly individuals.

CONCLUSIONS

Influenza vaccination reduced all-cause mortality, influenza-related hospitalization, length of stay, and medical expenditure in elderly individuals with a disability. The decrease in the length of stay and medical expenditure because of influenza vaccination was proportional to the severity of disability.

Assessment of the Risk of Oral Cancer Incidence in A High-Risk Population and Establishment of A Predictive Model for Oral Cancer Incidence Using A Population-Based Cohort in Taiwan

We aimed to assess the risk of oral cancer incidence in a high-risk population, establish a predictive model for oral cancer among these high-risk individuals, and assess the predictive ability of the constructed model. Individuals aged ≥30 years who had a habit of smoking or betel nut chewing and had undergone oral cancer screening in 2010 or 2011 were selected as study subjects. The incidence of oral cancer among the subjects at the end of 2014 was determined. The annual oral cancer incidence among individuals with a positive screening result was 624 per 100,000 persons, which was 6.5 times that of the annual oral cancer incidence among all individuals screened. Male sex, aged 45-64 years, divorce, low educational level, presence of diabetes, presence of other cancers, high comorbidity severity, a habit of smoking or betel nut chewing, and low monthly salary were high-risk factors for oral cancer incidence (p < 0.05). The area under the curve of the predictive model for oral cancer incidence was 0.73, which indicated a good predictive ability. Therefore, the oral cancer screening policy for the high-risk population with a habit of smoking and/or betel nut chewing is beneficial for the early diagnosis of oral cancer.

Correlation between Gout and Coronary Heart Disease in Taiwan: A Nationwide Population-Based Cohort Study

Background

Gout is the most common inflammatory arthritis in adult males. Patients with gout are at a higher risk of coronary heart disease (CHD). This study aimed to investigate the correlation between gout and CHD.

Methods

This was a retrospective cohort study that used data from the Longitudinal Health Insurance Database of Taiwan. The study subjects were 46,140 patients with new-onset gout during 2003-2010. To avoid selection bias, we used propensity score matching. A Cox proportional hazard model was used to analyze differences in the risk of CHD between patients with and without gout after controlling for related variables.

Results

The patients with gout had a higher risk of CHD than the patients without gout [adjusted hazards ratio (HR) = 1.34, 95% confidence interval (CI): 1.23-1.45]. The risk of CHD increased with older age. Other related factors for CHD included gender (female vs. male, adjusted HR = 0.86, 95% CI: 0.79-0.93), hypertension (adjusted HR = 1.53, 95% CI: 1.42-1.65), hyperlipidemia (adjusted HR = 1.18, 95% CI: 1.07-1.29), and diabetes mellitus (adjusted HR = 1.24, 95% CI: 1.13-1.36).

Conclusions

We found correlations between gout and CHD and other influencing factors including hypertension, hyperlipidemia, and diabetes mellitus. We also found that gender and age were associated with CHD.

Correlation between diabetes mellitus and periodontitis in Taiwan: A nationwide cohort study

AIMS

The mechanism underlying the association of diabetes mellitus (DM) and periodontitis is not clear. This study aimed to investigate the correlation between DM and periodontitis.

METHODS

This study was a retrospective cohort study, which conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 39,384 new-onset DM patients who aged above 20 years old from 2005 to 2012. To avoid selection bias, we applied propensity score matching to obtain patients without DM, as the control group. Cox proportional hazard model was used to analyze the risk of periodontitis in patients with DM.

RESULTS

After controlling for related variables, Patients with DM had a higher risk for periodontitis compared with the patients without DM (adjusted hazard ratios [aHR] = 1.04, 95% confidence interval [CI]: 1.01-1.08). Patients with hypertension (HTN) had no higher risk for periodontitis (aHR = 0.96, 95% CI: 0.92-1.00). Patients with dyslipidemia and rheumatoid arthritis (RA) patients both had a higher risk for periodontitis (aHR = 1.26, 95% CI: 1.19-1.34; aHR = 1.41, 95% CI: 1.19-1.67).

CONCLUSIONS

There is a correlation between DM and periodontitis. Patients with DM may have a higher risk of incident periodontitis. Besides, age, HTN, dyslipidemia, and RA are also associated with incident periodontitis.

Association between dementia and unintentional poisoning in Taiwan

PURPOSE

Older people with dementia are a particularly vulnerable group and have an increased risk of poisoning. We investigated the correlation between dementia and the risk of unintentional poisoning in a retrospective, longitudinal and nationwide population-based study.

METHODS

Overall, 27,438 patients with dementia were selected from the National Health Insurance Research Database of Taiwan between 1 January 2000 to 31 December 2010, and 109,752 controls were propensity score-matched by gender, age, index year, and presence of heart failure, liver disease, renal disease, and cancers. After adjustment for confounding factors, Cox proportional hazards analysis was used to compare the risk of poisoning during follow-up.

RESULTS

Among dementia patients, 100 (0.36%) had unintentional poisoning events compared to 350 (0.32%) controls. Cox proportional hazards regression revealed that the patients were more likely to develop poisoning than the controls (hazard ratio [HR]: 2.721, 95% CI = 2.162-3.424, p < 0.001). After adjustment for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the HR for poisoning was 2.385 (95% CI = 1.883-3.021, p < 0.001).

CONCLUSIONS

Patients with dementia have a high risk of unintentional poisoning, and appropriate prescription medications and careful review of dementia patient compliance are important.

Curcumin attenuates heat-stress-induced oxidant damage by simultaneous activation of GSH-related antioxidant enzymes and Nrf2-mediated phase II detoxifying enzyme systems in broiler chickens

The object of this study was to investigate the effect of curcumin on modulating the glutathione (GSH)-related antioxidant enzymes and antioxidant responses via NF-E2-related factor 2 (Nrf2) signaling pathway in heat-stressed broiler chickens. A total of 400 one-day-old male Arbor Acres broiler chicks was reared in an environmentally controlled room. At 21 d, broiler chicks were divided into 5 treatment groups and were fed one of 4 diets under 2 temperature conditions: 22°C + a basal diet (CON treatment); 34°C for 8 h (0900-1700) + a basal diet supplemented with 0, 50, 100, or 200 mg/kg curcumin (HS, CMN1, CMN2, and CMN3 treatments, respectively). The heat treatment lasted for 20 consecutive days. The results showed that heat stress significantly increased (P < 0.05) the weekly rectal temperature and average head and feet temperature. Compared to the HS treatment, feed conversion was significantly decreased (P < 0.05) in CMN1 and CMN2 treatments. CMN1 administration significantly improved (P < 0.05) the pH24 of muscle. The abnormal changes of serum malonaldehyde and corticosterone concentrations were prevented (P < 0.05) by curcumin. Mitochondrial GSH concentration in the liver was significantly increased (P < 0.05) in CMN1 and CMN2 treatments compared with the HS treatment. The CMN1, CMN2, and CMN3 supplementations significantly increased (P < 0.05) γ-GCL, GSH-Px, and GST activities. Curcumin significantly increased (P < 0.05) the expression of Nrf2, HO-1, and γ-GCLc in the liver as compared to the CON diet. The expression of Cu/ZnSOD and CAT were increased (P < 0.05) by feeding CMN2, respectively, as compared to the HS treatment. It was concluded that curcumin supplementation enhanced the resistance of broilers to heat stress, as evidenced by reversing the FC, increasing the GSH content and GSH-related enzyme activities, and inducing the expression of Nrf2 and Nrf2-mediated phase II detoxifying enzyme genes.

Risk factors for neonatal early-onset group B streptococcus-related diseases after the implementation of a universal screening program in Taiwan

Background

We examined the risk for Group B streptococcus (GBS)-related diseases in newborns born to mothers who participated in a universal GBS screening program and to determine whether differences are observed in factors affecting the morbidity for neonatal early-onset GBS-related diseases.

Methods

This is a retrospective study and the study subjects were women who had undergone GBS screening and who gave birth naturally and their newborns between April 15, 2012 and December 31, 2013. Data from the GBS screening system database and the National Health Insurance database were collected to calculate the GBS prevalence in pregnant women and morbidity of newborns with early-onset GBS-related diseases.

Results

The GBS prevalence in pregnant women who gave birth naturally was 19.58%. The rate of early-onset infection caused by GBS in newborns decreased from the original 0.1% to 0.02%, a decrease of as high as 80%. After the implementation of the universal GBS screening program, only three factors, including positive GBS screening result (OR = 2.84), CCI (OR = 2.45), and preterm birth (OR = 4.81) affected the morbidity for neonatal early-onset GBS-related diseases, whereas other factors had no significant impact.

Conclusion

The implementation of the universal GBS screening program decreased the infection rate of neonatal early-onset GBS diseases. The effects of socioeconomic factors and high-risk pregnancy on early-onset GBS infections were weakened.

The prescribing trend of oral antidiabetic agents for type 2 diabetes in Taiwan: An 8-year population-based study

The purpose of this study was to evaluate the prescription trend and pattern of oral antidiabetic (OAD) medications, which are extensively used worldwide for treating type 2 diabetes, in 2 age groups.In this population-based study, data obtained from the National Health Insurance Research Database, Taiwan, were analyzed to investigate the prescription trend of all types of OAD medications during 2005 to 2012. We used descriptive statistics to demonstrate the trend of prescription patterns stratified by age (aged 65 years and above or younger than 65).Sulfonylurea (SU) was once the most commonly used drug, but the proportion of its prescription had declined gradually (76.83% in 2005 to 63.70% in 2012). Consequently, biguanide (BG) became the most commonly used drug since 2010 (64.31% in 2005 to 74.41% in 2012). In addition, the prescriptions of thiazolidinedione decreased significantly (9.20% in 2005 to 2.86% in 2012), whereas the usage of DPP-4 inhibitor increased with time (3.73% in 2009 to 19.64% in 2012). The treatment choice of SU and α-glucosidase inhibitor (AGI) was higher in elderly patients compared with the younger population (SU: 62.70% in 2012, AGI: 12.78% in 2012). Two-drug combination therapies were the prevalent treatment choices for patients with type 2 diabetes (44.77% in 2012), particularly in the elderly group; however, ≥3 drug combination therapies increased gradually during the study period, particularly in the younger group.This descriptive study presents the change in the prescription of OAD medication for different age groups during 2005 to 2012.

Asthma status is an independent risk factor for herpes zoster in children: a population-based cohort study

BACKGROUNDS

Literatures regarding the effects of childhood asthma on the risk of herpes zoster (HZ) is very limited. The aim of this study is to investigate the risks of children developing HZ with asthma.

METHODS

From the National Health Insurance Research Database, we identified 300,649 patients who had asthma between 2000 and 2007 as an asthma cohort. We identified another matched non-asthma cohort. All subjects were followed until the end of 2008. A Cox model was used to estimate the association of asthma on the risk of HZ.

RESULTS

Asthma cohort had significantly higher risk of developing HZ than the comparison cohort (HR=1.15; 95 % CI =1.06-1.26). However, compared to those without regular controller, asthma cohort with regular inhaled corticosteroid (ICS) treatment had slightly increased risk for HZ (HR=1.14; 95% CI=1.01-1.27) but decreased risk for HZ in those with regular combined ICS and Montelukast (HR=0.83; 95% CI=0.69-0.98). Uncontrolled asthma with more than 3-4 times ED visits and admissions per year had 3.72 (CI =1.86-7.47) and 20.5 (CI =10.2-41.2) greater risks for HZ than those without asthma, respectively.

CONCLUSIONS

Asthma poses an increased risk of zoster, therefore control of asthma is important to minimize risk of HZ.

Influence of time interval from diagnosis to treatment on survival for oral cavity cancer: A nationwide cohort study

OBJECTIVES

We aimed to explore the relationship between the time interval from diagnosis to treatment and survival of oral cavity squamous cell carcinoma patients.

MATERIALS AND METHODS

A population-based study was conducted between 2004 and 2010. Claims data of oral squamous cell carcinoma patients were retrieved from the Taiwan Cancer Registry Database. Secondary data were obtained from Taiwan's National Health Insurance Research Database.

RESULTS

A total of 21,263 patients were included in the final analysis. The majority of the patients received treatment within 30 days of diagnosis (n = 18,193, 85.5%), while 572 patients (2.7%) underwent treatment after 120 days. The patients who were treated after 120 days had a higher risk of death when compared to those treated within 30 days (Hazard ratio: 1.32, 95% Confidence intervals: 1.19 to 1.47).

CONCLUSION

A longer time interval from diagnosis to treatment was found to be associated with a poorer prognosis among patients suffering from oral squamous cell carcinoma.

Incidence, risk, and associated factors of depression in adults with physical and sensory disabilities: A nationwide population-based study

BACKGROUND

Physical disability has been associated with the risk of depression. We examined the incidence, risk, and associated factors of depression in Taiwanese adults with physical/sensory disabilities.

METHODS

Two national databases were used to retrospectively analyze 749,491 ≥20-year-old Taiwanese with physical/sensory disabilities in 2002-2008. The incidence of depression was analyzed by univariate Poisson regression. Risk factors of depression were followed up through 2014 and examined with a Cox proportional hazards model.

RESULTS

Among the study subjects, the incidence of depression was 6.29 per 1000 person-years, with 1.83 per 1000 person-years corresponding to major depression. The subjects' depression risk was affected by disability type, disability severity, gender, age, education, marital status, aboriginal status, monthly salary, residence urbanization level, and Charlson comorbidity index (CCI). Subjects with rare diseases, mild disability, female gender, age 35-44 years, a high school education level, divorced/widowed status, non-aboriginal status, a NT$22,801-28,800 monthly salary, a highly urbanized residence area, or a CCI≥3 were at higher risk for depression.

CONCLUSIONS AND IMPLICATIONS

Adults with physical/sensory disabilities have a 3.7-fold higher incidence of depression than the general population. Social services departments and family members should take extra measures toward preventing and treating depression in this subpopulation.

Hair growth effect of traditional Chinese medicine BeauTop on androgenetic alopecia patients: A randomized double-blind placebo-controlled clinical trial

The aim of the present study was to evaluate the treatment effects of BeauTop in alopecia by observing its effectiveness in improving androgenetic alopecia. Hair growth was observed using a dermatoscope and clinical photos, and was scored by three dermatologists. Dermatologists evaluated and selected suitable participants for this study using the Norwood scale or Ludwig scale. A total of 40 participants with androgenetic alopecia were recruited in this study, and 32 participants completed the 6-month trial. The results revealed that in the BeauTop treatment group, 9/17 participants (52.9%) showed increased hair growth. Changes in hair growth were as follows: No change, 47.1% patients; minimally improved, 5.9% patients; moderately improved, 29.4% patients; and significantly improved, 17.6% patients. In the placebo group, 2/15 participants (13%) showed increased hair growth. A Chi-square test was performed and attained a value of 0.01 Collapse

Key Words

• BeauTop
• androgenetic alopecia
• ludwig scale
• norwood scale

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Affiliation(s)

Chien-Ying Lee Department of Pharmacology, Chung Shan Medical University, Taichung 40242, Taiwan, R.O.C Department of Pharmacy, Chung Shan Medical University Hospital, Taichung 40242, Taiwan, R.O.C Department of Medicine, Chung Shan Medical University, Taichung 40242, Taiwan, R.O.C
Cheng-Chung Wei Department of Medicine, Chung Shan Medical University, Taichung 40242, Taiwan, R.O.C Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40242, Taiwan, R.O.C
Min-Chien Yu Department of Medicine, Chung Shan Medical University, Taichung 40242, Taiwan, R.O.C Department of Dermatology, Chung Shan Medical University Hospital, Taichung 40242, Taiwan, R.O.C Department of Integrated Chinese and Western Medicine, Chung Shan Medical University Hospital, Taichung 40242, Taiwan, R.O.C
Ching-Che Lin Brion Research Institute, New Taipei City 23143, Taiwan, R.O.C
Shuenn-Jyi Sheu Brion Research Institute, New Taipei City 23143, Taiwan, R.O.C
Jen-Hung Yang College of Medicine, Tzu Chi University, Hualien 97004, Taiwan, R.O.C
Chien-Ying Chiang Brion Research Institute, New Taipei City 23143, Taiwan, R.O.C
Kuang-Hua Huang Department of Health Service Administration, China Medical University, Taichung 40402, Taiwan, R.O.C
Yu-Hsiang Kuan Department of Pharmacology, Chung Shan Medical University, Taichung 40242, Taiwan, R.O.C Department of Pharmacy, Chung Shan Medical University Hospital, Taichung 40242, Taiwan, R.O.C Department of Medicine, Chung Shan Medical University, Taichung 40242, Taiwan, R.O.C

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Use of Seasonal Influenza Vaccination and Its Associated Factors among Elderly People with Disabilities in Taiwan: A Population-Based Study

Background

Influenza immunization among elderly people with disabilities is a critical public health concern; however, few studies have examined the factors associated with vaccination rates in non-Western societies.

Methods

By linking the National Disability Registration System and health service claims dataset from the National Health Insurance program, this population-based study investigated the seasonal influenza vaccination rate among elderly people with disabilities in Taiwan (N = 283,172) in 2008. A multivariate logistic regression analysis was conducted to adjust for covariates.

Results

Nationally, only 32.7% of Taiwanese elderly people with disabilities received influenza vaccination. The strongest predictor for getting vaccinated among older Taiwanese people with disabilities was their experience of receiving an influenza vaccination in the previous year (adjusted odds ratio [AOR] = 6.80, 95% confidence interval [CI]: 6.67–6.93). Frequent OPD use (AOR = 1.85, 95% CI: 1.81–1.89) and undergoing health examinations in the previous year (AOR = 1.66, 95% CI: 1.62–1.69) also showed a moderate and significant association with receiving an influenza vaccination.

Conclusions

Although free influenza vaccination has been provided in Taiwan since 2001, influenza immunization rates among elderly people with disabilities remain low. Policy initiatives are required to address the identified factors for improving influenza immunization rates among elderly people with disabilities.

Adiabatic light transfer in titanium diffused lithium niobate waveguides

We report on the realization of adiabatic light transfer in lithium niobate (LiNbO₃) waveguides. This peculiar adiabatic tunneling scheme was implemented in a three-waveguide coupling configuration with the intermediate waveguide being inclined with respect to the outer waveguides to facilitate the adiabatic passage process. We have investigated and determined the adiabatic conditions of the LiNbO₃ device in terms of the structure configuration of the waveguide system and found optimal structure parameters by both simulation and experimental approaches. Broadband adiabatic couplings of bandwidth ~456 and 185 nm and peak coupling efficiencies of >0.96 have been obtained with a 2-cm long device for TE- and TM-polarized fundamental modes, respectively. Longer (5 cm) devices were also studied and found to be useful in increasing the adiabaticity of the device, especially for the TM-polarized mode.

Prescription patterns of Chinese herbal products for patients with sleep disorder and major depressive disorder in Taiwan

ETHNOPHARMACOLOGICAL RELEVANCE

Chinese herbal products (CHPs) are commonly prescribed for sleep disorder and major depressive disorder (MDD). The aim of this study was to investigate the prescription patterns of CHPs and Western medicine for patients with these disorders in Taiwan, and analyze the frequency of using single herbs (SHs) and herbal formulas (HFs).

MATERIALS AND METHODS

In this retrospective population-based study secondary data analysis was performed using data from Taiwan's Longitudinal Health Insurance Database (LHID) between January 2007 and December 2011. In total, 1000,000 beneficiaries from the LHID were randomly selected from the 2010 registry for beneficiaries of the National Health Insurance Research Database. Patients with sleep disorder and MDD according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes 307.40 and 311, respectively.

RESULTS

Among a total of 11,030 patients with sleep disorder, 9619 used Western medicine, 1334 used CHPs, and 77 used both, Among a total of 11,571 patients with MDD, 11,389 used Western medicine, 131 used CHPs, and 51 used both. Regardless of disorder type, women were predominant The majority of the patients were aged 22-44 years, had a monthly income of NT$17,281-NT$22,800, and lived in an area with Level 1 and Level 2 urbanization. Of the patients with sleep disorder, 1411 had used CHPs and visited a clinic 5298 times on average. Of the patients with MDD, 182 had used CHPs and visited a clinic 755 times on average. The three most commonly used SHs and HFs were Ziziphi Spinosae Semen, Polygoni Multiflori Caulis, and Polygalae Radix, and Jia-Wei-Xiao-Yao-San, Suan-Zao-Ren-Tang, and Chai-Hu-Chia-Lung-Ku-Mu-Li-Tang, respectively.

CONCLUSION

Chinese herbal products including SHs and HFs are prescribed for patients with sleep disorder and MDD. However, the efficacy and safety of CHPs for sleep disorder and MDD need to be further evaluated.

Distribution and clinical significance of tumour-associated macrophages in pancreatic ductal adenocarcinoma: a retrospective analysis in China

BACKGROUND

We aimed to characterize the localization and prognostic significance of tumour-associated macrophages (tams) in pancreatic ductal adenocarcinoma (pdac).

METHODS

Tumour specimens from 70 patients with pdac and inflammatory specimens from 13 patients with chronic pancreatitis were collected and analyzed for tam and M2 macrophage counts by immunohistochemistry. Correlations between tam distributions and clinicopathologic features were determined.

RESULTS

Immunohistochemical analysis showed that tam and M2 macrophage counts were higher in tissues from pdac than from chronic pancreatitis. The tams and M2 macrophages both infiltrated more into peritumour. Both macrophage types were positively associated with lymph node metastasis (p = 0.041 for tams in peritumour, p = 0.013 for M2 macrophages in introtumour, p = 0.006 for M2 macrophage in peritumour). In addition, abdominal pain was significantly more frequent in pdac patients with a greater tams count. The survival rate was much lower in patients having high infiltration by M2 macrophages than in those having low infiltration.

CONCLUSIONS

The tam count might be associated with neural invasion in pdac, and M2 macrophages might play an important role in lymph node metastasis. Higher counts of either macrophage type were associated with increased risk of lymph node metastasis, and the M2 macrophage count could potentially be a marker for evaluating prognosis.

Beneficial impact of multidisciplinary team management on the survival in different stages of oral cavity cancer patients: results of a nationwide cohort study in Taiwan

OBJECTIVES

The aim of this study was to investigate the association between multidisciplinary team (MDT) management and survival of oral cavity cancer patients using a nationwide database in Taiwan.

MATERIALS AND METHODS

A nationwide cohort study was conducted between 2005 and 2008. The follow-up end point was 2010. Claims data of oral cavity cancer patients were retrieved from the Taiwan Cancer Registry Database. Secondary data were obtained from the Taiwan's National Health Insurance Research Database. Among 19,766 newly diagnosed oral cavity cancer patients, we identified 16,991 patients who underwent treatment between 2004 and 2008 for further analyses.

RESULTS

Overall survival was compared between patients who received MDT management (n=3324) and those who did not (n=13,367). Hazard ratios (HR) of death in patients with MDT management were also analyzed. Patients with MDT management had a lower risk of death when compared with that of patients without MDT management (HR: 0.94, 95% confidence intervals (CI): 0.89-1.00; P=0.032). The effect of MDT management on survival was stronger for male patients than for female patients (HR: 0.94, 95% CI: 0.89-1.00; P=0.040 versus HR: 0.98, 95% CI: 0.75-1.27; P=0.866). In addition, the effect of MDT management was strong among patients with a Charlson Comorbidity Index between 4 and 6, in those without coexisting catastrophic illness/injury, and in patients with stage IV diseases.

CONCLUSION

Survival rates in oral cavity cancer patients with MDT management appeared to be marginally better than those of patients without MDT management.

Does chronic rhinosinusitis increase the risk of lung cancer? A population cohort study

BACKGROUND AND AIMS

Chronic rhinosinusitis is one of the most common chronic inflammatory diseases of the upper airway. A previous study of chronic rhinosinusitis and the risks of lung cancer was based on a self-reported questionnaire concerning rhinosinusitis. Population-based cohort studies of the correlation between chronic rhinosinusitis and the adenocarcinoma subtype of lung cancer have been limited.

OBJECTIVES

In the present study, we used a population-based database to investigate the risks related to the adenocarcinoma subtype of lung cancer among patients with chronic rhinosinusitis.

METHODS

We identified 13 072 patients who were diagnosed with chronic rhinosinusitis in 1998-2010 as the exposure group. There were 52 288 randomly selected patients as the comparison cohort. We used data from the Taiwan National Health Insurance Research Database; the Taiwan National Health Insurance programme offers health-care services to 99% of the 23 million people residing in Taiwan. We compared the incidence of the adenocarcinoma subtype of lung cancer between the two cohorts. The cumulative incidence and hazard ratios of developing the adenocarcinoma subtype of lung cancer were calculated.

RESULTS

This study included 13 072 participants with chronic rhinosinusitis and 52 288 participants with non-chronic rhinosinusitis. The risk of the adenocarcinoma subtype of lung cancer was higher in the chronic rhinosinusitis cohort than in the non-chronic rhinosinusitis cohort, with an adjusted hazard ratio of 3.52 after controlling for age and gender.

CONCLUSION

This large population-based cohort study demonstrated that patients in Taiwan with previous chronic rhinosinusitis are at greater risk of developing the adenocarcinoma subtype of lung cancer.

Do physicians with diabetes have differences in dialysis use and survival than other patients with diabetes

AIMS

To assess whether the increased knowledge and resources available to physicians led to differences in dialysis and survival rates between physicians and non-physician patients with diabetes.

METHODS

All newly diagnosed (1997-2009) type 2 diabetes patients aged ≥35 years from the National Health Insurance Program of Taiwan database were included. After propensity score matching (1:10), we estimated the relative risk of dialysis and death using Cox proportional hazards model adjusted for demographic characteristics and comorbidities.

RESULTS

Physicians with diabetes were more likely to start dialysis than general patients, with a 48% increased hazard risk (HR) (P=0.006). Physicians with diabetes had significantly lower risk of death (HR: 0.88; P=0.025). However, those requiring dialysis had a non-significant increased risk of death (HR: 1.19). There was an increased HR for death in older physicians (HR: 1.81; P<0.001) and those with cancer or catastrophic illness. The HR of dialysis (7.89; P<0.0001) increased dramatically with increasing Charlson Comorbidity Index scores.

CONCLUSIONS

Physicians with DM survived longer than other patients with diabetes, likely benefiting from their professional resources in disease control and prevention. Nonetheless, they displayed no advantage from their medical backgrounds compared with the general patients if they developed end stage renal disease.

Effects of multidisciplinary team care on utilization of emergency care for patients with lung cancer

OBJECTIVES

To improve the quality of care, multidisciplinary team (MDT) care was implemented in Taiwan. This study examined the relationship between MDT care and emergency department visits for lung cancer patients.

STUDY DESIGN

A retrospective cohort study with MDT care participants and matched a double number of control group of non-participants was followed.

METHODS

In this study, 22,817 patients with newly diagnosed lung cancer were recruited from 2005 to 2007 in Taiwan. Matching based on the propensity of receiving MDT care was used. A total of 8172 patients were observed in this study. A c2, ANOVA, logistic regression, and Poisson regression were used to elucidate the effects of MDT care.

RESULTS

The lung cancer patients participating in MDT had lower risk to visit an emergency department (ED) (OR = 0.89; 95% CI, 0.80-0.98), and the incidence rate ratio decreased by 11% (95% CI, -0.15 to -0.07). Gender, monthly salary, urbanization of the residence area, comorbid conditions, catastrophic illness/injury, treatment method, number of outpatient visits, length of stay, hospital ownership, level of hospital, and the age of the patient's physician were all significantly related to the frequency of ED visits (P < .05).

CONCLUSIONS

The frequency of emergency department visits of patients with MDT care was lower than that of those without it. The patients with MDT received enhanced care.

Protective effect of Ginkgo biloba leaves extract, EGb761, on endotoxin-induced acute lung injury via a JNK- and Akt-dependent NFκB pathway

Acute lung injury (ALI) is a clinical syndrome mainly caused by Gram-negative bacteria which is still in need of an effective therapeutic medicine. EGb761, an extract of Ginkgo biloba leaves, has several bioeffects including anti-inflammation, cardioprotection, neuroprotection, and free radical scavenging. Preadministration of EGb761 inhibited lipopolysaccharide (LPS)-induced histopathological changes and exchange of arterial blood gas. In addition, LPS-induced expression of proinflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, macrophage inflammatory protein (MIP)-2, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2), were suppressed by EGb761. The activation of nuclear factor (NF)κB, a transcription factor of proinflammatory mediators, and phosphorylation of IκB, an inhibitor of NFκB, were also reduced by EGb761. Furthermore, we found the inhibitory concentration of EGb761 on phosphorylation of JNK and Akt was less than those of ERK and p38 MAPK. In conclusion, EGb761 is a potential protective agent for ALI, possibly via downregulating the JNK- and Akt-dependent NFκB activation pathway.

Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer

BACKGROUND

Patients with alpha-fetoprotein (afp)-producing gastric cancer have a high incidence of liver metastasis and poor prognosis. There is some controversy about clinical manifestations in these patients.

METHODS

Our study enrolled patients who, before surgery, had gastric cancer with serum afp exceeding 20 ng/mL [afp>20 (n = 58)] and with serum afp 20 ng/mL or less [afp≤20 (n = 1236)]. Clinical manifestations were compared between the groups.

RESULTS

Early gastric cancer was more frequent (30.1% vs. 4%) and advanced gastric cancer was less frequent (69.9% vs. 96%) in the afp≤20 group than the afp>20 group (p < 0.001). Liver and lymph node metastasis occurred less frequently in the afp≤20 group (4.4% vs. 27.6%, p < 0.001, and 60.7% vs. 91.4%, p < 0.001, respectively). The 1-, 3-, 5-, and 10-year survival rates of afp≤20 patients were 75.2%, 53.4%, 45.8%, and 34.6% respectively. The 1-, 3-, 5-, and 10-year survival rates of patients with afp greater than 20 ng/mL, but 300 ng/mL or less, were 46.7%, 28.9%, 17.8%, and 13.3% respectively. The 1-, 3-, and 5-year survival rates of patients with serum afp greater than 300 ng/mL were 15.4%, 7.7%, and 0% respectively. The independent predictors for survival time were afp concentration, age, peritoneal seeding, liver metastasis, lymph node metastasis, vascular invasion, TNM stage, curative surgery, serosal invasion, and Lauren classification.

CONCLUSIONS

Patients with high serum afp had a high frequency of liver and lymph node metastasis and very poor prognosis. More aggressive management with multimodal therapy (for example, chemotherapy, radiotherapy) might be needed when treating such patients.

A neutral risk on the development of new-onset diabetes mellitus (NODM) in Taiwanese patients with dyslipidaemia treated with fibrates

There are no data on the incidence of new-onset diabetes mellitus (NODM ) in nondiabetic dyslipidaemia patients treated with fibrates. The aim of our study was to clarify these issues, to investigate the relationship between NODM and fibrate and whether the fibrates lead to increased risk for developing NODM. A retrospective cohort study was conducted by analyzing the Longitudinal Health Insurance Database (LHID 2005) of the National Health Insurance Research Database (NHIRD) from 2005 to 2010 to investigate all fibrate prescriptions for patients with dyslipidaemia. We estimated the hazard ratios (HRs) of NODM associated with fibrate use. We identified 145 NODM patients among 3,815 dyslipidaemic patients in the database for the study period. The risk estimates for NODM for users of fenofibrate (HR 1.30; 95% CI 0.82, 2.05) and gemfibrozil (HR 0.771; 95% CI 0.49, 1.22) were not associated with an increased risk of developing NODM (P > 0.05). Our results revealed that patients with dyslipidaemia who took fenofibrate and gemfibrozil had a neutral risk of NODM. The reasons may be associated with the fibrates have the properties that activate PPARα and in some cases also activated PPARγ, leading to showing a neutral risk of NODM.

Objective measurements differ for perception of left and right nasal obstruction

OBJECTIVE

Nasal obstruction is one of the most common sensation complaints of nasal disease in clinical practice. It is a subjective sensation of nasal airflow. Objective assessment of nasal patency and nasal physiology includes the use of rhinomanometry and acoustic rhinometry. The perception of nasal obstruction changes as the alternating of nasal airway resistance and nasal airflow. However, there were limited studies reported whether the perceptions of the left and right nostrils are similar. We examined the relationship between subjective and objective parameters of the nasal airway in the left and right nostrils.

METHODS

A prospective study of 101 patients with a deviated nasal septum and chronic hypertrophic rhinitis was conducted for subjective and objective nasal airway evaluation. Patients were then divided into three groups based on the visual analog scale. Associations between measures were evaluated with analysis of variance, f tests and simple regression.

RESULTS

Among three patient groups with different subjective sensations of nasal obstruction, there were significant differences among three patient groups according to the objective measurements of airflow resistance on the right side (p=0.0002 for inspiration right mean resistance; p=0.0049 for expiration right mean resistance), and for the minimal cross-sectional area (p=0.030) and nasal cavity volume (p=0.028 for 0-3.3cm left nostril; p=0.047 for 2-4cm left nostril) on the left side. This indicates that nasal flow resistance is an important determinant for right side nasal obstruction. Nasal minimal cross-sectional area and nasal cavity volume are an important determinant for left side nasal obstruction.

CONCLUSION

Our study indicates the important role of rhinomanometry in objective measurement of right side nasal obstruction and acoustic rhinometry in objective measurement of left side nasal obstruction. Thus, human perception of right and left nostrils may be different and requires further study.

Factors influencing antihypertensive medication compliance in Taiwan: a nationwide population-based study

BACKGROUND

Poor medication compliance with antihypertensive drugs may have a significant impact on clinical outcomes, hospitalisation and healthcare expenditure. This study aims to assess medication compliance and its underlying factors in patients receiving antihypertensive drugs in Taiwan.

METHODS

This retrospective population-based study was based on data from Taiwan's Longitudinal Health Insurance Database (LHID). All patients (n = 78,558) were aged 30 years or more and had received at least one antihypertensive prescription between January 2004 and December 2007. We used the medication possession ratio (MPR) as an index to measure the level of medication compliance.

RESULTS

Approximately 53% of the patients had high compliance with antihypertensive medication. Factors that were positively associated with medication compliance included patients being aged 30-44 years, higher comorbidity scores (odds ratio (OR): 1.18; 95% confidence interval (CI): 1.08-1.28), the same prescribing physician being visited and a single-drug therapy being prescribed. Female sex (OR: 0.92; 95% CI: 0.89-0.95) and higher socioeconomic status (OR: 0.91; 95% CI: 0.86-0.96) were negatively associated with drug compliance. In addition, high-compliance patients were less likely to be treated at medical centres, corporations (OR: 0.89; 95% CI: 0.84-0.93) or rural (OR: 0.88; 95% CI: 0.83-0.94) institutions.

CONCLUSION

Several patient- and institution-related factors may influence medication compliance. Therefore, for optimal outcomes, patients' awareness of the need for compliance with antihypertensive therapy must be enhanced, and effective intervention strategies should be developed.

The use of Pap smear and its influencing factors among women with disabilities in Taiwan

Cervical cancer is a prevalent cancer among Taiwanese women, and can be effectively cured if diagnosed early. Therefore, cervical cancer is worthy of preventive health screening. Due to physical and psychological barriers, patients with disability may be unable to express their physical complaints accurately, thus reducing their access to health care; some may not even receive proper preventive health care or medical treatment. This study investigates the utilization of Pap smear among women with disability in Taiwan and its influencing factors. With women aged 30 and over as the study subjects, this retrospective cohort study is conducted based on the database of the Ministry of the Interior, Taiwan, 2008, combined with information gathered between 2006 and 2008 regarding preventive health care and health insurance medical claims data from the Bureau f Health Promotion and the National Health Research Institutes, respectively. The frequency of Pap smears and the percentage differences of each variable are examined using the 2× tests to check for statistical significance. Finally, logistic regression analysis is used to examine the factors influencing the use of Pap smears. The results revealed that among disabled women aged 30 and over, the use of Pap smears was 7.71% in 2008. Disabled women with the following characteristics had lower use levels regarding Pap smears: greater age, residing in areas of higher urbanization, lower income, lower education levels, unmarried, not diagnosed with cancer, diagnosed with diabetes, and with severe disability levels. Disabled women with hearing impairments or mental retardation were possessed of the highest and lowest probabilities of using Pap smear, respectively. The recommendations of this study include: (1) provide physicians with a varying pricing scheme and incentives for Pap smear based on the type or severity of disability; (2) proactively encourage gynecologist and obstetricians to conduct regular and convenient Pap smear on disabled women; and (3) target disabled women in low usage groups, and improve their knowledge of Pap smear.

Adverse pharmaceutical payment incentives and providers' behaviour: the emergence of GP-owned gateway pharmacies in Taiwan

OBJECTIVES

We investigated whether a 2002 pharmaceutical payment reform policy, which provided adverse incentives, fostered an increase in market share of 'gateway pharmacies' (G-pharmacies--pharmacies owned, operated and located by the same clinics that prescribe medicines); what the financial impact of G-pharmacies to the clinics is; and what factors determine whether a clinic decides to open a G-pharmacy.

METHODS

Using the database of the National Health Research Institutes, we collected secondary data on all of Taiwan's National Health Insurance prescription claims from pharmacies and clinics between 1997 and 2003. A G-pharmacy was defined as a pharmacy in which more than 70% of the prescriptions it filled came from the same clinic, which prescribed at least 900 prescriptions monthly, more than 70% of which were released to the pharmacy. Trend plot and frequency were used to analyse the distribution of G-pharmacy data. Logistic regression was used to explore what factors determined whether a clinic decided to open a G-pharmacy.

RESULTS

After the 2002 reform, the percentage of total prescriptions filled by G-pharmacies reached 78.71%, the increase in percentage (15.23%) was the highest ever and significant (P < 0.01). The reform's adverse payment incentives resulted in a loss of NT$1.86 billion New Taiwan dollars to all clinics and resulted in a reduction in Taiwan's 2003 fee schedules under the global budget payment system. The decision to establish a G-pharmacy was associated with a clinic's being located in less urbanized areas, being a group practice, having higher patient volumes, being a general practitioner, and being privately owned.

CONCLUSION

The 2002 reform's adverse incentive fostered a significant increase in the market share of G-pharmacies, and reduced the earnings of clinics which did not own them. It is necessary to break the link between profits from pharmaceutical sales and physician prescribing behaviour to prevent the conflict of interest in how medicines are prescribed.

Temporal transcriptomic analysis as Desulfovibrio vulgaris Hildenborough transitions into stationary phase during electron donor depletion

Desulfovibrio vulgaris was cultivated in a defined medium, and biomass was sampled for approximately 70 h to characterize the shifts in gene expression as cells transitioned from the exponential to the stationary phase during electron donor depletion. In addition to temporal transcriptomics, total protein, carbohydrate, lactate, acetate, and sulfate levels were measured. The microarray data were examined for statistically significant expression changes, hierarchical cluster analysis, and promoter element prediction and were validated by quantitative PCR. As the cells transitioned from the exponential phase to the stationary phase, a majority of the down-expressed genes were involved in translation and transcription, and this trend continued at the remaining times. There were general increases in relative expression for intracellular trafficking and secretion, ion transport, and coenzyme metabolism as the cells entered the stationary phase. As expected, the DNA replication machinery was down-expressed, and the expression of genes involved in DNA repair increased during the stationary phase. Genes involved in amino acid acquisition, carbohydrate metabolism, energy production, and cell envelope biogenesis did not exhibit uniform transcriptional responses. Interestingly, most phage-related genes were up-expressed at the onset of the stationary phase. This result suggested that nutrient depletion may affect community dynamics and DNA transfer mechanisms of sulfate-reducing bacteria via the phage cycle. The putative feoAB system (in addition to other presumptive iron metabolism genes) was significantly up-expressed, and this suggested the possible importance of Fe2+ acquisition under metal-reducing conditions. The expression of a large subset of carbohydrate-related genes was altered, and the total cellular carbohydrate levels declined during the growth phase transition. Interestingly, the D. vulgaris genome does not contain a putative rpoS gene, a common attribute of the delta-Proteobacteria genomes sequenced to date, and the transcription profiles of other putative rpo genes were not significantly altered. Our results indicated that in addition to expected changes (e.g., energy conversion, protein turnover, translation, transcription, and DNA replication and repair), genes related to phage, stress response, carbohydrate flux, the outer envelope, and iron homeostasis played important roles as D. vulgaris cells experienced electron donor depletion.

Global analysis of heat shock response in Desulfovibrio vulgaris Hildenborough

Desulfovibrio vulgaris Hildenborough belongs to a class of sulfate-reducing bacteria (SRB) and is found ubiquitously in nature. Given the importance of SRB-mediated reduction for bioremediation of metal ion contaminants, ongoing research on D. vulgaris has been in the direction of elucidating regulatory mechanisms for this organism under a variety of stress conditions. This work presents a global view of this organism's response to elevated growth temperature using whole-cell transcriptomics and proteomics tools. Transcriptional response (1.7-fold change or greater; Z >/= 1.5) ranged from 1,135 genes at 15 min to 1,463 genes at 120 min for a temperature up-shift of 13 degrees C from a growth temperature of 37 degrees C for this organism and suggested both direct and indirect modes of heat sensing. Clusters of orthologous group categories that were significantly affected included posttranslational modifications; protein turnover and chaperones (up-regulated); energy production and conversion (down-regulated), nucleotide transport, metabolism (down-regulated), and translation; ribosomal structure; and biogenesis (down-regulated). Analysis of the genome sequence revealed the presence of features of both negative and positive regulation which included the CIRCE element and promoter sequences corresponding to the alternate sigma factors sigma(32) and sigma(54). While mechanisms of heat shock control for some genes appeared to coincide with those established for Escherichia coli and Bacillus subtilis, the presence of unique control schemes for several other genes was also evident. Analysis of protein expression levels using differential in-gel electrophoresis suggested good agreement with transcriptional profiles of several heat shock proteins, including DnaK (DVU0811), HtpG (DVU2643), HtrA (DVU1468), and AhpC (DVU2247). The proteomics study also suggested the possibility of posttranslational modifications in the chaperones DnaK, AhpC, GroES (DVU1977), and GroEL (DVU1976) and also several periplasmic ABC transporters.

Comparison of apparent ileal amino acid digestibility of feed ingredients measured with broilers, layers, and roosters

The apparent ileal digestibility of amino acids in 7 feed ingredients was determined using broilers, layers, and roosters. The ingredients included 3 cereals (wheat, sorghum, and corn), 3 oilseed meals (canola, cottonseed, and soybean meals), and 1 animal protein meal (meat and bone meal). Dietary protein in the assay diets was supplied solely by the test ingredient. All diets contained 20 g/kg of acid-insoluble ash as an indigestible marker, and each diet was offered ad libitum in mash form to 5 replicate pens of broilers and layers, and 4 replicate pens of roosters. The digestibility coefficients of individual amino acids for wheat, corn, and sorghum were higher (P < 0.05) in broilers than in layers and roosters. The digestibility of most amino acids for corn and sorghum was higher (P < 0.05) in roosters compared with those in layers, whereas the digestibility for wheat in layers and roosters was similar. In general, the digestibility of amino acids in canola meal, cottonseed meal, and meat and bone meal was similar among the 3 classes of chickens. The digestibility of amino acids in soybean meal was higher (P < 0.05) for layers compared with those for broilers and roosters but similar between broilers and roosters. These results suggest that the class of chickens significantly influenced the apparent ileal digestibility of amino acids in some feed ingredients.

Influence of age on the apparent ileal amino acid digestibility of feed ingredients for broiler chickens

The apparent ileal digestibility of amino acids in 8 feed ingredients was determined using 14-, 28- and 42-d-old male broiler chickens. The ingredients included three cereals (wheat, sorghum and maize), one cereal by-product (mill run), three oilseed meals (canola, cottonseed and soybean meals) and one animal protein meal (meat and bone meal). Dietary crude protein in the assay diets was supplied solely by the test ingredient. All diets contained 20 g/kg acid-insoluble ash as an indigestible marker, and each diet was offered ad libitum in mash form to 5 replicate pens from 11 to 14 d, 25 to 28 d and 39 to 42 d post-hatching. There were 12, 6 and 6 birds per pen for the 14, 28 and 42 d samplings, respectively. The results suggest that the age of broilers significantly influenced the apparent ileal digestibility of amino acids. The effects, however, varied among amino acids and ingredients. In wheat, the digestibility of most amino acids was higher in 14- than in 28- and 42-d-old broilers. In maize, the digestibility coefficients of amino acids were higher at 28 and 42 d than at 14 d. The digestibility coefficients in maize and wheat at 28 and 42 d were similar. The digestibility of amino acids in sorghum at 42 d was higher than those at 28 d, but similar to those at 14 d except for histidine, lysine, serine and glycine, which were significantly higher at 42 d. Digestibility of amino acids in sorghum was similar between 14 and 28 d except for isoleucine, leucine, phenylalanine, glutamic acid and alanine. The digestibility of amino acids in mill run at 42 d was significantly higher than those at 14 and 28 d. There were no differences in digestibility between 14 and 28 d. In general, the digestibility of amino acids in canola meal, soybean meal and, meat and bone meal was higher at 28 and 42 d compared to those at 14 d, and similar between 28 and 42 d of age. In cottonseed meal, age had no effect on the digestibility coefficient of amino acids, except for lysine and arginine, which increased with age. Analysis of the combined results for the 8 feed ingredients showed that, in general, the digestibility coefficients of amino acids increased with advancing age of broiler chickens.

Changing trends of prostate cancer in Asia

Although Asian people have the lowest incidence and mortality rates of prostate cancer in the world, these rates have risen rapidly in the past two decades in most Asian countries. Prostate cancer has become one of the leading male cancers in some Asian countries. In 2000, the age-adjusted incidence was over 10 per 100000 men in Japan, Taiwan, Singapore, Malaysia, the Philippines and Israel. Although some of the increases may result from enhanced detection, much of the increased incidence may be associated with westernization of the lifestyle, with increasing obesity and increased consumption of fat. The differences in incidences between native Americans and Asian immigrants are getting smaller, reflecting a possible improvement of diagnostic efforts and changes of environmental risk factors in Asian immigrants. Nevertheless, the huge variations in incidences among ethnic groups imply that there are important genetic risk factors. The stage distributions of prostate cancer in Asian populations are still unfavorable compared to those of Western developed countries. However, a trend towards diagnosing cancer with more favorable prognosis is seen in most Asian countries. Both genetic and environmental risk factors responsible for elevated risks in Asian people are being identified, which may help to reduce prostate cancer incidence in a chemopreventive setting.

Optimal treatment for distal ureteral calculi: extracorporeal shockwave lithotripsy versus ureteroscopy

BACKGROUND

The optimal treatment for distal ureteral calculi remains controversial. We present data from our institution to compare the efficacy of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with different lithotripsy modalities (URSL).

METHODS

From January 1994 to September 1997, 954 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar) in 524 patients and ureteroscopy (Wolf 8.0F instrument and Swiss Lithoclast) in 430 patients. Stone sizes and patient ages were similar in these two groups.

RESULTS

In the SWL group, the 3-month stone-free rate was 87%, and the effectiveness quotient (EQ) was 68.7%. In the URSL group, there was a 96% stone-free rate with an EQ of 92.1%. The SWL treatment was more expensive than URSL.

CONCLUSION

At our institution, ureteroscopy is more efficacious than SWL for the treatment of distal ureteral calculi. In selected patients who had stones >10 mm with evidence of impaction and severe colic pain, we strongly suggest that URSL is the best choice.