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Lin FA, Hwang LC, Tsou MT, Huang WH. Incidence of Metabolic Syndrome and Its Risk Factors in Elderly with Nonalcoholic Fatty Liver Disease. Diabetes Metab Syndr Obes 2023; 16:2835-2842. [PMID: 37732014 PMCID: PMC10508243 DOI: 10.2147/dmso.s425651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose This study aimed to determine the incidence of metabolic syndrome (MetS) and its predictors in older patients with nonalcoholic fatty liver disease. Patients and Methods This retrospective cohort study analyzed repeated health surveillance data collected between 2009 and 2018 at Mackay Memorial Hospital, Taiwan. MetS was defined based on the modified National Cholesterol Education Program Adult Treatment Panel III (Taiwan revision). Participants were diagnosed with fatty liver disease using abdominal ultrasonography. The exclusion criteria included age <65 years, having viral hepatitis, frequent alcohol consumption, and pre-existing MetS. Logistic regression analysis was conducted, adjusting for sex and age. Results We enrolled 758 older participants; 457 (60.3%) with preexisting metabolic syndrome were excluded. We studied the remaining 301 participants (39.7%), with a mean age of 71.3 ± 5.4 years. The cumulative incidence of MetS was 43.5% after a mean follow-up period of 4.2 years; moreover, it was higher in women as well as in participants with diabetes and hypertriglyceridemia. After adjusting for age and sex, we identified the following risk factors for MetS: baseline high fasting plasma glucose levels (adjusted odds ratio [aOR] =1.75; 95% confidence interval [CI] 1.03-2.95), baseline hypertriglyceridemia (aOR = 2.26; 95% CI 1.15-4.47), and baseline large waist circumference (aOR =1.71; 95% CI 1.01-2.89). Furthermore, increased waist circumference and fasting plasma glucose levels at follow-up were significant risk factors. Conclusion There is a high incidence of MetS among older individuals with nonalcoholic fatty liver disease; further, women and individuals with diabetes or hypertriglyceridemia are at risk of developing MetS. Moreover, waist circumference and fasting plasma glucose levels were positively associated with the risk of MetS.
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Affiliation(s)
- Fang-An Lin
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wei-Hsin Huang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
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Lor YCM, Tsou MT, Tsai LW, Tsai SY. The factors associated with cognitive function among community-dwelling older adults in Taiwan. BMC Geriatr 2023; 23:116. [PMID: 36864383 PMCID: PMC9983251 DOI: 10.1186/s12877-023-03806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND This research aimed to investigate the associations of anthropometric measurements, physiological parameters, chronic disease comorbidities, and social and lifestyle factors with cognitive function amongst community-dwelling older adults in Taiwan. METHODS This was an observational, cross-sectional study involving 4,578 participants at least 65 years old, recruited between January 2008 and December 2018 from the Annual Geriatric Health Examinations Program. Cognitive function was assessed using the short portable mental state questionnaire (SPMSQ). Multivariable logistic regression was done to analyze the factors associated with cognitive impairment. RESULTS Among the 4,578 participants, 103 people (2.3%) with cognitive impairment were identified. Associated factors were age (odds ratio (OR) = 1.16, 95% confidence interval (CI) = 1.13,1.20), male gender (OR = 0.39, 95% CI = 0.21,0.72), diabetes mellitus (DM) (OR = 1.70, 95% CI = 1.03, 2.82), hyperlipidemia (OR = 0.47, 95% CI = 0.25, 0.89), exercise (OR = 0.44, 95% CI = 0.34, 0.56), albumin (OR = 0.37, 95% CI = 0.15, 0.88), and high-density lipoprotein (HDL) (OR = 0.98, 95% CI = 0.97, 1.00). Whereas waistline, alcohol intake in recent six months, and hemoglobin was not significantly associated with cognitive impairment (all p > 0.05). CONCLUSIONS Our findings suggested that people with older age and a history of DM had a higher risk of cognitive impairment. Male gender, a history of hyperlipidemia, exercise, a high albumin level, and a high HDL level seemed to be associated with a lower risk of cognitive impairment amongst older adults.
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Affiliation(s)
- You-Chen Mary Lor
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu, 300, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Nursing and Management, MacKay Junior College of Medicine, New Taipei City, Taiwan
| | - Li-Wei Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Ying Tsai
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu, 300, Taiwan.
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Chung PT, Ma HC, Huang SY, Lien HN, Ho KH, Hsu HY, Hwang LC, Tsou MT, Lin HH, Chan HL. Association between Serum Uric Acid Levels and Bone Mineral Density in Taiwanese Elderly Population. Int J Environ Res Public Health 2023; 20:3448. [PMID: 36834143 PMCID: PMC9961147 DOI: 10.3390/ijerph20043448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Osteoporosis is a progressive metabolic bone disorder characterised by a decline in bone mineral density (BMD). Some previous studies have reported a controversial relationship between uric acid and osteoporosis. This cross-sectional study aimed to assess the association between serum uric acid levels and BMD in older adults from Taiwan. Data from participants aged ≥ 60 years were collected from 2008 to 2018. Furthermore, the participants were classified based on uric acid level quartiles. Regression models were used to assess the association between uric acid levels and bone health, including BMD values and risk of at least osteopenia. Crude and adjusted models of potential confounders, including age, sex and body mass index (BMI), were used. Compared with the first quartile of uric acid levels, the odds ratios for osteoporosis decreased in the higher uric acid level groups after adjustment for age, sex and BMI. The boxplot analysis showed that BMD values were higher in the groups with higher uric acid levels; moreover, the results of the multivariable linear regression model showed a consistent pattern. Notably, uric acid levels were positively correlated with BMD values. Higher uric acid levels in the elderly population might decrease the risk of at least osteopenia. As opposed to the anti-hyperuricemic policy for younger adults with a relatively lower risk of osteoporosis, BMD evaluation and urate-lowering therapy, goal adjustments should be considered for older adults with lower uric acid levels.
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Affiliation(s)
- Pei-Ting Chung
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Hsiao-Chi Ma
- Department of Family Medicine, Mackay Memorial Hospital, Tamsui Branch, New Taipei City 251020, Taiwan
| | - Sin-Yi Huang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Hsin-Ning Lien
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Kuan-Hsun Ho
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Hsin-Yin Hsu
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100025, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 252005, Taiwan
| | - Hsin-Hui Lin
- Department of Family Medicine, Mackay Memorial Hospital, Tamsui Branch, New Taipei City 251020, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan
| | - Hsin-Lung Chan
- Department of Family Medicine, Mackay Memorial Hospital, Taipei 104217, Taiwan
- Department of Family Medicine, Mackay Memorial Hospital, Tamsui Branch, New Taipei City 251020, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan
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Chang JHY, Hwang LC, Tsou MT, Chang BCC. Association Between Premorbid Metabolic Syndrome and Coronary Arterial Stenosis: Results from One Medical Center in Taiwan. Metab Syndr Relat Disord 2023; 21:57-62. [PMID: 36383133 DOI: 10.1089/met.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Although the relationship between metabolic syndrome (MetS) and cardiovascular disease is already well-established, there is limited evidence as to whether individuals are at risk for cardiovascular disease during the premorbid state of MetS. The aim of this study is to explore the relationship between coronary arterial stenosis and MetS in a nonhypertensive and nondiabetic population. Methods: In this cross-sectional study, we analyzed the data of participants who underwent annual health checkups in a medical center. These data were collected from physical examination, blood tests, cardiac computed tomography examinations, and medical charts. We excluded those with established hypertension or diabetes and age of <50 or >75 years. Results: This study recruited 700 participants with a mean age of 59.5 years. More than 31% had MetS, and the overall prevalence of coronary arterial stenosis was 48.0% (grade 1, 2, 3, 4: 16.3%, 20.9%, 8.4%, 2.4%, respectively). In univariate analysis, older age, male sex, smoking, body mass index, elevated fasting plasma glucose (FPG), elevated triglyceride, lower level of high-density lipoprotein cholesterol, and presence of MetS were all positively correlated with coronary arterial stenosis. After adjustment for confounding factors, MetS still showed strong association with high grades of coronary arterial stenosis [odds ratio (OR) 2.86, confidence interval (95% CI) 1.30-4.01]. Specific components of MetS, such as elevated triglyceride [OR 2.02, 95% CI 1.14-3.57] and elevated FPG [OR 2.25, 95% CI 1.31-3.88], were also associated with coronary arterial stenosis. Conclusion: Our study concluded that premorbid MetS was significantly associated with coronary arterial stenosis. As for the individual components, elevated triglyceride and elevated FPG were both correlated with coronary arterial stenosis. Early preventive measures would be suggested at this stage of MetS to prevent future cardiovascular events.
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Affiliation(s)
- Jason Hong-Yi Chang
- Department of Medical Education and MacKay Memorial Hospital, Taipei City, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
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Lin MY, Shao HH, Tsou MT. Measles immunity in medical center staff after changes in national and local hospital vaccination policies. BMC Infect Dis 2022; 22:427. [PMID: 35509007 PMCID: PMC9066859 DOI: 10.1186/s12879-022-07419-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Measles vaccination was introduced in Taiwan in 1978, and the disease was declared eliminated in Taiwan in 2007. However, new cases have been reported unpredictably since then. Hospital medical staff are at particularly high risk for measles. We evaluated the immunity status of hospital medical staff after changes in national and local hospital vaccination policies. Methods This retrospective study was conducted in a tertiary care medical center from January 2008 to June 2018. Data were retrieved from all healthcare workers receiving employment medical examinations. Those with a full medical record including the geometrical mean titer (GMT) of anti-measles IgG were included. Age and sex differences in the GMT were analyzed by Student’s t-tests and Chi-squared tests. Univariate and multivariate logistic regression analysis were used to determine the odds of immunity. Results The IgG positive rate increased with age group (p < 0.001). Seropositive rates for the birth before 1977 and after 1978 groups were 94.8% and 70.2% (p < 0.001). The odds ratio was also significantly different between both cohorts (1.000 vs. 0.423, p = 0.002). Staff in the examination department showed the lowest positive percentage of 70.3% (95% CI: 66.9–73.7%), whereas staff in preventive and long-term care services disclosed the highest positive percentage of 83.2% (95% CI: 76.1–90.2%). Subgroups 2015, 2017, and 2018 (p = 0.046, 0.046, 0.049), after the vaccination booster policy was launched, showed significant increases in seropositivity. Conclusions Immunity efficacy is better in birth groups before 1977, which was highly related to natural infection before national policy launched. The policy of vaccination is an effective method, but medical staff attains inadequate protective antibody levels for maintenance of herd immunity. A pre-employment policy of screening a third booster vaccine of measles (or MMR) is recommended to lower the incidence of disease spreading and avoid outbreaks.
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Affiliation(s)
- Meng-Yu Lin
- Lienchiang County Hospital, Lienchiang County, Taiwan ROC
| | - Hsin-Hui Shao
- The Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan ROC
| | - Meng-Ting Tsou
- The Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan ROC. .,Nursing, and Management, Mackay Junior College of Medicine, Taipei City, Taiwan ROC.
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Tsou MT. Association of 5-item Brief Symptom Rating Scale scores and health status ratings with burnout among healthcare workers. Sci Rep 2022; 12:7122. [PMID: 35505224 PMCID: PMC9062289 DOI: 10.1038/s41598-022-11326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
This cross-sectional study evaluated and quantified the possible association of psychological symptoms and health status ratings on the burnout of healthcare workers from a tertiary medical center. Demographic data were obtained through a questionnaire survey. We evaluated their psychological symptoms using a 5-item Brief Symptom Rating Scale (BSRS-5) and burnout was measured using the Chinese version of the Maslach Burnout Inventory–Health Services Survey. The study began in Nov. 2018 and ended in Nov. 2020. A total of 2813 participants (men = 296, 10.5%; women = 2517, 89.5%) completed the questionnaires between December 2018 and March 2019. The response rate and complete rate were 71.7% and 93.2%. The multivariate analysis showed that, as the BSRS-5 level added, the odds ratio (OR) of burnout increased (BSRS-5 scores 6–9, 10–14, and 15–20; OR = 1.83, 3.23, and 9.15, separately; p value < 0.05). Overall, men (≥ 30 years of age) and women staffs with BSRS-5 scores ≥ 6; women with longer working hours (more than 46 h/week), men and women (≥ 30 years of age) working night shifts, and poor health status ratings were highly associated with burnout. The findings highlight the importance of screening for the BSRS-5 scores and health status ratings level for healthcare professionals at high risk of burnout, especially men ≥ 30 years of age and women with stressful working conditions.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan. .,Department of Occupation Medicine, Mackay Medical College, Taipei, Taiwan. .,Department of MacKay Junior College of Medicine, Nursing, and Management, New Taipei, Taiwan.
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7
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Tsai HJ, Tsou MT. Age, Sex, and Profession Difference Among Health Care Workers With Burnout and Metabolic Syndrome in Taiwan Tertiary Hospital-A Cross-Section Study. Front Med (Lausanne) 2022; 9:854403. [PMID: 35492349 PMCID: PMC9048413 DOI: 10.3389/fmed.2022.854403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background This cross-sectional study aimed to analyze the association between burnout, work-related factors and metabolic syndrome (MetS) among various health-care workers (HCWs) at a tertiary hospital in Taiwan. Methods Relevant demographic data were obtained through written questionnaires. Information about psychosocial and work conditions, including assigned department, working hours, shifts, and sleep condition, was obtained. Burnout was evaluated according to the Chinese version of Maslach Burnout Inventory-Health Services Survey. MetS was analyzed according to the criteria of the National Cholesterol Education Program of Taiwan-Treatment Panel for Adults III. Results A total of 1,055 non-doctor/nurse and 2,078 doctor/nurse staff with a median age of 45.2 and 36.1 years participated in this study. The incidence of burnout was nearly 6.42 and 6.68% and that of MetS was 31.4 and 13.5% in non-doctor/nurse and doctor/nurse staff, respectively. The results showed that burnout induced a higher Odds ratio (OR) of MetS in the doctor/nurse group (OR = 1.96, p = 0.01). Other factors, such as night shift and seniority (>10 years), led to a higher OR of MetS, but a decreased risk was observed based on seniority (2-4 years). Further, young female participants and young doctors/nurses with burnout had a higher OR of MetS compare to other groups (OR = 2.43 and 2.32, p < 0.05). Conclusion The study results suggested positive relationship between burnout and MetS in young female staffs and young doctors/nurses. For doctor/nurse staff with higher seniority or more night shifts, strategies are needed to prevent burnout and MetS.
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Affiliation(s)
- Huel-Ju Tsai
- Departments of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
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Tsou MT. Influence of Prolonged Visual Display Terminal Use on Physical and Mental Conditions among Health Care Workers at Tertiary Hospitals, Taiwan. Int J Environ Res Public Health 2022; 19:ijerph19073770. [PMID: 35409467 PMCID: PMC8998003 DOI: 10.3390/ijerph19073770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to examine the effects of prolonged VDT working time on physical and mental health disadvantages among health care workers (HCWs) in tertiary hospitals based on their work characteristics, age, and sex. Included in the study were 945 and 1868 participants in the non-doctor/nurse and doctor/nurse groups, respectively. The questionnaire included VDT usage-related information, the Nordic Musculoskeletal Questionnaire (NMQ), computer vision syndrome (CVS), perceived occupational stress, burnout, the Brief Symptom Rating Scale-5 (BSRS-5), and self-rated health (SRH). After adjustment, multiple logistical regression analysis revealed that the two groups showed that the longer the VDT working time, the higher the risk of muscle pain, severe headaches, severe job stress, and self-assessed bad sleep quality. This showed that the condition of the doctor/nurse group was more severe than that of the non-doctor/nurse group. According to the stratified analysis by sex and age, in the group of women under the age of 30, the adjusted odds ratio value of physical and mental conditions increased with longer VDT working time and was statistically significant. The result show that it is important to reduce daily VDT exposure for doctor, nurses, and women under 30.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan; or ; Tel.: +886-2-2543-3535 (ext. 2131/2132)
- Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City 25245, Taiwan
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Tsou MT, Chen JY. Gender-Based Association of Coronary Artery Calcification and Framingham Risk Score With Non-alcoholic Fatty Liver Disease and Abdominal Obesity in Taiwanese Adults, a Cross-Sectional Study. Front Cardiovasc Med 2022; 9:803967. [PMID: 35310993 PMCID: PMC8928543 DOI: 10.3389/fcvm.2022.803967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background It is not certain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity (AO) has stronger associations with atherosclerosis and coronary artery disease (CAD) risk across different genders. The purpose of this study was to determine the gender-based association of NAFLD and AO with subclinical atherosclerosis represented by coronary artery calcification (CAC) and CAD risk by Framingham risk score (FRS). Methods A total of 1,655 participants in a health-screening program (mean age: 49.44 years; males: 70.33%) were enrolled for analysis. Fatty liver and coronary artery calcium score (CACS) were measured via ultrasonography (US) and multi-detector computed tomography (MDCT). The presence of CAC was defined as having a CACS > 0, intermediate to high CAD risk was defined as FRS ≥ 10%, while the presence of AO was defined as having a waist circumference (WC) of ≥90 cm for men and ≥80 cm for women. Participants were categorized into four groups depending on the presence or absence of NAFLD and/or AO. Results The percentage of subjects with CACS > 0 was highest in the AO-only group (overall: 42.6%; men: 48.4%; women: 35.8%); and FRS ≥ 10% was highest in the group with both abnormalities (overall: 50.3%%; men: 57.3%; women: 32.4%). After adjustment factors, the odds ratio (OR) for CAC and FRS was the highest in the group with both abnormalities [men: 1.61 (1.13–2.30) for CACS > 0 and 5.86 (3.37–10.20) for FRS ≥ 10%; women: 2.17 (1.13–4.16) for CACS > 0 and 6.31 (2.08–19.10) for FRS ≥ 10%]. In men, the OR of NAFLD was higher than that of AO [1.37 (1.03–1.83) vs. 1.35 (1.02–1.79) for CACS > 0, 3.26 (2.13–4.98) vs. 2.97 (1.91–4.62) for FRS ≥ 10%]. However, women with AO consistently showed increased OR for CACS > 0 [1.87 (1.11–3.16)] and FRS ≥ 10% [4.77 (2.01–11.34)]. Conclusion The degree of association of NAFLD and AO with CAC and FRS depends on the gender. NAFLD is more closely associated with CACS > 0 and FRS ≥ 10% in men and AO in women, respectively. NAFLD and AO could be considered independent determinants of CAC and FRS by gender.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Occupation Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Mackay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang-Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Jau-Yuan Chen
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Chen JY, Chen YH, Lee YC, Tsou MT. The Association Between White Blood Cell Count and Insulin Resistance in Community-Dwelling Middle-Aged and Older Populations in Taiwan: A Community-Based Cross-Sectional Study. Front Med (Lausanne) 2022; 9:813222. [PMID: 35252251 PMCID: PMC8892182 DOI: 10.3389/fmed.2022.813222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/27/2022] [Indexed: 12/11/2022] Open
Abstract
BackgroundInsulin resistance (IR) is a major pathophysiological factor in the development and progression of diabetes mellitus (DM). DM is highly prevalent in Taiwan and has become one of the most common health problems in family medicine and primary care. We aimed to use white blood cell count (WBC), a common physiological parameter, to develop a simple clinical prediction rule for IR in the middle-aged and old Taiwanese population.MethodsIn this cross-sectional community-based study, the participants completed a questionnaire comprising personal and medical history data and underwent anthropometric measurements and blood sampling. IR was defined as a HOMA-IR index ≥2. Independent t-test, Mann–Whitney U test, chi-square test, Pearson's correlation test, multivariate binary logistic regression, and receiver operating characteristic curves were used to evaluate the association between the WBC count and IR.ResultsA total of 398 community-dwelling middle-aged and older persons (34.9% men) with a mean age of 64.43 ± 8.45 years were enrolled for the analysis. A significant association was identified between the WBC counts and IR, with a Pearson's correlation coefficient of 0.37 (p-value <0.001). Multivariate logistic regression revealed that WBC count (OR = 1.50; 95% CI = 1.25–1.81) was an independent risk factor for IR after adjusting for confounding variables. The area under the receiver operating characteristic curve for WBC count was 0.67, and the optimal threshold value was 5.65 1,000/uL.ConclusionA high WBC count is positively related to an increased risk of IR among middle-aged and older people in Taiwan.
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Affiliation(s)
- Jau-Yuan Chen
- Department of Family Medicine, Chang-Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hung Chen
- Department of Family Medicine, Chang-Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yu-Chien Lee
- Department of Family Medicine, Chang-Gung Memorial Hospital, Taoyuan City, Taiwan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Occupation Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
- *Correspondence: Meng-Ting Tsou
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Tsou MT. Gender Differences in Insomnia and Role of Work Characteristics and Family Responsibilities Among Healthcare Workers in Taiwanese Tertiary Hospitals. Front Psychiatry 2022; 13:831075. [PMID: 35573378 PMCID: PMC9099067 DOI: 10.3389/fpsyt.2022.831075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insomnia is common among healthcare workers (HCWs), especially those working in tertiary hospitals. This study aimed to clarify whether gender differences in insomnia could be explained by gender differences in work characteristics and family responsibilities among HCWs in tertiary hospitals in Taiwan. METHODS This cross-sectional study was conducted in 22 departments of two tertiary hospitals in Northern Taiwan from December 2018 to March 2019. All data were obtained by a self-administered questionnaire given when participants underwent annual health check-ups. Insomnia was evaluated using the Chinese Athens Insomnia Scale. Work characteristics and family responsibilities were as follows: department, working hours, shift work, visual display terminals used at work, demand-control-support model, burnout level, breadwinner status, living conditions, and caregiver status. Data of 2,811 participants (317 men, 11.3%; 2,494 women, 88.7%) were analyzed (response rate: men, 85%; women, 88%). Logistic regression analysis examined howwork characteristics and family responsibilities explained gender differences in insomnia. RESULTS The prevalence of insomnia in women (61.7%) was significantly higher than that in men (52.7%), and gender differences strengthened after adjusting for work characteristics and family responsibilities [odds ratio: 1.45 (1.11-1.90) and 1.62 (1.18-2.22), p < 0.01]. Stratified analyses revealed that significant gender differences were found among HCWs with comparatively unfavorable work and family conditions. Furthermore, women had a higher association of insomnia owing to these factors. CONCLUSION These results suggest that gender differences in insomnia among HCWs are mainly explained by gender differences in work characteristics and family responsibilities.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
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Lu MC, Chen IJ, Hsu LT, Chen YJ, Tsou MT, Tung TH, Chen JY. Metabolic Risk Factors Associated With Chronic Kidney Disease in a Middle-Aged and Elderly Taiwanese Population: A Cross-Sectional Study. Front Med (Lausanne) 2021; 8:748037. [PMID: 34869437 PMCID: PMC8635038 DOI: 10.3389/fmed.2021.748037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: This study aimed to quantify the proportion of participants with chronic kidney disease (CKD) and associated metabolic risk factors in a middle-aged and elderly population in Guishan District, Taoyuan City, Taiwan. Methods: This cross-sectional study enrolled residents aged 50–90 years living in one community. All participants received a standardized personal interview, including a structured questionnaire, anthropometric measurements, and blood samples collected for laboratory testing. CKD was defined as the presence of kidney damage (urine albumin-creatinine ratio ≥30 mg/g) or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multiple logistic regression models were used to evaluate the risk factors associated with CKD. Results: A total of 400 participants were enrolled. The overall proportion of participants with CKD was 20.5% (95% confidence interval [CI]: 16.54–24.46%). The proportions of participants with CKD among those aged 50–64, 65–74, and 75 years and over were 17.7, 18.8, and 35.7%, respectively (p = 0.01). Multiple logistic regression model revealed that elevated blood pressure (odds ratio [OR] = 2.23, 95% CI: 1.16–4.30), hyperglycemia (OR = 2.87, 95% CI: 1.64–5.00), hyperuricemia (OR = 1.38, 95% CI: 1.14–1.69), and metabolic syndrome (OR = 2.30, 95% CI: 1.31–4.06) were significantly associated with CKD. Conclusions: The prevalence of CKD in the study population was high. Hypertension, hyperglycemia, hyperuricemia, and metabolic syndrome are significantly associated with CKD in a middle-aged and elderly population in Taiwan.
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Affiliation(s)
- Mei-Chun Lu
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - I-Ju Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Le-Tien Hsu
- Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ying-Jen Chen
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine and Occupation Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Nursing, and Management, MacKay Junior College of Medicine, Taipei City, Taiwan
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Tsou MT, Chang YC, Hsu CP, Kuo YC, Yun CH, Huang WH, Hu KC, Liu CY, Chen YJ, Sung KT, Liu CC, Hung CL, Kuo JY, Chen TY, Hung TC, Yeh HI. Visceral adiposity index outperforms conventional anthropometric assessments as predictor of diabetes mellitus in elderly Chinese: a population-based study. Nutr Metab (Lond) 2021; 18:87. [PMID: 34563209 PMCID: PMC8465784 DOI: 10.1186/s12986-021-00608-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background This study assessed the performance of visceral adiposity index and body shape index in predicting diabetes mellitus (DM) risk and compared their predictive ability to that of body mass index and waist circumference. Methods Among 8249 consecutive subjects who attended the Nationwide Health Check Up System for Senior Citizens (≥ 65 years) between 2008 and 2018, we examined the associations of several adiposity indices with DM risk and explored gender differences. Results Among all adiposity indicators, Chinese visceral adiposity index (CVAI) demonstrated the highest discriminatory ability for diabetes mellitus with area under receiver operating characteristic curves (AUC) of 0.65, 0.68, and 0.66 for men, women, and all participants, respectively, and optimal cut-offs set as 126.09 in men and 117.77 in women. Compared with body shape index (ABSI), both CVAI and VAI were strongly associated with baseline DM (adjusted OR: 4.85, 95% CI: 4.05–5.82 and 4.22, 95% CI: 3.53–5.05 for 4th vs 1st quartile groups by CVAI and VAI, P < 0.001), which was more pronounced in older adult women (Pinteraction < 0.05). Over a median of 5.25 years (IQR: 3.07–6.44 years) follow-up, Cox regression models showed higher predictive ability of CVAI and VAI compared to ABSI. Further, both CVAI and VAI independently predicted new-onset DM (adjusted HR: 1.29, 95% CI: 1.22–1.37 and 1.16, 95% CI: 1.11–1.21 by CVAI and VAI) and composite endpoint of new DM and death among those without baseline DM.
Conclusions Our population-based data demonstrated that Chinese visceral adiposity index may serve as a superior clinical indicator of diabetes when compared with conventional anthropometric indices among older adult Chinese, especially in women. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00608-6.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,MacMacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan, ROC
| | - Yu-Chen Chang
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Health Evaluation Center, MacKay Memorial Hospital, New Taipei City, 25245, Taiwan, ROC
| | - Ching-Ping Hsu
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Health Evaluation Center, MacKay Memorial Hospital, New Taipei City, 25245, Taiwan, ROC
| | - Yang-Che Kuo
- Department of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC.,Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,MacMacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan, ROC
| | - Wei-Hsin Huang
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC
| | - Kuang-Chun Hu
- Department of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Chia-Yuan Liu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Ying-Ju Chen
- Department of Telehealth, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Kuo-Tzu Sung
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| | - Chuan-Chuan Liu
- Department of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| | - Jen-Yuan Kuo
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| | - Tung-Ying Chen
- Department of Pathology, MacKay Memorial Hospital, 92, Sec 2, Chung Shan North Road, Taipei, 10449, Taiwan, ROC.
| | - Ta-Chuan Hung
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC. .,MacMacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan, ROC. .,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC.
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
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Ou Yang WY, Lai CC, Tsou MT, Hwang LC. Development of Machine Learning Models for Prediction of Osteoporosis from Clinical Health Examination Data. Int J Environ Res Public Health 2021; 18:ijerph18147635. [PMID: 34300086 PMCID: PMC8305021 DOI: 10.3390/ijerph18147635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/04/2023]
Abstract
Osteoporosis is treatable but often overlooked in clinical practice. We aimed to construct prediction models with machine learning algorithms to serve as screening tools for osteoporosis in adults over fifty years old. Additionally, we also compared the performance of newly developed models with traditional prediction models. Data were acquired from community-dwelling participants enrolled in health checkup programs at a medical center in Taiwan. A total of 3053 men and 2929 women were included. Models were constructed for men and women separately with artificial neural network (ANN), support vector machine (SVM), random forest (RF), k-nearest neighbor (KNN), and logistic regression (LoR) to predict the presence of osteoporosis. Area under receiver operating characteristic curve (AUROC) was used to compare the performance of the models. We achieved AUROC of 0.837, 0.840, 0.843, 0.821, 0.827 in men, and 0.781, 0.807, 0.811, 0.767, 0.772 in women, for ANN, SVM, RF, KNN, and LoR models, respectively. The ANN, SVM, RF, and LoR models in men, and the ANN, SVM, and RF models in women performed significantly better than the traditional Osteoporosis Self-Assessment Tool for Asians (OSTA) model. We have demonstrated that machine learning algorithms improve the performance of screening for osteoporosis. By incorporating the models in clinical practice, patients could potentially benefit from earlier diagnosis and treatment of osteoporosis.
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Affiliation(s)
- Wen-Yu Ou Yang
- Department of Neurology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan;
| | - Cheng-Chien Lai
- Department of Medicine, Taipei Veterans General Hospital, Taipei City 11217, Taiwan;
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City 10491, Taiwan;
- Mackay Junior College of Medicine, Nursing and Management, Taipei City 11260, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City 10491, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Correspondence:
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Abstract
Context From previous studies, decreased thermogenesis and metabolic rate in the patients with overt and subclinical hypothyroidism lead to an increase in visceral adipose tissue (VAT) incidence, and which was associated with cardiovascular diseases. In this paper, we want to explore the relationship between various forms of VAT [pericardial (PCF), and thoracic periaortic adipose tissue (TAT)] and obesity indices [body shape index (ABSI), and body roundness index (BRI), Chinese visceral adiposity index (CVAI)] with subclinical hypothyroidism by gender. Objective This study aims to evaluate region-specific cardiovascular (CV) fat tissue (pericardial fat [PCF] and thoracic periaortic fat [TAT) and noninvasive visceral adipose indices (a body shape index [ABSI], body roundness index [BRI]), and Chinese visceral adiposity index [CVAI]) in patients with subclinical hypothyroidism (SCH) as compared to a control population and relative to variations in CV risk. Methods A total of 125 Taiwanese patients recently diagnosed with SCH (age: 52.9 ± 10.16 years, 41.6% female) and 1519 healthy volunteers (age: 49.54 ± 9.77 years, 29.0% female) were evaluated for this study. All participants underwent PCF and TAT assessment using a multidetector computed tomography scanner, ABSI, BRI, and CVAI evaluation using a mathematical formula. CV risk was classified by Framingham risk score (FRS). Results Multivariable logistic regression models showed that the independent association of TAT and BRI with SCH were stronger in women than men. The adjusted model associations (odds ratio [OR]; 95% CI) with SCH for TAT and BRI in women were 2.61 (95% CI, 1.03-6.97) and 2.04 (95% CI, 1.07-3.92). The incidences of TAT and BRI third tertile were also higher in women with SCH (SCH vs euthyroid, TAT third tertile, 9 [17.3%] vs 35 [7.9%], P = .04; BRI third tertile, 22 [42.3%] vs 111 [25.2%], P = .01). In addition to BRI and TAT, there were higher risks of CVAI in SCH with intermediate/high FRS, especially in women (OR; 95% CI, TAT: 4.01; 95% CI, 1.01-6.640; BRI: 6.91; 95% CI, 1.03-10.23; CVAI: 7.81 95% CI, 1.01-12.03). Conclusion Our findings show that patients with SCH have significantly greater TAT, BRI, and CVAI values than control groups, especially in women (with different FRS).
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan, ROC.,Department of Occupation Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan, ROC.,Department of Medicine, Nursing, and Management, MacKay Junior College, New Taipei 25245, Taiwan, ROC
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Lee YS, Hwang LC, Hsu HY, Tsou MT. The Association Between Different Obesity Phenotypes and Liver Fibrosis Scores in Elderly Individuals with Fatty Liver in Taiwan. Diabetes Metab Syndr Obes 2021; 14:1473-1483. [PMID: 33833538 PMCID: PMC8019606 DOI: 10.2147/dmso.s302207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/11/2021] [Indexed: 04/14/2023] Open
Abstract
PURPOSE To examine the association between different phenotypes of obesity or metabolic syndromes and liver fibrosis score in a Taiwanese elderly population with fatty liver. PATIENTS AND METHODS This cross-sectional study included 1817 participants aged ≥65 years with fatty liver diagnosed by sonography. We used ethnicity-specific criteria for body mass index and metabolic syndrome, and to define obesity phenotypes as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Correlated fibrosis severity was calculated using the nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and Fibrosis-4 (FIB-4). Fibrosis severity was divided into two categories according to NFS (no-to-mild fibrosis and advanced fibrosis, defined as NFS ≤ 0.676 and >0.676, respectively) and FIB-4 score (no-to-mild fibrosis and advanced fibrosis, defined as FIB-4 score ≤2.67 and >2.67, respectively). RESULTS Compared with that in the MHNO group, the associated risk (odds ratio [OR], 95% confidence interval [CI]) of advanced fibrosis by NFS was 2.43 (1.50-3.93), 2.35 (1.25-4.41), and 6.11 (3.90-9.59), whereas that of advanced fibrosis by FIB-4 score was 1.34 (0.83-2.18), 2.37 (1.36-4.13), and 1.38 (0.82-2.31) in the MUNO, MHO, and MUO groups, respectively. CONCLUSION Both metabolic syndrome and obesity were positively associated with more advanced fibrosis according to NFS. The detrimental effect of obesity appears to be more than metabolic abnormalities per se in the elderly with more advanced fibrosis severity according to the FIB-4 score.
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Affiliation(s)
- Yu-Shan Lee
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hsin-Yin Hsu
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Correspondence: Meng-Ting Tsou Department of Family Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Road, Taipei City, 10449, Taiwan, R.O.C.Tel +886 2 2543 3535 (Ext. 2131 or 2132)Fax +886 2 2543 3642 Email
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Chen IJ, Hsu LT, Lu MC, Chen YJ, Tsou MT, Chen JY. Gender Differences in the Association Between Obesity Indices and Chronic Kidney Disease Among Middle-Aged and Elderly Taiwanese Population: A Community-Based Cross-Sectional Study. Front Endocrinol (Lausanne) 2021; 12:737586. [PMID: 34966356 PMCID: PMC8710780 DOI: 10.3389/fendo.2021.737586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditional risk factors for chronic kidney disease (CKD) include diabetes mellitus (DM), hypertension (HTN), and metabolic syndrome, which are health conditions related to obesity. We aimed to investigate which of the three obesity indices has the strongest association with CKD and to explore whether there are gender differences in these relationships in the middle-aged and elderly Taiwanese population. METHODS This was a cross-sectional, community-based study. It included 400 residents (141 males and 259 females, age 50-90 years) residing in a community in northern Taiwan. Each participant was asked to fill a questionnaire that collected personal information, medical history, medication use, and anthropometric measurements. The laboratory data were obtained by testing the blood and urine samples. The baseline characteristics were compared, and the obesity indices included body mass index (BMI), waist circumference (WC), and visceral adiposity index (VAI). CKD was defined as the presence of renal dysfunction (urine albumin-creatinine ratio ≥ 30 mg/g) or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. We used a multiple logistic regression model to evaluate the association between each obesity index and CKD for both genders. Further, we used the area under the receiver operating characteristic (ROC) curve (AUC) to examine the best obesity indices to predict CKD in different genders. RESULTS The average age of the subjects was 64.47 ± 8.45 years, and men were significantly older. CKD was found in 31 (22.0%) males and 50 (19.3%) females. In men, there was no significant difference between the CKD and non-CKD groups among the three obesity indices. However, in women, only VAI was significantly higher in subjects with CKD (1.9 [1.1, 3.4]) than in subjects without CKD (1.5 [1.0, 2.2]) (p-value = 0.03). The multivariate logistic regression revealed that even after adjusting for possible confounding factors, VAI was found to be an independent risk factor for CKD in women (OR: 1.32, 95% CI: 1.04-1.69, p = 0.02), but not in men (OR: 1.20, 95% CI: 0.85-1.69, p = 0.30). The AUC of VAI had a significant ability to predict CKD in women but not in men. CONCLUSION Our results showed that among the three obesity indices, VAI had the strongest association with CKD compared to BMI and WC in women. In addition, VAI in women should be given more importance in the screening for CKD among the middle-aged and elderly Taiwanese population.
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Affiliation(s)
- I-Ju Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Le-Tien Hsu
- Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Mei-Chun Lu
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ying-Jen Chen
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine and Occupation Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of Nursing, and Management, MacKay Junior College of Medicine, New Taipei City, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- *Correspondence: Jau-Yuan Chen,
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Tsou MT, Yun CH, Lin JL, Sung KT, Tsai JP, Huang WH, Liu CY, Hou CJY, Tsai IH, Su CH, Hung CL, Hung TC. Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype. Diagnostics (Basel) 2020; 11:diagnostics11010040. [PMID: 33383705 PMCID: PMC7824214 DOI: 10.3390/diagnostics11010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022] Open
Abstract
The debate regarding the actual cardiovascular burden in metabolically healthy obese or metabolically unhealthy non-obesity individuals is ongoing. Accumulating data have suggested a unique pathophysiological role of pro-inflammatory cytokines in mediating metabolic and cardiovascular disorders by dysregulated visceral adiposity. To compare the burden of visceral adiposity, the inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and the prevalent atherosclerotic burden in metabolically healthy obese (MHO) or metabolically unhealthy (MU) populations, were compared to those of metabolically healthy non-obesity subjects (MHNO). Coronary artery calcification score (CACS) and visceral fat, including pericardial fat (PCF)/thoracic peri-aortic fat (TAT), were quantified in 2846 asymptomatic subjects using a CT dataset. A cross-sectional analysis comparing CACS, inflammatory marker hs-CRP, and visceral fat burden among four obesity phenotypes (MHNO, metabolically unhealthy non-obesity (MUNO), MHO, and metabolically unhealthy obese (MUO)) was performed. Both MUNO and MUO demonstrated significantly higher hs-CRP and greater CACS than MHNO/MHO (adjusted coefficient: 25.46, 95% confidence interval (CI): 5.29–45.63; 43.55, 95% CI: 23.38–63.73 for MUNO and MUO (MHNO as reference); both p < 0.05). Visceral fat (PCF/TAT) was an independent determinant of MU and was similarly higher in the MUNO/MHO groups than in the MHNO group, with the MUO group having the largest amount. PCF/TAT, obesity, and MU remained significantly associated with higher CACS even after adjustment, with larger PCF/TAT modified effects for MU and diabetes in CACS (both pinteraction < 0.05). MU tightly linked to excessive visceral adiposity was a strong and independent risk factor for coronary atherosclerosis even in lean individuals, which could be partially explained by its coalignment with pathological pro-inflammatory signaling.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, New Taipei 25245, Taiwan
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Jui-Peng Tsai
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Chia-Yuan Liu
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - I.-Hsien Tsai
- Nutritional Medicine Center, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei 25245, Taiwan
- Correspondence: (C.-L.H.); (T.-C.H.); Tel.: +886-2-2543-3535 (C.-L.H. & T.-C.H.); Fax: +886-2-2543-3642 (C.-L.H. & T.-C.H.)
| | - Ta-Chuan Hung
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, New Taipei 25245, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Correspondence: (C.-L.H.); (T.-C.H.); Tel.: +886-2-2543-3535 (C.-L.H. & T.-C.H.); Fax: +886-2-2543-3642 (C.-L.H. & T.-C.H.)
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Chou HH, Tsou MT, Hwang LC. Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison. BMC Geriatr 2020; 20:60. [PMID: 32059646 PMCID: PMC7023686 DOI: 10.1186/s12877-020-1464-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing; however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). METHODS Data from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates. RESULTS A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. One-year mortality rates in the AHF and NGF groups were 8 and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58-9.70). There were no significant differences in hospitalization rate and duration. CONCLUSIONS For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.
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Affiliation(s)
- Hsiao-Hui Chou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan. .,Department of Medicine, Mackay Medical College, Taipei, Taiwan.
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Lin CJ, Chang YC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Factors associated with hospitalization for community-acquired pneumonia in home health care patients in Taiwan. Aging Clin Exp Res 2020; 32:149-155. [PMID: 30877643 PMCID: PMC6974528 DOI: 10.1007/s40520-019-01169-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
Background Pneumonia is a leading cause of hospitalization and death worldwide. However, studies focusing on risk factors of community-acquired pneumonia (CAP) in the home health care (HHC) population remain scarce. Aims This study aimed to evaluate risk factors associated with hospitalization for CAP among HHC patients in Taiwan. Methods This retrospective cross-sectional study extracted data from patients’ electronic medical records between 1 January 2017 and 31 December 2017. Multiple logistic regression analyses were performed to explore factors associated with hospitalization for CAP. Results In total, 598 patients (men/women: 236/362) were included. One hundred ninety-nine patients (33.28%) were hospitalized for pneumonia. Inpatients showed a higher proportion of the following: male sex, functional impairment, hypoalbuminemia, anemia, nasogastric tube use, excessive polypharmacy, stroke, dementia, heart failure, chronic respiratory disease, and chronic liver disease. Furthermore, nasogastric tube use (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.88–4.82), anemia (OR 2.37, 95% CI 1.48–3.80), male sex (OR 2.14, 95% CI 1.43–3.20), chronic respiratory disease (OR 2.09, 95% CI 1.33–3.30), dementia (OR 1.94, 95% CI 1.27–2.97), heart failure (OR 1.69, 95% CI 1.11–2.56), and hypoalbuminemia (OR 1.57, 95% CI 1.03–2.40) significantly increased the risk of hospitalization for CAP. Conclusions Our results revealed risk factors associated with hospitalization for CAP in HHC patients. In addition to chronic diseases, malnutrition is an important risk factor. Caregivers should make prompt assessments and take preventive measures for such patients.
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Hung MC, Chen CF, Tsou MT, Lin HH, Hwang LC, Hsu CP. Relationship Between Gallstone Disease and Cardiometabolic Risk Factors in Elderly People with Non-Alcoholic Fatty Liver Disease. Diabetes Metab Syndr Obes 2020; 13:3579-3585. [PMID: 33116709 PMCID: PMC7553650 DOI: 10.2147/dmso.s266947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prevalence of gallstone disease (GSD) increases with age, and the elderly have a much higher mortality risk and incidence of surgical comorbidities. The aim of this study was to explore the relationship between GSD and cardiometabolic risk factors in elderly people with non-alcoholic fatty liver disease (NAFLD). METHODS In this cross-sectional study, we analyzed the data of elderly people who underwent annual health check-ups at a Northern Taiwan health examination center. These data were collected from physical examination, blood tests, abdominal ultrasonography, and medical histories. We excluded those with hepatitis B or C infections, heavy alcohol consumption, or cholecystectomy. RESULTS The analysis included 3,037 participants with a mean age of 73.6±6.0 years. Over 70% were overweight or obese, and the overall prevalence of GSD was 17.7%. In our univariate analysis, GSD was positively correlated with age, body mass index, metabolic syndrome, diabetes mellitus (DM), hypertension (HTN), and various metabolic factors (fasting plasma glucose [FPG], triglyceride, uric acid, and high-density lipoprotein cholesterol [HDL-C] levels). After adjustment for age, gender, and body mass index, metabolic syndrome showed a positive association with GSD (odds ratio [OR] 1.31 [95% confidence interval [CI], 1.05-1.64]; P=0.020). Specific components of metabolic syndrome that increased the risk for GSD in NAFLD elderly include lower levels of HDL-C (OR 1.35 [95% CI, 1.10-1.66]; P<0.001) and elevated FPG (OR 1.36 [95% CI, 1.10-1.69]; P<0.001). CONCLUSION Our study concluded that GSD is significantly associated with metabolic syndrome in elderly people with NAFLD. Reduced HDL-C and elevated FPG both heighten the risk of developing GSD. Therefore, to lower the risk of GSD in NAFLD patients, their FPG levels and HDL-C levels must be regularly followed-up, and these patients should be educated about the symptoms of GSD if they meet the criteria for metabolic syndrome.
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Affiliation(s)
- Man-Chen Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chuen-Fei Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsin-Hui Lin
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lee-Ching Hwang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ching-Ping Hsu
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Correspondence: Ching-Ping Hsu Department of Family Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Road, Zhongshan District, Taipei City104, TaiwanTel +886-2-25433535Fax +886-2-25213847 Email
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Tsou MT, Shao HH. Varicella Seroprevalence in Healthcare Workers at a Medical Center Following Changes in National and Local Hospital Vaccination Policies. Int J Environ Res Public Health 2019; 16:ijerph16193544. [PMID: 31546692 PMCID: PMC6801610 DOI: 10.3390/ijerph16193544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Varicella seroprevalence in healthcare workers at a tertiary care hospital in Taiwan was assessed following the inclusion of varicella zoster vaccination in the national vaccination schedule in 2004 and was made a hospital policy in 2008. METHODS Seroprevalence data were extracted from records of pre-employment health check-ups performed between 2008 and 2018 at a single medical center. Staff with complete medical records and anti-varicella zoster virus immunoglobulin G (VZV IgG) titers were included. Sex and age group differences in terms of geometric mean titer (GMT) were compared using analysis of variance and chi-squared tests. The significance of the correlation between age and the anti-VZV IgG titer was tested by linear regression. The odds of significant associations among age, sex, vocation, and the years of national and hospital adoption of vaccination were determined using univariate and multivariate analyses. p < 0.05 was considered statistically significant. RESULTS Of the 7314 eligible participants, 5625 (76.90%) were women, and the mean patient age was 26.80 ± 8.00 years. The lowest VZV-positivity rates were in 18-20-year-old women (85.16%; GMT, 362.89 mIU/mL) and men (87.59%; GMT, 288.07 mIU/mL). VZV positivity increased with age (p < 0.001). Participants born before 2002 were more likely to be seropositive than those born after 2003 (odds ratio, 2.51 vs. 1.0; p < 0.001). The lowest seropositive rate was found in the nursing staff (88.91%; 95% confidence interval, 87.74%-90.05%). Varicella vaccine boosters have been required at pre-employment health check-ups since 2008 if anti-VZV antibodies were not detectable. A follow-up evaluation found marginal significant differences in the odds ratios of seropositivity after 2007 (p = 0.052), especially in 2008 and 2014 (p < 0.05) after the hospital policy launched. CONCLUSIONS Despite public health efforts, a small number of healthcare workers were inadequately protected, and antibody titers were lower than required to maintain herd immunity. For effective prevention of nosocomial infection, VZV IgG status should be documented for all HCWs, and susceptible HCWs should be vaccinated to avoid outbreaks. Pre-employment screening and vaccination have increased immunity and need to be conducted to ensure protection of vulnerable patients.
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Affiliation(s)
- Meng-Ting Tsou
- The Department of Family Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan.
| | - Hsin-Hui Shao
- The Department of Family Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan.
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Shih WY, Chang CC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Incidence and Risk Factors for Urinary Tract Infection in an Elder Home Care Population in Taiwan: A Retrospective Cohort Study. Int J Environ Res Public Health 2019; 16:ijerph16040566. [PMID: 30781460 PMCID: PMC6406410 DOI: 10.3390/ijerph16040566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
Abstract
Urinary tract infection (UTI) is a common infection worldwide. Numerous studies have demonstrated risk factors for UTI in facilities and communities. In this study, we aimed to identify risk factors for UTI in home care patients. Patients who received home care for at least three months in 2017 were included. A UTI episode was defined by admission for UTI treatment, and/or a visit to an outpatient department for UTI and receiving antibiotic prescription. A total of 598 patients aged 81.9 years were included. Overall 47% (281) had at least one UTI episode. After analysis, urinary catheter indwelling was the most important risk factor (odds ratio (OR), 3.21). Underlying diseases (coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM)) were related to UTI with OR ranging from 1.46 to 1.79. Higher Alb (albumin) (OR 0.68) and Hb (hemoglobin) (OR 0.91) were inversely related to UTI. Polypharmacy (OR 1.84) and lower Barthel index scores (OR 1.62) were also related to UTI by different degrees. In conclusion, apart from the unmodifiable factors, avoiding prolonged urinary catheter placement, unnecessary prescriptions, and keeping good nutritional status may help to prevent UTI in home care patients.
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Affiliation(s)
- Wei-Yi Shih
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Chia-Chen Chang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Hsin-Lung Chan
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Ying-Ju Chen
- Telehealth and Home Care Center, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Lee-Ching Hwang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
- Department of Medicine, MacKay Medical College No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
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Tsou MT. Healthcare Service Utilization and Associated Factors in Community-Dwelling Elderly in Northern Taiwan: One Medical Center's Experience. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chen YJ, Tsou MT, Hung CL, Chang WL, Liao PH. Predicting Long-Term Mortality with Biomarkers Level for Homecare Patients. Stud Health Technol Inform 2018; 250:269. [PMID: 29857461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Electronic health record (EHR) systems have been used widely in research. However, most of the EHRs are highly dimensional and it is challenging to analyze such large data set. Bioinformatics is an interdisciplinary science with a focus on data management and interpretation for complex biological phenomena. We investigated biomarkers of nutrition from 3001 patients. Multivariate-adjusted hazard ratios of mortality were calculated according to both albumin and sodium levels. We explore the association of aging predicted by all-cause mortality in future.
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Affiliation(s)
- Ying-Ju Chen
- School of Nursing National, Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Meng-Ting Tsou
- Division of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Wen-Ling Chang
- Telehealth Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Pei-Hung Liao
- School of Nursing, National Taipei University of Nursing and Health Sciences , Taipei, Taiwan
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Tsou MT. Association of Education, Health Behaviors, Concerns, and Knowledge with Metabolic Syndrome among Urban Elderly in One Medical Center in Taiwan. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tsou MT, Chang BCC, Huang WH, Hsu CP. Prevalence of Metabolic Syndrome and Risk Factor Analysis Among Urban Elderly in One Medical Center in Northern Taiwan. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2013.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hsu CP, Chen HW, Lee SY, Tsou MT. Knowledge and Attitude toward Hospice Palliative Care among Community-Dwelling Aged Taiwanese—Analysis of Related Factors. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2012.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
OBJECTIVES To examine the long term effects of low birth weight on academic achievements in twins and singletons and to determine whether the academic achievement of twins in early adulthood is inferior to that of singletons. DESIGN Cohort study. SETTING Taiwanese nationwide register of academic outcome. PARTICIPANTS A cohort of 218 972 singletons and 1687 twins born in Taiwan, 1983-5. MAIN OUTCOME MEASURE College attendance and test scores in the college joint entrance examinations. RESULTS After adjustment for birth weight, gestational age, birth order, and sex and the sociodemographic characteristics of the parents, twins were found to have significantly lower mean test scores than singletons in Chinese, mathematics, and natural science, as well as a 2.2% lower probability of attending college. Low birthweight twins had an 8.5% lower probability of college attendance than normal weight twins, while low birthweight singletons had only a 3.2% lower probability. The negative effects of low birth weight on the test scores in English and mathematics were substantially greater for twins than for singletons. The twin pair analysis showed that the association between birth weight and academic achievement scores, which existed for opposite sex twin pairs, was not discernible for same sex twin pairs, indicating that birth weight might partly reflect other underlying genetic variations. CONCLUSIONS These data support the proposition that twins perform less well academically than singletons. Low birth weight has a negative association with subsequent academic achievement in early adulthood, with the effect being stronger for twins than for singletons. The association between birth weight and academic performance might be partly attributable to genetic factors.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taiwan
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Abstract
The use of somato-visceral regulation has been proposed as a treatment for a wide range of diseases. The aim of this study was to test the hypothesis that through somato-visceral regulation, ischemia-reperfusion (I/R) injury to the myocardium can be avoided by electroacupuncture (EA) on PC6 (Neiguan). Electroacupuncture on PC6 (Neiguan) was brought about by the application of metal needles over the bilateral median nerve at a point 1.5 cm proximal to the palm crease in male Spraque-Dawley rats. The animals were randomized into two groups: (1) prevention group with preconditioning by the application of EA on PC6 (n = 13); and (2) treatment group with EA on PC6 during I/R injury (n = 10). The protection against myocardial injury was blocked by different mechanisms: (1) severing of the bilateral median nerve (n = 10), (2) bilateral vagotomy (n = 10), and (3) intravenous naloxone injection (n = 10). The hemodynamic parameters (mean artery pressure and heart rate), duration of arrhythmia, mortality rate and cardiac enzymes were evaluated in these groups. The results showed that there were significant reductions in cardiac enzymes, the duration of arrhythmia and mortality rate in rats that were either preconditioned or treated with EA on PC6, compared with those that did not undergo EA on PC6 (P < 0.05). The cardioprotective effects were blocked by different procedures (P > 0.05). We conclude that EA on bilateral PC6 (Neiguan) prevents and attenuates I/R injury to the heart, and that this approach may provide an applicable and preventative alternative for patients with ischemic heart disease.
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Affiliation(s)
- Meng-Ting Tsou
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
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Tsou MT, Ho JY, Lin CH, Chiu JH. Proteomic analysis finds different myocardial protective mechanisms for median nerve stimulation by electroacupuncture and by local somatothermal stimulation. Int J Mol Med 2005. [PMID: 15375581 DOI: 10.3892/ijmm.14.4.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ischemia-reperfusion (I/R) injury of the heart can be attenuated by application of median nerve stimulation (MNS) through either electroacupuncture (EA) or local somatothermal stimulation (LSTS). This study is aimed to investigate the differences of myocardial protein expression between MNS by EA and by LSTS. Twenty-four male Sprague-Dawley rats were randomly allocated to 8 groups. In MNS by EA groups, animals were EA-stimulated for 30 min and the hearts were taken for proteomics analysis at an interval of 0 min (group 1), 30 min (group 2), 60 min (group 3) and control group (group 4); whereas in MNS by LSTS groups, following 1 dose (group 5), 2 doses (group 6), 3 doses (group 7) and control group (group 8) of LSTS, the hearts were taken for proteomics analysis. Myocardial protein expression profiles were analyzed and validated by Western blot analysis. Finally, the biological responses were also evaluated. The results showed that either MNS by EA followed by a 30-min rest period (group 2) and by 3 doses of LSTS (group 7) had cardioprotective effect against I/R injury. However, the myocardial protein expression profiles are quite different between the above-mentioned groups. We conclude that MNS by either EA or LSTS attenuates I/R injury in rat hearts through different protective mechanisms and that EA and LSTS might provide an alternative treatment strategy for ischemic heart disease.
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Affiliation(s)
- Meng-Ting Tsou
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No. 155 Li-Nong Street Section 2, Taipei 112, Taiwan, R.O.C
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Tsou MT, Ho JY, Lin CH, Chiu JH. Proteomic analysis finds different myocardial protective mechanisms for median nerve stimulation by electroacupuncture and by local somatothermal stimulation. Int J Mol Med 2004; 14:553-63. [PMID: 15375581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Ischemia-reperfusion (I/R) injury of the heart can be attenuated by application of median nerve stimulation (MNS) through either electroacupuncture (EA) or local somatothermal stimulation (LSTS). This study is aimed to investigate the differences of myocardial protein expression between MNS by EA and by LSTS. Twenty-four male Sprague-Dawley rats were randomly allocated to 8 groups. In MNS by EA groups, animals were EA-stimulated for 30 min and the hearts were taken for proteomics analysis at an interval of 0 min (group 1), 30 min (group 2), 60 min (group 3) and control group (group 4); whereas in MNS by LSTS groups, following 1 dose (group 5), 2 doses (group 6), 3 doses (group 7) and control group (group 8) of LSTS, the hearts were taken for proteomics analysis. Myocardial protein expression profiles were analyzed and validated by Western blot analysis. Finally, the biological responses were also evaluated. The results showed that either MNS by EA followed by a 30-min rest period (group 2) and by 3 doses of LSTS (group 7) had cardioprotective effect against I/R injury. However, the myocardial protein expression profiles are quite different between the above-mentioned groups. We conclude that MNS by either EA or LSTS attenuates I/R injury in rat hearts through different protective mechanisms and that EA and LSTS might provide an alternative treatment strategy for ischemic heart disease.
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Affiliation(s)
- Meng-Ting Tsou
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No. 155 Li-Nong Street Section 2, Taipei 112, Taiwan, R.O.C
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Chiu JH, Tsou MT, Tung HH, Tai CH, Tsai SK, Chih CL, Lin JG, Wu CW. Preconditioned somatothermal stimulation on median nerve territory increases myocardial heat shock protein 70 and protects rat hearts against ischemia-reperfusion injury. J Thorac Cardiovasc Surg 2003; 125:678-85. [PMID: 12658212 DOI: 10.1067/mtc.2003.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was designed to test the hypotheses that local somatothermal stimulation on the left median nerve territory increases myocardial heat shock protein 70 and that preconditioning of rats with local somatothermal stimulation protects the hearts against subsequent ischemia-reperfusion injury. METHODS Local somatothermal stimulation was brought about by means of application of a heating rod over and above the left median nerve territory (1.5 cm proximal to the palm crease) in male Sprague-Dawley rats. After rats were treated with local somatothermal stimulation, the gene expression of heat shock protein 70 in regional muscle, heart, and liver was assessed by means of Western blotting and reverse transcription-polymerase chain reaction. In addition, durations of arrhythmia, mortality rates, and mitochondrial functions were compared between groups preconditioned with or without local somatothermal stimulation followed by subsequent myocardial ischemia-reperfusion injury. RESULTS The results showed that the gene expression of heat shock protein 70 was upregulated in the muscle beneath the area of local somatothermal stimulation, as well as in the heart, although not in the liver. When animals were preconditioned with local somatothermal stimulation on the left median nerve territory followed by subsequent ischemia-reperfusion injury of the heart, there were significant decreases of creatine kinase level from the heart, duration of arrhythmia, mortality rate, and improved mitochondrial respiratory function compared with that seen in those without local somatothermal stimulation preconditioning. CONCLUSION We conclude that local heat stress preconditioning on the left median nerve territory has a potential cardioprotective effect against subsequent ischemia-reperfusion injury.
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Affiliation(s)
- Jen-Hwey Chiu
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lin YH, Chiu JH, Tung HH, Tsou MT, Lui WY, Wu CW. Preconditioning somatothermal stimulation on right seventh intercostal nerve territory increases hepatic heat shock protein 70 and protects the liver from ischemia-reperfusion injury in rats. J Surg Res 2001; 99:328-34. [PMID: 11469906 DOI: 10.1006/jsre.2001.6177] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hyperthermic preconditioning attenuates the heat-induced cellular response to a subsequent severe heat challenge. However, it is impractical to perform whole-body hyperthermia in humans. This study was designed to test the hypotheses that hepatic heat shock protein 70 (Hsp70) could be induced by local somatothermal stimulation (LSTS) on right seventh intercostal nerve territory and that preconditioning the rats with LSTS protects the liver from subsequent ischemia-reperfusion injury. LSTS was brought about by application of a heating rod above right seventh intercostal nerve territory in male Sprague-Dawley rats. Hepatic gene expression of Hsp70 was assessed by Western blot and reverse transcription polymerase chain reaction (RT-PCR). Finally, serum ALT and AST and the lipid peroxidation product malondialdehyde (MDA) were evaluated in ischemic-reperfused rats preconditioned by application of LSTS on right seventh intercostal nerve territory. The results showed that hepatic gene expression of Hsp70 was upregulated in rats treated with LSTS. When animals were preconditioned with LSTS, followed by subsequent ischemia-reperfusion injury of the liver, there were significant decreases in liver enzymes (ALT/AST) and MDA formation in rats pretreated with one dose of LSTS (LSTS-1 group) as compared with those not treated with LSTS (control group) or treated with three doses of LSTS (LSTS-3 group). We conclude that mild local heat stress (one dose) on right seventh intercostal nerve territory upregulates hepatic gene expression of Hsp70 and protects the liver from subsequent ischemia-reperfusion injury. This might provide an easily applicable method for those patients facing ischemia-reperfusion challenge of the liver, as in liver resection and liver transplantation.
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Affiliation(s)
- Y H Lin
- Department of Life Science, National Yang-Ming University, Li-Nong Street, Peitou, Taipei, 112, Taiwan, Republic of China
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