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Yeh CM, Lai TY, Hu YW, Teng CJ, Huang N, Liu CJ. The impact of surgical volume on outcomes in newly diagnosed colorectal cancer patients receiving definitive surgeries. Sci Rep 2024; 14:8227. [PMID: 38589462 PMCID: PMC11001606 DOI: 10.1038/s41598-024-55959-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Colorectal cancer (CRC) patients who receive cancer surgeries from higher-volume providers may have better outcomes. However, the definitions of surgical volume may affect the results. We aim to analyze the effects of different definitions of surgical volume on patient outcomes. We conducted a nationwide population-based study in Taiwan that enrolled all patients who underwent definitive surgery for newly diagnosed CRC. We used three common definitions of surgical volume: total volume means the total surgical number conducted by the same provider during the study period; cumulative volume was calculated as the number of operations the surgeon performed before the index procedure; annual volume was calculated as the number of times the surgeon had been responsible for surgery during the index year. In this study, we included 100,009 newly diagnosed CRC patients, including 55.8% males, of median age 66 years at diagnosis (range 20-105 years). After adjustment for the patient and provider characteristics, we found that CRC patients receiving definitive surgery by higher-volume providers had better outcomes, especially where surgeon volume may play a more important role than hospital volume. The cumulative volume could predict the 5-year mortality of the study cohort better than the total and annual volume.
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Affiliation(s)
- Chiu-Mei Yeh
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Yu Lai
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Wen Hu
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Jen Teng
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Nicole Huang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155 Linong St., SeCc. 2, Beitou District, Taipei, 11217, Taiwan.
| | - Chia-Jen Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
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Zhang P, Huang N, Yang F, Yan W, Zhang B, Liu X, Peng K, Guo J. Determinants of depressive symptoms at individual, school and province levels: a national survey of 398,520 Chinese children and adolescents. Public Health 2024; 229:33-41. [PMID: 38394705 DOI: 10.1016/j.puhe.2024.01.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/06/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES The aims of this study were to describe the national distribution of depressive symptoms in Chinese children and adolescents, to examine the determinants of depressive symptoms at individual, school and province levels and to assess the gender and age differences in the effect of school factors on depressive symptoms. STUDY DESIGN This was a national cross-sectional study. METHODS A school-based online survey was conducted in mainland China from between December 1, 2021, and January 1, 2022. A total of 398,520 eligible participants were included in the analysis. School-level data were drawn from students, headteachers and Baidu Maps, and province-level data were obtained from the national human development report. The Patient Health Questionnaire-2 was used to measure depressive symptoms. RESULTS Areas with the highest mean scores for depressive symptoms were in the northeastern, inner central and southwestern regions of China. At the individual level, younger age, male sex, being an only child, Han ethnicity, lower body mass index, more days of exercise, less drinking and smoking behaviours, higher subjective family socio-economic status (SES) and popularity in school were related to fewer depressive symptoms; however, objective family SES and maternal education were not related to fewer depressive symptoms. The school-level variables of public status, psychological activities and psychological courses and province-level variable of higher Human Development Index were associated with fewer depressive symptoms. The effect of psychological courses and activities on depressive symptoms was greater in females. CONCLUSIONS The results showed multilevel factors related to depressive symptoms and emphasised the importance of implementing school-based psychological activities to ameliorate depressive symptoms in Chinese children and adolescents across age and gender.
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Affiliation(s)
- P Zhang
- Department of Psychology, Tsinghua University, Beijing 100084, China
| | - N Huang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - F Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - W Yan
- Department of Psychology, Tsinghua University, Beijing 100084, China.
| | - B Zhang
- Department of Neurology, Boston Children's Hospital, Boston, MA 02215, United States
| | - X Liu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - K Peng
- Department of Psychology, Tsinghua University, Beijing 100084, China
| | - J Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China.
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Lu H, Hatfield LA, Al-Azazi S, Bakx P, Banerjee A, Burrack N, Chen YC, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot CA, Weinreb G, Landon BE, Cram P. Sex-Based Disparities in Acute Myocardial Infarction Treatment Patterns and Outcomes in Older Adults Hospitalized Across 6 High-Income Countries: An Analysis From the International Health Systems Research Collaborative. Circ Cardiovasc Qual Outcomes 2024; 17:e010144. [PMID: 38328914 DOI: 10.1161/circoutcomes.123.010144] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/27/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Sex differences in acute myocardial infarction treatment and outcomes are well documented, but it is unclear whether differences are consistent across countries. The objective of this study was to investigate the epidemiology, use of interventional procedures, and outcomes for older females and males hospitalized with ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) in 6 diverse countries. METHODS We conducted a serial cross-sectional cohort study of 1 508 205 adults aged ≥66 years hospitalized with STEMI and NSTEMI between 2011 and 2018 in the United States, Canada, England, the Netherlands, Taiwan, and Israel using administrative data. We compared females and males within each country with respect to age-standardized hospitalization rates, rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery within 90 days of hospitalization, and 30-day age- and comorbidity-adjusted mortality. RESULTS Hospitalization rates for STEMI and NSTEMI decreased between 2011 and 2018 in all countries, although the hospitalization rate ratio (rate in males/rate in females) increased in virtually all countries (eg, US STEMI ratio, 1.58:1 in 2011 and 1.73:1 in 2018; Israel NSTEMI ratio, 1.71:1 in 2011 and 2.11:1 in 2018). Rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery were lower for females than males for STEMI in all countries and years (eg, US cardiac catheterization in 2018, 88.6% for females versus 91.5% for males; Israel percutaneous coronary intervention in 2018, 76.7% for females versus 84.8% for males) with similar findings for NSTEMI. Adjusted mortality for STEMI in 2018 was higher for females than males in 5 countries (the United States, Canada, the Netherlands, Israel, and Taiwan) but lower for females than males in 5 countries for NSTEMI. CONCLUSIONS We observed a larger decline in acute myocardial infarction hospitalizations for females than males between 2011 and 2018. Females were less likely to receive cardiac interventions and had higher mortality after STEMI. Sex disparities seem to transcend borders, raising questions about the underlying causes and remedies.
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Affiliation(s)
- Hannah Lu
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX (H.L., P.C.)
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
- Division of General Medicine, Beth Israel Deaconess Medical Center (L.A.H., B.E.L.)
| | - Saeed Al-Azazi
- George & Fay Yee Centre for Healthcare Innovation (S.A.-A., L.M.L.), University of Manitoba, Winnipeg, Canada
| | - Pieter Bakx
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, United Kingdom (A.B., L.P.)
- Consultant in Cardiology, University College London Hospitals, United Kingdom (A.B.)
| | - Nitzan Burrack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Y.-C.C., N.H.)
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)
| | - Renaud Heine
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Y.-C.C., N.H.)
| | - Dennis T Ko
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
- Schulich Heart Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (D.T.K.)
- Faculty of Medicine (D.T.K., P.C.), University of Toronto, ON, Canada
| | - Lisa M Lix
- George & Fay Yee Centre for Healthcare Innovation (S.A.-A., L.M.L.), University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences (L.M.L.), University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)
| | - Laura Pasea
- Institute of Health Informatics, University College London, United Kingdom (A.B., L.P.)
| | - Feng Qiu
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
| | - Therese A Stukel
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
- Institute for Health Management Policy and Evaluation (T.A.S.), University of Toronto, ON, Canada
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)
- Division of General Medicine, Beth Israel Deaconess Medical Center (L.A.H., B.E.L.)
| | - Peter Cram
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX (H.L., P.C.)
- ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)
- Faculty of Medicine (D.T.K., P.C.), University of Toronto, ON, Canada
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Hu YW, Yeh CM, Liu CJ, Chen TJ, Huang N, Chou YJ. Severity of Complications and Duration of Type 2 Diabetes and the Risk of Cancer: A Population-based Study. Cancer Epidemiol Biomarkers Prev 2024:734947. [PMID: 38412010 DOI: 10.1158/1055-9965.epi-23-1600] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/08/2024] [Accepted: 02/23/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The literature on the association between diabetes severity and cancer risk is limited and inconclusive. The study aimed to evaluate the association between the adapted Diabetes Complications Severity Index (aDCSI) and the duration of type 2 diabetes and cancer risk. METHODS Patients aged 20 years or older with newly diagnosed type 2 diabetes between January 1, 2007 and December 31, 2011 were identified from Taiwan National Health Insurance claims data. Standardized incidence ratios (SIRs) were calculated to compare cancer incidence in people with diabetes to that in the general population. Poisson regression was used to examine whether SIRs differed by age, sex, aDSCI, and duration of diabetes. RESULTS A total of 756,547 patients were included, with a median follow-up of 8.8 years. Excluding the first year after diagnosis, the SIR for overall cancer was 1.18(95% CI 1.17-1.19). Higher aDCSI was associated with increased SIRs for overall(SIR ratio 1.03(1.02-1.03) per point increase), head and neck(1.03(1.01-1.04)), liver(1.04(1.03-1.05)), pancreas(1.03(1.00-1.05)), kidney(1.13(1.10-1.15)) and leukemia(1.09(1.06-1.13)). There was no association between aDCSI and colorectal, extrahepatic biliary tract, uterus and thyroid cancer, and a negative association with breast cancer(0.97(0.95-0.98)). Type 2 diabetes duration was associated with increased SIRs for overall (1.01(1.00-1.02) per year increase), head and neck(1.03(1.01-1.05)) and liver cancer(1.04(1.02-1.05)). CONCLUSIONS The heterogeneity in the association between diabetes severity and diabetes-related cancers suggests diverse underlying connection. IMPACT Adopting distinct approaches in further research and prevention strategies for different kinds of diabetes-related cancers is important.
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Affiliation(s)
- Yu-Wen Hu
- Taipei Veterans General Hospital, Taipai, Taiwan
| | - Chiu-Mei Yeh
- Taipei Veterans General Hospital, Taipai, Taiwan
| | - Chia-Jen Liu
- Taipei Veterans General Hospital, Taipai, Taiwan
| | | | - Nicole Huang
- National Yang Ming Chiao Tung University, Taipei, Taiwan
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Huang N, Liu X, Liu Q, Zhang J, Fu Y, Zhu Z, Guo J, Li X, Yang L. Does COVID-19 vaccination affect post-traumatic stress symptoms via risk perception? A large cross-sectional study among the Chinese population. Public Health 2024; 226:107-113. [PMID: 38052112 DOI: 10.1016/j.puhe.2023.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Although infection rates may increase after relaxation of the zero COVID strategy, the extensive vaccination campaign in China could potentially curb the spread of COVID-19, which may be associated with a low level of risk perception and post-traumatic stress symptoms (PTSS). However, the relationship between vaccination, risk perception and PTSS has not been studied extensively. This study aims to examine the associations between the number of COVID-19 vaccine doses, consistency in the type of each dose and time since vaccination with PTSS, and the mediating role of risk perception on such relationships in China. STUDY DESIGN Cross-sectional sampling with a self-report questionnaire was used to measure vaccination, PTSS and risk perception. METHODS The survey was conducted in Beijing, China, from 13 January to 9 February 2023. Linear regression analyses were conducted to test the relationship between vaccination, risk perception and PTSS. RESULTS The analysis included 55,803 individuals. In total, 72.86 % of participants received two doses of the COVID-19 vaccine. Regression results indicated that people with two doses of the COVID-19 vaccine had a lower level of PTSS (β = -1.232, 95 % confidence interval [CI]: -1.930, -0.534) than those who had not received any doses of the COVID-19 vaccine. Only the negative relationship between two-dose vaccination and PTSS was mediated by risk perception, while the negative relationship between the time since vaccination and PTSS was suppressed by risk perception. CONCLUSIONS This study showed that receiving the COVID-19 vaccine reduced PTSS by decreasing perceived risk. Vaccination time was negatively associated with PTSS, but this relationship was suppressed by risk perception.
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Affiliation(s)
- N Huang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - X Liu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - Q Liu
- Department of General Practice, Second Outpatient Section, Peking University Third Hospital, Beijing, PR China
| | - J Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - Y Fu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - Z Zhu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China
| | - J Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China.
| | - X Li
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, PR China.
| | - L Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, PR China.
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Burrack N, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, Godoy Junior C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Ravi B, Al-Azazi S, Weinreb G, Cram P, Landon BE. Variation in care for patients presenting with hip fracture in six high-income countries: A cross-sectional cohort study. J Am Geriatr Soc 2023; 71:3780-3791. [PMID: 37565425 PMCID: PMC10840946 DOI: 10.1111/jgs.18530] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. METHODS We performed a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30-day readmission rates, and time-to-surgery. RESULTS The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30-day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%-45%) and THA (0.2%-10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%-60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30-day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). CONCLUSIONS We observed substantial between-country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence-based surgical approaches.
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Affiliation(s)
- Nitzan Burrack
- Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Pieter Bakx
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, University College London Hospitals, London, UK
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Godoy Junior
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
- ICES, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | | | - Therese A Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Saeed Al-Azazi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Cram
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, UTMB, Galveston, Texas, USA
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lai TY, Hu YW, Wang TH, Chen JP, Shiau CY, Huang PI, Lai IC, Tseng LM, Huang N, Liu CJ. Association of radiation dose to cardiac substructures with major ischaemic events following breast cancer radiotherapy. Eur Heart J 2023; 44:4796-4807. [PMID: 37585426 DOI: 10.1093/eurheartj/ehad462] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/18/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND AND AIMS Patients with left-sided breast cancer receive a higher mean heart dose (MHD) after radiotherapy, with subsequent risk of ischaemic heart disease. However, the optimum dosimetric predictor among cardiac substructures has not yet been determined. METHODS AND RESULTS This study retrospectively reviewed 2158 women with breast cancer receiving adjuvant radiotherapy. The primary endpoint was a major ischaemic event. The dose-volume parameters of each delineated cardiac substructure were calculated. The risk factors for major ischaemic events and the association between MHD and major ischaemic events were analysed by Cox regression. The optimum dose-volume predictors among cardiac substructures were explored in multivariable models by comparing performance metrics of each model. At a median follow-up of 7.9 years (interquartile range 5.6-10.8 years), 89 patients developed major ischaemic events. The cumulative incidence rate of major ischaemic events was significantly higher in left-sided disease (P = 0.044). Overall, MHD increased the risk of major ischaemic events by 6.2% per Gy (hazard ratio 1.062, 95% confidence interval 1.01-1.12; P = 0.012). The model containing the volume of the left ventricle receiving 25 Gy (LV V25) with the cut-point of 4% presented with the best goodness of fit and discrimination performance in left-sided breast cancer. Age, chronic kidney disease, and hyperlipidaemia were also significant risk factors. CONCLUSION Risk of major ischaemic events exist in the era of modern radiotherapy. LV V25 ≥ 4% appeared to be the optimum parameter and was superior to MHD in predicting major ischaemic events. This dose constraint could aid in achieving better heart protection in breast cancer radiotherapy, though a further validation study is warranted.
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Affiliation(s)
- Tzu-Yu Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Yu-Wen Hu
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ti-Hao Wang
- Department of Radiation Oncology, China Medical University Hospital, 404327 Taichung, Taiwan
- Department of Medicine, China Medical University, 404333 Taichung, Taiwan
- Everfortune.AI, 403020 Taichung, Taiwan
| | - Jui-Pin Chen
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
| | - Cheng-Ying Shiau
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
| | - Pin-I Huang
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - I Chun Lai
- Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ling-Ming Tseng
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 112201 Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Chia-Jen Liu
- School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 112201 Taipei, Taiwan
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Zheng A, Huang N, Bean D, Rayapaneni S, Deeney J, Sagar M, Hamilton JA. Resolvin E1 heals injured cardiomyocytes: Therapeutic implications and H-FABP as a readout for cardiovascular disease & systemic inflammation. Prostaglandins Leukot Essent Fatty Acids 2023; 197:102586. [PMID: 37604082 DOI: 10.1016/j.plefa.2023.102586] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
The purpose of this study is to investigate heart-fatty acid binding protein (H-FABP) leakage from cardiomyocytes as a quantitative measure of cell membrane damage and to test healing by Resolvin E1 (RVE1) as a potential therapeutic for patients with inflammatory diseases (cardiovascular disease and comorbidities) with high morbidity and mortality. Our quantitative ELISA assays demonstrated H-FABP as a sensitive and reliable biomarker for measuring cardiomyocyte damage induced by lipopolysaccharide (LPS) and healing by RvE1, a specialized pro-resolving mediator (SPM) derived from the Omega-3 fatty acid, eicosapentaenoic acid (EPA), a dietary nutrient that balances inflammation to restore homeostasis. RvE1 reduced leakage of H-FABP by up to 86%, which supports our hypothesis that inflammation as a mechanism of injury can be targeted for therapy. H-FABP as a blood biomarker was tested in 40 patients admitted to Boston Medical Center for respiratory distress, (20 patients with and 20 patients without COVID infection). High levels of H-FABP correlated with clinically diagnosed CVD, diabetes, and end-stage renal disease (ESRD) in both patient groups. The level of H-FABP indicates not only CVD damage but is a valuable measure for patients with increased inflammation disease comorbidities.
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Affiliation(s)
- A Zheng
- Boston University, United States of America
| | - N Huang
- Boston University School of Medicine, United States of America
| | - D Bean
- Boston University School of Medicine, United States of America
| | | | - Jude Deeney
- Boston University School of Medicine, United States of America
| | - M Sagar
- Boston Medical Center, United States of America
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Wang J, He Q, Li ZR, Huang N, Huang R, Wang JY, Zhou Q, Wang XH, Han F. The Lyman Normal Tissue Complication Probability Model and Risk Prediction for Temporal Lobe Injury after Re-Irradiation in Patients with Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e587. [PMID: 37785777 DOI: 10.1016/j.ijrobp.2023.06.1932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The risk of temporal lobe injury (TLI) in recurrent nasopharyngeal carcinoma (rNPC) patients with intensity-modulated radiation therapy (IMRT) is high. We aimed to construct the normal tissue complication probability (NTCP) model for TLI of rNPC and establish a risk predictive model. MATERIALS/METHODS We retrospectively analyzed 103 patients with rNPC who had received two courses of IMRT in our institution. The 206 temporal lobes (TLs) of these patients were randomly divided into a training (n = 144) and validation group (n = 62). We determined the mean value of the following parameters to construct the Lyman NTCP model: TD50(1) (the dose with a 50% probability of complications to an organ when all volumes are irradiated), m [steepness of the dose-response at TD50(1)], and n (the parameter related to volume effect). The most predictive dosimetric parameter and clinical variables were integrated in Cox proportional hazards models. A nomogram was developed for predicting risk of TLs. RESULTS The parameters of the fitted NTCP model were TD50(1) = 107.84 Gy (95% confidence interval (CI), [97.15, 118.54]), m = 0.16 (95% CI, [0.14, 0.19]), and n = 0.04 (95% CI, [0.01, 0.06]). The cumulative dose delivered to 0.1 cm3 of temporal lobe volume (D0.1cc-c) was the most predictive dosimetric parameter for TLI. The Kaplan-Meier curves showed a significant difference in 2-year TLI-free survival among different risk groups according to the total score of nomograms. CONCLUSION The TD50(1) of TLI in patients with rNPC is 107.84 Gy in Lyman NTCP model. The nomogram model can accurately predict the risk of TLI for individual.
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Affiliation(s)
- J Wang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Q He
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Z R Li
- Manteia Technologies Co., Ltd, Xiamen, Fujian, China
| | - N Huang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - R Huang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - J Y Wang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Q Zhou
- Manteia Technologies Co., Ltd, Xiamen, Fujian, China
| | - X H Wang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - F Han
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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10
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Winans T, Oaks Z, Choudhary G, Patel A, Huang N, Faludi T, Krakko D, Nolan J, Lewis J, Blair S, Lai Z, Landas SK, Middleton F, Asara JM, Chung SK, Wyman B, Azadi P, Banki K, Perl A. mTOR-dependent loss of PON1 secretion and antiphospholipid autoantibody production underlie autoimmunity-mediated cirrhosis in transaldolase deficiency. J Autoimmun 2023; 140:103112. [PMID: 37742509 PMCID: PMC10957505 DOI: 10.1016/j.jaut.2023.103112] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
Transaldolase deficiency predisposes to chronic liver disease progressing from cirrhosis to hepatocellular carcinoma (HCC). Transition from cirrhosis to hepatocarcinogenesis depends on mitochondrial oxidative stress, as controlled by cytosolic aldose metabolism through the pentose phosphate pathway (PPP). Progression to HCC is critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Although AR inactivation blocked susceptibility to hepatocarcinogenesis, it enhanced growth restriction, carbon trapping in the non-oxidative branch of the PPP and failed to reverse the depletion of glucose 6-phosphate (G6P) and liver cirrhosis. Here, we show that inactivation of the TAL-AR axis results in metabolic stress characterized by reduced mitophagy, enhanced overall autophagy, activation of the mechanistic target of rapamycin (mTOR), diminished glycosylation and secretion of paraoxonase 1 (PON1), production of antiphospholipid autoantibodies (aPL), loss of CD161+ NK cells, and expansion of CD38+ Ito cells, which are responsive to treatment with rapamycin in vivo. The present study thus identifies glycosylation and secretion of PON1 and aPL production as mTOR-dependent regulatory checkpoints of autoimmunity underlying liver cirrhosis in TAL deficiency.
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Affiliation(s)
- T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Nolan
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Sarah Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Lai
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - F Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
| | - B Wyman
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - P Azadi
- University of Georgia, Athens, GA 30602, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA.
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11
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Yeh HL, Hsieh FI, Lien LM, Kuo WH, Jeng JS, Sun Y, Wei CY, Yeh PY, Yip HT, Lin CL, Huang N, Hsu KC. Patient and hospital characteristics associated with do-not-resuscitate/do-not-intubate orders: a cross-sectional study based on the Taiwan stroke registry. BMC Palliat Care 2023; 22:138. [PMID: 37715158 PMCID: PMC10503153 DOI: 10.1186/s12904-023-01257-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Previous studies of do-not-resuscitate (DNR) or do-not-intubate (DNI) orders in stroke patients have primarily been conducted in North America or Europe. However, characteristics associated with DNR/DNI orders in stroke patients in Asia have not been reported. METHODS Based on the Taiwan Stroke Registry, this nationwide cross-sectional study enrolled hospitalized stroke patients from 64 hospitals between 2006 and 2020. We identified characteristics associated with DNR/DNI orders using a two-level random effects model. RESULTS Among the 114,825 patients, 5531 (4.82%) had DNR/DNI orders. Patients with acute ischemic stroke (AIS) had the highest likelihood of having DNR/DNI orders (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.61-1.93), followed by patients with intracerebral hemorrhage (ICH), and patients with subarachnoid hemorrhage (SAH) had the lowest likelihood (aOR 0.53, 95% CI 0.43-0.66). From 2006 to 2020, DNR/DNI orders increased in all three types of stroke. In patients with AIS, women were significantly more likely to have DNR/DNI orders (aOR 1.23, 95% CI 1.15-1.32), while patients who received intravenous alteplase had a lower likelihood (aOR 0.74, 95% CI 0.65-0.84). Patients with AIS who were cared for by religious hospitals (aOR 0.55, 95% CI 0.35-0.87) and patients with SAH who were cared for by medical centers (aOR 0.40, 95% CI 0.17-0.96) were significantly less likely to have DNR/DNI orders. CONCLUSIONS In Taiwan, DNR/DNI orders increased in stroke patients between 2006 and 2020. Hospital characteristics were found to play a significant role in the use of DNR/DNI orders.
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Affiliation(s)
- Hsu-Ling Yeh
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Fang-I Hsieh
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wen-Hua Kuo
- Institute of Science, Technology, and Society, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center, Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin de Porres Hospital, Chiayi City, Taiwan
| | - Hei-Tung Yip
- Management office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Taipei 112, Taipei, Taiwan.
| | - Kai-Cheng Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
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Chen JJ, Cheng YC, Lin LH, Chiang CC, Lin KH, Liu TC, Chou YJ, Lee IH, Huang N. Perception of transitional care quality associated with functional outcomes among patients with fractures and stroke in Taiwan. Geriatr Nurs 2023; 53:247-254. [PMID: 37598428 DOI: 10.1016/j.gerinurse.2023.08.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
This study aimed to examine the relationship between self-perceived quality of transitional care and functional outcome among patients with stroke and fractures. The Care Transition Measure (CTM-15) was used to survey patient's self-perceived transitional care quality before discharge. General estimating equations were used to investigate the influences of transitional care quality on patient's functional outcomes at before, 1 week after, and 1 or 3 months after discharge. Among stroke patients, higher CTM-15 scores were positively associated with greater outcome in Instrumental Activities of Daily Living (IADL) following discharge. Higher scores for "reader-friendly written care plan," "consideration of patient's preferences," and "understanding of health management" had significantly positive effects on functional recovery in IADL among both patient groups following discharge. These findings suggest that heterogeneity in transitional care needs between medical and surgical patients shall not be overlooked. A one-size-fits-all strategy may be insufficient for ensuring patient care continuity following discharge.
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Affiliation(s)
- Jing-Jer Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chun Cheng
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Hwa Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Ching Chiang
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kung-Hou Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Ching Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Nicole Huang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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13
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Huang N, Shen YJ, Chou YJ, Tsai TF, Lien CE. Advanced Age and Increased Risk for Severe Outcomes of Dengue Infection, Taiwan, 2014-2015. Emerg Infect Dis 2023; 29:1701-1702. [PMID: 37486786 PMCID: PMC10370833 DOI: 10.3201/eid2908.230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Dengue, a mosquitoborne flavivirus infection, is increasingly a disease of older adults who are more likely to have chronic diseases that confer risk for severe outcomes of dengue infection. In a population-based study in Taiwan, adjusted risks for dengue-related hospitalization, intensive care unit admission, and death increased progressively with age.
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Chen YC, Chou YJ, Yeh CM, Huang N. Hospital partnership and patient outcomes among postacute patients with stroke. Am J Manag Care 2023; 29:e215-e221. [PMID: 37523454 DOI: 10.37765/ajmc.2023.89401] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Postacute care (PAC) heavily relies on effective connection between acute and postacute providers. However, little is known about whether and to what extent providers' patient-sharing relationships influence patient outcomes. This study aimed to examine whether patients with stroke who were discharged to PAC hospitals with which the originating hospital had a strong patient-sharing relationship have a lower rate of rehospitalization and lower mortality risk. STUDY DESIGN This population-based retrospective cohort study used the Taiwan National Health Insurance Research Database. A total of 1988 patients initially hospitalized for stroke between July 1, 2017, and June 30, 2018, who were newly discharged to 193 PAC hospitals from 175 originating hospitals were included. METHODS We described the partnership between originating acute hospitals and PAC hospitals using tie strength and referral concentration. The main outcome included unplanned readmission and mortality. Hierarchical logistic regression analysis and Cox proportional hazards models were applied. RESULTS A dose-response relationship was clearly observed between tie strength and patient outcomes. Patients with stroke who were discharged to a PAC hospital that had the strongest tie strength with the originating hospital were least likely to be readmitted and had the lowest mortality risk. Moreover, patients who received care from hospital pairs with highly or moderately concentrated referrals also had lower readmission and mortality risk. CONCLUSIONS A greater number of shared patients and a more concentrated referral linkage between acute and PAC providers may reduce potential adverse outcomes in PAC patients. Instead of attaining more partners, PAC policies should encourage providers to strengthen their patient-sharing relationship with their existing PAC partners.
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Affiliation(s)
| | | | | | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Room 201, The Medical Building II, No. 155, Section 2, Li-Nong St, Taipei 112, Taiwan, ROC
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15
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Zhang J, Kuang SW, Huang N, Zhang JJ, Liu M, Wang LM. [Lenvatinib down-regulates IGF1R/Mek/Erk signaling pathway in the treatment of regorafenib-resistant hepatocellular carcinoma]. Zhonghua Zhong Liu Za Zhi 2023; 45:490-498. [PMID: 37355467 DOI: 10.3760/cma.j.cn112152-20221017-00704] [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] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
Objective: To investigate the therapeutic effect and mechanism of lenvatinib on regorafenib-resistant hepatocellular carcinoma cells. Methods: CCK-8 and clone formation assay were used to observe the inhibitory effect of lenvatinib on the growth of hepatocellular carcinoma cells. Flow cytometry was used to detect the apoptosis of regorafenib-resistant hepatocellular carcinoma cells treated with lenvatinib. The expression levels of related proteins were detected by western blot and immunohistochemical staining. The inhibitory effect of lenvatinib on the tumor formation ability of regorafenib-resistant hepatocellular carcinoma cells in vivo was observed by subcutaneous tumor formation experiment in mice. Results: CCK-8 and clone formation assay showed that lenvatinib could inhibit the proliferation of regorafenib-resistant hepatocellular carcinoma cells. The number of clones of HepG2, SMMC7721 and regorafenib-resistant HepG2, SMMC7721 cells in lenvatinib group (120.67±11.06, 53.00±11.14, 55.00±9.54, 78.67±14.64) were all lower than those in control group (478.00±24.52, 566.00±27.87, 333.67±7.02, 210.00±12.77, all P<0.05). Flow cytometry showed that lenvatinib could promote apoptosis of regorafenib-resistant hepatocellular carcinoma cells, the apoptosis rates of HepG2, SMMC7721 and regorafenib-resistant HepG2, SMMC7721 cells in lenvatinib group [(12.30±0.70)%, (9.83±0.38)%, (15.90±1.32)%, (10.60±0.00)%] were all higher than those in control group [(7.50±0.87)%, (5.00±1.21)%, (8.10±1.61)%, (7.05±0.78)%, all P<0.05]. The apoptosis-related protein levels suggested that apoptosis was increased in the treatment of lenvatinib. The animal study showed that lenvatinib can inhibit the growth of regorafenib-resistant cells in vivo. Immunohistochemistry and western blot results showed that lenvatinib could down-regulate the abnormally activated IGF1R/Mek/Erk signaling pathway in regorafenib-resistant cells. Conclusion: Lenvatinib can reverse regorafenib resistance in hepatocellular carcinoma, possibly by down-regulating IGF1R/Mek/Erk signaling pathway.
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Affiliation(s)
- J Zhang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - S W Kuang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - N Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J J Zhang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - M Liu
- Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - L M Wang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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16
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Chen HH, Lai JCY, Chiou ST, Huang N, Chien LY. The effect of hospital-based health promotion on the health practices of full-time hospital nurses: a cross-sectional study. Sci Rep 2023; 13:9763. [PMID: 37328544 PMCID: PMC10275936 DOI: 10.1038/s41598-023-36873-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
Many studies have reported positive contributions of health promotion on the health behavior of nursing staff working in hospitals, including the maintenance of a regular healthy diet, engagement in physical activity, performance of routine screening practices, and participation in a health examination. Despite being considered a role model for healthy lifestyles, little is known about the effect of health-promoting hospital settings on nursing staff. The aim of this study was to perform a nationwide, hospital-based, cross-sectional, survey comparing health practices between full-time nurses of health-promoting hospitals and those of non-health-promoting hospitals in Taiwan. We conducted a nationwide, hospital-based, cross-sectional, survey in 100 hospitals from May to July 2011 using a questionnaire as the measurement tool. Nurses aged between 18 and 65 years from certified health-promoting hospitals (n = 14,769) were compared with nurses in non-health-promoting hospitals (n = 11,242). A multiple logistic regression model was conducted to estimate the effect of certified HPH status on the likelihood of performing health behavior, receiving general physical examination, undergoing cancer screening, and participating in hospital-based health-promoting activities. All nurses of HPH hospitals were more likely to perform physical activity, practice cancer screening, receive at least one general physical examination in the past 3 years, and had a higher chance of participating in at least one hospital-based health-promoting activity in the past year (particularly weight-control groups and sports-related clubs) than those of non-HPH hospitals. This study suggests the effectiveness of implementing health promotion on the health behavior of full-time nursing staff in hospitals.
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Affiliation(s)
- Hung-Hui Chen
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jerry Cheng-Yen Lai
- Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung, Taiwan, ROC
- Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung City, Taiwan, ROC
| | - Shu-Ti Chiou
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Yang-Ming Campus, No.155, Sec. 2, Linong St., Beitou Dist., Taipei City, 11221, Taiwan, ROC.
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17
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Huang Y, Ding X, Huang N, Chen C, Deng X. [Construction and biological characterization of a Proteus mirabilis strain with modABC gene deletion]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:859-867. [PMID: 37313829 DOI: 10.12122/j.issn.1673-4254.2023.05.23] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To construct a modABC gene knockout strain of Proteus mirabilis and explore the effect of modABC gene deletion on biological characteristics of Proteus mirabilis. METHODS Fusion PCR was used to obtain the fusion gene of modABC and the kanamycin-resistant gene Kn, which was ligated with the suicide vector pCVD442 and transduced into Proteus mirabilis. The modABC gene knockout strain of Proteus mirabilis was obtained after homologous recombination with the suicide vector. PCR and Sanger sequencing were used to identify genomic deletion of modABC gene in the genetically modified strain. The concentration of molybdate in the wild-type and gene knockout strains was determined using inductively coupled plasma mass spectrometry (ICP-MS), and their survival ability in LB medium was compared under both aerobic and anaerobic conditions. RESULTS PCR and sanger sequencing confirmed genomic deletion of modABC gene in the obtained Proteus mirabilis strain. The concentration of intracellular molybdenum in the modABC gene knockout strain was 1.22 mg/kg, significantly lower than that in the wild-type strain (1.46 mg/kg, P < 0.001). Under the aerobic condition, the modABC gene knockout strain grown in LB medium showed no significant changes in survival ability compared with the wild-type strain, but its proliferation rate decreased significantly under the anaerobic condition and also when cultured in nitrate-containing LB medium under anaerobic condition. CONCLUSION Homologous recombination with the suicide vector can be used for modABC gene knockout in Proteus mirabilis. modABC gene participates in molybdate uptake and is associated with anaerobic growth of Proteus mirabilis in the presence of nitrate.
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Affiliation(s)
- Y Huang
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, Guangzhou 510180, China
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou 510180, China
| | - X Ding
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, Guangzhou 510180, China
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou 510180, China
| | - N Huang
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, Guangzhou 510180, China
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou 510180, China
| | - C Chen
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, Guangzhou 510180, China
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou 510180, China
| | - X Deng
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, Guangzhou 510180, China
- KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou 510180, China
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18
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Lechner MG, Zhou Z, Hoang AT, Huang N, Ortega J, Scott LN, Chen HC, Patel AY, Yakhshi-Tafti R, Kim K, Hugo W, Famini P, Drakaki A, Ribas A, Angell TE, Su MA. Clonally expanded, thyrotoxic effector CD8 + T cells driven by IL-21 contribute to checkpoint inhibitor thyroiditis. Sci Transl Med 2023; 15:eadg0675. [PMID: 37196065 PMCID: PMC10227862 DOI: 10.1126/scitranslmed.adg0675] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/19/2023] [Indexed: 05/19/2023]
Abstract
Autoimmune toxicity occurs in up to 60% of patients treated with immune checkpoint inhibitor (ICI) therapy for cancer and represents an increasing clinical challenge for expanding the use of these treatments. To date, human immunopathogenic studies of immune-related adverse events (IRAEs) have relied on sampling of circulating peripheral blood cells rather than affected tissues. Here, we directly obtained thyroid specimens from individuals with ICI-thyroiditis, one of the most common IRAEs, and compared immune infiltrates with those from individuals with spontaneous autoimmune Hashimoto's thyroiditis (HT) or no thyroid disease. Single-cell RNA sequencing revealed a dominant, clonally expanded population of thyroid-infiltrating cytotoxic CXCR6+ CD8+ T cells (effector CD8+ T cells) present in ICI-thyroiditis but not HT or healthy controls. Furthermore, we identified a crucial role for interleukin-21 (IL-21), a cytokine secreted by intrathyroidal T follicular (TFH) and T peripheral helper (TPH) cells, as a driver of these thyrotoxic effector CD8+ T cells. In the presence of IL-21, human CD8+ T cells acquired the activated effector phenotype with up-regulation of the cytotoxic molecules interferon-γ (IFN-γ) and granzyme B, increased expression of the chemokine receptor CXCR6, and thyrotoxic capacity. We validated these findings in vivo using a mouse model of IRAEs and further demonstrated that genetic deletion of IL-21 signaling protected ICI-treated mice from thyroid immune infiltration. Together, these studies reveal mechanisms and candidate therapeutic targets for individuals who develop IRAEs.
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Affiliation(s)
- Melissa G. Lechner
- Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Zikang Zhou
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Aline T. Hoang
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
- Drexel Medical School; Philadelphia, PA 19129
| | - Nicole Huang
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Jessica Ortega
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Lauren N. Scott
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Ho-Chung Chen
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Anushi Y. Patel
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Rana Yakhshi-Tafti
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
- Rosalind Franklin Medical School; Chicago, IL 60064
| | - Kristy Kim
- UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Willy Hugo
- Division of Dermatology, Department of Medicine, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Pouyan Famini
- Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Alexandra Drakaki
- Division of Hematology and Oncology, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Antoni Ribas
- Division of Hematology and Oncology, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
| | - Trevor E. Angell
- Division of Endocrinology and Diabetes, USC Keck School of Medicine; Los Angeles, CA 90033
| | - Maureen A. Su
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
- Division of Pediatric Endocrinology, UCLA David Geffen School of Medicine; Los Angeles, CA 90095
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19
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Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Yan L, Weinreb G, Cram P. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. JAMA 2023; 329:1088-1097. [PMID: 37014339 PMCID: PMC10074220 DOI: 10.1001/jama.2023.1699] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 04/05/2023]
Abstract
Importance Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Design, Setting, and Participants Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Exposures Being in the top and bottom quintile of income within and across countries. Main Outcomes and Measures Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. Results We studied 289 376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843 046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. Conclusions and Relevance High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.
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Affiliation(s)
- Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laura A. Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, England
- Department of Cardiology, University College London Hospitals, London, England
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Dennis T. Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, England
| | - Feng Qiu
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Peter Cram
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Texas Medical Branch, Galveston
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20
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Hu YW, Yeh CM, Liu CJ, Chen TJ, Huang N, Chou YJ. Adapted Diabetes Complications Severity Index and Charlson Comorbidity Index in predicting all-cause and cause-specific mortality among patients with type 2 diabetes. BMJ Open Diabetes Res Care 2023; 11:11/2/e003262. [PMID: 36977521 PMCID: PMC10069524 DOI: 10.1136/bmjdrc-2022-003262] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Adapted Diabetes Complications Severity Index (aDCSI) is a commonly used severity measure based on the number and severity of diabetes complications using diagnosis codes. The validity of aDCSI in predicting cause-specific mortality has yet to be verified. Additionally, the performance of aDCSI in predicting patient outcomes compared with Charlson Comorbidity Index (CCI) remains unknown. RESEARCH DESIGN AND METHODS Patients aged 20 years or older with type 2 diabetes prior to January 1, 2008 were identified from the Taiwan National Health Insurance claims data and were followed up until December 15, 2018. Complications for aDCSI including cardiovascular, cerebrovascular and peripheral vascular disease, metabolic disease, nephropathy, retinopathy and neuropathy, along with comorbidities for CCI, were collected. HRs of death were estimated using Cox regression. Model performance was evaluated by concordance index and Akaike information criterion. RESULTS 1,002,589 patients with type 2 diabetes were enrolled, with a median follow-up of 11.0 years. After adjusting for age and sex, aDCSI (HR 1.21, 95% CI 1.20 to 1.21) and CCI (HR 1.18, 1.17 to 1.18) were associated with all-cause mortality. The HRs of aDCSI for cancer, cardiovascular disease (CVD) and diabetes mortality were 1.04 (1.04 to 1.05), 1.27 (1.27 to 1.28) and 1.28 (1.28 to 1.29), respectively, and the HRs of CCI were 1.10 (1.09 to 1.10), 1.16 (1.16 to 1.17) and 1.17 (1.16 to 1.17), respectively. The model with aDCSI had a better fit for all-cause, CVD and diabetes mortality with C-index of 0.760, 0.794 and 0.781, respectively. Models incorporating both scores had even better performance, but the HR of aDCSI for cancer (0.98, 0.97 to 0.98) and the HRs of CCI for CVD (1.03, 1.02 to 1.03) and diabetes mortality (1.02, 1.02 to 1.03) became neutral. When aDCSI and CCI were considered time-varying scores, the association with mortality was stronger. aDCSI had a strong correlation with mortality even after 8 years (HR 1.18, 1.17 to 1.18). CONCLUSIONS The aDCSI predicts all-cause, CVD and diabetes deaths but not cancer deaths better than the CCI. aDCSI is also a good predictor for long-term mortality.
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Affiliation(s)
- Yu-Wen Hu
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
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21
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Oaks Z, Patel A, Huang N, Choudhary G, Winans T, Faludi T, Krakko D, Duarte M, Lewis J, Beckford M, Blair S, Kelly R, Landas SK, Middleton FA, Asara JM, Chung SK, Fernandez DR, Banki K, Perl A. Publisher Correction: Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis. Nat Metab 2023; 5:349. [PMID: 36755183 DOI: 10.1038/s42255-023-00752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Duarte
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Beckford
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - R Kelly
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - F A Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, China
| | - D R Fernandez
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
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22
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Oaks Z, Patel A, Huang N, Choudhary G, Winans T, Faludi T, Krakko D, Duarte M, Lewis J, Beckford M, Blair S, Kelly R, Landas SK, Middleton FA, Asara JM, Chung SK, Fernandez DR, Banki K, Perl A. Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis. Nat Metab 2023; 5:41-60. [PMID: 36658399 PMCID: PMC9892301 DOI: 10.1038/s42255-022-00711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/11/2022] [Indexed: 01/21/2023]
Abstract
Oxidative stress modulates carcinogenesis in the liver; however, direct evidence for metabolic control of oxidative stress during pathogenesis, particularly, of progression from cirrhosis to hepatocellular carcinoma (HCC), has been lacking. Deficiency of transaldolase (TAL), a rate-limiting enzyme of the non-oxidative branch of the pentose phosphate pathway (PPP), restricts growth and predisposes to cirrhosis and HCC in mice and humans. Here, we show that mitochondrial oxidative stress and progression from cirrhosis to HCC and acetaminophen-induced liver necrosis are critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Both TAL and AR are confined to the cytosol; however, their inactivation distorts mitochondrial redox homeostasis in opposite directions. The results suggest that AR acts as a rheostat of carbon recycling and NADPH output of the PPP with broad implications for disease progression from cirrhosis to HCC.
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Affiliation(s)
- Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Duarte
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Beckford
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - R Kelly
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - F A Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, China
| | - D R Fernandez
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
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23
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Csiki I, Glenn J, Schanzer J, Tuan B, Huang N, Dong A, John E, O'Toole L, Seppa J, Hawley R, Exon C, Klumpp K. 169P Immunomodulatory effects of RBS2418, an oral ENPP1 inhibitor in combination with pembrolizumab in checkpoint-refractory metastatic adrenal cancer. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Chang SS, Hu HY, Cheng FS, Chen YC, Yen YF, Huang N. Factors associated with nonadherence to surveillance for hepatocellular carcinoma among patients with hepatic C virus cirrhosis, 2000-2015. Medicine (Baltimore) 2022; 101:e31907. [PMID: 36451463 PMCID: PMC9704922 DOI: 10.1097/md.0000000000031907] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Hepatocellular carcinoma (HCC) surveillance can detect the early stage of tumors and lead to improved survival. Adherence to guideline-concordant HCC surveillance is crucial in at-risk populations, including patients with hepatic C virus (HCV) cirrhosis. This study was conducted to identify patient and provider factors associated with nonadherence to HCC surveillance in patients with HCV cirrhosis. Data were primarily obtained from the Taiwan National Health Insurance Research Database for the 2000 to 2015 period. Adult patients newly diagnosed as having HCV cirrhosis between 2003 and 2012 were enrolled. Each patient was followed up for 3 years and until the end of 2015. Annual HCC surveillance was defined as the uptake of an abdominal ultrasound and alpha-fetoprotein (AFP) test annually during the 3-years follow-up. Nonannual surveillance was defined as the lack of an annual abdominal ultrasound and AFP test during the same 3-years period. Multinomial logistic regression models were applied to determine factors influencing adherence or nonadherence to annual HCC surveillance. We included a total of 4641 patients with HCV cirrhosis for analysis. Of these patients, only 14% adhered to annual HCC surveillance. HCC surveillance improved in later years, compared with the earlier phases of the study period. Patients with HCV cirrhosis comorbid with coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) or those with a relatively high number of comorbidities had a significantly higher likelihood of nonadherence. Patients who primarily received care from internists were significantly less likely to exhibit nonadherence to annual HCC surveillance compared with patients receiving care from physicians of other specialties. Patients who primarily received care from physicians practicing in larger hospitals were significantly less likely to exhibit nonadherence. HCC surveillance rates remain unacceptably low among high-risk patients, and our findings may be helpful in the development of effective interventions to increase HCC surveillance. The effective incorporation of HCC surveillance into routine visits for other chronic comorbidities, particularly for CAD or COPD, may be crucial for increasing HCC surveillance.
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Affiliation(s)
- Shen-Shong Chang
- Division of Gastroenterology
- Department of Internal Medicine; Taipei City Hospital Yang-Ming Branch
- Department of Medicine, School of Medicine
- Institute of Public Health and Department of Public Health
| | - Hsiao-Yun Hu
- Institute of Public Health and Department of Public Health
- Institute of Hospital and Health Care Administration; National Yang Ming Chiao Tung University
| | - Feng-Shiang Cheng
- Institute of Hospital and Health Care Administration; National Yang Ming Chiao Tung University
| | - Yu-Chin Chen
- Department of Education and Research; Taipei City Hospital
| | - Yung-Feng Yen
- Institute of Public Health and Department of Public Health
- Institute of Hospital and Health Care Administration; National Yang Ming Chiao Tung University
- Section of Infectious Diseases, Taipei City Hospital Yang-Ming Branch
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Nicole Huang
- Department of Education and Research; Taipei City Hospital
- * Correspondence: Nicole Huang, Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Room 201, The Medical Building II, No. 155, Section 2, Li-Nong Street, Taipei 112, Taiwan (e-mail: )
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25
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Chang SS, Hu HY, Chen YC, Yen YF, Huang N. Late hepatitis C virus diagnosis among patients with newly diagnosed hepatocellular carcinoma: a case–control study. BMC Gastroenterol 2022; 22:425. [PMID: 36115934 PMCID: PMC9482748 DOI: 10.1186/s12876-022-02504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/13/2022] [Indexed: 12/09/2022] Open
Abstract
Abstract
Background
New direct-acting antiviral therapies have revolutionized hepatitis C virus (HCV) infection therapy. Nonetheless, once liver cirrhosis is established, the risk of hepatocellular carcinoma (HCC) still exists despite virus eradication. Late HCV diagnosis hinders timely access to HCV treatment. Thus, we determined trends and risk factors associated with late HCV among patients with a diagnosis of HCC in Taiwan.
Methods
We conducted a population-based unmatched case–control study. 2008–2018 Claims data were derived from the Taiwan National Health Insurance Research Database. Individuals with an initial occurrence of liver cancer between 2012 and 2018 were included. The late HCV group were referred as individuals who were diagnosed with HCC within 3 years after HCV diagnosis. The control group were referred as individuals who were diagnosed more than 3 years after the index date. We used multivariable logistic models to explore individual- and provider-level risk factors associated with a late HCV diagnosis.
Results
A decreasing trend was observed in the prevalence of late HCV-related HCC diagnosis between 2012 and 2018 in Taiwan. On an individual level, male, elderly patients, patients with diabetes mellitus (DM), and patients with alcohol-related disease had significantly higher risks of late HCV-related HCC diagnosis. On a provider level, patients who were mainly cared for by male physicians, internists and family medicine physicians had a significantly lower risk of late diagnosis.
Conclusions
Elderly and patients who have DM and alcohol related disease should receive early HCV screening. In addition to comorbidities, physician factors also matter. HCV screening strategies shall take these higher risk patients and physician factors into consideration to avoid missing opportunities for early intervention.
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Hamilton J, Huang N, Ng J, Gubler T, Khuda R, Deckelbaum R, Chang C. C-13 NMR spectroscopic characterization and distinction of EPA and DHA in lipid emulsions. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.501] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamilton J, Shah A, Tasik G, Sao K, Lin S, Huang N, Corkey B, Deeney J, Hajjar D, Gotto A, Sponseller C. Elucidating the differential effects of statins on metabolism in pancreatic Β-cells cultured under high and low glucose. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.581] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Lee JJ, Hu HY, Lin SY, Huang CM, Huang SJ, Huang N. Factors Associated with Having Home Care Physicians as an Integrated Source of Medications for Chronic Conditions Among Homebound Patients. Int J Qual Health Care 2022; 34:6617285. [PMID: 35748484 DOI: 10.1093/intqhc/mzac055] [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] [Received: 12/05/2021] [Revised: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inappropriate management of medications is a major threat to homebound patients with chronic conditions. Despite many efforts in improving medication reconciliation in ambulatory and inpatient settings, little research has focused on home care settings. In 2016, Taiwan initiated the Integrated Home Health Care programme, which was intended to reduce potentially inappropriate medication management and risks of uncontrolled polypharmacy through the integration of different medication sources for chronic conditions among homebound patients. This study investigated factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients. METHODS This retrospective cohort study enrolled 3,142 community-dwelling homebound patients from Taipei City Hospital. Homebound patients' adherence to using home care physicians as an integrated source of chronic condition medications was defined as having all prescriptions for their chronic conditions prescribed by a single home care physician for at least six months. Both patient and home care physician characteristics were analysed. Multivariable logistic regression was applied. RESULTS Of the 3,142 patients with chronic conditions, 1,002 (31.9%) had consistently obtained all medications for their chronic illnesses from their home care physicians for 6 months and 2,140 (68.1%) had not. The most common chronic diseases among homebound patients were hypertension, diabetes mellitus, dementia, cerebrovascular disease, and constipation. Oldest-old patients with poor functional status, fewer daily medications, no co-payment exemption, and no recent inpatient experience were more likely to adhere to this medication integration system. In addition, patients whose outpatient physicians were also their home care physicians were more likely to adhere to the system. CONCLUSION The finding suggests that building trust and enhancing communication among homebound patients, caregivers, and home care physicians are critical. Patient and provider variations highlight the need for further improvement and policy modification for medication reconciliation and management in home care settings. The improvement in medication management and care integration in home care settings may reduce misuse and polypharmacy and improve homebound patients' safety.
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Affiliation(s)
- Jason Jiunshiou Lee
- Department of Family Medicine, Taipei City Hospital, Yangming Branch, No. 105, Yusheng Street, Shilin District, Taipei 111, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Taipei 112, Taiwan.,Department of Health and Welfare, University of Taipei, No. 101, Section 2, Zhongcheng Rd, Shilin District, Taipei 111, Taiwan.,Department of Education and Research, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei 106, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Taipei 112, Taiwan.,Department of Health and Welfare, University of Taipei, No. 101, Section 2, Zhongcheng Rd, Shilin District, Taipei 111, Taiwan.,Department of Education and Research, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei 106, Taiwan
| | - Shu-Yi Lin
- Department of Education and Research, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei 106, Taiwan
| | - Chao-Ming Huang
- Data Office, Superintendent Office, Taipei City Hospital, No. 145, Zhengzhou Rd, Datong District, Taipei 103, Taiwan
| | - Sheng-Jean Huang
- Superintendent Office, Taipei City Hospital, No. 145, Zhengzhou Rd, Datong District, Taipei 103, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, No. 7, Zhongshan S Rd, Zhongzheng District, Taipei 100, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan
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Ngwenya TZ, Huang N, Wang IA, Chen CY. Urban-Rural Differences in Depression Literacy Among High School Teachers in the Kingdom of Eswatini. J Sch Health 2022; 92:561-569. [PMID: 35318668 DOI: 10.1111/josh.13173] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Concerns have been raised over teachers' mental health literacy in low-income countries and lower- and middle-income countries wherein pediatric mental health resources are limited. This study aims to investigate adolescent depression literacy among teachers in Eswatini and to explore the role of urbanicity. METHODS We conducted a cross-sectional survey in 59 public high schools in Eswatini in 2019-2020. Data were collected by a paper-and-pencil questionnaire; depression literacy was assessed by the 17-item Adolescent Depression Knowledge Questionnaire. RESULTS Teachers' adolescent depression literacy item-level correct rates fell between 27 and 80%. Although the multivariate response models indicated that teaching in urban areas was slightly associated with having higher depression literacy in general (adjusted odds ratio [aOR] = 1.46; 95% confidence interval = 1.00-2.12), such urban-rural differences did not manifest homogeneously across all items: urban teaching was significantly linked with reduced correct responses toward certain items concerning depression etiology and treatment, including "depression runs in some families," "major stress as a necessary cause," and "a curable illness" (aOR = 0.57 ∼ 0.68). CONCLUSION Urban-rural differences in teachers' depression literacy were manifested at both scale- and item-levels. A critical need exists for urban/rural areas-tailored intervention on teachers' literacy toward mental disorders in the resource-limited regions to better improve health and developmental outcomes of students.
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Affiliation(s)
- Thabo Zwelethu Ngwenya
- His Majesty's Correctional Services, Health Care Services, Box 166, Mbabane, Eswatini; International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nicole Huang
- International Health Program; Institute of Hospital and Health Care Administration; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-An Wang
- Center for Neuropsychiatric Research, National Health Research Institute, Zhunan, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
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Domínguez Conde C, Xu C, Jarvis LB, Rainbow DB, Wells SB, Gomes T, Howlett SK, Suchanek O, Polanski K, King HW, Mamanova L, Huang N, Szabo PA, Richardson L, Bolt L, Fasouli ES, Mahbubani KT, Prete M, Tuck L, Richoz N, Tuong ZK, Campos L, Mousa HS, Needham EJ, Pritchard S, Li T, Elmentaite R, Park J, Rahmani E, Chen D, Menon DK, Bayraktar OA, James LK, Meyer KB, Yosef N, Clatworthy MR, Sims PA, Farber DL, Saeb-Parsy K, Jones JL, Teichmann SA. Cross-tissue immune cell analysis reveals tissue-specific features in humans. Science 2022; 376:eabl5197. [PMID: 35549406 PMCID: PMC7612735 DOI: 10.1126/science.abl5197] [Citation(s) in RCA: 191] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite their crucial role in health and disease, our knowledge of immune cells within human tissues remains limited. We surveyed the immune compartment of 16 tissues from 12 adult donors by single-cell RNA sequencing and VDJ sequencing generating a dataset of ~360,000 cells. To systematically resolve immune cell heterogeneity across tissues, we developed CellTypist, a machine learning tool for rapid and precise cell type annotation. Using this approach, combined with detailed curation, we determined the tissue distribution of finely phenotyped immune cell types, revealing hitherto unappreciated tissue-specific features and clonal architecture of T and B cells. Our multitissue approach lays the foundation for identifying highly resolved immune cell types by leveraging a common reference dataset, tissue-integrated expression analysis, and antigen receptor sequencing.
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Affiliation(s)
- C Domínguez Conde
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - C Xu
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - LB Jarvis
- Department of Clinical Neurosciences, University of Cambridge
| | - DB Rainbow
- Department of Clinical Neurosciences, University of Cambridge
| | - SB Wells
- Department of Systems Biology, Columbia University Irving Medical Center
| | - T Gomes
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - SK Howlett
- Department of Clinical Neurosciences, University of Cambridge
| | - O Suchanek
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - K Polanski
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - HW King
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - L Mamanova
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - N Huang
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - PA Szabo
- Department of Microbiology and Immunology, Columbia University Irving Medical Center
| | - L Richardson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - L Bolt
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - ES Fasouli
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - KT Mahbubani
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - M Prete
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - L Tuck
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - N Richoz
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - ZK Tuong
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - L Campos
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- West Suffolk Hospital NHS Trust, Bury Saint Edmunds, UK
| | - HS Mousa
- Department of Clinical Neurosciences, University of Cambridge
| | - EJ Needham
- Department of Clinical Neurosciences, University of Cambridge
| | - S Pritchard
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - T Li
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - R Elmentaite
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - J Park
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - E Rahmani
- Center for Computational Biology, University of California, Berkeley, Berkeley, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - D Chen
- Department of Systems Biology, Columbia University Irving Medical Center
| | - DK Menon
- Department of Anaesthesia, University of Cambridge, Cambridge, UK
| | - OA Bayraktar
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - LK James
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - KB Meyer
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - N Yosef
- Center for Computational Biology, University of California, Berkeley, Berkeley, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - MR Clatworthy
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - PA Sims
- Department of Systems Biology, Columbia University Irving Medical Center
| | - DL Farber
- Department of Microbiology and Immunology, Columbia University Irving Medical Center
| | - K Saeb-Parsy
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - JL Jones
- Department of Clinical Neurosciences, University of Cambridge
| | - SA Teichmann
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Theory of Condensed Matter, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thomson Ave, Cambridge CB3 0HE, UK
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Cram P, Hatfield LA, Bakx P, Banerjee A, Fu C, Gordon M, Heine R, Huang N, Ko D, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, de Groot CU, Yan L, Landon B. Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries: cross sectional cohort study. BMJ 2022; 377:e069164. [PMID: 35508312 PMCID: PMC9066381 DOI: 10.1136/bmj-2021-069164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare treatment and outcomes for patients admitted to hospital with a primary diagnosis of ST elevation or non-ST elevation myocardial infarction (STEMI or NSTEMI) in six high income countries with very different healthcare delivery systems. DESIGN Retrospective cross sectional cohort study. SETTING Patient level administrative data from the United States, Canada (Ontario and Manitoba), England, the Netherlands, Israel, and Taiwan. PARTICIPANTS Adults aged 66 years and older admitted to hospital with STEMI or NSTEMI between 1 January 2011 and 31 December 2017. OUTCOMES MEASURES The three categories of outcomes were coronary revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery), mortality, and efficiency (hospital length of stay and 30 day readmission). Rates were standardised to the age and sex distribution of the US acute myocardial infarction population in 2017. Outcomes were assessed separately for STEMI and NSTEMI. Performance was evaluated longitudinally (over time) and cross sectionally (between countries). RESULTS The total number of hospital admissions ranged from 19 043 in Israel to 1 064 099 in the US. Large differences were found between countries for all outcomes. For example, the proportion of patients admitted to hospital with STEMI who received percutaneous coronary intervention in hospital during 2017 ranged from 36.9% (England) to 78.6% (Canada; 71.8% in the US); use of percutaneous coronary intervention for STEMI increased in all countries between 2011 and 2017, with particularly large rises in Israel (48.4-65.9%) and Taiwan (49.4-70.2%). The proportion of patients with NSTEMI who underwent coronary artery bypass graft surgery within 90 days of admission during 2017 was lowest in the Netherlands (3.5%) and highest in the US (11.7%). Death within one year of admission for STEMI in 2017 ranged from 18.9% (Netherlands) to 27.8% (US) and 32.3% (Taiwan). Mean hospital length of stay in 2017 for STEMI was lowest in the Netherlands and the US (5.0 and 5.1 days) and highest in Taiwan (8.5 days); 30 day readmission for STEMI was lowest in Taiwan (11.7%) and the US (12.2%) and highest in England (23.1%). CONCLUSIONS In an analysis of myocardial infarction in six high income countries, all countries had areas of high performance, but no country excelled in all three domains. Our findings suggest that countries could learn from each other by using international comparisons of patient level nationally representative data.
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Affiliation(s)
- Peter Cram
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
- ICES, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, University College London Hospitals, London, UK
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Dennis Ko
- ICES, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | | | - Therese A Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carin Uyl de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Bruce Landon
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Jerusalem G, Prat A, Salgado R, Reinisch M, Saura C, Ruiz Borrego M, Nikolinakos P, Filian J, Ades F, Huang N, Mazzei-Abba A, Tolaney S. 92MO Neoadjuvant nivolumab (NIVO) + palbociclib (PALBO) + anastrozole (ANA) for estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) primary breast cancer (BC): CheckMate 7A8. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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Huang N, Wang PS, Chen CY, Bai YM, Chou YJ. Influence of Care Delivery Models on Quality of Diabetes Care Among Individuals With Schizophrenia. J Clin Psychiatry 2022; 83. [PMID: 36036651 DOI: 10.4088/jcp.21m13880] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Managing chronic conditions in individuals with severe mental illnesses is critical for amending health disparities in this vulnerable group. The study aimed to compare the management and outcomes of diabetes care under different care models in individuals with schizophrenia in Taiwan. Methods: A population-based retrospective cohort comprising incident cases of diabetes in individuals (N = 9,109) with schizophrenia (ICD-9-CM code 295) in Taiwan between 2008 and 2015 was selected using the National Health Insurance Research Database. Generalized estimating equation (GEE) modeling was used to compare 3 care models: the sole-physician model, the colocation model, and the different-facilities model. Each individual was followed up for 3 years. Propensity score matching was used to address potential selection bias. Results: Patients in the sole-physician model had the highest number of recommended routine examinations (incident rate ratio [IRR] = 1.2; 95% CI, 1.1-1.2) and the highest likelihood of having regular diabetes-related visits as recommended (odds ratio [OR] = 2.6; 95% CI, 2.1-3.2), followed by those in the colocation model (number of recommended routine examinations: IRR = 1.1; 95% CI, 1.1-1.2; likelihood of regular visits: OR = 1.6; 95% CI, 1.3-1.9) and those in the different-facilities model. However, the sole-physician group had a significantly higher likelihood of admission for diabetes-related ambulatory care sensitive conditions within 1 year (OR = 1.9; 95% CI, 1.3-2.8) and 3 years (OR = 1.6; 95% CI, 1.2-2.1) than its counterparts. Within the sole-physician group, patients of psychiatrists had more favorable disease outcomes than those of non-psychiatrists. Conclusions: The sole-physician and colocation models may significantly improve the process quality of diabetes care; however, such models alone are not sufficient to improve diabetes outcomes.
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Affiliation(s)
- Nicole Huang
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Sen Wang
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan *Corresponding author: Yiing-Jenq Chou, MD, PhD, Office of the Deputy Superintendent, National Yang Ming Chiao Tung University, No. 169, School Road, Yilan City, Yilan County 260, Taiwan, R.O.C. (; )
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Nkambule BS, Huang N. Gender, working status, and access to HIV care among people who are HIV positive in Eswatini. AIDS Care 2022; 35:909-916. [PMID: 35254178 DOI: 10.1080/09540121.2022.2049198] [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: 10/18/2022]
Abstract
This study investigated the relationship between gender, working status, and access to HIV care and explored whether working status mediates the relationship between gender and access to HIV care. Nationally representative data from the 2016 Swaziland HIV Incidence Measurement Survey used. Sample comprised of 2,826 adults positive for HIV. Both 30-day and 1-year employment records were used to define working status. Access to HIV care was defined using data on both HIV viral load suppression and current antiretroviral therapy (ART) enrollment. People who worked in the past 12 months had a significantly lower likelihood of current ART enrollment (odds ratio [OR] 0.75; 95% confidence interval [CI]: 0.62-0.91) and viral load suppression (OR 0.78; 95% CI: 0.67-0.92). Working in the past 30 days was also significantly associated with current ART enrollment (OR 0.71; 95% CI: 0.59-0.85) and viral load suppression (OR 0.78; 95% CI: 0.66-0.93). The negative influence of working status on access to HIV care (current ART enrollment and viral load suppression) was stronger in men than in women. Working status partially explained the relationship between gender (male) and access to HIV care. Time constraints are a likely explanation for this.
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Affiliation(s)
- Bongi Siyabonga Nkambule
- International Health Program, Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan (R.O.C)
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Lien CE, Chou YJ, Shen YJ, Tsai T, Huang N. Population-based assessment of factors influencing antibiotic prescribing for adults with dengue infection in Taiwan. PLoS Negl Trop Dis 2022; 16:e0010198. [PMID: 35226674 PMCID: PMC8884547 DOI: 10.1371/journal.pntd.0010198] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022] Open
Abstract
Background Antibiotic treatment for dengue is likely considerable and potentially avoidable but has not been well characterized. This study aimed to assess antibiotic prescribing for confirmed dengue cases in outpatient and inpatient settings and to identify associated patient, physician and contextual factors. Methods 57,301 adult dengue cases reported in Taiwan between 2008–2015 were analyzed. We assessed both outpatient and inpatient claims data of dengue patients from a week before to a week after their dengue infections were confirmed under Taiwan’s National Health Insurance program. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of antibiotic prescribing in dengue patients. Results Overall, 24.6% of dengue patients were prescribed an antibiotic during the 14 day-assessment period. Antibiotics were prescribed in 6.1% and 30.1% of outpatient visits and inpatient admissions, respectively. Antibiotic prescriptions were reduced by ~50% in epidemic years. Among inpatients, advanced age, females, and major comorbidities were risk factors for receipt of an antibiotic; antibiotics were used in 26.0% of inpatients after dengue was diagnosed. Significant differences in antibiotic prescribing practices were observed among physicians in outpatient settings but not in inpatient settings. Conclusions In addition to patient and physician demographic characteristics, contextual factors such as care setting and during epidemics significantly influenced prescription of antibiotics. Characterization of prescribing patterns should help direct programs to curb antibiotic prescribing. Antimicrobial resistance is a growing global public health threat. The non-specific clinical manifestations of dengue overlap with signs and symptoms of other febrile illnesses common to tropical and subtropical zones making differential diagnosis between dengue and bacterial infections difficult, hence, leading to potentially unnecessary antibiotic prescribing. However, our understanding of factors underlying antibiotic prescribing for dengue is rather limited. Taiwan has experienced periodic dengue outbreaks and has a comprehensive national health insurance database including reliable infectious diseases surveillance and prescribing records. The findings in Taiwan show that other than commonly known patient characteristics, provider and contextual factors play a significant role. Physician’s age and practice setting were significant factors influencing the decision to prescribe antibiotics, particularly in outpatient visits. The likelihood of prescribing an antibiotic to dengue patients was reduced by more than 50% in medical visits occurring after the dengue infection was confirmed. Understanding patient, provider and contextual factors in antibiotics prescription for dengue infections can provide insights for improved antibiotic stewardship and unnecessary antibiotic treatment for dengue.
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Affiliation(s)
- Chia-En Lien
- Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan
| | - Yi-Jung Shen
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Theodore Tsai
- Takeda Vaccines, Cambridge, Massachusetts, United States of America
- * E-mail: (TT); (NH)
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (TT); (NH)
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Huang N, Chen L, He J, Nguyen QD. The Efficacy of Clinical Breast Exams and Breast Self-Exams in Detecting Malignancy or Positive Ultrasound Findings. Cureus 2022; 14:e22464. [PMID: 35371742 PMCID: PMC8942605 DOI: 10.7759/cureus.22464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objective A breast exam is a low-risk, low-cost method for early detection, which is crucial for improved mortality. However, clinical breast exams (CBE) and breast self-exams (BSEs) remain controversial with unclear guidelines. This study analyzes the efficacy of these two exam types in evaluating palpable breast masses. Methods This retrospective cross-sectional study included 2019 medical records from Epic of women with breast lumps. Patient demographics, provider types, and breast exam types were recorded. Primary outcomes were detection of cancer and positive ultrasound finding. Fisher’s exact tests and two-sample t-tests determined the statistical significance of the association between the outcomes and categorical and continuous variables. Results Of 462 breast masses, 69 demonstrated positive ultrasound findings, with 26 of those yielding cancer; 96% of cancers and 81% of ultrasound findings resulted from patient-identified lumps. Of provider-identified lumps, 100% of cancers and 92.3% of positive ultrasound findings were diagnosed by MDs (doctors of medicine) rather than midlevel providers. There was no statistically significant difference in identifying cancer or positive ultrasound finding between CBEs and BSEs (p = 0.3709 and p = 0.1556). Conclusion Despite no difference between CBEs and BSEs in identifying cancer or positive ultrasound finding, 25 of the 26 breast cancers were initially detected by patients, while only one of 26 was detected by CBE. BSEs detect breast cancers. Although some guidelines encourage CBEs over self-exams, not all CBEs are equal. Key message There is no significant difference between CBEs and BSEs in identifying cancer or positive ultrasound finding. The majority of cancers were initially identified by patients. BSEs detect breast cancers and women should continue performing them. Not all CBEs are equal. CBEs by MDs, especially women health specialists, are generally more effective than those by midlevel providers.
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Yeh HJ, Chen TA, Cheng HC, Chou YJ, Huang N. Long-Term Rehabilitation Utilization Pattern Among Stroke Patients Under the National Health Insurance Program. Am J Phys Med Rehabil 2022; 101:129-134. [PMID: 33782272 DOI: 10.1097/phm.0000000000001747] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to understand the frequency of patients receiving rehabilitation services at various periods after stroke and the possible medical barriers to receiving rehabilitation. DESIGN A retrospective cohort study was conducted using a nationally representative sample in Taiwan. A total of 14,600 stroke patients between 2005 and 2011 were included. Utilization of physical therapy or occupational therapy at different periods after stroke onset was the outcome variable. Individual and geographic characteristics were investigated to determine their effect on patients' probability of receiving rehabilitation. RESULTS More severe stroke or more comorbid diseases increased the odds of receiving physical therapy and occupational therapy; older age was associated with decreased odds. Notably, sex and stroke type influenced the odds of rehabilitation only in the early period. Copayment exemption lowered the odds of rehabilitation in the first 6 mos but increased the odds in later periods. Rural and suburban patients had significantly lower odds of receiving physical therapy and occupational therapy, as did patients living in areas with fewer rehabilitation therapists. CONCLUSIONS Besides personal factors, geographic factors such as urban-rural gaps and number of therapists were significantly associated with the utilization of post-stroke rehabilitation care. Furthermore, the influence of certain factors, such as sex, stroke type, and copayment exemption type, changed over time.
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Affiliation(s)
- Huan-Jui Yeh
- From the Department of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan (H-JY, T-AC); Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-JY, Y-JC); Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan (H-CC); Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); Department of Life Sciences and Institute of Genome Sciences, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan (NH)
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Hwang AC, Lee WJ, Huang N, Chen LY, Peng LN, Lin MH, Chou YJ, Chen LK. Longitudinal changes of frailty in 8 years: comparisons between physical frailty and frailty index. BMC Geriatr 2021; 21:726. [PMID: 34922488 PMCID: PMC8684153 DOI: 10.1186/s12877-021-02665-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/05/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have made longitudinal comparisons between frailty phenotype (FP) and frailty index (FI) changes. We aimed to investigate frailty status changes defined by FP and FI concurrently, and to compare the associated factors and incident disability among different combination of FI and FP trajectory groups. Methods Data on respondents aged over 50 who completed the 1999, 2003 and 2007 Taiwan Longitudinal Study on Aging (TLSA) surveys (n = 2807) were excerpted. Changes of FI, FP and major time-dependent variables were constructed by group-based trajectory modeling. Logistic regression was used to investigate the associated factors and relationships with incident disability among different frailty trajectories. Results We identified four FP trajectories – stably robust, worsened frailty, improved frailty, and stably frail and three FI trajectories – stable FI, moderate increase FI and rapid increase FI. Lower self-rated health, mobility impairment, and depressed mood were associated with unfavorable FP and FI changes (all p < 0.001). Regardless of FP trajectory groups, the moderate and rapid increase FI group had significantly more comorbidities than the stable FI group, and more visual, hearing, oral intake impairment, more difficulty in meeting living expenses, and poorer cognitive function in ≥65-year-olds (all p < 0.05). In addition, the worsened frailty, improved frailty, and stably frail groups had ORs for incident disability of 10.5, 3.0, and 13.4, respectively, compared with the stably robust group (all p < 0.01); the moderate and rapid increase FI groups had 8.4-fold and 77.5-fold higher risk than the stable FI group (both p < 0.001). When combining FI and FP trajectories, risk increased with FI trajectory steepness, independent of FP change (all p < 0.01 in rapid increase FI vs stable FI). Conclusions Four FP trajectories (stably robust, worsened frailty, improved frailty, and stably frail) and three FI trajectories (stable FI, moderate increase FI and rapid increase FI) were identified. Lower self-rated health, mobility impairment, and depressed mood were associated with both unfavorable FP and FI trajectories. Nevertheless, even for individuals in stably robust or improved frailty FP groups, moderate or rapid increase in FI, either due to comorbidities, sensory impairment, cognitive deficits, or financial challenges, may still increase the risk of incident disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02665-1.
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Affiliation(s)
- An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, No.115, Sec. 2, Li-Nong Street, Taipei, 112, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ju Lee
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan County, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, No.115, Sec. 2, Li-Nong Street, Taipei, 112, Taiwan. .,Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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Chang PY, Chiou ST, Lo WY, Huang N, Chien LY. Stressors and level of stress among different nursing positions and the associations with hyperlipidemia, hyperglycemia, and hypertension: a national questionnaire survey. BMC Nurs 2021; 20:250. [PMID: 34903232 PMCID: PMC8667416 DOI: 10.1186/s12912-021-00777-y] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nurses are faced with varying job stressors depending on their positions and duties. Few previous studies have compared job stress and related chronic conditions among different nursing positions. The objectives were to compare job stressors among clinical registered nurses, nurse practitioners, and head nurses and explore the impact of job stressors and stress level on hyperlipidemia, hyperglycemia, and hypertension. METHODS Secondary data extracted from a survey of health-care workers conducted from May to July 2014 across 113 hospitals in Taiwan was used. This analysis included 17,152 clinical registered nurses, 1438 nurse practitioners, and 2406 head nurses. Socio-demographic characteristics, job stressors, stress levels, and hyperlipidemia, hyperglycemia, and hypertension variables were extracted. RESULTS Perceived stressors differed among clinical registered nurses, nurse practitioners, and head nurses, but overall stress level did not. Nurse practitioners and head nurses showed significantly higher prevalence of hyperlipidemia, hyperglycemia, and hypertension than clinical registered nurses. Higher stress levels, age, body mass index, work hours, and caring for family members were positively associated with hyperlipidemia, hyperglycemia, and hypertension. After adjustment for these variables, risk of hyperlipidemia, hyperglycemia, and hypertension did not differ across the nursing positions. CONCLUSIONS Although stressors vary by different nursing positions, overall stress level does not. Hyperlipidemia, hyperglycemia, and hypertension are related to stress level, age, body mass index, weekly working hours, and caring for family members. Hence, alleviating job stress and avoiding long working hours are likely to reduce the risk of hyperlipidemia, hyperglycemia, and hypertension in nurses.
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Affiliation(s)
- Po-Ya Chang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Ti Chiou
- Institute of Public Health, National Yang Ming Chaio Tung University, Yang-Ming Campus, Taipei, Taiwan.,Center for Healthcare Quality Management, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wen-Yen Lo
- Department of Nursing, National Yang Ming Chiao Tung University, Yang-Ming Campus, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Yang-Ming Campus, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Yang-Ming Campus, 155 Li-Nong Street, Section 2, Bei-Tou, Taipei, 11221, Taiwan.
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Cheng SL, Li YR, Huang N, Yu CJ, Wang HC, Lin MC, Chiu KC, Hsu WH, Chen CZ, Sheu CC, Perng DW, Lin SH, Yang TM, Lin CB, Kor CT, Lin CH. Effectiveness of Nationwide COPD Pay-for-Performance Program on COPD Exacerbations in Taiwan. Int J Chron Obstruct Pulmon Dis 2021; 16:2869-2881. [PMID: 34703221 PMCID: PMC8539057 DOI: 10.2147/copd.s329454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It has also imposed a substantial economic and social burden on the health care system. In Taiwan, a nationwide COPD pay-for-performance (P4P) program was designed to improve the quality of COPD-related care by introducing financial incentives for health care providers and employing a multidisciplinary team to deliver guideline-based, integrated care for patients with COPD, reducing adverse outcomes, especially COPD exacerbation. However, the results of a survey of the effectiveness of the pay-for-performance program in COPD management were inconclusive. To address this knowledge gap, this study evaluated the effectiveness of the COPD P4P program in Taiwan. Methods This retrospective cohort study used data from Taiwan’s National Health Insurance claims database and nationwide COPD P4P enrollment program records from June 2016 to December 2018. Patients with COPD were classified into P4P and non-P4P groups. Patients in the P4P group were matched at a ratio of 1:1 based on age, gender, region, accreditation level, Charlson Comorbidity Index (CCI), and inhaled medication prescription type to create the non-P4P group. A difference-in-difference analysis was used to evaluate the influence of the P4P program on the likelihood of COPD exacerbation, namely COPD-related emergency department (ED) visit, intensive care unit (ICU) admission, or hospitalization. Results The final sample of 14,288 patients comprised 7144 in each of the P4P and non-P4P groups. The prevalence of COPD-related ED visits, ICU admissions, and hospitalizations was higher in the P4P group than in the non-P4P group 1 year before enrollment. After enrollment, the P4P group exhibited a greater decrease in the prevalence of COPD-related ED visits and hospitalizations than the non-P4P group (ED visit: −2.98%, p<0.05, 95% confidence interval [CI]: −0.277 to −0.086; hospitalization: −1.62%, p<0.05, 95% CI: −0.232 to −0.020), whereas no significant difference was observed between the groups in terms of the changes in the prevalence of COPD-related ICU admissions. Conclusion The COPD P4P program exerted a positive net effect on reducing the likelihood of COPD exacerbation, namely COPD-related ED visits and hospitalizations. Future studies should examine the long-term cost-effectiveness of the COPD P4P program.
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Affiliation(s)
- Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan.,Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli, Taoyuan, 320, Taiwan
| | - Yi-Rong Li
- Changhua Christian Hospital, Thoracic Medicine Research Center, Changhua, 500, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan
| | - Kuo-Chin Chiu
- Division of Chest, Department of Internal Medicine, Poh-Ai Hospital, Luodong, 265, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, 701, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Sheng-Hao Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, 613, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Ching-Hsiung Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, 523, Taiwan
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Nguyen AV, Ross E, Westra J, Huang N, Nguyen CY, Raji M, Lall R, Kuo YF. Opioid Utilization in Geriatric Patients After Operation for Degenerative Spine Disease. J Neurosurg Anesthesiol 2021; 33:315-322. [PMID: 32091468 PMCID: PMC7442665 DOI: 10.1097/ana.0000000000000682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few studies have investigated opioid utilization by geriatric patients after spinal surgery, a population in whom degenerative spine disease (DSD) is highly prevalent. We aimed to quantify rates of chronic, continuous opioid utilization by geriatric patients following spine surgery for DSD-related diagnoses. MATERIALS AND METHODS Utilizing a national 5% Medicare sample database, we investigated individuals aged above 66 years who underwent spinal surgery for a DSD-related diagnosis between the years of 2008 and 2014. The outcomes of interest were the rate of and risk factors for continuous opioid utilization at 1-year following anterior cervical discectomy and fusion, posterior cervical fusion, 360-degree cervical fusion, lumbar microdiscectomy, lumbar laminectomy, posterior lumbar fusion, anterior lumbar fusion, or 360-degree lumbar fusion for a DSD-related diagnosis. RESULTS Of the 14,583 Medicare enrollees who met study criteria, 6.0% continuously utilized opioids 1-year after spinal surgery. When stratified by preoperative opioid utilization (with the prior year divided into 4 quarters), the rates of continuous utilization at 1-year postsurgery were 0.3% of opioid-naive patients and 23.6% of patients with opioid use in all 4 quarters before surgery. Anxiety, benzodiazepine use within the year before surgery, and Medicaid dual-eligibility were associated with prolonged opioid utilization. CONCLUSIONS Of opioid-naive geriatric patients who underwent surgery for DSD, 0.3% developed chronic, continuous opioid use. Preoperative opioid use was the strongest predictor of prolonged utilization, which may represent suboptimal use of nonopioid alternatives, pre-existing opioid use disorders, delayed referral for surgical evaluation, or over-prescription of opioids for noncancer pain.
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Affiliation(s)
- Anthony V. Nguyen
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Evan Ross
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan Westra
- Preventive Medicine and Community Health, Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Nicole Huang
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Christine Y. Nguyen
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila Raji
- Department of Internal Medicine, Division of Geriatrics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rishi Lall
- Department of Surgery, Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Preventive Medicine and Community Health, Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA
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Sintes M, Serror K, Bouaziz J, Mimoun M, Bensussan A, Agnely F, Huang N, Michel L. 238 Modulation of the antigen presentation capacity of Langerhans cells by a Pickering emulsion combining an immunosuppressive and an anti-inflammatory drug. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.243] [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: 11/16/2022]
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Lien CE, Chou YJ, Shen YJ, Tsai T, Huang N. A Population-Based Cohort Study on Chronic Comorbidity Risk Factors for Adverse Dengue Outcomes. Am J Trop Med Hyg 2021; 105:1544-1551. [PMID: 34583328 PMCID: PMC8641312 DOI: 10.4269/ajtmh.21-0716] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022] Open
Abstract
The global burden of dengue is increasing against a background of rising global prevalence of chronic noncommunicable diseases (NCDs) and an epidemiological shift of dengue toward older age groups. The contribution of NCDs toward risk for adverse clinical and healthcare utilization outcomes was assessed in a national linked-database study. About 51,433 adult dengue cases between 2014 and 2015 were assessed for outpatient and inpatient claims data in Taiwan’s National Health Insurance Research Database for the 30 days after their dengue diagnosis. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of adverse dengue outcomes in patients with NCDs compared with dengue patients without underlying diseases. Rheumatoid arthritis and related disease were associated with the highest risk of hospitalization after dengue diagnosis (odds ratio: 1.78; 95% CI: 1.37–2.30), followed by stroke, chronic kidney disease (CKD), liver cirrhosis, asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, congestive heart failure, hypertension, and malignancy. Chronic kidney disease and diabetes were associated with higher risks of hospitalization, intensive care unit (ICU) use, and all-cause mortality. After adjusting for socioeconomic status and other variables, the number of coexisting chronic diseases was associated with increasing risk of adverse dengue outcomes. Specific NCDs were associated with longer hospitalizations, ICU admission, and higher healthcare costs. Quantifying the risks of adverse dengue outcomes and health expenditures among dengue patients with preexisting NCDs provides insights for improved clinical management and essential inputs for health economic analyses on the cost-benefit of risk-based routine or catch-up immunization programs.
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Affiliation(s)
- Chia-En Lien
- Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan
| | - Yi-Jung Shen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Li W, Wang Y, Tang X, Yuen TTT, Han X, Li J, Huang N, Chan JFW, Chu H, Wang L. Liquid repellency enabled antipathogen coatings. Mater Today Bio 2021; 12:100145. [PMID: 34642656 PMCID: PMC8495064 DOI: 10.1016/j.mtbio.2021.100145] [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: 07/26/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Currently, Coronavirus Disease 2019 (COVID-19)-a respiratory contagion spreading through expiratory droplets-has evolved into a global pandemic, severely impacting the public health. Importantly, the emerging of immune evasion SARS-CoV-2 variants and the limited effect of current antivirals against SARS-CoV-2 in clinical trials suggested that alternative strategies in addition to the conventional vaccines and antivirals are required to successfully control the COVID-19 pandemic. Here, we propose to use liquid-repellent coatings to prevent the spread of the disease in the absence of effective vaccines, antimicrobial agents, or therapeutics, wherein the deposition and penetration of pathogen droplets are prohibited. We use SARS-CoV-2 as a model pathogen and find that SARS-CoV-2 remnants are reduced by seven orders of magnitude on coated surfaces, yielding a repelling efficacy far outperforming the inactivation rate of disinfectants. The SARS-CoV-2 remnant scales exponentially with the liquid/solid adhesion, uncovering the mechanism and effective means for minimizing pathogen attachment. The antipathogen coating that both repels and inactivates pathogens is demonstrated by incorporating the super-liquid-repellent coating with antipathogen additives. Together with its versatility over a wide range of substrates and pathogens, the novel antipathogen coating is of considerable value for infection control in everyday life as well as during pandemics.
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Affiliation(s)
- W Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
- HKU-Zhejiang Institute of Research and Innovation (HKU-ZIRI), Hangzhou, Zhejiang 311300, China
| | - Y Wang
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - X Tang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
- HKU-Zhejiang Institute of Research and Innovation (HKU-ZIRI), Hangzhou, Zhejiang 311300, China
| | - T T T Yuen
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - X Han
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
- HKU-Zhejiang Institute of Research and Innovation (HKU-ZIRI), Hangzhou, Zhejiang 311300, China
| | - J Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
- HKU-Zhejiang Institute of Research and Innovation (HKU-ZIRI), Hangzhou, Zhejiang 311300, China
| | - N Huang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - J F W Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - H Chu
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - L Wang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
- HKU-Zhejiang Institute of Research and Innovation (HKU-ZIRI), Hangzhou, Zhejiang 311300, China
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45
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Chou KT, Tsai YL, Yeh WY, Chen YM, Huang N, Cheng HM. Risk of work-related injury in workers with obstructive sleep apnea: A systematic review and meta-analysis. J Sleep Res 2021; 31:e13446. [PMID: 34384138 DOI: 10.1111/jsr.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
The objective of this study is to elucidate the relationship between obstructive sleep apnea (OSA) and the risk of work-related injuries (WRIs), synthesize the latest clinical evidence and conduct a systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020). Observational studies published before April 2020 in PubMed, Cochrane library, PsycINFO, Scopus, Google Scholar and Web of Science were included. Random-effects Mantel-Haenszel meta-analysis was performed. A total of 15 studies with 21,507 participants were included. Prespecified subgroup analyses based on study design and the characteristics of the enrollees were conducted. Overall, workers with OSA had 1.64-fold increased odds of being involved in WRIs compared to their counterparts (OR = 1.64, 95% CI = 1.24-2.16, p = 0.0005). In addition to the professional drivers that have been studied in the past, such a trend also existed in the general working population (OR = 1.68, 95% CI = 1.14-2.49, p = 0.01). We also found that workers with excessive daytime sleepiness (Epworth Sleepiness Scale score >10) had a 1.68-fold increased risk of WRIs compared to those with lower ESS scores (OR = 1.68, 95% CI = 1.22-2.30, p = 0.002). This study verified that OSA workers had a higher risk of WRIs, and such correlations do not show obvious differences in subgroups with different sample sizes, OSA diagnosis methods, job types or definitions of WRI. Based on the association between OSA and WRIs identified in our study, further studies investigating the protective effects of early identification and management of OSA on WRIs are warranted.
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Affiliation(s)
- Kun-Ta Chou
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Yu-Lun Tsai
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Yu Yeh
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
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46
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Ren Y, Zhao Y, Sun W, Chen Y, Yang J, Li Z, Wu X, Zhao L, Sun W, Lv C, Huang N, Li X. Effect of CRISPR/Cas9 system-mediated NF-κB knockdown on CNE-2 immune function in nasopharyngeal carcinoma. J BIOL REG HOMEOS AG 2021; 35:4. [PMID: 34337911 DOI: 10.23812/21-171-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Y Ren
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Y Zhao
- Department of Anesthesiology, The First Hospital of Qujing, Qujing, Yunnan Province, China
| | - W Sun
- Operation Room of Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Y Chen
- Department of Pathology, Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - J Yang
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Z Li
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - X Wu
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - L Zhao
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - W Sun
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - C Lv
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - N Huang
- Department of Pharmacology, Kunming Medical University, Kunming, Yunnan Province, China
| | - X Li
- Head and Neck Tumor Research Center, Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Hamilton J, Tasik G, Sao K, Bodde J, Gajrawala E, Huang N, Kolar E, Corkey B, Deeney J, Hajjar D, Gotto A, Erion K, Burritt N, Sitaram M, Schwartz S, Sponseller C. Effects of different statins on glucose-induced CA2+ oscillations and oxygen consumption from pancreatic β-cells: Mechanisms and clinical implications. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Liang LL, Tussing AD, Huang N, Tsai SL. Incentives for physician teams: Effectiveness of performance feedback and payment distribution methods. Health Policy 2021; 125:1377-1384. [PMID: 34334226 DOI: 10.1016/j.healthpol.2021.07.007] [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] [Received: 04/11/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
Best practices in team-based incentive design remain underexplored. This study examines under group-based pay-for-performance, how managers incentivize physicians for teamwork through internal feedback and payment distribution methods. In collaboration with Taiwan Association of Family Medicine, authors conducted a national survey of physician groups, with a response rate of 48.3%. Multilevel linear regression was applied to 134 groups, collectively consisting of 1,245 physicians in Taiwan. The outcome variables were two manager-rated scores for group performance on achieving (a) comprehensive, coordinated, continuous care, and (b) patient health improvement. The results indicate that providing each physician feedback on peer performance is superior to not providing it; when providing peer information within a group, concealing identities is superior to revealing them. These findings imply that application of the principle of social comparison can be effective; however, caution should be taken when disclosure of identifiable peer performance may intensify peer competition and undermine care coordination in team-based models. Further, groups that distribute payments equally among physicians perform better than groups that distributed payment proportionally to physicians' patient shares. The findings are germane to small teams, where physicians do not have full control over care processes and outcomes, and need to work cooperatively to maximize group-based payment.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, No.70 Lien-Hai Rd., Kaohsiung 804, Taiwan; Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, No.155, Sec. 2, Li‑Nong Street, Taipei 112, Taiwan.
| | - A Dale Tussing
- Department of Economics, Syracuse University, 900 South Crouse Ave. Syracuse, NY 13244, USA
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No.155, Sec. 2, Li‑Nong Street, Taipei 112, Taiwan
| | - Shu-Ling Tsai
- National Health Insurance Administration, Ministry of Health and Welfare, No.140, Sec.3, Hsinyi Rd., Taipei 106, Taiwan
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49
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Ye H, Huang N, Sun T, Hou W, Bai J, Li H. [Preparation of doxorubicin-loaded metallic organic nanoparticles and their effect for enhancing efficacy of high-intensity focused ultrasound therapy in tumor-bearing mice]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:640-648. [PMID: 34134949 DOI: 10.12122/j.issn.1673-4254.2021.05.02] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To prepare metallic organic nanoparticles that produce synergistic effect in high-intensity focused ultrasound (HIFU) therapy of tumors. OBJECTIVE Glucose oxidase (GOD), MnO2, ferric iron (Fe3+) and doxorubicin (DOX) were self-assembled by physical adsorption with previously prepared manganese dioxide (MnO2) nanoparticles to obtain GOD-MnO2-Fe3+-DOX nanoparticles (GMFD NPs). HepG2 tumor-bearing nude mouse models were given intravenous injections of normal saline or GMFD NPs followed 4 h later by HIFU at the acoustic power of 90 W with a total treatment time of 3 s. The changes of tumor gray value before and after HIFU irradiation were observed and 24 h after HIFU irradiation, coagulation necrosis in the tumor tissues was examined; the histological changes of the tumor tissues were observed with HE staining. OBJECTIVE We successfully prepared GMFD NPs, which had an average particle size of 131.23±0.84 nm with a surface potential of 21.87±1.72 mV. GMFD NPs, with a drug loading rate of 40.18%, was capable of releasing more than 77.2% of the loaded DOX within 4 h in acidic environment. In the tumor-bearing mouse models, HIFU irradiation following GMFD NP injection, as compared with saline injection, resulted in significantly enhanced gray value of the tumor (25.5±4.5 vs 18.7±3.9, P=0.04) and greater volume of coagulation necrosis (105.80 ± 1.21 mm3 vs 38.02 ± 0.34 mm3). The energy efficiency factor (EEF) was significantly lower in GMFD NPs group than in saline group (1.79 vs 4.97, P < 0.001). OBJECTIVE GMFD NPs prepared in this study can enhance tumor ablation efficacy of HIFU and release DOX for further treatment of the residual tumor tissue in mice.
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Affiliation(s)
- H Ye
- State Key Laboratory of Ultrasound Medical Engineering//College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - N Huang
- State Key Laboratory of Ultrasound Medical Engineering//College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - T Sun
- State Key Laboratory of Ultrasound Medical Engineering//College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - W Hou
- State Key Laboratory of Ultrasound Medical Engineering//College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - J Bai
- State Key Laboratory of Ultrasound Medical Engineering//College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - H Li
- State Key Laboratory of Ultrasound Medical Engineering//College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
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50
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Li WJ, Huang N, Zhang SC, Ma DX, Yang YQ, Zhu RF. [Airborne pollens in Wuhan urban area and its correlation with hospital visits of allergic rhinitis patients from 2017 to 2018]. Zhonghua Yu Fang Yi Xue Za Zhi 2021; 55:620-626. [PMID: 34034402 DOI: 10.3760/cma.j.cn112150-20210312-00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the species and concentrations of airborne pollens in Wuhan urban area and their correlation with the number of visits of allergic rhinitis patients. Methods: Retrospective analysis of pollen dispersal characteristics and the number of patients with allergic rhinitis presenting to Tongji Hospital of Huazhong University of Science and Technology in Wuhan city from October 2017 to September 2018, as well as pollen allergen testing results of patients with allergic rhinitis presenting to the Department of Allergy during the same period. Pollen data was collected by a 1-year air sampling conducted in Wuhan City during the same period using the volumetric method. The samples were examined microscopically to identify airborne pollen species and counted, and the concentrations of various pollens were calculated. Information on patients with allergic rhinitis who came to the hospital during the same period was collected, and the correlation between pollen concentration and the number of patient visits was statistically analyzed using Pearson correlation analysis. Results: A total of 35 types of airborne pollen were collected from October 2017 to September 2018. The dominant pollens in spring were Moraceae (68.46%, 1 042/1 522), Pendula (12.22%, 186/1 522) and Cupressaceae (2.30%, 35/1 522); in summer and autumn, the dominant pollens were Artemisia (3.81%, 58/1 522), Humulus (4.01%, 61/1 522) and Ambrosia (0.59%, 9/1 522). The peak number of visits for allergic rhinitis patients occurred in March-April and July-September, both exceeding 2 200 visits and reaching a maximum of 2 545 visits. There was a very weak correlation between the number of visits and the total pollen concentration (r=0.17, P=0.001). The average monthly pollen skin prick test positive rate of patients with allergic rhinitis was highest in March-May, exceeding 40% with a maximum of 45.73%, and there was a significant correlation between the positive pollen skin prick test positive rate and the average monthly pollen concentration (r=0.62, P=0.031). Conclusions: Pollen species and concentrations fluctuated continuously with time in Wuhan urban area, with peak pollen dispersal in spring from March to April and in autumn from August to September. The number of visits to patients with allergic rhinitis and the positive pollen skin prick test positive rate increased accordingly during the peak pollen concentration periods.
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Affiliation(s)
- W J Li
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - N Huang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - S C Zhang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - D X Ma
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y Q Yang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - R F Zhu
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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