Publications by authors named "Pesus Chou"

340 Publications

Using hand grip strength to detect slow walking speed in older adults: the Yilan study.

BMC Geriatr 2021 Jul 16;21(1):428. Epub 2021 Jul 16.

Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Background: Walking speed is an important health indicator in older adults, although its measurement can be challenging because of the functional decline due to aging and limited environment. The aim of this study was to examine whether hand grip strength can be a useful proxy for detecting slow walking speed in this population.

Methods: A cross-sectional study was conducted using the cohort from the Yilan Study in Taiwan. Community-dwelling older adults aged 65 years and older were included. Slow walking speed was defined as a 6-meter walking speed < 1.0 m/s, according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Stepwise multiple linear regression was used to determine the most significant variables associated with walking speed. Receiver operating characteristic analysis was used to determine the optimal cutoff values for hand grip strength in detecting slow walking speed.

Results: A total of 301 participants with an average age of 73.9 ± 6.8 years were included; 55.1 % participants were women. In stepwise multiple linear regression analysis that included various variables, hand grip strength was found to be the most explainable factor associated with walking speed among all participants and among participants of each sex. The optimal cutoff values for hand grip strength in the detection of slow walking speed were 19.73 kg for all participants (sensitivity: 55 %, specificity: 83 %, area under the curve: 0.74, accuracy: 66.9 %), 35.10 kg for men (sensitivity: 92 %, specificity: 42 %, area under the curve: 0.70, accuracy: 66.4 %), and 17.93 kg for women (sensitivity: 62 %, specificity: 80 %, area under the curve: 0.76, accuracy: 67.9 %).

Conclusions: Hand grip strength was found to be a useful proxy for the identification of slow walking speed in older adults.
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http://dx.doi.org/10.1186/s12877-021-02361-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285830PMC
July 2021

Manifestations and Virus Detection in the Ocular Surface of Adult COVID-19 Patients: A Meta-Analysis.

J Ophthalmol 2021 19;2021:9997631. Epub 2021 Jun 19.

School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.

Purpose: This study aims to examine the prevalence rate of ocular manifestations and the positive rate for the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival/tear swabs among adult patients with coronavirus disease 2019 (COVID-19).

Methods: PubMed and EMBASE were reviewed between December 1, 2019, and January 31, 2021, and only peer-reviewed clinical studies in our pooled analyses were included. Details regarding the patient numbers, demographics, ocular manifestations, positivity of ocular surface RT-PCR, and severity of pneumonia were recorded from each study. Primary outcomes were the occurrence of ocular manifestations and virus detection on the ocular surface. Meanwhile, secondary outcomes included frequencies of various ocular symptoms/signs (s/s), the proportion of patients with ocular manifestation as the initial symptom, and the relationship between the severity of pneumonia and the presentation of ocular manifestations.

Results: In total, 35 studies with 4,432 adult COVID-19 patients were included in this analysis. The overall prevalence rate of ocular manifestations was found to be 11.3%, and the positive rate of SARS-CoV-2 in the ocular surface was 7.4%. The four most common ocular s/s were follicular conjunctivitis, redness, watering, and discharge. A proportion of 3.3% presented with ocular s/s preceding other findings. Besides, patients with higher severity of pneumonia were more likely to have ocular manifestations (odds ratio = 2.25; 95% confidence interval (CI): 1.45-3.50).

Conclusion: As per our findings, it was determined that ocular transmission of SARS-CoV-2 might be possible, highlighting the importance of eye protective equipment among healthcare personnel.
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http://dx.doi.org/10.1155/2021/9997631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225454PMC
June 2021

Volunteering and self-reported health outcomes among older people living in the community: the Yilan study, Taiwan.

Qual Life Res 2021 Jul 7. Epub 2021 Jul 7.

Community Medicine Research Center and Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Purpose: This study aimed to explore associations between volunteering and various self-reported health outcomes among older people, including subjective physical and mental health, self-rated health, and self-rated happiness.

Methods: This questionnaire survey was conducted in Yilan, Taiwan. By convenient sampling, a total of 3692 older people living in the community were recruited from 2012 to 2016. Participants' engagement in community volunteer activities in the past month was recorded. Subjective physical and mental health were evaluated using the Short Form-12 version2 Health Survey physical and mental component summary scores. Self-rated health and happiness were each evaluated by a single question. Participants' demographic information and comorbidities were also recorded. We conducted multiple linear regression analyses adjusted for age, sex, marital status, body mass index, educational level, living status, comorbidities, smoking status, and status of alcohol drinking.

Resultss: After adjusting for covariates, volunteering was significantly associated with better subjective physical health, self-rated health, and self-rated happiness scores (B = 2.41, 95% confidence interval [CI] (1.56, 3.26); B = 3.46, 95% CI (2.66, 4.66), and B = 4.62, 95% CI (3.18, 6.05), respectively). The strength of the relationships between volunteering and various self-reported health outcomes differed.

Conclusions: Volunteering has positive associations on subjective physical health, self-rated health, and happiness for older people living in the community in Yilan, Taiwan. Further follow-up studies are needed to examine the mechanisms of associations between volunteering and various self-reported health outcomes, and clarify the differences in the strength of their associations.
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http://dx.doi.org/10.1007/s11136-021-02933-yDOI Listing
July 2021

Increased mortality after intravitreal injections of anti-VEGF for neovascular AMD among patients with prior stroke or acute myocardial infarction.

Eye (Lond) 2021 Mar 2. Epub 2021 Mar 2.

School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.

Objectives: To evaluate whether intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) in neovascular age-related macular degeneration (nAMD) patients with prior stroke or acute myocardial infarction (AMI) are associated with increased mortality.

Methods: From 2005 to 2013, nAMD patients in the Taiwan National Health Insurance Research Database who received IVI of anti-VEGF and had a diagnosis of stroke/AMI prior to their first injections were defined as the IVI group. The mortality of the IVI group during the study period was compared to that of the non-IVI group, which consisted of nAMD patients who had prior stroke/AMI but were never exposed to anti-VEGF. The IVI group and the non-IVI group were 1-4 matched according to propensity score (PS), which was derived from age, sex, date of stroke/AMI and comorbidities. PS-adjusted Cox regression analyses were used to estimate the hazard ratio (HR) for mortality associated with IVI of anti-VEGF. Subgroup analyses were also performed according to the interval between stroke/AMI and IVI (≤6 months, 6 months to 1 year, 1-2 years, >2 years).

Results: There were 3384 individuals in the IVI group and 13,536 individuals in the non-IVI group. The IVI group had a significantly higher mortality risk (adjusted HR = 2.37; 95% confidence interval (CI), 2.14-2.62) than the non-IVI group. Subgroup analyses revealed that elevated mortality was significant when anti-VEGF was injected within 1 year after stroke/AMI.

Conclusions: We found an increased mortality risk associated with IVI of anti-VEGF in nAMD patients with prior stroke/AMI compared to the mortality risk of nAMD patients with prior stroke/AMD but without exposure to anti-VEGF.
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http://dx.doi.org/10.1038/s41433-021-01416-1DOI Listing
March 2021

Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet's disease: a population-based cohort study.

BMJ Open 2021 01 15;11(1):e042201. Epub 2021 Jan 15.

School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Objectives: To investigate whether uveitis is a predictor of acute myocardial infarction (AMI) among patients with Behcet's disease (BD).

Design: Retrospective cohort study.

Setting: Patients with BD were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013.

Participants: Among the 6508 patients with BD, 2517 (38.7%) were in the uveitis group and 3991 were in the non-uveitis group.

Primary And Secondary Outcome Measures: Kaplan-Meier curves were generated to compare the cumulative hazard of AMI in the uveitis and non-uveitis groups. Multivariate Cox regression analysis was used to estimate the adjusted HRs and 95% CI of AMI, and was adjusted for age, gender, systemic comorbidities (eg, hypertension, diabetes, hyperlipidaemia, smoking) and clinical manifestation of BD (eg, oral ulcers, genital ulcers, skin lesions, arthritis and gastrointestinal involvement).

Results: The mean age of the BD cohort was 38.1±15.1 years. Compared with non-uveitis patients, uveitis patients were significantly younger and male predominant. There was no significant difference between the two groups for most proportions of systemic comorbidities and clinical manifestations. The Kaplan-Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI compared with the non-uveitis group (p<0.0001). In the multivariable Cox regression after adjustment for confounding factors, patients with uveitis had a significantly higher risk of AMI (adjusted HR 1.87; 95% CI 1.52 to 2.29). Other significant risk factors for AMI were age, hypertension, smoking, and skin lesions.

Conclusions: Statistical analyses from the nationwide database demonstrated that uveitis is a potential predictor of AMI in patients with BD.
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http://dx.doi.org/10.1136/bmjopen-2020-042201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813367PMC
January 2021

Association between dry eye and depressive symptoms in an elderly Chinese population in Taiwan: the Shihpai Eye Study.

Eye (Lond) 2020 Nov 30. Epub 2020 Nov 30.

Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.

Background: Dry eye may impact quality of life and daily activities and depression is a widespread illness. Many studies showed the two diseases often coexist. However, studies were limited to retrospective chart review. This study aimed to investigate the association between dry eye and depressive symptoms in an older Asian population.

Methods: The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects 65 years of age and older in Shihpai, Taipei, Taiwan. Residents fulfilling these criteria were randomly selected to be invited to participate in the study, which included a questionnaire and an eye examination conducted between July 1, 1999 and December 31, 2000.

Results: Of the 2045 subjects recruited, 1361 (66.6%) completed the examination. 8.8% (95% confidence interval (CI): 7.3-10.3%) of the participants were diagnosed to have depressive symptoms. Under multivariate analysis, depressive symptoms were significantly associated with frequent symptoms of dry eye (odds ratio (OR): 1.97, 95% CI: 1.36-2.92; p < 0.001). None of the dry eye signs was associated with depressive symptoms. For participants reporting frequent symptoms, tear-film break-up time ≤ 10 s (OR: 2.06, 95% CI: 1.38-3.05; p < 0.001), Schirmer test score ≤ 5 mm (OR: 2.01, 95% CI: 1.33-3.03; p < 0.001), and meibomian gland disease (OR: 1.99, 95% CI: 1.31-3.01; p = 0.001) were significantly related to depressive symptoms. Fluorescein staining of the cornea was not correlated to depressive symptoms in participants with dry eye symptoms.

Conclusions: Depressive symptoms are more highly correlated with dry eye symptoms than dry eye signs.
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http://dx.doi.org/10.1038/s41433-020-01329-5DOI Listing
November 2020

Determinants of post-mydriatic intraocular pressure in phakic eyes with prevalent angle closure diseases.

Graefes Arch Clin Exp Ophthalmol 2021 Jan 30;259(1):137-143. Epub 2020 Sep 30.

Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.

Purpose: This study aimed to identify acute angle closure (AAC) risk following pharmacologic mydriasis and the factors affecting post-mydriatic intraocular pressure (IOP) in a population with a high prevalence of angle closure disease.

Methods: In total, 460 individuals aged ≥ 72 years were enrolled in this cross-sectional community-based screening program. IOP was measured at baseline and 1 hour after mydriasis. Individuals with post-mydriatic IOP spike > 6 mmHg received indentation gonioscopy and IOP-lowering medication. Linear regression analysis was used to identify ocular parameters associated with post-mydriatic IOP elevation.

Results: The mean age of participants was 77.8 ± 4.1 years, and 65.4% of them were men. In total, 21 eyes of 16 participants (3.48%) had post-mydriatic IOP spikes (range: 6-13.7 mmHg); among them, 15 eyes had an IOP of > 21 mmHg. None of the participants developed AAC. All eyes with IOP spikes were phakic, except for one with pseudophakic angle closure. Analysis of 381 participants with at least one phakic eye revealed that higher post-mydriatic IOP and IOP changes were associated with narrower angle grading, more extensive peripheral anterior synechiae, shallower central anterior chamber, and thicker lens. According to multiple linear regression analysis, post-mydriatic IOP was independently associated with baseline IOP and factors suggestive of crowded anterior chamber based on gonioscopic findings and central or peripheral anterior chamber depth evaluation in conjunction with lens thickness.

Conclusion: Post-mydriatic IOP should be measured in phakic eyes with a crowded anterior chamber. Post-mydriatic IOP spikes can be effectively blunted with intervention to prevent AAC.
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http://dx.doi.org/10.1007/s00417-020-04941-zDOI Listing
January 2021

Prevalence of glaucoma in the elderly population in Taiwan: The Shihpai Eye Study.

J Chin Med Assoc 2020 Sep;83(9):880-884

Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Background: This study aimed to evaluate the prevalence, characteristics, and the awareness status of glaucoma in an elderly Chinese population.

Methods: A total of 460 individuals aged ≥72 years were enrolled in this cross-sectional community-based eye disease screening program. Glaucoma was diagnosed according to the diagnostic criteria proposed by the International Society of Geographical and Epidemiological Ophthalmology. Characteristics of subjects with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) were described and compared between groups using Mann-Whitney U and Fisher's exact tests.

Results: Forty subjects were diagnosed with glaucoma, including 17 subjects with POAG, 22 with PACG, and one with secondary glaucoma. The estimated prevalence of glaucoma, POAG, and PACG was 8.7%, 3.7%, and 4.8%, respectively. In total, 71% of the subjects with PACG and 77% of POAG subjects presented with a normal intraocular pressure (IOP) of <19 mmHg. The demographic and ocular characteristics were similar between the two groups; however, subjects with POAG had a longer axial length and smaller vertical disc diameter than those with PACG. Further, 95% of the glaucoma subjects ever visited the eye clinic, but only 32.5% of them were aware of the disease.

Conclusion: Glaucoma is prevalent in the elderly population in Taiwan, but the diagnostic rate and disease awareness are low. Since most subjects with glaucoma presented with normal IOPs, optic disc evaluation is critical for diagnosing glaucoma in the elderly in Taiwan.
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http://dx.doi.org/10.1097/JCMA.0000000000000385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478203PMC
September 2020

Hand grip strength in predicting the risk of osteoporosis in Asian adults.

J Bone Miner Metab 2021 Mar 5;39(2):289-294. Epub 2020 Sep 5.

Department of Medical Imaging, Cheng Hsin General Hospital, 45 Cheng Hsin Street, Taipei, 112, Taiwan.

Introduction: There is a need for a cost-effective method to identify individuals with a high risk of osteoporosis. This study aimed to investigate the suitability of hand grip strength in predicting the risk of osteoporosis in Asian adults.

Materials And Methods: In this cross-sectional, hospital-based study of 1007 participants, the bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry according to the 2019 International Society for Clinical Densitometry official positions. Bone microarchitecture was evaluated using the trabecular bone score, and hand grip strength was measured in the dominant hand using a hand digital dynamometer.

Results: Hand grip strength was significantly related to bone density and bone microarchitecture. Moreover, hand grip strength was a significant predictor of osteoporosis in both women and men. For osteoporosis prediction in women, a threshold of 21.9 kg of hand grip strength had a sensitivity of 59%, specificity of 59%, and area under the curve (AUC) of 0.61. In men, a threshold of 28.7 kg had a sensitivity of 66%, specificity of 78%, and AUC of 0.75. The optimal cutoff strengths for osteoporosis depended on age and sex.

Conclusion: The measurement of hand grip strength is a simple, cost-effective and an easy assessment method for identifying individuals at a high risk of osteoporosis. The cutoff strength for evaluating osteoporosis in adults is age and sex specific.
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http://dx.doi.org/10.1007/s00774-020-01150-wDOI Listing
March 2021

Validation of Global Self-Rated Health and Happiness Measures Among Older People in the Yilan Study, Taiwan.

Front Public Health 2020 31;8:346. Epub 2020 Jul 31.

Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.

Single-item measures of physical and mental health are feasible for older adults, but their validity for that age group is unclear. This study tested validity of a global self-rated health and a global self-rated happiness measure in a large sample of community-dwelling older adults in Taiwan. A cross-sectional sample of 3,982 men and women aged 65 or older in Yilan, Taiwan, provided data on global self-rated health and happiness using 100-point numerical scales. The Physical Component Summary of the 12-Item Short Form Health Survey (version 2) and the Groningen Activity Restriction Scale were used to test the validity of the self-rated health item. The Mental Component of that 12-item scale and the Hospital Anxiety and Depression Scale were validators regarding the self-rated happiness item. Criterion validity was tested using the 12-Item Short Form Health Survey (version 2). The correlations between the self-rated health and happiness measures and the 12-Item Short Form Health Survey (version 2) validators were positive and statistically significant, supporting convergent validity. Sufficient divergent validity was demonstrated through the negative and significant relationship between the self-rated health item and the Groningen Activity Restriction Scale scores and the negative and significant relationship between the self-rated happiness item and the Hospital Anxiety and Depression Scale. Optimal cut-off scores for physical and mental health states depended on age and gender. The global self-rated health and happiness measures were validated. Cut-off scores for evaluating older adults' physical and mental health should be age- and gender-specific.
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http://dx.doi.org/10.3389/fpubh.2020.00346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411153PMC
May 2021

The association between various characteristics of hypnotics and cardiac autonomic control in community-dwelling older adults: the Yilan Study, Taiwan.

Sleep Med 2020 07 3;71:77-82. Epub 2020 Apr 3.

Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Background: Alteration of cardiac autonomic function may underlie the link between hypnotics use and the risk for cardiovascular morbidity and mortality. This study aimed to examine the relationship between the various characteristics of benzodiazepine receptor agonists (BzRAs) and heart rate variability (HRV).

Methods: A community-based survey using the cohort from the Yilan Study, Taiwan was conducted. Older adults aged 65 and older were randomly selected to participate from August 2013 to November 2016. Cardiac autonomic function was evaluated using HRV, and the lowest quartiles of HRV parameters were defined as unhealthy. Those who used BzRAs as a sleep aid were defined as BzRA hypnotic users. The characteristics of BzRA use were further detailed and included the half-life, drug compound, frequency of use, and cumulative daily equivalent dosage.

Results: Of all participants, 379 (14.5%) were BzRA hypnotic users. After controlling for covariates, BzRA hypnotic users had a higher risk for unhealthier HRV than non-users. Among all BzRA hypnotic users, those who only used benzodiazepines (BZDs), used short half-life BzRAs, and used the middle tertile of daily cumulative BZD equivalent had a higher risk for poor total power (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.07-4.16), high frequency (OR: 3.43, 95% CI: 1.07-10.97), and high frequency (OR: 2.94, 95% CI: 1.35-6.42), respectively, than their counterparts.

Conclusions: BzRA hypnotics are linked with poor cardiac autonomic function. Various characteristics of BzRA hypnotics showed an independent pattern of association with cardiac autonomic function.
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http://dx.doi.org/10.1016/j.sleep.2020.03.026DOI Listing
July 2020

Normative data and associated factors of hand grip strength among elderly individuals: The Yilan Study, Taiwan.

Sci Rep 2020 04 20;10(1):6611. Epub 2020 Apr 20.

Community Medicine Research Center & Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Weak grip strength is associated with subsequent mortality in elderly populations. The normative data and associated factors of HGS in community-dwelling elderly Taiwanese populations require further evaluation. From February 2012 until the end of 2016, all residents of Yilan City, Taiwan aged 65 years or older were randomly selected for a population-based community health survey. A total of 2,470 older adults were enrolled in this study. The relationships between HGS and various anthropometric and sociodemographic correlates were examined. The results showed that HGS was higher in men than in women. The mean HGS exhibited a decreasing trend with advanced age in both men and women. HGS was significantly associated with height, weight, and exercise habits. The physical as well as the mental component summary measures of health-related quality of life (HRQoL) were positively associated with HGS. After HRQoL was integrated into the regression model, female sex, age, waist circumference, and diabetes mellitus were significantly negatively associated with HGS. In conclusion, HGS significantly decreased with advanced age. among community-dwelling Taiwanese elderly people, Various factors had different effects on HGS.
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http://dx.doi.org/10.1038/s41598-020-63713-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170913PMC
April 2020

Subgrouping Poor Sleep Quality in Community-Dwelling Older Adults with Latent Class Analysis - The Yilan Study, Taiwan.

Sci Rep 2020 03 25;10(1):5432. Epub 2020 Mar 25.

Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.

The manifestation of older adults with poor sleep quality is heterogeneous. Using data-driven classifying methods, the study aims to subgroup community-dwelling older adults with poor sleep quality. Adults aged 65 and older participated in the Yilan study. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index. Latent class analysis with the 7 subscores of the Pittsburgh Sleep Quality Index as the indicators was used to generate empirical subgroups. Differences in comorbidity patterns between subgroups were compared. A total of 2622 individuals, of which 1011 (38.6%) had Pittsburgh Sleep Quality Index -defined poor sleep quality, participated. Three groups for poor sleep quality were specified in the latent class analysis: High Insomnia (n = 191, 7.3%), Mild Insomnia (n = 574, 21.9%), and High Hypnotics (n = 246, 9.4%). The High Insomnia and Mild Insomnia groups shared similar profiles but different severities in the 7 domains of the Pittsburgh Sleep Quality Index. In contrast, the High Hypnotics group had the lowest Pittsburgh Sleep Quality Index total scores and insomnia severity but had similar mental and physical comorbid patterns as the High Insomnia group. This finding suggests that poor sleep quality in community-dwelling older adults had various feature-based subgroups. It also implicates the development of group-centered interventions.
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http://dx.doi.org/10.1038/s41598-020-62374-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096492PMC
March 2020

Repeated intravitreal injections of antivascular endothelial growth factor in patients with neovascular age-related macular degeneration may increase the risk of ischemic optic neuropathy.

BMC Ophthalmol 2019 Dec 30;19(1):268. Epub 2019 Dec 30.

School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Background: Previous case reports have demonstrated the occurrence of ischemic optic neuropathy (ION) following intravitreal injections of antivascular endothelial growth factor (anti-VEGF). However, no previous studies have investigated the impact of injection numbers on the risk of ION. The aim of our study was to investigate whether repeated intravitreal injections of anti-VEGF would increase the risk of subsequent ION in patients with neovascular age-related macular degeneration (AMD).

Methods: A population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from 2007 to 2013. Neovascular AMD patients receiving intravitreal injections of anti-VEGF during the study period were enrolled in the study cohort. Enrollees were divided into three groups according to the categorized levels of injection number (first level: < 10 times, second level: 10-15 times, and third level: > 15 times). Kaplan-Meier curves were generated to compare the cumulative hazard of subsequent ION among the three groups. Cox regression analyses were used to estimate crude and adjusted hazard ratios (HRs) for ION development with respect to the different levels of injection numbers. The confounders included for adjustment were age, sex, and comorbidities (diabetes, hypertension, hyperlipidemia, ischemic heart disease, and glaucoma).

Results: In total, the study cohort included 77,210 patients. Of these, 26,520, 38,010, and 12,680 were in the first-, second-, and third-level groups, respectively. The Kaplan-Meier method revealed that the cumulative hazards of ION were significantly higher in those who had a higher injection number. After adjusting for confounders, the adjusted HRs for ION in the second- and third-level groups were 1.91 (95% confidence interval [CI], 1.32-2.76) and 2.20 (95% CI, 1.42-3.43), respectively, compared with those in the first-level group.

Conclusions: Among patients with neovascular AMD, those who receive a higher number of anti-VEGF injections have a significantly higher risk of developing ION compared with individuals who receive a lower number of injections.
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http://dx.doi.org/10.1186/s12886-019-1284-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937927PMC
December 2019

Association between Metformin and a Lower Risk of Age-Related Macular Degeneration in Patients with Type 2 Diabetes.

J Ophthalmol 2019 31;2019:1649156. Epub 2019 Oct 31.

School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.

Purpose: This population-based, retrospective cohort study was to investigate whether metformin is associated with a lower risk of subsequent age-related macular degeneration (AMD) in patients with type 2 diabetes.

Methods: Using the Taiwan National Health Insurance Research Database from 2001 to 2013, 68205 subjects with type 2 diabetes were enrolled in the study cohort. Among them, 45524 were metformin users and 22681 were nonusers. The metformin and nonmetformin groups were followed until the end of 2013. Cox regression analyses were used to estimate hazard ratios (HRs) for AMD development associated with metformin use. Confounders included for adjustment were age, sex, and comorbidities (hypertension, hyperlipidemia, coronary artery disease, obesity, diabetic retinopathy, chronic kidney disease, and insulin treatment). Furthermore, propensity score (PS) matching method was used to choose the matched sample, and PS-adjusted Cox regression was performed. Finally, how HRs changed according to metformin treatment duration and dose was also evaluated in the metformin group.

Results: After adjusting for confounders, the metformin group had a significantly lower risk of AMD (adjusted HR = 0.54; 95% confidence interval [CI], 0.50-0.58). In the PS-matched sample, the significance remained (adjusted HR = 0.57; 95% CI, 0.52-0.63). In the metformin group, the adjusted HRs for the second (1.5-4 years) and third (≥4 years) tertiles of metformin treatment duration were 0.52 and 0.14, respectively, compared with the first tertile (<1.5 years). We also found significant trends of lower HRs (all -value for trend <0.05) with increasing total and average doses.

Conclusions: Among patients with type 2 diabetes, those who use metformin are at a significantly lower risk of developing AMD relative to individuals who do not use metformin. Also, the trend of a significantly lower AMD risk was found with a higher dose of metformin.
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http://dx.doi.org/10.1155/2019/1649156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875398PMC
October 2019

The association between clinically diagnosed insomnia and age-related macular degeneration: a population-based cohort study.

Acta Ophthalmol 2020 Mar 8;98(2):e238-e244. Epub 2019 Sep 8.

National Yang-Ming University School of Medicine, Taipei, Taiwan.

Purpose: The decreased level of melatonin, the substance involved in the control of the sleep-wake cycle, has been reported among the patients with age-related macular degeneration (AMD). However, knowledge about the relationship between sleep disturbance and AMD is still limited. This longitudinal case-control study aims to investigate the risk of incident AMD among the patients with clinically diagnosed insomnia using the Taiwan National Health Insurance Research Database.

Methods: The insomnia cohort (n = 15 465) consisted of newly diagnosed insomnia cases aged ≥55 years between 2000 and 2009. Subjects without insomnia, matched for age, gender and enrolment time, were randomly sampled as the control cohort (n = 92 790). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of incident AMD for the two cohorts after adjusting for potential confounders.

Results: Of the 108 255 sampled subjects, 2094 (1.9%) were diagnosed with AMD, including 214 (0.2%) with neovascular AMD, during a mean follow-up period of 5.1 ± 2.8 years. Insomnia patients were more likely to have subsequent AMD than those without insomnia (2.5% versus 1.8%, p < 0.001). Further, the incidence of exudative AMD was also higher in the insomnia cohort than the control cohort (0.3% versus 0.2%, p = 0.002). The adjusted HR was 1.33 (95% confidence interval [CI], 1.18-1.48, p < 0.001) for AMD and 1.67 (95% CI, 1.20-2.33, p = 0.002) for exudative AMD.

Conclusions: Clinically diagnosed insomnia is an independent indicator for the increased risk of subsequent AMD development.
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http://dx.doi.org/10.1111/aos.14238DOI Listing
March 2020

Association between Central Serous Chorioretinopathy and Risk of Depression: A Population-Based Cohort Study.

J Ophthalmol 2019 2;2019:2749296. Epub 2019 May 2.

Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei 112, Taiwan.

Purpose: To investigate the association between central serous chorioretinopathy (CSC) and the risk of developing depression. The risk factors associated with depression in CSC patients were also assessed.

Methods: A population-based retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from the beginning of 2001 through the end of 2013. CSC patients and age- and gender-matched (1 : 4 matched) control subjects without CSC were enrolled in the study. Kaplan-Meier curves were generated to compare the cumulative hazard of subsequent depression between the CSC and control groups. A Cox regression analysis estimated the crude and adjusted hazard ratios (HRs) for depression. Risk factors leading to depression were investigated among the CSC patients.

Results: 25,939 CSC patients and 103,756 controls were enrolled in the study. The CSC group had a significantly higher cumulative hazard for depression compared to the control group ( value < 0.0001). The Cox regression model indicated that the CSC group had a significantly higher risk for depression (adjusted HR = 1.33). Within the CSC group, significant risk factors for depression included age, female gender, low income, first-onset CSC, peptic ulcer, and smoking. The recent use of steroids prior to CSC, by all routes of administration, also significantly increased the risk for depression. However, treatment of CSC did not significantly reduce the risk for depression.

Conclusion: Patients with CSC are at significantly greater risk of developing depression. Among CSC patients, age, female gender, low income, first-onset CSC, peptic ulcer, smoking, and recent use of steroids prior to CSC were significant risk factors for depression.
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http://dx.doi.org/10.1155/2019/2749296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525878PMC
May 2019

The associations between various sleep-wake disturbances and depression in community-dwelling older adults- the Yilan study, Taiwan.

Aging Ment Health 2020 05 5;24(5):717-724. Epub 2019 Mar 5.

Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan.

Given the close relationship between sleep-wake disturbances and depression, an in-depth investigation of such a relationship is imperative. The present study aims at elucidating the relationship between various sleep-wake disturbances and depression in older adults and at examining the influence of co-occurring anxiety on such associations. A community-based survey using the cohort from the Yilan Study in Taiwan was conducted from August 2013 to November 2016. Adults aged 65 and older were randomly selected to participate in the study. The Hospital Depression and Anxiety Scale was used to measure clinical depressive and anxiety symptoms. Insomnia and daytime sleepiness were defined through the Athens Insomnia Scale and the Epworth Sleepiness Scale, respectively. Furthermore, the use of hypnotics, subjective sleep duration and sleep-wake scheduling were evaluated. Their relationship with depression was examined through logistic regression analyses. There were 2620 participants surveyed and 247 (9.4%) had depression. Before controlling for anxiety, insomnia (OR: 1.78, 95% CI: 1.23-2.55), daytime sleepiness (OR: 1.79, 95% CI: 1.27-2.53), and long sleepers (OR: 1.77, 95% CI: 1.24-2.53) have a higher likelihood for depression in the multivariable regression analysis. However, when including anxiety into the multivariable regression model, only those with daytime sleepiness and long sleepers had an elevated risk for depression. Therefore, the association between insomnia and depression turned to be statistically non-significant. In older adults, various sleep-wake disturbances differ in their relationship with depression. In addition, daytime sleepiness and long sleep duration were mostly characteristic of depression when co-occurring anxiety was considered.
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http://dx.doi.org/10.1080/13607863.2019.1582006DOI Listing
May 2020

Antithrombotic Treatment May Reduce Mortality Among New-Onset Atrial Fibrillation Patients with Gray-Zone Risk of Stroke.

Int Heart J 2019 Mar 8;60(2):303-309. Epub 2019 Feb 8.

Division of Cardiology, Department of Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University.

In clinical practice, some atrial fibrillation (AF) patients were classified as having low and moderate stroke risk by the CHADS score (≤ 1) in 2001 but in 2012 they were not truly classified as low risk of stroke according to the CHADS-VASc score (≥ 2) (defined gray zone). Therefore, a treatment gap exists in gray zone AF patients. This study aimed to evaluate whether gray zone AF patients could benefit from reduced all-cause mortality under antithrombotic treatment. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance from January 2000 to December 2011. The new-onset AF patients consisted of a gray zone cohort with a total of 1237 patients being enrolled. The primary outcome was all-cause mortality between 2001 and 2011. Patients in the gray zone receiving antithrombotic treatment had a significant reduction in all-cause mortality [hazard ratio (HR): 0.21; 95% confidence interval (CI): 0.16-0.28] compared with the no treatment group [warfarin only: HR, 0.28 (95% CI, 0.15-0.52); warfarin + Aspirin: HR, 0.21 (95% CI, 0.15-0.30); and Aspirin only: HR, 0.22 (95% CI, 0.16-0.29) ]. All-cause mortality was notably increased when any of the following risk factors were present: age 65-74 years, age ≥ 75 years, chronic kidney disease, and vascular disease. We concluded that AF patients in the gray zone must receive either anticoagulant and/or antiplatelet treatment and there is a lower mortality in these groups during long-term follow-up. Further investigation is needed to observe whether the antithrombotic drugs have benefits for patients with AF with a CHADS-VASc score < 2.
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http://dx.doi.org/10.1536/ihj.18-174DOI Listing
March 2019

Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).

Soc Psychiatry Psychiatr Epidemiol 2019 Jun 7;54(6):661-670. Epub 2018 Dec 7.

Institute of Public Health, National Yang-Ming University, 155 Li-Nong St., Sec. 2 Beitou, Taipei, Taiwan.

Purpose: To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).

Methods: We conducted a matched case-control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD.

Results: 277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings.

Conclusions: Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.
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http://dx.doi.org/10.1007/s00127-018-1624-9DOI Listing
June 2019

Associations between Body Mass Index and Subjective Health Outcomes among Older Adults: Findings from the Yilan Study, Taiwan.

Int J Environ Res Public Health 2018 11 26;15(12). Epub 2018 Nov 26.

Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei 11221, Taiwan.

Previous findings on the associations between body mass index (BMI) and subjective health outcomes among older adults are inconsistent. The aims of this study were to explore the associations of BMI with health-related quality of life (HRQoL), self-rated health (SRH) and happiness among older adults. This study was part of the Yilan study, which was a community-based survey conducted in the Yilan city in Taiwan. A total of 3722 older adults were randomly recruited during 2012⁻2016. HRQoL was measured using the Short Form-12 Health Survey physical component summary (PCS) and mental component summary (MCS) scores and SRH and happiness were also evaluated. By hierarchical regression, after adjusting for covariates, compared with normal-weight participants, overweight did not have significantly different PCS scores (B = 0.20, 95% confidence interval [CI]: -0.45 to 0.85, = 0.546) but obese had significantly lower PCS scores (B = -0.97, 95% CI: -1.68 to -0.26, < 0.0001); overweight and obese participants had significantly better MCS scores (B = 1.00, 95% CI: 0.40 to 1.61, = 0.001 and B = 1.22, 95% CI: 0.60 to 1.88, < 0.0001, respectively); overweight participants had significantly higher SRH scores (B = 1.08, 95% CI: 0.16 to 2.00, = 0.022) but underweight had significantly lower SRH scores (B = -2.88, 95% CI: -4.81 to -0.95, = 0.003); overweight and obese participants had better happiness scores (B = 1.55, 95% CI: 0.45 to 2.66, = 0.006 and B = 1.68, 95% CI: 0.49 to 2.88, = 0.006, respectively). In conclusion, compared with normal-weight individuals, overweight individuals had better mental HRQoL, SRH and happiness but underweight older people reported poorer SRH and obese reported poorer physical HRQOL but better mental HRQoL and self-rated happiness.
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http://dx.doi.org/10.3390/ijerph15122645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313453PMC
November 2018

Associations Between PFA-Measured Aspirin Resistance, Platelet Count, Renal Function, and Angiotensin Receptor Blockers.

Clin Appl Thromb Hemost 2018 Dec 11;24(9_suppl):63S-68S. Epub 2018 Jul 11.

Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.

Aspirin resistance is used to describe patients who are undergoing aspirin therapy but fail for the inhibition of thromboxane biosynthesis in platelets. Although the true mechanism is unclear, drug-drug interaction remains a possible factor. The study aimed to determine whether there was association between aspirin resistance and the concomitant cardiovascular medication. Using the Platelet Function Analyzer-100 system, aspirin resistance was evaluated in aspirin-treated patients from the outpatient department. The associations between aspirin resistance and their concomitant common cardiovascular medication were analyzed. Aspirin resistance was prevalent in 147 (17.7%) of 831 patients. Concomitant angiotensin receptor blocker (ARB) treatment and low platelet count were associated with aspirin response ( = .04, .02, respectively). Multivariate logistic regression analysis results showed an association between aspirin response and ARB therapy (adjusted odds ratio [OR] 1.48; 95% confidence interval, CI: 1.08-2.18). And the association was blunted when platelet count was considered (adjusted OR 1.43, 95% CI: 0.92-2.23). In ARB-treated patients, increased creatinine and decreased hematocrit laboratory data increased the risk of aspirin resistance ( = .02, .04, respectively), and the effect of platelet count on aspirin resistance was diminished by ARB therapy. Concomitant ARB treatment in aspirin-treated patients decreased the risk of aspirin resistance, and the effect was dependent on low platelet count. In ARB-treated patients, increased creatinine and decreased hematocrit data increased the risk of aspirin resistance. In addition, the effect of platelet count on aspirin resistance was diminished by ARB treatment.
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http://dx.doi.org/10.1177/1076029618786588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714849PMC
December 2018

Association Between Dialysis Modalities and Risk of Coronary Artery Disease: A Population-Based Cohort Study in Taiwan.

Ther Apher Dial 2018 Oct 10;22(5):469-475. Epub 2018 Jul 10.

School of Medicine, National Yang-Ming University, Taipei, Taiwan.

The hemodynamic effects of hemodialysis (HD) and peritoneal dialysis (PD) on end-stage renal disease (ESRD) patients differ. The influence of dialysis modalities on the cardiovascular system has not been well investigated. We aimed to evaluate the association between dialysis modalities and risk of coronary artery disease (CAD) by using the claim data of Taiwan's Longitudinal Health Insurance Database. This study followed up a cohort of 1624 new onset ESRD patients (≥18 years old), who had started renal replacement therapy during 2000 to 2010; and was followed until 2012. After adjusting for potential confounders, patients who underwent HD had significantly higher risks of incidence of CAD, in comparison with patients who underwent PD (adjusted hazard ratio = 1.47; 95% confidence interval = 1.01-2.11). An increased risk of incident CAD was distinguished in patients receiving HD, compared with those on PD. Further studies are warranted to explore the underlying mechanism and improve dialysis outcomes.
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http://dx.doi.org/10.1111/1744-9987.12676DOI Listing
October 2018

The association between glaucoma and risk of depression: a nationwide population-based cohort study.

BMC Ophthalmol 2018 Jun 22;18(1):146. Epub 2018 Jun 22.

Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, 155, sec.2, Linong St, Taipei, 11221, Taiwan.

Background: Previous cross-sectional studies revealed a higher prevalence of depression among glaucoma patients. However, cohort studies were in lack to build the risk of incident depression after the diagnosis of glaucoma. The aim of our study was to investigate the association between glaucoma and the subsequent risk of developing depression and to assess risk factors associated with depression in glaucoma patients.

Methods: A population-based retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from January 1, 2001 through December 31, 2011. Glaucoma patients (n = 8777) and age- and gender-matched control subjects without glaucoma (n = 35,108) were enrolled in the study. Kaplan-Meier curves were generated to compare the cumulative hazard of subsequent depression between the glaucoma and control groups. A Cox regression analysis estimated the crude and adjusted hazard ratios (HRs) for depression. Risk factors leading to depression were investigated among the glaucoma patients.

Results: Glaucoma patients had a significantly higher cumulative hazard of depression compared to the control group (p-value < 0.0001). The Cox regression model indicated that the glaucoma group had a significantly higher risk of depression (adjusted HR = 1.71). Within the glaucoma group, significant risk factors for depression included age, female, low income, substance abuse, and living alone. However, the use of β-blocker eye drops and the number of glaucoma medications were not significant risk factors for depression.

Conclusion: Patients with glaucoma are at significantly greater risk of developing depression. Among glaucoma patients, age, female, low income, substance abuse, and living alone were significant risk factors for depression.
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http://dx.doi.org/10.1186/s12886-018-0811-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013853PMC
June 2018

Long-term effect of statins on the risk of new-onset osteoporosis: A nationwide population-based cohort study.

PLoS One 2018 3;13(5):e0196713. Epub 2018 May 3.

Division of Internal Cardiology, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, ROC.

Background: Several observational cohort and meta-analytical studies in humans have shown that statin users have a lower risk of fractures or greater bone mineral densities (BMD) than nonusers. However, some studies including randomized clinical trials have the opposite results, particularly in Asian populations.

Objective: This study investigates the impacts of statins on new-onset osteoporosis in Taiwan.

Methods: In a nationwide retrospective population-based cohort study, 45,342 subjects aged between 50-90 years having received statin therapy (statin-users) since January 1 2001, and observed through December 31 2013 were selected from the National Health Insurance Research Database of Taiwan. Likewise, 115,594 patients had no statin therapy (statin-non-users) were included as controls in this study. Multivariable Cox proportional hazards analysis for drug exposures was employed to evaluate the association between statin treatment and new-onset of osteoporosis risk. We also used the long-rank test to evaluate the difference of probability of osteoporosis-free survival.

Results: During the 13-year follow-up period, 16,146 of all enrolled subjects (10.03%) developed osteoporosis, including 3097 statin-users (6.83%) and 13,049 statin-non-users (11.29%). Overall, statin therapy reduced the risk of new-onset osteoporosis by 48% (adjusted hazard ratio [HR] 0.52; 95% CI 0.50 to 0.54). A dose-response relationship between statin treatment and the risk of new-onset osteoporosis was observed. The adjusted hazard ratios for new-onset osteoporosis were 0.84 (95% CI, 0.78 to 0.90), 0.56 (95% CI, 0.52 to 0.60) and 0.23 (95% CI, 0.21 to 0.25) when cumulative defined daily doses (cDDDs) ranged from 28 to 90, 91 to 365, and more than 365, respectively, relative to nonusers. Otherwise, high-potency statins (rosuvastatin and atorvastatin) and moderate-potency statin (simvastatin) seemed to have a potential protective effect for osteoporosis.

Conclusions: In this population-based cohort study, we found that statin use is associated with a decreased risk of osteoporosis in both genders. The osteoprotective effect of statins seemed to be more prominent with a dependency on the cumulative dosage and statin intensity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196713PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933736PMC
August 2018

Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan.

BMC Geriatr 2018 04 13;18(1):90. Epub 2018 Apr 13.

Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.

Background: Fall episodes are not unusual among community residents, especially the elderly, and lower muscle strength is an important issue to address in order to prevent falls.

Methods: A community health survey was conducted in a suburban area of Taiwan, and 1067 older adults were selected for enrollment in the present study. All the enrolled subjects had been visited at their homes; the subjects' strength of both hands and muscle mass of both legs were measured and well-established questionnaires were finished by certificated paramedic staffs.

Results: The incidence of fall episodes in the previous 1 year in the Yilan elderly population was 15.1%, and the female predominance was significant. A significantly higher prevalence of cataracts was found in group who experienced a fall in the past year (64% vs. 54.9% in the non-fall group). Mild or more severe dementia was much more prevalent in the group who experienced a recent fall (33.8% vs. 25.7% in the non-fall group). The strength of both hands tested as the physical function was 17.6 ± 8.0 kg in the recent fall group, significantly weaker than that in the non-fall group (20.7 ± 8.7 kg). Multivariate regression analysis revealed a greater weekly exercise duration and greater strength of both hands reduced the occurrence of falls among the whole and the female population. The standardized effect sizes of hand grip strength between both groups, not trivial, were 0.29 and 0.37 for the total population and the female subpopulation respectively.

Conclusions: Less weekly exercise duration and weaker muscle strength were f ound to be independent risk factors of fall episode(s) in an elderly Taiwanese population, especially in the female sub-population. Muscle strength, measured by average of both hands grip strength, was the most significantly factor of one-year fall episode(s) accessed retrospectively.
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http://dx.doi.org/10.1186/s12877-018-0779-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899404PMC
April 2018

High-potency statins but not all statins decrease the risk of new-onset osteoporotic fractures: a nationwide population-based longitudinal cohort study.

Clin Epidemiol 2018 18;10:159-165. Epub 2018 Jan 18.

Division of Internal Cardiology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China.

Background: Statins have been linked to new-onset osteoporotic fractures (NOFs), and different statins may alter the risk for the development of NOFs.

Aim: In this study, we investigated the association between different statins and the development of NOFs.

Patients And Methods: This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance, including case patients with NOFs from January 2004 to December 2013 and non-NOF subjects. We estimated the hazard ratios (HRs) of NOFs associated with statin use. Nonuser subjects served as the reference group.

Results: A total of 44,405 patients with NOFs were identified from among 170,533 patients with hyperlipidemia during the study period. The risk of developing NOFs after adjusting for age, sex, comorbidities, and concurrent medication use was lower among users of atorvastatin (HR, 0.77; 95% CI, 0.71-0.84) and rosuvastatin (HR, 0.72; 95% CI, 0.64-0.81) than among simvastatin users. Lovastatin, pravastatin, fluvastatin, and pitavastatin were not associated with the risk of developing NOFs compared with simvastatin users.

Conclusion: This study supports previous reports regarding a beneficial effect of statin use and NOF risk, but not all statins. Patients taking atorvastatin or rosuvastatin were at lower risk of developing NOFs compared with simvastatin users during the 10-year follow-up. Other statins such as pravastatin, fluvastatin, lovastatin, and pitavastatin were not associated with NOFs. This study also highlighted that high-potency statin has a dose-response effect on lower NOF risk.
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http://dx.doi.org/10.2147/CLEP.S145311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779306PMC
January 2018

Prognostic Utility of Morning Blood Pressure Surge for 20-Year All-Cause and Cardiovascular Mortalities: Results of a Community-Based Study.

J Am Heart Assoc 2017 Dec 9;6(12). Epub 2017 Dec 9.

Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Background: Morning blood pressure (BP) surge (MS), defined by the MS amplitude, is an independent prognostic factor of cardiovascular outcomes in some, but not all, populations.

Method And Results: We enrolled 2020 participants (1029 men; aged 30-79 years) with 24-hour ambulatory BP data. During a median 19.7-year follow-up, 607 deaths (182 by cardiovascular causes) were confirmed from the National Death Registry. The amplitude of sleep-trough MS (STMS) was derived from the difference between morning systolic BP (SBP) and lowest nighttime SBP. The rate of STMS was derived as the slope of linear regression of sequential SBP measures on time intervals within the STMS period. Thresholds for high STMS amplitude and rate were determined by the 95th percentiles (43.7 mm Hg and 11.3 mm Hg/h, respectively). Multivariable Cox models, adjusting for age, sex, body mass index, smoking, alcohol, low-density lipoprotein cholesterol, 24-hour SBP, night:day SBP ratio, and antihypertensive treatment, revealed that a high STMS rate (hazard ratio, 1.666; 95% confidence interval, 1.185-2.341), but not STMS amplitude (hazard ratio, 1.245; 95% confidence interval, 0.984-1.843), was significantly associated with a greater mortality risk. Similarly, STMS rate (hazard ratio, 2.608; 95% confidence interval, 1.554-4.375), but not STMS amplitude, was significantly associated with the risk of cardiovascular mortality (hazard ratio, 0.966; 95% confidence interval, 0.535-1.747). Moreover, the prognostic values of STMS rate were comparable in subjects with or without morning and nocturnal hypertension (>0.05 for interaction for all). In simulation studies, STMS rate was less susceptible to measurement errors of the sleep-trough SBP than STMS amplitude.

Conclusions: STMS rate could independently help identify subjects with an increased cardiovascular risk.
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http://dx.doi.org/10.1161/JAHA.117.007667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779060PMC
December 2017

A preliminary report on psychiatric impairments and quality of life among Kaohsiung gas explosion victims 6 months after the event.

Qual Life Res 2018 Mar 1;27(3):631-638. Epub 2017 Nov 1.

Department of Nursing, Meiho University, Neipu, Ping-Tong County, Taiwan.

Objective: To investigate the prevalence and related risk factors for probable disaster-related psychiatric disorders, such as major depressive episodes (MDEs) and posttraumatic stress disorder (PTSD), among the victims of a petrochemical gas explosion in Kaohsiung, Taiwan, 6 months after the event. Additionally, the quality of life (QOL) of victims with related risk factors was simultaneously investigated.

Methods: A community-based screening survey with cross-sectional assessments was conducted. The victims of a petrochemical gas explosion were surveyed 6 months after the event. We used two scales, the Disaster-Related Psychological Screening Test and Short Form 12v2, to survey a representative sample of 502 participants (average age: 42.90 ± 16.61 years; M: 270, average age: 40.89 ± 16.40 years; F: 232; average age: 45.25 ± 16.58 years). The Chinese version of SPSS 17.0 software was used to perform the analysis.

Results: Non-PTSD or non-MDE (non-P or M), probable PTSD, probable MDE and probable PTSD, and MDE were present in 341 (67.9%), 54 (10.8%), 37 (7.4%) and 70 (13.9%) participants, respectively. QOL worsened (negative trend) among the groups in the following order: non-P or M, probable PTSD or MDE alone, and probable PTSD and MDE. The risk factors for probable PTSD or MDE were female gender, older age, physical injury, significant financial loss, and lack of religious belief. The risk factors for poorer QOL subscales were older age, financial problems, physical injury, higher educational level, religious beliefs, and probable PTSD and/or MDE.

Conclusion: This study shows that probable PTSD/MDE is associated with lower QOL, supporting the need for early mental health rehabilitation after a disaster. Therefore, rapid screening and early mental rehabilitation are very important.
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http://dx.doi.org/10.1007/s11136-017-1727-xDOI Listing
March 2018

Trends and Comparisons of Utilization of Emergency Departments Due to Traumatic or Non-Traumatic Causes among the HIV-Positive Population in Taiwan, 2006-2011.

Int J Environ Res Public Health 2017 10 11;14(10). Epub 2017 Oct 11.

Community Medicine Research Center, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.

It is important that the utilization of emergency departments (EDs) among people living with the human immunodeficiency virus (HIV) be epidemiologically evaluated in order to assess and improve the HIV care continuum. All participants newly-diagnosed with HIV in Taiwan registered in the National Health Insurance Database from 2000 to 2005 were enrolled in this study and followed-up from 2006 to 2011. In total, 3500 participants newly-diagnosed with HIV in 2000-2005 were selected as a fixed-cohort population and followed-up from 2006 to 2011. Overall, 704, 645, 591, 573, 578, and 568 cases made 1322, 1275, 1050, 1061, 1136, and 992 ED visits in 2006, 2007, 2008, 2009, 2010 and 2011, respectively, with an average number of ED visits ranging from 1.75 to 1.98 per person, accounting for 20.1-22.6% of the whole HIV-positive population. Fewer ED visits were due to traumatic reasons, accounting for 19.6-24.4% of all cases. The incidence of traumatic and non-traumatic ED visits among the HIV-positive participants ranged from 7.2-9.3 and 27.0-33.9 per 100 people, respectively. The average direct medical cost of traumatic and non-traumatic ED visits ranged from $89.3-112.0 and $96.6-120.0, respectively. In conclusion, a lower incidence of ED visits for all reasons and fewer ED visits owing to traumatic causes were observed in the population living with HIV in comparison with the general population; however, the direct medical cost of each ED visit owing to both traumatic and non-traumatic causes was greater among those living with HIV than in the general population.
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http://dx.doi.org/10.3390/ijerph14101214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664715PMC
October 2017
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