Different item characteristics of a mild cognitive impairment screening tool in the community-based Yilan Study: application of the item response theory.

BACKGROUND: This study aimed to use item response theory (IRT) to explore the item-by-item characteristics of a mild cognitive impairment (MCI) screening tool using community-based data. METHODS: The Yilan Study is a community-based study that has been conducted since 2012. Until March 2020, 2230 older adults were interviewed according to the household registration data. IRT was applied to determine the item-by-item distinctive characteristics of the Eight-item Interview to Differentiate Aging and Dementia (AD8). RESULTS: The MCI characteristics in the AD8 items have varying degrees of item response threshold. In all circumstances, item AD8-8, which is related to self-rated memory ability, had a low item response threshold. AD8-5 and AD8-7, which are related to the comparisons of time-oriented functional status, had slightly lower thresholds, especially for those aged 65-79 years or without activity limitations. Conversely, AD8-1, AD8-2, AD8-3, AD8-4, and AD8-6 had similar item response thresholds and discriminative power; these items have more detailed functional descriptions or examples for illustration. CONCLUSIONS: Concise and understandable elements are often expected in community-based screening tools. For community-based health screening and population empowerment in the early detection of MCI, assessment tool items with detailed functional descriptions and examples for illustration have similar validities in most of the population. Items related to self-rated memory ability might be less valid. More examples may be needed for items constructed for comparing time-oriented functional status, especially in extremely old adults and individuals with activity limitations.

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

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.

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

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

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.

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

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.

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

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 (p 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.

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

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.

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

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.

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

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 (P>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.

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

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.

Lifestyles and Mortality in Taiwan: An 11-Year Follow-up Study.

The associations of modifiable lifestyle-related factors with cardiovascular and all-cause mortality were examined in a population-based sample of older Taiwanese people. A total of 4176 individuals aged 50 years and older, with 11 years of follow-up, were analyzed. Current and former smokers had a higher risk of all-cause mortality compared with never smokers ([HR = 1.33; 95% CI = 1.12, 1.58], [HR = 1.39; 95% CI = 1.16, 1.68]). Low intake of vegetables and fruits was associated with a significantly higher risk of 1.43 (95% CI = 1.13, 1.81) for cardiovascular mortality and 1.22 (95% CI = 1.09, 1.38) for all-cause mortality. The low physical activity group at baseline who became part of the low, moderate, and high physical activity groups during follow-up had the following risks of cardiovascular mortality: ([HR = 2.89; 95% CI = 1.91, 4.36], [HR = 2.17; 95% CI = 1.29, 3.63], [HR = 1.59; 95% CI = 0.90, 2.82]). Similarly, the moderate physical activity group at baseline who became part of the low, moderate, and high physical activity groups during follow-up had the following risks of cardiovascular mortality: ([HR = 3.52; 95% CI = 2.14, 5.80], [HR = 2.25; 95% CI = 1.34, 3.80], [HR = 1.44; 95% CI = 0.78, 2.66]). The same tendencies were found in all-cause mortality. Smoking, diet, and physical activity were significantly modifiable lifestyle-related factors for mortality.Besides, individuals who decreased their physical activity had a significantly higher risk, whereas those who increased their physical activity had a significantly lower risk.

Smoking behavioral changes and subsequent mortality during a 18-year follow-up in Kinmen, Taiwan.

BACKGROUND: The aim of this study was to examine the changes in smoking behavior over 6 years and to relate these changes to mortality risk during 18 years' follow-up. METHODS: We followed a cohort for 6 years (1991-1997) to assess changes in smoking behavior and then for an additional 12 years (1997-2008) to relate these findings to mortality in 4986 Chinese individuals. Participants were classified as never smokers, long-term quitters, new smokers, new quitters, and continuing smokers. Mortality was ascertained by linkage with the nationwide death registry. RESULTS: Compared with never smokers, continuing smokers had the highest risk of 1.84 [95% confidence interval (CI): 1.38, 2.45] for all-cause mortality, new quitters had a risk of 1.49 (95% CI: 1.04, 2.15), new smokers had a risk of 1.26 (95% CI: 0.59, 2.68), and long-term quitters had a risk of 1.11 (95% CI: 0.64, 1.91). There was a significant 19% risk reduction in all-cause mortality for new quitters. CONCLUSION: Smoking cessation was associated with a significant reduction in mortality risk within approximately 6 years, while no significantly increased risk was observed for long-term quitters.

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease.

Chronic kidney disease (CKD) is a widespread condition in the global population and is more common in the elderly. Thyroid-stimulating hormone (TSH) level increases with aging, and hypothyroidism is highly prevalent in CKD patients. However, the relationship between low thyroid function and mortality in CKD patients is unclear. Therefore, we conducted a retrospective cohort study to examine the relationship between TSH elevation and all-cause mortality in elderly patients with CKD. This retrospective cohort study included individuals ≥65 years old with CKD (n = 23,786) in Taipei City. Health examination data from 2005 to 2010 were provided by the Taipei Databank for Public Health Analysis. Subjects were categorized according to thyroid-stimulating hormone (TSH) level as follows: low normal (0.34

Fear of falling and mortality among community-dwelling older adults in the Shih-Pai study in Taiwan: A longitudinal follow-up study.

AIM: Little is known about the association between fear of falling (FOF) and the risk of mortality. The aim of the present study was to investigate the association between FOF and mortality among community-dwelling older adults. METHODS: A total of 3814 older adults aged 65 years and older living in the Shih-Pai area in Taiwan participated in this 7-year follow-up longitudinal study. A structured questionnaire was used to record participants' FOF, history of falling, demographic characteristics, medical conditions, history of insomnia, depression symptoms and subjective health from 1999 to 2002. Follow-up all-cause mortality data were obtained from the National Death Registry of the Department of Health to identify the occurrence of deaths from the initial interview through to 31 December 2008. RESULTS: At the baseline assessment, the mean age of the participants was 73.8 ± 5.8 years, 56.4% were men and 53.4% had FOF. Cox regression showed that participants with FOF had an increased risk of mortality (aHR 1.16, 95% CI 1.02-1.33) after adjusting for sex, history of falling, age, body mass index, marital status, education level, smoking status, alcohol use, living status, chronic condition, depression and subjective health. Furthermore, FOF was a significant risk factor for male participants (aHR 1.17, 95% CI 1.00-1.38), but had a marginal risk for female participants (aHR 1.24, 95% CI 0.95-1.60) after adjusting for other risk factors, as in the full model except for sex. CONCLUSIONS: The findings of the present study suggest that FOF is a significant risk factor of mortality, especially in older male adults. Further research on the mechanism and effects of fear of falling on mortality is necessary. Geriatr Gerontol Int 2017; 17: 2216-2223.

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction: A cohort study.

In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to remove the drain for best clinical outcome remains controversial.We did a retrospective cohort study of 569 patients of prosthesis-based breast reconstruction with infection rate as the outcome variable; drain duration and last daily drainage volume as the main independent variables. Data on age, smoking history, diabetes mellitus history, body mass index, breast weight, tissue expander size, drain size, number of retrieved lymph nodes, tumor size, number of metastatic lymph nodes, tumor stage, mastectomy type, reconstruction type, submuscular implantation, skin defect, operative time, duration of antibiotics use, chemotherapy, and radiotherapy were collected as covariates. Multivariable logistic regression analysis was used to control for confounding.The total infection rate was 5.1% (29/569). The daily drainage volume ≥30 mL/d at the time of drain removal was not found associated with increased infection rate (P = 0.32). Of the various cutoff values of last daily drainage volume, none was found to be a determinant for drain removal where the risk of infection was concerned. By contrast, drain duration over 21 days significantly increased infection rate (P = 0.001). The multivariable logistic regression analysis showed an increase of 76.2% in the infection rate with each additional week of drain retention (P = 0.001). Breast weight also had a significant influence on risk of infection. Chemotherapy and drain size showed borderline effect on risk of infection whereas the last daily drainage volume was not associated with risk of infectionIn summary, our study revealed that drain duration, rather than the last daily drainage volume, significantly affects the infection rate in prosthesis-based breast reconstruction. We recommend that the drain is better removed no longer than 3 weeks postoperatively and can be removed as early as postoperative day 7, even when the drainage is over 30 mL in a 24-hour period.

Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study.

Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.

The trends of utilization in traditional Chinese medicine in Taiwan from 2000 to 2010: A population-based study.

INTRODUCTION: There is no study exploring the trend of utilization in traditional Chinese medicine (TCM) from 2000 to 2010. The objective of this study was to investigate the trends of TCM utilization among 3 cross-sectional cohorts of 2000, 2005, and 2010. METHOD: This study was a cross-sectional analysis of TCM utilization over time. We compared the mean TCM visits among 3 cohorts of 2000, 2005, and 2010. We derived 3 randomly sampled cohorts of nearly 1 million representative beneficiaries in each of 2000, 2005, and 2010 from National Health Insurance Research Database for this research. Multivariate logistic regression was performed to evaluate the relative relationship in categorical variables correlating to TCM users. The percentage change (% change) in mean TCM visits between 2000 and 2005 (2010) was used to evaluate the trends of TCM utilization during the period. RESULTS: The ratio of TCM users increased throughout cohorts. The ratio of TCM users among women was more than that among men in all cohorts of 2000, 2005, and 2010 (adjusted odds ratio = 1.47; 1.52; 1.62). The mean TCM visits increased from 2000 to 2010. The percentage change in mean TCM visits among women was more than that among men. The group aged less than 20 years had the least percentage change in mean TCM visits (18.8%); nevertheless, the group aged 20 to 34 years had the largest change (30.2%). The high socioeconomic status group had the largest percentage change in mean visits to TCM, whereas the central region had the least percentage change. Neoplasms had the greatest increase in percentage change in mean TCM visits among all disease categories; in contrast, diseases of the respiratory system had the greatest decrease. CONCLUSION: Both the ratio of TCM users and mean TCM visits increased gradually from 2000 to 2005 and further to 2010. Women used TCM more than men, and this is expected to continue in the future. The high socioeconomic status group used TCM more and more over time. The picture of TCM need among different types of cancer patients should be explored in further research because of the substantial increase in TCM utilization for the disease category of neoplasms.

Soluble ICAM-1, Independent of IL-6, Is Associated with Prevalent Frailty in Community-Dwelling Elderly Taiwanese People.

BACKGROUND: Activation of inflammatory pathway with elevation of inflammatory biomarkers such as Interleukin 6 (IL-6) has been considered a pathophysiological feature of frailty. In recent years, the association between Intercellular adhesive molecule -1 (ICAM-1) and vascular inflammatory was established. Provocation of inflammatory cascades from ICAM-1 is potential IL-6 related, although the association between the inflammatory process and frailty is little to known. The study was intended to evaluate the relationship between serum ICAM-1, IL-6 and frailty. MATERIALS AND METHODS: Data was derived from a representative national sampling cohort in Taiwan. The cross-sectional study included nine-hundred-forty-six community-dwelling people aged 53 and older. Frailty was defined as having three or more components (including, muscle shrinkage, slowness, weakness, exhaustion, and low activity) Serum IL-6 and ICAM-1 levels were measured using standard enzyme-linked immunosorbent assays. RESULTS: Soluble ICAM-1 (sICAM-1) levels were stepwise increased in non-frail, pre-frail and frail elderly people (the median levels were 255 vs. 265 vs. 285 ng/ml, respectively p<0.001). A multivariate multinomial logistic regression, which was adjusted for age, sex, smoking, education, BMI, and chronic disease number, was utilized to determine that the probability of being frail due to increased log (ICAM-1) and log (IL-6) standard deviation levels were 1.44 (95% CI 1.09-1.91) and 1.54 (95%CI 1.07-2.20), respectively. CONCLUSION: sICAM-1 was significantly associated with frailty, independent of IL-6. This implied that leukocyte migration and inflammation cascade activation might contribute to frailty, in addition to monocyte/macrophage-mediated immuno-inflammation.

Abnormal Thyroid-Stimulating Hormone and Chronic Kidney Disease in Elderly Adults in Taipei City.

OBJECTIVES: To examine whether older people with abnormal thyroid function are more likely to develop chronic kidney disease (CKD) over a 5-year follow-up period. DESIGN: Retrospective cohort study. SETTING: Health examination data from the Taipei Databank for Public Health Analysis. PARTICIPANTS: Individuals aged 65 and older (N = 41,454). MEASUREMENTS: Thyroid-stimulating hormone (TSH) levels were repeatedly measured, and subjects were categorized into four thyroid function groups (hyperthyroid, euthyroid, subclinical hypothyroid, overt hypothyroid). The risk of incident CKD was evaluated using a stepwise Cox proportional hazards regression model adjusted for sex, baseline age, hypertension, diabetes mellitus (DM), dyslipidemia, hyperuricemia, anemia, obesity, liver function, smoking, and alcohol. RESULTS: Higher TSH levels were associated with greater risk of subsequent CKD. Individuals with subclinical hypothyroidism (hazard ratio (HR) = 1.15, 95% confidence interval (CI) = 1.05-1.26) and those with overt hypothyroidism (HR = 1.27, 95% CI = 1.04-1.55) were more likely than those who were euthyroid to have CKD. Women were more likely to have CKD than men (HR = 1.11, 95% CI = 1.06-1.16). When stratified by gender, subclinical hypothyroidism in women was associated with an increased risk of developing CKD (HR = 1.22; 95% CI = 1.08-1.39). When stratified by DM, subclinical hypothyroidism and overt hypothyroidism were associated with an increased risk of developing CKD in nondiabetics (HR = 1.19; 95% CI = 1.07-1.31; and HR = 1.34; 95% CI = 1.08-1.65, respectively). CONCLUSION: This cohort study of elderly persons in Taipei City found a significant association between hypothyroidism and development of CKD in women and individuals without DM.

Relationship of myocardial substrate characteristics as assessed by myocardial perfusion imaging and cardiac reverse remodeling levels after cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) can provide cardiac reverse remodeling (RR), which may include mechanical reverse remodeling (MRR) and/or electrical reverse remodeling (ERR). However, uncoupling of MRR and ERR is not uncommon, and the underlying mechanisms are not clear. This study aimed to evaluate the relationship of myocardial substrate characteristics as assessed by myocardial perfusion imaging (MPI) and cardiac RR post-CRT. MATERIALS AND METHODS: Forty-one patients (26 men, mean age 66 ± 10 years) with heart failure received CRT for at least 12 months were assigned to three groups according to their levels of RR: I, MRR + ERR (ESV reduced ≥15 % and intrinsic QRS duration reduced ≥10 ms); II, MRR only (ESV reduced ≥15 %); and III, non-responder (the others). All the patients also underwent MPI under transient CRT-off to evaluate the intrinsic myocardial substrates, including myocardial scar, LV volumes and function, systolic dyssynchrony, and activation sequences. In addition, ventricular tachycardia (VT) and ventricular fibrillation (VF) detected by the CRT devices during follow-up periods were also recorded. RESULTS: Quantitative analysis of MPI showed that there were significant differences for scar burden [15.9 ± 9.5, 26.8 ± 16.1, and 45.6 ± 15.1 % for group I (n = 15), II (n = 16), and III (n = 10), respectively, p < 0.001], EDV (136.6 ± 64.9, 221.6 ± 123.9, and 351.8 ± 216.3 ml, p = 0.002), ESV (82.6 ± 59.8, 172.3 ± 117.2, and 293.3 ± 209.6 ml, p = 0.001), LVEF (44.9 ± 15.0, 25.6 ± 10.9, and 21.5 ± 11.7 %, p < 0.001), systolic phase SD (23.4° ± 10.3°, 36.0° ± 16.2°, and 57.0° ± 22.2°, p < 0.001), and bandwidth (72.5° ± 31.1°, 113.4° ± 56.4°, and 199.1° ± 90.1°, p < 0.001). Myocardial scar interfered with the normal propagation of mechanical activation, resulting in heterogeneous activation sequences. Compared with group II (MRR only), group I (ERR + MRR) had significantly less initial activation segments (1.9 ± 1.0 vs. 2.6 ± 0.7, p < 0.05) and shorter maximal contraction delay (46.9° ± 12.9° vs. 58.8° ± 18.5°, p < 0.05). During the periods of follow-up, 21 patients developed VT/VF, including only 1 patient (1 VT) in group I (6.7 %), 8 patients (7 VT and 1 VF) in group II (50 %), and 9 patients (7 VT and 5 VF) in group III (90 %). CONCLUSION: The characteristics of myocardial substrates as assessed by MPI differed significantly between different levels of cardiac RR post-CRT. Myocardial scar played an important role in the development of ERR. Different cardiac RR levels contributed to different incidences of ventricular arrhythmia, and the combination of ERR and MRR provided highest anti-arrhythmic effects.