Prevalence and Metabolic Factors of Hyperuricemia in an Elderly Agricultural and Fishing Population in Taiwan.

OBJECTIVES: This study aims to explore the potential condition-related sex differences to understand the overall pathogenesis of hyperuricemia among the elderly agricultural and fishing population in Taipei, Taiwan. PATIENTS AND METHODS: This study included 4,372 healthy elderly agricultural and fishing professionals (2,766 males, 1,606 females; mean age 74.4±6.6 years; range 65.0 to 90.3 years) voluntarily admitted to a teaching hospital in Taipei, Taiwan for physical exams in 2010. Their fasting blood samples were drawn through venipuncture, and they were administered a structured questionnaire by clinical nurses. RESULTS: The overall prevalence of hyperuricemia was 30.4%, which increased significantly with increasing age (p<0.001). The prevalence was similar in males (30.2%) and females (30.6%) (p=0.78). Age, obesity, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia as well as low high- density lipoprotein and high blood urea nitrogen, creatinine, and alanine amino transferase levels were significantly associated with hyperuricemia. Hypercholesterolemia (odds ratio [OR]=1.26, 95% confidence interval [CI]: 1.05-2.50) and high creatinine levels (OR=3.75, 95% CI: 2.64-5.33) were significantly associated with hyperuricemia in males, whereas type 2 diabetes (OR=1.54, 95% CI: 1.22-1.93) and high alanine amino transferase levels (OR=1.79, 95% CI: 1.31-2.43) were significantly associated with hyperuricemia in females. Hyperuricemia disparity among age groups was also revealed. CONCLUSION: Several sex-related differences with regard to factors including age, obesity, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia, low high-density lipoprotein, high blood urea nitrogen, creatinine, and alanine amino transferase levels were indicated in the prevalence of hyperuricemia in this specific elderly population.

Evaluation of work stress, turnover intention, work experience, and satisfaction with preceptors of new graduate nurses using a 10-minute preceptor model.

BACKGROUND: Preparing new graduate nurses (NGNs) to achieve standards of nursing competence is challenging; therefore, this study developed and evaluated the effects of a 10-minute preceptor (10MP) model for assisting NGNs in their professional development and increasing their retention in hospitals. METHOD: A repeated-measures design study, with an intervention and a two-group comparison, was conducted. A total of 107 NGNs participated in the study. At day 7, work stress and work experience were moderately high for the NGNs in both the 10MP and traditional preceptor model (TPM) groups. RESULTS: The preceptorship program showed significant differences between groups (p = 0.001) regarding work stress at months 2 and 3 and work experience at months 1, 2, and 3. The 10MP group reported lower turnover intention and higher satisfaction with the preceptors than the TPM group. CONCLUSION: The 10MP model is effective at improving training outcomes and facilitating the professional development of NGNs.

Prevalence and associated metabolic factors of gallstone disease in the elderly agricultural and fishing population of taiwan.

Purpose. To evaluate sex-related differences in the prevalence of and cardiovascular risk factors related to gallstone disease (GSD) in an elderly agricultural and fishing population of Taipei, Taiwan. Methods. The study sample consisted of 6511 healthy elderly participants (3971 men and 2540 women) who were voluntarily admitted to a teaching hospital for a physical checkup in 2010. The participants' blood samples and real-time ultrasound fatty liver results were collected. Results. The prevalence of GSD in the study population was 13.2%, which increased significantly with population age (P < .0001). Women were associated with significantly higher GSD prevalence than men (14.8% versus 12.2%; for the chi-square test, P = .003). In a multiple logistic regression analysis, female sex, older age, and metabolic syndrome (MetS) were significantly associated with GSD. Multiple logistic regression analysis also revealed that obesity (odds ratio (OR) = 1.26, 95% confidence interval (CI): 1.09-1.44) and metabolic factors (one or 2 versus none, OR = 1.48, 95% CI: 1.08-1.76) were significantly associated with GSD in women but not in men. Conclusion. In the study population, female sex, older age, and MetS were associated with higher GSD prevalence. The population exhibited other sex-related differences.

Relationship between obesity, metabolic syndrome, and nonalcoholic fatty liver disease in the elderly agricultural and fishing population of Taiwan.

BACKGROUND: The purpose of this study was to explore the relationship between obesity, the metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) in the elderly agricultural and fishing population of Taipei, Taiwan. METHODS: The study participants comprised 6,511 (3,971 male and 2,540 female) healthy elderly subjects voluntarily attending a teaching hospital for a physical check-up in 2010. Blood samples and real-time ultrasound-proven fatty liver sonography results were collected. RESULTS: The prevalence of NAFLD in this elderly population was 27.2%, including mild NAFLD (16.0%), moderate NAFLD (10.3%), and severe NAFLD (0.9%). The prevalence of moderate or severe NAFLD for metabolic syndrome proved to be substantially greater (P<0.0001, χ(2) test) for one or two metabolic factors. Using multinomial logistic regression analysis, age, sex, metabolic syndrome, and higher body mass index had a statistically significant association with mild NAFLD. Age, sex, metabolic syndrome, higher body mass index, and higher alanine aminotransferase were significantly related to moderate NAFLD. In addition, higher body mass index, higher uric acid, and higher alanine aminotransferase levels were significantly related to severe NAFLD. The sensitivity and specificity of body mass index and waist circumference as markers of NAFLD were estimated to be 81% and 84%, respectively, and 77% and 69%, respectively. CONCLUSION: The prevalence of mild or moderate NAFLD was related to obesity and metabolic syndrome. Higher body mass index was also related to severe NAFLD but not to metabolic syndrome. Targeting this population for control of obesity and improved metabolic function is important.

Clinical investigation of metabolic syndrome in the female elderly occupational population.

PURPOSE: To explore prevalence of metabolic syndrome (MetS) and factors associated with its components in the elderly female occupational population in Taipei, Taiwan. METHODS: A total of 1,589 healthy subjects voluntarily and 65 years or above admitted to a teaching hospital for a physical check-up in 2010. Demographic and blood sample results were collected. RESULTS: The mean age of the study participants is 74.8 ± 6.7 years. The prevalence of MetS is 40.5 % (95 % CI 38.1-42.9 %). After adjustment for confounding factors, the older age, higher body mass index, and higher serum uric acid are the most significant risk factors related to MetS. CONCLUSION: The prevalence of MetS is related to obesity and elevated serum uric acid. Promoting this population with controlled obesity and health improvement for renal function is important.

Clinical implications in the prevalence and associated cardiovascular factors of elevated serum alanine aminotransferase levels among elderly agricultural and fishing population in Taipei, Taiwan: experience at a teaching hospital.

AIM: To discuss the prevalence and associated factors related to an elevated serum alanine aminotransferase (ALT) level among the elderly agricultural and fishing population. METHODS: A total of 6542 (3989 males and 2553 females) healthy adults voluntarily admitted to a teaching hospital for a physical checkup in 2010 in Taipei, Taiwan. Fasting blood samples were drawn via venipuncture, and clinical nurses interviewed the study participants using a structured questionnaire from. RESULTS: The overall prevalence of an elevated serum ALT level was 18.2% and revealed a statistically significant decrease with increasing age (P < 0.001). The men exhibited a higher prevalence than the women (19.7% vs 15.9%; P < 0.001). Male sex; younger age; and presence of obesity, hypertension, hyperuricemia, and hypoalbuminemia were significantly associated with an elevated serum ALT level. Sex-related differences were also revealed. For the men, type 2 diabetes (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.02-1.57), hypercholesterolemia (OR, 1.78; 95% CI, 1.22-2.83), hypertriglyceridemia (OR, 1.32; 95% CI, 1.04-1.73), and low high-density lipoprotein (OR, 1.26; 95% CI, 1.05-1.51) were significantly related to an elevated serum ALT level, but this was not so for the women. The disparity of ALT in age groups was revealed. CONCLUSION: Several sex-related differences were indicated pertaining to the prevalence of an elevated serum ALT level among elderly specific occupational population.

Clinical epidemiology of reduced kidney function among elderly male fishing and agricultural population in Taipei, Taiwan.

PURPOSE: To quantify the prevalence of and associated factors for chronic kidney disease (CKD) among male elderly fishing and agricultural population in Taipei, Taiwan. METHODS: Subjects (n = 2,766) aged 65 years and over voluntarily admitted to a teaching hospital for a physical checkup were collected in 2010. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m². RESULTS: Among these subjects, the over prevalence of chronic kidney disease was 13.6% (95% CI: 12.3-14.9%). The age-specific prevalence of CKD in 65-74 years, 75-84 years, and ≥85 years was 8.2%, 19.1%, and 27.0%, respectively. From the multiple logistic regression, age (OR = 1.05, 95% CI: 1.02-1.09), hyperuricemia (OR = 2.94, 95% CI: 1.90-3.78), central obesity (OR = 1.17, 95% CI: 1.02-1.56), hyperglycemia (OR = 1.23, 95% CI: 1.11-1.67), hypertriglyceridemia (OR = 1.25, 95% CI: 1.08-1.66), and lower HDL-C (OR = 1.61, 95% CI: 1.23-1.92) were statistically significantly related to CKD. The presence of metabolic components (one or two versus none, OR = 1.10, 95% CI: 1.04-1.25; three or more versus none, OR = 2.12, 95% CI: 1.86-2.78) also appeared to be statistically significantly related to CKD after adjustment for other independent factors. CONCLUSION: Several clinical factors independently affect the development of CKD in the elderly male fishing and agricultural population.

Effects of tooth scaling reminders for dental outpatients.

We investigated the effect of sending reminders for patients to attend appointments for tooth scaling. A total of 389 outpatients were assigned to three intervention groups (reminders sent by postcard, mobile-phone text message or telephone call) and one control group. Reminders accompanied by short health education messages were sent to patients in each of the intervention groups. The outpatient revisiting behaviour of the patients was monitored. Patients who were reminded to come in for tooth scaling were 2.6 (95% CI 1.3-5.4) to 2.9 (CI 1.1-7.8) times more likely to revisit compared to those who were not reminded. For every one point increase in the patient satisfaction score, patients were 3.8 (CI 1.2-11.6) times more likely to revisit. Patients with a high level of patient satisfaction and who had also received a reminder had the highest return rates (26%). Most patients (89-96%) had good feelings regarding the reminders; 65% of the patients agreed that reminders had enhanced their intention to revisit; 91% of patients hoped to continue to receive reminders concerning broader dental health information. A reminder combined with health education is an effective way of improving preventative dental visiting behaviour.

Clinical characteristics and risk behavior as a function of HIV status among heroin users enrolled in methadone treatment in northern Taiwan.

BACKGROUND: Methadone treatment was introduced in Taiwan in 2006 as a harm-reduction program in response to the human immunodeficiency virus (HIV), which is endemic among Taiwanese heroin users. The present study was aimed at examining the clinical and behavioral characteristics of methadone patients in northern Taiwan according to their HIV status. METHODS: The study was conducted at four methadone clinics. Participants were patients who had undergone methadone treatment at the clinics and who voluntarily signed a consent form. Between August and November 2008, each participant completed a face-to-face interview that included questions on demographics, risk behavior, quality of life, and psychiatric symptoms. Data on HIV and hepatitis C virus (HCV) infections, methadone dosage, and morphine in the urine were retrieved from patient files on the clinical premises, with permission of the participants. RESULTS: Of 576 participants, 71 were HIV positive, and 514 had hepatitis C. There were significant differences between the HIV-positive and HIV-negative groups on source of treatment payment, HCV infection, urine test results, methadone dosage, and treatment duration. The results indicate that HIV-negative heroin users were more likely to have sexual intercourse and not use condoms during the 6 months prior to the study. A substantial percent of the sample reported anxiety (21.0%), depression (27.2%), memory loss (32.7%), attempted suicide (32.7%), and administration of psychiatric medications (16.1%). There were no significant differences between the HIV-positive and HIV-negative patients on psychiatric symptoms or quality of life. CONCLUSIONS: HIV-positive IDUs were comorbid with HCV, indicating the need to refer both HIV- and HCV-infected individuals for treatment in methadone clinics. Currently, there is a gap between psychiatric/psychosocial services and patient symptoms, and more integrated medical services should be provided to heroin-using populations.

Psychometric properties of the Chinese craving beliefs questionnaire for heroin abusers in methadone treatment.

BACKGROUND: This paper reports the psychometric properties of the Chinese version of Craving Beliefs Questionnaire (CCBQ), an easy-to-administer assessment instrument of measurement of craving beliefs for heroin abusers. METHODS: Participants were 445 heroin abusers from four methadone clinics in Northern Taiwan. Fifty-one of the participants were tested twice within a two-week period at a different hospital to examine test-retest reliability. RESULTS: Three-factor solution using principal component analysis was identified in the CCBQ: will power, compulsive behavior, and negative coping, accounting for 54.6% of the variance. Internal consistency analysis indicated that the three factors have strong reliability, with Cronbach alphas ranging from .81 to .92. The test-retest ICC coefficient is .80. The test-retest coefficients for the subscales will power, compulsive behavior, and negative coping are .76, .51, and .64, respectively. Overall, the data show that the CCBQ has acceptable reliability and validity, demonstrating that it can be a research instrument for assessing heroin craving beliefs. CONCLUSIONS: The psychometric properties of the CCBQ seem promising for both research and clinical purposes, and the scale thus deserves further refinement and validation with heroin abusers.

Pulmonary tuberculosis increases the risk of lung cancer: a population-based cohort study.

BACKGROUND: The possible effect of pulmonary tuberculosis (TB) on subsequent lung cancer development has been suspected, but the evidence remains inconsistent. The purpose of this study was to perform a nationwide population-based cohort study to investigate the risk of lung cancer after pulmonary TB infection. METHODS: This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database. In total, 5657 TB patients and 23,984 controls matched for age and sex were recruited for the study from 1997 to 2008. RESULTS: The incidence rate of lung cancer (269 of 100,000 person-years) was significantly higher in the pulmonary TB patients than that in controls (153 of 100,000 person-years) (incidence rate ratio [IRR], 1.76; 95% confidence interval [CI], 1.33-2.32; P < .001). Compared with the controls, the IRRs of lung cancer in the TB cohort were 1.98 at 2 to 4 years, 1.42 at 5 to 7 years, and 1.59 at 8 to 12 years after TB infections. The multivariate Cox proportional hazards model revealed pulmonary TB infections (hazard ratio [HR], 1.64; 95% CI, 1.24-2.15; P < .001) and chronic obstructive pulmonary disease (HR, 1.09; 95% CI, 1.03-1.14; P = .002) to be independent risk factors for lung cancer. CONCLUSIONS: Pulmonary infection with TB is associated with an increased risk of lung cancer.

Hospital environment, nurse-physician relationships and quality of care: questionnaire survey.

AIM: This paper is a report of a study conducted to (a) to compare hospitalized patients' and nurses' perceptions of the hospital environment, nurse-physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables. BACKGROUND: Quality of care is a function of many factors and includes elements of the hospital environment and nurse-physician relationships. However, comparisons between patients' and nurses' perceptions are relatively limited. METHODS: This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis. RESULTS: Overall, patients' mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse-physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P < 0·001). Both the hospital environment and nurse-physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse-physician relationships and years of education for patients (P < 0·05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse-physician relationships (P < 0·05). CONCLUSION: These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients' and nurses' expectations.

Do the health-care workers gain protection against herpes zoster infection? A 6-year population-based study in Taiwan.

Varicella zoster virus (VZV) causes varicella, and may reactivate to cause herpes zoster later in the life of the host. It has been previously observed that exposure to VZV may boost the host's latent immunity. Health-care workers who are frequently exposed to ill patients ought to receive a protective effect. We investigated the incidence of herpes zoster among health-care workers and the general population in Taiwan to see whether such a protective effect exists among health-care workers against herpes zoster. This nationwide population-based retrospective cohort study was based on data obtained from the Taiwan National Health Insurance Database. In total, 7744 health-care workers, including 168 dermatologists and pediatricians, and 695 188 general adults were recruited for the study. Health-care workers in the age groups 20-29, 30-39 and 40-49 years were found to have a significant higher herpes zoster incidence compared to the general adults (P < 0.001, 0.011 and <0.001, respectively). Both logistic regression and Cox regression showed that dermatologists, pediatricians, and other medical professionals have a higher herpes zoster incidence than the general population (odds ratio [OR] = 1.36, 95% confidence interval [95% CI] = 0.63-2.90, hazards ratio [HR] = 1.35, 95% CI = 0.64-2.82 in dermatologist and pediatrician groups, and OR = 1.39, 95% CI = 1.23-1.58, HR = 1.38, 95% CI = 1.22-1.56 in other medical professionals). The incidence of herpes zoster is higher among health-care workers and it can be clearly concluded that no protective effect against herpes zoster exists for health-care workers in Taiwan.

Nurses' perception of nursing workforce and its impact on the managerial outcomes in emergency departments.

AIMS: (1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. BACKGROUND: While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. DESIGN: A cross-sectional questionnaire survey. METHOD: A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. RESULTS: The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). CONCLUSIONS: Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. RELEVANCE TO CLINICAL PRACTICE: The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.

The inhibition in tumor necrosis factor-alpha-induced attenuation in endothelial thrombomodulin expression by carvedilol is mediated by nuclear factor-kappaB and reactive oxygen species.

Carvedilol, a nonselective beta-adrenoceptor antagonist, has been shown to possess antioxidant effects and reduce the risk of hospitalization and death in patients with severe congestive heart failure, which is featured by the activation of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), and leads to thrombotic complications. Thrombomodulin (TM) plays protective roles against thrombosis. Treatment of ECs with TNF-alpha resulted in a down-regulation in the TM expression in a time-dependent manner. Pre-treatment of ECs with carvedilol (1 and 10 microM) for 1 h significantly up-regulated the TM expression in ECs in response to TNF-alpha. When ECs were pre-treated with a nuclear factor-kappaB (NF-kappaB) inhibitor, i.e., parthenolide, their TNF-alpha-mediated down-regulation of TM expression was inhibited. Pre-treatment of ECs with carvedilol inhibited the NF-kappaB-DNA binding activity in ECs induced by TNF-alpha. Our findings provide insights into the mechanisms by which carvedilol exerts anti-thrombotic effects by inducing TM expression in ECs in response to pro-inflammatory stimulation.

Over-expression of EphB3 enhances cell-cell contacts and suppresses tumor growth in HT-29 human colon cancer cells.

Receptor tyrosine kinase EphB3 is expressed in cells in the bottom of intestinal crypts near stem cell niches. Loss of Ephb3 has recently been reported to produce invasive colorectal carcinoma in Apc(Min/+) mice and EphB-mediated compartmentalization was demonstrated to be a mechanism suppressing colorectal cancer progression; however, it is unknown whether other factors contribute to EphB-mediated tumor suppression. EphA4-ephrin-A and EphB4-ephrin-B2 signaling have been reported to promote mesenchymal-to-epithelial transition (MET). Here, we examine whether EphB3-ephrin-B interaction has a similar effect and investigate its role in tumor suppression. We found in a clinical cohort that EphB3 expression was significantly reduced in advanced Dukes' stage tumor specimens, so we over-expressed EphB3 in HT-29 cells by stable transfection. EphB3 over-expression inhibited HT-29 growth in monolayer cultures, anchorage-independent growth in soft agar and xenograft growth in nude mice and initiated morphological, behavioral and molecular changes consistent with MET. Specifically, EphB3 over-expression re-organized cytoskeleton (converting spreading cells to a cobble-like epithelial morphology, patterning cortical actin cytoskeleton and polarizing E-cadherin and ZO-1), induced functional changes favoring MET (decreased transwell migration, increased apoptosis and Ca(2+)-dependent cell-cell adhesion), decreased mesenchymal markers (fibronectin and nuclear beta-catenin), increased epithelial markers (ZO-1, E-cadherin and plakoglobin) and inactivated CrkL-Rac1, a known epithelial-to-mesenchymal transition signaling pathway. Additionally, cross talk from Wnt signaling potentiated the restoration of epithelial cell polarity. Noteworthily, the same factors contributing to MET, owing to EphB3 signaling, also facilitated tumor suppression. We conclude that EphB3-ephrin-B interaction promotes MET by re-establishing epithelial cell-cell junctions and such an MET-promoting effect contributes to EphB3-mediated tumor suppression.

Risk adjustment for inter-hospital comparisons of caesarean section rates in Taipei municipal hospitals.

BACKGROUND: This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. METHODS: Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. RESULTS: The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR=1.08, CI=1.01-1.15) and C (RR=1.01, CI=1.00-1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR=1.09, CI=1.05-1.14) and D (RR=1.02, CI=0.99-1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR=0.92, CI=0.88-0.96) and F (RR=0.80, CI=0.77-0.84) were the same as the observed rates. CONCLUSIONS: Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.