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1.
PLoS One ; 15(3): e0230715, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32214403

RESUMO

Evidence suggests the existence of association between a large panel of modifiable biomarkers representing inflammation, coagulation, paraoxonase, and endothelial activation pathways and carotid atherosclerosis. Thus, this study investigated whether CRP, FGA, FGB, FGG, PON1, and EDNRA gene variants affected plasma hs-CRP, fibrinogen levels, and thickness of carotid intima media thickness (IMT). Nineteen single-nucleotide polymorphisms of CRP, FGA, FGB, FGG, PON1, and EDNRA genes were examined in 480 participants from 160 families. Carotid IMT was measured by ultrasound. Generalized linear models with generalized estimating equation were utilized to consider the dependence of subjects within families. In the recessive model, homozygotes for the minor alleles of rs1800789, rs1800790 and rs4220 SNPs in FGB gene indicated a reduced risk of IMT (Exp. ß = 0.89, 0.89, 0.88), which remained significant after adjustment for confounding factors. Significant interaction effects between CRP SNP rs1130864 and rs3093059 and gender for IMT were observed with a significant association in men only. Men carrying minor-minor genotype of CRP SNP rs1130864 and rs3093059 had 0.70- and 0.78-fold lower IMT than men carrying minor-major/major-major genotype. We also observed that the interaction of CRP SNP rs1130864 and rs3093059 with obesity on IMT, hs-CRP and fibrinogen levels. These results support the hypothesis that inflammatory genes are involved in atherosclerosis, most likely via complex gene-gender and gene-obesity interactions.

2.
Cardiovasc Diabetol ; 19(1): 4, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910828

RESUMO

BACKGROUND: This study investigated whether visit-to-visit fasting plasma glucose (FPG) variability, as measured by the coefficient of variation (CV), increased peripheral artery disease (PAD) risk. METHODS: Individuals with type 2 diabetes from the National Diabetes Care Management Program during the period 2002-2004, ≥ 30 years of age, and free of PAD (n = 30,932) were included and monitored until 2011. Cox proportional hazards regression models were implemented to analyze related determinants of PAD. RESULTS: A total of 894 incident cases of PAD were identified during an average 8.2 years of follow-up, resulting in a crude incidence rate of 3.53 per 1000 person-years. Both FPG-CV and HbA1c were significantly associated with PAD after multivariate adjustment, with corresponding hazard ratios of 1.24 [95% confidence interval (CI) 1.04-1.47] for FPG-CV in the third tertile and 1.50 (95% CI 1.10-2.04) for HbA1c ≥ 10%. The findings of the sensitivity analysis remained consistent after excluding potential confounders, demonstrating the consistency of the results. CONCLUSIONS: The associations between HbA1c, variability in FPG-CV, and PAD suggest a linked pathophysiological mechanism, suggesting the crucial role of glycemic variability in clinical management and therapeutic goals in preventing PAD in type 2 diabetes.

3.
Diabetologia ; 63(1): 194-205, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31686118

RESUMO

AIMS/HYPOTHESIS: Elevated glucose level is one of the risk factors for lower extremity amputation (LEA), but whether glycaemic variability confers independent risks of LEA remains to be elucidated. This study aimed to investigate the association between visit-to-visit glycaemic variability and minor and major LEA risks during 8 years of follow-up in type 2 diabetic individuals aged 50 years and older. METHODS: This retrospective cohort study included 27,574 ethnic Chinese type 2 diabetic individuals aged ≥50 years from the National Diabetes Care Management Program in Taiwan. Glycaemic variability measures were presented as the CVs of fasting plasma glucose (FPG-CV) and of HbA1c (A1c-CV). The effect of glycaemic variability on the incidence of LEA events was analysed using Cox proportional hazards models. RESULTS: After a median follow-up of 8.9 years, 541 incident cases of LEA with a crude incidence density rate of 2.4 per 1000 person-years were observed. After multivariate adjustment, FPG-CV and A1c-CV were found to be significantly associated with minor LEA, with corresponding HRs of 1.53 (95% CI 1.15, 2.04) and 1.34 (95% CI 1.02, 1.77) for the third tertiles of FPG-CV and A1c-CV, respectively. In addition, these associations were stronger amongst older adults with longer diabetes duration (≥3 years) than amongst those with shorter duration (<3 years) (pinteraction < 0.01). CONCLUSIONS/INTERPRETATION: Our study suggests that visit-to-visit variations in HbA1c and FPG are important predictors of minor LEA amongst older adults with type 2 diabetes, particularly for those with more than 3 years of diabetes duration.

4.
PLoS One ; 14(12): e0225363, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800599

RESUMO

Exposure to air pollutants is known to have adverse effects on human health; however, little is known about the association between hydrocarbons in air and an ischemic stroke (IS) event. We investigated whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increased IS risk. This retrospective cohort study included 283,666 people aged 40 years or older in Taiwan. Cox proportional hazards regression analysis was used to fit single- and multiple-pollutant models for two targeted pollutants, total hydrocarbons (THC) and nonmethane hydrocarbons (NMHC), and estimated the risk of IS. Before controlling for multiple pollutants, hazard ratios (HRs) of IS with 95% confidence intervals for the overall population were 2.69 (2.64-2.74) at 0.16-ppm increase in THC and 1.62 (1.59-1.66) at 0.11-ppm increase in NMHC. For the multiple-pollutant models controlling for PM2.5, the adjusted HR was 3.64 (3.56-3.72) for THC and 2.21 (2.16-2.26) for NMHC. Our findings suggest that long-term exposure to THC and NMHC may be a risk factor for IS development.

5.
PLoS One ; 14(12): e0226973, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887189

RESUMO

Gene effects on osteoporosis have been studied separately and may have been masked by gene-gene and gene-environment interactions. We evaluated gene-gene and gene-physical activity interactions of the variants of tumor necrosis factor-α (TNF-α) and vitamin D receptor (VDR) genes on osteoporosis. A total of 472 elders were included. Seven variants (TNF-α: rs1799964, rs1800629, rs3093662; VDR: rs7975232, rs1544410, rs2239185, rs3782905) were genotyped. Bone mineral densities of the lumbar spine, femoral neck, and total hip were measured by dual-energy X-ray absorptiometry. Predictive models' ability to discriminate osteoporosis status was evaluated by areas under the receiver operating characteristics (AUROC) curve. After multivariable adjustment, significant interactions of TNF-α rs1800629 and VDR rs3782905 were observed on overall and lumbar spine osteoporosis. In elderly women, we found that those carrying the CG/CC genotype of VDR rs3782905 were significantly associated with increased odds of overall osteoporosis compared with those carrying the GG genotype of VDR rs3782905 among those carrying TNF-α rs1800629 GG genotype. The adjusted odds ratios (ORs) for VDR rs3782905 CG/CC genotype in elderly women carrying TNF-α rs1800629 AG/AA and GG genotypes were 0.1 (0.01, 0.98) and 3.54 (1.51, 8.30), respectively. We observed significant differences in AUROCs between the model with traditional covariates plus variants and their interaction term and the model with traditional covariates only (AUROCs: 0.77 and 0.81; p = 0.028). Although the sample size of this study may have been relatively small, our results suggest that the interaction of the CG/CC genotype of VDR rs3782905 with TNF-α rs1800629 GG genotype was associated with increased odds of overall and lumbar spine osteoporosis in elderly women.

6.
Sci Rep ; 9(1): 19897, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882689

RESUMO

We evaluated whether genetic information could offer improvement on risk prediction of diabetic nephropathy (DN) while adding susceptibility variants into a risk prediction model with conventional risk factors in Han Chinese type 2 diabetes patients. A total of 995 (including 246 DN cases) and 519 (including 179 DN cases) type 2 diabetes patients were included in derivation and validation sets, respectively. A genetic risk score (GRS) was constructed with DN susceptibility variants based on findings of our previous genome-wide association study. In derivation set, areas under the receiver operating characteristics (AUROC) curve (95% CI) for model with clinical risk factors only, model with GRS only, and model with clinical risk factors and GRS were 0.75 (0.72-0.78), 0.64 (0.60-0.68), and 0.78 (0.75-0.81), respectively. In external validation sample, AUROC for model combining conventional risk factors and GRS was 0.70 (0.65-0.74). Additionally, the net reclassification improvement was 9.98% (P = 0.001) when the GRS was added to the prediction model of a set of clinical risk factors. This prediction model enabled us to confirm the importance of GRS combined with clinical factors in predicting the risk of DN and enhanced identification of high-risk individuals for appropriate management of DN for intervention.

7.
PLoS One ; 14(9): e0222895, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31550294

RESUMO

This study aimed to investigate whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increases the risk of developing retinal vein occlusion (RVO) among the population of Taiwan. A retrospective cohort study involving 855,297 people was conducted. Cox proportional hazards regression analysis fitted the multiple pollutant models for two targeted pollutants, including total hydrocarbons (THC), nonmethane hydrocarbons (NMHC) were used, and the risk of RVO was estimated. The chi-squared test and one-way analysis of variance were used to test differences in demographics and comorbidity distribution among tertiles of the targeted pollutants. Before controlling for multiple pollutants, hazard ratios for the overall population were 19.88 (95% CI: 17.56-22.50) at 0.51-ppm increases in THC and 4.33 (95% CI: 3.97-4.73) at 0.27-ppm increases in NMHC. The highest adjusted hazard ratios for different multiple pollutant models of each targeted pollutant were statistically significant (all p values were ≤0.05) for all patients at 29.67 (95% CI: 25.57-34.42) for THC and 16.24 (95% CI: 14.14-18.65) for NMHC. Our findings suggest that long-term exposure to THC and NMHC contribute to RVO development.

8.
Sci Rep ; 9(1): 13760, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551567

RESUMO

This study aimed to explore the combined effects of having sleep problems and taking sleeping pills on the skeletal muscle mass and performance of community-dwelling elders. A total of 826 participants who have complete information regarding dual-energy X-ray absorptiometry examination, questionnaire, and physical performance tests were included. The status of having sleep problems and taking sleeping pills was assessed with a self-reported questionnaire. The prevalence rates of sleep problems among older men and women were 37.4% and 54.5%, respectively. After multivariate adjustment, the mean height-adjusted skeletal muscle indices for elders having sleep problems and taking sleeping pills among men and women were 7.29 and 5.66 kg/m2, respectively, which were lower than those without sleep problems (P = 0.0021 and P = 0.0175). The performance of the older men having sleep problems and taking sleeping pills in terms of walking speed, grip strength, and number of squats, was poorer than those of the older men without sleep problems. The status of having sleep problems and taking sleeping pills was correlated with low skeletal muscle mass and poor physical performance in community-dwelling elders. These findings suggest that having sleep problems and taking sleeping pills are associated with having sarcopenia among community elderly.

9.
Geriatr Gerontol Int ; 19(10): 1017-1022, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31522460

RESUMO

AIM: Advanced glycation end-products are important factors in muscle function and physical performance among older adults. However, the association between sarcopenia and urinary carboxymethyl-lysine (uCML) levels remains unclear. The present study aimed to investigate the relationship among uCML levels, skeletal muscle mass, physical performance and sarcopenia among community-dwelling older adults. METHODS: This work was a community-based cross-sectional study. The participants were recruited from the Taichung Community Health Study-Elderly and were followed up until 2017. A total of 104 participants underwent dual-energy X-ray absorptiometry examination, physical performance tests and measurement of uCML levels. After the natural log transformation of the uCML levels, Pearson's correlation coefficient and a general linear model were used for statistical analysis. RESULTS: The mean uCML levels of older men and women were 1.34 µg/mg and 1.63 µg/mg creatinine, respectively. After multivariate adjustment, grip strength among older women significantly decreased as uCML levels increased. Participants with uCML levels and Timed Up and Go test values higher than the median had a 13.76-fold risk of acquiring sarcopenia compared with those whose corresponding variables were lower than the median after adjusting for age, sex, body fat percentage, and serum creatinine and blood urea nitrogen levels. CONCLUSIONS: uCML levels were negatively associated with grip strength among older women. The joint association of uCML and Timed Up and Go test values was correlated with the risk of acquiring sarcopenia among older adults. This finding suggests that uCML levels can be used as a biomarker for screening sarcopenia and as a strategy for treating sarcopenia. Geriatr Gerontol Int 2019; 19: 1017-1022.

10.
J Nurs Manag ; 27(5): 1047-1054, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30963649

RESUMO

AIM: To explore the effectiveness of a clinical reasoning teaching workshop (CRTW) in preceptors' teaching ability, self-efficacy of clinical reasoning teaching. BACKGROUND: Preceptors' teaching skills are crucial for training novice nurses. How to enhance preceptors' teaching ability is a pertinent concern in clinical practice. METHODS: This study comprised two stages. At stage I, we administered a pre- to post-test single group with 33 participants to investigate the changes in preceptors' knowledge and self-efficacy in clinical reasoning teaching after clinical reasoning teaching workshop. At stage II, a quasi-experimental design was adopted to assess the effectiveness of the clinical reasoning teaching workshop by comparing the preceptors' teaching ability by novice nurses. There were 22 nurses' preceptors who underwent the clinical reasoning teaching workshop and 70 nurses with preceptors who did not undergo clinical reasoning teaching workshop and matched with preceptors' age and working experience. RESULTS: After clinical reasoning teaching workshop, preceptors' knowledge and self-efficacy of clinical reasoning teaching ware increased significantly. Novice nurses (study group) scored their preceptors' teaching ability significantly higher than nurses' (control group). CONCLUSION: The clinical reasoning teaching workshop can enhance preceptors' teaching ability and confidence, thereby improving their teaching ability. IMPLICATIONS FOR NURSING MANAGEMENT: A well-designed workshop with appropriated teaching method can allow preceptors to learn effectiveness. Clinical reasoning teaching workshop can be used in the training of preceptors.


Assuntos
Educação/normas , Preceptoria/métodos , Ensino/educação , Adulto , Atitude do Pessoal de Saúde , Educação/estatística & dados numéricos , Feminino , Humanos , Masculino , Mentores/educação , Mentores/estatística & dados numéricos , Preceptoria/normas , Competência Profissional/normas , Pesquisa Qualitativa , Inquéritos e Questionários , Ensino/normas , Ensino/estatística & dados numéricos
11.
J Ethnopharmacol ; 238: 111889, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31009707

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) is characterized by chronic, recurrent abdominal pain or abdominal discomfort and changes in defecation habits. Xiang-Sha-Liu-Jun-Zi tang (XSLJZT) is a traditional Chinese medical formula that can modulate gastrointestinal disturbance. PURPOSE: To investigate the therapeutic effect of XSLJZT on IBS. MATERIALS AND METHODS: This study was designed as a double-blind, randomized, controlled preliminary study. Eighty patients with IBS were assigned to a control group (CG, 40 patients) that received oral administration of an XSLJZT 10% comparator (3.0 g three times daily) for 28 days or to a treatment group (TG, 40 patients) that received XSLJZT. The primary outcome measure was changes in scores on the Gastrointestinal System Rating Scale-IBS. The secondary outcome measures were changes in scores on the irritable bowel syndrome-quality of life (IBS-QOL) and World Health Organization-quality of life-brief. RESULTS: A total of 63 patients completed the study (n = 31 for the CG; n = 32 for the TG). The TG were discovered to have significantly lower diarrhea scores than the CG at V2 (second assessment) compared with V1 (first assessment, baseline) (mean change ±â€¯SD: CG: 0.19 ±â€¯1.33 vs. TG: -0.38 ±â€¯0.91, p = 0.05). The scores for Item 28 on the IBS-quality of life (QOL) scale ("I feel frustrated that I cannot eat when I want because of my bowel problems") were lower in the CG at V3 (third assessment) compared with V1 but slightly higher in the TG (CG: -0.48 ±â€¯0.89 vs. TG: 0.03 ±â€¯0.65, p = 0.01). CONCLUSION: Oral administration of XSLJZT (3.0 g) for 28 days lowered the mean diarrhea score in patients with IBS, indicating that the patients in the TG had greater diarrhea improvement than those in the CG. The present study used 10% XSLJZT as a comparator, and the different items of the Gastrointestinal System Rating Scale-IBS, IBS-QOL, and World Health Organization Quality of Life-Brief were scored separately. Therefore, the selection of an appropriate comparator or placebo and score assessment are crucial issues for future study.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Síndrome do Intestino Irritável/tratamento farmacológico , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Diabetes Metab ; 45(6): 564-572, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30858146

RESUMO

AIM: Diabetes is a primary cause of hospitalization and in-hospital mortality. However, studies exploring the relationships between body mass index (BMI) and hospitalization-related and mortality-related outcomes in patients with type 2 diabetes are lacking. METHODS: Our data were obtained from two independent retrospective cohort studies, namely, the Taiwan Diabetes Study (Taiwan DS), providing hospitalization outcome measures, and the Taichung Diabetes Study (Taichung DS) that can be linked with the National Death Registry dataset. BMI and hospitalization, in-hospital mortality, and all-cause and cause-specific death events were analyzed by Cox proportional hazard regression model. RESULTS: A total of 3,541, 38,779, and 10,399 patients died during hospitalization, hospitalized for all-cause and diabetes-related events, respectively, in the Taiwan DS cohort. Moreover, 685 deaths were identified in the Taichung DS cohort. Compared with patients with increasing-but-acceptable-risk obesity, multivariable-adjusted hazard ratios (HRs) of in-hospital mortality, all-cause hospitalization, hospitalization due to diabetes, hypoglycaemia, and renal failure for patients who were underweight were 2.09 (95% confidence interval 1.73, 2.51), 1.39 (1.28, 1.50), 1.69 (1.49, 1.90), 1.87 (1.34, 2.61), and 1.55 (1.26, 1.91). Adjusted HRs of all-cause mortality and non-expanded CVD-related mortality in patients with underweight were 2.02 (1.28, 3.21), and 2.27 (1.28, 4.03). CONCLUSIONS: The BMI associated with the best survival and less hospitalization was the higher-high-risk obesity (≥ 27.5 kg/m2) category. We observed obesity paradox for mortality outcomes, which should be addressed by further research, particularly on whether randomized controlled trials of adopting a healthy lifestyle for patients with obesity can improve type 2 diabetes patients' survival.

13.
BMC Geriatr ; 19(1): 26, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30691410

RESUMO

BACKGROUND: Previous studies have reported the associations of frailty phenotype or its components with mortality. However, studies that explored the effects of transition in frailty status on mortality were far less in Asian or Chinese. The aim of this study was to evaluate baseline frailty status and one-year change of frailty status in relation to all-cause mortality in Taiwanese community-dwelling older adults who participated in the Taichung Community Health Study for Elders. METHODS: We conducted a community-based prospective cohort study. A total of 921 community-dwelling elderly men and women aged 65-99 years in Taichung City were enrolled in 2009-2010 and were followed up through 2016. We adopted the definition of frailty proposed by Fried et al., including five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs) for frailty at baseline and one-year change in frailty status. RESULTS: There were 160 deaths during the follow-up period. The mortality rates in groups of robust and frail were 20.26 and 84.66 per 1000 person-years respectively. After multivariate adjustment, the HR (CIs) for baseline frailty was 2.67 (1.73-4.12). Poor endurance and energy [1.88 (1.03-3.42)], slowness [2.60 (1.76-3.83)] and weakness [1.65 (1.16-2.33)] were found to be predictors of mortality. Increased risks in mortality for subgroups of robust-to-frail [2.76 (1.22-6.27)], frail-to-robust [3.87 (1.63, 9.19)], and frail-to-frail [4.08 (1.92-8.66)] over one-year period were observed compared with those remaining robust. CONCLUSION: Baseline frailty status and one-year change in frailty status are associated with 6-year all-cause mortality among Taiwanese elderly adults. Frailty may be useful for identifying older adults at high risks for mortality prevention.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/mortalidade , Vida Independente/tendências , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Mortalidade/tendências , Estudos Prospectivos , Taiwan/epidemiologia
14.
Phytomedicine ; 56: 118-125, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30668332

RESUMO

BACKGROUND: The main symptoms of gastroesophageal reflux disease GERD are heartburn and acid regurgitation. Proton-pump inhibitors (PPI) are considered to be safe and effective for the treatment of GERD. In traditional Chinese medicine, wu chu yu tang (WCYT) is used to treat nausea after eating, vomiting, and diarrhea. PURPOSE: We designed a randomized, double-blind, placebo-controlled clinical trial to evaluate the therapeutic effect of WCYT on GERD using omeprazole as a PPI for the positive control. METHODS: Ninety patients with GERD were randomly assigned to the 1) control group (CG), who received an oral administration of omeprazole (20 mg) once per day and given WCYT placebo (3.0 g) three times per day for 4 weeks continuously; or the 2) treatment group (TG), who received oral administration of omeprazole (20 mg) placebo once per day and WCYT (3.0 g) three times per day for 4 weeks continuously. RESULTS: Seventy-seven patients (37 in CG, 40 in TG) completed the trial. Both Reflux Disease Questionnaire (RDQ) and Gastroesophageal Reflux Disease Questionnaire (GERDQ) scores was less in the second assessment (V2) and in the third assessment (V3) than those in V1 (first assessment; baseline) in the CG and TG groups (all p < 0.001); the score difference of both RDQ and GERDQ between V2 and V1 was similar between CG and TG (p = 1.00, p = 0.54, respectively). The score difference of both RDQ and GERD between V3 and V1 was less in the CG group than those of the TG group (both p = 0.004). CONCLUSION: WCYT has an effect similar to omeprazole for GERD treatment. Furthermore, this effect resulting from WCYT appeared to be maintained for a longer period of time than did that of omeprazole. A study with a larger sample size and longer study period is needed to corroborate our findings.


Assuntos
Alcaloides/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Quinolinas/uso terapêutico , Administração Oral , Adulto , Idoso , Alcaloides/administração & dosagem , Método Duplo-Cego , Evodia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/administração & dosagem , Omeprazol/farmacologia , Omeprazol/uso terapêutico , Placebos , Extratos Vegetais/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/uso terapêutico , Quinolinas/administração & dosagem , Resultado do Tratamento
15.
Community Dent Oral Epidemiol ; 47(1): 58-64, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30238494

RESUMO

OBJECTIVES: Betel quid (BQ) chewing is extremely prominent in South and Southeast Asia because it considered by users to be of social, cultural and religious importance. BQ chewing has been recognized as a risk factor for oral premalignant lesions and oral cancer. Because BQ chewing has become a severe health risk in Taiwan, the development of prevention and cessation programmes is essential. The purpose of this study was to explore the attitudes and perceptions associated with BQ consumption and its oral health implications in an attempt to inform the development of health promotion initiatives and BQ cessation efforts in Taiwan, where the dental profession could have a pivotal role in preventing and controlling BQ use among persons at risk. METHODS: This qualitative study used data gathered from focus groups and individual interviews. A convenience sample of 41 adults from Jhushan and Lugu Townships (Nantou County) and Taichung City, Taiwan, participated in this study (27 men, 14 women; 31 Han, 10 aboriginals from the Paiwan tribe; mean age 40.3, SD 9.2 years). RESULTS: Among the seven themes that emerged from the original study, five (Initiation, Health Risk Perception, Health Consequences, Withdrawal Symptoms and Help from Healthcare Providers) had oral/dental implications. CONCLUSIONS: Our study highlights research areas relevant to further investigation, such as incorporating brief BQ prevention and cessation counselling when early oral and dental signs associated with BQ consumption are detected. Undertaking behavioural interventions in dental settings might help to reduce the prevalence of BQ chewing in Taiwan.


Assuntos
Areca , Neoplasias Bucais/epidemiologia , Saúde Bucal , Adulto , Areca/efeitos adversos , Atitude , Feminino , Humanos , Masculino , Mastigação , Lesões Pré-Cancerosas/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taiwan
16.
Psychiatry Res ; 271: 153-160, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30476753

RESUMO

The purposes of this study were to develop the Chinese-version betel quid dependence instrument (BQDI) and to test its reliability and validity. An item pool relevant to betel quid dependence was generated. A panel of three experts assessed content validity including content relevance, clarity, and domain coverage. A cross-sectional study was conducted, consisting of 113 participants from a construction site, betel quid stalls, and a teaching hospital in Taichung, Taiwan. Construct validity was assessed by hypothesizing a significant correlation between the BQDI score and number of pieces-years for betel quid chewing and betel quid biomarkers. The overall Cronbach's alpha coefficient was 0.94. Factor analysis indicated the BQDI consisted of a three-factor structure, including physical and psychological cravings, lack of resistance to betel quid, and maladaptive use. We observed significant associations of BQDI total and factor scores with arecaidine (adjusted odds ratio [OR] for medium total BQDI score: 12.87, 95% CI: 1.45-114.5; high total BQDI score: 28.9, 3.53-236.6) and N-methylnipecotate (medium total BQDI score: 6.18, 1.21-31.62; high total BQDI score: 13.10, 2.72-63.03, respectively). Our results provide preliminary good internal consistency and construct validation of the Chinese-version BQDI as a measure of betel quid dependence in community adults.


Assuntos
Areca , Grupo com Ancestrais do Continente Asiático/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Inquéritos e Questionários/normas , Adulto , Arecolina/análogos & derivados , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Razão de Chances , Reprodutibilidade dos Testes , Taiwan , Traduções
17.
Curr Alzheimer Res ; 16(14): 1276-1289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31902365

RESUMO

BACKGROUND: Alzheimer's disease, the most common cause of dementia among the elderly, is a progressive and irreversible neurodegenerative disease. Exposure to air pollutants is known to have adverse effects on human health, however, little is known about hydrocarbons in the air that can trigger a dementia event. OBJECTIVE: We aimed to investigate whether long-term exposure to airborne hydrocarbons increases the risk of developing dementia. METHOD: The present cohort study included 178,085 people aged 50 years and older in Taiwan. Cox proportional hazards regression analysis was used to fit the multiple pollutant models for two targeted pollutants, including total hydrocarbons and non-methane hydrocarbons, and estimated the risk of dementia. RESULTS: Before controlling for multiple pollutants, hazard ratios with 95% confidence intervals for the overall population were 7.63 (7.28-7.99, p <0.001) at a 0.51-ppm increases in total hydrocarbons, and 2.94 (2.82-3.05, p <0.001) at a 0.32-ppm increases in non-methane hydrocarbons. The highest adjusted hazard ratios for different multiple-pollutant models of each targeted pollutant were statistically significant (p <0.001) for all patients: 11.52 (10.86-12.24) for total hydrocarbons and 9.73 (9.18-10.32) for non-methane hydrocarbons. CONCLUSION: Our findings suggest that total hydrocarbons and non-methane hydrocarbons may be contributing to dementia development.

18.
Medicine (Baltimore) ; 97(51): e13803, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572541

RESUMO

Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67 ±â€Š11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015. The analyses included glycated hemoglobin, estimated glomerular filtration rate, and other characteristics.In total, 539 (74.3%) patients showed an abnormality of at least 1 thermal threshold in their feet. All patients with an abnormal ABI (<0.9) had concurrent impaired thermal thresholds, and 93% (87/94) of patients with an abnormal TBI experienced abnormal thermal thresholds in the lower limbs. Age- and sex-adjusted TBI and estimated glomerular filtration rate were significantly correlated to abnormal thermal thresholds. In the multivariate analysis, fasting plasma glucose, and glycated hemoglobin were independently associated with abnormal thermal thresholds in the lower extremities.Subclinical thermal threshold abnormalities of the feet are significantly associated with PAD and nephropathy in patients who have type 2 diabetes without cardiovascular disease.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/fisiopatologia , Doença Arterial Periférica/fisiopatologia , Limiar Sensorial/fisiologia , Temperatura Ambiente , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Estudos Retrospectivos , Distribuição por Sexo , Inquéritos e Questionários
19.
Sci Rep ; 8(1): 16779, 2018 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-30405164

RESUMO

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

20.
Sci Rep ; 8(1): 14816, 2018 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-30287845

RESUMO

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. Early diagnosis and treatment of HCC remain a key goal for improving patient survival. Chronic hepatitis B virus (HBV) infection is a major risk factor for HCC development. Pre-S mutants harboring deletions in HBV large surface antigen have been well demonstrated as HBV oncoproteins that dysregulate multiple signaling pathways in hepatocytes, leading to HCC formation. The presence of pre-S mutants in plasma represents important predictive and prognostic markers for HCC in patients with chronic HBV infection. However, the method to detect pre-S mutants remains to be optimized. In this study, we developed a platform, based on the next-generation sequencing (NGS) technology, for detection of pre-S mutants in plasma of HBV-related HCC patients. Compared to the current TA cloning-based analysis, the NGS-based analysis could detect pre-S deletion quantitatively, and the detection rate was significantly more sensitive in 49 plasma analyzed (McNemar's paired proportion test, P value < 0.0001; simple kappa coefficient, κ = 0.29 (95% CI, 0.12 to 0.46)). Our data suggest that the NGS-based platform may hold a promise for improving the clinical application of pre-S mutants in serving as predictive and prognostic markers for HBV-related HCC.


Assuntos
Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/genética , Genes Virais , Vírus da Hepatite B/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/genética , Mutação/genética , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Feminino , Genótipo , Antígenos de Superfície da Hepatite B/sangue , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade
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