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1.
Sleep Breath ; 28(5): 2197-2204, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38935268

RESUMO

PURPOSE: Insomnia is a prevalent sleep disorder among patients undergoing hemodialysis for chronic kidney disease. This study aimed to translate the sleep condition indicator (SCI), an insomnia screening tool based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into a traditional Chinese version (SCI-TC) and evaluate the reliability and validity of this version for patients undergoing hemodialysis. METHODS: This cross-sectional study conducted from November 2022 to June 2023 involved 200 patients on hemodialysis (mean age, 65.56 years; 61.5% men). Participants completed a series of questionnaires, with insomnia diagnosed according to DSM-5 criteria as the gold standard. A receiver operating characteristic (ROC) curve analysis was conducted to examine the sensitivity and specificity of the SCI-TC. RESULTS: According to the DSM-5 criteria, 38% of the participants had insomnia. Cronbach's alpha for the SCI-TC was 0.92. The SCI-TC exhibited a good fit as a two-factor model, and its scores were significantly associated with those of the traditional Chinese versions of the Insomnia Severity Index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, EuroQol 5-Dimensions scale, and EuroQol Visual Analogue Scale (r = - 0.94, - 0.53, - 0.38, 0.27, and 0.30, respectively; all p < 0.05). The ROC curve analysis revealed an optimal cutoff of 16 points, with the sensitivity, specificity, and area under curve of 88.2%, 84.7%, and 0.91(95% confidence interval, 0.87-0.95), respectively. CONCLUSION: The SCI-TC demonstrates robust reliability and validity in detecting insomnia among patients undergoing hemodialysis. These findings suggest that health-care providers should considering using the SCI as an easy-to-use tool for the timely detection of insomnia in this population.


Assuntos
Psicometria , Diálise Renal , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Idoso , Reprodutibilidade dos Testes , Inquéritos e Questionários , China , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/diagnóstico , Sensibilidade e Especificidade , Adulto
2.
Artigo em Inglês | MEDLINE | ID: mdl-39179913

RESUMO

PURPOSE: The link between human papillomavirus (HPV) infections and salivary gland cancer is still a subject of ongoing debate. This study aimed to explore the association between HPV infections and salivary gland cancer in a Taiwanese cohort. We hypothesize that HPV infection is associated with an increased risk of developing salivary gland cancer. METHODS: This case-control study included 416 individuals aged ≥ 20 years who had received their first diagnosis of salivary gland cancer as cases, and 2080 propensity-score-matched controls. We performed multivariate logistic regressions to evaluate the association of salivary gland cancer with HPV infections while considering sociodemographic characteristics and medical comorbidities. RESULTS: Statistical analysis showed a significant difference in the prevalence of HPV infections between patients diagnosed with salivary gland cancer and the controls, with rates of 10.8% and 6.2%, respectively (p < 0.001). The odds ratio for having prior HPV infections among patients with salivary gland cancer compared to controls was 1.885, with a 95% confidence interval of 1.315 to 2.701 after adjusting for variables such as age, sex, monthly income, geographic location, urbanization level, diabetes, hypertension, hyperlipidemia, tobacco use, and alcohol abuse/alcohol dependence syndrome. CONCLUSIONS: Our study adds to the evidence suggesting an association between HPV infections and salivary gland cancer. Individuals with a history of HPV infection have an approximately 88% higher likelihood of developing salivary gland cancer.

3.
Sleep Breath ; 27(5): 2021-2030, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-36928548

RESUMO

OBJECTIVE/BACKGROUND: Insomnia is highly prevalent in modern society. However, the hierarchical selection of hypnotics in young and middle-aged adults with insomnia remains unclear. We aimed to compare the efficacy and daytime drowsiness associated with different hypnotics for treating insomnia in young and middle-aged adults. METHODS: We searched Embase, PubMed, Cochrane Library, and ProQuest Dissertations and Theses A&I databases from inception until December 15, 2021. We also manually searched reference lists and relevant publications. The literature search, data collection, and risk of bias evaluation were all carried out separately by pairs of reviewers. We included randomized control trials (RCTs) that compared hypnotics approved by the Food and Drug Administration. The R and Stata software were both used to perform the meta-analysis. RESULTS: In total, 117 RCTs comprising 22,508 participants with the age of 18 to 65 years were included. Assessment of the efficacy of the hypnotics and adverse events (drowsiness) revealed that zolpidem improved all objective sleep parameters (oTST, oSOL, oWASO, and oSE), zopiclone increased oTST and oSE and reduced oSOL, and daridorexant increased oTST and reduced oWASO. Regarding subjective sleep outcomes, zolpidem exhibited beneficial effects on sTST, sSOL, and sWASO. Zaleplon reduced sSOL, and zopiclone was the recommended hypnotic for improving SQ. Zolpidem was associated with drowsiness effect (odds ratio = 1.82; 95% confidence interval = 1.25 to 2.65). The results of sensitivity analysis remained unchanged after the exclusion of studies reporting long-term effects. CONCLUSION: Zolpidem is recommended for managing sleep-onset insomnia and sleep maintenance insomnia but should be used with caution because of daytime drowsiness effects. Daridorexant is recommended as a promising agent for managing sleep maintenance insomnia.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Pessoa de Meia-Idade , Adulto , Humanos , Adolescente , Adulto Jovem , Idoso , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Hipnóticos e Sedativos/efeitos adversos , Zolpidem/efeitos adversos , Metanálise em Rede
4.
Sleep Breath ; 27(5): 2013-2020, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-36854859

RESUMO

BACKGROUND: No study has examined the psychometric properties of the sleep condition indicator (SCI) for screening poststroke insomnia in the Indonesian population. We aimed to develop the Indonesian version of the sleep condition indicator (ISCI) and to examine its psychometric properties for screening adult patients in late sub-acute and chronic periods after stroke. METHODS: This was a cross-sectional study with two stages. In the first stage, the English version of the SCI was translated into the ISCI using standard procedures. The psychometric properties of the ISCI were tested in the second stage. Internal consistency and test-retest reliability of ISCI were used to evaluate reliability. A confirmatory factor analysis (CFA) was performed to test construct validity. To test concurrent and convergent validity, the Indonesian version of the insomnia severity index (ISI-INA), generalized anxiety disorder questionnaire (IGAD-7), and patient health questionnaire (IPHQ-9) were used. A receiver operating characteristic (ROC) analysis was conducted to calculate the optimal cutoff score of the ISCI on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for insomnia. RESULTS: A total of 160 adults with a diagnosis of stroke for more than 3 months were included (median age of 58.5 years, 31% met the DSM-5 criteria for insomnia). The ISCI had a satisfactory Cronbach's alpha of 0.89 and test-retest reliability of 0.78. The CFA revealed that the ISCI exhibited a satisfactory model fit and was associated with the ISI-INA, IGAD-7, and IPHQ-9 (r = -0.81, -0.32, and -0.52, respectively; all P < .001). The ROC test revealed that the optimal cutoff point of ≤23 yielded the highest sensitivity (94%) and specificity (97%). CONCLUSION: The study results revealed that the 8-item ISCI is a reliable and valid screening tool for detecting insomnia symptoms according to the DSM-5 criteria in the chronic period after stroke.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Adulto , Humanos , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologia , Sono , Psicometria , Reprodutibilidade dos Testes , Estudos Transversais , Indonésia , Inquéritos e Questionários , Índice de Gravidade de Doença
5.
Behav Sleep Med ; 21(6): 802-810, 2023 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36606311

RESUMO

OBJECTIVES/BACKGROUND: Insomnia is a common sleep complaint among patients who had a stroke and has been recognized as an independent risk factor for cognitive impairment. However, the relationship between poststroke insomnia and cognitive impairment over time is under-researched. Therefore, we examined the association between poststroke insomnia and the risk of cognitive impairment. PARTICIPANTS: Stroke participants who had a stroke and were 20 years and older. METHODS: This multicenter hospital-based retrospective cohort study with a 13-year follow-up period (2004-2017). The diagnosis of stroke, insomnia, and cognitive impairment was based on the International Classification of Diseases. The study participants who experienced a stroke were divided into two cohorts: those who also had insomnia and those who did not have insomnia. A Cox proportional-hazards regression model was used. RESULTS: A total of 1,775 patients with a mean age of 67.6 years were included. Of these patients, 146 and 75 patients were diagnosed with insomnia and cognitive impairment during the follow-up period, respectively. The cumulative incidence of cognitive impairment in the stroke with insomnia cohort was significantly lower than that in the stroke without insomnia cohort (log-rank test, P < .001). The adjusted hazard ratio and 95% confidence interval (CI) of the stroke with insomnia cohort indicated a higher risk of cognitive impairment compared with the stroke without insomnia cohort (adjusted hazard ratio: 2.38; 95% CI: 1.41-4.03). CONCLUSIONS: Patients who had a stroke and were diagnosed with insomnia exhibited a substantial increased risk of cognitive impairment over time.


Assuntos
Disfunção Cognitiva , Distúrbios do Início e da Manutenção do Sono , Acidente Vascular Cerebral , Humanos , Idoso , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Disfunção Cognitiva/complicações , Fatores de Risco , Hospitais
6.
Hum Factors ; : 187208231183874, 2023 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-37387305

RESUMO

OBJECTIVE: This study proposed a moving average (MA) approach to dynamically process heart rate variability (HRV) and developed aberrant driving behavior (ADB) prediction models by using long short-term memory (LSTM) networks. BACKGROUND: Fatigue-associated ADBs have traffic safety implications. Numerous models to predict such acts based on physiological responses have been developed but are still in embryonic stages. METHOD: This study recorded the data of 20 commercial bus drivers during their routine tasks on four consecutive days and subsequently asked them to complete questionnaires, including subjective sleep quality, driver behavior questionnaire and the Karolinska Sleepiness Scale. Driving behaviors and corresponding HRV were determined using a navigational mobile application and a wristwatch. The dynamic-weighted MA (DWMA) and exponential-weighted MA were used to process HRV in 5-min intervals. The data were independently separated for training and testing. Models were trained with 10-fold cross-validation strategy, their accuracies were evaluated, and Shapley additive explanation (SHAP) values were used to determine feature importance. RESULTS: Significant increases in the standard deviation of NN intervals (SDNN), root mean square of successive heartbeat interval differences (RMSSD), and normalized spectrum of high frequency (nHF) were observed in the pre-event stage. The DWMA-based model exhibited the highest accuracy for both driver types (urban: 84.41%; highway: 80.56%). The SDNN, RMSSD, and nHF demonstrated relatively high SHAP values. CONCLUSION: HRV metrics can serve as indicators of mental fatigue. DWMA-based LSTM could predict the occurrence of the level of fatigue associated with ADBs. APPLICATION: The established models can be used in realistic driving scenarios.

7.
Sensors (Basel) ; 22(22)2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36433227

RESUMO

Obstructive sleep apnea (OSA) is a global health concern and is typically diagnosed using in-laboratory polysomnography (PSG). However, PSG is highly time-consuming and labor-intensive. We, therefore, developed machine learning models based on easily accessed anthropometric features to screen for the risk of moderate to severe and severe OSA. We enrolled 3503 patients from Taiwan and determined their PSG parameters and anthropometric features. Subsequently, we compared the mean values among patients with different OSA severity and considered correlations among all participants. We developed models based on the following machine learning approaches: logistic regression, k-nearest neighbors, naïve Bayes, random forest (RF), support vector machine, and XGBoost. Collected data were first independently split into two data sets (training and validation: 80%; testing: 20%). Thereafter, we adopted the model with the highest accuracy in the training and validation stage to predict the testing set. We explored the importance of each feature in the OSA risk screening by calculating the Shapley values of each input variable. The RF model achieved the highest accuracy for moderate to severe (84.74%) and severe (72.61%) OSA. The level of visceral fat was found to be a predominant feature in the risk screening models of OSA with the aforementioned levels of severity. Our machine learning models can be employed to screen for OSA risk in the populations in Taiwan and in those with similar craniofacial structures.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Teorema de Bayes , Apneia Obstrutiva do Sono/diagnóstico , Polissonografia , Antropometria , Aprendizado de Máquina
8.
J Neurooncol ; 154(2): 179-186, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34304334

RESUMO

PURPOSE: To explore the prevalence of sleep disturbances and their effects on quality of life in adults with pituitary tumor or meningioma. METHODS: This prospective study included 33 and 44 patients with pituitary tumor and meningioma, respectively. All participants completed a series of valid questionnaires for assessing sleep and quality of life; all participants wore 3-day actigraph prior to related treatment. The actigraph-derived sleep parameters included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and dichotomy index (I < O) value. RESULTS: The prevalence of insomnia, excessive daytime sleepiness, and poor sleep quality was 46.8%, 6.5%, and 81.8%, respectively. The differences in these sleep parameters between patients with pituitary tumor and those with meningioma were nonsignificant. Only 27 participants completed the actigraphic assessments. The mean I < O value was 95.99%, and nearly 60% participants exhibited circadian rhythm disruption. Sleep quality was the only sleep variable independently correlated with preoperative quality of life, even after adjustments for confounders (B = 0.80, p = 0.02). CONCLUSIONS: Insomnia, poor sleep quality, and disrupted circadian rhythm are highly prevalent in adults with untreated pituitary tumor or meningioma. Sleep quality independently correlated with quality of life. We indirectly confirmed that tumor location may not be a possible cause of sleep changes.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias Hipofisárias , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Adulto , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/epidemiologia , Meningioma/complicações , Meningioma/epidemiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/epidemiologia , Prevalência , Estudos Prospectivos , Qualidade de Vida , Sono , Qualidade do Sono , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
9.
J Psychiatry Neurosci ; 46(5): E518-E527, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34548386

RESUMO

BACKGROUND: Rumination, a tendency to focus on negative self-related thoughts, is a central symptom of depression. Studying the self-related aspect of such symptoms is challenging because of the need to distinguish self effects from the emotional content of task stimuli. This study employed an emotionally neutral self-related paradigm to investigate possible altered self-processing in depression and its link to rumination. METHODS: People with major depressive disorder (n = 25) and controls (n = 25) underwent task-based electro-encephalogram recording. We studied late event-related potentials, along with low-frequency oscillatory power. We compared electroencephalogram metrics between groups and correlated them with depressive symptoms and reported rumination. RESULTS: Participants with major depressive disorder displayed a difference in late positive potentials across frontocentral electrodes between self-related and non-self-related conditions. We found no such difference in controls. The magnitude of this difference was positively correlated with depressive symptoms and reported rumination. Participants with major depressive disorder also had elevated theta oscillation power at central electrodes in self-related conditions, a finding that we did not see in controls. LIMITATIONS: Patients with major depressive disorder were medicated at the time of the study. The group studied was primarily female, so the observed effects may have been sex-specific. CONCLUSION: Rumination appears to be linked to altered self-related processing in depression, independent of stimuli-related emotional confounds. This connection between self-related processing and depression may point to a self disorder as a core component of depression.


Assuntos
Encéfalo/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/psicologia , Ruminação Cognitiva , Adulto , Encéfalo/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Emoções , Feminino , Humanos , Masculino
10.
Aust N Z J Psychiatry ; 55(2): 196-206, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32900213

RESUMO

OBJECTIVE: Currently, pharmaceutical treatment options for autism spectrum disorder are limited. Brain glutaminergic dysregulation is observed in autism spectrum disorder. N-acetylcysteine, which can be converted to glutathione and subsequently release glutamate into the extracellular space, and thus reduce glutamatergic neurotransmission at synapses, is considered a potential drug for autism spectrum disorder treatment. Here, we analyzed the treatment effects of N-acetylcysteine on autism spectrum disorder in randomized controlled trials. STUDY DESIGN: Updated systematic review and meta-analysis. DATA SOURCES: By systematically searching the PubMed, Embase and Cochrane Library, we obtained five randomized controlled trials. STUDY SELECTION: Meta-analyses were performed to examine the improvement in autistic behaviors as measured by the Aberrant Behavior Checklist, Social Responsiveness Scale and Repetitive Behavior Scale-Revised, using mean difference with a 95% confidence interval and a random-effects model. DATA SYNTHESIS: After 8-12 weeks of N-acetylcysteine supplementation, the pooled result of four trials revealed an improvement in Aberrant Behavior Checklist total score (mean difference = 1.31, 95% confidence interval = [0.42, 2.20]). When one trial was excluded, the sensitivity test result was stronger (mean difference = 1.88, 95% confidence interval = [0.92, 2.83]). The pooled results of three trials revealed significant improvements in hyperactivity (mean difference = 4.80, 95% confidence interval = [1.20, 8.40]) and irritability (mean difference = 4.07, 95% confidence interval = [1.13, 7.04]). Regarding Social Responsiveness Scale, the pooled result of two trials showed significant improvement in social awareness after 8-12 weeks of N-acetylcysteine supplementation (mean difference = 1.34, 95% confidence interval = [0.09, 2.59]). No differences were observed in the pooled results of two trials using Repetitive Behavior Scale, either in the total or the subscales. CONCLUSION: We concluded that N-acetylcysteine is safe and tolerable, reduces hyperactivity and irritability and enhances social awareness in children with autism spectrum disorder. However, further evidence should be sought before a general recommendation.


Assuntos
Acetilcisteína , Transtorno do Espectro Autista , Acetilcisteína/uso terapêutico , Transtorno do Espectro Autista/tratamento farmacológico , Criança , Humanos , Humor Irritável , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Sensors (Basel) ; 21(23)2021 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-34884101

RESUMO

Obstructive sleep apnoea (OSA) is a global health concern, and polysomnography (PSG) is the gold standard for assessing OSA severity. However, the sleep parameters of home-based and in-laboratory PSG vary because of environmental factors, and the magnitude of these discrepancies remains unclear. We enrolled 125 Taiwanese patients who underwent PSG while wearing a single-lead electrocardiogram patch (RootiRx). After the PSG, all participants were instructed to continue wearing the RootiRx over three subsequent nights. Scores on OSA indices-namely, the apnoea-hypopnea index, chest effort index (CEI), cyclic variation of heart rate index (CVHRI), and combined CVHRI and CEI (Rx index), were determined. The patients were divided into three groups based on PSG-determined OSA severity. The variables (various severity groups and environmental measurements) were subjected to mean comparisons, and their correlations were examined by Pearson's correlation coefficient. The hospital-based CVHRI, CEI, and Rx index differed significantly among the severity groups. All three groups exhibited a significantly lower percentage of supine sleep time in the home-based assessment, compared with the hospital-based assessment. The percentage of supine sleep time (∆Supine%) exhibited a significant but weak to moderate positive correlation with each of the OSA indices. A significant but weak-to-moderate correlation between the ∆Supine% and ∆Rx index was still observed among the patients with high sleep efficiency (≥80%), who could reduce the effect of short sleep duration, leading to underestimation of the patients' OSA severity. The high supine percentage of sleep may cause OSA indices' overestimation in the hospital-based examination. Sleep recording at home with patch-type wearable devices may aid in accurate OSA diagnosis.


Assuntos
Apneia Obstrutiva do Sono , Eletrocardiografia , Hospitais , Humanos , Polissonografia , Sono , Apneia Obstrutiva do Sono/diagnóstico
12.
Eur J Neurosci ; 52(12): 4840-4850, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32524682

RESUMO

The brain's intrinsic activity plays a fundamental role in its function. In normal conditions this activity is responsive to behavioural context, changing as an individual switches between directed tasks and task-free conditions. A key feature of such changes is the movement of the brain between corresponding critical and sub-critical states, with these dynamics supporting efficient cognitive processing. Breakdowns in processing efficiency can occur, however, in brain disorders such as depression. It was therefore hypothesised that depressive symptoms would be related to reduced intrinsic activity responsiveness to changes in behavioural state. This was tested in a mixed group of major depressive disorder patients (n = 26) and healthy participants (n = 37) by measuring intrinsic EEG activity temporal structure, quantified with detrended fluctuation analysis (DFA), in eyes-closed (EC) and eyes-open task-free states and contrasting between the conditions. The degree to which DFA values changed between the states was found to correlate negatively with depressive symptoms. DFA values did not differ between states in those with higher symptom levels, meaning that the brain remained in a less flexible sub-critical condition. This sub-critical condition in the EC state was further found to correlate with levels of maladaptive rumination. This may reflect a general cognitive inflexibility resulting from a lack in neural activity reactivity that may predispose people to overly engage in self-directed attention. These results provide an initial link between intrinsic activity reactivity and psychological features found in psychiatric disorders.


Assuntos
Depressão , Transtorno Depressivo Maior , Atenção , Encéfalo , Mapeamento Encefálico , Humanos
13.
Nurs Health Sci ; 22(4): 949-957, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32562329

RESUMO

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self-reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount.


Assuntos
Depressão/diagnóstico , Fumantes/psicologia , Estresse Psicológico/classificação , Adolescente , Comportamento do Adolescente/psicologia , Fumar Cigarros/efeitos adversos , Fumar Cigarros/epidemiologia , Fumar Cigarros/psicologia , Correlação de Dados , Depressão/classificação , Depressão/psicologia , Feminino , Humanos , Masculino , Psicometria/instrumentação , Psicometria/métodos , Fumantes/estatística & dados numéricos , Estresse Psicológico/psicologia , Taiwan
14.
Psychosom Med ; 81(3): 237-245, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30652987

RESUMO

OBJECTIVE: Anxiety and depression are risk factors for obstructive coronary artery disease (CAD), but their effects on coronary artery spasm (CAS) remain unestablished. METHODS: Patient records in this population-based study were retrospectively collected from the Taiwan National Health Insurance Research Database. Using propensity score matching, we used 1:1:1 ratio stratification into a control group of 10,325 individuals without CAS or CAD, a CAS group comprising 10,473 patients, and a CAD group comprising 10,473 patients during 2000-2012. RESULTS: The prevalence of CAS and CAD was 0.067% and 8.7%, respectively, in the general population. The prevalence of anxiety and depression diagnoses was significantly higher in patients with new-onset CAS than in those with new-onset CAD and controls without CAS/CAD, even after propensity score matching. Compared with CAD, anxiety and depression diagnoses conferred a higher risk of developing CAS (odds ratio [OR] = 2.29, 95% confidence interval [CI], 2.14-2.45, p < .001, and OR = 1.34, 95% CI, 1.08-1.66, p = .007, respectively). The association was even stronger when comparing CAS with the control group without CAD or CAS (OR = 5.20, 95% CI, 4.72-5.74, p < .001, and OR = 1.98, 95% CI, 1.50-2.62, p < .001, respectively). The increased risk of new-onset CAS as related to previous anxiety and depression diagnoses was comparable between males and females. CONCLUSIONS: Compared with CAD or the general population, anxiety and depression diagnoses confer a higher risk of developing CAS. No sex differences are found for the association of anxiety and depression with CAS.


Assuntos
Transtornos de Ansiedade/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Transtorno Depressivo/epidemiologia , Espasmo/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Risco , Taiwan/epidemiologia
15.
Psychogeriatrics ; 19(4): 355-362, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30734419

RESUMO

AIM: Older patients with bipolar disorder (BD) are at a high risk of stroke. Silent stroke could be neglected in BD patients after middle age, particularly in those with illness onset at the young age. Therefore, we investigated the morbidity and related factors for stroke in older BD patients with typical-onset age. METHODS: Older patients with bipolar I disorder (age > 50 years) and their illness onset prior to the age of 40 years were recruited. After whole-brain magnetic resonance imaging was conducted, the patients were divided into stroke and non-stroke groups. Clinical data were obtained by reviewing all available medical records and directly interviewing the patients along with their reliable family members. RESULTS: We recruited 62 patients with a mean age of 60.4 years and illness onset at the mean age of 28.4 years. Cerebral infarction or old stroke was observed in 24 (38.7%) patients, including 22 without any reported clinical history of stroke. That is, silent stroke (n = 22) was detected in 36.7% of 60 patients without clinical history of stroke. The stroke group had significantly higher mean numbers of lifetime mood episodes (P = 0.006) than the non-stroke one. Logistic regression analysis showed that 10 or more prior mood episodes (odds ratio = 3.43, 95% confidence interval = 1.12-10.47, P < 0·04) was significantly associated with the occurrence of stroke. The two study groups did not exhibit any other differences in demographic and clinical variables, such as age, laboratory or physical measurements during the last acute psychiatric hospitalisation, body mass index, and substance use problems and concurrent medical diseases. CONCLUSIONS: High morbidity of stroke, particularly silent stroke, could be found in older bipolar patients with typical-onset age. In addition to traditional risk factors, the number of recurrent mood episodes in a lifetime may increase the risk of stroke in older BD patients.


Assuntos
Envelhecimento , Transtorno Bipolar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idade de Início , Idoso , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/epidemiologia , Comorbidade , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Taiwan/epidemiologia
16.
Br J Clin Pharmacol ; 84(9): 2000-2009, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29745438

RESUMO

AIMS: We conducted a cohort study utilizing a nationwide health insurance database to assess the European Medicines Agency's restrictions on using metoclopramide and its association with the risk of parkinsonism. METHODS: New oral metoclopramide users aged ≥20 years, and age- and gender-matched non-users were recruited between 2001 and 2011. Users were divided into high-exposure (dose >30 mg day-1 and/or duration >5 days) and standard-exposure (dose ≤30 mg day-1 and duration ≤5 days) groups. The adjusted hazard ratio (aHR) with 95% confidence interval (CI) estimated the risk of parkinsonism. RESULTS: During a 1-year period, 122 of 218 931 (0.06%) users of metoclopramide vs. 56 of 218 931 (0.03%) non-users developed parkinsonism (P < 0.001). Among the 122 cases of parkinsonism in users, 64 (0.04%) were from 168 566 standard-exposure users and 58 (0.12%) from 50 365 high-exposure users. Compared with non-users, the risk of parkinsonism was higher in users (aHR 2.16; 95% CI 1.54, 3.02), including standard-exposure (aHR 1.73; 95% CI 1.11, 2.70), and high-exposure (aHR 3.15; 95% CI 1.78, 5.57) users. High-exposure users had a higher risk of parkinsonism than standard-exposure users (aHR 1.83; 95% CI 1.28, 2.63). Within the high-exposure group, 45 233 of 50 365 (89.81%) users and 55 of 58 (94.83%) parkinsonism were from long-duration exposure; 5 132 of 50 365 (10.19%) users and 3 of 58 (5.17%) parkinsonism were from high-dose exposure and long-duration + high-dose exposure. CONCLUSIONS: The risk of parkinsonism in metoclopramide users, although extremely low (0.06%), is 2.16-fold greater than in non-users. High-exposure users have a 1.83-fold higher risk than standard-exposure users. As users in high-exposure group had a higher risk of parkinsonism than in standard-exposure group, and the majority of users and parkinsonism in high-exposure group were from long-duration exposure; thus, physician are advised to avoid prescribing metoclopramide for >5 days, even if the daily dose is ≤30 mg.


Assuntos
Antagonistas dos Receptores de Dopamina D2/efeitos adversos , Refluxo Gastroesofágico/tratamento farmacológico , Metoclopramida/efeitos adversos , Doença de Parkinson Secundária/epidemiologia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Bases de Dados Factuais/estatística & dados numéricos , Antagonistas dos Receptores de Dopamina D2/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Metoclopramida/administração & dosagem , Pessoa de Meia-Idade , Doença de Parkinson Secundária/induzido quimicamente , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
J Formos Med Assoc ; 121(1 Pt 2): 444-445, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34281728

Assuntos
COVID-19 , Humanos , SARS-CoV-2
19.
BMC Urol ; 16(1): 67, 2016 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-27852299

RESUMO

BACKGROUND: Anxiety disorders (ADs) are common with a high rate of medical comorbidities. Although the association between ADs and the overall cancer risk remains controversial, patients with ADs were found to be more likely to develop specific cancer types. Herein, we estimated the risk of developing urological cancers among patients with ADs in a 5-year follow-up period using a population-based database. METHODS: Two study cohorts were identified from the Taiwan Longitudinal Health Insurance Database 2005: patients with ADs, and comparison subjects selected by one-to-one matching for sex, age, and the year of recruitment. Follow-up was undertaken to determine whether sampled patients and comparison subjects had developed urological cancers in the subsequent 5 years. RESULTS: We found that urological cancers occurred among 0.54% of patients with ADs and 0.13% of comparison subjects. After adjusting for sociodemographic characteristics, medical comorbidities, and alcohol and tobacco use disorder, the stratified Cox proportional hazard regression suggested that patients with ADs were more likely to develop urological cancers relative to comparison subjects (adjusted hazard ratio, 3.67; 95% confidence interval, 2.85 ~ 4.72). The adjusted HR for males with ADs was 3.82 (95% CI: 2.79 ~ 5.23) in comparison to males without ADs. In addition, the adjusted HR for females with ADs was 3.47 (95% CI: 2.26 ~ 5.31) than those females without ADs. CONCLUSIONS: We concluded that during the 5-year follow-up period, there was a significantly increased risk of urological cancers among patients with ADs.


Assuntos
Transtornos de Ansiedade/complicações , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
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