Association between amiodarone use and risk of cataract: a population-based active-comparator study.

BACKGROUND: Despite previous concerns about ocular side effects related to amiodarone, the relationship between amiodarone and cataract remains uncertain. Therefore, this study aimed to assess the potential association between amiodarone use and the subsequent risk of cataract, taking into account potential confounders. METHODS: This population-based, active comparator-controlled cohort study utilized the data from the Taiwan National Health Insurance program and involved adults over 40 years old between 2001 and 2013. We analyzed 12 055 new amiodarone users and contrasted them with a propafenone user cohort. The primary outcome was the incidence of cataract. Inverse-probability treatment-weighting (IPTW) was further used to eliminate the potential confounding effects, and Cox proportional-hazard regression analyses were performed to calculate the risk of cataract. Serial subgroup analyses were also performed. RESULTS: In the main analysis, amiodarone users did not exhibit a significant causal relationship in both full cohort [adjusted hazard ratio (aHR): 0.994, 95% confidence interval (CI): 0.913-1.082] and IPTW cohort (IPTW-aHR 0.977, 95% CI: 0.900-1.060). Furthermore, it is important to highlight a significantly reduced risk of cataract among patients with heart failure (IPTW-aHR 0.708, 95% CI: 0.554-0.905) and during the 2-year follow-up period (IPTW-aHR 0.889, 95% CI: 0.794-0.996), implying potential advantages linked to the use of amiodarone. CONCLUSIONS: The study found no increased risk of cataract with amiodarone, one of the most frequently used antiarrhythmic medications, compared to the use of propafenone. Future research is recommended to explore potential mechanisms and their implications for clinical practice.

Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study.

BACKGROUND: Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context. METHODS: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students. RESULTS: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood. CONCLUSION: In our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

Effects of home-based long-term care services on caregiver health according to age.

BACKGROUND: Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. METHODS: This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). RESULTS: The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The involvement of daughters-in-law, rather than spouses, and care recipient health were positively related to the health of caregivers aged less than 65 years. CONCLUSIONS: The findings suggest that home-based LTC service use benefits the health of elderly caregivers. By contrast, home-based LTC service use may be negatively correlated with the health of the caregivers aged less than 65 years.

Impact of the use of anti-diabetic drugs on survival of diabetic dialysis patients: a 5-year retrospective cohort study in Taiwan.

BACKGROUND: Type 2 diabetes mellitus (DM) and associated complications are common in patients with chronic kidney disease (CKD) and can increase morbidity and mortality. A longitudinal 5-year observational study was conducted to investigate whether the use of anti-diabetic medications or not affected survival rates of diabetic dialysis patients. METHODS: Using a data sample of a million patients from Taiwan's National Health Insurance Database, a retrospective cohort study surveyed patients with type 2 DM who began dialysis between 2002 and 2007. The study population was classified into groups using or not using anti-diabetic drugs. The group using anti-diabetic drugs was then categorized into 3 subgroups, including use of only oral hypoglycemic agents (OHAs), only insulin, and OHAs-combined insulin groups. Subjects of these four groups were followed 5 years or to date of death. Three major areas were analyzed: (1) demographic data and medical history; (2) survival prognosis and causes of death; and (3) effects on survival prognosis of different classes of OHAs. RESULTS: A total of 912 patients fitting inclusion criteria were enrolled and followed-up for 5 years or to date of death. A total 465 patients died, and those not using anti-diabetic drugs (67.34 %) had a higher mortality rate than those using anti-diabetic drugs (46.42 %). After the multivariate analysis, group of OHAs-combined insulin had the lowest risk of death (HR 0.36, 95 % CI 0.27-0.47), followed by OHAs alone (HR 0.49, 95 % CI 0.38-0.63) and then insulin alone (HR 0.67, 95 % CI 0.51-0.88). To clarify four classes of OHAs (sulfonylurea, α-glucosidase inhibitors, meglitinide, and thiazolidinedione) are used in Taiwan for uremia patient with type 2 DM, and in our study, there were no significant differences in survival prognosis for the four drugs. Finally, the most common cause of death was infectious disease and there were no significant differences among the four groups. CONCLUSION: This 5-year observational study results suggested that diabetic dialysis patients with anti-diabetic drugs had a lower risk of death compared with those without anti-diabetic drugs. Despite insulin therapy, appropriate OHAs should play an important role in treating these patients.

Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

BACKGROUND: Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced "My health bank," a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR. OBJECTIVE: This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it. METHODS: This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 ("disagree strongly") to 5 ("Agree strongly"). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis. RESULTS: This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65.1%). They were still students (195 out of 350 participants, 56.6%), with a monthly income of less than NT $30,000 (230 of 350 participants, 65.7%), and living in the North Taiwan (236 of 350 participants, 67.4%), with a good self-identified health status (171 of 350 participants, 48.9%). After performing the importance-performance analysis, we found the following: (1) instead of complex functions, people just want to have a platform that can let them integrate and manage their medical visit, health examination, and life behavior records; (2) they do not care whether their PHR is shared with others; and (3) most of the participants think the system security design is not important, but they also do not feel satisfied with the current security design. CONCLUSIONS: Overall, the issues receiving the most user attention were the system functions, circulation, integrity, ease of use, and continuity of the PHRs, data security, and privacy protection.

Metadata Correction: Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

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Risk factors and their interaction on chronic kidney disease: A multi-centre case control study in Taiwan.

BACKGROUND: Chronic kidney disease (CKD) is highly prevalent in Taiwan. More than two-thirds of end-stage renal disease is associated with diabetes mellitus (DM) or hypertension (HTN). Therefore, the formulation of a special preventative policy of CKD in these patients is essential. This study surveyed 14 traditional risk factors and identified their effects on CKD in patients with HTN/DM and compared these with their effects in the general population. METHODS: This study included 5328 cases and 5135 controls in the CKD/HTN/DM outpatient and health centres of 10 hospitals from 2008 to 2010. Fourteen common effect factors were surveyed (four demographic, five disease and five lifestyle), and their effects on CKD were tested. Significance tests were adjusted by the Bonferroni method. Results of the stratified analyses in the variables were presented with significant heterogeneity between patients with different comorbidities. RESULTS: Male, ageing, low income, hyperuricemia and lack of exercise habits were risk factors for CKD, and their effects in people with different comorbidities were identical. Anaemia was a risk factor, and there was an additive effect between anaemia and HTN on CKD. Patients with anaemia had a higher risk when associated with HTN [odds ratio (OR) = 6.75, 95% confidence limit (95% CI) 4.76-9.68] but had a smaller effect in people without HTN (OR 2.83, 95% CI 2.16-3.67). The association between hyperlipidaemia-related factors and CKD was also moderated by HTN. It was a significant risk factor in people without HTN (OR = 1.67, 95% CI 1.38-2.01) but not in patients with HTN (OR =1.03, 95% CI 0.89-1.19). Hepatitis B, hepatitis C, betel nut chewing, smoking, alcohol intake and groundwater use were not associated with CKD in multivariate analysis. CONCLUSIONS: We considered that patients with HTN and anaemia were a high CKD risk population. Physicians with anaemic patients in outpatient clinics need to recognise that patients who also have HTN might be latent CKD cases.

Factors associated with Taiwan anesthesiologists' intention to leave anesthesia practice.

BACKGROUND/PURPOSE: Anesthesiologists in Taiwan had the heaviest workload compared with other Taiwanese specialists. In a previous study, anesthesia-related mortality was >12 times the rate reported in the USA, UK, and Japan. Nine percent of Taiwanese anesthesiologists left their jobs to work as general practitioners in clinics. This study aims to assess the current working conditions of anesthesiologists in Taiwan and their satisfaction with their occupation, and to identify the factors associated with the intentions of anesthesiologists in Taiwan to leave anesthesia practice. METHODS: A self-reported questionnaire was completed by 474 attending anesthesiologists in Taiwan. The Chi-square test was used for categorical variables and the t test for continuous variables. Multivariate logistic regression was conducted to identify the factors significantly associated with the willingness of anesthesiologists to continue in anesthesiology. RESULTS: The sample anesthesiologists worked 59.9 hours/week, however a reasonable length of time to work is 49.6 hours/week. They simultaneously covered four operating rooms daily, but three rooms is considered reasonable. Surprisingly, 54.9% of them expressed their unwillingness to practice clinical anesthesia. Those anesthesiologists dissatisfied with their overall working conditions had a substantially increased odds ratio (6.96) of deterring continuing to practice in anesthesia. Furthermore, an inability to take care of the family and a low salary significantly decreased the willingness to practice in anesthesia (odds ratio: 0.42 and 0.38, respectively). CONCLUSION: Unfavorable working conditions were considered to lower the satisfaction of anesthesiologists in Taiwan. In particular, an inability to take care of the family and a low salary were major factors in deterring anesthesiologists in Taiwan from continuing in anesthesia.

Current status of anesthesia residency in Taiwan: a questionnaire survey.

PURPOSE: There are 26 teaching hospitals in Taiwan that provide anesthesia residency training programs (one program per hospital), and only an average of 40 medical graduates are accepted for residency training per year. The aim of this study is to understand how this situation affects the learning and working conditions of anesthesia residents in Taiwan. METHODS: A self-structured survey was mailed to all 178 anesthesia residents receiving training in Taiwan in April 20, 2012. Survey questions included resident characteristics, working and learning conditions, satisfaction with resident training programs, and reasons for choosing anesthesiology as a career. In addition to descriptive statistics, linear regression was used to test correlation between working conditions and satisfaction with training programs. RESULTS: The survey was completed by 136 residents. Although the residents' expected optimal working time was 54.1 ± 12.2 h per week, their actual working time was an average of 64.0 ± 15.7 h per week. In addition, the workload included managing 4.2 ± 1.3 operating rooms simultaneously. The ratio of working vs. learning time was 2.2 ± 1.1. Less than 40 % of the residents were satisfied with their training in critical care and pain management. Anesthesia residents with heavier workloads and higher ratios of work vs. learning time had significantly lower satisfaction with their training programs, especially with training environments (R (2) = 0.169). General interest in anesthesiology and related work (66.1 %) was the main factor in choosing anesthesia as their career. CONCLUSIONS: Anesthesia residents in Taiwan are treated as an integral part of hospital manpower. This may limit the effectiveness of their learning and cause dissatisfaction with their training environment. To improve the current status, anesthesia residents should perform anesthesia in one operating room at a time and some of the anesthesia training hospitals should be suggested for removal.

A functional polymorphism in the promoter region of TLR3 is associated with susceptibility to end-stage renal disease.

BACKGROUND/AIMS: End-stage renal disease (ESRD) is simultaneously associated with immune activation, systemic inflammation and immune deficiency. Toll-like receptor 3 (TLR3), a receptor for viral double-stranded RNA, is involved in immune cell activation in renal diseases and may contribute to chronic inflammatory disease progression. To date, effects of TLR3 polymorphisms on ESRD remain unknown. Therefore, we determined the predictive value of TLR3 polymorphisms and further functionally studied ESRD. METHODS: We performed a case-control association study and genotyped 616 ESRD patients and 813 healthy controls. Patients were genotyped for -7C/A, 1377C/T and 1234C/T polymorphisms of TLR3 using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The Haplotype association analysis was performed using the Haploview package. A luciferase reporter assay and real-time PCR were used to test the function of the -7C/A promoter polymorphism in TLR3 expression in human embryonic kidney 293 (HEK293) cells. RESULTS: Genotype distributions of -7C/A and 1377C/T in TLR3 were significantly different in ESRD patients and healthy controls. The ATC haplotype of TLR3 was associated with a decreased risk of ESRD. We also found significant differences in TLR3 expression by dexamethasone treatment between various genotypes of -7C/A (p = 0.02). TLR3 transcriptional activity of the variant -7 C allele was higher than that of the -7 A allele after dexamethasone treatment. CONCLUSION: RESULTS indicate that, in our population, the presence of the C allele of -7C/A in TLR3 increases the susceptibility to ESRD. In vitro studies demonstrated that -7C/A may be involved in ESRD development through transcriptional modulation of TLR3.

Gene-gene interactions in renin-angiotensin-aldosterone system contributes to end-stage renal disease susceptibility in a Han Chinese population.

OBJECTIVE: In this study, we investigated whether RAAS gene single nucleotide polymorphisms (SNPs) and their interactions were associated with end-stage renal stage (ESRD). METHODOLOGY AND RESULTS: This was a case-control study for 647 ESRD cases and 644 controls. AGT (M235T (rs699) and T174M (rs4762)), AGTR1 (A1166C (rs5186) and C573T (rs5182)), ACE (I/D (rs1799752) and G2350A (rs4343)), and CYP11B2 C-344T (rs1799998) were genotyped and compared between cases and controls to identify SNPs associated with ESRD susceptibility. Multifactor dimensionality reduction (MDR) was used to identify gene-gene interactions. Several RAAS genes were associated with ESRD: AGT M235T, ACE I/D, ACE G2350A, and CYP11B2 C-344T. By MDR analysis, a three-locus model (ACE ID/ACE G2350A/CYP11B2 C-344T) of gene-gene interaction was the best for predicting ESRD risk, and its maximum testing accuracy was 56.08% and maximum cross-validation consistency was 9/10. ESRD risk was higher with the simultaneous occurrence of ACE I/D DD-ACE G2350A AA. AGT, ACE, and CYP11B2 gene polymorphisms are associated with ESRD. CONCLUSIONS: The gene-gene interaction effects of ACE I/D, ACE G2350A, and CYP11B2 C-344T polymorphisms are more important than individual factors for ESRD development among Han Chinese.

Analysis of national empirical data on the characteristics and trends of injury among Taiwan's victims of hospitalized child abuse between 1997 and 2009.

OBJECTIVE: To investigate the characteristics and trends of injury among hospitalized child abuse children younger than 18 years between 1997 and 2009. METHODS: We selected hospitalized child abuse cases from the Taiwan's National Health Insurance (NHI) Database in accordance with ICD-9-CM 995.5x or E967.x. RESULTS: There were 1,212 victims of hospitalized child abuse during the research period, including 735 boys and 477 girls. The victims were most frequently inflicted by the father or stepfather, and the most common injury was intracranial damage; besides, the victims most commonly sought treatment in medical centers. Infants younger than 1 year accounted for the highest percentage of hospitalized victims. Although there were no apparent trends in the overall hospitalization rate of the child abuse victims over the 13-year period, the rate of abuse among girls increased gradually over the years. CONCLUSIONS: The medical staff in hospitals should provide appropriate treatment to the victims and contact relevant organizations to intervene; moreover, government agencies should formulate effective control measures to develop a safe growth environment for children.

Preoperative Use and Discontinuation of Traditional Chinese Herbal Medicine and Dietary Supplements in Taiwan: A Cross-Sectional Questionnaire Survey.

Traditional Chinese herbal medicine has widespread use in Taiwan. This cross-sectional questionnaire survey investigates the preoperative use and discontinuation of Chinese herbal medicine and dietary supplements among Taiwanese patients. We obtained the types, frequency, and sources of Chinese herbal remedies and supplements used. Among 1428 presurgical patients, 727 (50.9%) and 977 (68.4%) reported the use of traditional Chinese herbal medicine and supplements in the past one month, respectively. Only 17.5% of the 727 patients stated discontinuation of herbal remedies 4.7 ± 5.1 (1-24) days before the surgery, and 36.2% took traditional Chinese herbal medicine with concomitant physician-prescribed Western medicine for their underlying diseases. The most commonly used Chinese herbs are goji berry (Lycium barbarum) (62.9%) and Si-Shen-Tang (48.1%) in single and compound forms, respectively. The presurgical use of traditional Chinese herbal medicine was common in patients undergoing gynecologic (68.6%) surgery or diagnosed with asthma (60.8%). Women and those with a high household income had a greater tendency to use herbal remedies. This study demonstrates the high proportion of the presurgical use of Chinese herbal remedies and supplements along with physician-prescribed Western medicine in Taiwan. Surgeons and anesthesiologists should be aware of the potential adverse effects of drug-herb interaction for Chinese patients.

Verifying the accuracy of self-reported smoking behavior in female volunteer soldiers.

Smoking rates in the military are evaluated through questionnaire surveying. Because the accurate identification of smokers facilitates the provision of smoking cessation services, this study conducted urine cotinine concentration testing to verify the accuracy of self-reported smoking behavior by female volunteer soldiers and analyzed the effects of second-hand smoking on urine cotinine concentrations. This study is a cross-sectional study conducted using purposive sampling on female volunteer soldiers receiving training at the Taichung Recruit Training Center in May 2014. This study simultaneously collected questionnaires and urine samples, and urine samples were analyzed with an enzyme-linked immunosorbent assay. The self-reported smoking rate of female volunteer soldiers was 19.3%, whereas the smoking rate as determined by urine cotinine concentration testing was 26.3%, indicating an overall underestimation of 7.0%. Chi-square (χ2) goodness of fit test results indicated that the distribution of self-reported smoking behaviors and that verified from urine cotinine concentration testing were significantly different. The sensitivity of self-reported smoking behavior was 66.7% with a specificity of 97.6%. There was no significant association between second-hand smoking and urine cotinine concentrations. Questionnaire survey self-reporting methods could underestimate the smoking behavior of female volunteer soldiers and routine testing with biochemical verification is necessary.

Interactive effect between depression and chronic medical conditions on fall risk in community-dwelling elders.

BACKGROUND: It is well documented that fall risk among elderly people is associated with poor health and depression. In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents among community-dwelling elderly people. METHODS: A cross-sectional study was carried out to investigate the fall history of community-dwelling elders involving 360 participants. Those who had experienced at least two falls over the previous year, or one injurious fall, were defined as "fallers." The Geriatric Depression Scale-15 was used as a screening instrument for depression status. RESULTS: Based on a multivariate logistic regression and stratification analysis, depression was found to interact with various medical conditions on fall risk. In comparison with the non-depressive reference group, a six-fold fall risk was discernible among depressed elders with polypharmacy, while a five-fold risk was found among depressive elders using ancillary devices, along with a four-fold risk among depressive elders with diabetes or cardiovascular disease. Finally, arthritis was found to produce a nine-fold risk of falls among such populations. CONCLUSIONS: These findings suggest that greater emphasis should be placed on the integration of depression screening as an element of fall risk assessment in elderly people.

A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan.

BACKGROUND: Previous follow-up studies of repeated self-harm show that the cumulative risk of repeated self-harm within one year is 5.7%-15%, with females at greatest risk. However, relatively few studies have focused on the Far East. The objective of this study was to calculate the cumulative risk of repeated self-harm over different lengths of follow-up time (3 months, 6 months, and 1-8 years), to determine factors influencing repeated self-harm and to explore the interaction between gender and self-harm methods. METHODS: We used self-harm patient who hospitalized due to first-time self-harm between 2000 and 2007 from 1,230 hospitals in Taiwan. Hospitalization for repeated self-harm among members of this cohort was tracked after 3 months, 6 months, and 1-8 years. Tracking continued until December 31, 2008. We analyzed the cumulative risk and risk factors of repeated self-harm by using negative binomial regression. RESULTS: Of the 39,875 individual study samples, 3,388 individuals (8.50%) were found to have repeatedly self-harmed. The cumulative risk of repeated self-harm within three months was 7.19% and within one year was 8%. Within 8 years, it was 8.70%. Females were more likely to repeatedly self-harm than males (RR = 1.21, 95% CI = 1.15-1.76). The main method of self-harm was solid or liquid substances (RR = 1.88, 95% CI = 1.23-2.04) or cutting or piercing (RR = 1.36, 95% CI = 1.02-1.82), and in patients with psychiatric disorders were more likely to self-harm (RR = 1.61, 95% CI = 1.48-1.75). CONCLUSIONS: The key time for intervention for repeated self-harm is within three months. Appropriate prevention programs should be developed based on gender differences.

Depression as a predictor of falls amongst institutionalized elders.

OBJECTIVE: In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents amongst institutionalized elderly people. METHODS: A cross-sectional study was carried out to investigate the fall history of institutionalized elders involving 286 subjects. Experiences of falls over the previous year were recorded, with at least two falls during the prior one-year period, or one injurious fall defined as 'fallers'. The Geriatric Depression Scale-15 was used as a screening instrument for depression status. RESULTS: Based on a multivariate logistic regression and stratification analysis, depression was found to have enhanced effects with various medical conditions on fall risk. As compared with the non-depressive reference group, a five-fold fall risk was discernible amongst depressed elders with multiple medications, whilst a six-fold risk was found amongst depressive elders using ancillary devices, along with a 11-fold amongst depressive elders with neural system diseases. CONCLUSIONS: This study provides the evidence of enhancing effects between depression and medical conditions on the risk of falls amongst institutionalized elderly people. Thus, depressed elders with neural system diseases, using ancillary devices or multiple medications, should be specifically listed as very high risk of falling amongst institutionalized elderly, and strictly prevent them from falls. Screening and treatment of depression could also be a useful strategy in the prevention of falls amongst institutionalized elderly with poor medical condition.

Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study.

UNLABELLED: (See the editorial commentary by Corona and Flores, on pages 177-8.) OBJECTIVE: Varicella zoster virus (VZV) has been proposed to be involved in the pathogenesis of multiple sclerosis (MS). However, the epidemiological data regarding the MS occurrence rate following herpes zoster are still scanty. The goal of this study is to investigate the frequency and risk for MS following occurrence of herpes zoster. METHODS: This study used the Taiwan National Health Insurance Research Database. A total of 315,550 patients with herpes zoster were included as the study group, and the control group consisted of 946,650 randomly selected subjects. The stratified Cox proportional hazard regression was performed to calculate the 1-year MS-free survival rate. RESULTS: Of 1,262,200 sampled patients, 29 from the study group (.009%) and 24 from the control group (.003%) had MS during the 1-year follow-up period. After adjusting for monthly income and geographic region, the hazard of MS was 3.96 times greater (95% CI = 2.22-7.07, p < 0.001) for the study group than controls. CONCLUSIONS: Our findings support the notion that occurrence of MS could be associated with herpes zoster attack. We found a significantly higher risk for MS within 1 year of herpes zoster attack compared with the control population.

Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study.

Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery (n = 38) or standard catheter removal, within 12 to 24 hours of surgery (n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.

Factors influencing smoking cessation counselors' intention to stay: An application of a conceptual model of intention to stay verified with path analysis.

Background: The Taiwanese military trains smoking cessation counselors to counsel officers and soldiers on quitting smoking as part time. The intention to stay among smoking cessation counselors affects the promotion of smoking cessation. This study investigated smoking cessation counselors' intention to stay by applying a conceptual model of intent to stay (CMIS) to analyze influencing factors. Methods: In this cross-sectional study, we applied the CMIS to design a questionnaire. We invited 577 smoking cessation counselors trained in the military from 2016 to 2017. The response rate was 46.7%, and the questionnaire responses of 260 military smoking cessation counselors were analyzed. We used path analysis to verify the relationships among the various aspects of the CMIS. Results: We determined that smoking cessation counselors' intention to stay is directly affected by job satisfaction (ß = 0.150, p = 0.014), job stress (ß = -0.225, p < 0.001), and institutional identification (ß = 0.431, p < 0.001). Career opportunities indirectly affect intention to stay through institutional identification, working environment indirectly affects intention to stay through job stress, and co-worker support and self-fulfillment indirectly affect intention to stay through job satisfaction and institutional identification. Our model could explain 36.7% of the variance in intent to stay among smoking cessation counselors. Conclusion: Our results suggest that relevant policies should be formulated to enhance smoking cessation counselors' recognition, affirmation, and sense of belonging as related to smoking cessation counseling work, thereby raising their institutional identification and promoting their intention to stay.