-
[show abstract]
[hide abstract]
ABSTRACT: Abstract The professional attitude of health care workers (HCWs) who serve HIV/AIDS patients and drug users is important in implementation of the harm reduction program (HRP). This study was to explore the causal relationships between education and training, AIDS-related knowledge, attitude of supporting methadone maintenance treatment (MMT), risk perception, and professional attitude of HCWs toward serving HIV/AIDS patients and drug users. We distributed a self-administered questionnaire to HCWs who have served HIV/AIDS patients and drug users due to work in Taoyuan, northern Taiwan. Structural equation modeling (SEM) was used to test various pathways regarding the professional attitudes of HIV/AIDS patients and drug users among HCWs. A total of 218 HCWs were eligible for this study. The dual pathway model was emerged: (1) have attended education and training courses regarding to HRP positively and significantly affects professional attitude via the attitude of supporting MMT. The correlation (r) was 0.27 between education and training and the attitude of SMMT, and was 0.42 between the attitude of SMMT and professional attitude. (2) AIDS-related knowledge negatively and significantly affects professional attitude via risk perception of contracting HIV. The correlation was -0.22 between AIDS-related knowledge and risk perception, and was -0.25 between risk perception and professional attitude. Various fit indices confirmed a reasonable and acceptable fit of the model. Balance theory and approach-avoidance conflict may partially explain the dual pathways of professional attitude of HCWs toward serving HIV/AIDS patients and drug users. Our result suggests that, among HCWs, education and training courses regarding to HRP are important in increasing the attitude SMMT and AIDS-related knowledge directly, thus, professional attitude serving HIV/AIDS patients and drug users can be enhanced indirectly.
AIDS Care 07/2012; · 1.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the mortality rate and identify factors predicting survival in patients with polymyositis (PM) and dermatomyositis
(DM). The medical records of 192PM/DM patients who were treated at Chang Gung Memorial Hospital from 1999 through 2008 were
retrospectively reviewed. The Taiwan National Death Registry (1999–2008) was used to obtain their survival status. Thirty-one
(16.1%) of the 192 patients with PM/DM had an associated malignancy; 41 (21.4%) had interstitial lung disease (ILD). During
the follow-up period, 55 (28.6%) patients died and the overall cumulative survival rate was 79.3% at 1year, 75.7% at 2years,
69.9% at 5years, and 66.2% at 10years. In univariate analysis, older age at PM/DM onset, anemia, thrombocytopenia, leukopenia,
diabetes mellitus, ILD, cancer, and non-use of azathioprine were associated with higher mortality (p = 0.0172, 0.0484, <0.0001, 0.0008, 0.0001, 0.0036, 0.0010, and 0.0019, respectively). In multivariate Cox regression analysis,
thrombocytopenia (hazard ratio [HR] 4.94, 95% confidence interval [CI] 2.60–9.37, p < 0.0001), diabetes mellitus (HR 2.57, 95% CI 1.38–4.80, p < 0.0001), cancer (HR 2.30, 95% CI 1.26–4.22, p = 0.0030), and ILD (HR 1.98, 95% CI 1.11–3.51, p = 0.0182) were positively associated with mortality. Use of azathioprine (HR 0.35, 95% CI 0.16–0.74, p = 0.0064) was negatively associated with mortality. This study confirmed the high mortality rate (28.6%) in PM/DM patients.
Survival time was significantly reduced in patients with thrombocytopenia, diabetes mellitus, ILD, and cancer patients than
in those without these conditions.
KeywordsDermatomyositis–Polymyositis–Prognosis–Survival analysis
Clinical Rheumatology 04/2012; 30(12):1595-1601. · 2.00 Impact Factor
-
Archives of dermatology 03/2012; 148(3):397-400. · 4.76 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In the treatment of nail psoriasis, standardized therapeutic regimens are currently lacking.
To evaluate the therapeutic efficacy of indigo naturalis oil extract in patients with nail psoriasis.
Patients with nail psoriasis applied indigo naturalis oil extract on affected nails twice daily for 24 weeks. Efficacy was evaluated using the Nail Psoriasis Severity Index (NAPSI) and modified target NAPSI for the single most severely affected nail.
Twenty-eight out of 32 patients completed the study. The mean NAPSI was 36.1 ± 14.7 at baseline and decreased to 14.9 ± 11.1 at week 24 while the mean modified target NAPSI was 11.7 ± 3.9 at baseline and decreased to 3.6 ± 3.2 at week 24.
Indigo naturalis oil extract appeared to improve nail psoriasis. Although preliminary, these results indicate that it could provide a novel therapeutic option for nail psoriasis, a disease notoriously difficult to treat.
Dermatology 11/2011; 223(3):239-43. · 2.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The manner in which health care workers (HCWs) interact with HIV/AIDS patients and drug users during their work clearly influences the sustainability of harm reduction programs. To evaluate the professional attitudes of HCWs, we designed a questionnaire with four constructs - discrimination, acceptance of HIV/AIDS patients, acceptance of drug users, and fear - and tested its reliability and validity. Ten experts rated the questionnaire and the mean content validity index was 85.6%. Analysis of 251 anonymous questionnaires from HCWs in Taiwan yielded a composite reliability and Cronbach's α for the four constructs of >0.7. First-order and second-order confirmatory factor analysis revealed a χ(2)/degrees of freedom <3, goodness-of-fit index (GFI) >0.9, adjusted goodness-of-fit index (AGFI) >0.9, Bentler-Bonnett normal fix index >0.9, and a root mean square error of approximation between 0.00 and 0.07 indicating a good fit of the model. HCWs with training in HRPs or AIDS prevention had higher questionnaire scores than those without such training, indicating good known-group validity.
AIDS Care 11/2011; 23(11):1448-55. · 1.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the mortality rate and identify factors predicting survival in patients with polymyositis (PM) and dermatomyositis (DM). The medical records of 192 PM/DM patients who were treated at Chang Gung Memorial Hospital from 1999 through 2008 were retrospectively reviewed. The Taiwan National Death Registry (1999-2008) was used to obtain their survival status. Thirty-one (16.1%) of the 192 patients with PM/DM had an associated malignancy; 41 (21.4%) had interstitial lung disease (ILD). During the follow-up period, 55 (28.6%) patients died and the overall cumulative survival rate was 79.3% at 1 year, 75.7% at 2 years, 69.9% at 5 years, and 66.2% at 10 years. In univariate analysis, older age at PM/DM onset, anemia, thrombocytopenia, leukopenia, diabetes mellitus, ILD, cancer, and non-use of azathioprine were associated with higher mortality (p = 0.0172, 0.0484, <0.0001, 0.0008, 0.0001, 0.0036, 0.0010, and 0.0019, respectively). In multivariate Cox regression analysis, thrombocytopenia (hazard ratio [HR] 4.94, 95% confidence interval [CI] 2.60-9.37, p < 0.0001), diabetes mellitus (HR 2.57, 95% CI 1.38-4.80, p < 0.0001), cancer (HR 2.30, 95% CI 1.26-4.22, p = 0.0030), and ILD (HR 1.98, 95% CI 1.11-3.51, p = 0.0182) were positively associated with mortality. Use of azathioprine (HR 0.35, 95% CI 0.16-0.74, p = 0.0064) was negatively associated with mortality. This study confirmed the high mortality rate (28.6%) in PM/DM patients. Survival time was significantly reduced in patients with thrombocytopenia, diabetes mellitus, ILD, and cancer patients than in those without these conditions.
Clinical Rheumatology 09/2011; 30(12):1595-601. · 2.00 Impact Factor
-
Robert Lins,
Nicolas Coen,
Ann Aerts,
Karen Macdonald,
Heidi Brié,
Christine Hermans, Yu-Ming Shen,
Christopher Lee,
Stefaan Vancayzeele,
Natalie Mecum,
Ivo Abraham
[show abstract]
[hide abstract]
ABSTRACT: European guidelines recommend that antihypertensive management should be graded as a function of total cardiovascular risk.
To examine the multilevel (patient- and physician-level) determinants of blood pressure and residual total cardiovascular risk outcomes associated with second-line valsartan therapy.
The BSCORE study was a prospective, multi-centre, pharmacoepidemiological study of the "real-world" effectiveness of second-line valsartan with or without hydrochlorothiazide.
A total of 3497 patients were recruited by 354 physicians. Mean age was 63.8±12.0 years; 52.3% were male; 20.9% were smokers; 47.7% were dyslipidaemic; and 23.6% had diabetes. On average, reductions in blood pressure and increases in the proportions of patients with controlled blood pressure after 90 days were statistically significant (all P<0.001). Twenty-one percent of systolic blood pressure and 25.6% of diastolic blood pressure variability at follow-up was attributable to physician-level characteristics. Significant reductions in total cardiovascular risk were observed (P<0.001); with 12.5% of the variability in total cardiovascular risk change attributable to physician-level characteristics. Several independent determinants of blood pressure outcomes were identified, many of which are modifiable.
Second-line valsartan therapy improves blood pressure outcomes under variable real-world conditions, and is associated with a decrease in total cardiovascular risk. Optimizing antihypertensive effectiveness, including the reduction of residual cardiovascular risk, involves managing concomitant conditions and risk factors, improving adherence, and identifying physician-level factors amenable to intervention.
Archives of cardiovascular diseases 08/2011; 104(8-9):428-34. · 0.66 Impact Factor
-
Robert Lins,
Ann Aerts,
Nicolas Coen,
Christine Hermans,
Karen MacDonald,
Heidi Brié,
Christopher Lee, Yu-Ming Shen,
Stefaan Vancayzeele,
Natalie Mecum,
Ivo Abraham
[show abstract]
[hide abstract]
ABSTRACT: Both patient- and physician-related factors have been shown to explain variability in the outcomes of antihypertensive treatment. Total cardiovascular risk (TCVR) is increasingly used as a determinant of treatment effectiveness but has also been proposed as a treatment outcome. To our knowledge, no studies have reported how antihypertensive treatment impacts blood pressure and TCVR outcomes.
To examine in patients treated with a regimen including single-pill combinations (SPCs) of amlodipine/valsartan (1) blood pressure (BP) reduction and control, total cardiovascular risk (TCVR) change, and TCVR reduction of 1 class or more; (2) hierarchical patient- and physician-level determinants of these outcomes; and (3) predictors of uncontrolled BP and improved TCVR classification.
A prospective (90 days), multicenter, multilevel pharmacoepidemiologic study was conducted in 3546 patients with hypertension treated with SPC amlodipine/valsartan by 698 general practitioners. Statistical analysis included hierarchical linear and logistic modeling of BP and TCVR outcomes.
Mean (SD) systolic BP (SBP) reductions were 20.1 (15.5) mm Hg and diastolic BP (DBP) reductions were 9.8 (10.3) mm Hg, with higher reductions among high-risk patients. SBP, DBP, and SBP/DBP control rates were 33.3%, 45.3%, and 25.5%, respectively, with lower rates among high-risk patients. Mean TCVR improvement was a reduction of 0.73 (0.96) classes (-4 [best] to +4 [worst]), with higher reductions for high-risk patients; 58.2% of patients achieved a TCVR reduction of 1 or more classes, with lower percentages for high-risk patients. Twenty-two percent of systolic variability and 26% of diastolic variability in 90-day BP values were attributable to a physician class effect, as was 16% of TCVR change.
Regimens that include SPC amlodipine/valsartan formulations are effective in reducing BP and TCVR in a real-world observational setting. Hierarchical modeling identified patient- and physician-related determinants of BP values and TCVR change, as well as independent predictors of uncontrolled BP and reduced TCVR. TCVR is a scientifically feasible and clinically relevant effectiveness outcome of antihypertensive treatment.
Annals of Pharmacotherapy 06/2011; 45(6):727-39. · 2.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background: Foreign-born mothers have been reported to have better pregnancy outcomes as measured by the preterm birth rate, neonatal mortality, and birth weight compared with native-born mothers in Belgium, France, Taiwan, and the United States. However, little is known about the association between maternal nationality and the prevalence of orofacial clefts in Asian countries. Methods: Taiwan Birth Registry data from 2004 to 2006 were analyzed for an association between maternal nationality and orofacial clefts. Singleton live births with a gestational age ≥24 weeks were included in this study. Results: The overall estimated prevalence percentages of orofacial clefts were 0.11 (95% confidence interval [CI] = 0.03 to 0.12) among newborns of Taiwan-born mothers (TBMs) and 0.13 (95% CI = 0.04 to 0.16) among newborns of foreign-born mothers (FBMs), respectively. The estimated prevalence of orofacial clefts of all live births of FBMs in Taiwan was similar to that of the FBMs from Southeast Asian countries. Conclusion: There was a slightly higher but no significant difference of estimated prevalence of orofacial clefts between newborns of TBMs and newborns of FBMs in Taiwan.
The Cleft Palate-Craniofacial Journal 05/2011; 48(3):337-41. · 0.82 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Accumulating evidence suggests that gout is associated with increased overall and cardiovascular mortality. Using data from a large consecutive cohort of gout sufferers who were followed for 8 years, we investigated mortality among gout sufferers and compared the results with data from the general population of Taiwan.
The study comprised 6631 people who had gout diagnosis at outpatient department of the Chang Gung Memorial Hospital in 2000. Survival status and cause of death were ascertained by examining the National Death Registry of Taiwan through 2008.
During 53,048 person-years of follow-up in 6631 gout patients, 1273 (male, 941; female, 332) deaths were identified, corresponding to the crude mortality rate was 21.3 (male, 20.0; female, 26.1) per 1000 patient-years, which was significantly higher than that of the national population. As compared with the national population of Taiwan in 2000, the all-cause standardized mortality ratio (95% confidence interval) was 1.29 (1.21-1.37) for men and 1.70 (1.53-1.89) for women. Both men and women in this cohort had higher standardized mortality ratios for death due to kidney diseases (men, 3.10; women, 3.54), endocrine and metabolic diseases (men, 2.24; women, 2.71), and cardiovascular diseases (men, 1.58; women, 1.81). Multivariate Cox regression showed no difference in mortality between genders.
Individuals with gout have increased mortality risk in both sexes; however, the extent of risk increment is higher in women. Kidney diseases, endocrine and metabolic diseases, and cardiovascular diseases are primary causes of death.
Joint, bone, spine: revue du rhumatisme 03/2011; 78(6):577-80. · 2.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The effects of serum uric acid (SUA) and metabolic syndrome on chronic kidney disease (CKD) remain controversial. This study grouped subjects according to a combination of their uric acid and metabolic syndrome status and investigated the association between these groups and CKD to clarify the relationships of SUA and metabolic syndrome to CKD. This survey analyzed data from 81,799 adults (45,148 men and 36,651 women) who underwent health examinations at Chang Gung Memorial Hospital, in northern Taiwan, from 2000 through 2007. Hyperuricemia was defined as an SUA greater than 7.7 mg/dL in men or greater than 6.6 mg/dL in women. Patients were classified by uric acid-metabolic syndrome status as follows: A = no hyperuricemia and no metabolic syndrome, B = presence of metabolic syndrome but not hyperuricemia, C = presence of hyperuricemia but no metabolic syndrome, and D = presence of both hyperuricemia and metabolic syndrome. Kidney function was assessed in terms of the estimated glomerular filtration rate (eGFR) by using the Modification of Diet in Renal Disease Study equation modified for Chinese. CKD was defined as an eGFR <60 mL/min/1.73 m(2). The prevalences of hyperuricemia, metabolic syndrome, and CKD were 22.8% (26.3% in men and 18.6% in women), 13.5% (15.0% in men and 11.6% in women), and 2.2% (2.1% in men and 2.2% in women), respectively. In men, the age-adjusted odds ratios for CKD, with group A as reference, were 1.95 for group B, 4.86 for group C, and 5.85 for group D. In women, the age-adjusted odds ratios were 1.96 for group B, 6.66 for group C, and 9.01 for group D. Hyperuricemia is strongly associated with CKD, independent of the presence of metabolic syndrome.
Clinical Rheumatology 03/2011; 30(3):323-30. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the feasibility of a school-based asthma management programme for middle school children.
Asthma rates are increasing among school-aged children. Successful asthma treatment in children depends in part on clear communication and effective education.
This feasibility study employed a one-group only longitudinal design with four time points over 18 months.
Nineteen female and twelve male (n = 31) seventh-grade children with asthma (13 SD 0·71 years) were identified using a six-stage asthma case-finding approach. Teachers and school staff were trained in the principles and methods of the proposed school-based asthma management programme. An individualised guided asthma self-management programme was developed for each child by a clinical team at a major academic medical centre. We assisted teachers in implementing the school programme; building a support network and monitoring children's activities. Outcome measures included lung function tests (at 0, six, 12 and 18 months), disease-related symptoms, psychosocial status and impact of asthma on learning (at 0 and 18 months). School provided data on academic achievement and school absences at 0, six, 12 and 18 months.
Significant improvements were noted at six, 12 and 18 months on forced vital capacity (FVC)% of predicted (p = 0·001, 0·015, 0·015, respectively), forced expiratory volume in one second (FEV(1) )% of predicted (p = 0·001, 0·006, 0·088, respectively) and FEV(1) /FVC% of predicted (p = 0·001, 0·015, 0·099, respectively). There was a trend towards improved asthma symptoms (p = 0·050) and a significant decrease in positive perception of curriculum (p = 0·017) at 18 months after adjustment for covariates.
This programme was associated with respiratory benefits on physiological asthma markers commonly, with a trend for symptom control. Academic and psychosocial outcomes are subject of further inquiry.
School-based asthma management holds promise as a feasible clinical option for middle school children with asthma in the Taiwanese school system.
Journal of Clinical Nursing 09/2010; 19(17-18):2415-23. · 1.12 Impact Factor
-
Chang-Fu Kuo,
Kuang-Hui Yu,
Shue-Fen Luo,
Yu-Shien Ko,
Ming-Shien Wen,
Yu-Sheng Lin,
Kuo-Chun Hung,
Chun-Chi Chen,
Chi-Ming Lin,
Jawl-Shan Hwang,
Wen-Yi Tseng,
Hung-Wei Chen, Yu-Ming Shen,
Lai-Chu See
[show abstract]
[hide abstract]
ABSTRACT: Hyperuricaemia has been linked to atherosclerosis; however, there is limited evidence about its association with arterial stiffness and cardiac hypertrophy, which are associated with adverse cardiovascular outcomes. We studied the association of hyperuricaemia with an increased risk of arterial stiffness and cardiac hypertrophy in a population participating in a health-screening programme.
In subjects who underwent health screening from 2005 to 2007, arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV), whereas cardiac hypertrophy was determined by plain chest radiography and electrocardiography. Polychotomous logistic regression was used to identify associations of hyperuricaemia with arterial stiffness and cardiac hypertrophy, after adjusting for the presence of metabolic syndrome.
Of the total 9375 subjects enrolled, 1324 (14.5%) had hyperuricaemia. Subjects with hyperuricaemia had a significantly higher baPWV [1618.8 (379.3) cm/s] than those without it [1501.8 (334.9) cm/s]. Cardiac hypertropy was observed in 1047 (11.2%) subjects. Hyperuricaemia was associated with cardiac hypertrophy with an odds ratio (OR) of 1.53 (95% CI 1.32, 1.77). Polychotomous logistic regression showed that hyperuricaemia was associated with ORs (95% CI) for coexisting abnormal baPWV and cardiac hypertrophy of 1.75 (95% CI 1.24, 2.47) and 1.41 (95% CI 1.04, 1.91) in men and women, respectively, after adjusting for age, proteinuria, high high-sensitive CRP, abnormal ankle-brachial index or a number of metabolic syndrome components present.
Hyperuricaemia was associated with arterial stiffness and cardiac hypertrophy. Hyperuricaemia, along with other risk factors related to atherosclerosis, could play a role in the development of cardiac hypertrophy by increasing arterial stiffness.
Rheumatology (Oxford, England) 04/2010; 49(6):1189-96. · 4.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We compared the birth weight of newborns born to foreign-born mothers (FBMs) and Taiwan-born mothers (TBMs), using data from the 2005-2006 Taiwan Birth Registry of singleton live births.
The Wilcox-Russell method, data restriction, and multiple linear regression were used to analyze the data. The rates of low birth weight (<2500 g) with 95% confidence intervals were computed for TBMs, and for each of the nationalities of FBMs.
The mean birth weight of newborns of FBMs was 3157 g, which was higher than that of newborns of TBMs (3109 g). On analysis using the Wilcox-Russell method, both the rate and residual proportion of low-birth-weight (LBW) births were lower among newborns of FBMs (4.1% and 1.1%, respectively) than among newborns of TBMs (5.9% and 1.7%, respectively). After adjusting for sex, mode of delivery, maternal age, smoking status, predisposing maternal risk factors, and condition during pregnancy, the newborns of FBMs weighed 72.9 g (95% CI, 68.8 g to 77.0 g) more than the newborns of TBMs. When data were restricted to mothers without any adverse conditions and adjusted for maternal age, the differences in birth weight between the 2 groups remained unchanged. The rates of LBW deliveries among FBMs in Taiwan were significantly lower than those in their respective countries of origin.
In Taiwan, newborns of FBMs had a higher birth weight than those of TBMs, even after accounting for potential confounding factors, and had lower rates of LBW deliveries than did mothers in their respective countries of origin.
Journal of Epidemiology 04/2009; 19(3):152-60. · 1.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The nativity composition of the Taiwan population has changed substantially since 1980, which resulted in one in six children being born to foreign-born mothers in 2004. The purpose of this study was to compare the early neonatal mortality rates among babies of foreign-born and Taiwan-born mothers. Data was obtained from the Taiwan Birth Registry Database in 2004 by the Bureau of Health Promotion, Department of Health, Taiwan. Multivariate analysis was used to examine the influence of the different maternal nationalities on early neonatal mortality after adjusting for important maternal and infant variables. Infants born to foreign-born mothers had a lower early neonatal mortality rate (5.6 per thousand) compared to those born to Taiwan-born mothers (9.4 per thousand). Even after adjusting for important maternal and infant variables, newborns of foreign-born mothers still had a lower risk of early neonatal death compared to newborns of Taiwan-born mothers (odds ratio = 0.68, 95% CI = 0.57-0.80). Foreign-born status may serve as an important index of differentiation in early neonatal mortality among the current Taiwan population. Selection, economic and non-economic aspects may explain the paradox of favorable early neonatal mortality outcomes.
European Journal of Epidemiology 02/2008; 23(7):483-9. · 4.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Psoriasis has a significant negative impact on quality of life. The aim of this study was to identify factors associated with the quality of life of patients with psoriasis in Taiwan.
A retrospective study analyzing data from psoriasis patients who visited the outpatient clinics in the Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital at Taipei, Taoyuan and Keelung from July 2009 to January 2010 was performed.
A total of 480 patients who had completed the assessment of disease severity and the dermatology life quality index (DLQI) questionnaire were analyzed. Of these patients, 67.5% were men. The mean score on the DLQI was 9.16 ± 6.3 and 67% of all patients reported a moderate to extremely large impact on their quality of life (DLQI > 6). A higher psoriasis area and severity index (PASI), younger age and initial lesions on the nails significantly negatively impacted patients' quality of life. Smoking, alcohol intake and gender were also weakly correlated.
The clinical severity, age and site of initial lesions are associated with negative impacts on the quality of life of patients with psoriasis. These findings provide significant new insights into factors that affect the life quality of patients with psoriasis in Taiwan.
Chang Gung medical journal 34(2):186-96.
