316 results on '"Chih Cheng Hsu"'
Search Results
2. Can peripheral biomarkers reflect the psychological condition in geriatric populations? The influence of cardiovascular comorbidities
- Author
-
Wei‐Chia Huang, Chi‐Shin Wu, Kai‐Chieh Chang, Hsin‐Shui Chen, Chin‐Kai Chang, Juey‐Jen Hwang, Su‐Hua Huang, Yung‐Ming Chen, Bor‐Wen Cheng, Min‐Hsiu Weng, Chih‐Cheng Hsu, and Wei‐Lieh Huang
- Subjects
Psychiatry and Mental health ,Geriatrics and Gerontology ,Gerontology - Published
- 2023
3. TASL, TADE, and DAROC consensus for the screening and management of hepatitis C in patients with diabetes
- Author
-
Ming-Lung Yu, Chih-Yuan Wang, Mei-Hsuan Lee, Horng-Yih Ou, Pin-Nan Cheng, Shih-Te Tu, Jee-Fu Huang, Jung-Fu Chen, Tsung-Hui Hu, Chih-Cheng Hsu, Jia-Horng Kao, Chien-Jen Chen, Han-Chieh Lin, and Chien-Ning Huang
- Subjects
General Medicine - Published
- 2023
4. Diabetes, Hypertension, and the Risk of Dementia
- Author
-
Fu-Shun, Yen, James Cheng-Chung, Wei, Hei-Tung, Yip, Chii-Min, Hwu, and Chih-Cheng, Hsu
- Subjects
Male ,Dementia, Vascular ,General Neuroscience ,Taiwan ,General Medicine ,Cohort Studies ,Psychiatry and Mental health ,Clinical Psychology ,Diabetes Mellitus, Type 2 ,Risk Factors ,Hypertension ,Humans ,Female ,Geriatrics and Gerontology ,Retrospective Studies - Abstract
Background: Type 2 diabetes (T2D) and hypertension (HTN) are well-known modifiable risk factors for dementia, but their intricate attributes accounting for dementia development has not been clearly delineated. Objective: We conducted this study to investigate and compare the effects of T2D and HTN on dementia risk. Methods: We screened data of matched pairs of patients with T2D or HTN between January 1, 2000 and December 31, 2017 from Taiwan’s National Health Insurance Research Database. Fine and Gray’s subdistribution hazard models were used for calculating the risk of dementia. Results: Patients with T2D and subsequent HTN were associated with significantly higher risks of all-cause dementia (aHR 1.51, 95% CI 1.25–1.83) and vascular dementia (aHR 2.30, 95% CI 1.71–3.13) compared with those without subsequent HTN. Patients with HTN and subsequent T2D were associated with significantly higher risks of all-cause dementia (aHR 1.15, 95% CI 1.08–1.21), vascular dementia (aHR 1.25, 95% CI 1.62–1.34), and other dementia (aHR 1.31, 95% CI 1.03–1.66) compared with those without subsequent HTN. The subgroups of male and female patients, age of 50–69 and 70–90 years with subsequent comorbidity were associated with significantly higher risks of all-cause dementia and vascular dementia than those without subsequent comorbidity. Conclusion: This nationwide cohort study demonstrated that patients with T2D and subsequent HTN had association with higher risks of all-cause dementia and vascular dementia, and those with HTN and subsequent T2D were associated with higher risks of all-cause dementia, vascular dementia, and other dementia.
- Published
- 2022
5. Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study
- Author
-
Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chih-Cheng Hsu, and Chii-Min Hwu
- Subjects
Endocrinology, Diabetes and Metabolism ,Cardiology and Cardiovascular Medicine - Abstract
Background This study compared the risks of cardiovascular morbidity and mortality between patients with type 2 diabetes (T2D) with and without microvascular diseases, and between matched patients with microvascular diseases. Methods We identified newly diagnosed type 2 diabetes patients from National Health Insurance Research Database in Taiwan from January 1, 2008, to December 31, 2019. Propensity score matching was applied to construct matched pairs of patients with diabetic kidney disease, retinopathy, or neuropathy. Multivariable Cox proportional-hazard models were adopted to compare the risks of cardiovascular morbidity and mortality. Results Patients with microvascular disease had a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. Among the matched cohorts, patients with diabetic retinopathy had a significantly higher risk of stroke development than those with diabetic kidney disease (aHR 1.11, 95%CI 1.03–1.2). Diabetic neuropathy showed a significantly higher risk of stroke development than diabetic kidney disease (aHR 1.17, 95%CI 1.1–1.25) and diabetic retinopathy (aHR 1.12, 95%CI 1.03–1.21). Diabetic retinopathy had a significantly higher risk of incident heart failure than diabetic kidney disease (aHR 1.43, 95%CI 1.3–1.57), and diabetic neuropathy had a significantly lower risk of incident heart failure than diabetic retinopathy (aHR 0.79, 95%CI 0.71–0.87). Conclusions T2D patients with microvascular disease have a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. In the matched cohorts, diabetic neuropathy was significantly associated with stroke development, and diabetic retinopathy had a significant association with heart failure compared to other microvascular diseases.
- Published
- 2023
6. Epidemiology and clinical impact of osteoporosis in Taiwan: A 12-year trend of a nationwide population-based study
- Author
-
Ming-Tsung Lee, Shau-Huai Fu, Chih-Cheng Hsu, Ho-Min Chen, Jou-Wei Lin, Keh-Sung Tsai, Jawl-Shan Hwang, Sheng-Chieh Lin, Chih-Hsing Wu, and Chen-Yu Wang
- Subjects
General Medicine - Published
- 2023
7. Role of Physical Activity in Lowering Risk of End-Stage Renal Disease
- Author
-
Min-Kuang, Tsai, Wayne, Gao, Kuo-Liong, Chien, Chih-Cheng, Hsu, and Chi-Pang, Wen
- Subjects
Male ,Leisure Activities ,Risk Factors ,Diabetes Mellitus ,Humans ,Kidney Failure, Chronic ,Female ,General Medicine ,Motor Activity ,Exercise - Abstract
To investigate the association between the amount and intensity of leisure-time physical activity (LTPA) and the risk of end-stage renal disease (ESRD).The study examined a cohort of 543,667 participants aged 20 years and older who participated in a health screening program from January 1, 1996, through December 31, 2017. We identified 2520 individuals undergoing dialysis or who had a kidney transplant by linking participants' encrypted personal identification with the registry for ESRD with a median follow-up of 13 years. We classified participants into 5 categories measured by metabolic equivalent of tasks. Within each category, we analyzed the effect of moderate- and vigorous-intensity LTPA in reducing risk of ESRD. We used a Cox proportional hazards model to calculate hazard ratios (HRs).We observed a dose-response relationship between LTPA and the risk of ESRD. The fully active group had a 12% lower hazard of ESRD compared with the no reported LTPA group (HR, 0.88; 95% CI, 0.80 to 0.98) adjusting for covariates including baseline estimated glomerular filtration rate and proteinuria. Within the same category of LTPA, vigorous-intensity exercise carried a 35% lower HR for ESRD compared with moderate-intensity exercise (HR, 0.65; 95% CI, 0.52 to 0.81). The effect was observed stronger among men, younger participants, and participants with diabetes or hyperlipidemia.Sustained LTPA (≥ 150 minutes per week), particularly with vigorous intensity, significantly lowered the ESRD risk, even among individuals with comorbidities such as diabetes or hyperlipidemia. This finding suggested that patients with no reported LTPA with cardiovascular risks should engage in more LTPA to lower their risk of ESRD.
- Published
- 2022
8. Dietary Inflammatory Patterns Are Associated With Serum TGs and Insulin in Adults: A Community-Based Study in Taiwan
- Author
-
Shu-Chun Chuang, I-Chien Wu, Chao Agnes Hsiung, Huei-Ting Chan, Chiu-Wen Cheng, Hui-Ling Chen, Yen-Feng Chiu, Marion M. Lee, Hsing-Yi Chang, and Chih-Cheng Hsu
- Subjects
Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
9. Reduced risk of pneumonia and influenza infection after bariatric surgery: a retrospective cohort study among patients with nondiabetic obesity in Taiwan
- Author
-
Pei-Yun Chen, Chia-Wen Lu, Yi-Hsuan Lee, Chi-Ting Huang, Chih-Cheng Hsu, and Kuo-Chin Huang
- Subjects
Surgery - Published
- 2023
10. Living Alone and Loneliness in Predicting Health-Related Quality of Life: Results from the Healthy Aging Longitudinal Study in Taiwan (HALST)
- Author
-
Han-Yun Tseng, Chun-Yi Lee, Chi-Shin Wu, I-Chien Wu, Hsing-Yi Chang, Chih-Cheng Hsu, and Chao Agnes Hsiung
- Abstract
Purpose. This study examined two related but distinct features of social isolation – living alone and loneliness – concerning their unique and joint effects on predicting health-related quality of life (HRQoL). In addition, we examined the moderating and mediating role of loneliness in the associations between living alone and HRQoL. Method. Analyses were with a nationally representative sample of 5,012 community-residing adults aged 55 and older (Mage = 59.3, SD = 8.1) and with their follow-up data 3.2 years later. Results. At baseline, 9% (n = 508) reported living alone, and 10.3% (n = 586) reported feeling lonely. 2.5% (n = 130) reported both living alone and feeling lonely. A series of regression showed that loneliness was consistently associated with lower physical (PCS) and mental (MCS) components of HRQoL, concurrently and longitudinally, whereas living alone was only associated with lower PCS 3.2 years later. Moderation analysis showed compounded effects of loneliness and living alone in predicting lower MCS. Mediation analyses revealed a cascading effect where living alone was associated with concurrent and subsequent loneliness, which, in turn, was associated with lower PCS and MCS 3.2 years later. Conclusion. Loneliness appeared to be a more potent predictor of lower HRQoL in later life. Nevertheless, living alone could indirectly worsen adults’ HRQoL by either exacerbating the negative impacts of loneliness or triggering a sense of prolonged loneliness predicting lower HRQoL. For practice, programs and policies to improve adults’ HRQoL should pay special attention to older adults who report loneliness, especially those who live alone.
- Published
- 2023
11. Thiazolidinediones lower the risk of pneumonia in patients with type 2 diabetes
- Author
-
Fu-Shun Yen, James Cheng-Chung Wei, Yu-Tung Hung, Chung Y. Hsu, Chii-Min Hwu, and Chih-Cheng Hsu
- Subjects
Microbiology (medical) ,Microbiology - Abstract
IntroductionWe conducted this study to compare the risk of pneumonia between thiazolidinedione (TZD) use and nonuse in persons with type 2 diabetes (T2D).MethodsWe identified 46,763 propensity-score matched TZD users and nonusers from Taiwan’s National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risk of morbidity and mortality associated with pneumonias.ResultsCompared with the nonuse of TZDs, the adjusted hazard ratios (95% CI) for TZD use in hospitalization for all-cause pneumonia, bacterial pneumonia, invasive mechanical ventilation, and death due to pneumonia were 0.92 (0.88–0.95), 0.95 (0.91–0.99), 0.80 (0.77–0.83), and 0.73 (0.64–0.82), respectively. The subgroup analysis revealed that pioglitazone, not rosiglitazone, was associated with a significantly lower risk of hospitalization for all-cause pneumonia [0.85 (0.82–0.89)]. Longer cumulative duration and higher cumulative dose of pioglitazone were associated with further lower adjusted hazard ratios in these outcomes compared to no-use of TZDs.DiscussionThis cohort study demonstrated that TZD use was associated with significantly lower risks of hospitalization for pneumonia, invasive mechanical ventilation, and death due to pneumonia in patients with T2D. Higher cumulative duration and dose of pioglitazone were associated with a further lower risk of outcomes.
- Published
- 2023
12. Evaluation of the optimal cutoff number of types of social participation activities in older people
- Author
-
Kai-Chieh Chang, Hsin-Shui Chen, Chi-Shin Wu, Chin-Kai Chang, Juey-Jen Hwang, Su-Hua Huang, Yung-Ming Chen, Bor-Wen Cheng, Min-Hsiu Weng, Chih-Cheng Hsu, and Wei-Lieh Huang
- Subjects
General Medicine - Published
- 2023
13. A prediction model with lifestyle factors improves the predictive ability for renal replacement therapy: a cohort of 442 714 Asian adults
- Author
-
Min-Kuang Tsai, Wayne Gao, Kuo-Liong Chien, Chih-Cheng Hsu, and Chi-Pang Wen
- Subjects
Transplantation ,Nephrology - Abstract
Background There are limited renal replacement therapy (RRT) prediction models with good performance in the general population. We developed a model that includes lifestyle factors to improve predictive ability for RRT in the population at large. Methods We used data collected between 1996 and 2017 from a medical screening in a cohort comprising 442 714 participants aged 20 years or over. After a median follow-up of 13 years, we identified 2212 individuals with end-stage renal disease (RRT, n: 2091; kidney transplantation, n: 121). We built three models for comparison: model 1: basic model, Kidney Failure Risk Equation with four variables (age, sex, estimated glomerular filtration rate and proteinuria); model 2: basic model + medical history + lifestyle risk factors; and model 3: model 2 + all significant clinical variables. We used the Cox proportional hazards model to construct a points-based model and applied the C statistic. Results Adding lifestyle factors to the basic model, the C statistic improved in model 2 from 0.91 to 0.94 (95% confidence interval: 0.94, 0.95). Model 3 showed even better C statistic value i.e., 0.95 (0.95, 0.96). With a cut-off score of 33, model 3 identified 3% of individuals with RRT risk in 10 years. This model detected over half of individuals progressing to RRT, which was higher than the sensitivity of cohort participants with stage 3 or higher chronic kidney disease (0.53 versus 0.48). Conclusions Our prediction model including medical history and lifestyle factors improved the predictive ability for end-stage renal disease in the general population in addition to chronic kidney disease population.
- Published
- 2022
14. Factors associated with burden among male caregivers for people with dementia
- Author
-
Chia-Fen Tsai, Mao-Hsuan Huang, Jun-Jun Lee, Kai-Ming Jhang, Ling-Chun Huang, Li-Kai Huang, Wei-Ju Lee, Pi-Shan Sung, Yi-Chien Liu, Wen-Chen Ouyang, Chih-Ming Cheng, Chih-Cheng Hsu, and Jong-Ling Fuh
- Subjects
Male ,Asia ,Caregivers ,Cost of Illness ,Activities of Daily Living ,Caregiver Burden ,Humans ,Dementia ,General Medicine - Abstract
There is a dearth of information on male dementia caregivers in Asia and, in particular, on the factors relating to caregiver burden. We aimed to identify factors that may be associated with burden among male caregivers of people with dementia (PWD).Data were collected from a national dementia registration survey. The caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). We analyzed the correlation between ZBI scores and variables, such as demographic data of PWD and their male caregivers, caregivers' monthly income, the relationship between PWD and caregivers, the severity of dementia, physical comorbidities and activities of daily living (ADL) of PWD, and neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI).A total of 509 PWD and their male caregivers were included. The majority of caregivers were sons (72.1%) and husbands (22.0%). Sons had higher ZBI scores than husbands (28.5 ± 15.2 vs 22.0 ± 17.0; p0.001). Multivariable linear regression showed that sons as caregivers (β = 7.44, p = 0.034), ADL (β = 0.52, p = 0.002), and NPI_severity subscore of apathy (β = 2.74, p = 0.001) were positively associated with ZBI scores.Poor ADL and apathy in PWD and being a patient's son were associated with higher levels of burden among male dementia caregivers. Effective interventions are needed to assist male caregivers in accomplishing their caregiving role and at the same time to alleviate their caregiver burden.
- Published
- 2022
15. Trends in the incidence and prevalence of end-stage kidney disease requiring dialysis in Taiwan: 2010–2018
- Author
-
Tai-Shuan Lai, Chih-Cheng Hsu, Ming-Huang Lin, Vin-Cent Wu, and Yung-Ming Chen
- Subjects
Adult ,Male ,Renal Dialysis ,Incidence ,Prevalence ,Taiwan ,Humans ,Kidney Failure, Chronic ,General Medicine ,Middle Aged ,Aged - Abstract
Taiwan has the highest incidence and prevalence of end-stage kidney disease (ESKD) worldwide. However, the epidemiologic features of ESKD requiring dialysis in Taiwan are unclear.Our study population included all patients undergoing chronic dialysis (i.e., receiving dialysis treatment for at least three successive months) from the National Health Insurance Research Database from 2010 to 2018. Dialysis was defined using ICD-9-CM order codes for dialysis treatment. The age-standardized incidence and prevalence rates were calculated based on the World Health Organization standard population.The mean age was 47.7 ± 15.4 years at dialysis initiation. The incidence of ESKD requiring dialysis increased steadily during the study period, whereas the age-standardized incidence rate remained constant. The increased rate was particularly prevalent in men aged 65-74 and 75+ years. Additionally, the percentage of patients with estimated glomerular filtration rates10 mL/min/1.73 mThe annual incidence and prevalence of dialysis increased steadily from 2010 to 2018, whereas the age-standardized incidence and prevalence of dialysis remained stable. The increased numbers of patients undergoing incident and prevalent dialysis were mostly elderly, especially men aged ≥65 years. Age-based prevention strategies and multidisciplinary care should be implemented to target the elderly population at risk of developing ESKD.
- Published
- 2022
16. Healthcare utilization and expenditure among individuals with end-stage kidney disease in Taiwan
- Author
-
Chia-Chun Lee, Chih-Cheng Hsu, Ming-Huang Lin, Junne-Ming Sung, and Te-Hui Kuo
- Subjects
National Health Programs ,Taiwan ,Humans ,Kidney Failure, Chronic ,General Medicine ,Health Expenditures ,Patient Acceptance of Health Care - Abstract
The prevalence of end-stage kidney disease (ESKD) in Taiwan has been increasing in recent decades. ESKD care and medical expenditures constitute an important part of the entire healthcare system.This study analyzed data collected from the National Health Insurance (NHI) Research Database from 2010 to 2018.The annual medical cost increased by approximately 4% both in the entire Taiwanese population and in its ESKD population. The total medical expenditure in the ESKD population from 2010 to 2018 increased from 48.03 to 65.65 billion reimbursement points, with dialysis treatments costing higher than non-dialysis treatments. ESKD outpatient and inpatient costs accounted for 10.4%-11.1% and 4.8%-5.6% of the entire NHI expenditure, respectively. The leading cause of inpatient costs was circulatory diseases, accounting for 29.3% of the total ESKD inpatient costs in 2018. Furthermore, percutaneous coronary intervention had the highest cost followed by simple percutaneous transluminal angioplasty. In 2018, the hemodialysis population had the highest average monthly cost of 73 thousand points per person, while the kidney transplant population had the lowest average monthly cost of 39 thousand points per person.Medical expenditure, including both inpatient and outpatient costs, of the ESKD population continued to grow from 2010 to 2018. The non-dialysis cost in the ESKD population was mainly for cardiovascular disease management and vascular access care, for which prevention will always be challenging.
- Published
- 2022
17. Clinical characteristics and outcomes of patients requiring incident dialysis in Taiwan
- Author
-
Yen-Chung, Lin, Chia-Te, Liao, Cai-Mei, Zheng, Ming-Huang, Lin, Chih-Cheng, Hsu, Yung-Ho, Hsu, and Mai-Szu, Wu
- Subjects
Renal Dialysis ,Incidence ,Taiwan ,Humans ,Kidney Failure, Chronic ,General Medicine ,Renal Insufficiency, Chronic ,Aged - Abstract
Despite having a well-established pre-end-stage kidney disease (pre-ESKD) care program, Taiwan has a high incidence of ESKD. Unrecovered incident dialysis may lead to the maintenance of dialysis. Contrast medium (CM) or general anesthesia (GA) may also induce dialysis. We aimed to examine the trends for incident dialysis, use of CM or GA, and its long-term trajectory outcomes.Patients who received at least one dialysis intervention between 2010 and 2017 were identified using the National Health Insurance Research Database. We collected information on age, sex, comorbidities, causes of dialysis in outpatient or inpatient settings, use of CM or GA or pre-ESKD program enrolment before incident dialysis, and trajectory outcomes.Incident dialysis occurred more frequently in elderly inpatients with infectious diseases or previous chronic kidney disease (CKD). The number of patients who had a pre-ESKD care plan before incident dialysis increased from 25% in 2010 to 41% in 2017 (P 0.001). In general, CM or GA exposure related with a higher mortality rate. Over the five-year longitudinal follow-up, patients without a history of CKD had a higher mortality rate than those with a history of CKD.Enrolment in the pre-ESKD care program increased, and inpatient incident dialysis decreased. The long-term survival of patients with CKD was higher than that of non-CKD patients after incident dialysis. CM or GA exposure appears to be related to dialysis-induced mortality, and further investigations are warranted.
- Published
- 2022
18. Multidisciplinary care program in pre-end-stage kidney disease from 2010 to 2018 in Taiwan
- Author
-
Ming-Yen Lin, Min-Yu Chang, Pei-Yu Wu, Ping-Hsun Wu, Ming-Huang Lin, Chih-Cheng Hsu, Jer-Ming Chang, Shang-Jyh Hwang, and Yi-Wen Chiu
- Subjects
Male ,National Health Programs ,Renal Dialysis ,Taiwan ,Humans ,Kidney Failure, Chronic ,Female ,General Medicine ,Reimbursement, Incentive ,Aged - Abstract
The Taiwanese government launched a universal pay-for-performance (P4P) program in 2006 to promote multidisciplinary care for patients with stage 3b-5 chronic kidney disease (CKD). This study aimed to understand the enrollments, care processes, and outcomes of the P4P program between 2010 and 2018.We conducted a population-based study using the Taiwan National Health Insurance Research Data. We divided the incident dialysis population into joining and not joining P4P groups based on whether patients had joined the pre-ESRD program before dialysis or not. Trends in the medications prescribed, anemia correction, vascular access preparation before dialysis initiation, and cumulative survival rate were compared.The program included more than 100,000 patients with late-stage CKD. Enrollment increased by almost 100% from 2010 to 2018, with increases seen in those over 75 years old (127.5%), male (96.7%), and earlier CKD stages (≥35% stage 3b in 2018). Females were more likely to stay being enrolled. The joining P4P group was prescribed more appropriate medications, such as erythropoietin-stimulating agents and statins. However, a high number of patients were still prescribed metformin (≥40%) and non-steroidal anti-inflammatory drugs (≥20%). Compared to the not joining P4P group, the patients in the P4P group had better anemia management, dialysis preparation, and post-dialysis survival.The patients in the joining P4P program group were delivered more appropriate CKD care and were associated with better survival outcomes. Polices and action plans are needed to extend the coverage of and enrollment in the P4P program.
- Published
- 2022
19. Mortality rate of end-stage kidney disease patients in Taiwan
- Author
-
Bo-Sheng Wu, Chia-Ling Helen Wei, Chih-Yu Yang, Ming-Huang Lin, Chih-Cheng Hsu, Yu-Juei Hsu, Shih-Hua Lin, and Der-Cherng Tarng
- Subjects
Survival Rate ,Renal Dialysis ,Taiwan ,Humans ,Kidney Failure, Chronic ,General Medicine ,Retrospective Studies - Abstract
End-stage kidney disease (ESKD) is a global burden that reflects each country's unique condition. We used the National Health Insurance Research Database (NHIRD) of Taiwan to decipher changes in the mortality and international survival rates and to determine the effectiveness of the pre-end-stage renal disease care program (pre-ESRD care program) to guide future health policies for ESKD.We conducted a retrospective cohort analysis of the NHIRD data along with records from the catastrophic illness certificate program of ESKD patients from 2010 to 2018.From 2010 to 2018, the annual dialysis-related mortality rate in Taiwan increased from 10.6 to 11.8 deaths per hundred patient-years. The mortality rate for patients below 40 years appears to be decreasing, reflecting the improved quality of care for ESKD patients. Patients above 75 years showed increasing mortality, indicating the prolonged survival and aging of the ESKD population. Patients undergoing dialysis who participated in the pre-ESRD care program had a higher post-dialysis initiation life expectancy than those who did not participate. Among the program enrollees, the post-dialysis initiation life expectancy was higher in patients who had participated for more than one year. Taiwan has one of the highest ESKD patient survival rates globally.From 2010 to 2018, the reduced mortality in young patients and aging of the ESKD population might indicate that the quality of care in Taiwan for ESKD has improved. Furthermore, a better survival rate after dialysis initiation was observed in the pre-ESRD care program participants.
- Published
- 2022
20. Early Antiplatelet Resumption and the Risks of Major Bleeding After Intracerebral Hemorrhage
- Author
-
Chi-Hung Liu, Yi-Ling Wu, Chih-Cheng Hsu, and Tsong-Hai Lee
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: The appropriate timing of resuming antithrombotic therapy after intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to compare the risks of major bleeding between early and late antiplatelet resumption in ICH survivors. Methods: Between 2008 and 2017, ICH patients were available in the National Health Insurance Research Database. Patients with a medication possession ratio of antiplatelet treatment ≥50% before ICH and after antiplatelet resumption were screened. We excluded patients with atrial fibrillation, heart failure, under anticoagulant or hemodialysis treatment, and developed cerebrovascular events or died before antiplatelet resumption. Finally, 1584 eligible patients were divided into EARLY (≤30 days) and LATE groups (31–365 days after the index ICH) based on the timing of antiplatelet resumption. Patients were followed until the occurrence of a clinical outcome, end of 1-year follow-up, death, or until December 31, 2018. The primary outcome was recurrent ICH. The secondary outcomes included all-cause mortality, major hemorrhagic events, major occlusive vascular events, and ischemic stroke. Cox proportional hazard model after matching was used for comparison between the 2 groups. Results: Both the EARLY and LATE groups had a similar risk of 1-year recurrent ICH (EARLY versus LATE: 3.12% versus 3.27%; adjusted hazard ratio [AHR], 0.967 [95% CI, 0.522–1.791]) after matching. Both groups also had a similar risk of each secondary outcome at 1-year follow-up. Subgroup analyses disclosed early antiplatelet resumption in the patients without prior cerebrovascular disease were associated with lower risks of all-cause mortality (AHR, 0.199 [95% CI, 0.054–0.739]) and major hemorrhagic events (AHR, 0.090 [95% CI, 0.010–0.797]), while early antiplatelet resumption in the patients with chronic kidney disease were associated with a lower risk of ischemic stroke (AHR, 0.065 [95% CI, 0.012–0.364]). Conclusions: Early resumption of antiplatelet was as safe as delayed antiplatelet resumption in ICH patients. Besides, those without prior cerebrovascular disease or with chronic kidney disease may benefit more from early antiplatelet resumption.
- Published
- 2023
21. Liver-related long-term outcomes of alpha-glucosidase inhibitors in patients with diabetes and liver cirrhosis
- Author
-
Fu-Shun, Yen, Ming-Chih, Hou, James Cheng-Chung, Wei, Ying-Hsiu, Shih, Chung Y, Hsu, Chih-Cheng, Hsu, and Chii-Min, Hwu
- Subjects
Pharmacology ,Pharmacology (medical) - Abstract
Background: Adequate management of diabetes in patients with liver cirrhosis can be challenging. We conducted this study to investigate the liver-related long term outcomes of alpha-glucosidase inhibitors (AGIs) in patients with diabetes and cirrhosis.Methods: From National Health Insurance Research Database (NHIRD) in Taiwan, we recruited propensity-score matched alpha-glucosidase inhibitor users and non-users from a cohort of type 2 diabetes mellitus (T2DM) with compensated liver cirrhosis between 1 January 2000, and 31 December 2017, and followed them until 31 December 2018. Cox proportional hazards models with robust sandwich standard error estimates were used to assess the risk of main outcomes for alpha-glucosidase inhibitor users versus non-users.Results: The incidence rates of mortality during follow-up were 65.56 vs. 96.06 per 1,000 patient-years for alpha-glucosidase inhibitor users and non-users, respectively. The multivariable-adjusted model shows that alpha-glucosidase inhibitor users had significantly lower risks of all-cause mortality (aHR 0.63, 95% CI 0.56–0.71), hepatocellular carcinoma (aHR 0.55, 95% CI 0.46–0.67), decompensated cirrhosis (aHR 0.74 95% CI 0.63–0.87), hepatic encephalopathy (aHR 0.72, 95% CI 0.60–0.87), and hepatic failure (aHR 0.74, 95% CI 0.62–0.88) than alpha-glucosidase inhibitor non-users. Patients who received alpha-glucosidase inhibitors for a cumulative duration of more than 364 days had significantly lower risks of these outcomes than non-users.Conclusion: Alpha-glucosidase inhibitor use was associated with a lower risk of mortality, hepatocellular carcinoma, decompensated cirrhosis, and hepatic failure in patients with diabetes and compensated cirrhosis. alpha-glucosidase inhibitors may be useful for the management of diabetes in patients with compensated liver cirrhosis. Large-scale prospective studies are required to verify our results.
- Published
- 2022
22. Association of leukocyte mitochondrial DNA copy number with longitudinal C-reactive protein levels and survival in older adults: a cohort study
- Author
-
I-Chien Wu, Chin-San Liu, Wen-Ling Cheng, Ta-Tsung Lin, Hui-Ling Chen, Pei-Fen Chen, Ray-Chin Wu, Chen-Wei Huang, Chao A. Hsiung, and Chih-Cheng Hsu
- Subjects
Aging ,Immunology - Abstract
Background Systemic chronic inflammation occurs with age. The association of the leukocyte mitochondrial DNA copy number, a measure of mitochondrial function in aging, with the temporal profile of serum high-sensitivity C-reactive protein and mortality risk remains uncertain. The objectives of this study were to examine the association of the leukocyte mitochondrial DNA copy number with longitudinal high-sensitivity C-reactive protein levels and the association of the longitudinal high-sensitivity C-reactive protein levels with mortality risk. Methods This prospective cohort study included 3928 adults aged ≥ 55 years without systemic inflammation in the baseline examination of the Healthy Aging Longitudinal Study in Taiwan, which started in 2009. Each participant received leukocyte mitochondrial DNA copy number measurement using a fluorescence-based quantitative polymerase chain reaction at baseline, serum high-sensitivity C-reactive protein measurements at baseline and the follow-up examination five years later, and the ascertainment of all-cause death (until November 30, 2021). The relationships among the leukocyte mitochondrial DNA copy number, longitudinal serum high-sensitivity C-reactive protein levels, and time to all-cause mortality were examined using the joint longitudinal and survival modeling analysis. Results Of the 3928 participants (mean age: 69 years; 2060 [52%] were women), 837 (21%) died during follow-up. In the adjusted analysis, one standard deviation lower natural log-transformed baseline leukocyte mitochondrial DNA copy number was associated with an increase of 0.05 (95% confidence interval [CI], 0.02 to 0.08) standard deviation in serum high-sensitivity C-reactive protein in subsequent years. An increase of 1 standard deviation in instantaneous high-sensitivity C-reactive protein levels was associated with a hazard ratio (HR) for all-cause mortality of 1.22 (95% CI, 1.14 to 1.30). Similar results were obtained after further adjusting for baseline high-sensitivity C-reactive protein levels (HR [95% CI], 1.27 [1.16 to 1.38]) and after excluding those with serum high-sensitivity C-reactive protein above 10 mg/L (HR [95% CI], 1.21[1.11 to 1.31]) or 3 mg/L (HR [95% CI], 1.19 [1.06 to 1.31]) during follow-up. Conclusions A lower leukocyte mitochondrial DNA copy number was associated with persistently higher high-sensitivity C-reactive protein levels. Moreover, these higher time-varying high-sensitivity C-reactive protein levels were instantaneously associated with a higher risk of death.
- Published
- 2022
23. Associations of Prolonged Occupational Sitting with the Spectrum of Kidney Disease: Results from a Cohort of a Half-Million Asian Adults
- Author
-
Min-Kuang Tsai, Wayne Gao, Kuo-Liong Chien, Chin-Kun Baw, Chih-Cheng Hsu, and Chi-Pang Wen
- Subjects
Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine - Abstract
Background Kidney diseases are viewed as continuously progressing diseases from microalbuminuria and chronic kidney disease (CKD), to end-stage renal disease (ESRD) and its mortality including deaths. The report on the association between prolonged sitting and kidney diseases is limited. Methods We examined a cohort of 455,506 participants in a screening program in Taiwan conducted between 1996 and 2017. Data on occupational sedentary behavior and physical activity were collected with a standardized questionnaire. The outcomes of ESRD and death were identified by linking with the Catastrophic Illness Dataset and Cause of Death Data. The association between prolonged sitting and CKD, the incidence of ESRD, and death were assessed using logistic regression models to compute odds ratios (ORs) and Cox proportional hazards models for hazard ratios (HRs). Results More than half of the participants, i.e., 265,948 (58.4%), were categorized as “prolonged sitting” during their work. During a median of 13 years of follow-up, we identified 2227 individuals undergoing dialysis and 25,671 deaths. Prolonged occupational sitting was significantly associated with a higher risk of CKD (OR: 1.26, 95% confidence interval: 1.21, 1.31), ESRD (HR: 1.19, 95% CI 1.03, 1.38), and kidney-specific mortality (HR: 1.43, 95% CI 1.07, 1.91) compared to mostly standing participants after controlling for physical activity and other risk factors. Inactive prolonged sitting carries a significantly higher risk of ESRD than physically active mostly standing participants (HR: 1.34, 95% CI 1.04, 1.73). However, active prolonged sitting decreased the risk of ESRD (HR: 1.03, 95% CI 0.79, 1.34) compared to inactive prolonged sitting. Conclusion The results suggest that prolonged occupational sitting is associated with a greater risk of the spectrum of kidney disease, proteinuria, CKD, dialysis (ESRD), and mortality for all causes and kidney diseases. Physical activity, even at a minimal level of 15 min/day (90 min/week) of moderate-intensity exercise, was associated with a reduction in these risks.
- Published
- 2022
24. The Risk of Severe Hypoglycemia and Mortality in Patients with Type 2 Diabetes and Discharged with Acute Liver Injury
- Author
-
Fu-Shun Yen, Ming-Chih Hou, Chun-Wei Pan, Jia-Sin Liu, Chih-Cheng Hsu, and Chii-Min Hwu
- Subjects
Advanced and Specialized Nursing ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
OBJECTIVE To compare the risks of severe hypoglycemia and mortality between patients with type 2 diabetes (T2D) and discharged with and without acute liver injury. RESEARCH DESIGN AND METHODS From 1 January 2000 to 31 December 2010, we identified patients with T2D and hospitalization for acute liver injury and hospitalization for other causes from the National Health Insurance Research Database of Taiwan. Multivariable-adjusted Cox proportional hazards models were used to compare the risks of severe hypoglycemia and mortality between the study and control groups. RESULTS The incidence rates and adjusted hazard ratios (aHRs) for severe hypoglycemia within 90 days and 365 days after discharge were 12.28 and 5.59/1,000 person-years (aHR 1.92 [1.30–2.85]) and 7.35 and 2.9/1,000 person-years (aHR 1.98 [1.52–2.58]) for patients discharged with and without acute liver injury, respectively. The incidence rates and aHRs for mortality within 90 days and 365 days after discharge were 82.4 and 27.54/1,000 person-years (aHR 1.73 [1.46–2.05]) and 36.8 and 9.3/1,000 person-years (aHR 1.94 [1.69–2.24]) for patients discharged with and without acute liver injury, respectively. The subgroup analysis of hypoglycemia risk in patients discharged with acute liver injury revealed no significant interaction in risk factors of age, chronic kidney disease, and medications, except for sex difference, which has significant interaction. CONCLUSIONS This cohort study demonstrated that patients with T2D and discharged with acute liver injury showed significantly higher risks of severe hypoglycemia and mortality within 90 days and 365 days after discharge than patients discharged with other causes.
- Published
- 2022
25. Epidemiological characteristics of diabetic kidney disease in Taiwan
- Author
-
Kun-Der Lin, Jun-Sing Wang, Chih-Cheng Hsu, Yueh-Han Hsu, Fu-Shun Yen, and Shyi-Jang Shin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,Taiwan ,Review Article ,Type 2 diabetes ,Prognostic factors ,Diseases of the endocrine glands. Clinical endocrinology ,End stage renal disease ,Young Adult ,Renal Dialysis ,Internal medicine ,Diabetes mellitus ,Prevalence ,Internal Medicine ,medicine ,Humans ,Diabetic Nephropathies ,Diabetic kidney disease ,Family history ,education ,Dialysis ,Aged ,Type 1 diabetes ,education.field_of_study ,business.industry ,Incidence ,General Medicine ,Middle Aged ,RC648-665 ,medicine.disease ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Risk factors ,Kidney Failure, Chronic ,Female ,business ,Dyslipidemia - Abstract
Diabetic kidney disease (DKD) is a critical microvascular complication of diabetes. With the continuous increase in the prevalence of diabetes since 2000, the prevalence of DKD has also been increasing in past years. The prevalence of DKD among individuals with type 2 diabetes in Taiwan increased from 13.32% in 2000 to 17.92% in 2014. The cumulative incidence of DKD among individuals with type 1 diabetes in Taiwan was higher than 30% during 1999–2012. DKD is the leading cause of end‐stage renal disease (ESRD), with a prevalence of approximately 45% in a population on chronic dialysis in Taiwan. Among individuals with type 2 diabetes, the prevalence of ESRD in the receipt of dialysis also increased from 1.32% in 2005 to 1.47% in 2014. Risk factors for DKD development are age, race, family history, hyperglycemia, hypertension, dyslipidemia, dietary patterns, and lifestyles. Prognostic factors that aggravate DKD progression include age, family history, sex, glycemic control, blood pressure (BP), microvascular complications, and atherosclerosis. This review summarizes updated information on the onset and progression of DKD, particularly in the Taiwanese population. Translating these epidemiological features is essential to optimizing the kidney care and improving the prognosis of DKD in Asian populations., This review summarizes updated information on the onset and progression of DKD, particularly in Taiwan. Translating these epidemiological features is essential to optimizing kidney care and improving the prognosis of DKD in Asian populations.
- Published
- 2021
26. Metformin use and the risks of herpes zoster and postherpetic neuralgia in patients with type 2 diabetes
- Author
-
Fu‐Shun Yen, James Cheng‐Chung Wei, Hei‐Tung Yip, Chih‐Cheng Hsu, and Chii‐Min Hwu
- Subjects
Infectious Diseases ,Virology - Abstract
Herpes zoster and postherpetic neuralgia cause substantial pain in patients. Persons with type 2 diabetes (T2D) are prone to zoster infection and postherpetic neuralgia due to compromised immunity. We conducted this study to evaluate the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers. Propensity score matching was utilized to select 47 472 pairs of metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers in patients with T2D. Compared with no-use of metformin, the adjusted hazard ratios (95% confidence interval) for metformin use in herpes zoster and postherpetic neuralgia were 0.70 (0.66, 0.75) and 0.510 (0.39, 0.68), respectively. A higher cumulative dose of metformin had further lower risks of herpes zoster and postherpetic neuralgia than metformin no-use. This nationwide cohort study demonstrated that metformin use was associated with a significantly lower risk of herpes zoster and postherpetic neuralgia than metformin no-use. Moreover, a higher cumulative dose of metformin was associated with further lower risks of these outcomes.
- Published
- 2022
27. Interaction among dietary n-3 and n-6 polyunsaturated fatty acid intake, fatty acid desaturase 2 genetic variants, and low-density lipoprotein cholesterol levels in type 2 diabetes patients
- Author
-
Pei‐Chi Huang, Hsuan Cheng, Yu‐Ting Su, Meng‐Chuan Huang, Chih‐Cheng Hsu, Shang‐Jyh Hwang, Shyi‐Jang Shin, and Wen‐Tsan Chang
- Subjects
Endocrinology, Diabetes and Metabolism ,Internal Medicine ,General Medicine - Abstract
Fatty acid desaturase (FADS) genetic polymorphisms are strongly correlated with the risk of dyslipidemia and cardiovascular disease. In this study, we examined the impact of FADS1 and FADS2 genetic variants on plasma lipid status, and assessed interactions between FADS genetic polymorphisms and plasma n-3/n-6 fatty acids regarding lipid status within a population of 816 Taiwanese patients with type 2 diabetes.Selected tag single-nucleotide polymorphisms (FADS1 rs174546 [T/C]; FADS2 rs174602 [A/G] and rs2072114 [A/G]) were genotyped (n = 816).The distribution of genotypes were compared with reports publicly available in the Genome Aggregation Database for East Asian populations (https://gnomad.broadinstitute.org). In the subgroup of patients not taking lipid-lowering medications (n = 192), we observed that the G allele of FADS2 rs174602 was statistically significantly correlated with lower low-density lipoprotein cholesterol (LDL-C) concentrations (P = 0.001), whereas the G allele of rs2072114 was marginally associated with LDL-C concentrations (P = 0.091). Using a general linear model adjusted for confounding factors, statistically significant interactions (P = 0.016) between single-nucleotide polymorphisms in rs2072114 and a low alpha-linolenic acid (18:3n-3)/linoleic acid (18:2n-6) ratio; the G allele correlated with lower LDL-C levels among individuals with a low alpha-linolenic acid/linoleic acid ratio. Interaction between rs174602 single-nucleotide polymorphisms and low alpha-linolenic acid/linoleic acid values on LDL-C was only marginally significant (P = 0.063).Our results show the role of n-3/n-6 dietary polyunsaturated fatty acids in modifying the effects of genetic susceptibility on lipoprotein concentrations in patients with type 2 diabetes. Our findings highlight the potential of interventions with dietary polyunsaturated fatty acids regarding developing individualized prevention strategies for type 2 diabetes presenting with co-occurring dyslipidemia and cardiovascular diseases.
- Published
- 2022
28. Trends in all-cause mortality and major causes of death between 2007 and 2018 among patients with diabetes in Taiwan
- Author
-
Jun-Sing, Wang, Yi-Ling, Wu, Horng-Yih, Ou, Yi-Sun, Yang, Chih-Cheng, Hsu, and Chii-Min, Hwu
- Subjects
Survival Rate ,Risk Factors ,Cause of Death ,Endocrinology, Diabetes and Metabolism ,Diabetes Mellitus ,Taiwan ,Humans - Abstract
Optimal control of diabetes and relevant risk factors substantially reduce the risks of chronic complications and mortality. We investigated all-cause mortality rate and major causes of death between 2007 and 2018 in patients with diabetes in Taiwan. This study was conducted using data from Taiwan National Health Insurance Research Database. We selected patients with diabetes diagnosed between 2007 and 2017 (grouped according to the year of diabetes diagnosis 2007-2010 vs. 2011-2017). Information on mortality and causes of death by the end of 2018 was confirmed through linking to the National Death Registry. Standardized mortality rate (SMR) were calculated by weighting the World Health Organization (WHO) standard population (WHO 2000-2025). More than 2.7 million of patients with diabetes were analyzed and a total of 566121 deaths were identified. Overall, the SMR was 11.72 per 1000 person-years. Patients with diabetes diagnosed in 2011-2017 had a lower SMR (8.42 vs. 12.92 per 1000 person-years) than those diagnosed in 2007-2010. Similar finding were noted regarding the major causes of death (cancer, diabetes, heart disease, hypertensive disease, and cerebrovascular disease). Compared with patients who were diagnosed in 2008-2010, those who were diagnosed in 2011-2014 and 2015-2018 had a higher 3-year survival rate (0.9356 vs. 0.9438 vs. 0.946, log-rank test p
- Published
- 2022
29. Using a Short Food Frequency Questionnaire to Evaluate Macronutrients, Fiber, Phosphorus, Potassium, and Calcium in Adults with Stages 3-5 Chronic Kidney Disease
- Author
-
Meng-Chuan Huang, Szu-Chun Hung, Tsen-Hua Tai, Ting-Yun Lin, Chiao-I Chang, and Chih-Cheng Hsu
- Subjects
Adult ,Dietary Fiber ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,chronic kidney disease ,dietary record ,short food frequency questionnaire ,nutrition assessment ,Reproducibility of Results ,Phosphorus ,Nutrients ,Diet Surveys ,Diet Records ,Diet ,Calcium, Dietary ,Surveys and Questionnaires ,Potassium ,Humans ,Kidney Failure, Chronic ,Calcium ,Renal Insufficiency, Chronic ,Energy Intake - Abstract
The progression of chronic kidney disease (CKD) can be directly or indirectly accelerated by a poor diet and the diet’s influence on risk factors for this disease. There have been no food frequency questionnaires (FFQs) developed for the assessment of diet in patients with CKD in Taiwan. This study analyzed the validity of a short FFQ (SFFQ) with 42 items for estimating patient intake of macronutrients, fiber, phosphorus, potassium, and calcium against 3-day dietary records (3-day DRs) in Taiwanese patients with stages 3–5 CKD. In an interview, 107 participants with the help of a dietician filled out an SFFQ and reviewed a 3-day DR the patients had filled out prior to the interview. Partial Pearson correlation coefficients between SFFQ and 3-day DR were 0.722, 0.619, 0.593, 0.572, 0.450, 0.611 and 0.410 for protein, fat, carbohydrate, fiber, phosphorus, potassium, and calcium, respectively, after adjusting for energy intake. Cross-classification analysis revealed 63.5–83.2% similarity in cross-tool estimated intakes of macronutrients, fiber, phosphorus, potassium, and calcium in the same quartiles or adjacent ones. Bland–Altman plots revealed good agreement between the two tools along different intake levels. In conclusion, the newly developed SFFQ had moderate relative validity in estimating the usual intake of key nutrients related to nutrition management of patients with late-stage CKD, suggesting it can be used to assess dietary intakes in a population with CKD, especially in those residing in an Asian region.
- Published
- 2022
30. Assessment of incident frailty hazard associated with depressive symptoms in a Taiwanese longitudinal study
- Author
-
I-Chien Wu, Yen-Feng Chiu, Chao A. Hsiung, Han-Yun Tseng, Hsing-Yi Chang, Che-Chia Chang, Chih-Cheng Hsu, Chi-Shin Wu, and Chun-Yi Lee
- Subjects
Gerontology ,medicine.medical_specialty ,Longitudinal study ,Frail Elderly ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Geriatric Assessment ,Depression (differential diagnoses) ,Aged ,Frailty ,Depression ,business.industry ,Public health ,Confounding ,Hazard ,Psychiatry and Mental health ,Clinical Psychology ,Geriatrics and Gerontology ,Rural area ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Objectives:To estimate the risks of depressive symptoms for developing frailty, accounting for baseline robust or pre-frailty status.Design:An incident cohort study design.Setting:Community dwellers aged 55 years and above from urban and rural areas in seven regions in Taiwan.Participants:A total of 2,717 participants from the Healthy Aging Longitudinal Study in Taiwan (HALST) were included. Subjects with frailty at baseline were excluded. The average follow-up period was 5.9 years.Measurements:Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) Scale. Frailty was assessed using the Fried frailty measurement. Participants were stratified by baseline robust or pre-frailty status to reduce the confounding effects of the shared criteria between depressive symptoms and frailty. Overall and stratified survival analyses were conducted to assess risks of developing frailty as a result of baseline depressive symptoms.Results:One hundred individuals (3.7%) had depressive symptoms at baseline. Twenty-seven individuals (27.0%) with depressive symptoms developed frailty, whereas only 305 out of the 2,617 participants (11.7%) without depressive symptoms developed frailty during the follow-up period. After adjusting for covariates, depressive symptoms were associated with a 2.6-fold (95% CI 1.6, 4.2) increased hazard of incident frailty. The patterns of increased hazard were also observed when further stratified by baseline robust or pre-frailty status.Conclusions:Depressive symptoms increased the risk of developing frailty among the older Asian population. The impact of late-life depressive symptoms on physical health was notable. These findings also replicated results from Western populations. Future policies on geriatric public health need to focus more on treatment and intervention against geriatric depressive symptoms to prevent incident frailty among older population.
- Published
- 2021
31. Trends in hospitalizations and emergency department visits among women with hyperglycemia in pregnancy between 2008 and 2017 in Taiwan
- Author
-
Jun-Sing Wang, Ming-Chu Chin, Jung-Fu Chen, Chien-Ning Huang, Chii-Min Hwu, Horng-Yih Ou, Yi-Sun Yang, Chih-Cheng Hsu, and Chih-Yuan Wang
- Subjects
Hospitalization ,Pregnancy ,Endocrinology, Diabetes and Metabolism ,Hyperglycemia ,Humans ,Female ,Length of Stay ,Emergency Service, Hospital ,Delivery, Obstetric - Abstract
IntroductionWe investigated health service utilization, including hospitalizations and emergency department visits, for women with hyperglycemia in pregnancy between 2008 and 2017 in Taiwan.MethodsData from the Health and Welfare Data Science Center were used to conduct this nationwide population-based study. We identified pregnant women and the date of childbirth according to Birth Certificate Applications from 2007 to 2018. The study population was divided into four groups: known DM, newly diagnosed DM, GDM, and no DM/GDM. To assess quality of healthcare during the gestation period, trends in 30-day readmission rate, number of emergency department visits/hospitalizations per 100 childbirths, and length of hospital stay from 2008 to 2017 were examined.ResultsA total of 1830511 childbirths and 990569 hospitalizations were identified for analyses. Between 2008 and 2017, women with hyperglycemia in pregnancy (known DM, newly diagnosed DM, and GDM) had a higher rate of hospitalization, a longer length of hospital stay, and higher rates of various maternal and fetal outcomes, compared with women with no DM/GDM. Nevertheless, the differences between women with GDM and those with no DM/GDM in the aforementioned outcome measures were modest. Women with GDM had a modest decrease in the 30-day readmission rate (p for trend 0.046) with no significant difference in the number of emergency department visits during the study period.DiscussionOur findings provide evidence of the quality of healthcare for women with GDM between 2008 and 2017 in Taiwan.
- Published
- 2022
32. Risk of Dementia after Exposure to Contrast Media: A Nationwide, Population-Based Cohort Study
- Author
-
Tung-Min Yu, Ya-Wen Chuang, Shih-Ting Huang, Jin-An Huang, Cheng-Hsu Chen, Mu-Chi Chung, Chun-Yi Wu, Pi-Yi Chang, Chih-Cheng Hsu, and Ming-Ju Wu
- Subjects
dementia ,contrast medium ,Alzheimer’s disease ,vascular dementia ,Medicine (miscellaneous) ,General Biochemistry, Genetics and Molecular Biology - Abstract
Contrast-medium-associated kidney injury is caused by the infusion of contrast media. Small vessel disease is significantly associated with various diseases, including simultaneous conditions of the kidney and brain, which are highly vulnerable to similar vascular damage and microvascular pathologies. Data to investigate the adverse effect of contrast media on the brain remain extremely lacking. In this study, 11,332,616 NHI enrollees were selected and divided into two groups, exposed and not exposed to a contrast medium during the observation period, from which 1,461,684 pairs were selected for analyses through matching in terms of age, sex, comorbidities, and frequency of outpatient visits during the previous year. In total, 1,461,684 patients exposed to a contrast medium and 1,461,684 controls not exposed to one were enrolled. In multivariable Cox proportional hazard models, patients exposed to a contrast medium had an overall 2.09-fold higher risk of dementia. In multivariable-stratified analyses, the risk of Alzheimer’s disease was remarkably high in younger patients without any underlying comorbidity. This study is the first to discover that exposure to contrast media is significantly associated with the risk of dementia. A four-fold increased risk of vascular dementia was observed after exposure to a contrast medium. Further studies on the influence of exposure to contrast media on the brain are warranted.
- Published
- 2022
33. Vitamin D supplementation worsens Alzheimer's progression: Animal model and human cohort studies
- Author
-
Rai‐Hua Lai, Chih‐Cheng Hsu, Ben‐Hui Yu, Yu‐Ru Lo, Yueh‐Ying Hsu, Mei‐Hsin Chen, and Jyh‐Lyh Juang
- Subjects
Cohort Studies ,Aging ,Disease Models, Animal ,Mice ,Alzheimer Disease ,Dietary Supplements ,Animals ,Humans ,Cell Biology ,Longitudinal Studies ,Tumor Suppressor Protein p53 ,Vitamin D ,Aged - Abstract
Vitamin D deficiency has been epidemiologically linked to Alzheimer's disease (AD) and other dementias, but no interventional studies have proved causality. Our previous work revealed that the genomic vitamin D receptor (VDR) is already converted into a non-genomic signaling pathway by forming a complex with p53 in the AD brain. Here, we extend our previous work to assess whether it is beneficial to supplement AD mice and humans with vitamin D. Intriguingly, we first observed that APP/PS1 mice fed a vitamin D-sufficient diet showed significantly lower levels of serum vitamin D, suggesting its deficiency may be a consequence not a cause of AD. Moreover, supplementation of vitamin D led to increased Aβ deposition and exacerbated AD. Mechanistically, vitamin D supplementation did not rescue the genomic VDR/RXR complex but instead enhanced the non-genomic VDR/p53 complex in AD brains. Consistently, our population-based longitudinal study also showed that dementia-free older adults (n = 14,648) taking vitamin D
- Published
- 2022
34. Clinical course of adolescents with type 2 diabetes mellitus: A nationwide cohort study in Taiwan
- Author
-
Fu‐Shun Yen, James Cheng‐Chung Wei, Jia‐Sin Liu, Chih‐Cheng Hsu, and Chii‐Min Hwu
- Subjects
Cohort Studies ,Sulfonylurea Compounds ,Adolescent ,Diabetes Mellitus, Type 2 ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Taiwan ,Humans ,Hypoglycemic Agents ,Insulin ,General Medicine ,Metformin ,Retrospective Studies - Abstract
The global incidence of adolescents with type 2 diabetes mellitus is increasing. This cohort study was conducted aiming to describe the characteristics, drug-use condition, and long-term outcomes of adolescents with type 2 diabetes mellitus.Two thousand seven hundred fifty-five newly diagnosed adolescents with type 2 diabetes mellitus (using ICD-9-CM: 250.x and having ≥3 clinic visits) were identified from the national health insurance dataset during 2000-2014. Treatments were classified into four groups: metformin, sulfonylurea (SU), metformin plus SU, and insulin with or without oral antidiabetic drugs. The multiple Cox regression model was used to compare the risks of mortality and hospitalization among these four groups.The mean follow-up period was 5.4 years. After 1 year of antidiabetic treatment, they gradually needed intensified therapy, and at 3 years, half of them showed treatment failure. The mortality rate was 2.08 per 1,000 person-years. Respiratory diseases (36.2%) and dysglycemia (16.4%) were the most common causes of hospitalization among these adolescents. Compared with persons taking metformin plus SU, metformin users were associated with a lower risk of all-cause hospitalization [0.82 (0.67-0.99)]; insulin users were associated with a higher risk of dysglycemia [4.38 (2.14-8.96)], cancer [3.76 (1.39-10.1)], and respiratory hospitalization [1.66 (1.14-2.41)]; and SU users were associated with a higher risk of hospitalization for respiratory diseases [1.91 (1.13-3.23)].This nationwide cohort study demonstrated that adolescents with type 2 diabetes mellitus were prone to treatment failure. Furthermore, respiratory diseases and dysglycemia were the most common causes of hospitalization.
- Published
- 2022
35. Metformin and the Development of Asthma in Patients with Type 2 Diabetes
- Author
-
Fu-Shun Yen, Chih-Cheng Hsu, Ying-Hsiu Shih, Wei-Lin Pan, James Cheng-Chung Wei, and Chii-Min Hwu
- Subjects
Hospitalization ,Diabetes Mellitus, Type 2 ,Health, Toxicology and Mutagenesis ,Incidence ,Public Health, Environmental and Occupational Health ,Taiwan ,type 2 diabetes ,metformin ,asthma ,exacerbation ,hospitalization ,Humans ,Hypoglycemic Agents ,Asthma ,Metformin ,Proportional Hazards Models ,Retrospective Studies - Abstract
We conducted this study to compare the risks of asthma development and exacerbation between metformin users and nonusers. Overall, 57,743 propensity score-matched metformin users and nonusers were identified from Taiwan’s National Health Insurance Research Database between 1 January 2000, and 31 December 2017. We used the Cox proportional hazards model with robust standard error estimates to compare the risks of asthma onset, exacerbation, and hospitalization for asthma in participants with type 2 diabetes (T2D). Compared with metformin nonuse, the aHRs (95% CI) for metformin use in asthma development, exacerbation, and hospitalization for asthma were 1.13 (1.06–1.2), 1.62 (1.35–1.95), and 1.5 (1.22–1.85), respectively. The cumulative incidences of asthma development, exacerbation, and hospitalization for asthma were significantly higher in metformin users than nonusers (p < 0.001). A longer cumulative duration of metformin use for more than 728 days was associated with significantly higher risks of outcomes than metformin nonuse. Our study demonstrated that metformin users showed significantly higher risks of asthma development, exacerbation, and hospitalization for asthma than metformin nonusers. Moreover, metformin use for more than 728 days was associated with higher risks of outcomes. A randomized control study is warranted to verify our results.
- Published
- 2022
36. Central obesity and elevated blood pressure in middle life are associated with physical and cognitive impairment in later life: A retrospective design with repeated measures
- Author
-
Shao-Yuan Chuang, Wen-Ling Liu, Hsing-Yi Chang, Chih-Cheng Hsu, and Wen-Harn Pan
- Subjects
Aging ,Endocrinology ,Genetics ,Cell Biology ,Molecular Biology ,Biochemistry - Published
- 2023
37. Risk of Major Cardiovascular Disease after Exposure to Contrast Media: A Nationwide Population-Based Cohort Study on Dialysis Patients
- Author
-
Shih-Ting Huang, Tung-Min Yu, Chia-Hsin Chen, Yun-Chung Cheng, Ya-Wen Chuang, Cheng-Hsu Cheng, Jia-Sin Liu, Chih-Cheng Hsu, and Ming-Ju Wu
- Subjects
cardiovascular disease ,inflammasome ,Endocrinology, Diabetes and Metabolism ,dialysis ,Molecular Biology ,Biochemistry ,iodinated contrast media - Abstract
Contrast associated kidney injury is caused by side effects of iodinated contrast media (ICM), including inflammation. Chronic inflammation among dialysis patient contributes to atherosclerosis, which leads to simultaneous conditions of the kidney, brain, and vasculature. Data to investigate the pathologic effects of ICM on cardiovascular complications in dialysis patients are lacking. Dialysis patients who had been exposed to ICM from computed tomography (ICM-CT) were allocated as the ICM-CT cohort (N = 3751), whereas dialysis patients without ICM exposure were randomly allocated as the non-ICM cohort (N = 17,196). Furthermore, 540 pairs were selected for analyses through propensity score-matching in terms of age, sex, comorbidities, dialysis vintage, and index date. During a median follow-up of 10.3 years, ICM-CT cohort had significantly higher risks in the following, compared with non-ICM cohort: all-cause mortality (adjusted hazard ratio [aHR], 1.36; 95% confidence interval [CI], 1.26–1.47), cardiovascular events (aHR,1.67; 95% CI, 1.39–2.01), acute coronary syndrome (adjusted HR: 2.92; 95% CI, 1.72–4.94), sudden cardiac arrest (aHR, 1.69; 95% CI, 0.90–3.18), heart failure (aHR, 1.71; 95% CI,1.28–2.27), and stroke (aHR, 1.84; 95% CI,1.45–2.35). The proinflammatory ICM is significantly associated with an increased risk of major cardiovascular events in patients on dialysis.
- Published
- 2023
38. Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: a nationwide population-based cohort study in Taiwan
- Author
-
James Cheng-Chung Wei, Chih-Cheng Hsu, Fu-Shun Yen, Chii-Min Hwu, Hei-Tung Yip, and Ming-Chih Hou
- Subjects
medicine.medical_specialty ,Cirrhosis ,Hepatology ,business.industry ,Proportional hazards model ,Hazard ratio ,Type 2 Diabetes Mellitus ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Diabetes mellitus ,Cohort ,medicine ,030211 gastroenterology & hepatology ,Decompensation ,business - Abstract
Management of type 2 diabetes mellitus (T2DM) in patients with liver cirrhosis is complex and suboptimal, but no clinical trial has adequately investigated antidiabetic drug use for such patients. We evaluate the risk of mortality, cardiovascular events, and hepatic outcomes between dipeptidyl peptidase-4 (DPP-4) inhibitor users and nonusers in patients with type 2 diabetes mellitus (T2DM) and cirrhosis. We selected 2828 paired propensity score matched DPP-4 inhibitor users and nonusers from a cohort of T2DM with compensated liver cirrhosis between January 1, 2007, and December 31, 2012. Cox proportional hazards models were used to assess the risk of main outcomes for DPP-4 inhibitor users. The incidence rate of decompensated cirrhosis during follow-up was 2.20 and 1.53 per 100 patient-years (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.03–1.77) for DPP-4 inhibitor users and nonusers, respectively. The aHRs (95% CI) of variceal bleeding and hepatic failure were 1.67 (1.11–2.52) and 1.35 (1.02–1.79), respectively, for DPP-4 inhibitor users over nonusers. The risk of all-cause mortality, hepatocellular carcinoma, and major cardiovascular events between DPP-4 inhibitor users and nonusers were not statistically different. This study found that DPP-4 inhibitor users were associated with higher risks of decompensated cirrhosis and hepatic failure than did nonusers among patients with T2DM and compensated liver cirrhosis. We must continue to search for appropriate antidiabetic drugs for patients with liver cirrhosis.
- Published
- 2021
39. Early Comprehensive Kidney Care in Dialysis-Requiring Acute Kidney Injury Survivors: A Populational Study
- Author
-
Chun-Yi Wu, Jia-Sin Liu, Cheng-Hsu Chen, Chun-Te Huang, Tung-Min Yu, Ya-Wen Chuang, Shih-Ting Huang, Chih-Cheng Hsu, and Ming-Ju Wu
- Subjects
General Medicine - Abstract
BackgroundFor patients with Acute Kidney Injury (AKI), a strong and graded relationship exists between AKI severity and mortality. One of the most severe entities of AKI is Dialysis-Requiring Acute Kidney Injury (D-AKI), which is associated with high rates of mortality and end-stage renal disease (ESRD). For this high-risk population group, there is a lack of evidence regarding optimal post-AKI care. We propose that post-AKI care through the combined efforts of the nephrologist and the multidisciplinary care team may improve outcomes. Our aim here is to study for survivors of dialysis-requiring acute kidney injury, the effects of implementing early comprehensive kidney care.MethodsThis is a retrospective longitudinal cohort study of Taiwanese through analyzing the National Health Insurance Research Database (NHIRD). We included patients with acute dialysis during hospitalization from January 1, 2015 to December 31, 2018. Propensity match was done at 1:1, including estimated glomerular filtration rate (eGFR) based on CKD-EPI which was performed due to large initial disparities between these two cohorts.ResultsAfter the propensity match, each cohort had 4,988 patients. The mean eGFR based on CKD-EPI was 27.5 ml/min/1.73 m2, and the mean follow-up period was 1.4 years.The hazard ratio for chronic dialysis or ESRD was 0.55 (95% CI, 0.49–0.62; p < 0.001). The hazard ratio for all-cause mortality was 0.79 (95% CI, 0.57–0.88; p < 0.001). Both outcomes favored early comprehensive kidney care.ConclusionsFor survivors of dialysis-requiring acute kidney injury, early comprehensive kidney care significantly lowered risks of chronic dialysis and all-cause mortality.
- Published
- 2022
40. Author Correction: Aberrant serum parathyroid hormone, calcium, and phosphorus as risk factors for peritonitis in peritoneal dialysis patients
- Author
-
Chia-Te Liao, Cai-Mei Zheng, Yen-Chung Lin, Mei-Yi Wu, Yuh-Feng Lin, Yung-Ho Hsu, Chih-Cheng Hsu, and Mai-Szu Wu
- Subjects
Multidisciplinary - Published
- 2022
41. Determinants of long‐term care service use by persons with dementia: A national dementia registry study conducted in Taiwan
- Author
-
Chia‐Fen Tsai, Mao‐Hsuan Huang, Chih‐Ming Cheng, Jun‐Jun Lee, Wen‐Fu Wang, Ling‐Chun Huang, Li‐Kai Huang, Wei‐Ju Lee, Pi‐Shan Sung, Yi‐Chien Liu, Wen‐Chen Ouyang, Chih‐Cheng Hsu, and Jong‐Ling Fuh
- Subjects
Psychiatry and Mental health ,Geriatrics and Gerontology - Abstract
This study investigated the determinants and use of Taiwan's long-term care (LTC) Plan Version 2.0 (LTC 2.0) services by persons with dementia (PWDs) and their caregivers.In total, 1268 PWD-caregiver dyads were enrolled for analysis from a national dementia registry. Andersen's Behavioral Model of Health Services Use was used to investigate the association of LTC service use with several factors, namely the demographic data of PWDs and their caregivers, migrant caregiver employment, monthly household income, caregiver burden as determined by the Zarit Burden Interview (ZBI), Mini-Mental State Examination score, Clinical Dementia Rating scores, neuropsychiatric inventory scores for the behavioral and psychological symptoms of dementia, and PWDs' activities of daily living (ADLs).Among the studied family caregivers, 81.4% did not use LTC resources. A multivariable logistic analysis revealed that aberrant motor behaviors (odd ratio [OR] = 1.31, 95% confidence interval [CI] = 1.10-1.56, p = 0.003), dysfunction in ADLs (OR = 1.06, 95% CI = 1.02-1.10, p = 0.002), higher ZBI scores (OR = 1.02, 95% CI = 1.01-1.03, p = 0.004), not residing with family members (OR = 1.88, 95% CI = 1.32-2.66, p 0.001), and not employing a migrant caregiver (OR = 4.41, 95% CI = 2.59-7.51, p 0.001) were the factors most significantly associated with LTC service use.Factors such as whether PWDs live alone, specific neuropsychiatric symptoms, and impaired function should be considered in future policy amendments to provide required activities and care resources for PWDs and their caregivers.
- Published
- 2022
42. Cardiovascular outcomes of metformin use in patients with type 2 diabetes and chronic obstructive pulmonary disease
- Author
-
Fu-Shun Yen, James Cheng-Chung Wei, Lu-Ting Chiu, Chih-Cheng Hsu, and Chii-Min Hwu
- Subjects
Pharmacology ,Pharmacology (medical) - Abstract
Aim: To know whether metformin use has different influence on cardiovascular risks in patients with type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) as compared with metformin no-use.Methods: This study employed a retrospective cohort study design. Using propensity score matching, we recruited 55 ,224 pairs of metformin users and nonusers from Taiwan’s National Health Insurance Research Database between 1 January 2000, and 31 December 2017. Cox proportional-hazards models with robust standard error estimates were used to compare the risks of cardiovascular outcomes.Results: The mean study period of metformin users and nonusers was 11.04 (5.46) and 12.30 (4.85) years, respectively. Compared with the nonuse of metformin, the adjusted hazard ratios (95% CI) of metformin use for composited cardiovascular events, stroke, coronary artery disease, and heart failure were 0.51 (0.48–0.53), 0.62 (0.59–0.64), 0.48 (0.46–0.50), and 0.61 (0.57–0.65), respectively. The longer cumulative duration of metformin use had even lower adjusted hazard ratios compared with metformin nonuse.Conclusion: In patients with coexisting T2DM and COPD, metformin use was associated with significantly lower risks of CVD; moreover, longer duration of metformin use was associated with a lower risk of CVD. A well-designed prospective study is required to verify the results.
- Published
- 2022
43. Impact of chronic hepatitis on cardiovascular events among type 2 diabetes patients in Taiwan pay-for-performance program
- Author
-
Yi-Jing Sheen, Chih-Cheng Hsu, Pei-Tseng Kung, Li-Ting Chiu, and Wen-Chen Tsai
- Subjects
Adult ,Multidisciplinary ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Risk Factors ,Incidence ,Taiwan ,Humans ,Hepatitis C ,Reimbursement, Incentive ,Hepatitis, Chronic ,Retrospective Studies - Abstract
To investigate the impact of chronic hepatitis on cardiovascular events in patients with type 2 diabetes mellitus (T2DM). This nationwide retrospective cohort study included 152,709 adult patients (> 20 years) with T2DM enrolled in the National Health Insurance Diabetes Pay-for-Performance Program from 2008 to 2010 and followed up until the end of 2017. Patients were categorized into groups with hepatitis B, hepatitis C, fatty liver disease, and patients without chronic hepatitis. The incidence of cardiovascular events in patients with T2DM and hepatitis C (79.9/1000 person-years) was higher than that in patients with diabetes combined with other chronic hepatitis, or without chronic hepatitis. After adjusting for confounding factors, T2DM with fatty liver (adjusted hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.07–1.13) and hepatitis C (adjusted HR: 1.09; 95% CI: 1.03–1.12) demonstrated a significantly higher risk of cardiovascular events. The adjusted visit-to-visit coefficient of variation of HbA1c and fasting blood glucose were associated with a high risk of cardiovascular events (HRs of the highest quartile were 1.05 and 1.12, respectively). Chronic hepatitis affects cardiovascular events in adult patients with T2DM. Glucose variability could be an independent risk factor for cardiovascular events in such patients.
- Published
- 2022
44. Statin Therapy for Hyperlipidemic Patients With Chronic Kidney Disease and End-Stage Renal Disease: A Retrospective Cohort Study Based on 925,418 Adults in Taiwan
- Author
-
Fung-Chang Sung, Ying-Chin Jong, Chih-Hsin Muo, Chih-Cheng Hsu, Wen-Chen Tsai, and Yueh-Han Hsu
- Subjects
Pharmacology ,Pharmacology (medical) ,cardiovascular diseases - Abstract
Background: For non-dialysis patients with hyperlipidemia, statins may provide clinical benefits in reducing mortality risk; however, the optimal treatment for dialysis patients with hyperlipidemia remains debatable. We evaluated the mortality risks for hyperlipidemic patients with renal disorders associated with statin therapy (ST), using the insurance claims data of Taiwan.Methods: From hyperlipidemic patients diagnosed in 2000–2011, we identified 555,153 patients receiving statin treatment for at least 90 days continuously and 1,141,901 non-statin users, and then randomly selected, from both groups, the propensity score-matched subcohorts of statin users and nonusers in a 1:1 pair by renal function: 415,453 pairs with normal renal function , 43,632 pairs with chronic kidney disease (CKD), and 3,624 pairs with end-stage renal disease (ESRD). We compared the mortalities, by the end of 2016, from all causes, cancer, heart disease, and septicemia between statin users and non-users and between hydrophilic-statin users and lipophilic-statin users. The Cox method estimated ST users to non-user hazard ratios. The time-dependent model was also conducted as sensitivity analysis.Results: The mean ages were 58.7 ± 10.7, 64.2 ± 10.7, and 62.2 ± 10.8 years in normal renal function, CKD, and ESRD groups, respectively. Compared with non-users, statin users had reduced mortality risks from all causes for 32%–38%, from cancer for 37%–46%, from heart disease for 6%–24%, and from septicemia for 17%–21% in all three renal groups. The hydrophilic statin therapy was superior than the lipophilic statin therapy, particularly for reducing deaths from all-causes and cancer. The results under the time-dependent model were similar.Conclusion: Statin therapy is associated with reduced all-causes and non-cardiovascular mortality in ESRD patients.
- Published
- 2022
45. Effect of Renin-Angiotensin-Aldosterone System Blockade on Long-Term Outcomes in Postacute Kidney Injury Patients With Hypertension*
- Author
-
Yao Ping Lin, Der Cherng Tarng, Chih Yu Yang, Ming Huang Lin, Jia Sin Liu, Ming Tsun Tsai, Zih Kai Kao, Chih Cheng Hsu, and Wei Cheng Tseng
- Subjects
Adult ,Male ,medicine.medical_specialty ,Angiotensin receptor ,medicine.medical_treatment ,Angiotensin-Converting Enzyme Inhibitors ,Critical Care and Intensive Care Medicine ,Renin-Angiotensin System ,Angiotensin Receptor Antagonists ,Young Adult ,Internal medicine ,Renin–angiotensin system ,medicine ,Humans ,Renal replacement therapy ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hazard ratio ,Acute kidney injury ,Retrospective cohort study ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Blockade ,Treatment Outcome ,Hypertension ,Female ,business - Abstract
Objectives Renal replacement therapy-requiring acute kidney injury frequently occurs in ICUs, which require evidence-based medical attention. However, in the postacute kidney injury patient population, the evidence regarding effective therapies to improve patient outcomes is lacking. Therefore, we aimed to examine whether the renin-angiotensin-aldosterone system blockade is effective in improving renal outcomes in postacute kidney injury patients who experienced temporary renal replacement therapy and have hypertension. Design A retrospective cohort study. Setting A nationwide database in Taiwan. Patients From January 1, 2000, to December 31, 2013, we identified 8,558 acute kidney injury patients with hypertension in the national registry database. All these patients experienced an acute kidney injury episode, which required temporary renal replacement therapy for at least once. Interventions Users (n = 3,885) and nonusers (n = 4,673) of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Measurements and main results We used Cox proportional hazards regression models to analyze hazard ratios for the commencement of end-stage renal disease and all-cause mortality for angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users (n = 3,885) and nonusers (n = 4,673). In a median follow-up of 4.3 years, 5,880 patients (68.7%) required long-term dialysis, and 4,841 patients (56.6%) died. Compared with postacute kidney injury patients who did not use angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users are marginally less likely to progress to end-stage renal disease (adjusted hazard ratio 0.95; 95% CI 0.90-1.01; p = 0.06) and significantly less likely to suffer from all-cause mortality (adjusted hazard ratio 0.93; 95% CI 0.87-0.98; p = 0.011). Conclusions In patients who experienced renal replacement therapy-requiring acute kidney injury and have hypertension, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use is associated with better survival outcomes compared with nonuser.
- Published
- 2020
46. Peptic Ulcer Disease is Associated with Increased Risk of Chronic Urticaria Independent of Helicobacter pylori Infection: A Population-Based Cohort Study
- Author
-
Chih-Cheng Hsu, Li-Jen Chang, Yueh-Han Hsu, Chun-Ming Chen, and Wan-Ting Huang
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Absolute risk reduction ,Retrospective cohort study ,Dermatology ,General Medicine ,Helicobacter pylori ,biology.organism_classification ,Confidence interval ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Risk factor ,business ,Cohort study - Abstract
Some studies showed patients with chronic urticaria have a higher rate of peptic ulcer disease (PUD). Whether PUD is a risk factor for chronic urticaria is unclear. The objective of this study was to evaluate the incidence of and risk factors for chronic urticaria in patients with PUD using the Taiwan National Health Insurance Research Database. We conducted a retrospective nationwide cohort study of the period 2000–2012 and involving 11,901 patients with PUD who underwent Helicobacter pylori (HP) therapy (PUD + HP group) and an equal number of matched patients without HP infection (PUD − HP group). Furthermore, we enrolled 23,802 patients without PUD for comparison (non-PUD group). The Cox proportional hazards regression model was used to analyze chronic urticaria risk after adjusting for potential confounding factors. The mean ages of the three groups were around 50 years. Approximately 42.6% were female. Chronic urticaria incidences in the PUD + HP and PUD − HP groups were both significantly higher than that in the non-PUD group. The hazard ratios of chronic urticaria in the PUD + HP group and the PUD − HP group were 1.34 (95% confidence interval 1.09–1.64) and 1.45 (95% confidence interval 1.19–1.79), respectively. The risk difference became significant 2 years after patients with PUD had the HP infection tests and persisted till the end of follow-up. The risk increase was significant in patients with PUD who were female or aged 40–64 years. There was no difference in the risk comparison between PUD + HP and PUD − HP groups. Peptic ulcer disease, independent of HP infection, is associated with an increased chronic urticaria risk. Patients with PUD who were female or aged 40–64 years are more likely to have chronic urticaria.
- Published
- 2020
47. The 10-Year Prognosis and Prevalence of Brugada-Type Electrocardiograms in Elderly Women
- Author
-
Sherri Shih-Fan Yeh, Chih-Cheng Hsu, Chao A. Hsiung, Chi-Chung Wang, Feng-Cheng Tang, Huey-Ming Lo, Ching-Yu Julius Chen, Wei-Ting Tseng, Hou-Chang Chiu, Tzu-Yu Chen, I-Chien Wu, Dun-Hui Yang, Chung-Chou Juan, and Jyh-Ming Jimmy Juang
- Subjects
Advanced and Specialized Nursing ,Pediatrics ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,030204 cardiovascular system & hematology ,medicine.disease ,Stratified sampling ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Anxiety ,cardiovascular diseases ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,education ,business ,Survival analysis ,Brugada syndrome ,Cause of death - Abstract
Background Brugada syndrome is a disorder associated with sudden cardiac death and characterized by an abnormal electrocardiogram (ECG). Previous studies were predominantly conducted in men, and the data on long-term prognosis are limited. Information about women, especially elderly women, is lacking. Objective The aim of this study was to investigate the long-term prognosis of the Brugada ECG pattern in elderly women. Method We investigated the 10-year prognosis of the Brugada ECG pattern in elderly women in a nationwide community-based population in Taiwan. Community-dwelling women older than 55 years were prospectively recruited from December 2008 to March 2013 by a stratified random sampling method. All enrolled individuals were followed up annually until April 2019, and the cause of death was documented by citizen death records. Results Among 2597 women, 60 (2.31%) had a Brugada-type ECG, and this prevalence was higher than the mean global prevalence of 0.23%. One woman had a type 1 ECG (0.04%), whereas 15 (0.58%) and 44 (1.70%) women had type 2 and type 3 ECG patterns, respectively. Cox survival analysis revealed that all-cause mortality and cardiac mortality were similar in the individuals with and without a Brugada-type ECG during a mean follow-up of 96.1 ± 20.5 months. Conclusions Our findings suggest that Brugada ECG patterns are not infrequent in elderly women but are not associated with increased risk of mortality in long-term follow-up; these findings may help reduce unnecessary anxiety for physicians, nurses, allied health caregivers, and patients.
- Published
- 2020
48. Sleep habits are associated with cognition decline in physically robust, but not in frail participants: a longitudinal observational study
- Author
-
Shu-Chun Chuang, I.-Chien Wu, Jen-Jen Chang, Yi-Fen Tsai, Chiu-Wen Cheng, Yen-Feng Chiu, Hsing-Yi Chang, Marion M. Lee, Chih-Cheng Hsu, and Chao Agnes Hsiung
- Subjects
Sleep Wake Disorders ,Multidisciplinary ,Cognition ,Frailty ,Frail Elderly ,Sleep Initiation and Maintenance Disorders ,Humans ,Cognitive Dysfunction ,Disorders of Excessive Somnolence ,Sleep ,Geriatric Assessment ,Aged - Abstract
Frail older adults are vulnerable to stressors; thus, sleep related cognition impairment might more greatly affect frail than healthy older adults. In the present study, we investigated whether the association between sleep problems and cognition varies with physical frailty status (modified from Fried et al.). Participants 55 years and older who completed a baseline and follow-up questionnaire (median follow-up: 5.5 years), were included in the analysis. Sleep parameters were evaluated in an interview at the baseline. Cognitive decline was defined as a loss of 3 or more points on the Mini-Mental State Examination (MMSE) at follow-up. Associations between sleep problems and cognitive decline were examined using logistic regression and were stratified by baseline physical frailty status, adjusted for potential confounders. A short total sleep duration ($$\ge $$ ≥ 2 vs. 0, OR = 3.79, 95% CI 2.10–6.85, p
- Published
- 2022
49. Statins Reduce Hepatocellular Carcinoma Risk in Patients with Chronic Kidney Disease and End-Stage Renal Disease: A 17-Year Longitudinal Study
- Author
-
Fung-Chang Sung, Yi-Ting Yeh, Chih-Hsin Muo, Chih-Cheng Hsu, Wen-Chen Tsai, and Yueh-Han Hsu
- Subjects
Cancer Research ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,nutritional and metabolic diseases ,hepatocellular carcinoma ,chronic kidney failure ,hydroxymethylglutaryl-CoA reductase inhibitors ,renal dialysis ,retrospective cohort study ,statins ,urologic and male genital diseases ,Oncology ,lipids (amino acids, peptides, and proteins) ,cardiovascular diseases ,RC254-282 - Abstract
Hepatocellular carcinoma (HCC) is the most common cancer in end-stage renal disease (ESRD) patients in Taiwan. Whether statin therapy associated with the HCC risk in hyperlipidemic patients with chronic kidney disease (CKD) and ESRD is unclear. Using population-based insurance claim data from Taiwan, we identified from hyperlipidemic patients taking statins or not (677,364 versus 867,707) in 1999–2015. Among them, three pairs of propensity score matched statin and non-statin cohorts were established by renal function: 413,867 pairs with normal renal function (NRF), 46,851 pairs with CKD and 6372 pairs with ESRD. Incidence rates of HCC were compared, by the end of 2016, between statin and non-statin cohorts, between hydrophilic statins (HS) and lipophilic statins (LS) users, and between statin-ezetimibe combination therapy (SECT) and statin monotherapy (SM) users. The HCC incidence increased progressively from NRF to CKD and ESRD groups, was lower in the statin cohort than in the non-statin cohort, with the differences of incidence per 10,000 person-years increased from (7.77 vs. 21.4) in NRF group to (15.8 vs. 37.1) in CKD group to (19.1 vs. 47.8) in ESRD group. The incidence increased with age, but the Cox method estimated hazard ratios showed a greater statin effectiveness in older patients. Among statin users, the HCC incidence was lower in HS users than in LS users, and lower in SECT users than in SM users, but the difference was significant only in the NRF group. Hyperlipidemic patients with CKD and ESRD receiving statins are at reduced HCC risks; the treatment effectiveness is superior for HS users than for LS users, and for SECT users than for SM users, but not significant.
- Published
- 2022
50. Prevalence and Risk Factors of Neuropsychiatric Symptoms in Institutionalized Patients with Parkinson’s Disease in Taiwan: A Nationwide Observational Study
- Author
-
Yang-Pei Chang, Ching-Fang Chien, Sun-Wung Hsieh, Ling-Chun Huang, Chung-Fen Lin, Chih-Cheng Hsu, and Yuan-Han Yang
- Subjects
nursing home ,Health Information Management ,Leadership and Management ,Health Policy ,prevalence ,Parkinson’s disease ,risk factors ,neuropsychiatric symptoms ,Health Informatics - Abstract
Neuropsychiatric symptoms (NPSs) are known to be frequent in Parkinson’s disease (PD) with great impacts on the quality of life, but reports about the prevalence in institutions are few. Our aim was to investigate the prevalence of and risk factors for NPSs in institutionalized patients with PD in Taiwan. The National Health Research Institute executed a cross-sectional, community-based, observational study on residential long-term care service institutions. The diagnosis of PD was determined by physicians with the estimated Hoehn and Yahr stage of PD according to the EQ-5D-5L questionnaire. A total of 370 patients with PD (80.1 ± 9.94 years old, 55.1% females) were included, and 139 (37.6%) had more than one NPS in the prior 3 months. The top three NPSs were nighttime behavior (65 (17.6%)), depression (53 (14.3%)), and fear/anxiety (49 (13.2%)). There were no differences between those with NPS and those without NPS in terms of age, gender, education, Mini-Mental State Examination, or Hoehn and Yahr stage. However, multivariate logistic regression analysis showed that genitourinary disease (odds ratio (OR) = 3.13; 95% confidence interval (95%CI) = 1.77–5.51) and psychiatric disorders (OR = 5.18; 95%CI = 3.09–8.69) may be associated with increased risk of NPSs. Increased physical restraint was observed in residents with advanced PD. Genitourinary disease and psychiatric disorders appear to increase the risk of NPSs in institutionalized residents with PD.
- Published
- 2023
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.