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Background: A genome-wide association study identified variants in or near patatin-like phospholipase domain-containing-3 (PNPLA3), neurocan (NCAN), lysophospholipase-like 1 (LYPLAL1), glucokinase regulatory protein (GCKR), and protein phosphatase 1 regulatory subunit 3b (PPP1R3B) that were strongly associated with nonalcoholic fatty liver disease (NAFLD) in adults of European ancestry. Objective: We examined these genetic variants in obese children and tested whether their effects on NAFLD are significant in the Taiwanese Han Chinese population. Design: We genotyped PNPLA3 rs738409, NCAN rs2228603, LYPLAL1 rs12137855, GCKR rs780094, and PPP1R3B rs4240624 in 797 obese children aged 7-18 y. NAFLD was identified by liver ultrasonography. We analyzed the effect of these genetic variants on NAFLD. Results: NAFLD was identified in 24% of the recruited obese children. We found significant associations with NAFLD at variants in PNPLA3 and GCKR but not in NCAN, LYPLAL1, and PPP1R3B. Multiple logistic regression analysis showed that, after control for the effects of age- and sex-adjusted body mass index, waist-to-hip ratio, sex, and PNPLA3 rs738409 polymorphism, the variant GCKR rs780094 TT genotype independently increased the OR of NAFLD by 1.997 (95% CI: 1.196, 3.335; P = 0.008) compared with the CC genotype. Subjects with the variant GCKR rs780094 TT genotype had a higher mean serum alanine aminotransferase concentration than did those with the CC genotype (30.8 ± 34.7 compared with 22.2 ± 18.6 IU/L; P = 0.01). Conclusions: By studying the genetic variants of obese Taiwanese children, we confirmed that the genetic variants in GCKR rs780094 and PNPLA3 rs738409, but not in NCAN rs2228603, LYPLAL1 rs12137855, and PPP1R3B rs4240624, are associated with an increased risk of NAFLD. GCKR and PNPLA3 variants are the common genetic factors that may confer susceptibility to NAFLD in obese individuals across multiple ethnic groups. This trial was registered at clinicaltrials.gov as NCT00274183. [ABSTRACT FROM AUTHOR]

Background: The utilization of medical care for gastrointestinal diseases increased over the past decade worldwide. The aim of the study was to investigate the difference between rural and urban patients in seeking medical service for gastrointestinal diseases at ambulatory sector in Taiwan. Methods: From the one-million-people cohort datasets of the National Health Insurance Research Database, the utilization of ambulatory visits for gastrointestinal diseases in 2009 was analyzed. Rural patients were compared with urban and suburban patients as to diagnosis, locality of visits and choice of specialists. Results: Among 295,056 patients who had ambulatory visits for gastrointestinal diseases in 2009, rural patients sought medical care for gastrointestinal diseases more frequently than urban and suburban patients (1.60 ± 3.90 vs. 1.17 ± 3.02 and 1.39 ± 3.47). 83.4% of rural patients with gastrointestinal diseases were treated by non-gastroenterologists in rural areas. Rural people had lower accessibility of specialist care, especially for hepatitis, esophageal disorders and gastroduodenal ulcer. Conclusion: The rural-urban disparity of medical care for gastrointestinal diseases in Taiwan highlighted the importance of the well communication between rural physicians and gastroenterologists. Besides the establishment of the referral system, the medical teleconsultation system and the arrangement of specialist outreach clinics in rural areas might be helpful. [ABSTRACT FROM AUTHOR]

Curvilinear relationships between role stress and innovative performance were explored in a study conducted in Taiwan and mainland China. Results showed that when perceived support for innovation was low, role conflict showed a U-shaped relationship with both self-rated and supervisor-rated innovative performance, which contrasts sharply with the well known inverted U-shaped relationship between challenge stress and performance. Role ambiguity showed a similar but weaker pattern with regard to supervisor-rated innovative performance. When perceived support for innovation was high, role conflict showed a generally positive relationship with both self-rated and supervisor-rated innovative performance, but role ambiguity showed no significant relationship with supervisor-rated innovative performance. Theoretical and applied implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Objectives: The rate of recombinant tissue plasminogen activator (rtPA) use for stroke is low among the Chinese-Taiwanese. The study objective was to determine if less restrictive exclusion criteria for rtPA would increase eligibility and the rate of treatment. Methods: This retrospective before-and-after study was conducted from 2006 to 2009. The authors compared stroke patients treated under the old rtPA exclusion criteria (January 2006 to December 2008) with those treated with less restrictive rtPA exclusion criteria (January to December 2009). Rates of eligibility and treatment and reasons for exclusion from rtPA between the two phases were assessed. Results: Of 461 eligible patients during the study period, 333 were evaluated by the old criteria and 128 were evaluated by the less restrictive criteria. Minor or improving stroke was the primary exclusion reason in both groups (194/333, 58% vs. 70/128, 55%). Eligibility for rtPA was increased in the less restrictive criteria (35/127, 27%, 95% confidence interval [CI] = 20% to 36%) compared to the old criteria (40/333, 12%, 95% CI = 8.7% to 16%; p = 0.0001). Fewer patients were excluded due to old age in the less restrictive criteria (0/128, 0%) compared to the old criteria (37/333, 11%; p = 0.0001). The rate of consent refusal increased in the less restrictive criteria (27/128, 21%, 95% CI = 14% to 29%) compared to the old criteria (23/333, 6.9%, 95% CI = 4.4% to 10%; p < 0.0001). Rate of rtPA treatment was unchanged between the less restrictive criteria (8/128, 6.3%, 95% CI = 2.7% to 12%) and the old criteria (17/333, 5.1%, 95% CI = 3% to 8%; p = 0.63). Conclusions: Increasing eligibility for rtPA does not increase the rate of treatment, possibly due to the high symptomatic intracerebral hemorrhage rate among Chinese-Taiwanese, which is a major concern among emergency physicians (EPs), neurologists, and patients. Dealing with perceived safety issues of rtPA is crucial before the rate of treatment can be increased. [ABSTRACT FROM AUTHOR]

Background: Patients must adhere to their prescribed warfarin regimens and regularly monitor the anticoagulation effect to maintain therapeutic levels. The ability to evaluate regimen adherence accurately is crucial to the success of patient coaching. However, prevention of thromboembolic events is challenging when the association between medication adherence and the actual amount of anticoagulant agent taken cannot be determined. Purpose: This study used self-reported medication taken and prescription refills to (a) verify warfarin medication adherence and (b) assist clinicians to determine the discrepancy between medication adherence and anticoagulant control efficacy. Methods: This study was conducted at a national-university-affiliated hospital in Yilan County, Taiwan. Structured questionnaires and medical record reviews were adopted. A 100-point visual analog scale was used to measure the reported adherence of participants, whereas medication refill adherence was compared against self-reported adherence. Finally, degree of adherence was evaluated based on time in therapeutic range. Results: This study included 192 participants. Half (n = 94, 49%) were women, and the mean age was 69.6 years. Mean scores were 92.2% for the visual analog scale and 87.3% for medication refill adherence. Medication adherence correlated significantly with age, as reflected in the visual analog scale scores (p <.05). The participants who were receiving polypharmacy with five types of medicines or less attained higher visual analog scale scores, whereas participants who were on warfarin for 2–12 months exhibited higher medication refill adherence. Time in therapeutic range correlated negatively with age, although stability improved with therapy duration. Conclusions/Implications for Practice: Despite their high self-reported adherence levels, patients of advanced age require careful monitoring of their time in therapeutic range. The participants in this study who were on warfarin for a relatively longer time exhibited higher stability in the therapeutic range, despite their low medication refill adherence. The results of this study suggest that patient age, duration of warfarin therapy, and polypharmacy are factors associated with medication adherence. The findings may facilitate future assessments of warfarin adherence in patients as well as the implementation of more effective clinical nursing procedures and management practices. [ABSTRACT FROM AUTHOR]