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Both focused extracorporeal shockwave (f-ESWT) and radial extracorporeal shockwave therapy (r-ESWT) can alleviate symptoms in patients with knee osteoarthritis, but no trials have directly compared f-ESWT with r-ESWT for knee osteoarthritis. This study aimed to compare the effectiveness of f-ESWT and r-ESWT on knee osteoarthritis. Forty-two patients with bilateral knee osteoarthritis were randomly assigned to receive three sessions of either f-ESWT or r-ESWT at 1-week intervals. The patients were evaluated at baseline and at 4 and 8 weeks after the final treatment. The primary outcome was the change in pain intensity, as measured on the visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion of the knee joint, and the 6-minute walk test. At the end of 4 weeks, the VAS score was substantially reduced in both groups (f-ESWT, −4.5 ± 2.5 points; r-ESWT, −2.6 ± 2.0 points), with a greater reduction in the f-ESWT group. Both groups showed significant improvement in secondary outcomes; however, the f-ESWT group yielded greater improvement in the VAS score, WOMAC score, and 6-minute walk test. Our results showed that f-ESWT was more effective than r-ESWT in improving pain and physical function in patients with knee osteoarthritis.

Summary: Spasticity is a common condition in stroke survivors, and may be associated with pain and joint contracture, leading to poor quality of life and increased caregiver burden. Although the underlying mechanisms are not well-understood, it may be due to disruption of the balance of supra-spinal inhibitory and excitatory sensory inputs directed to the spinal cord, leading to a state of disinhibition of the stretch reflex. The treatment options include physical therapy, modality and pharmacological treatments, neurolysis with phenol and botulinum toxin, and surgical treatment. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, natural history, and impact on patient's performances. This review focuses on the epidemiology, presumed mechanism, clinical manifestation, and recent evidences of management. Keywords: stroke, muscle spasticity, mechanism, symptom management

Objective To investigate whether extracorporeal shock wave therapy (ESWT) is noninferior to botulinum toxin type A (BoNT-A) for the treatment of poststroke upper limb spasticity. Design Randomized noninferiority trial. Setting Referral medical center. Participants Patients (N=42) with chronic stroke (28 men; mean age, 61.0±10.6y). Interventions Patients received either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation. Main Outcome Measures Assessments were performed at baseline and at 1, 4, and 8 weeks after the intervention. The primary outcome was the change from baseline of the modified Ashworth scale (MAS) score of the wrist flexors at week 4. Secondary outcomes included the change of the MAS scores, Tardieu angles of the wrist and elbow flexors, wrist and elbow passive range of motion (PROM), and upper extremity Fugl-Meyer Assessment (UE-FMA) score during the study period, as well as the treatment response rate. Results The primary outcome result in the ESWT group (−0.80±0.41) was similar to that in the BoNT-A group (−0.90±0.44), with a higher confidence limit (0.4) for the difference between groups within the prespecified margin of 0.5, indicating the noninferiority of ESWT to BoNT-A. The response rate was not significantly different between the 2 groups. Both groups showed significant improvement in secondary outcomes relative to baseline; however, the ESWT group yielded greater improvement in wrist and elbow PROM and UE-FMA score. Conclusion Our results suggest that ESWT is a noninferior treatment alternative to BoNT-A for poststroke upper limb spasticity. ESWT and BoNT-A caused similar reduction in spasticity of the wrist and elbow flexors; however, ESWT yielded greater improvement in wrist and elbow PROM and UE-FMA score.

Patients with stroke have an increased risk of dementia. Some studies have found that statin use might lower the risk of incident dementia; however, there is still a lack of data from patients with stroke. Therefore, the aim of our study was to investigate the impact of statin use on the risk of dementia in patients with stroke.We used the National Health Insurance Research Database in Taiwan to identify 14,807 patients diagnosed with stroke from 1997 to 2005. These patients were classified as statin users and nonusers. Propensity score matching was performed to balance selected confounders between the statin users and nonusers. Cox proportional hazard regression models were used to evaluate the association between statin use and the risk of dementia.During the follow-up period (median, 7.5 years), 1895 patients were diagnosed with incident dementia. Statin use was associated with a significantly lower incidence of dementia (adjusted hazard ratio, .81; 95% confidence interval, .73-.89) than nonuse was. In particular, lipophilic and high-potency statins were associated with lower risk of dementia. Statin exposure duration was inversely related to the risk of dementia (P.001 for the trend). No significant effect modification for the relationship between statin use and the risk of dementia was found for either age or sex.In this nationwide cohort study, statin use was associated with decreased risk of dementia among patients with stroke. The use of high-potency statins, lipophilic statins, and prolonged exposure to statins may be associated with greater benefits.

Background: Most stroke cases lead to serious mental and physical disabilities, such as dementia and sensory impairment. Chronic diseases are contributory risk factors for stroke. However, few studies considered the transition behaviors of stroke to dementia associated with chronic diseases and environmental risks. Objective: This study aims to develop a prognosis model to address the issue of stroke transitioning to dementia associated with environmental risks. Design: This cohort study used the data from the National Health Insurance Research Database in Taiwan. Setting: Healthcare data were obtained from more than 25 million enrollees and covered over 99% of Taiwan&rsquo, s entire population. Participants: In this study, 10,627 stroke patients diagnosed from 2000 to 2010 in Taiwan were surveyed. Methods: A Cox regression model and corresponding semi-Markov process were constructed to evaluate the influence of risk factors on stroke, corresponding dementia, and their transition behaviors. Main Outcome Measure: Relative risk and sojourn time were the main outcome measure. Results: Multivariate analysis showed that certain environmental risks, medication, and rehabilitation factors highly influenced the transition of stroke from a chronic disease to dementia. This study also highlighted the high-risk populations of stroke patients against the environmental risk factors, the males below 65 years old were the most sensitive population. Conclusion: Experiments showed that the proposed semi-Markovian model outperformed other benchmark diagnosis algorithms (i.e., linear regression, decision tree, random forest, and support vector machine), with a high R2 of 90%. The proposed model also facilitated an accurate prognosis on the transition time of stroke from chronic diseases to dementias against environmental risks and rehabilitation factors.

Summary Background Self-rated health (SRH) is known to be a valid indicator for the prediction of mortality among middle-aged and older adults, but findings regarding age and gender differences are inconsistent. This study aimed to determine the association of SRH with subsequent mortality risk among middle-aged and elderly people in Taiwan. Methods This study was based on data from the “Taiwan Longitudinal Survey on Aging” (TLSA). A total of 2553 men and 2192 women aged ≥ 50 years of age comprised the major analytic cohort (mean age, 66.8 ± 9.1 years). SRH was categorized into good, fair, and poor health. Cox regression methods were used to examine the association between SRH and mortality. Results During the follow-up period (median: 10.1 years), 1644 deaths occurred. Participants with poor SRH were at higher risk of mortality [relative risk (RR), 1.35 95% confidence interval (CI), 1.16–1.55)] than those with good SRH. This SRH-mortality association was more pronounced among men (RR, 1.56, 95% CI, 1.30–1.87) than women (RR, 1.01, 95% CI, 0.80–1.27). The associations decreased with increasing age. The SRH-mortality associations were significant for the oldest age group among men, but among women, there was no significant SRH-mortality association across all age groups. Conclusion Low SRH was associated with increased risk of mortality among middle-aged and older adults. The association varied across different age and gender groups. The association was strongest in the group of men aged 50–59 years. The factors that might explain the differences in the associations warrant further research.

Background Recent studies have suggested that either focused or radial shock wave therapy is an effect method for the treatment of spasticity in patients with stroke. However, no previous study compared these two types of extracorporeal shock wave on spasticity in patients with stroke. This study aimed to compare the effect of focused and radial shock wave therapy for the treatment of spastic equinus in patients with stroke. Design Randomized control trial. Setting Outpatient rehabilitation center in a medical center. Population Thirty-two stroke patients with spastic equinus (18 males and 14 women; mean age, 60.1±10.6 years). Methods Patients were randomly assigned to receive three sessions of either focused or radial shock wave therapy at 1-week intervals. The intensities that were used during focused shock wave therapy (0.12 mJ/mm2) and radial shock wave therapy (2.4 bar) were comparable. The patients were evaluated at baseline and at 1, 4, and 8 weeks after the final shockwave treatment. The primary outcome measure was change of modified Ashworth Scale Score of gastrocnemius muscle. The secondary outcome measures were Tardieu Scale, ankle passive range of motion, dynamic foot contact area and gait speed. A linear mixed model with repeated measures was used to compare each outcome measure between the two groups. Results Both groups improved significantly in terms of modified Ashworth Scale Score and Tardieu Scale, and no differences were found between the two groups. In terms of ankle passive range of motion and plantar contact area during gait, the radial shock wave therapy yielded a significantly greater improvement than the focused shock wave therapy. No significant changes were observed in gait speed in either group. Conclusions Our study suggested that focused and radial shock wave therapy resulted in similar significant improvements in the modified Ashworth scale score and Tardieu scale, but those in the radial shock wave therapy group experienced greater improvements in the ankle passive range of motion and plantar contact area during gait. Clinical rehabilitation impact Both focused and radial shock wave therapy yielded similar improve the spasticity of gastrocnemius muscle. Radial shock wave therapy is superior to focused shock wave therapy in terms of improving the ankle passive range of motion and plantar contact area during gait in patients with stroke.

Objective: Agomelatine is a new antidepressant with unique melatonin receptor type 1A (MTNR1A) and 1B ( MTNR1B) agonism and serotonergic receptor 5-hydroxytryptamine receptor 2C (5-HT-2C) antagonism. Several studies of patients with major depressive disorder (MDD) have confirmed the superior efficacy and safety of agomelatine in comparison with established treatments, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs). This meta-analysis comprehensively shows the efficacy, acceptability, and safety of agomelatine in comparison with SSRIs and SNRIs used as antidepressants in MDD. Method: Comprehensive electronic database searches were performed to identify reports of head-to-head randomized controlled trials that have compared agomelatine with SSRIs or SNRIs in terms of efficacy/effectiveness in treating MDD. Response and remission rates at both acute (6–12 weeks) and follow-up (24 weeks) phases, Clinical Global Impression-Improvement Scale response and remission rates, changes in depression scale scores, improvements in subjective sleep, dropout rates, and side effect rates were extracted and analysed. Results: The meta-analysis included six head-to-head trials involving 1871 patients. In the acute phase, agomelatine had higher response rates (relative risk (RR) 1.08, 95% confidence interval (CI) 1.02–1.15) compared to SSRIs and SNRIs. In the remission analysis, only acute remission rates (RR 1.12, 95% CI 1.01–1.24) significantly differed. The action of agomelatine was superior on the Leeds Sleep Evaluation Questionnaire-Quality of Sleep score (mean difference 4.05, 95% CI 0.61–7.49). Discontinuation due to inefficacy did not differ between agomelatine and SSRIs/SNRIs (RR 0.74, 95% CI 0.42–1.28). Compared to SSRIs and SNRIs, however, agomelatine revealed a lower rate of discontinuation due to side effects (RR 0.38, 95% CI 0.25–0.57). Conclusions: Agomelatine has significantly higher efficacy and potential acceptability compared to SSRIs and SNRIs when treating MDD. However, the difference in efficacy is not considered clinically relevant. Because of its unique chronobiotic effects, agomelatine may be useful for the management of some MDD patients with circadian disturbance.

To investigate the relationship between the volume of inpatient rehabilitation therapy and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity.A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009.Referral medical center.Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital.Not applicable.Stroke-related mortality.During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. Greater volume of rehabilitation therapy was associated with a reduced risk of all-cause and cardiovascular mortality (P for trend.001 for both). Compared with the first tertile, the third tertile of rehabilitation volume was associated with a 55% lower risk of all-cause mortality (hazard ratio [HR]=.45; 95% confidence interval [CI], .30-.65) and a 50% lower risk of cardiovascular mortality (HR=.50; 95% CI, .31-.82). The association did not vary with respect to stroke severity (P for interaction = .45 and .73 for all-cause and cardiovascular mortality, respectively).The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke. Thus, further programs aimed at promoting greater use of rehabilitation services are warranted.

Summary Cardiovascular disease (CVD) represents a leading cause of mortality and morbidity especially among the elder people, and therefore the need of effective preventive strategies is imperative. Despite limited data among the elderly people, the majority of published studies have demonstrated that physically active elderly people have lower rates of CVD. In this article, we provide an overview of the epidemiology studies that investigate this association and analyze the relevant underlying biological mechanisms. We also discuss the types and amounts of physical activity recommended for the primary prevention of CVD in older adults.

Aim Predictors of short- and long-term all-cause mortality of older stroke patients were explored. Methods Cox regression models were used to estimate the relative risk and 95% confidence intervals (CI) in the database entries of 636 older stroke patients aged 70 years and over. Results National Institutes of Health Stroke Scale (NIHSS) score on admission, age and coronary heart disease were significantly associated with 28-day death. The hazard ratios for the predictors of long-term mortality were as follows: NIHSS score, 1.1 (95% CI: 1.07–1.1); serum glucose level, 1.08 (95% CI: 1.01–1.2); serum triglyceride level, 0.6 (95% CI: 0.4–0.8); age, 1.04 (95% CI: 1.01–1.08); and coronary heart disease, 2.7 (95% CI: 1.4–5.4). Conclusions NIHSS score on admission, age and coronary heart disease are independent predictors of short- and long-term mortality. Higher glucose and lower triglyceride level are significantly associated with the long-term mortality.

Summary Significant progress in our understanding of risk factors and interventions in heart failure, a leading cause of death and disability, has occurred in recent years. Several advances in therapy for heart failure with reduced left ventricular systolic function (i.e., systolic heart failure) have led to significantly improved outcomes. Treatment options for diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), by contrast, remain comparatively limited. In part, this is due to gaps in our understanding of the underlying pathophysiology and the lack of standardized criteria for its diagnosis and classification. Aging and hypertension remain the leading causes of HFpEF; increased ventricular and vascular stiffness is a feature of both. Comorbidities such as diabetes, renal insufficiency, and metabolic abnormalities further aggravate disease process, and data regarding effective treatment are lacking. This article discusses the risks, mechanisms, and outcomes of HFpEF from previous studies, and summarizes potential interventions that may provide new insights into our understanding of the disease and its treatment.

Summary Background Functional status is an important component of health status of the elderly. However, few studies have discussed the correlation between health status and each item of the activities of daily living scales (ADLs). The aim of this study was to investigate both the prevalence of functional disability in each activity of daily living (ADL) item and the association between each ADL item and the self-rated health of the elderly. Methods A stratified random sample of 302 male and 298 female elderly residents, aged 65 and older, in Miaoli County was drawn. Baseline characteristics, functional status of each ADL item, and self-rated health of the participants were collected. Results The results showed that the self-rated health status was excellent, good, or fair in 72.3% of the sample, and bad or poor in 27.7%. The most common disability among basic ADLs was transfers (9.3%); the most common disability among instrumental ADLs (IADLs) was transportation (24.7%). Multiple logistic regression analysis revealed that bathing, feeding, dressing, bowel and bladder control, transfers, transportation, and responsibility for own medication, were independently associated factors of self-rated health. Bowel and bladder control (odds ratio, 4.72; 95% confidence interval, 1.76–12.67) and feeding (odds ratio, 4.27; 95% confidence interval, 1.61–11.37) were the leading items correlated with self-rated health. Conclusion In summary, in terms of self-rated health, the most important ADLs were bowel and bladder control and feeding. Further study is warranted to investigate the effects of restoring specific health-related ADL to improve the health of the elderly.

Background and purpose: Previous studies demonstrated that post-stroke hyperglycemia was associated with poor outcome in non-diabetic patients. However, evidence was inconclusive amongst patients with diabetes. The aim of this study was to evaluate the relationship between initial glucose levels and mortality amongst patients with acute ischaemic stroke, and further, to assess whether the association varied by diabetes mellitus and glycated hemoglobin (HbA1c) levels. Methods: Data were collected from the medical records of 1277 first-ever stroke patients admitted to the emergency room between January 1, 2008 and June 30, 2009. Cox regression analysis was performed to assess the relationship between initial glucose level and mortality. Results: Compared with the lowest quartile of initial glucose level, a significant association with all-cause death [hazard ratio (HR), 2.18; 95% CI, 1.36–3.48] and cardiovascular death (HR, 1.91; 95% CI, 1.01–3.61) was seen in the highest quartile. In non-diabetic subgroup, those patients within the highest quartile of initial glucose level had a 3.29-fold relative risks (RR) [95% confidence interval (CI), 1.62–6.68] for all-cause and a 2.54-fold RR (95% CI, 1.43–8.77) for cardiovascular death compared with those within the lowest quartile. However, the association between initial glucose levels and the risk of death was not significant amongst those with diabetes (P for interaction = 0.01). In addition, the risk amongst patients with diabetes varied by the HbA1c levels. Conclusions: A significant association was confirmed between initial glucose level and mortality in non-diabetic ischaemic stroke patients. The possible relationship between initial glucose level, HbA1c level, and mortality amongst ischaemic stroke patients with diabetes warrants further research.

This study was aimed to compare the application of a tree model and regression approach for developing data-driven models that identified frisk factors related to functional outcomes among ischaemic stroke patients.Data were derived from 271 hospitalised patients with a first-ever ischaemic stroke. The Barthel Index (BI) and Modified Rankin Scale (MRS) were used to assess the functional outcomes. The stroke severity at admission and related information from 2006 to December 2007 were extracted retrospectively from a chart review.In the regression approach, including age, the National Institutes of Health Stroke Scale (NIHSS) score and glucose level were the most significant predictors affecting both the BI and MRS. After applying the tree model, different tree structures were found. For the BI score, the NIHSS score interact with glucose, age and systolic blood pressure to form the tree structure. By contrast, the NIHSS score mainly interact with patients' age to form the tree model for MRS.Both models have their pros and cons. The tree model otherwise provides risk interactions, and can effectively discriminate the risk groups for different functional outcomes. Applying both models to specific situations will provide a different angle for functional assessment and intervention in stroke rehabilitation.

Objective: To compare the effect of equivalent doses in two different volumes of botulinum toxin type A (Dysport) on gastrocnemius spasticity. Design: Single-blind, randomized, controlled trial. Setting: Hospital rehabilitation department Subjects: Twenty-two children with spastic diplegic or quadriplegic cerebral palsy. Intervention: High (500 U/5 mL) and low (500 U/1 mL)-volume preparations of Dysport were injected into the gastrocnemius muscles, each child randomly receiving one preparation in the right and the other in the left leg. Main measures: Dynamic ankle joint range of motion (ROM), passive ROM of the ankle joint, modified Ashworth Scale scores, and the areas of the compound muscle action potential assessed before treatment and at four and eight weeks post treatment. Results: Both legs improved significantly. The mean (SD) improvements between baseline and the end of follow-up were 19.7 (10.83) degrees for dynamic ROM, 8.4 (9.19) degrees for passive ROM, -1.3 (0.6) for modified Ashworth Scale scores, and -9.4 (11.41) mV-ms for compound muscle action potential in the high-volume group; and 13.5 (10.45) degrees for dynamic ROM, 7.4 (7.88) for passive ROM, -0.9 (0.5) for modified Ashworth Scale scores, and -5.9 (7.50) mV-ms for areas of compound muscle action potential in the low-volume group. The high-volume preparation yielded significantly greater improvement in dynamic ROM (P Conclusions: A high-volume preparation of Dysport is more effective than a low volume in reducing spasticity in the gastrocnemius muscle.

This article reports the difference between neuralgic amyotrophy and neuropathy caused by chemotherapy and radiation treatment which manifested with severe shoulder pain followed by marked weakness of bilateral upper arms and involvement of cranial nerves. A 62-year-old man presented with acute severe neuropathic pain at the left shoulder, bilateral shoulder weakness, hoarseness of voice from vocal cord palsy, and respiratory insufficiency from left diaphragm palsy, which all occurred sequentially over a 1-month period. The diagnosis of neuralgic amyotrophy was supported and differentiated from tumor-induced and radiation-induced neuropathy by clinical presentation, electrophysiologic and imaging studies. Unlike previous reports of the onset of neuralgic amyotrophy being associated with initiation of radiation treatment in cancer patients, this report demonstrates that neuralgic amyotrophy can occur at any point of the malignant disease process after radiation and chemotherapy.

We appreciate Dr. Lloyd-Sherlock's research work on the nature of long-term care in low and middle income countries1. His review of recent evidence indicates an extreme mismatch between the demand for long-term care and the quality of published research. Because aging is a universal concern, it is important to know the information about the nature of a country's long-term care for policymaking and planning2,3. The developments and determinants of demand for long-term care occur differently in different countries and country groups. In high income countries, long-term care needs are primarily related to the growing proportion of elderly in the population; in lowincome countries, long-term care needs are primarily the result of the high prevalence of chronic communicable diseases [such as AIDS and tuberculosis] and the result of physical and mental disability caused by war, violence, and accidents. During the years 2000e2050, the dependency ratios are expected to increase most significantly in high income countries, and meanwhile are expected to growmore slowly or even decrease in low income countries. Economic, social, and political factors may also be dramatically less favorable in low income countries, and the capacity of these governments to achieve social goals may often be compromised. Long-term care is covered very little by public financing schemes in low and middle income countries4. Twothirds of people worldwide who are aged 65 years live in low and middle income countries, but very little research about long-term care has been conducted to support policymaking in these regions. Evidence from population-based research on long-term care from low and middle income countries should help stimulate a wider debate about older people's health and social care demands, and how they should be provided for in these regions. Good quality research that is effectively disseminated can raise awareness

Predictors of short- and long-term all-cause mortality of older stroke patients were explored.Cox regression models were used to estimate the relative risk and 95% confidence intervals (CI) in the database entries of 636 older stroke patients aged 70 years and over.National Institutes of Health Stroke Scale (NIHSS) score on admission, age and coronary heart disease were significantly associated with 28-day death. The hazard ratios for the predictors of long-term mortality were as follows: NIHSS score, 1.1 (95% CI: 1.07-1.1); serum glucose level, 1.08 (95% CI: 1.01-1.2); serum triglyceride level, 0.6 (95% CI: 0.4-0.8); age, 1.04 (95% CI: 1.01-1.08); and coronary heart disease, 2.7 (95% CI: 1.4-5.4).NIHSS score on admission, age and coronary heart disease are independent predictors of short- and long-term mortality. Higher glucose and lower triglyceride level are significantly associated with the long-term mortality.

The aim of the study was to investigate the associations of occupational physical activity (OPA) and leisure-time physical activity (LTPA) with the risk of cardiovascular disease (CVD) and mortality. Physical activity data from the Baeck questionnaire was available for 1706 participants. During a follow-up period, there were 215 cases of CVD and 438 deaths. With the lowest tertile as the reference, the hazard ratios (HRs) for CVD and mortality in the highest tertiles of LTPA were 0.65 (95% confidence interval [CI] = 0.46-0.92) and 0.73 (95% CI = 0.58-0.92). In contrast, the HRs for CVD and mortality in the highest tertiles of OPA were 1.75 (95% CI = 1.10-2.80) and 1.53 (95% CI = 1.06-2.22). The association between OPA and the risk of CVD and mortality was significant in men but not in women. Our findings suggest that high OPA imposes harmful effects on the risk of CVD and mortality, particularly among men.

An association may exist between obstructive sleep apnea (OSA) and depression. However, results regarding this association are inconsistent, and the direction of the association between OSA and depression remains unknown. Therefore, we used the Taiwan National Health Insurance Research Database to investigate the bidirectional association between OSA and depression. A total of 6427 OSA patients and 32,135 age and sex-matched control subjects were enrolled to analyze the risk of depression among patients with OSA, where 27,073 patients with depression and 135,365 control subjects were enrolled to address the risk of OSA among patients with depression. All subjects were followed to identify their outcomes of interest from January 1, 1997 to December 31, 2012. Cox proportional-hazards models, after adjusting for potential confounders, demonstrated that patients with OSA had an increased risk (adjusted hazard ratio 2.48, 95% confidence interval 2.20–2.79) of developing depression, whereas those with depression were associated with an increased risk of future OSA (adjusted hazard ratio 2.30, 95% confidence interval 2.11–2.50). Our results suggested that a strong bidirectional relationship exists between OSA and depression, with each disease influencing the development of the other. Health providers are recommended to ensure the early detection and management of depression among patients with OSA and vice versa.

To identify the prognostic roles of initial glucose level in the emergency department among patients with acute ischemic stroke, and to evaluate whether or not the impact varied with diabetes.A total of 774 first-ever ischemic stroke patients admitted to the emergency department of a tertiary hospital in Taiwan. Participants were stratified into tertiles by initial glucose level in the emergency department. The Barthel Index (BI) and modified Rankin Scale (mRS) were used to assess functional outcome 3 months after the ischemic stroke.Initial glucose level was significantly associated with functional outcome 3 months after ischemic stroke. Compared with the 1st tertile, adjusted odds ratios for 2nd and 3rd tertiles of initial glucose level were 1.84 (95% confidence interval [CI], 1.15-2.95) and 4.57 (95% CI, 2.87-7.29), for BI of less than 60, 2.07 (95% CI, 1.28-3.36) and 4.45 (95% CI, 2.76-7.18) for mRS score of2. The association was apparent among the nondiabetic stroke patients compared with diabetic patients.A positive association was found between initial glucose level and poor functional outcome at 3 months in patients with acute ischemic stroke, particularly among nondiabetic patients.