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Lin WY, Lin PY, Liang WM, Kuo HW. Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan. BMC Public Health 2024; 24:1186. [PMID: 38678225 PMCID: PMC11055299 DOI: 10.1186/s12889-024-18679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND/OBJECTIVE Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic inequalities and urbanization levels in township-based CBD mortality in Taiwan. METHODS Socioeconomic variables, including the percentages of low-income households, individuals with a university education and above, and tax payments, were measured at the township level from 2011 to 2020. Urbanization was also determined by the national survey and divided into seven levels. Age-standardized mortality rate (ASMR) of CBD was calculated using a Geographic Information System (GIS) in 358 townships. The effects of socioeconomic variables and urbanization levels on relative and absolute inequalities in township-based CBD mortality rates were examined. RESULTS Significant differences in ASMR of CBD were observed across all socioeconomic status indicators over the years. Higher proportions of low-income households were associated with higher ASMR of CBD. Conversely, there were negative correlations between higher proportions of individuals with a university education and above and tax payments with ASMR of CBD. The regression analysis indicated significant impacts of relative and absolute socioeconomic inequalities on ASMR of CBD. Additionally, a moderation effect of socioeconomic variables and urbanization on CBD mortality rates was observed, with rural areas showing sensitivity to these factors. CONCLUSION Although ASMR of CBD showed significant decreases over time, socioeconomic inequalities in CBD mortality rates persist. Interventions targeting socioeconomic inequalities in health outcomes, especially in rural areas, are needed to address this issue.
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Affiliation(s)
- Wen-Yu Lin
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming Chao Tung University, No.155, Sec.2, Linong Street, 112, Taipei, Taiwan
- Resource Circulation Administration, Ministry of Environment, Taipei, Taiwan
| | - Ping-Yi Lin
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Hsien-Wen Kuo
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming Chao Tung University, No.155, Sec.2, Linong Street, 112, Taipei, Taiwan.
- Institute of Public Health, National Defense University, Taipei, Taiwan.
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Ranta A, Ozturk S, Wasay M, Giroud M, Béjot Y, Reis J. Environmental factors and stroke: Risk and prevention. J Neurol Sci 2023; 454:120860. [PMID: 37944211 DOI: 10.1016/j.jns.2023.120860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/01/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Stroke is a leading cause of death and adult disability globally. In addition to traditional risk factors, environmental risk factors have emerged over the recent past and are becoming increasingly important. The disproportionate rise of stroke incidence in low- and middle-income countries has been attributed, at least in part, to environmental factors. This narrative review provides details on the interplay between the environment and health generally and stroke specifically, covering topics including air pollution, atmospheric brown clouds, desert dust storms, giant wildfires, chemical contamination, biological aggressors, urbanization, and climate change. It also covers some beneficial environmental effects such as can be harnessed from the exposure to green spaces. It concludes with a summary of pragmatic actions that can be taken to help address some of these challenges at individual, community, and political advocacy levels.
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Affiliation(s)
- Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand; Department of Neurology, Wellington Hospital, Wellington, New Zealand.
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mohammad Wasay
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, France; Dijon Stroke Registry, Pathophysiology and Epidemiology of cerebrocardiovascular diseases (EA7460), University of Bourgogne, Dijon, France.
| | - Yannick Béjot
- Department of Neurology, University Hospital of Dijon, France; Dijon Stroke Registry, Pathophysiology and Epidemiology of cerebrocardiovascular diseases (EA7460), University of Bourgogne, Dijon, France.
| | - Jacques Reis
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
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Liu TY, Liao WL, Wang TY, Chan CJ, Chang JG, Chen YC, Lu HF, Yang HH, Chen SY, Tsai FJ. Genome-wide association study of hyperthyroidism based on electronic medical record from Taiwan. Front Med (Lausanne) 2022; 9:830621. [PMID: 35991636 PMCID: PMC9390483 DOI: 10.3389/fmed.2022.830621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Excess thyroid hormones have complex metabolic effects, particularly hyperthyroidism, and are associated with various cardiovascular risk factors. Previous candidate gene studies have indicated that genetic variants may contribute to this variable response. Electronic medical record (EMR) biobanks containing clinical and genomic data on large numbers of individuals have great potential to inform the disease comorbidity development. In this study, we combined electronic medical record (EMR) -derived phenotypes and genotype information to conduct a genome-wide analysis of hyperthyroidism in a 35,009-patient cohort in Taiwan. Diagnostic codes were used to identify 2,767 patients with hyperthyroidism. Our genome-wide association study (GWAS) identified 44 novel genomic risk markers in 10 loci on chromosomes 2, 6, and 14 (P < 5 × 10–14), including CTLA4, HCP5, HLA-B, POU5F1, CCHCR1, HLA-DRA, HLA-DRB9, TSHR, RPL17P3, and CEP128. We further conducted a comorbidity analysis of our results, and the data revealed a strong correlation between hyperthyroidism patients with thyroid storm and stroke. In this study, we demonstrated application of the PheWAS using large EMR biobanks to inform the comorbidity development in hyperthyroidism patients. Our data suggest significant common genetic risk factors in patients with hyperthyroidism. Additionally, our results show that sex, body mass index (BMI), and thyroid storm are associated with an increased risk of stroke in subjects with hyperthyroidism.
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Affiliation(s)
- Ting-Yuan Liu
- Center for Precision Medicine, China Medical University Hospital, Taichung, Taiwan
- Million-Person Precision Medicine Initiative, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Ling Liao
- College of Chinese Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung, Taiwan
- Genetics Center, Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Yuan Wang
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Endocrinology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Jung Chan
- Genetics Center, Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jan-Gowth Chang
- Center for Precision Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chia Chen
- Center for Precision Medicine, China Medical University Hospital, Taichung, Taiwan
- Million-Person Precision Medicine Initiative, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Hsing-Fang Lu
- Million-Person Precision Medicine Initiative, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | | | - Shih-Yin Chen
- Genetics Center, Medical Research, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: Shih-Yin Chen
| | - Fuu-Jen Tsai
- Genetics Center, Medical Research, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Genetics, China Medical University Hospital, Taichung, Taiwan
- Fuu-Jen Tsai
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Shiao C, Tang PF, Wei YC, Tseng WYI, Lin TT. Brain white matter correlates of learning ankle tracking using a wearable device: importance of the superior longitudinal fasciculus II. J Neuroeng Rehabil 2022; 19:64. [PMID: 35761285 PMCID: PMC9237986 DOI: 10.1186/s12984-022-01042-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Wearable devices have been found effective in training ankle control in patients with neurological diseases. However, the neural mechanisms associated with using wearable devices for ankle training remain largely unexplored. This study aimed to investigate the ankle tracking performance and brain white matter changes associated with ankle tracking learning using a wearable-device system and the behavior–brain structure relationships in middle-aged and older adults. Methods Twenty-six middle-aged and older adults (48–75 years) participated in this study. Participants underwent 5-day ankle tracking learning with their non-dominant foot using a custom-built ankle tracking system equipped with a wearable sensor and a sensor-computer interface for real-time visual feedback and data acquisition. Repeated and random sequences of target tracking trajectories were both used for learning and testing. Ankle tracking performance, calculated as the root-mean-squared-error (RMSE) between the target and actual ankle trajectories, and brain diffusion spectrum MR images were acquired at baseline and retention tests. The general fractional anisotropy (GFA) values of eight brain white matter tracts of interest were calculated to indicate their integrity. Two-way (Sex × Time) mixed repeated measures ANOVA procedures were used to investigate Sex and Time effects on RMSE and GFA. Correlations between changes in RMSE and those in GFA were analyzed, controlling for age and sex. Results After learning, both male and female participants reduced the RMSE of tracking repeated and random sequences (both p < 0.001). Among the eight fiber tracts, the right superior longitudinal fasciculus II (R SLF II) was the only one which showed both increased GFA (p = 0.039) after learning and predictive power of reductions in RMSE for random sequence tracking with its changes in GFA [β = 0.514, R2 change = 0.259, p = 0.008]. Conclusions Our findings implied that interactive tracking movement learning using wearable sensors may place high demands on the attention, sensory feedback integration, and sensorimotor transformation functions of the brain. Therefore, the SLF II, which is known to perform these brain functions, showed corresponding neural plasticity after such learning, and its plasticity also predicted the behavioral gains. The SLF II appears to be a very important anatomical neural correlate involved in such learning paradigms. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01042-2.
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Affiliation(s)
- Chishan Shiao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Fang Tang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan. .,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan. .,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Chen Wei
- Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ta-Te Lin
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Biomechatronics Engineering, College of Bio-Resources and Agriculture, National Taiwan University, Taipei, Taiwan
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Chang SH, Kao CH, Hung CH, Chou MC, Yip HT, Hung YM, Chang R, Wei CCJ. Syphilis and Ischemic Stroke: Old Question Revisited by a Nationwide Cohort Study. Int J Stroke 2022; 17:997-1005. [PMID: 35102806 DOI: 10.1177/17474930221079163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the era of easily available antibiotic use, this study provides epidemiological evidence for a re-examination of the relationship between syphilis and IS. METHODS Patients aged 18 years and older with newly diagnosed syphilis were included (N=1,585) from 2000, to 2012, and participants without syphilis in the control group (N=6,340) were matched by propensity score (age, sex, index year, insured amount, urbanization, seasons, and comorbidities). The Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of IS. Five different Cox regression models, sensitivity analyses, and negative control were conducted to test our findings. RESULTS 1,585 patients (1,055 [66.56%] men; mean [SD] age, 49.59 [20.32] years) had syphilis, and 3.8% had new-onset IS. The syphilis group had a higher risk of IS than the controls (adjusted HR, 1.35; 95% CI, 1.01-1.80; P-value<0.05) after full adjustment. Serial sensitivity analyses yielded consistent results. CONCLUSIONS Syphilis patients have higher risk of IS, and our data raise the question of implementation of prophylactic treatment for IS.
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Affiliation(s)
- Shu-Han Chang
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 89234
| | | | - Chih-Hsin Hung
- National Pingtung University of Science and Technology, Pingtung, Taiwan 63279
| | | | - Hei-Tung Yip
- China Medical University, Clinical Trial Center, Taichung, Taiwan 38019
| | - Yao-Min Hung
- Kaohsiung Municipal United Hospital, Department of Internal Medicine, Kaohsiung, Taiwan 210825
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Yang CP, Li CY, Huang WJ, Yu HL, Yang CC, Lu MC, Lang HC, Yan YH. Short-, Mid-, and Long-Term Associations Between PM2.5 and Stroke Incidence in Taiwan. J Occup Environ Med 2021; 63:742-751. [PMID: 33852547 DOI: 10.1097/jom.0000000000002222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the association between the risk of stroke and exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) over various exposure periods. METHODS This was a nationwide population-based case-control study in which 10,035 incident patients with a primary diagnosis of ischemic stroke each were matched with two randomly selected controls for sex, age, Charlson Comorbidity Index, year of stroke diagnosis, and level of urbanization. Multiple logistic models adjusted for potential confounders were used to assess the association of PM2.5 with ischemic stroke incidence. RESULTS There were significant short-term, medium-term, and long-term relationships between PM2.5 exposure and ischemic stroke incidence. CONCLUSIONS This study supports existing evidence that PM2.5 should be considered a risk factor for ischemic stroke.
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Affiliation(s)
- Chun-Pai Yang
- From the Department of Neurology (Dr Yang); Department of Medical Research (Dr Yang, Ms Lu, Dr Yan), Kuang Tien General Hospital, Taichung, Taiwan; Institute of Biomedical Nutrition, Hung Kuang University, Taichung, Taiwan (Dr Yang, Dr Yan); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Dr Li); Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (Dr Li); Department of Safety, Health, and Environmental Engineering, Hung Kuang University, Taichung, Taiwan (Dr Huang); Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan (Dr Yu); Department of Healthcare Administration, Asia University, Taichung, Taiwan (Dr Yang); Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Dr Lang); National Yang Ming Chiao Tung University, Taipei, Taiwan (Dr Lang); Department of Endocrinology and Metabolism, Kuang Tien General Hospital, Taichung, Taiwan (Dr Yan)
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Appelros P, Arvidsson‐Lindvall M, Matérne M. Stroke prevalence in a medium-sized Swedish municipality. Acta Neurol Scand 2021; 143:210-216. [PMID: 33016341 DOI: 10.1111/ane.13357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many patients who have had stroke survive with functional disability for years. Stroke prevalence is a fundamental measure of the impact of stroke in society. Stroke prevalence has never been evaluated in Sweden. MATERIALS & METHODS In this study, we use a registry-based method, using three overlapping Swedish registers, namely, the Swedish Stroke Register (Riksstroke), the National Patient Register, and a primary healthcare-based patient register. Data were gathered from these registers and cross-checked with the population register as per December 31st, 2019, with respect to stroke survivors (ICD-10 I60-I69) living in Kumla (population 21,738), a municipality well representative of Sweden. RESULTS A total of 330 individuals with stroke were found, of which 42% were women. The mean age was 74.1 years in men and 75.1 years in women. 11.5% of the patients had more than one stroke. The mean duration since the first stroke was 8.3 years. The crude prevalence per 100,000 was 1754 in men, 1281 in women, and 1518 in both sexes. Adjusted to the European population, the ratio was 1570 per 100,000, and to the World population 936 per 100,000. CONCLUSIONS In spite of a declining stroke incidence in Sweden, the stroke prevalence in Kumla, Sweden, is relatively high. Comparisons with other studies indicate that a decline in prevalence may have occurred since the early 2000s. Modern registers can support data collection, but the index stroke may have occurred almost forty years back in time.
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Affiliation(s)
- Peter Appelros
- Faculty of Medicine and Health University Health Care Research Center Örebro University Örebro Sweden
| | | | - Marie Matérne
- Faculty of Medicine and Health University Health Care Research Center Örebro University Örebro Sweden
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Chang FH, Chiu V, Ni P, Lin YN, Kang JH, Liou TH, Lu L, Han DS, Skidmore ER. Enhancing community participation for stroke survivors with cognitive impairment: study protocol for a randomised controlled trial in Taiwan. BMJ Open 2020; 10:e040241. [PMID: 33293312 PMCID: PMC7722819 DOI: 10.1136/bmjopen-2020-040241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stroke can lead to life-long disability and constitutes a huge financial burden on the family and society. Stroke survivors with cognitive impairment often experience considerable challenges in the process of recovery and returning to society. Interventions that effectively help individuals resume essential daily activities and return to active participation in their communities are lacking. This study examines the efficacy of a newly-developed intervention programme, the Optimising Participation after Stroke through Strategy-training (OPASS) programme, for improving community participation among stroke survivors with cognitive impairment. METHODS AND ANALYSIS A single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding will be implemented to assess the efficacy of the OPASS programme. An expected 210 adults with cognitive impairment following stroke will be randomly assigned to either the experimental intervention (OPASS) group or the attention control group. In addition to their usual rehabilitation, both groups will receive 45 min sessions, twice weekly for a total of 12-15 sessions. The primary outcome is change in participation performance, which will be measured using the participation measure-three domains, four dimensions scale. Additional measures include the Activity Measure for Post-Acute Care generic outpatient short forms, Montreal Cognitive Assessment, Stroop Test, Trail Making Test and General Self-Efficacy Scale. These scales will be administered at baseline, post-intervention, 3-month follow-up, 6-month follow-up and 12-month follow-up. Their results will be analysed using multiple linear regression models and mixed-effects regression models. Further assessment of feasibility and acceptability of the intervention will be conducted through structured interviews with participants, caregivers and therapists. These interviews will be transcribed and thematically analysed. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N201804055). The findings will be disseminated through presentations at scientific conferences and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03792061; pre-results.
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Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Valeria Chiu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Pengsheng Ni
- Health Law, Policy & Management; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
| | - Lu Lu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis. J Clin Med 2020; 9:jcm9093012. [PMID: 32962006 PMCID: PMC7565280 DOI: 10.3390/jcm9093012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.
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Hsu CC, Huang YK, Kang JH, Ko YF, Liu CW, Jaw FS, Chen SC. Novel design for a dynamic ankle foot orthosis with motion feedback used for training in patients with hemiplegic gait: a pilot study. J Neuroeng Rehabil 2020; 17:112. [PMID: 32811516 PMCID: PMC7433152 DOI: 10.1186/s12984-020-00734-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We designed a novel ankle foot orthosis (AFO), namely, ideal training AFO (IT-AFO), with motion feedback on the hemiparetic lower limb to improve ambulation in individuals with stroke-related hemiplegia. We, therefore sought to compare the kinematic parameters of gait between IT-AFO with and without dynamic control and conventional anterior-type AFO or no AFO. METHODS Gait parameters were measured using the RehaWatch® system in seven individuals with hemiplegia (mean 51.14 years). The parameters were compared across four conditions: no AFO, conventional anterior AFO, IT-AFO without dynamic control, and IT-AFO with dynamic control, with three trials of a 10-m walk test for each. RESULTS The dorsiflexion angle increased during the swing phase when the IT-AFO was worn, and it was larger with dynamic control. These data can confirm drop foot improvement; however, the difference between the parameters with- and without-AFO control conditions was not significant in the swing phase. The IT-AFO with or without dynamic control enhanced the loading response to a greater extent between the hemiparetic and unaffected lower limbs than conventional AFO or no AFO. The duration of the stance phase on the hemiparetic lower limb was also longer when using IT-AFO with and without dynamic control than that when using conventional AFO, which improved asymmetry. User comfort and satisfaction was greater with IT-AFO than with the other conditions. CONCLUSIONS The IT-AFO with dynamic control improved gait pattern and weight shifting to the hemiparetic lower limb, reducing gait asymmetry. The difference with and without dynamic control of IT-AFO is not statistically significant, and it is limited by sample size. However, this study shows the potential of IT-AFO in applying positive motion feedback with gait training. TRIAL REGISTRATION Taipei Medical University-Joint Institutional Review Board. N201510010 . Registered 12 February 2015. http://ohr.tmu.edu.tw/main.php .
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Affiliation(s)
- Chih-Chao Hsu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yin-Kai Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist, Taipei City, 110, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist, Taipei City, 110, Taiwan
| | - Yi-Feng Ko
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia-Wei Liu
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
- School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist, Taipei City, 110, Taiwan.
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Chen WS, Hsu HC, Chuang YW, Lee M, Lu KY, Chen YF, Chen CM. Predictors for the use of traditional Chinese medicine among inpatients with first-time stroke: a population-based study. BMC Complement Med Ther 2020; 20:244. [PMID: 32762664 PMCID: PMC7409405 DOI: 10.1186/s12906-020-03037-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 07/26/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stroke is one of the major causes of death and disability. The treatments that are provided to patients during hospitalization after an acute stroke are very important in stabilizing their medical condition and enabling the recovery of their motor functions. However, limited information is available regarding the use of traditional Chinese medicine (TCM) during hospitalization for first-time stroke patients. The researchers aimed to investigate the factors affecting TCM use and to provide clinicians with comprehensive information on TCM use among first-time stroke inpatients in Taiwan. METHODS The researchers collected and analyzed data, including patient characteristics, TCM use, and TCM prescription patterns, from the National Health Insurance Research Database in Taiwan for first-time stroke inpatients between 2006 and 2012. RESULTS Among the 89,162 first-time stroke patients, 7455 were TCM users, and 81,707 were TCM nonusers. The predictors for TCM use were as follows: age, 45-64 or < 45 years; men; living in a level 2, 4, or 7 urbanized area; insured amount ≥ 576 USD per month; ischemic stroke; hospitalized for first-time stroke for 8-14 days, 15-28 days, or ≥ 29 days; stroke severity index score 0-9 or 10-19; Charlson-Deyo comorbidity index score 0 or 1-2; hospitalization in a regional or community hospital; receiving rehabilitation; and previous experience with outpatient TCM use. An increase in the number of TCM users was observed from 2006 to 2012. Furthermore, 68.8-79.7% of TCM users used acupuncture only, while 17.8-26.1% used both acupuncture and Chinese herbal medicine. CONCLUSIONS An increasing number of first-time stroke patients have been choosing TCM as a complementary treatment during hospitalization. Moreover, TCM use is associated with demographic, clinical, and socioeconomic characteristics. These findings may help clinicians comprehensively understand the trend and the important factors affecting TCM utilization among patients who are hospitalized due to first-time stroke.
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Affiliation(s)
- Wei-Sen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Department of Physical Medicine and Rehabilitation, Jing Mei Hospital, Taipei, Taiwan
| | - Hung-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.,Department of Natural Biotechnology, Nanhua University, Dalin, Chiayi, Taiwan.,Center for Musculoskeletal Regenerative Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Physical Medicine and Rehabilitation, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yi-Wen Chuang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Jinan Rehabilitation Clinic, Tainan, Taiwan
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuan-Yu Lu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan
| | - Yi-Fei Chen
- School of Traditional Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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12
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Yang TH, Xirasagar S, Cheng YF, Wu CS, Kuo NW, Lin HC. Peripheral Vestibular Disorders: Nationwide Evidence From Taiwan. Laryngoscope 2020; 131:639-643. [PMID: 32621538 DOI: 10.1002/lary.28877] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the prevalence of peripheral vestibular disorders in an Asian population of predominantly Han Chinese ethnicity. STUDY DESIGN Cross-sectional study. METHODS Patients with a peripheral vertigo disorder were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of 2 million enrollees of Taiwan's National Health Insurance system covering over 99% of Taiwan's citizens. In 2016, 59,986 patients received a diagnosis of peripheral vestibular disorders in Taiwan. We calculated the population-wide prevalence rates of peripheral vestibular disorders in 2016 by sex and age group (20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, and ≥ 70 years) stratified into five urbanization levels. RESULTS The prevalence rate of peripheral vestibular disorders was 2,833.4 per 100,000 population during the year. Prevalence of Meniere's disease was 70.4 per 100,000, benign paroxysmal positional vertigo, 446.4, vestibular neuritis 307.2, and other or unspecified peripheral vestibular dizziness, 2,009.5 per 100,000. Prevalence rates steadily increased with age for every type of peripheral vestibular disorder, and were higher among females compared to males. The female-to-male gender ratios were 1.84, 1.89, and 1.93 for Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, respectively. Counties with the lowest urbanization level had the highest prevalence rates of all types of peripheral vestibular disorders except vestibular neuritis. CONCLUSIONS Results showed that peripheral vestibular disorders are common in Taiwan, increase with age, are predominantly female, and show higher prevalence in rural areas. LEVEL OF EVIDENCE 2b Laryngoscope, 131:639-643, 2021.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, U.S.A
| | - Yen-Fu Cheng
- Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,College of Science and Engineering, Fu Jen University, New Taipei City, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Moreira TCL, Polizel JL, Santos IDS, Silva Filho DF, Bensenor I, Lotufo PA, Mauad T. Green Spaces, Land Cover, Street Trees and Hypertension in the Megacity of São Paulo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030725. [PMID: 31979152 PMCID: PMC7038323 DOI: 10.3390/ijerph17030725] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
Proximity to green spaces has been shown to be beneficial to several cardiovascular outcomes in urban spaces. Few studies, however, have analyzed the relationship between these outcomes and green space or land cover uses in low-medium income megacities, where the consequences of rapid and inordinate urbanization impose several health hazards. This study used a subgroup of the dataset from The Brazilian Longitudinal Study of Adult Health ELSA-BRASIL (n= 3418) to identify the correlation between the medical diagnosis of hypertension and green spaces in the megacity of São Paulo. Land cover classification was performed based on the random forest algorithm using geometrically corrected aerial photography (orthophoto). Three different indicators of exposure to green spaces were used: number of street trees, land cover and number of parks within 1 km. We used logistic regression models to obtain the association of the metrics exposure and health outcomes. The number of street trees in the regional governments (OR = 0.937 and number of parks within 1 km (OR = 0.876) were inversely associated with a diagnosis of hypertension. Sixty-three percent of the population had no parks within 1 km of their residence. Our data indicate the need to encourage large-scale street tree planting and increase the number of qualified parks in megacities.
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Affiliation(s)
- Tiana C. L. Moreira
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo 01246-903, Brazil;
- Harvard T. H. CHAN School of Public Health, Environmental Health Department, Boston, MA 02215, USA
- Correspondence:
| | - Jefferson L. Polizel
- Escola Superior de Agricultura “Luiz de Queiroz”, Universidade de São Paulo, Piracicaba 13418-900, Brazil; (J.L.P.); (D.F.S.F.)
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo 05508-000, Brazil; (I.d.S.S.); (I.B.); (P.A.L.)
- Faculdade de Medicina, Departamento de Clínica Médica, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Demóstenes F. Silva Filho
- Escola Superior de Agricultura “Luiz de Queiroz”, Universidade de São Paulo, Piracicaba 13418-900, Brazil; (J.L.P.); (D.F.S.F.)
| | - Isabela Bensenor
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo 05508-000, Brazil; (I.d.S.S.); (I.B.); (P.A.L.)
- Faculdade de Medicina, Departamento de Clínica Médica, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Paulo A. Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo 05508-000, Brazil; (I.d.S.S.); (I.B.); (P.A.L.)
- Faculdade de Medicina, Departamento de Clínica Médica, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Thais Mauad
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo 01246-903, Brazil;
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo 05508-060, Brazil
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Kuo YW, Huang YC, Lee M, Lee TH, Lee JD. Risk stratification model for post-stroke pneumonia in patients with acute ischemic stroke. Eur J Cardiovasc Nurs 2019; 19:513-520. [PMID: 31735079 DOI: 10.1177/1474515119889770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-stroke pneumonia (PSP) has been implicated in the morbidity, mortality, and increased medical costs after acute ischemic stroke. AIM The aim of this study was to develop a prediction model for PSP in patients with acute ischemic stroke. METHODS A retrospective, case-control, secondary analysis study was conducted using data for 10,034 patients with ischemic stroke who presented to the hospital within 24 hours of onset of stroke symptoms. The predictive factors for PSP were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. RESULTS Among the study population, 546 patients (5.4%) had PSP. Multivariate logistic regression revealed that age, atrial fibrillation, smoking habit, body temperature at admission, pulse rate at admission, National Institute of Health Stroke Scale (NIHSS) score upon admission, white blood cell count, and blood urea nitrogen level were major predictive factors of PSP. CART analysis identified NIHSS score at admission, pulse rate at admission, and percentage of lymphocyte as important factors for PSP to stratify the patients into subgroups. The subgroup of patients with an NIHSS score >14 at admission and pulse rate >111 beats per minute at admission and those with an NIHSS score >14, pulse rate ⩽111 beats per minute at admission, and percentage of lymphocyte ⩽9.2% had a relatively high risk of PSP (39.6% and 35.5%, respectively). CONCLUSIONS In this study, CART analysis has a similar predictive value of PSP as compared with a logistic regression model. In addition, decision rules generated by CART can easily be interpreted and applied in clinical practice.
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Affiliation(s)
- Ya-Wen Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi.,College of Medicine, Chang Gung University, Taoyuan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi.,College of Medicine, Chang Gung University, Taoyuan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan.,Department of Neurology, Chang Gung Memorial Hospital, Taoyuan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi.,College of Medicine, Chang Gung University, Taoyuan
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15
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Xie B, Jiao J, An Z, Zheng Y, Li Z. Deciphering the stroke-built environment nexus in transitional cities: Conceptual framework, empirical evidence, and implications for proactive planning intervention. CITIES (LONDON, ENGLAND) 2019; 94:116-128. [PMID: 38239895 PMCID: PMC10795972 DOI: 10.1016/j.cities.2019.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Adverse lifestyle-associated health outcomes, and stroke in particular, have been aggravated in transitional countries under high-speed urbanisation. Against this backdrop, deciphering the nexus between built environments (BEs) and lifestyle-associated health outcomes is of importance for crafting proactive interventions. The existing literature on this topic, however, fails to sufficiently capture the multiplicity of health-related BEs and, in turn, the complexity of such a nexus, largely challenging the applicability of established frameworks and the reliability of relevant findings. Looking at the case of stroke in Wuhan, China, this research aims to flesh out the understanding of the nexus between multidimensional BEs and lifestyle-associated health outcomes in transitional cities, with regards to conceptual framework and empirical evidence. To this end, we clarified stroke-related BE elements and integrated them into one conceptual framework. We then visualised stroke risk and examined its BE determinants using the Bayesian conditional autoregressive model. The visualisation results showed that stroke risks exhibited significant clustering in the high-density urban core. The statistical analysis found that, after the data were controlled for sociodemographic characteristics, net population density and building density were positively associated with stroke risk. In contrast, an abundance of public parks and institutional land use and access to medical care facilities have presented negative correlations with stroke risk, regardless of urban density. Our research reveals that compact urban developments might not be a silver bullet for health promotion in transitional cities, calling for an urgent need to scrutinise their applicability. To offset the adverse effects of increasingly dense urban environments, more efforts should also be made to provide better access to the identified salubrious resources. Furthermore, we argue that the establishment of comprehensive conceptual frameworks that connect BEs and lifestyle-associated health outcomes deserves to be highlighted in further research, planning intervention schemes, and health impact assessment projects.
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Affiliation(s)
- Bo Xie
- School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Junfeng Jiao
- School of Architecture, The University of Texas at Austin, 310 Inner Campus Drive, Austin, TX 78712, United States of America
| | - Zihao An
- Institute for Transport Studies, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Yiling Zheng
- School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Zhigang Li
- School of Urban Design, Wuhan University, Wuhan 430072, China
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16
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The Relationship between Scabies and Stroke: A Population-Based Nationwide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183491. [PMID: 31546833 PMCID: PMC6766212 DOI: 10.3390/ijerph16183491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Scabies is a commonly occurring infectious skin infestation that substantially impacts the quality of life, while stroke, which consists of a neurological deficit resulting from a lack of blood flow to the brain, carries sizable economic costs. The pathophysiologic mechanisms underlying both diseases involve inflammatory processes that are mediated by the immune system; however, no prior research has been conducted to explore the relationship between the two conditions. METHODS This population-based nationwide study utilized data from the National Health Insurance Research Database (NHIRD) of Taiwan for a total of 6628 scabies patients, who comprised a scabies group, and a randomly selected cohort of 26,509 matching patients, who served as a control group. More specifically, the medical records for the patients in both groups were checked for seven years to identify any new cases of stroke within that seven-year follow-up period. The hazard ratio (HR) of stroke for the follow-up period was then calculated using Cox proportional hazards regressions, while comorbidities and demographic characteristics were likewise analyzed. RESULTS During the follow-up period, 2892 patients, or 8.7%, of the overall total of 33,137 patients included in the study were newly diagnosed with a stroke. Of those newly diagnosed stroke patients, 833 were from the scabies group, and 2059 were from the control group, accounting for 12.6% and 7.8%, respectively, of the individuals in each group. With a crude hazard ratio of 1.67, the patients in the scabies group had a significantly higher risk of subsequent stroke than those in the control group, although the adjusted hazard ratio (aHR) for the scabies patients, which was determined by adjusting for covariates, was only 1.32 (95% confidence interval (CI): 1.21-1.43). CONCLUSIONS The results of the study indicated an elevated risk of stroke among scabies patients, an association that might be contributed to by immunopathological factors. This information could serve as a reminder to clinicians to remain alert to any indications of neurological impairment in patients previously infected with scabies.
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17
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Wu CY, Yu HS, Chai CY, Wen YH, Wu SS, Chang YP, Lin CHR, Tsai JH. Increased ischemic stroke risk in patients with Behçet's disease: A nationwide population-based cohort study. PLoS One 2019; 14:e0218652. [PMID: 31237911 PMCID: PMC6592528 DOI: 10.1371/journal.pone.0218652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background Behçet’s disease (BD) is a recurrent, multisystemic, inflammatory disorder that mainly affects blood vessels. Because recurrent inflammation of blood vessels in the brain plays a crucial role in the development of ischemic stroke, we hypothesized that patients with BD might have an elevated risk of ischemic stroke. This potential association has been suggested in a few case reports, but not epidemiological studies. Hence, the present study aimed to examine the relation between BD and subsequent ischemic stroke in Taiwan using a nationwide, population-based database. Methods To establish a study cohort, the longitudinal data of 306 patients newly diagnosed with BD during 2000–2010 were extracted from the National Health Insurance Research Database, Taiwan. For comparison of ischemic stroke incidence, a control cohort of 1224 subjects without BD was established using a frequency-matched ratio of 1:4 for age, sex, and pre-existing comorbidities. Results During the 10-year follow-up, 13 (4.2%) patients with BD and 20 (1.6%) control subjects experienced ischemic stroke. Kaplan–Meier analysis revealed the higher prevalence of ischemic stroke in the BD group (log-rank test, p = 0.001). After adjusting for comorbidities and demographic characteristics, Cox regression analysis revealed that patients with BD had a 2.77-fold risk of ischemic stroke (95% confidence interval, 1.38–5.57) compared to control subjects. Conclusions Patients with BD have an elevated risk of ischemic stroke. Hence, BD may affect the vascular system in the brain, resulting in a stroke event.
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Affiliation(s)
- Ching-Ying Wu
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Cosmetic Science, College of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan
| | - Hsin-Su Yu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
| | - Chee-Yin Chai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsia Wen
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shihn-Sheng Wu
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
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18
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Hsieh KY, Tsai KY, Chou FHC, Chou YM. Reduced risk of stroke among psychiatric patients receiving ECT: A population-based cohort study in Taiwan. Psychiatry Res 2019; 276:107-111. [PMID: 31048180 DOI: 10.1016/j.psychres.2019.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 10/27/2022]
Abstract
Electroconvulsive therapy (ECT) as well as the diseases it treats have been associated with stroke and cognitive impairment. We investigate the relationship between ECT and the subsequent development of stroke in patients with different severe mental illnesses. Tapping Taiwan's National Health Insurance Research Database, we identified patients diagnosed with severe mental illnesses who had received ECT between Jan 1, 2002 and Dec 31, 2007. A comparison cohort was constructed of patients who were matched by age, gender, and diagnosis but did not receive ECT. The patients were then followed up for occurrence of subsequent new-onset stroke. We identified 6264 patients had been diagnosed with mental illness and had received ECT. They were matched with 18,664 mentally ill patients who had not. The study cohort had a lower incidence of subsequent stroke than the matched controls, after controlling for age, diabetes, hypertension, coronary heart disease and enrollee sociodemographic category, risk factors for stroke in both study and control cohorts. ECT is associated with reduced risk of subsequent stroke in patients with severe mental illnesses in Taiwan. Therefore, clinicians should not let risk of stroke stop them from suggesting ECT to physically healthy patients who might benefit from this therapy.
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Affiliation(s)
- Kuan-Ying Hsieh
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Yi Tsai
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | | | - Yu-Mei Chou
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Taiwan; Department of Nursing, Meiho University, Ping-Tong County, Taiwan.
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Chiang KL, Cheng CY. Epidemiology, risk factors and characteristics of pediatric stroke: a nationwide population-based study. QJM 2018; 111:445-454. [PMID: 29648667 DOI: 10.1093/qjmed/hcy066] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stroke, classically characterized as an acute acquired neurological deficit, is an important leading cause of death and chronic morbidity in children. AIMS This study reported the period prevalence, incidence and risk factors of pediatric stroke in Taiwan. METHODS AND PROCEDURES All Taiwan inhabitants aged 1 month to 18 years registered in the National Health Insurance Research Database between 2010 and 2011 were enrolled in this study. Factors including age, sex, location and household income levels were collected. Incidence, period prevalence, mortality rate and the possible risks were completely evaluated. Outcomes and results: Hemorrhagic stroke has a significantly higher mortality rate than ischemic stroke (27.6% vs. 10.2%, P<0.05). Risk factors or underlying diseases for stroke were identified in 77.8% of the patients and 16.2% had more than one risk factor. The most common risk factors were vascular diseases (26.3%), infection (14.0%) and cardiac disorders (9.1%). CONCLUSIONS AND IMPLICATIONS Infants younger than 2 years, boys and children in lower socioeconomic status have a significantly higher risk of stroke. Hemorrhagic stroke has a significantly higher mortality rate than ischemic stroke. More than half of the children with stroke had underlying diseases and the causes of hemorrhagic stroke are significantly different from ischemic stroke.
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Affiliation(s)
- K-L Chiang
- From the Department of Pediatrics, Kuang-Tien General Hospital, No. 117, Shatian Road Shalu District, Taichung City 43302
- Department of Nutrition, Hungkuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, Taichung City 43302
- Program of Health Administration, Tunghai University, No. 1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung 40704
| | - C-Y Cheng
- Program of Health Administration, Tunghai University, No. 1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung 40704
- Department of Industrial Engineering and Management, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd, Taipei 10608, Taiwan, R.O.C
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Kao YH, Liu YT, Koo M, Chiang JK. Factors associated with emergency services use in Taiwanese advanced cancer patients receiving palliative home care services during out-of-hours periods: a retrospective medical record study. BMC Palliat Care 2018. [PMID: 29530021 PMCID: PMC5848533 DOI: 10.1186/s12904-018-0302-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background For patients receiving palliative home care, the need to visit the emergency department is considered to be an indicator of poor quality care. The situation can be particularly distressing when it occurs outside of normal hours of palliative home care service. The aim of this study was to investigate the factors for emergency department use during out-of-hours periods of palliative home care service among advanced cancer patients in Taiwan. Methods This case-control study was based on a retrospective medical chart review (January 2010 to December 2012) of advanced cancer patients who were receiving palliative home care in a community hospital in south Taiwan. The use of emergency medical services by these patients was dichotomized into either normal hours (8 a.m. to midnight, Monday to Friday, excluding public holidays) of palliative home care or outside normal hours. Logistic regression analyses were performed to evaluate factors associated with emergency services use during out-of-hours period of palliative home care. Results: Of the 94 patients receiving palliative home care, 65 had used emergency services at least once during the 3-year study period. Of these 65 patients, 40% used emergency services during out-of-hours of palliative home care. Patients with distressing conditions (defined as the occurrence of any two conditions of dyspnea, change of consciousness, or gastrointestinal bleeding) were significantly more likely to use emergency services during out-of-hours of palliative home care. Conclusions Patients at risk of developing dyspnea, change of consciousness, or gastrointestinal bleeding should be provided with relevant information regarding these symptoms and signs.
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Affiliation(s)
- Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Yao-Ting Liu
- Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Malcolm Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Jui-Kun Chiang
- Division of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.
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Lee M, Lee CC, Lai CC, Hsu TC, Porta L, Lee M, Chang SS, Chien KL, Chen YM. Preadmission statin use improves the outcome of less severe sepsis patients - a population-based propensity score matched cohort study. Br J Anaesth 2017; 119:645-654. [DOI: 10.1093/bja/aex294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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22
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Gan Y, Wu J, Zhang S, Li L, Yin X, Gong Y, Herath C, Mkandawire N, Zhou Y, Song X, Zeng X, Li W, Liu Q, Shu C, Wang Z, Lu Z. Prevalence and risk factors associated with stroke in middle-aged and older Chinese: A community-based cross-sectional study. Sci Rep 2017; 7:9501. [PMID: 28842623 PMCID: PMC5572736 DOI: 10.1038/s41598-017-09849-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 08/01/2017] [Indexed: 11/09/2022] Open
Abstract
Although the prevalence of stroke and its risk factors has been widely reported in some Western countries, information on essential stroke parameters is lacking in China, the most populous nation. A community-based cross-sectional study with 8,018 Chinese adults aged ≥40 years was used to determine the prevalence of stroke and associated risk factors. Within the screened population, the prevalence of stroke was 2.21% for both sexes, 1.60% for females, and 3.18% for males. Prevalence increased with age in both sexes (P < 0.0001). In a multivariable model, factors significantly associated with stroke were increasing age (odds ratio [OR] = 1.87, 95% CI: 1.58-2.24), male gender (OR = 2.03, 95% CI: 1.42-2.90), family history of stroke (OR = 4.33, 95% CI: 2.89-6.49), history of hyperlipidemia (OR = 1.87, 95% CI 1.31-2.68), history of hypertension (OR = 1.47, 95% CI 1.02-2.12), and physical inactivity (OR = 1.74, 95% CI: 1.16-2.59). The findings indicate that stroke prevalence in middle-aged and older Chinese adults is higher in males than in females, and increases with age in both sexes. Population-based public health intervention programs and policies targeting hyperlipidemia and hypertension control and encouragement of physical activity should be highly prioritized for middle-aged and older adults in Shenzhen, China.
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Affiliation(s)
- Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiang Wu
- Bao'an Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Shengchao Zhang
- Bao'an Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Liqing Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Management, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chulani Herath
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Naomie Mkandawire
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanfeng Zhou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xingyue Song
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaozhou Zeng
- Bao'an Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiaoyan Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chang Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhihong Wang
- Department of Neurosurgery, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, Guangdong, China.
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Prescribed Renoprotective Chinese Herbal Medicines Were Associated with a Lower Risk of All-Cause and Disease-Specific Mortality among Patients with Chronic Kidney Disease: A Population-Based Follow-Up Study in Taiwan. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:5632195. [PMID: 28798802 PMCID: PMC5535732 DOI: 10.1155/2017/5632195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/06/2017] [Indexed: 11/18/2022]
Abstract
Chinese herbal medicines (CHMs) containing aristolochic acid (AA) are associated with chronic kidney disease (CKD), but some prescribed CHMs have been shown to possess renoprotective effects. We conducted a nationwide retrospective cohort study to delineate the role of prescribed CHMs on the CKD progression. Renoprotective CHM (RPCHM) was defined if a CHM contained dong chong xia cao (Cordyceps sinensis (Berk.) Sacc.), da huang (Rheum palmatum L), huang qi (Astragalus membranaceus), dan shen (Salvia miltiorrhiza Bge.), and dong quai (Angelica sinensis (Oliv.) Diels) or belonged to specific mixture herbal formulations (Yishen capsule, Saireito, or Wen Pi Tang). Subjects who had ever used AA-containing CHMs, had cancer or HIV prior to CKD diagnosis, or died within the first month of CKD diagnosis were excluded. A total of 11,625 patients were eligible subjects. The adjusted hazard ratio (aHR) for all-cause mortality was 0.6 (p < 0.001) and 0.6 (p = 0.013) among subjects receiving RPCHMs containing Angelica sinensis and those receiving other RPCHMs, respectively. For CKD-related mortality, the aHR among subjects receiving RPCHMs containing Angelica sinensis was 0.6 (p = 0.025). The use of specific RPCHMs, especially those that contained Angelica sinensis, was associated with a lower risk of mortality among CKD patients.
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Lu YC, Huang WY, Chen YF, Chang HC, Pong YH, Shih TH, Huang KH. Factors associated with reoperation in hypospadias surgery — A nationwide, population-based study. Asian J Surg 2017; 40:116-122. [DOI: 10.1016/j.asjsur.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/08/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
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Wu CW, Huang SW, Lin JW, Liou TH, Chou LC, Lin HW. Risk of stroke among patients with cerebral palsy: a population-based cohort study. Dev Med Child Neurol 2017; 59:52-56. [PMID: 27346658 DOI: 10.1111/dmcn.13180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/28/2022]
Abstract
AIM The aim of the study was to investigate the risk of stroke in patients with cerebral palsy (CP), based on nationwide data in Taiwan. METHOD This prospective cohort study was comprised of patients recorded on the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005) who had a diagnosis of CP (n=1975) in records between 1 January 2004 and 31 December 2007. A comparison group (1:5) drawn from the same database was matched for age and sex (n=9875). Each patient was tracked by data until the development of stroke or the end of 2008. Cox proportional-hazards regression analysis was used to evaluate the hazard ratios after adjusting for potential confounding factors. RESULTS Patients with CP were more likely to suffer stroke than the comparison population, after adjusting for potential confounding factors (adjusted hazard ratio: 2.17; 95% confidence interval [CI]: 1.74-2.69). The hazard ratio of stroke was 4.78 (95% CI: 3.18-7.17) and 1.57 (95% CI: 1.20-2.05) for patients with CP aged 50 years and under, and over 50 years respectively. INTERPRETATION Cerebral palsy is a risk factor or marker for stroke that is independent of traditional stroke risk factors. Further research in this area is warranted.
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Affiliation(s)
- Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jia-Wei Lin
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Lin-Chuan Chou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan.,Evidence Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Chen CM, Yang YH, Chang CH, Chen CC, Chen PC. The Utilization of Rehabilitation in Patients with Hemophilia A in Taiwan: A Nationwide Population-Based Study. PLoS One 2016; 11:e0164009. [PMID: 27690229 PMCID: PMC5045205 DOI: 10.1371/journal.pone.0164009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 09/19/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Rehabilitation plays an important role in the physical health of patients with hemophilia. However, comprehensive information regarding the utilization of rehabilitation for such patients remains scarce. AIM This population-based study aimed to examine the characteristics, trends, and most important factors affecting rehabilitation usage in patients with hemophilia A using a nationwide database in Taiwan. METHODS Data from 777 patients with hemophilia A who were registered in the National Health Insurance Research Database between 1998 and 2008 were analyzed using SAS 9.0. RESULTS Musculoskeletal or nervous system-related surgical procedures and clotting factor VIII concentrate costs were identified as factors affecting rehabilitation usage; musculoskeletal or nervous system-related surgical procedures (odds ratio = 3.788; P < 0.001) were the most important predictor of whether a patient with hemophilia A would use rehabilitation services. Joint disorders, arthropathies, bone and cartilage disorders, intracranial hemorrhage, and brain trauma were common diagnoses during rehabilitation use. The costs of physical therapy (physiotherapy) comprised the majority (71.2%) of rehabilitation therapy categories. Increasingly, rehabilitation therapy was performed at physician clinics. The total rehabilitation costs were <0.1% of the total annual medical costs. CONCLUSION Musculoskeletal or nervous system-related surgical procedures and increased use of clotting factor VIII concentrate affect the rehabilitation utilization of patients with hemophilia A the most. The findings in this study could help clinicians comprehensively understand the rehabilitation utilization of patients with hemophilia A.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Hemophilia and Thrombosis Treatment Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hao Chang
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Chih-Cheng Chen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Hemophilia and Thrombosis Treatment Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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27
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Abstract
Gallbladder polyp (GP) and stroke share several metabolic disorders as risk factors. We assessed the association between GP and subsequent stroke risk. From 2000 to 2011, patients with GP aged >20 years were identified from the Longitudinal Health Insurance Database 2000. Of the 15,975 examined patients, 12,780 and 3195 were categorized into the non-GP and GP cohorts, respectively. The relative risks of stroke were estimated using the Cox proportional hazard model after adjusting for age, sex, and comorbidities. The overall incidence of stroke was higher in the GP cohort than in the non-GP cohort (6.66 vs 5.20/1000 person-yr), with an incidence rate ratio (IRR) of 1.28 (95% confidence interval [CI] = 1.15-1.42). The risk of stroke was 1.32-fold (95% CI = 1.06-1.63) in patients with GP compared with patients without GP after adjusting for age, sex, income level, urbanization level, occupation and comorbidities of gallstone, alcohol-related illness, diabetes, hyperlipidemia, hypertension, obesity, COPD, coronary heart disease, and asthma. Furthermore, the stroke risk was higher among elderly patients (with 1-yr intervals; adjusted HR [aHR] = 1.06, 95% CI = 1.05-1.07), the male sex (aHR = 1.62, 95% CI = 1.35-1.96), lower income level (aHR = 1.37, 95% CI = 1.02-1.85 for level I; aHR = 1.62, 95% CI = 1.25-2.10 for level II), living in second urbanized areas (aHR = 1.28, 95% CI = 1.00-1.63), alcohol-related illness (aHR = 1.56, 95% CI = 1.07-2.28), diabetes (aHR = 1.78, 95% CI = 1.41-2.24), and hypertension (aHR = 2.74, 95% CI = 2.19-3.42). GP is associated with stroke; however, GP may be less influential than other risk factors are, such as male sex, lower income level, alcohol-related illness, diabetes, and hypertension, on stroke development. Additional studies are required to clarify whether GP is a risk factor for or an epiphenomenon of stroke development.
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Affiliation(s)
- Chien-Hua Chen
- From the Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua (C-HC); Hungkuang University, Taichung (C-HC); Meiho University of Technology, Pingtung (C-HC); School of Medicine, China Medical University (C-LL); Management Office for Health Data, China Medical University Hospital (C-LL); Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University (C-HK); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Tsai MS, Chuang PY, Huang CH, Shih SR, Chang WT, Chen NC, Yu PH, Cheng HJ, Tang CH, Chen WJ. Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients. Int J Clin Pract 2015; 69:1473-85. [PMID: 26299643 DOI: 10.1111/ijcp.12724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An increased risk for ischaemic stroke has been reported in young hyperthyroidism patients independent of atrial fibrillation (AF). However, whether the use of antithyroid drugs in hyperthyroidism patients can reduce the occurrence of ischaemic stroke remains unclear. METHODS A total of 36,510 newly diagnosed hyperthyroidism patients during 2003-2006 were identified from the Taiwan National Health Insurance Research database. Each patient was individually tracked for 5 years from their index date (beginning the antithyroid drugs) to identify those who suffered from new episode of ischaemic stroke. Medication possession ratio (MPR) was used to represent the antithyroid drug compliance. The association between the MPR and the risk of stroke was examined. RESULTS The stroke incidence rates for hyperthyroidism patients with age < 45 years and age ≥ 45 years were 0.42 and 3.76 per 1000 person-years, respectively. The patients aged < 45 years with MPR < 0.2 (adjusted hazard ratio, HR, 2.30; 95% CI, 1.13-4.70; p = 0.02) and 0.2 ≤ MPR < 0.4 (adjusted HR, 2.24; 95% CI, 1.06-4.72; p = 0.035) had a significantly increased risk of ischaemic stroke as compared to those with ≥ 0.6. In patients of the age ≥ 45 years, only the patients with MPR < 0.2 (adjusted HR, 1.44; 95% CI, 1.03-2.01; p = 0.036) had a significantly higher risk of ischaemic stroke as compared to those with MPR ≥ 0.6. In hyperthyroidism patients without AF, good antithyroid drugs compliance also reduced the incidence of stroke significantly (adjusted HR, range: 1.52-1.61; p = 0.02); but not in hyperthyroidism with AF. CONCLUSION Hyperthyroidism patients with good antithyroid drug compliance had a lower risk of ischaemic stroke than patients with poor compliance.
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Affiliation(s)
- M-S Tsai
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - P-Y Chuang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - C-H Huang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - S-R Shih
- Department of Internal Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - W-T Chang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - N-C Chen
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan County, Taiwan
| | - P-H Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - H-J Cheng
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - C-H Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - W-J Chen
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan
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Abstract
Using 10-year population data from 2000 through 2009 in Taiwan, this is the first paper to analyze the relationship between margin trading in stock markets and stroke hospitalizations. The results show that 3 and 6 days after an increase of margin trading in the Taiwan stock markets are associated with greater stoke hospitalizations. In general, a 1 % increase in total margin trading positions is associated with an increment of 2.5 in the total number of stroke hospitalizations, where the mean number of hospital admissions is 233 cases a day. We further examine the effects of margin trading by gender and age groups and find that the effects of margin trading are significant for males and those who are 45-74 years old only. In summary, buying stocks with money you do not have is quite risky, especially if the prices of those stocks fall past a certain level or if there is a sudden and severe drop in the stock market. There is also a hidden danger to one's health from margin trading. A person should be cautious before conducting margin trading, because while it can be quite profitable, danger always lurks just around the corner.
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Affiliation(s)
- Shu-Hui Lin
- Department of Finance, National Changhua University of Education, 2, Shi-Da Road, Changhua City, 500, Taiwan.
| | - Chien-Ho Wang
- Department of Economics, National Taipei University, 151, University Rd., San Shia, New Taipei City, 23741, Taiwan.
| | - Tsai-Ching Liu
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City, 23741, Taiwan.
| | - Chin-Shyan Chen
- Department of Economics, National Taipei University, 151, University Rd., San Shia, New Taipei City, 23741, Taiwan.
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Shen CC, Yang AC, Kuo BIT, Tsai SJ. Risk of Psychiatric Disorders Following Primary Sjögren Syndrome: A Nationwide Population-based Retrospective Cohort Study. J Rheumatol 2015; 42:1203-8. [PMID: 25979721 DOI: 10.3899/jrheum.141361] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Primary Sjögren syndrome (pSS) is a chronic autoimmune disease. A clear temporal causal relationship between pSS and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between pSS and the subsequent development of psychiatric disorders. METHODS We identified subjects who were newly diagnosed with pSS between January 1, 2000, and December 31, 2008, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed for patients without pSS. There were 2686 patients with pSS and 10,744 matched controls observed until diagnosed with psychiatric disorders or until death, withdrawal from the NHI system, or December 31, 2009. The Institutional Review Board of Taipei Veterans General Hospital approved this study (2012-12-013BC). RESULTS The adjusted HR of depressive disorder, anxiety disorder, and sleep disorder in subjects with pSS were significantly higher at 1.829, 1.856, and 1.967 than those of the controls during the followup. We found that pSS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder that may impair life quality. CONCLUSION Our findings highlight the need for psychiatric evaluation and intervention for patients with pSS.
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Affiliation(s)
- Cheng-Che Shen
- From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University
| | - Albert C Yang
- From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University
| | - Benjamin Ing-Tiau Kuo
- From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University
| | - Shih-Jen Tsai
- From the Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management, National Chung-Cheng University, Chiayi; Department of Psychiatry, and Department of Research and Medication, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.C.C. Shen, MD, Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital; A.C. Yang, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; B.I. Kuo, MD, PhD, Department of Research and Medication, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University; S.J. Tsai, MD, Department of Psychiatry, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University.
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Huang YY, Kung PT, Chiu LT, Tsai WC. Related factors and incidence risk of acute myocardial infarction among the people with disability: A national population-based study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:366-375. [PMID: 25462496 DOI: 10.1016/j.ridd.2014.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/11/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023]
Abstract
Cardiovascular disease has always been a leading cause of death worldwide. Because the mobility of people with disability is relatively decreased, their risk of cardiovascular disease is increased. This study investigated the risks and relevant factors of acute myocardial infarction (AMI) among people with disability. This is a retrospective cohort study based on secondary data analysis. This study focused on 798,328 people with disability who were aged 35 and above during 2002-2008 and were registered in the National Disability Registration Database; the relevant medical data from 2000 to 2011 were acquired from the National Health Insurance Research Database. A Cox proportional hazards model was adopted for analyzing the relative AMI risks among different disability types and finding latent risk factors. The results indicated that the AMI incidence rate (per 1000 patient-years) among people with disability was 2.48. Men had an AMI incidence rate of 2.68 per 1000 patient-years, which was significantly higher than that of women (2.21; p<.05). The AMI risk for people with mental disabilities was 0.76 times the risk for people with physical disabilities (95% confidence interval [CI]=0.71-0.82). The AMI risk for people with profound disabilities was 2.04 times (95% CI=1.93-2.16) the risk for people with mild disabilities. AMI risk increased with age. People with disability aged 65 and above had an AMI risk that was 5.01-6.03 times the risk for people with disability aged below 45. Disabled indigenous people had a relatively higher AMI risk (HR=1.35, 95% CI=1.19-1.52). The AMI risk for people with disability with a Charlson comorbidity index (CCI) of 4 and above was 5.89 times (95% CI=5.56-6.25) the risk for those with a CCI of 0. Compared with people with physical disabilities, people with visual impairment and people with dysfunctional primary organs had significantly higher AMI risks (HR=1.15; HR=1.66). This study found that people with disability who were male, aged 65 and above, married, indigenous, with physical disabilities, with high comorbidity, or with high disability levels had relatively higher AMI risks than other people with disability. The research outcomes can be used as references by public health authorities to improve the engagement of people with disability in AMI-prevention health services.
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Affiliation(s)
- Ying-Ying Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
| | - Li-Ting Chiu
- China Medical University Hospital, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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Factors related to the time to cryptorchidism surgery—A nationwide, population-based study in Taiwan. J Formos Med Assoc 2014; 113:915-20. [DOI: 10.1016/j.jfma.2013.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/21/2022] Open
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Huang WY, Wu SC, Chen YF, Lan CF, Hsieh JT, Huang KH. Surgeon Volume for Percutaneous Nephrolithotomy Is Associated with Medical Costs and Length of Hospital Stay: A Nationwide Population-Based Study in Taiwan. J Endourol 2014; 28:915-21. [DOI: 10.1089/end.2014.0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wei-Yi Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
- National Health Insurance Committee, Ministry of Health and Welfare, Executive Yuan, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Fen Chen
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
- Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan
- Business Place Hygiene Management, Department of Health, Taipei City Government, Taipei, Taiwan
| | - Chung-Fu Lan
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Ju-Ton Hsieh
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Chiang KL, Cheng CY. Prevalence and neuro-psychiatric comorbidities of pediatric epilepsy in Taiwan: a national population-based study. Epilepsy Res 2014; 108:1451-60. [PMID: 25107685 DOI: 10.1016/j.eplepsyres.2014.07.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/27/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Children with epilepsy may have comorbidities that result in significant disability. Epidemiological information for pediatric patients with epilepsy in Taiwan is scant. This research estimates the prevalence and common neuro-psychiatric comorbidities of children with epilepsy in Taiwan. METHODS Patients aged less than 20 years old who had received a diagnosis of epilepsy and suffered from epileptic seizures in 2005 were identified in the NHIRD based on ICD-9-CM and prescription records for the use of at least one AED. We used cases of epileptic seizure to survey outpatient service data, and identify common neuro-psychiatric comorbidities. The crude prevalence rate and the age- and sex-specific prevalence were estimated. We also examined the effects of urbanization. RESULTS The estimated prevalence of epilepsy was 0.33% in the pediatric population, with 0.29% for girls and 0.36% for boys. The most common neuropsychiatric comorbidities were learning disability and developmental delay, cerebral palsy, and mental retardation. Epilepsy was more prevalent in boys than in girls, especially among infants, preschool children, and those living in rural areas. In addition, boys with epilepsy had a higher rate of neurological comorbidities. The prevalence of psychiatric comorbidities was lower than that reported in previous studies performed in other countries, especially among children with epilepsy living in rural areas. CONCLUSION This research provides the largest nationwide, population-based study of childhood epilepsy to estimate the prevalence and the associated neuropsychiatric comorbidities of pediatric epilepsy in Taiwan. Potential rural-urban disparity basing on prevalence and associated neuropsychiatric comorbidities cannot be ignored in Taiwan.
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Affiliation(s)
- Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, No. 117, Shatian Road Shalu District, Taichung City 433, Taiwan ROC.
| | - Chen-Yang Cheng
- Program of Health Administration, Tunghai University, No. 181, Section 3, Taichung Harbor Road, Taichung, 407-04, Taiwan ROC.
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Wu CH, Chen LS, Yen MF, Chiu YH, Fann CY, Chen HH, Pan SL. Does non-central nervous system tuberculosis increase the risk of ischemic stroke? A population-based propensity score-matched follow-up study. PLoS One 2014; 9:e98158. [PMID: 25048551 PMCID: PMC4105466 DOI: 10.1371/journal.pone.0098158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/29/2014] [Indexed: 12/02/2022] Open
Abstract
Background Previous studies on the association between tuberculosis and the risk of developing ischemic stroke have generated inconsistent results. We therefore performed a population-based, propensity score-matched longitudinal follow-up study to investigate whether contracting non-central nervous system (CNS) tuberculosis leads to an increased risk of ischemic stroke. Methods We used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 5804 persons with at least three ambulatory visits in 2001 with the principal diagnosis of non-CNS tuberculosis were enrolled in the tuberculosis group. The non-tuberculosis group consisted of 5804, propensity score-matched subjects without tuberculosis. The three-year ischemic stroke-free survival rates for these 2 groups were estimated using the Kaplan-Meier method. The stratified Cox proportional hazards regression was used to estimate the effect of tuberculosis on the occurrence of ischemic stroke. Results During three-year follow-up, 176 subjects in the tuberculosis group (3.0%) and 207 in the non-tuberculosis group (3.6%) had ischemic stroke. The hazard ratio for developing ischemic stroke in the tuberculosis group was 0.92 compared to the non-tuberculosis group (95% confidence interval: 0.73–1.14, P = 0.4299). Conclusions Non-CNS tuberculosis does not increase the risk of subsequent ischemic stroke.
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Affiliation(s)
- Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Yuan Fann
- Department of Nutrition and Health Sciences, Kainan University, Tao-Yuan, Taiwan
| | - Hsiu-Hsi Chen
- Centre of Biostatistics Consultation, College of Public Health, National Taiwan University, Taipei, Taiwan
- Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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Risk of stroke in patients with rheumatism: a nationwide longitudinal population-based study. Sci Rep 2014; 4:5110. [PMID: 24898360 PMCID: PMC4046260 DOI: 10.1038/srep05110] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/13/2014] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to investigate rheumatoid arthritis (RA), and systemic lupus erythematous (SLE) as risk factors for stroke. The study was analyzed by Using the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005), this cohort study investigated patients with a recorded diagnosis of RA (N = 6114), and SLE (N = 621) between January 1, 2004, and December 31, 2007, with age-matched controls (1:4) (for RA, N = 24456; SLE, N = 2484). We used Cox proportional-hazard regressions to evaluate the hazard ratios (HRs) after adjusting confounding factors. Our study found 383 of 6114 RA patients, experienced stroke during the 20267 person-year follow-up period. The adjusted HR of stroke for RA patients was 1.24 (95% CI, 1.11 to 1.39), and for SLE patients was 1.88 (95% CI, 1.08 to 3.27). When steroid was added as additional confounding factor, the adjusted HR of ischemic stroke for RA patients was 1.32 (95% CI, 1.15 to 1.50), and for SLE patients was 1.31 (95% CI, 0.51 to 3.34). In conclusion, the rheumatic diseases of RA, and SLE are all risk factors for stroke. After controlled the effect of steroid prescription, RA is risk factor for ischemic stroke.
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Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in taiwan. J Stroke 2014; 16:59-64. [PMID: 24949310 PMCID: PMC4060269 DOI: 10.5853/jos.2014.16.2.59] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.
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Affiliation(s)
- Fang-I Hsieh
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
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Increased risk of ischemic stroke after hyperosmolar hyperglycemic state: a population-based follow-up study. PLoS One 2014; 9:e94155. [PMID: 24714221 PMCID: PMC3979762 DOI: 10.1371/journal.pone.0094155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although much attention has been focused on the association between chronic hyperglycemia and cerebrovascular diseases in type 2 diabetes mellitus (DM) patients, there is no data regarding the risk of ischemic stroke after a hyperosmolar hyperglycemic state (HHS) attack. The objective of this study was to investigate the risk of ischemic stroke in type 2 DM patients after an HHS attack. METHODS From 2004 to 2008, this retrospective observational study was conducted on a large cohort of Taiwanese using Taiwan's National Health Insurance Research Database (NHIRD). We identified 19,031 type 2 DM patients who were discharged with a diagnosis of HHS and 521,229 type 2 DM patients without an HHS diagnosis. Using the propensity score generated from logistic regression models, conditional on baseline covariates, we matched 19,031 type 2 DM patients with an HHS diagnosis with the same number from the comparison cohort. The one-year cumulative rate for ischemic stroke was estimated using the Kaplan-Meier method. After adjusting covariates, Cox proportional hazard regression was used to compute the adjusted one-year rate of ischemic stroke. RESULTS Of the patients sampled, 1,810 (9.5%) of the type 2 DM patients with HHS and 996 (5.2%) of the comparison cohort developed ischemic stroke during the one-year follow-up period. After adjusting for covariates, the adjusted HR for developing ischemic stroke during the one-year follow-up period was 1.8 (95% C.I., 1.67 to 1.95, P<0.001) for type 2 DM patients with HHS compared with those without HHS. CONCLUSION Although DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS.
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High incidence of ischemic stroke occurrence in irradiated lung cancer patients: a population-based surgical cohort study. PLoS One 2014; 9:e94377. [PMID: 24709837 PMCID: PMC3978039 DOI: 10.1371/journal.pone.0094377] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/15/2014] [Indexed: 12/27/2022] Open
Abstract
Background and Purpose A high risk of stroke occurrence has been reported in several types of irradiated cancer patients. However, clinical data are lacking in irradiated lung cancer patients. The present study intended to explore a risk level of ischemic stroke occurrence in irradiated lung cancer patients. Methods A nationwide population-based database obtained from the Taiwan National Health Insurance was analyzed. Between 2003 and 2006, we recruited 560 resected lung cancer patients into two study groups: surgery-plus-irradiation (n = 112) and surgery-alone (n = 448). Patients treated with chemotherapy were excluded. Propensity score match was used for pairing cases with a ratio of 1∶4. Two-year ischemic-stroke-free survival was defined as the primary endpoint. Results Three observations supported a high risk of ischemic stroke occurrence in patients with postoperative irradiation when compared with those patients with surgery alone: first, a high incidence per 1,000 person-year (22.3 versus 11.2, 1.99 folds); second, a low two-year ischemic-stroke-free survival rate (92.2% versus 98.1%, P = 0.019); and third, a high adjusted hazard ratio (HR, 4.19; 95% CI, 1.44–12.22; P = 0.009). More notably, the highest risk of ischemic stroke occurrence was found in irradiated patients who had diabetes mellitus (HR, 34.74; 95% CI, 6.35->100; P<0.0001). Conclusions A high incidence of ischemic stroke was observed in irradiated lung cancer patients, especially in those with diabetes mellitus. For these patients, close clinical surveillance and strict diabetes control should be considered. Further studies to define detail biological mechanisms are encouraged.
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Chiang CH, Liu CJ, Chen PJ, Huang CC, Hsu CY, Chan WL, Huang PH, Chen TJ, Lin SJ, Chen JW, Leu HB. Primary Sjögren’s syndrome and risk of ischemic stroke: a nationwide study. Clin Rheumatol 2014; 33:931-7. [DOI: 10.1007/s10067-014-2573-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/02/2014] [Indexed: 01/05/2023]
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Increased risk of ischemic heart disease in young patients with migraine: A population-based, propensity score-matched, longitudinal follow-up study. Int J Cardiol 2014; 172:213-6. [DOI: 10.1016/j.ijcard.2014.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/07/2014] [Indexed: 11/24/2022]
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Hung PH, Huang YT, Hsiao CY, Sung PS, Guo HR, Tsai KJ. Young stroke patients are at high risk for subsequent end-stage renal disease: a population-based observational study. Nephrol Dial Transplant 2014; 29:873-8. [DOI: 10.1093/ndt/gft534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Environmental effects on WHODAS 2.0 among patients with stroke with a focus on ICF category e120. Qual Life Res 2014; 23:1823-31. [DOI: 10.1007/s11136-014-0624-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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Wu X, Zhu B, Fu L, Wang H, Zhou B, Zou S, Shi J. Prevalence, incidence, and mortality of stroke in the chinese island populations: a systematic review. PLoS One 2013; 8:e78629. [PMID: 24250804 PMCID: PMC3826735 DOI: 10.1371/journal.pone.0078629] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/13/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In China, there are 2.5 million new stroke cases each year and 7.5 million stroke survivors. However, stroke incidence in some island populations is obviously lower compared with inland regions, perhaps due to differences in diet and lifestyle. As the lifestyle in China has changed significantly, along with dramatic transformations in social, economic and environmental conditions, such changes have also been seen in island regions. Thus, we analyzed stroke in the Chinese island regions over the past 30 years. METHODS We conducted a systematic review to identify reliable and comparable epidemiologic evidence about stroke in the Chinese island regions between 1980 and 2013. Two authors independently assessed the eligibility and the quality of the articles and disagreement was resolved by discussion. Owing to the great heterogeneity among individual study estimates, a random-effects or fixed-effects model was used to incorporate the heterogeneity among records into a pooled estimate for age-standardized rates. Age-standardized rates were calculated by the direct method with the 2000 world population if included records provided the necessary information. RESULTS During the past three decades, the overall pooled age-standardized prevalence of stroke is 6.17 per 1000 (95% CI 4.56-7.78), an increase from 5.54 per 1000 (95% CI 3.88-7.20) prior to 2000 to 8.34 per 1000 (95% CI 5.98-10.69) after 2000. However, this difference was not found to be statistically significant. The overall pooled age-standardized incidence of stroke is 120.42 per 100,000 person years (95% CI 26.17-214.67). Between 1982 and 2008, the incidence of stroke increased and mortality declined over time. CONCLUSIONS Effective intervention and specific policy recommendations on stroke prevention should be required, and formulated in a timely fashion to effectively curb the increased trend of stroke in Chinese island regions.
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Affiliation(s)
- Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Bo Zhu
- Liaoning Academy of Safety Sciences, Shenyang, China
- Department of Environmental and Occupational Health, School of Public Health, China Medical University, Taichung, Taiwan
| | - Lingyu Fu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Hailong Wang
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Bo Zhou
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Safeng Zou
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Jingpu Shi
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
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Huang WY, Chen YF, Chang HC, Yang TK, Hsieh JT, Huang KH. The frequency of vesicoureteral reflux diagnosis is correlated with urbanization level of residence in pediatric population: a nationwide study in Taiwan. J Pediatr Urol 2013; 9:546-50. [PMID: 23619352 DOI: 10.1016/j.jpurol.2013.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/27/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the frequency and characteristics of newly diagnosed vesicoureteral reflux (VUR) in children younger than 18 years based on a nationwide database in Taiwan. METHODS The present study utilizes a subset of the Taiwan's National Health Insurance Research Database, known as the Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over 1997-2007 for a subset of 1,000,000 beneficiaries randomly drawn from the population of 22.72 million individuals during any part of the 2005 calendar year. Our analysis includes the data of all pediatric patients with the diagnosis of VUR. RESULTS A total of 738 subjects with VUR diagnosis were identified, including 412 (55.8%) boys and 326 (44.2%) girls. The peak age of VUR occurrence was the first year for males and 1-4 years for females. Approximately 49.7% of all subjects presented with urinary tract infection (UTI); moreover, there were significant differences between genders concerning the presence of UTI (RR = 0.8; p = 0.002). The occurrence rate of VUR in the pediatric population ranged from 2.63 in 1998 to 3.94 in 2003 per 10,000 children during 1998-2005. The frequency of newly-diagnosed VUR in the pediatric population was significantly correlated with urbanization levels of residence. CONCLUSION The nationwide, population-based study of pediatric VUR shows there were gender differences in age distribution and presence of UTI. Further studies are warranted to clarify the correlations between urbanization level of residence and occurrence of VUR.
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Affiliation(s)
- Wei-Yi Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
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Parkinson's disease is related to an increased risk of ischemic stroke-a population-based propensity score-matched follow-up study. PLoS One 2013; 8:e68314. [PMID: 24023710 PMCID: PMC3759416 DOI: 10.1371/journal.pone.0068314] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/28/2013] [Indexed: 11/19/2022] Open
Abstract
Objective The risk of stroke in patients with Parkinson’s disease (PD) remains controversial. The purpose of this population-based propensity score-matched longitudinal follow-up study was to determine whether there is an increased risk of ischemic stroke after PD. Methods We used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 2204 patients with at least two ambulatory visits with the principal diagnosis of PD in 2001 was enrolled in the PD group. The non- PD group consisted of 2204, propensity score-matched subjects without PD. The ischemic stroke-free survival rates of the two groups were estimated using the Kaplan-Meier method. Stratified Cox proportional hazard regression with patients matched on propensity score was used to estimate the effect of PD on the occurrence of ischemic stroke. Results During the three-year follow-up period, 328 subjects in the PD group and 156 subjects in the non-PD group developed ischemic stroke. The ischemic stroke-free survival rate of the PD group was significantly lower than that of the non-PD group (P<0.0001). The hazard ratio (HR) of stroke for the PD group was 2.37 (95% confidence interval [CI], 1.92 to 2.93, P<0.0001) compared to the non- PD group. Conclusions This study shows a significantly increased risk of ischemic stroke in PD patients. Further studies are required to investigate the underlying mechanism.
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The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study. PLoS One 2013; 8:e73037. [PMID: 24023667 PMCID: PMC3758282 DOI: 10.1371/journal.pone.0073037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder. Methods This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430–438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors. Results A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12–1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06–1.55; p = 0.012) after adjusting for patient, physician and hospital variables. Conclusions The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.
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Oncel C, Tokgöz F, Bozkurt AI, Erdoğan C. Prevalence of cerebrovascular disease: a door-to-door survey in West Anatolia. Neurol Sci 2013; 35:373-7. [PMID: 23975522 DOI: 10.1007/s10072-013-1521-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/07/2013] [Indexed: 01/06/2023]
Abstract
The aim of this study was to demonstrate the prevalence of cerebrovascular disease (CVD), and its relation to age, education, gender, and other risk factors in the city of Denizli, Turkey. The study was performed between 2010 and 2011 in the city center, where 138,000 inhabitants >45 years were included in the research. 2,441 inhabitants were selected by cluster sampling method. A specific questionnaire about CVD was employed during the interview. We inquired about patient's age, gender, and educational history. If there was suspicion of CVD, cranial imaging was performed, and recent medical records were re-evaluated. The mean age was 58 ± 10.1 (45-100) among 2,441 in this study. Of those, 1,257 (51.5 %) participants were female and 1,184 (48.5 %) were male. We found the prevalence of CVD to be 0.9 % with 0.68 % among males and 1.21 % among females (p = 0.023). The mean age of subjects with CVD was 72.4 ± 8.1 (56-86) years. CVD was found to increase with age (p = 0.001), but was lower than reported rates in other European countries; however, it was similar to that of Mediterranean countries. CVD was detected more frequently in women than men. This finding differed from other studies, but was first to evaluate the prevalence of CVD in Turkey.
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Affiliation(s)
- Cağatay Oncel
- Department of Neurology, Pamukkale University Medical Faculty, Denizli, Turkey,
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Huang WY, Chen YF, Chang HC, Yang TK, Hsieh JT, Huang KH. The incidence rate and characteristics in patients with testicular torsion: a nationwide, population-based study. Acta Paediatr 2013; 102:e363-7. [PMID: 23611668 DOI: 10.1111/apa.12275] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/19/2013] [Indexed: 11/28/2022]
Abstract
AIM To determine the incidence rate and characteristics in patients with testicular torsion in Taiwan using a nationwide insurance database. METHODS This study utilizes a subset of national health insurance research database, which contains the data of all paid medical benefit claims over the period 1997-2010 for in 1 000 000 beneficiaries in 2005. We analysed claims data for all male subjects younger than 25 years with the diagnosis of testicular torsion. RESULTS A total of 86 subjects younger than 25 years with the diagnosis of testicular torsion were included. Among them, 22 (25.6%) underwent orchiectomies and 64 (74.4%) underwent orchiopexies. The estimated incidence of testicular torsion was 3.5 per 100 000 person-years. There are two peaks in the age-specific incidence rates: the first in boys aged 10-14 years (at 7.7 per 100 000 person-years) and the second in male infants aged <1 year (at 7.6 per 100 000 person-years). There was significant difference between orchiectomy and orchiopexy groups in the Insurance fee (p = 0.032). CONCLUSION The incidence of testicular torsion in Taiwan was similar with previous report in the United States. It is important to improve the medical access to achieve better outcomes of testicular torsion.
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Affiliation(s)
- Wei-Yi Huang
- Institute of Health and Welfare Policy; National Yang-Ming University; Taipei Taiwan
- NHI Committee; Executive Yuan; Taipei Taiwan
| | - Yu-Fen Chen
- Institute of Health and Welfare Policy; National Yang-Ming University; Taipei Taiwan
- NHI Committee; Executive Yuan; Taipei Taiwan
- Department of Nursing; Kang-Ning Junior College of Medical Care and Management; Taipei Taiwan
| | - Hong-Chiang Chang
- Department of Urology; National Taiwan University Hospital; Taipei Taiwan
| | - Teng-Kai Yang
- Department of Surgery; Cardinal-Tien Hospital; Yonghe Branch; New Taipei city Taiwan
| | - Ju-Ton Hsieh
- Department of Urology; National Taiwan University Hospital; Taipei Taiwan
| | - Kuo-How Huang
- Department of Surgery; Cardinal-Tien Hospital; Yonghe Branch; New Taipei city Taiwan
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Danesi MA, Okubadejo NU, Ojini FI, Ojo OO. Incidence and 30-day case fatality rate of first-ever stroke in urban Nigeria: The prospective community based Epidemiology of Stroke in Lagos (EPISIL) phase II results. J Neurol Sci 2013; 331:43-7. [DOI: 10.1016/j.jns.2013.04.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 04/25/2013] [Accepted: 04/25/2013] [Indexed: 11/29/2022]
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