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Meng NH, Li CI, Hua CH, Lin TC, Chiu CJ, Lin CL, Tsai MH, Chiu PJ, Chang WD, Tsou YA. Longitudinal changes in swallowing function after surgery and proactive swallowing therapy for oral cancer. Head Neck 2023. [PMID: 37155345 DOI: 10.1002/hed.27373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND This study aimed to describe and explore the longitudinal changes in swallowing function among patients with oral cancer who underwent surgery and proactive swallowing therapy from baseline to 1-year postoperation. METHODS We retrospectively studied 118 patients over a 4.5-year duration. Swallowing functional assessment including 10-item Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), M. D. Anderson Dysphagia Inventory, and Modified Barium Swallow Impairment Profile (MBSImP™) was performed at baseline, 1-month, 6-month, and 1-year postoperatively. RESULTS All swallowing parameters worsened 1-month postoperation. EAT-10, FOIS, and MBSImP™ oral and pharyngeal impairment scores improved significantly compared with 1-month postoperation at 6 months. Other swallowing parameters, except for weight, did not differ significantly from baseline at 6 months. The rate of tube-feeding dependency was 11.5% and 5.6% at 1 and 6 months postoperation, respectively. CONCLUSIONS Periodic swallowing functional assessments help delineate the longitudinal changes in swallowing functional outcomes.
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Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Hua
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Otolaryngology - Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Otolaryngology - Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Jen Chiu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Otolaryngology - Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Lin Lin
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Hsui Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Otolaryngology - Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Ju Chiu
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan
| | - Yung-An Tsou
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
- Department of Otolaryngology - Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
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Meng NH, Tsou YA, Yang PY, Chen HC, Chang CW. Dysphagia in a Patient with Esophageal and Hypopharyngeal Cancers After Esophageal Reconstruction: A Pharyngeal Clearance Facilitating Maneuver. Dysphagia 2022; 37:1337-1339. [PMID: 34999931 DOI: 10.1007/s00455-021-10394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 2 Yude Road, Taichung, 404, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yung-An Tsou
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Pei-Yu Yang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 2 Yude Road, Taichung, 404, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chi Chen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Plastic and Reconstruction Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Wei Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 2 Yude Road, Taichung, 404, Taiwan.
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Chang CC, Jan WL, Juan CH, Meng NH, Lin BS, Chen HC. Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study. Sensors (Basel) 2021; 21:s21248187. [PMID: 34960279 PMCID: PMC8707995 DOI: 10.3390/s21248187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023]
Abstract
An innovative wireless device for bioimpedance analysis was developed for post-dual-site free vascularized lymph node transfer (VLNT) evaluation. Seven patients received dual-site free VLNT for unilateral upper or lower limb lymphedema. A total of 10 healthy college students were enrolled in the healthy control group. The device was applied to the affected and unaffected limbs to assess segmental alterations in bioimpedance. The affected proximal limb showed a significant increase in bioimpedance at postoperative sixth month (3.3 [2.8, 3.6], p = 0.001) with 10 kHz currents for better penetration, although the difference was not significant (3.3 [3.3, 3.8]) at 1 kHz. The bioimpedance of the affected distal limb significantly increased after dual-site free VLNT surgery, whether passing with the 1 kHz (1.6 [0.7, 3.4], p = 0.030, postoperative first month; 2.8 [1.0, 4.2], p = 0.027, postoperative third month; and 1.3 [1.3, 3.4], p = 0.009, postoperative sixth month) or 10 kHz current ((1.4 [0.5, 2.7], p = 0.049, postoperative first month; 3.2 [0.9, 6.3], p = 0.003, postoperative third month; and 3.6 [2.5, 4.1], p < 0.001, postoperative sixth month). Bioimpedance alterations on the affected distal limb were significantly correlated with follow-up time (rho = 0.456, p = 0.029 detected at 10 kHz). This bioimpedance wireless device could quantitatively monitor the interstitial fluid alterations, which is suitable for postoperative real-time surveillance.
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Affiliation(s)
- Chang-Cheng Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung 404332, Taiwan; (C.-C.C.); (W.-L.J.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan 711010, Taiwan
| | - Wei-Ling Jan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung 404332, Taiwan; (C.-C.C.); (W.-L.J.)
| | - Cheng-Huei Juan
- Institute of Biomedical Science, China Medical University, Taichung 404333, Taiwan;
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan 711010, Taiwan
- Correspondence: (B.-S.L.); (H.-C.C.); Tel.: +886-6-3032121-57835 (B.S.-L.); +886-4-22052121-1538 (H.-C.C.)
| | - Hung-Chi Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung 404332, Taiwan; (C.-C.C.); (W.-L.J.)
- International Medical Service Center, China Medical University Hospital, Taichung 404332, Taiwan
- Correspondence: (B.-S.L.); (H.-C.C.); Tel.: +886-6-3032121-57835 (B.S.-L.); +886-4-22052121-1538 (H.-C.C.)
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4
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Chien A, Chang FC, Meng NH, Yang PY, Huang C, Chou LW. Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients. J Med Biol Eng 2021. [DOI: 10.1007/s40846-020-00590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose
Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone.
Methods
Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions.
Results
Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire.
Conclusion
The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.
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Heng HM, Lu MK, Chou LW, Meng NH, Huang HC, Hamada M, Tsai CH, Chen JC. Changes in Balance, Gait and Electroencephalography Oscillations after Robot-Assisted Gait Training: An Exploratory Study in People with Chronic Stroke. Brain Sci 2020; 10:brainsci10110821. [PMID: 33171938 PMCID: PMC7694605 DOI: 10.3390/brainsci10110821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Robot-assisted gait training (RAGT) systems offer the advantages of standard rehabilitation and provide precise and quantifiable control of therapy. We examined the clinical outcome of RAGT and analyzed the correlations between gait analysis data and event-related desynchronization (ERD) and event-related synchronization (ERS) in patients with chronic stroke. We applied the Berg balance scale (BBS) and analyzed gait parameters and the ERD and ERS of self-paced voluntary leg movements performed by patients with chronic stroke before and after undergoing RAGT. A significant change was observed in BBS (p = 0.011). We also showed preliminary outcomes of changes in gait cycle duration (p = 0.015) and in ipsilesional ERS in the low-beta (p = 0.033) and high-beta (p = 0.034) frequency bands before and after RAGT. In addition, correlations were observed between BBS and ipsilesional ERS in the alpha and low-beta bands (r = −0.52, p = 0.039; r = −0.52, p = 0.040). The study demonstrated that RAGT can improve balance and provided an idea of the possible role of brain oscillation and clinical outcomes in affecting stroke rehabilitation.
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Affiliation(s)
- Hoon-Ming Heng
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Li-Wei Chou
- Department of Rehabilitation, Asia University Hospital, Taichung City 404, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404, Taiwan;
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 404, Taiwan
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404, Taiwan;
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 404, Taiwan
| | - Hui-Chun Huang
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Masashi Hamada
- Department of Neurology, The University of Tokyo, Graduate School of Medicine, Tokyo 100-0000, Japan;
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
- Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu 300, Taiwan
- Correspondence:
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Meng NH, Li CI, Liu CS, Lin CH, Chang CK, Chang HW, Yang CW, Li TC, Lin CC. Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults: A randomized trial of supervised versus home-based programs. Medicine (Baltimore) 2020; 99:e21187. [PMID: 32702879 PMCID: PMC7373606 DOI: 10.1097/md.0000000000021187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aimed to investigate the effects of supervised and home-based exercise programs on older people with frailty or pre-frailty. METHODS A total of 146 community-dwelling participants aged 65 and older who were prefrail or frail were randomly allocated into supervised exercise (N = 74) and home exercise (N = 72) groups. The 3-month supervised exercise training consisted of 3 exercise sessions per week, was performed at a hospital and supervised by a physical therapist. Home exercise participants took instructions on exercise and illustrated exercise handouts. The baseline and 3-month follow-up measurements included body composition, strength of selected upper and lower limb muscle groups, grip and leg press strengths, and five physical performance tests. Mixed-model repeated-measures analysis was applied to determine whether two groups differ in terms of changes before and after the intervention and to compare within-group improvements. RESULTS After 3 months of supervised or home-based exercise, the average number of frailty criteria met and fat percentage decreased significantly. Strength of knee extensors, knee flexors and leg press improved significantly in supervised exercise group. In home-based exercise group, the strength of all muscle groups tested improved significantly, except for leg press strength. Walking speed improved in both groups, and timed-up-and-go and timed chair rise tests improved significantly only in supervised exercise group. CONCLUSIONS Three-month supervised or home-based exercise improved walking speed and strength of the limb muscles. Supervised group showed more improvements in the physical performance tests compared with home-based exercise group.
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Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University
- Department of Medical Research
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University
- Department of Family Medicine, China Medical University Hospital
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University
- Department of Family Medicine, China Medical University Hospital
| | - Chin-Kai Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Heng-Wei Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | | | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University
- Department of Family Medicine, China Medical University Hospital
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Abstract
RATIONALE Bariatric surgery is the recommended treatment for morbid obesity because of its rapid and sustained body weight loss effect. Nutrient deficiency-related neurological complications after bariatric surgery are often disabling. Thus, early recognition of these complications is important. Neurological complications involving the central and peripheral nerve system after bariatric surgery were reported. However, the report on the clinical course of the concurrent involvement of central and peripheral nervous system is limited. We present a rare case of a patient who developed Wernicke encephalopathy concurrent with polyradiculoneuropathy after receiving bariatric surgery. PATIENT CONCERNS A 22-year-old man with a history of morbid obesity presented progressive bilateral lower limbs weakness, blurred vision, and gait disturbance 2 months after receiving laparoscopic sleeve gastrectomy. Bilateral lower limb numbness and cognition impairment were also noted. DIAGNOSIS Brain magnetic resonance imaging and electrophysiologic studies confirmed the diagnosis of Wernicke encephalopathy concurrent with acute polyradiculoneuropathy. INTERVENTIONS Vitamin B and folic acid were given since admission. He also received regular intensive rehabilitation program. OUTCOMES The subject's cognitive impairment and diplopia improved 1 week after admission under medical treatments, yet lower limb weakness and gait disturbance were still noted. After a month of intensive inpatient rehabilitation, he was able to ambulate with a walker for 30 munder supervision. LESSONS Nutrient deficiency-related neurological complications after bariatric surgery are often disabling and even fatal. Prevention of neurological complications can be improved through close postsurgical follow-up of the nutritional status. Recognizing the signs and symptoms and evaluating the medical history are critical to the early diagnosis and treatment of this potentially serious yet treatable condition.
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Affiliation(s)
- Heng-Wei Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Pei-Yu Yang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Ting-I Han
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
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Yang PY, Chen CC, Chang CYY, Chou ECL, Meng NH. Cross-sectional study of the feasibility of urinating in a standing position among women in the third trimester of pregnancy. Int J Gynaecol Obstet 2017; 138:226-227. [PMID: 28453872 DOI: 10.1002/ijgo.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/19/2017] [Accepted: 04/26/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Pei-Yu Yang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Cheng Chen
- Department of Urology, Taichung Tzu Chi Hospital, Taichung, Taiwan
| | - Cherry Yin-Yi Chang
- School of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Eric Chieh-Lung Chou
- School of Medicine, China Medical University, Taichung, Taiwan.,Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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Li CI, Li TC, Liao LN, Liu CS, Yang CW, Lin CH, Hsiao JH, Meng NH, Lin WY, Wu FY, Lin CC. Joint effect of gene-physical activity and the interactions among CRP, TNF-α, and LTA polymorphisms on serum CRP, TNF-α levels, and handgrip strength in community-dwelling elders in Taiwan - TCHS-E. Age (Dordr) 2016; 38:46. [PMID: 27056089 PMCID: PMC5005924 DOI: 10.1007/s11357-016-9909-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/29/2016] [Indexed: 05/05/2023]
Abstract
This study assesses interactions of tumor necrosis factor α (TNF-α) gene polymorphisms with C-reactive protein (CRP) or lymphotoxin α (LTA) gene on serum CRP and TNF-α levels and handgrip strength. Eleven single nucleotide polymorphisms (SNPs), including rs2794520, rs1205, rs1130864, rs1800947, and rs3093059 in CRP; rs1799964, rs1800629, and rs3093662 in TNF-α; and rs2239704, rs909253, and rs1041981 in LTA, were genotyped in 472 unrelated elders (mean age 73.8 years). Among elders with TNF-α rs1799964 AA genotype, adjusted mean difference for handgrip strength decreased by -2.60 (-4.82, -0.38) and -2.51 kg (-4.75, -0.28) for LTA rs909253 and rs1041981 in women and by -2.39 kg (-3.98, -0.81) for CRP rs3093059 in men. Among elders with TNF-α rs1799964 AA genotype, adjusted mean ratios for hs-CRP levels increased by 2.32 (1.38, 3.90) and 2.27 (1.35, 3.84) for both CRP rs909253 and rs1041981 in women. The A-A-C LTA haplotype was associated with TNF-α levels that were 1.55 times higher than those of the C-G-A haplotype (P = 0.005). The joint effects of SNPs (the rs1800947 or rs3093059 of CRP, rs1799964 or rs1800629 of TNF-α, and rs909253 or rs1041981 of LTA) and physical inactivity appeared to have greater magnitude of decreased handgrip strength than main effects of these SNPs and physical inactivity. Our data showed that significant interactions of TNF-αrs1799964 and LTA rs909253 were observed. Moreover, joint effects of these CRP, TNF-α, and LTA risk alleles with physical inactivity in elders were observed, suggesting that physical activity may modulate effects of genotypes on handgrip strength.
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Affiliation(s)
- Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Li-Na Liao
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chuan-Wei Yang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jen-Hao Hsiao
- Bioinformatics and Biostatistics Core, Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Hsin Meng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fang-Yang Wu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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Li CI, Liu CS, Lin WY, Meng NH, Chen CC, Yang SY, Chen HJ, Lin CC, Li TC. Glycated Hemoglobin Level and Risk of Hip Fracture in Older People with Type 2 Diabetes: A Competing Risk Analysis of Taiwan Diabetes Cohort Study. J Bone Miner Res 2015; 30:1338-46. [PMID: 25598134 DOI: 10.1002/jbmr.2462] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/05/2023]
Abstract
Hip fracture, which is associated with substantial morbidity and long-term mortality, imposes a major burden on the healthcare system. Diabetes is a risk factor for osteoporosis, which is a crucial risk factor of hip fracture. However, epidemiological studies investigating the risk of hip fracture among patients with type 2 diabetes are limited. This study explored the association between hemoglobin A1c (HbA1c) and the risk of hip fracture in people with type 2 diabetes aged 65 years and older. We conducted a retrospective cohort study of 20,025 older patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. The HbA1c level at the baseline and hip fracture incidence over an average of 7.41 years of follow-up were analyzed (maximum and standard deviation were 10.9 and 2.42 years, respectively). A total of 1514 hip fracture cases were recorded. The incidence rates of hip fracture were 9.15, 8.02, 9.58, 10.61, 12.51, and 13.43 per 1000 person-years in patients with baseline HbA1c levels of < 6%, 6-7%, 7%-8%, 8%-9%, 9%-10%, and ≥ 10%, respectively. After multivariate adjustment, the risk of hip fracture increased among patients with HbA1c levels of 9%-10% and ≥ 10.0% compared with patients with HbA1c levels of 6-7% (hazard ratio, 1.24; 95% confidence interval, 1.02-1.49 and 1.32; 1.09-1.58, respectively). Significant linear trends among various HbA1c levels were observed (P < 0.05). Patients with type 2 diabetes whose HbA1c levels exceeded 9.0% exhibited an increased risk of hip fracture, confirming a linear relationship. Our study's findings demonstrated the importance of glycemic control for fracture prevention in older adults with type 2 diabetes.
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Affiliation(s)
- Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Nai-Hsin Meng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Sing-Yu Yang
- Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
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Li CI, Lin CH, Lin WY, Liu CS, Chang CK, Meng NH, Lee YD, Li TC, Lin CC. Successful aging defined by health-related quality of life and its determinants in community-dwelling elders. BMC Public Health 2014; 14:1013. [PMID: 25263664 PMCID: PMC4195952 DOI: 10.1186/1471-2458-14-1013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Successful aging in old age is important. However, the determinants of successful aging vary across populations due to cultural differences, and only a limited number of studies have addressed these determinants in Taiwan population. This study aimed to evaluate successful aging via better physical and mental functions as well as to explore associated determinants in an elderly Taiwan population that had no impaired cognitive function. Methods A community-based cross-sectional survey was conducted in January 2009 in Taichung, Taiwan. A total of 903 elderly persons (≥65 years) without impaired cognitive function were enrolled. Those with physical and mental component scores in the top tertile of the Short-Form 36 were considered to be aging successfully. All participants completed a structured questionnaire and the comprehensive geriatric assessment measurements of the five components of frailty defined by Fried et al. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to evaluate the relationship between associated factors and successful aging using logistic regression analysis. Results The prevalence of successful aging was 10.4% in elders. A higher proportion of successful aging was found in non-frail (16.9%) and pre-frail elders (7.2%) than in frail elders (0.9%). Multivariate logistic regression showed pre-frail elders to be associated with lower prevalence of successful aging relative to non-frail elders (OR: 0.45; 95% CI: 0.24–0.84). Relative to those aged ≤70 years, elders aged 71–75 years were associated with a lower prevalence of successful aging (OR: 0.27; 95% CI: 0.13–0.58). Successful aging was also more likely among those able to visit relatives and friends (OR: 3.86, 95% CI: 1.09–13.61) and among those without a history of falling (OR: 4.95; 95% CI: 1.79–13.74), pain (OR: 4.04; 95% CI: 2.18–7.50), or sleep disorders (OR: 2.36; 95% CI: 1.30–4.27). Conclusion Successful aging was associated with age, frail status, chronic health-related problems and psychosocial support. However, whether or not these associations are causal requires further exploration.
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Affiliation(s)
| | | | | | | | | | | | | | - Tsai-Chung Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Lin CC, Wu FY, Liao LN, Li CI, Lin CH, Yang CW, Meng NH, Chang CK, Lin WY, Liu CS, Li TC. Association of CRP gene polymorphisms with serum CRP level and handgrip strength in community-dwelling elders in Taiwan: Taichung Community Health Study for Elders (TCHS-E). Exp Gerontol 2014; 57:141-8. [PMID: 24862635 DOI: 10.1016/j.exger.2014.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 05/09/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
Low handgrip strength is one component of frailty, characterized by loss of reserves, including energy, physical ability, cognition and health. This study rated the effect of five single-nucleotide polymorphisms (SNPs) in C-reactive protein (CRP) gene on the serum CRP level and handgrip strength in elderly Taiwanese. Five SNPs (rs2794520, rs1205, rs1130864, rs1800947, and rs3093059) of CRP gene were utilized to genotype 472 unrelated elderly subjects (mean age 73.8years). Handgrip strength was measured by handgrip dynamometer (TTM Dynamometer, Tsutsumi, Tokyo). Our study demonstrated that minor alleles of rs2794520 and rs1205 were C, whereas they were T in most ethnic groups. There exist significant associations of three CRP polymorphisms (rs2794520, rs1205 and rs3093059) with serum CRP level and handgrip strength. All three had simultaneous influence on raising CRP levels and reducing handgrip strength. Genotype and sex interactions emerged for rs2794520 and rs1205 in relation to CRP levels (p<0.05). In addition, haplotype C-C-C-C-C was associated with higher levels of CRP (exp(β)=1.45; p<0.001) and lower handgrip strength (β=-1.00kg, p<0.05). We conclude that SNPs rs2794520, rs1205, and rs3093059 of CRP gene, as well as haplotype C-C-C-C-C may be important biomarkers for susceptibility to low handgrip strength and high serum CRP level in elders; further studies are required.
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Affiliation(s)
- Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Fang-Yang Wu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Na Liao
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chuan-Wei Yang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
| | - Nai-Hsin Meng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Kai Chang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan.
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Meng NH, Li CI, Liu CS, Lin CH, Lin WY, Chang CK, Li TC, Lin CC. Comparison of height- and weight-adjusted sarcopenia in a Taiwanese metropolitan older population. Geriatr Gerontol Int 2014; 15:45-53. [PMID: 24397819 DOI: 10.1111/ggi.12227] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/27/2022]
Abstract
AIM The present population-based, cross-sectional study was carried out in communities in Taichung, Taiwan, to identify the prevalence of and the factors associated with sarcopenia, using the diagnostic criteria of the European Working Group on Sarcopenia in Older People, which requires the presence of low muscle mass and low muscle function. METHODS We recruited 771 participants aged 65 years or older. Lean soft tissue mass was determined by dual-energy X-ray absorptiometry. Skeletal muscle index was calculated by dividing limb muscle mass by the square of height or weight. Low muscle mass was defined as having a skeletal muscle index two standard deviations or more below the gender-specific means of 506 healthy young adults. Sarcopenic obesity was defined as having sarcopenia and a body mass index over 25. RESULTS The prevalence of height- and weight-adjusted sarcopenia was 5.7% and 9.7%, respectively. The prevalence of height-adjusted sarcopenic obesity was 0.13%, much lower than that of weight-adjusted sarcopenic obesity (7.1%). Multivariate logistic regression analyses showed that higher urinary albumin-to-creatinine ratio was associated with both height- and weight-adjusted sarcopenia. Height-adjusted sarcopenia was also associated with male gender, lower body mass index and lower diastolic blood pressure. Weight-adjusted sarcopenia was also associated with older age, female gender, higher body mass index, gout, lack of regular exercise and a history of accidental falls. CONCLUSIONS The weight-adjusted skeletal muscle index is more capable of showing the effect of increased age on the prevalence of sarcopenia and identifying subjects with sarcopenic obesity among our study population.
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Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Lo SF, Chu SW, Muo CH, Meng NH, Chou LW, Huang WC, Huang CM, Sung FC. Diabetes mellitus and accompanying hyperlipidemia are independent risk factors for adhesive capsulitis: a nationwide population-based cohort study (version 2). Rheumatol Int 2013; 34:67-74. [DOI: 10.1007/s00296-013-2847-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Lin CC, Li CI, Meng NH, Lin WY, Liu CS, Lin CH, Chang CK, Lee YD, Lee CC, Li TC. Frailty and its associated factors in an elderly Taiwanese metropolitan population. J Am Geriatr Soc 2013; 61:292-4. [PMID: 23405925 DOI: 10.1111/jgs.12103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lin CC, Lin WY, Meng NH, Li CI, Liu CS, Lin CH, Chang CK, Lee YD, Lee CC, Li TC. Sarcopenia Prevalence and Associated Factors in an Elderly Taiwanese Metropolitan Population. J Am Geriatr Soc 2013; 61:459-62. [PMID: 23496184 DOI: 10.1111/jgs.12129] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cheng-Chieh Lin
- Department of Family Medicine; Department of Medical Research; China Medical University Hospital; Taichung Taiwan
- School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | - Nai-Hsin Meng
- School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
- Department of Physical Medicine and Rehabilitation; China Medical University Hospital; Taichung Taiwan
| | - Chia-Ing Li
- School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
- Department of Medical Research; China Medical University Hospital; Taichung Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine; China Medical University Hospital; Taichung Taiwan
- School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | - Chih-Hsueh Lin
- School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
- Department of Family Medicine; China Medical University Hospital; Taichung Taiwan
| | - Chiu-Kai Chang
- Department of Physical Medicine and Rehabilitation; China Medical University Hospital; Taichung Taiwan
| | - Yih-Dar Lee
- Department of Psychiatry; Medical College; National Cheng-Kung University; Tainan Taiwan
- Global Development & Medical Affairs; Bristol-Myers Squibb (Taiwan) Ltd; Taipei Taiwan
| | - Cheng-Chun Lee
- School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics; College of Public Health; China Medical University; Taichung Taiwan
- Institute of Health Care Administration; College of Health Science; Asia University; Taichung Taiwan
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Chou ECL, Yang PY, Hsueh WH, Chang CH, Meng NH. Urinating in the standing position: a feasible alternative for elderly women with knee osteoarthritis. J Urol 2011; 186:949-53. [PMID: 21791344 DOI: 10.1016/j.juro.2011.04.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Urinating while standing is a possible alternative for elderly women with knee osteoarthritis when a sitting toilet is unavailable. We evaluated uroflowmetric characteristics and post-void residual urine volume in elderly women with knee osteoarthritis who urinated while standing. MATERIALS AND METHODS We recruited 21 women with a mean±SD age of 65.0±4.6 years who had a knee osteoarthritis Lequesne index score of at least 6 points and were unable to maintain or found it difficult to stand up from a squat or crouch. Participants used a homemade auxiliary appliance to collect urine and drain it forward while stand voiding. Uroflowmetric data, including voided volume, and maximal and average flow rates, were recorded. Post-void residual urine volume was detected using an ultrasound bladder scanner. Participants completed a questionnaire to evaluate their attitude toward stand voiding and using the auxiliary device. RESULTS Maximal and average flow rates, and voided and post-void residual urine volumes were not statistically different while sitting and standing. No learning curve was noted for stand voiding. Uroflowmetry patterns while standing were smooth. Of the 21 participants 17 (81%) experienced no difficulty while stand voiding. All expressed willingness to urinate while standing position if they did not have access to a satisfactorily clean toilet seat. CONCLUSIONS Urinating while standing is a feasible option for elderly women with knee osteoarthritis who have difficulty crouching or squatting to void in public restrooms.
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Affiliation(s)
- Eric Chieh-Lung Chou
- Department of Urology, China Medical University Hospital and School of Medicine, China Medical University, Taichung, Taiwan, Republic of China
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Lin CC, Li CI, Chang CK, Liu CS, Lin CH, Meng NH, Lee YD, Chen FN, Li TC. Reduced health-related quality of life in elders with frailty: a cross-sectional study of community-dwelling elders in Taiwan. PLoS One 2011; 6:e21841. [PMID: 21747961 PMCID: PMC3128625 DOI: 10.1371/journal.pone.0021841] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 06/10/2011] [Indexed: 12/05/2022] Open
Abstract
Purpose Exploring the domains and degrees of health-related quality of life (HRQOL) that are affected by the frailty of elders will help clinicians understand the impact of frailty. This association has not been investigated in community-dwelling elders. Therefore, we examined the domains and degree of HRQOL of elders with frailty in the community in Taiwan. Methods A total of 933 subjects aged 65 years and over were recruited in 2009 from a metropolitan city in Taiwan. Using an adoption of the Fried criteria, frailty was defined by five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity level. HRQOL was assessed by the short form 36 (SF-36). The multiple linear regression model was used to test the independent effects of frailty on HRQOL. Results After multivariate adjustment, elders without frailty reported significantly better health than did the pre-frail and frail elders on all scales, and the pre-frail elders reported better health than did the frail elders for all scales except the scales of role limitation due to physical and emotional problems and the Mental Component Summary (MCS). The significantly negative differences between frail and robust elders ranged from 3.58 points for the MCS to 22.92 points for the physical functioning scale. The magnitude of the effects of frail components was largest for poor endurance and energy, and next was for slowness. The percentages of the variations of these 10 scales explained by all factors in the models ranged from 11.1% (scale of role limitation due to emotional problems) to 49.1% (scale of bodily pain). Conclusions Our study demonstrates that the disabilities in physical health inherent in frailty are linked to a reduction in HRQOL. Such an association between clinical measures and a generic measure of the HRQOL may offer clinicians new information to understand frailty and to conceptualize it within the broader context of disability.
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Affiliation(s)
- Cheng-Chieh Lin
- Department of Family Medicine, China Medical University & Hospital, Taichung, Taiwan
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Meng NH, Chen FN, Lo SF, Lo SF, Cheng WE. Reliability and validity of the Taiwan (Mandarin Chinese) version of the chronic respiratory questionnaire. Qual Life Res 2011; 20:1745-51. [PMID: 21476117 DOI: 10.1007/s11136-011-9906-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The chronic respiratory disease questionnaire (CRQ) has been validated and proved useful in assessing therapies for pulmonary diseases. We translated the CRQ into a Taiwan (Mandarin Chinese) version and surveyed its validity and reliability. METHODS The CRQ includes 20 items divided into four domains: dyspnea, fatigue, emotional function, and mastery. We followed a forward-back translation procedure to create the Taiwan version. A cross-sectional survey was conducted among outpatients with chronic obstructive pulmonary disease. Participants underwent tests including the CRQ, the medical outcomes study short form (SF-36), the St. George respiratory questionnaire (SGRQ), lung function tests (LFTs), and a graded exercise test (GET). We used Cronbach's alpha to evaluate the internal consistency of the CRQ, intraclass coefficient for test-retest reliability, and Spearman's correlation for validity. RESULTS Thirty-six men and 4 women (mean age 67.9 ± 9.9 years) were recruited. Evidence of good internal consistency, test-retest reliability, convergent, discriminant, concurrent, and construct validity of the CRQ was shown. Spearman's correlation showed moderate-to-strong correlation between the CRQ scores and scores of the SGRQ, subscales of the SF-36, and the results of LFTs and GET. CONCLUSIONS The Taiwan version of the CRQ shows good validity, internal consistency, and test-retest reliability.
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Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan, Republic of China
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Abstract
AIMS This study aims to evaluate the voiding disorder and lower urinary tract symptoms in mentally retarded children. METHODS Fifty-one mentally retarded children (age 7.7 years) was assessed. A volunteer sample comprised of 36 typically developing children (age 6.4 years) served as the comparative group. All participants underwent uroflometric investigation, and residual urine was detected by sonography. Urological history including history of urinary tract infection, incontinence, frequency, and dysurea was collected. In addition, the mentally retarded group was classified according to IQ: severe mentally retarded group (IQ below 40) (n = 11), moderate mentally retarded group (IQ: 41 to 55) (n = 19), mild mentally retarded group (IQ: 56 to 70) (n = 21). Group comparisons were analyzed using Chi-square and Student's t-test. RESULTS Of the 51 mentally retarded children, 18(35.2%) were found to have voiding dysfunction, which is significantly higher than the control group (8.3%). The incidence of urine incontinence and frequency is also significantly higher in the mentally retarded group. The comparison of the three mentally retarded subgroups showed that the severe mentally retarded group had the highest incidence of voiding dysfunction and urinary incontinence. Overall, the mentally retarded group had higher percentage of small bladder capacity. CONCLUSIONS We concluded that mentally retarded children have a higher incidence of voiding dysfunction and incontinence than the control group. Early detection of voiding dysfunction in an objective, non-invasive manner is important in mentally retarded children, particularly those with severe cognitive impairment.
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Affiliation(s)
- Pei-Yu Yang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
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Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou ECL. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause? Arch Phys Med Rehabil 2010; 91:1105-9. [PMID: 20599050 DOI: 10.1016/j.apmr.2010.03.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 03/10/2010] [Accepted: 03/12/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To delineate the frequency, clinical risk factors, and urodynamic mechanisms of incomplete bladder emptying (IBE) among patients with recent stroke. DESIGN Retrospective study. SETTING Inpatient setting in the rehabilitation ward of a university hospital. PARTICIPANTS All patients with acute stroke admitted for rehabilitation between January and December 2005, excluding those with a history of lower-urinary tract symptoms and urologic diseases. Eighty-two patients (42 women and 40 men; mean age, 65.5 y) were included. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We measured postvoid residual (PVRs) by catheterization or by using an ultrasonic bladder scanner. Twenty-five patients (30.5%) had IBE with PVRs greater than 100 mL on 2 consecutive days. Patients with IBE were evaluated by a urologist and subsequently underwent urodynamic studies. RESULTS The presence of IBE was significantly associated with urinary tract infection (P<.001) and aphasia (P=.046). The presence of IBE was not related to sex, stroke location, nature of stroke (hemorrhagic or ischemic), history of diabetes mellitus, or previous stroke. Urodynamic studies done on 22 patients with IBE revealed acontractile detrusor in 8 patients (36%) and detrusor underactivity in 3 (14%). Eleven patients (50%) had detrusor-external sphincter dyssynergia (DESD) combined with normative detrusor function (5 patients) or detrusor hyperactivity (6 patients); all but 1 of these patients had a supratentorial lesion. The presence of DESD was associated with a longer onset-to-evaluation interval (P=.018) [corrected] and spasticity of the stroke-affected lower limb (P=.02). [corrected] Diabetes mellitus was associated with the presence of acontractile detrusor or detrusor underactivity (P=.03). CONCLUSIONS IBE is common among patients with stroke and is caused by decreased detrusor contractility or DESD. Spasticity of the external urethral sphincter is a possible pathophysiologic mechanism of DESD.
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Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
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Abstract
AIM The patients in the permanent diabetes insipidus (DI) group are more likely to have more severe TBI, which is defined by a post-resuscitational and pre-sedational Glasgow Coma Scale (GCS) score of 8/15 or less. This study presents a case of permanent, central DI following mild traumatic brain injury with post-resuscitation GCS 13/15. CASE REPORT A 17-year-old boy suffered from mild brain injury and experienced permanent DI without any anatomical changes on image in the early stage of traumatic brain injury. However, 1 year later, magnetic resonance imaging (MRI) of the brain in this patient has revealed some sequel of contusion. Moreover, the patient still has DI after treatment with diamino-8-D-arginine vasopressin (DDAVP). CONCLUSION This patient had a rare clinical presentation of permanent, central DI, following a mild traumatic brain injury. Identification of head trauma as the aetiology of hypopituitarism may be overlooked if there is a long delay in onset after trauma. Since anterior hypopituitarism can develop decades after the episode of head trauma, monitoring for endocrine dysfunction during follow-up of these patients is important.
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Affiliation(s)
- Yi-Chun Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan, PR China
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Joe YS, Chen HS, Meng NH, Fong YC, Chou LW. Solitary Neurofibroma at the Popliteal Fossa in a Patient With Leg Numbness—A Case Report. J Med Ultrasound 2010. [DOI: 10.1016/s0929-6441(10)60019-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yang PY, Meng NH, Chou LW. Thickening of finger extensor tendons in affected hands among patients with stroke: prevalence and sonographic features. J Rehabil Med 2010; 42:853-7. [DOI: 10.2340/16501977-0604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND/PURPOSE Accurate length-of-stay (LOS) estimates have an impact on medical costs for stroke patients. Most studies have reported only descriptive sample means or have provided linear-model-based estimates for LOS. This study calculated point and interval estimates by treating hospital discharge as an event, and utilizing the proportional hazards (PH) model to provide the estimation of hospital stay for first-ever stroke patients in a rehabilitation department of a clinical center. METHODS Pairwise analysis for correlations between age, sex, comorbidity status, modified Barthel index (MBI) and functional independence measure (FIM) was performed. These explanatory variables are used in the K-sample comparisons, the Chi-squared test for association, the PH regression analysis, and log-transformed linear (LTL) regression. RESULTS The PH model gave a prediction on estimated mean LOS, with an absolute bias of 0.85 days, by combining MBI and FIM into a single variable, or a bias of 1.15 days and 1.16 days with MBI and FIM variables, respectively. The LTL-based estimation generated a bias of 5.91 days. The PH model has relatively shorter confidence intervals than those obtained by sample-mean and LTL methods. CONCLUSION We recommend using the PH model for predicting mean LOS when the PH assumption for patients with different clinical characteristics is satisfied. However, the proposed method only applies to rehabilitating stroke patients.
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Affiliation(s)
- Chien-Lin Lin
- Department of Rehabilitation, China Medical University Hospital, Taiwan
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Chen FF, Lo SF, Meng NH, Lin CL, Chou LW. Effects of wrist position and contraction on wrist flexors H-reflex, and its functional implications. J Electromyogr Kinesiol 2006; 16:440-7. [PMID: 16289712 DOI: 10.1016/j.jelekin.2005.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 08/11/2005] [Accepted: 08/31/2005] [Indexed: 11/30/2022] Open
Abstract
In order to determine whether joint position exerts a powerful influence on length-tension regulation in multiarticulate wrist flexors, three wrist positions (neutral, flexion and extension) and four levels of flexor contraction [0%, 10%, 20% and 30% maximum voluntary contraction (MVC)] were manipulated. There were significant differences in H-reflex amplitudes according to wrist positions and levels of flexor contraction. H-reflex increased linearly as a function of contraction in all three wrist positions. H-reflex was consistently larger in the wrist flexion than in the wrist extension position. The strength of the relationship (omega2) indicated that wrist position had a greater effect on H-reflex than force of muscle contraction. The interaction between wrist flexors contraction and joint position was significant only in the wrist flexion position. Trend analysis showed that, in the wrist flexion position, a low level of contraction was sufficient to maximally facilitate the H-reflex; however, a quadratic component was seen at higher contraction levels. The above findings may reflect the length-tension relationship of the multiarticulate wrist flexors. Therefore, this paper will discuss the functional implications related to the larger H-reflex in flexion position and the depressed H-reflex in the wrist extension position.
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Affiliation(s)
- Fen-Fen Chen
- Department of Physical Therapy, China Medical University, Taichung, Taiwan.
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Lo SF, Chen SY, Lin HC, Jim YF, Meng NH, Kao MJ. Arthrographic and clinical findings in patients with hemiplegic shoulder pain11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1786-91. [PMID: 14669184 DOI: 10.1016/s0003-9993(03)00408-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN Case series. SETTING Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.
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Affiliation(s)
- Sui-Foon Lo
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 91 Shiuesh Road, Taichung 404, Taiwan, ROC
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Abstract
OBJECTIVE This study was conducted to delineate the incidence and outcome of dysphagia among hospitalized patients who were referred for rehabilitation because of brainstem stroke. DESIGN We retrospectively reviewed the medical records of 36 patients who were admitted because of brainstem stroke. Information on the patients' clinical features, feeding status, and the results of clinical and videofluoroscopic swallowing examinations were obtained through chart review. Follow-up interviews were conducted via telephone to learn the general medical condition and feeding status of the patients 7-43 mo after hospital discharge. RESULTS A total of 81% of the patients had dysphagia at the time of initial clinical swallowing evaluation, which was performed 10-75 days after the onset of stroke. A total of 79% of the dysphagic individuals depended on tube feeding at the initial evaluation; 22% of all individuals could not resume oral intake at discharge. Statistical analyses revealed a significant association between poor outcome and disease involving the medulla, the presence of a wet voice during the initial swallowing test, and a delay or absence of the swallowing reflex. The incidence of aspiration pneumonia was 11%. There was a correlation between the detection of aspiration by modified barium meal videofluoroscopy and the development of aspiration pneumonia. Follow-up interviews showed that 88% of the 27 patients who were contacted had resumed full oral intake 4 mo after the onset of stroke. CONCLUSIONS The incidence of dysphagia was relatively high in our study population. The long-term outcome was favorable.
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Affiliation(s)
- N H Meng
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Republic of China
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