Wang S.-Y.,University of Minnesota |
Chen L.-K.,National Taiwan University Hospital |
Hsu S.H.,York University |
Wang S.-C.,Hsinchu Cathay General Hospital
Health Policy and Planning | Year: 2012
Facing escalating health care expenditures, the governments of countries with national health insurance programs are trying to control or even to reduce health care utilization. Little research has examined the effects of decreased health care utilization on health outcomes. Applying a natural experiment design to the Taiwan population between 2000 and 2004, which includes the 2003 SARS epidemic when an average 20% decline in health care utilization occurred, this study examines the association between a decline in health care utilization and health outcomes measured by cause-specific mortality rates. We analyse the monthly mortality rates caused by infectious diseases, cancer, diabetes mellitus, nervous system diseases, cerebrovascular diseases, heart and other vascular diseases, respiratory system diseases, digestive system diseases, genitourinary system diseases and accidents. Models control for age, sex, month and year effects. Results show the heterogeneous effect of reduced health care utilization on health outcomes. Patients with diabetes mellitus or cerebrovascular diseases are vulnerable to short-term reductions in health care; compared with the non-SARS period, mortality caused by diabetes mellitus and cerebrovascular diseases significantly increased during the SARS epidemic by 8.4 and 6.2, respectively. No significant change in mortality rates caused by the other diseases or accidents is found. This study suggests that governments of countries where health care utilization and spending are similar to or inferior to those in Taiwan should carefully evaluate the impact of policies that attempt to reduce health care utilization. Furthermore, when an area encounters an epidemic, governments should be aware of the negative consequences of voluntary restraints on access to health care that accompany decreases in utilization. © 2011 The Author all rights reserved.
Chan C.-C.,Hsinchu Cathay General Hospital |
Chan C.-C.,Taipei Medical University |
Fan C.-W.,Chang Gung Memorial Hospital |
Kuo Y.-B.,Chang Gung University |
And 6 more authors.
International Journal of Cancer | Year: 2010
The aim of this study was to initiate a survey of human autoantibody responses to a panel of select colorectal tumorassociated antigens identified by previous serological analysis of a cDNA expression library and to subsequently identify multiple serological biomarkers for the detection of colorectal cancer. For screening of autoantibodies against colorectal tumor-associated antigens, sera from 94 colorectal cancer patients and 54 normal controls were analyzed by enzyme-linked immunosorbent assay using recombinant rCCCAP, rHDAC5, rP53, rNMDAR and rNY-CO-16 proteins as coating antigens. Seropositivity among colorectal cancer patients to the 5 individual coating antigens varied from 18.1% to 35.1%. Seropositivity to any of the 5 coating antigens was 58.5% and combining this analysis with evaluation of serum carcinoembryonic antigen (≥5 ng/ml) significantly increased the seropositivity to 77.6%. Seropositivity of early-stage (Dukes' Stages A and B) colorectal cancer patients to CEA was 21.9%, and seropositivity to any of the 5 colorectal cancer-associated antigens was 53.7%, and the combination of these 2 measurements resulted in a higher diagnostic capacity (65.9%) than either marker alone. In conclusion, these results collectively indicated that combined detection of serum autoantibody profiles against our panel of colorectal tumor-associated antigens and the analysis of carcinoembryonic antigen provides a promising diagnostic biomarker for colorectal cancer, particularly among early-stage patients. © 2009 UICC.
Lin K.-H.,Hsinchu Cathay General Hospital |
Ho-Jun S.,National Taiwan University |
Chen C.-L.,National Taiwan University |
Torng P.-L.,National Taiwan University Hospital
Gynecology and Minimally Invasive Therapy | Year: 2015
Uterine leiomyosarcomas (LMSs) are rare and aggressive but difficult to predict before surgery. Minimally invasive surgery using morcellation might cause tumor spreading during manipulating of tumor tissue. We aim to study the influence of morcellation on the prognosis of patients with early uterine LMS. Methods: We retrospectively reviewed the medical records of all patients with stage 1 LMS treated between April 1993 and April 2014. Demographics and outcomes were compared between patients who underwent total hysterectomy without morcellation and those who underwent surgery with abdominal, vaginal, and laparoscopic morcellation. Results: In total, 43 consecutive patients were identified, including 29 without morcellation and 14 with morcellation. Tumor size was significantly smaller (7.3 cm vs. 11.6 cm, p = 0.006) in patients with morcellation. Six (42.9%) patients with morcellation received reoperation at 18.5 days after the initial surgery. Patients with morcellation did not show higher recurrence rate, including the recurrence rate at the pelvic cavity, compared with patients without morcellation. Compared with patients without morcellation, Kaplan-Meier curves did not show significant difference in the disease-free survival (DFS) and overall survival (OS) in patients with morcellation. In univariate and multivariate analyses, tumor size was significantly associated with poor DFS and OS. Morcellation was not associated with survivals. Conclusion: In patients with stage 1 LMS, survival is associated with tumor size. Morcellation does not seem to be associated with a worse prognosis in early stage LMS. © 2015.
Chen S.-W.,National Taiwan University |
Chen S.-W.,Hsinchu Cathay General Hospital |
Tsan Y.-T.,National Taiwan University |
Tsan Y.-T.,Taichung Veterans General Hospital |
And 12 more authors.
Diabetes Care | Year: 2013
OBJECTIVE-Preclinical data suggest that peroxisome proliferator-activated receptor g (PPARg) agonists have antineoplastic effects in colorectal cancer. We aimed to assess the association between the use of synthetic PPARg agonists, represented by thiazolidinediones (TZDs), and the risk of developing colorectal cancer. RESEARCH DESIGN AND METHODS-We conducted a nationwide, population-based, case-control study using the Taiwan National Health Insurance Research Database. Case subjects were defined as patients who were diagnosed with diabetes at least 365 days prior to a new diagnosis of colorectal cancer between 2000 and 2008. We randomly selected diabetic control subjects for each case subject, which were matched by sex, age, and the duration of diabetes. Among the 24,496 eligible case subjects and control subjects, we used conditional logistic regression to assess the risk of colorectal cancer in association with the use of TZDs. An additional analysis was conducted to assess the effects of concomitant use of TZDs and low-dose aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) on the risk of colorectal cancer. RESULTS-A decreased risk of colorectal cancer was observed in patients who had used TZDs compared with those who had never used TZDs (adjusted odds ratio 0.86 [95% CI 0.79-0.94]). Furthermore, the benefit of a decreased colorectal cancer risk was also found with concomitant use of TZDs and low-dose aspirin or NSAIDs. CONCLUSIONS-The use of TZDs may be associated with a decreased risk of colorectal cancer in patients with diabetes. Further studies are warranted to confirm our findings.© 2013 by the American Diabetes Association.
Lin J.-L.,Hsinchu Cathay General Hospital |
Lin Y.-H.,Sijhih Cathay General Hospital |
Chueh K.-H.,Fu Jen Catholic University
Journal of Clinical Nursing | Year: 2014
Aims and objectives: To explore sleep quality in infertile women and examine the factors that contribute to sleep disturbances during intrauterine insemination treatment. Background: Sleep disturbance is an important factor of human health and well-being. Sleep disturbances tend to occur among infertile women during intrauterine insemination treatment. Although many studies have focused on the high percentage of somatic symptoms and psychological distress in infertile women associated with their treatment, few studies have investigated factors linked to their sleep disturbances. Design: A cross-sectional study. Methods: The study was conducted during the period of September 2010-January 2011 in a teaching hospital in Taiwan. Infertile women (n = 117) who received assisted reproduction with intrauterine insemination treatment completed a questionnaire. Demographic data, somatic symptoms, psychological distress and perceived sleep quality were collected. Results: More than one-third (35%) of the infertile women reported having sleep disturbances. Their nausea symptoms and psychological distress were risk factors that contributed to sleep disturbance. Conclusions: The variables of nausea and psychological distress significantly explained 30% of the sleep disturbances in the infertile women. The evaluation of nausea symptoms and/or psychological distress among infertile women is an important area of future research; such research should aim to identify the best compromise between infertility treatment and sleep quality. Relevance to clinical practice: Clinical obstetrics and gynaecology nurses should develop strategies to help infertile women reduce their nausea symptoms and psychological distress during intrauterine insemination treatment to promote healthy sleep. © 2013 John Wiley & Sons Ltd.
Liang C.-J.,National Taiwan University |
Wang S.-H.,National Taiwan University |
Chen Y.-H.,China Medical University at Taichung |
Chang S.-S.,China Medical University at Taichung |
And 5 more authors.
Free Radical Biology and Medicine | Year: 2011
Viscolin, a major active component in a chloroform extract of Viscum coloratum, has antioxidative and anti-inflammatory properties. We focused on its effects on the expression of vascular cell adhesion molecule-1 (VCAM-1) in tumor necrosis factor-α (TNF-α)-treated human umbilical vein endothelial cells (HUVECs). The TNF-α-induced expression of VCAM-1 was significantly reduced by respectively 38 ± 7 or 34 ± 16% when HUVECs were pretreated with 10 or 30 μM viscolin, as shown by Western blotting, and was also significantly reduced by pretreatment with the antioxidants N-acetylcysteine, diphenylene iodonium chloride, and apocynin. Viscolin also reduced TNF-α-induced VCAM-1 mRNA expression and promoter activity, decreased reactive oxygen species (ROS) production, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, and significantly reduced the binding of monocytes to TNF-α-stimulated HUVECs. The attenuation of TNF-α-induced VCAM-1 expression and cell adhesion was partly mediated by a decrease in JNK phosphorylation. Furthermore, viscolin reduced VCAM-1 expression in the aorta of TNF-α-treated mice in vivo. Taken together, these data show that viscolin inhibits TNF-α-induced JNK phosphorylation, nuclear translocation of NF-κB p65, and ROS generation and thereby suppresses VCAM-1 expression, resulting in reduced adhesion of leukocytes. These results also suggest that viscolin may prevent the development of atherosclerosis and inflammatory responses. © 2011 Elsevier Inc. All rights reserved.
Wang C.-J.,Chang Gung University |
Huang H.-J.,Chang Gung University |
Chao A.,Chang Gung University |
Lin Y.-P.,Chang Gung University |
And 2 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011
Objective: Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB). Study design: The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode. Results: The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time. Conclusions: Resectoscopic uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus. © 2010 Elsevier Ireland Ltd.
Chang C.-Y.,Hsinchu Cathay General Hospital |
Tang C.-H.,Taipei Medical University |
Chen K.-C.,Taipei Medical University |
Huang K.-C.,Taipei Medical University
Osteoporosis International | Year: 2016
Summary: This study estimated the fracture-related mortality and direct medical costs among postmenopausal women in Taiwan by fracture types and age groups by utilizing a nationwide population-based database. Results demonstrated that hip fractures constituted the most severe and expensive complication of osteoporosis across fracture sites. Introduction: The aims of the study were to evaluate the risk of death and direct medical costs associated with osteoporotic fractures by fracture types and age groups among postmenopausal women in Taiwan. Methods: This nationwide, population-based study was based on data from the National Health Insurance Research Database in Taiwan. Female patients aged 50 years and older in the fracture case cohort were matched in 1:1 ratio with randomly selected subjects in the reference control cohort by age, income-related insurance amount, urbanization level, and the Charlson comorbidity index. There were two main outcome measures of the study: age-differentiated mortality and direct medical costs in the first and subsequent years after osteoporotic fracture events among postmenopausal women. The bootstrap method by resampling with replacement was conducted to generate descriptive statistics of mortality and direct medical costs of the case and control cohorts. Student’s t tests were then performed to compare mortality and costs between the two cohorts. Results: A total of 155,466 postmenopausal women in the database met the inclusion criteria for the fracture case cohort, including 22,791 hip fractures, 72,292 vertebral fractures, 15,621 upper end humerus (closed) fractures, 36,774 wrist fractures, and 7,988 multiple fractures. Analytical results demonstrated that patients experiencing osteoporotic fractures were at considerable excess risk of death and incurred substantially higher treatment costs, notably for hip fractures. Furthermore, results also revealed that the risk of mortality increased with advancing age across the spectrum of fracture sites. Conclusions: The present study confirmed an excess mortality and higher direct medical costs associated with osteoporotic fractures. Moreover, hip fractures constituted the most severe and expensive complication of osteoporosis among fracture types. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation.
Liu C.-C.,Hsinchu Cathay General Hospital |
Huang C.-T.,Hsinchu Cathay General Hospital |
Lin C.-M.,Hsinchu Cathay General Hospital |
Liu K.-N.,Hsinchu Cathay General Hospital
European Spine Journal | Year: 2011
Intradural lumbar disc herniation is a rare complication of disc disease. The reason for the tearing of the dura matter by a herniated disc is not clearly known. Intradural disc herniations usually occur at the disc levels and are often seen at L4-L5 level but have also been reported at other intervertebral disc levels. However, intradural disc herniation at mid-vertebral levels is rare in the literature and mimics an intradural extramedullary spinal tumor lesion in radiological evaluation. Although magnetic resonance imaging (MRI) with gadolinium is useful in the diagnosis of this condition, preoperative correct diagnosis is usually difficult and the definitive diagnosis must be made during surgery. We describe here a 50-year-old female patient who presented with pain in the lower back for 6 months and a sudden exacerbation of the pain that spread to the left leg as well as numbness in both legs for 2 weeks. MRI demonstrated an intradural mass at the level of L5. Laminectomy was performed, and subsequently durotomy was also performed. An intradural disc fragment was found and completely removed. The patient recovered fully in 3 months. Intradural lumbar disc herniation must be considered in the differential diagnosis of mass lesions in the spinal canal. © Springer-Verlag 2011.
Chang C.-Y.,Hsinchu Cathay General Hospital |
Yew C.-W.,Hsinchu Cathay General Hospital
Formosan Journal of Musculoskeletal Disorders | Year: 2012
Although intertrochanteric fractures of the proximal femur are commonly seen in geriatric patients, their treatments remain challenging for most orthopedic surgeons. Dynamic hip screws (DHSs) with slide plating have become the golden standard for treating these difficult fractures. The goals of lateral wall buttress reconstruction and stable fixation are to promote early ambulation and partial weight bearing, which in turn minimizes possible morbidity. Intertrochanteric fractures, especially those that are unstable, when fixed with DHSs alone will often result in significant medial displacement of the shaft, secondary to excessive sliding of lag screws within the barrel and a higher incidence of lag screw cut-out. Fixation with an additional trochanter stabilizing plate (TSP) superimposed on the regular DHSs has recently gained wide advocacy among authors. However, TSP is expensive. To overcome problems with medial displacement of the shaft, excessive head-neck fragment collapse, and excessive sliding of lag screws within the barrel and lag screw cut-out, and to reduce the cost of TSP as well, we treated 2 patients with unstable intertrochanteric fractures by fixing the fractures with dynamic hip screws reinforced by tension band wiring. Both patients had good results without complications. The final outcomes were comparable to those of fractures fixed with DHSs and supported by TSP, but the cost was markedly lower. Additionally, complications from lateralization of the greater trochanter were significantly prevented. Our method of DHS fixation with tension band wiring reinforcement may be beneficial for patients with unstable osteoporotic intertrochanteric fractures. © 2012.