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Kaohsiung, Taiwan

Chou P.-S.,Kaohsiung Medical University | Chou W.-P.,Kaohsiung Medical University | Chen M.-C.,Kai Syuan Psychiatric Hospital | Lai C.-L.,Kaohsiung Medical University | And 4 more authors.
Journal of Sexual Medicine | Year: 2015

Introduction: Depression might increase the risk of erectile dysfunction (ED), and ED might further exacerbate depression. The causal relationship between these two diseases remains controversial. In addition, limited evidence is available regarding the age-dependent and time-dependent effects on the association of depression and ED. Aim: We investigated the hypothesis that ED increases the risk of depression by using a nationwide Taiwanese population-based claims database. In addition, we assessed the age-dependent and time-dependent effects on the association of depression and ED. Methods: A longitudinal cohort study was conducted to determine the association between patients with ED and depression development during a 5-year follow-up period, using claims data from the Taiwanese National Health Insurance Research Database. Main Outcome Measures: The study cohort comprised patients who were diagnosed with ED during 1997 to 2005 (N=2,527). For a comparison cohort, 5 age- and sex-matched patients for every patient in the study cohort were selected using random sampling (N=12,635). All of the patients were followed-up for 5 years from the date of cohort entry to identify the development of depression. Results: The main finding of this study was that patients with ED are at an increased risk of developing depression. The adjusted hazard ratio (AHR) for depression was 2.24-fold higher in the patients with ED than in the comparison cohort (95% confidence interval [CI]: 1.83-2.74; P<0.001). Regarding the time-dependent effect, the incidence of depression was highest during the first year of follow-up (AHR: 3.03, 95% CI=2.08-4.40; P<0.001). Conclusions: This study demonstrates that patients with ED are at a higher longitudinal risk of developing depression in Asian men, particularly within the first year after the diagnosis of ED. © 2014 International Society for Sexual Medicine. Source


Huang C.-Y.,Foundation Medicine | Huang C.-Y.,Tzu Chi University | Chou F.H.C.,Kai Syuan Psychiatric Hospital | Chou F.H.C.,Meiho University | And 11 more authors.
Journal of Psychiatric Research | Year: 2014

Objective: Recent case reports suggest that zolpidem usage may be associated with infection events. The aim of this study was to determine the risk of infection events in patients with sleep disturbance taking zolpidem in a full 3-year follow-up study. Methods: A total of 17474 subjects with a diagnosis of sleep disturbance in 2002 and 2003 were identified, of whom 5882 had used zolpidem after recruitment. A Cox proportional hazard model was used to estimate the 3-year infection event-free rates for the patients using zolpidem and those not using zolpidem after adjusting for confounding factors. To maximize case ascertainment, only patients hospitalized for infection events were included. Results: A total of 646 patients had had infection events, 331 (5.63%) of whom had been taking zolpidem and 315 (2.71%) had not. Zolpidem usage increased the risk of infection events. After adjustments for gender, age, co-morbidities, and other medications, patients using zolpidem with cDDD 1-28, 29-84, and >84 had hazard ratios of 1.67 (95% CI, 1.32-2.11), 1.91 (95% CI, 1.47-2.49) and 1.62 (95% CI, 1.32-1.98) respectively, compared with patients who did not use zolpidem. Conclusions: Zolpidem increased the risk of infection events in sleep disturbance patients. This increased risk of infection should be explained to sleep disturbance patients, and prescriptions of zolpidem to chronic insomnia patients should be restricted. © 2014 Elsevier Ltd. Source


Wu H.-C.,Kai Syuan Psychiatric Hospital | Chou F.H.-C.,Kai Syuan Psychiatric Hospital | Chou F.H.-C.,Meiho University | Tsai K.-Y.,Kai Syuan Psychiatric Hospital | And 4 more authors.
PLoS ONE | Year: 2013

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. © 2013 Wu et al. Source


Lin C.-H.,Kai Syuan Psychiatric Hospital | Chou L.-S.,Kai Syuan Psychiatric Hospital | Lin C.-H.,Chang Gung University | Hsu C.-Y.,Kai Syuan Psychiatric Hospital | And 2 more authors.
Journal of Clinical Psychopharmacology | Year: 2012

Remission seems achievable for a portion of schizophrenic patients. This study aimed to identify the early predictors for remission and to establish an optimal prediction model. One hundred thirty-five acutely ill schizophrenic inpatients received 150-mg/d zotepine treatment for 4 weeks. Psychopathologic severity was assessed weekly using the Brief Psychiatric Rating Scale (BPRS). Symptomatic remission was defined according to the consensus criteria proposed by Andreasen et al. Backward stepwise logistic regression model was used to obtain the early predictors. The receiver operating characteristic curve was used to determine the cutoff point of predictors. The study was conducted from June 2004 to April 2005. Twenty-one (21.0%) of 100 completers remitted after 4 weeks of treatment. The most influential predictors for ultimate remission were percentage of BPRS score reduction at week 2 and BPRS remission-items score at week 2. Brief Psychiatric Rating Scale score reduction at week 2 of 35% and BPRS remission-items score of 18 at week 2 seemed to be the optimal cutoff points. They provided a sensitivity of 62% and 84% and a specificity of 86% and 65%. Patients with less than a 35% BPRS score reduction and a BPRS remission-items score larger than 18 during the first 2 weeks of treatment were unlikely to reach a final remission. Whether the finding can be extrapolated to other validated assessment scales and other antipsychotics require further studies. Copyright © 2012 Lippincott Williams & Wilkins. Source


Chen Y.-L.,Fu Jen Catholic University | Wang C.-Y.,Fu Jen Catholic University | Wu C.-C.,Dalin Tzu Chi Hospital | Lee M.-S.,Dalin Tzu Chi Hospital | And 12 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2014

Conclusion: High LNR exerts a significant role as a negative prognostic factor when comparing the traditional American Joint Committee on Cancer (AJCC) lymph nodes classification for major cancers. Therefore, LNR could be considered as an alternative and superior to, at least partially, traditional AJCC lymph nodes classification for cancer patients.Results: A total of 431 cancer patients with pN+ were eligible in the current study: 149 patients with colorectal cancer; 141 patients with breast cancer; and 141 patients with head and neck cancer. High LNR was associated with poor DSS rates with the mean 24–45 months of follow-up period. In the multivariate analysis, high LNR was an independent poor prognostic factor in colorectal cancer (LNR ≥ 0.5; HR 4.10; p < 0.001), breast cancer (LNR ≥ 0.8; HR 5.75; p = 0.002), and head and neck cancer (LNR ≥ 0.4; HR 2.56; p = 0.005).Background: The utility of lymph node ratio (LNR) in predicting outcomes has been reported previously. In current study, we further subgroup by LNR in subjects with lymph nodes metastasis of colorectal cancer, breast cancer, and head and neck cancer.Methods: Cancers with pathological lymph node metastasis (pN+) at time of diagnosis between 2004 and 2012 were identified from the cancer registry database of the Dalin Tzu Chi General Hospital. The Kaplan–Meier method with log-rank test and the Cox proportional hazards model were used to compare the disease-specific survival (DSS) rates for different LNR after adjusting for possible confounding risk factors. © 2014, Springer-Verlag Berlin Heidelberg. Source

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