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Huang C.-J.,Kaohsiung Medical University | Chiu H.-C.,Kaohsiung Medical University | Lee M.-H.,Kaohsiung Medical University | Lee M.-H.,Kaohsiung Municipal Hsiao Kang Hospital | Wang S.-Y.,Kaohsiung Medical University
General Hospital Psychiatry | Year: 2011

Objective: This study aimed to investigate the prevalence and incidence of anxiety disorders among diabetic patients in Taiwan. Methods: Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of anxiety disorders and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004 in the National Health Insurance database. Results: The 1-year prevalence rate of anxiety disorders among diabetic patients was 128.76 per 1000 in 2000, and the cumulative prevalence increased to 289.89 per 1000 in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age (?65, 55-64), female sex and low income by multiple logistic regression analysis. Cox regression analysis revealed that a higher incidence was associated with female sex and low income. Conclusions: The prevalence and annual incidence density of anxiety disorders in diabetic patients were significantly higher than in patients with mental illness only in the general population. Female diabetic patients had a higher prevalence and incidence density of anxiety disorders. Anxiety disorders in diabetic patients were more prevalent in elderly women and in those with low income. © 2011 Elsevier Inc.


Chen Y.-M.,Kaohsiung Municipal Hsiao Kang Hospital | Chen Y.-M.,Kaohsiung Medical University | Johantgen M.E.,University of Maryland, Baltimore
International Journal of Nursing Studies | Year: 2010

Background: The Magnet Recognition Program in the USA has been based on 14 hospital characteristics that were common in hospitals that were "magnets" for professional nurses. While the program has expanded to other countries, no research has explored how the concept translates to other cultures and healthcare systems, nor have multilevel approaches been used. Objective: The primary aim of this study was to explore the presence of Magnet Hospital attributes in hospitals in two European countries. In addition, the relationship between Magnet Hospital attributes and nurses' job satisfaction was examined at both the nurse and the hospital level. Design: A secondary data analysis with cross-sectional design was conducted. A multilevel approach was taken to account for the hospital effect due to the nested nature of the data. Settings: Nurses practicing in acute care hospitals in Germany (16) and Belgium (15) were examined. Hospitals that had less than five respondents were excluded. Participants: Survey responses from 2303 registered nurses (RNs) from Belgium and 2646 RNs from Germany were included. Non-RN providers, RNs with administrative positions, and those working in non-inpatient areas were excluded. The final sample was 3182 staff nurses working in acute care hospitals. Methods: Magnet Hospital attributes that might be represented in NEXT survey items were reviewed by an expert panel before psychometric testing. Only six Magnet Forces could be measured. Latent constructs of these forces and job satisfaction were established. The measurement models and structural regression models were estimated using multilevel modeling in Mplus 4.21. Results: Six Magnet Forces were validated by two-level confirmatory factor analyses, with good fit to the data as demonstrated by the fit indices. All six Magnet Forces significantly predicted job satisfaction at the nurse level, with personnel policies having the strongest effect (b = 0.96). At the hospital level, management style had the strongest effect (b = 0.84) in predicting job satisfaction, followed by professional development, interdisciplinary relationship, and autonomy. Conclusions: Magnet Hospital attributes are evident in hospitals in two European countries and were found to be associated with job satisfaction. Further multilevel research should explore these attributes particularly at the nursing unit-level where work environment is experienced. © 2010 Elsevier Ltd.


Wang S.-N.,Kaohsiung Medical University | Wang S.-N.,Kaohsiung Municipal Hsiao Kang Hospital | Lee K.T.,Kaohsiung Medical University | Ker C.-G.,Kaohsiung Medical University
World Journal of Gastroenterology | Year: 2010

The risk factors for hepatocellular carcinoma (HCC) development have been established, and include chronic hepatitis B and C, heavy alcohol consumption, and aflatoxins. In fact, 5%-30% of patients with HCC still lack a readily identifiable risk factor. It has been reported that the majority of "cryptogenic" HCC may be attributed to nonalcoholic fatty liver disease, the hepatic presentation of the metabolic syndrome (MS). Obesity is associated with the development of the MS. Recently, adipose tissue has been considered as an endocrine organ because of its capacity to secrete a variety of cytokines, which are collectively known as the adipokines. Leptin, the product of the obese gene, is mainly produced by adipose tissue. Since leptin was first characterized in 1994, accumulated literature has demonstrated the involvement of this adipokine in several areas of human physiology. After binding to its receptor, leptin initiates a cascade of signaling events and subsequent cellular effects. In addition to being the regulatory mediator of energy homeostasis, several in vitro studies have demonstrated the fibrogenic role of leptin in the liver. Furthermore, the deregulated expression of leptin and its receptor have been demonstrated to be associated with a variety of metabolic disorders as well as human cancers. Most importantly, direct evidence supporting the inhibitory and/or activating role of leptin in the process of carcinogenesis and progression of human HCC has been accumulating rapidly. This review aims to provide important insights into the potential mechanisms of leptin in the development of HCC. Hopefully, further investigations will shed light on a new therapeutic target in HCC. © 2010 Baishideng.


Lee C.-H.,Kaohsiung Municipal Hsiao Kang Hospital | Lee C.-H.,Kaohsiung Medical University | Yu H.-S.,Kaohsiung Medical University
Current Problems in Dermatology | Year: 2011

Atopic dermatitis (AD) is a common allergic disease and constitutes a huge social and economic burden for the whole country. AD usually heralds other allergic diseases, such as asthma and allergic rhinitis. The pathogenesis of AD remains to be studied but generally includes abnormal skin barrier and aberrant cutaneous immune responses. Biomarkers are important in monitoring disease severity, prognosis and treatment responses. With the investigation and robust knowledge on AD pathophysiology, more and more biomarkers are being explored. Aberrant cutaneous inflammation is associated with Th2 polarization, chemokine upregulation in Langerhans cells and keratinocytes, IgE production by B cells, and degranulation of mast cells and eosinophils, subsequently leading to changes in the levels of cell-specific biomarkers in blood or urine. Furthermore, skin barrier abnormalities, including increased transepidermal water loss and decreased skin hydration, are biomarkers for severity and itch intensity in AD. Cross-talk between skin barrier abnormalities and aberrant immune responses is evidenced by epidermal abnormalities enhancing the release of keratinocyte-derived cytokines and chemokines, including CC chemokine ligand (CCL) 17, CCL27 and thymic stromal lymphopoietin, resulting in modulation of skin immune responses. The pathophysiology of itch in AD remains unclear. The subjective nature of itch makes biomarkers to estimate its intensity crucial in AD patients. Pruritus results from the activation of small nerve endings in the skin by noxious mediators, including neuropeptides, proinflammatory cytokines and prostaglandins, all of which might serve as potential biomarkers for itch. Recently, IL-31 and gastrin-releasing peptide have been reported to be involved in the development of itch, making the estimation of itch intensity a future reality. With the enormous amount of research in immunology, skin physiology and neurology in AD, more biomarkers in AD and its itch will be found in the near future. Copyright © 2011 S. Karger AG, Basel.


Yeh J.-J.,National Sun Yat - sen University | Tsai S.,National Sun Yat - sen University | Tsai S.,Kaohsiung Municipal Hsiao Kang Hospital | Wu D.-C.,Kaohsiung Medical University | And 3 more authors.
Blood | Year: 2010

P-selectin expression has been shown in Helicobacter pylori-infected persons, an infection that has been clinically associated with platelet-related diseases, such as idiopathic thrombocytopenic purpura. However, the role of P-selectin expression during H pylori infection remains unclear. In this study, we hypothesized that P-selectin expression was associated with platelet aggregation during H pylori infection. Using flow cytometry, we examined the levels of adhesion between H pylori and platelets as well as the levels of P-selectin expression and platelet phosphatidylserine (PS) expression during H pylori infection. Significantly high levels of adhesion between proaggregatory bacteria and platelets were observed. We identified that H pylori IgG is required for bacteria to induce P-selectin expression and that a significant release of P-selectin is essential for H pylori to induce aggregation. In addition, cellular apoptotic signs, such as membrane blebbing, were observed in platelet aggregates. PS expression was also detected in platelets during infection with both pro-aggrogatory and nonaggregatory strains of H pylori. These results suggest that the decrease in platelet counts seen during H pylori infection is the result of P-selection-dependent platelet aggregation and PS expression induced by the bacteria. © 2010 by The American Society of Hematology.


Huang P.,Kaohsiung Medical University | Chen C.-H.,Kaohsiung Medical University | Lin W.-C.,Kaohsiung Medical University | Lin R.-T.,Kaohsiung Medical University | And 3 more authors.
Journal of Neurology | Year: 2012

Susceptibility weighted imaging (SWI) is a newly developed magnetic resonance (MR) protocol. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the susceptibility vessel sign (SVS). Some authors have even suggested that SWI can be used to predict outcome. We conducted a prospective study of patients hospitalized with middle cerebral artery territory infarction receiving MRI within 2 days of stroke onset. The presence of prominent veins, microbleeds and SVS in SWI was analyzed along with hospital characteristics of the patients. A total of 44 patients were enrolled. Among the 44 patients, 15 (34.1%) patients showed prominent veins, 19 (43.2%) showed SVS, and 14 (31.8%) showed microbleeds. The presence of SVS and prominent veins was not associated with prognosis. Though not statistically significant (p = 0.06), patients with SVS were more likely to develop later brain edema. SVS was significantly associated with arterial occlusion (p = 0.008) based on the MR angiogram, and microbleeds were significantly associated with later hemorrhagic transformation (p = 0.018). In our study, SWI could not be used to predict outcome as previously suggested. However, the presence of microbleeds may predict further hemorrhagic transformation, and the presence of SVS could be used to detect intra-arterial thrombus. Patients with SVS were also more likely to develop later brain edema. Including SWI in routine MR protocols for major acute ischemic stroke would be worthwhile. © Springer-Verlag 2011.


Hsieh S.-W.,Kaohsiung Municipal Hsiao Kang Hospital | Hsieh S.-W.,Kaohsiung Medical University | Lai C.-L.,Kaohsiung Medical University | Liu C.-K.,Kaohsiung Municipal Hsiao Kang Hospital | And 3 more authors.
Journal of Neurology | Year: 2012

Obstructive sleep apnea (OSA) has been considered as one of the risk factors for ischemic stroke, but the impact of OSA on wake-up stroke (WUS) is not well studied. We aimed to determine the relationship between OSA and WUS. We prospectively recruited 71 patients with mild to moderate ischemic stroke during hospitalization. Patients were classified into WUS and non-WUS. A full-night sleep respiratory study was performed between 3 and 14 days after stroke onset. Demographic data, sleep respiratory data, heart rate variability, stroke risk factors, stroke classification and sleep-related scales were recorded. We compared the differences in the variables between the two groups and determined the independent variables associated with WUS. Of the 71 patients, 26 (36.6%) had WUS. The patients with WUS had a significantly higher apnea-hypopnea index (23.1 ± 19.4 vs. 12.5 ± 11.9, p = 0.016), obstructive apnea index (7.8 ± 9.7 vs. 3.0 ± 4.0, p = 0.021) and lower mean blood oxygen saturation (95.1 ± 1.5 vs. 95.8 ± 1.3, p = 0.046) than the non-WUS patients. There were no significant differences in demographic data, stroke risk factors, sleep-related scales or heart rate variability. Logistic regression revealed that severe sleep-disordered breathing (apnea-hypopnea index ≥30) was the only independent variable associated with WUS (OR 6.065, 95% CI 1.451-25.350; p = 0.014). We conclude that in patients with mild to moderate ischemic stroke, OSA is the only risk factor associated with WUS, which cannot be distinguished clinically from non-WUS. © Springer-Verlag 2011.


Tsai Y.-C.,Kaohsiung Medical University | Tsai J.-C.,Kaohsiung Medical University | Chen S.-C.,Kaohsiung Medical University | Chen S.-C.,Kaohsiung Municipal Hsiao Kang Hospital | And 6 more authors.
American Journal of Kidney Diseases | Year: 2014

Background Fluid overload is a common phenomenon in patients in a late stage of chronic kidney disease (CKD). However, little is known about whether fluid overload is related to kidney disease progression in patients with CKD. Accordingly, the aim of the study was to assess the association of the severity of fluid status and kidney disease progression in an advanced CKD cohort. Study Design Prospective observational cohort study. Setting & Participants This cohort study enrolled 472 non-dialysis-dependent patients with CKD stages 4-5 who were in an integrated CKD care program from January 2011 to December 2011 and followed up until December 2012 or initiation of renal replacement therapy (RRT). Predictors Tertile of fluid overload, with cutoff values at 0.6 and 1.6 L. Outcomes RRT, rapid estimated glomerular filtration rate (eGFR) decline (faster than 3 mL/min/1.73 m2 per year), and change in eGFR. Measurements The severity of fluid overload was measured by a bioimpedance spectroscopy method. eGFR was computed using the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation. Results During a median 17.3-month follow-up, 71 (15.0%) patients initiated RRT and 187 (39.6%) experienced rapid eGFR decline. The severity of fluid overload was associated with increased risk of RRT (tertile 3 vs tertile 1: adjusted HR, 3.16 [95% CI, 1.33-7.50]). Fluid overload value was associated with increased risk of rapid eGFR decline (tertile 3 vs tertile 1: adjusted OR, 4.68 [95% CI, 2.30-9.52]). Furthermore, the linear mixed-effects model showed that the reduction in eGFR over time was faster in tertile 3 than in tertile 1 (P = 0.02). Limitations The effect of fluid volume variation over time must be considered. Conclusions Fluid overload is an independent risk factor associated with initiation of RRT and rapid eGFR decline in patients with advanced CKD. © 2013 by the National Kidney Foundation, Inc.


Hsu P.I.,National Yang Ming University | Wu D.-C.,Kaohsiung Medical University | Wu J.-Y.,Kaohsiung Medical University | Wu J.-Y.,Kaohsiung Municipal Hsiao Kang Hospital | Graham D.Y.,Baylor College of Medicine
Helicobacter | Year: 2011

Background and Aims: Ten-day sequential therapy with a proton-pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori (H. pylori) eradication rates between 90 and 94% (i.e., Grade B success). It has been suggested that prolonging the duration of therapy might improve the treatment success. We tested whether prolonging treatment duration to 14-days would improve the results to 95% or greater eradication. Methods: This was a multi-center, single site, pilot study in which H. pylori-infected patients received a 14-day sequential therapy (esomeprazole and amoxicillin for 7days followed by esomeprazole, clarithromycin, and metronidazole for 7days). H. pylori status was assessed 8weeks after therapy. Success was defined as achieving 95% or greater eradication by per-protocol (PP) analysis. Results: One hundred and twenty-three subjects received the 14-day sequential therapy. The eradication rate was 93.9% (95% confidence interval [CI], 89.5-98.3%) by PP and 91.9% (95% CI, 87.1-96.7%) by intention-to-treat analysis. Adverse events were experienced by 21.1%; compliance of 90% or greater was 95.9%. Conclusions: Extending sequential therapy to 14 days did not result in improving the treatment outcome to 95% or greater. © 2011 Blackwell Publishing Ltd.


Hsu P.-I.,National Yang Ming University | Wu D.-C.,Kaohsiung Medical University | Wu J.-Y.,Kaohsiung Medical University | Wu J.-Y.,Kaohsiung Municipal Hsiao Kang Hospital | Graham D.Y.,Baylor College of Medicine
Helicobacter | Year: 2011

Background: Ten-day sequential therapy with a proton pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori eradication rates of 90-94% (Grade B success). Aims: We tested whether prolonging treatment and continuing amoxicillin throughout the 14-day treatment period would produce a ≥95% result. Methods: This was a multicenter pilot study in which H. pylori-infected patients received a 14-day sequential-concomitant hybrid therapy (esomeprazole and amoxicillin for 7days followed by esomeprazole, amoxicillin clarithromycin, and metronidazole for 7days). H. pylori status was examined 8weeks after therapy. Success was defined as achieving ≥95% eradication by per-protocol analysis. Results: One hundred and seventeen subjects received hybrid therapy. The eradication rate was 99.1% (95% confidence interval (CI), 97.3-100.0%) by per-protocol analysis and 97.4% by intention-to-treat analysis (95% CI, 94.5-100.0%). Adverse events were seen in 14.5%; drug compliance was 94.9%. Conclusions: Fourteen-day hybrid sequential-concomitant therapy achieved >95%H. pylori eradication (Grade A result). Further studies are needed 1, in regions with different patterns and frequencies of resistance to confirm these findings, and 2, to examine whether Grade A success is maintained with hybrid therapy shorter than 14days. © 2011 Blackwell Publishing Ltd.

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