Taoyuan, Taiwan
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Fang Y.-T.,National Yang Ming University | Fang Y.-T.,Universal Eye Center | Chen L.-K.,National Yang Ming University | Chen L.-K.,Taipei Veterans General Hospital | And 8 more authors.
Archives of Gerontology and Geriatrics | Year: 2012

Medical utilization by elderly population is influenced by a number of factors, and physical disabilities may play an important role. Despite the fact that extensive studies have been carried evaluating medical utilization by older individuals, little is known regarding the impact of physical disabilities on eye care utilization. Using datasets from the Taiwan National Health Interview Survey and National Health Insurance (NHI) system, a sample of 1726 elderly people was obtained for analysis. Older persons with worse Activity of Daily Living (ADL) disabilities were less likely to have eye care (odds ratio (OR): 0.39, 95% confidence interval (CI): 0.25-0.62), but elderly who had Instrumental Activity of Daily Living (IADL) disabilities alone were not associated with lower odds (OR = 0.86, 95% CI = 0.61-1.20). In addition to the above, female individuals (OR = 1.91, 95% CI = 1.44-2.53), those with poorer vision (OR = 1.89, 95% CI = 1.36-2.62), those having eye discomfort (OR = 1.66, 95% CI = 1.26-2.18 and OR = 2.14, 95% CI = 1. 32-3.46 respectively for mild and more than moderate eye discomfort), and those with severe eye disease (OR = 1.96, 95% CI = 1.23-3.10) were more likely to undergo eye care. In conclusion, physical disability is a strong risk factor for lack of eye care utilization among older Taiwanese. The barriers associated with low eye care utilization among individuals with ADL disabilities should be explored in order to facilitate effective policy implementation among those elderly with disabilities so that they are able to receive appropriate eye care. © 2011 Elsevier Ireland Ltd.

Lei H.-L.,Chang Gung Memorial Hospital | Lei H.-L.,Chang Gung University | Yang K.-J.,Chang Gung Memorial Hospital | Yang K.-J.,Chang Gung University | And 11 more authors.
Journal of Ocular Pharmacology and Therapeutics | Year: 2011

Purpose: The purpose of this study was to evaluate obtained mydriasis and prevalence of small pupil in long-term type 2 diabetic patients. Methods: A prospective observational cross-sectional study was carried out. We included 107 eyes from 107 patients (mean age: 60.8) with long-term (≥10 years) type 2 diabetes mellitus. Patients were divided into 2 groups: no apparent diabetic retinopathy (group 1, n=33) and diabetic retinopathy (group 2, n=74). Exclusion criteria were eyes with prior intraocular surgeries, presence of other ocular disorders that may affect iris, or any other condition that precludes the precise measurement of pupil size. Sixty eyes in 60 age-matched nondiabetic patients (mean age: 61.0) scheduled for routine fundoscopy exam were enrolled as control. We measured pupil diameter by pupil gauges at 40 min after instillation of eye drops (phenylephrine 10% and tropicamide 1%). Small pupil was defined as pupil diameter of 6 mm or less. Results: Mean pupil diameter was 8.07 mm [standard deviation (SD): 0.59 mm] in the control group, 7.46 mm (SD: 0.71 mm) in group 1, and 7.24 mm (SD: 0.83 mm) in group 2. Both group 1 (P<0.001) and group 2 (P<0.001) showed significant difference when compared with the control group. The incidences of small pupil were 1.9% in the control group, 6.1% in group 1, and 13.5% in group 2. When compared with control, group 2 showed significantly higher incidence of small pupil (P=0.023). Conclusions: Long-term diabetic patients showed poorer response to pharmacological mydriasis than nondiabetic patients. Higher prevalence of small pupil size was found in patients with diabetic retinopathy. © Mary Ann Liebert, Inc.

Wu C.-Y.,National Yang Ming University | Wu C.-Y.,Taipei Medical University Hospital | Hu H.-Y.,National Yang Ming University | Hu H.-Y.,Taipei Medical University Hospital | And 7 more authors.
PLoS ONE | Year: 2014

Objectives: The aim of the study was to investigate determinants of long-term care use and to clarify the differing characteristics of home/community-based and institution-based services users. Design: Cross-sectional, population-based study. Setting: Utilizing data from the 2005 National Health Interview Survey conducted in Taiwan. Participants: A national sample of 2,608 people (1,312 men, 1,296 women) aged 65 and older. Measurements: The utilization of long-term care services (both home/community- and institution-based services) was measured. A χ2 analysis tested differences in baseline characteristics between home/community-based and institution-based long-term care users. The multiple-logistic model was adopted with a hierarchical approach adding the Andersen model's predisposing, enabling, and need factors sequentially. Multiple logistic models further stratified data by gender and age. Results: Compared with users of home/community-based care, those using institution-based care had less education (p = 0.019), greater likelihood of being single (p = 0.001), fewer family members (p = 0.002), higher prevalence of stool incontinence (p = 0.011) and dementia (P = .025), and greater disability (p = 0.016). After adjustment, age (compared with 65-69 years; 75-79 years, odds ratio [OR] = 2.08, p = 0.044; age ≥80, OR = 3.30, p = 0.002), being single (OR = 2.16, p = 0.006), urban living (OR = 1.68, p = 0.037), stroke (OR = 2.08, p = 0.015), dementia (OR = 2.32, p = 0.007), 1-3 items of activities of daily living (ADL) disability (OR = 5.56, p<0.001), and 4-6 items of ADL disability (OR = 21.57, p<0.001) were significantly associated with long-term care use. Conclusion: Age, single marital status, stroke, dementia, and ADL disability are predictive factors for long-term care use. The utilization was directly proportional to the level of disability. © 2014 Wu et al.

Yang K.-J.,Chang Gung Memorial Hospital | Yang K.-J.,Chang Gung University | Yang K.-J.,Universal Eye Center | Sun C.-C.,Chang Gung Memorial Hospital | And 9 more authors.
Optometry and Vision Science | Year: 2012

Purpose.: To determine the correlation between axial length and diabetic retinopathy (DR) in patients with diabetes mellitus for 10 years or more. Methods.: This study was a prospective, observational, cross-sectional study. Patients with diabetes for 10 years or more were included. We excluded eyes with any other significant ocular disease or any prior intraocular surgery, except uncomplicated cataract surgery. Only one eye of each patient was included as the study eye. The severity of DR was graded as no DR, non-proliferative DR (NPDR), or proliferative DR (PDR). Axial length was measured by A-scan ultrasound (10 MHz Transducer, AL-2000 Biometer/Pachymeter; Tomey, Phoenix, AZ). Univariate logistic regression models were used to evaluate the relationship between the dependent variables (any DR, PDR) and all potential risk factors. Axial length and other factors with p value <0.1 were included in multivariate logistic regression models. Backward selection based on the likelihood ratio statistic was used to select the final models. Results.: We included 166 eyes from 166 patients (93 female and 73 male; mean age, 68.8 years). The mean diabetes duration was 15.4 years. Fifty-four (32.5%) eyes had no DR, 72 (43.4%) eyes had NPDR, and 40 (24.1%) eyes had PDR. In univariate analysis, hypertension (p = 0.009), renal impairment (p = 0.079), and insulin use (p = 0.009) were associated with developing any DR. Hypertension (p = 0.042), renal impairment (p = 0.014), insulin use (p = 0.040), pseudophakia (p = 0.019), and axial length (p = 0.076) were associated with developing PDR. In multivariate analysis, hypertension (p = 0.005) and insulin use (p = 0.010) were associated with developing any DR. Hypertension (p = 0.020), renal impairment (p = 0.025), pseudophakia (p = 0.006), and axial length (p = 0.024) were associated with developing PDR. Conclusions.: This observational study suggests an inverse relationship between axial length and the development of PDR in patients with diabetes for 10 years or more. No relationship was found between axial length and the development of any DR. © 2012 American Academy of Optometry.

Wu C.-Y.,National Yang Ming University | Wu C.-Y.,Taipei Medical University Hospital | Hu H.-Y.,National Yang Ming University | Hu H.-Y.,Taipei Medical University Hospital | And 7 more authors.
Archives of Gerontology and Geriatrics | Year: 2013

Disability is associated with increased long-term care use among the elderly, but its association with utilization of acute care is not well understood. The aim of this study is to investigate the association between functional disability and acute medical care utilization among the elderly. This nationwide, population-based cohort study was based on data from the 2005 National Health Interview Survey (NHIS), linking to the 2004-2007 National Health Insurance (NHI) claims data. A total of 1521 elderly subjects aged 65 years or above were observed from the year 2004 to 2006; this sample was considered to be a national representative sample. The utilization of acute medical care (including outpatient services, emergency services, and inpatient services) and medical expenditure were measured. Functional disability was measured by determining limitations on activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. After adjusting for age, comorbidity, and sociodemographic characteristics, functional disability that affected IADLs or mobility was a significant factor contributing to the increased use of care. A clear proportional relationship existed between disability and utilization, and this pattern persisted across different types of acute care services. Disability affecting IADLs or mobility, rather than ADLs, was a more sensitive predictor of acute medical care utilization. Compared to elderly persons with no limitations, the medical expenditure of those with moderate-to-severe limitations was 2-3 times higher for outpatient, emergency, and inpatient services. In conclusion, functional disability among the elderly is a significant factor contributing to the increased use of acute care services. © 2013 Elsevier Ireland Ltd.

Huang S.-F.,Chang Gung University | Lee T.-J.,Chang Gung University | Lee Y.-S.,Chang Gung University | Lee Y.-S.,Ming Chuan University | And 3 more authors.
Annals of Otology, Rhinology and Laryngology | Year: 2011

Objectives: Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop subperiosteal orbital abscesses and to need emergency surgery for acute orbital swelling. Methods: In an observational retrospective cohort study, we reviewed 64 children less than 18 years of age who visited emergency rooms for periorbital swelling and were hospitalized with a diagnosis of periorbital cellulitis and subperiosteal orbital abscess between 1996 and 2007 at Chang Gung Memorial Hospital. The presence of periorbital abscess was diagnosed radiographically, and all of the patients had concomitant sinusitis that was proved by computed tomographic scan. Results: The mean age of the patients was 6.95 years, and 42 (65.63%) were male (male-to-female ratio, 1.91). Thirty patients (46.88%) had surgical drainage, and 34 (53.13%) received antibiotic therapy only. The factors associated on bivariate analysis with abscess formation were age of 6 years or less (p = 0.023), proptosis (p = 0.012), fever (p < 0.001), and a white blood cell count of more than 11,100 cells per microliter (p = 0.004). On multivariate analysis, fever and proptosis were independent factors that predicted abscess formation. In patients who underwent surgical drainage, the most frequently cultured microbes were Staphylococcus aureus, Streptococcus viridans, and coagulase-negative staphylococci, and 29% of our patients had polymicrobial pus cultures. Conclusions: The most important factor in predicting the failure of antibiotic treatment of sinusitis-related periorbital infections is abscess formation. Patients with fever and proptosis are prone to develop subperiosteal orbital abscesses. © 2011 Annals Publishing Company. All rights reserved.

Fang Y.-T.,National Yang Ming University | Fang Y.-T.,Universal Eye Center | Chou Y.-J.,National Yang Ming University | Pu C.,National Yang Ming University | And 6 more authors.
Eye (Basingstoke) | Year: 2013

PurposeThis study was conducted to examine the atropine eye drop prescription trend for children diagnosed with myopia, and to determine the factors associated with the prescription of atropine eye drops.DesignThis was a population-based cross-sectional study.MethodsThis study was conducted using a national representative sample from the National Health Insurance (NHI) claims data. All school children between 4 and 18 years of age who had visited an ophthalmologist and were diagnosed with myopia between 2000 and 2007 were included herein. The main outcome measure was the proportion of subjects who were prescribed atropine eye drops in each year. Logistic regression was used to identify the factors associated with atropine eye drops being prescribed.ResultsThe prescription of atropine eye drops for children diagnosed with myopia increased significantly from the school years 2000 (36.9%) to 2007 (49.5%). There was also a shift from prescribing high concentrations (0.5 and 1%) of atropine eye drops to lower concentration ones (0.3, 0.25, and 0.1%) within this period. Atropine eye drops were more frequently prescribed to 9-12-year-old children (OR=1.26-1.42, compared with those 7-8 years old), and to children from families with a high socioeconomic status (OR=1.19-1.25); however, they were less prescribed to those living in mid to low urbanized areas (OR=0.65-0.84).ConclusionsThis study revealed an increasing trend of atropine eye drop prescription for children with myopia in Taiwan. Our study provides eye-care professionals worldwide a reference for the potential integration of atropine eye drops into their clinical practice toward children with myopia. © 2013 Macmillan Publishers Limited All rights reserved.

PubMed | Fujian Medical University and Universal Eye Center
Type: Journal Article | Journal: International journal of ophthalmology | Year: 2016

To evaluate blood pressure (BP) changes during phacoemulsification (PC) and femtosecond laser (FSL)-assisted cataract surgery.A retrospective chart review was performed for all patients who received traditional phacoemulsification surgery (PC group) and FSL-assisted cataract surgery (FS group) from July 2013 to December 2014. Totally 206 eyes from 133 patients receiving the two types of procedures were included. Patient characteristics (age, gender, and hypertension history), pre- and post-operative BPs were collected.The pro-operative systolic and diastolic BPs (mm Hg) were 124.8920.48 BP increases but at a limited level after FSL-assisted cataract surgery compared to traditional phacoemulsification.

Pu C.,National Yang Ming University | Tang G.-J.,National Yang Ming University | Fang Y.-T.,National Yang Ming University | Fang Y.-T.,Universal Eye Center | Chou Y.-J.,National Yang Ming University
Journal of Epidemiology | Year: 2012

Background: We attempted to identify the domain of self-rated health (SRH) that bestpredicts medical care utilization among Taiwanese adults. In addition, we examined the association between SRH and different measure of medical care utilization.Methods: We analyzed data on 11 987 community-dwelling adults aged 18 to 64 years from the 2005 Taiwan National Health Interview Survey (NHIS). NHIS data were linked to the 2006 National Health Insurance (NHI)administrative database. Then, medical care utilization in 2006, including all outpatient visits, hospitalizations, and mental health outpatient visits, was identified. Domain-specific health ratings were measured by using the Short Form-36 (SF-36) health survey questionnaire. Negative binominal models were used to estimate the contributionof the health domains to medical care utilization. Incidence rate ratios (IRRs) are presented.Results: The IRR for the physical component scale showed that those with the highestscores had 77% of the outpatient visits of those with the lowest scores. The importance of mental health domains was markedly higher in estimating mental health outpatient visits. Those with mental health scores above the median had only 61% of mental health outpatient visits of those with scores below the median.Conclusions: A person's medical care utilization is reflected in the different domains of general health. Domainspecific measures of subjective health are not interchangeable with global general health ratings, because different domains have independent effects on medical care utilization. Our results are potentially important for medical resource allocation because they identify different health domain experiences that require improvement.© 2012 by the Japan Epidemiological Association.

Horng S.-S.,National Yang Ming University | Chou Y.-J.,National Yang Ming University | Huang N.,National Yang Ming University | Fang Y.-T.,Universal Eye Center | Chou P.,National Yang Ming University
Neurourology and Urodynamics | Year: 2014

Aims This study assesses the prevalence, comorbidity, and risk factors of fecal incontinence (FI), and explores help seeking patterns among older FI people. Methods The data were obtained from the 2005 National Health Interview Survey, in which 1,345 men and 1,370 women aged above 65 years responded to questions concerning FI occurrence, and 218 FI-affected elderly people responded to the question about FI help seeking. The chi-square test, Student's t-test, and multiple logistic regression were used. Results The weighted FI prevalence of older Taiwanese people was 6.9% for men and 9.3% for women. Urinary incontinence, diabetes mellitus, dementia, and asthma significantly increased the risk of FI among old men, but being overweight appeared to be FI-protective (OR 0.37, 95% CI=0.17-0.80). In women, urinary incontinence, stroke, transit ischemia attack, dementia, chronic hepatitis, being underweight (BMI<18.5), and greater parity were significant FI risk factors. Of those with FI, 49.1% had sought medical help. Using Andersen's model, data analysis showed that living in an urban area (OR 2.36, CI=1.19-4.68), mucous stool incontinence (OR 3.56, 95% CI=1.35-8.32), and one or more of the following FI-related problems, namely, anxiety, families interaction, social life, work life, and sexual life, significantly predicted FI sufferers seeking medical attention. Conclusion Self-reported FI is a prevalent condition with various etiologies among older people in Taiwan. Understanding the epidemiology and comorbidity of FI, and investigating the factors associated with help seeking, is beneficial in devising and implementing prevention and management strategies. © 2013 Wiley Periodicals, Inc.

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