Chiu S.-J.,National Yang Ming University |
Chen P.-T.,Cardinal Tien Hospital |
Chou Y.-T.,Yonghe Cardinal Tien Hospital |
Chien L.-Y.,National Yang Ming University
Journal of Intellectual Disability Research | Year: 2017
Background: Early intervention (EI) practitioners provide individualised family-centred services to enhance the quality of life (QOL) of families of children with developmental delay (DD). Family QOL (FQOL) could be an important outcome indictor for EI, but there is no measurement tool for FQOL in Mandarin Chinese. The purpose of this study was to translate the Beach Centre FQOL Scale (BCFQOL) into Mandarin Chinese and to examine the psychometric properties of the scale in families of children with DD. Methods: Two independent translations were performed by two bilingual professors whose mother tongue was Mandarin, and two back-translations were performed by two bilingual professionals whose mother tongue was English. The translated and back-translated questionnaires were reviewed to revise the questionnaire. Five experts assessed the accuracy, equivalence and cultural appropriateness of the scale, and 10 parents of children with DD were interviewed to examine its readability, clarity and cultural appropriateness. From July to November 2014, we recruited 360 primary caregivers of children with DD who were receiving EI in northern Taiwan to validate the scale. The participants completed the BCFQOL as well as a one item overall ratings of their FQOL. Results: Item analysis was performed to assess each item. Confirmatory factor analysis supported the following five-factor structure as in the original scale: family interaction, parenting, emotional well-being, physical/material well-being and disability-related support. The scale exhibited excellent internal consistency reliability (Cronbach's alpha = 0.96) and test–retest reliability at a 2-week interval (intra-class correlation coefficient = 0.92). Contrasted group validity was supported by significantly higher BCFQOL scores in the top quartile of the overall FQOL rating than the lowest quartile. The convergent validity was supported by the significant correlation between the FQOL item and the BCFQOL (r = 0.608, p < 0.01). Conclusions: This study showed that the Mandarin Chinese version of the BCFQOL is reliable and valid for Taiwanese families of children with DD. The instrument could be applied to assess FQOL in families of children with DD who are receiving EI in order to evaluate family services and supports. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
PubMed | National Taiwan University Hospital, Taipei City Hospital Renai Branch, National Yang Ming University and Yonghe Cardinal Tien Hospital
Type: Clinical Trial | Journal: JAMA pediatrics | Year: 2016
Sleep disturbance is common in children with atopic dermatitis (AD), but effective clinical management for this problem is lacking. Reduced levels of nocturnal melatonin were found to be associated with sleep disturbance and increased disease severity in children with AD. Melatonin also has sleep-inducing and anti-inflammatory properties and therefore might be useful for the management of AD.To evaluate the effectiveness of melatonin supplementation for improving the sleep disturbance and severity of disease in children with AD.This randomized clinical trial used a double-blind, placebo-controlled crossover design to study 73 children and adolescents aged 1 to 18 years with physician-diagnosed AD involving at least 5% of the total body surface area. The study was conducted at the pediatric department of a large tertiary care hospital in Taiwan from August 1, 2012, through January 31, 2013. Forty-eight children were randomized 1:1 to melatonin or placebo treatment, and 38 of these (79%) completed the cross-over period of the trial. Final follow-up occurred on April 13, 2013, and data were analyzed from January 27 to April 25, 2014. Analyses were based on intention to treat.Melatonin, 3 mg/d, or placebo for 4 weeks followed by a 2-week washout period and then crossover to the alternate treatment for 4 weeks.The primary outcome was AD severity evaluated using the Scoring Atopic Dermatitis (SCORAD) index, with scores ranging from 0 to 103 and greater scores indicating worse symptoms. Secondary outcomes included sleep variables measured by actigraphy, subjective change in sleep and dermatitis, sleep variables measured by polysomnography, nocturnal urinary levels of 6-sulfatoxymelatonin, and serum IgE levels.After melatonin treatment among the 48 children included in the study, the SCORAD index decreased by 9.1 compared with after placebo (95% CI, -13.7 to -4.6; P<.001), from a mean (SD) of 49.1 (24.3) to 40.2 (20.9). Moreover, the sleep-onset latency shortened by 21.4 minutes after melatonin treatment compared with after placebo (95% CI, -38.6 to -4.2; P=.02). The improvement in the SCORAD index did not correlate significantly with the change in sleep-onset latency (r=-0.04; P=.85). No patient withdrew owing to adverse events, and no adverse event was reported throughout the study.Melatonin supplementation is a safe and effective way to improve the sleep-onset latency and disease severity in children with AD.clinicaltrials.gov Identifier: NCT01638234.
PubMed | Taipei Veterans General Hospital and Yonghe Cardinal Tien Hospital
Type: | Journal: Urology | Year: 2016
Calyceal diverticulum is an eventration of the upper collecting system within the renal parenchyma. This nonsecretory outpouching is lined by transitional epithelium and communicates with the main collecting system via a narrow channel. Tumor growth arising from a calyceal diverticulum is rare, and primary squamous cell carcinoma arising from a calyceal diverticulum has never been described in literature. Herein, we report a case of primary squamous cell carcinoma arising from a calyceal diverticulum and present initial imaging of a benign-appearing cystic lesion.
PubMed | National Taiwan University Hospital, National Taiwan University, Taipei City Hospital and Yonghe Cardinal Tien Hospital
Type: | Journal: BMC public health | Year: 2016
The Taiwanese government increased financial subsidies for smoking cessation services in 2012. We aimed to evaluate the effects of this new policy on smoking cessation services from the physicians perspective.This was a cross-sectional nationwide survey. Physicians who provided smoking cessation services for more than ten patient encounters in the preceding year of the new policy (February 2011 to March 2012) were recruited. The questionnaire was developed by two experts and was validated by a committee consisting of 11 delegates.We sent a total of 1,319 questionnaires. The response rate was 45.9%. The majority of respondents were male (88.4%), middle-aged (65.3%), and worked as family physicians (56.1%). Most physicians agreed that the new policy had increased the number of patients seeking smoking cessation, increased patients willingness to adopt pharmacotherapy, helped physicians to prescribe medications, improved patients adherence to medications, and improved quality of care. These changes were most prominent in medical centers. Changes in the practice of the 5As (ask, advise, assess, assist, arrange) were moderate. Among different medical settings, the most significant change was an increase in the expenditure on smoking cessation medications.The new subsidization policy in Taiwan has improved smoking cessation services. Overall, physicians reported positive effects of the new policy. Further study is warranted to evaluate the long-term influence of the policy.
PubMed | Taipei Medical University Hospital, Yonghe Cardinal Tien Hospital, Fu Jen Catholic University and National Taiwan University Hospital
Type: | Journal: TheScientificWorldJournal | Year: 2015
To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms.Children aged from 5 to 12 years with the chief complaint of PE treated with desmopressin were enrolled in pediatric urology clinics. The parent-reported SNAP-IV questionnaire was used to evaluate ADHD symptoms (cut-off value: 90th percentile). Voiding symptoms were assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. The responses to desmopressin were analyzed in children with and without ADHD symptoms.The study sample comprised 68 children; 27 (39.7%) presented with ADHD symptoms and 41 (60.3%) with non-ADHD symptoms. The children collected from a tertiary referral center may explain the high prevalence of ADHD symptoms in the present study. The total DVSS score in the ADHD symptoms group was significantly higher than in the non-ADHD symptoms group (7.72 versus 5.65, P=0.05). In the ADHD symptoms group, there were significantly higher score in the pee 1-2 times/day and cant wait subscales of DVSS and lower sleep quality based on the Pediatric Sleep Quality questionnaire, as well as significantly lower peak flow rate and voided volume. The responses to desmopressin for enuresis were comparable between children with ADHD and non-ADHD symptoms.Approximately 39.7% of PE children presented with ADHD symptoms at urologic clinics. PE children with ADHD symptoms had higher risk of daytime LUTS and comparable response to desmopressin treatment for PE. To evaluate ADHD symptoms and daytime voiding symptoms is important in children with PE.
PubMed | National Taiwan University Hospital and Yonghe Cardinal Tien Hospital
Type: Journal Article | Journal: PloS one | Year: 2016
To investigate the impact of metabolic components and body composition indices on prostate volume (PV) in a population of middle-aged men receiving health check-ups.Six hundred and sixteen men receiving health assessments were stratified to large and small prostates based on the cut-off of median PV. Their demographic data, health history, and international prostate symptoms scores (IPSS) were collected. Metabolic components and body composition indices were compared between subjects with large and small prostates. Moreover, the correlations between these parameters and PV were analyzed by multivariate logistic regression.The median PV was 27 mL and mean age was 54.8 years. Subjects with large PV were older (56.5 vs. 52.7 years) and had higher serum prostate specific antigen (PSA) level (1.73 vs. 0.96 ng/mL), higher IPSS score (8.37 vs. 6.16), and higher body fat, body mass, and waist circumference (all p<0.05). In multivariate analysis, age (OR, 2.45; 95%CI, 1.74-3.45), serum PSA (OR, 2.75; 95%CI, 1.96-3.86), waist circumference (OR, 1.45; 95%CI, 1.02-2.07), fatness (OR, 1.47; 95%CI, 1.04-2.09), and body fat mass (OR, 1.43; 95%CI, 1.00-2.03) were significantly correlated with PV of study subjects. In subgroup analysis, raised waist circumference (OR, 1.89; 95%CI, 1.00-3.59) was the independent predictor of PV in subjects with bothersome lower urinary tract symptoms.Several metabolic components and body composition indices are significantly associated with PV of middle-aged men, including raised waist circumference, fatness, and body fat mass. Raised waist circumference is the only independent predictor of PV in middle-aged men with bothersome LUTS.
Lu K.-C.,Fu Jen Catholic University |
Wu C.-C.,Tri Service General Hospital |
Yen J.-F.,Yonghe Cardinal Tien Hospital |
Liu W.-C.,Yonghe Cardinal Tien Hospital
Scientific World Journal | Year: 2014
At the early stage of chronic kidney disease (CKD), the systemic mineral metabolism and bone composition start to change. This alteration is known as chronic kidney disease-mineral bone disorder (CKD-MBD). It is well known that the bone turnover disorder is the most common complication of CKD-MBD. Besides, CKD patients usually suffer from vascular calcification (VC), which is highly associated with mortality. Many factors regulate the VC mechanism, which include imbalances in serum calcium and phosphate, systemic inflammation, RANK/RANKL/OPG triad, aldosterone, microRNAs, osteogenic transdifferentiation, and effects of vitamins. These factors have roles in both promoting and inhibiting VC. Patients with CKD usually have bone turnover problems. Patients with high bone turnover have increase of calcium and phosphate release from the bone. By contrast, when bone turnover is low, serum calcium and phosphate levels are frequently maintained at high levels because the reservoir functions of bone decrease. Both of these conditions will increase the possibility of VC. In addition, the calcified vessel may secrete FGF23 and Wnt inhibitors such as sclerostin, DKK-1, and secreted frizzled-related protein to prevent further VC. However, all of them may fight back the inhibition of bone formation resulting in fragile bone. There are several ways to treat VC depending on the bone turnover status of the individual. The main goals of therapy are to maintain normal bone turnover and protect against VC. © 2014 Kuo-Cheng Lu et al.
PubMed | Tri Service General Hospital, Fu Jen Catholic University and Yonghe Cardinal Tien Hospital
Type: | Journal: TheScientificWorldJournal | Year: 2014
At the early stage of chronic kidney disease (CKD), the systemic mineral metabolism and bone composition start to change. This alteration is known as chronic kidney disease-mineral bone disorder (CKD-MBD). It is well known that the bone turnover disorder is the most common complication of CKD-MBD. Besides, CKD patients usually suffer from vascular calcification (VC), which is highly associated with mortality. Many factors regulate the VC mechanism, which include imbalances in serum calcium and phosphate, systemic inflammation, RANK/RANKL/OPG triad, aldosterone, microRNAs, osteogenic transdifferentiation, and effects of vitamins. These factors have roles in both promoting and inhibiting VC. Patients with CKD usually have bone turnover problems. Patients with high bone turnover have increase of calcium and phosphate release from the bone. By contrast, when bone turnover is low, serum calcium and phosphate levels are frequently maintained at high levels because the reservoir functions of bone decrease. Both of these conditions will increase the possibility of VC. In addition, the calcified vessel may secrete FGF23 and Wnt inhibitors such as sclerostin, DKK-1, and secreted frizzled-related protein to prevent further VC. However, all of them may fight back the inhibition of bone formation resulting in fragile bone. There are several ways to treat VC depending on the bone turnover status of the individual. The main goals of therapy are to maintain normal bone turnover and protect against VC.
Chang S.-I.,Yonghe Cardinal Tien Hospital |
Chang S.-I.,National Yang Ming University |
Tsai M.-D.,Shin Kong Wu Ho Su Memorial Hospital |
Wei C.-P.,Shin Kong Wu Ho Su Memorial Hospital |
Wei C.-P.,Cardinal Tien Hospital
Turkish Neurosurgery | Year: 2014
AIm: One of the clinical presentations of intracranial aneurysm is unilateral oculomotor nerve palsy (ONP). The most common location is the posterior communicating artery. Surgical clipping and/or endovascular coiling of the aneurysm are the treatments. The aim of this study was to identify the factors that influence the postoperative recovery of patients who have posterior communicating aneurysm with ONP. Mat erIal and Methods: We included 13 patients diagnosed at our hospital from 1993 to 2008 with posterior communicating aneurysm with ONP. Ten patients underwent craniotomy to clip the aneurysm; 3 patients refused surgery. Result s: Five (50%) patients presented with periorbital pain. Seven (70%) patients had complete ONP recovery with a median recovery time of 58 days. We found that the first recovered component of ONP after clipping was the parasympathetic fibers with a mean recovery time of 4.4 days. Nine patients had a good recovery outcome; one patient died from postoperative vasospasm. There was no significant linear trend in complete recovery rate across palsy symptom periods. However, the palsy symptom period was significant correlated with recovery time. ConclusIon: Early decompression of the posterior communicating aneurysm yielded satisfactory recovery and ONP can be reversible. In our patients, the first component of oculomotor function to recover was the parasympathetic fibers.
PubMed | YongHe Cardinal Tien Hospital
Type: | Journal: Turkish neurosurgery | Year: 2016
Shunt-dependent hydrocephalus (SDH) is a relatively common complication following aneurysmal subarachnoid hemorrhage (aSAH). Delay in diagnosis and treatment may worsen neurological outcome. This study was conducted to identify early clinical factors associated with SDH following aSAH.Patients diagnosed with aSAH at our hospital from January 2010 through July 2014 were included. Patients aged 18 or 90 year, with concurrent arteriovenous malformation, treated with both clipping and coiling, or not receiving definitive treatment were excluded. Both clinical and radiological variables were analyzed by univariate and multivariate logistic model to identify factors independently associated with outcome of SDH following aSAH.Overall, 33 patients (36.2%) developed SDH following aSAH after definitive treatment. Univariate analysis revealed age, emergency department (ED) WBC count, hypernatremia, Hunt & Hess Grade, modified Fisher Grade, presentation of acute hydrocephalus, initial placement of external ventriculostomy, and post-operative central nervous system infection were clinically significant factors. Multivariate logistic regression showed ED WBC count 14,500/L (OR 5.096, 95% CI 1.332 to 19.499, p=0.017), poor Hunt & Hess Grade (III, IV & V) (OR 3.562, 95% CI 1.081 to 11.737, p=0.037), and initial placement of external ventriculostomy (OR 4.294, 95% CI 1.125 to 16.393, p=0.033) were independent factors.Three early independent predictors of SDH were identified including poor Hunt & Hess Grade, initial placement of external ventriculostomy and ED leukocytosis. Early placement of a ventricular-peritoneal shunt after aSAH may shorten hospital and ICU LOS.