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Wu T.-Y.,Taipei Medical University Hospital | Wu T.-Y.,National Taiwan University | Hung L.-Y.,Yonghe Cardinal Tien Hospital | Chie W.-C.,National Taiwan University | And 2 more authors.
BMC Public Health | Year: 2016

Background: 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 physician's perspective. Methods: 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. Results: 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. Conclusions: 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. © 2016 Wu et al.

Tsao Y.-C.,Yonghe Cardinal Tien Hospital | Tsao Y.-C.,Taipei Veterans General Hospital | Tsao Y.-C.,National Yang Ming University | Chung C.-P.,Taipei Veterans General Hospital | And 12 more authors.
Journal of Psychiatric Research | Year: 2014

Objective: Panic disorder (PD) is characterized by panic attacks accompanied with respiratory symptoms. Internal jugular vein (IJV) alters its hemodynamics in response to respiration and which might cause cerebral blood flow (CBF) changes. In the present study, we compared (1) respiratory-related IJV hemodynamics and (2) CBF changes during Valsalva maneuver (VM) between PD and normal subjects. Methods: 42 PD patients and age/gender-matched controls (14 men; 52.3 ± 11.4 years) were recruited. Duplex ultrasonography measured time-averaged mean velocity (TAMV) and lumen in IJV at baseline and deep inspiration. Lumen area <0.10 cm2 at deep inspiration was defined as IJV collapse. CBF changes during VM were recorded by transcranial Doppler (TCD). Results: Compared with normal group, PD patients had significantly higher frequency of IJV collapse at deep inspiration (Left: 40.0% vs. 7.0%, p = 0.0003, Right: 17.0% vs. 0%, p = 0.0119). IJV collapse was associated with symptoms of respiratory subtype in our PD patients. PD group also had smaller lumen (Left: 0.53 ± 0.29 vs. 0.55 ± 0.26 cm2, p = 0.8296, Right: 0.63 ± 0.36 vs. 0.93 ± 0.45 cm2, p = 0.0014) and slower TAMV of IJV at baseline (Left: 11.8 ± 8.43 vs. 20.6 ± 16.5 cm/s, p = 0.0003, Right: 15.9 ± 9.19 vs. 24.1 ± 15.7 cm/s, p = 0.0062). PD patients with inspiration-induced IJV collapse had more decreased CBF during VM compared with the other PD patients and normal individuals respectively. Interpretation: We are the first to show that PD have less IJV flow at baseline and more frequent collapse at deep inspiration. Inspiration-induced IJV collapsed was associated with CBF decrement during VM in PD patients. These results suggest that venous drainage impairment might play a role in the pathophysiology of PD by influencing CBF. © 2014 Elsevier Ltd. All rights reserved.

Liu W.-C.,Yonghe Cardinal Tien Hospital | Lu K.-C.,Cardinal Tien Hospital | Lu K.-C.,Fu Jen Catholic University
Journal of Internal Medicine of Taiwan | Year: 2014

Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease (CKD) which attribute about 40% of dialysis patient's death. Vascular smooth muscle cell (VSMC) calcification contributes the most important factor of cardiovascular disease. Arterial calcification is divided into atherosclerosis of intima and arteriosclerosis of medial layer muscular tunica which is the prominent characteristic of vascular injury in CKD. There are many risk factors promote vascular calcification in CKD such as hyperphosphatemia, hypercalcemia, secondary hyperparathyroidism, active Vit D3 overdoses, and inflammation/oxidative stress. However, the elevated serum phosphate plays the most important cause of vascular calcification in CKD. This review article will discuss the pathos-physiological metabolic mechanisms of vascular calcification in CKD and the role of non-metal containing phosphate binder in the treatment of hyperphosphatemia.

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
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.

Yang T.-K.,Yonghe Cardinal Tien Hospital | Yang T.-K.,Fu Jen Catholic University | Guo Y.-J.,Taipei Medical University Hospital | Chang H.-C.,National Taiwan University Hospital | And 2 more authors.
Scientific World Journal | Year: 2015

Purpose. To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms. Materials and Methods. 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. Results. 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 "can't 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. Conclusions. 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. © 2015 Teng-Kai Yang et al.

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