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Aim: To investigate frailty trajectories in nursing home residents, and to test whether chewing difficulty was a significant factor associated with frailty trajectories. Methods: This is a 1‐year prospective cohort study. Data were collected from 27 nursing home residents in China at baseline, 6 months, and 12 months. Latent class growth modeling was used to identify frailty trajectories. Multilevel multinomial logistic regression was used to test the relative risk ratios (RRRs) with 95% confidence intervals (CIs) of the chewing difficulty assessed at baseline on frailty trajectories. Results: In total, 269 nursing home residents were included in the analysis. Three frailty trajectories identified were non‐frailty trajectory (n = 181, 67.3%), stable frailty trajectory (n = 52, 19.3%), and progressive frailty trajectory (n = 36, 13.4%). Chewing difficulty was found among 138 (51.3%) nursing home residents. With the non‐frailty trajectory group as the reference, residents with chewing difficulty were more likely to demonstrate stable frailty trajectory (RRR = 2.55, 95% CI [1.28–5.11]) or progressive frailty trajectory (RRR = 3.46, 95% CI [1.47–8.15]). Conclusions: Changes in the frailty of nursing home residents are heterogeneous and chewing difficulty should be assessed and addressed on a routine basis in nursing homes to prevent the deterioration of frailty or reverse it. Geriatr Gerontol Int 2023; 23: 803–808. [ABSTRACT FROM AUTHOR]

Combining immune checkpoint inhibitors with vascular endothelial growth factor/vascular endothelial growth factor receptor inhibitors is effective in treating a number of solid tumors; however, evidence in advanced gastric/gastroesophageal junction (G/GEJ) cancer is limited. This retrospective study included consecutive patients who received a programmed cell death protein 1 (PD‐1) inhibitor plus the vascular endothelial growth factor receptor 2 inhibitor apatinib, second‐line or later to treat unresectable advanced or metastatic, histologically proven, human epidermal growth factor receptor 2–negative G/GEJ cancer in a single center between November 1, 2018, and March 31, 2021. Treatment was continued until the disease progressed or the toxicity became intolerable. We examined data from 52 patients. The primary tumor site was the stomach in 29 patients and the GEJ in 23 patients. PD‐1 inhibitors administered included camrelizumab (n = 28), sintilimab (n = 18), pembrolizumab (n = 3), and tislelizumab (n = 1), and all patients were given 200 mg every 3 weeks, and toripalimab (240 mg every 3 weeks) and nivolumab (200 mg every 2 weeks) were given to 1 patient each. For 28 days, apatinib 250 mg was administered orally once a day. The objective response rate was 15.4% (95% confidence interval [CI], 6.9‐28.1), and the disease control rate was 61.5% (95%CI, 47.0‐74.7). After 14.8 months of median follow‐up, the median progression‐free survival was 4.2 months (95%CI, 2.6‐4.8), and the overall survival was 9.3 months (95%CI, 7.9‐12.9). Twelve patients underwent grade 3‐4 treatment‐related adverse events (23.1%). There was no unexpected toxicity or death. This trial demonstrated combination therapy with an anti–PD‐1 antibody and apatinib was effective and safe in patients with previously treated unresectable advanced or metastatic G/GEJ cancer. [ABSTRACT FROM AUTHOR]

Aims. To estimate the prevalence and bother of lower urinary tract symptoms (LUTS) and the work-related and individual factors associated with LUTS among a representative sample of female nurses. Background. A healthy nursing workforce is essential to advance global health goals, especially during times of extraordinary demand for nursing care. LUTS frequently occur and persist in women and are correlated with multiple negative health outcomes and diminished work engagement and productivity. However, the study of LUTS among female nurses failed to receive sufficient attention from researchers. Methods. We used baseline data for 13,191 female nurses in China collected for the prospective cohort study, the Nurse Urinary Related Health Study (NURS). We assessed nurses' self-reported LUTS and symptom-related bother using the International Consultation on Incontinence Questionnaire-Female LUTS. We used descriptive statistics to summarize LUTS prevalence and its related bother and a mixed-effects logistic regression model to test the effects of work-related and individual factors on LUTS. Results. Most of the participants in this study were younger than 40 years old (82.9%), were married (74.8%), and had given birth once or never (73.7%). Few participants had chronic diseases (3.4%), consumed alcohol (7.3%), smoked (0.4%), or had overweight/obesity (27.7%). The prevalence of any LUTS was 51.1%, and over 50% of the nurses with LUTS in this study had experienced moderate or severe bother, except for urinary frequency. Working longer than five years, more than 40 hours per week, and in Level A, major tertiary hospitals were found to be risk factors of LUTS, and a nurse-to-bed ratio higher than 0.40 was found to be a protective factor. Increased fluid intake also was found to be a protective factor of LUTS in nurses, and having chronic constipation was found to be a risk factor. Conclusions. LUTS are highly prevalent and severely bothersome among female nurses in China, despite the fact that the female nurses in this study were relatively young, healthy, had few childbirths, and were living healthy lifestyles. This finding warrants remedial action that is related to both behavioral and environmental factors to ensure a healthy nursing workforce. Nurses cannot reasonably be expected to contribute to global health when one of their basic needs as humans, i.e., the normal function of urinary elimination, is ignored. Implications for Nursing Management. Nurse managers should be aware that nurses' basic needs regarding urination are negatively affected by LUTS and related bother. Nurse managers should address LUTS-related problems on multiple levels, including overseeing and reporting LUTS in nurses, exploring innovative care models to mitigate the negative effects of excessive workloads on nurses, and remodeling the nursing culture and encouraging positive coping behaviors for the self-health of nurses. [ABSTRACT FROM AUTHOR]

Simple Summary: Mood disorders including depression and bipolar were associated with an increased hazard ratio of cervical cancer. The cumulative incidence of cervical cancer was significantly higher in participants with mood disorders than in the non-mood-disorder cohort. Thus, mood disorders could potentially increase the risk of developing subsequent cervical cancer. Objective: Psychological distress is considered a factor for cancer development. However, the impact of mood disorders (depression and bipolar) on the development of cervical cancer remains uncertain. We conducted a nationwide population-based retrospective cohort study to investigate the association between mood disorders and the subsequent risk of developing cervical cancer. Methods: A total of 138,130 participants' profiles between 2000 and 2012 were extracted from the National Health Insurance Research Database and subdivided into a mood-disorder cohort (27,626 participants) and a non-mood-disorder cohort (110,504 participants). Cohorts were propensity-matched for a 1:4 ratio according to age and index year. The Cox proportional hazards regression model was utilized for assessing cervical cancer risk between cohorts. Results: Kaplan–Meier analysis revealed that the mood-disorder cohort had a higher cumulative incidence of cervical cancer. The mood-disorder cohort was also associated with an increased risk of cervical cancer after adjustments for potential confounders. Subgroup analysis revealed a negative impact of mood disorders on cervical cancer, especially in the 30–50 years and white-collar groups. Conclusions: Our findings demonstrated that mood disorders were associated with an increased risk of cervical cancer development, which provide helpful information for clinical strategies to reduce the incidence of cervical cancer in this vulnerable population. [ABSTRACT FROM AUTHOR]

Simple Summary: Long-term low-dose aspirin use was associated with a reduced risk of primary cancer in survivors of ischemic cardiac or cerebrovascular disease. Thus, in contrast to the situation for the general population (for which the anticancer effects of aspirin are still controversial), long-term low-dose aspirin use in these patients, though originally employed for the secondary prevention of ischemic attack, also has extra anticancer benefits. Ischemic cardiac or cerebrovascular disease (ICCD) survivors represent a subpopulation with a high cancer risk. Antiplatelet medications, such as aspirin, remain a fundamental therapy for the secondary prevention of ischemic attack in these patients. We conducted a population-based cohort study to investigate the association of long-term low-dose aspirin use with the risk of primary cancer in ICCD survivors. Patients aged ≥20 years with newly diagnosed ICCD (n = 98,519) between January 2000 and December 2013 were identified from the Taiwan National Health Insurance Research Database. The aspirin user and nonuser groups (each n = 24,030) were propensity-matched (1:1) for age, sex, comorbidities, prior medications, ICCD diagnosis year, and year of index dates. The incidence rate of primary cancer was significantly lower in the user group (6.49/1000 person-years) than in the nonuser group (14.04/1000 person-years). Multivariate Cox regression analysis indicated that aspirin use was an independent factor associated with a reduced risk of primary cancer (aHR (95% confidence interval) = 0.42 (0.38–0.45)) after adjustment. Kaplan–Meier curve analysis revealed that the cumulative incidence rate of primary cancer was significantly lower (p < 0.0001) in the user group than in the nonuser group over the 14-year follow-up period. Subgroup analyses demonstrated that this anticancer effect increased with duration of treatment and with similar estimates in women and men. In addition, aspirin use was associated with a reduced risk for seven out of the ten most common cancers in Taiwan. These findings suggest the anticancer effect of aspirin in ICCD survivors and provide information for assessing the benefit-to-risk profile of aspirin as an antiplatelet medication in these patients. [ABSTRACT FROM AUTHOR]

Background: There is limited research investigating the diagnostic strength of 3-dimensional computed tomography (3D-CT) and multidirectional CT arthrography (CTA) for femoroacetabular impingement (FAI) and related hip lesions. Purpose: To evaluate the diagnostic strength of combined 3D-CT and CTA in patients with FAI and related hip lesions by comparing it with hip arthroscopic surgery findings. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: This study included patients who were suspected of having FAI and related hip lesions and who underwent a combination of 3D-CT and CTA and subsequent hip arthroscopic surgery between December 2013 and December 2017. The CT and intraoperative arthroscopic findings were recorded and compared. The sensitivity, specificity, and accuracy of 3D-CT for FAI and those of CTA for related hip lesions were calculated. Results: A total of 114 patients with 114 hips were included in our study. There were 101 patients with positive findings and 13 patients with negative findings for FAI (including cam, pincer, and combined morphology) according to 3D-CT. The sensitivity, specificity, and accuracy of 3D-CT for FAI were 91.58%, 57.14%, and 89.47%, respectively. The sensitivity, specificity, and accuracy of CTA for labral tears were 94.64%, 100.00%, and 94.73%, respectively. For acetabular cartilage defects, the sensitivity, specificity, and accuracy of CTA were 60.71%, 91.37%, and 76.31%, respectively. For femoral cartilage defects, the sensitivity, specificity, and accuracy of CTA were 82.22%, 76.81%, and 78.94%, respectively. Conclusion: The study results indicated that 3D-CT was able to provide excellent accuracy for FAI compared with hip arthroscopic surgery findings. In addition, multidirectional CTA demonstrated promising diagnostic strength for hip lesions such as labral tears and chondral defects. [ABSTRACT FROM AUTHOR]

Background: The effects of cigarette smoking and alcohol consumption on the risk of alopecia areata (AA) are unclear. Objective: The aim was to examine the association of cigarette smoking and alcohol consumption with AA. Methods: We collected participants from four rounds (2001, 2005, 2009, and 2013) of the Taiwan National Health Interview Survey. Incident AA cases were identified from the National Health Insurance database. Results: Of the 60,055 participants, 154 developed AA during the 647,902 person-years of follow-up. After controlling for confounders, current smokers had a higher risk of incident AA than never smokers [adjusted hazard ratio (aHR) 1.88; 95% confidence interval (CI) 1.22–2.88]. There was a trend toward an increased risk of AA with increasing numbers of years of smoking and cumulative pack-years of smoking among current smokers. The aHRs (95% CIs) of current smokers of > 5 and ≤ 15 cigarettes per day, > 10 and ≤ 20 years of smoking, ≤ 10, and > 10 and ≤ 20 pack-years of smoking were 2.03 (1.17–3.51), 2.25 (1.21–4.18), 1.86 (1.12–3.09), and 2.04 (1.04–4.01), respectively. Conversely, social and regular drinkers had significantly lower risks of AA than never drinkers [aHRs (95% CIs) 0.65 (0.43–0.98) and 0.49 (0.26–0.93), respectively]. Conclusion: Current smokers had an increased risk of developing AA, while alcohol consumption was associated with a decreased risk of AA. [ABSTRACT FROM AUTHOR]

Background: There is evidence suggesting an association between bullous pemphigoid (BP) and a range of neurological diseases. Whether neurological cancer is a risk factor for BP remains unknown. Objective: The aim of the study was to investigate the risk of subsequent BP among patients with neurological cancer. Methods: This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Research Database between 2000 and 2012. A total of 8313 patients with neurological cancer and 33,252 age-, sex-, and index-date-matched controls were recruited. The hazard ratio (HR) for subsequent BP in patients with neurological cancer was analyzed using a Cox model and Fine-Gray competing risk model, with mortality as the competing event. Results: The incidence rates of BP per 100,000 person-years were 37.2 for patients with neurological cancer and 6.8 for controls. The crude incidence rate ratio was 5.49 (95% confidence interval [CI] 2.18–13.30). The mean time to occurrence of BP was 4.48 ± 3.40 years for patients with neurological cancer. Neurological cancer (HR 9.65, 95% CI 3.76–24.77 for the Cox model; HR 2.41, 95% CI 1.14–5.14 for the competing risk model), age per year (HR 1.10, 95% CI 1.05–1.15 for the Cox model; HR 1.06, 95% CI 1.02–1.09 for the competing risk model), and dementia (HR 6.31, 95% CI 2.49–15.99 for the Cox model; HR 7.50, 95% CI 2.84–19.85 for the competing risk model) significantly increased the risk of BP. Conclusions: Neurological cancer increased the risk for subsequent BP by 2.4-fold, with a relatively short gap of 4.5 years. [ABSTRACT FROM AUTHOR]

BACKGROUND: Accumulating evidence suggests that individuals with glucose metabolism disorders are susceptible to mortality associated with fine particles. However, the mechanisms remain largely unknown. OBJECTIVES: We examined whether particle-associated respiratory inflammation differed between individuals with prediabetes and healthy control participants. METHODS: Based on a panel study [A prospective Study COmparing the cardiometabolic and respiratory effects of air Pollution Exposure on healthy and prediabetic individuals (SCOPE)] conducted in Beijing between August 2013 and February 2015, fractional exhaled nitric oxide (FeNO) was measured from 112 participants at two to seven visits to indicate respiratory inflammation. Particulate pollutants-including particulate matter with an aerodynamic diameter of =2.5 μm (PM 2.5), black carbon (BC), ultrafine particles (UFPs), and accumulated-mode particles-were monitored continuously at a single central monitoring site. Linear mixed-effects models were used to estimate associations between ln-FeNO with pollutant concentrations at individual 1-h lags (up to 24 h) and with average concentrations at 8 and 24 h before the clinical visit. We evaluated glucose metabolism disorders as a potential modifier by comparing associations between participants with high vs. low average fasting blood glucose (FBG) and homeostasis model assessment insulin resistance (HOMA-IR) levels. RESULTS: FeNO was positively associated with all pollutants, with the strongest associations for an interquartile range increase in 1-h lagged exposures (ranging from 21.3% for PM 2.5 to 74.7% for BC). Associations differed significantly according to average HOMA-IR values when lagged 6-18 h for PM 2.5, 15-19 h for BC, and 6-15 h for UFPs, with positive associations among those with HOMA-IR=1.6 while associations were closer to the null or inverse among those with HOMA-IR <1.6. Associations between PM 2.5 and FeNO were consistently higher among individuals with average FBG =6.1 mmol/L vs. low FBG, with significant differences for multiple hourly lags. DISCUSSION: Glucose metabolism disorders may aggravate respiratory inflammation following exposure to ambient particulate matter. [ABSTRACT FROM AUTHOR]

Background: Concurrent chemoradiotherapy (CCRT) is an optimal recommended treatment for stage III non‐small cell lung cancer (NSCLC). Herein, we aimed to investigate the efficacy and safety of oral vinorelbine plus cisplatin with concomitant radiotherapy for stage III NSCLC. Methods: This prospective, open‐label, single‐arm, observational cohort study was performed between January 2010 and September 2016. Patients were treated with two cycles of chemotherapy with 60 mg/m2 intravenous cisplatin on day 1 and 50 mg/m2 oral vinorelbine on days 1, 8, and 15; radiotherapy was administered concurrently from day 1 when chemotherapy was initiated. A total dose of 66–70 Gy radiotherapy was delivered in daily fractions of 2 Gy for 6.5–7 consecutive weeks. The tumor response was assessed after completing concomitant treatment. Results: A total of 58 patients were enrolled and analyzed; 31 patients had stage IIIA NSCLC and 27 had stage IIIB NSCLC. After induction CCRT, 31 patients achieved an objective response (complete response in one and partial response in 30; the response rate was 53.4%). The median progression‐free survival was 6.73 months (95% confidence interval [CI], 5.42–7.91), duration of response was 12.30 months (95% CI, 5.59–19.01), and overall survival was 24.83 months (95% CI, 19.26–30.21). No treatment‐related mortality was observed, and neutropenia was the most common grade 3 and 4 treatment‐related toxicity (11 patients; 18.9%). Conclusions: CCRT with the weekly regimen of oral vinorelbine plus triweekly cisplatin was effective and safe for stage III NSCLC. [ABSTRACT FROM AUTHOR]

Purpose: To assess a magnetic resonance imaging (MRI)-based nomogram in the prediction of prostate cancer (PCa) biochemical recurrence (BCR) within 3 years after prostatectomy.Materials and Methods: Between 2009 and 2013, 205 patients with biopsy-confirmed PCa had MRI before prostatectomy. BCR was defined as a PSA failure (>0.2 ng/ml) after prostatectomy. MR features (cancer location, diameter, apparent diffusion coefficients [ADCs], PI-RADS v2 score, dynamic contrast-enhanced [DCE] type, and MR T-stage) were retrospectively evaluated for predicting 3-year BCR based on partial least square regression analysis. Second, imaging features were added to a popularized D'Amico and CAPRA scheme to determine imaging contribution to published nomograms. Lastly, a multivariable Cox regression analysis was employed to determine the independent risk factors of time to BCR.Results: Three-year BCR rate (median follow-up of 44.9 mo) was 25.4% (52/205). The area under receiver operating characteristic (ROC) curve (Az) for MR nomogram (0.909, 95% confidence interval [CI]: 0.861-0.944) was higher than popularized D'Amico (0.793, 95% CI: 0.731-0.846, P = 0.001) and CAPRA (0.809, 95% CI: 0.748-0.860, P = 0.001). The performance of D'Amico (Az: 0.901, 95% CI: 0.852-0.938, P < 0.001) and CAPRA (Az: 0.894, 95% CI: 0.843-0.932, P = 0.004) was significantly improved by adding MR findings. Tumor ADCs (hazard ratio [HR] = 1.747; P = 0.011), PI-RADS score (HR = 4.123; P = 0.039), pathological Gleason score (HR = 3.701; P = 0.004), and surgical-T3b (HR = 6.341; P < 0.001) were independently associated with time to BCR.Conclusion: Multiparametric MRI, when converted into a prognostic nomogram, can predict the clinical outcome in patients with PCa after prostatectomy.Level Of Evidence: 3 J. Magn. Reson. Imaging 2017;45:586-596. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the clinical benefit and cost-effectiveness of routine head and neck magnetic resonance imaging (MRI) in the follow-up of patients with nasopharyngeal carcinoma after definitive intensity modulated radiation therapy.Patients and Methods: Two Markov models were developed to compare the cost and effectiveness of 3 strategies: routine clinical surveillance without serial imaging and routine annual and biannual MRI surveillance in the first 5 years. Two hypothetical cohorts of patients with primary stage T1-2 or T3-4 nasopharyngeal carcinoma who achieved complete remission after radical treatment and remained asymptomatic were analyzed. Baseline probabilities, transition probabilities, utilities, and costs were derived from published studies. Markov models were used to calculate life-time costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model robustness was addressed via univariable and probabilistic sensitivity analyses.Results: In T1-2 patients, surveillance strategies utilizing routine MRI provided few QALYs compared with non-MRI clinical follow-up (annual MRI, 0.022 QALYs; biannual MRI, 0.035 QALYs), whereas the costs associated with MRI surveillance were considerable. Compared with clinical follow-up, the ICERs for annual and biannual MRI strategies were $328,389 and $403,857 per QALY. In T3-4 patients, annual and biannual MRI surveillance provided 0.052 and 0.088 incremental QALYs, with ICERs of $156,204 and $169,772 per QALY, respectively. Model conclusions were robust and remained stable in 1-way and probabilistic sensitivity analyses.Conclusions: Routine MRI surveillance was not cost-effective owing to the high cost of MRI coupled with low rates of failure in T1-2 patients, whereas annual MRI surveillance was the dominant and possibly a cost-effective strategy for T3-4 patients, depending on the social willingness to pay. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore the prediction of aerobic exercise and resistance training on incidental metabolic syndrome (MetS) and diabetes in a Taiwanese cohort. Methods The participant underwent annual health examinations and physical fitness tests, including 2-min push-up, 2-min sit-up, and endurance 3000-m none weight-bearing running exercise test from 2013 to 2015, were recruited. The cohort study involved 27,787 participants aged ≥20 years in military services. Multivariate logistic regression odd ratios models were used to explore the associations between the performance of physical fitness and the development of MetS and diabetes. Results The male participants without MetS at baseline with poor performance in aerobic and resistance exercise tests were likely to develop the MetS and diabetes two years later; while the female participants did not show the same results in statistical significance. Additionally, only poor performance measuring by resistance training exercise test was significantly associated with increased risk of metabolic components numbers at follow-up in all subjects without MetS (all P < 0.05). Conclusions The poor performance in aerobic and resistance exercise tests might be predicting tools for MetS and diabetes in Taiwanese men without MetS at baseline. And resistance exercise displayed a substantial predicting ability in development of metabolic abnormality, MetS and diabetes in our study. [ABSTRACT FROM AUTHOR]

A growing amount of evidence suggests that thyroid-stimulating hormone (TSH) is associated with cardiometabolic risk. However, there have been few longitudinal studies. The aim of this study was to explore the causal relationship between TSH and metabolic syndrome (MetS) in a large population-based longitudinal study. From 2010 to 2016 at the Health Management Center at Tri-Service General Hospital, 25,121 eligible patients were enrolled in our cross-sectional analyses. Cox proportional hazard models were used to investigate the longitudinal association among hypertension (HTN), prediabetes (pre-DM), MetS, diabetes (DM) and TSH levels (N = 12,463). The average follow-up time was 7.2 years. In the cross-sectional analysis, the OR for MetS was 1.06 (95% CI = 1.03–1.09; P< 0.05), while the ORs for DM, pre-DM or HTN were not statistically significant (all P> 0.05). After dividing TSH levels into four quartiles, the ORs for the presence of MetS determined by comparing the highest TSH quartile with the lowest TSH quartile were 1.37 (95% CI = 1.18–1.60), 1.42 (95% CI = 1.20–1.67), and 1.44 (95% CI = 1.22–1.69) (all, P<0.05) in model 1, model 2 and model 3 respectively. The HR for the incidence of MetS was 1.33 (95% CI = 1.17–1.51; P < 0.05). Our study revealed that TSH levels had a strong association with incident MetS. [ABSTRACT FROM AUTHOR]

Objectives: Public health accreditation is intended to improve the performance of public health departments, and quality improvement (QI) is an important component of the Public Health Accreditation Board process. The objective of this study was to evaluate the QI maturity and accreditation readiness of local health departments (LHDs) in Nebraska during a 6-year period that included several statewide initiatives to progress readiness, including funding and technical assistance. Methods: We used a mixed-methods approach that consisted of both online surveys and key informant interviews to assess QI maturity and accreditation readiness. Nineteen of Nebraska's 21 LHDs completed the survey in 2011 and 2013, 20 of 20 LHDs completed the survey in 2015, and 19 of 20 LHDs completed the survey in 2016. We facilitated a large group discussion with staff members from 16 LHDs in 2011, and we conducted key informant interviews with staff members from 4 LHDs in 2015. Results: Both QI maturity and accreditation readiness improved from 2011 to 2016. In 2011, of 19 LHDs, only 6 LHD directors agreed that their LHD had a culture that focused on QI, but this number increased every year up to 12 in 2016. The number of LHDs that had a high capacity to engage in QI efforts improved from 3 in 2011 to 8 in 2016. The number of LHDs with a QI plan increased from 3 in 2011 to 10 in 2016. The number of LHDs that were confident in their ability to obtain Public Health Accreditation Board accreditation improved from 6 in 2011 to 13 in 2016. Although their QI maturity generally increased over time, LHDs interviewed in 2015 still faced challenges adopting a formal QI system. External financial and technical support helped LHDs build their QI maturity and accreditation readiness. Conclusion: Funding and technical assistance can improve LHDs' QI maturity and accreditation readiness. Improvement takes time and sustained efforts by LHDs, and support from external partners (eg, state health departments) helps build LHDs' QI maturity and accreditation readiness. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the diagnostic performance of isolated-check visual evoked potential (icVEP) with that of retinal ganglion cell-inner plexiform layer (GCILP) analysis using optical coherence tomography (OCT).Methods: A total of 45 patients were enrolled: 25 patients with open-angle glaucoma and 20 healthy patients. All patients underwent a complete ophthalmological examination. Moreover, the OCT examination was used to analyze the structures of the GCIPL. The icVEP technique was used to detect the transmission function of the magnocellular pathway, which is mainly managed by the retinal ganglion cells. The quantitative and qualitative comparisons between the diagnostic power of GCIPL analysis and that of icVEP were performed. The areas under the receiver operating characteristic curves (AUC) of GCIPL analysis and icVEP were compared using the Clarke-Pearson method. The sensitivity and specificity of the two techniques were analyzed and compared using the McNemar test.Results: With the quantitative comparison, the AUC of icVEP (AUC = 0.892) was higher than that of GCIPL analysis (AUC = 0.814). However, there was no statistical significance between the AUCs of icVEP and GCIPL (P > 0.05). With the qualitative comparison, the sensitivity of icVEP was 80%, and its specificity was 90%. The sensitivity of GCIPL analysis was 72%, and its specificity was 85%. There was no significant difference between the sensitivitiesor specificities of icVEP and GCIPL analysis (P > 0.05). Moreover, 30 (66.67%) eyeshad similar resultsbetween icVEP and GCIPL analysis, and 15 (33.33%) eyes had different results (7 eyes had abnormal results with GCIPL analysisbut normal results with icVEP, and8 eyes had normal results with GCIPL analysisbut abnormal results with icVEP).Conclusions: The diagnostic power of icVEP was close to that of GCIPL analysis whether the comparison was based on the qualitative or quantitative data. [ABSTRACT FROM AUTHOR]

Objectives To assess the relationship between hemoglobin concentration and cause-specific mortality. Design Cohort study. Setting Data from the government-sponsored Annual Geriatric Health Examination Program. Participants Community-dwelling Taipei citizens aged 65 and older followed up between 2006 and 2010 (N = 77,532). Measurements Mortality was determined by matching participants' medical records with national death files. Cox proportional hazards regression models were used to evaluate the relationship between hemoglobin concentration (World Health Organization ( WHO)-defined anemia and 7 hemoglobin concentrations) and cause-specific mortality. Results The mortality risk of WHO-defined anemia increased substantially in both sexes for all-cause and cancer mortalities (men, hazard ratio ( HR) = 1.86, 95% confidence interval ( CI) = 1.71-2.02 for all-cause mortality; HR = 1.94, 95% CI = 1.69-2.22 for cancer mortality; for women, HR = 1.63, 95% CI = 1.43-1.86 for all-cause mortality; HR = 1.74, 95% CI = 1.38-2.19 for cancer mortality). Men with hemoglobin concentrations of 15.0 to 15.9 g/ dL and women with hemoglobin concentrations of 13.0 to 13.9 g/ dL had the lowest risks of all-cause, cardiovascular, and cancer mortality. Risks of all-cause and cancer mortality increased significantly when hemoglobin concentrations were less than 14 g/ dL in men and less than 12 g/ dL in women. Even mild anemia (11.0-11.9 g/ dL) was associated with greater mortality risk. Stratification according to age, body mass index, estimated glomerular filtration rate, and presence of comorbidities did not lead to any substantial changes. Conclusion Hemoglobin concentrations associated with optimal survival in older adults were identified and additional data provided regarding the relationship between hemoglobin concentrations and cause-specific mortality risks in older adults. [ABSTRACT FROM AUTHOR]

Background: Prediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge. The aim of this study was to characterize the prognostic factors and functional outcomes of patients after CSE in order to develop a practicable scoring system for outcome prediction.Methods: We performed a retrospective explorative analysis on consecutive patients diagnosed with CSE between March, 2008 and November, 2014 in a tertiary academic medical center in northwest China. The modified Rankin Scale (mRS) was used to measure the functional outcome at three months post discharge.Results: A total of 132 CSE patients was included, with a median age of 25.5 years and 60.6% were male. Three months post discharge, an unfavorable outcome with mRS of 3-6 was seen in 62 (47.0%) patients, 25 (18.9%) of whom died. Logistic regression analysis revealed that encephalitis (p = 0.029), nonconvulsive SE (p = 0.018), diazepam resistance (p = 0.005), image abnormalities (unilateral lesions, p = 0.027; bilateral lesions or diffuse cerebral edema, p < 0.001) and tracheal intubation (p = 0.032) were significant independent predictors for unfavorable outcomes. Based on the coefficients in the model, these predictors were assigned a value of 1 point each, with the exception of the image, creating a 6-point scoring system, which we refer to as END-IT, for the outcome prediction of CSE. The area under the receiver operating characteristic curve for the END-IT score was 0.833 and using a cut-off point of 3 produced the highest sum sensitivity (83.9%) and specificity (68.6%). Compared with status epilepticus severity score (STESS) and Epidemiology-based Mortality score in SE (EMSE), END-IT score showed better discriminative power and predictive accuracy for the outcome prediction.Conclusions: We developed an END-IT score with a strong discriminative power for predicting the functional outcome of CSE patients. External prospective validation in different cohorts is needed for END-IT score. [ABSTRACT FROM AUTHOR]

Schizophrenia is a debilitating mental disorder that is associated with an impaired connection of cerebral white matter. Studies on patients with chronic and first-episode schizophrenia have found widespread white matter abnormalities. However, it is unclear whether the altered connections are inherent in or secondary to the disease. Here, we sought to identify white matter tracts with altered connections and to distinguish primary or secondary alterations among 74 fiber tracts across the whole brain using an automatic tractography-based analysis method. Thirty-one chronic, 25 first-episode patients with schizophrenia and 31 healthy controls were recruited to receive diffusion spectrum magnetic resonance imaging at 3T. Seven tracts were found to exhibit significant differences between the groups; they included the right arcuate fasciculus, bilateral fornices, left superior longitudinal fasciculus I, and fibers of the corpus callosum to the bilateral dorsolateral prefrontal cortices (DLPFC), bilateral temporal poles, and bilateral hippocampi. Post-hoc between-group analyses revealed that the connection of the callosal fibers to the bilateral DLPFC was significantly decreased in chronic patients but not in first-episode patients. In a stepwise regression analysis, the decline of the tract connection was significantly predicted by the duration of illness. In contrast, the remaining six tracts showed significant alterations in both first-episode and chronic patients and did not associate with clinical variables. In conclusion, reduced white matter connectivity of the callosal fibers to the bilateral DLPFC may be a secondary change that degrades progressively in the chronic stage, whereas alterations in the other six tracts may be inherent in the disease. [ABSTRACT FROM AUTHOR]

Objectives: To investigate speech and language outcomes in children with cochlear implants (CIs) who had mutations in common deafness genes and to compare their performances with those without mutations. Study Design: Prospective study. Methods: Patients who received CIs before 18 years of age and had used CIs for more than 3 years were enrolled in this study. All patients underwent mutation screening of three common deafness genes: GJB2, SLC26A4 and the mitochondrial 12S rRNA gene. The outcomes with CIs were assessed at post-implant years 3 and 5 using the Categories of Auditory Performance (CAP) scale, Speech Intelligibility Rating (SIR) scale, speech perception tests and language skill tests. Results: Forty-eight patients were found to have confirmative mutations in GJB2 or SLC26A4, and 123 without detected mutations were ascertained for comparison. Among children who received CIs before 3.5 years of age, patients with GJB2 or SLC26A4 mutations showed significantly higher CAP/SIR scores than those without mutations at post-implant year 3 (p = 0.001 for CAP; p = 0.004 for SIR) and year 5 (p = 0.035 for CAP; p = 0.038 for SIR). By contrast, among children who received CIs after age 3.5, no significant differences were noted in post-implant outcomes between patients with and without mutations (all p > 0.05). Conclusion: GJB2 and SLC26A4 mutations are associated with good post-implant outcomes. However, their effects on CI outcomes may be modulated by the age at implantation: the association between mutations and CI outcomes is observed in young recipients who received CIs before age 3.5 years but not in older recipients. [ABSTRACT FROM AUTHOR]

Objectives To estimate the all-cause, cardiovascular, and cancer mortality risks associated with serum uric acid levels in elderly adults. Design Cohort study. Setting The Annual Geriatric Health Examination Program database from 2006 to 2010. Paticipants Community-dwelling Taipei citizens aged 65 and older (N = 77,541). Measurements Stratified according to sex, serum uric acid levels were analyzed in quartiles and as normal versus high categories. Mortality was determined by matching cohort identifications with national death files. Results Men had significantly higher uric acid levels than women ( P < .001), and mean levels increased with age ( P < .001). Serum uric acid levels (normal vs high) were an independent risk factor for all-cause and cardiovascular mortality in men and women, with the strongest association found for cardiovascular mortality. The association between serum uric acid levels and cardiovascular mortality was independent of other cardiovascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, and glomerular filtration rate levels. When levels were analyzed as quartiles, men with levels in the second quartile had the lowest hazard ratios for all-cause and cardiovascular mortality. Conclusion High serum uric acid levels are associated with greater risk of all-cause and cardiovascular mortality but not cancer mortality in elderly adults. Further studies are warranted to investigate the prognostic implications and potential utility in the monitoring of therapy. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: Objective: This nationwide population-based study aims to evaluate the association between Body Mass Index (BMI) and mental health problems, and to investigate the effects of gender and socioeconomic status (SES) on this association. Methods: This study was a longitudinal study. 12,862 adults (aged 18years or older), who responded to the 2001 National Health Interview Survey (NHIS) and gave consent to the linking of the survey data to their National Health Insurance (NHI) claims records, were included. The 2002–2004 NHI claims records of the sample were analyzed. Logistic regression was used to evaluate the odds ratios. Those with middle and high income (per capita annual household income ≧US$9375) in the sample were referred to as the better-offs. Results: After adjustment, increased BMI was significantly associated with a higher risk of schizophrenia (OR: 1.14, 95% CI: 1.07–1.22) and a lower risk of mood disorder (OR: 0.95, 95% CI: 0.91–0.99) in women. In addition, a higher BMI was significantly associated with a lower risk of mood disorders (risk reduction: 6%) and a lower risk of any major mental health problem (risk reduction: 3%) among the better-offs. Conclusions: In contrast to other (cross-sectional) studies in other countries, our longitudinal results suggest that in a general Taiwanese population, the association between BMI and mental health may vary by type of mental health problems. Gender and SES may have influenced this relationship. Further studies are required to elucidate the biological or social factors underlying these empirical observations. [Copyright &y& Elsevier]

Aims: Higher bullous pemphigoid (BP) risk has been reported to be associated with dipeptidyl peptidase 4 inhibitor (DPP4i). The aim of this study is to examine the association between BP risk and DPP4i treatment.Methods: We conducted a nationwide cohort study based on the Taiwan National Health Insurance Database between 2000 and 2015. 124,619 diabetic patients who were receiving DPP4i therapy were matched 1: 1 with diabetic patients who had never received DPP4i by age, sex, duration of diabetes, insulin usage, and propensity score-matching of comorbidities.Results: The 6-year cumulative incidence of BP in the DPP4i-treated cohort was significantly higher than that in the non-DPP4i group (0.74 per 1000 vs 0.38 per 1000, P = 0.001). Modified Cox regression analysis revealed that DPP4i treatment (HR: 2.15, 95% CI: 1.18-3.91, P = 0.01), age (HR: 1.06, P < 0.001), renal disease (HR: 2.32, P < 0.001), and metformin user (HR: 1.93, P = 0.006) were associated with increased BP risk.Conclusions: DPP4i users had a 2.2-fold increase in the risk of BP, and the risk was the highest in those with concomitant use of DPP4i and insulin. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the influence of spatial overlap and radiographic length (RL) on the effective dose (ED) and organ dose for pediatric patients undergoing whole spine radiography using an auto-stitching digital radiography (DR) system.Methods: First, the system parameters were tested on a 10-year-old pediatric anthropomorphic phantom with a Shimadzu DR system, and the effects of the spatial overlap and RL on radiation doses were validated. The ED and organ dose were calculated on the basis of a Monte Carlo simulation program. Subsequently, 82 patients with adolescent idiopathic scoliosis were recruited. The spatial overlap and RL for each patient were modified to further investigate the dose reduction feasibility.Results: RL and ED were appropriately correlated on the basis of patients' height. For a patient measuring 158 cm, the Shimadzu DR system was equipped with a 17-inch detector with a cut-off RL of 75 cm. The phantom simulations indicated that ED was reduced to a minimum value of 0.188 ± 0.001 mSv with a high RL for RL < 75 cm. The minimum value increased to 0.300 ± 0.002 mSv for an RL of 75 cm and dropped to 0.222 ± 0.001 mSv for the maximum RL. By employing optimized RLs for patients, EDs were significantly reduced (p <  0.05). Moreover, ED reductions were higher when longer RLs were employed.Conclusion: A decrease in the spatial overlap and number of radiographic acquisitions by adjusting RLs when possible could reduce ED and almost all organ doses. This study emphasized the effects of RL on the radiation dose and provided useful guidance for modifying the RL for patients to reduce the whole spine radiography dose using a modern auto-stitching DR system. [ABSTRACT FROM AUTHOR]

Objectives: To clarify the incidence of brainstem toxicity and perform a dose-volume analysis for the brainstem after long-term follow-up of a large cohort of nasopharyngeal carcinoma (NPC) patients who underwent intensity-modulated radiation therapy (IMRT).Materials and Methods: All patients with NPC treated with IMRT at Sun Yat-sen University Cancer Center between April 2009 and March 2012 were retrospectively reviewed. A total of 1544 patients with follow-up >12months and detailed treatment plan data were included. Radiotherapy was administered using the simultaneous integrated boost technique in 2.0-2.48Gy per fractions/28-33 fractions. Brainstem necrosis was defined as lesions with high signal intensity on T2-weighted images and low signal intensity on T1-weighted images, with or without enhancement after administration of contrast in follow-up MRI.Results: After median follow-up of 79.7months (range, 12.2-85.6months), 2/1544 (0.13%) patients developed brainstem necrosis after intervals of 12.3 and 18.5months. Actuarial incidence of brainstem necrosis was 0.07%, 0.13%, 0.13% and 0.13% after 1, 2, 3 and 5years, respectively. Overall, 384 (24.9%), 153 (9.9%), 67 (4.3%), 39 (2.5%), 78 (5.1%), and 114 (7.4%) patients had excessive doses of Dmax≥64Gy, D1cc>59Gy, D2cc>59Gy, aV50>5.9cc, aV55>2.7cc and aV60>0.9cc respectively, of whom only two developed brainstem necrosis.Conclusions: Brainstem necrosis is rare in NPC. The definitive criteria based on conventional radiotherapy cannot accurately predict the occurrence of brainstem necrosis after IMRT, thus more flexible definitive criteria with strict restrictions need to be defined. [ABSTRACT FROM AUTHOR]