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BACKGROUND: Standing height (SH) is the most reliable parameter used to predict spirometric values in children, but measurement of this parameter may be difficult in children with thoracic or spinal abnormalities. This study was designed to establish reference equations to estimate SHs of children using their arm span length (ASL) or forearm ulnar length (UL) as an index. METHODS: Children aged 1-17 years were enrolled to measure their SH, body weight, ASL, and UL. Sex and age were also recorded. The relationship between SH and children's weight, age, ASL, and UL were analyzed. Regression equations using different indexes for SH of enrolled cases were used, and adults aged 18-64 years were also enrolled for comparison. RESULTS: A total of 512 children and 144 adults were enrolled. There was a strong linear relationship between SH and both ASL and UL in children and adults. Pearson's correlation coefficients of SH for ASL and UL were 0.989 and 0.968 (p < 0.001) in children and 0.933 and 0.845 (p < 0.001) in adults. The linear regression equations for estimating SH in children were calculated as SH = 9.363 + 0.943 ASL (r2 = 0.978, p < 0.001) and SH = 14.542 + 5.570 UL (r2 = 0.936, p < 0.001). In adults, age and sex were also added as indexes: SH = 59.849 + 0.642 ASL-0.047 Age +3.431 Sex (male = 1; female = 0) (r2 = 0.887, p < 0.001) and SH = 102.824 + 2.317 UL -0.049 age + 6.739 sex (r2 = 0.773, p < 0.001). CONCLUSION: Both ASL and UL have a significant linear relationship with SHs of children and adults. True SH can be estimated using regression equations with ASL or UL as a single index for situations where direct measurement of SH is difficult.
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Estatura , Antebrazo/anatomía & histología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Modelos Lineales , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Background: The prevalence of cognitive impairment is increasing due to the aging population, and early detection is essential clinically. The Ascertain Dementia 8 (AD8) questionnaire is a brief informant-based measure recently developed to assess early cognitive impairment, however, its overall diagnostic performance is controversial. The objective of this meta-analysis was to assess the diagnostic accuracy of the AD8 for cognitive impairment. Methods: All relevant studies were collected from databases including MEDLINE, EMBASE and the Cochrane Library up to April 2017. We used QUADAS-2 to assess the methodological quality after the systematic search. The accuracy data and potential confounding variables were extracted from the eligible studies which included those in English and non-English. All analyses were performed using the Midas module in Stata 14.0 and Meta-DiSc 1.4 software. Results: Seven relevant studies including 3728 subjects were collected, and classified into two subgroups according to the severity of cognitive impairment. The overall sensitivity (0.72, 0.91) was superior to specificity (0.67, 0.78). The pooled negative likelihood ratio (0.17, 0.13) was better than the positive likelihood ratio (2.52, 3.94). The areas under the summary receiver operating characteristic curve were 0.83 and 0.92, respectively. Meta-regression analysis showed that location (community versus non-community) may be the source of heterogeneity. The average administration time was less than 3 minutes. Conclusion: Our findings suggest that the AD8 is a competitive tool for clinically screening cognitive impairment and has an optimal administration time in the busy primary care setting. Subjects with an AD8 score â§2 should be highly suspected to have cognitive impairment and a further definite diagnosis is needed.
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Disfunción Cognitiva/diagnóstico , Demencia/psicología , Encuestas y Cuestionarios , Diagnóstico Precoz , Humanos , Atención Primaria de Salud/organización & administración , Curva ROC , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: To evaluate the combined effects of surfactant lavage and intratracheally instillation of budesonide on meconium-injured piglet lungs. DESIGN: A prospective, randomized, animal model study. SETTING: An experimental laboratory. SUBJECTS: Twenty-four anesthetized and mechanically ventilated newborn piglets. INTERVENTIONS: Human meconium slurry was intratracheally instilled into piglet lungs to induce lung injury. The injured piglets were randomly assigned to either the sham treatment group (control) or one of the three therapeutic groups: the intratracheally instilled budesonide (Bud) group, the bronchoalveolar lavage with diluted surfactant (dsBAL) group, and the combination therapy of Bud and dsBAL (dsBAL + Bud) group. MEASUREMENTS AND MAIN RESULTS: Cardiopulmonary profiles were measured hourly. Proinflammatory cytokine (interleukin-1ß, interleukin-6, and interleukin-8) levels in bronchoalveolar lavage fluid were measured. Finally, the pulmonary histology of the experimental subjects was examined at the end of experiments. Both of the lavaged groups (dsBAL and dsBAL + Bud) showed significantly better oxygenation than those that had not undergone lavage (control and Bud) (p < 0.05). The dsBAL + Bud group showed a significantly higher lung compliance and required a significantly lower peak inspiratory pressure during the experimental periods than the other three groups (p < 0.05). All treatment groups had significantly lower concentrations of interleukin-1ß concentration in the bronchoalveolar lavage fluid than the control group (p < 0.05). The dsBAL + Bud group also had a significantly lower interleukin-6 concentration in the bronchoalveolar lavage fluid (p< 0.05), as well as a significantly lower lung injury score based on pulmonary histology than the control group (p < 0.05). CONCLUSIONS: Therapeutic bronchoalveolar lavage with diluted surfactant followed by intratracheal instillation of budesonide has a synergistic and beneficial effect when treating severe meconium-injured newborn piglet lungs.
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Antiinflamatorios/uso terapéutico , Lavado Broncoalveolar , Budesonida/uso terapéutico , Síndrome de Aspiración de Meconio/terapia , Surfactantes Pulmonares/uso terapéutico , Animales , Biomarcadores/metabolismo , Líquido del Lavado Bronquioalveolar/química , Terapia Combinada , Citocinas/metabolismo , Humanos , Instilación de Medicamentos , Masculino , Síndrome de Aspiración de Meconio/metabolismo , Síndrome de Aspiración de Meconio/patología , Estudios Prospectivos , Distribución Aleatoria , Respiración Artificial , Porcinos , Resultado del TratamientoRESUMEN
OBJECTIVE: Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease. A higher prevalence of psychiatric comorbidities, including depressive disorder, has been proven in patients with AS. However, a clear temporal causal relationship between AS and psychiatric disorders has not been well established. We performed a nationwide population-based retrospective cohort study to analyze the relationship between AS and the subsequent development of psychiatric disorders, including schizophrenia, bipolar disorder, depressive disorders, anxiety disorders, and sleep disorders. METHODS: We identified subjects who were newly diagnosed with AS between January 1, 2000, and December 31, 2008, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed of patients without AS who were matched according to age and sex. All patients with AS and control patients were observed until diagnosed with psychiatric disorders, or until death or withdrawal from the NHI system, or until December 31, 2009. RESULTS: The AS cohort consisted of 2331 patients and the comparison cohort consisted of 9324 matched control patients without AS. The adjusted HR for depressive disorders, anxiety disorders, and sleep disorders in subjects with AS were higher than those of the controls during followup (HR 1.718, 95% CI 1.303-2.265; HR 1.848, 95% CI 1.369-2.494; and HR 1.494, 95% CI 1.031-2.162, respectively). CONCLUSION: AS might increase the risk of a subsequent newly diagnosed depressive disorder, anxiety disorder, or sleep disorder, but not schizophrenia or bipolar disorder. These observations highlight the need for psychiatric evaluation and intervention for patients with AS.
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Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Espondilitis Anquilosante/complicaciones , Adulto , Anciano , Estudios de Cohortes , Comorbilidad , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Riesgo , Taiwán/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease. A clear temporal causal relationship between pSS and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between pSS and the subsequent development of psychiatric disorders. METHODS: We identified subjects who were newly diagnosed with pSS between January 1, 2000, and December 31, 2008, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed for patients without pSS. There were 2686 patients with pSS and 10,744 matched controls observed until diagnosed with psychiatric disorders or until death, withdrawal from the NHI system, or December 31, 2009. The Institutional Review Board of Taipei Veterans General Hospital approved this study (2012-12-013BC). RESULTS: The adjusted HR of depressive disorder, anxiety disorder, and sleep disorder in subjects with pSS were significantly higher at 1.829, 1.856, and 1.967 than those of the controls during the followup. We found that pSS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder that may impair life quality. CONCLUSION: Our findings highlight the need for psychiatric evaluation and intervention for patients with pSS.
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Trastornos de Ansiedad/epidemiología , Trastorno Depresivo/epidemiología , Síndrome de Sjögren/complicaciones , Trastornos del Sueño-Vigilia/epidemiología , Adulto , Trastornos de Ansiedad/etiología , Estudios de Cohortes , Bases de Datos Factuales , Trastorno Depresivo/etiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Riesgo , Síndrome de Sjögren/epidemiología , Trastornos del Sueño-Vigilia/etiología , TaiwánRESUMEN
OBJECTIVES: This study aims to contribute to the development of objective diagnostic standards in Traditional Chinese Medicine (TCM), in order to improve the training of physicians. METHODS: We devised a questionnaire study to evaluate the accuracy of resident doctors' diagnostic skills by comparing their assessment of patients with those of their senior supervising physician and the patients themselves. We selected 39 patients with systemic lupus erythematosus (SLE) at Chang Gung Memorial Hospital, Taiwan, between November 1, 2008 and June 30, 2012, and had the resident doctors (R), their senior supervisor (S) and their patients (P) fill out questionnaires before treatment (V1), immediately after treatment (V5) and two months after treatment (V6), in order to record their assessments on the patients' condition. The R and S questionnaires covered subjective symptoms, tongue, and pulse, while the P questionnaires only included general symptoms. We then compared the assessment records to determine the level of agreement between them. RESULTS: The agreements of inquiry during the study for P and S were 0.78 (V1) to 0.84 (V6) and 0.87 (V1) to 0.94 (V6) for R and S, respectively, the agreements between R and S for tongue diagnosis and pulse diagnosis were 0.87 (V1) to 0.90 (V6) and 0.91 (V1) to 0.95 (V6), respectively. All the above agreements improved with time from V1 to V6. CONCLUSIONS: The results show that the patient input was feasible and effective and that the questionnaire method provided an objective assessment standard to determine how successfully the resident doctor was trained. Furthermore, it facilitated a training process that could help resident doctors improve their skills.
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Personal de Salud/estadística & datos numéricos , Lupus Eritematoso Sistémico/diagnóstico , Medicina Tradicional China/normas , Pacientes/estadística & datos numéricos , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios , Humanos , Pulso Arterial , Taiwán/epidemiología , Lengua/patologíaRESUMEN
OBJECTIVE: To evaluate the risk of Parkinson disease (PD) among patients with depression by using the Taiwan National Health Insurance Research Database (NHIRD). METHODS: We conducted a retrospective study of a matched cohort of 23,180 participants (4,634 patients with depression and 18,544 control patients) who were selected from the NHIRD. Patients were observed for a maximum of 10 years to determine the rates of new-onset PD, and Cox regression was used to identify the predictors of PD. We also examined the risk of PD after excluding patients who were diagnosed with PD within 2 or 5 years after their depression diagnosis. A logistic regression model was used to identify risk factors associated with PD onset in patients with depression. RESULTS: During the 10-year follow-up period, 66 patients with depression (1.42%) and 97 control patients (0.52%) were diagnosed with PD. After adjusting for age and sex, patients with depression were 3.24 times more likely to develop PD (95% confidence interval 2.36-4.44, p < 0.001) compared with the control patients. After excluding patients who were diagnosed with PD within 2 or 5 years after their depression diagnosis, patients with depression had a higher hazard ratio for developing PD than the control patients. The odds ratios for age (1.09) and difficult-to-treat depression (2.18) showed that each is an independent risk factor for PD in patients with depression. CONCLUSION: The likelihood of developing PD is greater among patients with depression than patients without depression. Depression may be an independent risk factor for PD.
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Depresión/epidemiología , Enfermedad de Parkinson/epidemiología , Sistema de Registros , Adulto , Factores de Edad , Anciano , Comorbilidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología , Factores de TiempoRESUMEN
Pain is a common problem among the elderly. The entire scope of chronic pain relief strategies used by community elderly is still unclear. A limited number of studies have investigated this issue from diverse culture perspectives. In the present study, we investigated the use and perceived effectiveness of pain relief strategies adopted by the elderly; gender differences between frequently used relief strategies were also explored. Two hundred nineteen participants living in Taiwan City, Taiwan, were recruited by a random sampling method and interviewed face to face. The prevalence of chronic pain among the elderly was 42.0% (n = 92). The elderly tended to adopt multiple strategies (mean ± SD = 9.08 ± 3.56; range = 2-18) to relieve their chronic pain. In three domains of pain relief strategies, conventional medicine was used more frequently than complementary and alternative medicine and psychologic approaches. Most pain relief strategies were ineffective. Among the 22 strategies used, no strategy was reported as "much improved" by a majority of users. The top five pain relief strategies used by men and women were the same. Elderly women tended to adopt more psychologic approaches, such as acceptance and ignoring to relieve pain, than men. The findings suggest that nurses should pay more attention to the issue of chronic pain relief and provide the elderly with more effective pain relief strategies.
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Adaptación Psicológica , Pueblo Asiatico/etnología , Pueblo Asiatico/psicología , Dolor , Caracteres Sexuales , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Identidad de Género , Humanos , Entrevistas como Asunto , Masculino , Dolor/etnología , Dolor/enfermería , Dolor/psicología , Características de la Residencia , Encuestas y Cuestionarios , TaiwánRESUMEN
BACKGROUND AND OBJECTIVE: ARDS is life-threatening acute respiratory failure, and pneumonia is one of the most common causes of direct ARDS. Procalcitonin (PCT) has been evaluated for its utility in determining the aetiology of community-acquired pneumonia (CAP), choice of antibiotics and prediction of outcome. This study evaluated the role of PCT in predicting the outcome of patients with ARDS caused by severe CAP. METHODS: This was a prospective observational study conducted from September 2002 to December 2003. The plasma PCT was analysed at baseline, 24 and 72 h after enrolment and measured by ELISA. RESULTS: Of the 22 patients with ARDS caused by CAP and enrolled in the study, 17 (77.3%) were alive 14 days after admission and five (22.7%) had died. The survivors had lower APACHE II scores (22.2 +/- 4.6 vs 30.6 +/- 9.6, P = 0.031), pneumonia severity index (141.9 +/- 2.2 vs 195.6 +/- 23.8, P = 0.005) and lower plasma PCT at baseline (9.83 +/- 3.54 vs 106.70 +/- 67.86, P = 0.004), at 24 h (10.51 +/- 5.39 vs 81.32 +/- 57.68, P = 0.014) and at 72 h (2.03 +/- 0.76 vs 19.57 +/- 6.67, P = 0.005). CONCLUSION: PCT analysed within 72 h of the onset of ARDS predicted mortality of patients with ARDS caused by severe CAP.
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Biomarcadores/sangre , Calcitonina/sangre , Precursores de Proteínas/sangre , Síndrome de Dificultad Respiratoria/mortalidad , Anciano , Anciano de 80 o más Años , Péptido Relacionado con Gen de Calcitonina , Infecciones Comunitarias Adquiridas/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/complicaciones , Pronóstico , Curva ROC , Síndrome de Dificultad Respiratoria/sangre , Síndrome de Dificultad Respiratoria/etiologíaRESUMEN
AIM: To explore the efficacy of hospitals using case management with Directly Observed Treatment - Short course (DOTS) to monitor the adherence of patients with pulmonary tuberculosis in Taiwan. BACKGROUND: Non-adherence to anti-tuberculosis chemotherapy is the major problem in treating patients with tuberculosis. Community-based case management coupled with DOTS has been applied to patients with tuberculosis and has resulted in good results in some countries. Taiwan has a high incidence of tuberculosis, and although it has implemented DOTS, the expected increased efficacy has not yet been realized. DESIGN AND METHODS: The study used a quasi-experimental design. Using age and gender as matching factors, 96 subjects were randomly assigned to one of three groups in 2002-2003. Experimental group I was to receive DOTS case management comprising in-hospital education, direct daily observation in the first two months and one home visit per week. Experimental group II received traditional case management comprising in-hospital education and one home visit per month. The control group did not receive any intervention. RESULTS: The adherence, the rate of completion, the treatment success, sputum conversion and chest X-ray improvement of experimental group I were significantly improved compared with experimental group II and the control group. The completion rate in experimental group I was higher than the general rate for Taiwan during the past six years and the treatment success rate met the standards of the World Health Organization. CONCLUSION: Hospitals using case management with DOTS can improve the adherence of tuberculosis patients and the control of tuberculosis-epidemic situations. Relevance to clinical practice. In a rapidly changing healthcare environment, clinical nurses can make a significant contribution to healthcare delivery for tuberculosis patients. This study has provided further insight into the implementation of hospital-to-community level case management using DOTS by nurses.
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Antituberculosos/uso terapéutico , Manejo de Caso , Terapia por Observación Directa , Cooperación del Paciente , Tuberculosis Pulmonar/tratamiento farmacológico , Anciano , Servicios de Salud Comunitaria , Femenino , Humanos , Masculino , Modelos de Enfermería , Proyectos Piloto , Resultado del Tratamiento , Tuberculosis Pulmonar/enfermeríaRESUMEN
BACKGROUND/PURPOSE: Acute respiratory distress syndrome (ARDS) is a serious disorder of intensive care unit patients. We evaluated the safety of continuous prone position ventilation (PRONE) and its effects on oxygenation and plasma cytokine concentrations in patients with ARDS caused by severe community-acquired pneumonia (CAP). METHODS: This was a prospective observational clinical study conducted in a respiratory intensive care unit of a 1200-bed medical center in central Taiwan. Twenty-two patients with severe CAP and ARDS were included. They were treated by traditional supine ventilation (SUPINE, n = 11) or PRONE (n = 11) if they met the criteria for ARDS. Patients in the PRONE group were ventilated in prone position continuously for at least 72 hours. Plasma cytokines were collected and analyzed at baseline, 24 hours and 72 hours after enrolment. Serial PaO2/FiO2 and complications were evaluated. RESULTS: Complications associated with PRONE were minor and self-limited. PRONE had higher PaO2/FiO2 ratio than SUPINE did at 48 hours after enrolment. The levels of plasma IL-6 concentration declined significantly with time in the PRONE group (p = 0.011). The levels of plasma IL-6 concentration at enrolment, 24 hours and 72 hours after enrolment also predicted the 14th day mortality of all patients. CONCLUSION: PRONE was a safe and effective maneuver for improving oxygenation in patients with severe CAP and ARDS. PRONE also influenced IL-6 expression in patients with severe CAP.
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Infecciones Comunitarias Adquiridas/complicaciones , Citocinas/sangre , Neumonía/complicaciones , Posición Prona , Síndrome de Dificultad Respiratoria/fisiopatología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Respiración con Presión Positiva , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapiaRESUMEN
STUDY DESIGN: The results for 37 surgical interventions in 31 consecutive patients with non-small cell lung cancer (NSCLC) with symptomatic spinal cord compression were reviewed retrospectively. OBJECTIVES: To evaluate postoperative outcomes and survival rates of NSCLC patients surgically treated for symptomatic spinal metastasis. SUMMARY OF BACKGROUND DATA: For patients with spinal cord compression secondary to lung cancer, the prognosis is usually poor. However, with the development of new chemotherapeutic drugs and targeted therapeutic agents, the survival rate may be better. METHODS: From November 2000 to March 2005, 31 patients with symptomatic metastatic spinal cord compression secondary to NSCLC underwent palliative surgery using a posterolateral transpedicular approach (PTA) or combined posterior and anterior procedures. The indication for surgery was neurologic progression due to spinal cord compression. RESULTS: The patients ranged in age from 20 to 81 years (mean, 61.4 years). Twenty-eight patients (90%) underwent PTA, and 3 patients had combined posterior and anterior procedures. Neurologic improvement by at least one Frankel grade was noted in 25 of 31 cases (80%). Overall, 74% of patients (23 of 31) were able to walk after surgery. There was no case of intraoperative mortality, but two deaths occurred in the postoperative period. Median survival time was 8.8 months. CONCLUSIONS: Even though lung cancer is considered an aggressive tumor, it is justifiable to aggressively treat patients with symptomatic spinal cord compression. Surgery by PTA can lead to good results in these patients.
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Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/patología , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/estadística & datos numéricos , Neoplasias Epidurales/secundario , Neoplasias Epidurales/cirugía , Espacio Epidural/patología , Espacio Epidural/cirugía , Femenino , Humanos , Laminectomía/métodos , Laminectomía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Canal Medular/patología , Canal Medular/cirugía , Compresión de la Médula Espinal/patología , Columna Vertebral/patología , Columna Vertebral/cirugía , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: The triggering receptor expressed on myeloid cell-1 (TREM-1) is a newly discovered molecule that is associated with the inflammatory response to microorganisms. We investigated the role of surface and soluble TREM-1 in differentiating different disease entities in pleural effusion formation. METHODS: Sixty-seven patients with pleural effusion due to transudate (14), malignancy (15), tuberculous pleuritis (16), para-pneumonic effusion (10) and empyaema (12) were included in this study. Surface TREM-1 was measured by flow cytometry and was expressed as mean fluorescence intensity and soluble TREM-1 was measured by ELISA and expressed as pg/mL. Results are given as mean levels +/- SEM. RESULTS: Surface TREM-1 was measured in 24 patients and the levels were highest in para-pneumonic effusion (30.0 +/- 8.4) and lowest in malignant pleural effusion (5.2 +/- 1.1) and tuberculous pleuritis (5.2 +/- 2.4). Soluble TREM-1 was highest in effusions of infectious aetiology (para-pneumonic effusion (979.4 +/- 229.6) and empyaema (1712.6 +/- 299.5)) and lowest in non-infectious effusions (transudate (81.2 +/- 4.5 pg/mL) and malignancy (111.3 +/- 20.7). At a cut-off value of 114 pg/mL, soluble TREM-1 yielded a sensitivity of 87.5% and a specificity of 89.7% in differentiating non-infectious effusion from tuberculous pleuritis. At a cut-off value of 374 pg/mL, sTREM-1 yielded a sensitivity of 93.8% and a specificity of 90.9 in differentiating tuberculous pleuritis from bacterial pleural effusion. CONCLUSION: Soluble and surface TREM-1 are valuable markers in establishing the aetiology of pleural effusions.
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Glicoproteínas de Membrana/metabolismo , Derrame Pleural/diagnóstico , Derrame Pleural/metabolismo , Receptores Inmunológicos/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/metabolismo , Empiema/complicaciones , Exudados y Transudados , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Derrame Pleural/etiología , Neumonía/complicaciones , Sensibilidad y Especificidad , Receptor Activador Expresado en Células Mieloides 1 , Tuberculosis Pleural/complicacionesRESUMEN
AIM: This paper reports an evaluation of the effect of symptom management programmed on drug adherence, CD4 count and virus load and the quality of life of patients with HIV/AIDS. BACKGROUND: Patients with HIV/AIDS have to face the long-term side effects caused by highly active antiretroviral therapy regimens. There has been little research to evaluate the influence of drug intervention side effects on self-care. METHODS: Sixty-seven patients with HIV/AIDS were randomly assigned to one-on-one teaching, group teaching, or control groups. All those in the one-on-one and group teaching groups attended a symptom management programme once a week, followed by 3 weeks of continuity and telephone counselling. Those in the control group were offered experimental intervention at the conclusion of data collection. The Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and Quality of Life Index were used to evaluate the effectiveness of the symptom management programme before and at 3 months after the intervention. RESULTS: Median differences on the Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and quality of life in both experimental groups were statistically significantly better than in the control group. CONCLUSIONS: The symptom management programme can increase self-care ability in managing medication side effects in patients with HIV/AIDS.
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Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/psicología , Cooperación del Paciente/psicología , Calidad de Vida/psicología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/psicología , Adulto , Recuento de Linfocito CD4 , Consejo/métodos , Femenino , Procesos de Grupo , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Educación del Paciente como Asunto/métodos , Autocuidado , Carga ViralRESUMEN
The purpose of this cross-sectional study was to investigate the prevalence, interference with daily life, and risk factors of chronic pain among older people. A total of 219 older people were interviewed after being selected from communities of Taipei City, Taiwan, by a multiple-stage random-sampling technique. A face-to-face interview with a structured questionnaire was used to collect data. Our findings indicated that 42% (n=92) of older people experience chronic pain. Walking problems and moods were reported as the two leading causes of interference in daily life. There were statistically significant correlations between the presence of chronic pain and being a single female, having a low level of education, being influenced by religious beliefs, and being in poor health. We conclude that in Taipei City, approximately half of the older people have chronic pain and walking and mood problems. From our findings, we recommend paying attention to single females who have poor health and low education levels, as well as gaining a better understanding of the role that religious influences play in chronic pain, to better understand the prevalence of chronic pain in older people.
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Dolor/epidemiología , Actividades Cotidianas , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Estudios Transversales , Escolaridad , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Estado Civil , Dolor/diagnóstico , Dolor/fisiopatología , Dolor/psicología , Dimensión del Dolor , Vigilancia de la Población , Prevalencia , Calidad de Vida , Religión , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores Socioeconómicos , Encuestas y Cuestionarios , Taiwán/epidemiología , Salud Urbana/estadística & datos numéricosRESUMEN
BACKGROUND: Thromboembolic disease is a major cause of morbidity and mortality in many countries. Our previous study found that Chinese subjects carried the same polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene as described in Western studies. The aim of the present study was to determine the influence of MTHFR polymorphism, B vitamins and other factors on plasma homocysteine (Hcy) levels and risk of thromboembolic disease in Chinese. METHODS: One hundred and six subjects were enrolled into the study. They were categorized into 4 groups: healthy individuals (n = 42); those with diabetes mellitus (n = 20); those with deep vein thrombosis (DVT) (n = 11); and those with coronary artery disease (CAD) (n = 33). Plasma levels of folic acid, vitamins B6 and B12, Hcy, and fasting blood sugar were measured; total cholesterol, triglycerides, complete blood count, and 677 C-->T mutation in MTHFR were determined. RESULTS: Plasma Hcy was lowest in the healthy subjects, higher in diabetics, followed by patients with DVT, and highest in patients with CAD (p < 0.001, ANOVA). MTHFR C677T polymorphism was the common factor affecting plasma logHcy levels in all 4 groups of subjects. Triglycerides affected plasma logHcy in the CAD patients. For the 4 groups as a whole, MTHFR polymorphism, triglycerides, and vitamin B12 were the most significant factors influencing plasma Hcy. CONCLUSION: We suggest that high plasma Hcy is an important risk factor for CAD. Other factors including MTHFR polymorphism, vitamin B12, triglycerides, total cholesterol, and gender might affect Hcy levels in different diseases and conditions.
Asunto(s)
Homocisteína/sangre , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo Genético , Tromboembolia/etiología , Vitamina B 12/sangre , Vitamina B 6/sangre , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/etiología , Femenino , Ácido Fólico/sangre , Humanos , Masculino , Persona de Mediana Edad , Mutación , Factores de RiesgoRESUMEN
Advanced non-small-cell lung cancer (NSCLC) patients with poor performance status (PS) are less likely to respond to chemotherapy, or to have an improvement in survival, but more likely to experience toxicity. We retrospectively evaluated the efficacy and tolerability of gefitinib in patients with advanced NSCLC and very poor PS in Taiwan. Patients with stage IIIB, IV NSCLC with an Eastern Cooperative Oncology Group (ECOG) PS of 3-4 received oral gefitinib 250 mg once daily. Totally, 52 patients were included (25 men, 27 women). Forty-three patients (82.7%) were in a PS of 3. Tumor response rate was 25.0% (13/52). Tumor response rate to gefitinib was highest in chemonaive patients 38.1% (8/21) vs. failed 1 chemotherapy regimen 13.3% (2/15) vs. failed 2 or more chemotherapy regimens 18.8% (3/16), p = 0.015. The median overall survival was 2.5 months (response group 9.1 months, stable disease 3.1 months, and progressive group 0.8 month, p < 0.001). Adverse events, mainly skin reactions and diarrhea, were generally mild (grade 1 or 2) except paronychia and acne. Thus, gefitinib has clinically antitumor activity and good tolerability in Taiwan patients with advanced NSCLC and very poor performance status, with a higher response rate than that seen Europe or in European heritage Americans. Chemonaive patients responded better than patients with prior chemotherapy. Formal clinical trials are warranted to evaluate the role of gefitinib in this situation.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Inhibidores Enzimáticos/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Quinazolinas/uso terapéutico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/patología , Femenino , Gefitinib , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Terapia Recuperativa , Tasa de SupervivenciaRESUMEN
OBJECTIVE: The aim of this study was to evaluate the characteristics of asthma in patients with different ages of disease onset. METHODOLOGY: Five hundred and four asthmatic patients (303 males and 201 females) were divided into five groups based on age of onset (group I, age of onset < 15 years old; group II, 15-24 years old; group III, 25-44 years old; group IV, 45-64 years old; and group V, > 64 years old). The relationship between age of onset and the characteristics of asthma, including lung function, reversibility, atopic status and the incidence of coexistent allergic rhinitis was assessed. Multivariate analysis, adjusted for the duration of disease, gender, educational level, smoking status, and degree of previous inhaled corticosteroid treatment, was performed. RESULTS: Thirty per cent of the patients developed asthma before they were 14 years old (group I), and the percentages of those developing asthma at other ages of onset were: group II, 12%; group III, 29%; group IV, 21% and group V, 8%. In all, 57.6% of the asthmatic patients had coexistent allergic rhinitis; younger patients tended to have this comorbidity. The pulmonary function of older onset asthma patients was worse than that of early onset patients. The multivariate analysis showed that there was a positive correlation between the reduction of pulmonary function and duration of the disease (P < 0.001), but there was no relationship between pulmonary function and gender (P = 0.502), educational level (P = 0.734), smoking pack-years (P = 0.902), or degree of use of inhaled corticosteroid treatment (P = 0.586). CONCLUSION: Asthma is a heterogeneous disease with a wide variety of presentations. This study provides information about the disease characteristics and their relationship with age of onset. Further study is necessary to determine why these differences exist.