Clinical correlation of nonalcoholic fatty liver disease in a Chinese taxi drivers population in Taiwan: Experience at a teaching hospital.

BACKGROUND: To explore any gender-related differences in the prevalence of conditions-associated with non-alcoholic fatty liver disease (NAFLD) among Taiwanese taxi drivers in Taipei, Taiwan. METHODS: We studied 1635 healthy taxi drivers (1541 males and 94 females) who volunteered for physical check-ups in 2006. Blood samples and ultrasound fatty liver sonography results were collected. RESULTS: The prevalence of NAFLD was 66.4% and revealed no statistically significant decrease with increasing age (p = 0.58). Males exhibited a greater prevalence of NAFLD than did females (67.5% vs 47.9%, p < 0.0001). Gender-related differences for associated factors were found. For males, hypertension, hyperuricemia, higher AST, higher ALT, hypertriglyceridemia, and higher fasting plasma glucose were significantly related to NAFLD. These conditions were not sigfinicantly related to NAFLD in females. CONCLUSION: Several gender-related differences were noted for NAFLD among Taiwanese taxi drivers.

Economic evaluation of screening for diabetic retinopathy among Chinese type 2 diabetics: a community-based study in Kinmen, Taiwan.

BACKGROUND: This community-based study conducted in Kinmen aimed to discover whether screening for diabetic retinopathy (DR) among Chinese with type 2 diabetes was economically feasible and clinically effective. METHODS: A total of 971 community-dwelling adults previously diagnosed with type 2 diabetes in 1991-1993 underwent DR screening in 1999-2002 by a panel of ophthalmologists, who used on-site indirect ophthalmoscopy and 45-degree color fundus retinal photographs. Economic evaluation included estimates for cost effectiveness and the cost utility of screening for DR. RESULTS: For each DR case, screening efficacy and utility decreased, while cost increased with the length of the screening interval. The cost per sight year gained in the annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and control groups were New Taiwan dollars (NT dollars) 20962, NT dollars 24990, NT dollars 30847, NT dollars 37435, NT dollars 44449, and NT dollars 83411, respectively. The cost per quality-adjusted life year gained by the annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and control groups were NT dollars 21924, NT dollars 25319, NT dollars 30098, NT dollars 35106, NT dollars 40037, and NT dollars 61542, respectively. Threshold values indicate that the screening programs are highly sensitive to screening cost in the plausible range. CONCLUSION: Screening for DR is both medically and economically worthwhile. Annual screening for DR among Chinese with type 2 diabetes should be conducted. Prevention programs aimed at improving eye care for patients with type 2 diabetes result in both substantial federal budgetary savings and highly cost-effective health care.

Prevalence and associated factors of lens opacities among Chinese type 2 diabetics in Kinmen, Taiwan.

The aim of this study is to assess the prevalence and associated risk factors of lens opacities among type 2 diabetics in Kinmen, Taiwan. A community-based mass screening ascertained 971 type 2 diabetics from 1991 to 1993. From that population, a total of 578 (59.5%) patients with type 2 diabetes underwent eye screening in 1999 with a 45 degrees thin slit-lamp biomicroscopy and ophthalmoscopy to examine the lens after dilation of the pupils. The prevalence of nuclear, cortical, and posterior subcapsular (PSC) opacity without surgery among type 2 diabetics was 22.5, 20.2, and 19.9%, respectively. The number of females affected was statistically higher than males in each type of lens opacity. The prevalence of each type of lens opacity also showed a statistically significant increase with (chi2 test). Based on multiple logistic regressions, age was the most significant factor related with each type of lens opacity. Triglyceride at baseline was associated with nuclear opacity (> or =200 vs. <200 mg/dl, OR = 2.35, 95% CI: 1.15-4.79) and PSC opacity (> or =200 vs. <200 mg/dl, OR = 2.11, 95% CI: 1.00-4.43). In conclusion, our results show that in addition to age, higher triglyceride level may increase the risk of prevalent nuclear or PSC opacity in type 2 diabetics.

A community-based study of the willingness to pay associated with screening for diabetic retinopathy among type 2 diabetes in Kinmen, Taiwan.

BACKGROUND: In Taiwan, there were few population-based studies of WTP values related to DR screening among persons with type 2 diabetes. This community-based study was to explore the willingness- to-pay (WTP) values for screening for diabetic retinopathy (DR) associated with varying degrees of DR among persons with type 2 diabetes in Kinmen, Taiwan. METHODS: A total of 725 eligible community-dwelling adults diagnosed with type 2 diabetes received DR screening during 1999-2002 and then evaluated WTP values in 2003. Diagnosis of DR was performed by a panel of ophthalmologists using ophthalmoscopy and a 45-degree color retinal photographs to examine fundus after dilating pupils. WTP values were measured by discrete-choice method. RESULTS: The 406 adults with type 2 diabetes participating in the WTP survey had a 56% response rate. Of 406 subjects, 265 (65.3%) said they would be willing to pay for DR screening to reduce blindness. The overall mean WTP value was New Taiwan Dollars 468.9 +/- 327.7 (US dollars 14.3 +/- 10.0). Age was borderline significant (p=0.07) related to WTP values. Those with severe stage DR had higher WTP values for screening than subjects with mild stage. CONCLUSIONS: Degree of DR was the independent factor affecting WTP values in DR screening among community-dwelling adults with type 2 diabetes.

Estimation of progression of multi-state chronic disease using the Markov model and prevalence pool concept.

BACKGROUND: We propose a simple new method for estimating progression of a chronic disease with multi-state properties by unifying the prevalence pool concept with the Markov process model. METHODS: Estimation of progression rates in the multi-state model is performed using the E-M algorithm. This approach is applied to data on Type 2 diabetes screening. RESULTS: Good convergence of estimations is demonstrated. In contrast to previous Markov models, the major advantage of our proposed method is that integrating the prevalence pool equation (that the numbers entering the prevalence pool is equal to the number leaving it) into the likelihood function not only simplifies the likelihood function but makes estimation of parameters stable. CONCLUSION: This approach may be useful in quantifying the progression of a variety of chronic diseases.

A community-based study of the relationship between insulin resistance/beta-cell dysfunction and diabetic retinopathy among type II diabetics in Kinmen, Taiwan.

PURPOSE: To explore whether insulin resistance and beta-cell dysfunction are both related to diabetic retinopathy (DR) in type II diabetics by using a community-based study in Kinmen, Taiwan. METHODS: A screening program for DR was performed by a panel of ophthalmologists who used ophthalmoscopy and 45 degrees color retinal photographs on dilated pupils to determine a consensus grade of diabetic retinopathy. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type II diabetes. The Homeostatis Model Assessment (HOMA) method was used to determine insulin resistance and beta-cell dysfunction. RESULTS: Seven hundred twenty-five diabetics who attended ophthalmological fundus checkups were studied. The overall response rate was 75%. After excluding 10 insulin-treated diabetics, diabetic retinopathy at first eye screening among the remaining 715 diabetics was 18.5%. Based on the multiple logistic regression, DR was found to be strongly related to both baseline insulin resistance (IR) and beta-cell dysfunction regardless of duration of diabetes. The strength of the relationships was maintained after adjustment for confounders. Those who were in the 2nd, 3rd, and 4th quartile of HOMA IR had 1.38 times (95% CI: 0.62-3.05), 2.37 times (95% CI: 1.19-4.69), and 4.16 times (95% CI: 2.15-8.06) the risk for DR compared to that in the 1st quartile, respectively. A reduced risk for DR in relation to HOMA beta-cell dysfunction for the 2nd, 3rd, and 4th quartile were 64% (95% CI: 27%-82%), 82% (95% CI: 58%-92%), and 82% (95% CI: 60%-92%) compared to that in the 1st quartile, respectively. CONCLUSIONS: Insulin resistance and beta-cell dysfunction are both associated with diabetic retinopathy in type II diabetes.

Population-based study of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan.

BACKGROUND: The purpose of this study was to assess the prevalence and associated factors of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan. METHODS: A community-based population survey between 1991 and 1993 identified 971 patients over the age of 30 years with type 2 diabetes. In 1999, a total of 578 patients (59.5%) with type 2 diabetes from the population were examined in an ophthalmic screening study. Two senior ophthalmologists employed slit-lamp biomicroscopy, indirect ophthalmoscopy, and retinal photographs with pupil dilatation to examine the patients' lenticular and retinal status. RESULTS: The prevalence of cataract surgery in one eye, both eyes, and any cataract surgery among patients with type 2 diabetes was 4.5%, 5.4%, and 9.9%, respectively. The prevalence of cataract surgery in women (11.3%) was not significantly higher than in men (7.7%), but there was a statistical increase with age (p = 0.001, chi2 trend test). Multiple logistic regression showed that age (OR 1.13, 95% CI 1.07-1.19) and diabetic retinopathy (OR 4.68, 95% CI 1.94-11.33) were independent factors associated with cataract surgery. INTERPRETATION: Age and diabetic retinopathy were associated with prevalence of cataract surgery among persons with type 2 diabetes.

Long-term survival and prognostic implications after coronary artery bypass grafting in Chinese patients with coronary artery disease.

OBJECTIVES: This hospital-based study was conducted to determine the survival rates of patients after coronary artery bypass grafting (CABG) surgery and the associated prognostic factors related to all-cause mortality during a 7-year follow-up in Taiwan. METHODS AND RESULTS: Between January 1997 and December 2003, the medical records of 1877 patients who underwent primary, isolated CABG surgery were studied. The Kaplan-Meier method was used to estimate survival. Multiple Cox regression was used to investigate the independence of prognostic factors associated with all-cause mortality. Of the 1877 patients who underwent CABG surgery, 192 expired during the 7-year study period. The overall patient survival rate was 85.96% (95% CI: 83.74-88.16). Using multiple Cox regression analysis, in addition to female gender, older age at surgery, pulmonary oedema, longer ischaemic time, longer cardiopulmonary bypass time, and poorer postoperative left ventricular ejection fraction were significant factors associated with all-cause mortality for both men and women. Associated prognostic factors varied by gender. For men, smoking (RR = 2.82, 95% CI: 1.06-4.16), respiratory failure (RR = 6.88, 95% CI: 3.29-14.40) and cardiogenic shock (RR = 4.04, 95% CI: 2.13-7.67) were significantly related to all-cause mortality, but not for women. Sepsis (RR = 8.97,95% CI: 1.19-19.81) and ICU stay (RR = 1.03,95% CI: 1.01-1.05) were significantly related to all-cause mortality among female patients only. CONCLUSIONS: Several gender-related differences were noted pertaining to all-cause mortality and the relationships between smoking, sepsis, respiratory failure, cardiogenic shock, and ICU stay.

Assessing the natural course of diabetic retinopathy: a population-based study in Kinmen, Taiwan.

PURPOSE: To explore the natural course of diabetic retinopathy among type 2 diabetics using the indirect ophthalmoscope and single-field fundus photographs in Kinmen, Taiwan. METHODS: A screening program for diabetic retinopathy was carried out by a panel of ophthalmologists, who employed the ophthalmoscope and 45-degree retinal color photographs to examine the fundus after pupil dilation. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type 2 diabetes. A multi-state Markov model was used to assess the natural course of diabetic retinopathy among type 2 diabetics. RESULTS: Among the 725 diabetes patients who attended at least two ophthalmological fundus check-ups and were screened, the overall response rate was about 75%. The mean duration of the disease states mild nonproliferative diabetic retinopathy, moderate nonproliferative diabetic retinopathy, severe nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy were 4.05 [95% confidence interval (CI): 3.28-5.32], 4.18 (95% CI: 3.18-6.06), 2.52 (95% CI: 1.78-4.27), and 4.22 (95% CI: 2.88-7.81) years, respectively. Compared to controls, the incidence of blindness reduction for annual, biennial, 3-year, 4-year, and 5-year screenings of diabetic retinopathy were approximately 94.4% (95% CI: 91.6%-96.3%), 83.9% (95% CI: 83.6%-84.2%), 70.2% (95% CI: 69.8%-70.7%), 57.2% (95% CI: 56.7%-57.7%), and 45.6% (95% CI: 45.0%-46.1%), respectively. CONCLUSIONS: In conclusion, the average time for the development of diabetic retinopathy from nonexistence to blindness was approximately 26.5 years. The present recommendation for annual screening in type 2 diabetics with nonproliferative diabetic retinopathy should be retained only for the mild form, not for the moderate or severe forms.

A population-based follow-up study on gallstone disease among type 2 diabetics in Kinmen, Taiwan.

AIM: To assess the incidence of and risk factors for gallstone disease (GSD) among type 2 diabetics in Kinmen, Taiwan. METHODS: A screening program for GSD was performed by two specialists who employed real-time abdominal ultrasound to examine the abdominal region after patients had fasted for at least eight hours. Screening, which was conducted in 2001, involved 848 patients diagnosed with type 2 diabetes. After exclusion of 63 subjects with prevalent GSD, 377 participants without GSD were invited in 2002 for a second round of screening. A total of 281 (74.5%) subjects were re-examined. RESULTS: Among the 281 type 2 diabetics who had no GSD at the first screening, 10 had developed GSD by 2002. The incidence was 3.56% per year (95% CI: 1.78% per year-6.24% per year). Using a Cox regression model, age (RR = 1.07, 95% CI: 1.00-1.14), waist circumference (RR = 1.12, 95% CI: 1.01-1.29), and ALT (RR = 1.13, 95%CI: 1.01-1.26) appeared to be significantly correlated with development of GSD. CONCLUSION: Older age is a known risk factor for the development of GSD. Our study shows that greater waist circumference and elevated ALT levels are also associated with the development of GSD among type 2 diabetics in Kinmen.

A community-based epidemiologic study of gender differences in the relationship between insulin resistance/beta-cell dysfunction and diabetic retinopathy among type 2 diabetic patients in Kinmen, Taiwan.

PURPOSE: The purpose of this study was to explore whether there were gender differences in the relation of insulin resistance and beta-cell dysfunction to diabetic retinopathy among type 2 diabetic patients. METHODS: From 1999 to 2002, a screening regimen for diabetic retinopathy was performed by a panel of ophthalmologists using ophthalmoscopy and 45-degree color fundus photography to examine the fundus in a total of 971 type 2 diabetic patients examined between 1991 and 1993 in Kinmen, Taiwan. Seven hundred and twenty-five type 2 diabetic patients (301 males and 424 females) attended ophthalmological fundus checkup. RESULTS: The response rate in males and females was 71.3 and 77.2%. The proportion of diabetic retinopathy at the first eye screening was 16.3% in males and 20.1% in females. From the multiple logistic regression, the type of diabetes (known cases vs. new cases) was a significant factor of diabetic retinopathy in both males (OR = 3.65, 95% CI: 1.59-8.37) and females (OR = 3.66, 95% CI: 2.01-6.70). Diabetic retinopathy was also strongly affected by the homeostasis model assessment of insulin resistance (HOMA IR) and homeostasis model assessment of beta-cell dysfunction (HOMA beta-cell) (p < 0.0001 for trend test). In males, those who were in the 2nd quartile, 3rd quartile, and 4th quartile of HOMA IR had 4.87 times (95% CI: 1.18-20.11), 6.83 times (95% CI: 1.91-24.46), and 10.15 times (95% CI: 2.42-42.56) the risk for diabetic retinopathy as compared to those in the 1st quartile. There was a reduced risk for diabetic retinopathy in relation to HOMA beta-cell for the 2nd quartile, 3rd quartile, and 4th quartile of 86% (95% CI: 37-97%), 95% (95% CI: 77-99%), and 96% (95% CI: 78-99%) as compared to that in the 1st quartile. Only the 4th quartile had a significant risk (OR = 2.62, 95% CI: 1.17-5.86) for diabetic retinopathy as compared to that in the 1st quartile in females. The reduced risk for diabetic retinopathy found in relation to HOMA beta-cell for the 3rd and 4th quartiles were 66% (95% CI: 6-88%) and 66% (95% CI: 10-87%) as compared to that in the 1st quartile. CONCLUSIONS: Gender differences in the relationship between insulin resistance/beta-cell dysfunction and diabetic retinopathy were demonstrated in type 2 diabetic patients.

Clinical correlation of gallstone disease in a Chinese population in Taiwan: experience at Cheng Hsin General Hospital.

AIM: To explore the prevalence of gallstone disease (GSD) in Taiwan and condition-associated factors related to it. METHODS: We studied a total of 2386 healthy adults (1235 males and 1151 females) voluntarily admitted to Cheng Hsin General Hospital for a paid physical check-up between January 2002 and December 2002. Blood samples and ultrasound sonography results were collected. RESULTS: The overall prevalence of GSD among this study-population was 5.3%, including 1.7% (n=40) having a single stone, 2.3% (n=55) having multiple stones, and 1.3% (n=31) having cholecystectomy. The prevalence revealed a statistically significant increase with increasing age (P<0.0001). Females exhibited a greater prevalence of multiple stones than did males (3.0% vs 1.7%, P=0.04). Using multiple logistic regression analysis, the following appeared to be significantly related to the prevalence of GSD: older age (40-49 years vs < 40 years, OR=1.63 [95% CI: 0.76-3.48], 50-59 years vs < 40 years, OR=4.93 [95% CI: 2.43-9.99], 60-69 years vs < 40 years, OR=6.82 [95% CI: 3.19-14.60], > or = 70 years vs < 40 years, OR=10.65 [95% CI: 4.78-23.73]), higher BMI (> or = 27 kg/m2 vs < 24 kg/m2, adjusted OR=1.74 [95% CI: 1.04-2.88]), and higher FPG (> or = 126 mg/dL vs < 110 mg/dL, OR=1.71, 95%CI: 1.01-2.96). CONCLUSION: Older age (> or = 50 years), obesity (BMI > or = 27 kg/m2), and type 2 diabetes (FPG > or = 126 mg/dL) are associated with the prevalence of GSD.

[The effectiveness of the video-based Lamaze method on prenatal mothers' knowledge, attitudes, and practice].

This study was conducted to explore the effectiveness of the video-based Lamaze method on pre-natal mothers' knowledge and attitudes, compared with that of traditional nursing guidelines. Using a quasi-experimental design, women in labor with gestations of 32 weeks or more were divided into four study groups, including two experimental groups (E(1): issued with traditional nursing guidelines and instructed in video-based Lamaze method; and E(2): instructed in video-based Lamaze method), and two control groups (C(1): issued with traditional nursing guidelines and C(2): issued with no guidelines). Before the intervention, E(1) had the highest score for knowledge. Scores for attitude showed no significant difference between the four groups. The experimental groups had higher scores than the control groups in the posttest. With the exception of the scores for attitude (E(1) > E(2)), knowledge (E(1): 13.09 +/- 1.40, E(2): 12.40 +/- 1.17) and management of the labor process (E(1): 119.00 +/- 10.91, E(2): 112.97 +/- 14.33) there were no significant differences between E(1) and E(2) in the posttest. Correlation analysis showed that the higher the scores for prenatal knowledge, the better the performance in prenatal practice, postnatal knowledge, attitude, and management of the labor process. The more positive the prenatal attitude, the better the performance in postnatal knowledge, attitude, and management of the labor process. The higher the scores in prenatal practice, the better the performance in postnatal knowledge, attitude, and management of the labor process. Positive associations were also found between postnatal knowledge, attitude, and management of the labor process. This study showed that the video-based Lamaze method is likely to promote more effectively than traditional guidelines the knowledge, attitudes, and practice of prenatal mothers in relation to giving birth. The use of this method in conjunction with traditional nursing guidelines may be even more effective in relation to maternal attitude.

Serum insulin, insulin resistance, beta-cell dysfunction, and gallstone disease among type 2 diabetics in Chinese population: a community-based study in Kinmen, Taiwan.

AIM: To explore the association of serum insulin, insulin resistance, and beta-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and beta-cell dysfunction (HOMA beta-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4(th) vs 1(st) quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4(th) vs 1(st) quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA beta-cell function was significantly related to decreased risk of GSD [4(th) vs 1(st) quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA beta-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and beta-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.

[Nursing experience in helping a primipara with intrauterine fetal death adapt to labor induction in hospital].

This article describes the experience of nursing an outpatient primipara in the 26th week of pregnancy who was not conscious of fetal movement and whose fetus was confirmed by sonography as having suffered intrauterine fetal death to adapt to labor induction as a hospital inpatient. The nursing care lasted between March 21 and March 28, 2002. I (the researcher) tried to use the well established Roy Adaptation Model of Nursing to collect information through observation, interview, and physical assessment. The subject's nursing problems included: 1.The sadness of losing child. 2. The frustration of not being able to take on the mother's role. 3. Feeling evil and sorry when facing her husband. 4. Doubting her course of medication. 5. Pain due to labor induction. In accordance with the situation, the main nursing strategies were: 1. To reduce the shock and pressure for the subject case and her family due to the loss of a child. 2. To help the subject accept the fact of loosing her child. 3. To help the subject and her husband to communicate well and establish support systems. 4. To help the patient to be receptive to medical treatment. 5. To reduce discomfort from labor induction. During the hospitalization, the researcher helped the subject case to face stress and adapt to physiological accommodation, develop a concept of herself, her functional role and interdependence and then accept the fact of losing child and maintain a healthy body image.