Risks of decreased renal function and increased albuminuria for glycemic status and metabolic syndrome components: Taichung Community Health study.

BACKGROUND: The objective of this study was to assess the association of glycemic status and decreased renal function as determined by estimated glomerular filtration rate (eGFR) and albuminuria in an adult Taiwanese metropolitan population. METHODS: We did a cross-sectional survey in a representative sample of 2,350 Taiwanese adults aged 40 years and over living in a metropolitan city in Taiwan from 2004 to 2005. Glycemic status was classified as normal glycemia, hyperglycemia, and type 2 diabetes (T2D). Renal function was assessed with eGFR using modified Modification of Diet in Renal Disease Study equation for Chinese. Albuminuria was determined by the urinary albumin-creatinine ratio. Decreased renal function was defined as eGFR <60 mL/min/1.73 m(2) and albuminuria as the albumin-creatinine ratio >30 mg g(-1) creatinine. RESULTS: 593 (25.23%) had hyperglycemia and 287 (12.21%) had T2D. As glycemia level increased, the prevalence of albuminuria and decreased eGFR increased. After adjustment, T2D was associated with an OR of 2.93 (95% CI: 2.11-4.07) for albuminuria, and an OR of 2.05 (95% CI: 1.18-3.58) for decreased eGFR. CONCLUSIONS: In a representative sample from a metropolitan city in Taiwan, T2D was associated with albuminuria and decreased eGFR.

Quality of life predicts survival in patients with non-small cell lung cancer.

BACKGROUND: Patients with non-small cell lung cancer (NSCLC) have a poor prognosis. The objective of this study was to examine the relationship of EORTC QLQ-C30 and QLQ-LC13 and survival in patients with NSCLC undergoing different treatments. METHODS: Investigators conducted a health-related quality of life (HRQOL) survey of 488 patients with NSCLC: 162 patients undergoing surgery, 312 patients without surgery, and their survival status was prospectively followed up. EORTC QLQ-C30 and QLQ-LC13 scores and clinical variables at baseline were analyzed using Cox's proportional hazard regression to identify factors that influenced survival. RESULTS: Median survival of these 474 patients was 9.82 months. After adjustment, emotional functioning scale, and symptom scales of pain and nausea/vomiting are associated with survival in NSCLC patients with surgery whereas social functioning scale, and symptom scales for fatigue, appetite loss, and financial problems had a significant impact on survival in NSCLC patients without surgery. The results of multivariate analysis showed that none of QLQ-LC13 scales are significant predictors of survival. After simultaneously considering these scales, we found significant independent predictors of survival were nausea/vomiting (HR = 0.11, 95% CI = 0.02-0.63 for score >0 compared with =0) in NSCLC patients with surgery and appetite loss (HR = 1.77, 95% CI = 1.26-2.49 for score >0 compared with =0) in NSCLC patients without surgery. CONCLUSIONS: HRQOL provides additional predictive information that supplements traditional clinical factors, and is a new prognostic indicator for survival of NSCLC patients under different treatments.

Reduced health-related quality of life in elders with frailty: a cross-sectional study of community-dwelling elders in Taiwan.

PURPOSE: Exploring the domains and degrees of health-related quality of life (HRQOL) that are affected by the frailty of elders will help clinicians understand the impact of frailty. This association has not been investigated in community-dwelling elders. Therefore, we examined the domains and degree of HRQOL of elders with frailty in the community in Taiwan. METHODS: A total of 933 subjects aged 65 years and over were recruited in 2009 from a metropolitan city in Taiwan. Using an adoption of the Fried criteria, frailty was defined by five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity level. HRQOL was assessed by the short form 36 (SF-36). The multiple linear regression model was used to test the independent effects of frailty on HRQOL. RESULTS: After multivariate adjustment, elders without frailty reported significantly better health than did the pre-frail and frail elders on all scales, and the pre-frail elders reported better health than did the frail elders for all scales except the scales of role limitation due to physical and emotional problems and the Mental Component Summary (MCS). The significantly negative differences between frail and robust elders ranged from 3.58 points for the MCS to 22.92 points for the physical functioning scale. The magnitude of the effects of frail components was largest for poor endurance and energy, and next was for slowness. The percentages of the variations of these 10 scales explained by all factors in the models ranged from 11.1% (scale of role limitation due to emotional problems) to 49.1% (scale of bodily pain). CONCLUSIONS: Our study demonstrates that the disabilities in physical health inherent in frailty are linked to a reduction in HRQOL. Such an association between clinical measures and a generic measure of the HRQOL may offer clinicians new information to understand frailty and to conceptualize it within the broader context of disability.

Disease-specific quality-of-life measures as predictors of mortality in individuals living with type 2 diabetes.

OBJECTIVE: The aim of this study was to examine whether disease-specific quality-of-life measures are independent predictors of mortality in patients with type 2 diabetes. METHODS: A cohort of 420 patients with type 2 diabetes was recruited from the outpatient clinic of a medical center. At baseline, the disease-specific measure of the Diabetes Impact Measurement Scales (DIMS) and clinical and biological marker variables were measured. The DIMS domains included symptoms, diabetes-related morale, social role fulfillment, and well-being. Complications consisted of stroke, heart disease, visual impairment, amputations, kidney disease, cognitive impairment, and incontinence. Mortality data were collected from the national mortality register using personal identification numbers. Multivariate Cox proportional hazards models were used. RESULTS: The overall mortality rate was 10.9%. The DIMS scales of symptoms and well-being and the total score were significantly associated with mortality, independent of age, gender, glucose control, and complications. When the scales of the DIMS were simultaneously considered, only symptom and social role fulfillment of the DIMS exerted a significant effect on mortality. Patients in the categories of the second and third quartiles (worse status) had significantly increased risk compared with those in the category of the fourth quartile (best status) [for the symptom scale: RR = 13.10, 95% confidence interval (CI) = 2.75-62.50 and RR = 5.49, 95% CI = 1.50-20.09, respectively; for the social role fulfillment scale: RR = 6.18, 95% CI = 1.10-34.87 and RR = 6.53, 95% CI = 1.40-30.57, respectively]. CONCLUSION: Our data suggest that the unique contribution of health-related quality of life to mortality was independent of objective health measures, such as glucose control and complications.

The relationship of high sensitivity C-reactive protein to percent body fat mass, body mass index, waist-to-hip ratio, and waist circumference in a Taiwanese population.

BACKGROUND: High-sensitivity C-reactive protein (hs-CRP) is an easily measured inflammatory biomarker. This study compared the association of percent body fat mass (%FM), body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with hs-CRP in a Taiwanese population. METHODS: A total of 1669 subjects aged 40-88 years were recruited in 2004 in a metropolitan city in Taiwan. The relationships between obesity indicators and a high level of hs-CRP were examined using multivariate logistic regression analysis. The upper quartile of the hs-CRP distributions was defined as the high category group. The areas under the curve (AUCs) of the receiver operating characteristic curves were calculated for all obesity indicators to compare their relative ability to correctly classify subjects with a high level of hs-CRP. RESULTS: After multivariate adjustment, the odds ratio for %FM was the only significant indicator that was associated with a high level of hs-CRP in men (1.55, 95% CI: 1.07-2.25). All indicators were associated with a high level of hs-CRP in women. In men, the AUCs for %FM were significantly higher than those for BMI, WHR, and WC, when demographic and lifestyle behaviors were considered (p < 0.001 for all comparisons), but they were not significantly different in females. CONCLUSIONS: Our study demonstrates that %FM is the only obesity indicator that is strongly associated with a high level of hs-CRP after adjusting for sociodemographic factors, lifestyle behaviors and components of metabolic syndrome in both genders in a Taiwanese population aged forty years and over. In men, %FM had the greatest ability to classify subjects with a high level of hs-CRP when only demographic and lifestyle behaviors were considered. Our study finding has important implications for the screening of obesity in community settings.

Sex difference in the association of metabolic syndrome with high sensitivity C-reactive protein in a Taiwanese population.

BACKGROUND: Although sex differences have been reported for associations between components of metabolic syndrome and inflammation, the question of whether there is an effect modification by sex in the association between inflammation and metabolic syndrome has not been investigated in detail. Therefore, the aim of this study was to compare associations of high sensitivity C-creative protein (hs-CRP) with metabolic syndrome and its components between men and women. METHODS: A total of 1,305 subjects aged 40 years and over were recruited in 2004 in a metropolitan city in Taiwan. The biochemical indices, such as hs-CRP, fasting glucose levels, lipid profiles, urinary albumin, urinary creatinine and anthropometric indices, were measured. Metabolic syndrome was defined using the American Heart Association and the National Heart, lung and Blood Institute (AHA/NHLBI) definition. The relationship between metabolic syndrome and hs-CRP was examined using multivariate logistic regression analysis. RESULTS: After adjustment for age and lifestyle factors including smoking, and alcohol intake, elevated concentrations of hs-CRP showed a stronger association with metabolic syndrome in women (odds ratio comparing tertile extremes 4.80 [95% CI: 3.31-6.97]) than in men (2.30 [1.65-3.21]). The p value for the sex interaction was 0.002. All components were more strongly associated with metabolic syndrome in women than in men, and all sex interactions were significant except for hypertension. CONCLUSIONS: Our data suggest that inflammatory processes may be of particular importance in the pathogenesis of metabolic syndrome in women.

The relation of metabolic syndrome according to five definitions to cardiovascular risk factors--a population-based study.

BACKGROUND: Although National Cholesterol Education Program (NCEP), International Diabetes Federation (IDF), American Heart Association and National Heart, Lung and Blood Institute (AHA/NHLBI), World Health Organization (WHO), and the European Group for the Study of Insulin Resistance (EGIR) definitions of metabolic syndrome (MetS) have been commonly used by studies, little is known about agreement among these five definitions. We examined the agreement among these five definitions and explored their relationship with risk factors of cardiovascular disease in a Taiwan population. METHODS: A total of 1305 subjects aged 40 years and over in Taiwan were analyzed. Biomedical markers and anthropometric indices were measured. Agreement among definitions was determined by the kappa statistic. Logistic regression models were fit to estimate the odds of a high cardiovascular risk group for five definitions of MetS. RESULTS: The agreement among the NCEP, IDF, and AHA/NHLBI definitions was from substantial to very good, and agreement between the WHO and EGIR definitions was also substantial. All MetS definitions were significantly associated prevalence of microalbuminuria, elevated highly sensitive CRP (hs-CRP), and arterial stiffness only in women. In men, MetS by NCEP and AHA/NHLBI was associated with elevated level of hs-CRP and arterial stiffness. MetS by WHO and EGIR were significantly associated with microalbuminuria. And MetS by WHO was the only MetS definition that significantly associated with prevalence of arterial stiffness (OR: 2.75, 95% CI: 1.22-6.19). CONCLUSIONS: The associations of these five definitions with cardiovascular risk factors were similar in women, and it was evident that the five definitions performed better in women than in men, with higher ORs observed in relation to arterial stiffness, elevated hs-CRP, and higher Framingham risk scores.

The functionality and economic costs of outpatients with schizophrenia in Taiwan.

The aims of this study were to investigate the economic costs of outpatients with schizophrenia in Taiwan, and to survey factors that influence the costs. The direct costs were defined as the costs associated with psychiatric services and other medical treatment. The indirect costs were estimated using the Human Capital Method. Patients' characteristics, including sex, age, duration of education, duration of illness, frequency of hospitalization, type of antipsychotic medication, severity of extrapyramidal side effects caused by antipsychotic medication, and global functions, were used to estimate the costs. The average annual total cost was approximately US$16,576 per patient. The direct and indirect costs were 13% and 87% of the total costs, respectively. Among the direct costs, folk therapy ranked third, just behind prescription drugs and acute ward hospitalization. The productivity loss of both the patients and their caregivers was the major component of the indirect costs. The patient's age and global functions had a significantly negative relationship with the direct costs. The severity of extrapyramidal side effects, type of antipsychotic medication, and the patient's illness duration correlated positively with the indirect costs, while the patient's global function correlated negatively with the indirect costs. Overall, the indirect costs of treating schizophrenia were higher than the direct costs. Improving patients' functionality and decreasing caregivers' burden are essential to reducing costs.

Metabolic syndrome in a Taiwanese metropolitan adult population.

BACKGROUND: Metabolic syndrome (MS) is a combination of medical disorders that increase one's risk for cardiovascular disease and diabetes. Little information exists on the prevalence of MS in a general adult population in Taiwan. METHODS: We did a cross-sectional survey in a representative sample of 2,359 Chinese adults aged 40 years and over who lived in a metropolitan city, Taiwan in 2004-05. MS was defined by Adult Treatment Panel III criteria modified for Asians. RESULTS: The prevalence of MetS was 35.32% and 43.23% in men aged 40-64 years and 65 years and over, respectively, and 24.19% and 51.82% in women aged 40-64 years and 65 years and over. Older age, postmenopausal status, higher body mass index, current smoking, low education attainment, low household income, no alcohol consumption, lower level of occupation physical activity, and a family history of diabetes were associated with increased odds of MetS. CONCLUSION: MetS was present in more than 30% of the Taiwan adult population aged 40 years and over in a metropolitan area; there were substantial variations by age and body mass index groups.

Validation of the Chinese version of the diabetes impact measurement scales amongst people suffering from diabetes.

OBJECTIVE: The purpose of this study was to test the validity and reliability of the Chinese translation of the Diabetes Impact Measurement Scale (DIMS). METHODS: A total of 219 consecutive patients with type II diabetes mellitus, who had visited the diabetic clinics at the China Medical University Hospital completed a questionnaire. Clinical data were extracted from the participants' medical records. Multiple regression analyses were used to estimate the differences in scores among type II diabetic patients in groups with different complications, glucose control statuses, and number of co-morbidities. RESULTS: The Cronbach's alpha coefficients for estimates of internal consistency testing ranged from 0.61 to 0.86. The Pearson's correlation coefficients for test-retest reliability ranged from 0.55 to 0.92. Patients with complications had lower symptom scale score compared with those without complications (p < 0.05); patients with poor glucose control had lower well-being, social role fulfillment, and total scale scores than those with good glucose control (all p < 0.05); patients with more co-morbidities had lower scores on all scales compared with those with fewer co-morbidities, except on the social role fulfillment scale (p < 0.01 or p < 0.001). These significant differences consistently supported the hypothesis that the scale truly measures health status and disease impact. CONCLUSIONS: Our preliminary results confirm the validity of the DIMS instrument as a measure of health-related quality of life in adult type II diabetic patients. Future research will be needed to establish its responsiveness to important changes in health.

Quality of life of primary caregivers of elderly with cerebrovascular disease or diabetes hospitalized for acute care: assessment of well-being and functioning using the SF-36 health questionnaire.

OBJECTIVE: To use the Short Form 36 (SF-36) to determine the extent to which health-related quality of life (HRQOL) is decreased among primary caregivers of patients with cerebrovascular accident (CVA) or diabetes mellitus (DM) compared to normal Taiwanese population and to identify the determinants of this decrease. METHODS: Data from a cross-sectional survey of 187 primary caregivers who had responsibility for inpatients with a medically verified diagnosis of CVA or DM were compared to those of randomly selected residents. Data were collected by face-to-face interviews with trained interviewers. RESULTS: The age- and gender-adjusted mean differences of caregivers on primarily mental scales of SF-36 were significantly negative compared to general population, as much as a 3-12 points reduction on this 100-point scale. While the age- and gender-adjusted mean differences on physical functioning and bodily pain scales were significantly positive, as much as a 3-6 points increase. Effects of caregiving on the perceived social life of the caregiver and disability of inpatients in eating and getting in/out of bed were associated with the SF-36 Physical Component Scale (PCS) score while female gender, type of caregiver, care conflicts, degree of care demand of daily living, and effects of caregivering on perceived social life of caregivers were negatively associated with the SF-36 Mental Component Scale (MCS) score. CONCLUSIONS: Primary caregivers of CVA or DM hospitalized elderly have poorer mental but better physical well-being than the population norm. Both caregiver and inpatient factors contribute to caregivers' HRQOL.

Correlation between performance on the Continuous Performance Test and economic costs in patients with schizophrenia.

The aim of the present study was to determine whether a relationship existed between the performance on the Continuous Performance Test (CPT) and the economic costs of schizophrenic patients in Taiwan. Forty-six schizophrenic patients and their caregivers were enrolled. The CPT is a vigilance task requiring the monitoring of rapid information processing and the detection of briefly presented target stimuli. Each patients undertook two CPT sections: the unmasked task and the masked task. Economic Cost Questionnaires were used for assessing the direct and indirect costs of the illness. The patients' performance on the masked version of the CPT correlated significantly with the indirect costs, although there was no significant relationship between CPT scores and direct costs. Schizophrenic patients with more severely impaired sustained attention, particularly as measured by CPT, may incur higher indirect costs.