Huang Tz Ou

A new comorbidity index: the health-related quality of life comorbidity index.

OBJECTIVE To derive and validate the health-related quality of life comorbidity index (HRQL-CI). STUDY DESIGN AND SETTING Of 261 clinical classification codes (CCCs) in the 2003 Medical Expenditure Panel Survey (MEPS), 44 were identified as adult, gender-neutral, chronic conditions. The least absolute shrinkage and selection operator (LASSO) procedure identified CCCs significantly associated with the Short Form-12 physical component summary (PCS) and mental component summary (MCS) scores. Regression models were fitted with the selected CCCs, resulting in two subsets corresponding to PCS and MCS, collectively called the HRQL-CI. Internal validation was assessed using 10-fold cross-validation, whereas external validation in terms of prediction accuracy was assessed in the 2005 MEPS database. Prediction errors and model R² were compared between HRQL-CI models and models using the Charlson-CI. RESULTS LASSO identified 20 CCCs significantly associated with PCS and 15 with MCS. The R² for the models, including the HRQL-CI (0.28 for PCS and 0.16 for MCS) were greater than those using the Charlson-CI (0.13 for PCS and 0.01 for MCS). The same pattern of higher R² for models using the HRQL-CI was observed in the validation tests. CONCLUSION The HRQL-CI is a valid risk adjustment index, outperforming the Charlson-CI. Further work is needed to test its performance in other patient populations and measures of HRQL.

Epilepsy in horses: Aetiological classification and predictive factors

REASONS FOR PERFORMING THE STUDY In contrast with reports in man and small animals, a systematic classification of seizures in horses is lacking. OBJECTIVES The purpose of this study was to classify seizures based on their aetiology and to characterise epilepsy in 104 horses presented for seizures at the Ohio State University Veterinary Medical Center between 1988 and 2009. METHODS In a retrospective observational study, seizures were classified by aetiology based on history, clinical observations, diagnostic investigations (e.g. electroencephalograms, cerebrospinal fluid and computed tomography imaging of the head) and post mortem examinations, when available. Univariate and multivariate logistic regression analyses were performed. RESULTS Epilepsy (i.e. 2 or more recurrent seizures) was identified in 70% of cases, and further classified as symptomatic (i.e. structural brain pathology, 35.6% of cases), cryptogenic (i.e. unknown, 54.8% of cases) and idiopathic (i.e. suspected genetic predisposition, 2.7% of cases). Normal neurological examination on admission, the presence of seizures unprovoked by any identified factors and paroxysmal epileptiform activity on electroencephalogram recordings were all strongly (P<0.05) correlated with epilepsy on univariate analysis. For a horse with generalised seizures, the odds of having epilepsy was 7 times lower compared with a similar horse with partial seizures (P<0.05) in multivariate modelling. CONCLUSIONS Seizure aetiology was symptomatic or cryptogenic in most horses, whereas reactive seizures and idiopathic epilepsy were less common. POTENTIAL RELEVANCE This study is the first attempt to classify seizures and to characterise epilepsy in a referral-based equine population. Predictive factors of epilepsy in horses were similar to those reported in other species and may assist the clinician with the early diagnosis of epilepsy.

Recent trends in the use of antidiabetic medications from 2008 to 2013: A nation‐wide population‐based study from Taiwan

Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase‐4 inhibitors [DPP‐4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP‐4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs.

Recent trends in utilization of antidiabetic medications from 2008-2013: a nation-wide population-based study from Taiwan.

Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase‐4 inhibitors [DPP‐4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP‐4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs.

Comparative cardiovascular risks of dipeptidyl peptidase 4 inhibitors with other second- and third-line antidiabetic drugs in patients with type 2 diabetes

AIMS Dipeptidyl peptidase 4 inhibitors (DPP4is) are suggested as a second- and third-line antidiabetic treatment for type 2 diabetes. Previous studies assessed only the cardiovascular effects of DPP4is as a second-line treatment, included sulphonylurea as the only comparator, and yielded inconclusive results on the risk of heart failure. The present study therefore evaluated the comparative cardiovascular risks of DPP4is with other second- and third-line antidiabetic drugs. METHODS Based on a large nationwide diabetic cohort, 113 051 patients with type 2 diabetes newly on metformin-based dual or triple therapy were identified in 2009-2011 and followed until 2013, or death if this occurred sooner. Primary interest targeted hospitalizations for ischaemic stroke, myocardial infarction and heart failure. Secondary outcomes were hypoglycaemia and all-cause mortality. Cox proportional hazards models were performed to assess time-to-event hazard ratio between propensity score-matched antidiabetic treatment groups. RESULTS DPP4is as a second-line add-on to metformin had a significantly lower stroke risk [hazard ratio (HR) 0.817 (95% confidence interval 0.687, 0.971)] and all-cause mortality [HR 0.825 (0.687, 0.992)] than those for sulphonylurea. DPP4is as a third-line add-on to metformin and sulphonylurea combined dual therapy had a significantly lower risk for stroke [HR 0.826 (0.740, 0.923)] and all-cause mortality [HR 0.784 (0.701, 0.878)] than those for acarbose, and significantly lower risks for stroke [HR 0.653 (0.542, 0.786)], heart failure [HR 0.721 (0.568, 0.917)] and all-cause mortality [HR 0.689 (0.594, 0.703)] than those for meglitinide. CONCLUSIONS DPP4is as a second- or third-line add-on treatment provided cardiovascular benefits and posed no increased risks for heart failure, hypoglycaemia or death.

Development of Chinese Version of Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (Chi-PCOSQ).

Objectives To develop the Chinese version of the Polycystic Ovary Syndrome Health-related Quality of Life Questionnaire (Chi-PCOSQ). Research Design and Method This cross-sectional study was conducted in a medical center in Taiwan. Eighty women who met the criteria were enrolled: female, age range of 18–45 years, competent in the Chinese language, had been diagnosed with polycystic ovary syndrome (PCOS), and were regularly followed at outpatient clinics (defined as at least two outpatient visits before enrollment). The PCOSQ was translated and culturally adapted according to standard procedures. A semi-structured interview was applied to assess face validity. Exploratory factor analysis (EFA) was applied to determine scale constructs. Measurements of internal consistency via Cronbach’s α, test-retest reliability via intraclass correlation coefficient (ICC), construct validity, and discriminative validity were performed. Results Five additional items, representing the issues of acne, hair loss, and fear of getting diabetes, were incorporated into the original scale. A six-factor structure emerged as a result of the EFA, explaining 71.9% of the variance observed. The reliability analyses demonstrated satisfactory results for Cronbach’s α ranging from 0.78–0.96, and for ICC ranging from 0.73–0.86. Construct validity was confirmed by significant correlation between the domains of the Chi-PCOSQ and generic health-related quality of life (HRQoL) measures (WHOQOL-BREF, EQ-5D) and clinical parameters (body mass index, waist-hip ratio, blood pressure). The known-group analysis indicated that the Chi-PCOSQ is a discriminative tool that differentiates patients according to their HRQoL. Conclusion The Chi-PCOSQ seems internally consistent, culturally acceptable, and our preliminary evidence suggests that it may be reliable and valid. The Chi-PCOSQ is a promising assessment tool to address the HRQoL of women affected by PCOS in Chinese-speaking countries and to further identify ethnic/cultural differences in the HRQoL of women with PCOS.

Intensive statin regimens for reducing risk of cardiovascular diseases among human immunodeficiency virus-infected population: A nation-wide longitudinal cohort study 2000–2011

OBJECTIVE This study evaluated the risk of cardiovascular diseases (CVD) in a statin-treated HIV-infected population and the effects of intensive statin regimens (i.e., high-dose or potency) on CVD risks. METHODS 945 HIV-infected patients newly on statin treatment (144, 15.7% with CVD history) were identified from Taiwans national HIV cohort. Using the median of the first year cumulative statin dosage as a cut-off point, patients were classified into either a high-dose or low-dose group. Patients were also classified as high-potency (i.e., atorvastatin) or low-potency (i.e., pravastatin) statin users. CVD, including ischemic stroke, coronary artery diseases, and heart failure, were identified after statin use to the end of 2011. Cox hazards regression was applied to assess the time-to-event hazards of CVD in association with intensive statin regimens. RESULTS In the HIV-infected population with CVD history, the high-dose group had a lower CVD risk compared to that of the low-dose group (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.39-1.99). The high-potency group showed a lower CVD risk compared to that of the low-potency group (HR: 0.42, 95% CI: 0.06-3.13). For those without CVD history, the corresponding figures were HR: 0.64 (95% CI: 0.30-1.35) and HR: 0.67 (95% CI: 0.16-2.87). The event rate of new-onset diabetes in high-dose statin group was higher than that in low-dose statin group (15.28% vs. 8.33%), while no muscle complications (i.e., myalgia, myositis, rhabdomyolysis) and dementia were observed in statin users. CONCLUSIONS There appears a trend showing a lower CVD risk in HIV patients receiving intensive statin therapy.

Life Expectancy and Lifetime Health Care Expenditures for Type 1 Diabetes: A Nationwide Longitudinal Cohort of Incident Cases Followed for 14 Years

OBJECTIVES To assess additional life expectancy (LE), expected years of life lost , and lifetime health care expenditures after type 1 diabetes diagnosis, stratified by sex and age of first diagnosis (early: 0-12 years; late: 13-40 years). METHODS A longitudinal cohort of patients with diabetes was constructed from Taiwans National Health Insurance Research Database of 1999 to 2012. The survival functions for diabetic patients and age- and sex-matched general population were estimated by using a semiparametric extrapolation method with annual life tables. The average monthly health care expenditures were multiplied by the corresponding monthly survival rates and summed to calculate the lifetime health care expenditures. Cox proportional hazard models were constructed to corroborate the effects of sex and age, after being adjusted for comorbidities, complications, and calendar years. RESULTS A total of 2386 cases (45% early diagnosis, 49% males) were identified. An additional LE after diabetes diagnosis was 45.12 years, with an estimated 17.63 years of life lost. The predicted total and diabetes-related lifetime costs were

Dipeptidyl peptidase-4 inhibitor use is not associated with elevated risk of severe joint pain in patients with type 2 diabetes: a population-based cohort study

56,939 and

Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species

102,140, respectively. Early diagnosed patients had a longer LE and lower health care spending compared with those of late-diagnosed patients. Male patients had a shorter LE and a higher expected years of life lost than the female patients, which corresponded to lower lifetime costs for the former. The Cox model results for overall mortality corroborated these trends. CONCLUSIONS Early detection of type 1 diabetes and sex-specific strategies would probably improve long-term health outcomes and save on the cost of diabetes care.