Su-Chiu Chen

Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men.

AIMS To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption. DESIGN Randomized controlled trial. SETTING Medical/surgical wards of a medical centre in Taipei, Taiwan. PARTICIPANTS Of 3669 consecutive adult male in-patients, 616 were identified as unhealthy alcohol users (>14 drinks/week) and assigned randomly to either usual care (n = 308) or a brief intervention (n = 308). MEASUREMENTS Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self-reported weekly alcohol consumption, drinking days and heavy drinking episodes assessed by 7-day time-line follow-back. Secondary outcomes were (i) self-reported alcohol problems, (ii) health-care utilization (hospital days and emergency department visits), (iii) self-reported seeking of speciality treatment for alcohol problems and (iv) 3-month Quick Drinking Screen. FINDINGS Based on intention-to-treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol-dependent participants over 12 months, on both 7-day and 3-month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19 of 230 versus 2.1%, four of 189) consulted specialists by 12 months (P = 0.01). However, alcohol-related problems and health-care utilization did not differ significantly in the two groups during follow-up. CONCLUSIONS Data from Taiwan confirm that brief in-hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.

Diagnostic procedures, revascularization, and inpatient mortality after acute myocardial infarction in patients with schizophrenia and bipolar disorder.

Objective To investigate inpatient mortality and the use of invasive diagnostic and revascularization procedures after acute myocardial infarction (AMI) in people with schizophrenia and bipolar disorder. Methods A case-control study was nested within the first AMI episodes between 1996 and 2007 using nationwide data. Participants with schizophrenia or bipolar disorder were compared with a random sample of all other adults without severe mental illness. Inpatient mortality and receipt of cardiac catheterization, coronary arteriography, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft were compared in logistic regression models after adjusting for demographic and health status, hospital type, and AMI complications. Results A total of 3361 adult patients who had incident AMI between 1996 and 2007 were identified. Patients with schizophrenia and bipolar disorder (n = 834; 24.8%) had a significantly decreased likelihood of catheterization (12.2% and 14.0%, respectively) and revascularization (9.0% and 12.8%, respectively) during the index AMI episode compared with controls (27.9% of whom received catheterization and 23.9% of whom received revascularizations). Inpatient mortality remained 2.68 times the rate in patients with schizophrenia (95% confidence interval = 1.73–4.15; p < .001) compared with controls after adjusting for intervention receipt among other covariates, but mortality was not significantly raised in patients with bipolar disorder. Conclusions In a large national sample and in the context of a comprehensive free health service, patients with schizophrenia and bipolar disorder were substantially disadvantaged, being half as likely to receive catheterization or revascularization procedures after AMI. Further research is required to clarify the reasons for this.

Plasma Adiponectin Levels Correlate Positively with an Increasing Number of Components of Frailty in Male Elders

Objective Frailty is an important geriatric syndrome. Adiponectin is an important adipokine that regulates energy homeostasis. The aim of this study is to investigate the relationship between plasma adiponectin levels and frailty in elders. Methods The demographic data, body weight, metabolic and inflammatory parameters, including plasma glucose, total cholesterol, triglyceride, tumor necrosis factor alpha (TNF-α), c-reactive protein (CRP) and adiponectin levels, were assessed. The frailty score was assessed using the Fried Frailty Index (FFI). Results The mean (SD) age of the 168 participants [83 (49.4%) men and 85 (50.6%) women] was 76.86 (6.10) years. Judged by the FFI score, 42 (25%) elders were robust, 92 (54.7%) were pre-frail, and 34 (20.3%) were frail. The mean body mass index was 25.19 (3.42) kg/m2. The log-transformed mean (SD) plasma adiponectin (µg/mL) level was 1.00 (0.26). The log-transformed mean plasma adiponectin (µg/mL) levels were 0.93 (0.23) in the robust elders, 1.00 (0.27) in the pre-frail elders, and 1.10 (0.22) in the frail elders, and the differences between these values were statistically significant (p  = 0.012). Further analysis showed that plasma adiponectin levels rose progressively with an increasing number of components of frailty in all participants as a whole (p for trend  = 0.024) and males (p for trend  = 0.037), but not in females (p for trend  = 0.223). Conclusion Plasma adiponectin levels correlate positively with an increasing number of components of frailty in male elders. The difference between the sexes suggests that certain sex-specific mechanisms may exist to affect the association between adiponectin levels and frailty.

Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness

To investigate the association between acute myocardial infarction (AMI) and recent exposure to antipsychotic agents in people with serious mental illness (SMI), and modifying influences.

Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study

Objective Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Method Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. Results A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. Conclusions In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

Plasma zinc α2-glycoprotein levels are elevated in smokers and correlated with metabolic syndrome

Smoking is a strong risk factor of metabolic syndrome. Zinc α2‐glycoprotein (ZAG) is a protein involved in metabolic syndrome. This study aims to investigate the effect of smoking on plasma ZAG levels and its relations to metabolic syndrome.

Correlates of Fatigue Phenomenon in Palliative Care Patients with Advanced Cancers in Taiwan

BACKGROUND Fatigue is a multidimensional phenomenon that has different meanings according to different societal and cultural settings. This study aims to decipher fatigue in Taiwanese patients with cancer. METHODS We recruited 440 patients with advanced cancer admitted consecutively to the palliative care unit of a major medical center in Taiwan. The data were collected at admission, 1 and 2 weeks after admission, and 2 days before death. RESULTS The subject group consisted of 51.8% males and 48.2% females with a median age of 67 years (ranging from 27 to 93 years). The leading primary tumor sites among these patients were lung (20.2%), liver (18.0%), and colon-rectum (10.7%), and the median survival was 15 days, with a range of 1 to 418 days. All symptoms improved 1 week after admission, but most of them significantly worsened 2 days before death. In general, the physical signs manifested variation patterns similar to those of symptoms. The severity of psychosocial distress and death fear was lower after admission and retained the same level at 2 days before death, defying the consistent patterns found in other symptoms and signs. In the correlation analysis, most symptoms were correlated with fatigue during admission, with weakness being the most significant one. Although self-efficacy and emotion were correlated with fatigue both on admission and 1 week after admission, social support and death fear were not correlated with fatigue at all times. CONCLUSION The meaning of fatigue is mainly associated with physical factors among these patients. Education of complexities in fatigue in tandem with psychosocial and spiritual care may help alleviate this symptom, and promote quality of life.

Changes of serum adiponectin and soluble intercellular adhesion molecule-1 concentrations after smoking cessation.

Abstract Background: This study aims to investigate the effect of increased serum adiponectin concentration during smoking cessation on soluble intercellular adhesion molecule-1 (sICAM-1) concentration. Methods: One hundred and sixty-six eligible smokers were assessed at baseline and were followed up at the 1st, 5th, and 9th weeks after smoking cessation. Demographic data, body weight and blood pressure of these participants were obtained; serum glucose biochemical data, sICAM-1 and adiponectin concentrations were measured. Repeated measures analysis paired t-tests and generalized estimating equations for balanced repeated measures were used for statistical analyses. Results: Forty-one individuals completed the 2-month smoking cessation program. The mean cigarette consumption dramatically decreased (p<0.0001) and the cotinine concentration also decreased significantly (p<0.0001) among the quitters. Serum adiponectin concentration significantly increased (p=0.0186) and sICAM-1 significantly decreased (p<0.0001) in quitters after smoking cessation. The elevation of serum adiponectin concentration significantly correlated with lowering of sICAM-1 (p=0.0001) concentration. Body weight changes at the end of 2-month smoking cessation was inversely correlated with adiponectin increment from baseline (p=0.0003). Conclusions: An increase in serum adiponectin concentration is an independent factor correlated with lowering of sICAM-1 concentration during smoking cessation.

Timing and Risk Factors for a Positive Fecal Immunochemical Test in Subsequent Screening for Colorectal Neoplasms

Background Following a negative test, the performance of fecal immunochemical testing in the subsequent screening round is rarely reported. It is crucial to allocate resources to participants who are more likely to test positive subsequently following an initial negative result. Objective To identify risk factors associated with a positive result in subsequent screening. Methods Dataset was composed of consecutive participants who voluntarily underwent fecal tests and colonoscopy in a routine medical examination at the National Taiwan University Hospital between January 2007 and December 2011. Risk factor assessment of positive fecal test in subsequent screening was performed by using the Cox proportional hazards models. Results Our cohort consisted of 3783 participants during a 5-year period. In three rounds of subsequent testing, 3783, 1537, and 624 participants underwent fecal tests, respectively; 5.7%, 5.1%, and 3.9% tested positive, respectively, and the positive predictive values were 40.2%, 20.3%, and 20.8%, respectively. Age ≥60 years (adjusted hazard ratio: 1.53, 95% CI: 1.21–1.93) and male gender (1.32, 95% CI: 1.02–1.69) were risk factors; however, an interaction between age and gender was noted. Men had higher risk than women when they were <60 years of age (p = 0.002), while this difference was no longer observed when ≥60 years of age (p = 0.74). The optimal interval of screening timing for participant with baseline negative fecal test was 2 years. Conclusions Following a negative test, older age and male gender are risk factors for a positive result in the subsequent rounds while the gender difference diminishes with age. Biennial screening is sufficient following a negative fecal test.

PBMC expressed adiponectin mRNA is predictive of survival in patients with gastric cancer

*Corresponding authors: Su-Chiu Chen, Associate Prof., Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Phone: +886 02 23885111 6128, Fax: +886 02 23758291, E-mail: suchiu@ntunhs.edu.tw; Prof. Lee-Ming Chuang, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, Phone: +886 02 23123456 65038, Fax: +886 02 23938859, E-mail: leeming@ntu.edu.tw; and Prof. Ching-Yu Chen, Department of Family Medicine, National Taiwan University Hospital, 7 ChungShan South Road, Taipei, Taiwan, Phone: +886 02 23123456 62147, Fax: +886 02 23118674, E-mail: chency@nhri.org.tw Jaw-Shiun Tsai: Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan Ming-Tsan Lin: Department of General Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan Ming-Shiang Wu: Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan Kuo-Chin Huang, Bee-Horng Lue, Long-Teng Lee, Tai-Yuan Chiu and Chao-Hsien Chen: Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan