Wen Hsuan Hou

The anxiolytic effect of aromatherapy on patients awaiting ambulatory surgery: a randomized controlled trial.

The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil) and control (water vapor) conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.

Trajectories and predictors of return to work after traumatic limb injury--a 2-year follow-up study.

OBJECTIVES This study aims to explore the trajectories of return to work (RTW) and examine the predictors of different trajectories among workers following traumatic limb injury. METHODS A total of 804 participants were recruited during hospital admission for a 2-year prospective study. The RTW outcome was repeatedly assessed at 1, 3, 6, 12, 18, and 24 months after the injury. A group-based trajectory model (GBTM) was employed to identify trajectories of RTW among the participants. Comparisons of group characteristics of different trajectories were performed based on a multinomial logistic regression. RESULTS GBTM identified three distinct trajectories of RTW: (i) fast RTW consisted of workers with early and stable RTW status from the first month after the injury; (ii) average RTW consisted of workers who achieved and remained at a stable RTW status within 6 months; and (iii) slow RTW consisted of workers who had slow and unsustainable RTW status within the 2-year follow-up period. The estimated proportions were 21.5%, 50.7%, and 27.8%, respectively. Workers with slow and unsustainable RTW after injury were found to be older, married, less educated, employed as repair personnel/operators/laborers, seriously injured, and depressed; they were also found to feel more disturbance in daily life, have lower self-efficacy, and believe they experience a poorer quality of life. CONCLUSION Following traumatic limb injury, individual workers showed three distinct RTW trajectories, each of which was associated with different categories of biopsychosocial factors. An understanding of how different factors contribute to increasing the likelihood of RTW for injured workers in each trajectory group should aid policy-making in worker-oriented vocational rehabilitation programs.

Risk of Amyotrophic Lateral Sclerosis in Patients With Diabetes: A Nationwide Population-Based Cohort Study

Background Glucose intolerance in patients with amyotrophic lateral sclerosis (ALS) has been inconsistently reported. Evidence for the association of ALS and diabetes mellitus is limited. We aimed to assess the overall and age- and sex-specific risks of ALS among patients with diabetes in Taiwan. Methods The study cohort included 615 492 diabetic patients and 614 835 age- and sex-matched subjects as a comparison cohort, followed from 2000 to 2008. We estimated the incidence densities of ALS and calculated the relative hazard ratios (HRs) of ALS (ICD-9-CM 335.20) in relation to diabetes using a Cox proportional hazard regression model, with adjustment for potential confounders, including sex, age, geographic area, urbanization status, Charlson Comorbidity Index, frequency of medical visit, and histories of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease. Results Over a 9-year period, 255 diabetic and 201 non-diabetic subjects developed ALS, corresponding to incidence densities of 7.42 and 5.06 per 100 000 person-years, respectively. After adjustment for potential confounders, patients with diabetes experienced a significantly elevated HR of 1.35 (95% confidence interval [CI], 1.10–1.67). A higher covariate adjusted HR was noted in men (HR 1.48; 95% CI, 1.13–1.94) than in women (HR 1.17; 95% CI, 0.84–1.64), while men aged ≤65 years showed the most increased HR of 1.67 (95% CI, 1.18–2.36). Conclusions This study demonstrated a moderate but significant association of diabetes with ALS onset, and such association is not confounded by socio-demographic characteristics or certain ALS-related co-morbidities. Further studies are warranted to examine whether the findings observed in our study can be replicated.

Return to work and quality of life in workers with traumatic limb injuries: A 2-year repeated-measurements study

OBJECTIVES To assess the impact of return-to-work (RTW) status on health-related quality of life (HRQOL) over a 2-year period in workers with traumatic limb injuries and to elucidate factors that may contribute to the association of RTW with HRQOL. DESIGN A 2-year repeated-measurements follow-up study using the generalized estimating equations approach for model fitting to account for within-subject correlations of HRQOL. SETTING One teaching hospital. PARTICIPANTS Injured patients (N=966, 61% men) with a mean age of 44.7 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The RTW status, HRQOL (assessed by the EuroQol five-dimensional questionnaire), and activity/participation were repeatedly surveyed at 2 weeks and 1, 3, 6, 12, 18, and 24 months after injury. A series of regression models was used to examine the associations between HRQOL and RTW, with sequential adjustment for explanatory variables such as personal and environmental factors, body structure and function, activity/participation, and postinjury period. RESULTS Over a 2-year study period, 81.2% of the study participants had 1 or more RTW episodes; 38.2% of them successfully maintained their RTW status until the end. A significant positive association was found between RTW status and HRQOL. The association could largely be explained by the domains of activity/participation. A higher HRQOL was associated with a shorter length of hospital stay, better coping ability, frequent participation in activities of daily living, and a longer postinjury period. A reduced HRQOL, however, was observed for participants with more depressive symptoms. CONCLUSIONS RTW showed a positive and independent influence on HRQOL in workers with limb injury. In addition, the activity/participation domains and the elapsed time since injury largely explained the association between RTW and HRQOL.

Effects of Stroke Rehabilitation on Incidence of Poststroke Depression: A Population-Based Cohort Study

OBJECTIVE To investigate the effects of rehabilitation intervention provided within the first 3 months after admission for stroke on the incidence of poststroke depression (diagnosed according to ICD-9-CM code 296, 309, or 311, or A-code A212 or A219). METHOD This population-based cohort study examined medical claim data of a random sample of 1 million insured people registered in 2000 in Taiwan. Between 2000 and 2005, there were 7,677 patients admitted as first-time stroke patients. Of these, 1,285 (16.7%) received a rehabilitation regimen within the first 3 months of admission for stroke. The other 83.3% of patients (n = 6,482) belonged to the control group. All study subjects were followed to the end of 2009 to identify any ambulatory treatment for depression as the end point. The incidence density of poststroke depression was calculated assuming a Poisson process. A Cox proportional hazard model was used to estimate the relative risk of poststroke depression in relation to receipt of rehabilitation. RESULTS Over a 10-year follow-up, 75 patients (5.8%) with rehabilitation and 566 controls (8.7%) developed poststroke depression, representing incidence densities of 11.3 and 18.5 per 1,000 person-years, respectively. After analyses were controlled for potential confounders, rehabilitation was found to significantly reduce the risk of poststroke depression, with a hazard ratio (HR) of 0.57 (95% CI, 0.45-0.73). The effect was greater for men (HR = 0.52; 95% CI, 0.37-0.71), especially for elderly men (HR = 0.45; 95% CI, 0.28-0.71), than for women (HR = 0.69; 95% CI, 0.47-1.02). CONCLUSIONS Stroke rehabilitation intervention in the first 3 months after admission for stroke may significantly reduce the risk of poststroke depression. Although this beneficial effect appears to be greater for men than for women, clinicians should also be alert for poststroke depression occurring in women.

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

Abstract This is the first large longitudinal cohort study to investigate the putative association of severe joint pain (SJP) with dipeptidyl peptidase-4 inhibitor (DPP4i) use in patients with type 2 diabetes. The propensity score-matched population-based cohort study was performed between 2009 and 2013 in a group of type 2 diabetes patients with stable metformin use. In total, 4743 patients with type 2 diabetes used a DPP4i as the second-line antidiabetic drug (ie, DPP4i users), and the same number of matched non-DPP4i users was selected. The 2 study groups were followed up until SJP diagnosis (International Classification of Diseases, Ninth Reversion, Clinical Modification code 719.4), health insurance policy termination, or the end of 2013. The incidence rate of SJP was estimated under the Poisson assumption. Multiple Cox proportional hazard model was used to estimate the covariate-adjusted hazard ratio and 95% CI of SJP in association with DPP4i use. Over a maximum follow-up of 5 years, 679 DPP4i users and 767 non-DPP4i users were newly diagnosed with SJP, representing incidence rates of 47.20 and 50.66 per 1000 person-years, respectively. Cox proportional hazard model indicated that DPP4i use slightly but nonsignificantly reduced the risk of SJP (adjusted hazard ratio: 0.92 [95% CI: 0.83-1.02]). Such null results were also observed among all age and sex stratifications and in a sensitivity analysis using all nonspecific arthropathies as the study endpoint. This study provides no support for the putative risk of SJP related to DPP4i use in type 2 diabetes patients during a maximum follow-up of 5 years.

Prevalence of hand syndromes among patients with diabetes mellitus in Taiwan: A population-based study

Population‐based data for diabetic hand syndrome (DHS) are limited. The aim of the present epidemiological study was to estimate the overall and cause‐specific prevalence and rate ratio (RR) of DHS in patients with diabetes.

Evaluating the European Health Literacy Survey Questionnaire in Patients with Stroke: A Latent Trait Analysis Using Rasch Modeling

BackgroundThe effective self-management and treatment of long-term disability after stroke depends greatly on the health literacy of patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q) is a comprehensive and theory-based measure that captures multiple self-perceived competencies of health literacy and covers a diverse range of health contexts. However, there is no psychometric evidence on the HLS-EU-Q in the stroke population.ObjectiveThe aim of this study was to examine the validity of the HLS-EU-Q in patients with stroke using Rasch analysis.MethodsWe compared the model deviance among the one-domain, three-domain, four-domain, and 12-domain structures using likelihood ratio tests to determine the dimensionality of the HLS-EU-Q. Thereafter, we examined the unidimensionality of each domain, local independence, item fit, response categories, and differential item functioning (DIF) for the best fitting structure.ResultsA total of 311 patients with stroke participated in this study. Rasch analysis revealed that the 12-domain HLS-EU-Q demonstrated the best data–model fit. The original 4-point scales showed disordering, which can be corrected by rescaling them as 3-point scales with the two middle categories collapsed. All 47 items in the rescaled HLS-EU-Q fit the 12-domain Rasch model, demonstrated local independence, assessed the 12 unidimensional domains respectively, and had invariant difficulties between different age or education groups of the patients with stroke.ConclusionWe recommend using the 12-domain scores of the rescaled HLS-EU-Q to comprehensively and accurately capture the competencies to access, understand, appraise, and apply health information within the three health contexts of healthcare, disease prevention, and health promotion for patients with stroke.

A population-based cohort study suggests an increased risk of multiple sclerosis incidence in patients with type 2 diabetes mellitus

Background To prospectively investigate the incidence and relative risks of multiple sclerosis (MS) in patients with type 2 diabetes (T2DM). Materials and methods Patients with T2DM (n = 614,623) and age- and sex-matched controls (n = 614,021) were followed from 2000 to 2008 to identify cases of newly diagnosed MS (ICD-9-CM: 340). The person-year approach with Poisson assumption was used to evaluate the incidence density. We estimated the covariate-adjusted hazard ratio (HR) of MS incidence in relation to T2DM diabetes using a multiple Cox proportional hazard regression model. Results Over 9 years of follow-up, 175 T2DM patients were newly diagnosed with MS, and 114 matched controls had the same first-ever diagnosis, representing a covariate-adjusted HR of 1.44 (95% confidence interval [CI], 1.08–1.94). The sex-specific adjusted HR for both men and women with T2DM was also elevated at 1.34 (95% CI, 0.81–2.23) and 1.51 (95% CI, 1.05–2.19), respectively. Women aged ≤50 years had the greatest risk of MS (HR 2.16; 95% CI, 1.02–4.59). Conclusion This study demonstrated a moderate but significant association of T2DM with MS incidence, and the association was not confounded by socio-demographic characteristics or certain MS-related co-morbidities.

Validation of the short-form Health Literacy Scale in patients with stroke

OBJECTIVE We aimed to validate a Mandarin version of the short-form Health Literacy Scale (SHEAL) in patients with stroke. METHODS Each patient with stroke was interviewed with the SHEAL. The Public Stroke Knowledge Quiz (PSKQ) was administered as a criterion for examining the convergent validity of the SHEAL. The discriminative validity of the SHEAL was determined with age and education level as independent grouping variables. RESULTS A total of 87 patients with stroke volunteered to participate in this prospective study. The SHEAL demonstrated sufficient internal consistency reliability (alpha=0.82) and high correlation with the PSKQ (r=0.62). The SHEAL scores between different age groups and education level groups were significantly different. The SHEAL, however, showed a notable ceiling effect (24.1% of the participants), indicating that the SHEAL cannot differentiate level of health literacy between individuals with high health literacy. CONCLUSION The internal consistency reliability, convergent validity, and discriminative validity of the SHEAL were adequate. However, the internal consistency reliability and ceiling effect of the SHEAL need to be improved. PRACTICE IMPLICATIONS The SHEAL has shown its potential for assessing the health literacy of patients with stroke for research purposes. For clinical usage, however, the SHEAL should be used with caution.