Yueh Hsia Chiu

Different prevalence rates of Parkinson's disease in urban and rural areas: a population-based study in Taiwan.

Background: Rural living has long been debated as a risk factor for idiopathic Parkinson’s disease (IPD). But few community-based studies compared this difference between urban and rural areas. Methods: Population-based surveys by neurologists using a standardized diagnostic protocol were conducted in the urban areas of Keelung City and compared the prevalence rates of IPD with those we had previously determined in the rural area of Ilan County, Taiwan. Subjects were diagnosed with IPD when at least 2 of the 4 cardinal signs of parkinsonism were present and by exclusion of secondary parkinsonism. Gender-specific age-standardized prevalence rates of IPD by using the 1970 and 2000 US censuses were calculated for comparison. Results: The participation rate was 84.9%. The crude prevalence rate of IPD in persons aged 40 years and over was 706 (95% CI: 551–864) per 100,000 population. The age-adjusted prevalence rates by using the 1970 US census were 633 (95% CI: 620–646) for people aged 40 and over and 230 (95% CI: 227–234) for all ages. Our results were similar to those obtained in Sicily, Rotterdam, and 3 communities in China. Moreover, the prevalence rates of IPD in Keelung, the urban area studied, were twice as high as those in Ilan, the rural area studied (p < 0.001). Conclusions: Our results suggest that urban living is more important as a risk factor for IPD development than rural living in Taiwan.

Health information system for community-based multiple screening in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 3)

BACKGROUND Community-based multiple screening for common cancers and chronic diseases has increasingly gained attention. However, as infrastructure and evaluation system are more diversified and complicated compared with single screening, the development of a novel health information system is paramount. METHODS The main goal of our health information system was to support the multiple screening program not only from technical aspect but also from a broad range of perspectives including quality assurance system, organized features appertaining to screening, economic evaluation (cost-effectiveness or cost-utility analysis), epidemiological applications, behavior risk factor surveillance system, and social impact due to the introduction of the Keelung Community-Based Integrated Screening (KCIS) program. RESULTS Health information system was designed and programmed on the basis of the demand derived from KCIS within which five cancers and three chronic diseases were included. In addition to the detailed description of infrastructure and process, design, relevant database and security involved in health information system, an innovative and extensive evaluation system in accordance with the main goals was included in our health information system. CONCLUSION Our information system proposed several aspects regarding organized screening system that has never been addressed in computerized system supporting for single screening. These included quality assurance system, organization features, co-morbidity profiles, epidemiological applications and social and economic considerations.

Community-based multiple screening model: Design, implementation, and analysis of 42,387 participants taiwan community-based integrated screening group

Multiple disease screening may have several advantages over single disease screening because of the economics of scale, with the high yield of detecting asymptomatic diseases, the identification of multiple diseases or risk factors simultaneously, the enhancement of the attendance rate, and the efficiency of follow‐up.

Progression of pre-hypertension, stage 1 and 2 hypertension (JNC 7): a population-based study in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 9).

Objective To investigate the prevalence and progression of, and identify risk factors for, pre-hypertension, stage 1 and 2 hypertension in a population-based study. Design A prospective cohort study. Setting An integrated community-based multiple screening program in Keelung, Taiwan. Participants A total of 67 011 individuals aged 20–79 years between 1999 and 2003 were included. Of these, 22 111 re-attended, yielding 53 689 repeated recordings of blood pressure, including movement between normal and pre-hypertension and progression from pre-hypertension to stage 1 or stage 2 hypertension. Main outcome measures Blood pressure was defined and classified according to the JNC 7 Report as normal, pre-hypertension, stage 1, and stage 2 hypertension. Results Below 50 years of age, males had a higher progression rate, particularly from normal to pre-hypertension, than females. Annual regression rates from pre-hypertension to normal were higher in the young age group than in the old age group, particularly for females. Factors associated with the occurrence of pre-hypertension were old age, male gender, high waist circumference, abnormal blood lipids, smoking, chewing betel nuts, lack of exercise, and having parents with hypertension. Factors associated with regression from pre-hypertension to normal were body mass index, fasting glucose, high-density lipoprotein level, smoking, and parents with hypertension. Progression from pre-hypertension to stage 1 hypertension was positively related to male gender, higher waist circumference, and having parents with hypertension. Conclusions The rates of progression and regression of hypertension vary with age and gender, anthropometric and biochemical measurements, and family history.

Feasibility of tele-ophthalmology for screening for eye disease in remote communities

We assessed the feasibility of tele-ophthalmology in a remote location, Tungyin, an island 200 km from Taiwan, which has no ophthalmologist. Screening for eye diseases was carried out among residents aged 40 years or more. A total of 113 subjects, approximately 31% of the whole population, were enrolled in the screening programme. Images were transmitted (via ADSL) to a retinal specialist in Taiwan for diagnosis. The average processing time, excluding the time for copying files, was 6.4 s (SD 2.1) per subject. Transmission took 60–90 s for most of the images (83%). The average time required to make a diagnosis for each subject, including data entry, was approximately 34 s (SD 18). In screening for retinopathy, the detection rate with digital imaging (8.8%) was two times higher than with indirect ophthalmoscopy (4.4%). In 12% of cases macular degeneration was identified, and in 6% there were mild or moderate problems with the optic disc. Community-based screening for four categories of eye disease was successfully demonstrated using store-and-forward tele-ophthalmology.

Diabetes mellitus associated with the occurrence and prognosis of non-Hodgkin's lymphoma

The aim of this case–control study was to assess the effect of preexisting diabetes mellitus on the risk of developing non-Hodgkins lymphoma, and also to investigate whether preexisting diabetes mellitus could further affect survival after diagnosis of non-Hodgkins lymphoma. The retrospective cohort consisted of 242 study participants with pathologically confirmed non-Hodgkins lymphoma who were referred to the Department of Radiation Oncology in Chang-Gung Memorial Hospital between January 2000 and March 2004. The controls were derived from a population-based multiple screening program. A logistic regression model was employed to calculate the odds ratios of the risk factors we examined and then to evaluate the association between preexisting diabetes mellitus and the occurrence of non-Hodgkins lymphoma. The results showed that preexisting diabetes mellitus was an independent risk factor for the occurrence of non-Hodgkins lymphoma (odds ratio, 1.88; 95% confidence interval, 1.22–2.89; P=0.0045). When subgroup analyses regarding certain tumor or disease characteristics were performed, the impact of preexisting diabetes mellitus was found to be particularly evident in some subgroups such as the tumors of T-cell origin (P=0.0266), those with extranodal involvement (P=0.0346), and those that were not localized or low grade (P=0.0096). The effect of preexisting diabetes mellitus on the risk of death from non-Hodgkins lymphoma varied with follow-up time. Such an effect modification was statistically significant (P=0.05). In the current study, preexisting diabetes mellitus was an independent risk factor for the occurrence of non-Hodgkins lymphoma, and it was also an accelerated factor for the risk of death from causes related to non-Hodgkins lymphoma.

Mortality of Parkinson's disease by Hoehn-Yahr stage from community-based and clinic series [Keelung Community-based Integrated Screening (KCIS) no. 17)].

PURPOSE We aimed to quantify the mortality reduction by which the early detection of Parkinsons disease (PD) within a community-based study could reduce the number of advanced cases. METHODS Data used in this study were derived from two community-based surveys and from a clinical series of PD cases identified from a medical centre. The cumulative survival by Hoehn-Yahr (H-Y) scale was estimated and the mortality reduction derived from a community-based survey was predicted. RESULTS A total of 117 PD patients were detected through two community-based approaches. By comparing the H-Y stage distribution of screen-detected cases with those from the clinical series, a 22.5% excess in the number of early PD (H-Y stage I and stage II) were identified with screening. The risk ratios of being H-Y stage III or severe for community-based detected cases versus clinical series were 0.49 (95% confidence interval: 0.30-0.78). The total death rate adjusted by H-Y stage distribution was 21% and 28% for cases from community and clinical series, respectively. CONCLUSIONS The present study revealed that early detection of PD through a community-based survey may reduce 51% incidence of stage III or more severe PD at diagnosis, leading to a 25% reduction in mortality.

Natural history and effectiveness of early detection of Parkinson's disease: Results from two community-based programmes in Taiwan (KCIS no. 11)

OBJECTIVES The natural course of Parkinsons disease (PD), as measured on the Hoehn-Yahr (H-Y) scale, and the impact that early detection would have on prognosis for those with the disease, has barely been addressed since the introduction of L-dopa. This study aimed to elucidate the natural history of PD and effectiveness of early detection in reducing advanced disability and mortality. METHOD A total of 21 362 participants aged 40 years or older were invited to two community-based programmes for the early detection of PD. The step-by-step annual progression rates from H-Y stage I to stage IV or V, and cumulative survival rates, by the H-Y scale, were estimated and applied to simulated data to assess the impact of different screening intervals upon stage at diagnosis and subsequent survival. RESULTS The average duration in stages I, II and III was estimated as 2.83, 6.62 and 1.41 years, respectively. The average delay time before deteriorating into H-Y stage III was 9.45 year. Application of these parameters to simulated model predicted a 36% (95% CI: 28-39%), 26% (95% CI: 20-32%) and 19% (95% CI: 13-24%) reduction in death for annual, 5-yearly and 10-yearly screening programmes, respectively. CONCLUSION The present study recommended a 5-yearly screening programme, with 74% of PD cases prevented from progressing to H-Y stage III or worse within 10 years of diagnosis, and leading to a corresponding 26% reduction in mortality.

Contents Vol. 33, 2009

68 Regional North American Annual Meeting of the World Federation of Neurology – Research Group on Neuroepidemiology. Seattle, Wash., May 1, 2009 Editors: Longstreth, W., Jr.; Ton, T. (Seattle, Wash.); Leimpeter, A.; Van Den Eeden, S.K. (Oakland, Calif.) (only available online)