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This study investigated the prevalence and characteristics of schizophrenia in patients with type 2 diabetes mellitus (T2DM) in Taiwan.
National Health Insurance claims data for patients with principal diagnoses of schizophrenia and T2DM were analysed.
Compared with patients with schizophrenia in the general population (GP), those with schizophrenia and T2DM were more likely to have higher Charlson comorbidity index (CCI) scores and multiple comorbidities, and were older. The prevalence of schizophrenia was significantly higher in patients with T2DM than in the GP from 2000 to 2010. In addition, during this period, the prevalence of schizophrenia in patients with T2DM increased from 0.64% to 0.85%; such an increase in the GP was also observed. A high prevalence of schizophrenia was observed in patients with T2DM aged less than 60 years old; those residing in eastern Taiwan; those with incomes of ≤NT$17,280, NT$17,281–NT$22,880, NT$22,881–NT$28,800, and NT$36,301–NT$45,800; and those with CCI > 2.
Our study found the prevalence of schizophrenia is higher in patients with T2DM than in the GP, particularly those with earlier ages less than 60 years old. Public health initiatives are necessary to prevent and treat schizophrenia in patients with T2DM, specifically for those with the aforementioned and premature death risk.
Glycogen stored in skeletal muscle is the main fuel for endurance exercise. The present study examined the effects of oral hydroxycitrate (HCA) supplementation on post-meal glycogen synthesis in exercised human skeletal muscle. Eight healthy male volunteers (aged 22·0 (se 0·3) years) completed a 60-min cycling exercise at 70–75 % and received HCA or placebo in a crossover design repeated after a 7 d washout period. They consumed 500 mg HCA or placebo with a high-carbohydrate meal (2 g carbohydrate/kg body weight, 80 % carbohydrate, 8 % fat, 12 % protein) for a 3-h post-exercise recovery. Muscle biopsy samples were obtained from vastus lateralis immediately and 3 h after the exercise. We found that HCA supplementation significantly lowered post-meal insulin response with similar glucose level compared to placebo. The rate of glycogen synthesis with the HCA meal was approximately onefold higher than that with the placebo meal. In contrast, GLUT4 protein level after HCA supplementation was significantly decreased below the placebo level, whereas expression of fatty acid translocase (FAT)/CD36 mRNA was significantly increased above the placebo level. Furthermore, HCA supplementation significantly increased energy reliance on fat oxidation, estimated by the gaseous exchange method. However, no differences were found in circulating NEFA and glycerol levels with the HCA meal compared with the placebo meal. The present study reports the first evidence that HCA supplementation enhanced glycogen synthesis rate in exercised human skeletal muscle and improved post-meal insulin sensitivity.
Whether traumatic brain injury (TBI) is an independent risk factor for the subsequent development of schizophrenia has evoked considerable controversy. No evidence has been previously reported from Asia. This study estimated the risk of schizophrenia during a 5-year period following hospital admission for TBI relative to a comparison group of non-TBI patients during the same period in Taiwan.
Two datasets were linked: the Traumatic Brain Injury Registry and the Taiwan National Health Insurance Research Dataset. A total of 3495 patients hospitalized with a diagnosis of TBI from 2001 to 2002 were included, together with 17 475 non-TBI patients as the comparison group, matched on sex, age, and year of TBI hospitalization. Each individual was followed for 5 years to identify any later diagnosis of schizophrenia. Cox proportional hazard regressions were performed for analysis.
During the 5-year follow-up period, patients who had suffered TBI were independently associated with a 1.99-fold (95% confidence interval 1.28–3.08) increased risk of subsequent schizophrenia, after adjusting for monthly income and residential geographical location. The severity and type of TBI was not associated with the subsequent development of schizophrenia.
Our findings add important evidence from Asia and suggest a potential link between TBI and schizophrenia. Our study suggests that clinicians and family members should be alert to possible neuropsychiatric conditions following TBI.
The purpose of this study was to investigate whether physicians with larger sepsis caseloads provide better outcomes, defined as lower in-hospital mortality rates, for patients with sepsis.
Retrospective cross-sectional study.
This study used pooled data from the 2002-2004 Taiwan National Health Insurance Research Database. A total of 48,336 patients hospitalized with a principal diagnosis of septicemia were selected and assigned to 1 of 4 caseload groups on the basis of their treating physician's sepsis caseload during the 3 years reflected in the pooled data (low caseload, less than 39 cases; medium caseload, 39–88 cases; high caseload, 89–176 cases; and very high caseload, more than 176 cases). Generalized estimating equation models were used for analysis.
Receipt of treatment from physicians in the very high, high, and medium caseload groups decreased patients' odds of inhospital mortality by 49% (95% confidence interval [CI], 0.41-0.67; P < .001 ), 40% (95% CI, 0.53-0.68; P < .001 ), and 18% (95% CI, 0.73-0.92; P < .001), respectively, compared with the odds for patients treated by low-caseload physicians. These findings persisted after partitioning out systematic physician-specific and hospital-specific variation and isolating the effects of most hospital, physician, and patient confounders.
Patients treated by physicians who had a larger sepsis caseload had a substantially lower in-hospital mortality rate than did patients treated by physicians in the other caseload groups, and the difference was statistically significant. This result supports the “practice makes perfect” hypothesis.
It is known that levels of brain natriuretic peptide predict outcomes of treatment for adults with decompensated heart failure. We hypothesized that it could predict outcomes in children with this condition.
We divided retrospectively 82 patients with serial measurements of brain natriuretic peptide into 3 groups: those who survived and did not need readmission within less than 60 days; those who survived but needed readmission within less than 60 days; and those who died in hospital or within less than 60 days. Initial and final levels of the peptide correlated with adverse outcomes.
The percent change in level of the peptide was minus 78 percent, minus 38 percent, and 138 percent in the readmission-free group, the readmitted, and nonsurviving groups, respectively. Final levels were significantly lower in the readmission-free group than in the readmitted and nonsurviving groups (p equals 0.013 and p is less than 0.00001, respectively) and in the readmitted group than in the nonsurvivors (p equals 0.013). On univariate analysis, the final level, the change in level, and the percentage change in level significantly predicted outcomes (p equals 0.0002, 0.0072 and 0.0005, respectively). On multivariate analysis, only the final level of the peptide significantly predicted outcomes (p equals 0.01).
A final level of brain natriuretic peptide of greater than or equal to 760 picograms per millilitre strongly predicted an adverse outcome. Patients with higher final levels may be at higher risk of death and readmission, suggesting that this variable effectively predicts the response to treatment and prognosis in children with heart failure.
In this work, the charge-trapping distributions of polysilicon-oxide-nitride-oxide-silicon (SONOS) structure are studied. The trapping energy level of SiNx films with different composition ratio deposited by low-pressure chemical vapor deposition (LPCVD) were first characterized by photoluminescence (PL) measurement. Moreover, using F-N/CHE program and charge pumping techniques, the vertical location and the lateral distribution of programmed charges are investigated in the nitride films with different composition ratio. The study offers strong evidence that the density of charge-trapping levels in the Si-rich nitride is higher than the standard nitride. A simple qualitative model and calculation explains that the trapping level distributions in the SiNx films are shallower by increasing relative Si-content. Furthermore, we have observed the nitride trap vertical location was changed by adjusted Si/N composition ratio. And the lateral distribution of hot electron programmed charges in the modified nitride is broader than that in the standard nitride because it offered more charge-trapping sites and shallower charge-trapping levels. In summary, the study can help researchers to understand the nitride charge-trapping mechanism and the analysis of optical/electrical characteristics.
This paper analyzes the pressure distribution on the platform screen door (PSD) subjected to a moving train running through a station in the tunnel. The advantages of adopting PSD design are to reduce the cooling load and the construction cost in mass rapid transport underground station. However, as the moving train enters or leaves the station, the PSD will face a long-term wind oscillation pressure force. For the safety design, dynamic simulation is requisite for the analysis of pressure force exerted on the PSD. The present study uses the commercial code PHOENICS to simulate dynamically the pressure and velocity distribution on the platform screen door. The results show that the maximum pressure on the platform screen door occurs at 6 m behind the front platform end with the values of 1,457 and 942 Pa, as the train moving speeds are 80km/hr and 65km/hr respectively. It is also indicated that the ratio of the different maximum pressures exerted on the PSD has a linear relationship with the square of train speed ratio for two different train speeds.
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