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Biomedical subjects

Shuu-Jiun Wang

Publications and source records attributed to Shuu-Jiun Wang.

At least 19 recordsLinked to original sources
PubMed2007

Mood state and quality of sleep in cancer pain patients: a comparison to chronic daily headache.

Cancer pain is commonly believed to be a unique type of pain and dissimilar to noncancer pain; however, only limited research efforts have been directed at examining this belief. The aim of this study was to explore whether patients with chronic daily headache (CDH) and patients with chronic cancer pain (CCP) present with different pain, mood, and sleep quality profiles. Forty-seven patients diagnosed with CDH were matched by age and gender with 47 patients with CCP. The research instruments included the Brief Pain Inventory-Chinese version, the Profile of Mood States Short Form, and the Pittsburgh Sleep Quality Index-Taiwan Form (PSQI-T). Results revealed that there was no difference in pain intensity between the patients with CDH and those with CCP; however, the CCP group reported significantly higher mean levels of pain interference with daily life than did the CDH group. These two groups did not differ on the Total Mood Disturbance score; however, the CCP group reported significantly lower mean levels of vigor than did the CDH group. Moreover, there was no difference on the PSQI-T total score between these two groups; however, the CDH group reported higher mean scores of sleep disturbance, higher mean scores of use of sleep medications, lower mean scores of sleep efficiency, and lower mean scores of daytime dysfunction than did the CCP group. Despite some differences between these two groups, pain, mood, and sleep quality profiles in these two types of pain groups are similar.

Adult↗
PubMed2006

Outcomes and predictors of chronic daily headache in adolescents: a 2-year longitudinal study.

OBJECTIVES: To assess the outcomes and predictors of chronic daily headache (CDH) in a community-based cohort of adolescents. METHODS: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as > or =15 headache days/month, average > or =2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. RESULTS: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly headache frequency was 11.0 +/- 9.7 days in 2001 and 7.7 +/- 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type headache deceased from 86 to 46% (p < 0.001). Chronic migraine prevalence increased markedly at baseline and became the most common CDH subtype at follow-up when using the ICHD-2 appendix criteria. During follow-up, seven subjects (6%) dropped out of school. Independent predictors for CDH persistence were medication overuse and major depression. CONCLUSIONS: Most adolescents with chronic daily headache (CDH) continued to have frequent headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as headache frequency decreased. The percentages of chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.

Adolescent↗
PubMed2006

Early relapse in multiple sclerosis-associated optic neuritis following the use of interferon beta-1a in Chinese patients.

PURPOSE: The incidence of multiple sclerosis (MS) is relatively rare in Chinese. The beneficial effect of interferon beta-1a in modifying the disease course of MS has been rarely analyzed in Chinese patients. The aim of this study was to investigate the clinical response to interferon beta1-a in Chinese patients with MS-associated optic neuritis (ON). METHODS: A retrospective case control study was conducted in 20 MS patients with optic nerve involvement. The interferon (IF) group comprised ten patients receiving interferon beta-1a. The noninterferon (NIF) group comprised another ten MS patients with optic nerve involvement who did not receive interferon treatment. The clinical characteristics, laboratory data, management, and disease course were retrospectively analyzed. The main outcomes of the study were the annualized relapse rate (ARR) for MS, and final visual outcome data. RESULTS: The ARR did not differ between the pretreatment period and the posttreatment period within the IF group. There was also no significant decrease of ARR in the IF group when compared with the NIF group. However, we observed an early recurrence of ON in 50% of the IF cases following the use of interferon beta-1a. The final visual outcome did not differ between the IF group and the NIF group. CONCLUSIONS: The use of interferon beta-1a should be carefully monitored because early relapse of ON may complicate the treatment course in this patient group.

Adolescent↗
PubMed2006

Chronic daily headache in adolescents: prevalence, impact, and medication overuse.

OBJECTIVES: To examine the prevalence, impact, and related medication use or overuse of primary chronic daily headache (CDH) among adolescents in a field sample. METHODS: The authors conducted a two-phase CDH survey of all students from ages 12 to 14 years in five selected middle schools in Taiwan. Subjects with CDH in the past year were identified and interviewed by neurologists. CDH was defined as headache occurring at a frequency of 15 days/month or more, average of 2 hours/day or more, for more than 3 months, and its subtypes were classified on the basis of the International Classification of Headache Disorders, 2nd edition. RESULTS: Of the 7,900 participants, 122 (1.5%) fulfilled the criteria for primary CDH in the past year. Girls had a higher prevalence (2.4%) than boys (0.8%) (p < 0.001). Of the CDH subjects, 88 (72%) could be classified into either chronic tension-type headache (65.6%) or chronic migraine (6.6%). None of them fulfilled the criteria of new daily-persistent headache or hemicrania continua. Twenty-four subjects (20%) overused medications. Eighty-two (67%) of all CDH subjects had migraine or probable migraine. In the past semester, most CDH subjects (65%) did not take any sick leave for headaches. Only 6 subjects consulted neurologists in the past year, and only 1 subject took headache prophylactic agents. CONCLUSIONS: Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype; however, a majority of adolescents with CDH had headaches with features of migraine.

Adolescent↗
PubMed2006

Assessing quality of life in Taiwanese patients with Alzheimer's disease.

OBJECTIVE: To measure differences in patients with Alzheimer's disease (AD) and caregiver assessments of the patients' quality of life (QOL) and to identify the patient characteristics, caregiver characteristics, or patient-caregiver interactions responsible for these differences. METHODS: We recruited consecutive patients with AD and their caregivers from an outpatient clinic of a teaching hospital in Taiwan. Each patient and caregiver rated the patient's quality of life (QOL) using the Quality of Life-Alzheimer's Disease (QOL-AD) questionnaire. Additional measures included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating, Blessed Activities of Daily Living assessment, and the Neuropsychiatric Inventory. Only patients with MMSE score >or= 10 were enrolled. RESULTS: Of the 94 patients enrolled, 81 with reliable caregivers were included. The internal consistency was good within both patient and caregiver reports (alpha=0.83 and 0.79, respectively). The agreement between patient and caregiver QOL-AD reports was moderate (absolute intraclass correlation coefficient: 0.41). Regression analyses indicated that caregiver distress was the most consistent predictor of QOL rating discrepancy between the patient and caregiver, and patient depressive disorder was the most significant predictor of QOL. CONCLUSIONS: Similar to previous studies in different ethnic groups, the QOL perception differed between the Taiwanese patients with AD and their caregivers. Medical professionals should be cautious if they try to use a caregiver-reported QOL to replace the patient-reported QOL among AD patients of mild to moderate severity.

Activities of Daily Living↗
PubMed2006

Validity, reliability and application of the taiwan version of the migraine disability assessment questionnaire.

BACKGROUND/PURPOSE: The seven-item Migraine Disability Assessment (MIDAS) questionnaire is a simple and useful tool for evaluating migraine-related disability. The goals of this study were: (1) to test the reliability and validity of the Taiwan version of the MIDAS (MIDAS-T) questionnaire, and (2) to measure the impact of migraine among Taiwanese patients in a headache clinic. METHODS: Consecutive migraine patients, aged 20-50 years, visiting the headache clinic at the Taipei Veterans General Hospital were invited to participate in the study. They completed the MIDAS-T and a form, which collected headache-related information including characteristics and impact on their lives. Of them, about 30 patients were randomly invited to repeat the MIDAS-T 3 weeks later. RESULTS: A total of 281 migraine patients (M/F, 63/218; mean age, 35.27 +/- 8.21 years) participated in the study. Of them, 31 completed the MIDAS-T again 3 weeks later. MIDAS-T showed acceptable internal consistency (Cronbach alpha = 0.79), test-retest reliability (r = 0.67) and criterion validity (r = 0.37 for question A [headache frequency] and r = 0.34 for question B [headache intensity], p < 0.001). The mean score of migraine patients on MIDAS-T was 34.21 +/- 45.90, ranging from 0 to 265. MIDAS grade I (score 0-5) was found in 22% of patients, grade II (6-10) in 15%, grade III (11-20) in 17%, and grade IV (>or=21) in 46%. CONCLUSION: This study supports the reliability and validity of MIDAS-T for use in Taiwanese patients. Almost half of the migraine patients were classified as having severe disability (grade IV).

Adult↗
PubMed2006

Characteristics and treatment of headache after traumatic brain injury: a focused review.

Headache is one of the most common complaints in patients with traumatic brain injury. By definition, headache that develops within 1 wk after head trauma (or within 1 wk after regaining consciousness) is referred to as posttraumatic headache (PTH). Although most PTH resolves within 6-12 mos after injury, approximately 18-33% of PTH persists beyond 1 yr. We performed a systematic literature review on this topic and found that many patients with PTH had clinical presentations very similar to tension-type headache (37% of all PTH) and migraine (29% of all PTH). Although there is no universally accepted protocol for treating PTH, many clinicians treat PTH as if they were managing primary headache. As a result of the heterogeneity in the terminology and paucity in prospective, well-controlled studies in this field, there is a definite need for conducting double-blind, placebo-controlled treatment trials in patients with PTH.

Analgesics↗
PubMed2006

The impact of migraine on patients with major depressive disorder.

BACKGROUND: The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described. OBJECTIVE: To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression. METHODS: This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated. RESULTS: Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode. CONCLUSIONS: Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.

Adult↗
PubMed2006

[The application of migraine disability assessment questionnaire (MIDAS)].

Migraine is a recurring and disabling pain disorder. The prevalence is estimated as 9.1% in Taiwan. Patients suffer from significant loss of work, time at school or ability to perform household chores, as well as other family or leisure activities. Treatment strategies during migraine attacks should be tailored based on the severity of disability. Stewart and Lipton (1999) developed the Migraine Disability Assessment Questionnaire (MIDAS) to assess the severity of disability related to migraine. This simple, self-administered, 7-item questionnaire focuses on disability in three domains (school or paid work, household chores, and family, social, or leisure activities) in the first 5 items of the questionnaire. The internal consistency, test-retest reliability, validity, ease of use, and clinical utility were all tested with good results. The questionnaire offers a simple tool to improve physician-patient communication. As for treatment strategies, a recent large-scale study done in the USA showed that it is more efficacious to treat migraine patients by adopting a strategy of stratified care based on different disability status than a stepped-care strategy. The simple questionnaire, MIDAS, has received world-wide popularity and has been translated into Japanese, Italian and Turkish. All of these versions showed good reliability and validity. Recently, one of our studies demonstrated that the Taiwan version also yielded comparable internal consistency, reliability, and validity. We hope that the MIDAS questionnaire can be widely adopted in Taiwan to help physicians assess their patients' disability related to migraine and provide clues for clinical management.

Disability Evaluation↗
PubMed2005

Does medication overuse headache represent a behavior of dependence?

Medication overuse is relatively common in patients with frequent headache. To explore the prevalence of patients who meet the criteria for substance dependence in Diagnostic and Statistical Manual of Mental Disorders, Edition IV (DSM-IV), and to identify variables of substance dependence among patients with chronic daily headache, we recruited consecutive patients with chronic daily headache at a headache clinic from November 1999 to June 2004. Each patient completed a headache intake form, a dependence questionnaire modified from DSM-IV, and the Hospital Anxiety and Depression Scale (HADS). The presence of probable medication overuse headache (pMOH) was defined on the basis of the International Classification of Headache Disorders, 2nd edition, 2004. A total of 1,861 patients with chronic daily headache (1,369 women, 492 men; mean age, 49.6+/-15.4 years) were recruited. Almost half (895/1,861, 48%) met criteria of pMOH, and 606 of these patients (606/895, 68%) met three of five DSM-IV substance dependence criteria. In contrast, only 191 of 968 patients without pMOH (20%) met the DSM-IV criteria (OR=8.6, [7.0-10.6], chi-square test, P<0.001). Patients who fulfilled DSM-IV criteria of dependence had higher numbers of physician appointments in the past year. Multivariate logistic regression analyses revealed that migraine headache, frequent physician consultation, intensity of headache, and presence of a higher anxiety score were significant independent variables for substance dependence. Among patients with chronic daily headache, pMOH was associated with behaviors of substance dependence.

Analgesics↗
PubMed2005

Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women.

OBJECTIVE: To explore the relationship between anxiety, depression, vasomotor symptoms, and menopausal status among middle-aged women. DESIGN: A population-based study involving a rural Taiwanese population. Participants received a structured questionnaire, which included the hospital anxiety and depression scale (HADS), gynecological history and a checklist of menopausal symptoms in the most recent 2 weeks. RESULTS: A total of 1273 women with no history of surgical menopause and hormonal therapy history participated. The mean anxiety, depression, and total HADS scores were 4.3 +/- 3.3, 3.3 +/- 2.8 and 7.6 +/- 5.3, respectively, and did not differ according to menopausal status. A total of 10.5% participants reported hot flashes within the previous 2 weeks. After controlling for educational status and insomnia, anxiety (6.0 +/- 3.8 versus 4.1 +/- 3.1) and depression scores (4.0 +/- 3.3 versus 3.2 +/- 2.7) were significantly higher (p < 0.001) compared with those without hot flashes. These differences were attributed to peri- and postmenopausal subjects. CONCLUSIONS: Hot flashes in peri- and postmenopausal women were associated with anxious and depressive symptoms in East Asian population with low prevalence of vasomotor symptoms.

Adult↗
PubMed2005

A longitudinal study of cognition change during early menopausal transition in a rural community.

OBJECTIVE: To characterize changes in cognition that occur during the hormonal transitions of menopause. METHOD: We conducted a longitudinal population-based study in Kinmen, Taiwan, recruiting all women age 40-54 years who were premenopausal and without a history of hormone replacement therapy (HRT) or hysterectomy. The cognitive measures used to assess function included the Auditory-Verbal Learning Test, visual memory, verbal fluency, Trail Making Test and digit span. RESULTS: A total of 694 eligible women participated in the baseline study, and 573 women (83%) completed follow-up 18 months later. After excluding 78 women who received hysterectomy or HRT, the final sample was composed of 495 subjects, of whom 114 (23%) progressed to perimenopause during follow-up. Women who remained premenopausal were younger than those who became perimenopausal (44.7 +/- 2.3 years versus 47.1 +/- 3.0 years, p < 0.01). All follow-up cognitive scores in women who entered perimenopause were slightly better than baseline measures except for Rey Auditory-Verbal Learning Test, which decreased by 0.23 (S.D. = 2.9, p = 0.3). At follow-up, cognitive function except for verbal fluency did not differ significantly between women who stayed premenopausal and those became perimenopausal after controlling for age, education, and baseline cognitive scores. Women who entered perimenopause have an average of 1.3 items (S.D. = 0.4) less in verbal fluency measures as compared with their premenopausal peers at the follow-up period. CONCLUSIONS: The menopausal transition might not accompany significant cognitive decline except for verbal fluency.

Adult↗
PubMed2005

Attitudes toward menopause among middle-aged women: a community survey in an island of Taiwan.

OBJECTIVES: The purpose of this report is to explore the attitudes toward menopause of middle-aged women in Taiwan as well as to examine related factors. METHODS: A large community-based sample of Taiwanese women aged 40-54 years who are living on the islet of Kinmen were recruited for this study. Attitudes toward menopause were collected with a self-administered questionnaire. RESULTS: Of a targeted population of 1429 individuals, 1113 (78%) participated in the study. The mean age was 48.5+/-4.0 years (range, 43-57 years) and 434 women (39%) were premenopausal. The rate of current hormone use was 13.5%. Compared to premenopausal women, fewer postmenopausal women agreed that menopause depressed them, and that interests distracted their attention from menopause (p<0.01, Mann-Whitney test). Postmenopausal women did not believe that menopause would change their lives, and not having periods made women feel regretful. Compared with the illiterate women, higher educated women were more regretful about menopause (p<0.05, Mann-Whitney test). Women who experienced vasomotor symptoms within 2 weeks of the study expressed a more negative attitude regarding menopause. CONCLUSIONS: Women in Taiwan held a more positive attitude toward menopause as compared to prior studies in other countries. They had a more positive attitude when they actually faced menopause. Education and vasomotor symptoms had a significantly negative impact on menopausal perceptions. This report provides more insight on the perception of menopause in Taiwanese women that will guide future public health initiatives.

Adult↗
PubMed2005

Correlation of magnetic resonance images with neuropathology in acute Wernicke's encephalopathy.

We correlated serial brain MRIs with neuropathological findings in a 16-year-old female whose autopsy was consistent with Wernicke's encephalopathy (WE). Diffusion-weighted imaging, diffusion coefficients mapping and neuropathology findings were suggested vasogenic edema in the periaqueductal and peri-the-fourth ventricular areas. This is the first documented case report to make this direct comparison. The characteristic WE changes in the mammillary body was also correlated with the findings of MRI with contrast enhancement. Bilateral cortical lesions revealed by MRI were atypical and rare in WE and were not evidenced by pathological changes.

Adolescent↗
PubMed2005

Quality of life in elderly patients with dizziness: analysis of the Short-Form Health Survey in 197 patients.

CONCLUSION: Elderly patients with chronic dizziness had a poor HRQoL, which could be successfully assessed using the SF-36, a generic health-status instrument. The frequency of dizziness and comorbid psychological distress were predictive of impairment in QoL. OBJECTIVES: To evaluate health-related quality of life (HRQoL) and its relationship to characteristics of dizziness in elderly persons with chronic dizziness. MATERIAL AND METHODS: A standardized dizziness questionnaire was used to evaluate characteristics of dizziness as well as medical, functional and demographic data in 197 consecutive patients with chronic dizziness aged > or =60 years. HRQoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Compared with normative data, results from patients with dizziness indicated a pervasive multidimensional decline in SF-36 scores. This decline was most notable in terms of role limitations in the physical and emotional dimensions. The frequency of attacks of dizziness correlated with perceived disability. Patients with chronic dizziness also had great psychological distress, as measured by the HADS score, which had a detrimental influence on their QoL.

Aged↗
PubMed2005

Assessing quality of life for adolescents in Taiwan.

This study was to evaluate the psychometric properties of the Taiwanese quality of life questionnaire for adolescents and the factors affecting the quality of life of Taiwanese adolescents. The survey involved 5538 junior high school students, aged 13-15 years. An initial 90-item questionnaire was shortened to 38 items by means of principal component analyses. Quality of life assessment involved seven factors: family, residential environment, personal competence, social relationships, physical appearance, psychological well-being, and pain. The rate of missing data was low. The Cronbach alpha coefficient remained above the 0.75 threshold criterion for the global scale and seven subdomain scales. A lower quality of life score was evident for female adolescents in higher grades in school, those living with a single parent or other relatives, and those living in rural areas. This 38-item questionnaire should serve as a reliable tool for future studies.

Adolescent↗
PubMed2005

Spontaneous intracranial hypotension presenting as mental deterioration.

A 55-year-old woman had new onset of postural headache followed by change of mental status 3 weeks later. Magnetic resonance imaging (MRI) of the brain and whole spine showed typical spontaneous intracranial hypotension (SIH) findings, bilateral subdural hematoma, and cerebrospinal fluid leakage over the T7-T9. Her headache and mentality improved after epidural blood patches. Early recognition and correct diagnosis are crucial for successful treatment in patients with SIH presenting with mental confusion.

Blood Patch, Epidural↗