Cost-effectiveness of diabetic retinopathy screening for newly diagnosed type 2 diabetic patients: A nationwide population-based propensity score-matched cohort study.

AIMS: This study investigated the association between the frequency of screening for diabetic retinopathy (DR) versus the development of DR and corresponding medical expenses among patients newly diagnosed with type 2 diabetes mellitus (T2DM). METHODS: This longitudinal, population-based study used the Taiwan National Health Insurance Research Database (2004 to 2020) as a data source. Propensity score matching (PSM) (sex, age, comorbidities and concurrent medication use) was employed in the grouping of T2DM patients according to different frequency of DR screening. Outcome measures included the proportion of patients who developed DR, who received DR treatment, and the associated medical expenses and hospitalizations. RESULTS: The 17-year cohort included 337,046 patients. After PSM, three groups each containing 35,739 patients were assembled and analyzed. Compared to low-frequency screening, high-frequency screening was more effective in detecting patients requiring treatment; however, the net cost for treatment was significantly lower. Standard-frequency screening appears to provide the best balance in terms of DR detection, diagnosis interval, the risk of DR-related hospitalization, and DR treatment costs. CONCLUSIONS: In this real-world cohort study covering all levels of the healthcare system, infrequent screening was associated with delayed diagnosis and elevated treatment costs, while a fundus screening interval of 1-2 years proved optimal in terms of detection and medical expenditures.

Increased Long-Term Risk of Dementia in Patients With Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis of Cohort Studies.

OBJECTIVE: To assess whether carbon monoxide (CO) poisoning increases the incidence of dementia. METHODS: We searched the Cochrane Library, PubMed, and EMBASE from inception to 14 August 2022. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Only cohort study with an enough follow-up period was included for systematic reviews and meta-analysis. RESULTS: Thirty-three full texts were initially searched, but only three studies met our inclusion criteria, and they were comprised of 134,563 participants who were initially free of dementia. The follow-up period ranged from 9 to 12 years. We found that CO poisoning increased the risk of dementia incidence (adjusted hazard ratio 2.61, 95% confidence interval 1.56 to 4.36, p=0.0003). Subgroup analysis showed that the increased dementia risk was significant in males but not in females, and the highest risk was in young age group, followed by in middle age group, but not in the old one. CONCLUSION: Overall the evidence from prospective cohort studies supported a link between CO exposure and an increased dementia risk, although all the included studies were limited to Taiwanese population.

The association between abusive behaviour and physician-patient relations: a systematic review.

OBJECTIVE: This systematic review aims to explore the association between abusive behaviour and physician-patient relations in healthcare settings. STUDY DESIGN: Systematic review. METHODS: We searched for related studies on databases such as PubMed, Embase, and the Cochrane library, without restrictions on language, from inception until July 15, 2022. The risk of bias and the methodological quality was evaluated using the Newcastle-Ottawa Scale and Risk of Bias in Non-randomised Studies of Interventions tool. RESULTS: Ten studies were included in this systematic review, the participants of which were physicians and patients. The research from all the studies highlighted the detrimental effects of abusive behaviour on the relationship between physicians and patients, regardless of who the abusers were. CONCLUSIONS: Abusive behaviour in a clinical setting has a negative influence on the physician-patient relationship, whoever the perpetrator might be. The research sheds light on the importance of teaching communication skills to physicians and training them to manage conflicts and aggressive behaviours in healthcare settings.

Quantifying microstructures of earth materials using higher-order spatial correlations and deep generative adversarial networks.

The key to most subsurface processes is to determine how structural and topological features at small length scales, i.e., the microstructure, control the effective and macroscopic properties of earth materials. Recent progress in imaging technology has enabled us to visualise and characterise microstructures at different length scales and dimensions. However, one limitation of these technologies is the trade-off between resolution and sample size (or representativeness). A promising approach to this problem is image reconstruction which aims to generate statistically equivalent microstructures but at a larger scale and/or additional dimension. In this work, a stochastic method and three generative adversarial networks (GANs), namely deep convolutional GAN (DCGAN), Wasserstein GAN with gradient penalty (WGAN-GP), and StyleGAN2 with adaptive discriminator augmentation (ADA), are used to reconstruct two-dimensional images of two hydrothermally rocks with varying degrees of complexity. For the first time, we evaluate and compare the performance of these methods using multi-point spatial correlation functions-known as statistical microstructural descriptors (SMDs)-ultimately used as external tools to the loss functions. Our findings suggest that a well-trained GAN can reconstruct higher-order, spatially-correlated patterns of complex earth materials, capturing underlying structural and morphological properties. Comparing our results with a stochastic reconstruction method based on a two-point correlation function, we show the importance of coupling training/assessment of GANs with higher-order SMDs, especially in the case of complex microstructures. More importantly, by quantifying original and reconstructed microstructures via different GANs, we highlight the interpretability of these SMDs and show how they can provide valuable insights into the spatial patterns in the synthetic images, allowing us to detect common artefacts and failure cases in training GANs.

Early Screening for Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes and Its Effectiveness in Terms of Morbidity and Clinical Treatment: A Nationwide Population-Based Cohort.

Purpose: To characterize the association between the frequency of screening for diabetic retinopathy (DR) and the detection of DR in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods: This nationwide population-based cohort study used data from the National Health Insurance Research Database to identify adult patients who were newly diagnosed with T2DM between 2000 and 2004. Data from their follow-up Diabetic retinopathy (DR) treatments over the next 10 years following diagnosis were also analyzed. Results: The 41,522 subjects were respectively assigned to a periodic screening group (n = 3850) and nonperiodic screening group (n = 37,672). Significant differences were observed between the two groups in terms of age, Charlson Comorbidity Index (CCI), sex, DR treatment, and the prevalence of DR. The association between periodic screening and DR treatment, only the elderly, female, and patient with severe CCI status showed the significance in the further stratified analysis. Conclusion: Periodic screening (annual or biannual screening in the first 5 years) was more effective than nonperiodic screening in detecting instances of DR in the middle-to-advanced aged group but not among younger patients. Screening pattern did not have a significant effect on the likelihood of DR-related treatment during the 5-year follow-up. It appears that a tight screening schedule for the first 5 years after diagnosis with diabetes is not necessary.

Quantifying microstructural evolution via time-dependent reduced-dimension metrics based on hierarchical n-point polytope functions.

We devise reduced-dimension metrics for effectively measuring the distance between two points (i.e., microstructures) in the microstructure space and quantifying the pathway associated with microstructural evolution, based on a recently introduced set of hierarchical n-point polytope functions P_{n}. The P_{n} functions provide the probability of finding particular n-point configurations associated with regular n polytopes in the material system, and are a special subset of the standard n-point correlation functions S_{n} that effectively decompose the structural features in the system into regular polyhedral basis with different symmetries. The nth order metric Ω_{n} is defined as the L_{1} norm associated with the P_{n} functions of two distinct microstructures. By choosing a reference initial state (i.e., a microstructure associated with t_{0}=0), the Ω_{n}(t) metrics quantify the evolution of distinct polyhedral symmetries and can in principle capture emerging polyhedral symmetries that are not apparent in the initial state. To demonstrate their utility, we apply the Ω_{n} metrics to a two-dimensional binary system undergoing spinodal decomposition to extract the phase separation dynamics via the temporal scaling behavior of the corresponding Ω_{n}(t), which reveals mechanisms governing the evolution. Moreover, we employ Ω_{n}(t) to analyze pattern evolution during vapor deposition of phase-separating alloy films with different surface contact angles, which exhibit rich evolution dynamics including both unstable and oscillating patterns. The Ω_{n} metrics have potential applications in establishing quantitative processing-structure-property relationships, as well as real-time processing control and optimization of complex heterogeneous material systems.

Systematic Review of the Effect of a Zero-Markup Policy for Essential Drugs on Healthcare Costs and Utilization in China, 2015-2021.

Objective: This systematic review aimed to discuss the effects of a zero-markup policy for essential drugs (ZPED) on healthcare costs and utilization in China in the years 2015-2021. Methods: We searched the PubMed, Embase, Scopus, and CINAHL databases for all associated studies carried out from January 1, 2015, to May 31, 2021, without any limitations regarding the language the studies were written in. To prevent selection bias, gray documents were tackled by other means. The methodological approaches were assessed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Newcastle-Ottawa Scale (NOS) collaboration tool. Results: Forty studies were selected at first and then 15 studies that met the inclusion criterion. Most of the studies showed a considerable decrease in total medical spending and drug spending in both outpatient and inpatient services. After the implementation of ZPED, studies showed that the medical services increased and total hospital income sustained, despite a decrease in drug revenue. Minimal or no government subsidy is required from a financial perspective. Conclusions: Although, the government could implement ZEPD with lower medical cost and drug cost to patients, and sustained income for health facilities, we have limited understanding of whether the increase in medical services was induced by the provider or was a response to unmet needs in the population. Further, studies using rigorous and advanced methods to study health policy, patient behaviors, provider behaviors, and government decisions are warranted.

Effects of Transapical Transcatheter Mitral Valve Implantation.

Purpose: In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes. Methods: We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results. Results: We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction (n = 58) and failed annuloplasty rings (n = 14) who underwent redo SRMVR (n = 36) or TAMVI (n = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (p-value = 0.02). TAMVI patients were more severe in New York Heart Association (p-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (p-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months (p < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3-24 months. Conclusions: In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.

The Relationship Between Fragility Fractures and Pain Experience: A Systematic Review.

Purpose: This systematic review is conducted to explore the relationship between fragility fractures and pain experience. Methods: We searched for relevant studies on Pubmed, Embase, Web of Science, and the Cochrane library without restrictions on language from inception until February 4th, 2021. The risk of bias and methodological quality was evaluated using the Newcastle-Ottawa Scale and ROBINS-I tool. Results: Twenty-one studies were included in this systematic review. The so-called study reported participants with continuous post-fracture pain. The included studies showed that post- fractured pain can decrease with time, however, the continual pain can last at least 1 year even longer, and some participants would need to self-manage pain. Moreover, the limited range of motion was considered as a factor that might distress the normal development of daily activities. Conclusions: The current evidence could not fully support that pain continues to influence patients' lives after a fragility fracture. However, it still showed the pain might come with fracture. The findings also could be useful to help health care providers better recognize and manage this clinical consequence of fractures. Nonetheless, future large-scale longitudinal studies will be required to evaluate the long-term effects of pain in fragility fractures.

Personality types of patients with glaucoma: A systematic review of observational studies.

OBJECTIVES: To synthesize recent empirical research on the association between personality and glaucoma among this sub-population. METHODS: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus and ScienceDirect databases were searched to identify eligible studies published between January 1950 and March 2019 in any language. The quality of included observational studies was assessed using an 11-item checklist which was recommended by Agency for Healthcare Research and Quality (AHRQ). After using the checklist, 12 papers are included into the systematic review. RESULTS: There are some differences on the studies about the negative personality of glaucoma patients. In spite of these differences, most included studies significantly showed that glaucoma patients tend to or do have some specific personality. CONCLUSION: The extant research could demonstrate that glaucoma patients tend to have some negative personality in some extent. Future studies are needed to provide more convincing support to personality of glaucoma patients.

Clinical Effects of Baduanjin Qigong Exercise on Cancer Patients: A Systematic Review and Meta-Analysis on Randomized Controlled Trials.

OBJECTIVE: Baduanjin is a traditional Chinese Qigong exercise for health improvement. However, a few studies were examining the association between Baduanjin Qigong exercise and cancer patients. This study is conducted to explore the clinical effects of the Baduanjin Qigong exercise among cancer patients. METHODS: We conducted a systematic review and meta-analysis using randomized controlled trials to assess the effects of the Baduanjin Qigong exercise on cancer patients. We searched Cochrane Library, PubMed, Embase, and Airiti Library for all relevant studies from inception through December 31, 2020, without language limitations. Two authors independently screened selected studies, assessed the quality of included studies, and extracted information. Any disagreement was discussed with a third senior author. Summary estimates were obtained using meta-analysis with the random effects model. RESULTS: Among the fourteen articles involved in the systematic review, ten studies were included in the meta-analysis. Cancer patients with moderate-severe cancer-related fatigue were significantly less in the Baduanjin group compared with the control group (odds ratio = 0.27; 95% confidence interval (CI) [0.17, 0.42]). Three studies used the questionnaire of Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) in the assessment of quality of life, and two used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). For FACT-B, the Baduanjin group scored significantly higher than the control group (mean difference = 11.04, 95% CI [9.56, 12.53]). For EORTC QLQ-C30, the Baduanjin group scored significantly higher than the control group (mean difference = 10.57, 95% CI [7.82, 13.32]). The Pittsburgh Sleep Quality Index (PSQI) score for sleep quality of the Baduanjin group is significantly lower than the control group (mean difference = -2.89, 95% CI [-3.48, -2.30]). CONCLUSION: In conclusion, we found the Baduanjin exercise had positive clinical effects on cancer patients. This meta-analysis not only supported that the Baduanjin exercise can alleviate the degree of cancer-related fatigue in patients but also improved their quality of life and sleep quality. Further long-term follow-up randomized controlled trials are warranted.

Effect of Postoperative Adverse Events on Hospitalization Expenditures and Length of Stay Among Surgery Patients in Taiwan: A Nationwide Population-Based Case-Control Study.

Background: The current study sought to determine the incidence of postoperative adverse events (AEs) based on data from the 2006 Taiwan National Health Insurance Research Database (NHIRD). Methods: This retrospective case-control study included patients who experienced postoperative AEs in 387 hospitals throughout Taiwan in 2006. The independent variable was the presence or absence of 10 possible postoperative AEs, as identified by patient safety indicators (PSIs). Results: A total of 17,517 postoperative AEs were identified during the study year. PSI incidence ranged from 0.1/1,000 admissions (obstetric trauma-cesarean section) to 132.6/1,000 admissions (obstetric trauma with instrument). Length of stay (LOS) associated with postoperative AEs ranged from 0.10 days (obstetric trauma with instrument) to 14.06 days (postoperative respiratory failure). Total hospitalization expenditures (THEs) ranged from 363.7 New Taiwan Dollars (obstetric trauma without instrument) to 263,732 NTD (postoperative respiratory failure). Compared to patients without AEs, we determined that the THEs were 2.13 times in cases of postoperative AE and LOS was 1.72 times higher. Conclusions: AEs that occur during hospitalization have a major impact on THEs and LOS.

The occurrence of delayed neuropsychologic sequelae in acute carbon monoxide poisoning patients after treatment with hyperbaric or normobaric oxygen therapy.

ABSTRACT: This study aimed at assessing which one of the 2 therapies is better for treating carbon monoxide (CO) poisoning from the perspective of reducing delayed neuropsychologic sequelae (DNS).We used Taiwan's National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess which therapy is better for CO poisoning patients. To accurately identify patients with DNS, the definition of DNS is included neurological sequelae, and cognitive and psychological sequele. The independent variable was therapy and the dependent variable was DNS occurred within 1 year after discharge from a medical institution. The control variables were age, gender, the severity of CO poisoning, and comorbidities present before CO poisoning admission.The risk of developing DNS in patients treated with Hyperbaric Oxygen (HBO) was 1.87-fold (P < .001) than normobaric oxygen (NBO) therapy. The severity of CO poisoning and comorbidities were also found to have significant influences on the risk of developing DNS.HBO may be a risk therapy for treating CO poisoning.

Association Between Asthma and Migraine: A Systematic Review and Meta-Analysis of Observational Studies.

Objectives: The purpose of this study was to determine the association between asthma and migraine and assess the risk for migraine in patients with asthma. Methods: We systematically searched the Cochrane Library, PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Excerpta Medica dataBASE (EMBASE) databases from inception to September 26, 2021, for indexed observational studies that examined either the odds or risk of migraine in subjects with asthma. The qualities of the included studies were evaluated using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to calculate the odds ratio for case-control and cross-sectional studies and the risk ratio for cohort studies. Results: Seven observational studies (four cross-sectional and three cohort studies) with a total of 549,534 study subjects were included in this systematic review and meta-analysis and selected for data extraction. Four articles were considered to be of moderate quality; other studies were considered to be of high quality. Asthma was associated with increased odds (OR, 1.85; 95%CI, 1.39-2.45) and risk of migraine (RR, 1.70; 95%CI, 1.52-1.90). Conclusions: The available evidence that supports the existence of an association between asthma and migraine is limited. Clinicians should be aware that patients with asthma show both increased prevalence and incidence of migraine. Further studies are warranted to further clarify the relationship between asthma and migraine. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185881, identifier: CRD42020185881.

Characterizing spatiotemporal progression and prediction of infarct lesion volumes in experimental acute ischemia using quantitative perfusion and diffusion imaging.

PURPOSE: This study was conducted to explore the diagnostic value of arterial spin labeling (ASL) combined with diffusion weighted imaging (DWI) in characterizing the spatiotemporal progression of infarct lesions in a rabbit middle cerebral artery occlusion (MCAO) model and predicting the acute cerebral infarction (ACI) volume. MATERIALS AND METHODS: Forty-two male rabbits (2.9 ± 0.2 kg body weight) were used in this experimental study. Animals were initially anesthetized by intravenous injection of uratan. There were seven experimental groups with six rabbits in each group. The apparent diffusion coefficient (ADC) and cerebral blood flow (CBF) thresholds were established in the control group (n = 6), which were sacrificed at 12 h, stained for infarct volume, and imaged at each time point. RESULTS: The normal ADC and CBF were estimated as 0.90 ± 0.03 × 10-3 mm2/s and 0.68 ± 0.06 mL g-1 min-1, respectively. The viability thresholds of ADC and CBF yielding the lesion volumes (LVs) at 3 h, which best approximated the 2,3,5-triphenyltetrazolium chloride (TTC) infarct volumes at 12 h, were 0.52 ± 0.02 × 10-3 mm2/s (42.2 ± 3% reduction) and 0.33 ± 0.09 mL g-1 min-1 (51.0 ± 11% reduction), respectively. The temporal evolution of the ADC- and CBF-defined LVs showed a significant perfusion/diffusion mismatch up to 1 h (p = 0.001). CONCLUSION: ADC values and ACI volumes were positively correlated, while CBF was negatively correlated, which is supposed to be a reference for predicting ACI volume.

Constructing a new health education model for patients with chronic hepatitis B.

To explore the effects of the project-achievement quality control circle in constructing a new health education model for patients with chronic hepatitis B.The quality control circle group was established and the theme of "constructing a new health education model for patients with chronic hepatitis B" was selected. The circle staff determined that this quality control circle was of project-achievement according to the quality control story judgment table, and then carry out activities in strict accordance with the 10 steps of project-achievement quality control circle, evaluate the tangible results and non-tangible results before and after the activity.After the implementation of the activity, the health education integrity of patients with chronic hepatitis B increased from 74.75 ±â€Š11.00 to 95.00 ±â€Š5.55 points (P < .001). The awareness of health education increased from 71.90 ±â€Š13.48 to 95.60 ±â€Š2.84 points (P < .001), the satisfaction rate of health education increased from 76.60 ±â€Š8.71 points to 98.00 ±â€Š2.03 points (P < .001), and the evaluation rate after health education increased from 10% to 100% (P < .001).The circle members have much more confidence in quality control circle activities, the use of techniques, and the knowledge related to scientific research.

Probing information content of hierarchical n-point polytope functions for quantifying and reconstructing disordered systems.

Disordered systems are ubiquitous in physical, biological, and material sciences. Examples include liquid and glassy states of condensed matter, colloids, granular materials, porous media, composites, alloys, packings of cells in avian retina, and tumor spheroids, to name but a few. A comprehensive understanding of such disordered systems requires, as the first step, systematic quantification, modeling, and representation of the underlying complex configurations and microstructure, which is generally very challenging to achieve. Recently, we introduced a set of hierarchical statistical microstructural descriptors, i.e., the "n-point polytope functions" P_{n}, which are derived from the standard n-point correlation functions S_{n}, and successively included higher-order n-point statistics of the morphological features of interest in a concise, explainable, and expressive manner. Here we investigate the information content of the P_{n} functions via optimization-based realization rendering. This is achieved by successively incorporating higher-order P_{n} functions up to n=8 and quantitatively assessing the accuracy of the reconstructed systems via unconstrained statistical morphological descriptors (e.g., the lineal-path function). We examine a wide spectrum of representative random systems with distinct geometrical and topological features. We find that, generally, successively incorporating higher-order P_{n} functions and, thus, the higher-order morphological information encoded in these descriptors leads to superior accuracy of the reconstructions. However, incorporating more P_{n} functions into the reconstruction also significantly increases the complexity and roughness of the associated energy landscape for the underlying stochastic optimization, making it difficult to convergence numerically.

A population-based study of the association between hemodialysis and cognitive impairment.

INTRODUCTION: End-stage renal disease is a serious public health issue. The objective of this retrospective cohort study was to assess the association between hemodialysis and cognitive impairment, while controlling for age, sex, residence, and comorbidities. METHODS: This study assesses the risk of cognitive impairment among a nationwide cohort of new hemodialysis patients derived from the NHIRD. RESULTS: A total of 4330 patients were assigned to the dialysis group and 17 320 patients were assigned to the control group. A total of 2103 of the patients developed cognitive impairment within 2 years after the date of dialysis initiation. Patients who developed cognitive impairment were older (69.85 ± 11.56) than their counterparts who did not develop cognitive impairment (58.58 ± 14.77; P < .001). The log-rank test of Kaplan-Meier analysis revealed a higher risk of cognitive impairment in the hemodialysis group than in the non-hemodialysis group (P < .001). The interval between dialysis initiation and the onset of cognitive impairment was 98.66 ± 46.39 months among non-dialysis subjects and 53.45 ± 41.90 months among dialysis subjects, and the between-group difference was significant (P < .001). The Cox Proportional Hazard Model revealed that after controlling for gender, age, residence, and comorbidities, hemodialysis was shown to have a significant impact on cognitive impairment (Hazard Ratio [HR]: 1.44; 95% confidence interval [CI]: 1.29-1.60). Furthermore, the risk of developing cognitive impairment increased with age (HR: 1.07; 95% CI: 1.06-1.08). DISCUSSION: Hemodialysis was associated with cognitive impairment. There was a significant association between age and cognitive impairment, regardless of the comorbidities prior to hemodialysis. There was no evidence of an association between comorbidities and cognitive impairment after beginning hemodialysis.

Correlation between potentially inappropriate medication and Alzheimer's disease among the elderly.

PURPOSE: This study is conducted to explore the association between potentially inappropriate medication (PIM) and Alzheimer's disease (AD) among the elderly. METHODS: We used Taiwan's National Health Insurance Research Database (NHIRD) to conduct a nationwide case-control study. Elderly individuals (over 65 years of age) who had been diagnosed with AD (ICD-9-CM: 331.0) for the first time in 2011 were selected as subjects for the case group. A control group was formed by selecting elderly patients without AD using 1:1 propensity score matching. Control variables included sex, age, health status, and 31 Elixhauser comorbidities. All analyses were performed using the Resource Utilization Band (Adjusted Clinical Groups software). All health utilization data associated with PIM were traced back for a period of 5 years. We examined the odds ratio (OR) and 95% confidence interval (CI) for PIM in relation to AD. RESULTS: We identified 5264 patients with AD (case group) and 5264 non-AD controls. After adjustment for confounding factors, proportion of all PIM (adjusted OR: 1.006, 95%CI: 1.002-1.010, p-value = 0.009) was significantly associated with AD. CONCLUSION: In conclusion, we observed a significant positive correlation between PIM and AD among elderly population.

Risk for Suicidal Behavior Among Psoriasis Patients: A Nationwide Cohort Study.

BACKGROUND: The link between psoriasis and suicidality remains elusive and understudied. OBJECTIVE: The aim was to assess the risk of suicidal behavior in psoriasis patients. METHODS: We used Taiwan's National Health Insurance Research Database to conduct a nationwide retrospective cohort study to examine the risk for suicidal behavior among psoriasis patients. We performed subgroup analyses based on the severity of psoriasis and psoriatic arthritis. RESULTS: We included 169,909 psoriasis patients (including 13,959 with concomitant psoriatic arthritis and 155,950 with psoriasis alone) and 169,909 matched nonpsoriasis controls. Suicidal behavior occurred in 104 and 89 subjects in the psoriasis group and nonpsoriasis controls, respectively; we found no significantly increased risk for suicidal behavior among psoriasis patients when compared to nonpsoriasis controls [adjusted hazard ratio (HR) 1.17, 95% confidence interval (CI) 0.88‒1.55]. The subgroup analysis showed no significantly increased risk for suicidal behavior in both the severe psoriasis group (adjusted HR 0.92, 95% CI 0.51-1.64) and the mild psoriasis group (adjusted HR 1.26, 95% CI 0.91‒1.75) when compared to nonpsoriasis controls. Also, we found no significant increased risk for suicidal behavior in the group of psoriasis patients who also had psoriatic arthritis (adjusted HR 2.00, 95% CI 0.68‒5.85) and in the group of patients with psoriasis alone (adjusted HR 1.12, 95% CI 0.83‒1.50) when compared to nonpsoriasis controls. CONCLUSION: In a Taiwanese setting, no link between psoriasis or psoriatic arthritis and suicidal behavior was detected.