Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia.

INTRODUCTION: People with dementia have high rates of hospitalization, and a share of these hospitalizations might be avoidable with appropriate ambulatory care, also known as potentially preventable hospitalization (PAH). This study investigates the associations between continuity of care and healthcare outcomes in the following year, including all-cause hospitalization, PAHs, and healthcare costs in patients with dementia. METHODS: This is a longitudinal retrospective cohort study of 69,658 patients with dementia obtained from the Taiwan National Health Insurance Research Database. The Continuity of Care Index (COCI) was calculated to measure the continuity of dementia-related visits across physicians. The PAHs were classified into five types as defined by the Medicare Ambulatory Care Indicators for the Elderly (MACIEs). Logistic regression models were used to examine the effect of COCI on all-cause hospitalizations and PAHs, while generalized linear models were used to analyze the effect of COCI on outpatient, hospitalization, and total healthcare costs. RESULTS: The high COCI group was significantly associated with a lower likelihood of all-cause hospitalization than the low COCI group (OR = 0.848, 95%CI: 0.821-0.875). The COCI had no significant effect on PAHs but was associated with lower outpatient costs (exp(ß) = 0.960, 95%CI: 0.941 ~ 0.979), hospitalization costs (exp(ß) = 0.663, 95%CI: 0.614 ~ 0.717), total healthcare costs (exp(ß) = 0.962, 95%CI: 0.945-0.980). CONCLUSION: Improving continuity of care for dementia-related outpatient visits is recommended to reduce hospitalization and healthcare costs, although there was no statistically significant effect of continuity of care found on PAHs.

Increased risk of rheumatoid arthritis among patients with endometriosis: a nationwide population-based cohort study.

OBJECTIVES: Autoimmunity may play a role in endometriosis. The association between endometriosis and RA remains unknown. This study was conducted to identify any evidence for this relationship. METHODS: This 13-year, nationwide, population-based, retrospective cohort study analysed the risk of RA in a cohort of individuals with endometriosis. We investigated the incidence of RA among patients with endometriosis using data from the Longitudinal Health Insurance Database 2000, which is maintained by the Taiwan National Health Research Institutes. We used propensity scores to match comorbidities in the two cohorts. Kaplan-Meier analysis and Cox proportional hazard model were employed to analyse the association between endometriosis and RA among patients with different potential risks. RESULTS: Patients with endometriosis [adjusted hazard ratio (HR) 1.75, 95% CI 1.27, 2.41], aged ≥45 years (adjusted HR 1.50, 95% CI 1.06-2.13) and with autoimmune disease (adjusted HR 6.99, 95% CI 2.84-17.21) had a significantly higher risk of RA. The analyses also showed that when stratified by age, comorbidities and medication use, the risk of RA in patients with endometriosis was also higher than in those without endometriosis. CONCLUSIONS: This 14-year, nationwide, population-based retrospective cohort study revealed that patients with endometriosis have a higher risk of RA. In the clinical management of patients with RA, rheumatologists should be especially mindful of the possibility of underlying endometriosis.

Risk of Breast Cancer in Females With Hypothyroidism: A Nationwide, Population-Based, Cohort Study.

OBJECTIVES: The results of studies investigating the relationship between breast cancer and hypothyroidism vary greatly from study to study. In this study, we analyzed a large and reliable, population-based database to gain a better understanding of the correlation. METHODS: This retrospective cohort study analyzed patients with hypothyroidism between January 1, 2000 and December 31, 2012 (hypothyroidism cohort) from the Longitudinal Health Insurance Database 2000 in Taiwan. For each woman with hypothyroidism, 1 woman without a history of breast cancer was randomly selected from the Longitudinal Health Insurance Database 2000 and frequency matched (1:4) with women without hypothyroidism by age and index year of hypothyroidism. The study outcome was the diagnosis of breast cancer during a 12-year follow-up period. RESULTS: In this study, 6665 women with hypothyroidism and 26 660 women without hypothyroidism were identified. The hypothyroidism cohort had a significantly higher risk of breast cancer than the nonhypothyroidism cohort (adjusted hazard ratio [aHR] 1.69 [95% CI, 1.15-2.49]; P = .01), especially in the group aged 40 to 64 years (aHR 2.07 [95% CI, 1.32-3.23]; P = .01). Women in the hypothyroidism cohort taking levothyroxine for a duration ˃588 days showed a significantly decreased risk of breast cancer (aHR 0.37 [95% CI, 0.19-0.71]; P = .003). CONCLUSION: Women with hypothyroidism are at a higher risk of breast cancer than those without hypothyroidism. Levothyroxine may reduce the risk of breast cancer in a woman with hypothyroidism.

Risk of ankylosing spondylitis following human papillomavirus infection: A nationwide, population-based, cohort study.

OBJECTIVE: To assess the incidence rate and risk of ankylosing spondylitis (AS) in patients with previous human papillomavirus (HPV) infection compared with those without HPV infection. METHODS: All patients with HPV infection (n = 66,314) in the NHIRD (2003-2013) were individually matched with up to four control subjects without HPV infection by age and sex (n = 265,256). All of the patients were tracked until an AS event was noted. Chi-square test was used to analyze the distribution of sociodemographic characteristics in the HPV cohort and non-HPV cohort. Cox proportional hazards regression was used to calculate the HRs for the development of AS, adjusting for age, sex, urbanization, length of hospital stay, medications, and comorbidities adjustment. The Kaplan-Meier method was used to plot the cumulative incidence curves. RESULTS: The HPV cohort had a 1.329 (95% C.I. = 1.138-1.552) times higher risk of AS than that of the non-HPV cohort after adjusting for sex, age, urbanization, length of hospital stay, comorbidities, and medications. Additionally, we applied propensity score weighting to reconfirm the accuracy of our analysis, and the results showed a 1.348 (95% C.I. = 1.153-1.575) times greater risk of AS in the HPV cohort compared with the non-HPV cohort. The cumulative incidence curves plotted by the Kaplan-Meier method revealed that after 120 follow-up months, the HPV cohort displayed a higher cumulative incidence of AS than that of the non-HPV cohort. (Log-rank test p < 0.0001). CONCLUSIONS: Patients with HPV infection had a higher risk of developing AS compared with non-HPV patients.

Birth defects in Taiwan: A 10-year nationwide population-based, cohort study.

BACKGROUND/PURPOSE: Birth defects (BDs) are main causes of mortality and disability in infants and children. The aims of this study were to analyze the prevalence, types and risk factors of BDs in Taiwan. METHODS: Data of all births (including live and stillbirths), types, characteristics, and associated risk factors of BDs were obtained from the National Birth Registry and National Health Insurance Research Data base in Taiwan between 2005 and 2014. Birth defects were coded according to International Classification of Diseases 9th Revision-Clinical Modification codes 740-759. RESULTS: A total of 55,299 infants were diagnosed as having BDs among 2,033,004 births. The prevalence of BDs was 271.66 per 10,000 births. The prevalence of BDs did not change significantly between 2005 and 2014, there was a higher birth rate and lower BDs in 2012 (year of dragon) in Taiwan. The most common type of BDs was cardiovascular abnormalities, and ventricular septal defect was the most common disease. Extreme maternal age (<18 years or ≧30 years), preterm, and low birth weight were associated with BDs. Maternal diseases associated with BDs included hypertension, cardiovascular diseases, renal diseases, genitourinary infections, anemia, mental disorders, and diabetes mellitus. CONCLUSION: The prevalence of BDs was 271.66 per 10,000 births. The most common types of BDs were cardiovascular abnormalities. If we can reduce maternal chronic diseases, we will decrease the prevalence of BDs.

Perceived pain for orthodontic patients with conventional brackets or self-ligating brackets over 1 month period: A single-center, randomized controlled clinical trial.

BACKGROUND/PURPOSE: The objective of this 2-arm parallel trial was to test the superiority of self-ligating brackets (SLB) over conventional brackets (CB) in terms of perceived pain for orthodontic patients. METHODS: Patients about to undergo treatment were included to fixed appliance placed with CB or SLB. Eligibility criteria included malocclusion patients whose age between 12 to 40 years and suitable for orthodontic fixed appliance treatment. The main outcome was pain intensity measured by visual analog scale (VAS) with all patients followed at 4 h, 24 h, 3 days, 1 week and 1 month. Randomization was accomplished with a computer-generated list of random numbers. Blinding was applicable for outcome assessment only. Data were analyzed using multi-level nonlinear mixed effect model, Friedman's test and Wilcoxon signed rank test with the Bonferroni correction for multiple tests. RESULTS: Eight-eight patients were randomized in a 1:1 ratio to either SLB or CB. All patients completed the study, and none were lost to follow-up. There were no drop-outs after randomization. Baseline characteristics were similar between groups. The is no statistical significant difference in pain intensity between CB and SLB at 4 h, 24 h, 3 days, 1 week and 1 month. Data were analyzed on an intention-to-treat basis. No serious harm was observed. CONCLUSION: The results of this study indicated no evidence that the pain intensity differs between CB and SLB at 4 h, 24 h, 3 days, 1 week and 1 month.

Early cardiovascular risk and all-cause mortality following an incident of severe hypoglycaemia: A population-based cohort study.

AIMS: Severe hypoglycaemia is associated with a high risk of cardiovascular events in patient with diabetes. The aim of this study was to clarify the temporal relationship between hypoglycaemia and cardiovascular events. MATERIALS AND METHODS: This observational cohort study was conducted using Taiwan's Longitudinal Cohort of Diabetes Patients Database, which included 360 000 patients with newly diagnosed diabetes during the period 1999 to 2001. Patients with the first severe hypoglycaemia after 2002 served as the study cohort. Each patient in the study cohort was matched with two control patients without severe hypoglycaemia, based on a propensity score. A joinpoint regression model was used to determine trends in all-cause mortality and incidence of cardiovascular disease (CVD) events in both cohorts. RESULTS: A total of 10 157 patients with severe hypoglycaemia and 20 314 matched controls were recruited. Patients with severe hypoglycaemia had a significantly higher risk of CVD (HR, 7.28; 95% CI, 5.19-10.20) and all-cause mortality (HR, 19.92; 95% CI, 13.42-29.56) during the first month compared with those without. In patients with severe hypoglycaemia, the incidence of CVDs dropped by 17.29% monthly during the first 4 months and slowly decreased (-0.67%) during subsequent months. All-cause mortality decreased by 16.55% and 3.24% monthly during months 0-6 and months 6-17, respectively. CONCLUSIONS: Severe hypoglycaemia is associated with a greater risk of cardiovascular events and death, especially during the first month following a hypoglycaemic episode. Patients prone to severe hypoglycaemia should be made aware of the elevated risk of subsequent cardiovascular events.

Etoricoxib and Diclofenac Might Reduce the Risk of Dementia in Patients with Osteoarthritis: A Nation-Wide, Population-Based Retrospective Cohort Study.

INTRODUCTION: This population-based cohort study investigates the association between osteoarthritis (OA) and dementia as well as the connection between NSAIDs and dementia. METHODS: We chose the samples from the Taiwan Longitudinal Health Insurance Database and then divided them into two groups, which were then matched 1: 1 by propensity score. The first group was the OA group that contained patients with newly diagnosed OA and the second group was the non-OA group. We used the χ2 test, Student t test, Kaplan-Meier analysis, and Cox proportional hazard model for different purposes. RESULTS: The prevalence of dementia in the OA group was higher than that in the non-OA group. The adjusted hazard ratio of the former was 1.42 (95% CI, 1.30-1.54). We also found that etoricoxib and diclofenac might reduce the incidence of dementia. CONCLUSION: Patients with OA might have a higher risk of dementia. Both etoricoxib and diclofenac might lower the risk of dementia in patients with OA.

THE TRENDS OF HYPERTHYROIDISM TREATMENT IN TAIWAN: A NATIONWIDE POPULATION-BASED STUDY.

OBJECTIVE: Few studies on hyperthyroidism treatment have been reported in the past 3 decades. We used a nationwide population-based database to evaluate the current practices and management of hyperthyroidism in Taiwan. METHODS: This retrospective study included a random selection of 1 million people in Taiwan between 2004 and 2010. We identified patients with hyperthyroidism who received antithyroid drugs (ATD), radioactive iodine (RAI), or surgery. We calculated the proportions and treatment trends of those 3 treatment options annually. A Poisson regression model was used to determine whether trends changed. RESULTS: The prevalence of overt hyperthyroidism in Taiwan steadily increased from 2,666 (0.27%) in 2004 to 3,464 (0.37%) in 2010. The incidence of hyperthyroidism (per 1,000 persons) also increased from 0.97 in 2004 to 1.06 in 2010. The major proportion of hyperthyroidism in this study was Graves disease (95%), followed by toxic nodular goiter (2%), and other causes (3%). ATD is the most commonly used (96-97%) treatment for hyperthyroidism, followed by surgery (2-3%) and RAI (<1%). There was a significant decreasing trend for surgery, from 2.9% in 2004 to 2% in 2010, especially in female patients (3.3% in 2004 to 2.3% in 2010, P<.01) and patients younger than 40 (3.8% in 2004 to 2.9% in 2010, P<.01). Meanwhile, the proportions of ATD and RAI remained unchanged. The most common ATD prescription was methimazole (45-50%), followed by propylthiouracil (30-32%) and carbimazole (19-21%). CONCLUSION: Between 2004 and 2010, ATD was the treatment of choice in Taiwan, followed by surgery and RAI. ABBREVIATIONS: ATA = American Thyroid Association; ATD = antithyroid drug; LHID2005 = Longitudinal Health Insurance database 2005 dataset; NHI = National Health Insurance; RAI = radioactive iodine.

Hydroxychloroquine may be associated with reduced risk of coronary artery diseases in patients with rheumatoid arthritis: A nationwide population-based cohort study.

OBJECTIVES: The aim of this study was to determine whether hydroxychloroquine (HCQ) usage is associated with incidental risk of coronary artery diseases (CAD) in patients with rheumatoid arthritis (RA). METHODS: The Longitudinal Health Insurance Database in Taiwan was used. The study cohort comprised of 1104 newly diagnosed RA patients between 2001-2010, and patients were followed until 31 December 2011. Patients with history of CAD before RA diagnosis were excluded. We define as HCQ users if the usage duration of HCQ>180 days and non-users if less than 90 days. After propensity score matching of age, sex, index date and comorbidities, the study cohort was comprised of 346 patients: 173 HCQ users and 173 non-users. The study outcome was incidence of CAD. Cox regression model was used to estimate the hazard ratio (HR) of disease after controlling for demographic, other comorbidities and drugs. We also evaluate the effects of HCQ use and CAD events on different characteristics of RA patients. RESULTS: Kaplan-Meier curves comparing the HCQ users and non-users revealed a statistical significant difference (P value of log-rank test <.001). The adjusted HR for HCQ users versus non-users for CAD events was 0.32 (95% CI, 0.18-0.56, P value <.01) over up to 10 years of follow-up. The adjusted HR (95% CI) of CAD for different age group, gender and other subgroups showed no effect of interaction among each subgroup analysis parameter. CONCLUSIONS: This study revealed association of decreased CAD risk in RA patients taking HCQ. The protective effect of HCQ on CAD is consistent regarding subgroup analysis on age, gender and different comorbidities groups.

The effect of benzodiazepine and nonbenzodiazepine prescriptions for diabetes mellitus type 2 in elderly Taiwanese with depressive symptoms.

BACKGROUND: This study examined the relationship between depression, benzodiazepine (BZD)/nonbenzodiazepine hypnotics (non-BZD), and other risk factors in a national sample of Taiwan's elderly diabetic patients. METHODS: Data were drawn from the 2005 Taiwan National Health Interview Survey and adults aged 65 years and older. A total of 1331 subjects were included in this study. The Chinese version of Center for Epidemiologic Studies Depression Scale was used to evaluate patients' depression symptoms. RESULTS: The rates of depression in the diabetes mellitus (DM) and non-DM groups were 13.5% (39/288) and 9.8% (102/1043) and the average ages were 73.7 and 73.4 years, respectively. In multivariate regression, the odds ratio of depression was 1.66-fold higher among BZD/non-BZD users (95% confidence interval: 1.10-2.51, model 2) than among those without BZD/non-BZD use. In addition, hyperlipidaemia, poor physical function, and antidepressant use were associated with a higher risk of depressive symptoms. Meanwhile, a monthly household income of NT$30 000-NT$49 999, exercise, and betel chewing were associated with a lower risk of depression. We performed an additional logistic analysis for which the odds ratio of depression significantly increased to 1.52 in non-DM elderly patients (95% confidence interval: 1.06-2.19) who were prescribed BZD/non-BZD. In contrast, there was no significant difference in the odds ratio of depression in the DM elderly regardless of BZD/non-BZD use, although there was a slight tendency for depression among those who used BZD/non-BZD. CONCLUSION: Depression in non-DM Taiwanese elderly patients was found to be associated with BZD/non-BZD use, whereas depression in DM Taiwanese elderly patients was not found to be associated with BZD/non-BZD use.

Modifiable Lifestyle Behaviors Are Associated With Metabolic Syndrome in a Taiwanese Population.

PURPOSE: To explore associations between metabolic syndrome and modifiable lifestyle behaviors among the adult population in Taiwan. DESIGN: This cross-sectional study analyzed data from a nationally representative sample that participated in the 2005-2008 Nutrition and Health Survey in Taiwan. The sample (2,337 participants older than 19 years) provided data on demographic characteristics, modifiable lifestyle behaviors, anthropometric measurements, and blood chemistry panel. METHODS: These data were analyzed by descriptive statistics, univariate logistic regression, and multivariate logistic regression to determine factors associated with metabolic syndrome. FINDINGS: Metabolic syndrome had a prevalence of 25.2%, and this prevalence increased with age. In univariate regression analysis, metabolic syndrome was associated with age, living with family members, educational level, and modifiable lifestyle behaviors (smoking, drinking, betel quid chewing, and physical activity). Individuals with a smoking history and currently chewing betel quid had the highest risk for metabolic syndrome. CONCLUSIONS: The risk for metabolic syndrome might be reduced by public health campaigns to encourage people to quit smoking cigarettes and chewing betel quid. Implementing more modifiable lifestyle behaviors in daily life will decrease metabolic syndrome in Taiwan. CLINICAL RELEVANCE: Considering that betel quid chewing and tobacco smoking interact to adversely affect metabolic syndrome risk, public health campaigns against both behaviors seem to be a cost-effective and efficient health promotion strategy to reduce the prevalence rate of metabolic syndrome.

Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study.

BACKGROUND: Although supportive care is the mainstay management for acute bronchiolitis, non-evidence-based diagnostic testing and medications remain common in emergency departments (EDs). OBJECTIVE: Our aim was to compare emergency physicians (EPs) and pediatricians practice patterns in the management of acute bronchiolitis in the ED. METHODS: A cross-sectional study was conducted by using registration and claims datasets from 2008 to 2011. Patients with acute bronchiolitis were divided into EP group and pediatrician group. RESULTS: A total of 2174 patients were enrolled. The diagnostic tests used, including chest x-ray (63.7% vs. 46%; adjusted odds ratio [OR] = 2.27; 95% CI 1.77-2.91), complete blood count (33.2% vs. 21.8%; adjusted OR = 1.74; 95% CI 1.33-2.26), C-reactive protein (35.1% vs. 22.6%; adjusted OR = 1.79; 95% CI 1.38-2.33), blood culture (23.9% vs. 14.3%; adjusted OR = 1.79; 95% CI 1.33-2.39), and arterial blood gas (3.7% vs. 1.8%, adjusted OR = 2.38; 95% CI 1.21-4.67), were higher in the EP group than in the pediatrician group. Intravenous fluid administration was also higher in the EP group (20.8% vs. 3.5%; adjusted OR = 7.49; 95% CI 5.12-10.8). In addition, EPs more frequently arranged for hospital admissions (36% vs. 19.5%; adjusted OR = 2.51; 95% CI 1.15-3.26). CONCLUSIONS: Both EPs and pediatricians had high rates of ordering diagnostic testing for acute bronchiolitis patients in ED. Compared with pediatricians, EPs used more diagnostic tests for the patients with acute bronchiolitis in ED.

Benzodiazepine & nonbenzodiazepine prescriptions for Taiwanese elderly with type 2 diabetes contributes to cognitive dysfunction.

BACKGROUND: This study examined the relationship of cognitive function and benzodiazepine/nonbenzodiazepine hypnotics (BZD/nonBZD) and other risk factors in a national sample of Taiwan's elderly diabetic patients. METHODS: Data were drawn from the "2005 Taiwan National Health Interview Survey (NHIS)", a population-based study of a national sample of adults aged 65 years and older. A total of 653 participants were included in this study. The Mini-Mental State Examination (MMSE) was used to evaluate patient's cognitive function for which the cut-off score is education-adjusted. RESULTS: There were 130 participants left in the diabetic group and 523 participants in the control group. The average age was 74.2 and 73.3 respectively. The rate of cognitive dysfunction in DM and non DM participants was 11.5% (15/130) and 8.4% (44/523). Compared with those without diabetes in multivariate logistic regression, the odds ratio of cognitive impairment was 1.87-fold higher for diabetic patients (95% CI 1.04-3.61) after adjusting for sociodemographic characteristics, comorbidities, and BZD/nonBZD. Other factors were not significant. We performed an additional logistic analysis for which the odds ratio of cognitive impairment in diabetic patients with BZD/nonBZD was significantly increased to 2.41 (95% CI 1.08-5.40) than for patients without diabetes and BZD/nonBZD. CONCLUSION: In our research, cognitive dysfunction was associated with diabetes. BZD/nonBZD may have conferred additional risk of cognitive impairment in our elderly diabetic patients. We should consider examining the mental function of DM patients regularly and try our best to avoid potentially inappropriate medications (PIMs).

General anesthesia is not associated with dementia in older adults with osteoarthritis for hip/knee replacements, a national population-based nested case-control study.

BACKGROUND: Dementia is a prevalent neurological condition, yet the relationship between dementia and general anesthesia remains uncertain. The study aimed to explore the association between general anesthesia and dementia using a nationwide population-based database. METHODS: The study extracted data from Taiwan's national health insurance, which encompassed the records of one million insured residents. A total of 59,817 patients aged 65 years and above, diagnosed with osteoarthritis between 2002 and 2010, were included. Among these patients, 3277 individuals with an initial diagnosis of dementia between 2004 and 2013 were matched with non-dementia patients based on age, gender, and the date of osteoarthritis diagnosis. Following a 1:2 random matching, the case group included 2171 patients with dementia, while the control group consisted of 4342 patients without dementia. The data was analyzed using conditional and unconditional logistic regressions. RESULTS: No significant differences in the odds of dementia were found between individuals exposed to general and regional anesthesia during hip/knee replacement surgeries (OR = 1.11; 95%CI: 0.73-1.70), after adjusting for age, sex, and co-morbidities. Similarly, there were no significant differences in the odds of dementia based on different durations of anesthesia exposure (General: <2 h: OR = 0.91, 95%CI = 0.43-1.92; 2-4 h: OR = 1.21, 95%CI = 0.82-1.79; >4 h: OR = 0.39, 95%CI = 0.15-1.01; compared to no exposure. Regional: <2 h: OR = 1.18, 95%CI = 0.85-1.62; 2-4 h: OR = 0.9, 95%CI = 0.64-1.27; >4 h: OR = 0.55, 95%CI = 0.15-1.96; compared to no exposure). Likewise, no significant differences were observed in the odds of dementia based on the number of replacement surgeries (twice: OR = 0.74, 95%CI = 0.44-1.23, compared to once). CONCLUSION: Neither general anesthesia nor regional anesthesia in hip/knee surgery was associated with dementia. Different numbers and durations of anesthesia exposure showed no significant differences in the odds for dementia.

[Associations between stigma perception and stigma coping behavior and quality of life in schizophrenic patients treated at a community rehabilitation center].

BACKGROUND: Quality of life (QOL) is a critical issue in mental health care. The associations between quality of life and schizophrenia patients' stigma perception and stigma coping behavior are not well understood. PURPOSE: This study investigated quality of life in schizophrenia patients. METHODS: We used a cross-sectional, correlational research design; enrolled 119 individuals diagnosed with schizophrenia as participants; and used instruments including a demographics datasheet, perceived stigma scale, stigma coping behavior scale, and the World Health Organization quality of life scale, brief version to collect data. Data were analyzed using SPSS 12.0 for Windows software. RESULT: (1) Participants had an average QOL index score of 62.40, indicating moderate quality of life; (2) Long working hours, holding rehabilitation-related employment, and receiving social welfare support correlated with lower QOL; (3) Marital issues had the greatest impact on quality of life, with participants who chose secrecy ÷ concealment reporting generally better QOL; (4) Social welfare support, number of working hours, stigma perception, stigma coping, level of job satisfaction, and level of salary satisfaction together accounted for 48.8% of total QOL variance. CONCLUSIONS: Findings increase our understanding of the influence of socio-demographics, stigma perception, and stigma coping behavior on quality of life in individuals with schizophrenia. Greater community involvement in schizophrenia treatment programs can enhance patient satisfaction with their jobs and lives.

Perinatal Factors in Newborn Are Insidious Risk Factors for Childhood Autism Spectrum Disorders: A Population-based Study.

We analyzed claims data from the Taiwan National Health Insurance database, which contains data of 23.5 million Taiwan residents. We included children born after January 1, 2000 who had received a diagnosis of autism spectrum disorders (ASD). Patients who were not diagnosed with ASD were included in the control group. The ASD prevalence was 517 in 62,051 (0.83%) children. Neonatal jaundice, hypoglycemia, intrauterine growth retardation (IUGR), and craniofacial anomalies (CFA) differed significantly between the ASD and control groups. After logistic regressive analysis, the adjusted odds ratios of IUGR, CFA, neonatal hypoglycemia, and neonatal jaundice were 8.58, 7.37, 3.83, and 1.32, respectively. Those insidiously perinatal risk factors, namely CFA, IUGR, neonatal hypoglycemia, and neonatal jaundice, could increase the risk of ASD.

Association of Permanent Vascular Access Dysfunction with Subsequent Risk of Cardiovascular Disease: A Population-Based Cohort Study.

A functional permanent vascular access (VA) is required to perform a successful hemodialysis procedure. Hemodialysis VA dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. Cardiovascular disease (CVD) is the leading cause of death in patients receiving chronic hemodialysis. Information about CVD associated with hemodialysis VA dysfunction is unclear. We analyzed the association between dialysis VA dysfunction and the risk of developing CVD in hemodialysis patients. This nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. One million subjects were sampled from 23 million beneficiaries and data was collected from 2000 to 2013. Patients with end-stage renal disease who had received permanent VA construction and hemodialysis and were aged at least 20 years old from 2000 to 2007 were included in the study population. The primary outcome was CVD, as defined by ICD-9-CM codes 410-414 and 430-437. A total of 197 individuals with permanent VA dysfunction were selected as the test group, and 100 individuals with non-permanent VA dysfunction were selected as the control group. Compared with the control group, the adjusted hazard ratio of CVD for the VA dysfunction group was 3.05 (95% CI: 1.14-8.20). A Kaplan-Meier analysis revealed that the cumulative incidence of CVD was higher in the permanent VA dysfunction group than in the comparison group. Permanent VA dysfunction is significantly associated with an increased risk of subsequent CVD.