Association between clinical use of nifedipine and the risk of osteoporosis: a nationwide retrospective cohort study.

Nifedipine is one of the common calcium channel blockers (CCBs) for hypertension that induce peroxisome-proliferator-activated receptor γ coactivator 1-α, which is envisioned as a potential therapeutic target in bone disease. The findings of this retrospective cohort study suggest that patients who receive nifedipine may have a potential protective effect on osteoporosis in comparison to other CCBs. INTRODUCTION: Nifedipine was one L-type dihydropyridine calcium channel blocker (CCB) that can improve bone loss. However, epidemiological studies on the association between the use of nifedipine and osteoporosis risk are limited. Thus, this study aimed to evaluate the association between the clinical use of nifedipine and the risk of osteoporosis. METHODS: This retrospective cohort was conducted using the National Health Insurance Research Database of Taiwan from 2000 to 2013. The study includes 1225 patients receiving nifedipine (the exposed cohort) and 4900 patients receiving other CCBs (the comparison cohort). The primary outcome was the diagnosis of osteoporosis. The hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the association between the use of nifedipine and the risk of osteoporosis. RESULTS: Patients receiving nifedipine treatment had a reduced risk of osteoporosis as compared with those undergoing other CCB treatments (adjusted HR, 0.44; 95% CI, 0.37-0.53). Moreover, this inverse association is evident in both sexes and various age groups. CONCLUSIONS: This population-based cohort study demonstrated that nifedipine may have potential protective effect on osteoporosis compared with other CCBs. The clinical implications of the present study need further investigation.

Impact of Nutritional Assessment on the Clinical Outcomes of Patients with Non-albicans Candidemia: A Multicenter Study.

Several studies have demonstrated that malnutrition is a negative prognostic factor for clinical outcomes. However, there is limited evidence for the effect of malnutrition on clinical outcomes in patients with candidemia. We investigated the relationship between malnutrition and all-cause 28-day mortality among patients with non-albicans candidemia. Between July 2011 and June 2014, all adult patients with non-albicans candidemia, including C. tropicalis, C. glabrata, C. parapsilosis and so on, were enrolled. The Malnutrition Universal Screening Tool (MUST) scores were used to determine the patients' nutritional status before the onset of candidemia. A total of 378 patients were enrolled; 43.4% developed septic shock and 57.1% had a high risk of malnutrition (MUST ≥ 2). The all-cause 28-day mortality rate was 40.7%. The Cox proportional hazards model revealed that C. tropicalis (HR, 2.01; 95% CI, 1.24-3.26; p = 0.005), Charlson comorbidity index (HR, 1.10; 95% CI, 1.03-1.18; p = 0.007), Foley catheter use (HR, 1.68; 95% CI, 1.21-1.35; p = 0.002), concomitant bacterial infections (HR, 1.55; 95% CI, 1.11-2.17; p = 0.010), low platelet count (HR, 3.81; 95% CI, 2.45-5.91; p < 0.001), not receiving antifungals initially (HR, 4.73; 95% CI, 3.07-7.29; p < 0.001), and MUST ≥ 2 (HR, 1.54; 95% CI, 1.09-2.17; p = 0.014) were independently associated with all-cause 28-day mortality. A simple screening tool for nutritional assessment should be used for patients with non-albicans candidemia to detect early clinical deterioration, and a tailored nutritional care plan should be established for malnourished individuals, to improve their clinical outcomes.

Analysis of the following Related Surgeries of Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty: A Taiwanese National Health Insurance Research Database Population-Based Study.

BACKGROUND: Current treatment options for both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are still controversial with no consistent results in which one is superior to others. This is the first study to examine and analyze the following related data available in patients receiving either UKA or TKA from the National Health Research Database (NHIRD) in Taiwan. METHODS: The database was searched from NHIRD, pooling one million random patients. Patients' age, gender, and comorbidities were analyzed in either UKA or TKA between January 2005 and December 2013, or up until death. For the patients that had received bilateral surgeries, further subgrouping was divided into TKA to TKA, UKA to UKA, TKA to UKA, and UKA to TKA to analyze the completion rate curve. Additional analysis of the order codes 64202B, 64053B, and 64198B was defined as failures, and the related failure rate curves were analyzed separately within ten years. Finally, infection-related codes were analyzed. RESULTS: 6,179 patients (n = 276 UKA; n = 5903 TKA) were selected. Age (p < 0.0001) and gender (p = 0.037) had significant differences, with more young population and males having UKA than TKA. Most comorbidities had no significant difference. For the bilateral surgery analysis, the UKA to UKA group had the fastest completion rate (p < 0.001) and UKA to TKA was the slowest. There were no significant differences in the failure rates of 64202B, 64053B, and 64198B. CONCLUSION: Most UKA and TKA are appropriate solutions to treat patients with osteoarthritis or osteonecrosis. UKA to UKA is the quickest bilateral completion surgery, and UKA has a higher chance of undergoing revision surgery than TKA.

Long term trend analysis of geographical disparity in aging and disability: Taiwanese population approach.

Purposes of the present paper were to describe the overtime change of disability prevalence among the elderly (65 years and older), and to analyze the geographic disparity of the disability prevalence during the year 2000-2010 in Taiwan. Study data mainly come from two public web-access information: (1) The physically and mentally disabled population by age and grade, 2000-2010; (2) Taiwan general population by age, 2000-2010. We used statistical methods include number, percentage and geographical information system (GIS) to describe the disability prevalence among the elderly people by year and administrative area, and a trend test was conducted to examine the overtime change of disability prevalence in the elderly people. The results found that the mean of disability prevalence rate in the elderly population was 14.8% and it was significantly increased during the past 11 years (R(2) = 0.901; p < 0.0001). With regards to the elderly disability prevalence disparity in administrative areas, those areas of higher elderly disability prevalence were more likely to occur in east-mountain areas-Taitung County (24.2%), Yilan County (21.0%), Hualien County (20.3%), and central-agricultural counties such as Yunlin County (21.8%), Nantou County (17.6%) and Chiayi County (17.3%). The most relative change areas of disability prevalence rate in the elderly population during the past 11 years were more likely to occur in central or east areas in Taiwan. The present study highlights the authorities should pay much attention to increasing rate and the geographical disparity of disability prevalence in the elderly population, to allocate appropriate health and welfare resources for this vulnerable population.