Association between Outpatient Visits and Initiating Medication among Elderly Patients after an Osteoporotic Vertebral Fracture.

PURPOSE: A treatment gap exists in vertebral fracture (VF) patients. An outpatient visit is a necessary step to initiate treatment. The study aimed to evaluate factors associated with an outpatient visit following a VF diagnosis, and the association between the interval of an outpatient visit after VF diagnosis and its impact on prescribing of anti-osteoporosis medications (AOMs). METHODS: Subjects 65 years and older from Tianliao Township in Taiwan with newly diagnosed VF between 2009 and 2010 were included. Information about outpatient visits and AOMs prescriptions were derived from the National Health Insurance Research database and followed up for 2 years. Factors associated with outpatient visits and the initiation of AOMs were assessed using the multivariable Cox proportional regression model analysis. The receiver operating characteristic curve (ROC curve) was analyzed to determine the predictive effects of the interval between an outpatient visit following the diagnosis of a new VF on initiating AOMs and the potential optimal cutoff point. RESULTS: Of 393 participants, 42.2% had outpatient visits within 2 years after a new VF diagnosis, for which the mean interval was 4.8 ± 4.8 months. Patients who were female and reported a current use of supplements were positively associated with visits after a new VF diagnosis, but the bone mineral density (BMD) T-score was negatively associated with visits. Furthermore, 140 (35.6%) patients had initiated AOMs within 2 years after the diagnosis of a new VF. It was found that a higher BMD T-score and a longer interval between an outpatient visit following diagnosis was negatively associated with initiation of AOMs. The ROC curve analysis showed outpatient visits within 3 months after a VF diagnosis had the highest Youden index and maximum area under the curve. CONCLUSIONS: Patients who were female, were currently taking supplements, and those who had a lower BMD T-score were more likely to visit doctors after being diagnosed with a new VF. Furthermore, a lower BMD T-score and a shorter interval, within 3 months and not more than 8 months, between an outpatient visit following the diagnosis of VF increased the likelihood of being prescribed AOMs.

Myocardial injury was associated with neurological sequelae of acute carbon monoxide poisoning in Taiwan.

BACKGROUND: Carbon monoxide (CO) poisoning has recently become a serious health problem in some Asian countries, including Taiwan. The aims of this study are to evaluate the changing trend of CO poisoning and to demonstrate the association between myocardial injury and neurological sequelae of CO poisoning in Taiwan between 1990 and 2011. METHODS: This retrospective cohort study included all eligible patients with acute CO poisoning reported to the Taiwan National Poison Control Center during the study period. The changing trend of CO poisoning and its impacts on the primary outcomes, i.e., persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS), were then assessed. RESULTS: 786 CO poisoned cases were reported. Among them, 467 cases were intentional. Intentional CO exposure started to become the major cause of CO poisoning in Taiwan in 2002. Increase in the number of intentional CO poisoning significantly correlated with the increase in the overall number of CO poisoning (r = 0.972, p < 0.001). Patients who took tranquilizer (OR = 3.89; 95% CI:1.94-7.77), had myocardial injury (OR = 1.70; 95% CI:1.03-2.82), had been stayed in intensive care unit (OR = 2.03; 95% CI:1.13-3.62), presented with GCS less than 9 (OR = 4.05; 95% CI:2.32-7.08) and had abnormal brain image (OR = 14.46; 95% CI:5.83-35.83) had a higher risk of PNS. Moreover, patients who were older age (OR = 1.04; 95% CI:1.02-1.07), had psychiatric disorder history (OR = 2.82; 95% CI:1.35-5.89), had myocardial injury (OR = 1.33; 95% CI:1.16-1.53), and presented with GCS less than 9 (OR = 3.23; 95% CI:1.65-6.34) had a higher risk of DNS. CONCLUSION: The pattern of CO poisoning had changed markedly during the study period, with a significant increase in both the numbers of intentional and overall CO poisoning. Moreover, intentional CO poisoning was associated with a higher risk of neurological sequelae, which was mediated by various indicators of poisoning severity such as myocardial injury and GCS less than 9.

Factors associated with newly diagnosed tic disorders among children in Taiwan: a 10-year nationwide longitudinal study.

Increased attention has been paid to tic disorders clinically, yet relatively few studies have probed potential factors that account for the occurrence of tic disorders in the general population. In this study, we used data derived from the Taiwan's National Health Insurance Research Database to examine an array of factors related to the diagnosis of tic disorders and to further probe gender heterogeneity in clinical manifestation. Poisson regression analyses were applied to model the effects of birth cohort, period, and age, separately, on tic disorders. A total of 880 newly diagnosed tic disorders were identified from 2002 to 2009 among 100,516 youngsters in the study dataset who were born between 1997 and 2005. The results showed that a significant increase in the adjusted incidence rate ratio (IRR) was observed when age increased, with the highest adjusted IRR found at age 8-9 years. Compared to the time period from 2002 to 2005, an elevated IRR was found in the time period from 2006 to 2009 (adjusted IRR: 1.37; 95% CI: 1.05-1.80). Boys tended to be more likely to receive their initial diagnosis from psychiatrists and have higher comorbid attention-deficit/hyperactivity disorder (ADHD), as compared with their girl counterparts. In conclusion, the findings indicate that the effects of age and period, respectively, influence the occurrence of newly diagnosed tic disorders. Gender difference and higher frequent comorbid ADHD in boys than in girls were observed in this study.

Smoking, habitual tea drinking and metabolic syndrome in elderly men living in rural community: the Tianliao old people (TOP) study 02.

The literature shows an inconsistent relationship between lifestyle behaviors and metabolic syndrome (MetS), especially in the elderly. We designed this study to investigate the interrelationships among cigarette smoking, tea drinking and MetS, and to verify the factors associated with MetS in elderly males dwelling in rural community. In July 2010, with a whole community sampling method, 414 male subjects aged over 65 dwelling in Tianliao township were randomly sampled. The response rate was 60.8%. Each subject completed the structured questionnaires including sociodemographic characteristics, habitual behaviors (including cigarette smoking and tea drinking habits) and medical history. After an overnight fast, the laboratory and anthropometric data were obtained. MetS was confirmed according to the criteria defined by the modified NCEP ATP III for the male Chinese population. Subjects were split into either non-MetS or MetS groups for further analysis. Of the 361 subjects with complete data, 132 (36.6%) elderly men were classified as having MetS. Using binary logistic regression, body mass index, serum uric acid, high sensitivity C-reactive protein, HOMA index, current smokers (OR = 2.72, 95%CI: 1.03 ~ 7.19), total smoking amount > = 30 (OR = 2.78, 95%CI: 1.31 ~ 5.90) and more than 20 cigarettes daily (OR = 2.54, 95%CI: 1.24 ~ 5.18) were positively associated with MetS. Current un- or partial fermented tea drinker (OR = 0.42, 95%CI: 0.22 ~ 0.84), tea drinking habit for 1-9 years (OR = 0.36, 95%CI: 0.15 ~ 0.90) and more than 240 cc daily (OR = 0.35, 95%CI: 0.17 ~ 0.72) were negatively associated with MetS. In conclusion, this study suggests that smoking habit was positively associated with MetS, but tea drinking habit was negatively associated with MetS in elderly men dwelling in rural community.