The association between clinically diagnosed insomnia and age-related macular degeneration: a population-based cohort study.

PURPOSE: The decreased level of melatonin, the substance involved in the control of the sleep-wake cycle, has been reported among the patients with age-related macular degeneration (AMD). However, knowledge about the relationship between sleep disturbance and AMD is still limited. This longitudinal case-control study aims to investigate the risk of incident AMD among the patients with clinically diagnosed insomnia using the Taiwan National Health Insurance Research Database. METHODS: The insomnia cohort (n = 15 465) consisted of newly diagnosed insomnia cases aged ≥55 years between 2000 and 2009. Subjects without insomnia, matched for age, gender and enrolment time, were randomly sampled as the control cohort (n = 92 790). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of incident AMD for the two cohorts after adjusting for potential confounders. RESULTS: Of the 108 255 sampled subjects, 2094 (1.9%) were diagnosed with AMD, including 214 (0.2%) with neovascular AMD, during a mean follow-up period of 5.1 ± 2.8 years. Insomnia patients were more likely to have subsequent AMD than those without insomnia (2.5% versus 1.8%, p < 0.001). Further, the incidence of exudative AMD was also higher in the insomnia cohort than the control cohort (0.3% versus 0.2%, p = 0.002). The adjusted HR was 1.33 (95% confidence interval [CI], 1.18-1.48, p < 0.001) for AMD and 1.67 (95% CI, 1.20-2.33, p = 0.002) for exudative AMD. CONCLUSIONS: Clinically diagnosed insomnia is an independent indicator for the increased risk of subsequent AMD development.

Repeated intravitreal injections of antivascular endothelial growth factor in patients with neovascular age-related macular degeneration may increase the risk of ischemic optic neuropathy.

BACKGROUND: Previous case reports have demonstrated the occurrence of ischemic optic neuropathy (ION) following intravitreal injections of antivascular endothelial growth factor (anti-VEGF). However, no previous studies have investigated the impact of injection numbers on the risk of ION. The aim of our study was to investigate whether repeated intravitreal injections of anti-VEGF would increase the risk of subsequent ION in patients with neovascular age-related macular degeneration (AMD). METHODS: A population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from 2007 to 2013. Neovascular AMD patients receiving intravitreal injections of anti-VEGF during the study period were enrolled in the study cohort. Enrollees were divided into three groups according to the categorized levels of injection number (first level: < 10 times, second level: 10-15 times, and third level: > 15 times). Kaplan-Meier curves were generated to compare the cumulative hazard of subsequent ION among the three groups. Cox regression analyses were used to estimate crude and adjusted hazard ratios (HRs) for ION development with respect to the different levels of injection numbers. The confounders included for adjustment were age, sex, and comorbidities (diabetes, hypertension, hyperlipidemia, ischemic heart disease, and glaucoma). RESULTS: In total, the study cohort included 77,210 patients. Of these, 26,520, 38,010, and 12,680 were in the first-, second-, and third-level groups, respectively. The Kaplan-Meier method revealed that the cumulative hazards of ION were significantly higher in those who had a higher injection number. After adjusting for confounders, the adjusted HRs for ION in the second- and third-level groups were 1.91 (95% confidence interval [CI], 1.32-2.76) and 2.20 (95% CI, 1.42-3.43), respectively, compared with those in the first-level group. CONCLUSIONS: Among patients with neovascular AMD, those who receive a higher number of anti-VEGF injections have a significantly higher risk of developing ION compared with individuals who receive a lower number of injections.

Trends and Comparisons of Utilization of Emergency Departments Due to Traumatic or Non-Traumatic Causes among the HIV-Positive Population in Taiwan, 2006-2011.

It is important that the utilization of emergency departments (EDs) among people living with the human immunodeficiency virus (HIV) be epidemiologically evaluated in order to assess and improve the HIV care continuum. All participants newly-diagnosed with HIV in Taiwan registered in the National Health Insurance Database from 2000 to 2005 were enrolled in this study and followed-up from 2006 to 2011. In total, 3500 participants newly-diagnosed with HIV in 2000-2005 were selected as a fixed-cohort population and followed-up from 2006 to 2011. Overall, 704, 645, 591, 573, 578, and 568 cases made 1322, 1275, 1050, 1061, 1136, and 992 ED visits in 2006, 2007, 2008, 2009, 2010 and 2011, respectively, with an average number of ED visits ranging from 1.75 to 1.98 per person, accounting for 20.1-22.6% of the whole HIV-positive population. Fewer ED visits were due to traumatic reasons, accounting for 19.6-24.4% of all cases. The incidence of traumatic and non-traumatic ED visits among the HIV-positive participants ranged from 7.2-9.3 and 27.0-33.9 per 100 people, respectively. The average direct medical cost of traumatic and non-traumatic ED visits ranged from $89.3-112.0 and $96.6-120.0, respectively. In conclusion, a lower incidence of ED visits for all reasons and fewer ED visits owing to traumatic causes were observed in the population living with HIV in comparison with the general population; however, the direct medical cost of each ED visit owing to both traumatic and non-traumatic causes was greater among those living with HIV than in the general population.

Seasonal variations of prescriptions for the major syndrome types and manifestations of upper respiratory tract infection in tradition Chinese medicine.

OBJECTIVE: The aim of this study is to investigate the seasonal variations of prescriptions for the three most common syndrome types and the three major manifestations of upper respiratory infections (URIs) according to the theories of traditional Chinese medicine (TCM). DESIGN: This is a cross-sectional study. We examined a random sample comprising 1,000,000 beneficiaries from the National Health Insurance program in 2005. Primary diagnoses including International Classification of Diseases, Ninth Revision, Clinical Modification Codes 460-465 and 487 were regarded as URIs, for which 160,357 prescriptions of Chinese herbal medicine were analyzed. MAIN OUTCOME MEASURES: We estimated the adjusted odds ratios (ORs) of three categories of Chinese herbal formulae (CHF) used to treat the three most common types of URIs and another CHF used to alleviate manifestations of URIs throughout the four seasons. RESULTS: The OR for pungent-cool CHF used to relieve external syndromes was highest in the summer (OR=1.07). The OR for pungent-warm CHF used to relieve external syndromes was highest in the winter (OR=1.14). The OR for CHF used to alleviate cough and reduce sputum production was highest in the spring (OR=1.00). The OR for CHF used to alleviate nasal discharge and congestion was highest in the winter (OR=1.19). CONCLUSION: There are seasonal variations of prescriptions for the major syndrome types and manifestations of URIs in TCM. The results of this study may serve as a reference for TCM physicians in medical preparation and clinical practice.

The trends of utilization in traditional Chinese medicine in Taiwan from 2000 to 2010: A population-based study.

INTRODUCTION: There is no study exploring the trend of utilization in traditional Chinese medicine (TCM) from 2000 to 2010. The objective of this study was to investigate the trends of TCM utilization among 3 cross-sectional cohorts of 2000, 2005, and 2010. METHOD: This study was a cross-sectional analysis of TCM utilization over time. We compared the mean TCM visits among 3 cohorts of 2000, 2005, and 2010. We derived 3 randomly sampled cohorts of nearly 1 million representative beneficiaries in each of 2000, 2005, and 2010 from National Health Insurance Research Database for this research. Multivariate logistic regression was performed to evaluate the relative relationship in categorical variables correlating to TCM users. The percentage change (% change) in mean TCM visits between 2000 and 2005 (2010) was used to evaluate the trends of TCM utilization during the period. RESULTS: The ratio of TCM users increased throughout cohorts. The ratio of TCM users among women was more than that among men in all cohorts of 2000, 2005, and 2010 (adjusted odds ratio = 1.47; 1.52; 1.62). The mean TCM visits increased from 2000 to 2010. The percentage change in mean TCM visits among women was more than that among men. The group aged less than 20 years had the least percentage change in mean TCM visits (18.8%); nevertheless, the group aged 20 to 34 years had the largest change (30.2%). The high socioeconomic status group had the largest percentage change in mean visits to TCM, whereas the central region had the least percentage change. Neoplasms had the greatest increase in percentage change in mean TCM visits among all disease categories; in contrast, diseases of the respiratory system had the greatest decrease. CONCLUSION: Both the ratio of TCM users and mean TCM visits increased gradually from 2000 to 2005 and further to 2010. Women used TCM more than men, and this is expected to continue in the future. The high socioeconomic status group used TCM more and more over time. The picture of TCM need among different types of cancer patients should be explored in further research because of the substantial increase in TCM utilization for the disease category of neoplasms.

Exploring the role of multiple chronic conditions in traditional Chinese medicine use and three types of traditional Chinese medicine therapy among adults in Taiwan.

INTRODUCTION: Numerous people with chronic conditions like to use traditional Chinese medicine (TCM) treatment, or integrated treatment of TCM and Western medicine (WM). Our study explored the associations between multiple chronic conditions (MCC) and TCM use and the use of specific types of TCM therapy among adults in Taiwan. In addition, we explored the TCM use of adults with seven common types of chronic conditions. METHODS: In our study, a national representative sample in 2005 was used. The Chronic Condition Indicator and the Clinical Classifications System created by the U.S. Agency for Healthcare Research and Quality were used to define the number of chronic conditions of adults. Logistic regressions adjusted for demographic characteristics were used to analyze the associations. The frequency of TCM use among adults with different numbers of chronic conditions was quantified. RESULTS: TCM use for adults with ≥5 chronic conditions (odds ratio [OR] 1.86) was higher than TCM use for adults with 2-4 chronic conditions (OR 1.51) and TCM use for adults with one chronic condition (OR 1.48). The increase in the OR of the use of Chinese herbs and traumatology manipulative therapy according to the number of chronic conditions was not as substantial as that of acupuncture-moxibustion. The frequency of TCM use exhibited an increasing trend with the increase in the number of chronic conditions (p<.001). Among the seven common types of chronic conditions for adults, TCM use for adults with arthropathy (OR 2.01) was the highest. CONCLUSION: The probability and frequency of TCM use increased as the number of chronic conditions increased. The probability of Chinese herbs use, traumatology manipulative therapy use, and, particularly, acupuncture-moxibustion use increased as the number of chronic conditions increased. We suggest that government policy makers emphasize administering integrated TCM and WM care to people with chronic conditions or MCC.

Risk factors for developing glaucoma among patients with uveitis: a nationwide study in Taiwan.

PURPOSE: To investigate the incidence and risk factors for developing ocular hypertension or glaucoma needing treatment among uveitis patients in Taiwan. METHODS: The nationwide database-derived retrospective cohort study was designed using Taiwan's National Health Insurance Research Database. From 1 million representative samples randomly selected from the beneficiaries of the National Health Insurance program, all patients with a diagnosis of uveitis were identified. Only newly onset uveitis patients who were diagnosed after January 1, 2002 and had no prior diagnosis of glaucoma were included in the study, and were followed up until December 31, 2008 or the last day that they were covered by the program. A patient was defined as having glaucoma as soon as both a diagnosis of glaucoma or ocular hypertension as well as a claim for medical or surgical treatment of glaucoma was found. Risk factors for developing glaucoma at the time of, or after the uveitis incidence were evaluated and discussed. RESULTS: Initially, 5757 newly diagnosed uveitis patients were enrolled in the study. Of these patients, 488 (8.5%) were also diagnosed with glaucoma at the time of uveitis incidence. Patients aged 17 to 64 years, of male sex and diagnosed with anterior uveitis were more likely to have glaucoma at the time of the uveitis incidence. Among the remaining 5269 patients, 351 (6.7%) patients developed glaucoma during the follow-up period. Significant risk factors included increasing age, having been diagnosed with anterior uveitis, having more than an average number of ophthalmic claims within the first 3 months, and complications with corneal edema. A stratified analysis showed that having a history of receiving intraocular surgery is also a risk factor for the development of glaucoma among adult patients. CONCLUSIONS: The development of glaucoma in uveitis patients is noteworthy and is associated with several demographic and clinical factors. To minimize the visual impairment caused by uveitis-related glaucoma, clinicians should pay more attention to those uveitis patients who are at high risk for developing glaucoma.

Pediatric invasive pneumococcal disease in Taiwan following a national catch-up program with the 13-valent pneumococcal conjugate vaccine.

BACKGROUND: Seven-valent pneumococcal conjugate vaccine (PCV) has been available in Taiwan since late 2005. A national catch-up program was launched in Taiwan in 2013, providing 1 dose of 13-valent PCV to children aged 2-5 years. Here, we report the epidemiology of invasive pneumococcal disease (IPD) in children aged ≤5 years in this setting. METHODS: We collected demographic and clinical information for pediatric patients (≤5 years) with IPD between 2008 and 2013. The incidence of IPD was estimated. The logs for PCV import into Taiwan were obtained to evaluate the impact of PCV usage on IPD epidemiology. RESULTS: The overall incidence of IPD in children aged ≤5 years was 15.9 cases per 100,000 person-years. The IPD incidence caused by 7-valent PCV serotypes decreased significantly from 10.0 cases per 100,000 person-years in 2008 to 2.3 cases per 100,000 person-years in 2013. The incidence of IPD caused by serotype 19A increased substantially from 1.7 cases per 100,000 person-years in 2008 to 10.3 cases per 100,000 person-years in 2012, followed by a significant decrease to 5.6 cases per 100,000 person-years in 2013. The significant decrease in the incidence of serotype 19A IPD occurred primarily in children aged 2-5 years. CONCLUSIONS: The 13-valent PCV catch-up program was associated with a significant decrease in serotype 19A IPD incidence in 2013, primarily in children eligible for the 13-valent PCV immunization. Continued surveillance is necessary to assess the further impact of the national catch-up program on pediatric IPD epidemiology in Taiwan.

Persistence of topical glaucoma medication: a nationwide population-based cohort study in Taiwan.

IMPORTANCE: Medication persistence is an important factor for treatment effect in patients with glaucoma. Evaluating risk factors for refill discontinuation might be helpful for improving persistence and preventing blindness in patients with glaucoma. OBJECTIVES: To estimate the persistence rate with topical glaucoma medication 2 years after diagnosis and evaluate risk factors for nonpersistence among patients in Taiwan with open-angle glaucoma and ocular hypertension. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based study using claims data from the National Health Insurance Research Database. One million patients were randomly selected from the registered beneficiaries of the National Health Insurance Research Database in 2000. All patients with newly diagnosed open-angle glaucoma and ocular hypertension were included and followed up until December 31, 2008. Patients were included in the analysis only if they had follow-up data for more than 2 years after diagnosis. MAIN OUTCOMES AND MEASURES: Nonpersistence was defined as the patient not refilling any topical glaucoma medication for more than 90 days. Patient characteristics, prescription-related clinical factors, and physician and hospital characteristics were identified and considered in the analysis. The rate of persistence was estimated and risk factors for nonpersistence were investigated using Cox proportional regression models. RESULTS: A total of 3134 patients were identified and observed in the study. After a 2-year follow-up, 759 patients (24.2%) persisted with their glaucoma medications. Multivariate analysis showed that patients' living or working areas (P < .001), number of glaucoma medications (P < .001), prescription of pilocarpine hydrochloride (adjusted ratio of persistence = 0.72; 95% CI, 0.59-0.88) or prostaglandin analogs (adjusted ratio of persistence = 2.04; 95% CI, 1.82-2.33), the year in which glaucoma diagnosis was made (adjusted ratios of persistence for patients whose condition was diagnosed after 2004 = 1.18; 95% CI, 1.09-1.27), sex of the main physicians (adjusted ratios of persistence for male ophthalmologists = 0.82; 95% CI, 0.74-0.90), treatment in hospitals (P < .001), and continuity of care index (P < .001) were associated with patients' persistence with glaucoma medications. CONCLUSIONS AND RELEVANCE: The rate of persistence for glaucoma medications is low in Taiwan, although health care costs, including the cost of medication, are mostly covered by the nationwide health insurance system. This study suggests that factors other than cost, such as physician-patient relationship and patient education, may play an important role in the persistence of topical glaucoma medication.

Risk of central serous chorioretinopathy in adults prescribed oral corticosteroids: a population-based study in Taiwan.

PURPOSE: To investigate the incidence and risk factors for central serous chorioretinopathy (CSCR) in adults who use oral corticosteroids in Taiwan. METHODS: This is a population-based nested case-control study between 2000 and 2008. From the Taiwan National Health Insurance Research Database, adults who were repetitively prescribed oral corticosteroids were included as the study cohort. Of those, newly diagnosed CSCR cases were identified and the CSCR incidence was calculated. Subjects matched for age, gender, and the enrollment time were randomly selected as the controls. Corticosteroids use was compared between the cases and controls. Poisson and conditional logistic regressions were used to analyze the potential risk factors for CSCR. RESULTS: Among 142,035 oral corticosteroids users, 320 cases of CSCR were identified, and 1,554 matched controls were randomly selected. The incidence rate of CSCR was 44.4 (95% confidence interval, 39.5-49.3) cases per 100,000 person-years. Multivariate Poisson regression showed that male patients and those aged 35 years to 44 years had significantly higher incidence rates of CSCR. There were no differences in either median dosage or mean duration of systemic corticosteroid treatment between the cases and controls. After adjusting for other confounders, current use of oral corticosteroids was found to be significantly associated with the risk of CSCR (odds ratio, 2.40; 95% confidence interval, 1.49-3.89). CONCLUSION: Male gender, middle age, and current use of oral corticosteroids were found to be the risk factors for CSCR. However, oral corticosteroids dosage and treatment duration were not associated with the CSCR risk.

The association between zolpidem and infection in patients with sleep disturbance.

OBJECTIVE: Recent case reports suggest that zolpidem usage may be associated with infection events. The aim of this study was to determine the risk of infection events in patients with sleep disturbance taking zolpidem in a full 3-year follow-up study. METHODS: A total of 17474 subjects with a diagnosis of sleep disturbance in 2002 and 2003 were identified, of whom 5882 had used zolpidem after recruitment. A Cox proportional hazard model was used to estimate the 3-year infection event-free rates for the patients using zolpidem and those not using zolpidem after adjusting for confounding factors. To maximize case ascertainment, only patients hospitalized for infection events were included. RESULTS: A total of 646 patients had had infection events, 331 (5.63%) of whom had been taking zolpidem and 315 (2.71%) had not. Zolpidem usage increased the risk of infection events. After adjustments for gender, age, co-morbidities, and other medications, patients using zolpidem with cDDD 1-28, 29-84, and >84 had hazard ratios of 1.67 (95% CI, 1.32-2.11), 1.91 (95% CI, 1.47-2.49) and 1.62 (95% CI, 1.32-1.98) respectively, compared with patients who did not use zolpidem. CONCLUSIONS: Zolpidem increased the risk of infection events in sleep disturbance patients. This increased risk of infection should be explained to sleep disturbance patients, and prescriptions of zolpidem to chronic insomnia patients should be restricted.

Trends, correlates, and disease patterns of antipsychotic use among children and adolescents in Taiwan.

PURPOSE: We used Taiwan's population-based National Health Insurance database to investigate the trends, correlates, and disease patterns of antipsychotic use among children and adolescents. METHODS: The National Health Research Institutes provided a database of 1,000,000 random subjects for study. We chose subjects who were aged 18 years or younger during 1997-2005. In this sample, subjects who were given at least one antipsychotic prescription, including first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs), were identified. Trends, prevalence, and associated factors of antipsychotic use were determined. The proportion of antipsychotic use for psychiatric and medical disorders was also analyzed. RESULTS: The 1-year prevalence of SGA use increased from 0.00 % in 1997 to 0.09 % in 2005, whereas the 1-year prevalence of FGA use ranged from 2.24 to 3.43 % during this same period, with no significant change. Age and male gender were associated with higher SGA use. Among SGA users, the greatest proportion suffered from psychiatric disorders, including tics, hyperkinetic syndrome of childhood, schizophrenia, affective disorders, and autism. Among FGA users, a larger proportion was for medical conditions, including diseases of the digestive and respiratory systems. CONCLUSION: The prevalence of pediatric SGA use increased greatly from 1997 to 2005. Among pediatric subjects using antipsychotics, SGAs were mostly used for psychiatric disorders, whereas FGAs were mostly prescribed for medical conditions. Future research will focus on indication, dosage, frequency, duration, adverse effects, and off-label use of antipsychotics in the pediatric population.

Increased risk of erectile dysfunction among males with central serous chorioretinopathy -- a retrospective cohort study.

PURPOSE: Central serous chorioretinopathy (CSCR) mostly affects middle-aged men and has been associated with stress and hypercortisolism. We hypothesized that some factors prone to inducing CSCR could also have a harmful effect on erectile function. This study aimed to investigate the risk of subsequent erectile dysfunction after CSCR using Taiwan National Health Insurance Research Database. METHODS: The study cohort (n = 1220) consisted of newly diagnosed CSCR men aged 19-64 years between 1999 and 2007, and men matched for age, monthly income and time of enrolment were randomly selected as the control group (n = 10870). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of clinically diagnosed erectile dysfunction (including organic origin and/or psychogenic origin) for the two groups. Erectile dysfunction-free survival analysis was assessed using a Kaplan-Meier method. RESULTS: Twenty-five patients (2.0%) from the CSCR cohort and 103 (0.9%) from the control group were diagnosed erectile dysfunction clinically during a mean observation period of 4.3 years. Patients with CSCR had a significantly higher incidence of erectile dysfunction diagnosis than those without CSCR (p < 0.001). After adjusting for age, geographic location, chronic comorbidities and medication habits, patients with CSCR were found to have a 2.22-fold [95% confidence interval (CI), 1.42-3.46] higher hazard ratio of a subsequent erectile dysfunction diagnosis than the matched controls. The adjusted HR for organic and psychogenic erectile dysfunction were 2.14 (95% CI: 1.34-3.44) and 3.83 (95% CI: 1.47-10.01), respectively. CONCLUSIONS: Central serous chorioretinopathy was independently associated with an increased risk of being diagnosed with erectile dysfunction.

Increased risk of chronic obstructive pulmonary disease in patients with schizophrenia: a population-based study.

OBJECTIVE: We investigated the prevalence and incidence of chronic obstructive pulmonary disease (COPD) among patients with schizophrenia in Taiwan. METHODS: From the database provided by the National Health Research Institute, we obtained a random sample of 766,427 subjects aged ≥18 years in 2005. Subjects with a primary or secondary diagnosis of COPD during 2005 were identified. We compared the prevalence of COPD in schizophrenic patients with that in the general population. We also detected new cases of COPD from 2006 to 2008. RESULTS: The prevalence of COPD in patients with schizophrenia was higher than that in the general population (3.83% vs. 2.88%, odds ratio [OR] 1.66; 95% confidence interval [CI]),1.42-1.94) in 2005. Compared with the general population, patients with schizophrenia had a higher prevalence of COPD in individuals <50 years old and ≥70 years old; among both sexes, and among insurance amount of a fixed premium and an amount less than US$640. Patients with schizophrenia had a higher annual incidence of COPD than that in the general population (2.21% vs. 1.43%, risk ratio 1.83; 95% CI, 1.62-2.07). The higher incidence of COPD in patients with schizophrenia was associated with increased age and male sex. CONCLUSIONS: Patients with schizophrenia had a higher prevalence and incidence of COPD than individuals in the general population in Taiwan. Younger adults and men with schizophrenia had a much higher prevalence of COPD compared with those groups in the general population, a result deserving further study.

Factors associated with subsequent eye care for children in Taiwan: a population-based historical cohort study.

PURPOSE: To investigate patterns and factors associated with subsequent eye care for Taiwan's children. METHODS: We conducted a population-based historical cohort study of 2464 children aged between 3 and 12 years old from the 2005 National Health Interview Survey (NHIS). Participants' ocular conditions were identified based on 2005 NHIS questionnaire answers given by caregivers. Subsequent eye care data was obtained from 2006 and 2007 National Health Insurance claim data. Eye care related to these children's ocular conditions was defined by physician's diagnosis using the International Classification of Diseases version 9 clinical modification codes. Poisson regression with robust variance estimation was used to determine factors associated with eye care use. RESULTS: Of the 2464 children, 712 (28.9%) had ocular conditions in 2005, and 56.5% and 44.7% of them didn't receive eye care during the subsequent 1- and 2-year periods, respectively. Among those with ocular conditions, the 3-4-year-olds were least likely to receive eye care in the subsequent 1 and 2 years. Children with highly educated fathers were more likely to receive eye care in the subsequent 1-year period. Sex, family income, level of mother's education, residential area and eye care resources were not significant factors for children with ocular conditions receiving subsequent eye care within either 1 or 2 years. CONCLUSIONS: Despite the fact that Taiwan has a National Health Insurance Program, lack of subsequent eye care remains high, even when a child's ocular condition is known by the caregiver. Determinants associated with follow-up eye care must be considered when designing eye care enhancing programs for children.

Epidemiology of uveitis among the Chinese population in Taiwan: a population-based study.

PURPOSE: This study aimed to investigate the incidence and prevalence of uveitis in Taiwan, and then analyzed the risk factors related to uveitis using multivariate regression. DESIGN: Population-based cohort study using medical claims data. PARTICIPANTS: We randomly selected 1 000 000 residents from the Taiwan National Health Insurance Research Database. All participants with correct registry data (96%) were included in the study. The study period was from 2000 to 2008. METHODS: All types of uveitis were identified using the International Classification of Diseases, 9th revision, Clinical Modification diagnostic codes. The annual incidence and cumulative prevalence of uveitis were calculated. A univariate and a multivariate Poisson regression were used to determine the risk factors associated with uveitis. MAIN OUTCOME MEASURES: The first diagnosis of uveitis noted during the study period. RESULTS: The annual cumulative incidence rate of uveitis ranged from 102.2 to 122.0 cases per 100 000 persons over the study period, and the average incidence density was 111.3 cases per 100 000 person-years (95% confidence interval, 108.4-114.1). The cumulative prevalence was found to have increased from 318.8 cases per 100 000 persons in 2003 to 622.7 cases per 100 000 persons in 2008. Anterior uveitis was the most common location and accounted for 77.7% of all incident cases, which was followed by panuveitis, posterior uveitis, and intermediate uveitis. Multivariate regression analysis showed that males, the elderly, and individuals who lived in an urban area had higher incidence rates for uveitis. CONCLUSIONS: The epidemiology of uveitis in Taiwan differs from most previous studies in other countries. The incidence of uveitis in Taiwan has increased significantly recently. The elderly and individuals living in urban areas are the populations that are most commonly affected by uveitis. These findings are consistent with suggestions found in several recent studies.

Multiple interacting factors corresponding to repetitive use of complementary and alternative medicine.

OBJECTIVE: To examine the factors correlating with repetitive use of complementary and alternative medicine (CAM). RESEARCH DESIGN: In 2006, a community-based epidemiological survey was conducted in Taiwan. A total of 2457 participants (1237 men and 1220 women) aged 18 and over participated in the study. RESULTS: From the application of regression tree analysis and the Health Belief Model, we have noticed the following findings. First, demand motive was the most dominant discriminator factor for the repetitive use of CAM. Second-layer discriminators were evaluated on the basis of action benefits and barriers, as well as sources of action information. Another predominant factor is the heterogeneity of individual background. When participants used CAM for treatment of illness, their household income was ≥ 1000 US dollars per month, they had past experience of western medicine seeking without effects and aged between 30 and 60 years, the predicted mean values for all types of CAM use is 5.62 (the highest). By contrast, when participants used CAM for maintenance of health, their household income was <2000 US dollars per month, they are male, with moderate or good self-rated health who had less than 9 education years, the predicted mean values for all types of CAM use is 1.36 (the lowest). CONCLUSION: Upon the above components, it assists us to understand the multiple interactive reasons on people's repetitive use of CAM. It also provides essential information for specific CAM issues. Furthermore, from the different perspectives; it stimulates the thoughts for the future medical care projects.

Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996-2005: a national population-based study.

PURPOSE: We used National Health Insurance (NHI) database to examine the prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder (ADHD) diagnosis in Taiwan. METHODS: The National Health Research Institute provided a database of 10,00,000 random subjects for study. A population-based random sample of 372,642 patients aged younger than 18 was obtained as a dynamic cohort. Those study subjects who had at least one service claim from 1996 to 2005, with a principal diagnosis of ADHD, were identified. RESULTS: The cumulative prevalence of ADHD diagnosis increased from 0.06 to 1.64 % from 1996 to 2005. The annual incidence of ADHD diagnosis increased from 0.02 to 0.34 % from 1997 to 2005. The highest incidence rates of ADHD diagnosis for both males and females were in the 6- to 11-year age group. Higher incidence was detected in males (HR 3.76, 95 % CI 3.48-4.07), those who lived in northern region (HR 1.35, 95 % CI 1.07-1.71) and urban area (HR 1.53, 95 % CI 1.40-1.66). The percentage of stimulant use in children with ADHD diagnosis increased from 39.6 to 54.0 % from 1997 to 2005. CONCLUSIONS: Our findings suggest increases in the prevalence and incidence rates of ADHD diagnosis in Taiwan, which was in line with those studies of Western countries. However, the prevalence of ADHD diagnosis in the NHI program was still much lower than in the community studies. The percentage of stimulant use in children with ADHD diagnosis also has an increasing trend, which warrants further study.

Does supplementation with green tea extract improve insulin resistance in obese type 2 diabetics? A randomized, double-blind, and placebo-controlled clinical trial.

BACKGROUND: Green tea is one of the most popular beverages in the world. It is believed to have beneficial effects in the prevention and treatment of many diseases, one of which is type 2 diabetes. The aim of the study is to examine the effect of a decaffeinated green tea extract (GTE) providing a daily dose of 856 mg of epigallocatechin gallate (EGCG) on obese individuals with type 2 diabetes. MATERIALS AND METHODS: The clinical trial was a randomized, double-blind, placebo-controlled clinical trial conducted from December 2007 through November 2008. The subjects were randomly assigned to either receive 1,500 mg of a decaffeinated GTE or placebo daily for 16 weeks. Sixty-eight of 80 subjects, ages 20-65 years with BMI > 25 kg/m2 and type 2 diabetes for more than one year, completed this study. Homeostasis model assessment for insulin resistance (HOMA-IR) was used as the major outcome measurement. At baseline and after 16 weeks of treatment, anthropometric measurements, fasting glucose, hemoglobin A1C percent (HbA1C), hormone peptides, and plasma lipoproteins were measured from both groups. RESULTS: No statistically significant differences were detected between the decaffeinated GTE and placebo groups in any measured variable. A statistically significant within-group 0.4-percent reduction in HbA1C (from 8.4 to 8.0%) was observed after GTE treatment compared to baseline. Within-group comparison also revealed that the GTE group had significant reductions in waist circumference (WC), HOMA-IR index, and insulin level, and a significant increase in the level of ghrelin. Within-group comparison of those in the placebo group showed a significant increase in the level of ghrelin. CONCLUSIONS: This study found no statistical difference in any measured variable between the decaffeinated GTE and placebo groups; however, there were some statistically significant within-group changes detected. More research is required to determine whether a decaffeinated GTE standardized for EGCG content will provide any clinical benefits in obese individuals with type 2 diabetes. Clinical Trial Registration NO: NCT00567905.

Prevalence and incidence of autism spectrum disorders among national health insurance enrollees in Taiwan from 1996 to 2005.

The authors used a national database to examine the prevalence and incidence of autism spectrum disorders. The National Health Research Institute provided a database of 1,000,000 random participants for study. A population-based sample of 372,642 aged younger than 18 was obtained as a dynamic cohort. Those study participants who had at least one service claim from 1996 to 2005 with a principal diagnosis of autism spectrum disorders were identified. The cumulative prevalence of autism spectrum disorders increased from 1.79 to 28.72 per 10 000 from 1996 to 2005. The annual incidence of autism spectrum disorders increased from 0.91 to 4.41 per 10,000 per year from 1997 to 2005. Higher incidence was detected in the 0 to 5 age group, in males, and in those who lived in northern, southern, and eastern regions and urban areas. Our findings suggest increases in the prevalence and incidence of treated autism spectrum disorders in Taiwan.