Epidemiological Survey of Enterovirus Infections in Taiwan From 2011 to 2020: Retrospective Study.

Background: Young children are susceptible to enterovirus (EV) infections, which cause significant morbidity in this age group. Objective: This study investigated the characteristics of virus strains and the epidemiology of EVs circulating among young children in Taiwan from 2011 to 2020. Methods: Children diagnosed with EV infections from 2011 to 2020 were identified from the routine national health insurance data monitoring disease system, real-time outbreak and disease surveillance system, national laboratory surveillance system, and Statistics of Communicable Diseases and Surveillance Report, a data set (secondary data) of the Taiwan Centers for Disease and Control. Four primary outcomes were identified: epidemic features, characteristics of sporadic and cluster cases of EV infections, and main cluster institutions. Results: From 2011 to 2020, between 10 and 7600 person-times visited the hospitals for EV infections on an outpatient basis daily. Based on 2011 to 2020 emergency department EV infection surveillance data, the permillage of EV visits throughout the year ranged from 0.07‰ and 25.45‰. After typing by immunofluorescence assays, the dominant type was coxsackie A virus (CVA; 8844/12,829, 68.9%), with most constituting types CVA10 (n=2972), CVA2 (n=1404), CVA6 (n=1308), CVA4 (n=1243), CVA16 (n=875), and CVA5 (n=680); coxsackie B virus CVB (n=819); echovirus (n=508); EV-A71 (n=1694); and EV-D68 (n=10). There were statistically significant differences (P<.001) in case numbers of EV infections among EV strains from 2011 to 2020. Cases in 2012 had 15.088 times the odds of being EV-A71, cases in 2014 had 2.103 times the odds of being CVA, cases in 2015 had 1.569 times the odds of being echovirus, and cases in 2018 had 2.274 times the odds of being CVB as cases in other years. From 2011 to 2020, in an epidemic analysis of EV clusters, 57 EV clusters were reported. Clusters that tested positive included 53 (53/57, 93%) CVA cases (the major causes were CVA6, n=32, and CVA10, n=8). Populous institutions had the highest proportion (7 of 10) of EV clusters. Conclusions: This study is the first report of sporadic and cluster cases of EV infections from surveillance data (Taiwan Centers for Disease and Control, 2011-2020). This information will be useful for policy makers and clinical experts to direct prevention and control activities to EV infections that cause the most severe illness and greatest burden to the Taiwanese.

Gender differences in oral health among prisoners: a cross-sectional study from Taiwan.

BACKGROUND: The prevalence of oral diseases among Taiwanese prisoners has rarely been investigated. This study aimed to estimate the gender-specific prevalence of oral disease in a sample of Taiwanese prisoners. METHODS: We included 83,048 participants from the National Health Insurance (NHI) Program. Outcomes were measured using the clinical version of the International Classification of Diseases, Ninth Revision (ICD-9-CM). For prevalence, we provide absolute values and percentages. We also performed a χ2 test to assess sex and age group differences in the percentage of disease in the oral cavity, salivary glands, and jaw. RESULTS: The prevalence rate of oral diseases was 25.90%, which was higher than that of the general population. The prevalence of oral diseases in female prisoners was higher than that in male prisoners (p < 0.001), and the prevalence of oral diseases in prisoners aged ≤ 40 was higher than that of prisoners aged > 40. Among all cases of diagnosed oral diseases, the top three diseases were dental hard tissue diseases (13.28%), other cellulitis and abscesses (9.79%), and pruritus and related conditions (2.88%), respectively. The prevalence of various oral diseases in female prisoners was significantly higher than that in male prisoners. CONCLUSION: Oral disease is common among Taiwanese prisoners. Female prisoners had a higher prevalence of oral, salivary gland, and jaw diseases than male prisoners. Therefore, early prevention and appropriate treatment are required and also a need for gender-specific oral disease products given the differences in the prevalence of oral disease among male and female prisoners.

Effect of far-infrared radiation on inhibition of colonies on packaging during storage of sterilised surgical instruments.

The sterilisation of surgical instruments is a major factor in infection control in the operating room (OR). All items used in the OR must be sterile for patient safety. Therefore, the present study evaluated the effect of far-infrared radiation (FIR) on the inhibition of colonies on packaging surface during the long-term storage of sterilised surgical instruments. From September 2021 to July 2022, 68.2% of 85 packages without FIR treatment showed microbial growth after incubation at 35 °C for 30 days and at room temperature for 5 days. A total of 34 bacterial species were identified, with the number of colonies increasing over time. In total, 130 colony-forming units were observed. The main microorganisms detected were Staphylococcus spp. (35%) and Bacillus spp. (21%) , Kocuria marina and Lactobacillus spp. (14%), and mould (5%). No colonies were found in 72 packages treated with FIR in the OR. Even after sterilisation, microbial growth can occur due to movement of the packages by staff, sweeping of floors, lack of high-efficiency particulate air filtration, high humidity, and inadequate hand hygiene. Thus, safe and simple far-infrared devices that allow continuous disinfection for storage spaces, as well as temperature and humidity control, help to reduce microorganisms in the OR.

The benefit of vegetarian diets for reducing blood pressure in Taiwan: a historically prospective cohort study.

OBJECTIVE: Past vegetarians research has often found that they have lower blood pressure (BP). Effects may include their lower BMI and higher intake levels of fruit and vegetables. Besides, the study pursues to extend this evidence in a diverse population containing vegans, lacto-ovo vegetarians and omnivores. DESIGN: The study analyzed data on five hundred vigorous individuals aged 20 years or older from a standard medical screening program and provided validated questionnaire. Criteria were established for vegan, lacto-ovo vegetarian, partial vegetarian and omnivorous dietary patterns. SETTING: Health screening programs were conducted at a standard medical screening program in Taiwan between 2006 and 2017. Dietary data were gathered by self-administered questionnaire. SUBJECTS: Five hundred Taiwanese subjects representing the cohort. RESULTS: Multiple regression analyses confirmed that the vegan vegetarians had lower systolic and diastolic BP (mmHg) than omnivorous Taiwanese (ß = - 6.8, p < 0.05 and ß = - 6.9, p < 0.001). Findings for lacto-ovo vegetarians (ß = - 9.1, p < 0.001 and ß = - 5.8, p < 0.001) were similar. The vegetarians were also less likely to be using antihypertensive medications. Defining hypertension as systolic BP > 139 mmHg or diastolic BP > 89 mmHg or routine of antihypertensive medications, the odds ratio of hypertension compared with omnivores was 0.37 (95% CI = 0.19-0.74), 0.57 (95% CI = 0.36-0.92) and 0.92 (95% CI = 0.50-1.70), respectively, for vegans, lacto-ovo vegetarians and partial vegetarians. Results were reduced after adjustment for BMI. CONCLUSIONS: The study concludes from this relatively large study that vegetarians, especially vegans, with otherwise diverse characteristics but stable diets, do have lower systolic and diastolic BP and less hypertension than omnivores.

Standardized rate of hospitalization for violent injuries among different generations in counties and cities in Taiwan from 2000 to 2015.

This study aimed to understand the distribution of the standardized rate of hospitalization for violent injuries in counties and cities in Taiwan. The ICD-9 diagnosis code N-codes 995.5 (abused child) and 995.8 (abused adult) or E-code E960-E969 (homicide and intentional injury by others) were defined as research cases. The study analyzed the standardized medical treatment rate of children and adolescents aged 0 to 17, adults aged 18 to 64, and older adults over 65 years old suffering from violence for the first time. During the 15-year period, the counties and cities with the highest rate of medical treatment for violent injuries among children (unit: per 105 people) were Pingtung County (33.1 males, 22.9 females), Lienchiang County (8.8 males, 9.8 females), and New Taipei City (8.2 males, 8.8 females). For adults, Pingtung County (73.2 males, 36.8 females), New Taipei City (26.0 males, 14.3 females), and Yunlin County (19.7 males, 7.7 females) registered the highest rates. For older adults, Pingtung County (33.6 persons), New Taipei City (12.5 persons), Yun Lin County (11.2 persons), and Taichung City (9.2 persons) registered the highest rates. The highest rates of older female adults receiving treatment were recorded in Pingtung County (15.1 persons), Yunlin County (9.0 persons), Taichung City (5.5 persons), and New Taipei City (5.1 persons). With the Poisson regression model, the relative risk ratio of seeking medical care owing to violence in Pingtung County (reference: Taipei City) was 25.1 times for children, 20.1 times for adults, and 11.7 times for older adults. The counties and cities with higher rates of violent medical treatment for adults and older adults during the 15-year period were Pingtung County, New Taipei City, and Yunlin County. For children and adolescents, Pingtung County, Lienchiang County, and New Taipei City recorded the highest rates. Pingtung County had the highest risk of sexual violence. These results may be related to the local industrial structure, demographic composition, and other characteristics explained in the text.

The association between abused adults and substance abuse in Taiwan, 2000-2015.

OBJECTIVE: To investigate whether adults suffering from violence were at risk of substance abuse and provides insight into the relationship between male and female abusers and substance abuse from 2000 to 2015 in Taiwan. METHODS: This study used data on outpatient, emergency, and inpatient visits for 2 million people enrolled in universal health insurance from 2000 to 2015. ICD-9 diagnosis codes 995.8 (abused adult) and E960-E969 (homicide and injury purposely inflicted by other persons) were defined in this case study, analyzing first-time violence in adults aged 18-64 (study group). Non-abused patients (control group) were matched in a 1:4 ratio, and the paired variables were gender, age (± 1 year), pre-exposure Charlson Comorbidity Index, and year of medical treatment. SAS 9.4 and Cox regression were used for data analysis. RESULTS: A total of 8,726 people suffered violence (control group: 34,904 people) over 15 years. The prevalence of substance abuse among victims of violence was 78.3/104, 61.9/104, and 51.5/104 for tobacco use disorder, alcoholism, and alcohol abuse, respectively. The risk (adults, overall) of drug abuse, drug dependence, and alcoholism after exposure to violence (average 9 years) was 7.47, 7.15, and 6.86 times (p < 0.01), respectively, compared with those without violence. The risk (adults, males) of drug abuse, drug dependence, and alcohol abuse after exposure to violence (average 9 years) was 6.85, 6.27, and 6.07 times, respectively, higher than those without violence (p < 0.01). Risks of drug dependence, alcohol abuse and alcoholism (adults, females) after exposure to violence (average 9 years) were 14.92, 12.26, and 11.55 times, respectively, higher than non-abused ones (p < 0.01). CONCLUSION: The risks of substance abuse, after adult violence, are higher than in those who have not suffered violent injuries.

Adult abuse and poor prognosis in Taiwan, 2000-2015: a cohort study.

BACKGROUND: To investigate the risk of poor prognosis regarding schizophrenic disorders, psychotic disorders, suicide, self-inflicted injury, and mortality after adult violence from 2000 to 2015 in Taiwan. METHODS: This study used data from National Health Insurance Research Database (NHIRD) on outpatient, emergency, and inpatient visits for two million people enrolled in the National Health Insurance (NHI) from 2000 to 2015. The case study defined ICD-9 diagnosis code N code 995.8 (abused adult) or E code E960-E969 (homicide and intentional injury of another). It analyzed first-time violence in adults aged 18-64 years (study group). 1:4 ratio was matched with injury and non-violent patients (control group). The paired variables were sex, age (± 1 year), pre-exposure to the Charlson comorbidity index, and year of medical treatment. Statistical analysis was conducted using SAS 9.4 and Cox regression for data analysis. RESULTS: In total, 8,726 individuals experienced violence (case group) while34,904 did not experienced violence (control group) over 15 years. The prevalence of poor prognosis among victims of violence was 25.4/104, 31.3/104, 10.5/10,4 and 104.6/104 for schizophrenic disorders, psychotic disorders, suicide or self-inflicted injury and mortality, respectively. Among adults, the risks of suicide or self-inflicted injury, schizophrenic disorders, psychotic disorders, and mortality after exposure to violence (average 9 years) were 6.87-, 5.63-, 4.10-, and 2.50-times (p < 0.01), respectively, compared with those without violence. Among males, the risks were 5.66-, 3.85-, 3.59- and 2.51-times higher, respectively, than those without violence (p < 0.01), and they were 21.93-, 5.57-, 4.60- and 2.46-times higher than those without violence (p < 0.01) among females. CONCLUSION: The risk of poor prognosis regarding schizophrenic disorders, psychotic disorders, suicide, or self-inflicted injury and mortality after adult violence was higher than in those who have not experienced a violent injury. Adults at the highest risk for violent suicide or self-inflicted injuries due to exposure to violent injuries -males were at risk for schizophrenia and females were at risk for suicide or self-inflicted injuries. Therefore, it is necessary for social workers and medical personnel to pay attention to the psychological status of victims of violence.

Epidemiology and risk factors for notifiable Clostridium botulinum infections in Taiwan from 2003 to 2020.

Botulinum toxin is produced by Clostridium botulinum, a gram-positive anaerobic bacterium. This study aimed to examine the epidemiological characteristics, including sex, age, season in which infection occurred, place of residence, and epidemiological trends, of confirmed botulism cases in Taiwan from 2003 to 2020. This study examined the annual summary data on reported botulism in Taiwan' s Center for Disease Control from 2003 to 2020 available to the public on the internet. We found that there were 50 confirmed domestic cases of botulism. The incidence of botulism ranged from 0 to 0.48 per 1000,000 from 2003 to 2020 and peaked in 2008 and 2010. During the 18-year investigation period in which 6-year intervals were used, the study results showed a decreasing trend (2003-2008, 2009-14, and 2015-2020, had 22, 19, 9 cases each). In terms of patients' gender, age, and place of residence, most of the patients were females (56%), were aged ≥ 50 years (48%), and resided in Taipei and northern Taiwan (44%). The number of botulism cases in Taiwan from 2012 to 2020 compared with other years (from 2003 to 2011) found that there were significant differences among patients within an age group of <20 years (P = .003, odds ratio = 18.500, and 95% confidence interval = 3.287-104.111), and there were significant differences among patients whose place of residence was Taipei metropolitan area (P = .025, odds ratio = 5.667, and 95% confidence interval = 1.248-25.734). During 2003 to 2009, there was no case of botulism among those aged <20 years. Over the last 10 years, botulism in children showed an increasing trend. A total of 9 children were found to have botulism during 2010 to 2020; most of these children were male (66.7%) and were infected during spring and summer (66.7%). This study is the first to report the number of confirmed domestic cases with botulism from surveillance data from Taiwan's Center for Disease Control during 2003 to 2020. This study also found that the place of residence and age were associated with an increased risk of botulism in Taiwan. This information may be useful for policymakers and clinical experts to direct prevention- and control-based activities regarding botulism that result in the most severe illness and the greatest burden on Taiwanese.

Intestinal infectious diseases increase the risk of psychiatric disorders: A nationwide population-based cohort study.

Intestinal infectious diseases (IIDs) are among the most common diseases and are prevalent worldwide. IIDs are also one of the major disease groups with the highest incidence worldwide, especially among children and older adults. We observed a higher probability of IIDs in patients from the psychiatric department of Tri-Service General Hospital. Therefore, our objective was to investigate if there is an association between IIDs and the risk of developing psychiatric disorders. This nationwide population-based study used the database of the National Health Insurance (NHI) program in Taiwan. The study included 150,995 patients from 2000 to 2015, comprising 30,199 patients with IIDs as the study group and 120,796 patients without IIDs as the control group. Cox proportional hazards regression analysis was performed to calculate the hazard ratio of psychiatric disorders during the 16-year follow-up. Of the patients with IIDs, 4022 (13.32%) developed psychiatric disorders compared to 8119 (6.72%) who did not (P < .001). The adjusted hazard ratio (aHR) for overall psychiatric disorders in the study group was 2.724 (95% confidence interval [CI]: 2.482-2.976; P < .001). More specifically, the study group had a higher risk of developing a psychiatric disorder, including sleep disorders, depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD)/acute stress disorder (ASD), schizophrenia, mental retardation (MR), substance abuse, and other psychiatric disorders. Furthermore, refractory IIDs (seeking medical attention for IIDs 3 or more times) increased the risk (aHR: 3.918; 95% CI: 3.569-4.280; P < .001) of developing psychiatric disorders. There was an association between IIDs and the increased risk of developing psychiatric disorders. The novel role of etiological factors in the development of psychiatric disorders deserves more attention, and the control of pathogens that cause IIDs is of urgent public health importance.

Persistent Depressive Disorder-Related Effect of Sleep Disorder on the Highest Risk of Suicide in Taiwan, 2000-2015.

OBJECTIVE: to investigate whether persistent depressive disorder (PDD) affects sleep disorders (SDs) and increased suicide risk. METHODS: in this study, we used the National Health Insurance Research Database (NHIRD) to select 117,033 SD patients, of whom 137 died by suicide, and 468,132 non-SD patients, of whom 118 died by suicide, and analyzed gender, age, and co-existing diseases. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using a multivariate Cox proportional hazards model. RESULTS: the hazard ratio of suicide in SD patients was 1.429 times that of non-SD patients. The hazard ratio of suicide in female patients was 1.297 times higher than in males. Compared with people without PDD, people with PDD had a 7.195 times higher hazard ratio for suicide than those without PDD. PDD patients with SDs had a 2.05 times higher hazard ratio for suicide than those with no SDs. CONCLUSIONS: suicide risk was increased in SD patients, and the maximum suicide risk was greater in SD patients with PDD than in non-PDD patients. PDD affected SDs and increased suicide risk. Clinicians should be aware of the possibility that PDD affects patients with SDs and contributes to suicide risk.

Obese patients experience more severe OSA than non-obese patients.

To investigate whether previous exposure to obstructive sleep apnea (OSA) increases the risk of obesity in obese and nonobese patients. We identified 24,363 obese patients diagnosed between January 1, 2000, and December 31, 2015, in the Taiwan Longitudinal Health Insurance Database (LHID) 2005 National Health Insurance Research Database; 97,452 sex-, age- and index date-matched nonobese patients were identified from the same database. This study is based on the ninth edition of the International Classification of Sleep Disorders. Multiple logistic regression was used to analyze the previous exposure of obese patients to OSA. P < .05 was considered significant. The average age of 121,815 patients was 44.30 ±â€…15.64 years old; 42.77% were males, and 57.23% were females. Obese patients were more likely to be exposed to OSA than nonobese patients (adjusted odds ratio [AOR] = 2.927, 95% CI = 1.878-4.194, P < .001), and the more recent the exposure period was, the more severely obese the patient, with a dose-response effect (OSA exposure < 1 year, AOR = 3.895; OSA exposure 1 year, <5 years, AOR = 2.933; OSA exposure 5 years, AOR = 2.486). The probability of OSA exposure in obese patients was 2.927 times that in nonobese patients, and the longer the exposure duration was, the more severe the obesity situation, with a dose-response effect (OSA exposure < 1 year, AOR = 2.251; OSA exposure 1 year, <5 years, AOR = 2.986; OSA exposure 5 years, AOR = 3.452). The risk of obesity in subjects with OSA was found to be significantly higher in this nested case-control study; in particular, a longer exposure to OSA was associated with a higher likelihood of obesity, with a dose-response effect.

Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan.

Objective: Previous studies have shown an increased in psychiatric disorders in women with disorders associated with hyperandrogenism, but few nationwide cohorts have studied this phenomenon. Therefore, this study is aimed to examine the association between the clinical manifestations of hyperandrogenism and subsequent psychiatric disorders. Methods: Based on the National Health Insurance Research Database, 49,770 enrolled participants were matched for age and index date between January 1, 2000, and December 31, 2015. Hirsutism, polycystic ovary syndrome, and acne are characterized by hyperandrogenism. After adjusting for confounding factors, we used Cox proportional analysis to compare the risk of psychiatric disorders during the 16 years of follow-up. Results: Of all the participants, 1319 (13.25%) had psychiatric disorders in the study group, whereas only 3900(9.80%) had psychiatric disorders in the control group. After adjusting for age, and monthly income, the Cox regression analysis showed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.004, 95% confidence interval [CI] = 1.327-2.724, P < 0.001). The results demonstrated that women aged 20-29 years had a more significant risk. Conclusion: Women with clinical characteristics of hyperandrogenism have a higher risk of developing psychiatric disorders, especially those aged 20-29 years.

Adults Suffering from Violence Are at Risk of Poor Prognosis in Taiwan, 2000-2015.

Objective: To understand the risk of developing a poor prognosis in adulthood after violent injury in Taiwan. Methods: This study used the data of outpatients, from emergency departments, and from hospitalization of 2 million people under National Health Insurance from 2000 to 2015. The ICD-9 diagnostic code N-code was defined as the case of this study and was 995.8 (abused adult) or E-code was E960-E969 (homicide and intentional injury by others) The first violent injury of 18−64-year-old adults (the study group) was analyzed. Patients who had not suffered violent abuse were the control group. The groups were matched in a 1:4 ratio, and the paired variables were gender, age ±1 year, Charlson Comorbidity index (CCI) before exposure, and year of medical treatment. SAS 9.4 statistical software was used, and the Cox regression method was used for data analysis. Results: During the 15-year period, a total of 8726 people suffered from violence (34,904 controls). The incidences of common poor prognoses among the victims of violence were sleep disorder, anxiety, and depression, in 33.9%, 21.6%, and 13.2% of people, respectively. The risk (Adults, Overall) of developing Post-Traumatic Stress Disorder (PTSD), bipolar disorder, and manic disorder after being violently injured (average 9 years) was 34.86, 4.4, and 4.1 times higher than those who had not suffered violence (all p values < 0.01). The risk (Adults, Males) of developing PTSD, bipolar disorder, and manic disorder after being violently injured (average 9 years) was 30.0, 3.81, and 2.85 times higher, respectively, than those who had not suffered violence (all p values < 0.01). The risk (Adults, Females) of developing PTSD, manic disorder, and bipolar disorder after being violently injured (average 9 years) was 36.8, 6.71, and 5.65 times higher, respectively, than of those who had not suffered violence (all p values < 0.01). Conclusion: The risks of poor prognosis are higher in adults who have suffered violent abuse than in those who have not. Therefore, police, social workers, and medical personnel should pay attention to the mental state of victims of violence. They should aim to support prompt treatment, to avoid PTSD, bipolar disorder, manic disorder, etc.

Males with low income and catastrophic illnesses are important risk factors for in-hospital homicide-related deaths in Taiwan from 1998 to 2015: A cross-sectional study.

This study aimed to investigate not only the differences in in-hospital deaths between male and female homicides in Taiwan from 1998 to 2015, but also the epidemiological characteristics and long-term trend analysis. We collected data on 76,125 hospitalized patients injured in attempted homicides from January 1, 1998, to December 31, 2015, from the National Health Insurance Research Database (NHIRD), identifying 59,161 male and 16,694 female patients. Age, gender, and index date match. Multiple logistic regression was used to analyze the risks of gender differences in terms of homicide. The death risk of male patients was 1.673 times that of female patients and the mortality risk of low-income male patients was 3.447 times greater than that of non-low-income male patients. Moreover, the in-hospital death risk was 23.584 and 5.064 times higher for male and female patients with catastrophic illness, respectively, compared to patients with noncritical diseases. There is a higher trend of male than female patients hospitalized after an attempted homicide. Gender differences are significantly related to homicide, with males having a higher risk of death risk from homicide than females, especially in terms of low-income and catastrophic illness.

Trend Distribution of Violent Injuries in Taiwan from 2000 to 2015.

This study aims to understand the trend distribution of violent injuries in Taiwan from 2000 to 2015. It used the data of outpatient, emergency, and hospitalization of 2 million people in the National Health Insurance sample from 2000 to 2015. We analyzed children and adolescents (hereinafter referred to as children, 0-17 years old), adults (18-64 years old), and The Elderly (over 65 years old) who suffered for the first time. The standardized rate of medical treatment for violent injuries was compared annually using the Poisson regression method. A total of 11,077 victims (7163 men, 3914 women) suffered violence during the 15 years, and the standardized rate of medical treatment for violence in adults dropped from 6.01 (1/104) in 2001 to 2.58 (1/104) in 2015. The standardized rate of medical treatment in adults over the years was higher than that in children (2.962001, 1.232015) and The Elderly (3.522001, 1.622015). The medical treatment rate of the adult generation is higher than that of the children and the elderly. The relative hazard ratio (RR) decreased from 2.38 in 2001 to 1.13 in 2014 (but the RR in 2014 was not significant). Furthermore, the rate of adult violence treatment has been decreasing every year, which shows that the government has achieved remarkable results in general violence prevention. With the accelerated aging of Taiwan's population, it is expected that older adults exposed to the risk of violence will also increase and become more serious. Therefore, the government should continue to pay attention to this issue.

The Synergetic Impact of Physical Activity and Fruit and Vegetable Consumption on the Risk of Depression in Taiwanese Adults.

BACKGROUND: This research focused on the association between physical activity and fruit-vegetable intake and the risk of depression in middle aged and older Taiwanese adults. METHODS: Data were obtained from the 1999 to 2015 datasets of the Taiwan Longitudinal Survey on Aging (TLSA), and 4400 participants were included in 1999 (aged ≥53 years). Descriptive statistics provided all of the basic characteristic variables. A chi-square test analyzed the association between sex, age, years of education, marriage, hypertension, drinking, smoking, and the incidence of depression. Logistic regression analysis was used to determine significant associations between physical activity and fruit-vegetable intake, and the presence or absence of depression after 16 years. RESULTS: Combined high physical activity and fruit-vegetable intake reduced the risk of depression by 80% (OR = 0.20, 95% CI = 0.10-0.45, p = 0.001) compared to low physical activity and fruit-vegetable intake; high physical activity and moderate or low fruit-vegetable intake caused a 70% reduction (OR = 0.30, 95% CI = 0.15-0.63, p = 0.005). High fruit-vegetable intake and low physical activity caused a 65% reduction (OR = 0.35, 95% CI = 0.15-0.63, p = 0.005), compared to low physical activity and low fruit-vegetable intake. High physical activity alone caused a 40% reduction, which is the same as by high fruit-vegetable intake alone. CONCLUSIONS: Fruit-vegetable intake combined with physical activity was negatively correlated with the risk of depression. More fruit-vegetable intake and physical activity might reduce this risk. The results highlight the importance of physical activity and fruit-vegetable consumption for middle-aged and older adults to prevent depression.

Atrial Fibrillation's Influence on Short Sleep Duration Increases the Risk of Fatness in Management Executives.

This study explored whether atrial fibrillation (AF)'s influence on short sleep duration (SD) increases the subsequent risk of fatness in management executives. This study included 25,953 healthy individuals working as management executives with ages ranging from 35 to 65 years (19,100 men and 6853 women) who participated in a qualifying physical filter program from 2006 to 2017 in Taiwan. Men and women who slept < 4 h had a 4.35-fold and 5.26-fold higher risk of developing AF than those who slept 7−8 h normally. Men and women who slept < 4 h had a 6.44-fold and 9.62-fold higher risk of fatness than those who slept 7−8 h. Men and women with AF had a 4.52-fold and 6.25-fold higher risk of fatness than those without AF. It showed that AF induced by short SD increases the risk of fatness. A short SD can predict an increased risk of fatness among management executives in Taiwan.

Association of Postpartum Depression with Maternal Suicide: A Nationwide Population-Based Study.

BACKGROUND: To examine the association of postpartum depression (PPD) with maternal suicide in the Taiwanese population. METHODS: We examined the medical records of women aged 18-50 years who experienced childbirth and had PPD (the study cohort, n = 2882), who experienced childbirth but did not have PPD (comparison cohort 1, n = 5764), and who neither experienced childbirth nor had PPD (comparison cohort 2, n = 5764) between 2000 and 2015. The patients were followed up until suicide, withdrawal from the National Health Insurance program, or 31 December 2015. RESULTS: The rates of anxiety and depression symptoms, as well as the cumulative risk of suicide, were significantly higher in the study cohort. PPD was significantly correlated with an increased risk of maternal suicide and was associated with a greater risk of developing comorbidities such as hypertension, diabetes mellitus, hyperlipidemia, and stroke. The comparison cohorts did not differ significantly in terms of suicide risk. CONCLUSION: PPD was associated with a significantly higher rate of suicide and a shorter time to suicide after childbirth. Younger age, winter, and subclinical depression and anxiety positively predicted suicide in the study cohort. To prevent maternal suicide, clinicians should be observant of subclinical depression and anxiety symptoms among patients.

Relationship between Injuries and Attention-Deficit Hyperactivity Disorder: A Population-Based Study with Long-Term Follow-Up in Taiwan.

OBJECTIVE: To investigate the association between various injuries and attention-deficit hyperactivity disorder (ADHD) and distinguish ADHD from non-ADHD with regards to risk of various injuries among children in Taiwan. METHOD: Using the data from the National Health Insurance Research Database, we selected a total of 1802 subjects under the age of 18 who were diagnosed with ADHD as well as an additional 7208 subjects as a comparison group. RESULTS: Compared with children who were not diagnosed with ADHD, children diagnosed with ADHD were more likely to intentionally injure themselves. During the school year, ADHD children were injured less frequently than were non-ADHD children on traffic-related incidents. The adjusted hazard ratio of injury for the ADHD children was 2.493 times higher than that of comparison subjects. The ADHD children had a greater length of stay and medical cost when compared to those of the non-ADHD children. Age showed a significant inverse relationship with injury. Among the ADHD children, the injury rate was evidently higher for the low-income group than for the non-low-income group. CONCLUSIONS: Age, cause of injuries, low-income household status, and school season all have a significant connection to the risk of injury for ADHD children.

Chronic Obstructive Pulmonary Disease Effect of Nonapnea Sleep Disorder on the Risk of Obesity: A Nationwide Population-Based Case-Control Study.

Objectives: To investigate whether chronic obstructive pulmonary disease (COPD) affects nonapnea sleep disorder (NASD) on the risk of obesity. Materials and Methods: From 1 January 2000 to 31 December 2015, a total of 24,363 patients with obesity from the 2005 Longitudinal Health Insurance Database were identified; 97,452 patients without obesity were also identified from the same database. Multiple logistic regression was used to analyze the previous exposure risk of patients with obesity and NASD. A p value of <0.05 was considered significant. Results: The risk of developing obesity in patients with COPD is 3.05 times higher than that in patients without COPD. Patients with COPD with NASD had a 1.606-fold higher risk of developing obesity than those without NASD. Patients with obesity were more likely to be exposed to NASD than did those without obesity (adjusted odds ratio, 1.693; 95% confidence interval, 1.575−1.821, p < 0.001). Furthermore, the closeness of the exposure period to the index time was positively associated with the severity of obesity, with a dose−response effect. The exposure duration of NASD in patients with obesity was 1.693 times than that in those without obesity. Longer exposure durations were associated with more severe obesity, also with a dose−response effect. Conclusions: The COPD effect of NASD increases the subsequent risk of obesity, and the risk of obesity was determined to be significantly higher in patients with NASD in this case−control study. Longer exposure to NASD was associated with a higher likelihood of obesity, also with a dose−response effect.