Tamoxifen usage correlates with increased risk of Parkinson's disease in older women with breast cancer: a case-control study in Taiwan.

BACKGROUND AND OBJECTIVES: Little is known about the association between tamoxifen usage and risk of Parkinson's disease in women with breast cancer. The present study aimed to evaluate the association between tamoxifen usage and Parkinson's disease in older women with breast cancer in Taiwan. METHODS: We conducted a retrospective nationwide case-control study using the database of the Taiwan National Health Insurance Program. In total, 293 female subjects with breast cancer, aged 65 years and above, who were newly diagnosed with Parkinson's disease between 2000 and 2011 were included. Additionally, 1053 female subjects with breast cancer aged 65 years and above without Parkinson's disease were randomly selected as controls. Both cases and controls were matched for age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before the index date, whereas never use of tamoxifen was defined as those who never had a prescription for tamoxifen before the index date. We used the unconditional logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for the association between tamoxifen usage and risk of Parkinson's disease. RESULTS: After adjusting for confounding variables, the adjusted OR of Parkinson's disease was 3.32 for subjects with ever use of tamoxifen (95% CI, 2.50-4.43), compared with nonusers. Further analysis showed that the adjusted ORs of Parkinson's disease were 3.21 (95% CI, 2.29-4.49), 3.95 (95% CI, 2.77-5.64), and 11.4 (95% CI, 2.63-49.7) for subjects with < 2, 2-6, and ≥ 6 years of cumulative tamoxifen usage, respectively, when compared with nonusers. CONCLUSIONS: Tamoxifen usage was associated with a 3.32-fold increase in the likelihood of having Parkinson's disease among older women with breast cancer in Taiwan.

Correlation between proton pump inhibitors and risk of pyogenic liver abscess.

BACKGROUND/OBJECTIVE: Little is known about the relationship between proton pump inhibitors use and pyogenic liver abscess. The objective of this study was to evaluate the correlation between proton pump inhibitors use and pyogenic liver abscess in Taiwan. METHODS: This was a population-based case-control study using the database of the Taiwan National Health Insurance Program since 2000 to 2011. Subjects aged 20 to 84 who experienced their first episode of pyogenic liver abscess were enrolled as the case group (n = 1372). Randomly selected subjects aged 20 to 84 without pyogenic liver abscess were enrolled as the control group (n = 1372). Current use, early use, and late use of proton pump inhibitors was defined as subjects whose last one tablet for proton pump inhibitors was noted ≤30 days, between 31 to 90 days and ≥91 days before the date of admission for pyogenic liver abscess. Subjects who never received a prescription for proton pump inhibitors were defined as nonusers of proton pump inhibitors. A multivariable unconditional logistic regression model was used to measure the odds ratio and 95% confidence interval to evaluate the correlation between proton pump inhibitors use and pyogenic liver abscess. RESULTS: After adjusting for confounders, the adjusted odds ratio of pyogenic liver abscess was 7.59 for subjects with current use of proton pump inhibitors (95% confidence interval 5.05, 11.4), when compared with nonusers. CONCLUSIONS: Current use of proton pump inhibitors is associated with a greater risk of pyogenic liver abscess.

Association of use of selective serotonin reuptake inhibitors with risk of acute pancreatitis: a case-control study in Taiwan.

BACKGROUND AND OBJECTIVES: Few studies have reported the association of the use of selective serotonin reuptake inhibitors (SSRIs) with acute pancreatitis. We conducted a population-based case-control study to explore this relationship. METHODS: In this study, 4631 cases with first attack of acute pancreatitis and 4631 controls without acute pancreatitis were selected using a randomly sampled cohort of one million health insurance enrollees from 2000 to 2013. Both cases and controls were aged 20-84 years and were matched with sex, age, comorbidities, and index year of diagnosis of acute pancreatitis. Patients with current use of SSRIs were defined as those whose last tablet of SSRIs was noted ≤ 7 days before the date of diagnosis of acute pancreatitis; patients with late use of SSRIs were defined as those whose last tablet of SSRIs was noted ≥ 8 days before the date of diagnosis; and patients with no use of SSRIs were defined as those who were never prescribed SSRIs. The odds ratio (OR) and 95% confidence interval (CI) for acute pancreatitis associated with the use of SSRIs were assessed using multivariate unconditional logistic regression analysis. RESULTS: After adjusting for covariables, multivariate logistic regression analysis revealed that compared with patients with no use of SSRIs, the adjusted OR of acute pancreatitis for those with current use of SSRIs was 1.7 (95% CI, 1.1-2.5), whereas that for patients with late use of SSRIs was 1.0 (95% CI, 0.9-1.2) without statistical significance. CONCLUSIONS: Current use of SSRIs is associated with the diagnosis of acute pancreatitis. Therefore, clinicians should consider the possibility of SSRI-associated acute pancreatitis among patients currently taking SSRIs and those presenting with the diagnosis of acute pancreatitis without a definite cause.

A study on the relationship between age and inpatient falls in Taiwan.

Falls are the most frequently reported adverse hospital events. How to prevent inpatients from falling has become an important issue of patient safety in hospitals. The purpose of this study was to investigate the correlation between age and inpatient falls. A retrospective study design was used. This study, which extracted information from fall-related incident reports, enrolled patients who had fallen during hospitalization in Taiwan. Of the 221 falls evaluated, 63.8% had occurred under companion care, 98.2% of patients had fallen once and most fall-related injuries were minor (46.6%). Falls occurred most frequently when patients were going to the toilet, walking and being moved. There were significant correlations with age groups and fall-related factors (P = 0.000; P < 0.05), the presence/absence of a companion (P = 0.022, P < 0.05), the situation of falls (P = 0.000; P < 0.05), and fall-related injuries (P = 0.000, P < 0.05). Preventive interventions related to falls should vary for different age groups.

[A qualitative study of physical experiences associated with cervical screenings].

BACKGROUND: Papnicolauo (Pap) smear screening is an invasive examination that intrudes upon women's privacy, forcing them to physically perceive both inner and external worlds. This subjective physical experience has rarely been explored in the literature. PURPOSE: This article explores the subjective physical experiences of patients undergoing cervical screening. METHODS: This phenomenological study employed purposive sampling; five females were recruited. All provided informed consent and were enrolled as participants. The content analysis method analyzed and categorized interview content. RESULTS: The 3 main themes associated with participant experiences were: Loss of physical control (e. g., negative feelings, body unresponsive to mental commands); interaction between the subjective and objective body (e.g., objectification of the body, subjectification of gender); experiencing the spatial dimensions of the body (e.g., bodily exposure, protection). CONCLUSION: Findings recommend healthcare providers help pap smear recipients strengthen "inter-subjectivity" and focus on "body space" to enhance patients' "physical consciousness" and "physical emotions."

Reliability and Validity of a Pediatric Fall Risk Assessment Scale for Hospitalized Patients in Taiwan.

BACKGROUND AND OBJECTIVES: A valid fall risk assessment scale could increase the efficacy of fall prevention programs. Most fall scales were developed for adults, and it is very difficult to predict and prevent falls in pediatric inpatients. This study aimed to investigate the reliability and validity of a pediatric fall assessment scale (PFAS). METHODS: This study was conducted as a cohort study in Taichung City, Taiwan. We analyzed the scale for internal consistency, test-retest reliability, and construct validity. A receiver operating characteristic (ROC) curve was generated to show sensitivity and specificity for predicting falls. RESULTS: The results indicated that test-retest reliability was 0.89 (P = .000). The area under the ROC curve was 0.797. For the ROC curves for the pediatric fall risk assessment scale, with 11.5 points being the minimum score for a high risk of fall, sensitivity was 71.8%, specificity 74.6%, and the 95% CI was 0.746-0.848. CONCLUSION: The results of the data analysis showed that the PFAS is an appropriate scale for assessing the fall risk of hospitalized pediatric patients in Taiwan and potentially in other nations.

Does Jaundice in Newborn Infants Affect Exclusivity and Duration of Breastfeeding in Taiwan?

BACKGROUND: Cases of breastfeeding- and breast-milk-related jaundice tend to increase with increased rates of breastfeeding. Diagnoses of jaundice often lead mothers to discontinue breastfeeding because of assumptions that breastfeeding may exacerbate neonatal jaundice and lengthen the duration of phototherapy treatment. PURPOSE: This study was designed to explore the effect of neonatal jaundice on breastfeeding duration and exclusivity during the first 4 months postpartum. METHODS: This study applied a two-group comparative and follow-up design. The two groups comprised 135 and 160 mothers of infants, respectively, with and without neonatal jaundice. All of the participants were recruited from three certified baby-friendly hospitals in northern Taiwan. Follow-up was conducted by telephone at 1 and 4 months postpartum. RESULTS: Mean breastfeeding duration was longer in the group of participants whose infants had neonatal jaundice (group with neonatal jaundice) than in the group whose infants did not have this condition (group without neonatal jaundice; 102.00 vs. 89.85 days, p = .007). The degree of breastfeeding was higher in the group with neonatal jaundice, although the difference was significant only at 1 month postpartum and not during hospitalization or at 4 months postpartum. The results of a Cox regression model showed that the group without neonatal jaundice was more likely to discontinue breastfeeding (adjusted hazard ratio = 1.68, 95% CI [1.08, 2.62]). A generalized estimating equation model suggests that infants with neonatal jaundice had a higher likelihood of being breastfed for at least half of their feedings (adjusted OR = 1.53, 95% CI [1.04, 2.25]). CONCLUSIONS: On the basis of the results of this study, neonatal jaundice is not an obstacle to breastfeeding in pro-breastfeeding hospital environments. Participants whose infants developed neonatal jaundice were found in this study to breastfeed more often, which promotes breastfeeding success.

Correlation of the tamoxifen use with the increased risk of deep vein thrombosis and pulmonary embolism in elderly women with breast cancer: A case-control study.

The association between tamoxifen use and risk of deep vein thrombosis or pulmonary embolism in women with breast cancer has been reported in the Western population. The study aimed to evaluate the association between tamoxifen use and deep vein thrombosis or pulmonary embolism in older women with breast cancer in Taiwan.We conducted a retrospective case-control study using the database of the Taiwan National Health Insurance Program. A total of 281 women subjects with breast cancer aged ≥65 years with newly diagnosed deep vein thrombosis/or pulmonary embolism from 2000 to 2011 were identified as the cases. Additionally, 907 women subjects with breast cancer aged ≥65 years without deep vein thrombosis or pulmonary embolism were randomly selected as the controls. The cases and the controls were matched with age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before index date. Never use of tamoxifen was defined as subjects who never had a prescription for tamoxifen before index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and the 95% confidence interval (CI) of deep vein thrombosis or pulmonary embolism associated with tamoxifen use.After adjustment for confounding variables, the adjusted OR of deep vein thrombosis or pulmonary embolism was 1.95 for subjects with ever use of tamoxifen (95% CI 1.45, 2.62), as compared with never use of tamoxifen. In addition, atrial fibrillation (adjusted OR 3.73, 95% CI 1.89, 7.35) and chronic kidney disease (adjusted OR 1.72, 95% CI 1.06, 2.80) were also associated with deep vein thrombosis or pulmonary embolism.Tamoxifen use is associated with 1.95-fold increased odds of deep vein thrombosis or pulmonary embolism among older women with breast cancer in Taiwan.

Use of thiazolidinediones and risk of hip fracture in old people in a case-control study in Taiwan.

Little research is available on the association between use of thiazolidinediones and hip fracture in old people in Taiwan. We conducted a population-based case-control study to examine this issue.Using the database of the Taiwan National Health Insurance Program, we identified 603 type 2 diabetic subjects 65 years or older in age with newly diagnosed hip fracture in 2000 to 2013 as cases. We randomly selected 603 type 2 diabetic subjects 65 years or older without hip fracture as the controls. Both cases and controls were matched with sex, age, comorbidities, and index year of diagnosing hip fracture. Current use of thiazolidinediones was defined as subjects whose last remaining one tablet of thiazolidinediones was noted ≤30 days before the date of diagnosing hip fracture. Never use of thiazolidinediones was defined as subjects who never had a prescription of thiazolidinediones. The odds ratio (OR) and 95% confidence interval (CI) for hip fracture associated with thiazolidinediones use was estimated by the multivariable unconditional logistic regression analysis.After adjustment for covariables, the multivariable logistic regression analysis revealed that the adjusted OR of hip fracture was 1.64 for subjects with current use of thiazolidinediones (95% CI 1.01, 2.67), when compared with subjects with never use of thiazolidinediones.Our findings suggest that current use of thiazolidinediones is associated with a 64% higher risk of hip fracture in type 2 diabetic old people in Taiwan. Clinicians should consider the possibility of thiazolidinediones-associated hip fracture among type 2 diabetic old people currently using thiazolidinediones.

Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan.

OBJECTIVE: This study aimed to investigate the association between splenectomy and empyema in Taiwan. METHODS: A population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20-84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities. RESULTS: The overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone. CONCLUSION: The incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

Statin use correlates with reduced risk of chronic osteomyelitis: a nationwide case-control study in Taiwan.

BACKGROUND/OBJECTIVE: Potential association between prior statin use and chronic osteomyelitis is examined. METHODS: A nationwide case-control study was conducted based on data taken from the Taiwan National Health Insurance program. The case group includes 2338 subjects aged 20-84 years newly diagnosed for chronic osteomyelitis from 2000 to 2013; the control group included 2338 randomly selected subjects without chronic osteomyelitis matched for sex, age, and index year. Statin use was respectively defined as "current", "recent" or "past" if the most recent statin prescription was filled <3 months, 3-6 months or ≥6 months prior to the chronic osteomyelitis diagnosis. Relative risk of chronic osteomyelitis associated with statin use was measured by the odds ratio (OR) with 95% confidence interval (CI) using the conditional logistic regression model. RESULTS: After controlling for potential confounders, the adjusted ORs of chronic osteomyelitis were 0.57 for subjects with current statin use (95% CI 0.45, 0.72), 0.80 for subjects with recent statin use (95% CI 0.48, 1.33), and 1.00 for subjects with past statin use (95% CI 0.83, 1.20), compared patients with no prior statin use. In further analysis, the adjusted ORs of chronic osteomyelitis were 0.70 for subjects with cumulative statin use <12 months (95% CI 0.47, 1.07), and 0.56 for subjects with cumulative statins use ≥12 months (95% CI 0.41, 0.77), compared with those with no prior statin use. CONCLUSIONS: Current statin use is associated with reduced concurrent diagnosis of chronic osteomyelitis, particularly for a cumulative statin use ≥12 months.

Prevalence and factors of elevated alanine aminotransferase in central Taiwan - a retrospective study.

BACKGROUND: The aims of this study were to assess the prevalence of elevated alanine aminotransferase (ALT) and explore its related factors in Central Taiwan. METHODS: The study employed a retrospective design. The study selected a sample of 5,550 subjects between the years 2000 to 2004. The indivduals undergoing health examinations in a medical center in Central Taiwan were enrolled as subjects for this research. The patients' demographics, smoking and drinking habits, laboratory findings, and abdominal ultrasound results were collected and analyzed. Correlations between variables were analyzed using SPSS/ PC Windows for frequency distribution, t-test, Chi-square test, and multivariate logistic regression. RESULTS: There were 3103 men (55.9%) and 2447 women (44.1%). The mean age was 49.4 ± 12.3 years (age range of 20-87). The overall prevalence of elevated ALT was 17.1%, with a significant gender difference (23.2% in men vs. 9.4% in women, P < .0001). The multivariate logistic regression analysis showed that the factors significantly related to elevated ALT were central obesity, hypertriglyceridemia, and anti-HCV positive in men and women. CONCLUSIONS: Central obesity, hypertriglyceridemia, and anti-HCV positive are factors predominantly related to elevated ALT in men and women.