Association of prostate cancer with human papillomavirus infections: a case-control study.

BACKGROUND: The highly oncogenic human papillomavirus (HPV) is associated with numerous cancer types. While the role of viruses in the development of certain cancers is well established, the association between HPV infections and prostate cancer remains a subject of ongoing debate. This study aimed to investigate a potential association of prostate cancer with HPV infections utilizing a case-control study. METHODS: We extracted data from the Taiwan Longitudinal Health Insurance Database 2010. We retrieved 5137 patients with prostate cancer as cases and a 3:1 ratio of propensity score-matched patients without prostate cancer (15,411 patients) as controls. Multiple logistic regression analyses were carried out to scrutinize the association of prostate cancer with HPV infections while taking into account age, monthly income category, geographic location and urbanization level of the patient's residence as well as hyperlipidemia, diabetes, hypertension and chronic prostatitis, tobacco use disorder, and alcohol abuse/alcohol dependence syndrome. RESULTS: The data indicate that out of all sampled patients, 1812 (8.8%) had a prior diagnosis of HPV infections before the index date. Among cases and matched controls, HPV infections were diagnosed in 743 (14.5%) and 1069 (6.9%) patients, respectively. The results from the chi-square test demonstrate that individuals with prostate cancer exhibited a significantly higher incidence rate of HPV infections than their control counterparts (p < 0.001). Furthermore, in comparison to controls, individuals with a history of HPV infections had an adjusted odds ratio of 2.321 (95% CI: 2.097~2.568) for developing prostate cancer. Notably, individuals diagnosed with chronic prostatitis were also more likely to be subsequently diagnosed with prostate cancer (adjusted odds ratio=1.586; 95% CI = 1.338~1.879), which aligns with expectations in this context. CONCLUSIONS: We found prostate cancer to be significantly associated with HPV infections, contributing to the mounting body of evidence indicating a plausible connection between the two.

Quantifying public preferences for healthcare priorities in Taiwan through an integrated citizens jury and discrete choice experiment.

Priority setting is a critical process for national healthcare systems that need to allocate limited resources across unlimited healthcare demands. In recent decades, health policymakers have identified the need to combine technical dimensions of priority setting with political dimensions relating to community values. A range of methods for engaging the public in priority setting has been developed, yet there is no consensus around the most effective methodology. A 2014 paper proposed the integration of two methods currently used for soliciting public preferences around health care services: i) an individual survey instrument, Discrete Choice Experiments (DCEs) and ii) Citizen Juries (CJs), a group-based model that incorporates education and deliberative dialogue. This pilot study is among the first to empirically test this integrated method to assess its value across two domains: does the CJ process alter participant preferences and are the consensus values of the CJ captured by the individualistic DCE? The two-part, mixed methods study was administered in Taipei, Taiwan in August of 2016. Twenty-seven participants completed a DCE as a baseline pre-test, ranking a set of attributes in terms of importance for future resource allocation under Taiwan's National Health Insurance System. Twenty of the participants next took part in the integrated CJ-DCE method, which consisted of education and facilitated dialogue through a CJ, followed by retaking the DCE survey. Participant preferences changed after undergoing the CJ process and these new, group-based preferences were reflected in the second DCE, meaning participants did not revert to their original individualistic preferences. The results of this study demonstrate that the integrated CJ-DCE method adds value in allowing an ethically communitarian set of values to be developed and captured via an individualistic methodology. Further testing is needed to investigate the reliability of our findings and how it may be implemented to maximize public acceptance.

Mode of Delivery Is Associated with Postpartum Depression: Do Women with and without Depression History Exhibit a Difference?

Whether the mode of birth delivery correlates with the incidence of postpartum depression (PPD) is still under debate. This study seeks to clarify such a correlation and to further investigate if there are any differences in the likelihood of PPD medical care use among women with and without a history of depression. A logistic regression at two assessment points (6-month and 12-month postpartum) on the National Health Insurance Database in Taiwan is performed. In total, 32,729 women were included who gave first birth from 2007 to 2011 via cesarean section (CS), elective CS, and vaginal delivery, of whom 3580 (10.9%) were diagnosed with a history of depression. Findings show that CS was associated with a higher likelihood of PPD doctor visits regardless of whether the women have a history of depression or not, but elective CS tended to have different impacts for these two groups of women. Mentally healthy women who experienced elective CS had 1.36- and 1.64-times higher risk of PDD medical care use than those who delivered vaginally, whereas previous depressive women undertaking an elective cesarean birth had no significant difference observed in incidences. A notably higher risk of elective CS delivery versus vaginal delivery for mentally healthy women suggests that elective CS is not clinically appropriate, yet it might be an alternative to vaginal delivery with careful counseling for pregnant women who experience a history of depression.

Asian dust storms result in a higher risk of the silicosis hospital admissions.

Purpose: Previous studies found that silicosis was majorly associated with occupation-related risks. However, little evidence was available to clarify the relation between Asian dust storm (ADS) and silicosis hospital admissions. This present paper aims to investigate the association between ADS events and hospital admissions for silicosis. Methods: We applied a Poisson time-series regression on the 2000-2012 National Health Insurance Research Database in Taiwan, linking air quality data and ambient temperature data to estimate the impact of ADS on silicosis hospital admissions in the age-specific groups. Results: A total of 2154 hospital admissions were recorded for silicosis in Taiwan, for a daily average number of 0.45. The number rises from 0.43 on a day without ADS to 0.70 on the outbreak day and continues increasing to 0.83 one day after outbreak. Among patients under 45, the effect of ADS appears on the event day as well as several post-event days (lag2-6) at the significant level of p < 0.1. There is also a significant lag effect on post-event day 2 (p < 0.05) for those aged above 74. Conclusion: Asian dust storms do result in a rise of silicosis hospital admissions, particularly for those above 74, those under 45, and for females.

Dust Storms Increase the Risk of Age-Related Macular Degeneration.

The main purpose of this study was to examine the association between dust storms (DSs) and age-related macular degeneration (AMD) using a 5 year representative national dataset with one million participants, according to information on DS, meteorology, and air pollution in Taiwan. There were 18,855 AMD outpatient cases and 1080 AMD inpatient cases during 2008-2012. A Poisson time-series model was used for the analysis. The results show that AMD cases are significantly associated with exposure to dust storm events. Average daily numbers of wet and dry AMD outpatient cases increased from 6.03 and 4.26 on no-event days to 8.25 and 6.67, 2 days after DSs. Average daily numbers of wet and dry AMD inpatient cases increased from 0.26 and 0.33 on no-event days to 0.58 and 0.75, 1 day after DSs. Both genders and different age groups are all affected by the occurrence of DSs, especially 1 and 2 days after DS events. Women are at a higher risk of outpatient visits and hospitalizations for relatively severe wet AMD. Although AMD highly correlated with age, this study also found that dry AMD outpatient visits in people under the age of 50 were also found to be significantly associated with DS events. In order to protect the health of eyes and avoid AMD, one should reduce or avoid outdoor activities when DS events occur.

Tracheitis hospital admissions are associated with Asia dust storm.

The risks of tracheitis have been widely studied, but no investigation has yet to assess the impact of air pollutants on tracheitis hospital admissions. This research explores the relationship between Asia dust storm (ADS) and tracheitis hospital admissions, by using a Poisson time-series model on the 2000-2012 National Health Insurance Research Database (NHIRB) from Taiwan and linking air pollutants and temperature data. From a total of 126,013 tracheitis hospital admissions, the average number of daily tracheitis hospital admissions is 26.53 and increases 10% notably one day after ADS. The empirical result shows that ADS does significantly affect tracheitis hospital admissions 3 and 5 days after an event for the overall sample and 2-4 days after it for females. For the age group <45, the number significantly increases 3-4 days after ADS, revealing that ADS has a prolonged effect on tracheitis hospital admissions.

Ten-year trends in the incidence of microtia: a nationwide population-based study from Taiwan.

PURPOSE: Few studies have explored population-based incidence rates of microtia using nationwide data. The aim of this study was to analyze the 10-year secular trends in the incidence of microtia and/or anotia in Taiwan from 2008 to 2017 using nationwide population-based data. METHODS: Patient data were retrieved from Taiwan's National Health Insurance Dataset, after identifying 1152 children aged ≤ 1 year with a first-time diagnosis of microtia or anotia between January 2008 and December 2017. The annual microtia-anotia incidence rate was the sum of new microtia-anotia cases in a year divided by total infant population in the year. Furthermore, we used the annual percent change (APC) to study the secular trend in microtia-anotia incidence rate. RESULTS: The annual incidence rate of microtia-anotia averaged across the 10-year period was 57.7 per 100,000 infants (standard deviation = 8.6). The annual incidence rates of microtia and anotia were 53.3 and 4.4 per 100,000 infants, respectively, during this period. Furthermore, female infants had a higher incidence than males (63.3 vs. 52.4 per 100,000). The incidence of microtia-anotia gradually decreased between 2008 and 2017 with an APC of - 5.64% (95% CI - 9.31 ~ - 1.18%, p = 0.004). Since 2011, females had a significantly higher annual incidence rate of microtia-anotia than males. CONCLUSIONS: The incidence of microtia-anotia was 57.7 per 100,000 infants in Taiwan, which declined during the study period 2008-2017. The female-to-male incidence ratio was 1.21:1.

A Nationwide Population-Based Study on the Association between Land Transport Accident and Peripheral Vestibular Disorders.

This case-control study aimed to investigate the association of peripheral vestibular disorders (PVD) with subsequent land transport accidents. Data for this study were obtained from Taiwan's National Health Insurance (NHI) dataset. We retrieved 8704 subjects who were newly found to have land transport accidents as cases. Their diagnosis date was used as their index date. Controls were identified by propensity score matching (one per case, n = 8704 controls) from the NHI dataset with their index date being the date of their first health service claim in 2017. Multiple logistic regressions were performed to calculate the prior PVD odds ratio of cases vs. controls. We found that 2.36% of the sampled patients had been diagnosed with PVD before the index date, 3.37% among cases and 1.36% among controls. Chi-square test revealed that there was a significant association between land transport accident and PVD (p < 0.001). Furthermore, multiple logistic regression analysis suggested that cases were more likely to have had a prior PVD diagnosis when compared to controls (OR = 2.533; 95% CI = 2.041-3.143; p < 0.001). After adjusting for age, gender, hypertension, diabetes, coronary heart disease, and hyperlipidemia, cases had a greater tendency to have a prior diagnosis of PVD than controls (OR = 3.001, 95% CI = 2.410-3.741, p < 0.001). We conclude that patients with PVD are at twofold higher odds for land transport accidents.

Impact of Provider Competition under Global Budgeting on the Use of Cesarean Delivery.

OBJECTIVE: To examine the impact of provider competition under global budgeting on the use of cesarean delivery in Taiwan. DATA SOURCES/STUDY SETTING: (1) Quarterly inpatient claims data of all clinics and hospitals with birth-related expenses from 2000 to 2008; (2) file of health facilities' basic characteristics; and (3) regional quarterly point values (price conversion index) for clinics and hospitals, respectively, from the fourth quarter in 1999 to the third quarter in 2008, from the Statistics of the National Health Insurance Administration. STUDY DESIGN: Panel data of quarterly facility-level cesarean delivery rates with provider characteristics, birth volumes, and regional point values are analyzed with the fractional response model to examine the effect of external price changes on provider behavior in birth delivery services. PRINCIPAL FINDINGS: The decline in de facto prices of health services as a result of noncooperative competition under global budgeting is associated with an increase in cesarean delivery rates, with a high degree of response heterogeneity across different types of provider facilities. CONCLUSIONS: While global budgeting is an effective cost containment tool, intensified financial pressures may lead to unintended consequences of compromised quality due to a shift in provider practice in pursuit of financial rewards.

The association between attempted suicide and stock price movements: Evidence from Taiwan.

This study is the first comprehensive analysis to investigate the potential association between stock market fluctuations and attempted suicide events as measured by self-inflicted injuries treated in hospitalization. Using nationwide, 15-year population-based data from 1998 through 2012, we observe that the occurrences for the hospitalizations of attempted suicides are apparently predicted by stock price movements. A low stock price index, a daily fall in the stock index, and consecutive daily falls in the stock index have been shown to be associated with increased risk of hospitalization in patients with attempted suicide. More specifically, stock price index is found to be significant impact on attempted suicide in the 45-54 age groups of both genders, whilst daily change is significant for both genders in the 25-34 and 55-64 age groups and accumulated change is only significant in female aged 25-44 and above 65. On the basis of the results, relevant organizations should consider the suicidal factors that relate prime-working-age and near-retirement-age people to better carry out specific suicide prevention measures, and, meanwhile, encourage those people to pay less attention towards daily stock price movements.

Correction: Routine Endoscopy for Esophageal Cancer Is Suggestive for Patients with Oral, Oropharyngeal and Hypopharyngeal Cancer.

[This corrects the article DOI: 10.1371/journal.pone.0072097.].

Economic Stress and Mental Health: The Relationship Between the Stock Market and Neurotic Disorder Doctor Visits.

This paper investigates the relationship between the stock market and the neurotic disorder doctor visits. We use aggregate data, partition the population by age and gender and examine the impact of changes in the stock market on neurotic disorders. Using doctor visits as a proxy measure of morbidity, we find evidence of some relationship between neurotic disorder morbidity and stock market variations. A stock market falling in a single day and the accumulation of daily stock market drops are both associated with more neurotic disorder doctor visits. We also observe more neurotic disorder doctor visits during periods of a low stock index for the elderly, regardless of gender. Copyright © 2016 John Wiley & Sons, Ltd.

Influence of Asian dust storms on daily acute myocardial infarction hospital admissions.

OBJECTIVE: This study was the first to explore the relationship between Asian dust storm events (ADS) and acute myocardial infarction (AMI) hospital admissions by applying time series models. DESIGN AND SAMPLE: Nationwide population-based hospitalization claims data in Taiwan were used. There were 143,063 AMI admissions during 2000-2009. MEASURES: An autoregressive with exogenous variables (ARX) time series model was used to investigate the dynamic connection between AMI hospital admissions and ADS events. RESULTS: AMI hospitalizations significantly spiked on post-ADS day three. Among the total population, 3.2 more cases of AMI admissions occurred on post-ADS day three. When the data were stratified by age and gender, the same delayed effect was present in the male population, especially those aged 45-64 and over 74. CONCLUSIONS: Our study shows that although an ADS event does not cause an immediate incidence of AMI, storms may increase AMI incidence through a delayed effect. Hence, AMI prevention is not only important during a dust storm, but particularly so in subsequent days. During the days after an ADS, exposure to dust should be minimized by staying indoors as much as possible and by wearing a mask when exposure to dust is unavoidable. This is especially true for working and older adults. Nurses at local public health centers can increase awareness and promote public safety by providing health information to local communities regarding the link between dust storms and AMI.

Does prenatal care benefit maternal health? A study of post-partum maternal care use.

Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section.

Stroke: a Hidden Danger of Margin Trading in Stock Markets.

Using 10-year population data from 2000 through 2009 in Taiwan, this is the first paper to analyze the relationship between margin trading in stock markets and stroke hospitalizations. The results show that 3 and 6 days after an increase of margin trading in the Taiwan stock markets are associated with greater stoke hospitalizations. In general, a 1 % increase in total margin trading positions is associated with an increment of 2.5 in the total number of stroke hospitalizations, where the mean number of hospital admissions is 233 cases a day. We further examine the effects of margin trading by gender and age groups and find that the effects of margin trading are significant for males and those who are 45-74 years old only. In summary, buying stocks with money you do not have is quite risky, especially if the prices of those stocks fall past a certain level or if there is a sudden and severe drop in the stock market. There is also a hidden danger to one's health from margin trading. A person should be cautious before conducting margin trading, because while it can be quite profitable, danger always lurks just around the corner.

The effectiveness of preventive care at reducing curative care risk for the Taiwanese elderly under National Health Insurance.

Whether provision of free preventive care for the elderly under National Health Insurance has reduced the risk for curative care use raises much concern in Taiwan. This study analyzes the relationship by examining the impact of health examination utilization on the utilizations of outpatient care and inpatient care. Data come from the 2005 National Health Interview Survey and National Health Insurance Research Database. A two-stage method is used in the estimation. We found a negative relationship between the utilization of preventive care and hospitalization care in terms of length of stay and medical expenditures. On average, the elderly people who used preventive care tended to have 16 shorter hospitalization stays and NTD64,220 lower hospitalization expenditures than their counterparts. In order to improve the health of the elderly and reduce the escalation of medical expenditures due to aging, including preventive care in the health insurance is a very effective strategy.

Do stock prices drive people crazy?

This is the first research to examine a potential relation between stock market volatility and mental disorders. Using data on daily incidences of mental disorders in Taiwan over 4000 days from 1998 through 2009 to assess the time-series relation between stock price movements and mental disorders, we observe that stock price fluctuation clearly affects the hospitalization of mental disorders. We find that during a 12-year follow-up period, a low stock price index, a daily fall in the stock price index and consecutive daily falls in the stock price index are all associated with greater of mental disorders hospitalizations. A 1000-point fall in the TAIEX (Taiwan Stock Exchange Capitalization Weighted Stock Index) increases the number of daily mental disorders hospitalizations by 4.71%. A 1% fall in the TAIEX in one single day increases daily hospitalizations for mental disorders by 0.36%. When the stock price index falls one consecutive day, it causes a daily increase of approximately 0.32% hospitalizations due to mental disorders on that day. Stock price index is found to be significant for both gender and all age groups. In addition, daily change is significant for both gender and middle-age groups, whereas accumulated change is significant for males and people aged 45-64. Stockholdings can help people accumulate wealth, but they can also increase mental disorders hospitalizations. In other words, stock price fluctuations do drive people crazy.

The failure of financial incentive? The seemingly inexorable rise of cesarean section.

Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.

Do cesarean deliveries on maternal request lead to greater maternal care utilization during six-month, one-year, and two-year postpartum periods? Evidence from NHI claims data in Taiwan.

OBJECTIVE: The purpose of the study is to examine whether women who have undergone cesarean deliveries on maternal request (CDMR) have a higher utilization of outpatient and inpatient obstetric and gynecological services than do those with vaginal deliveries (VD). METHODS: We use two population-based claims datasets to trace the six-month, one-year, and two-year postpartum periods (PP) medical care utilizations by women who have undergone CDMRs or VDs during 2002 in Taiwan. The paper analyses the utilization of services through logistic, negative binomial, linear, and log-linear regressions based on the data types. RESULTS: We find that CDMRs are associated with a greater utilization of medical care than are VDs. Compared to mothers who have undergone VDs, those who underwent CDMRs have a greater likelihood to have additional outpatient visits (by 9.6% for six-month PP and 7.5% for one-year PP) and re-hospitalization (by 0.24%, 0.3%, and 0.66% for the three PPs, respectively), more outpatient revisits (by 0.47, 0.66, and 1.07, respectively), greater outpatient expenditure (by NT$324 for one-year PP) and inpatient expenditure (by NT$6178, NT$5992, and NT$5484, respectively). CONCLUSION: Cesarean deliveries on maternal request lead to significant negative outcomes during the postpartum period, which should be taken into account in the cost-benefit calculation.

Routine endoscopy for esophageal cancer is suggestive for patients with oral, oropharyngeal and hypopharyngeal cancer.

BACKGROUND: This study attempted to reveal the incidence and risk of synchronous and metachronous esophageal cancer in subjects with oral, oropharyngeal and hypopharyngeal cancer based on a population-wide database in Taiwan. METHODS: We retrieved data for this cross-sectional study from the Taiwanese Longitudinal Health Insurance Database 2000. The study group included 2,965 subjects who had received their first-time diagnosis of oral/oropharyngeal/hypopharyngeal cancer in 2002∼2009. We assigned the date of their first diagnosis of oral/oropharyngeal/hypopharyngeal cancer as the index date. We also randomly retrieved 29,650 comparison subjects matched with the study subjects in terms of gender and age group. We assigned their first medical utilization that occurred in the index year as the index date for the comparison group. We further performed a conditional logistic regression to investigate the association between esophageal cancer and oral cancer. RESULTS: Results showed that prevalences of esophageal cancer within 3 months before and after the index date were respectively 2.19% and 0.04% for the study and comparison groups. A conditional logistic regression revealed that the odds ratio (OR) of esophageal cancer for subjects with oral/oropharyngeal/hypopharyngeal cancer was 55.33 (95% confidence interval (CI): 29.86∼102.52) compared to comparison subjects. Furthermore, compared to comparison subjects, ORs for esophageal cancer were respectively 18.41 (95% CI: 8.50-39.85), 40.49 (95% CI: 15.11∼108.64), and 240.96 (95% CI: 125.49-462.69) for study subjects with a malignancy of the oral cavity, oropharynx, and hypopharynx. CONCLUSION: We concluded that there were relatively high chances for synchronous and metachronous esophageal cancers being detected through panendoscopy in patients with oral, oropharyngeal, and hypopharyngeal cancers. The routine use of panendoscopy in such patients should be encouraged with a higher priority.