Translation and validation of the Chinese version of the menstrual distress questionnaire.

BACKGROUND: The Menstrual Distress Questionnaire (MDQ) is a commonly used questionnaire that assesses various symptoms and distress associated with the menstrual cycle in women. However, the questionnaire has not been completely translated into Chinese with rigorous reliability and validity testing. METHODS: This study translated the Menstrual Distress Questionnaire Form Cycle (MDQC) from English into Chinese: MDQCC in two stages. First, it was translated forward and backward using Jones' model; second, to test the validity and reliability, 210 Chinese-speaking women were recruited through online announcements and posters posted between June 2019 and May 2020. Expert validity, construct validity, convergent validity, and factorial validity were determined using content validity index (CVI), intraclass correlation coefficient (ICC), composite reliability (CR), and exploratory factor analysis, respectively. For concurrent criterion validity, MDQCC score was compared with three existing pain scales. Reliability was evaluated using internal consistency across items and two-week test-retest reliability over time. RESULTS: The CVI for content validity was .92. Item-CVI for expert validities among the 46 items ranged from .50 - 1; scale-CVI for the eight subscales, from .87 - 1; ICC, from .650 - .897; and CRs, from .303 - .881. Pearson correlation coefficients between MDQCC and short-form McGill pain questionnaire, present pain intensity, and visual analog scale scores were .640, .519, and .575, respectively. Cronbach's α for internal consistency was satisfactory (.932). ICC for test-retest reliability was .852 for the entire MDQCC. CONCLUSION: MDQCC was valid and reliable for Mandarin Chinese-speaking women. It can be used to evaluate female psychiatric symptoms related to the menstrual cycle in future work.

The Menstrual Distress Questionnaire has been used to evaluate menstrual distress, including dysmenorrhoea and premenstrual syndrome. This questionnaire has been translated into Persian, Korean, Japanese, and Cantonese, rendering it to be used more and more widely all over the world. The study translated all 46 items of the Menstrual Distress Questionnaire from English to Mandarin Chinese using a two-stage strategy. The Chinese version of this questionnaire developed by the present study was found to be a valid and reliable tool in Chinese Mandarin-speaking female populations. It could be used to evaluate women's physical and psychiatric symptoms related to the menstrual cycle in future works.

Stroke and suicide among people with severe mental illnesses.

The associations between people with severe mental illnesses (SMI) and the risks of stroke, suicide, and death remain unclear. We examined healthcare service usage among adults with and without SMI and explored the risk of stroke, suicide, and death. We divided 18-80-year-old adults with SMI into catastrophic and non-catastrophic illness groups. These groups were subjected to a 1:5:5 propensity score matching with people without SMI. Data on demographic characteristics, economic factors, environmental factors, comorbid conditions, self-injury behavior, the number of outpatients and ED visits, and hospitalization were collected. The primary outcomes were risks of stroke, suicide, and death. We included 19,570 people with catastrophic SMI, 97,850 with non-catastrophic SMI, and 97,850 controls. Patients with SMI, especially those with catastrophic illnesses, had higher stroke risk, suicide, and death than those without SMI. People with SMI used health services more frequently than those without SMI. Patients with a history of hospitalization or ED access had a higher risk of stroke, suicide, and death. Our data indicate that special attention should be given to patients with SMI, particularly those with a history of healthcare service utilization, such as through more extended hospital stays with high-intensity interventions.

Anxiety and depression risk in Taiwan women with breast cancer and cervical cancer.

Background: Studies comparing mental disorder risks between women with breast cancer and cervical cancer are lacking. This study compared risks of developing anxiety and depression between women with breast cancer (BC cohort) and women with cervical cancer (CC cohort) using insurance claims data of Taiwan. Methods: From the 2000 to 2016 data, we identified a BC cohort and BC controls (N = 96,862) and a CC cohort and CC controls (N = 26,703), matched by propensity scores. Incident mental disorders and the Cox method estimated the related cancer cohort to control cohort hazard ratios (HRs), and 95% confidence intervals (CIs) were estimated by the end of 2016. Results: Compared to the CC cohort, the BC cohort had slightly higher incident anxiety (15.9 versus 15.5 per 1,000 person-years) and depression (6.92 vs. 6.28 per 1,000 person-years). These mental disorders were higher in respective cancer cohorts than controls. The BC cohort to BC control adjusted HRs of anxiety and depression were 1.29 (95% CI = 1.25-1.33) and 1.78 (95% CI = 1.69-1.87), respectively. The corresponding adjusted HRs for the CC cohort were 1.12 (95% CI = 1.06-1.18) and 1.29 (95% CI = 1.18-1.41). The combined incidence rates of both disorders were 1.4-fold greater in the BC cohort than in BC controls (22.8 vs. 15.8 per 1,000 person-years), and 1.2-fold greater in the CC cohort than in the CC controls (21.7 vs. 18.3 per 1,000 person-years). Conclusion: Women with breast cancer or cervical cancer are at an elevated likelihood of developing anxiety and depression disorders. These incident disorders are slightly higher in those with breast cancer.

Effects of customized resin base on bonding strength of spherical self-ligating brackets.

PURPOSE: Fabricating resin bases has become an easy and economical method to achieve the customization of brackets. This study aimed to assess the effect of the resin base on bonding strength of spherical self-ligating brackets. METHODS: A defined amount of adhesive was bonded to the bracket base and constituted the new resin base. The thickness of the adhesive was measured and controlled at 0.5, 1.0, 1.5 and 2.0 mm, and a group without a resin base was used as a control. Sixty extracted human premolars were randomly divided into five groups. The brackets in each group were bonded to the specimen, and debonding tests were conducted. The shear bond strength (SBS) was calculated according to the measured debonding force in relation to the base area. The adhesive remnant index (ARI) score and the residual location of the fractured resin base were recorded. Enamel damage was also analyzed by scanning electron microscopy. After assessing for data normality and homogeneity, statistical comparisons between the groups and correlations among parameters were determined. P < 0.05 was regarded as significant. RESULTS: The correlation analysis revealed an inverse correlation between the resin base thickness and the SBS (Coeff = -0.719, P < 0.01). The highest SBS was 9.33 MPa, in the control group, which was significantly greater than the lowest SBS (6.03 MPa), in the 2.0-mm group (P < 0.05). Multiple comparisons analysis revealed no differences in SBS between the 1.0-, 1.5- and 2.0-mm groups. Nonparametric analysis found that only the ARI score in the 0.5-mm group (2.92) was significantly different (P < 0.05) from that in the control group (1.25). As the thickness of the resin base increased, the fractured resin base tended to remain at the bracket base, and the risk of enamel damage decreased. CONCLUSIONS: As the thickness of the resin base increased, the bonding strength of the spherical bracket decreased. However, the required clinical bonding strength was still satisfied when the thickness was less than 2.0 mm. The existence of a resin base could protect the enamel surface from damage caused by debonding. The customization of spherical brackets by tailoring a resin base can be applied in clinical practice because of the clinically acceptable bonding strength.

Patients with Cerebral Stroke Have an Increased Risk of Gastroesophageal Reflux Disease: A Population-Based Cohort Study.

BACKGROUND: Medical complications following stroke often result in significant morbidity. This study was designed to investigate the prevalence and risk of gastroesophageal reflux disease (GERD) between patients with stroke and those without stroke in Taiwan. METHODS AND RESULTS: This retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. The study included 18,412 patients newly diagnosed as having stroke during 2000-2006 and 18,412 patients without stroke frequency-matched by sex, age, and index year. All patients were followed from the index date to December 31, 2011. The Cox proportional hazards regression model was used to estimate the GERD risk. The GERD risk was approximately 1.51-times higher in the stroke group than in the nonstroke group, after adjustment for age, sex, and the cumulative incidence of some comorbidities. GERD was positively associated with stroke; the male sex (adjusted hazard ratio [HR] = 1.31); an age of 65 years or older (adjusted HR = 1.11); hyperlipidemia (adjusted HR = 1.14); ischemic heart disease (adjusted HR = 1.27); renal disease (adjusted HR = 1.45); and use of aspirin (adjusted HR = 2.34), clopidogrel (adjusted HR = 1.41), and dipyridamole (adjusted HR = 1.30). CONCLUSIONS: This study indicates a significantly higher GERD risk in patients with stroke than in the nonstroke group. In clinical practice, neurologists should focus on the risk of GERD symptoms.

Severe hypertriglyceridemia secondary to venlafaxine use in an older adult on dialysis -case report.

BACKGROUND: Although the prescribing information for Venlafaxine extended release includes a discussion about possible increases in total cholesterol and triglycerides (TG) seen in healthier adult patients during premarketing clinical trials, no post-marketing studies or case reports, that discuss the effects of venlafaxine on TG in elderly patients with chronic kidney disease. CASE PRESENTATION: We report a 71 year-old male patient with end-stage renal disease on hemodialysis, with a history of coronary artery disease, mild hyperlipidemia, and hypertension. This patient twice demonstrated the severe rises in triglycerides while taking the antidepressant, i.e., venlafaxine, and discontinuing the long-term use of fenofirate. The adverse drug reaction sub-committee at the hospital rated the second event as a "probable reaction" using the Naranjo nomogram, accordingly. CONCLUSIONS: This case demonstrates the risk of changes in lipid profiles while taking venlafaxine and receiving on and off fenofibrate therapy in the older adult patient with chronic kidney disease and under hemodialysis. Regular monitoring for lipid changes after starting venlafaxine is strongly advised for patients with existing risk factors.

Increased risk of concurrent gastroesophageal reflux disease among patients with Sjögren's syndrome: A nationwide population-based study.

BACKGROUND: Little data is available on the risk of gastroesophageal reflux disease in patients diagnosed with Sjögren's syndrome. METHODS: We identified 4650 Sjögren's syndrome patients between 2000 and 2011 from the National Health Insurance Research Database. Each Sjögren's syndrome patient was matched to 4 controls based on age, sex, and index year, and all subjects were followed up from the index date to December 31, 2011. Cox proportional hazards regression model was used to estimate the risk of gastroesophageal reflux disease. RESULTS: The risk of gastroesophageal reflux disease for Sjögren's syndrome patients was 2.41-fold greater than that for the comparison cohort after adjusting for age, sex, and comorbidities. In age stratified analyses, the youngest Sjögren's syndrome cohort (age: 20-44years old) had the highest risk (HR=3.02; 95% CI=2.48-3.69) and the lowest risk at age ≥65years (HR=1.95; 95% CI=1.61-2.36). Regardless of in subjects with and without comorbidity, Sjögren's syndrome patients had a higher risk than the controls. Sjögren's syndrome subjects with ischemic heart disease, hyperlipidemia and renal disease had the highest risk for gastroesophageal reflux disease compared with the comparison cohort without those diseases (HR=7.67; 95% CI=5.32-11.1). CONCLUSION: Patients with Sjögren's syndrome have a significantly greater risk of developing subsequent gastroesophageal reflux disease than the general population.

Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics: A Systematic Review and Meta-analysis.

IMPORTANCE: Antipsychotics are used increasingly in youth for nonpsychotic and off-label indications, but cardiometabolic adverse effects and (especially) type 2 diabetes mellitus (T2DM) risk have raised additional concern. OBJECTIVE: To assess T2DM risk associated with antipsychotic treatment in youth. DATA SOURCES: Systematic literature search of PubMed and PsycINFO without language restrictions from database inception until May 4, 2015. Data analyses were performed in July 2015, and additional analyses were added in November 2015. STUDY SELECTION: Longitudinal studies reporting on T2DM incidence in youth 2 to 24 years old exposed to antipsychotics for at least 3 months. DATA EXTRACTION AND SYNTHESIS: Two independent investigators extracted study-level data for a random-effects meta-analysis and meta-regression of T2DM risk. MAIN OUTCOMES AND MEASURES: The coprimary outcomes were study-defined T2DM, expressed as cumulative T2DM risk or as T2DM incidence rate per patient-years. Secondary outcomes included the comparison of the coprimary outcomes in antipsychotic-treated youth with psychiatric controls not receiving antipsychotics or with healthy controls. RESULTS: Thirteen studies were included in the meta-analysis, including 185,105 youth exposed to antipsychotics and 310,438 patient-years. The mean (SD) age of patients was 14.1 (2.1) years, and 59.5% were male. The mean (SD) follow-up was 1.7 (2.3) years. Among them, 7 studies included psychiatric controls (1,342,121 patients and 2,071,135 patient-years), and 8 studies included healthy controls (298,803 patients and 463,084 patient-years). Antipsychotic-exposed youth had a cumulative T2DM risk of 5.72 (95% CI, 3.45-9.48; P < .001) per 1000 patients. The incidence rate was 3.09 (95% CI, 2.35-3.82; P < .001) cases per 1000 patient-years. Compared with healthy controls, cumulative T2DM risk (odds ratio [OR], 2.58; 95% CI, 1.56-4.24; P < .0001) and incidence rate ratio (IRR) (IRR, 3.02; 95% CI, 1.71-5.35; P < .0001) were significantly greater in antipsychotic-exposed youth. Similarly, compared with psychiatric controls, antipsychotic-exposed youth had significantly higher cumulative T2DM risk (OR, 2.09; 95% CI, 1.50-52.90; P < .0001) and IRR (IRR, 1.79; 95% CI, 1.31-2.44; P < .0001). In multivariable meta-regression analyses of 10 studies, greater cumulative T2DM risk was associated with longer follow-up (P < .001), olanzapine prescription (P < .001), and male sex (P = .002) (r(2) = 1.00, P < .001). Greater T2DM incidence was associated with second-generation antipsychotic prescription (P ≤ .050) and less autism spectrum disorder diagnosis (P = .048) (r(2) = 0.21, P = .044). CONCLUSIONS AND RELEVANCE: Although T2DM seems rare in antipsychotic-exposed youth, cumulative risk and exposure-adjusted incidences and IRRs were significantly higher than in healthy controls and psychiatric controls. Olanzapine treatment and antipsychotic exposure time were the main modifiable risk factors for T2DM development in antipsychotic-exposed youth. Antipsychotics should be used judiciously and for the shortest necessary duration, and their efficacy and safety should be monitored proactively.

High prevalence of herpes zoster in patients with depression.

OBJECTIVE: Patients diagnosed with depression are at an elevated risk of physical illness. Researchers have noted that depression negatively affects immune function and leads to increased susceptibility to infection, including herpes zoster. Few epidemiologic studies have been conducted on whether patients with depression are at a higher risk of herpes zoster. We conducted a retrospective population-based cohort study to investigate whether depression is associated with an increased risk of herpes zoster. METHOD: We identified 22,886 patients with depression (ICD-9: 296.2, 296.3, 300.4, and 311) in 2000-2005 from National Health Insurance (Taiwan) claims and selected 91,542 controls, frequency matched by sex, age, and index year. We calculated the risk of herpes zoster (ICD-9: 053) between the 2 cohorts in Cox proportional hazards regression. RESULTS: Incidence of herpes zoster was 1.3 times higher in patients with depression than in controls (4.58 vs 3.54 per 1,000 person-years, respectively), with an adjusted hazard ratio (HR) of 1.11 (95% CI, 1.01-1.21). In subjects aged 45-54 years, those with depression had a significantly higher risk than controls (HR = 1.44; 95% CI, 1.19-1.73). In multivariable analysis, malignant conditions (HR = 1.41; 95% CI, 1.15-1.72), rheumatic diseases (HR = 1.28; 95% CI, 1.14-1.44), hyperlipidemia (HR = 1.24; 95% CI, 1.14-1.36), renal diseases (HR = 1.21; 95% CI, 1.08-1.36), anxiety (HR = 1.21; 95% CI, 1.07-1.38), sleep disorder (HR = 1.20; 95% CI, 1.09-1.31), and hypertension (HR = 1.11; 95% CI, 1.02-1.21) were potential risk factors for herpes zoster. CONCLUSIONS: Patients diagnosed with depression are at an elevated risk of herpes zoster, particularly those aged 45 to 54 years and those with comorbidities, including renal diseases, hyperlipidemia, malignant conditions, rheumatic diseases, hypertension, anxiety, and sleep disorder.

The Association Between Behavior Restrictions in Doing-the-Month Practice and Mental Health Status Among Postpartum Women.

OBJECTIVES: Doing-the-month practice has been commonly observed by women during the first month after delivery for hundreds of years in several countries of Asia. This retrospective study examined the correlation between these restricted behaviors and mental status in postpartum women. MATERIALS AND METHODS: The frequencies of seven restricted behaviors during the first month after delivery and levels of depression, anxiety, and sleep quality were measured in 341 women 4-6 weeks after delivery through self-reported questionnaires. The multivariate linear regression model was used to determine independent behavioral predictors for depression, anxiety, and sleep quality. RESULTS: Bathing or showering was an independent predictor of low depression status, low anxiety status (p<0.05), and good sleep quality (p<0.001). Behaviors related to high depression status were touching cold water and squatting (both p<0.05). Squatting was also related to high anxiety status (p<0.01), while exposing oneself to drafts was related to poor sleep quality (p<0.05). CONCLUSION: The results indicate that the restrictions on squatting, touching cold water, and exposure to drafts are positively associated with good mental health in postpartum women and are worth preserving; however, the restriction on bathing or showering might negatively impact the mental health of postpartum women and needs further evaluation.

Depression and risk of venous thromboembolism: a population-based retrospective cohort study.

OBJECTIVE: This study investigated the relationship between depression and the risk of subsequent venous thromboembolism (VTE) development. METHODS: We conducted a population-based retrospective cohort analysis by using data for the period of 2000 to 2011 from the Longitudinal Health Insurance Database 2000 of Taiwan. A depression cohort comprising 35,274 patients and a nondepression cohort comprising 70,548 patients matched according to sex, age, and index year with no history of VTE were evaluated. Cox proportional hazard regression analysis was used to assess the effects of depression and comorbidities, and the Kaplan-Meier method was applied to estimate the cumulative VTE incidence curves. RESULTS: Compared with individuals without depression, depressed patients had a 1.38-fold greater risk (95% confidence interval = 1.09-1.73) of developing VTE. This risk was significantly higher in male and younger (≤49 years) patients. In addition, patients with comorbidities such as hypertension, diabetes, heart failure, and cancer had a higher risk of depression-associated VTE that was attenuated, although nonsignificantly, by antidepressant use. CONCLUSIONS: The incidence of VTE in Taiwan is higher in depressed patients than in nondepressed patients. Moreover, men, people 49 years or younger, and patients with comorbidities have a significantly greater risk of VTE after depression.

Increased risk of osteoporosis in patients with depression: a population-based retrospective cohort study.

OBJECTIVE: To investigate the relationship between depression and risk of subsequent osteoporosis development. PARTICIPANTS AND METHODS: A population-based retrospective cohort analysis was conducted using the Longitudinal Health Insurance Database 2000 of Taiwan. We included 32,978 patients in the depression cohort and 131,912 patients in the no-depression cohort between January 1, 1998, and December 31, 2008, and calculated the incidence rates of newly diagnosed osteoporosis. We used Cox proportional hazards models to assess the effects of depression. The Kaplan-Meier method was applied to estimate the cumulative osteoporosis incidence curves. RESULTS: Patients with depression were 1.30 times more likely to experience osteoporosis than those without depression. The risk was higher for patients with severe depression and mild depression than for those without depression. A greater hazard ratio magnitude was observed in patients aged 35 to 49 years. We also observed a significant decrease in osteoporosis risk in patients with depression treated with antidepressant agents. CONCLUSION: The incidence of osteoporosis in Taiwan is associated with an a priori depression history. The risk was identified in both men and women, particularly in patients aged 35 to 49 years, and was inversely correlated with antidepressant drug treatment.

The association of peptic ulcer and schizophrenia: a population-based study.

BACKGROUND: The association of schizophrenia with peptic ulcer is not conclusive. In the last 30years, there has been little evaluation of peptic ulcer among schizophrenia patients. METHODS: To explore the relation of peptic ulcer and schizophrenia during this new phase, we used the data from Taiwan insurance claims, identified 1496 schizophrenia patients (ICD-9-CM: 295) and selected 5984 non-schizophrenia controls that were frequency-matched by sex, age, and index year with schizophrenia patients during the years 1998-2001. All subjects were free of peptic ulcer at baseline. We measured incidences of peptic ulcer (ICD-9-CM: 531-534) until the end of 2009. RESULTS: The incidence of peptic ulcer was 1.27 times higher in schizophrenia patients than in the control group (12.1vs. 9.52 per 1000 person-years). Patients are at higher risk taking anti-depression, anxiolytic and hypnotics or non-steroidal anti-inflammatory drugs. After controlling the confounding factors, schizophrenia patients had no significant increase incidence of peptic ulcer. CONCLUSION: Schizophrenia patients have a slightly higher risk of peptic ulcer compared to the general population. This might be due to a higher rate of taking anti-depression, anxiolytic and hypnotics or non-steroidal anti-inflammatory drugs and alcoholism among this group.

Retrospective population cohort study on hip fracture risk associated with zolpidem medication.

STUDY OBJECTIVE: Few studies have evaluated the hip fracture risk for zolpidem users. We assessed the risk for subjects taking zolpidem. DESIGN: Population-based retrospective cohort study using claims data of a universal insurance system. PARTICIPANTS: We identified 6,978 patients newly prescribed for zolpidem in 2000-2001 age 18 y and older, and 27,848 nonusers frequency matched with sex, age, and date visiting a clinic. MEASUREMENTS AND RESULTS: Both cohorts were followed up to the end of 2008 to measure the hip fracture incidence and risk, which considered factors such as sex, age, occupation, days of drug use, and osteoporosis status. The zolpidem users had a 2.23-fold higher hip fracture incidence than nonusers (3.10 versus 1.39 per 1,000 person-y). The risk increased with age for both cohorts. The elderly users had a 21-fold higher incidence than the younger users, or twofold higher than the elderly nonusers. Among 33 patients (20.4%) with hip fracture occurring during presumed medication days, which was accountable for an incidence of 1,083.0 per 1,000 person-y. Those taking the medicine for 8 days or longer had a moderately higher fracture rate than those taking it for less days (6.02 versus 4.48 per 100 person-times) with a ratio of 1.34 (95% confidence interval 0.42-4.56). Subjects with blue collar occupations were at a higher fracture risk. CONCLUSION: The hip fracture risk of zolpidem users is higher than that of nonusers. Fracture prevention awareness should be disseminated to the users.

Patients with epilepsy are at an increased risk of subsequent stroke: a population-based cohort study.

PURPOSE: Epilepsy is well known as a disorder in poststroke patients. However, studies that have investigated the association between epilepsy and the risk of subsequent stroke are limited. This population-based study investigated the incidence and risk of stroke in patients with epilepsy by using the Taiwan National Health Insurance claims data. METHODS: We identified 3812 patients newly diagnosed with epilepsy in 2000-2008 and 15,248 nonepilepsy comparisons frequency matched according to sex, age, and index year. We searched for subsequent stroke diagnoses in both cohorts until the end of 2009. The incidence rates and hazard ratios of stroke were estimated based on sex, age, the average defined daily doses (DDDs) of antiepilepsy drugs, and comorbidity. RESULTS: The stroke incidence of the epilepsy cohort was 3-fold higher than that of the comparison cohort. The age-specific results indicated that in the epilepsy cohort and the comparison cohort, the risk was the highest for the youngest group (20-39 years). CONCLUSION: The patients with epilepsy exhibited a higher incidence of cerebral stroke than the general population did. In addition, younger patients with epilepsy and patients who took a high doses of antiepileptic drugs exhibited a high risk of stroke.

Associating emergency room visits with first and prolonged extreme temperature event in Taiwan: A population-based cohort study.

The present study evaluated emergency room visit (ERV) risks for all causes and cardiopulmonary diseases associated with temperature and long-lasting extreme temperatures from 2000 to 2009 in four major cities in Taiwan. The city-specific daily average temperatures at the high 95th, 97th, and 99th percentiles, and the low 10th, 5th, and 1st percentiles were defined as extreme heat and cold. A distributed lag non-linear model was used to estimate the cumulative relative risk (RR) of ERV for morbidities associated with temperatures (0 to 3-day lags), extreme heat and cold lasting for 2 to 9 days or longer, and with the annual first extreme heat or cold event after controlling for covariates. Low temperatures were associated with slightly higher ERV risks than high temperatures for circulatory diseases. After accounting for 4-day cumulative temperature effect, the ERV risks for all causes and respiratory diseases were found to be associated with extreme cold at the 5th percentile lasting for >8 days and 1st percentile lasting for >3 days. The annual first extreme cold event of 5th percentile or lower temperatures was also significantly associated with ERV, with RRs ranging from 1.09 to 1.12 for all causes and from 1.15 to 1.26 for respiratory diseases. The annual first extreme heat event of 99th percentile temperature was associated with higher ERV for all causes and circulatory diseases. Annual first extreme temperature event and intensified prolonged extreme cold events are associated with increased ERVs in Taiwan.

The risk of temporomandibular disorder in patients with depression: a population-based cohort study.

OBJECTIVES: This study used a population-based retrospective cohort design to examine whether depression is a risk factor of temporomandibular disorder (TMD). METHODS: From a universal insurance database, we identified 7587 patients who are newly diagnosed individuals with depression in 2000 and 2001. A total of 30,197 comparison subjects were randomly selected from a nondepression cohort. Both groups were followed until the end of 2008 to measure the incidence of TMD. RESULTS: The incidence of TMD was 2.65 times higher in the depression cohort than in the nondepression cohort (6.16 versus 2.32 per 1000 person-years). The hazard ratio (HR) measured by multivariate Cox's proportional hazard regression analysis of TMD for the depression cohort was 2.21 (95% confidence interval (CI) 1.83-2.66), after controlling for socio-demographic factors and other psychiatric comorbidities. Women had higher risk to develop TMD than men (HR 1.61, 95% CI 1.36-1.92 for women without depression; HR 3.54, 95% CI 2.81-4.45 for women with depression). CONCLUSIONS: This study demonstrates that patients with depression are at an elevated risk of developing TMD.

Schizophrenia patients at higher risk of diabetes, hypertension and hyperlipidemia: a population-based study.

OBJECTIVE: This study investigates risks of developing diabetes mellitus (DM), hypertension, and hyperlipidemia in treating schizophrenia with first- and second-generation antipsychotics (FGA and SGA, respectively). METHODS: We established two study sets, each consisting of patients with schizophrenia and without schizophrenia, from the insurance claims from 1997 to 2000. Study set I had 1631 patients taking FGA and 6524 non-schizophrenia controls; the other had 1224 patients taking SGA and 4896 controls. Controls were selected frequency matched with sex, age and the index year. All subjects were free of the studied metabolic disorders at the baseline. We measured incidences of these disorders developed by the end of 2008 in each cohort and their respective hazard ratios (HRs) for these disorders. RESULTS: Schizophrenic patients taking FGA were older than those taking SGA. In the Cox models, significance adjusted HRs associated with SGA were 1.82 (95% confidence interval (CI) 1.30-2.55) for DM and 1.41 (95% CI 1.09-1.83) for hyperlipidemia. For those on the FGA, the risk was only significant in developing DM (HR 1.32, 95% CI 1.01-1.75). The age-specific antipsychotics-associated risks for metabolic disorders were higher in young patients than in older patients particularly for hypertension; the HRs in 10-19 years of age were 4.52 (95% CI 1.76-11.6) associated with FGA and 3.92 (95% CI 1.83-8.39) associated with SGA. CONCLUSIONS: Patients with schizophrenia on SGA have higher risk of developing metabolic disorders than those on FGA. It is likely that older patients have already gone through the age of developing these side-effects and were free of them at the baseline.

[Study on the posterior teeth mesiodistal tipping degree of normal occlusion subjects among different facial growth patterns].

OBJECTIVE: To study the relationship between the mesiodistal tipping degree of maxillary and mandible posterior teeth and different vertical facial skeletal types of subjects with normal occlusion. METHODS: 163 subjects with normal occlusion were selected, lateral cephalograms were taken and divided into three different facial skeletal types. The difference of the mesiodistal tipping degrees and intersection angles of upper and lower posterior teeth between the three different facial skeletal types were analyzed. RESULTS: Among 163 subjects, vertical growth pattern, average growth pattern and horizontal growth pattern were 24, 96 and 43 respectively. There were statistic differences of mesiodistal tipping degrees of the first and second maxillary and mandible premolar and the first permanent molar between vertical growth and horizontal growth pattern, horizontal growth and average growth pattern (P < 0.05). But there were no statistically significant differences between vertical growth and average growth pattern (P > 0.05). The differences of the maxillary and mandible posterior teeth's intersection angle among three vertical facial skeletal types had no statistic significance (P > 0.05). CONCLUSION: Different vertical facial skeletal type has its own normal and coordinated posterior teeth mesiodistal tipping degrees.

[Morphological characteristics of mandibular symphysis in adult skeletal class II and class III malocclusions with abnormal vertical skeletal patterns].

OBJECTIVE: To figure out the differences of the morphological characteristics of mandibular symphysis between Class II and Class III adult skeletal malocclusions with different abnormal vertical skeletal patterns. METHODS: 109 Chinese female adults of skeletal Class II and Class III were chosen and divided into four groups according to vertical and sagittal skeletal pattern: Class II--vertical-growth-pattern group (n=30), Class III--vertical-growth-pattern group (n=25), Class II--horizontal-growth-pattern group (n=29), Class III--horizontal-growth-pattern (n=25). Lateral cephalograms were taken. The symphyseal widths and heights, along with lower incisor positions were evaluated. Observation and statistics analysis were done to clarify the morphological characteristics of the symphyseal region of different skeletal patterns. RESULTS: There were morphological differences of symphyseal region between Class II and Class III skeletal malocclusions, but not significant in width and total height. With a vertical-growth-pattern, Class II malocclusions had higher alveolus than Class III, but smaller chin prominence and lower basal bone (P < 0.01). With a horizontal-growth-pattern, Class II malocclusions had higher alveolus (P < 0.05) and larger alveolar top width (P < 0.001). With a same sagittal skeletal pattern, vertical-growth-pattern group had thinner but higher symphyseal region and bigger chin prominence (P < 0.001 in Class II while P < 0.05 in Class III). Besides, a vertical-growth-pattern malocclusion was prone to have a cucurbit-morph chin, of which Id width was larger than basal width (P < 0.01). CONCLUSION: There are morphological differences in symphyseal region between Class II and Class III skeletal malocclusions with different abnormal vertical skeletal patterns. The influence of abnormal vertical skeletal pattern to symphyseal morphological characteristics is greater than that of abnormal sagittal skeletal pattern. There is a risk of orthodontic movement of low incisors in vertical-growth-pattern skeletal malocclusion.