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1.
Medicine (Baltimore) ; 99(22): e20476, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481457

RESUMO

To investigate the healthcare expenditures and length of stay (LOS) of sepsis-related hospitalizations in Taiwan.This is a retrospective claim database study. Data were obtained from the two-million-sample longitudinal health and welfare database (LHWD). Adult patients hospitalized with sepsis between 2010 and 2014 were identified by International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes, and these patients were divided into three levels of sepsis severity. The amount and distribution of their total medical expenditures were investigated.In total, 62,517 patients with 97,790 sepsis-related hospitalizations were included in the present study. It was found that ward fees and medicines comprised the largest component of expenses for sepsis-related hospitalizations. In addition, our study results indicated that the median sepsis-related hospitalization cost was 66.4 thousand New Taiwan Dollar (NT dollars) in 2014, and a significant temporal change was found between 2010 and 2014. The median LOS in a hospital and in an intensive care unit were 11 and 7 days, respectively. Both expenditures and LOS were found to increase with sepsis severity.This study provides an updated and better understanding of the costs and LOS of sepsis-related hospitalizations in Taiwan. It was found that ward fees and medicine fees were the major components of hospital costs.


Assuntos
Hospitalização/economia , Sepse/economia , Cuidados Críticos/economia , Gastos em Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Estudos Longitudinais , Estudos Retrospectivos , Índice de Gravidade de Doença , Taiwan
2.
Artigo em Inglês | MEDLINE | ID: mdl-32478484

RESUMO

OBJECTIVES: The data concerning the association between Tx and ADs remain unclear and are scarce. This study was undertaken to investigate whether people with Tx are more likely to develop ADs, compared to those without Tx. METHODS: Individuals who received Tx between 2002 and 2015 were identified and matched on age and sex with individuals without Tx. We performed multivariate and stratified analysis using the Kaplan-Meier method and Cox proportional hazards models in order to estimate the association between Tx and the risk of developing ADs. RESULTS: A total of 2550 thymectomized (Txd) patients and 24,664.941 non-Txd comparison subjects were selected from NHIRD. Tx-MG (myasthenia gravis) as compared with general population (nonTx-nonMG), adjusted hazard ratio (aHR) were higher for incident Addison disease (aHR = 10.40, 95% CI 1.01-107), autoimmune hemolytic anemia (aHR = 21.54, 95% CI 2.06-14.8), Hashmoto thyroiditis (aHR = 5.52, 95% CI 1.34-34.7), ankylosing spondylitis (aHR = 2.73, 95% CI 1.09-6.84), rheumatoid arthritis (aHR = 5.25, 95% CI 1.79-15.47), primary Sjogren syndrome (pSS) (aHR = 3.77, 95% CI 1.30-11.0), and systemic lupus erythemtoasus (aHR = 10.40). Tx-nonMG as compared with general population, aHR were higher for incident autoimmune hemolytic anemia (aHR = 25.50), Hashmoto thyroiditis (aHR = 6.75) and systemic lupus erythematosus (SLE) (aHR = 13.38). NonTx-MG as compared with general population, aHR were higher for incident Hashmoto thyroiditis (aHR = 6.57), pSS (aHR = 4.50), SLE (aHR = 17.29), and systemic vasculitis (aHR = 25.86). INTERPRETATION: In conclusion, based on a retrospective cohort study throughout Taiwan, patients with Tx have a higher risk of new onset ADs than patients without Tx.

3.
Clin Rheumatol ; 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32240432

RESUMO

OBJECTIVE: This study assessed the risk of Parkinson disease (PD) in patients with primary Sjögren's syndrome (pSS) using a nationwide, population-based cohort during a 15-year follow-up period. METHOD: We identified 17,028 patients with pSS by using the catastrophic illness registry in the Taiwan National Health Insurance Research Database, and 68,094 matched non-pSS controls. RESULTS: The pSS cohort showed a higher incidence of PD development than did the non-pSS cohort (1.60% vs. 1.17%, p = 0.0001). The adjusted hazard ratio (aHR) of developing PD was 1.23 times greater in the pSS group than in the non-pSS group. When stratified by sex, age, and comorbidities, the female patients with pSS and patients aged between 61 and 70 years were associated with a higher PD risk (aHR 1.28 and aHR 1.30, respectively). Patients with pSS with no other comorbidity had a higher risk of PD (aHR: 2.17), compared with the non-pSS patients with no other comorbidity. When comparing non-pSS patients without or with comorbidity with pSS without or with comorbidity, pSS patients with comorbidity had highest risk of PD (aHR: 3.814). CONCLUSIONS: All of the above findings suggested that pSS is an independent risk factor for the development of PD.Key Points•The patients with pSS had 1.23 times risk of Parkinson disease than the non-pSS group.•The female patients with pSS and patients aged between 61 and 70 years were associated with a higher PD risk (aHR 1.28 and aHR 1.30, respectively).•The pSS patients with comorbidity had highest risk of PD (aHR: 3.814).

4.
Ying Yong Sheng Tai Xue Bao ; 31(1): 165-172, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-31957393

RESUMO

The unreasonable resource allocation and lower resource use efficiency for rice-wheat double cropping system in Jianghuai region resulted from climate change severely limit the coordinated development of annually high yield and high efficiency crops. Optimizing seasonal resource allocation through sowing date adjustment is an important way to tap the annual high-yield potential and improve resource use efficiency. To quantify the effects of sowing date of rice and wheat on annual yield and resource allocation and utilization efficiency, field experiments were conducted in 2013-2015. Results showed that compared with the conventional rice-wheat cropping system (T2), the two seasons appropriate late-cast cropping system (T3) could coordinate resource allocation in the two seasons through the sowing date adjustment, and transfer the redundant radiation and heat resources in the wheat season to the rice. The distribution rate of accumulated temperature, radiation and rainfall resources for T3 were: rice season accounted for 60.5%, 46.5% and 56.7%, wheat season accounted for 36.3%, 50.0% and 40.9%, and the ratio between two seasons was 1.67, 0.94 and 1.39, respectively. Rice yield and its proportion of annual production were significantly increased. The wheat yield was significantly decreased, with the variation range being smaller than that of rice. The total annual yield was increased by 336.3 kg·hm-2 as compared with T2. The temperature, radiation and rainfall production efficiency for rice in T3 were increased by 9.8%, 5.6% and 8.3% in compared to T2, respectively. There was no significant difference in the climate resource utilization efficiency of wheat season. The annual resource production efficiency of T3 was increased by 4.8%, 3.1% and 6.0% over the T2, respectively. Earlier (T1) or latest sowing (T4) of two seasons cropping system was not appropriate for annual yield formation and resource utilization. In summary, improving resource utilization efficiency in rice season is the key way to increase annual grain yield potential in Jianghuai region. The results provided theoretical and practical bases for the excavation of yield potential of the regional annual cropping system and the adjustment of planting structure.


Assuntos
Oryza , Triticum , Agricultura , Produtos Agrícolas , Grão Comestível , Estações do Ano
5.
Sleep Breath ; 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900884

RESUMO

PURPOSE: Patients with obstructive sleep apnea (OSA) have a higher risk of Behçet's disease (BD) and Sjögren syndrome (SS). However, the bidirectional relationship between these autoimmune diseases and OSA is unclear. We investigated the relationship between autoimmune diseases (SS and BD) and OSA. METHODS: SS and BD patients were identified through the Taiwan National Health Insurance Research Database from 2002 to 2012. Patients with SS or BD were matched according to age and sex with a control group in a ratio of 1:4. The study included 12,926 patients with SS and 51,704 non-SS controls. Similarly, 1221 patients with BD were matched with 4884 non-BD controls. We used a Cox regression model, stratified by age, gender, and comorbidities, to assess the risk of OSA. RESULTS: OSA was diagnosed in 0.61% of the SS cohort and 1.23% of the BD cohort. The higher overall risk for OSA was observed significantly in patients with SS than in controls (adjusted hazard ratio [HR] = 2.48, 95% confidence interval [CI] = 1.89-3.24). The higher risk was also observed significantly in BD patients than in controls (HR = 1.99, 95% CI = 1.06-3.72). Furthermore, men with SS or BD exhibited HR of 2.62 (95% CI 1.89 to 3.62) and 6.40 (95% CI 2.96 to 13.84) for developing OSA, respectively. CONCLUSION: Risk of OSA was significantly elevated in SS or BD patients compared with controls. Further study is warranted to elucidate underlying mechanisms.

6.
Int J Syst Evol Microbiol ; 70(2): 1139-1144, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31751198

RESUMO

A Gram-stain-positive, moderately halophilic, strictly aerobic, endospore-forming, rod-shaped bacterium, strain JSM 102062T, was isolated from a non-saline farm soil sample collected from Dehang Canyon in Hunan, PR China. Growth occurred with 0.5-20 % (w/v) NaCl (optimum 4-7 %) at pH 5.5-11.0 (optimum pH 8.0) and at 20-50 °C (optimum 30-35 °C). Contained cell-wall peptidoglycan based on meso-diaminopimelic acid and possessed menaquinone-7 (MK-7) as the major respiratory isoprenoid quinone. The major cellular fatty acids were anteiso-C15 : 0, anteiso-C17 : 0 and iso-C16 : 0. The polar lipid pattern consisted of diphosphatidylglycerol, phosphatidylglycerol, five unidentified phospholipids and an unidentified glycolipid. The DNA G+C content was 44.1 mol%. Phylogeny based on 16S rRNA gene sequences indicated that strain JSM 102062T belonged to the genus Sediminibacillus, sharing high 16S rRNA gene sequence similarities to Sediminibacillus halophilus EN8dT (99.4 %) and Sediminibacillus albus NHBX5T (98.3 %). The whole genomic analysis showed that strain JSM 102062T constituted a different taxon separated from the recognized Sediminibacillus species. Combined data from phenotypic and genotypic studies demonstrated that strain JSM 102062T represents a noval species of the genus Sediminibacillus, for which the name Sediminibacillus terrae sp. nov. is proposed; the type strain is JSM 102062T (=CCTCC AB 2014166T = CGMCC 1.12957T=DSM 28949T=KCTC 33541T).


Assuntos
Bacillaceae/classificação , Fazendas , Filogenia , Microbiologia do Solo , Bacillaceae/isolamento & purificação , Técnicas de Tipagem Bacteriana , Composição de Bases , China , DNA Bacteriano/genética , Ácido Diaminopimélico/química , Ácidos Graxos/química , Peptidoglicano/química , Fosfolipídeos/química , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Vitamina K 2/análogos & derivados , Vitamina K 2/química
7.
Cancers (Basel) ; 11(11)2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31703359

RESUMO

Both gemcitabine and fluoropyrimidine are recommended backbones in the first-line treatment of pancreatic ductal adenocarcinoma (PDAC). To compare the efficacy and safety of these two therapeutic backbones, and to investigate the optimal therapies, we conducted a network meta-analysis. By retrospective analysis of randomized controlled trials (RCT), the most preferred therapeutic regimen may be predicted. The eligible RCTs of the gemcitabine-based therapies and fluoropyrimidine-based therapies were searched up to 31 August 2019. In a frequentist network meta-analysis, treatments were compared and ranked according to overall survival (OS) and progression-free survival (PFS). Thirty-two trials with 10,729 patients were included. The network meta-analyses results for overall survival and progression-free survival showed that fluoropyrimidine-based therapy seems to be the most effective treatment choice. Compared to gemcitabine combined with taxanes or immunotherapy, fluoropyrimidine-based therapy had comparable treatment effects (PFS: 0.67, p-Value = 0.11; 0.76, p-Value = 0.32; OS: 0.80, p-Value = 0.16; 0.77, p-Value = 0.21). Moreover, the combination of immunotherapy and gemcitabine had tolerable toxicities. Based on current evidence, fluoropyrimidine-based therapies and the combination of gemcitabine and taxanes were the most effective therapies in the advanced pancreatic cancer, and the combination of immunotherapy and gemcitabine can be developed into a new form of therapy.

8.
J Am Med Inform Assoc ; 26(11): 1227-1236, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390470

RESUMO

OBJECTIVE: In this era of digitized health records, there has been a marked interest in using de-identified patient records for conducting various health related surveys. To assist in this research effort, we developed a novel clinical data representation model entitled medical knowledge-infused convolutional neural network (MKCNN), which is used for learning the clinical trial criteria eligibility status of patients to participate in cohort studies. MATERIALS AND METHODS: In this study, we propose a clinical text representation infused with medical knowledge (MK). First, we isolate the noise from the relevant data using a medically relevant description extractor; then we utilize log-likelihood ratio based weights from selected sentences to highlight "met" and "not-met" knowledge-infused representations in bichannel setting for each instance. The combined medical knowledge-infused representation (MK) from these modules helps identify significant clinical criteria semantics, which in turn renders effective learning when used with a convolutional neural network architecture. RESULTS: MKCNN outperforms other Medical Knowledge (MK) relevant learning architectures by approximately 3%; notably SVM and XGBoost implementations developed in this study. MKCNN scored 86.1% on F1metric, a gain of 6% above the average performance assessed from the submissions for n2c2 task. Although pattern/rule-based methods show a higher average performance for the n2c2 clinical data set, MKCNN significantly improves performance of machine learning implementations for clinical datasets. CONCLUSION: MKCNN scored 86.1% on the F1 score metric. In contrast to many of the rule-based systems introduced during the n2c2 challenge workshop, our system presents a model that heavily draws on machine-based learning. In addition, the MK representations add more value to clinical comprehension and interpretation of natural texts.

9.
Eur Radiol ; 29(12): 7073, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31197443

RESUMO

The original version of this article, published on 24 May 2014, unfortunately contained a referencing omission.

10.
PLoS One ; 14(5): e0216337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048897

RESUMO

BACKGROUND: The evidence supporting the benefit of femoral nerve block (FNB) for positioning before spinal anesthesia (SA) in patients suffering from a femur fracture remains inconclusive. In the present study, the authors intended to determine the efficacy and safety of FNB versus an intravenous analgesic (IVA) for positioning before SA in patients with a femur fracture. METHOD: PubMed, EMBASE, Cochrane, and Scopus databases were searched up to January 2018. We included randomized controlled studies (RCTs) and observational studies that compared FNB versus IVA for the positioning of patients with femur fracture receiving SA. The primary outcome was pain scores during positioning within 30 min before SA. Secondary outcomes were the time for SA, additional analgesic requirements, anesthesiologist's satisfaction with the quality of positioning for SA, participant acceptance, and hemodynamic changes. A random-effects model was used to synthesize the data. We registered the study at PROSPERO with an ID of CRD42018091450. RESULTS: Ten studies with 584 patients were eligible for inclusion. FNB achieved significantly lower pain scores than IVA during positioning within 30 min before SA (pooled standardized mean deviation (SMD): -1.27, 95% confidence interval (CI): -1.84 to -0.70, p < 0.05). A subgroup analysis showed that the analgesic effect was larger in patients in the sitting position for SA than a non-sitting position (sitting position vs non-sitting: pooled SMD: -1.75 (p < 0.05) vs -0.61 (not significant). A multivariate regression showed that the analgesic effect was also associated with age and the total equivalent amount as lidocaine after adjusting for gender (age: coefficient 0.048, p < 0.05; total equivalent amount as lidocaine: coefficient 0.005, p < 0.05). Patients receiving FNB also had a significantly shorter time for SA, greater anesthesiologist satisfaction, and higher patient acceptance than patients receiving IVA. The use of local anesthetics did not produce significant clinical hemodynamic change. CONCLUSION: Compared to IVA, FNB was an effective and safe strategy for the positioning of femur fracture patients for a spinal block, particularly patients who received SA in the sitting position.


Assuntos
Analgésicos/uso terapêutico , Raquianestesia , Fraturas do Fêmur/terapia , Nervo Femoral , Lidocaína/uso terapêutico , Bloqueio Nervoso , Feminino , Humanos , Masculino
11.
Medicine (Baltimore) ; 98(20): e15725, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096527

RESUMO

To investigate the epidemiology trend and characteristics of sepsis-related hospitalizations in Taiwan, and to compare the differences among different severity levels of sepsis.This study is a retrospective national claim database analysis. Hospitalized adult patients with sepsis between 2010 and 2014 were identified from the Two-Million-Sample Longitudinal Health and Welfare Database (LHWD) by the International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM). The patients were divided into 3 severity groups based on their medical records during hospitalization.The study results showed that in Taiwan, there were 643 new cases of sepsis in 100,000 Taiwanese. The mortality of all septic patients in Taiwan was 287 per 100,000 people, and the case fatality was 29.2%. It was found that the mortality and incidence of sepsis in Taiwan have increased year by year, but there has been no significant change over time. In addition, demographic variation exists in the epidemiology of sepsis. In all the rates investigated, the men's were higher than the women's and the elderly's were higher than the youths'. The analysis results also showed that the respiratory system was the most common site of organ failure in septic patients.The incidence and mortality of any severity level of sepsis were 643, and 287 per 100,000 people in Taiwan, respectively, and the average case fatality was 29.2% during the study period (2010-2014). The respiratory system was the major infected site and site of organ dysfunction, especially in the more severe levels.


Assuntos
Insuficiência Respiratória/epidemiologia , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Registros Médicos , Mortalidade , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Índice de Gravidade de Doença , Taiwan/epidemiologia
12.
Biomed Pharmacother ; 116: 108976, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31103827

RESUMO

With the development of more effective direct-acting antivirals (DAAs), dual- or triple-therapy regimens represent the major strategy used to cure chronic hepatitis C virus (HCV) infection. Thus, shorter treatment duration regimens with low burden, few adverse effects and good patient adherence are urgently needed. This study theoretically demonstrates a proof-of-concept approach for shortening therapy duration by examining HCV-infected Huh7.5 cells after treatment with a high or low fixed dose of three DAAs (simeprevir + daclatasvir + sofosbuvir) for 6-15 days. The results demonstrated that HCV-infected Huh7.5 cells achieved an ultrarapid virologic response with undetectable HCV RNA and protein and were cured after treatment with the triple-therapy regimen for 15 days. When the treatment duration was shortened, virologic relapse might occur after treatment with a low fixed dose of the three DAAs for 9 days and did occur after treatment with a low fixed dose for 6 days, although HCV was below detectable levels at the end of treatment. However, virologic relapse could be avoided with treatment of a high fixed dose of the three DAAs for 9 or 6 days. Although a virologic breakthrough occurred after an intermittent treatment regimen at the low fixed dose, the high fixed dose cured HCV-positive Huh7.5 cells with intermittent treatment. In conclusion, HCV is persistently present below detectable levels in HCV-infected Huh7.5 cells for a long time after treatment, and a shortened therapy duration is associated with an increased risk of virologic relapse, but virologic relapse or breakthrough might be avoided by treatment with a combination of more highly effective DAAs.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/fisiologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Antivirais/farmacologia , Morte Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Sinergismo Farmacológico , Quimioterapia Combinada , Hepacivirus/efeitos dos fármacos , Humanos , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Espaço Intracelular/virologia , Recidiva , Simeprevir/farmacologia , Simeprevir/uso terapêutico , Sofosbuvir/farmacologia , Sofosbuvir/uso terapêutico , Replicação Viral/efeitos dos fármacos
13.
Molecules ; 24(9)2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31027344

RESUMO

The objective of this study was to identify novel acetylation (Ac) modifications of the C1-inhibitor (C1-INH) and explain the association of the levels of autoantibodies against acetylated C1-INH peptides with the risk of developing systemic lupus erythematosus (SLE). Ac modifications of the C1-INH were identified and validated through in-gel digestion, nano-liquid chromatography-tandem mass spectrometry, immunoprecipitation, and Western blotting by using serum protein samples obtained from patients with SLE and age-matched healthy controls (HCs). In addition, the levels of serum C1-INH, Ac-protein adducts, and autoantibodies against unmodified and acetylated C1-INH peptides were measured. C1-INH levels in patients with SLE were significantly lower than those in HCs by 1.53-fold (p = 0.0008); however, Ac-protein adduct concentrations in patients with SLE were significantly higher than those in HCs by 1.35-fold (p = 0.0009). Moreover, immunoglobulin M (IgM) anti-C1-INH367-385 Ac and IgA anti-C1-INH367-385 Ac levels in patients with SLE were significantly lower than those in HCs. The low levels of IgM anti-C1-INH367-385 (odds ratio [OR] = 4.725, p < 0.001), IgM anti-C1-INH367-385 Ac (OR = 4.089, p = 0.001), and IgA anti-C1-INH367-385 Ac (OR = 5.566, p < 0.001) indicated increased risks for the development of SLE compared with HCs.


Assuntos
Proteína Inibidora do Complemento C1/imunologia , Imunoglobulina A/imunologia , Imunoglobulina M/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Peptídeos/imunologia , Acetilação , Sequência de Aminoácidos , Autoanticorpos/imunologia , Autoantígenos/imunologia , Proteína Inibidora do Complemento C1/química , Proteína Inibidora do Complemento C1/metabolismo , Feminino , Humanos , Lúpus Eritematoso Sistêmico/sangue , Peso Molecular , Peptídeos/química , Ligação Proteica/imunologia , Curva ROC , Taiwan
14.
Ann Clin Transl Neurol ; 6(4): 633-641, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31019988

RESUMO

Objective: We studied the risk of dementia in patients with primary Sjögren's syndrome (pSS) using a nationwide, population-based cohort in Taiwan. Methods: Our study analyzed the medical data of the Taiwanese population from 2000 to 2014. We identified 17,072 patients with pSS and 68,270 controls. Dementia risk was analyzed using a Cox proportional hazards regression model stratified by sex, age, and comorbidities. Results: A higher incidence of dementia development in the pSS group during the observation period (P = 0.0001). In multivariate analysis adjusted by age groups, gender, and the comorbidities, the adjusted hazard ratio (aHR) of developing dementia was 1.246 (95% CI 1.123-1.384) times greater in the pSS group than in the non-pSS group. When stratified by sex, age, and comorbidities, the patients with pSS less than 60 years (aHR 1.67, 95% CI 1.16-2.41), and without any comorbidity (aHR 2.27, 95% CI 1.76-2.93) were particularly associated with a higher risk of dementia. Furthermore, the patients with pSS combined with any other comorbidity had an additionally higher risk of dementia (aHR: 3.978, 95% CI 3.309-4.782), also suggesting that pSS was an independent risk factor for the development of dementia. Interpretation: Primary Sjogren's syndrome is associated with increased dementia risk and further study is needed to understand why and what the specific dementia phenotypes are.


Assuntos
Demência/complicações , Demência/etiologia , Síndrome de Sjogren/complicações , Síndrome de Sjogren/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Síndrome de Sjogren/diagnóstico , Adulto Jovem
15.
J Pain Symptom Manage ; 57(5): 933-943, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30708124

RESUMO

CONTEXT: At the end of life, chronic obstructive pulmonary disease (COPD) and lung cancer (LC) patients exhibit similar symptoms; however, a large-scale study comparing end-of-life health care utilization between these two groups has not been conducted in East Asia. OBJECTIVES: To explore and compare end-of-life resource use during the last six months before death between COPD and LC patients. METHODS: Using data from the Taiwan National Health Insurance Research Database, we conducted a nationwide retrospective cohort study in COPD (n = 8640) and LC (n = 3377) patients who died between 1997 and 2013. RESULTS: The COPD decedents were more likely to be admitted to intensive care units (57.59% vs 29.82%), to have longer intensive care unit stays (17.59 vs 9.93 days), and to undergo intensive procedures than the LC decedents during their last six months; they were less likely to receive inpatient (3.32% vs 18.24%) or home-based palliative care (0.84% vs 8.17%) and supportive procedures than the LC decedents during their last six months. The average total medical cost during the last six months was approximately 18.42% higher for the COPD decedents than for the LC decedents. CONCLUSION: Higher intensive health care resource use, including intensive procedure use, at the end of life suggests a focus on prolonging life in COPD patients; it also indicates an unmet demand for palliative care in these patients. Avoiding potentially inappropriate care and improving end-of-life care quality by providing palliative care to COPD patients are necessary.

16.
Rheumatology (Oxford) ; 58(1): 135-143, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189048

RESUMO

Objectives: Previous studies have shown myasthenia gravis (MG) and autoimmune rheumatic diseases (ARDs) share common pathogenetic mechanisms. Therefore, the present study investigated the possible relationship between MG and ARDs. Methods: We analysed Taiwanese medical data from the Registry of Catastrophic Illness and identified patients with MG. From the entire general population data of the National Health Insurance Research Database, we randomly selected a comparison cohort that was frequency-matched by age (in 5-year increments), sex, and index date. We analysed the risk of ARDs by using a Cox proportional hazards regression model stratified by sex, age and treatment. Results: In the present study, we enrolled 6478 patients with MG (58.03% women; mean age, 50.55 years) and 25 912 age- and sex-matched controls. The risk of total ARDs was 6.25 times higher in the MG cohort than in the non-MG cohort after adjustment for age and sex. Furthermore, the MG cohort was associated with a significantly higher risk of primary SS (pSS), SLE and other ARD types (adjusted hazard ratios: 15.84 [95% CI: 8.39, 23.91]; 11.32 [95% CI: 5.04, 25.429]; and 4.07 [95% CI: 1.31, 12.62], respectively). The MG cohort who underwent thymectomy had an increased risk of RA, pSS and SLE (adjusted hazard ratios: 4.41; 15.06; and 23.68, respectively). Conclusion: The present nationwide cohort study revealed an association between MG and incident ARDs. The MG cohort who underwent thymectomy had an increased risk of RA, pSS and SLE. Future studies are needed to elucidate the underlying pathogenesis and to translate this into clinical therapeutic options.


Assuntos
Doenças Autoimunes/epidemiologia , Miastenia Gravis/cirurgia , Complicações Pós-Operatórias/epidemiologia , Doenças Reumáticas/epidemiologia , Timectomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/etiologia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Modelos de Riscos Proporcionais , Sistema de Registros , Doenças Reumáticas/etiologia , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
17.
Curr Med Res Opin ; 35(6): 1051-1058, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30474438

RESUMO

OBJECTIVE/METHODS: The Longitudinal Health Insurance Database (LHID) 2010 was used to identify gout cases and their number of gout flares. RESULTS: Out of 21,376 gout patients, a total of 3561 (16.7%) had frequent gout flares (≥3 gout flares/year). Average all-cause healthcare utilization (35.9 visits vs. 30.7 visits; p < .001) and gout-related utilization (22.7 visits vs. 15.6 visits; p < .001) were higher in frequent gout flare patients than in those with infrequent gout flares. The median gout-related cost (USD $369 vs. $285; p < .001), but not all-cause costs (p = .25), were higher in frequent gout flare patients compared to the infrequent group. Over 55.8% of the flares were treated with colchicine + NSAIDs. CONCLUSIONS: In conclusion, patients with frequent gout flares had higher healthcare utilization and gout-related healthcare costs. Colchicine + NSAIDs are commonly used therapy for gout flare.


Assuntos
Gota/tratamento farmacológico , Custos de Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Colchicina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Padrões de Prática Médica , Estudos Retrospectivos
18.
Medicine (Baltimore) ; 97(31): e11602, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30075532

RESUMO

To estimate the healthcare utilization and costs of major diabetes mellitus (DM)-related complications in Taiwan in the year of first occurrence and in subsequent years.This study is a retrospective claim database analysis using the longitudinal cohort of diabetes patients (LHDB) with 2012 as the base year. Occurrences of 8 DM-related complications of interest were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Annual healthcare costs and utilization of these DM-related complications in the LHDB cohorts of the years 2004 to 2009 were examined, and the generalized linear model was used to estimate annual total healthcare costs for each complication.DM patients with complications were more likely to have at least 1 emergency room (ER) visit and at least 1 hospitalization (both P < .001), and they also had more outpatient visits, higher hospitalization costs, higher outpatient costs, and higher ER costs (all P < .001) than those without. The mean annual total healthcare cost of the patients with DM-related complications was US $4189, whereas the mean annual cost of those patients without complication was $1424 (P < .001). The complications with the greatest event costs were amputation ($7877; 95% confidence interval [CI]: $6628-$9322) and fatal MI ($4067; 95% CI: $3001-$5396) while the complication with the greatest state costs was end-stage renal disease (ESRD) ($2228; 95% CI: $2155 to $2302).DM-related complications could significantly increase healthcare utilization and costs. The results of this study provide data that are useful for local economic evaluations of DM treatments.


Assuntos
Efeitos Psicossociais da Doença , Complicações do Diabetes/economia , Diabetes Mellitus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Ambulatorial/economia , Bases de Dados Factuais , Feminino , Hospitalização/economia , Humanos , Revisão da Utilização de Seguros , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan
19.
Sci Rep ; 8(1): 9686, 2018 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-29946182

RESUMO

In this study, we conducted an indirect comparison analysis to compare the efficacy and safety of immune checkpoint inhibitors with those of antiangiogenic therapy-two effective treatment methods for advanced non-small-cell lung cancer (NSCLC). Eligible randomised control trials of immune checkpoint inhibitors, antiangiogenic therapy, and doublet platinum-based therapy published up to July 2017 were comprehensively analysed. Through the indirect comparison analysis of 37 trials involving 16810 patients, treatments were compared for overall survival (OS) and grade 3-5 adverse events. For first-line treatment, the use of pembrolizumab alone (hazard ratio [HR]: 0.6; 95% confidence interval [CI]: 0.4-0.91) and a combination of bevacizumab and doublet platinum-based therapy (HR: 0.86; 95% CI: 0.75-0.99) demonstrated substantial survival benefits compared with doublet platinum-based therapy. For subsequent treatment, nivolumab may provide higher efficacy and lower toxicity than antiangiogenic therapy. Overall, anti-PD1 monoclonal antibodies may be superior to antiangiogenic therapy in terms of OS and grade 3-5 adverse events. This meta-analysis suggests that pembrolizumab and nivolumab might be favourable choices for first-line and subsequent treatment, respectively, for patients with advanced NSCLC. Additional randomised control trials are required for a comprehensive evaluation of the outcomes among regimens.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Anticorpos Monoclonais/metabolismo , Bevacizumab/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Humanos , Neoplasias Pulmonares/metabolismo , Nivolumabe/uso terapêutico
20.
PLoS One ; 13(1): e0186475, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29304089

RESUMO

OBJECTIVE: Dementia is a common neurological disease that substantially affects public health. A previous study revealed that dementia occurs when the body's immune system attacks the cells of the brain, indicating that dementia may be similar to autoimmune rheumatic diseases (ARDs). In the current retrospective cohort study, we focused on middle-aged ARD patients (45 years or older) to investigate the association between ARDs in middle-aged people and dementia by using a nationwide population-based database in Taiwan. METHOD: Our study analyzed the medical data of the Taiwanese population from 2001 to 2012, with a follow-up period extending until the end of 2011. We identified middle-aged patients with ARDs by using the Taiwan National Health Insurance Research Database. We selected a comparison cohort from the general population that was randomly frequency-matched by age (in 5-year increments), sex, and index year and further analyzed the dementia risk by using a Cox regression model that considers sex, age, and comorbidities. RESULTS: The study enrolled 34,660 middle-aged ARD patients (77% female, mean age = 59.8 years) and 138,640 controls. The risk of developing dementia was 1.18 times higher for middle-aged patients with ARDs compared with patients without ARDs after adjustment for age, sex, and comorbidities. Among the patients with ARDs, the subgroups with rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome (SS) were associated with a significantly higher dementia risk (adjusted hazard ratio [HR] 1.14, 95% confidence index [CI] 1.06-1.32; adjusted HR 1.07, 95% CI 0.86-1.34; adjusted HR 1.46, 95% CI 1.32-1.63, respectively). Furthermore, primary SS and secondary SS patients had the highest risks of dementia among all the ADR subgroups (adjusted HR 1.35, 95% CI 1.18-1.54; adjusted HR 1.67, 95% CI 1.43-1.95 respectively). CONCLUSION: This nationwide retrospective cohort study demonstrated that dementia risk is significantly higher in middle-aged patients with ARDs compared with the general population.


Assuntos
Doenças Autoimunes/epidemiologia , Demência/epidemiologia , Doenças Reumáticas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Síndrome de Sjogren/epidemiologia , Taiwan/epidemiologia
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