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1.
Qual Manag Health Care ; 30(1): 61-68, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33306657

RESUMO

BACKGROUND AND OBJECTIVES: In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus. METHOD: Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures. RESULTS: For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigation workflow failure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%. CONCLUSION: The HFMEA model can effectively implement preventive risk assessment and workflow management of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect.


Assuntos
/prevenção & controle , Infecção Hospitalar/prevenção & controle , Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Visitas a Pacientes , /transmissão , Cuidadores , Infecção Hospitalar/transmissão , Desinfecção das Mãos , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/organização & administração , Hospitais Urbanos/organização & administração , Humanos , Modelos Organizacionais , Política Organizacional , Medição de Risco , Taiwan/epidemiologia
2.
Phytomedicine ; 80: 153376, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33086171

RESUMO

BACKGROUND: The utilization of traditional Chinese medicine is a common therapeutic approach for stroke patients in Chinese population, but little is known about the effect of Bu Yang Huan Wu Tang (BYHWT) on post-stroke diabetes. PURPOSE: We aimed to evaluate the risk of diabetes in stroke patients who used BYHWT. STUDY DESIGN: A retrospective cohort study based on a real-world database was conducted. METHODS: Newly diagnosed stroke patients receiving inpatient care from 2000 to 2004 were identified using a large-scale insurance database in Taiwan. Propensity score matching was used to select eligible stroke patients who did (n = 9849) and did not (n = 9849) receive BYHWT. These two groups were followed up until the end of 2009 to track incident diabetes. Cox proportional hazard models were used to calculate the adjusted hazard rations (HRs) and 95% confidence intervals (CIs) for post-stroke diabetes associated with BYHWT during the follow-up period. RESULTS: Stroke patients who used BYHWT had a reduced incidence of diabetes (14.1% vs. 19.0%, p < 0.0001) and reduced risk of diabetes (HR 0.77; 95% CI 0.72 to 0.83) compared with the control group. The association between BYHWT and reduced risk of post-stroke diabetes was significant across sexe, age group, and stroke subtype. Additionally, the use of BYHWT was associated with a reduced risk of post-stroke diabetes even after excluding the initial three months of diabetes cases in the sensitivity analysis. CONCLUSIONS: Stroke patients who received BYHWT therapy had a reduced risk of diabetes, and a positive effect was observed in various subgroups. However, future clinical trials will be necessary to validate the present findings and identify the biochemical mechanism involved.


Assuntos
Diabetes Mellitus/prevenção & controle , Medicamentos de Ervas Chinesas/uso terapêutico , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Taiwan/epidemiologia
3.
Emerg Infect Dis ; 27(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261719

RESUMO

In Taiwan, lower nonpolio enterovirus activity during the coronavirus disease pandemic in 2020 compared with 2014-2019 might be attributable to adherence to nonpharmaceutical interventions. The preventable fraction among unexposed persons indicated that 90% of nonpolio enterovirus activity might have been prevented during 2014-2019 by adopting the same measures enforced in 2020.


Assuntos
/epidemiologia , Infecções por Enterovirus/epidemiologia , Enterovirus/fisiologia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Taiwan/epidemiologia
4.
Sci Total Environ ; 750: 141579, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32853937

RESUMO

BACKGROUND: Understanding the effects of environmental factors on birth outcomes is crucial for public health because newborns' birth size affects their likelihood of childhood survival, risk of perinatal morbidity, and subsequent health and growth. Therefore, we investigated the associations of birth outcomes with prenatal air pollutant exposure and residential land use characteristics in the Greater Taipei Area. METHODS: Participants were selected from the Longitudinal Examination across Prenatal and Postpartum Health in Taiwan study, which is an ongoing prospective study launched in July 2011. Parental sociodemographic data and medical histories were collected using standardized questionnaires. Mean air pollutant levels during each trimester were estimated using the spatial interpolation technique (Ordinary Kriging). Land use types surrounding participants' homes were evaluated within a designated radius of their residential addresses. We used multiple regressions to examine relationships between birth outcomes (i.e., birth weight, height, and head circumference) and environmental factors after adjustment for parental characteristics. RESULTS: A total of 436 pregnant women-infant pairs were included. Birth weight was negatively associated with commercial land and greenhouse areas near the residence. Living near greenhouse areas negatively affected birth height, but higher greenness level within 100 m of the residence had a positive effect. Birth head circumference was only associated with sociodemographic factors in the multivariate model. CONCLUSION: Land use types near the homes of pregnant women, but not exposure to air pollutants, were significantly associated with birth weight and height in the Greater Taipei Area. Increased greenness level was positively associated with birth height, and living near commercial or greenhouse areas had adverse effects on birth outcomes. Living in a healthy neighborhood is critical for the birth outcomes of infants and presumably their health in early childhood.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Peso ao Nascer , Criança , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Taiwan/epidemiologia
5.
Sci Total Environ ; 750: 141547, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32858293

RESUMO

High total urinary arsenic concentrations and low estimated glomerular filtration rate (eGFR) increase the risk of renal cell carcinoma (RCC). This study aimed to determine whether other metals or metalloids can affect RCC. A total of 401 patients with RCC and 774 age- and sex-matched controls were recruited between November 2006 and December 2012 in Taiwan. Surgical resection or image-guided biopsy of renal tumors was performed to pathologically verify RCC. High-performance liquid chromatography linked to a hydride generator and atomic absorption spectrometer were used to measure the urinary arsenic species concentrations. Inductively coupled plasma mass spectrometry was used to determine plasma selenium and red blood cell cadmium and lead concentration. Plasma selenium levels were inversely related to RCC, whereas red blood cell cadmium levels were directly related to RCC. The odds ratio (OR) and 95% confidence interval (CI) were 0.14 (95% CI, 0.10-0.20) and 1.33 (95% CI, 1.03-1.72), respectively. A low plasma selenium level tended to interact with high total urinary arsenic levels or with high red blood cell cadmium concentration to increase the OR of RCC. In particular, low eGFR multiplicatively interacted with high red blood cell cadmium concentration to increase the OR of RCC (Pinteraction=0.003). This study was the first to find a significant multiplicative interaction between eGFR and the red blood cell cadmium levels on the increased OR of RCC.


Assuntos
Arsênico , Carcinoma de Células Renais , Neoplasias Renais , Selênio , Cádmio , Estudos de Casos e Controles , Receptores ErbB , Eritrócitos , Taxa de Filtração Glomerular , Humanos , Taiwan/epidemiologia
6.
Sci Total Environ ; 758: 143665, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33293090

RESUMO

Bacterial strains of the Bacillus cereus group produce various toxins that cause diarrheal and emetic food poisoning. In this study, five main oyster farming areas and 15 fishing ports in Taiwan were examined for the status of B. cereus group bacteria inhabiting seawater and shellfish. On average, bacteria of the B. cereus group were detected in 32.6% of the seawater samples (n = 89) and 2.5% of the oysters (n = 81) in the oyster farming areas and in 7.9% of the seawater samples (n = 202) and 0.68% of the shellfish products (n = 292) in fishing ports. To trace the potential source of B. cereus group bacteria in intertidal oyster farming areas, we simultaneously explored their terrestrial river basins. In total, 44 B. cereus group strains were purified and cultured from water and shellfish for the analysis of virulence genes, panC gene typing, antibiotic susceptibility testing, and enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) fingerprinting. The enterotoxin-coding genes nheABC, hblCDA, entFM, cytK-1, and cytK-2 were detected in 70.4%, 84.1%, 97.7%, 72.7%, and 75% of the total isolates, among which 40.9% carried all these genes. According to panC gene analysis, the dominant isolates belonged to the panC group IV. In antibiotic susceptibility tests, most B. cereus group isolates were resistant to ampicillin (97.7%) and sulfamethoxazole/trimethoprim (100%). The percentage of multidrug resistant B. cereus group isolates was 34.6%. Finally, the 44 B. cereus group isolates were classified into 43 types and categorized into five clusters using ERIC-PCR fingerprinting. The B. cereus group isolates from different oyster farming areas were concentrated within the two main clusters; however, those from river basins displayed a wide genetic diversity, indicating the presence of multiple sources of B. cereus group bacteria in river basins.


Assuntos
Bacillus , Enterotoxinas , Antibacterianos/farmacologia , Bacillus cereus/genética , Farmacorresistência Bacteriana/genética , Enterotoxinas/análise , Enterotoxinas/genética , Microbiologia de Alimentos , Variação Genética , Prevalência , Frutos do Mar , Taiwan/epidemiologia
8.
J Formos Med Assoc ; 120(1 Pt 3): 713-719, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32773262

RESUMO

BACKGROUND: Coronavirus disease-2019 (COVID-19) is a worldwide pandemic. We present the clinical characteristics and outcomes of 28 COVID-19 patients treated in our hospital in Taiwan. METHODS: Patients with COVID-19, confirmed by positive real-time reverse-transcriptase polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral nucleic acids from oropharyngeal swab specimens between February 4, 2020 and July 6, 2020, were enrolled. Their clinical characteristics and outcomes were reviewed. RESULTS: Seventeen of the 28 patients (60.7%) had pneumonia. The most frequent symptoms were cough (n = 23, 82.1%) and fever (n = 17, 60.7%). The development of pneumonia was associated with age ≥40 years (p < 0.024), body mass index (BMI) ≥25 kg/m2 (p = 0.014), fever (p = 0.007), shortness of breath (p = 0.036), chills ((p = 0.047), and lower platelet counts (<200,000/µL) (p = 0.007). Increased quarantine duration was associated with age ≥40 years (p = 0.026), Charlson index ≥1 (p = 0.037), lower lymphocyte (<1500/uL; p = 0.028) or platelet counts (<200,000/µL) (p = 0.016), lower serum sodium (<140 mEq/L; p = 0.006), and higher C-reactive protein (CRP) level (≥1 mg/dl; p = 0.04). Treatment with hydroxychloroquine or in combination with other medicines did not reduce the quarantine duration. All 28 patients recovered with a median quarantine duration of 27.2 days. CONCLUSION: COVID-19 patients with older age, higher BMI, fever, chills or shortness of breath, lower serum sodium level, lower platelet or lymphocyte count, and higher CRP level may be associated with developing pneumonia or longer quarantine duration.


Assuntos
/métodos , Pneumonia Viral , /isolamento & purificação , Adulto , Fatores Etários , Contagem de Células Sanguíneas/métodos , Índice de Massa Corporal , Proteína C-Reativa/análise , /epidemiologia , /terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Quarentena , Fatores de Risco , Avaliação de Sintomas/métodos , Taiwan/epidemiologia
9.
Chemosphere ; 266: 129094, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33310355

RESUMO

Arsenic is a well-established human carcinogen and is considered a health risk worldwide, especially where groundwater is consumed as drinking water. In 2018, bladder and kidney cancers were the 14th and 17th leading causes of global cancer mortality, respectively. Our aim was to investigate the association between arsenic exposure, DNA damage, and the incidence of bladder and kidney cancers. A total of 788 participants aged ≥40 years were enrolled in a prospective cohort study in Taiwan between 1991 and 1994, with follow-up between 2011 and 2014. Well-water and first-morning spot urine samples were collected between 1991 and 1994 to estimate arsenic exposure, and the baseline urinary levels of 8-Oxo-2'-deoxyguanosine (8-OHdG) and N7-methylguanine (N7-MeG) were quantified to assess DNA lesions. The Cox proportional hazard model was used to estimate the effects of arsenic exposure and DNA adduct levels on the risk of bladder or kidney cancer. Urinary arsenic species were associated with significantly increased 8-OHdG and N7-MeG after adjusting for age, sex, and cigarette smoking. Only non-statistically significant mediation effects of 8-OHdG were observed. In a fully adjusted Cox model, participants with arsenic exposure and urinary 8-OHdG levels higher than the median had a higher risk of bladder cancer (HR = 4.60, confidence interval: 1.43-14.85). Overall, the combined effects of high cumulative arsenic exposure from artesian well-water and advanced DNA damage predicted the risk of bladder cancer.


Assuntos
Arsênico , Neoplasias , Poluentes Químicos da Água , Arsênico/análise , Arsênico/toxicidade , Dano ao DNA , Exposição Ambiental/análise , Seguimentos , Humanos , Taiwan/epidemiologia , Poluentes Químicos da Água/toxicidade , Abastecimento de Água
10.
Artigo em Inglês | MEDLINE | ID: mdl-33322220

RESUMO

This study aimed to compare risk perception, information sources, adoption of protective behaviors against coronavirus disease 2019 (COVID-19), and levels of general anxiety among affiliated health care professionals, frontline health care professionals, and the general public in Taiwan. We recruited participants via a Facebook advertisement. We determined the risk perception, information sources, adoption of protective behaviors against COVID-19, and levels of general anxiety among 1954 respondents. In total, 269 affiliated healthcare workers, 371 frontline healthcare workers, and 1314 members of the general public were recruited into this study. The results indicated that both affiliated and frontline health care professionals had a higher level of risk perception of COVID-19, and more adopted protective behaviors against COVID-19 than the general public. No significant differences in risk perception or the adoption of protective behaviors were identified between affiliated, and frontline, health care professionals. Affiliated health care professionals had a lower level of general anxiety than the general public, whereas frontline health care professionals exhibited no significant difference in level of general anxiety compared with the general public or affiliated health care professionals. As important members of COVID-19 treatment teams, the need for psychological and educational support in affiliated health care professionals should receive attention.


Assuntos
Ansiedade/epidemiologia , Pessoal de Saúde/psicologia , Saúde Mental , Pandemias , Comportamentos Relacionados com a Saúde , Humanos , Medição de Risco , Taiwan/epidemiologia
11.
J Clin Psychiatry ; 81(6)2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33264818

RESUMO

Many but not all studies suggest that gestational exposure to antidepressant drugs is associated with an increased risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in offspring. All of these studies have been observational in design, and observational research may suggest but cannot establish cause-effect relationships. In this context, a recent, large, population-based, observational study found that exposure to maternal depression before, during, or after pregnancy was each associated with an increased risk of ASD as well as ADHD. Strikingly, the same finding was obtained for paternal depression, as well, with mostly similar values for risk. If paternal depression before, during, or after pregnancy can increase the risk of ASD and ADHD in the offspring, it suggests that genetic variables, or environmental adversities engendered by behaviors related to paternal depression, may drive the risk for the adverse neurodevelopmental outcomes; some data exist to support this view. An understanding of these possibilities allows greater room for flexibility when considering the prescription of antidepressant drugs to depressed pregnant women.


Assuntos
Antidepressivos/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Espectro Autista/etiologia , Transtorno Depressivo , Pai , Mães , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/induzido quimicamente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Espectro Autista/induzido quimicamente , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Pré-Escolar , Estudos de Coortes , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/genética , Pai/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Mães/estatística & dados numéricos , Estudos Observacionais como Assunto , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/genética , Risco , Taiwan/epidemiologia
13.
J Chin Med Assoc ; 83(12): 1111-1116, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33273270

RESUMO

BACKGROUND: As outbreak of COVID-19 infection, on April 3, 2020, it is stipulated that the number of inpatient companions is limited to one in Taiwan. All companions are required to register their real personal data with 14 days of travel history, occupation, contact history, and cluster history. We would like to evaluate the impact of the new regulations to the accompanying and visiting culture in Taiwan, via analyzing the appearance and characteristics of inpatient companions in this period. METHODS: Using intelligent technology, we designed a novel system in managing the inpatient companions (InPatients Companions Management System [IPCMS]), and the IPCMS was used to collect data about characteristics of inpatients and companions between April 27 and May 3, 2020. The database is built using MySQL software. Microsoft Excel 2016 and SPSS version 20.0 statistical software were used for data analysis, including the basic data of the companions, differential analysis of companions' gender, person-days and cumulative time, differential analysis of accompaniment-patient relationship, and frequency of accompaniment and cumulative hours. RESULTS: During study period, daily inpatient admissions ranged from 2242 to 2514, the number of companions per day ranged from 2048 to 2293, and the number of companions for one inpatient is 1 to 9 per day, with an average of 1.20 to 1.26. The companions were mostly family members, and most of them were the inpatients' children (32.9%), and spouse (26.13%). More females than males were noted in all categories of companionship with statistical significance. CONCLUSION: The data obtained in this study could be an important basis for the transformation and reform of the companions culture in Taiwan's hospitals and will also provide a glimpse into the attitudes and culture of companions who have long been ignorant and neglected. The experience gained in our IPCMS could also serve as a reference for other hospitals in Taiwan and worldwide.


Assuntos
/epidemiologia , Visitas a Pacientes , Feminino , Humanos , Pacientes Internados , Masculino , Taiwan/epidemiologia
14.
JMIR Public Health Surveill ; 6(4): e24598, 2020 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-33302255

RESUMO

BACKGROUND: Since the COVID-19 outbreak began in Wuhan, China, countries worldwide have been forced to take unprecedented measures to combat it. While some countries are still grappling with the COVID-19 pandemic, others have fared better and have re-established relative normalcy quickly. The rapid transmission rate of the virus has shown a greater need for efficient and technologically modern containment measures. The use of digital tools to facilitate strict containment measures in countries that have fared well against the COVID-19 pandemic has sparked both interest and controversy. OBJECTIVE: In this study, we compare the precautions taken against the spread of COVID-19 in the United States, Spain, and Italy, with Taiwan, South Korea, and Singapore, particularly related to the use of digital tools for contact tracing, and propose policies that could be used in the United States for future COVID-19 waves or pandemics. METHODS: COVID-19 death rate data were obtained from the European Center for Disease Prevention and Control (ECDC), accessed through the Our World in Data database, and were evaluated based on population size per 100,000 people from December 31, 2019, to September 6, 2020. All policies and measures enacted were obtained from their respective governmental websites. RESULTS: We found a strong association between lower death rates per capita and countries that implemented early mask use and strict border control measures that included mandatory quarantine using digital tools. There is a significant difference in the number of deaths per 100,000 when comparing Taiwan, South Korea, and Singapore with the United States, Spain, and Italy. CONCLUSIONS: Based on our research, it is evident that early intervention with the use of digital tools had a strong correlation with the successful containment of COVID-19. Infection rates and subsequent deaths in Italy, Spain, and the United States could have been much lower with early mask use and, more importantly, timely border control measures using modern digital tools. Thus, we propose that the United States execute the following national policies should a public health emergency be declared: (1) immediately establish a National Command responsible for enacting strict mandatory guidelines enforced by federal and state governments, including national mask use; (2) mandate civilian cooperation with health officials in contact tracing and quarantine orders; and (3) require incoming travelers to the United States and those quarantined to download a contact tracing app. We acknowledge the countries we studied differ in their cultures, political systems, and reporting criteria for COVID-19 deaths. Further research may need to be conducted to address these limitations; however, we believe that the proposed policies could protect the American public.


Assuntos
/prevenção & controle , Busca de Comunicante/métodos , Pandemias/prevenção & controle , /epidemiologia , Humanos , Itália/epidemiologia , Política Pública , Quarentena/legislação & jurisprudência , República da Coreia/epidemiologia , Estudos Retrospectivos , Singapura/epidemiologia , Espanha/epidemiologia , Taiwan/epidemiologia , Estados Unidos/epidemiologia
15.
Medicine (Baltimore) ; 99(50): e23644, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327345

RESUMO

Prostate cancer is one of the most common cancer in males. Both the incidence and the mortality rates of prostate cancer show an increasing trend. Androgen deprivation therapy (ADT) is the standard treatment for metastatic prostate cancer. The aim of our study was to show the epidemiology of prostate cancer and the proportion of patients utilizing ADT.This study used Taiwan's National Health Insurance Research Database (NHIRD) and identified the patients who had been diagnosed with prostate cancer (International Classification of Disease (ICD)-10: C61) and followed up between Jan 1, 2008 and Dec 31, 2015. The ADT drugs used by prostate cancer patients were recorded: Gonadotropin-releasing hormone (GnRH) agonists; GnRH antagonist; estrogen analogs and androgen receptor antagonist.A total of 25,233 patients with newly diagnosed prostate cancer in 2008-2014 were enrolled. The utilization of ADT increased from more than 7,000 person-time in 2008 to more than 50,000 person-time in 2014. Cyproterone acetate was the most commonly used drug in 2008-2015, but its proportion of utilization, which was the highest in stage 2 cancer, dropped from 43% in 2008 to 15% in 2015. Bicalutamide was the second most used drug from 2008 to 2015, but its utilization was not different for different stages.The incidence rate of prostate cancer increased in the study period and medical expenditure also increased in ADT treatment. Health insurance benefits for various ADT drugs should be further evaluated.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Neoplasias da Próstata/dietoterapia , Neoplasias da Próstata/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/administração & dosagem , Antagonistas de Androgênios/economia , Antagonistas de Receptores de Andrógenos/uso terapêutico , Estrogênios/uso terapêutico , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias da Próstata/patologia , Fatores de Risco , Taiwan/epidemiologia
16.
Medicine (Baltimore) ; 99(50): e23651, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327348

RESUMO

Tocolytic agents, commonly used for inhibiting preterm labor, pose the risk of uterine atony, leading to postpartum hemorrhage. This study elucidated the effects of different tocolytic agents on postoperative hemorrhage among women in preterm labor undergoing Cesarean delivery (CD). Data from Taiwan National Health Insurance Research Database were analyzed. The risk (adjusted hazard ratio [aHR] and 95% confidence intervals [CI]) of postoperative hemorrhage in CD women with preterm labor diagnosis using tocolytic agents (Tocolysis group) comparing to CD women not using tocolytic agents (Control group) were determined. Impacts of different tocolytic agents in this regard were also investigated. Our data revealed that the incidence (11.7% vs 2.6%, P < .001) and risk (aHR: 1.21, 95% CI: 1.12-1.31, P < .001) of postoperative hemorrhage were significantly higher in the Tocolysis group (n = 15,317) than in the Control group (n = 244,096). Ritodrine was the most frequently used tocolytic agent (80.5%), followed by combination therapy (using more than one tocolytic agents) (8.5%), magnesium sulfate (MgSO4, 4.6%), calcium channel blockers (3.8%), betamimetics other than ritodrine (1.9%), prostaglandin synthase inhibitors (0.5%), and nitrates (0.1%). Barring those using calcium channel blockers and combination therapy, the use of MgSO4 (aHR: 1.43, P = .001), betamimetics other than ritodrine (aHR: 1.71, P < .001), prostaglandin synthase inhibitors (aHR: 2.67, P < .001) and nitrates (aHR: 3.30, P = .001) was associated with higher risks of postoperative hemorrhage compared with ritodrine. In conclusion, CD women with preterm labor diagnosis using tocolytic agents exhibit an increased risk of postoperative hemorrhage and that this risk varies with the use of different tocolytic agents.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Prematuro/tratamento farmacológico , Hemorragia Pós-Operatória/epidemiologia , Tocolíticos/efeitos adversos , Tocolíticos/classificação , Adulto , Fatores Etários , Comorbidade , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Taiwan/epidemiologia , Tocolíticos/administração & dosagem
17.
J Med Internet Res ; 22(12): e22703, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33259324

RESUMO

BACKGROUND: Telehealth is a recommended method for monitoring the progression of nonsevere infections in patients with COVID-19. However, telehealth has not been widely implemented to monitor SARS-CoV-2 infection in quarantined individuals. Moreover, studies on the cost-effectiveness of quarantine measures during the COVID-19 pandemic are scarce. OBJECTIVE: In this cohort study, we aimed to use telehealth to monitor COVID-19 infections in 217 quarantined Taiwanese travelers and to analyze the cost-effectiveness of the quarantine program. METHODS: Travelers were quarantined for 14 days at the Taiwan Yangmingshan quarantine center and monitored until they were discharged. The travelers' clinical symptoms were evaluated twice daily. A multidisciplinary medical team used the telehealth system to provide timely assistance for ill travelers. The cost of the mandatory quarantine was calculated according to data from the Ministry of Health and Welfare of Taiwan. RESULTS: All 217 quarantined travelers tested negative for SARS-CoV-2 upon admission to the quarantine center. During the quarantine, 28/217 travelers (12.9%) became ill and were evaluated via telehealth. Three travelers with fever were hospitalized after telehealth assessment, and subsequent tests for COVID-19 were negative for all three patients. The total cost incurred during the quarantine was US $193,938, which equated to US $894 per individual. CONCLUSIONS: Telehealth is an effective instrument for monitoring COVID-19 infection in quarantined travelers and could help provide timely disease management for people who are ill. It is imperative to screen and quarantine international travelers for SARS-CoV-2 infection to reduce the nationwide spread of COVID-19.


Assuntos
/economia , Quarentena/métodos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos , Adulto , /epidemiologia , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Masculino , Taiwan/epidemiologia , Telemedicina/economia
18.
Medicine (Baltimore) ; 99(52): e23775, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350763

RESUMO

ABSTRACT: Nontuberculous mycobacteria (NTM) infection may interfere in the diagnosis and treatment of tuberculosis (TB) in TB-endemic regions. However, the population-based incidence of NTM disease and NTM-TB coinfection remains unclear.We used Taiwan's National Health Insurance Research Database to identify new diagnoses of NTM disease and TB from 2005 to 2013 and calculated the incidence rate and the proportion of NTM-TB coinfection. The patients with NTM disease or TB were determined by the use of disease codes from International Classification of Diseases, Ninth Revision, Clinical Modification, laboratory mycobacterium examination codes, and antimycobacterial therapy receipts.From 2005 to 2013, the age-adjusted incidence rate of NTM disease increased from 5.3 to 14.8 per 100,000 people per year and the age-adjusted incidence rate of NTM-TB coinfection was around 1.2 to 2.2 per 100,000 people per year. The proportion of NTM-TB coinfection among patients with confirmed TB was 2.8%. Male and older patients had a significantly higher incidence of NTM disease. The effects of urbanization and socioeconomic status (SES) on the incidences of TB and NTM disease were different. Rural living and lower SES were significantly associated with increasing the incidence of confirmed TB but not with that of NTM disease. For NTM disease, those living in the least urbanized area had significantly lower incidence rate ratio than in the highest urbanized area. The incidence of NTM-TB coinfection was higher in older patients and compared with patients aged < 45 years, the incidence rate ratio of the patients aged> 74 years was 12.5.In TB-endemic Taiwan, the incidence of NTM disease increased from 2005 to 2013. Male gender and old age were risk factors for high incidence of NTM disease. SES did not have a significant effect on the incidence of NTM disease, but rural living was associated with lower incidence of NTM disease. In TB-endemic areas, NTM-TB coinfection could disturb the diagnosis of TB and treatment, especially in elderly patients.


Assuntos
Coinfecção/epidemiologia , Infecções por Mycobacterium não Tuberculosas , Tuberculose , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Doenças Endêmicas/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Taiwan/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia
19.
PLoS One ; 15(11): e0242365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196674

RESUMO

BACKGROUND: Few studies have reported on the clustering pattern of CVD risk factors, including sedentary behavior, systemic inflammation, and cadiometabolic components in the general population. OBJECTIVE: We aimed to explore the clustering pattern of CVD risk factors using exploratory factor analysis to investigate the underlying relationships between various CVD risk factors. METHODS: A total of 5606 subjects (3157 male, 51.5±11.7 y/o) were enrolled, and 14 cardiovascular risk factors were analyzed in an exploratory group (n = 3926) and a validation group (n = 1676), including sedentary behaviors. RESULTS: Five factor clusters were identified to explain 69.4% of the total variance, including adiposity (BMI, TG, HDL, UA, and HsCRP; 21.3%), lipids (total cholesterol and LDL-cholesterol; 14.0%), blood pressure (SBP and DBP; 13.3%), glucose (HbA1C, fasting glucose; 12.9%), and sedentary behavior (MET and sitting time; 8.0%). The inflammation biomarker HsCRP was clustered with only adiposity factors and not with other cardiometabolic risk factors, and the clustering pattern was verified in the validation group. CONCLUSION: This study confirmed the clustering structure of cardiometabolic risk factors in the general population, including sedentary behavior. HsCRP was clustered with adiposity factors, while physical inactivity and sedentary behavior were clustered with each other.


Assuntos
Doenças Cardiovasculares/epidemiologia , Estudos Transversais/métodos , Adiposidade , Adulto , Biomarcadores/sangue , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Análise por Conglomerados , Análise Fatorial , Feminino , Humanos , Inflamação/metabolismo , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Sedentário , Postura Sentada , Taiwan/epidemiologia , Triglicerídeos/sangue , Circunferência da Cintura
20.
PLoS One ; 15(11): e0242429, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33211759

RESUMO

Elevated Renal cell carcinoma (RCC) risk has been associated with the use of several antihypertensive medications but has not yet been elucidated in the populations prescribed alpha-1 blockers that are commonly used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). The aim of the present study was to investigate the association between alpha-1 blocker use and the risk of developing RCC using a nationwide population-based database in Taiwan. Patients who were treated with alpha-1 blockers for at least 28 days were identified through the Taiwan National Health Insurance Research Database from 2000 to 2010. The unexposed participants were matched with the exposed cases according to age, sex, and index year at a ratio of 3:1. Cox proportional hazards regression, stratified by sex and comorbidities and adjusted for age, was performed to estimate hazard ratios (HRs) for the risk of subsequent RCC. Among 2,232,092 subjects, patients who received alpha-1 blocker treatment had a higher risk of RCC than the unexposed group. Taking into account hypertension and BPH, the adjusted HR was significantly higher in male alpha-1 blocker users who had no BPH and either the presence (HR: 1.63, 95% confidence interval [CI] = 1.22-2.18) or absence (HR: 2.31, 95% CI = 1.40-3.81) of hypertension than in men not receiving these drugs. Taken together, male alpha-1 blocker users who had no comorbidity of BPH exhibited an increased risk for developing RCC independent of hypertension. Further study is warranted to elucidate the underlying mechanisms of this association.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Carcinoma de Células Renais/induzido quimicamente , Neoplasias Renais/induzido quimicamente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Neoplasias Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/epidemiologia , Estudos Retrospectivos , Risco , Distribuição por Sexo , Taiwan/epidemiologia
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