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1.
BMC Ophthalmol ; 22(1): 25, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35033037

RESUMO

The management of neovascular age-related macular degeneration (nAMD) has taken a major stride forward with the advent of anti-VEGF agents. The treat-and-extend (T&E) approach is a refined management strategy, tailoring to the individual patient's disease course and treatment outcome. To provide guidance to implementing anti-VEGF T&E regimens for nAMD in resource-limited health care systems, an advisory board was held to discuss and generate expert consensus, based on local and international guidelines, current evidence, as well as local experience and reimbursement policies. In the experts' opinion, treatment of nAMD should aim to maximize and maintain visual acuity benefits while minimizing treatment burden. Based on current evidence, treatment could be initiated with 3 consecutive monthly injections. After the initial period, treatment interval may be extended by 2 or 4 weeks each time for the qualified patients (i.e. no BCVA loss ≥5 ETDRS letters and dry retina), and a maximum interval of 16 weeks is permitted. For patients meeting the shortening criteria (i.e. any increased fluid with BCVA loss ≥5 ETDRS letters, or presence of new macular hemorrhage or new neovascularization), the treatment interval should be reduced by 2 or 4 weeks each time, with a minimal interval of 4 weeks. Discontinuation of anti-VEGF may be considered for those who have received 2-3 consecutive injections spaced 16 weeks apart and present with stable disease. For these individuals, regular monitoring (e.g. 3-4 months) is recommended and monthly injections should be reinstated upon signs of disease recurrence.


Assuntos
Degeneração Macular , Degeneração Macular Exsudativa , Inibidores da Angiogênese/uso terapêutico , Consenso , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Taiwan/epidemiologia , Resultado do Tratamento , Degeneração Macular Exsudativa/tratamento farmacológico
2.
J Med Internet Res ; 24(1): e33399, 2022 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-34951863

RESUMO

BACKGROUND: During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan's National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile apps with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low. OBJECTIVE: We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the app's log data to examine patients' MHB use during the COVID-19 pandemic. METHODS: We integrated our existing blockchain-enabled mobile app with the MHB SDK to enable NHIA MHB data retrieval. The app utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the app and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the app's access logs to compare patients' activities during high and low COVID-19 infection periods. RESULTS: We successfully integrated the MHB SDK into our mobile app, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the app's log data for the period of July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people who applied to create a blockchain account for access to their medical data and the number of app subscribers among patients who visited the outpatient department (OPD) and emergency department (ED). Notably, for patients who visited the OPD and ED, the peak proportions with respect to the use of the app for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40% for ED notes in June 2021, 88.10% for ED laboratory test reports in May 2021, 34.61% for OPD notes in June 2021, and 41.87% for OPD laboratory test reports in June 2021. These peaks coincided with Taiwan's local COVID-19 outbreak lasting from May to June 2021. CONCLUSIONS: This study developed a blockchain-enabled mobile app, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users' access logs revealed that the COVID-19 pandemic substantially increased individuals' use of PHRs and their health awareness with respect to COVID-19 prevention.


Assuntos
COVID-19 , Registros de Saúde Pessoal , Aplicativos Móveis , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Taiwan/epidemiologia
3.
Sci Total Environ ; 806(Pt 3): 151261, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34715222

RESUMO

The Taiwan Maternal and Infant Cohort Study (TMICS) was launched with the aim to assess the effects of prenatal exposure to phthalic acid esters (PAEs) on infant health. A total of 1102 pregnant women were enrolled in this study from 2012 to 2015. All participants completed a structured questionnaire, and provided urine specimens. The urinary concentrations of PAE metabolites in the third trimester were measured using liquid chromatography-electrospray ionization tandem mass spectrometry. Generalized additive model-penalized regression splines and logistic regression models were employed to determine the risk for low birth weight (LBW) or small for gestational age (SGA) among pregnant women exposed to PAEs. After adjustments for other covariates, each incremental unit of ln-transformed mono-n-butyl phthalate (MnBP) for pregnant women increased the odds of SGA in male neonates by 1.44 (95% CI: 0.92-2.23). An inverse association between SGA and maternal MnBP exposure level was observed in female neonates. An increase in one ln-transformed MnBP concentration unit decreased the risk of female SGA to 0.50 (95% CI: 0.24-0.97). In the penalized regression splines, increased risks of LBW/SGA in male neonates were presented while pregnant women exposed to increased MnBP levels. However, an association in the opposite direction was observed between maternal MnBP and LBW or SGA for male and female neonates. This study indicated that high maternal MnBP exposure in the third trimester was associated with LBW or SGA for male infants. Adverse effects on susceptible populations exposed to high levels of PAEs should be of concern.


Assuntos
Ácidos Ftálicos , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Exposição Materna/efeitos adversos , Ácidos Ftálicos/efeitos adversos , Gravidez , Inquéritos e Questionários , Taiwan/epidemiologia
4.
PLoS One ; 16(12): e0261156, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932591

RESUMO

BACKGROUND: Kawasaki disease (KD) is a systematic vasculitis that occurs predominantly in young children, and is the leading cause of acquired heart disease in children younger than five-years-old in developed countries. Although the etiology of KD is unknown, it is believed to be an inflammatory disease resulting from abnormal immune responses to possible environmental or infectious stimuli in genetically predisposed individuals. Breast milk contains numerous anti-inflammatory factors which may protect against allergic and autoimmune diseases. In this study we tried to examine the effect of breastfeeding for 6 months or more on disease outcomes in patients with Kawasaki disease. METHODS: A retrospective cohort study of 249 KD patients admitted from 1999- 2013 who were older than 6 months at time of diagnosis and had data regarding breastfeeding in the first 6 months of life. Demographic, clinical and laboratory data was collected by chart review. Continuous data was compared using Student's t-test and categorical variables were compared using Chi-square. Stepwise multivariate regression of all demographic factors was performed. RESULTS: Breastfeeding for 6 months or more was associated with a shorter total duration of fever (5.980± 1.405 Vs. 6.910 ± 2.573 days, p = 0.001) and a lower risk of developing persistent coronary artery lesions (CALs) (7.8% Vs. 20.2%, p-value = 0.039) on univariate analysis. Multivariate regression of all factors associated with CALs including breastfeeding for 6 months found that only the presence of CALs at baseline (ß-coefficient = 0.065, p < 0.001) and white blood count (ß-coefficient = 0.065, p = 0.018) remained significant after regression analysis. CONCLUSIONS: Breastfeeding for 6 months or more was associated with a shorter duration of fever and a lower risk of persistent CAL formation in patients with KD on univariate analysis, although this effect may be modest when other factors such as the presence of CALs at baseline and white blood cell count are also taken into consideration.


Assuntos
Aleitamento Materno/métodos , Leite Humano , Síndrome de Linfonodos Mucocutâneos/prevenção & controle , Adulto , Feminino , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Estudos Retrospectivos , Taiwan/epidemiologia , Fatores de Tempo
5.
JAMA Netw Open ; 4(12): e2141321, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34967881

RESUMO

Importance: Statins are the drug class most commonly used to treat hyperlipidemia. Recently, they have been used during pregnancy for the prevention or treatment of preeclampsia. However, the safety of statin use during pregnancy has been questioned, and the sample sizes of most previous studies have been small. Objective: To examine the perinatal outcomes among offspring associated with maternal use of statins during pregnancy. Design, Setting, and Participants: This retrospective cohort study included 1 443 657 pregnant women 18 years of age or older with their first infant born during the period from January 1, 2004, to December 31, 2014. Data for this study were taken from the Taiwan National Health Insurance Research Database. Statistical analysis was performed from April 7, 2020, to July 31, 2021. Exposures: Maternal statin use during pregnancy. Main Outcomes and Measures: Women who have received a diagnosis of hyperlipidemia before pregnancy and who were receiving prescription statins during pregnancy were the statin-exposed group. Data on congenital anomalies, birth weight, gestational age, preterm birth, low birth weight, very low birth weight, fetal distress, and Apgar score were compared between participants with and partcipants without statin exposure during pregnancy. Risk ratios (RRs) were calculated by multivariable analyses using Poisson regression models to adjust for potential confounders. Subgroup analysis was performed to compare offspring of women who used statins for more than 3 months prior to pregnancy and maintained or stopped statin use after pregnancy. Results: A total of 469 women (mean [SD] age, 32.6 [5.4] years; mean [SD] gestational age, 38.4 [1.6] weeks) who used statins during pregnancy and 4690 age-matched controls (mean [SD] age, 32.0 [4.9] years; mean [SD] gestational age, 37.3 [2.4] weeks) with no statin exposure during pregnancy were enrolled. After controlling for maternal comorbidities and age, low birth weight was more common among offspring in the statin-exposed group (RR, 1.51 [95% CI, 1.05-2.16]), with a greater chance of preterm birth (RR, 1.99 [95% CI, 1.46-2.71]), and a lower 1-minute Apgar score (RR, 1.83 [95% CI, 1.04-3.20]). Congenital anomalies were not associated with statin exposure during pregnancy. In addition, multivariable analysis showed that there was no association between statin use for periconceptual hyperlipidemia and adverse perinatal outcomes among women who had used statins prior to pregnancy. Conclusions and Relevance: This study suggests that statins may be safe when used during pregnancy because there was no association with congenital anomalies, but caution is needed because of an increased risk of low birth weight and preterm labor. The data also suggest that statins could be safely used during pregnancy for women with long-term use of statins before pregnancy.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Cuidado Pré-Natal , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Hiperlipidemias/tratamento farmacológico , Recém-Nascido , Revisão da Utilização de Seguros , Gravidez , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
6.
Nutrients ; 13(12)2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34959762

RESUMO

This study was conducted to investigate the adherence of Daily Food Guides (DFGs) among older Taiwanese, and the relationship of dietary quality and frailty. 154 functional independent older adults who were retirement home residents or community dwellers involved in congregate meal services were recruited. DFGs adherence was measured using a novel Taiwanese Healthy Index (T-HEI). Dietary quality was further assessed using Dietary Approach to Stop Hypertension (DASH) and Mediterranean Diet Score (MDS). Frailty was defined using modified Fried's criteria. Of the total participants, 12.3% were considered non-frail individuals, while 77.3% were prefrail, and 10.4% were frail. Compared to non-frail participants, prefrail and frail individuals indicated significantly lower adherence to DFGs (ptrend = 0.025). Intake of dark or orange vegetables (ptrend = 0.010), whole grains (ptrend = 0.007), as well as nuts and seeds (ptrend = 0.029) by non-frail individuals were significantly higher than the levels by prefrail and frail individuals. Linear regression model adjusted for age, gender, and functional ability showed that T-HEI was inversely associated with frailty status (ß = -0.16 ± 0, p = 0.047), but additional adjustment for nutritional status attenuated the association (ß = -0.14 ± 0, p = 0.103). A similar relationship was observed for DASH but not MDS (DASH: ß = -0.18 ± 0.01, p = 0.024; MDS: ß = -0.06 ± 0.02, p = 0.465). After adjustment for confounders, the association was not observed. However, the distribution of whole grains component in both DASH and MDS was significantly higher in non-frail than prefrail and frail individuals, indicating the importance of whole grains intake in frailty prevention. In conclusion, higher adherence to DFGs and better dietary quality were associated with a lower prevalence of frailty. Higher nutrient-dense foods intake such as whole grains, dark or orange vegetables, nuts, and seeds mark a watershed in frailty prevention.


Assuntos
Dieta Saudável/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Política Nutricional , Inquéritos Nutricionais , Prevalência , Taiwan/epidemiologia
7.
Medicina (Kaunas) ; 57(12)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34946231

RESUMO

Background and Objectives: Drug-induced esophageal ulcer is caused by focal drug stimulation. It may occur in adults and children. Limited research is available in pediatric patients with drug-induced esophageal ulcer; therefore, we designed this study to determine the characteristics of this disease in this population. Materials and Methods: Thirty-two pediatric patients diagnosed with drug-induced esophageal ulcers from a hospital database of upper gastrointestinal tract endoscopies were included. After treatment, patients were followed for 2 months after upper gastrointestinal endoscopy. Results: Female patients were predominant (56.2%/43.8%). The mean age of patients was 15.6 years (median, 16 years; interquartile range, 2 years). Doxycycline was administered in most cases (56.3%); other drugs were dicloxacillin, amoxicillin, clindamycin, L-arginine, and nonsteroidal anti-inflammatory drugs. Doxycycline was associated with kissing ulcers. Esophageal ulcers induced by nonsteroidal anti-inflammatory drugs were more often associated with gastric or duodenal ulcers. The most common location was the middle-third of the esophagus (78.1%). Patients were treated with proton pump inhibitors, sucralfate, or H2-blockers. The mean duration for which symptoms lasted was 9.2 days. No esophageal stricture was found in 24 patients who were followed for 2 months after upper gastrointestinal endoscopy. Conclusions: The authors suggest informing patients to take medicine with enough water (approximately 100 mL) and enough time (15-30 min) before recumbency, especially high-risk drugs, such as doxycycline or nonsteroidal anti-inflammatory drugs.


Assuntos
Anti-Inflamatórios não Esteroides , Doxiciclina/efeitos adversos , Úlcera Péptica , Adolescente , Anti-Inflamatórios não Esteroides/efeitos adversos , Criança , Feminino , Hospitais , Humanos , Masculino , Úlcera Péptica/induzido quimicamente , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/epidemiologia , Taiwan/epidemiologia
8.
Stud Health Technol Inform ; 284: 77-79, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34920477

RESUMO

Early detection of chronic kidney disease (CKD) for high-risk population adults is very important. It has a common risk factor and causal relationship with chronic diseases such as diabetes, hypertension and cardiovascular disease etc. The results of this study provide that for early high-risk factors detection in CKD healthy population can be used by home care to recommend adjuvant treatment.


Assuntos
Doenças Cardiovasculares , Insuficiência Renal Crônica , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Diagnóstico Precoce , Humanos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Medição de Risco , Taiwan/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34948559

RESUMO

Smoking poses critical risks for heart disease and cancers. Heavy smokers, defined as smoking more than 30 pack-year, are the most important target for smoking cessation. This study aimed to obtain the cessation rate and its predictors among heavy smokers. We collected data from heavy smokers who visited a smoking-free hospital in Taiwan during 2017. All patients were prescribed either varenicline or nicotine replacement therapy (NRT) for smoking cessation, and their smoking status was followed for six months. Successful smoking cessation was defined by self-reported no smoking over the preceding seven days (7-day point abstinence). In total, 280 participants with a mean aged of 53.5 years were enrolled, and 42.9% of participants successfully stopped smoking in 6 months. The results revealed that quitters were older, with hypertension, fewer daily cigarettes, and being prescribed with varenicline. Multiple logistic regressions analyses identified that fewer daily cigarettes and being prescribed with varenicline were predictors of successful smoking cessation. Therefore, we suggest that varenicline use may help heavy smokers in smoking cessation.


Assuntos
Abandono do Hábito de Fumar , Hospitais , Humanos , Pessoa de Meia-Idade , Fumantes , Fumar , Taiwan/epidemiologia , Dispositivos para o Abandono do Uso de Tabaco , Vareniclina/uso terapêutico
10.
Artigo em Inglês | MEDLINE | ID: mdl-34948570

RESUMO

BACKGROUND: Prescription drug misuse (PDM) is a critical mental health issue relating to psychiatric morbidity. This study investigated the prevalence of PDM and its associated psychopathology and psychosocial factors in the general population in Taiwan. METHODS: The survey randomly selected a representative sample >15 year-olds using the stratified proportional randomization method. The measurements included demographic variables, previous experience with PDM, self-rated physical and mental health, health self-efficacy, risk factors for suicidality, and psychological distress. RESULTS: The weighted one-year prevalence of PDM was 8.5% (n = 180) among 2126 participants. Those with psychological distress and lifetime suicide ideation (23.3%) or suicide attempts (5.0%) were significantly associated with PDM. PDM was also prevalent among those with poorer self-rated health and lower self-efficacy. Insomnia (OR = 1.52), depression (OR = 1.77), and low self-efficacy (OR = 2.29) had higher odds of PDM after adjustment in the logistic regression model. CONCLUSIONS: Individuals who misused prescription drugs had a higher prevalence of psychological distress and suicidality and lower levels of self-rated health. Prescription drug misuse problems should be screened for early prevention when prescribing medications for people with insomnia, depression, or lower perceived health beliefs or conditions.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , Humanos , Prevalência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taiwan/epidemiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-34948746

RESUMO

Lung adenocarcinoma is the most common histological type of non-small cell lung cancer, which accounts for the majority of lung cancers. Previous studies have showed that dysregulation of WW domain-containing oxidoreductase (WWOX) participates in the generation of several cancer types, including lung cancer. However, whether these WWOX polymorphisms are related to the clinical risk of epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma is worthy of investigation. The present study examined the relationship between the WWOX single-nucleotide polymorphisms (SNPs; rs11545028, rs12918952, rs3764340, rs73569323, and rs383362) and the clinicopathological factors in lung adenocarcinoma patients with or without EGFR mutations. We found that there was no significant difference in the genotype distribution of WWOX polymorphism between EGFR wild-type and EGFR mutant in patients with lung adenocarcinoma. Our results demonstrated that the presence of at least one G genotype (CG and GG) allele on WWOX rs3764340 was associated with a significantly higher risk of nearby lymph node involvement in those patients harboring EGFR mutations (odds ratio (OR) = 3.881, p = 0.010) compared with the CC genotype. Furthermore, in the subgroup of lung adenocarcinoma patients with the EGFR-L858R mutation, both WWOX rs3764340 C/G (OR = 5.209, p = 0.023) and rs73569323 C/T polymorphisms (OR = 3.886, p = 0.039) exhibited significant associations with the size of primary tumors and the invasion of adjacent tissues. In conclusion, these data indicate that WWOX SNPs may help predict tumor growth and invasion in patients with EGFR mutant lung adenocarcinoma, especially those with the EGFR-L858R mutant in Taiwan.


Assuntos
Adenocarcinoma de Pulmão , Carcinoma Pulmonar de Células não Pequenas , Receptores ErbB , Neoplasias Pulmonares , Proteínas Supressoras de Tumor , Oxidorredutase com Domínios WW , Adenocarcinoma de Pulmão/genética , Receptores ErbB/genética , Humanos , Neoplasias Pulmonares/genética , Mutação , Polimorfismo de Nucleotídeo Único , Taiwan/epidemiologia , Oxidorredutase com Domínios WW/genética
12.
Front Public Health ; 9: 777255, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34957028

RESUMO

In response to the COVID-19 pandemic, Taiwan has been one of the best performers in the world with extremely low infections and deaths. This success can be attributed to the long experiences dealing with natural disasters and communicable diseases. However, with different disastrous characteristics, the disaster management systems for communicable diseases and natural disasters are very different in terms of laws, plans, frameworks, and emergency operations. Taking the response to COVID-19 pandemic as a study subject, we found that disaster management for communicable diseases can be improved through a comparison with natural disasters, and vice versa. First, having wider and longer impacts than natural disasters, the plans and framework for communicable diseases in Taiwan focus more on national and regional scales. Local governments would need more capacity support including budgets and training to conduct investigations and quarantine during the COVID-19 pandemic. Second, for quick response, the emergency operation for communicable diseases was designed to be more flexible than that for natural disasters by giving the commander more authority to adjust to the circumstances. The commanding system requires a more objective consultation group to prevent arbitrary decisions against the COVID-19 pandemic. Finally, risk governance is important for communicable diseases as well as for natural disasters. Additional efforts should be made to enhance vulnerability assessment, disaster reduction, and risk communication for shaping responses and policies in an efficient and coordinating way.


Assuntos
COVID-19 , Desastres Naturais , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Taiwan/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34948836

RESUMO

(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional method based on the Registry for Catastrophic Illness Patient Database from Taiwan's National Health Insurance Research Database. Patients with newly diagnosed prostate cancer between 1997 and 2013 were enrolled in the study and divided into four treatment-related groups. The rate of emergency department presentation, disease categorization of emergency department visits, emergency department-related medical expenditures, and temporal trends were investigated. (3) Results: A total of 18,728 patients with prostate cancer were identified between 1997 and 2013, for whom 13,098 emergency department visits were recorded. The number of emergency department visits increased during the study period. The incidence rate for the medical utilization of emergency department visits was 822 per 1000 people during the study period. The incidence rates for patients with prostate cancer in the radical prostatectomy, radiotherapy, androgen deprivation therapy, and chemotherapy groups were 549, 1611, 1101, and 372, respectively. The average medical expenditure per emergency department visit was TWD 3779.8 ± 5116.2, and the expenditure was recorded for the chemotherapy group at TWD 4690.8 ± 7043.3. The most common disease diagnoses among patients with prostate cancer who presented to the emergency department were injury/poisoning (16.79%), genitourinary disorders (10.66%), and digestive disorders (10.48%). (4) Conclusions: This nationwide population-based study examined the emergency department visits of patients with prostate cancer in Taiwan, providing useful information for improving the quality of medical care.


Assuntos
Antagonistas de Androgênios , Neoplasias da Próstata , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , Masculino , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/terapia , Taiwan/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-34949031

RESUMO

Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall injury. The data were collected during 2000-2015 from Taiwan's National Health Insurance Research Database. A total of 8901 individuals diagnosed with OSA were inpatients, or outpatients at least three times were enrolled. Finally, 6915 participants with OSA were included as the study cohort. We matched the study cohort with a comparison cohort, at a ratio of 1:4. Cox proportional hazards regression was used to analyse the association between OSA and overall injury. Patients with OSA had 83.1% increased risk of overall injury, compared to non-OSA individuals [adjusted hazards ratio (HR) = 1.831, confidence interval (CI) = 1.674-2.020, p < 0.001]. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 2.014; CI = 1.842-2.222, p < 0.001). Patients with OSA were at a higher risk of falls, traffic injury, poisoning, suffocation, suicide, and abuse or homicide than non-OSA individuals, with falls and traffic injury as the leading causes of injuries. The data demonstrated that patients with OSA have a higher risk of overall injury. The study results can be a reference for developing injury prevention strategies in the future. The general population and clinicians should have more awareness regarding OSA and its negative effects on injury development.


Assuntos
Apneia Obstrutiva do Sono , Acidentes de Trânsito , Idoso , Estudos de Coortes , Humanos , Incidência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Taiwan/epidemiologia
15.
PLoS One ; 16(12): e0260763, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34914755

RESUMO

BACKGROUND: Sarcopenia and muscle weakness in elderly are contributed burden of public health and impact on quality of life. Weak grip strength was key role in diagnosis of sarcopenia and reported increased mortality, function declined in elderly. This study evaluated the association between GS and each common anthropometric characteristic in community-dwelling elderly. DESIGN AND METHOD: From 2017 to 2019, we conducted a community-based health survey among the elderly in Chiayi county, Taiwan. Participants were 65 years old or older, and total of 3,739 elderly subjects (1,600 males and 2,139 females) with a mean age of 76 years (range 65-85 years old) were recruited. General demographic data and lifestyle patterns were measured using a standard questionnaire. Anthropometric characteristics such as body height, body weight, body mass index (BMI), body waist and hip circumference, and body fat were measured by standard methods. GS was measured using a digital dynamometers (TKK5101) method. RESULTS: The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females (p < 0.001). For both sexes, elderly subjects with the same body weight but smaller body waist circumference had greater GS. The subjects with the same body waist size but heavier weight had greater GS. Furthermore, after adjusting for age, lifestyles, disease status, and potential anthropometric variable, multivariate regression analyses indicated that BMI was positively associated with GS (for males, beta = 0.310 and for females beta = 0.143, both p < 0.001) and body waist was negatively associated with GS (for males, beta = -0.108, p < 0.001; for females, beta = -0.030, p = 0.061). CONCLUSIONS: This study suggested that old adults with higher waist circumstance had weaker GS. Waist circumstance was negatively associated with GS, body weight was positively associated with GS in contrast. It may implies that central obesity was more important than overweight for GS in elderly.


Assuntos
Composição Corporal , Fragilidade/epidemiologia , Força da Mão , Vida Independente/estatística & dados numéricos , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Circunferência da Cintura , Idoso , Idoso de 80 Anos ou mais , Antropometria , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Taiwan/epidemiologia
16.
PLoS One ; 16(12): e0260842, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34910749

RESUMO

OBJECTIVES: To determine the risk of having OSA in a cohort of female subjects who are infertile and the odds of being infertile in women with OSA. PATIENTS AND METHODS: A nationwide, case-control study of female patients 20 years or older diagnosed with female infertility living in Taiwan, from January 1, 2000, through December 31, 2013 (N = 4,078). We identified women who were infertile and created a 2:1 matched control group with women who were not infertile. We used multivariable logistic regression analysis to further estimate the effects of OSA on female infertility. RESULTS: In this 14- year retrospective study, we included 4,078 patients having an initial diagnosis of female infertility. Of those women with infertility, 1.38% had a history of OSA compared with 0.63% of fertile controls (p = 0.002). The mean ages in the study groups were 32.19 ± 6.20 years, whereas the mean ages in the control groups were 32.24 ± 6.37years. Women with OSA had 2.101- times the risk of female infertility compared to women without OSA (p<0.001). CONCLUSION: Our study showed that OSA is more commonly seen in infertile women and increases the odds that a woman will be infertile. More studies need to be done on the whether or not diagnosing and treating OSA can decrease the rate of infertility.


Assuntos
Infertilidade Feminina/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Razão de Chances , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
17.
Front Public Health ; 9: 650452, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34722429

RESUMO

Background: Patients with type 2 diabetes (T2DM) often experience depression during treatment, negatively influencing their treatment compliance and clinical outcomes. Recently, the pay-for-performance (P4P) program for chronic diseases, with high-cost and high-risk feature, such as T2DM, has been implemented and has been operational for several years. Nevertheless, its effect on the risk of developing depression among T2DM cases is unknown. This study aims to explore the association of P4P use with the subsequent risk of developing depression among these patients. Methods: This cohort study used a nationwide health insurance database to identify patients 20-70 years of age newly diagnosed with T2DM who enrolled in the P4P program between 2001 and 2010. From this group, we enrolled 17,022 P4P users and then 17,022 non-P4P users who were randomly selected using propensity-score-matching. Enrolled patients were followed until the end of 2012 to record the occurrence of depression. The Cox proportional hazards regression was utilized to obtain the adjusted hazard ratio (aHR) for P4P use. Results: During the study period, a total of 588 P4P users and 1,075 non-P4P users developed depression at incidence rates of 5.89 and 8.41 per 1,000 person-years, respectively. P4P users had a lower depression risk than did non-P4P users (aHR, 0.73; 95% Confidence Interval, 0.65-0.80). This positive effect was particularly prominent in those receiving high-intensity use of the P4P program. Conclusion: Integrating P4P into routine care for patients with T2DM may have beneficial effects on curtailing the subsequent risk of depression.


Assuntos
Diabetes Mellitus Tipo 2 , Reembolso de Incentivo , Estudos de Coortes , Depressão/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Humanos , Taiwan/epidemiologia
18.
Front Public Health ; 9: 718846, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34722435

RESUMO

Background: Carbon monoxide (CO) poisoning is the leading cause of poisoning death worldwide, but associations between CO poisoning and weather remain unclear. Objective: To quantify the influence of climate parameters (e.g., temperature, relative humidity, and wind speed) on the incidence risk of acute CO poisoning in Taiwan. Methods: We used negative binomial mixed models (NBMMs) to evaluate the influence of weather parameters on the incidence risk of acute CO poisoning. Subgroup analyses were conducted, based on the seasonality and the intentionality of acute CO poisoning cases. Results: We identified a total of 622 patients (mean age: 32.9 years old; female: 51%) with acute CO poisoning in the study hospital. Carbon monoxide poisoning was associated with temperature (beta: -0.0973, rate ratio (RR): 0.9073, p < 0.0001) but not with relative humidity (beta: 0.1290, RR: 1.1377, p = 0.0513) or wind speed (beta: -0.4195, RR: 0.6574, p = 0.0806). In the subgroup analyses, temperature was associated with the incidence of intentional CO poisoning (beta: 0.1076, RR: 1.1136, p = 0.0333) in spring and unintentional CO poisoning (beta: -0.1865, RR: 0.8299, p = 0.0184) in winter. Conclusion: Changes in temperature affect the incidence risk for acute CO poisoning, but the impact varies with different seasons and intentionality in Taiwan. Our findings quantify the effects of climate factors and provide fundamental evidence for healthcare providers to develop preventative strategies to reduce acute CO poisoning events.


Assuntos
Intoxicação por Monóxido de Carbono , Adulto , Intoxicação por Monóxido de Carbono/epidemiologia , Feminino , Humanos , Estudos Retrospectivos , Estações do Ano , Taiwan/epidemiologia , Tempo (Meteorologia)
19.
Medicine (Baltimore) ; 100(41): e27496, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731131

RESUMO

ABSTRACT: Using animal models and molecular biology researches, hyperuricemia has been shown to instruct renal arteriolopathy, arterial hypertension, and microvascular injury involving the renin-angiotensin system and resulting in renal function impairment. Nevertheless, the association between uric acid levels and the development of albuminuria has been under-investigated in patients with type 2 diabetes mellitus. Patients with type 2 diabetes and regular outpatient visits were recruited from the Puli Branch of the Taichung Veterans General Hospital in Taiwan since January 2014. Demographics, lifestyle features, and medical history were gathered by well-trained interviewers. All participants underwent comprehensive physical examinations, including a biochemical assay of venous blood specimens and urine samples after an 8-hour overnight fast. Participants were followed until June 2018. The primary outcome was the albuminuria incidence. Univariable and multivariable Cox regression analysis were employed to explore the relation between uric acid and incident albuminuria. Uric acid cutoffs for incident albuminuria were determined with the receiver operator characteristic curve. We included 247 qualified subjects (mean age: 64.78 years old [standard deviation = 11.29 years]; 138 [55.87%] men). During a 4.5-year follow-up duration, 20 subjects with incident albuminuria were recognized. Serum uric acid was significantly associated with an increased risk of incident albuminuria (adjusted hazard ratio = 2.39; 95% confidence interval: 1.53-3.75; P < .001) with potential confounders adjustment. The uric acid cutoff point was 6.9 mg/dL (area under the curve 0.708, sensitivity 60.0%, specificity 84.58%) for incident albuminuria. Serum uric acid was associated with incident albuminuria among patients with type 2 diabetes.


Assuntos
Albuminúria/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/urina , Ácido Úrico/sangue , Idoso , Albuminúria/etiologia , Animais , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/complicações , Feminino , Humanos , Hipertensão/complicações , Hiperuricemia/complicações , Incidência , Masculino , Camundongos , Microvasos/lesões , Pessoa de Meia-Idade , Modelos Animais , Insuficiência Renal/etiologia , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco , Taiwan/epidemiologia
20.
Medicine (Baltimore) ; 100(41): e27506, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731134

RESUMO

ABSTRACT: Previous studies have suggested that obesity might be associated with chronic periodontitis (CP); however, no clear conclusions have been reached so far. In this retrospective cohort study, we aimed to investigate the association between obesity and CP by using a large population-based dataset in Taiwan.A population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2010 (LHID2010) derived from the National Health Insurance Research database in Taiwan, from 2000 to 2013. Obesity and non-obesity groups were matched with sex, age, urbanization level, socioeconomic status, and the related comorbidities by using the propensity score method at a 1:2 ratio.An obese cohort (n = 4140) and a non-obese cohort (n = 8280) were included in this study, with an average age of 41.7 ±â€Š13.8 years and 42.0 ±â€Š14.0 years, respectively. The risk of CP for the patients with obesity was 1.12-fold compared with those without obesity (hazard ratio, 1.12; 95% confidence interval, 1.01-1.25). In the subgroup analysis according to age and sex, the hazard ratio of CP were 1.98 (95% confidence interval, 1.22-3.22) in the subgroup of age equal to or older than 65 years. The risk of CP showed no difference between obesity and non-obesity groups in both sex.This population-based cohort study demonstrated that obesity was associated with the development of CP in Taiwan.


Assuntos
Periodontite Crônica/diagnóstico , Periodontite Crônica/etiologia , Obesidade/complicações , Adulto , Idoso , Estudos de Casos e Controles , Doença Crônica , Periodontite Crônica/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos , Classe Social , Taiwan/epidemiologia
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