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1.
Hu Li Za Zhi ; 67(1): 55-65, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960397

RESUMO

BACKGROUND: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear. PURPOSE: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time. METHODS: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm3, >350-500 cells/mm3 and >500 cells/mm3. Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs. RESULTS: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p < .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count >500 cells/mm3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7-9th month assessment (p < .001). ARDs decreased significantly over time in the CD4 count > 500 cells/mm3 group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count > 500 cells/mm3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs.


Assuntos
Antirretrovirais/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Contagem de Linfócito CD4/estatística & dados numéricos , Estudos de Coortes , Infecções por HIV/diagnóstico , Humanos , Taiwan/epidemiologia , Fatores de Tempo
2.
Epidemiol Psychiatr Sci ; 29: e96, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31992379

RESUMO

AIMS: Several studies suggested that depression might worsen the clinical outcome of diabetes mellitus; however, such association was confounded by duration of illness and baseline complications. This study aimed to assess whether depression increases the risk of diabetes complications and mortality among incident patients with diabetes. METHODS: This was a population-based matched cohort study using Taiwan's National Health Insurance Research Database. A total of 38 537 incident patients with diabetes who had depressive disorders and 154 148 incident diabetes patients without depression who were matched by age, sex and cohort entry year were randomly selected. The study endpoint was the development of macrovascular and microvascular complications, all-cause mortality and cause-specific mortality. RESULTS: Among participants, the mean (±SD) age was 52.61 (±12.45) years, and 39.63% were male. The average duration of follow-up for mortality was 5.5 years, ranging from 0 to 14 years. The adjusted hazard ratios were 1.35 (95% confidence interval [CI], 1.32-1.37) for macrovascular complications and 1.08 (95% CI, 1.04-1.12) for all-cause mortality. However, there was no association of depression with microvascular complications, mortality due to cardiovascular diseases or mortality due to diabetes mellitus. The effect of depression on diabetes complications and mortality was more prominent among young adults than among middle-aged and older adults. CONCLUSIONS: Depression was associated with macrovascular complications and all-cause mortality in our patient cohort. However, the magnitude of association was less than that in previous studies. Further research should focus on the benefits and risks of treatment for depression on diabetes outcome.


Assuntos
Depressão/complicações , Depressão/mortalidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Depressão/psicologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia
3.
Medicine (Baltimore) ; 99(1): e18461, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895777

RESUMO

This study was conducted to examine the effect of protective factors on the relationship between crisis episodes and depression in the elderly population in Taiwan.In this study, the Taiwan Longitudinal Study on Aging was used as basis for a cross-sectional secondary data analysis. After eliminating respondents below the age of 65 years and those with missing values, 2426 samples were collected. Predictive variables, such as crisis episodes, personal resources, family ties, social participation, and social support, were investigated, and the dependent variable of "depression status" was measured using the Center for Epidemiologic Studies Depression scale.According to the results of regression analysis, the protective factors of self-assessed health (ß = -0.290, P < .001), instrumental support (ß = -0.153, P < .001), financial satisfaction (ß = -0.126, P < .001), emotional support (ß = -0.101, P < .001), crisis episodes (ß = 0.087, P < .001), support satisfaction (ß = -0.081, P < .001), leisure participation (ß = -0.053, P < .05), family ties (ß = -0.048, P < .05), and community participation (ß = -0.042, P < .05) had a significant effect on depression status. Moreover, leisure participation had a moderating effect on the relationship between crisis episodes and depression (ß = -0.07, P < .01). In addition, according to path analysis results, family ties had a significant negative predictive power on depression (ß = -0.225, P < .001), as did social support (ß = -0.978, P < .001). The predictive power of crisis episodes on depression through social support was 0.197 (-0.201 × -0.978 = 0.197, P < .001), and it was -0.324 (-0.331 × -0.978 = -0.324, P < .001) through social participation, which indicated that social support plays a mediating role between crisis episodes and depression and between social participation and depression.Strengthening effective protective factors can improve the resilience of elderly people and enable them to cope with dilemmas rapidly and effectively when faced with crisis episodes as well as restore their health status and enjoy a satisfactory life.


Assuntos
Depressão/epidemiologia , Resiliência Psicológica , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/diagnóstico , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Proteção , Apoio Social , Taiwan/epidemiologia
4.
Medicine (Baltimore) ; 99(1): e18530, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895788

RESUMO

The role of atopic dermatitis (AD) in the development of colorectal cancer (CRC) has been a matter of scientific debate with mixed results. We conducted a nationwide cohort study to assess the association between AD and risk of CRC. Drawing on Taiwan's National Health Insurance Research Database, 46,703 patients with AD (the AD cohort) and 186,812 sex, age, and index year-matched patients without AD (the non-AD cohort) were identified in the period between 2000 and 2008. Follow-up time was calculated from the date of entry in the cohort until the occurrence of a first CRC diagnosis, death, or the end of the observation period (December 31, 2013), whichever occurred first. Hazards ratios (HRs) and accompanying 95% confidence intervals (CIs) derived from the Fine-Gray competing risk model were used to estimate the association between AD and CRC risk. After multivariable adjustment, AD was associated with an increased risk of CRC (adjusted HR, 1.26; 95% CI, 1.14-1.40). Of note, a significant positive association between AD and CRC risk was evident in both men and women and in all age groups. In summary, this population-based cohort study revealed that AD was associated with an increased risk of CRC in an Asian population. It will be of interest for cohort studies with prediagnostic specimens to evaluate the potential relationship between AD and CRC using biomarkers for allergy status.


Assuntos
Neoplasias Colorretais/epidemiologia , Dermatite Atópica/complicações , Adulto , Neoplasias Colorretais/etiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 99(2): e18517, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914024

RESUMO

Atrial fibrillation (AF) is an important complication of acute myocardial infarction (AMI). The association between AF and serum lipid profile is unclear and statin use for lowering the incidence of new-onset AF remains controversial. The objective of this study was to investigate whether statins confer a beneficial effect on AF after AMI.Data available in the Taiwan National Health Insurance Research Database on 32886 AMI patients between 2008 and 2011 were retrospectively analyzed. Total 27553 (83.8%) had complete 1-yr follow-up data. Cardiovascular outcomes were analyzed based on the baseline characteristics and AF type (existing, new-onset, or non-AF). AF groups had significantly higher incidence of heart failure (HF), stroke, all-cause death, and major adverse cardiac and cerebrovascular event (MACCE) after index AMI (all P < .05). In contrast, myocardial re-infarction (re-MI) was not significantly different among the three groups (P = .95). Statin use tended to be associated with lower risk of new-onset AF after AMI (HR: 0.935; 95% confidence interval (CI): 0.877-0.998; P = .0427).Existing AF and new-onset AF subgroups had similar cardiovascular outcomes after AMI and were both inferior to the non-AF group. Statin tended to reduce new-onset AF after AMI.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/complicações , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Taiwan/epidemiologia
6.
Medicine (Baltimore) ; 99(2): e18630, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914045

RESUMO

Work stress and burnout have become important issues. Changes in work patterns frequently, long working hours, and too much pressure among workers in high-tech companies may result in the chronic fatigue symptoms and increase the risk of cardiovascular diseases, even leading to sudden death. Changes of heart rate variability (HRV) can be treated as a warning from the autonomic nervous systems and as a long-term monitoring method for chronic disease, for example, cardiovascular diseases and sudden death. The purpose of this study was to explore the association between occupational burnout and HRV.Proportional stratified convenient sampling was performed and in total, 120 individuals participated in this study. Questionnaires and the "occupational burnout inventory" were used to collect biographical and burnout information. A novel wrist physiological monitor was used to measure autonomic nervous system-related data, including HRV, low-frequency (LF) %, high-frequency (HF) %, and LF/HF ratio. Descriptive statistics and logistic regressions were computed using SPSS 17.0 (Chinese version, IBM Corp., New York, NY).The results show that participants who were 20 to 25 years old, work overtime because of onerous personal tasks, had a medical history, and recently felt unwell have higher "personal burnout." "Participants with a graduate degree, with onerous tasks, who were indirect staff, and with a regular-hour job tended to overcommit to their work." Significant associations were found among medical history, recently feeling unwell, and "work-related burnout." There was a positive association between HRV and job seniority. LF%, HF%, and LF/HF ratio were significantly correlated with job category. "Work overcommitment" was related to LF/HF ratio among men. Some items in "personal burnout" and "work overcommitment" were also associated with HRV among women.The findings suggest that the measurement of HRV can be applied in occupational settings to assess burnout. It not only allows administrators to quickly select the colleagues who need health care, but also provides timely and appropriate care, thereby promoting the health of the worker.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/fisiopatologia , Frequência Cardíaca/fisiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/fisiopatologia , Ocupações , Projetos Piloto , Fatores Socioeconômicos , Taiwan/epidemiologia , Fatores de Tempo , Carga de Trabalho , Adulto Jovem
7.
Ann Hematol ; 99(2): 321-330, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31802187

RESUMO

The incidence of multiple myeloma (MM) is increasing worldwide, but the rate of increase is greatest in Asia. Few data describe the epidemiology and treatment of MM in Asia. Building on a cohort study from 2007 to 2012 using the Taiwan National Healthcare Insurance Research database, we extended our analysis to estimate the disease burden and treatment patterns of patients with MM in Taiwan through 2015. A further 1664 patients with newly diagnosed MM from 2013 to 2015 (total 4387 patients from 2007 to 2015) were enrolled and followed up until death or end of the observation period (December 31, 2016), whichever occurred first. The age distribution of the 2013-2015 cohort was similar to that for previous years, but there were fewer men (52.1% versus 58.0%), and more patients had renal impairment at diagnosis (19.7% versus 16.4%). From 2007 to 2015, crude annual incidences per 100,000 population of newly diagnosed MM increased from 1.74 to 2.48 and age-adjusted incidences from 1.41 to 1.65. Crude all-cause mortality rates increased over time. Case fatality decreased from 25.5 to 18.3% and median survival increased from 2.10 to 3.12 years. From 2007 to 2015, the percentage of patients receiving first-line therapy with novel agents increased from 0.4 to 89.4%, autologous stem cell transplantation doubled, and chemotherapy use decreased by 81%. Comprehensive national data covering 9 years of follow-up demonstrate continuing change in the disease burden, treatment, and survival of MM in Taiwan. Despite increased use of new treatments, MM remains largely incurable.


Assuntos
Mieloma Múltiplo , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Taxa de Sobrevida , Taiwan/epidemiologia
8.
J Cancer Res Clin Oncol ; 146(1): 43-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31705294

RESUMO

BACKGROUND: There are several studies comparing the difference between adenocarcinoma (AC) and squamous cell carcinoma (SqCC) of lung cancer. However, seldom studies compare the different overall survival (OS) between AC and SqCC at same clinical or pathological stage. The aim of the study was to investigate the 5-year OS between AC and SqCC groups. METHODS: Data were obtained from the Taiwan Society of Cancer Registry. There were 48,296 non-small cell lung cancer (NSCLC) patients analyzed between 2009 and 2014 in this retrospective study. We analyzed both the AC and SqCC groups by age, gender, smoking status, Charlson co-morbidity index (CCI) score, clinical TNM stage, pathological stage, tumor location, histologic grade, pleura invasion, performance status, treatment, stage-specific 5-year OS rate in each clinical stage I-IV and causes of death. We used propensity score matching to reduce the bias. RESULTS: The AC and SqCC groups are significantly different in age, gender, smoking status, CCI score, clinical TNM stage, pathological stage, tumor location, histologic grade, pleura invasion, performance status, treatment, stage-specific 5-year OS rate in each clinical stage and causes of death (p < 0.0001). The stage-specific 5-year OS rates between AC and SqCC were 79% vs. 47% in stage I; 50% vs. 32% in stage II; 27% vs. 13% in stage III; 6% vs. 2% in stage IV, respectively (all p values < 0.0001). CONCLUSIONS: AC and SqCC have significantly different outcomes in lung cancer. We suggest that these two different cancers should be analyzed separately to provide more precise outcomes in the future.


Assuntos
Adenocarcinoma de Pulmão/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/terapia , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Masculino , Sistema de Registros , Estudos Retrospectivos , Taiwan/epidemiologia
9.
Accid Anal Prev ; 134: 105330, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31678785

RESUMO

BACKGROUND: Driving/riding under the influence (DUI) of alcohol is a major public concern worldwide. Only a few studies have distinguished DUI-related variables between motorcyclists and car drivers. This study examined the differences in demographic characteristics and drinking behaviors among first-time DUI offenders operating different transportation vehicles, and risk factors for frequent DUI (fDUI) among them. METHODS: We conducted an anonymous survey for 561 first-time DUI offenders who attended a mandatory educational program. Participants self-administered questionnaires concerning alcohol drinking behaviors and DUI. We defined fDUI as at least two DUI behaviors per month based on self-reported information. Demographic and drinking characteristics were compared between DUI offenders, car drivers and motorcyclists. Logistic regression analysis was used to examine risk factors for fDUI. RESULTS: Two-thirds of first-time DUI offenders were motorcyclists. Compared with car drivers, motorcyclists were younger and less educated, with a higher percentage of them being women and unmarried. Car drivers reported a higher rate of fDUI than motorcyclists (16.5% vs. 9.7%). Regression analysis revealed that binge drinkers had a higher fDUI risk in both groups. Regarding the drinking place prior to DUI behavior, workplace was significantly associated with fDUI in car drivers. CONCLUSIONS: Distinct strategies may be required for motorcyclists and car drivers for DUI recidivism prevention, and drinking place interventions should also be considered.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Dirigir sob a Influência/estatística & dados numéricos , Adulto , Automóveis/estatística & dados numéricos , Dirigir sob a Influência/legislação & jurisprudência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motocicletas/estatística & dados numéricos , Autorrelato , Taiwan/epidemiologia
10.
Hu Li Za Zhi ; 66(6): 43-53, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31802454

RESUMO

BACKGROUND: Anxiety and depression are common emotional distresses experienced by women during gynecologic cancer treatment. These often have dangerous effects on physical and mental health and may impact quality of life (QoL). PURPOSE: To investigate the factors influencing anxiety, depression, social support, and QoL in women with gynecologic cancer. METHODS: This was a cross-sectional correlational study. A total of 111 women with gynecologic cancer receiving treatment at a medical center in central Taiwan were selected as subjects using convenience sampling. A demographic characteristics questionnaire, the World Health Organization Quality of Life-Brief-Taiwan version (WHOQOL-BREF-Taiwan version) questionnaire, the International Support Evaluation List (ISEL), and the Hospital Anxiety and Depression Scale (HADS) were used for data collection. RESULTS: Of the 111 subjects, 41.4% and 24.3% had tendencies for anxiety and depression, respectively, and a moderate QoL score (mean = 3.46; SD = 0.73). The physical health domain had the highest mean QoL score (14.93; SD = 2.24), followed by environmental health (14.76; SD = 1.97), social relationships (14.13; SD = 2.33), and psychological health (13.92; SD = 2.44). Anxiety, depression, marital status, and social support respectively explained 18.5%-37.0% of the total variation in QoL scores. Of the four QoL domains examined in this study, anxiety was the most significant predictor of QoL. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: It is recommended that healthcare professionals strengthen the early assessment of anxiety, depression, and social support in women with gynecologic cancer. In addition, sensitivity towards emotional status should be increased in these cases. Healthcare professionals should provide care, support, and timely completion of referrals. Finally, psychological and social support and related interventions should be provided based on patient needs in order to maintain QoL.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Neoplasias dos Genitais Femininos/psicologia , Qualidade de Vida/psicologia , Estudos Transversais , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/terapia , Humanos , Inquéritos e Questionários , Taiwan/epidemiologia
11.
Medicine (Baltimore) ; 98(49): e18154, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804326

RESUMO

Plasma lipids in mid-life are important predictors for cardiovascular events and deaths. However, the association between plasma lipid concentrations and mortality in late life is controversial. Recent studies showed that older people with extremely low total cholesterol (TC) have poor survival outcome, but this conclusion was drawn mostly from Western cohorts. Our study investigated association between plasma lipid concentrations and mortality in Taiwanese elderly population.A retrospective cohort study was conducted among the 69,824 elderly people who participated in the Taipei City Geriatric Health Examination between 2006 and 2010, with a mean follow-up of 3.6 years. The measurements of TC, high density lipoprotein (HDL) and triglycerides were obtained from the records of the participants. Low density lipoprotein (LDL) was calculated using Friedewald formula in 69,088 participants. All lipid components were categorized into quartiles. Males and females were analyzed separately using multivariate Cox proportional hazards models.The elderly with the lowest quartile of TC (<175 mg/dL), HDL cholesterol (<43 mg/dL) and LDL cholesterol (<100.4 mg/dL) were at higher risk of all-cause mortality. Older females with the lowest quartile of TC and LDL cholesterol had higher cardiovascular mortality. Older females with the lowest quartile of HDL had higher mortality from cardiovascular and cerebrovascular diseases.We concluded that TC, mostly attributed to LDL cholesterol, was inversely related to all-cause mortality. HDL remained to be protective against both cardiovascular and stroke mortality in older females. The target levels of plasma lipids in people older than 65 years should be different from that in younger adults.


Assuntos
Lipídeos/sangue , Mortalidade/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Taiwan/epidemiologia
12.
Medicine (Baltimore) ; 98(50): e18190, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852074

RESUMO

The purpose of this study was to evaluate the association between tocolysis for preterm uterine contraction and the risk of nonreassuring fetal status.This was a retrospective cohort study using data from the Taiwan National Health Insurance Research Database. Pregnant women were enrolled if they delivered a baby during January 1, 2003 to December 31, 2011. The occurrence of the nonreassuring fetal status was compared between pregnant women with and without tocolytic treatment for preterm uterine contraction. Multivariable logistic regression models with adjusted cofounders were used to evaluate the association between tocolysis and the risk of nonreassuring fetal status.Of 24,133 pregnant women, 1115 (4.6%) received tocolytic treatment during pregnancy. After adjusting for covariates, pregnant women receiving tocolysis more than one time during pregnancy were found to have significantly higher risk of the nonreassuring fetal status when compared with pregnant women who did not receive tocolysis for uterine contraction (Odds Ratio = 2.70, 95% Confidence Interval: 1.13-6.49).Pregnant women with more frequent tocolysis for preterm uterine contraction during pregnancy had an increased risk of nonreassuring fetal status. Close evaluation of dose and duration of tocolytic treatment is necessary for pregnant women with preterm uterine contraction.


Assuntos
Sofrimento Fetal/prevenção & controle , Trabalho de Parto Prematuro/prevenção & controle , Vigilância da População , Tocólise/métodos , Tocolíticos/uso terapêutico , Adulto , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Estudos Retrospectivos , Taiwan/epidemiologia
13.
Medicine (Baltimore) ; 98(51): e18195, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860966

RESUMO

The finding of a decrease in subsequent fibroid-related operation following the use of Chinese herbal products (CHPs) has led to speculation that CHPs might play a role in uterine fibroids prevention.This study provides an overview of uterine fibroids incidence, comparing CHP users with those who do not use CHPs, referred to as non-CHP users. The results can provide information to clinicians for counseling women about the preventive use of CHPs.A total of 52,151 women (20-45 years of age) were recruited from a nationwide 1-million-person representative sample of those covered by National Health Insurance in Taiwan and were followed from 2000 to 2013. Exact matching was performed for comparative analysis. The age-specific hazard ratios (HRs) of uterine fibroids in relation to either CHP or the phytoestrogen use were calculated with multivariate Cox proportional hazard regression.More than 71% of patients had used a CHP at some point previously. The overall incidence density rate of uterine fibroids for non-CHP users was estimated at 27.5 per 1000 patient-years. The corresponding values for CHP and the phytoestrogen users were lower than those of the non-CHP group (CHP group = 15.5; the phytoestrogen group = 12.5 per 1000 patient-years). The covariate adjusted HRs for uterine fibroid were 0.73 (95% confidence interval [CI] 0.63-0.85) and 0.65 (95% CI 0.52-0.82) in women using CHPs and the phytoestrogen, respectively.CHPs seem to contribute to a decreased risk in developing uterine fibroids. Although the mechanism of action of these products is unclear, their use as a preventive agent for uterine fibroids might be taken into consideration.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Leiomioma/prevenção & controle , Adulto , Fatores Etários , Estudos de Coortes , Humanos , Leiomioma/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
14.
Medicine (Baltimore) ; 98(51): e18450, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861018

RESUMO

Restless legs syndrome (RLS) increases the risks of cardiovascular disease and death in hemodialysis (HD) patients. Previous studies of risk factors for RLS in HD patients have yielded varying results. We attempted to identify risk factors for RLS in HD patients in Taiwan.This case-control study recruited 59 HD patients with RLS and 353 HD patients without RLS from the largest HD center in Taiwan during the period from April 1, 2015 through August 31, 2015. Demographic and disease characteristics, information from the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic questionnaire, and IRLSSG Severity Scale scores were collected by interview. Clinical laboratory data were abstracted from medical records and then analyzed with logistic regression and Pearson correlation analysis. A P value of less than .05 was considered to indicate statistical significance.A dialysis duration of longer than 5 years (odds ratio [OR] = 2.32; 95% CI = 1.23-4.39; P = .002) and a low high-density lipoprotein cholesterol level (<40 mg/dL in men; <50 mg/dL in women) (OR = 2.73; 95% CI = 1.44-5.15; P = .009) were associated with increased risk of RLS. Among the 59 patients with RLS, 48 (81.3%) had moderate or severe symptoms (IRLSSG Severity Scale >10), and RLS severity was significantly correlated with dialysis duration (r = .26; P = .043).Among HD patients, RLS was more common among those receiving dialysis for longer than 5 years and those with a low serum high-density lipoprotein cholesterol (HDL-C) level.


Assuntos
Falência Renal Crônica/complicações , Síndrome das Pernas Inquietas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Síndrome das Pernas Inquietas/etiologia , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
15.
Medicine (Baltimore) ; 98(51): e18472, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861027

RESUMO

Previous researches have shown that anesthesia can affect the outcomes of many kinds of cancer after surgery. Here, we investigated the association between anesthesia and patient outcomes after elective open intrahepatic cholangiocarcinoma surgery.This was a retrospective cohort study of patients who received elective open intrahepatic cholangiocarcinoma surgery between January 2005 and December 2014. Patients were grouped according to the anesthesia received, that is, propofol or desflurane anesthesia. Kaplan-Meier analysis was performed and survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor node metastasis staging and postoperative metastasis and recurrence.A total of 34 patients (21 deaths, 62.0%) with propofol anesthesia and 36 (31 deaths, 86.0%) with desflurane anesthesia were eligible for analysis. After propensity matching, 58 patients remained in each group. In the matched analysis, the propofol anesthesia had a better survival with hazard ratio of 0.51 (95% confidence interval, 0.28-0.94, P = .032) compared with desflurane anesthesia. In addition, subgroup analyses showed that patients under propofol anesthesia had less postoperative metastases (hazard ratio, 0.36; 95% confidence interval, 0.15-0.88; P = .025), but not fewer postoperative recurrence formation (hazard ratio, 1.17; 95% confidence interval 0.46-2.93; P = .746), than those under desflurane anesthesia in the matched groups.In a limited sample size, propofol anesthesia was associated with better survival in open intrahepatic cholangiocarcinoma surgery. Prospective and large sample size researches are necessary to evaluate the effects of propofol anesthesia on the surgical outcomes of intrahepatic cholangiocarcinoma surgery.


Assuntos
Anestesia Intravenosa/mortalidade , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Desflurano , Propofol , Idoso , Anestésicos Intravenosos , Neoplasias dos Ductos Biliares/mortalidade , Colangiocarcinoma/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Complicações Pós-Operatórias , Estudos Retrospectivos , Taiwan/epidemiologia
16.
Environ Health Perspect ; 127(11): 117007, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31769300

RESUMO

BACKGROUND: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multi-country study has explored the shape of the association and the role of moderate and extreme heat across different locations. OBJECTIVES: We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y. METHODS: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country. RESULTS: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27°C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain. DISCUSSION: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898.


Assuntos
Temperatura Alta/efeitos adversos , Suicídio/estatística & dados numéricos , Brasil/epidemiologia , Canadá/epidemiologia , Cidades , Humanos , Japão/epidemiologia , Filipinas/epidemiologia , República da Coreia/epidemiologia , Risco , África do Sul/epidemiologia , Espanha/epidemiologia , Suíça/epidemiologia , Taiwan/epidemiologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Vietnã/epidemiologia
17.
BMC Complement Altern Med ; 19(1): 328, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752791

RESUMO

BACKGROUND: In recent years, acupuncture has been increasingly integrated into pediatric care worldwide. However, recent epidemiological studies about pediatric users of acupuncture are lacking. The current study aimed to fill the gap and carry out the large-scale investigation on the basis of the pediatric population in Taiwan. METHODS: We conducted a nationwide population-based study to investigate the utilization of acupuncture in Taiwan. We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000). The datasets contained all original claims data for 1 million beneficiaries who were randomly sampled from the registry of all beneficiaries enrolled in the Taiwan's National Health Insurance Program from January 1, 2000 to December 31, 2011. Children younger than 18 years old were enrolled into our study for analysis. The demographic data, treatment modalities and distributions by disease categories of the pediatric acupuncture users were analyzed by descriptive statistics. Logistic regression analysis was used to investigate the trends in acupuncture use over time. RESULTS: The one-year prevalence of pediatric acupuncture users increased from 1.78% in 2002 to 5.34% in 2011. Acupuncture use significantly increased each year (p-value< 0.0001). Patients who were male, of greater age, resided in highly urbanized areas and suffered from injury or disorders of the musculoskeletal system were more likely to accept acupuncture treatment. Infantile cerebral palsy and psychoses were the top two health issues among those receiving complex acupuncture treatment. Older (> 9 years old) children tended to receive acupuncture treatment due to injury and musculoskeletal system disorders more than younger (≤9 years old) children. CONCLUSIONS: Our study revealed that the utilization of acupuncture in pediatrics became increasingly popular year by year in Taiwan from 2002 to 2011. The results of this study may provide some valuable information for further clinical practice and acupuncture research, as well as to the government and societies concerning pediatric health care.


Assuntos
Terapia por Acupuntura/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Prevalência , Taiwan/epidemiologia
18.
Medicine (Baltimore) ; 98(48): e18058, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770221

RESUMO

Studies on the relationship between gynecologic surgery and subsequent ovarian cancer have been carried out in limited Western ethnic groups. We aim to evaluate whether receiving hysterectomy and/or salpingectomy associated with ovarian cancer risk in Taiwan.From the Taiwan National Health Insurance Research Database, we identified a gynecologic surgery cohort consisting of women who had newly received hysterectomy (N = 181,151), salpingectomy (N = 45,410) or both hysterectomy and salpingectomy (N = 11,875) in 2000 to 2013. A comparison cohort of 953,744 women was randomly selected from women without the surgeries, frequency-matched by age and index date of the surgery case. They were followed up to identify subsequent ovarian cancer by the end of 2013.The overall ovarian cancer incidence was 4.4-fold greater in the gynecologic surgery cohort than in the comparison cohort (41.5 vs 9.43 per 10 person-years) with an adjusted hazard ratio of 3.86 (95% confidence interval = 2.56-5.84). Women with both hysterectomy and salpingectomy had the highest incidence and followed by women with hysterectomy or salpingectomy (52.5, 45.5, or 23.3 per 10 person-years, respectively). No ovarian cancer was noted in the subgroup with bilateral salpingectomies.We conclude that women with gynecologic surgery of hysterectomy and/or salpingectomy are at an increased risk of developing ovarian cancer, particularly among women who have had other gynecologic comorbidity. Women with gynecologic surgery and comorbidity deserve greater attention to prevent and screen for ovarian cancer.


Assuntos
Histerectomia/efeitos adversos , Neoplasias Ovarianas/etiologia , Complicações Pós-Operatórias/etiologia , Salpingectomia/efeitos adversos , Adulto , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Neoplasias Ovarianas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Salpingectomia/métodos , Taiwan/epidemiologia
19.
Medicine (Baltimore) ; 98(48): e18127, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770243

RESUMO

This study aimed to examine the association between colorectal cancer and zolpidem use in Taiwan.A case-control study was conducted using the database of Taiwan National Health Insurance Program from 2000 to 2013. Participants aged 20 to 84 years with newly diagnosed colorectal cancer were selected as the cases. Sex-matched and age-matched participants without colorectal cancer were randomly selected as the matched controls. The odds ratio and 95% confidence interval for colorectal cancer associated with zolpidem use were calculated by the multivariable logistic regression model.There were 4912 cases with colorectal cancer and 4912 matched controls without colorectal cancer. The mean age was 63 years and 58% were male participants. After adjustment for co-variables, the multivariable logistic regression model disclosed that there was no statistical association between colorectal cancer and zolpidem use (adjusted OR 1.05, 95% CI 0.95-1.15).No statistical association can be detected between colorectal cancer and zolpidem use in Taiwan.


Assuntos
Neoplasias Colorretais/induzido quimicamente , Neoplasias Colorretais/epidemiologia , Medicamentos Indutores do Sono/efeitos adversos , Zolpidem/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
20.
Cyberpsychol Behav Soc Netw ; 22(10): 662-669, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31613156

RESUMO

Mobile gaming has gained popularity among adolescents, and an increase in problematic use has been reported. The aims of this study are as follows: (a) develop a self-report questionnaire, the Problematic Mobile Gaming Questionnaire (PMGQ); (b) establish a validated cutoff value using structured interviews; and (c) evaluate the prevalence of mobile gaming addiction in adolescents. The PMGQ was built as a 12-item questionnaire rated on a 4-point Likert scale to evaluate the symptoms of problematic mobile gaming (PMG). The construct validity of the PMGQ was examined using exploratory factor analysis. Overall, 10,775 students with smartphones from grade 4 to senior high school were recruited to complete the questionnaire. A total of 113 senior high school students were interviewed using previously developed criteria for PMG to develop an optimal cutoff point measuring sensitivity, specificity, and diagnostic accuracy. The cutoff point was determined using the Youden index and optimal diagnostic accuracy. The PMGQ showed good internal consistency (Cronbach's α = 0.92) and adequate diagnostic efficiency (area under the receiver operating characteristic curve = 0.802). The items revealed three factors of addiction: compulsion, tolerance, and withdrawal. For the PMGQ, a cutoff point of 29/30 demonstrated the most optimal Youden index and diagnostic accuracy. Demographic data showed that the proportion of PMG was 19.1 percent among elementary school students, 20.5 percent among junior high school students, and 19.0 percent among senior high school students. The PMGQ demonstrated appropriate validity and accuracy in the assessment for PMG.


Assuntos
Comportamento Aditivo/epidemiologia , Jogos de Vídeo/efeitos adversos , Adolescente , Humanos , Prevalência , Inquéritos e Questionários , Taiwan/epidemiologia
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