The synergistic effect of insomnia and depression on risk of herpes zoster.

Sleep problems was associated with increased risk for herpes zoster (HZ). This study examined subjects with insomnia or a combination of insomnia and depression and their risk of HZ. This retrospective cohort study included a total of 47,256 participants, with a control comprising 31,504 age- and sex-matched patients. Clinical data from 2000 to 2013 in the Taiwan National Health Insurance Research Database were used for analysis. Insomnia, depression, and HZ were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Subjects with insomnia had a significantly higher incidence of HZ (2.77 per 1000 person-years) than the controls (1.81 per 1000 person-years) as well as a higher risk of developing HZ (adjusted hazard ratio (AHR) = 1.62, 95% confidence interval (CI) = 1.35-1.93). Results shown subjects with insomnia durations of < 4 years, 4-6 years, and > 6 years had a significantly higher risk of HZ compared with the controls (AHR: 6.69, 95% CI 4.44-9.39; AHR: 4.42, 95% CI 3.07-6.36; AHR:1.38, 95% CI 1.14-1.87, respectively). We found a significantly higher risk of HZ in subjects with both insomnia and depression (AHR = 4.95; 95% CI = 3.99-7.02) than in those without related conditions. Patients with insomnia, and even more so those with comorbid depression, had a higher risk of developing HZ. This indicates a joint effect of insomnia and depression on HZ.

Associations between domestic violence and poor pregnancy outcomes in taiwanese women: a nested case-control study.

BACKGROUND AND AIMS: Domestic violence (DV) are one of the important risk factors for women's health outcomes. The aim of this study was explored the risk of DV association with the poor pregnancy outcomes (PPOs), including premature delivery, abortion, and stillbirth. METHODS: A nested case-control study was applied. Data from the Taiwan National Health Insurance Research Database were collected from 2000 to 2015. A total of 41,730 participants were included in this study, including 8,346 participants in the case group and 33,384 age- and index year-matched control group. Assessments of DA and PPOs were determined according to the International Classification of Diseases, 9th Revision. We conducted a conditional logistic regression analysis to estimate the effect of DV on PPOs. RESULTS: The mean age was 35.53 in the 41,730 female participants. The overall incidence rate of PPOs of the participants, who had experienced DV, was 84.05 per 100,000 person-years. which was significantly higher than that for the controls (18.19 per 100,000 person-years). The risk of PPOs was higher in the participants who had experienced DV than in the controls (adjusted odds ratio [AOR] = 3.31; 95% confidence interval [CI] [95% CI]: 2.83-3.86), including for premature delivery (AOR = 3.57; 95% CI: 3.05-4.17), abortion (AOR = 3.31; 95% CI: 2.83-3.86) and stillbirth (AOR = 2.98; 95% CI: 2.55-3.47). The results showed that the longer a participant has been suffering DV, the risk of PPOs was higher. CONCLUSIONS: Present results reaved the risk of PPOs associated with DV. Especially, the longer a woman has been experiencing DV, the risk of PPOs was higher, showed a dose-response effect.

Novel lissencephaly-associated DCX variants in the C-terminal DCX domain affect microtubule binding and dynamics.

OBJECTIVE: Pathogenic variants in DCX on the X chromosome lead to lissencephaly and subcortical band heterotopia (SBH), brain malformations caused by neuronal migration defects. Its product doublecortin (DCX) binds to microtubules to modulate microtubule polymerization. How pathogenic DCX variants affect these activities remains not fully investigated. METHODS: DCX variants were identified using whole exome and Sanger sequencing from six families with lissencephaly/SBH. We examined how these variants affect DCX functions using microtubule binding, regrowth, and colocalization assays. RESULTS: We found novel DCX variants p.Val177AlafsTer31 and p.Gly188Trp, as well as reported variants p.Arg196His, p.Lys202Met, and p.Thr203Ala. Incidentally, all of the missense variants were clustered on the C-terminal DCX domain. The microtubule binding ability was significantly decreased in p.Val177AlafsTer31, p.Gly188Trp, p.Lys202Met, and previously reported p.Asp262Gly variants. Furthermore, expression of p.Val177AlafsTer31, p.Gly188Trp, p.Arg196His, p.Lys202Met, and p.Asp262Gly variants hindered microtubule growth in cells. There were also decreases in the colocalization of p.Val177AlafsTer31, p.Thr203Ala, and p.Asp262Gly variants to microtubules. SIGNIFICANCE: Our results indicate that these variants in the C-terminal DCX domain altered microtubule binding and dynamics, which may underlie neuronal migration defects during brain development.

Challenges faced by community connectors: lessons learned from a Taiwan public health initiative.

BACKGROUND: Effective solutions that meet the diverse community health needs of older adult populations are of critical importance. To address these needs, a nationwide community connector team-tasked with providing referral support to older adult populations and completing an asset mapping resource inventory initiative centered around the needs of older adult populations-was developed in Taiwan. The purpose of this qualitative study was to explore community connectors' experiences and challenges. METHODS: Community connectors (n = 26) across four diverse sites participated in focus group interviews in July 2020. Interviews explored the challenges community connectors encountered in their roles; the strategies used to address these challenges; the asset mapping process; and on how they conceptualized their roles. Qualitative content analysis was applied. RESULTS: Three themes were uncovered: developing community ties, cross-organization interactions and professional conflicts. The findings show that community connectors face hurdles in uncovering community resources and that they experience considerable professional instability. The findings also shed light on the day-to-day approaches used to navigate on-the-job challenges and the steps taken to develop community partnerships. CONCLUSIONS: The experiences of community connectors provide important insights and can serve to illuminate the development of similar initiatives that seek to use community connectors for community health related purposes.

Obstructive sleep apnea and injury events in Taiwanese adults: A retrospective cohort study.

PURPOSE: The aim of this study was to examine the association between obstructive sleep apnea (OSA) diagnosis and diverse types of injuries. DESIGN: This population-based retrospective cohort study compared records from 2000 to 2013 in the Taiwan National Health Insurance Research Database. METHODS: 3025 patients identified with OSA were compared against the control cohort consisting of 12,100 age- and sex-matched patients. Cox proportional hazards regression analysis was performed to estimate the effects of OSA on injury risk. FINDINGS: Patients with OSA exhibited a significantly higher overall incidence of injury of 2599 per 100,000 person-years compared to the control cohort (2248 per 100,000 person-years). After the confounding factors were considered, subjects with OSA showed a higher risk of injury than subjects in the control group (adjusted hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.64-1.93). The risk of unintentional injury (traffic, poisoning, falls) and intentional injury (suicide) in the group of patients with OSA was higher than that in the controls. CONCLUSIONS: Our study strongly supports the conclusion that adults with OSA are at increased risk of injury. CLINICAL RELEVANCE: The present results indicate the significance of OSA as a predictor of injury risk, which will provide valuable information for clinical practice and injury prevention.

The association between obstructive sleep apnea and the risk of poor delivery events in women: A population-based nested case-control study.

PURPOSE: To investigate the risk of poor delivery events (PDEs; premature delivery, abortion, and stillbirth) in female subjects with obstructive sleep apnea (OSA). METHODS: The study identified 8346 female subjects with PDEs as cases between January 1, 2000 and December 31, 2015 from the Longitudinal Health Insurance Database 2005 in Taiwan. A total of 33,384 controls were also identified based on frequency matching for age and year of index date. Diagnoses of OSA and PDEs were determined according to the International Classification of Diseases, 9th Revision. The risk of PDEs in female subjects with OSA was estimated with conditional logistic regression analyses. FINDINGS: The mean age of the 41,730 female subjects was 35.53 years. The overall incidence rate of PDEs was 506.22 per 100,000 person-years for subjects with OSA, which was significantly higher than that for the controls (501.95 per 100,000 person-years). The risk of PDEs was higher in subjects with OSA than in controls (adjusted odds ratio [AOR] = 1.19; 95% confidence interval [CI] [95% CI]: 1.08-1.43), including for premature delivery (AOR = 1.20; 95% CI: 1.16-1.50), and abortion (AOR = 1.19; 95% CI: 1.09-1.47). OSA showed no relation to stillbirth (AOR = 1.04; 95% CI: 0.99-1.31). The findings indicate that the longer a subject has been experiencing OSA, the higher the probability of PDEs. CONCLUSIONS: The risk of PDEs associated with OSA was found in this study. In particular, the longer a subject has OSA, the higher the likelihood of PDEs, exhibiting a dose-response effect. CLINICAL RELEVANCE: To effectively promote maternal health in clinical practice, health providers need to recognize OSA as a risk factor associated with negative pregnancy outcomes. Furthermore, OSA symptoms should be assessed and managed in all pregnant women to enable more comprehensive maternal care.

Risk factors associated with frailty in older adults with type 2 diabetes: A cross-sectional study.

AIMS AND OBJECTIVES: The aims of the study were to (i) estimate the prevalence of frailty among older adults with type 2 diabetes, and (ii) investigate risk factors associated with frailty in the study group. BACKGROUND: The high prevalence of frailty among older adults and its adverse health impacts including higher risks for physical disabilities and a higher mortality rate is quickly evolving to become an important public health issue. DESIGN: A cross-sectional design. METHODS: Data were collected from the Clinical Diabetes Centre of our study group. Frailty was assessed using the Chinese version of the Tilburg frailty indicator. Other questionnaires included Activities of Daily Living, Mini-Mental State Examination, Taiwan Geriatric Depression Scale and Instrumental Activities of Daily Living. Multivariable logistic regression was established to identify factors associated with frailty. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used preparing the manuscript. RESULTS: A total of 248 subjects were recruited in this study, a total of 66 participants had frailty (26.6%). Our results showed that factors including age, number of chronic diseases, cerebrovascular accident, renal diseases, frequency of falling, frequency of hyperglycaemia, Activities of Daily Living, depression, Mini-Mental State Examination, and Instrumental Activities of Daily Living ≧1 task disability were correlated with frailty in older adults with type 2 diabetes. After adjusting for confounding factors, multivariate logistic regression analyses showed a significant increase in the probability of frailty by 1.72-times when comparing type 2 diabetes subjects with depression to those without depression. CONCLUSION: This study revealed that depression is a significant factor associated with the occurrence of frailty among older adults with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE: Our results provided strong clinical evidence showing depression as an important factor associated with the risk of frailty in older individuals with type 2 diabetes. We recommend early detection via routine screenings for symptoms of depression during diabetes care to achieve early prevention or the delay of frailty and its implicated adverse health consequences.

Estimating the incidence rate ratio of common cold among patients with non-apnea sleep disorders: a retrospective cohort study.

The purpose was to explore the potential effects of nonapnea sleep disorders (NSDs) and hypnotic use on the incidence of common cold. This study adapted population-based retrospective cohort study designed. We used the data from the Taiwan National Health Insurance Research Database between 1998 and 2011. In total, 59,476 patients with NSDs were included in the study cohort, and the reference cohort comprised 59,476 propensity score-matched patients. We conducted a Poisson regression analysis to assess the incidence of common cold. The overall incidence of common cold was significantly higher than that in the reference cohort. Compared with the patients of the reference cohort without hypnotic use, those of the NSDs cohort with benzodiazepines and zolpidem use had higher incidence of common cold. In conclusion, study cohort had a higher incidence of developing common cold, and particularly pronounced in NSDs with hypnotic use.

Experiences of Middle-Aged and Older Taiwanese Adults With Chronic Insomnia: A Descriptive Qualitative Study.

The purpose of the current study was to describe the experiences of middle-aged and older adults with chronic insomnia. A descriptive qualitative study design was used, and semi-structured interviews were conducted with 17 participants from two primary clinic health centers in northern Taiwan. Mean age of participants was 64.3 years, most (58.8%) participants were middle aged (aged 40 to 64 years), and mean duration of insomnia was 5.6 years. Three themes emerged: Imperfection of Lived Experience, Dilemma of Whether to Take a Hypnotic, and Seeking Help from Alternative Therapy. Participants believed chronic insomnia contributed to an accumulation of anxiety and negative emotions, resulting in psychological burden. For participants with insomnia, because of their negative impressions of hypnotics, they usually sought alternative therapies to improve sleep. Health care providers should endeavor to understand the needs of individuals with insomnia and provide them with sleep hygiene knowledge and assistance in safe sleep practices. [Journal of Gerontological Nursing, 48(11), 21-28.].

Machine Learning in Prediction of Second Primary Cancer and Recurrence in Colorectal Cancer.

BACKGROUND: Colorectal cancer (CRC) is the third commonly diagnosed cancer worldwide. Recurrence of CRC (Re) and onset of a second primary malignancy (SPM) are important indicators in treating CRC, but it is often difficult to predict the onset of a SPM. Therefore, we used mechanical learning to identify risk factors that affect Re and SPM. PATIENT AND METHODS: CRC patients with cancer registry database at three medical centers were identified. All patients were classified based on Re or no recurrence (NRe) as well as SPM or no SPM (NSPM). Two classifiers, namely A Library for Support Vector Machines (LIBSVM) and Reduced Error Pruning Tree (REPTree), were applied to analyze the relationship between clinical features and Re and/or SPM category by constructing optimized models. RESULTS: When Re and SPM were evaluated separately, the accuracy of LIBSVM was 0.878 and that of REPTree was 0.622. When Re and SPM were evaluated in combination, the precision of models for SPM+Re, NSPM+Re, SPM+NRe, and NSPM+NRe was 0.878, 0.662, 0.774, and 0.778, respectively. CONCLUSIONS: Machine learning can be used to rank factors affecting tumor Re and SPM. In clinical practice, routine checkups are necessary to ensure early detection of new tumors. The success of prediction and early detection may be enhanced in the future by applying "big data" analysis methods such as machine learning.

α-Phellandrene enhances the immune response and resistance against Vibrio alginolyticus in white shrimp (Litopenaeus vannamei).

Innate immunity and resistance against Vibrio alginolyticus in white shrimp, Litopenaeus vannamei, that received α-phellandrene were examined. The results indicated that the percent survival of shrimp receiving 4, 8, and 12 µg g-1 α-phellandrene was significantly higher than that of control shrimp after 72 h (p < 0.05). In a separate experiment, the phenoloxidase (PO), respiratory bursts, superoxide dismutase (SOD), and phagocytic and lysozyme activity of L. vannamei receiving 8 and 12 µg g-1 α-phellandrene were significantly higher than those of the other groups upon challenge with V. alginolyticus at 24-60, 36-60, 12-60, 12-72 and 48-72 h, respectively. However, no significant differences in the total haemocyte counts (THC) of L. vannamei receiving any dose of α-phellandrene and of control shrimp were observed at 12-72 h. The expression (mRNA transcripts) of the immune genes prophenoloxidase (proPO), LPS- and ß-1,3-glucan-binding protein (LGBP) and peroxinectin (PE) of shrimp receiving α-phellandrene at 8 and 12 µg g-1 significantly increased after challenge with V. alginolyticus for 72 h (p < 0.05). We conclude that the immune ability and resistance against V. alginolyticus infection increased in L. vannamei receiving >4 µg g-1 α-phellandrene. These results indicated that α-phellandrene plays an important role in the innate immunity of white shrimp.

Risk of type 2 diabetes in patients with insomnia: A population-based historical cohort study.

BACKGROUND: We investigated the risk of type 2 diabetes mellitus (T2DM) in patients with and without insomnia. METHODS: In this historical cohort study, we performed a secondary analysis of data from 2001 to 2010, which was obtained from Taiwan's National Health Insurance Database. We developed a Cox proportional hazard regression model to estimate the effects of insomnia on T2DM risk. Kaplan-Meier survival analysis was applied to compare the differences in the cumulative incidence of T2DM between the groups with and without insomnia. RESULTS: During the follow-up period, the T2DM incidence rate of patients with insomnia was significantly higher than that of patients without insomnia (34.7 vs 24.3 per 1000 person-years). Overall, patients with insomnia had a higher risk of T2DM than did patients without insomnia (adjusted hazard ratio, 1.16; 95% confidence interval [CI], 1.10-1.19). Among patients aged younger than 40 years, those with insomnia had a higher risk of T2DM than did the comparison cohort (adjusted hazard ratio, 1.31; 95% CI, 1.14-1.55). Compared with patients without insomnia, the risk tended to increase with the duration of follow-up in patients with insomnia; when the insomnia duration was <4 years, 4 to 8 years, and >8 years, the risk of T2DM increased by 1.14, 1.38, and 1.51 times (95% CI, 1.03-1.17, 1.15-1.49, and 1.20-1.86), respectively. Patients with insomnia had a higher risk of T2DM, and this risk was particularly pronounced among the younger (≤40 years) population. CONCLUSION: Chronic insomnia could be an important risk factor for T2DM.

Association between sleep disorders and injury: a nationwide population-based retrospective cohort study.

BACKGROUND: The evidence is insufficient for the association between the exposure of sleep disorders and the risk of injury. The aim of this study was to examine the association between patients with sleep disorders and the risk of injury. METHODS: This was a population-based retrospective cohort study using Taiwan National Health Insurance Research Database from 2005 to 2010. A total of 15 109 patients with sleep disorders were identified as the study cohort. The non-sleep disorders control cohort comprised 29 955 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of sleep disorders on the risk of injury. RESULTS: The overall incidence of injury was 77.03 per 1000 person-years for patients with sleep disorders, which was significantly higher than that of the control cohort (60.63 per 1000 person-years). Overall, patients with sleep disorders had a higher risk of injury compared with control cohort (adjusted HR=1.27, 95% CI 1.26 to 1.28). Comparing to the control cohort, patients with insomnia had a 12% higher risk for injury (adjusted HR, 1.12 (95% CI 1.01 to 1.41)). CONCLUSIONS: Comparing to patients with non-sleep disorders, patients with sleep disorders had a higher risk of injury and the risk was particularly pronounced in those who had insomnia.

The relationship between insomnia with short sleep duration is associated with hypercholesterolemia: a cross-sectional study.

AIM: To examine the association between insomnia with short sleep duration and hypercholesterolemia in Taiwanese adults. BACKGROUND: Previous studies mostly focused on the association between sleep duration and hyperlipidemia, but the results were not consistent. Besides, very few studies extensively examined the association between insomnia and hypercholesterolemia. This study hypothesized that insomnia with short sleep duration is associated with hypercholesterolemia. DESIGN: Secondary data analysis. This study analysed the latest database of the cross-sectional Nutrition and Health Survey in Taiwan which was released on 2011 (data collected between 2005-2008) and collected data using stratified three-staged probability sampling design. METHODS: This study analysed 1533 participants aged between 19-64 (733 males and 800 females) and used logistic regression model to calculate the odds ratio and the 95% confidence interval of insomnia with short sleep duration to hypercholesterolemia. Controlled confounders included age, gender, sample weight, body mass index, waist circumference, fasting plasma glucose, hypertension and diabetes. RESULTS: Insomnia with 5-6 hours of sleep duration was significantly associated with hypercholesterolemia. The odds ratio of mild insomnia or moderate/severe insomnia with 5-6 hours of sleep duration to hypercholesterolemia was higher, compared with the reference group (without insomnia and >6 hours of sleep duration). CONCLUSION: Insomnia with short sleep duration was associated with increased odds of hypercholesterolemia. Caregivers in clinical practice should watch out for the effect brought by this novel factor.

Associations between sleep duration and type 2 diabetes in Taiwanese adults: A population-based study.

BACKGROUND/PURPOSE: Research on the association between sleep duration and type 2 diabetes in an adult community population has been relatively scarce. The objective of this study was to analyze the association between sleep duration and the risk of diabetes in Taiwanese adults. METHODS: Secondary data analysis was based on the database of Nutrition and Health Survey in Taiwan between 2005 and 2008. A stratified three-staged probability sampling method was used to create a cross-sectional research design and 1533 participants (733 men, 800 women, between 19 years and 64 years of age) were selected in this study. Logistic regression models were conducted to estimate the effect of sleep duration for type 2 diabetes patients. RESULTS: The average sleep duration for all participants in this study was 7.2 ± 1.4 hours, with 35.1% of the participants having a sleep duration less than 7 hours. After controlling related confounders, such as age, sex, body mass index, abdominal circumference, total cholesterol levels, sleep disturbances, and hypertension, the risk of having diabetes for participants with ≤ 5 hours sleep was 2.04-fold (95% confidence interval, 1.05-3.95) higher than for participants with 7-8.9 hours of sleep. In particular, the risk of having diabetes for young adults (between 19 years and 44 years of age) with ≤5 hours of sleep was 5.24-fold (95% confidence interval, 1.17-23.47) higher than for young adults who reported 7-8.9 hours of sleep. CONCLUSION: Our results show that a short sleep duration was associated with a higher prevalence of diabetes and this correlation was particularly strong in young adults.

[Applying Team Resource Management to the Reduction of Ventilator-Associated Pneumonia in the Intensive Care Unit].

BACKGROUND & PROBLEMS: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit. The average VAP rate was .128% in our unit during 2011. Therefore, we designed a project to identify relevant problems, including: inadequate knowledge about VAP care, incorrect techniques for sputum suction, patient head elevation < 30~45 degrees, ventilator humidifier installed with water equipment designed without water-resistant barriers, failure to change the resuscitator and small-volume nebulizer regularly, and possible cross-contamination between respiratory-care devices. PURPOSE: We targeted a VAP rate decrease from the current .128% to less than .1%. RESOLUTION: The improvement measures implemented included team resource management (TRM) with VAP education, promotion, a written reminder regarding sputum accumulation sites, instruction to elevate the head of patients to an appropriate height, introduction of an auto-stop water adding system, and regular changes of related devices at assigned positions. RESULTS: The VAP rate decreased from .128% to .065%. CONCLUSIONS: The risk identification and associated TRM project improved teamwork and the quality of care in the ICU.

[The efficacy of e-health management on weight control in adolescents: a systematic review].

BACKGROUND: Advances during the past decade have made it feasible to apply e-health methods to chronic disease management. Researchers have recently begun applying these methods to weight control. The application of e-health management methods to weight control in adolescents has yet to be investigated empirically. PURPOSE: This study conducted a systematic review of reports discussing the weight-control effects of e-health management in adolescents. METHODS: Researchers searched 6 electronic databases for relevant articles published between 1995 and April 2013. Data were collected using inclusion and exclusion criteria. A modified Jadad Scale was used to evaluate the quality of the identified articles. RESULTS: Seven studies met the inclusion criterion of targeting adolescent subject populations. A total of 3728 adolescents and 1394 parents participated in these studies. The majority of participants were overweight girls and median participant ages ranged from 12.52 (SD = 3.15) to 15.31 (SD = 0.69). All studies reported that e-health management reduced body mass index and body fat percentage. Four studies indicate that e-health management may improve physical activity knowledge and skills. However, diet control outcomes among the seven studies varied. CONCLUSIONS: Empirical results demonstrate that e-health management significantly affects weight control. However, the effectiveness of log-in versus primary outcome indicators was inconclusive. Future studies should consider the use of incentives, reminder systems, and other strategies to enhance website usage. The development of an Internet-based, computer-tailored weight-management intervention for overweight adolescents and the development of an appropriate care model are recommended.

Intranasal corticosteroids reduced acute rhinosinusitis in children with allergic rhinitis: A nested case-control study.

BACKGROUND: Children with allergic rhinitis (AR) have substantially more acute rhinosinusitis than children without AR. We evaluated whether intranasal corticosteroids (INCS), second-generation antihistamines (SGH), and/or intranasal antihistamines (INH) for AR affect acute rhinosinusitis in children with AR aged 2-18 years. METHODS: By using the National Health Research Institutes Database 2005 of Taiwan, a cohort of patients with AR aged 2-18 years treated with AR medications between 2002 and 2018 was made, within which a nested case-control study was performed. Risk settings for acute rhinosinusitis cases matched controls for age, sex, and comorbidities. Current users of INCS, INH, and/or SGH were compared with remote and recent users of any AR medications and current users of INCS with and without SGH were compared with current users of SGH. RESULTS: Current users of SGH and/or INCS had a higher risk of acute rhinosinusitis than remote users of AR drugs, and current users of SGH had a higher risk of acute rhinosinusitis than recent users; however, no difference in the risk of acute rhinosinusitis was found between current users of INCS and recent users of AR drugs. Current users of INCS with and without SGH had a lower risk of acute rhinosinusitis than current users of SGH alone. CONCLUSIONS: Treatment of INCS with and without SGH diminished the risk of acute rhinosinusitis compared with treatment using SGH alone. Adequate INCS treatment for patients with AR is important to reduce the incidence of acute rhinosinusitis.

Risk of Herpes Simplex virus type 1 (HSV-1) among patients with insomnia: A retrospective cohort study.

The aim of this study was to explore the risk of Simplex virus type 1 (HSV-1) in patients with insomnia. This study applied a population-based retrospective cohort design. A total of 50,210 patients aged ≥ 20 years who had received a diagnosis of insomnia between 2000 and 2015. They were identified according to the corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. The control cohort comprised 100,420 age-matched and sex-matched patients. Data from the Taiwan National Health Insurance Research Database were employed from 2000 to 2015. The overall incidence of HSV-1 in the insomnia cohort was significantly higher than that in the comparison cohort (3.10 vs 0.33 per 1000 person-years). Patients with insomnia had a higher risk of HSV-1 infection, compared with the comparisons (hazard ratio (HR) = 4.33, 95% confidence interval (CI) 2.18-5.58). For individuals divided into 3 age groups (≤40, 41-65, and >65 years old), the HSV-1 infection risk of the insomnia cohort was significantly greater than that of the comparisons. As the duration of insomnia increases, the risk of HSV-1 occurrence decreases.

The experiences of public health nurses during the COVID-19 in Taiwan: A qualitative study.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has had a substantial effect on frontline health care workers and caused public health nurses (PHNs) to come under various forms of pressure. PHNs face high-risk challenges in their work environment, and their professional commitment and adaptability are key concerns. The aim of this qualitative study was to describe the experiences of PHNs during the COVID-19 outbreak. METHODS/DESIGN: Twenty PHNs who worked during the COVID-19 outbreak were recruited from seven public health centres through posters. Data were collected through in-depth interviews that comprised semi-structured and open-ended questions; subsequently, the data were analysed through content analysis. RESULTS: Three themes emerged from the study findings, namely (1) the disorderliness of COVID-19 pandemic prevention work, (2) managing stress and fear, and (3) the establishment of a new normal. Because of the severity of the pandemic, the workload and stress associated with epidemic prevention policies continue to increase. PHNs may infect their family members and experience a sense of alienation and distance. They must also deal with irrationality and reactions in the people within their community. CONCLUSION: Health department directors and policymakers should provide the necessary support and assistance to frontline pandemic prevention workers to increase the efficiency of pandemic prevention efforts. PATIENT OR PUBLIC CONTRIBUTION: The participants agreed to participate in the qualitative study during the study period.