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Background: Dementia is a syndrome that involves the deterioration of several higher mental functions in advanced age, and psoriasis is an autoimmune disease characterized by skin plaque. Epidemiological studies have indicated an association between dementia and psoriasis; however, to date, no studies in Asia have reported this association. Objective: This study used a population-based medical dataset to explore the association between previously diagnosed psoriasis and dementia in Taiwan. Methods: Using the Taiwan Longitudinal Health Insurance Database 2000, we identified 7118 individuals with a diagnosis of dementia; a further 21,354 sex- and aged-matched individuals were randomly extracted as controls. Patients with bullous pemphigoid, which is characterized by inflammatory phenomena similar to that evident in psoriasis, were chosen as a control group. Conditional logistic regression was performed to evaluate the association between dementia and prior psoriasis or bullous pemphigoid among the sampled patients. Results: Of the 28,472 individuals, 2.2, 3.0, and 1.5% of the total, case, and control groups, respectively, had been diagnosed with psoriasis. After adjustments were made for patients' monthly income, region, urbanization level, diabetes, hyperlipidemia, hypertension, and coronary heart disease, the odds ratio (OR) of diagnosed psoriasis for the case group was 1.46 (95% confidence interval [CI] 1.23–1.73; p < 0.001) compared with the control group. The ORs of a previous psoriasis diagnosis with arthritis and without arthritis in the case group were, respectively, 1.95 and 1.44 times (95% CI 1.03–3.89 and 1.21–1.72, respectively) those of the control group after adjustments for socioeconomic variables, diabetes, hyperlipidemia, hypertension, and coronary heart disease. However, no significant differences in prior bullous pemphigoid were observed between the dementia and control groups (0.5% and 0.4%, respectively). Conclusions: More patients with dementia had prior psoriasis than did patients in the control group. Additional research is required to confirm our results and clarify the relationship. [ABSTRACT FROM AUTHOR]

Highlights • This study aimed to evaluate the relationship between IBD and BD. • BD was found in 0.72% patients with IBD and in 0.34% comparison patients. • The adjusted odds ratio of BD for IBD patients was 2.10 than comparison group. Abstract Background To date, some experimental studies showed that inflammatory bowel disease (IBD) and bipolar disorder (BD) may share similar biological pathways. Nevertheless, only a few western studies have attempted to demonstrate the potential association between IBD and BD, and relevant findings are still conflicting. Therefore, this cross-sectional study aimed to evaluate the relationship between IBD and BD using a nationwide database in Taiwan. Method This study used data from the National Health Insurance Research Database. In total, 3590 patients with IBD and 14,360 propensity score-matched comparison patients without IBD were included in this study. Conditional logistic regressions were performed to evaluate the association between BD and IBD. Results Results showed that BD was found in 26 (0.72%) patients with IBD and in 49 (0.34%) matched comparison patients without IBD. After adjustment, the adjusted odds ratio (OR) of BD for IBD patients was 2.10 (95% confidence interval (CI): 1.30∼3.38) compared to the comparison group. Additionally, this study showed that adjusted OR of BD for ulcerative colitis patients were 2.23 (95% CI: 1.31∼3.82) compared to the comparison group. Limitations we could not precisely determine the causal association between BD and IBD. Conclusions We concluded that patients with IBD were more likely to have BD than those comparison patients without IBD. [ABSTRACT FROM AUTHOR]

Background: To date, some experimental studies showed that inflammatory bowel disease (IBD) and bipolar disorder (BD) may share similar biological pathways. Nevertheless, only a few western studies have attempted to demonstrate the potential association between IBD and BD, and relevant findings are still conflicting. Therefore, this cross-sectional study aimed to evaluate the relationship between IBD and BD using a nationwide database in Taiwan.Method: This study used data from the National Health Insurance Research Database. In total, 3590 patients with IBD and 14,360 propensity score-matched comparison patients without IBD were included in this study. Conditional logistic regressions were performed to evaluate the association between BD and IBD.Results: Results showed that BD was found in 26 (0.72%) patients with IBD and in 49 (0.34%) matched comparison patients without IBD. After adjustment, the adjusted odds ratio (OR) of BD for IBD patients was 2.10 (95% confidence interval (CI): 1.30∼3.38) compared to the comparison group. Additionally, this study showed that adjusted OR of BD for ulcerative colitis patients were 2.23 (95% CI: 1.31∼3.82) compared to the comparison group.Limitations: we could not precisely determine the causal association between BD and IBD.Conclusions: We concluded that patients with IBD were more likely to have BD than those comparison patients without IBD. [ABSTRACT FROM AUTHOR]

Prior studies attempted to explore the association between schizophrenia and hepatitis C virus (HCV). However, their conclusions were inconsistent. This study aimed to examine the association of schizophrenia with HCV using a population-based dataset in Taiwan. There were 6097 patients with schizophrenia and 6097 sex- and age-matched comparison patients without schizophrenia included in this study. We defined the dependent variable of interest as whether or not a patient had received a diagnosis of HCV. We found that of the sampled patients, 2.1% of patients with schizophrenia and 1.4% of comparison patients had concurrent HCV. We further found that schizophrenia was not significantly associated with concurrent HCV after adjusting for sex, age, urbanization level, geographic region, monthly income, and drug abuse. However, of the sampled male patients, the adjusted odds of concurrent hepatitis C for patients with schizophrenia were 1.72-times higher than the odds of concurrent HCV among comparison patients. We failed to observe this association among female sampled patients. We concluded that schizophrenia was not significantly associated with concurrent HCV. However, of the sampled male patients, the risk of concurrent HCV among patients with schizophrenia was higher than comparison patients. [ABSTRACT FROM AUTHOR]

Purpose This case-control study aimed to explore the association between prior coronary heart disease ( CHD) and neovascular age-related macular degeneration (AMD) using a population-based data set in Taiwan. Methods We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2005. The study consisted of 1970 patients with neovascular AMD as cases and 5910 age- and sex-matched controls. We performed a conditional logistic regression to examine the odds ratio ( OR) and its corresponding 95% confidence interval ( CI) for previously diagnosed CHD between cases and controls. Results Of the 7880 sampled patients, 24.5% had a prior history of CHD; CHD was found in 25.7% of cases and in 22.7% of controls (p = 0.008). The conditional logistic regression analysis indicated that the OR for prior CHD for cases was 1.17 [95% confidence interval ( CI): 1.04-1.32] compared to the controls. However, after adjusting for patient's monthly income, geographic location, urbanization level, age, hyperlipidaemia, diabetes and hypertension, we failed to observe an association between prior CHD and AMD ( OR = 1.03, 95% CI = 0.91-1.17). Additionally, the medical comorbidities of hyperlipidaemia (adjusted OR = 1.29, 95% CI = 1.15-1.45), hypertension (adjusted OR = 1.20, 95% CI = 1.05-1.37) and diabetes (adjusted OR = 1.47, 95% CI = 1.32-1.65) were significantly associated with AMD. Conclusions This study presented no significant difference in the odds of prior CHD between patients with AMD and those without AMD after adjusting for comorbidities and sociodemographic characteristics in a Chinese population. [ABSTRACT FROM AUTHOR]

Associations of hepatitis C virus infection with Alzheimer’s disease have not been studied among higher risk, bipolar disorder patients. This population-based case-control study investigated the risks of hepatitis C virus infection among Alzheimer’s disease patients with bipolar disorder in the years preceding their Alzheimer’s disease diagnosis. We used 2000–2013 data from the Longitudinal Health Insurance Database in Taiwan. Among patients with bipolar disorder, 73 were diagnosed with Alzheimer’s disease (cases), who were compared with 365 individuals with bipolar disorder but without Alzheimer’s disease (randomly selected controls matched on sex, age, and index year with cases). Prior claims (before the diagnosis year/index year for controls) were screened for a diagnosis of hepatitis C virus infection. Conditional logistic regression models were used for analysis. We found that 23 (31.51%) and 60 (16.44%) patients with bipolar disease were identified with a hepatitis C diagnosis among those with and without Alzheimer’s disease, respectively. Compared to controls, patients with Alzheimer’s disease showed 2.31-fold (95% confidence interval = 1.28–4.16) increased risk of hepatitis C infections adjusted for demographics and socio-economic status. Findings suggest an association of Alzheimer’s disease with a preceding diagnosis of hepatitis C infection among patients with bipolar disorder. Findings may suggest a need for increased awareness of and appropriate surveillance for Alzheimer’s disease in patients with bipolar disorder diagnosed with hepatitis C infection. [ABSTRACT FROM AUTHOR]

Objective Ulcerative colitis ( UC) is a chronic relapsing inflammatory disease with significant clinical diversity. However, the aetiology, pathogenesis and optimal treatment of UC remain unclear. The purpose of this case-control study was to investigate the association between previously diagnosed hyperthyroidism and UC using a large population-based data set in Taiwan. Methods The data for this population-based case-control study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included 2709 patients with UC as cases and 8127 sex- and age-matched patients without UC as controls. A conditional logistic regression analysis was conducted to compute the odds ratio ( OR) and corresponding 95% confidence interval ( CI) for the association between UC and prior hyperthyroidism. Results We found that, in total, 327 of the 10 836 sampled patients (3.02%) had previously been diagnosed with hyperthyroidism. There was a higher proportion of prior hyperthyroidism among cases than controls (4.10% vs 2.66%, P<.001). A conditional logistic regression showed that the OR of prior hyperthyroidism was 1.57 (95% CI=1.24-1.98) compared to controls. Similarly, after adjusting for monthly income, geographic location and urbanization level, cases were still more likely to have previously been diagnosed with hyperthyroidism than controls ( OR=1.61, 95% CI=1.27-2.05). Furthermore, we analysed the ORs of prior hyperthyroidism between cases and controls according to age group. We found that of the youngest group of sampled patients (18-39 years), cases had the greatest adjusted OR for having previously been diagnosed with hyperthyroidism than controls ( OR=1.98, 95% CI=1.04-3.79). Conclusions This study demonstrated an association between UC and hyperthyroidism. [ABSTRACT FROM AUTHOR]

Patients with gastroesophageal reflux disease (GERD) present with comorbid complications with implications for healthcare utilization. To date, little is known about the effects of GERD treatment with a proton-pump inhibitor (PPI) on patients’ subsequent healthcare utilization for acute respiratory infections (ARIs). This population-based study compared ARI episodes captured through outpatient visits, one year before and one year after GERD patients received PPI treatment. We used retrospective data from the Longitudinal Health Insurance Database 2005 in Taiwan, comparing 21,486 patients diagnosed with GERD from 2010 to 2012 with 21,486 age-sex matched comparison patients without GERD. Annual ARI episodes represented by ambulatory care visits for ARI (visits during a 7-day period bundled into one episode), were compared between the patient groups during the 1-year period before and after the index date (date of GERD diagnosis for study patients, first ambulatory visit in the same year for their matched comparison counterpart). Multiple regression analysis using a difference-in-difference approach was performed to estimate the adjusted association between GERD treatment and the subsequent annual ARI rate. We found that the mean annual ARI episode rate among GERD patients reduced by 11.4%, from 4.39 before PPI treatment, to 3.89 following treatment (mean change = -0.5 visit, 95% confidence interval (CI) = (-0.64, -0.36)). In Poisson regression analysis, GERD treatment showed an independent association with the annual ARI rate, showing a negative estimate (with p<0.001). The study suggests that GERD treatment with PPIs may help reduce healthcare visits for ARIs, highlighting the importance of treatment-seeking by GERD patients and compliance with treatment. [ABSTRACT FROM AUTHOR]

The study aimed to estimate the risk of developing chronic rhinosinusitis (CRS) among children who had undergone a tonsillectomy by utilizing a cohort study based on a population-based database. Data for this retrospective cohort study were sourced from the Taiwan "Longitudinal Health Insurance Database 2000". We included 202 children who had undergone a tonsillectomy as the study group and 2020 sex- and age-matched children as the comparison group. We used stratified Cox proportional hazard regressions to calculate the hazard ratio (HR) and its corresponding 95% confidence interval (CI) for CRS during the 3-year follow-up period. Of 2222 sampled children, the incidence rate of CRS during the 3-year follow-up period was 3.2 (95% CI = 2.0–4.8) 1000 person-years; 18.2 (95% CI = 9.1–32.5) per 1000 person-years and 1.7 (95% CI = 0.8–3.0) per 1000 person-years for the study and comparison group, respectively. The stratified Cox proportional analysis showed that the adjusted hazard ratio for CRS during the 3-year follow-up period was 8.28 (95% CI = 3.24–21.16) for children who had undergone a tonsillectomy than comparison patients. We demonstrated that the risk of developing CRS is significantly increased among children who have undergone a tonsillectomy. [ABSTRACT FROM AUTHOR]

Objective Several observational studies raised the possibility that the use of statins may decrease the overall risk of cancer and of specific cancers. This study aimed to evaluate the association of statin use with thyroid cancer based on a population-based data set. Design The data for this case-control study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We included 500 subjects with thyroid cancer as cases and 2500 gender- and age-matched subjects without thyroid cancer as controls. We used a conditional logistic regression to calculate the odds ratio ( OR) and its corresponding 95% confidence interval ( CI) for having previously used statins between cases and controls. Results The OR of prior statin use for cases was 1·39 (95% CI = 1·08-1·78) compared to controls, and thyroid cancer was significantly associated with previous regular statin use ( OR = 1·40, 95% CI = 1·05-1·86). However, thyroid cancer was not significantly associated with previous irregular statin use ( OR = 1·35; 95% CI = 0·88-2·07). Furthermore, the significant association between thyroid cancer and previous statin use only existed for females ( OR: 1·43; 95% CI: 1·07-1·90) but not for males ( OR: 1·28; 95% CI: 0·75-2·17). Conclusions We concluded that statin use was associated with thyroid cancer in female patients. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The influence of mental illness early in life on the subsequent risk of Parkinson disease (PD) and its clinical picture remain obscure. This study investigated the effects of psychiatric diseases on a subsequent PD diagnosis. Methods: We used the Longitudinal Health Insurance Database 2000 of Taiwan to identify 73,597 patients who visited ambulatory care centers or were hospitalized with a first-time diagnosis of anxiety, affective disorders, or schizophrenia between 2001 and 2003 as the study cohort. We also randomly selected 220,791 enrollees matched with the study cohort for comparison. Each patient was individually tracked for 6 years to identify a subsequent PD diagnosis. Stratified Cox proportional hazard regressions were performed for the analysis. Results: The incidence rate of PD per 1000 person-years was 4.91 (95% confidence interval [CI], 4.71–5.12) and 1.63 (95% CI, 1.56–1.70) for the psychiatric and comparison groups, respectively. Patients with psychiatric illnesses were more vulnerable to developing PD than nonpsychiatric individuals, exhibiting a 2.38-fold increased risk (95% CI, 2.23–2.53) after other covariates were considered. Furthermore, patients with schizophrenia exhibited the highest risk for developing PD. Conclusions: We suggest effective monitoring of patients with psychiatric disturbances for potential long-term neurodegenerative diseases. [Copyright &y& Elsevier]

Aim To explore the frequency and risk for injury among children with Attention-deficit/hyperactivity Disorder ( ADHD) in Taiwan through a population-based study. Methods A total of 3616 subjects aged between four and twelve years diagnosed with ADHD were selected along with a comparison cohort comprising 18 080 subjects. Each subject was individually traced for a three-year period from their index date to identify those subjects who subsequently received a diagnosis of injury. We used stratified Cox proportional hazards regressions to examine the three-year injury-free survival rates between the two cohorts. Results Of the subjects, the incidence rate of injury during the three-year follow-up period was 7.97 (95% CI = 7.45-8.51) and 5.36 (95% CI = 5.17-5.56) for the study and comparison cohort, respectively. After adjusting for geographic region, the hazard ratio ( HR) of injury for subjects with ADHD was 1.64 (95% CI = 1.50-1.79) that of comparison subjects. In addition, we found children with ADHD aged between four and 6 years to demonstrate a greater HR (1.98, 95% CI = 1.72-2.28) than those aged between seven and twelve (HR = 1.46, 95% CI = 1.31-1.63). Conclusions Children with ADHD appear to be at a higher risk for injury than children that are not diagnosed with ADHD. [ABSTRACT FROM AUTHOR]

Background: this case-control study utilized a population-based dataset to examine the association of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with prior anxiety disorder (AD) by comparing the risk of prior AD between subjects with CP/CPPS and matched controls in Taiwan. Methods: We study used data sourced from the Taiwan Longitudinal Health Insurance Database. The cases comprised 8,088 subjects with CP/CPPS and 24,264 randomly matched subjects as controls. We used a conditional logistic regression to calculate the odds ratio (OR) for having been previously diagnosed with AD between subjects with and without CP/CPPS. Results: Of the 24,264 sampled subjects, 2309 (7.1%) had received an AD diagnosis before the index date; AD was found in 930 (11.5%) cases and 1379 (5.7%) controls (p<0.001). The conditional logistic regression analysis revealed that compared to controls, the OR for prior AD among cases was 2.10 (95% CI = 1.92∼2.29, p<0.001) after adjusting for diabetes, hypertension, hyperlipidemia, and sexually transmitted diseases. Our results show that CP/CPPS was consistently and significantly associated with prior AD in all age groups (18∼39, 40∼59, and >59 years). In particular, subjects aged 40∼59 years had the highest adjusted OR (of 2.53) for prior AD among cases compared to controls. Conclusions: We concluded that CP/CPPS is associated with previously diagnosed AD. Urologists should be alert for the association between CP/CPPS and AD in subjects suffering from AD. [ABSTRACT FROM AUTHOR]

Background: The impact of anti-hypertensive treatment on fetus was unclear, and hence, remains controversial. We set out in this study to estimate the prevalence of adverse pregnancy outcomes, including low birth weight, preterm delivery and small for gestational age amongst women with chronic hypertension, and to determine whether the use of anti-hypertensive drugs increases the risk of such adverse pregnancy outcomes. Methodology/Principal Findings: A total of 2,727 hypertension mothers and 8,181 matched controls were identified from the population-based cohort. These hypertension women were divided into seven sub-groups according to different types of prescribed anti-hypertensive drugs. Multivariable logistic regressions were conducted to estimate the risk of low birth weight, preterm birth and small for gestational age. Increased risk of low birth weight (OR = 2.29, 95% CI = 1.95–2.68), preterm birth (OR = 2.18, 95% CI = 1.89–2.52) and small for gestational age (OR = 1.62, 95% CI = 1.45–1.81) were all discernible within the hypertension group after adjusting for potential confounding factors. The increased ORs were found to differ with different types of anti-hypertensive drugs. Women who received vasodilators were associated with the highest risk of low birth weight (OR = 2.96, 95% CI = 2.06–4.26), preterm birth (OR = 2.92 95% CI = 2.06–4.15) and small for gestational age (OR = 2.12, 95% CI = 1.60–2.82). Conclusions/Significance: This finding is important for practitioners, because it indicates the need for caution while considering the administration of anti-hypertensive drugs to pregnant women. These observations require confirmation in further studies that can better adjust for the severity of the underlying HTN. [ABSTRACT FROM AUTHOR]

Abstract: Background: Obstructive sleep apnea (OSA) has been associated with chronic inflammation. However, no data regarding the risk for autoimmune disease in patients with OSA has been reported. This study aims to investigate the longitudinal risk for the development of certain autoimmune diseases in patients with OSA. Methods: For the study cohort, we identified 1411 patients from the Taiwan Longitudinal Health Insurance Database who had a diagnosis of OSA. For controls, 7055 subjects matched in terms of sex, age, and the index year were randomly extracted from the same database. Each patient was tracked for a five-year period to identify those patients who had received a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), or systemic lupus erythematous (SLE). Stratified Cox proportional hazard regression was performed on the two cohorts to compute the risk of autoimmune diseases during follow-up period. Results: Of 8466 patients, 1.76% had developed autoimmune diseases during the five-year follow-up period; 2.91% and 1.53% for the study cohort and the controls, respectively. The stratified Cox proportional analysis revealed that, after eliminating individuals who died during the follow-up period and adjusting for geographic and socioeconomic factors, the hazard for developing autoimmune disease during the five-year follow-up period was 1.91 (95% CI=1.32–2.77, p <0.001) times greater for patients with OSA than for controls. Conclusion: Patients with OSA have a higher risk of developing certain autoimmune diseases. Further study is advised to confirm our findings and explore the underlying pathomechanism. [Copyright &y& Elsevier]

AbstractThe etiology of multiple sclerosis (MS) is still not well known. Previous data show conflicting results regarding the association between MS and prior brain trauma. This study aims to investigate the risk for MS following a traumatic brain injury (TBI) using a large-scale cohort study design. This study used data from the National Health Insurance Research Database. A total of 72,765 patients with TBI were identified and included as the study cohort, and 218,295 randomly selected subjects were matched with the study cohort by sex and age as controls. We traced each patient individually for a 6-year period from their index health care utilization to identify those who received a subsequent diagnosis of MS. We used the Kaplan-Meier method and the log-rank test to compare the difference in 6-year MS-free survival rates between the two groups. Stratified Cox proportional hazard regressions were computed to compare the risk of developing MS for these two cohorts. Patients with TBI had a higher incidence of MS during the 6-year period than the comparison group (0.055% versus 0.037%). After excluding cases who died from non-MS causes, stratifying for hospitalization of cases as a proxy for severity, and adjusting for monthly income and geographic region of the community in which the patient resided, the hazard ratio (HR) of MS for patients with hospital-treated TBI injuries was 1.97 (95% CI 1.31,2.93, p<0.01) that of patients without TBI during the 6-year follow-up period after index health care use. Our study concludes that patients with TBI are at higher risk for subsequent MS over a 6-year follow-up period. [ABSTRACT FROM AUTHOR]

This study aimed to examine the seasonal variability of retinal detachment (RD) in Taiwan by using an 11-yr nationwide population database. This study also investigated the association of weather conditions, i.e., ambient temperature, relative humidity, rainfall, monthly hours of sunshine, and atmospheric pressure, with RD. Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study sample included 23 718 RD hospitalizations between January 1999 and December 2009. The incidence rate of RD//100 000 people over the 132 months was computed according to sex and age groupings of <20, 20-39, 40-59, and ≥60 yrs. Then, the association between climatic factors and the monthly RD incidence rate was examined. The ARIMA (autoregressive integrated moving average) method was also employed to test the seasonality of RD incidence rates and their association with climatic factors. The annual RD incidence rates were between 7.8 and 10.8 cases//100 000 people during the study period. A fairly similar seasonal pattern of monthly RD incidence rates was apparent for males and females and males and females combined. Rates were highest August through October, decreasing in November, and lowest in February. After adjusting for time, trend, and month, the ARIMA regression models for the male, female, and males and females combined consistently revealed the monthly RD incidence rate was significantly and positively associated with ambient temperature, but negatively associated with atmospheric pressure. The authors conclude that the monthly RD incidence rates were significantly associated with seasonality. The monthly RD incidence rates were positively associated with ambient temperature and negatively associated with atmospheric pressure. (Author correspondence: ) [ABSTRACT FROM AUTHOR]

Abstract: Background: Empirical findings on the association between a history of depression and subsequent cancer incidence are mixed and inconclusive. A link between depression and cancer would gain greater credence if it can be sustained across cultures. This nationwide, population-based study aimed to prospectively examine the relationship between a psychiatric diagnosis of depression in an inpatient setting and the risk of developing cancer in the following five years in Taiwan. Method: This study used data from the Taiwan National Health Insurance Research Database. A total of 778 patients hospitalized for depression from 1998 to 2003 were recruited, together with 3890 matched non-depressive enrollees as a comparison cohort. Each patient was tracked five years to identify the occurrence of any type of cancer. The Cox proportional hazards models were carried out to compute the risk of cancer between study and comparison cohorts, following adjustment for residence and socio-demographic characteristics. Results: We found that during a five-year follow-up, 61 severely depressed patients (7.8%) and 212 patients in the non-depressed comparison cohort (5.5%) received cancer diagnoses. For adults age 18 and older, having been hospitalized with a diagnosis of depressive disorder was independently associated with a 1.62-fold (95% CI: 1.12, 2.34) overall increased risk of subsequent cancer during five years of follow-up, after adjusting for residence and socio-demographic characteristics. Conclusion: Our results suggest depression is significantly associated with increased risk of cancer in a rather short follow-up time. Our results call attention to the immediate health impacts of severe depression on patients. [Copyright &y& Elsevier]

Objective: To determine the prevalence of selected comorbidities in patients with open-angle glaucoma (OAG) and whether these comorbidities are more prevalent among individuals with OAG than those without OAG. Design: A retrospective, nationwide, case-control study using an administrative database. Participants: The study group comprised 76 673 OAG patients. The comparison group comprised 230 019 subjects matched to the study cohort. Methods: Data were collected retrospectively from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365.1–365.11) in 2005 (n = 76 673). The comparison cohort comprised randomly selected patients (3 for every 1 OAG patient; n = 230 019) matched with the study group in terms of age, gender, urbanization level, and monthly income. In total, 31 medical comorbidities were selected based mainly on the Elixhauser Comorbidity Index. Separate conditional logistic regression analyses were used to estimate the adjusted odds ratio for each of the medical comorbidities between patients with and without OAG. Main Outcome Measures: The prevalences of selected comorbidities. Results: More than half (50.5%) of the OAG patients had hypertension, and more than 30% had hyperlipidemia or diabetes (30.5% and 30.2%, respectively). The prevalences of 28 of 31 comorbidities were significantly higher for OAG patients than subjects without glaucoma after adjusting for age, gender, urbanization level, and monthly income. The adjusted odds ratio was more than 1.50 for hypertension, hyperlipidemia, systemic lupus erythematosus, diabetes, hypothyroidism, fluid and electrolyte disorders, depression, and psychosis. Among the studied comorbidities, the prevalence difference of the OAG group minus the control group was 3% or higher for hypertension, hyperlipidemia, stroke, diabetes, liver disease, and peptic ulcer. Conclusions: Open-angle glaucoma patients are significantly more likely to have comorbidities, many of which can be life threatening or can affect the quality of life appreciably. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To investigate the risk of open-angle glaucoma (OAG) after a diagnosis of hypothyroidism. Design: A retrospective, population-based follow-up study using an administrative database. Participants: The study group comprised 257 hypothyroidism patients. The comparison group included 2056 subjects. Methods: Data were retrospectively collected from the Taiwan Longitudinal Health Insurance Database. The study cohort comprised patients aged ≥60 who received a first diagnosis of hypothyroidism (International Classification of Diseases, Ninth Revision, Clinical Modification code 244.9) from 1997 to 2001 (n = 257). The comparison cohort consisted of randomly selected patients without hypothyroidism who were aged ≥60 and had no diagnosis of glaucoma before 2001 (8 for every OAG patient; n = 2056). Each sampled patient was tracked for 5 years from their index visit. Cox proportional hazard regressions were used to compute the 5-year OAG-free survival rate, after adjusting for possible confounding factors. Main Outcome Measures: The risk of developing OAG during the 5-year follow-up period. Results: Open-angle glaucoma developed in 7.4% of patients with hypothyroidism and 3.8% of patients in the comparison cohort during the follow-up period. Hypothyroid patients had a significantly lower 5-year OAG-free survival rate than patients in the comparison cohort. After adjusting for patients'' age, gender, monthly income, urbanization level, and comorbid medical disorders, hypothyroidism patients were found to have a 1.78-fold (95% confidence interval [CI], 1.04–3.06) greater risk of developing OAG than the comparison cohort. This association remained significant in untreated hypothyroidism patients (adjusted hazard ratio [HR], 2.37; 95% CI, 1.10–5.09) and became statistically nonsignificant in patients treated with levothyroxine (adjusted HR, 1.73; 95% CI, 0.89–3.38). Conclusions: Hypothyroid patients had a significantly increased risk of OAG development during the 5-year follow-up period. Levothyroxine seemed to be protective. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract: Objective: To investigate pregnancy outcomes, including low birthweight, preterm births, and small-for-gestational-age (SGA) among women with bipolar disorder, schizophrenia compared with women with no history of mental illness using nationwide population-based data. Methods: This study linked the Taiwan National Health Insurance Research Dataset with the national birth certificate registry. A total of 528,398 singleton births between 2001 and 2003 were included; 337 were diagnosed with bipolar disorder. Multivariate logistic regression analyses were carried out to examine the relationship between maternal bipolar disorder, schizophrenia and the odds of low birthweight, preterm births, and SGA, after adjusting for characteristics of infant, mother and father. Results: It shows that pregnant women with bipolar disorder were more likely to have LBW infants (9.8% vs. 5.7%), preterm births (14.2% vs. 6.9%) and SGA (22.3% vs. 15.7%) than pregnant women with no history of mental illness. The adjusted odds of low birthweight for women with bipolar disorder was 1.66 times (95% CI, 1.16–2.38) that of women with no history of mental illness. In terms of preterm births and SGA, the adjusted odds ratios were 2.08 (95% CI, 1.53–2.83) and 1.47 (95% CI, 1.14–1.91) respectively, for women with bipolar disorder, compared to their counterparts with no history of mental illness. Conclusions: We conclude that women with bipolar disorder had increased risk of low birthweight, preterm births, and SGA than women without a history of mental illness. More active monitoring and early intervention to counter potential adverse pregnancy outcomes for pregnant women with bipolar disorder should be initiated. [Copyright &y& Elsevier]

Abstract: Objective: This study compared the risk of adverse pregnancy outcome—including preterm births, low birth weight (LBW), large-gestational-age (LGA), and small-gestational-age (SGA)—among mothers with schizophrenia receiving typical, atypical, and no antipsychotics during pregnancy. They were all compared with control subjects. Methods: We used population-based data from the Taiwan National Health Insurance Research Database and birth certificate registry covering the years 2001 to 2003. In total, 696 mothers with schizophrenia and 3480 matched unaffected mothers were included for analysis. After adjusting for characteristics of mother, father, and infants, multivariate logistic regression analyses were performed to examine the risk of LBW, preterm gestation, SGA, and LGA, comparing mothers with schizophrenia and unaffected mothers. Results: After adjusting for potential confounders, the odds of LBW and SGA for unaffected mothers respectively were 0.72 (95% CI=0.50–0.88) and 0.81 (95% CI=0.64–0.92) times those of mothers with schizophrenia who had not receiving antipsychotics during pregnancy. There was no significant difference in the risk of LBW, preterm births, LGA, and SGA babies compared to mothers with schizophrenia receiving atypical antipsychotics during pregnancy and those not receiving antipsychotics. However, mothers with schizophrenia receiving typical antipsychotics during pregnancy had higher odds of preterm birth (OR=2.46, 95% CI=1.50–4.11) compared to those not receiving antipsychotics. Conclusions: The data suggest that the risks for LBW and SGA among mothers with schizophrenia are not affected by antipsychotic use. Women who receive treatment with typical antipsychotics during pregnancy are at slightly higher risk of preterm birth. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the risks that maternal panic disorder (PD) during pregnancy contribute to adverse pregnancy outcomes, with the effects further specifically differentiated into mothers who experienced a panic attack during pregnancy and those who did not. Method: This study linked two nationwide population-based datasets: the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 371 women who gave birth from 2001 to 2003, who had been diagnosed with PD within 2 years prior to the index delivery, together with 1585 matched women without this chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed to estimate odds ratios. Results: Results indicated that compared to women without chronic disease, PD mothers who experienced panic manifestations during pregnancy and those who did not were independently associated with respective 2.29- (95% confidence interval (CI)=1.14–4.60) and 1.45-fold (95% CI=1.03–2.04) increased risks of having small-for-gestational-age infants. Further, for PD mothers who experienced a panic attack during gestation, the adjusted odds ratio for having a preterm delivery was 2.54 (95% CI=1.09–5.93), whereas no significant difference was identified between PD women who did not have a panic attack during pregnancy and women without PD. Limitation: Our study was unable to investigate the effects of such risk factors as dietary habits, cigarette smoking, and alcohol use in the regression model. Conclusion: We conclude that prenatal PD, particularly the occurrence of panic attacks during pregnancy, was associated with adverse birth outcomes. [Copyright &y& Elsevier]

Abstract: This study aimed to compare psychiatrists'' in-patient caseload volume with length of stay (LOS) and 30-day readmission rates in Taiwan. We hypothesized that high-volume psychiatrists would be associated with shorter LOS and lower 30-day readmission rates. The sample of 66,959 patients hospitalized for the first time for mental disorders was taken from Taiwan''s 2001–2003 National Health Insurance Research Database and categorized into four patient groups according to attending psychiatrists'' caseload volume. A total of 21,669 (32.4%) of the patients sampled were readmitted within a 30-day period, with the mean LOS being 24.0 (±19.5) days. As caseload volume increased, there was a corresponding increase in the adjusted odds ratio for 30-day readmission rates. The regression analysis reveals adjusted LOS for patients treated by psychiatrists with medium caseload volumes was 1.22 days shorter than that for patients treated by low caseload volume psychiatrists. The adjusted LOS for patients seeing high caseload volume psychiatrists was 2.03 days shorter than for those seeing psychiatrists with low caseload volumes; and for the very-high-volume group, it was 7.59 days shorter. Although the findings confirm our hypothesis regarding LOS, they do not support our hypothesis regarding the relationship between psychiatrists'' caseload volume and readmission rates. [Copyright &y& Elsevier]

Abstract: Background: Young adults aged from 18 to 44 years comprise a large portion of the population suffering from depression. Yet few studies have compared the likelihood of dying of natural causes or by suicide among depressed patients. This study uses a case–control approach to compare the likelihood of dying of natural causes and by suicide for depressed and non-depressed patients based on a representative national sample in Taiwan. Method: A retrospective case–control study design was used to analyze two nationwide population-based datasets: the National Health Insurance Research Database (NHIRD) and the official Cause of Death data file in Taiwan. The study cohort consisted of 827 patients from 18 to 44 years old who were hospitalized with a primary diagnosis of depressive disorder from 1998–2003. A comparison cohort of patients hospitalized for appendectomies was matched with the study sample in terms of age and gender (N =2481). Results: After adjusting for the age and comorbid medical disorders, the hazard of dying during the five-year follow-up period was 1.72 times greater for depressed patients than for appendectomy patients. Depressed patients were more likely to die by suicide during the follow-up period, as no significant difference in odds of dying from natural causes was observed between these two cohorts. Conclusion: Further studies should be initiated to identify specific risk factors for suicide among younger adults, while prevention strategies might focus on stresses associated with particular life stages, taking age and gender patterns into account. [Copyright &y& Elsevier]

Abstract: Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI=0.85–0.98, p =0.014), 0.84 (95% CI=0.78–0.91, p <0.001), 0.83 (95% CI=0.68–0.88, p <0.001), 0.79 (95% CI=0.72–0.86, p <0.001), and 0.70 (95% CI=0.62–0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate. [Copyright &y& Elsevier]

Background: This study aims to estimate the risk of developing stroke within 5 years of discharge among young patients ages 18 to approximately 44 who were hospitalized for depressive disorders. Methods: Our study design features a study cohort and a comparison cohort. The study cohort included patients ages 18 to approximately 44 who were hospitalized with a principal diagnosis of depressive disorder (n = 827), whereas the comparison cohort consisted of 4,135 patients selected randomly (five for every depressed patient) and matched with the study group in terms of gender, age, and date of discharge. Each patient was tracked for 5 years after their discharge in 1998. Cox proportional hazard regressions were performed to compute the 5-year stroke-free survival rates after adjusting for possible confounding factors. Results: During the 5-year follow-up period, 50 depressed patients (6.05% of the study cohort) and 48 non-depressed subjects (1.16% of the comparison cohort) developed strokes. The adjusted hazard of stroke was 5.43 (95% confidence interval = 3.47–8.51, p < .001) times greater for depressed patients than for non-depressed subjects. Conclusions: Our findings show young patients ages 18 to approximately 44 who were hospitalized for depressive disorders were at over five times greater risk of developing stroke within 5 years of discharge compared with non-depressed age- and gender-matched subjects. [Copyright &y& Elsevier]

Early rehospitalization is common in schizophrenia. Given the impact on cost containment, there is an urgent need to identify the predictors of rehospitalization. This study aims to examine the association between the frequency of timely outpatient visits and the likelihood of early rehospitalization in schizophrenia patients. After adjusting for gender, age, substance use, and length of stay, patients failing to attend any outpatient appointments within 2 months after discharge had significantly higher rehospitalization rates than those attending at least I appointment. Thus, timely outpatient visits, shortly after discharge, may be associated with a decreased risk of rehospitalizations. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To explore risk factors, such as characteristics of psychiatrist, patient and hospital at index hospitalization, associated with depressed patients who committed suicide within 3 months of discharge using a case-control design. Methods: By linking the Taiwanese nationwide mortality database and the National Health Insurance dataset, all hospitalized patients with major depression who committed suicide within a 90-day period post-discharge during the years 2002–2004 were selected as a study cohort (n =85). We randomly selected 425 cases (five for every case in the study cohort) that were matched with the study cohort in terms of age, gender and date of discharge as a control cohort. Cox proportional hazard regression was carried out to compute the adjusted 90-day survival rate after adjusting for other factors. Results: The majority of suicide occurred 30 days after discharge from hospitals, with a mean of 29.9 days. The adjusted hazard for committing suicide after hospital discharge for patients who left on their own initiative was 2.85 times (95% CI=1.387–5.856, p =0.004) greater than for those who were discharged with doctors'' approval. Furthermore, the adjusted hazard for patients who were discharged from medical centers was higher than for patients discharged from regional hospitals, by a multiple of 3.38 (95% CI=1.421–8.055, p =0.006). Limitations: Some patient-specific predictors of post-discharge suicide, such as suicidal ideation prior to admission, recent life events and social relationships with close relatives were not available. Conclusion: We conclude that, in addition to patient characteristics, hospital characteristics also constitute important risk factors for suicide within 90 days of discharge for depressed patients. [Copyright &y& Elsevier]

This study used a nationwide population-based dataset to explore the variation among the days of week of stroke onset within population subgroups defined by age, sex, and stroke type. We used ambulatory care data from the 2002 Taiwan National Health Insurance Research Database, focusing on 42,779 emergency room (ER) visits for stroke that year. All analyses were stratified by sex, age (<60 and ≥60 yrs), and type of stroke. Auto-Regressive Integrated Moving Average (ARIMA) was performed to investigate the relationship between daily number of stroke events and holidays and days of the week after adjusting for the effects of seasonality and trends. One-way ANOVA revealed significant differences in stroke ER admissions according to day of week according to age <60 (p<0.01), age ≥60 (p<0.001), male (p<0.001), female (p<0.001), ischemic stroke (IS) (p<0.001), and unspecified stroke (UNSP) (p<0.001). However, the analysis by type—subarachnoid hemorrhage and intracerebral hemorrhage—did not show significant relationships between daily emergency room stroke admissions, holidays, or day of the week. The ARIMA regression analyses also showed that Mondays had the highest rate of emergency room admissions for stroke regardless of sex, age, or IS and UNSP types of stroke, after adjusting for seasonality and trends. We conclude that stroke occurs more frequently on Mondays than on the other days of the week, which might be associated with short-term changes in lifestyle or due to the sudden return of stress on the first working day of the week, and on holidays. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between the urologist case volume for transurethral resection of the prostate (TURP) and in-hospital mortality using a Taiwan nationwide population-based data set. Methods: This study used data from the 2003 Taiwan National Health Insurance Research Database. The sample of 9539 patients who had undergone TURP was divided into three urologist caseload volume groups: fewer than 27 cases annually (low volume), 27-55 cases annually (medium volume), and more than 55 cases annually (high volume). Multivariate logistic regression analysis using generalized estimating equations was conducted to assess the adjusted association of urologist TURP caseload volume and patient in-hospital mortality to account for the urologist, patient, and hospital characteristics and the clustered nature of the study sample. Results: The in-hospital mortality rate decreased with an increasing TURP caseload volume. The in-hospital mortality rate was 2.37%, 1.97%, and 1.16% for patients treated in the low, medium, and high-volume urologist group, respectively. After adjusting for others factors, the likelihood of in-hospital mortality for patients treated by urologists with a low and medium TURP caseload volume was 1.835 (95% confidence interval 1.198-2.812, P < .01) and 1.606 (95% confidence interval 1.052-2.452, P < .05) respectively, compared with that for patients treated at high-volume hospitals. Conclusions: The results of our study have shown that, after adjusting for patient, urologist, and hospital characteristics, high-volume urologists are associated with superior treatment outcomes for patients undergoing TURP. [Copyright &y& Elsevier]

Abstract: Objective: This study sets out to estimate the risk of stroke developing among young schizophrenia patients during a five-year follow-up period after hospitalization for episodes of acute exacerbation. Methods: Hospitalized schizophrenia patients under 45 years of age were identified from the Taiwan National Health Insurance Research Database for the year 1998 (n =5001). Two age-matched cases were randomly selected for each schizophrenia patient from among patients who underwent appendectomies in the same year (n =10,002). Each individual patient was retrospectively followed up from 1998 until the end of 2003 to determine whether any had developed strokes. Cox proportional hazard regressions were carried out to compute the adjusted five-year survival rate. Results: A total of 219 patients (1.46%) developed strokes during the five-year follow-up period, with the attacks occurring among 2.46% of schizophrenia patients and 0.94% of the comparison cohort. Following adjustment for patients'' demographic characteristics, select comorbid medical disorders and substance abuse, schizophrenia patients were found to be 2.02 times (p <0.001) more likely to develop strokes during the follow-up period than age-matched appendectomy patients. The adjusted hazard ratios of developing stroke for male and female schizophrenia patients were, respectively, 1.64 (p <0.001) and 2.87 (p <0.001) times greater than their counterparts in the comparison group. Conclusions: As compared with the comparison group, young schizophrenia patients demonstrated a two-fold increased risk of developing stroke during the five-year period after hospitalization. The risk of developing stroke among schizophrenia patients was found to be much higher for females than males. [Copyright &y& Elsevier]

Abstract: Objective: To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics). Study design: Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS. Results: After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR=1.53) and clinics (OR=2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals. Conclusions: While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions. [Copyright &y& Elsevier]

Purpose: Using data from seven years of hospital admissions in Taiwan, this study sets out to investigate meteorological factors associated with primary angle closure glaucoma (PACG). We investigated the relationship between PACG admissions and five different climate indices. Method: Hospital admissions data from the Taiwan National Health Insurance Research Database (1997 to 2003) provided monthly PACG admission rates (per 100,000 population). We categorized the 4,722 PACG cases by gender and age (including four subgroups: 40-49, 50-59, 60-69, and ≥ 70 years). After adjusting for the time-trend effect, the Auto-Regressive Integrated Moving Average regression method was performed to evaluate the effects of climatic and monthly factors on PACG admission rates. Results: The mean annual rate of PACG admissions across the entire study period was 9.48/100,000 and higher in females than males (11.28 vs. 7.80/100,000). The PACG admissions were significantly higher in March for male patients, and for the 60 to 69-year-old and > 69-year-old age groups (p < 0.05). After adjustment for seasonality, month, and time-trend, a significant association between relative humidity and monthly PACG admission rates was observed for the total data set, for males, and for the 60- to 69-year-old (p < 0.05) populations. No such relationship existed with temperature, rainfall, barometric pressure or hours of sunshine. Conclusion: This is the largest, nationwide, population-based study to investigate the dependence of PACG admission rates on meteorological conditions. PACG admission rates were significantly higher in March and with increased relative humidity. We recommend data be collected from other regions and from other ethnic groups to determine the general pattern worldwide. [ABSTRACT FROM AUTHOR]

Background: Using 7-year population-based data on Taiwan, we examined seasonal variation in violent versus nonviolent suicide, and its association with meteorological factors: ambient temperature, relative humidity, atmospheric pressure, rainfall and daily sunshine hours. Methods: We used Taiwan’s nationwide mortality data from 1997 to 2003, categorizing the sample decedents into two groups, violent (ICD-9-CM codes E953–E958) and nonviolent (E950–E952) suicide, based on the suicide method used. Seasonal autoregressive integrated moving average (SARIMA) modeling was used to detect seasonality of suicide, and the association of climate variables with violent versus nonviolent suicide. Results: The SARIMA test of seasonality was significant for both genders and the pooled sample (all p < 0.001) in violent suicide deaths, but not nonviolent suicides. Seasonal trends show a significant peak in March–May (early to late spring) for violent suicides. Increasing ambient temperature predicted increasing violent suicide rates. Conclusions: We conclude that seasonality exists in violent but not nonviolent suicide rates. Our findings suggest that suicide is a heterogeneous phenomenon and violent suicide may be more influenced by biochemical and chronobiological mechanisms. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on high caesarean section.

Abstract: Background: Despite cerebrovascular diseases having been reported as one of the major causes of death among patients with bipolar disorder, there is scant information on the risk of stroke among this patient population. This study estimated the relative risk of developing stroke among patients with bipolar disorder in 6 years following hospitalization for an acute mood episode compared with patients undergoing appendectomy. Methods: Two study cohorts were identified from the Taiwan National Health Insurance Research Database for the year 1998: patients hospitalized with bipolar disorder, and patients undergoing an appendectomy. Follow-up was undertaken to determine whether sampled patients had utilized emergency medical services for the management of any type of stroke in the period 1998–2003. Results: Stroke occurred among 2.97% of patients with bipolar disorder and 1.50% of patients undergoing appendectomy between 1998 and 2003. The adjusted odds ratio of developing stroke, by cohort, shows that after adjusting for demographic characteristics, comorbid medical disorder, and substance or alcohol dependence, patients with bipolar disorder were more likely to develop stroke (OR=2.05; 95% CI=1.73–3.54). Limitations: The validity of diagnoses, lacking of information on smoking, body mass index, and socioeconomic status, and possible selection bias might compromise the findings. Conclusions: During the six-year follow-up period, the likelihood of developing stroke was twice as great amongst patients with bipolar disorder as patients undergoing an appendectomy. A requirement exists for the initiation of research providing an understanding of the pathophysiological mechanisms of the association between stroke and bipolar disorder. [Copyright &y& Elsevier]

Abstract: Objective: To examine whether hospitals’ for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively. Method: Retrospective, cross-sectional, population-based study of Taiwan''s National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997–2000, using multiple logistic regression analyses. Results: Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5–2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively). Conclusions: Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals’ preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure. [Copyright &y& Elsevier]

Abstract: Background: Seasonality of suicide has been noted in several studies. A spring peak of suicide was observed, and associations between various climatic parameters and suicide have been suggested. This study sets out to verify seasonal patterns of suicide rates and to explore the association with climate in Taiwan. Method: The study used a nationwide mortality database in Taiwan from January 1997 to December 2003. An autoregressive integrated moving average model was applied to examine the presence of seasonality and the association of climate with suicidal death. Results: Seasonality with a spring peak was evident in suicidal death regardless of gender or age. Ambient temperature was positively associated with suicide after adjustment for trend and seasonality. Limitations: Misclassification and underreporting of suicidal death in the registry system might confound the results. Ecological fallacies might exist. Conclusions: The seasonal effect on suicide is significant in Taiwan. Suicide rates may be influenced by ambient temperatures. The findings are of research interest for future studies regarding mechanisms of suicidal behavior, and also of practical interest for better timing of suicide interventions and effective preventive strategies. [Copyright &y& Elsevier]

Abstract: The protection of patients’ health information is a very important concern in the information age. The purpose of this study is to ascertain what constitutes an effective legal framework in protecting both the security and privacy of health information, especially electronic medical records. All sorts of bills regarding electronic medical data protection have been proposed around the world including Health Insurance Portability and Accountability Act (HIPAA) of the U.S. The trend of a centralized bill that focuses on managing computerized health information is the part that needs our further attention. Under the sponsor of Taiwan''s Department of Health (DOH), our expert panel drafted the “Medical Information Security and Privacy Protection Guidelines”, which identifies nine principles and entails 12 articles, in the hope that medical organizations will have an effective reference in how to manage their medical information in a confidential and secured fashion especially in electronic transactions. [Copyright &y& Elsevier]

Objective: A nationwide population-based dataset was used to explore the association between length of stay (LOS) and 30-day readmission rates for hospitalized patients with schizophrenia in Taiwan. Methods: The National Health Insurance Research Database was used for the years 2001-2003 and included a total of 29,373 patients with schizophrenia divided equally into four groups according to LOS of index hospitalization. After adjusting for hospital, physician and patient characteristics, a multivariate regression analysis was used to determine the relationship between LOS and 30-day readmission rates. Results: After discharge from their index hospitalization, 12,468 (42.5%) patients with schizophrenia were readmitted within 30 days. The adjusted odds ratio for 30-day readmission rates was increased for shorter LOS. Conclusions: Healthcare providers should exert caution while trying to reduce LOS within the current cost-conscious environment and balance it with creating a minimal status necessary for discharge. [ABSTRACT FROM AUTHOR]

This study sets out to explore the relationship between hospital characteristics, asthma length of stay (LOS), and costs per discharge. The study adopts hospitalization data from the Taiwan National Health Insurance Research Database covering the period from 1997 to 2001. Study subjects were identified from the database by principal diagnosis of asthma or asthmatic bronchitis, with a total of 139,630 cases being included in the study. Multiple-regression analyses were performed to explore the relationship between LOS, costs per discharge and hospital characteristics, adjusting for age, gender, and discharge status of patients, as well as complications or comorbidities. The regression analyses showed that, compared with district hospitals, medical centers and regional hospitals have longer and more statistically significant LOS, as well as higher costs. Hospitals operating on a for-profit basis have shorter LOS and lower costs than public and not-for-profit hospitals. This study shows the existence of wide variations in LOS and costs per discharge for asthma hospitalizations, between the various types of hospitals in Taiwan. [ABSTRACT FROM AUTHOR]

To test the hypotheses that: (1) average adjusted costs per discharge are higher in high-competition relative to low-competition markets, and (2) increased competition is associated with cost convergence between public and for-profit (FP) hospitals for case payment diagnoses, but not for cost-plus reimbursed diagnoses.Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost-based payment).Retrospective population-based, cross-sectional study.Diagnosis-wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics.Adjusted costs per discharge are higher for all diagnoses in high-competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost-based diagnoses.We find that the empirical evidence supports both our hypotheses. [ABSTRACT FROM AUTHOR]

A majority of studies examining the relationship between advancing maternal age and the likelihood of cesarean section (CS) use data from regional samples or from a limited number of medical institutions. This study uses population-based data from Taiwan to explore the relationship between maternal age and the likelihood of a CS.The National Health Insurance Research Database (NHIRD) on registries of medical facilities and board-certified physicians and monthly claim summaries for inpatients were used. In total, 502 524 singleton deliveries were included in the study. Multivariate logistic regressions were performed with the presence of CS as the dependent variable and maternal age (<20, 20–29, 30–34 and>34 years) as the independent variable. The study controlled for maternal indications, institution characteristics, maternal requests and attending physician characteristics.CS rates for the age groups<20, 20–29, 30–34 and>34 years were 17.7, 27.4, 37.4 and 47.5%, respectively. The regression analyses consistently showed that the likelihood of a CS significantly increased with advancing maternal age within each category of complication after adjusting for medical institution characteristics and characteristics of the attending physician.This study found that, after adjusting for maternal indications, and healthcare institution and physician characteristics, there was a significant relationship between advancing maternal age and an increased likelihood of a CS. This finding, together with the high CS rate of 32.1% in Taiwan, one of the highest reported in the world today, highlights an imperative need to devise interventions to reduce the frequency of CSs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the association of peripheral vestibular disorders with type 1 and type 2 diabetes using a population-based dataset. Methods: The data for this study were obtained from Taiwan's Longitudinal Health Insurance Database 2010. The sample consisted of 150,916 patients who were newly diagnosed with peripheral vestibular disorders as cases and 452,748 propensity-score-matching controls without peripheral vestibular disorders. We utilized multivariate logistic regression models to quantitatively evaluate the association between peripheral vestibular disorders and diabetes while considering factors such as sex, age, geographic location, monthly income, urbanization level of the patient's residence, coronary heart disease, hypertension, and hyperlipidemia. Results: The chi-squared test indicates that diabetes was more common in the peripheral vestibular disorder group compared to controls (20.6% vs. 15.1%, p < 0.001). Of all sampled patients, the adjusted odds ratio for diabetes was 1.597 (95% CI = 1.570~1.623) for those with peripheral vestibular disorders when compared to controls, while patients with Ménière's disease, benign paroxysmal positional vertigo, unilateral vestibulopathy, and other peripheral vestibular disorders had respective adjusted odds ratios of diabetes at 1.566 (95% CI = 1.498~1.638), 1.677 (95% CI = 1.603~1.755), 1.592 (95% CI = 1.504~1.685), and 1.588 (95% CI = l.555~1.621) in comparison to controls. Conclusions: Our research has revealed an association between diabetes and an increased susceptibility to peripheral vestibular disorders. [ABSTRACT FROM AUTHOR]

The article explores the relationship between herpes zoster ophthalmicus (HZO) and the risk of neovascular age-related macular degeneration (AMD). Topics mentioned the use of a population-based data set in Taiwan for the study cohort, the incidence rate of neovascular AMD among the sampled patients, and the abnormal inflammation in HZO patients as a mechanism to explain the disease connection with neovascular AMD.

Abstract: This study sets out to assess the relationship between in-hospital mortality rates and physician acute myocardial infarction (AMI) volume, along with an examination of the impact of physician specialty on in-hospital mortality rates in Taiwan. Analysis was undertaken on a total of 19,086 patients hospitalized for AMI, following the division of the sample patients into four roughly equivalent groups. Within each physician specialty, the AMI patients were also subsequently grouped into four roughly equivalent groups based upon physician volume. After adjusting for other factors, the likelihood of in-hospital mortality among patients treated by low-volume physicians was 2.141 (p <0.001) times as high as that for patients treated by high-volume physicians, and 2.410 (p <0.001) times as high as that for patients treated by very high-volume physicians. However, while such an inverse relationship was found to persist for those physicians specializing in general internal medicine and ‘others’, this was not the case for cardiologists. [Copyright &y& Elsevier]

Background: Although peripheral vestibular disorder is a non-fatal complication of Fabry disease, fatalities have been reported in some case reports and case series. To date, no studies have examined the relative risk of peripheral vestibular disorder in patients with Fabry disease compared to the general population without the condition. Due to the high prevalence of Fabry disease in East Asia and the potential shared pathogenic pathways between Fabry disease and vasculopathy, we conducted a study using a nationwide population-based dataset to compare the prevalence of peripheral vestibular disorder between patients with Fabry disease and matched comparison patients. Methods: Data was sourced from Taiwan's Longitudinal Health Insurance Database 2010. this study consists of 11,668 sampled patients, 2917 study patients with Fabry disease and 8751 propensity-score-matching comparison patients. We conducted multiple logistic regression analysis to study the association between peripheral vestibular disorder and Fabry disease. Results: The study identified notable differences in the prevalence of various vestibular disorders between the study and comparison groups. Specifically, there was a 7.2% increased prevalence of peripheral vestibular disorder in the study group (28.3%) compared to the comparison group (20.9%), Meniere's disease (5.4% vs. 3.7%), benign paroxysmal positional vertigo (5.1% vs. 3.3%), and other/ unspecified peripheral vestibular dizziness (15.6% vs. 11.8%) (all p < 0.001). The odds ratios for PVD, MD, BPPV, and other PVD were 1.44 (95% CI = 1.29–1.60), 1.50 (95% CI = 1.23–1.83), 1.59 (95% CI = 1.30–1.95), and 1.40 (95% CI = 1.24–1.58), respectively, among the Fabry disease group relative to the comparison group after adjusting for age, monthly income, geographic location, urbanization level, hyperlipidemia, diabetes, coronary heart disease, and hypertension. Conclusion: This study found that patients with Fabry disease had increased prevalence of peripheral vestibular disorder. [ABSTRACT FROM AUTHOR]

While Human Papillomavirus (HPV) particles have been detected in a small proportion of benign thyroid nodules or thyroid cancer cases, a role of HPV in these thyroid conditions has not been established. This study aims to investigate the association of HPV infection with thyroid cancer (TC) using a nationwide population-based study. We retrieved data for this case–control study from Taiwan's Longitudinal Health Insurance Database 2010. The study sample included 3062 patients with TC and 9186 propensity-scored matched controls. We employed multivariate logistic regression models to quantitatively evaluate the association of TC with HPV infections after taking age, sex, monthly income, geographic location and urbanization level of the patient's residence, diabetes, hypertension, and hyperlipidemia into considerations. Chi-squared test revealed that there was a significant difference in the prevalence of prior HPV infections between patients with TC and controls (15.3% vs. 7.6%, p < 0.001). The adjusted odds ratio of prior HPV infections for patients with TC was 2.199 (95% CI = 1.939–2.492) relative to controls. The adjusted ORs of prior HPV infections for patients with TC was similar for males and females. Our research suggests a significant link between HPV infection and the development of TC. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the risk of attempted suicide in the population of patients diagnosed with peripheral vestibular disorders (PVD). We conducted a retrospective cohort study. We extracted data on patients diagnosed with PVD (72,569 study patients) and a 3:1 ratio of propensity-score matched comparison patients without PVD (217,707 patients) from Taiwan's Longitudinal Health Insurance Database 2010. The claims records of sampled patients were tracked for a one-year period from their index date to identify claims showing a diagnosis of suicide attempt. Cox proportional hazards regression analyses were performed to calculate the one-year hazard ratio (HR) of suicide attempt following the PVD diagnosis among PVD patients relative to comparison patients. Of total 290,276 sampled patients, the rate of attempted suicide was 0.158 per 100 person-years, being 0.460 and 0.057, respectively, among PVD patients and comparison patients. Cox proportional hazard analysis showed that PVD patients had a high relative hazard of suicide attempt (adjusted HR = 7.622, 95 % CI = 6.196–9.376) during one-year follow-up relative to comparison patients. We also found that subcategories of PVD, showed similar adjusted hazard ratios as all PVDs: Meniere's disease (HR = 7.608, 95 % CI = 4.350–13.305), benign paroxysmal positional vertigo (HR = 8.201, 95 % CI = 4.716–14.260), and vestibular neuritis (HR = 9.399, 95 % CI = 5.036–17.544). The incidence of suicide attempts could be underestimated in both the study group and comparison group, if the suicide attempt did not cause a medical emergency and the patient did not seek medical assistance. We found a high magnitude of association between PVD and subsequent suicide attempt. • The incidence rates of suicide was 0.460 per 100 person-years on PVD patients. • PVD patients had lower suicide attempt-free survival at one year than comparison cohort. • PVD patients had a high relative hazard of suicide attempt (HR = 7.622) than comparison patients. [ABSTRACT FROM AUTHOR]