Search

Objectives: The increased risk of pulmonary tuberculosis (PTB) in patients with diabetes mellitus (DM) remains to be clarified with cohort study. The present study further examined whether the anti-diabetic drug treatment associates with developing PTB. Methods: From the Taiwan National Health Insurance database, we identified 22256 patients adults newly diagnosed with DM in 2000-2006 as DM cohort and 89024 persons without DM frequency matched with sex, age and DM diagnosed year as non-DM comparison cohort. Both cohorts were followed to the end of 2009 to document the PTB incidence. Medications were analyzed for the DM cohort to examine the hazard of developing PTB. Results: The incidence of PTB was 1.64-fold higher in DM cohort than in comparison cohort (52.1 vs. 31.8 per 10,000 person-years) with an adjusted hazard ratio of 1.53 (95% Cl = 1.40-1.67), measured using multivariable Cox proportional hazards regression analysis. Men were at higher risk than women to have PTB. The age-specific incidence rates showed that the DM cohort to comparison cohort incidence rate ratio was higher in younger group. But, the Cox model measured HR increased with age. Alcoholism, chronic obstructive pulmonary disease, alcoholic liver damage and chronic kidney diseases were comorbidities independently associated with PTB. In the DM cohort, anti-DM medications significantly reduced the risk of PTB with a HR of 0.52 for those had taken metformin, followed by alpha-glucosidase inhibitors, thiazolidinediones, insulins and sulfonylureas (HR, 0.76). The effects of all anti-diabetic drugs were statistically significant. Conclusions: These findings show patients with DM are associated with an elevated risk of developing PTB, but treatment with anti-diabetic drugs may mediate the risk significantly. [ABSTRACT FROM AUTHOR]

Importance: Antipsychotics are used increasingly in youth for nonpsychotic and off-label indications, but cardiometabolic adverse effects and (especially) type 2 diabetes mellitus (T2DM) risk have raised additional concern.Objective: To assess T2DM risk associated with antipsychotic treatment in youth.Data Sources: Systematic literature search of PubMed and PsycINFO without language restrictions from database inception until May 4, 2015. Data analyses were performed in July 2015, and additional analyses were added in November 2015.Study Selection: Longitudinal studies reporting on T2DM incidence in youth 2 to 24 years old exposed to antipsychotics for at least 3 months.Data Extraction and Synthesis: Two independent investigators extracted study-level data for a random-effects meta-analysis and meta-regression of T2DM risk.Main Outcomes and Measures: The coprimary outcomes were study-defined T2DM, expressed as cumulative T2DM risk or as T2DM incidence rate per patient-years. Secondary outcomes included the comparison of the coprimary outcomes in antipsychotic-treated youth with psychiatric controls not receiving antipsychotics or with healthy controls.Results: Thirteen studies were included in the meta-analysis, including 185,105 youth exposed to antipsychotics and 310,438 patient-years. The mean (SD) age of patients was 14.1 (2.1) years, and 59.5% were male. The mean (SD) follow-up was 1.7 (2.3) years. Among them, 7 studies included psychiatric controls (1,342,121 patients and 2,071,135 patient-years), and 8 studies included healthy controls (298,803 patients and 463,084 patient-years). Antipsychotic-exposed youth had a cumulative T2DM risk of 5.72 (95% CI, 3.45-9.48; P < .001) per 1000 patients. The incidence rate was 3.09 (95% CI, 2.35-3.82; P < .001) cases per 1000 patient-years. Compared with healthy controls, cumulative T2DM risk (odds ratio [OR], 2.58; 95% CI, 1.56-4.24; P < .0001) and incidence rate ratio (IRR) (IRR, 3.02; 95% CI, 1.71-5.35; P < .0001) were significantly greater in antipsychotic-exposed youth. Similarly, compared with psychiatric controls, antipsychotic-exposed youth had significantly higher cumulative T2DM risk (OR, 2.09; 95% CI, 1.50-52.90; P < .0001) and IRR (IRR, 1.79; 95% CI, 1.31-2.44; P < .0001). In multivariable meta-regression analyses of 10 studies, greater cumulative T2DM risk was associated with longer follow-up (P < .001), olanzapine prescription (P < .001), and male sex (P = .002) (r(2) = 1.00, P < .001). Greater T2DM incidence was associated with second-generation antipsychotic prescription (P ≤ .050) and less autism spectrum disorder diagnosis (P = .048) (r(2) = 0.21, P = .044).Conclusions and Relevance: Although T2DM seems rare in antipsychotic-exposed youth, cumulative risk and exposure-adjusted incidences and IRRs were significantly higher than in healthy controls and psychiatric controls. Olanzapine treatment and antipsychotic exposure time were the main modifiable risk factors for T2DM development in antipsychotic-exposed youth. Antipsychotics should be used judiciously and for the shortest necessary duration, and their efficacy and safety should be monitored proactively. [ABSTRACT FROM AUTHOR]

The article discusses a study on the relationship between depression and individuals diagnosed with Parkinson's Disease (PD) in Taiwan. Topics covered include the serotonergic and dopaminergic hypotheses in examining the pathophysiology between the mood disorder and the progressive disease, the neuroendocrine implications of stress found in PD resulting to the onset of depression, and the age of PD patients between 40-49 years as more at risk for the medical condition.

Purpose Febrile convulsion (FC) and Tourette syndrome (TS) are both common neurological disorders in infants and children. Both disorders share clinical similarities, such as paroxysmal symptoms with normal neurodevelopment and expected remission over time. This population-based study investigated the association between FC with TS during childhood neurodevelopment. Method We used the Taiwan National Health Insurance Research Database to conduct a retrospective cohort analysis on 1586 FC patients. A reference cohort of 6344 non-FC patients, matched for age, sex, urbanization level, parental occupation, and index year, was used for comparison. The risk of the occurrence of TS in FC patients was assessed using a Cox proportional hazard regression model. Results The overall incidence of TS was higher in the FC cohort than in the non-FC cohort (28.5 vs 13.9 per 10,000 person-years; adjusted hazard ratio=1.91, 95% confidence interval=1.32-2.75). The associated risk factors for FC patients to develop TS were boys, children living in rural areas, and children whose parents held blue-collar positions. Moreover, the risk of TS in FC patients rose from 0.89 to 16.0 (trend test P<0.0001) when the frequency of FC-related medical visits increased from 1 to 2 times to more than 4 times. The adjusted hazard ratio for TS in related to FC-related medical visits was 1.02 (95% CI=1.02-1.03) per one frequency increment. Conclusion FC may increase the risk of subsequent TS occurrence in children. Children who had frequent medical visits for FC were particularly vulnerable. [ABSTRACT FROM AUTHOR]

Studies on the physicians’ health have paid less attention on the Chinese medicine than on the western medicine professionals. Like western medicine professionals, Chinese medicine physicians’ health condition is critical to the quality of care and patients’ safety. They also cared a large number of patients in many Asia societies. However, no data have been reported regarding the health problems associated with Chinese medicine physicians. The aim of this study was to examine the mortality patterns of a cohort consisting of 6109 male physicians of Chinese medicine who were followed from 1991 through 2003 in Taiwan. The analyses of female subjects were not included due to small sample size. We calculated the overall and cause-specific standardized mortality ratios (SMRs) and life expectancy of the study cohort using the death rates of some 11 millions of Taiwanese male population as reference. We found out that physicians of Chinese medicine experienced significantly lower death rate of mortality from all causes (SMR = 0.63, 95% > CI: 0.57, 0.69), from malignant neoplasms (SMR = 0.69, 95% CI: 0.57, 0.82) and from cerebrovascular disease (SMR = 0.53, 95% CI: 0.38, 0.72). Additionally, they have longer life expectancy (ranged from 3 years to approximately 15 years). Our study is crucial to evaluate potential health risks associated with Chinese medicine physicians. Although this study did not reveal elevated death rate among Chinese medicine physicians, researchers and policy makers should not overlook other heath problems that Chinese medicine physicians might have experienced. ──── Chinese medicine Physicians; standardized mortality ratio; life expectancy; mortality rate; occupational epidemiology. [ABSTRACT FROM AUTHOR]

The article evaluates the data from the National Health Insurance system of Taiwan to assess the relationship between depression and cancer risk in Taiwan in the period of 2000-2002. The methods used in the study are described including the Poisson regression and Cox proportional hazard regression analysis. Results show that Taiwanese patients with depression do not have a higher risk of developing overall or site-specific cancer except for colorectal cancer which showed a negative direction in change.