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A 56-year-old woman was maintained on continuous ambulatory peritoneal dialysis (PD) for 12 years. The patient presented to our hospital with chief complaints of intermittent abdominal pain and frequent loose stool. Plain radiograph of abdomen revealed extensive peritoneal calcification. Computed tomography confirmed the extensive peritoneal calcification and revealed a large right ovarian cyst. Torsion of the right ovarian cyst was suspected. Right oophorectomy was performed. Small intestinal perforation developed 37 days after the operation. The patient expired because of peritonitis and sepsis. Extensive peritoneal calcification is a rare and serious complication after long-term PD. Intestinal perforation is a rare complication of PD. Pathognomic signs of imaging studies can be important in early diagnosis and treatment.

Objectives: This study compared the neonatal mortality rates (NMRs) and certification behaviors between New Taipei City (NTC) and other cities/counties in Taiwan. Methods: We first examined the NMR trends for days <28 and day 0 for each city or county for the years 2002 to 2022. Joinpoint regression was performed to identify significant changes in the trends. We then linked five population-based data sets to calculate the proportion of day-0 deaths for which the death certificate was issued by an obstetrician and to examine the related characteristics. Finally, we reviewed the charts for 50 day-0 deaths in NTC in 2021 and interviewed hospital managers regarding the regulation of certification behaviors. Results: Only the day 0 NMR trends for NTC and Kaohsiung City (KC) exhibited a decline-and-rise pattern. The annual percent change was 11.4% since 2012 for NTC and 8.1% since 2006 for KC. In total, 788 day-0 deaths occurred between 2018 and 2021, and the death certificates of 404 (52%) were issued by obstetricians. The percentage of day-0 deaths with obstetrician-issued death certificates was 72% in NTC, which was higher than those of other cities/counties (approximately 55%), and a rising trend was also identified (63% in 2018, 73% in 2019, 74% in 2020, and 78% in 2022). More than nine-tenths of these deaths involved a gestational age of <24 weeks, and most of them were the result of artificial abortions. The interviewed hospital managers indicated that various regulations for certification behaviors have been introduced. Conclusions: The higher NMRs and rising NMR trend in NTC compared with other cities/counties were partially due to certification-related behavioral artifacts. To properly interpret the regional variations in NMRs we should first remove this behavioral artifact. [ABSTRACT FROM AUTHOR]

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Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)