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Previous studies have reported that sleep duration may increase the risk of hypertension and hyperuricemia. However, the results are contradictory. We investigated whether sleep duration was independently associated with hypertension and hyperuricemia. We aimed to assess the association between sleep duration, hypertension, and hyperuricemia in a population-based cross-sectional study. MJ Health Examination Center Database was used to obtain a large, representative sample of Taiwan population. This study revealed that short sleep duration is associated with an increased risk of hyperuricemia and hypertension. Patients who sleep ≤ 4 hours have a higher risk of hypertension than those who sleep 7 hours (Male: AOR = 1.131, 95% CI = 1.073-1.192; Female: AOR = 1.257, 95% CI = 1.190 -1.327). The risk of hyperuricemia in patients who sleep ≤ 4 hours is higher than those who sleep 7 hours (Male: AOR = 1.657, 95% CI = 1.213-5.768; Female: AOR = 1.583, 95% CI = 1.050-3.660). Besides, the risk of hyperuricemia in females who slept for more than 8 hours was 1.019 times that of those who slept for 7 hours. Participants aged < 50 years who sleep less than 4 hours a day have a higher risk of hypertension and hyperuricemia than those of the ages of 50-75 and >75 years. There were excellent response rates to sleep duration associated with hypertension and hyperuricemia questions and measurements representative sample of Taiwan population. &nbsp

Obstructive sleep apnea (OSA) and alcohol-related diseases (ARDs), including alcohol use disorder, alcohol-related psychiatric disorders, alcoholic liver disease, alcoholic polyneuropathy alcoholic cardiomyopathy, and alcoholic gastritis, are both highly prevalent conditions. Alcohol consumption is associated with a higher risk of sleep apnea. However, whether OSA increases the risk of ARD has not, as yet, been studied comprehensively. Our study aimed to determine whether OSA increases the subsequent risk of ARD.This study utilized the data from Taiwan's National Health Insurance Database between 2000 and 2015. We identified 7722 individuals newly diagnosed with OSA and randomly selected sex-, age-, and index date-matched (1:3) 22,166 controls without OSA, with a total of 29,888 subjects. We used the Fine and Gray's survival analysis to estimate the effects of OSA on ARD.The OSA cohort had an adjusted hazard ratio of subsequent ARDs as 1.486 (95% Confidence Interval: 1.301-1.698), when comparing the cohort without OSA. The Kaplan-Meier analysis showed that the cumulative incidence of ARDs was significantly higher in the OSA cohort than in the controls in the first year of follow-up, till the end of the follow-up. A post-hoc analysis showed that OSA was associated with alcohol use disorder, alcohol-related psychiatric disorders, and alcoholic liver disease, but not alcoholic polyneuropathy, alcoholic cardiomyopathy, and alcoholic gastritis. The use of psychoactive medication, including the sedative-hypnotics, antidepressants or antipsychotics were associated with a lower risk of ARDs.Our study demonstrates that the OSA patients are at a higher risk of developing ARDs.

Background Previous population-based studies in western countries had revealed increased skin cancer risk among transplant recipients compared to the general population. However, population-based studies in Asia on skin cancer among recipients of different transplanted organs were lacking in the literature. Aims This study aims to estimate skin cancer risk among recipients in Taiwan, examine the association between each specific type of skin cancer and each type of transplanted organ, and compare skin cancer risk between different immunosuppressive regimens. Methods This population-based retrospective cohort study identified 7550 patients with heart, lung, kidney or liver transplantation and 30,200 controls matched for gender, age and comorbidity index from the National Health Insurance Research Database in Taiwan between 2000 and 2015. Using multivariable Cox proportional hazard models, we estimated the hazard ratios and 95% confidence intervals for the correlation of skin cancer with organ transplantation as well as immunosuppressive regimen. Results Organ transplant recipients in Taiwan had an increased risk of skin cancer with adjusted hazard ratios of 4.327 (95% confidence intervals 2.740-6.837, P < 0.001), with the greatest risk, observed among heart recipients (adjusted hazard ratios 6.348, 95% confidence intervals 3.080-13.088, P < 0.001). The risk of non-melanoma skin cancer and melanoma was 4.473 (95% confidence intervals 2.568-7.783, P < 0.001) and 3.324 (95% confidence intervals 1.300-8.172, P < 0.001), respectively. When comparing immunosuppressants, those with calcineurin inhibitors carried the highest risk of skin cancer (adjusted hazard ratios 4.789, 95% confidence intervals 3.033-7.569, P < 0.001), followed by those with antimetabolites (adjusted hazard ratios 4.771, 95% confidence intervals 3.025-7.541, P < 0.001). Limitations We could not evaluate confounding behavioural risk factors of skin cancers that were not documented in the database, nor could we recognize patients’ compliance with immunosuppressants. Conclusion Organ recipients have a greater risk of skin cancer. Clinicians should inform recipients of the importance of photoprotection and regular dermatologic follow-up.

To investigate the risk of injury in patients with Ménière's disease (MD) and the effects of treatment.Population-based retrospective cohort study.Data were collected from the Longitudinal Health Insurance Database 2005, containing the information of 2 million randomly selected individuals in Taiwan.We enrolled 90,481 patients with newly diagnosed MD between 2000 and 2017 and 361,924 matched individuals without MD. The study outcomes were diagnoses of all-cause injuries. The Kaplan-Meier method was used to determine the cumulative incidence rates of injury in the MD and non-MD cohorts, and a log-rank test was used to analyze the differences between the cohorts. Cox proportional hazards models were used to calculate the 18-year hazard ratios of each cohort.A total of 80,151 patients were diagnosed with injuries during the follow-up period: 24,031 and 56,120 from the MD and non-MD cohorts, respectively. The adjusted hazard ratio (aHR) was 2.19 (95% CI, 2.16-2.35) after adjusting for demographic characteristics and comorbidities. Subgroup analysis revealed that MD was associated with an increased incidence of unintentional and intentional injuries (aHR, 2.24 [95% CI, 2.21-2.41] and 2.05 [95% CI, 2.01-2.19], respectively). Treatment with diuretics, antivertigo medications, or surgery did not reduce the risk of injury (aHR, 0.98 [95% CI, 0.59-1.54], 0.94 [95% CI, 0.58-1.50], and 0.99 [95% CI, 0.61-1.54]).MD is independently associated with an increased risk of injuries. Medical or surgical treatment for MD does not reduce the risk of injury in patients with MD. Physicians should counsel patients with MD regarding preventive measures for avoiding subsequent injuries.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening adverse reactions to drugs and psychological sequelae are also observed to follow the trauma of widespread epidermal necrolysis. To delineate the association between SJS and TEN, and psychiatric disorders, we conducted a retrospective population-based cohort study by including 212 patients diagnosed with first-time SJS or TEN in Taiwan between 2000 and 2013 and 669 population controls. Adjusted hazard ratios were calculated after adjusting for sex, age, comorbidity in the form of Charlson comorbidity index, and facility level of care. Overall, SJS or TEN was associated with an increased risk of developing psychiatric disorders including schizophrenia, major depressive disorder, mania, anxiety, and bipolar with an adjusted hazard ratio of 1.392 (95% CI, 1.192-1.625; p 0.001). Particularly, the adjusted hazard ratios of psychiatric disorders were 1.290 (95% CI, 1.105-1.506; p 0.001) for SJS and 1.855 (95% CI, 1.587-2.167; p 0.001) for TEN.

To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan.We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders.Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95% confidence interval, 1.90-2.36; p 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p 0.001).The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible.

Objective There is limited clarity concerning the risk of dementia after pneumonia with intensive care unit (ICU) stay. We conducted a nationwide cohort study, which aimed to investigate the impact of dementia after pneumonia with and without intensive care unit admission.Methods Data was obtained from Taiwan’s National Health Insurance Research Database between 2000 and 2015. A total of 7,473 patients were identified as having pneumonia required ICU stay, along with 22,419 controls matched by sex and age. After adjusting for confounding factors, multivariate Cox regression model analysis was used to compare the risk of developing dementia during the 15-years follow-up period.Results The enrolled pneumonia patients with ICU admission had a dementia rate of 9.89%. Pneumonia patients without ICU admission had a dementia rate of 9.21%. The multivariate Cox regression model analysis revealed that the patients with ICU stay had the higher risk of dementia, with a crude hazard ratio of 3.371 (95% confidence interval, 3.093–3.675; p

Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children; however, studies delineating the association between ADHD and central precocious puberty are limited. This study aimed to understand whether children with ADHD are at a higher risk of central precocious puberty.This population-based retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan to investigate the association between ADHD and the incidence of central precocious puberty between 2000-2015. We identified ADHD individuals treated with methylphenidate, atomoxetine or not. The control cohort consisted of individuals without ADHD. The outcome measure was central precocious puberty diagnosis.Among 290,148 children (mean age: 5.83 years), central precocious puberty incidence was 4.24 and 1.95 per 10This study showed an association between ADHD and a higher risk of central precocious puberty. Early referral of children with ADHD to a pediatric endocrinologist for evaluation may facilitate correct diagnoses and early interventions.ADHD is associated with a higher risk of central precocious puberty. This study provides relevant findings, as it is the first nationwide, population-based cohort study to investigate the association between ADHD and the risk of central precocious puberty with a 15-year follow-up. Early referral of children with ADHD to a pediatric endocrinologist for the evaluation of suspected precocious puberty could facilitate correct diagnosis. Early intervention treatment with gonadotropin-releasing hormone agonist might improve final height in children with central precocious puberty.

There is a positive association between electrical cardioversion (ECV) and acute ischemic stroke (AIS). Although 4 weeks of anticoagulation therapy after ECV in atrial fibrillation (AF) patients is generally suggested by current guidelines to reduce the risk of AIS, limited studies have been conducted in Asian populations to determine the risk and timing of AIS after ECV for AF in recent years. Therefore, we aim to use the National Health Insurance Research Database (NHIRD) in Taiwan to determine the risk and timing of AIS after ECV for AF.The data analyzed in this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan. The outcome in this study was the cumulative incidence of AIS in patients with AF during 7-day and 30-day follow-up periods after the patients underwent ECV.Our analysis included 39,697 patients with AF, of whom 5723 received ECV and 5723 were propensity score-matched controls. Compared to the controls, patients who received ECV exhibited a significantly increased incidence of 7-day AIS development (adjusted hazard ratio [HR] = 1.524, p = 0.003). In contrast, the incidence of 30-day AIS development showed no significant increase (adjusted HR = 1.301, p = 0.426).AF patients who underwent ECV had a higher incidence of 7-day AIS development but not 30-day AIS development. Considering the timing of AIS development after ECV in AF patients, the optimal duration of antithrombotic therapy after ECV deserves further investigation.

The sterilisation of surgical instruments is a major factor in infection control in the operating room (OR). All items used in the OR must be sterile for patient safety. Therefore, the present study evaluated the effect of far-infrared radiation (FIR) on the inhibition of colonies on packaging surface during the long-term storage of sterilised surgical instruments. From September 2021 to July 2022, 68.2% of 85 packages without FIR treatment showed microbial growth after incubation at 35 °C for 30 days and at room temperature for 5 days. A total of 34 bacterial species were identified, with the number of colonies increasing over time. In total, 130 colony-forming units were observed. The main microorganisms detected were Staphylococcus spp. (35%) and Bacillus spp. (21%) , Kocuria marina and Lactobacillus spp. (14%), and mould (5%). No colonies were found in 72 packages treated with FIR in the OR. Even after sterilisation, microbial growth can occur due to movement of the packages by staff, sweeping of floors, lack of high-efficiency particulate air filtration, high humidity, and inadequate hand hygiene. Thus, safe and simple far-infrared devices that allow continuous disinfection for storage spaces, as well as temperature and humidity control, help to reduce microorganisms in the OR.

Objective Two-way relationship between periodontitis and diabetes was advocated. However, bidirectional epidemiological observation is still limited and inconsistent. Using the National Health Insurance Research Database of Taiwan (covering over 99% of the entire population), we estimate the development of diabetes in periodontitis patients or that of periodontitis in patients with type 2 diabetes mellitus (T2DM), respectively. Methods A total of 11,011 patients with severe periodontitis were recruited from 2000 to 2015. After matching by age, sex, and index date, 11,011 patients with mild periodontitis and 11,011 non-periodontitis controls were registered. Conversely, 157,798 patients with T2DM and 157,798 non-T2DM controls were enrolled, whereas the development of periodontitis was traced. Cox proportional hazards model was performed. Results Periodontitis patients tended to have a statistically high risk of having T2DM. Adjusted hazard ratio (aHR) was 1.94 (95% CI 1.49–2.63, p Conclusions We suggested the bi-direction is between T2DM and severe periodontitis, but not in mild type.

The psychosocial and health consequences of ocular conditions that cause visual impairment (VI) are extensive and include impaired daily activities, social isolation, cognitive impairment, impaired functional status and functional decline, increased reliance on others, increased risk of motor vehicle accidents, falls and fractures, poor self-rated health, and depression. We aimed to determine whether VI increases the likelihood of a poor prognosis, including mental illness, suicide, and mortality over time. In this large, location, population-based, nested, cohort study, we used data from 2000 to 2015 in the Taiwan National Health Insurance Research Database (NHIRD), which includes diagnoses of all the patients with VI. Baseline features, comorbidities, and prognostic variables were evaluated using a 1:4-matched cohort analysis. Furthermore, comparisons were performed using Cox regression and Bonferroni-correction (for multiple comparisons) to study the association between VI and poor prognosis (mental illness, suicide). The study outcome was the cumulative incidence of poor prognosis among the visually impaired and controls. A two-tailed Bonferroni-corrected p < 0.001 was considered statistically significant. Among the 1,949,101 patients enlisted in the NHIRD, 271 had been diagnosed with VI. Risk factors for poor prognosis and the crude hazard ratio was 3.004 (95% confidence interval 2.135–4.121, p < 0.001). Participants with VI had an increased risk of poor prognosis according to the sensitivity analysis, with a poor prognosis within the first year and first five years. VI was associated with suicide and mental health risks. This study revealed that patients with VI have a nearly 3-fold higher risk of psychiatric disorders, including anxiety, depression, bipolar, and sleep disorders, than the general population. Early detection through comprehensive examinations based on increased awareness in the clinical context may help maintain visual function and avoid additional complications.

Traumatic brain injury (TBI) is a silent epidemic that has been easily ignored. The safety and efficacy of restarting antiplatelet therapy after encountering traumatic brain injury (TBI) events remain a challenge. We explored the outcomes of restarting aspirin use on secondary stroke and mortality in patients with chronic stroke 4 weeks after suffering from a TBI episode in Taiwan. This study analyzed data from the National Health Insurance Research Database from January 2000 to December 2015. Overall, 136,211 individuals diagnosed with chronic stroke who suffered from acute TBI and received inpatient service were enrolled. The study outcomes were a competing risk of secondary stroke (ischemic and hemorrhagic) hospitalization and all-cause mortality. We identified a case group of 15,035 patients with chronic stroke (mean [SD] age of 53.25 [19.74] years; 55.63% male) who restarted aspirin use 4 weeks after suffering from TBI and a control group of 60,140 patients with chronic stroke (mean [SD] age of 53.12 [19.22] years; 55.63% male) who discontinued aspirin use after suffering from TBI. The risk of hospitalization of secondary ischemic stroke [adjusted hazard ratio (aHR) 0.694; 95% confidence interval (CI) 0.621–0.756; P P P

Objective Past vegetarians research has often found that they have lower blood pressure (BP). Effects may include their lower BMI and higher intake levels of fruit and vegetables. Besides, the study pursues to extend this evidence in a diverse population containing vegans, lacto-ovo vegetarians and omnivores. Design The study analyzed data on five hundred vigorous individuals aged 20 years or older from a standard medical screening program and provided validated questionnaire. Criteria were established for vegan, lacto-ovo vegetarian, partial vegetarian and omnivorous dietary patterns. Setting Health screening programs were conducted at a standard medical screening program in Taiwan between 2006 and 2017. Dietary data were gathered by self-administered questionnaire. Subjects Five hundred Taiwanese subjects representing the cohort. Results Multiple regression analyses confirmed that the vegan vegetarians had lower systolic and diastolic BP (mmHg) than omnivorous Taiwanese (β = − 6.8, p p p p 139 mmHg or diastolic BP > 89 mmHg or routine of antihypertensive medications, the odds ratio of hypertension compared with omnivores was 0.37 (95% CI = 0.19–0.74), 0.57 (95% CI = 0.36–0.92) and 0.92 (95% CI = 0.50–1.70), respectively, for vegans, lacto-ovo vegetarians and partial vegetarians. Results were reduced after adjustment for BMI. Conclusions The study concludes from this relatively large study that vegetarians, especially vegans, with otherwise diverse characteristics but stable diets, do have lower systolic and diastolic BP and less hypertension than omnivores.

Pioglitazone is an insulin resistance inhibitor widely used as monotherapy or combined with metformin or insulin in treating type 2 diabetes mellitus (T2DM). This study further investigated the relationship between pioglitazone use and the risk of developing Alzheimer's disease (AD) in patients newly diagnosed with T2DM, and examined the potential impact of insulin use on this association. Data were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Our data exhibited that the risk of developing AD in the pioglitazone group was 1.584-fold (aHR = 1.584, 95% CI 1.203–1.967, p p

Purpose: Vancomycin can be used to treat many bacterial infections, although the generation of vancomycin-resistant Enterococci (VRE) may cause adverse consequences. We analysed the trends and the risk factors for healthcare-associated urinary tract infections (UTIs) by VRE. Methods: This retrospective study included patients who were hospitalized from 2009–2015 and had hospital-acquired enterococci infections who fulfilled the Centers for Disease Control and Ministry of Health and Welfare criteria, as determined by infection control professionals. Results: The mean age of the 594 participants was 72.3 years. The proportion of men with enterococcal UTIs was 70%. The proportion of VRE infections among all enterococcal UTIs was lowest in 2009 (18.1%) and highest in 2015 (47.3%). An increasing trend in the proportion of patients with VRE UTIs was observed from 2009–2015. Length of hospitalization of more than 40 days, placement of double-lumen catheters, and placement of a nasogastric tube were associated with a higher risk of VRE in UTIs (odds ratio=1.93–2.72, all P Conclusions: The use of unnecessary invasive catheters in patients with double-lumen catheters or nasogastric tubes should be reduced. Environmental disinfection and hand hygiene should be implemented.

Liver cancer is a detrimental complication in patients with chronic viral hepatitis and alcoholic or nonalcoholic fatty liver disease (NAFLD). However, metabolic risk factors underlying NAFLD usually cause substantial differences in their clinical outcomes. Recently, several studies have used a novel definition of metabolic dysfunction-associated fatty liver disease (MAFLD) to reassess patients with NAFLD and pointed out the importance of metabolic risk factors. Since patients with NAFLD, MAFLD, or metabolic syndrome (MetS) have different burden of metabolic risk factors, it is crucial to decipher the risk of developing hepatic complications in these populations.Through a longitudinal nationwide cohort study, the risk of liver cancer was investigated in patients with MetS alone, NAFLD alone, overlap NAFLD/MAFLD, and coexisting MetS and NAFLD. The general characteristics, comorbidities, and incidence of liver cancer were also compared.Intriguingly, patients diagnosed with MetS alone did not have a significant risk of developing HCC compared to control individuals, while patients with NAFLD alone, NAFLD/MAFLD, and coexisting NAFLD and MetS exhibited 6.08-, 5.81-, and 15.33-fold risks of developing HCC, respectively. Apart from metabolic risk factors, renal function status and liver cirrhosis were the independent risk factors for the development of HCC among these groups.Our data emphasize that metabolic dysfunction has a significant impact on hepatocarcinogenesis in patients with NAFLD. Moreover, coexisting multiple metabolic risk factors would dampen the risk of developing HCC in patients with NAFLD. Closely tracing HCC formation through laboratory examination or imaging is crucial in these patients.

Background After isotretinoin's approval to treat patients with recalcitrant acne, there have been continued debates around its psychiatric safety profile. This study aimed to assess the risk of psychiatric disorders in patients with acne who are taking isotretinoin. Methods We used de-identified information from Taiwan's National Health Insurance Research Database from 2000 to 2015 to examine the risk for psychiatric disorders among patients with acne who were taking isotretinoin. We performed subgroup analyses based on the dosage and duration of isotretinoin administration. Results This study included 29,943 participants during a 16-year follow-up period. We found no significantly increased risk for psychiatric disorders among patients taking isotretinoin compared with patients who did not receive isotretinoin treatment (adjusted hazard ratio [aHR]: 1.009, 95% confidence interval [CI]: 0.422–1.696). Subgroup analyses showed no significantly increased risk for psychiatric disorders in patients taking different doses of isotretinoin (≤ 20 mg per day, aHR: 0.892, 95% CI: 0.371–1.501; > 20 mg per day, aHR: 1.068, 95% CI: 0.446–1.798). There was also no significant increase in risk for patients undergoing isotretinoin treatment over different periods (≤ 6 months, aHR: 0.924, 95% CI: 0.392–1.612; > 6 months, aHR: 1.196, 95% CI: 0.488–2.004). Limitations We did not analyze the risk of suicidal ideation, and it could be underestimated in medical claims databases. Conclusions We found no increased risk of psychiatric disorders among Taiwanese patients with acne who were taking isotretinoin. Higher dosage or longer duration of isotretinoin treatment did not increase the risk for developing a psychiatric disorder.

Office workers often work overtime, stay up late, lack of sleep, and have poor sleep quality, resulting in a high liver index. Abnormal liver function is the main risk factor for modern social civilization diseases and chronic diseases. The purpose of this study was to explore the relationship between sleep time, sleep quality, and liver function, and analyze the collected data from the Taiwan MJ Health Examination Center from 2001 to 2010. This study mainly found that participants with extremely poor sleep had 1.128 times the chance of developing abnormal liver function compared with participants with good sleep. At the same time, it was found that the average daily sleep time of fewer than 4 hours, compared with people who sleep for 7-8 hours, the probability of abnormal liver function is 1.206 times. Therefore, good sleep quality and proper sleep time will reduce the occurrence of abnormal liver function.

This study investigates an association between oral cancers and the risk of developing depression. We conducted a total of 3031 patients with newly diagnosed oral cancers and 9093 age-, sex-, and index year-matched controls (1:3) from 2000 to 2013 were selected from the National Health Insurance Research Database (NHIRD) of Taiwan. After adjusting for confounding factors, multivariate Cox proportional hazards analysis was used to compare the risk of depression over a 13-year follow-up. Of the patients with oral cancer, 69 (2.28%, or 288.57 per 105 person-years) developed depression compared to 150 (1.65%, 135.64 per 105 person-years) in the control group. The Cox proportional hazards regression analysis showed that the adjustment hazard ratio (HR) for subsequent depression in patients with oral cancer diagnosed was 2.224 (95% Confidence Interval [CI] 1.641–3.013, p

Objective To investigate whether adults suffering from violence were at risk of substance abuse and provides insight into the relationship between male and female abusers and substance abuse from 2000 to 2015 in Taiwan. Methods This study used data on outpatient, emergency, and inpatient visits for 2 million people enrolled in universal health insurance from 2000 to 2015. ICD-9 diagnosis codes 995.8 (abused adult) and E960–E969 (homicide and injury purposely inflicted by other persons) were defined in this case study, analyzing first-time violence in adults aged 18–64 (study group). Non-abused patients (control group) were matched in a 1:4 ratio, and the paired variables were gender, age (± 1 year), pre-exposure Charlson Comorbidity Index, and year of medical treatment. SAS 9.4 and Cox regression were used for data analysis. Results A total of 8,726 people suffered violence (control group: 34,904 people) over 15 years. The prevalence of substance abuse among victims of violence was 78.3/104, 61.9/104, and 51.5/104 for tobacco use disorder, alcoholism, and alcohol abuse, respectively. The risk (adults, overall) of drug abuse, drug dependence, and alcoholism after exposure to violence (average 9 years) was 7.47, 7.15, and 6.86 times (p p p Conclusion The risks of substance abuse, after adult violence, are higher than in those who have not suffered violent injuries.

Many studies have demonstrated an increased cardiovascular (CV) risk in ankylosing spondylitis (AS) patients. Nevertheless, the influence of an endophthalmitis episode toward the future risks of acute myocardial infarction (AMI) in AS patients has been unclear. The objective of this study was to explore the impact of endophthalmitis on AMI risk in this particular patient population by a population-based retrospective cohort study with a follow-up period up to 16 years. Univariate and multivariate Cox regression analyses were used for the risk evaluation and the results were presented as crude and adjusted hazard ratios (HRs). Overall, we enrolled 557 AS patients with endophthalmitis as the study cohort and selected another 2228 matched AS patients without endophthalmitis as the comparison cohort. Comparing the comparison cohort, the study cohort showed a significantly higher overall AMI incidence rate with an adjusted HR of 1.631 (p < 0.001). In conclusion, endophthalmitis increased the risk of AMI in AS patients after adjusting for possible clinical confounders. Special attention and work-up are required for physicians when encountering a history of endophthalmitis in these special patient populations, especially when they are comorbid with other potential CV risk factors.

The risk of glaucoma in patients suffering from Sjögren’s syndrome has not been elucidated. We aimed for evaluating the absolute incidence as well as the relative risk of glaucoma in patients with SS at the level of the whole country population. We conducted a retrospective cohort study using a national health insurance database in Taiwan from 2000 to 2013. We used International Classification of Diseases, Ninth Revision, to categorise medical conditions for study group and comparison group. We used Cox proportional hazard regression analysis to determine adjusted hazard ratios (aHRs) of glaucoma between study and comparison group after adjusting for sex, age, and comorbidities. Among 17,398 patients with primary Sjögren’s syndrome, 133 patients were diagnosis with glaucoma during follow-up. Of the 69,592 non-primary Sjögren’s syndrome patients, 429 patients developed glaucoma. Glaucoma risk was elevated in patients with primary Sjögren’s syndrome than in the non-Sjögren’s syndrome group (adjusted hazard ratio [HR] 2.274, 95% in the confidence interval [95% CI] 1.847–2.800; P < .001). The risk of glaucoma among the population having Sjögren’s syndrome was higher than those did not have Sjögren’s syndrome. It indicated the necessity of regular examination for glaucoma in patients with Sjögren’s syndrome.

Background and Objectives: Postoperative adjuvant therapy with uracil and tegafur (UFT) is often used for stage II colon cancer in Japan, but a limited number of studies have investigated the effects of UFT in these patients. Materials and Methods: We conducted a population-based cohort study in patients with resected stage II colon cancer comparing the outcomes after postoperative adjuvant chemotherapy with UFT with an observation-only group. The data were collected from the Taiwan National Health Insurance Research Database from 2000 to 2015. The outcomes of the study were disease-free survival (DFS) and overall survival (OS). The hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression models. Results: No differences in the DFS and OS were detected between the UFT (1137 patients) and observation (2779 patients) cohorts (DFS: adjusted HR 0.702; 95% confidence interval (CI) 0.489–1.024; p = 0.074) (OS: adjusted HR 0.894; 95% CI 0.542–1.186; p = 0.477). In the subgroup analyses of the different substages, UFT prolonged DFS in patients with stage IIA colon cancer (adjusted HR 0.652; 95% CI 0.352–0.951; p = 0.001) compared with DFS in the observation cohort, but no differences in the OS were detected (adjusted HR 0.734; 95% CI 0.475–1.093; p = 0.503). Conclusions: Our results show that DFS improved significantly in patients with stage IIA colon cancer receiving UFT as a postoperative adjuvant chemotherapy compared with DFS in the observation group.

IntroductionOxidative stress is involved in numerous inflammatory diseases, including trauma. Micronutrients, such as selenium (Se), which contribute to antioxidant defense, exhibit low plasma levels during critical illness. This study aimed to investigate the impact of early Se supplementation on trauma patients.Materials and methodsA total of 6,891 trauma patients were registered at a single medical center from January 2018 to December 2021. Twenty trauma patients with Se supplemented according to the protocol were included in the study group. Subsequently, 1:5 propensity score matching (PSM) analysis was introduced. These patients received 100 mcg three times a day for 5 days. The primary outcome was overall survival (OS); the secondary outcomes were hospital/intensive care unit (ICU) length of stay (LOS), serologic change, ventilator dependence days, and ventilation profile.ResultsThe hospital LOS (20.0 ± 10.0 vs. 37.4 ± 42.0 days, p = 0.026) and ICU LOS (6.8 ± 3.6 vs. 13.1 ± 12.6 days, p < 0.006) were significantly shorter in the study group. In terms of serology, improvement in neutrophil, liver function, and C-reactive protein (CRP) level change percentile indicated better outcomes in the study group as well as a better OS rate (100 vs. 83.7%, p = 0.042). Longer ventilator dependence was found to be an independent risk factor for mortality and pulmonary complications in 6,891 trauma patients [odds ratio (OR) = 1.262, 95% confidence interval (CI) = 1.039–1.532, p < 0.019 and OR = 1.178, 95% CI = 1.033–1.344, p = 0.015, respectively].ConclusionEarly Se supplementation after trauma confers positive results in terms of decreasing overall ICU LOS/hospital LOS and mortality. Organ injury, particularly hepatic insults, and inflammatory status, also recovered better.

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.

There is little comprehensive education for people with end-stage renal disease (ESRD) progress. We investigated the differences in terms of outcomes between patients with CKD stages 3–5 who enrolled and did not enroll in the pre-ESRD care education in Taiwan. This retrospective cohort study was conducted using data from the National Health Insurance Research Database (NHIRD). All patients diagnosed with CKD stages 3–5 who received the pre-ESRD care education through the pay for performance (P4P) program were enrolled. Based on whether or not they participated in the program, they were categorized into P4P or non-P4P groups. All analyses were performed from January 2006 through December 2015. Study outcomes were risk of hemodialysis dependency, hospitalization, and all-cause mortality. In this study of 29,337 patients, those with CKD stages 3–5 in the P4P group had lower events of hemodialysis, hospitalization, and all-cause mortality compared to patients in the non-P4P group. This study suggested that pre-ESRD care education is associated with increased patient outcomes, resulting in lower hemodialysis and hospitalization events and a higher overall survival rate in patients with CKD stages 3–5. Patient education could raise opportunities to improve pre-ESRD care by reaching patients outside the traditional health care setting.

Tien-Yu Chen,1– 3,&ast; Vincent Yi-Fong Su,4,5,&ast; Chung-Hsin Lee,6 Chi-Hsiang Chung,7– 9 Chia-Kuang Tsai,3,10 Chung-Kan Peng,3,11 Hsiao-Ching Lai,1 Wu-Chien Chien,7– 9,12 Nian-Sheng Tzeng1,13 1Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; 2Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan; 3Sleep Medicine Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; 4Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; 5Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan; 6Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; 7Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 8School of Public Health, National Defense Medical Center, Taipei, Taiwan; 9Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; 10Department of Neurology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; 11Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; 12Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; 13Student Counseling Center, National Defense Medical Center, Taipei, Taiwan&ast;These authors contributed equally to this workCorrespondence: Wu-Chien ChienDepartment of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, TaiwanTel +886 2-87923311, Ext. 19189Fax +886 2-87927235Email chienwu@mail.ndmctsgh.edu.twNian-Sheng TzengDepartment of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, TaiwanTel +886 2-87927299Fax +886 2-87927221Email pierrens@mail.ndmctsgh.edu.twPurpose: Asthma, which is caused by inflammation of the airways, affects the sensitivity of nerve endings. Narcolepsy is a chronic sleep disorder that may be caused by autoimmunity. Recent studies have reported a positive association between narcolepsy and asthma. We aimed to examine the association between asthma and narcolepsy and determine the effects of therapeutic corticosteroid or bronchodilator use.Materials and Methods: We conducted a nationwide population-based, nested case-control study using Taiwan’s National Health Insurance Research Database (NHIRD) between 2000 and 2013. Subjects with narcolepsy (ICD-9-CM code 347) were enrolled, with 1:3 estimated propensity score-matched controls based on sex, age, and index year. The association between narcolepsy and asthma was assessed using multiple logistic regression analyses. The covariates included sex, age, monthly insurance premiums, geographical area of residence, urbanization level of residence, level of care, and presence of diseases related to immune response and central nervous system. The effects of corticosteroid and bronchodilator use were also analyzed.Results: Overall, 2008 subjects were identified from the NHIRD (502 patients with narcolepsy and 1506 controls). The participants with narcolepsy had almost three times the level of previous asthma diagnosis than controls. Compared to those without asthma, patients with asthma had an adjusted odds ratio (OR) of 3.181 for narcolepsy comorbidity (95% confidence interval [CI]: 2.048– 4.941, p< 0.001). The use of inhaled corticosteroids was associated with a lower risk of narcolepsy comorbidity, with an adjusted OR of 0.465 (95% CI, 0.250– 0.634; p< 0.001), in patients with asthma when compared to those without treatment.Conclusion: This study demonstrated a significantly higher level of previous asthma diagnosis in patients with narcolepsy. The use of inhaled corticosteroids was associated with a lower risk of narcolepsy comorbidity in asthma patients, compared to those without treatment.Keywords: asthma, narcolepsy, corticosteroid, bronchodilators

Background This study aimed to investigate the association between posttraumatic stress disorder and the risk of developing erectile dysfunction. Methods In this population-based retrospective cohort study, we used Taiwan’s National Health Insurance Research Database to analyze patients who were newly diagnosed with posttraumatic stress disorder (PTSD) between 2000 and 2013, with a 1:3 ratio by age and index year matched with patients in a non-PTSD comparison group, for the risk of erectile dysfunction. Results In total, 5 out of 1079 patients in the PTSD group developed erectile dysfunction, and 3 out of 3237 patients in the non-PTSD group (47.58 vs. 9.03 per 100,000 per person-year) developed erectile dysfunction. The Kaplan–Meier analysis showed that the PTSD cohort had a significantly higher risk of erectile dysfunction (log-rank, p, Highlights Utilizing a nationwide, population-based database, the Longitudinal Health Insurance Database in 2000–2015 in Taiwan, which comprised 2 million people, we conducted a study to clarify the association between posttraumatic stress disorder and erectile dysfunction.Posttraumatic stress disorder was associated with the risk of erectile dysfunction.Psychotropic medications in the subjects with PTSD were not associated with the risk of erectile dysfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s12991-021-00368-w.

Two-way relationship between periodontitis and diabetes was advocated; however, bidirectional observation in general population is still inconclusive. Using the Taiwan Health Insurance Database (covering over 99% of the entire population),11,011 patients with severe periodontitis were recruited from 2000 to 2015.After matching by age, sex, and index date, 11,011 patients with mild periodontitis and 11,011 non-periodontitis controls were registered. The outcome of T2DM was traced. Conversely, the development of periodontitis was traced in 157,798 patients with T2DM, and 157,798 non-diabetic controls enrolled. The risks of T2DM significantly increased in groups with severe and mild periodontitis, with the adjusted hazard ratio (aHR) and 95% confidence interval (CI) being 1.94 (1.49–2.63, p < 0.01) and 1.72 (1.24–2.52, p < 0.01), respectively. Patients with severe periodontitis had a high risk of having diabetes compared to those with mild periodontitis [aHR, 1.17 (95% CI 1.04–1.26, p < 0.001)]. Conversely, the risk of periodontitis increased significantly in patients with T2DM [1.99 (1.42–2.48, p < 0.01)]. However, the high risk was not observed for the outcome of mild periodontitis [0.97 (0.38–1.57, p = 0.462)]. We, therefore, suggested the bi-direction is between diabetes and severe periodontitis, but not in mild type.

To investigate whether previous exposure to obstructive sleep apnea (OSA) increases the risk of obesity in obese and nonobese patients. We identified 24,363 obese patients diagnosed between January 1, 2000, and December 31, 2015, in the Taiwan Longitudinal Health Insurance Database (LHID) 2005 National Health Insurance Research Database; 97,452 sex-, age- and index date-matched nonobese patients were identified from the same database. This study is based on the ninth edition of the International Classification of Sleep Disorders. Multiple logistic regression was used to analyze the previous exposure of obese patients to OSA. P .05 was considered significant. The average age of 121,815 patients was 44.30 ± 15.64 years old; 42.77% were males, and 57.23% were females. Obese patients were more likely to be exposed to OSA than nonobese patients (adjusted odds ratio [AOR] = 2.927, 95% CI = 1.878-4.194, P .001), and the more recent the exposure period was, the more severely obese the patient, with a dose-response effect (OSA exposure 1 year, AOR = 3.895; OSA exposure 1 year,5 years, AOR = 2.933; OSA exposure 5 years, AOR = 2.486). The probability of OSA exposure in obese patients was 2.927 times that in nonobese patients, and the longer the exposure duration was, the more severe the obesity situation, with a dose-response effect (OSA exposure 1 year, AOR = 2.251; OSA exposure 1 year,5 years, AOR = 2.986; OSA exposure 5 years, AOR = 3.452). The risk of obesity in subjects with OSA was found to be significantly higher in this nested case-control study; in particular, a longer exposure to OSA was associated with a higher likelihood of obesity, with a dose-response effect.

Background: This cohort study aimed to research the correlation between endophthalmitis and stroke development in ankylosing spondylitis (AS) patients by reviewing National Health Insurance Research Database (NHIRD) data. Methods: This study obtained data from the NHIRD over a sixteen-year period. The primary outcome was stroke development. We used Fisher’s exact test and Pearson’s chi-squared test to analyze the variables. We investigated the risk factors for disease development using Cox regression analyses. We compared the cumulative incidence of stroke using Kaplan–Meier analysis. Results: The study cohort included 549 patients with AS and endophthalmitis, while the comparison cohort included 2196 patients with AS but without endophthalmitis. The stroke development was increased in the study cohort (adjusted hazard ratio, 1.873; p ≤ 0.001). The total stroke development in the study cohort and the comparison cohort was 1724.44 per 100,000 person-years and 1085.11 per 100,000 person-years, respectively (adjusted hazard ratio, 1.873; 95% confidence interval, 1.776–2.022; p < 0.001). Our study cohort showed an increased stroke rate. Conclusions: Our studies showed that endophthalmitis increases the risk of stroke in AS patients and endophthalmitis is an independent risk factor for stroke in AS patients. Nonetheless, advanced studies that thoroughly investigate the correlation between endophthalmitis and stroke in AS patients are needed to validate our findings.

Background and purposeEvidence increasingly suggests that Helicobacter pylori infection (HPI) is associated with movement disorders such as Parkinson's disease (PD). However, the relationship between HPI and sleep-related movement disorders (SRMD) remains unknown. This nationwide population-based study tried to demonstrate whether patients with HPI have a higher risk of developing SRMD in a general adult population.MethodsThe study cohort enrolled 9,393 patients who were initially diagnosed with HPI between 2000 and 2013. Notably, 37,572 age- and sex-matched controls without prior HPI were selected as the reference. A Cox proportional hazard regression analysis was performed for multivariate adjustment.ResultsPatients with HPI had a higher risk of developing SRMD (adjusted hazard ratio [HR] = 2.18, 95% confidence interval [CI] = 1.26–3.82, p < 0.01). Patients with HPI aged ≥65 years exhibited the highest risk (HR = 3.01, 95% CI = 1.90–5.30, p < 0.001), followed by patients aged 45–64 years (HR = 1.69, 95% CI = 1.26–2.90, p p < 0.01). Patients were most likely to develop SRMD 5 years or more after diagnosis of HPI (HR = 3.33, 95% CI = 1.97–5.89, p < 0.001). The increased risk of SRMD in male patients with HPI (HR = 2.73, 95% CI = 1.53–4.79, p < 0.001) was greater than in female patients (HR = 1.14, 95% CI = 1.04–1.65, p < 0.05).ConclusionPatients with HPI were associated with an increased risk for SRMD, with a higher risk in men, aged ≥65 years, and diagnosed for more than 5 years.

Objective The two-way relationship between periodontitis and diabetes was advocated far past. However, the population-based bidirectional observation is still limited. Using the National Health Insurance Research Database of Taiwan, we estimate associations between pre-existing clinical periodontitis and incident type 2 diabetes mellitus (T2DM), and between pre-existing diabetes and incident periodontitis, respectively. Methods A total of 11,011 periodontitis patients who underwent periodontal therapy (Pt group) were recruited from 2000 to 2015. After matching by age, sex, and index date, 11,011 periodontitis patients who did not receive treatment (Pwt group) and 11,011 non-periodontitis controls were registered. The outcome of T2DM was traced. Conversely, 157,798 patients with T2DM and 157,798 non-diabetic controls were enrolled, whereas the development of periodontitis was traced. Cox proportional hazards model was performed. Results The patients with periodontitis tended to have a statistically high risk of having diabetes. The adjusted hazard ratio (aHR) was 1.94 [95% CI 1.49–2.63, p p p p p

Dementia is one of neurodegenerative disease without preventive medicine currently. Dextromethorphan (DXM) has been reported to reduce neuronal damage and neurodegeneration in animal and human models. The effect of DXM on the dementia has not been fully examined. We examined the medical records over 40 years old in Taiwan’s National Health Insurance Research Database between 2000 and 2015 to establish matched cohorts. We used a Cox regression hazard model to identify risk factors of dementia during 16 years of follow-up, and the results indicate that a significantly lower percentage of subjects with DXM use ( P < .001) developed dementia compared with those without DXM use (11.38%, 4541/39 895 vs 18.66%, 29 785/159 580). After adjustment for age and other variables [adjusted hazard ratio: .567 (95% confidence interval: .413-.678, P < .001)], this study also demonstrated that DXM use appeared to reduce the risk of developing dementia. DXM use may potentially provide a protective effect against dementia.

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.

Jen-Ta Shih,1,2 Tsu-Te Yeh,1 Pei-Hung Shen,1 Chih-Chien Wang,1 Sheng-Hao Wang,1 Wu-Chien Chien,3– 6 Chi-Hsiang Chung,3– 5 Chia-Chun Wu1 1Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 2Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; 3School of Public Health, National Defense Medical Center, Taipei, Taiwan; 4Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 5Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; 6Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, TaiwanCorrespondence: Chia-Chun WuDepartment of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu Dist, Taipei City, 11472, TaiwanTel +886-953-086-492Fax +886-2-8792-7186Email orthopedicsintsgh@gmail.comPurpose: With recent advances in surgical techniques and instruments, orthopedic surgeons are better equipped to treat metastatic bone disease. There has also been considerable progress in the non-surgical treatment of cancers, specifically in improving the survival rate of patients with advanced cancer. However, it remains unclear whether surgical resection of a metastatic bone lesion poses additional risk to the survival of patients with advanced cancer.Patients and Methods: This study utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2015. Patients aged ≥ 18 years, who had been recently diagnosed with bone metastases (BM), were enrolled and assigned to either the surgery or non-surgery groups. The demographic characteristics were analyzed, and the adjusted hazard ratios (aHR) of mortality were calculated using Cox regression analysis.Results: Of the 4,549,226 individuals in the inpatient database of the NHIRD, 83,536 patients with BM were enrolled in this study. Among them, 8802 underwent surgical resection for skeletal metastatic lesion and 66,098 did not. Altogether, 28,691 patients died, including 2798 (31.8%) in the surgery group and 25,893 (39.2%) in the non-surgery group. The aHR for mortality was 0.7-fold lower in the surgery group (p < 0.001).Conclusion: This study demonstrates that surgical resection of metastatic bone lesions did not pose any additional risk to survival outcomes. Thus, we believe that surgery, if indicated, could have a competitive role in the management of metastatic bone disease.Keywords: bone metastasis, surgical resection, mortality, bone resorption inhibitor

Yi-Jen Huang,1,2 Senyeong Kao,1,3 Li-Ting Kao,1,3– 5 Chih-Feng Chian,6 Chi-Hsiang Chung,3,7 Wu-Chien Chien,1,3,7,* Kwua-Yun Wang1,8,9,* 1Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; 2Department of Nursing, University of Kang Ning, Taipei, Taiwan; 3School of Public Health, National Defense Medical Center, Taipei, Taiwan; 4Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; 5School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri‐Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 7Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 8School of Nursing, National Defense Medical Center, Taipei, Taiwan; 9Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Wu-Chien ChienDepartment of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, Republic of ChinaTel +886-2-87923311, Ext. 19189Fax +886-2-87927235Email chienwu@ndmctsgh.edu.twKwua-Yun WangGraduate Institute of Life Sciences, National Defense Medical Center, 9314R, No. 161, Section 6, Min-Chuan East Road, Neihu District, Taipei City, 11490, TaiwanTel +886-2-87923100 ext.18766Email kywang7@vghtpe.gov.twPurpose: The role of statins as anti-inflammatory drugs in chronic obstructive pulmonary disease (COPD) is controversial. This study aimed to determine the efficacy of statins used with or without corticosteroids in COPD patients.Patients and Methods: This was a retrospective cohort study and used the two million outpatients and inpatients in Taiwan’s Longitudinal Health Insurance Database covering 2000 to 2015. A total of 92,460 patients were identified in this study. We divided COPD patients into four groups by auditing each patient’s medication (statins used or not; corticosteroids used or not) and used Cox regression to analyze and compare the effects of statins in COPD patients with or without corticosteroids.Results: In terms of all COPD patients, our findings were consistent with previous studies showing that statins decreased COPD-related hospitalization and mortality rates. However, the beneficial effects were only observed in younger patients or those not taking corticosteroids in further analysis. Statins significantly decreased hospitalization and mortality rates in the non-corticosteroids groups. The hazard ratios increased with age and were not statistically significant for patients > 70 years old. Statins did not significantly decrease ED visits, hospitalization, and mortality in corticosteroids groups.Conclusion: Statins decreased hospitalization and mortality rates in COPD patients not taking corticosteroids but were not efficacious in patients on corticosteroids therapy. Furthermore, the beneficial effects of statins gradually decreased with patient age. Based on the findings, statins used in COPD patients may need to consider the patient age and corticosteroids used or not.Keywords: COPD, exacerbation, statins, corticosteroids, mortality

Objective: to investigate whether persistent depressive disorder (PDD) affects sleep disorders (SDs) and increased suicide risk. Methods: in this study, we used the National Health Insurance Research Database (NHIRD) to select 117,033 SD patients, of whom 137 died by suicide, and 468,132 non-SD patients, of whom 118 died by suicide, and analyzed gender, age, and co-existing diseases. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using a multivariate Cox proportional hazards model. Results: the hazard ratio of suicide in SD patients was 1.429 times that of non-SD patients. The hazard ratio of suicide in female patients was 1.297 times higher than in males. Compared with people without PDD, people with PDD had a 7.195 times higher hazard ratio for suicide than those without PDD. PDD patients with SDs had a 2.05 times higher hazard ratio for suicide than those with no SDs. Conclusions: suicide risk was increased in SD patients, and the maximum suicide risk was greater in SD patients with PDD than in non-PDD patients. PDD affected SDs and increased suicide risk. Clinicians should be aware of the possibility that PDD affects patients with SDs and contributes to suicide risk.

Tsan-Min Wang,1,2 Cheng-Hao Chou,1,2 Yi-Liang Lee,3,4 Chi-Hsiang Chung,1,5,6 Yao-Ching Huang,1,7 Xiao-Cheng Lai,8 Chien-An Sun,9,10 Chieh-Yi Kang,11 Gwo-Jang Wu,1,3,12 Wu-Chien Chien1,5,6,8 1Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan; 2Taipei Municipal Jianguo High School, Taipei, Taiwan; 3Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; 4Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China; 5School of Public Health, National Defense Medical Center, Taipei, Taiwan; 6Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan; 7Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, Taiwan; 8Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; 9Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China; 10Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China; 11Chi Mei Medical Center Gynecologic Oncologist Division, Department of Obstetrics & Gynecology, Tainan City, Taiwan, Republic of China; 12Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, TaiwanCorrespondence: Gwo-Jang Wu; Chieh-Yi Kang, Email gwojang@yahoo.com; albert0113@yahoo.com.twObjective: Previous studies have shown an increased in psychiatric disorders in women with disorders associated with hyperandrogenism, but few nationwide cohorts have studied this phenomenon. Therefore, this study is aimed to examine the association between the clinical manifestations of hyperandrogenism and subsequent psychiatric disorders.Methods: Based on the National Health Insurance Research Database, 49,770 enrolled participants were matched for age and index date between January 1, 2000, and December 31, 2015. Hirsutism, polycystic ovary syndrome, and acne are characterized by hyperandrogenism. After adjusting for confounding factors, we used Cox proportional analysis to compare the risk of psychiatric disorders during the 16 years of follow-up.Results: Of all the participants, 1319 (13.25%) had psychiatric disorders in the study group, whereas only 3900(9.80%) had psychiatric disorders in the control group. After adjusting for age, and monthly income, the Cox regression analysis showed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.004, 95% confidence interval [CI] = 1.327– 2.724, P < 0.001). The results demonstrated that women aged 20– 29 years had a more significant risk.Conclusion: Women with clinical characteristics of hyperandrogenism have a higher risk of developing psychiatric disorders, especially those aged 20– 29 years.Keywords: hyperandrogenism, psychiatric disorders, national health insurance research database, cohort study, women, Taiwan

Performing esophagogastroduodenoscopy (EGD) in recently occurring peri-coronary artery disease (CAD) accident settings is always a dilemma. This study used the Taiwan National Health Insurance Research Database to identify patients with CAD and gastrointestinal bleeding who had received EGD or not between 2000 and 2013.The final population included in this study was 15,147 individuals, with 3801 individuals having received EGD (study cohort group) and 11,346 individuals not having received EGD (comparison cohort group). We initially performed a sensitivity test for CAD recurrence-related factors using multivariable Cox regression during the tracking period. A relatively earlier EGD intervention within one week demonstrated a lower risk of CAD recurrence (adjusted HR = 0.712). Although there were no significant differences in the overall tracking period, the adjusted HR of CAD recurrence was still lower in patients in the EGD group. Furthermore, our findings revealed that there were no remarkably short intervals to CAD recurrence in the study group. The Kaplan–Meier survival curve demonstrated that individuals who underwent EGD were not associated with a significantly increased CAD recurrence rate compared with the control (Log-rank test, p = 0.255). CAD recurrence is always an issue in recent episodes of peri-CAD accident settings while receiving EGD. However, there is not a higher risk in comparison with the normal population in our study, and waiting periods may not be required.