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Objectives: Whether tinnitus is associated with pre-existing hypertension remains uncertain. This study explored the association between tinnitus and pre-existing hypertension., Methods: We obtained data on a retrospective cohort of 542 884 cases ≥18 years old with a first-time tinnitus diagnosis from Taiwan's National Health Insurance Research Database. We used propensity-score matching to select 542 884 matched controls and performed multiple logistic regression analyses to estimate the adjusted odds of prior hypertension among patients with tinnitus versus controls., Results: Bivariate analysis showed no significant difference in the prevalence of prior hypertension between the tinnitus and no-tinnitus groups (35.58% vs 35.5%, P  = .617). Univariable logistic regression analysis confirmed the bivariate analysis finding, unadjusted odds of prior hypertension among the tinnitus group relative to controls, 1.002, 95% CI: 0.994-1.010, P  = .617). After adjusting for age, sex, monthly income, geographic location and urbanization level, hyperlipidemia, diabetes, hearing loss, obesity, anemia, rheumatoid arthritis, alcohol abuse, nicotine dependence, anxiety disorder, depressive disorder and idiopathic intracranial hypertension, the odds of prior hypertension were similar among the tinnitus and no-tinnitus groups (OR = 1.006, 95% CI: 0.997-1.016, P  = .178)., Conclusions: Our population-based study found no evidence for an association between tinnitus and pre-existing hypertension.

COVID-19 has dramatically altered daily life worldwide, with some urban residents resorting to panic buying at the beginning of the pandemic. Large-scale lockdowns and restaurant closures have increased the need for grocery shopping. Such shifts in consumer patterns have altered supply-demand systems. Insufficient food store availability increases the likelihood of crowding and thus increases the probability of viral infection. People who live without easy access to food stores also face high infection risks when forced to travel long distances for grocery shopping. The COVID-19 pandemic has demonstrated the importance of the number and distribution of food stores to virus transmission. Food access is also a core factor of urban resilience during the pandemic. This study used the Gini coefficient to investigate the fairness of accessibility to food stores at the city and village levels, with Taipei City chosen as the research area. Different spatial scales were considered, and we calculated the equality of food access for older (≥65 years old) and non-older populations separately to determine whether one group faces greater inequality. At the city level, both older and non-older populations in Taipei have reasonable access (Gini coefficient between 0.3 and 0.4), with mean Gini coefficients of 0.3616 and 0.3655, respectively. This city-level analysis represents the overall degree of unequal access to food stores. At the village level, eight villages (1.8 %; total N  = 456) had severe access inequality (Gini coefficient > 0.6) for older adults; they are located primarily in downtown or suburban areas. For the non-older population, only two villages (0.4 %; total N  = 456) in suburban areas exhibit severe access inequality. The village-level analysis identified villages with low equality of access to food stores and revealed local problems that cannot be observed at the city level., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Elsevier Ltd. All rights reserved.)

Background: Tinnitus causes emotional stress that can be extreme, bringing on anxiety, depression, or sleep disorders. We used a nationwide, population-based database to study the risk of attempted suicide among adults with tinnitus., Methods: Data for this retrospective cohort study were extracted from the Taiwan National Health Insurance Research Database, on 386,055 patients with tinnitus and propensity score-matched controls. We performed Cox proportional hazards regression analysis to calculate the one-year hazard of a suicide attempt and 95 % confidence intervals (CI) following a first-time diagnosis of tinnitus., Results: The results shows that the incidence of attempted suicide was 0.253 (95 % CI = 0.237-0.269) and 0.123 (95 % CI = 0.113-0.135) for the study cohort and comparison cohort, respectively. The log-rank test suggested that the study cohort had significantly lower suicide attempt-free survival at one year than the comparison cohort (p < 0.001). Cox proportional analysis shows that the hazard ratio of attempted suicide within the one-year follow-up period was 2.04 (95 % CI = 1.83-2.28) for patients with tinnitus than those in the comparison cohort after adjusting for the patients' age, sex, monthly income, geographic region, urbanization level of the patient's residence, hyperlipidemia, diabetes, coronary heart disease, and hypertension., Limitations: The database lacks information on socioeconomic problems, specific personal characteristics or traits, marital status, or other factors associated with attempts to commit suicide. Notably, our study addressed suicide attempts as detected from claims-based ICD codes which do not cover suicidal ideation or suicidal death., Conclusions: We found increased likelihood of attempted suicide among patients with tinnitus., Competing Interests: Conflict of interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This population-based, case−control study aims to explore the relationship between prior tinnitus and the occurrence of chronic kidney disease (CKD) using a nationwide, population-based cohort study. We used data from the Taiwan National Health Insurance Research Database to explore the association of CKD with tinnitus. We identified 15,314 patients aged ≥40 years old with a first-time diagnosis of CKD as the cases. We used propensity-scored matching to select 45,942 controls (1:3 ratio). We performed multivariate logistic regression to estimate the odds ratio (OR) of a prior tinnitus diagnosis among the CKD group vs. the control group. Analysis showed that 770 (1.26%) out of the 61,256 sampled patients had previously diagnosed tinnitus. Chi-square testing revealed a significant difference in the rate of previously diagnosed tinnitus between cases and controls (3.86% vs. 0.93%, p < 0.001). Univariate logistic regression analysis showed an OR of prior tinnitus for cases of 10.249 (95% confidence interval (CI): (8.662~12.126)) relative to controls. In adjusted analysis, cases were more likely than controls to have a prior diagnosis of tinnitus (OR = 10.970, 95% CI = 9.255~13.004, p < 0.001) after adjusting for age, sex, monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and autoimmune disease. Our study shows that CKD patients have a higher likelihood of having suffered from tinnitus before CKD was diagnosed, but we have no data suggesting that tinnitus is a predictor of subsequent CKD. Patients diagnosed with tinnitus may benefit from proactive measures to prevent CKD and detect it early through lifestyle modifications and regular renal function examinations, regardless of CKD-related symptoms.

Central line-associated bloodstream infections are frequent, deadly, costly, and preventable. The study aimed to explore how some hospital-related characteristics were associated with incidence rates of central line-associated bloodstream infections reported by community hospitals in California from January to December 2019. This retrospective, cross-sectional study used combined data from records submitted to the California Department of Public Health, California Open Data Portal, the California Health and Human Services Open Data Portal, and the American Hospital Directory by community hospitals in California with central line-associated bloodstream infections in 2019. Results showed that CLABSIs are significantly associated with bed capacity, health care system affiliation, ownership, and hospital accreditation status (p < 0.0001). CLABSI remains a relevant threat to patient safety and quality of care, even more so in the community hospital setting. Understanding if a relationship exists between institutional factors and CLABSI rates might better prepare leaders in healthcare organizations to reduce HAIs., Competing Interests: The authors have declared that no competing interests exist.

Objective: This study aimed to investigate the association of prior hearing loss with land transport accidents using a nationwide population-based dataset., Design: A case-control study., Study Sample: Data for this study were obtained from Taiwan's National Health Insurance Dataset. We retrieved data on 2066 patients who had received a diagnosis of a land transport accident as cases. We used a propensity score-matched method to select 6198 controls., Results: A Chi-squared test revealed that there was a significant difference in the prevalence of prior hearing loss between cases and controls (6.8% vs. 5.6%, p  = 0.046). The odds ratio (OR) of prior hearing loss for cases was 1.128 (95% confidence interval [CI]: 1.003 ∼ 1.503) compared to controls. After adjusting for demographic variables and comorbidities, the OR of hearing loss for cases was 1.238 (95% CI: 1.008 ∼ 1.522) that of controls., Conclusions: Our finding suggests that pre-existing hearing loss may be associated with land transport accidents among adults aged 50 years and older. Further study is needed to elucidate the mechanism(s) through which hearing loss may contribute to land transport accidents and examine how the use of hearing rehabilitation devices, for example, hearing aids impacts the observed associations.

Prior studies suggest a possible association between thyroid disease and the subsequent development of age-related macular degeneration (AMD), although it remains inconclusive. This study aimed to evaluate the association of AMD with prior hyper-/hypothyroidism based on nationwide population-based data. We retrieved records of the study patients from the National Health Insurance Research Database, 7522 patients with a first-time diagnosis of AMD and 7522 propensity score-matched controls. Multiple logistic regression analyses were performed to explore the association of neovascular AMD with previously diagnosed hyperthyroidism or hypothyroidism. The Chi-square test shows that there was a statistically significant difference in the prevalence of prior hyperthyroidism between cases and controls (1.18 vs. 0.13%, p < 0.001). Furthermore, there was a statistically significant difference the prevalence of prior hypothyroidism between cases and controls (0.44 vs. 0.69%, p < 0.001). Multiple logistic regression analysis reveals that AMD was statistically and significantly associated with prior hyperthyroidism after adjusting for age, sex, monthly income, geographical location, urbanization level, hypertension, hyperlipidemia, diabetes, and coronary heart disease (odds ratio (OR) = 9.074, 95% CI = 4.713−17.471). The adjusted OR of prior hypothyroidism in patients with AMD was 3.794 (95% CI: 2.099~6.858) when compared to the controls. We conclude that patients with thyroid dysfunction are at higher risk of developing AMD Results suggest that these patients could benefit from proactive regular eye checkups to detect evolving eye pathology, even while vision remains normal during the initial phases.

Prcis: This study aims to investigate the association between primary open-angle glaucoma (POAG) and tinnitus. We found that tinnitus was significantly associated with preexisting POAG [adjusted odds ratio (OR)=1.298]., Purpose: The purpose of this study was to investigate the association between POAG and tinnitus using nationwide population-based data from Taiwan., Methods: Data for this case-control study were retrieved from the Taiwan National Health Insurance Research Database for all 542,682 patients with a first-time diagnosis of tinnitus (cases), and 1,628,046 propensity score-matched controls from Taiwan's National Health Insurance system. We performed multiple logistic regression analysis to estimate the odds (ORs) of prior POAG among cases versus controls., Results: Of total 2,170,728 study patients, 85,257 (3.93%) had POAG before the index date of tinnitus, 25,496 (4.70%) among cases and 59,761 (3.67%) among controls (P<0.001). Multiple logistic regression analysis showed a significant association between prior POAG and tinnitus (OR=1.298, 95% confidence interval: 1.278-1.318) after adjusting for age, sex, monthly income, geographic location and residential urbanization level, hyperlipidemia, diabetes, obesity, anemia, rheumatoid arthritis, alcohol abuse, nicotine dependence, anxiety disorder, depressive disorder, and hypertension., Conclusions: Patients with POAG have a higher risk of tinnitus compared with those without the disease. Ophthalmologists should be aware of this association and further studies are needed to understand underlying mechanisms., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

A few population-based studies have reported an association between prior age-related macular degeneration and senile dementia. No study has explored a possible link between prior macular degeneration and young-onset dementia (YOD). This case-control study aimed to evaluate the association of YOD with prior macular degeneration diagnosed in the 5-year period before their index date. Data for this retrospective observational study were retrieved from Taiwan's National Health Insurance (NHI) dataset. A total of 36,577 patients with newly diagnosed YOD from January 2010 to December 2017 were identified as the study cohort, assigning their diagnosis date as their index date. Comparison patients were identified by propensity score-matching (three per case, n = 109,731 controls) from the remaining NHI beneficiaries of the period, their index date being the date of their first ambulatory care claim in the year of diagnosis of their matched YOD case. Chi-square test revealed no significant difference in the prevalence of prior macular degeneration between cases and controls (1.1% vs. 1.0%, p = 0.111). Conditional logistic regression analysis also showed an unadjusted odds ratio (OR) for prior macular degeneration of 1.098 among cases relative to controls (95% CI: 0.9797-1.232). Adjusted analysis confirmed that YOD was not associated with prior macular degeneration, adjusted odds ratio 1.098 (95% CI = 0.979-1.232). We conclude that patients with macular degeneration are not at increased risk for YOD.

Purpose: Few studies have explored population-based incidence rates of microtia using nationwide data. The aim of this study was to analyze the 10-year secular trends in the incidence of microtia and/or anotia in Taiwan from 2008 to 2017 using nationwide population-based data., Methods: Patient data were retrieved from Taiwan's National Health Insurance Dataset, after identifying 1152 children aged ≤ 1 year with a first-time diagnosis of microtia or anotia between January 2008 and December 2017. The annual microtia-anotia incidence rate was the sum of new microtia-anotia cases in a year divided by total infant population in the year. Furthermore, we used the annual percent change (APC) to study the secular trend in microtia-anotia incidence rate., Results: The annual incidence rate of microtia-anotia averaged across the 10-year period was 57.7 per 100,000 infants (standard deviation = 8.6). The annual incidence rates of microtia and anotia were 53.3 and 4.4 per 100,000 infants, respectively, during this period. Furthermore, female infants had a higher incidence than males (63.3 vs. 52.4 per 100,000). The incidence of microtia-anotia gradually decreased between 2008 and 2017 with an APC of - 5.64% (95% CI - 9.31 ~ - 1.18%, p = 0.004). Since 2011, females had a significantly higher annual incidence rate of microtia-anotia than males., Conclusions: The incidence of microtia-anotia was 57.7 per 100,000 infants in Taiwan, which declined during the study period 2008-2017. The female-to-male incidence ratio was 1.21:1., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Clinical care during labor and childbirth is important, however understanding women's preferences and experiences have become more important in assessing quality health care delivery and maternity services utilization. Knowledge on women's satisfaction will be one of the important steps towards solving maternal and child health problems faced in Swaziland. The aim of the study was to determined maternity experiences and women's demographic characteristics that affect perceived satisfaction with maternity care at a regional hospital in Swaziland. A cross sectional survey using structured interview questionnaire was used to obtain data from 198 women who had a normal childbirth during their postnatal hospital stay. One-way ANOVA and t-test were used to examine association between variables and stepwise multiple linear regression analysis was conducted to identify predictors of satisfaction. The final model indicated that respecting women's description of pain/discomfort, staff kindness, gender of birth assistant, never being alone during labor and woman's education level determined satisfaction with maternity experience, explaining 44.6% of the variation in maternity satisfaction (F= 30.932, p <.001). The study findings show the importance of provider related factors (interpersonal aspect of care, gender of provider) and consideration of woman's education on satisfaction with care during intrapartum and postpartum.

With many previous studies indicating a higher prevalence of sexual problems in patients with tinnitus, the association between tinnitus and erectile dysfunction (ED) has become an interesting topic that warrants further research. In our study, we hypothesized that tinnitus may be associated with ED and aimed to further explore the relationship between these two medical conditions using a nationwide population-based database. After retrieving data of 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls) from Taiwan's National Health Insurance Dataset, we defined the diagnosis date (the date of the first ED claim) for patients with ED as the index date for cases, and the date of the first utilization of ambulatory care by patients without ED during the index year of their matched case as the index date for controls. We found that 1247 out of 38,658 sampled patients (3.23%) had received a tinnitus diagnosis within the year before the index date, with 792 (4.10%) from cases and 455 (2.35%) from controls. We then utilized multiple logistic regression analysis and observed that cases were more likely to have had a prior tinnitus diagnosis compared to controls (OR 1.772; 95% CI 1.577-1.992; p < 0.001). Lastly, we adjusted the data for co-morbid medical disorders and social economic factors, with the end results showing that cases were more likely than controls to have a prior diagnosis of tinnitus (OR 1.779, 95% CI 1.582-2.001, p < 0.001). Through our investigation, we have ultimately detected a novel association between ED and tinnitus and urge physicians to be alert to the possibility of the development of ED in patients treated for tinnitus.

Objectives/hypothesis: This study aimed to evaluate the prevalence of peripheral vestibular disorders in an Asian population of predominantly Han Chinese ethnicity., Study Design: Cross-sectional study., Methods: Patients with a peripheral vertigo disorder were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of 2 million enrollees of Taiwan's National Health Insurance system covering over 99% of Taiwan's citizens. In 2016, 59,986 patients received a diagnosis of peripheral vestibular disorders in Taiwan. We calculated the population-wide prevalence rates of peripheral vestibular disorders in 2016 by sex and age group (20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, and ≥ 70 years) stratified into five urbanization levels., Results: The prevalence rate of peripheral vestibular disorders was 2,833.4 per 100,000 population during the year. Prevalence of Meniere's disease was 70.4 per 100,000, benign paroxysmal positional vertigo, 446.4, vestibular neuritis 307.2, and other or unspecified peripheral vestibular dizziness, 2,009.5 per 100,000. Prevalence rates steadily increased with age for every type of peripheral vestibular disorder, and were higher among females compared to males. The female-to-male gender ratios were 1.84, 1.89, and 1.93 for Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, respectively. Counties with the lowest urbanization level had the highest prevalence rates of all types of peripheral vestibular disorders except vestibular neuritis., Conclusions: Results showed that peripheral vestibular disorders are common in Taiwan, increase with age, are predominantly female, and show higher prevalence in rural areas., Level of Evidence: 2b Laryngoscope, 131:639-643, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: This population-based study aimed to study the association between tinnitus and cervical spondylosis., Design: A case-control study., Study Sample: We retrieved data from the Taiwan Longitudinal Health Insurance Database. We identified 2465 patients with tinnitus (cases) and 7395 comparison patients by propensity score matching. Multivariable logistic regressions were conducted to estimate the odds (OR) of a diagnosis of cervical spondylosis preceding the tinnitus diagnosis relative to controls., Results: We found that 1596 (16.19%) of 9860 sample patients had received a diagnosis of cervical spondylosis before the index date, significantly different between the tinnitus group and control group (17.20% vs. 15.85%, p  < 0.001). Logistic regression analysis showed an adjusted OR for prior cervical spondylosis of 1.235 for cases vs. controls (95% confidence interval [CI]: 1.088-1.402). Further, the adjusted ORs were 1.246 (95% CI: 1.041-1.491) and 1.356 (95% CI: 1.016-1.811), respectively, among patients aged 45 ∼ 64 and >64 groups. No difference in cervical spondylosis likelihood between cases and controls was found among patients aged 18 ∼ 44 groups., Conclusions: In conclusion, the study shows a positive association between cervical spondylosis and tinnitus. The findings call for greater awareness among physicians about a possible somatosensory component of cervical spine function which may contribute to tinnitus.

Objectives/hypothesis: This study aimed to assess the association of prior cervical spondylosis (CS) with peripheral vertigo., Study Design: Case-control study., Methods: Data were retrieved from the Taiwan Longitudinal Health Insurance Database. A total of 2,570 patients who were newly diagnosed with peripheral vertigo were identified. We compared them with a 3:1 ratio of propensity score-matched patients, 7,710 comparison patients from the same dataset. We performed multivariate logistic regressions to estimate the odds ratio for prior CS occurrence among peripheral vertigo patients versus controls., Results: Of 10,280 sample patients, 1,739 (16.92%) patients had CS prior to the index date. A significant difference in prior CS between peripheral vertigo patients and controls (19.49% vs. 16.06%, P < .001) was observed. Logistic regression analysis shows that the odds of prior CS was 1.285 for peripheral vertigo patients versus controls (95% confidence interval [CI]: 1.143-1.446) after adjusting for age, sex, urbanization level, monthly income, geographic region, hyperlipidemia, diabetes, coronary heart disease, hypertension, and asthma. Prior CS with myelopathy was not associated with peripheral vertigo. Stratified analysis by age showed that the odds of CS were highest among patients with peripheral vertigo in the 45- to 64-year-old age group (1.442, 95% CI: 1.215-1.712)., Conclusions: CS is associated with subsequent peripheral vertigo in the Taiwan population, with higher risk among those aged 45 to 64 years., Level of Evidence: 2b Laryngoscope, 131:E625-E630, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To investigate the changing indications for corneal transplantations in southern Taiwan from 2008 to 2018 and compare the results with those of other previous studies., Methods: We retrospectively reviewed the records of patients who underwent corneal transplantations from January 2008 to December 2018 at Kaohsiung Veterans General Hospital. The patients' age, sex, indication for corneal transplantation, and the surgical technique were recorded and analyzed., Results: In total, 336 patients (421 eyes) were included in our study from January 1, 2008, to December 31, 2018. The mean age was 63.6±15.3 years; 371 penetrating keratoplasty (88.1%), 35 deep anterior lamellar keratoplasty (8.3%), and 15 Descemet-stripping automated endothelial keratoplasty (3.6%) were performed. The leading indication for corneal transplantation was regraft (n=103, 24.5%), followed by bullous keratopathy (n=82, 19.5%), corneal scar and opacity (n=79, 18.8%), keratitis (n=59, 14.0%), corneal dystrophy (n=58, 13.8%), other indications (n=26, 6.2%), and keratoconus (n=14, 3.3%)., Conclusion: The indications for corneal transplantations changed with time in Taiwan. Regraft was the leading indication, but there was a decreasing trend over time. The proportion of bullous keratopathy increased significantly over the past decade and is the second most common indication, similar to the most developed countries. Both corneal scar and opacity, and keratitis showed a decreasing trend of occurrence compared with a previous study in Taiwan. The proportion of keratoconus remained low, making it the least common indication for corneal transplantation.

Bone implants with surface modifications that promote the physiological activities of osteoblasts are the first step for osseointegration in bone repair. Hydroxyapatite is the main inorganic component in mammal bones and teeth, and nanoscaled hydroxyapatite promotes the adhesion of osteoblastic cells. In this study, we created a nano/micro hierarchical structure using micro-arc oxidation coatings and hydrothermal treatments at 150 °C, 175 °C, and 200 °C for 2, 6, 12, and 24 h. After undergoing hydrothermal treatment for 24 h, CaTiO 3 began forming regular-shaped crystals at the surface at 175 °C. In order to decrease the CaTiO 3 formations and increase the apatite fabrication, a shorter time of hydrothermal treatment was required at 175 °C. There was still surface damage on samples treated for 6 h at 175 °C; however, the nano/micro hierarchical structures were formed in 2 h at 175 °C. The normalized alkaline phosphatase (ALP) activities of the MC3T3-E1 cells with micro-arc oxidation (MAO) coatings and nano/micro hierarchical bioceramics coatings were 4.51 ± 0.26 and 7.36 ± 0.51 μmol p-NP/mg protein (*** P value of <0.001), respectively. The MC3T3-E1 cells with coatings showed highly statistically significant results in terms of the ALP activity. This proposed nano/micro hierarchical structure promoted cell proliferation and osteogenic differentiation of the osteoblast MC3T3-E1 cells. This study realized a promising nano system for osseointegration via bone implant surface treatments, which can promote the physiological activities of osteoblasts.

Objective: The objective of this study was to examine the impact of urban landscape from window views on quality of care for women who underwent Cesarean Section (C-section) in Taiwan., Design: The participants were randomly assigned into 46 different hospital rooms to see the effects of various window views and daylight exposure on women's recovery from post C-section care., Setting: We carried out this study in the obstetrics departments of three tertiary hospitals located in two major cities of Taiwan: Taipei City and New Taipei City., Participants: A total of 296 women who underwent C-sections and used patient-controlled analgesic (PCA) for pain control after their surgery during the 10-month data collection period were recruited for this study., Intervention: The 46 different patient rooms provided diverse window views and different daylight exposure for the participants., Main Outcome Measures: Recovery for the women who underwent C-sections in this study was defined as PCA usage and perceived pain measured by Brief Pain Inventory (BFI)., Results: Higher satisfaction of window view significantly decreased analgesic usage (P = 0.057), reduced the scores of overall perceived pain (P = 0.046), pain severity (P = 0.004), and 'pain's interference with relations with others, enjoyment of life, and mood (REM).' (P = 0.095)., Conclusions: To maximize benefit and well-being of patients recovering from surgery, health care architects should design patient rooms to create maximum satisfaction with visual impacts and optimize window views. By doing so, it may decrease the use of pain medication and substantially reduce healthcare costs., (© The Author(s) 2019. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Certain viruses have the ability to subvert the mammalian immune response, including interference in the chemokine system. Poxviruses produce the chemokine binding protein vCCI (viral CC chemokine inhibitor; also called 35K), which tightly binds to CC chemokines. To facilitate the study of vCCI, we first provide a protocol to produce folded vCCI from Escherichia coli ( E. coli .) It is shown here that vCCI binds with unusually high affinity to viral Macrophage Inflammatory Protein-II (vMIP-II), a chemokine analog produced by the virus, human herpesvirus 8 (HHV-8). Fluorescence anisotropy was used to investigate the vCCI:vMIP-II complex and shows that vCCI binds to vMIP-II with a higher affinity than most other chemokines, having a K d of 0.06 ± 0.006 nM. Nuclear magnetic resonance (NMR) chemical shift perturbation experiments indicate that key amino acids used for binding in the complex are similar to those found in previous work. Molecular dynamics were then used to compare the vCCI:vMIP-II complex with the known vCCI:Macrophage Inflammatory Protein-1β/CC-Chemokine Ligand 4 (MIP-1β/CCL4) complex. The simulations show key interactions, such as those between E143 and D75 in vCCI/35K and R18 in vMIP-II. Further, in a comparison of 1 μs molecular dynamics (MD) trajectories, vMIP-II shows more overall surface binding to vCCI than does the chemokine MIP-1β. vMIP-II maintains unique contacts at its N-terminus to vCCI that are not made by MIP-1β, and vMIP-II also makes more contacts with the vCCI flexible acidic loop (located between the second and third beta strands) than does MIP-1β. These studies provide evidence for the basis of the tight vCCI:vMIP-II interaction while elucidating the vCCI:MIP-1β interaction, and allow insight into the structure of proteins that are capable of broadly subverting the mammalian immune system., Competing Interests: The authors declare no conflict of interest.

A previous study has demonstrated that Danshui River has almost the highest dissolved inorganic nitrogen (DIN) yield in the world and exports most of the DIN in the form of ammonium unlike the world's large rivers. However, the DIN sources are poorly constrained. In this study, the contributions of major sources in the Taipei metropolitan area to the DIN export in the Danshui River were investigated. It is observed that ammonium is the major DIN species in the downstream reaches, resulting from the ammonium-dominated inputs of the effluents of wastewater treatment plants (WWTP) and rain water pumping stations (RWPS). DIN concentrations in the downstream (urban) reaches are substantially elevated. The upstream tributaries annually discharge ∼2709 t DIN to the downstream reaches. However, the DIN discharge off the downstream reaches rises to ∼17,918 t, resulting from the contribution of RWPS-collected water, i.e., ∼14,632 t, and the effluents of two WWTP, i.e., ∼577 t. RWPS-collected water inherently contains the contribution of atmospheric deposition, ∼2937 t DIN. This finding implies that ∼11,695 t (∼66 % of the downstream output) DIN flux off the Danshui River is from urban runoff and can be attributed to human activities in the Taipei metropolitan area. To improve the water quality in the Danshui River, water quality controls in urban runoff are important.

Background: Atopic dermatitis (AD) is the single most common allergic disease in children. STAT6 has been noted as a hub molecule in IL-4 mediated response and AD pathogenesis. However, the association between STAT6 genetic variants and childhood AD has never been thoroughly examined., Objective: We investigate the association between STAT6 genetic variants and childhood AD risk in Taiwanese population., Methods: We used data from the Han Chinese in Beijing genome panel of International HapMap Project and the Taiwan Children Health Study cohort to investigate the association of STAT6 genetic variants and childhood AD risks. Four tagged SNPs were selected from HapMap database and rs324011 was most significantly associated with childhood AD. Subsequently, deep sequencing around rs324011 and unconditional/conditional logistic models were applied., Results: rs324011 showed statistical significance for the occurrence of childhood AD (OR: 1.23; 95% CI: 1.01-1.51) and rs167769 showed borderline statistical significance (OR: 1.21; 95% CI: 0.99-1.49). Likelihood ratio tests revealed that haplotypes (rs167769/rs324011) were associated with childhood AD (global p=0.0018). T alleles of two STAT6 intron2 SNPs, rs324011 and rs167769, increased STAT6 promoter activity significantly in luciferase reporter assay., Conclusion: T allele of rs324011 in STAT6 would increase the risk of AD occurrence in children. Haplotypes of rs324011/rs167769 were also significantly associated with childhood AD in Taiwanese population., (Copyright © 2015 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.)

Chemokines play important roles in the immune system, not only recruiting leukocytes to the site of infection and inflammation but also guiding cell homing and cell development. The soluble poxvirus-encoded protein viral CC chemokine inhibitor (vCCI), a CC chemokine inhibitor, can bind to human CC chemokines tightly to impair the host immune defense. This protein has no known homologs in eukaryotes and may represent a potent method to stop inflammation. Previously, our structure of the vCCI·MIP-1β (macrophage inflammatory protein-1β) complex indicated that vCCI uses negatively charged residues in β-sheet II to interact with positively charged residues in the MIP-1β N terminus, 20s region and 40s loop. However, the interactions between vCCI and other CC chemokines have not yet been fully explored. Here, we used NMR and fluorescence anisotropy to study the interaction between vCCI and eotaxin-1 (CCL11), a CC chemokine that is an important factor in the asthma response. NMR results reveal that the binding pattern is very similar to the vCCI·MIP-1β complex and suggest that electrostatic interactions provide a major contribution to binding. Fluorescence anisotropy results on variants of eotaxin-1 further confirm the critical roles of the charged residues in eotaxin-1. In addition, the binding affinity between vCCI and other wild type CC chemokines, MCP-1 (monocyte chemoattractant protein-1), MIP-1β, and RANTES (regulated on activation normal T cell expressed and secreted), were determined as 1.1, 1.2, and 0.22 nm, respectively. To our knowledge, this is the first work quantitatively measuring the binding affinity between vCCI and multiple CC chemokines.

The circadian oscillator of cyanobacteria is composed of only three proteins, KaiA, KaiB, and KaiC. Together, they generate an autonomous ~24-h biochemical rhythm of phosphorylation of KaiC. KaiA stimulates KaiC phosphorylation by binding to the so-called A-loops of KaiC, whereas KaiB sequesters KaiA in a KaiABC complex far away from the A-loops, thereby inducing KaiC dephosphorylation. The switch from KaiC phosphorylation to dephosphorylation is initiated by the formation of the KaiB-KaiC complex, which occurs upon phosphorylation of the S431 residues of KaiC. We show here that formation of the KaiB-KaiC complex is promoted by KaiA, suggesting cooperativity in the initiation of the dephosphorylation complex. In the KaiA-KaiB interaction, one monomeric subunit of KaiB likely binds to one face of a KaiA dimer, leaving the other face unoccupied. We also show that the A-loops of KaiC exist in a dynamic equilibrium between KaiA-accessible exposed and KaiA-inaccessible buried positions. Phosphorylation at the S431 residues of KaiC shift the A-loops toward the buried position, thereby weakening the KaiA-KaiC interaction, which is expected to be an additional mechanism promoting formation of the KaiABC complex. We also show that KaiB and the clock-output protein SasA compete for overlapping binding sites, which include the B-loops on the CI ring of KaiC. KaiA strongly shifts the competition in KaiB's favor. Thus, in addition to stimulating KaiC phosphorylation, it is likely that KaiA plays roles in switching KaiC from phosphorylation to dephosphorylation, as well as regulating clock output., (Copyright © 2013. Published by Elsevier Ltd.)

The most well-understood circadian clock at the level of molecular mechanisms is that of cyanobacteria. This overview is on how solution-state nuclear magnetic resonance (NMR) spectroscopy has contributed to this understanding. By exciting atomic spin-&frac12; nuclei in a strong magnetic field, NMR obtains information on their chemical environments, inter-nuclear distances, orientations, and motions. NMR protein samples are typically aqueous, often at near-physiological pH, ionic strength, and temperature. The level of information obtainable by NMR depends on the quality of the NMR sample, by which we mean the solubility and stability of proteins. Here, we use examples from our laboratory to illustrate the advantages and limitations of the technique.

Interleukin (IL)-13 genetic polymorphisms have shown adverse effects on respiratory health. However, few studies have explored the interactive effects between IL-13 haplotypes and environmental exposures on childhood asthma. The aims of our study are to evaluate the effects of IL-13 genetic variants on asthma phenotypes, and explore the potential interaction between IL-13 and household environmental exposures among Taiwanese children. We investigated 3,577 children in the Taiwan Children Health Study from 14 Taiwanese communities. Data regarding children's exposure and disease status were obtained from parents using a structured questionnaire. Four SNPs were tagged accounting for 100% of the variations in IL-13. Multiple logistic regression models with false-discovery rate (FDR) adjustments were fitted to estimate the effects of IL-13 variants on asthma phenotypes. SNP rs1800925, SNP rs20541 and SNP rs848 were significantly associated with increased risks on childhood wheeze with FDR of 0.03, 0.04 and 0.04, respectively. Children carrying two copies of h1011 haplotype showed increased susceptibility to wheeze. Compared to those without carpet use and h1011 haplotype, children carrying h1011 haplotype and using carpet at home had significantly synergistic risks of wheeze (OR, 2.5; 95% CI, 1.4-4.4; p for interaction, 0.01) and late-onset asthma (OR, 4.7; 95% CI, 2.0-10.9; p for interaction, 0.02). In conclusions, IL-13 genetic variants showed significant adverse effects on asthma phenotypes among children. The results also suggested that asthma pathogenesis might be mediated by household carpet use.

The oscillator of the circadian clock of cyanobacteria is composed of three proteins, KaiA, KaiB, and KaiC, which together generate a self-sustained ∼24-h rhythm of phosphorylation of KaiC. The mechanism propelling this oscillator has remained elusive, however. We show that stacking interactions between the CI and CII rings of KaiC drive the transition from the phosphorylation-specific KaiC-KaiA interaction to the dephosphorylation-specific KaiC-KaiB interaction. We have identified the KaiB-binding site, which is on the CI domain. This site is hidden when CI domains are associated as a hexameric ring. However, stacking of the CI and CII rings exposes the KaiB-binding site. Because the clock output protein SasA also binds to CI and competes with KaiB for binding, ring stacking likely regulates clock output. We demonstrate that ADP can expose the KaiB-binding site in the absence of ring stacking, providing an explanation for how it can reset the clock.

Background: Dampness in the home is a strong risk factor for respiratory symptoms and constitutes a significant public health issue in subtropical areas. However, little is known about the effects of dampness and genetic polymorphisms on asthma., Methods: In 2007, 6078 schoolchildren were evaluated using a standard questionnaire with regard to information about respiratory symptoms and environmental exposure. Multiple logistic regression analyses were performed to assess the effects of home dampness and beta-2-adrenergic receptor (ADRB2) gene polymorphisms on the prevalence of asthma and selected indicators of severity of asthma., Results: The frequency of mildewy odor, the number of walls with water stamp, and the duration of water damage were all associated with being awakened at night due to wheezing. However, no other clear-cut associations were found for any of the other indicators of asthma. Children exposed to mildewy odor with ADRB2 Arg/Arg genotype were associated with being awakened at night due to wheezing (OR=1.95, 95% CI, 1.14-3.36), compared to those without exposure and with the ADRB2 Gly allele. ADRB2 Arg16Gly showed a significant interactive effect with home dampness on being awakened at night due to wheezing and current wheezing, but no significant effect on active asthma and medication use. Frequency and degree of home dampness were also associated with the prevalence of asthma and selected indicators of severity of asthma, in an exposure-response manner among children with ADRB2 Arg/Arg genotype., Conclusions: Home dampness prevention is one of the important steps of asthma control, especially in children carrying ADRB2 Arg/Arg genotypes., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Diabetes is a known risk factor for developing hepatocellular carcinoma (HCC). Reported rates of diabetes are higher in chronic hepatitis, cirrhosis and HCC patients. However, its effects on postoperative recurrence and survival with HCC are controversial. This study offers a retrospective analysis of the impacts of diabetes on postoperative recurrence and survival in patients with cirrhosis and HCC. A total of 389 cirrhotic patients who underwent curative resection for primary HCC at our institution between January 2000 and December 2008 were enrolled. Of them, 272 (70%) patients were classified into a non-diabetes group and 117 (30%) patients into the diabetes group. The diabetes group was divided into an oral hypoglycemic agent (OHA) control group (n = 100) and an insulin control group (n = 17). The result indicates that the diabetes group had a higher postoperative recurrence rate and poorer long-term survival rate (p = 0.001 vs. 0.01). There was no significant difference in recurrence-free survival rate between the OHA control group and the insulin control group (p = 0.17). The insulin control group had a poorer long-term surgical outcome than the OHA control group (p = 0.035). In conclusion, our results suggest that diabetes is an independent risk factor for postoperative recurrence and surgical survival of cirrhotic HCC patients. Cirrhotic HCC patients with diabetes who received hepatic resection should be closely followed-up for postoperative recurrence and long-term outcome. Moreover, an effective peri-operative sugar control planning in HCC patients with diabetes should be established.

Objective: The objective of our study was to assess the association of hospital characteristics and diagnosis with repeated utilization of CT and MRI using the nationwide population-based Taiwan National Health Insurance database., Materials and Methods: All CT and MR examinations for all health care services-including inpatient, outpatient, and emergency services-performed during 2004 and 2005 were identified. Logistic regression using generalized estimating equations was used for multivariate analysis to explore the relationships between hospital characteristics, diagnosis, and the use of CT and MRI repeated within 90 days., Results: A total of 2,152,292 patients underwent CT and MR examinations during the study period, and 21.5% of those patients underwent repeat scanning within 90 days. The medical center had the highest rate of repeat scanning (24.9%) followed by the regional hospital (20.4%) and community hospital (13%). Repeat CT or MRI was most commonly performed of patients with a malignancy (31.8%), a neurologic disorder (24.0%), or a brain or spinal injury (25.3%)., Conclusion: Our study shows that repeat use of CT and MRI within 90 days is high and is related to both diagnosis and hospital characteristics. Although the Taiwanese experience might not apply to all countries, this knowledge should aid in the review of health care policies so that guidelines for repeat scanning may be tailored to the different levels of hospitals (medical centers, 25%; regional hospital, 20%; community hospital, 13%) and to different diseases (malignant neoplasms, 32%; neurologic disorders and brain, neck, or spinal injury, 25%; other entities, 20%) to achieve maximum efficiency within a limited health care budget.

Background: The importance of gene-gene and gene-environment interactions on asthma is well documented in literature, but a systematic analysis on the interaction between various genetic and environmental factors is still lacking., Methodology/principal Findings: We conducted a population-based, case-control study comprised of seventh-grade children from 14 Taiwanese communities. A total of 235 asthmatic cases and 1,310 non-asthmatic controls were selected for DNA collection and genotyping. We examined the gene-gene and gene-environment interactions between 17 single-nucleotide polymorphisms in antioxidative, inflammatory and obesity-related genes, and childhood asthma. Environmental exposures and disease status were obtained from parental questionnaires. The model-free and non-parametrical multifactor dimensionality reduction (MDR) method was used for the analysis. A three-way gene-gene interaction was elucidated between the gene coding glutathione S-transferase P (GSTP1), the gene coding interleukin-4 receptor alpha chain (IL4Ra) and the gene coding insulin induced gene 2 (INSIG2) on the risk of lifetime asthma. The testing-balanced accuracy on asthma was 57.83% with a cross-validation consistency of 10 out of 10. The interaction of preterm birth and indoor dampness had the highest training-balanced accuracy at 59.09%. Indoor dampness also interacted with many genes, including IL13, beta-2 adrenergic receptor (ADRB2), signal transducer and activator of transcription 6 (STAT6). We also used likelihood ratio tests for interaction and chi-square tests to validate our results and all tests showed statistical significance., Conclusions/significance: The results of this study suggest that GSTP1, INSIG2 and IL4Ra may influence the lifetime asthma susceptibility through gene-gene interactions in schoolchildren. Home dampness combined with each one of the genes STAT6, IL13 and ADRB2 could raise the asthma risk.

Background/purpose: The use and cost of computed tomography (CT) and magnetic resonance imaging (MRI) are both very high. The purpose of this study was to evaluate the relation between physicians' characteristics and the CT and MRI repeated within 90 days, using a nationwide population-based data set from Taiwan's National Health Insurance system., Methods: All physicians who ordered CT and MRI examinations in 2004-2005 were identified. We analyzed the total number of CT and MRI scans, the number of repeat scans, and the repeat scan rate, according to physician characteristics (specialty, age, sex, and type of practice hospital). A multivariate logistic regression analysis was performed to explore the adjusted relationship between physician characteristics and their rate of ordering repeat CT and MRI., Results: A total of 16,307 physicians were responsible for a total of 2,152,292 CT and MRI scans during 2004-2005 in Taiwan. The repeat scans accounted for 21.5% of the total scans. Male physicians and physicians aged 41-50 years ordered more repeat scans. Internal medicine physicians ordered 44.3% of all scans and 50.6% of all repeat scans. Surgeons ordered 40.4% of the total scans and 38.5% of repeat scans. Internal medicine physicians were the most frequent users of CT/MRI scans. Family doctors, obstetricians/gynecologists, and pediatricians ranked last among the specialists. Physicians who practiced in medical centers ordered the most CT/MRI scans., Conclusion: Our study shows that repeat use of CT and MRI scans is related to physicians' characteristics. We recommend that different monitoring standards should be set for CT and MRI repeat use by physicians of different specialties and in hospitals of different accreditation levels., (Copyright © 2011. Published by Elsevier B.V.)

In the cyanobacterial circadian oscillator, KaiA and KaiB alternately stimulate autophosphorylation and autodephosphorylation of KaiC with a periodicity of approximately 24 h. KaiA activates autophosphorylation by selectively capturing the A loops of KaiC in their exposed positions. The A loops and sites of phosphorylation, residues S431 and T432, are located in the CII ring of KaiC. We find that the flexibility of the CII ring governs the rhythm of KaiC autophosphorylation and autodephosphorylation and is an example of dynamics-driven protein allostery. KaiA-induced autophosphorylation requires flexibility of the CII ring. In contrast, rigidity is required for KaiC-KaiB binding, which induces a conformational change in KaiB that enables it to sequester KaiA by binding to KaiA's linker. Autophosphorylation of the S431 residues around the CII ring stabilizes the CII ring, making it rigid. In contrast, autophosphorylation of the T432 residues offsets phospho-S431-induced rigidity to some extent. In the presence of KaiA and KaiB, the dynamic states of the CII ring of KaiC executes the following circadian rhythm: CII STflexible → CIISpTflexible → CIIpSpTrigid → CIIpSTvery-rigid → CIISTflexible. Apparently, these dynamic states govern the pattern of phosphorylation, ST → SpT → pSpT → pST → ST. CII-CI ring-on-ring stacking is observed when the CII ring is rigid, suggesting a mechanism through which the ATPase activity of the CI ring is rhythmically controlled. SasA, a circadian clock-output protein, binds to the CI ring. Thus, rhythmic ring stacking may also control clock-output pathways.

Background: To investigate the difference of ocular biometric and corneal topographic characteristics between the two eyes in high anisometropes with difference of 4 D or more in spherical component., Methods: Fifty-one young anisometropic men were collected. Detailed ocular examinations, including cycloplegic autorefraction, best-corrected visual acuity, intraocular pressure, A-scan, and Orbscan topography were done and recorded. The comparisons between two eyes were performed and the correlations between different ocular parameters were evaluated., Results: The mean axial length in the more myopic/less hyperopic eye was longer than that in the less myopic/more hyperopic eye [difference 1.8 mm, 95% confidence interval (CI) 1.6-2.0 mm, p < 0.001]. The mean thinnest corneal thickness in the more myopic/less hyperopic eye was an average of 4.0 μm thicker than that in the other eye (95% CI 1.2-6.8 μm, p = 0.007). The mean anterior chamber depth in the more myopic/less hyperopic eye was an average of 0.05 mm (95% CI 0.02-0.07 mm, p < 0.001) more than that in the other eye. The curvature and size of cornea were not significantly different., Conclusion: The anterior chamber depth is deeper, axial length is longer, and thinnest corneal thickness is thicker in the more myopic/less hyperopic eye of high-anisometropic patients. Anisometropic eyes provide the chance to understand the biometric changes of eyeball with different refractive statuses in the same person. Such information is helpful for us to calculate the intraocular lenses power in cataract surgery and to do the surgical planning for corneal refractive surgery in eyes of different refractive power., (Copyright © 2011. Published by Elsevier B.V.)

Purpose: The aim was to study the association of surgeon age with operative outcomes for primary rhegmatogenous retinal detachment (RRD) in Taiwan., Methods: A total of 7427 adult patients of primary RRD who were treated by 284 ophthalmologists with scleral buckling (SB), pars plana vitrectomy (PPV), or their combination from 2002 to 2004 were identified in the Taiwan National Health Insurance Research Database. The adjusted odds ratios (OR) of 180-day readmission between ophthalmologist age groups were calculated., Results: For SB, patients treated by ophthalmologists aged >or=51 years had a greater 180-day readmission rate (OR=1.44, 95% confidence interval (CI)=1.01-2.07, P<0.05) than those treated by ophthalmologists aged 41-50 years. For PPV, patients treated by ophthalmologists aged or=51 years (OR=0.58 and 0.22, 95% CI=0.47-0.71 and 0.13-0.63, P<0.001 and <0.001, respectively). For PPV+SB, patients treated by ophthalmologists aged >or=51 years had a higher 180-day readmission rate than those treated by ophthalmologists aged or=51-year groups, respectively., Conclusions: Surgeon age is a relatively weak predictor for the outcomes of primary RRD surgery in aggregate in Taiwan and certainly not appropriate for discriminating performance among individual surgeons.

Indoor air quality (IAQ) has begun to surface as an important issue that affects the comfort and health of people; however, there is little research concerned about the IAQ monitoring of hotels up to now. Hotels are designed to provide comfortable spaces for guests. However, most complaints related to uncomfortable thermal environment and inadequate indoor air quality appear. In addition, microbial pollution can affect the health of tourists such as the Legionnaire's disease and SARS problems. This study is aimed to establish the comprehensive IAQ audit approach for hotel buildings with portable equipment, and one five-star international hotel in Taiwan was selected to exam this integrated approach. Finally, four major problems are identified after the comprehensive IAQ audit. They are: (1) low room temperature (21.8 degrees C), (2) insufficient air exchange rate (<1.5 h(-1)), (3) formaldehyde contamination (>0.02 ppm), and (4) the microbial pollution (total bacteria: 2,624-3,799 CFU/m(3)). The high level of formaldehyde may be due to the emission from the detergent and cleaning agents used for housekeeping.

Purpose: We investigated the relationship between physician clinical experience and inappropriate prostate specific antigen testing using a Taiwan nationwide population based data set. We used physician age as a surrogate for general practice experience and the frequency of ordered prostate specific antigen tests as a surrogate for procedure specific experience., Materials and Methods: This study used data sourced from the 2005 Taiwan National Health Insurance Research Database. We extracted all patients who underwent prostate specific antigen tests in 2005 and their corresponding physicians. A total of 24,595 patients and 2,086 physicians were included. Physician age was categorized into 8 age groups of younger than 31, 31 to 35, 36 to 40, 41 to 45, 46 to 50, 51 to 55, 56 to 60 and 60 years or older. Physicians were divided into 4 groups according to the frequency of prostate specific antigen tests ordered in 40 to 75-year-old patients, including low frequency--less than 1 case per 3 months, medium-between 1 in 3 months and 1 per month, high--between 1 per month and 1 per week, and very high--greater than 1 per week., Results: In sampled physicians the mean +/- SD rate of inappropriate prostate specific antigen test use was 30.8% +/- 36.6%. Multiple regression analysis showed that after adjusting for other factors physicians who ordered fewer prostate specific antigen tests (those in the low and medium frequency groups) had a higher rate of inappropriate PSA test use than their counterparts who ordered prostate specific antigen tests with very high frequency (each p <0.001) Furthermore, physicians in the age groups 30 years or younger and 31 to 35 years had higher rates of inappropriate prostate specific antigen testing than their counterparts in the 41 to 45-year-old group (p = 0.019 and 0.010, respectively)., Conclusions: The likelihood of inappropriate prostate specific antigen screening was significantly and negatively associated with physician clinical experience.

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.

Purpose: Using 8 year nationwide administrative data, this study sets out to investigate the relationship between the total number of cataract operations undertaken in Taiwan and admissions for acute primary angle closure (APAC)., Methods: Monthly cataract surgery and APAC admission rates, per 100,000 of the population, were provided by 1997-2004 inpatient and outpatient data obtained from the Taiwanese National Health Insurance Research Database. The 3814 cases of APAC and 503 687 patients who had undergone cataract operations were categorized by age groups (40-49, 50-59, 60-69 and > or =70 years) and by gender. Spearman rank correlation coefficients were used to examine the direction and strength of the relationships., Results: Throughout the study period, the admissions for APAC showed a steady decline from 630 cases in 1997 to 351 cases in 2004, while the number of cataract operations revealed a gradual increase from 26 600 in 1997 to 77 924 in 2004. The Spearman rank correlation coefficients showed significant inverse relationships between monthly APAC admission rates and monthly cataract operation rates for the total group (r = -0.407, P < 0.001), males (r = -0.330, P < 0.001), females (r = -0.444, P < 0.001), 40-49 year olds (r = -0.335, P < 0.001), 50-59 year olds (r = -0.497, P < 0.001) and 60-69 year olds (r = -0.417, P < 0.001). No significant inverse relationship was observed for the > or =70 age group., Conclusion: Significant inverse relationships were noted between the monthly APAC admission rates and the monthly cataract operation rates. We recommend that data should be collected from other regions and ethnic groups to determine the inter-relationships.

Objective: Using nationwide population-based data from Taiwan's National Health Insurance database, we examined the association between hospitals' coronary artery bypass grafting surgery volume and 5-year major adverse cardiovascular events., Methods: We used Taiwan's National Health Insurance claims data linked to the Cause of Death file for the years approximately 1997 to 2004. All 5718 patients who underwent nonemergency coronary artery bypass grafting operations during 1997 through 1999 were classified into one of 4 hospital volume groups: 282 cases or less (low volume, n = 1584 patients), 283 to 517 cases (medium volume, n = 1317), 518 to 725 cases (high volume, n = 1437), and 726 cases or more (very high volume, n = 1380)., Results: Increasing hospital volume is associated with increasing 5-year major adverse cardiovascular event-free survival (72.0%, 75.5%, 76.9%, and 79.4% in low-volume, medium-volume, high-volume, and very high-volume hospitals, respectively). Cox regression analysis shows that increasing hospital volume predicts a systematic decrease in adjusted major adverse cardiovascular event hazard at 5 years. The 5-year major adverse cardiovascular event hazard ratios for high-volume and very high-volume hospitals were 0.884 (95% confidence interval, 0.809-0.965) and 0.811 (95% confidence interval, 0.728-0.904) relative to low-volume hospitals after adjusting for patient demographics and economic status, initial case severity, coronary artery bypass grafting procedure attributes, and hospital characteristics., Conclusions: The findings suggest that high-volume hospitals have some processes, infrastructure/personnel factors, or both that seem to produce not only better short-term outcomes but also better long-term outcomes.

This study aimed to identify distribution of metals and to estimate the amount of these metals that can be potentially recovered from incineration residues. First, the partitioning behavior of Cr, Cu, Fe, Cd, Al, Zn, and Pb in bottom ash and fly ash was investigated in one large municipal waste incinerator in Taiwan. In addition, the material flow analysis (MFA) method was used to estimate the material flux of metals within incinerator plant, and to calculate the amount of metal recovery. According to the findings of this study, six metals (Fe, Al, Cu, Zn, Cr, and Pb) concentrated in bottom ash mostly, while Cd existed primarily in fly ash. The weight percentages of Fe (4.49%), Al (5.24%), Cu (1.29%), Zn (2.21%), and Pb (0.58%) in incinerator ash are high, and even higher than the compositions of natural minerals. Finally, the amount of Cr, Cu, Fe, Cd, Al, Zn and Pb that can be potentially recovered from incineration residues will reach 2.69 x 10(2), 1.46 x 10(4), 4.91 x 10(4), 6.92 x 10(1), 5.10 x 10(4), 1.85 x 10(4) and 4.66 x 10(3) ton/yr, respectively.

Purpose: Recent laboratory evidence indicates that the inflammatory cytokine, interleukin-1 (IL-1), has either protective or adverse effects on primary open angle glaucoma (POAG). Inheritance of the IL-1alpha (-889) polymorphism (the T allele), previously shown to increase IL-1 production, has been associated with an elevated risk of Alzheimer's disease. The neuronal injuries associated with Alzheimer's disease have a number of similarities with the optic nerve changes often seen with POAG. In this report we have explored the possible association between the IL-1alpha (-889) polymorphism and the development of POAG., Methods: Chinese patients with POAG (156) were recruited and compared with 167 healthy chinese controls. Genomic DNA was amplified by polymerase chain reaction, followed by enzymatic restriction fragment length polymorphism technique (PCR-RFLP). Patients and controls were genotyped for the C/T polymorphism at position -889 of the IL-1alpha gene promoter region., Results: The frequency of the IL-1alpha (-889) T allele (21% versus 13%, respectively; p=0.007) and the carriers of the IL-1alpha (-889) T allele (37% versus 25%; p=0.019, OR 1.76, 95%CI 1.1-2.83) were greater in POAG patients compared with controls. There is a higher risk of POAG associated with homozygosity for the IL-1alpha (-889) T allele (TT genotype) compared with the control population (CC genotype; 5% versus 1%, respectively, p=0.04; OR 5.1, 95% CI 1.19-21.66)., Conclusions: The IL-1alpha (-889) T allele polymorphism, previously shown to increase IL-1 gene expression, may be a risk factor in the development of POAG.

The aim of this study was to identify key cytokine polymorphisms associated with disease susceptibility, clinical phenotype, and outcome in patients with chronic anterior uveitis (CAU) as compared to those with recurrent self-limiting anterior uveitis (RAU). One hundred fifty seven British Caucasian patients with anterior uveitis were identified and divided into those where the inflammatory process lasted less than 3 months (RAU=118) and those where the inflammation persisted longer than 3 months (CAU=39). Patients with CAU were further sub-divided into idiopathic CAU, CAU associated with systemic disease, CAU with and without complications (posterior synechiae, posterior subcapsular lens opacity, raised intraocular pressure, cystoid macular oedema, and poor response to treatment). Sixty-six healthy controls were ethnically matched. TaqMan PCR amplification was used to genotype five single nucleotide polymorphisms in cytokine genes; IL-1RN+2018, IL-6-174, IL-10-1082, TNF-238, TNF-308 and these were correlated with clinical phenotype.

Objectives: The aim of this study was to determine whether there are any associations between single nucleotide polymorphisms of the chemokine genes IL-8, MCP-1, their corresponding receptors CXCR1 and CCR2 and disease outcome in patients with acute idiopathic anterior uveitis., Methods: 60 Caucasian patients with idiopathic acute recurrent anterior uveitis together with 120 healthy Caucasian control subjects were tested for the presence of 16 bi-allelic polymorphisms and HLA-B27 using polymerase chain reaction in association with sequence-specific primers with mismatches at the 3' end. The genetic data was then compared between patients and controls, and within the patient group itself for association with clinical disease outcome., Results: As expected, the frequency of HLA-B27 was significantly higher in the patient group than the control group (63.33% versus 15.83%; Pearson's P<0.0001, Fisher's P<0.0001). In addition, the frequency of the T allele of MCP-1 63555 was found to be significantly higher in the control group when compared to the patient group (P=0.0160)., Conclusion: This study describes an association between acute anterior uveitis and MCP-1 63555 polymorphisms where the T allele may be a protective marker against the disease.

Through literature analysis, in-depth interviews, and the application of the Delphi survey, this study explored long-term care resident priorities with regard to long-term care facility design in terms of both physical and psychological needs. This study further clarified changing trends in long-term care concepts; illustrated the impact that such changes are having on long-term care facility design; and summarized zeitgeists related to the architectural design of long-term care facilities. Results of our Delphi survey indicated the following top five priorities in long-term care facility design: (1) creating a home-like feeling; (2) adhering to Universal Design concepts; (3) providing well-defined private sleeping areas; (4) providing adequate social space; and (5) decentralizing residents' rooms into clusters. The three major zeitgeists related to long-term care facility design include: (1) modern long-term care facilities should abandon their traditional "hospital" image and gradually reposition facilities into homelike settings; (2) institution-based care for the elderly should be de-institutionalized under the concept of aging-in-place; and (3) living clusters, rather than traditional hospital-like wards, should be designed into long-term care facilities.

Purpose: To determine the association between 17 single nucleotide polymorphisms (SNPs) of tumor necrosis factor-alpha, lymphotoxin-alpha, and the TNF-receptors genes (TNF, LTA, and TNFRSF1A and -B) and idiopathic acute anterior uveitis (IAU) and to investigate their association with HLA-B27 and/or the development of visually significant complications., Methods: Ninety-eight white patients in the United Kingdom were identified (by SL) from the uveitis clinics of Moorfields Eye Hospital (London, UK). Sequence-specific primers with 3' end mismatches were used to identify the presence of specific allelic variants by PCR amplification., Results: There was a significant increase in the frequency of the TNF-857T allele in patients with IAU when compared with control subjects (15.3% vs. 7.3%, P = 0.0006). The frequency of haplotype 4, containing the T allele at nucleotide position -857, was also significantly increased in patients with IAU compared with control subjects (15.4% vs. 7.1%, P = 0.0003, OR 2.4, 95% confidence interval 1.4-4.0). In subgroup analysis, there were significant differences in the frequencies of the uncommon TNFRSF1A-201T and TNFRSF1A-1135T alleles between HLA-B27(+) patients with inflammation-related complications and those without complications (80.0% vs. 33.6%, P = 0.006; 80.0% vs. 36.6%, P = 0.01, respectively)., Conclusions: A significant difference in the frequency of TNF-857T allele was found in patients with IAU. There was a trend toward the development of inflammation-related complications in HLA-B27(+) patients with IAU who were carriers of TNFRSF1A-201T or TNFRSF1A-1135T alleles. Genetic variations in these proinflammatory mediators and their receptors appear to influence the susceptibility and severity of the inflammatory response within the eyes of patients during the development of IAU.

Background: This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders., Methods: Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage., Results: The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders., Conclusion: Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.