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(1) Background: Medical disputes have long been resolved via lawsuits. Alternative dispute resolutions have been promoted for their benefits and win–win results. This study aims to investigate Taiwanese hospital medical dispute capacities and burdens. (2) Methods: This study used 2015 nationwide questionnaire data. The number and value of medical disputes that occurred in 2014 was examined to evaluate hospitals' capabilities. Poisson regressions were used to determine the impact of coping abilities on the incidence of disputes and the associated compensation. (3) Results: The response rate of the questionnaire was 90%. Hospital features associated with higher medical disputes incidence included those of a scale ≤ 100 or 200–499 and having a dispute–inform process of over 4 h. In contrast, hospitals whose compensation fund was solely based on medical liability insurance reported less medical dispute incidence. The features associated with higher compensation were lack of continuing training and having a dispute–inform process over 4 h. In contrast, hospitals with standard operating procedures for in-hospital mediation and solicitude paid lower compensation. (4) Conclusions: Hospitals with quicker response times experienced fewer medical disputes and paid lower compensation. Dispute coping skills, other than reaction time, were more visible in compensation bargaining, but were not significantly correlated with incidence. [ABSTRACT FROM AUTHOR]

Summary: This population-based longitudinal follow-up study showed a protective effect of tea consumption against osteoporosis, particularly among women and middle-aged people. High tea consumption was also associated with a reduced risk of hip fracture. Introduction: To investigate the association of tea consumption with the risks of osteoporosis and hip fracture. Methods: This study used the Keelung Community-based Integrated Screening database and Taiwan's National Health Insurance Research Database. A total of 42,742 subjects aged 45 to 74 years were enrolled. Each was classified as no tea consumption, low tea consumption, and high tea consumption, according to the results of an eating habits questionnaire. The diagnosis of osteoporosis and hip fracture was based on BMD measured by dual-energy X-ray absorptiometry and the X-ray findings. The median follow-up time was 8.5 years. Results: As compared with the no tea consumption group, the osteoporosis HRs for the low tea consumption and high tea consumption groups were 0.88 (95% confidence interval (CI) 0.80–0.96) and 0.87 (95% CI 0.80–0.94), respectively. Among those participants aged 59 or below, the osteoporosis HRs for low tea consumption and high tea consumption (vs. no tea consumption) were 0.85 (95% CI 0.74–0.96) and 0.79 (95% CI 0.69–0.90). The HRs of hip fracture for the low tea consumption and high tea consumption groups (vs. no tea consumption) were 0.85 (95% CI 0.67–1.08) and 0.69 (95% CI 0.55–0.86), respectively. Conclusion: Tea consumption was linked to a lower risk of osteoporosis, particularly among women and middle-aged people. High tea consumption was also associated with a reduced risk of hip fracture. [ABSTRACT FROM AUTHOR]

Objectives: This study analyzed the role of the interleukin (IL)‐6/signal transducer and activator of transcription 3 (STAT3) pathway in dihydropyridine‐induced gingival overgrowth (DIGO) fibroblasts. Materials and methods: Tissue samples were obtained through surgical dissection from five DIGO patients and five healthy individuals. Cell cultures were conditioned with nifedipine (Nif) (0.34 µM) and stimulated with IL‐1β (10 ng/ml) to clarify whether IL‐6 upregulates extracellular matrix overproduction or has an impact on the cell proliferation rate of DIGO fibroblasts. STAT3 was knocked down using short hairpin (sh)RNA to determine its role in collagen (Col) type I alpha 1 (Colα1(I)) synthesis. Results: Results showed that phosphorylated (p)STAT3 nuclear translocation was activated by a simulated autocrine concentration (50 ng/ml) of IL‐6, and application of an anti‐IL‐6 antibody significantly decreased the pSTAT3/STAT3 ratio in DIGO fibroblasts. STAT3 knockdown significantly decreased STAT3 and Colα1(I) expressions in DIGO cells. DIGO tissues presented stronger proliferating cell nuclear antigen (PCNA) expression than did healthy individuals under the effect of IL‐1β/Nif treatment. Conclusions: Gingival inflammation (e.g., IL‐1β) and taking dihydropyridine (e.g., Nif) may additively stimulate Col overproduction through the IL‐6−STAT3−Colα1(I) cascade in DIGO cells. IL‐6–STAT3 signaling may be considered a target for the control of DIGO. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the long-term effectiveness of a school-based child oral hygiene program on oral heath after approximately 10 years of follow-up. Methods A prospective cohort study was designed to include 120 schoolchildren aged 10-11 years with instructions on how to practice daily flossing and brushing under the supervision of school nurses for one semester (the intervention group) and to recruit a comparison group with no intervention from 120 classmates matched by gender (the nonintervention group). Both groups participated in a questionnaire survey and received dental examinations after long-term follow-up. Results The mean value of overall plaque score in the intervention group (16.9%) was lower than that of the nonintervention group (32.6%); the adjusted relative risk ( aRR) of having a plaque score for the intervention group versus the nonintervention group was 0.4 (95% CI: 0.3, 0.5). The percentage of pocketing ( CPI ≧ 2) in the intervention group (75.0%) was lower than that of the nonintervention group (90.8%); the aRR of having calculus or pocketing ( CPI ≧ 2) was 0.3 (95% CI: 0.1, 0.6). The intervention group had lower DMFT values and DMFS score than the nonintervention group (4.1 and 6.6 versus 6.2 and 11.0). Moreover, the intervention group had significantly better dental knowledge and habits and dental conditions than the nonintervention group. Conclusions This longitudinal follow-up study demonstrated that a highly targeted oral hygiene program can display positive long-term effectiveness. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to predict periodontal disease ( PD) with demographical features, oral health behaviour, and clinical correlates based on a national survey of periodontal disease in Taiwan. Materials and Methods A total of 4061 subjects who were enrolled in a cross-sectional nationwide survey on periodontal conditions of residents aged 18 years or older in Taiwan between 2007 and 2008 were included. The community periodontal index ( CPI) was used to measure the periodontal status at the subject and sextant levels. Information on demographical features and other relevant predictive factors for PD was collected using a questionnaire. Results In our study population, 56.2% of subjects had CPI grades ≥3. Periodontitis, as defined by CPI ≥3, was best predicted by a model including age, gender, education, brushing frequency, mobile teeth, gingival bleeding, smoking, and BMI. The area under the curve ( AUC) for the final prediction model was 0.712 (0.690-0.734). The AUC was 0.702 (0.665-0.740) according to cross-validation. Conclusions A prediction model for PD using information obtained from questionnaires was developed. The feasibility of its application to risk stratification of PD should be considered with regard to community-based screening for asymptomatic PD. [ABSTRACT FROM AUTHOR]

Background We propose a chain binomial model to elucidate the transmission modes of influenza within households and with which to further evaluate the spread of influenza in a community. Methods Data on the surveillance of influenza in Taiwan were collected from July 2001 to March 2002. A series of chain binomial models were fitted to estimate the escape probability. This parameter together with accumulated cases of the first episode were further applied to derive the transmission probability, the contact rate and the recovery rate, yielding an estimate of the basic reproductive number and providing a simulation approach with which to assess the spread of influenza in the community. Results Of the 6 391 614 cases identified during the study period, 4 451 046 were from 3 654 320 households consisting of two to five people, with at least one case used to estimate the escape probabilities within households. The escape probability within households was 92.4%, which, in turn, led to a contact rate estimate of 7.7 per day. The transmission probability was estimated as 8.3%. These three parameters yielded 2.56 as the basic reproductive number. Conclusions The proposed method provides a means for using household data to evaluate the transmissibility of influenza within a community. [ABSTRACT FROM AUTHOR]

Background: Currently there is a debate regarding whether tamoxifen used in breast cancer has an impact on lipid profiles. The aim of this study was to determine whether tamoxifen has an impact on the serum lipid profile in Taiwanese women. Patients and Methods: Data of 109 patients were collected from the routine clinical follow-up for women with hormone receptor-positive breast cancer who were treated between July 2005 and March 2008. These patients were divided into 2 subgroups, based on their tumor grade and lymph node status. Subgroup 1 patients had tumor grade I/II and a negative lymph node status. Those patients with tumor grade III or a positive lymph node status were defined as subgroup 2. Results: In the 109 patients, the mean serum total cholesterol (TC) levels after tamoxifen treatment, as well as the serum low-density lipoprotein cholesterol (LDL-C) levels, were lower than the baseline levels, with statistically significant differences. Treatment with tamoxifen lowered the serum TC and LDL-C levels in both subgroups. Conclusions: The results indicate that tamoxifen has an impact on the serum lipid profile of breast cancer patients in Taiwan. Physicians should follow up the lipid profile in these patients. © 2014 S. Karger GmbH, Freiburg [ABSTRACT FROM AUTHOR]

Summary Purpose: We studied geographic variation in age- and gender-specific prevalence and incidence of epilepsy in four different areas of Taiwan. Methods: By using large-scale, National Health Insurance (NHI)-based data from 2000-2003 in Taiwan, we identified 131,287 patients diagnosed with epilepsy (ICD code 345) receiving at least of one of 11 antiepileptic drugs (AEDs). Information on age, gender, and location were also collected. The multivariable Poisson regression analysis was used to assess the heterogeneity of the morbidity of epilepsy in different regions. External data validation was also performed to assess the accuracy of capturing epilepsy cases through our NHI data set. Key Findings: The age-adjusted prevalence and incidence of epilepsy were 5.85 (per 1,000) between 2000 and 2003 and 97 (per 100,000 person-years) during the follow-up time from 2001 to 2003 in Taiwan. The sensitivity and specificity of ICD-9 coding for epilepsy in the NHI data set were 83.91% and 99.83%, respectively, resulting in a slight overestimation. Male patients had a higher probability of having epilepsy than did females. East Taiwan had significantly higher prevalence and incidence than did other areas. The age-specific incidence pattern in east Taiwan was atypical in that it revealed clustering in young and middle-aged groups. Significance: Our study demonstrated geographic variation in epidemiologic patterns of epilepsy within Taiwan. The findings are informative and provide insight into the clinical management of epilepsy based on consideration of different target groups in different areas. [ABSTRACT FROM AUTHOR]

This study is to identify an optimal cut-off for two-stage breast cancer screening making allowance for variation of the baseline incidence rate and utility values between sensitivity and specificity. We used data from a two-stage breast cancer screening of Taiwanese women aged 50-69 years for whom risk stratification was based on a composite risk score (conventional risk factors); subjects with a risk score greater than the cut-off score were screened using mammography. The Bayesian posterior risk for breast cancer was computed by incorporation of the baseline incidence rate and the risk score. Bayes' maximum utility decision rule was then developed to determine the optimal screening cut-off. With a risk score of −9 applied to the current two-stage breast cancer screening programme, we could detect one breast cancer case for every 1406 women. Given different predetermined risks, the selected cut-offs were −9 for 1:1200, −8 for 1:800, −4 for 1:600, −1 for 1:400 and 3 for 1:200 for women aged 50-59 years. When the regret utility ratio of positive predictive value to negative predictive value was set at 1:10, the specificity and sensitivity were 58.5% and 70.4%, respectively, and the optimal cut-off was −5.5. When the ratio was set at 10:1, the sensitivity and specificity were 75.5% and 57.1%, respectively, and the optimal cut-off value was −7.5. This study demonstrates that Bayes' maximum utility decision rule can be used to determine optimal cut-off values for two-stage breast cancer screening in countries or areas with lower or intermediate incidence of breast cancer. [ABSTRACT FROM AUTHOR]

Background: Few studies have been published regarding the practice of breast cancer screening in Asian countries. Aims: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. Data sources: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995–1998); (2) a programme of mass screening (1999–2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002–2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. Results: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme. Conclusions: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies. [ABSTRACT FROM AUTHOR]

Background: Low infection and case-fatality rates have been thus far observed in Taiwan. One of the reasons for this major success is better use of big data analytics in efficient contact tracing and management and surveillance of those who require quarantine and isolation.Objective: We present here a unique application of big data analytics among Taiwanese people who had contact with more than 3000 passengers that disembarked at Keelung harbor in Taiwan for a 1-day tour on January 31, 2020, 5 days before the outbreak of coronavirus disease (COVID-19) on the Diamond Princess cruise ship on February 5, 2020, after an index case was identified on January 20, 2020.Methods: The smart contact tracing-based mobile sensor data, cross-validated by other big sensor surveillance data, were analyzed by the mobile geopositioning method and rapid analysis to identify 627,386 potential contact-persons. Information on self-monitoring and self-quarantine was provided via SMS, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were offered for symptomatic contacts. National Health Insurance claims big data were linked, to follow-up on the outcome related to COVID-19 among those who were hospitalized due to pneumonia and advised to undergo screening for SARS-CoV-2.Results: As of February 29, a total of 67 contacts who were tested by reverse transcription-polymerase chain reaction were all negative and no confirmed COVID-19 cases were found. Less cases of respiratory syndrome and pneumonia were found after the follow-up of the contact population compared with the general population until March 10, 2020.Conclusions: Big data analytics with smart contact tracing, automated alert messaging for self-restriction, and follow-up of the outcome related to COVID-19 using health insurance data could curtail the resources required for conventional epidemiological contact tracing. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the patterns of immediate seismic deaths and post-earthquake mortality changes in the disaster area after the September 21, 1999 Taiwan earthquake.METHODS: We used the data of 1,826 seismic deaths to elucidate the immediate seismic effects on mortality patterns, and to determine the association between seismic death rates and house damage among 23 townships in the disaster area. We used standardized mortality ratios (SMRs) to estimate the changes in mortality of all natural causes (ICD-9: 1–799) in the 12 months after the earthquake.RESULTS: For the 1,826 seismic deaths, two leading causes of death were asphyxiation and intracranial injury and the death rates were higher among the female and elderly population. Township-specific seismic death rates were proportional to the proportion of completely collapsed houses. SMRs decreased six months after the earthquake for all residents and female adults aged 45 years and over.CONCLUSIONS: The immediate effects of the Taiwan earthquake included a higher proportion of female and elderly seismic deaths and an association between seismic death rates and earthquake damages in the disaster area. The prolonged effect of the earthquake on mortality in the post-earthquake year was a decrease in mortality for all residents except male adults. [Copyright &y& Elsevier]

Introduction: Despite the serious risks of diabetes with hepatitis C virus (HCV) infection, this preventable comorbidity is rarely a priority for HCV elimination. We aim to examine how a shared care model could eliminate HCV in patients with diabetes (PwD) in primary care., Methods: There were 27 community-based Diabetes Health Promotion Institutes in each township/city of Changhua, Taiwan. PwD from these institutes from January 2018 to December 2020 were enrolled. HCV screening and treatment were integrated into diabetes structured care through collaboration between diabetes care and HCV care teams. Outcome measures included HCV care continuum indicators. Township/city variation in HCV infection prevalence and care cascades were also examined., Results: Of the 10,684 eligible PwD, 9,984 (93.4%) underwent HCV screening, revealing a 6.18% (n = 617) anti-HCV seroprevalence. Among the 597 eligible seropositive individuals, 507 (84.9%) completed the RNA test, obtaining 71.8% positives. Treatment was initiated by 327 (89.8%) of 364 viremic patients, and 315 (86.5%) completed it, resulting in a final cure rate of 79.4% (n = 289). Overall, with the introduction of antivirals in this cohort, the prevalence of viremic HCV infection dropped from 4.44% to 1.34%, yielding a 69.70% (95% credible interval 63.64%-77.03%) absolute reduction., Discussion: Although HCV prevalence varied, the care cascades achieved consistent results across townships/cities. We have further successfully implemented the model in county-wide hospital-based diabetes clinics, eventually treating 89.6% of the total PwD. A collaborative effort between diabetes care and HCV elimination enhanced the testing and treatment in PwD through an innovative shared care model., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Objective: Subjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear., Design: Subjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004-2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC., Results: The study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004-2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20-39; aHR=1.93 (1.04-3.56), 0.95 (0.45-2.00), 2.26 (1.16-4.43) and 2.44 (1.44-4.12) for FHbC=40-59, 60-99, 100-149 and ≥150, respectively)., Conclusion: Subsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: We aimed to assess the effect of metabolic syndrome (MetS) on incident oral potentially malignant disorder (OPMD)., Design: We conducted a prospective cohort study of the Changhua community-based integrated screening (CHCIS) programme and nationwide oral cancer screening programme during the period between 2005 and 2014., Setting: CHCIS, Taiwan., Participants: We enrolled 17 590 participants aged 30 years and older., Main Outcomes and Measures: We assessed the impact of MetS on the outcome measured by incident OPMD., Results: The incidences of OPMD among subjects with and without MetS were 7.68 ‰ and 5.38 ‰, respectively. After adjusting for confounders, subjects with MetS exhibited a statistically greater risk of developing OPMD compared with those who were free of MetS by 33% (adjusted rate ratio, aRR=1.33, 95% CI 1.14 to 1.55). Individual components of MetS still remained significant, including central obesity (aRR=1.22, 95% CI 1.04 to 1.44), hypertriglyceridaemia (aRR=1.26, 95% CI 1.07 to 1.49) and hyperglycaemia (aRR=1.20, 95% CI 1.02 to 1.41). Central obesity and hypertriglyceridaemia were also statistically associated with a subtype of OPMD, namely, leukoplakia., Conclusion: The temporal influence of MetS on the risk of incident OPMD was noted in our prospective cohort study. Therefore, promoting an MetS prevention and control programme might reduce the occurrence of OPMD and oral cancer., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The role of faecal haemoglobin as a colorectal cancer screening tool has been demonstrated. However, the association between the faecal haemoglobin concentration and the risk of cardiovascular disease events and deaths is still unclear., Design: Cohort study design., Setting: Population-based organised integrated service screening in Keelung City, Taiwan PARTICIPANTS: A total of 33 355 healthy individuals aged over 40 years who were free of cardiovascular disease at study entry were followed up., Main Outcomes and Measures: Newly diagnosed cardiovascular disease events and deaths., Results: After a median follow-up of 2.39 years, a total of 2768 participants developed cardiovascular events, and after a median follow-up of 8.43 years, 317 cases of cardiovascular deaths occurred. The risk of cardiovascular disease increased with baseline faecal haemoglobin in a dose-response manner, yielding a significant elevated risk of cardiovascular disease in parallel with the incremental concentration of faecal haemoglobin (adjusted HRs=1.04, 1.10, 1.40 and 1.23 for faecal haemoglobin concentrations of 1-19, 20-49, 50-99 and ≥100 ng/mL, trend test, p<0.0001, as compared with the reference group with undetectable faecal haemoglobin concentrations). A similar pattern was observed for the risk of cardiovascular disease deaths. In addition, the faecal haemoglobin improved the prediction performance of the model for the risk of cardiovascular diseases; the integrated discrimination improvement was 0.3% (p<0.001) for cardiovascular events and 0.1% (p=0.020) for cardiovascular deaths., Conclusions: Our data support that faecal haemoglobin concentrations may be associated with the risk of cardiovascular diseases. The biological mechanisms underlying the role of faecal haemoglobin as health outcomes should be investigated., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The relationship between hyperglycemia (including diabetes) and periodontal disease (PD) has been noted previously, but its temporal sequence in the same study based on a population-based study has been barely addressed. Our study sought to clarify temporal bidirectional relationships between both diseases among Taiwanese aged 35-44 years. A prospective follow-up cohort study was designed by following over time the two normal cohorts (PD-free or hyperglycemia-free) derived from 5,885 subjects aged 35-44 years who were periodically attending a screening program. We ascertained both incident cases of PD (defined by Community Periodontal Index score ≧ 3) and hyperglycemia [fasting plasma glucose (FPG) ≧100 mg/dL] or type 2 diabetes (FPG ≧ 126 mg/dL) with 5-year follow-up. Cox proportional hazards regression model was used to assess the effect of PD on hyperglycemia and vice versa with adjustment for other confounding factors. Participants with PD presented a 33 % increase in their risk of incident hyperglycemia (including diabetes) [adjusted hazard ratio (aHR) = 1.33 (95 % CI 1.09-1.63)] after controlling for potential confounding factors. Conversely, prediabetes and type 2 diabetes mellitus led to a significant elevated risk for PD [aHR = 1.25 (95 % CI 1.00-1.57) and aHR = 1.95 (95 % CI 1.22-3.13)] after adjustment for other confounding factors. In conclusion, a significant bidirectional relationships was found between hyperglycemia and PD, suggesting that both diseases may share common latent traits and pathways that are worthy of being further elucidated by continuing a long-term follow-up of this cohort.

Background: Previous studies on the association between tuberculosis and the risk of developing ischemic stroke have generated inconsistent results. We therefore performed a population-based, propensity score-matched longitudinal follow-up study to investigate whether contracting non-central nervous system (CNS) tuberculosis leads to an increased risk of ischemic stroke., Methods: We used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 5804 persons with at least three ambulatory visits in 2001 with the principal diagnosis of non-CNS tuberculosis were enrolled in the tuberculosis group. The non-tuberculosis group consisted of 5804, propensity score-matched subjects without tuberculosis. The three-year ischemic stroke-free survival rates for these 2 groups were estimated using the Kaplan-Meier method. The stratified Cox proportional hazards regression was used to estimate the effect of tuberculosis on the occurrence of ischemic stroke., Results: During three-year follow-up, 176 subjects in the tuberculosis group (3.0%) and 207 in the non-tuberculosis group (3.6%) had ischemic stroke. The hazard ratio for developing ischemic stroke in the tuberculosis group was 0.92 compared to the non-tuberculosis group (95% confidence interval: 0.73-1.14, P = 0.4299)., Conclusions: Non-CNS tuberculosis does not increase the risk of subsequent ischemic stroke.

Background: Although female pattern hair loss (FPHL) has been considered simply the female counterpart of male pattern hair loss in men, the risk factors may differ., Objective: We sought to evaluate factors associated with FPHL and to estimate its prevalence in women., Method: In total, 26,226 subjects aged 30 years and older participated in a cross-sectional survey. Ludwig and Norwood classifications were used to assess the degree of hair loss. Information on possible risk factors for FPHL was collected using a questionnaire interview., Results: The prevalence of FPHL (Ludwig grade >I) for all ages was 11.8% (95% CI 11.5%-12.2%), increasing with advancing age. After controlling for age and family history, statistically significant associations were noted between FPHL and high fasting glucose (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.04-1.28), fewer childbirths (OR 1.24, 95% CI 1.12-1.38), breast-feeding (OR 0.88, 95% CI 0.78-0.98), oral contraceptive use (OR 1.21, 95% CI 1.01-1.45), and ultraviolet exposure more than 16 hours per week (OR 1.12, 95% CI 1.02-1.22)., Limitations: The validity and reliability of FPHL classification may be not perfect in this survey and may need to be verified. Information on family history may be still subject to recall bias., Conclusions: Risk factors for FPHL and male androgenic alopecia may differ., (Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Objective: Although it has been suggested that diabetes mellitus (DM) is a risk factor for developing adhesive capsulitis of the shoulder (ACS), data on the temporal association between these 2 conditions are sparse. The purpose of this population-based age- and sex-matched cohort study was to investigate the risk of developing ACS in patients with newly diagnosed DM., Methods: A total of 78,827 subjects with at least 2 ambulatory care visits with a principal diagnosis of DM in 2001 were recruited for the DM group. The non-DM group comprised 236,481 age- and sex-matched randomly sampled subjects without DM. The 3-year cumulative risk of ACS was calculated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to estimate the crude and adjusted hazard ratio (HR) of developing ACS., Results: During a 3-year followup period, 946 subjects (1.20%) in the DM group and 2,254 subjects (0.95%) in the non-DM group developed ACS. The crude HR of developing ACS for the DM group compared to the non-DM group was 1.333 (95% confidence interval [95% CI] 1.236-1.439, P < 0.0001), whereas the adjusted HR was 1.321 (95% CI 1.224-1.425, P < 0.0001) after adjustment for age, sex, and dyslipidemia., Conclusion: This longitudinal population-based followup study showed that there is a significantly increased risk of developing ACS after developing DM., (Copyright © 2013 by the American College of Rheumatology.)

Objective: This study aimed to investigate whether triple-negative breast cancer has a worse prognosis; here, we present the 10-year follow-up results of triple-negative breast cancer patients in Taiwan., Methods: We identified 2858 breast cancer patients in Taiwan, of whom 416 (14.6%) had triple-negative breast cancer. Data used for analysis were derived from those breast cancer patients who were diagnosed between January 1996 and December 2006., Results: In the Kaplan-Meier analysis, tumor subgroup (triple-negative breast cancer vs. non-triple-negative breast cancer) was a prognostic factor related to 10-year breast cancer death-specific survival and disease-free survival. The results of univariate analysis showed that tumor subgroup was a significant factor related to 10-year disease-free survival and breast cancer death-specific survival, as well as menopausal status, tumor size, lymph node, metastasis, grade, stage, estrogen receptor status, progesterone receptor status and her2/neu gene expression status. Similarly, the multivariate analysis also revealed that tumor subgroup was a significant factor related to 10-year breast cancer death-specific survival and disease-free survival, in addition to tumor size, lymph node, metastasis and grade., Conclusions: It was suggested that triple-negative breast cancer patients in Taiwan have worse 10-year survival. Notably, in node-positive patients, triple-negative breast cancer played a prognostic role in 10-year breast cancer death-specific survival.

Objective: This study aimed to reveal the relationships between histologic grade and other clinicopathologic parameters including intrinsic subtype in Taiwanese women with breast cancer., Methods: There were 1302 women diagnosed with breast cancer recruited for this study. Histologic grade was scored according to the Nottingham-modified Bloom-Richardson grading system., Results: Higher tumor grade was associated with larger tumor size (P = 0.021), a larger number of lymph node metastases (P = 0.001), advanced clinical stage (P = 0.010), higher human epithelial growth receptor-2 positivity (P < 0.001), negative estrogen receptor and progesterone receptor (P < 0.0001) status. Triple negative breast cancer (56.6%) and human epithelial growth receptor-2 (44.3%) subtypes were associated with more Grade III breast cancer in contrast to luminal A (22.3%) and B (29.9%) breast cancer. In multivariate Cox regression analysis for cancer-specific survival, histologic grade (hazard ratio = 1.78) was a significant prognostic factor., Conclusions: This study demonstrated that histologic grade is highly correlated with some valuable biomarkers and confirmed the significance of histologic grade in Taiwanese female breast cancers.

Background: Small hepatocellular carcinoma (HCC) affects millions of individuals worldwide. Surveillance of high-risk patients increases the early detection of small HCC., Objective: To identify prognostic factors affecting the overall survival (OS) and recurrence-free survival (RFS) of patients with small HCC., Methods: The present prospective study enrolled 140 Taiwanese patients with stage I or stage II small HCC. Clinical parameters of interest included operation type, tumour size, tumour histology, Child- Pugh class, presence of hepatitis B surface antigen and liver cirrhosis, hepatitis C status, alpha-fetoprotein, total bilirubin and serum albumin levels, and administration of antiviral and salvage therapies., Results: Tumour size correlated significantly with poorer OS in patients with stage I small HCC (P=0.014); however, patients with stage II small HCC experienced a significantly poorer RFS (P=0.033). OS rates did not differ significantly between patients with stage I and stage II small HCC. Tumour margins, tumour histology and cirrhosis did not significantly affect OS or RFS (P>0.05)., Discussion: Increasing tumour size has generally been associated with poorer prognoses in cases of HCC. The present study verified the relationship between small HCC tumour size and OS; however, a reduction in OS with increasing tumour size was demonstrated for patients with stage I - but not for stage II - small HCC., Conclusion: Patients with stage II small HCC may benefit from aggressive surveillance for tumour recurrence and appropriate salvage treatment. Further studies are needed for additional stratification of stage I patients to identify those at increased risk of death.

Background: Despite widespread use of the immunochemical faecal occult blood test (iFOBT), little is known about the subsequent risk of developing colorectal neoplasia for participants with negative iFOBT results. We investigated whether the concentration of faecal haemoglobin at the first screen is predictive of the subsequent incidence of colorectal neoplasia in those with a negative screening result., Methods: Between 2001 and 2007, we did a prospective cohort study within the Keelung community-based iFOBT screening programme for residents aged 40-69 years, using a cutoff faecal haemoglobin concentration of 100 ng/mL to classify attendees as negative and positive groups for further clinical investigations. 44,324 participants with negative findings and 1668 with a positive result at the first screen (854 non-referrals who refused colonoscopy and 814 with a false-positive result as assessed by colonoscopy) were followed up to ascertain cases of colorectal neoplasia. We investigated the association between baseline faecal haemoglobin concentration and risk of incident colorectal neoplasia, after adjusting for possible confounders., Findings: Median follow-up was 4·39 years (IQR 2·53-6·12) for all 45 992 participants, during which the incidence of colorectal neoplasia increased from 1·74 per 1000 person-years for those with baseline faecal haemoglobin concentration 1-19 ng/mL, to 7·08 per 1000 person-years for those with a baseline concentration of 80-99 ng/mL. The adjusted hazard ratios (HRs) increased from 1·43 (95% CI 1·08-1·88) for baseline faecal haemoglobin concentration of 20-39 ng/mL, to 3·41 (2·02-5·75) for a baseline concentration of 80-99 ng/mL (trend test p<0·0001), relative to 1-19 ng/mL. These results did not change when we included repeated iFOBT measurements. Non-referrals had the highest risk of incident colorectal neoplasia (adjusted HR 8·46 [6·08-11·76])., Interpretation: Quantitative faecal haemoglobin concentration at first screening predicts subsequent risk of incident colorectal neoplasia. During follow-up, risk stratification based on faecal haemoglobin could help clinicians, with particular attention being paid to those with higher initial faecal haemoglobin concentrations, especially those just under the threshold taken to indicate presence of colorectal neoplasia., Funding: None., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background and Aim: The widespread use of screening programs has resulted in an increase in detection of small hepatocellular carcinoma (HCC). Surgical resection generally leads to favorable outcomes in this group of patients; however, the prognostic significance of tumor size and the optimal cutoff point in resected specimens of small HCC have not been well defined. The aim of current study is to evaluate the prognostic significance of tumor size in small resected HCC., Methods: Patients who underwent surgical resection for small HCC at the Changhua Christian Hospital during January 2001 to June 2007 were enrolled. Small HCC was defined as a single HCC nodule with maximum diameter ≤ 5 cm. Cox regression hazard ratios for cancer-specific death were calculated to survey the prognostic significance of tumor size. We then determined the optimal cut-point for tumor size that could be used to stratify patients into 5-year disease-free survival (DFS) and cancer-specific survival (CSS) groups., Results: A total of 140 patients who underwent resection of small HCC were enrolled. The mean tumor size was 2.9 cm (range 0.9-5.0) and the mean follow-up period was 43.4 months. The 5-year DFS and CSS rates were 46.6% and 81.6%, respectively. Cox regression analysis revealed that tumor size (hazard ratio = 2.973, 95% confidence interval: 1.073-8.239, P = 0.036) was an independent prognostic factor. Our analysis showed that a tumor size of 3 cm was the cut-point that could dichotomize patients into statistically different 5-year DFS and CSS risk groups., Conclusions: Tumor size is an independent prognostic factor in resected small HCC and the prognostic significance of tumor size may vary according to different cut-off points., (© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.)

Objective: To incorporate clinical complications in the susceptible-infectious-recovered model to estimate parameters needed in dynamic changes of infectious diseases and to further evaluate the impact of disease-controlling methods., Methods: We developed a new extended epidemic model that incorporates of disease-related complications. This model was applied to empirical data on influenza during the epidemic season of 2001-2002 in Taipei County, Taiwan, to estimate the transmission parameters that were converted to the basic reproductive rate (R(0)). The proposed model, in conjunction with estimated parameters, was applied in quantifying the efficacy of different preventive strategies., Results: During the study period there were 5 outbreaks of influenza. The estimated transmission probability for outbreak 1 was 0.135, with corresponding estimate of R(0), 2.7; for outbreak 2, 0.165, with estimated R(0), 3.3; for outbreak 3, 0.15, with R(0), 4.5; for outbreak 4, 0.165, with R(0), 5; and for outbreak 5, 0.165, with R(0), 5. The efficacy of antiviral prophylaxis to reduce the total episodes was 18% (95% CI, 15%-21%) under the coverage rate of 30%, 31% (95% CI, 26%-36%) under the coverage rate of 50%, and 73% (95% CI, 59%-90%) under the coverage rate of 80%. The corresponding figures for the efficacy of vaccination were 17% (95% CI, 15%-20%), 41% (95% CI, 35%-48%), and 76% (95% CI, 61%-95%). Combination of both methods would yield efficacy of 32% (95% CI, 28%-38%), 59% (95% CI, 49%-71%), and 88% (95% CI, 66%-118%), respectively., Conclusions: We demonstrate how to apply a novel extended model to empirical surveillance data of an influenza study for estimating parameters pertaining to dynamic changes in the infection process. These parameters were further used to evaluate the impact of antiviral prophylaxis alone, vaccination alone, or the use of both methods.

Background: Currently, there is a debate as to whether triple negative breast carcinoma (TNBC) has a worse prognosis than non-TNBC. Our aim was to determine whether TNBC is a prognostic factor for survival., Methods: We identified 1,048 Taiwanese breast carcinoma patients, of whom 167 (15.9%) had TNBC. Data used for analysis were derived from our cancer registry database for women with breast cancer who were diagnosed between 2002 January and 2006 December., Results: In the Kaplan-Meier analysis, tumor subgroup (TNBC vs. non-TNBC) was a prognosis factor related to 5-year overall survival. In the univariate analysis, tumor subgroup (TNBC vs. non-TNBC) was a significant factor related to 5-year overall survival, in addition to age, tumor size, lymph node, metastasis, grade, stage, estrogen receptor status, progesterone receptor status, and HER2 overexpression status. In the multivariate analysis, tumor subgroup was not a significant factor related to 5-year disease-free survival (DFS). In node-positive patients, tumor subgroup was a significant factor related to 5-year overall survival, in addition to age, tumor size, metastasis, and grade. In node-negative patients, tumor subgroup was not a significant factor related to 5-year disease-free survival and 5-year overall survival., Conclusion: Our results indicated that TNBC patients in Taiwan have worse 5-year overall survival than non-TNBC patients. Notably, in node-positive patients, TNBC played a prognostic role in 5-year overall survival.

Background: Betel-quid chewing, a recognized risk factor for oral cancer, was shown to be a contributory cause of metabolic syndrome in humans, which implies a greater likelihood of developing cardiovascular disease (CVD) among those with the betel habit., Objective: This study investigated the effect of betel chewing on the risk of developing overt CVD., Design: We used the prospective cohort data derived from a community-population-registry-based integrated screening program to quantify the effect of betel-quid chewing on the incidence of newly diagnosed CVD by classifying the study population into either exposed or nonexposed groups according to chewing status at baseline. We then followed the group free of CVD at recruitment for 2.72 y (SD=1.52 y) to learn of new cardiovascular events. Proportional hazards regression modeling was used to estimate the magnitude of the effect of betel-quid chewing on CVD., Results: After control for age and education level, ever chewers had a 23% (95% CI: 11%, 37%) greater risk of developing CVD than did never chewers; ever chewers were still at greater risk of developing CVD by 24% (95% CI: 11%, 39%) after further adjustment for age, education, and other significant confounders. Significant dose-response relations were found for betel-quid chewing (P<0.05, trend test) after adjustment for other significant variables., Conclusion: The habit of chewing betel nut was shown to have independent dose effects to predict increases in the risk of CVD in men, with the use of a prospective community-population-registry-based cohort study.

Background: Community-based multiple screening for common cancers and chronic diseases has increasingly gained attention. However, as infrastructure and evaluation system are more diversified and complicated compared with single screening, the development of a novel health information system is paramount., Methods: The main goal of our health information system was to support the multiple screening program not only from technical aspect but also from a broad range of perspectives including quality assurance system, organized features appertaining to screening, economic evaluation (cost-effectiveness or cost-utility analysis), epidemiological applications, behavior risk factor surveillance system, and social impact due to the introduction of the Keelung Community-Based Integrated Screening (KCIS) program., Results: Health information system was designed and programmed on the basis of the demand derived from KCIS within which five cancers and three chronic diseases were included. In addition to the detailed description of infrastructure and process, design, relevant database and security involved in health information system, an innovative and extensive evaluation system in accordance with the main goals was included in our health information system., Conclusion: Our information system proposed several aspects regarding organized screening system that has never been addressed in computerized system supporting for single screening. These included quality assurance system, organization features, co-morbidity profiles, epidemiological applications and social and economic considerations.