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Introduction: Stress-induced hyperglycemia (SIH) and malnutrition are common in trauma patients and are linked to worse outcomes. This study examined the influence of nutritional status, determined by the Geriatric Nutritional Risk Index (GNRI), on the incidence of SIH in trauma patients. Methods: A retrospective analysis was conducted on adult trauma patients admitted to a Level I trauma center from 1 January 2009 to December 31, 2021. Patients were categorized into four groups: SIH, diabetic hyperglycemia (DH), diabetic normoglycemia (DN), and non-diabetic normoglycemia (NDN). Nutritional status was assessed using GNRI: high risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI ≤ 98), and no risk (GNRI > 98). Incidence of SIH and outcomes were analyzed across GNRI groups. Results: SIH was associated with higher mortality across all GNRI groups compared to NDN, with the highest rate (45.7%) in the high-risk group. Mortality decreased as GNRI increased in all glucose groups. NDN patients had the lowest mortality rates across GNRI groups. There was no correlation between GNRI and SIH incidence (p = 0.259). Conclusion: SIH significantly influenced mortality across all nutritional status groups, with the highest impact in malnourished patients. Although malnutrition did not affect SIH incidence, both SIH and poor nutritional status independently contributed to worse trauma outcomes. Targeted management of hyperglycemia and nutritional deficiencies is crucial for improving survival. [ABSTRACT FROM AUTHOR]

Aim: Chronic diseases are influential components of stroke, one of the dominant reasons for dementia and premature mortality. Environmental risks are risk factors for transitioning from stroke to dementia. This study addresses the transition behaviors in stroke and dementia development associated with chronic diseases and environmental risks. Methods: This study is an integrated survey of medical and environmental informatics concerning stroke patients' quality of life. A total of 10 627 stroke patients diagnosed in Taiwan were surveyed in this study. A covariate model and subgroup analysis were used to evaluate the influence of chronic diseases and environmental risk factors (i.e., divorce rate, unemployment rate, solitariness rate, temperature, and air pollution rate) on stroke and the corresponding dementia transition behaviors. Results: This study constructed a total of 98 covariate analysis models, consisting of 14 transition types [10 transitions from chronic diseases to stroke (5 metabolic risk states × 2 stroke states) and 4 transitions from stroke to dementia (2 stroke states × 2 dementia states)] by 7 covariates (i.e., sex, age, divorce rate, unemployment rate, temperature, air pollution, and solitariness rate). Among the 98 transitions, 26 were statistically significant. Conclusions: Sex, age, divorce rate, unemployment rate, temperature, and air pollution rate exerted a partially significant influence on the transition from chronic diseases to stroke. Sex, age, unemployment rate, and temperature partially influenced the transition from stroke to dementia. This study also considered high‐risk sub‐populations of stroke patients, particularly males aged 65 years and below. Geriatr Gerontol Int 2024; 24: 766–772. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to assess the incidence and risk factors of major adverse cardiovascular events (MACEs) in patients with systemic sclerosis (SSc). Methods We conducted a nationwide, population-based, cohort study using Taiwan's National Health Insurance Research Database. We performed propensity score matching (PSM) using a 1:2 ratio, resulting in inclusion of 1379 patients with SSc and 2758 non-SSc individuals in the analysis. We assessed the association between SSc and MACEs, using the multivariable Cox proportional hazard regression model with adjustment of time-dependent covariates, and investigated risk factors for MACEs in patients with SSc, shown as adjusted hazard ratios (aHRs) with 95% CIs. Results SSc was not significantly associated with the risk of MACEs (aHR 1.04; 95% CI 0.77–1.42). Nevertheless, SSc was associated with increased risk of myocardial infarction [incidence rate ratio (IRR) 1.76; 95% CI 1.08–2.86] and peripheral arterial occlusion disease (IRR 3.67; 95% CI 2.84–4.74) but not of ischaemic stroke (IRR 0.89; 95% CI 0.61–1.29). Factors independently associated with MACEs in SSc patients included age (aHR 1.02), male gender (aHR 2.01), living in a suburban area (aHR 2.09), living in a rural area (aHR 3.00), valvular heart disease (aHR 4.26), RA (aHR 2.14), use of clopidogrel (aHR 26.65), and use of aspirin (aHR 5.31). Conclusions The risk of MACEs was not significantly increased in Taiwanese patients with SSc, and our investigation effectively identified the factors independently associated with MACEs in SSc patients. Additionally, patients with SSc exhibited higher risks of myocardial infarction and peripheral arterial occlusion disease but not of ischaemic stroke. [ABSTRACT FROM AUTHOR]

Background: Deep neck infections (DNIs) can compromise the airway and are associated with high morbidity and mortality rates. Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia that is associated with several comorbidities. We compared the clinical characteristics of DNI patients with and without DM. Methods: This study recorded the relevant clinical variables of 383 patients with DNIs between November 2016 and September 2022; of those patients, 147 (38.38%) had DM. The clinical factors between DNI patients with and without DM were assessed. Results: Patients with DM were older (p < 0.001), had higher white blood cell counts (p = 0.029) and C-reactive protein levels (CRP, p < 0.001), had a greater number of deep neck spaces (p = 0.002) compared to patients without DM, and had longer hospital stays (p < 0.001). Klebsiella pneumoniae was cultured more frequently from patients with DM than those without DM (p = 0.002). A higher CRP level (OR = 1.0094, 95% CI: 1.0047–1.0142, p < 0.001) was a significant independent risk factor for DM patients with prolonged hospitalization. The lengths of hospital stays in patients with poorly controlled DM were longer than those with well-controlled DM (p = 0.027). Conclusions: DNI disease severity and outcomes were worse in patients with DM than those without DM. Antibiotics effective against Klebsiella pneumoniae should be used for DNI patients with DM. DNI patients with DM and high CRP levels had more prolonged hospitalizations. Appropriate blood glucose control is essential for DNI patients with DM. [ABSTRACT FROM AUTHOR]

Summary: The epidemiological data on osteogenesis imperfecta (OI) in Asia is limited. This study, representing the first comprehensive epidemiological investigation on OI in Taiwan, reveals high medical resource utilization and underscores the importance of early diagnosis to enhance care quality. Introduction: This study examines osteogenesis imperfecta, a hereditary connective tissue disorder causing pediatric fractures and limb deformities, using a nationwide database from Taiwan to analyze clinical features and medical burden. Methods: The study identified validated OI patients from the Catastrophic Illness Registry in the National Health Insurance Research Database from 2008 to 2019. Demographic data and medical resource utilization were analyzed. A multivariate Cox model assessed the influence of sex, validation age, and comorbidities. Results: 319 OI patients (M/F = 153/166) were identified, with 58% validated before age 20. Prevalence and incidence were 0.8–1.3/100,000 and 0.02–0.09/100,000, respectively, with higher rates in the pediatric demographic. In the study period, 69.6% of the patients had admission history, primarily to pediatric and orthopedic wards. The median admission number was 3, with a median length of stay of 12 days and a median inpatient cost of approximately 3,163 USD during the period. Lower limb fractures were the main reason for hospitalization. 57% of OI patients received bisphosphonate treatment. The leading causes of mortality were OI-related deaths, neurovascular disease, and cardiovascular disease. The median age of validation in the non-survival group was significantly higher compared to the survival group (33 vs. 14 years), and patients validated during childhood required more inpatient fracture surgeries than those validated during adulthood. Conclusion: This study provides comprehensive real-world evidence on the clinical characteristics and high medical resource utilization of OI patients in a low prevalence region like Taiwan. Early diagnosis is crucial for improving care quality and enhancing health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The relationship between dental caries and stroke remains inconclusive. The aim of this study is to investigate whether different severities of dental caries affect the risk of stroke. Methods: This retrospective cohort study was conducted using the 2000–2013 Taiwan National Health Insurance Database. We selected 23,662 patients with advanced/severe dental caries and 23,662 patients with incipient/moderate dental caries between 2000 and 2006. These patients were followed to the occurrence of stroke or to the end of the study in 2013. Hazard ratios (HRs) and 95% confidence intervals (CIs) derived from the Cox proportional hazards models were calculated to assess the association between severity of dental caries and the risk of stroke. Results: The advanced/severe dental caries group had a significantly higher risk of stroke compared with incipient/moderate dental caries group (adjusted HR, 1.16; 95% CI, 1.03–1.31). Stratified analyses showed that advanced/severe dental caries was positively associated with the risk of ischemic stroke in patients aged ≥40 years and with the risk of hemorrhagic stroke in patients aged <40 years. Conclusion: There is a severity‐dependent association between dental caries and stroke in an Asian population. [ABSTRACT FROM AUTHOR]

The potential adverse effects of coronavirus disease 2019 (COVID-19) vaccinations raise public concerns. Data from Taiwan's Vaccine Injury Compensation Program (VICP) can provide valuable insights. This study analyzed the preliminary application data for COVID-19 vaccine compensation in Taiwan's VICP, focusing on applicants receiving vaccines between March 2021 and June 2022. Among the 2941 adverse events, 113 cases (3.8%) were deemed causally associated with vaccination, 313 (10.6%) were indeterminate, and 2515 (85.5%) had no causal association. Nearly half (47.6%) of the applicants were over 60 years old, and 76.6% had a history of pre-existing chronic diseases. Among the 426 vaccine-associated or indeterminate cases, the most common causes were hematological diseases and thrombosis. There were 920 mortality cases reported, and 97.4% were unassociated with vaccination. Only five deaths were judged to be associated with the COVID-19 vaccination, all involving the adenovirus vector vaccine and thrombosis with thrombocytopenia syndrome. In conclusion, most compensation applications were not causally linked to vaccination. Compared to other countries, the number of applications in Taiwan's VICP is relatively high. These findings may indicate a need to adjust the application requirements for compensation in Taiwan's program. [ABSTRACT FROM AUTHOR]

This cross‐sectional study examined sleep disturbance associations between parents and their school‐age children with overweight and obesity. A 7‐day wrist‐worn actigraph recording was performed on 246 children aged 6–9 years with overweight and obesity recruited from 10 public elementary schools in Taipei, Taiwan. Children's sleep disturbance was assessed using the Children's Sleep Habits Questionnaire. Parental subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index, with parental depressive symptoms measured using the Epidemiologic Studies‐Depression Scale. General linear models were used to examine sleep disturbance associations within parent‐child dyads. The results showed that 208 (84.6%) children had a clinically significant sleep disturbance score, and 123 (50%) parents had poor sleep quality. Higher children's sleep disturbance scores significantly predicted poorer parental sleep quality (b = 0.11, p < 0.001). Poorer parental sleep quality was associated with more severe sleep disturbances in children (b = 0.46, p < 0.001). This association was independent of children's actigraphic sleep (all p > 0.05) and was not attenuated by adjustment for parental depressive symptoms (b = 0.14, p < 0.001). Findings from our study suggest that sleep disturbances occur in both parents and their school‐age children with overweight and obesity, with a significant bidirectional association between the two. Nurses and healthcare professionals should proactively assess and screen for sleep disturbances in parent‐child dyads of children with overweight and obesity. Future studies should develop family‐based sleep interventions and evaluate their effects on the sleep, health, and well‐being of children with overweight and obesity and their parents. [ABSTRACT FROM AUTHOR]

Simple Summary: The study examined the relationship between Human Papillomavirus (HPV) and various types of skin cancer, including squamous cell carcinoma, basal cell carcinoma, and melanoma. It aimed to assess how HPV influenced the likelihood of developing these cancers, considering factors such as age, gender, urbanization, and existing health conditions. Through statistical models, the research quantified the risk of skin cancer in individuals with HPV compared to those without, underscoring how behaviors related to sun exposure and protection practices could alter these risks. The findings were crucial for guiding prevention and treatment strategies and were of significant interest to medical professionals and public health policymakers. Overall, the study enhanced our understanding of the risks associated with HPV, potentially leading to more effective health interventions. Human papillomavirus (HPV) has been implicated in various cancers, including those affecting the skin. The study assessed the long-term risk of skin cancer associated with HPV infection in Taiwan region, using data from the National Health Insurance Research Database between 2007 and 2015. Our analysis revealed a significant increase in skin cancer risk among those with HPV, particularly for squamous cell carcinoma (SCC), the subtype with the highest observed adjusted hazard ratio (aHR) = 5.97, 95% CI: 4.96–7.19). The overall aHR for HPV-related skin cancer was 5.22 (95% CI: 4.70–5.80), indicating a notably higher risk in the HPV-positive group. The risk of skin cancer was further stratified by type, with basal cell carcinoma (aHR = 4.88, 95% CI: 4.14–5.74), and melanoma (aHR = 4.36, 95% CI: 2.76–6.89) also showing significant associations with HPV. The study also highlighted regional variations, with increased risks in southern Taiwan and the Kaohsiung-Pingtung area. Key findings emphasize the importance of sun protection, particularly in regions of high UV exposure and among individuals in high-risk occupations. This research contributes to a better understanding of the complex interactions between HPV and skin cancer risk, reinforcing the importance of preventive strategies in public health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Impaired upper limb function in stroke survivors is characterized by muscle weakness, increased muscle tone, contracture, or impaired motor control. OBJECTIVE: We aimed to evaluate the effectiveness of Kinesio-taping application for functional recovery on the affected arm and forearm during rehabilitation. METHODS: Forty-one patients eligible for this study were randomly assigned to either the Kinesio-taping group (n = 21), receiving Kinesio-taping intervention and conventional therapy, or control group (n = 20), receiving sham Kinesio-taping intervention and conventional therapy. The whole intervention lasted for 3 weeks. Fugl-Meyer assessment of the upper extremity, Barthel Index, the Stroke Impact Scale, and modified Ashworth scale were measured at 3 time points: baseline, post-treatment (3rd week), and follow-up (6th week). RESULTS: In the Kinesio-taping group, there were significant differences in the upper extremity (p = 0.003), wrist (p = 0.000) and hand (p = 0.000) parts of the Fugl-Meyer assessment of the upper extremity between the three assessment times. On the other hand, the Barthel Index showed significant differences in both groups after therapy. CONCLUSION: Combining conventional rehabilitation with Kinesio-taping intervention may improve functional motor performance of both the proximal and distal parts of the affected upper extremity in stroke survivors, with potential benefits for activity of daily living. [ABSTRACT FROM AUTHOR]

Task-specific training generally targets motor function, with the ultimate goal of improving quality of life (QoL). This study aimed to determine whether motor function indirectly affects QoL through daily use of the affected arm and activities of daily living (ADL) in patients with chronic stroke. This was a retrospective cohort study of 155 patients who received training for 90–120 min/session, 3–5 sessions/week, for 4–6 weeks. The training involved specific mirror or robot-assisted therapy, followed by functional task practice for 15–30 min in each session. Patients were assessed before and after the intervention. At both pre-test and post-test, significant indirect effects of motor function on QoL through daily use of the affect arm and ADL were observed (β = 0.087–0.124). When the change scores of the measures between the pre-test and post-test were used, significant mediating effects of daily arm use on the relationship between motor function and QoL were identified (β = 0.094–0.103). Enhanced motor function after intervention may lead to an increase in arm use for daily activities and subsequently result in an improvement in QoL. These results highlight the critical role of daily arm use in task-specific training aimed at improving QoL. Task-specific training may improve motor function, daily arm use, activities of daily living, and quality of life in patients with mild-to-moderate arm hemiparesis. To improve quality of life in task-specific training, clinicians may work in sequence from motor function to daily arm use and then to activities of daily living. Emphasizing the use of the affected arm in daily life is critical to improve quality of life in task-specific training. [ABSTRACT FROM AUTHOR]

Simple Summary: Our study aimed to delineate the variables associated with the link between chronic periodontitis and hematologic cancers. The hazard ratio for hematologic cancers in patients with chronic periodontitis was also evaluated. Comprehensive statistical analyses revealed a 1.25-fold risk of hematologic cancers in the chronic periodontitis group. Factors such as being male and having hypertension were identified as increased risk factors for hematologic cancers. This nuanced exploration, including a subtype analysis for leukemia and lymphoma, contributes valuable insights into the complex relationship between chronic periodontitis and specific hematologic cancer subtypes. These findings could enhance our understanding of potential cancer risk factors in Taiwan. Background: Chronic periodontitis, an inflammation-related disorder affecting global populations, has been revealed to be linked to diverse cancers. Numerous epidemiological studies have not shown a link between chronic periodontitis and blood cancers in Taiwan. Methods: This study included 601,628 patients, diagnosed with newly chronic periodontitis by the ICD-9-CM classification, who were enrolled from 2001 to 2021 in the National Health Insurance Research Database (NHIRD) in Taiwan. In this study, we employed comprehensive statistical analyses to investigate the association between chronic periodontitis and hematologic cancers. Initially, we calculated incidence density and used a Poisson regression to analyze relative risk. Subsequently, we compared the cumulative incidence of hematological cancer in both chronic and non-chronic periodontitis groups using the Kaplan–Meier method. Results: The results revealed a significantly lower cumulative incidence of hematologic cancer in individuals with non-chronic periodontitis over a 12-year follow-up period. To further explore the risk factors, a Cox proportional hazard regression analysis was conducted. Being male (adjusted hazard ratio [aHR] = 1.21, 95% CI: 1.04 to 1.42; p = 0.014) and having hypertension (aHR = 1.34, 95% CI: 1.06 to 1.69; p = 0.015) were demonstrated to be associated with an increased risk of hematologic cancers, respectively. In addition, in a subtype multivariate analysis for categorizing hematologic cancers into lymphoma and leukemia, the aHR for leukemia was 1.48 (95% CI: 1.13 to 1.93; p = 0.004) and aHR for lymphoma was 1.15 (95% CI: 0.96 to 1.37; p = 0.140). Conclusions: This study found that being male and having hypertension were the significant risk factors for hematological malignancies. Moreover, the association between chronic periodontitis and specific subtypes of hematologic cancers was confirmed. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal adenoma formation has multiple contributing factors and how these risk factors interact is not precise. Past studies have demonstrated that increased weight is one of the risk factors of colorectal adenoma formation, but does not mean participants with normal body weight are not concerned about colorectal adenoma formation. We aimed to explore the specific risk factors for colorectal adenomas in individuals with normal body weight, who are often overlooked, and the interaction between these risk factors. Background: We aimed to evaluate the interaction between colorectal adenoma risks among asymptomatic individuals in terms of metabolic health status and obesity, and examine the normal waist-to-hip ratio (WHR) in adults with colorectal adenoma risk. Methods: A cross-sectional, retrospective study was conducted at MacKay Memorial Hospital involving 16,996 participants who underwent bidirectional gastrointestinal endoscopy between 2013 and 2023. The study recorded important clinicopathological characteristics, including age, body mass index and WHR, Framingham Risk Score (FRS), blood glucose level, and Helicobacter pylori (H. pylori) infection status. Results: Multivariate logistic regression analysis demonstrated that elevated hemoglobin A1C (HbA1c), increased FRS, positive H. pylori infection, and WHR ≥ 0.9 are independent risk factors for colorectal adenoma. In examining the interaction between FRS and WHR using multivariate logistic regression to evaluate adenoma risk, the OR for the interaction term was 0.95, indicating a decline in adenoma risk when considering the interaction between these two factors. Incorporating HbA1c into the analysis, evaluating the interaction between FRS and WHR still demonstrated a statistically significant impact on adenoma risk (OR 0.96, p < 0.001). Participants with WHR < 0.9, elevated FRS, positive H. pylori infection, and increased HbA1c levels were associated with a higher risk of colorectal adenoma formation. Remarkably, the increased risk of adenoma due to rising HbA1c levels was statistically significant only for those with a WHR < 0.9. Conclusions: An increase in FRS and HbA1c or a positive H. pylori infection still warrants vigilance for colorectal adenoma risk when WHR is 0.9. These factors interacted with each other and were found to have a minimal decline in adenoma risk when considering the interaction between WHR and FRS. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the association between atrial fibrillation (AF) and sudden sensorineural hearing loss (SSNHL). Methods: This study was conducted by searching the longitudinal health insurance database of the Taiwan National Health Insurance Program for relevant information from January 1, 2000, to December 31, 2011. Patients with AF were matched with non-AF controls with a 1:1 strategy according to propensity scores. Multiple logistic regression analyses were performed to determine the risk of SSNHL. Results: In total, 14 698 patients with AF were matched with the same number of non-AF patients as controls. After propensity score matching, the use of antiplatelet or anticoagulation medications and the occurrence of SSNHL were found to have a significant difference between AF and non-AF patients. The occurrence of SSNHL was found to be higher in men, those of 45 to 74 years old, and patients with hypertension in both AF and non-AF groups. Multiple logistic regression analyses revealed that male gender, age between 45 and 74 years, hyperlipidemia, and hypertension are risk factors for SSNHL. The use of aspirin was found to reduce the rate of SSNHL (odds ratio [OR]: 0.67, 95% CI: 0.49-0.94, P =.019), but AF was not found to be a risk factor for SSNHL (OR: 0.89, 95% CI: 0.64-1.23, P =.467). Conclusion: The association between AF and SSNHL is not significant. [ABSTRACT FROM AUTHOR]

Denosumab and zoledronic acid are both effective and easily administrable injectable anti‐osteoporotic medications for postmenopausal women. This study investigated the treatment efficacy of these agents in older male patients with low a bone mass and history of fragility fracture. A cohort of 175 male patients receiving continuous zoledronic acid treatment and a cohort of 366 male patients receiving continuous denosumab treatment at our medical center between 2015 and 2020 were included, and we analyzed the efficacy of treatment by the improvement in bone mineral density (BMD) and the new‐onset low‐energy fracture rate after 5 years of continuous medication. BMD significantly improved after 5 years of medication, and >90% of patients were satisfied with their treatment medication. BMD improved more with denosumab than with zoledronic acid, especially in patients with T‐scores higher than −2.5. Smoking, alcohol abuse, diabetes, and inflammatory polyarthritis were associated with poor improvements in BMD. The incidence rate of new fragile fracture was 4.4% and old age was significantly associated with the incidence rate of new fracture. In summary, our study revealed that denosumab and zoledronic acid both significantly increased BMD among older male patients with high fragility fracture rates over a 5‐year follow‐up period. Early medical treatment and lifestyle adjustment were crucial for improving quality of life. [ABSTRACT FROM AUTHOR]

Aims: Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy. Methods: We adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale. Results: A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age. Conclusion: Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management. Summary statement: What is already known about this topic? Psychological insulin resistance is a common psychological barrier to initiation and persistence with insulin therapy.Psychological insulin resistance causes poor glycaemic control and diabetes‐related complications.Psychological insulin resistance may negatively impact self‐management in patients with type II diabetes mellitus. What is the contribution of this paper? Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy.Patients with poor self‐management had statistically significantly higher levels of overall psychological insulin resistance, fear of injections and self‐testing, expectations regarding positive insulin‐related outcomes, and stigmatization by insulin injections, compared to those with appropriate self‐management. What are the implications of this paper? Knowing in advance the factors associated with diabetes self‐management will allow healthcare professionals prevent psychological insulin resistance in patients with type II diabetes mellitus treated with insulin therapy.Healthcare professionals can design and provide patient‐centred diabetes education based on education level to enhance self‐management. [ABSTRACT FROM AUTHOR]

Simple Summary: Trismus is a common complication in oral cancer patients that may influence surgical outcomes. This retrospective matched cohort analysis examined the influence of preoperative trismus on survival outcomes in 40 male Taiwanese oral cancer patients undergoing transoral robotic surgery (TORS). Through 1:1 propensity score matching, 20 trismus patients were compared to 20 non-trismus controls. TORS demonstrated comparable short-term surgical outcomes in trismus patients compared to non-trismus patients. There were no significant differences between groups in operation time, blood loss, margin status, flap reconstruction rates, duration of nasogastric tube feeding, or length of hospital stay. Analysis of long-term oncological outcomes demonstrated similar 5-year disease-free survival between groups, indicating comparable tumor control. However, trismus patients experienced significantly poorer 5-year overall survival. After adjusting for confounders, trismus independently conferred a 13-fold higher long-term mortality risk. Ultimately, this study highlights preoperative trismus as a harbinger of non-inferior short-term surgical outcomes, but diminished long-term survival in oral cancer patients treated robotically, even among those with equivalent tumor persistence following surgery. Further research should explore mechanisms linking trismus to mortality and approaches to improve outcomes in this population. Trismus, defined as restricted mouth opening, is a common complication among Taiwanese oral cancer patients, especially those who chew betel quid. However, the impact of trismus on survival outcomes in oral cancer patients undergoing transoral robotic surgery (TORS) is unclear. This study aimed to investigate the associations between trismus and surgical outcomes in Taiwanese male oral cancer patients treated with TORS. We conducted a retrospective propensity score-matched cohort study of 40 Taiwanese male oral cancer patients who underwent TORS between 2016 and 2022. Overall, 20 patients with trismus were matched to 20 patients without trismus. TORS achieved similar operative and short-term clinical outcomes in trismus patients to non-trismus patients. There were no significant differences between groups in operation time, blood loss, margin status, flap reconstruction rates, duration of nasogastric tube feeding, or length of hospital stay. Kaplan–Meier and Cox proportional hazard regression analyses were performed to compare overall survival (OS) and disease-free survival (DFS) between the two groups. The overall survival (OS) rate at three years was significantly lower in patients with trismus than those without trismus (27.1% vs. 95.0%, log-rank p = 0.02). However, there was no significant difference in disease-free survival (DFS) rates between the trismus and non-trismus groups (36.6% vs. 62.7%, log-rank p = 0.87). After adjusting for confounders, trismus was independently associated with a 13-fold increased risk of mortality (adjusted HR 12.87, 95% CI 1.55–106.50, p < 0.05). In conclusion, trismus appears to be an independent prognostic factor for reduced long-term OS in Taiwanese male oral cancer patients undergoing TORS, though short-term surgical outcomes were non-inferior in the trismus patients. Further research is warranted to clarify the mechanisms linking trismus and survival in this population. [ABSTRACT FROM AUTHOR]

Introduction: Concussion symptoms following a traumatic accident are both common and known to adversely affect mental health and recovery in patients with traumatic brain injury. Depression, highly prevalent among patients with traumatic brain injury, is also associated with the important factors of sleep quality and resilience. However, the mediator and moderator roles of depression following concussion in patients with traumatic brain injury have been underexplored. The aims of this study were to investigate the mediating role of sleep quality in the relation between concussion symptoms and depression and to examine the moderating effect of resilience on this mediated model. Design: Cross‐sectional pretest data analysis of a randomized controlled trial. Methods: A total of 249 adult patients with mild traumatic brain injury (Glasgow Coma Scale 13–15) at admission following brain injury were surveyed at a medical center in Taipei, Taiwan. The outcome variables were concussion symptoms (Rivermead Post‐Concussion Symptom Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), resilience (Resilience Scale for Adults), and depression (Beck Depression Inventory II). These data were analyzed using moderated mediation regressions with the SPSS PROCESS macro. Results: In patients with mild traumatic brain injury, there was a significant positive relation between concussion symptoms and depression, of which sleep quality was a significant mediator. Additionally, resilience had a negative moderating effect on the relations between sleep quality and depression. Patients with less resilience showed a stronger negative effect of sleep quality on depression. Conclusion: Our findings suggest that ameliorating both concussion symptoms and sleep disturbance is important for reducing the risk of depression in patients with mild traumatic brain injury, especially in those patients with less resilience. Clinical Relevance: It is essential for clinical nurses to develop interventions for patients with mild traumatic brain injury that will improve their sleep quality, while strengthening their resilience, to alleviate depression. [ABSTRACT FROM AUTHOR]

This study aimed to assess the health-related quality of life and identify its associated factors in women with endometriosis. A cross-sectional correlation study design and convenience sampling were conducted in the gynecological outpatient clinic of a teaching hospital in northern Taiwan. A total of 216 women with endometriosis were recruited. The data were collected using structured questionnaires and analyzed using descriptive and inferential statistics. Participants reported a moderate level of health-related quality of life. The most significant impact of endometriosis on health-related quality of life was emotional well-being, followed by feeling of control or powerless, pain, social support, and self-image. Educational attainment, menstrual cycle, period length, perceived menstrual flow, symptom distress, and self-management strategies explained 66% of the variance in health-related quality of life. Factors influencing health-related quality of life in women with endometriosis play a key role in promoting women's well-being. Interventions based on these related factors should be developed and taken into practice to effectively manage the disease-related symptoms for women with endometriosis and thereby improve their overall health-related quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the cognitive functions of Mandarin speakers with poststroke aphasia and to investigate the relationship between nonlinguistic cognitive deficits and the severity of aphasia. Method: Twenty-three adults with aphasia resulting from left-hemispheric stroke and 23 adults matched for age and educational level completed a series of six nonlinguistic cognitive tests measuring nonverbal intelligence, short-term memory, visual selective attention, visual alternating attention, auditory selective attention, and auditory alternating attention. A standardized aphasia assessment (Concise Chinese Aphasia Test [CCAT]) was also conducted to evaluate the severity of aphasia. Data analyses examined cognitive functions by comparing task performance of the two groups and examining the relationship between scores on the cognitive tasks and aphasia severity based on a hierarchical regression analysis. Results: The aphasia group scored significantly lower than the control group on all nonlinguistic cognitive tasks with large effect sizes (d = 0.95 ~ 1.54). Significant associations between different nonlinguistic cognitive tasks and CCAT subtests were observed. Results from the hierarchical regression analysis showed that auditory alternating attention was the only factor that significantly predicted aphasia severity based on CCAT overall scores after age and education level were taken into account. Conclusions: The findings align with prior research observing deficits in nonlinguistic cognition in individuals with aphasia. Implications for clinical practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Importance:Reablement is a person-centered and goal-oriented rehabilitative intervention to optimize people's chances to live independently. Objective: To investigate the effects of a reablement intervention on performance of instrumental activities of daily living (IADLs) in three aspects (i.e., actual performance, ability, and self-perceived difficulty) for patients with stroke. Design: A single-blinded, randomized crossover study. Setting: Participants' home and community. Participants: Twenty-seven patients with stroke. Interventions: Each participant received two interventions (IADL reablement and health education). Each intervention was administered for 6 wk. All participants were randomly assigned to one intervention and then received the other intervention after a 4-wk washout period. Outcomes and Measures: Outcomes of actual performance and self-perceived difficulty were derived from the Frenchay Activities Index (FAI) and the difficulty dimension of the Participation Measure–3 Domains, 4 Dimensions (PM–3D4D), respectively. Outcomes of ability were measured with the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Canadian Occupational Performance Measure Performance score (COPM Performance). Results: No statistically significant differences were found in the three aspects between the IADL reablement and health education (ps =.148–.570). Compared with the health education, the IADL reablement showed better improvements on the FAI, LIADL, COPM Performance, and difficulty dimension of the PM–3D4D with trivial to small effect sizes (ds = 0.17–0.45). Conclusions and Relevance: Our results reveal that the IADL reablement has the potential to increase the frequency of IADL administration, enhancing the capability to perform IADLs and reducing the self-perceived difficulty of carrying out IADLs. Plain-Language Summary: The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. An IADL reablement intervention may be useful for improving the ability to carry out IADL tasks at home and in the community. The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. [ABSTRACT FROM AUTHOR]

Background: Psychological, social and spiritual needs are often unmet during the care of patients with cancer in Taiwan. Aim: The purpose of this study was to confirm the spiritual care models including the spiritual distress symptoms (SDS), spiritual distress symptoms interventions (SDSI), and spiritual distress outcomes criteria (SDOC) of patients with cancer in the initial, relapse and terminal stages. Method: This cross-sectional survey collected data from 150 professional nurses about their perceptions of the SDS, SDSI and SDOC for patients with cancer. Results: The significant total effects of SDS on SDOC by SDSI of the patients with cancer in the initial, relapse and terminal stages were found. Additionally, the direct effects of SDS on SDOC by SDSI of the patients with cancer from the initial, relapse to terminal stage were gradually enhanced. Conclusions: The relationship between spiritual distress symptoms, interventions and outcomes was significantly higher from the initial to relapse state until at the end of life, based on the perceptions of 150 professional nurses. [ABSTRACT FROM AUTHOR]

Objectives: The role of autoimmune diseases on the risk for acute epiglottitis remains uncertain. This study aimed to delineate the association between epiglottitis and autoimmune diseases using population database. Methods: A population-based retrospective study was conducted to analyze claims data from Taiwan National Health Insurance Research Database collected over January, 2000, to December, 2013. Results: In total, 2339 patients with epiglottitis were matched with 9356 controls without epiglottitis by sex, age, socioeconomic status, and urbanization level. The correlation between autoimmune diseases and epiglottitis was analyzed by multivariate logistic regression. Compared with controls, patients with epiglottitis were much more likely to have preexisting Sjögren syndrome (adjusted odds ratio [aOR]: 2.37; 95% CI: 1.14-4.91; P =.021). In addition, polyautoimmunity was associated with increased risk of epiglottitis (aOR: 2.08; 95% CI: 1.14-3.80; P =.018), particularly in those aged >50 years (aOR: 2.61; 95% CI: 1.21-5.66; P =.015). Conclusions: Among autoimmune diseases, we verify the association between epiglottitis and Sjögren syndrome in Taiwan. Furthermore, we present the novel discovery that patients with epiglottitis have an increased risk of polyautoimmunity, particularly those aged >50 years. [ABSTRACT FROM AUTHOR]

This paper attempts to examine how malaria eradication in Taiwan during the 1950s, which successfully wiped out malaria within a short period, affected long-term health. Relying on three data sets covering the entire population of Taiwan, we construct diverse measures of health, including health-care utilization, functional abilities, chronic diseases, and catastrophic illnesses. Our results indicate that people who experienced larger reductions in early-life malaria exposure tend to have better health status as adults, especially women. Our results suggest a sizable cost saving from the eradication program that improves early-life environment and helps to avoid costly diseases at a later point. [ABSTRACT FROM AUTHOR]

Background: The chronic systemic inflammatory response in periodontitis may be a potential risk factor for dementia, especially in adults. This study determined the association between periodontal treatment and dementia in adults and evaluated the effect of regular scaling treatment on the risk of dementia in this population. Methods: This case–control study identified 18,930 patients with a dementia-related diagnosis from the Taiwan National Health Insurance Research Database. Scaling and periodontal emergency treatments were evaluated after 1 year and 3 years. Using multivariable logistic regression analysis to evaluate the association between periodontal emergency treatment and dementia risk. Results: The results showed that scaling treatment rates were lower in the dementia cohort than the non-dementia cohort after 1 and 3 years. Patients who received periodontal emergency treatment within 3 years had a significantly increased risk of dementia. Furthermore, patients with periodontitis who did not receive scaling treatment within 3 years had a higher risk of dementia than patients without periodontitis (OR, 1.22; 95% CI, 1.10–1.35). Conclusion: This study demonstrated that periodontitis and dementia are associated, and that periodontitis is a risk factor for dementia in adults. The risk of dementia was dependent on the periodontal health status of adults, and our findings suggest that regular scaling can reduce the incidence of dementia in adults. Therefore, regular and routine scaling treatment is suggested for adults. [ABSTRACT FROM AUTHOR]

Objectives: Metabolic syndrome (MetS) and hepatitis C virus (HCV) are associated with a higher risk of impaired pulmonary function (iPF). This study aimed to investigate the relationships among MetS, iPF, and viral hepatitis. Methods: This community-based study enrolled participants undergoing annual health check-ups in southern Taiwan between March and December 2019. We performed multivariable logistic regression analyses adjusted for demographics and characteristics to identify the factors associated with iPF. Results: A total of 2337 participants completed examinations, of whom 928 (39.7%) had iPF. The participants with iPF were elderly (68.8 ± 12.8 years old) and predominately female (63%). MetS increased the risk of iPF (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27–1.81, p < 0.001). Beyond age (OR 1.03, 95% CI 1.02–1.04) and smoking (OR 1.309, 95% CI 1.004–1.705), female sex (OR 0.74, 95% CI 0.59–0.93) and high education level (OR 0.96, 95% CI 0.94–0.98, p < 0.001) protected against iPF. HCV was not significantly associated with iPF (OR 1.17, 95% CI 0.90–1.52, p = 0.235) in multivariable analysis. MetS was associated with a higher risk of iPF in the non-HBV/HCV group (OR 1.86, 95% CI 1.54–2.26) and HBV alone group (OR 3.44, 95% CI 1.89–6.28), but not in the HCV alone group (OR 1.02, 95% CI 0.64–1.62). Discussion: MetS was an independent predictor of iPF, especially the restrictive type, and had different effects in the HBV/non-viral hepatitis and HCV groups. Female sex and education were inversely associated with iPF. [ABSTRACT FROM AUTHOR]

Simple Summary: Although fertility sparing surgery (FSS) may be a favorable surgical option for young women with early-stage borderline ovarian tumors (BOTs) or epithelial ovarian cancer (EOC) who wish to preserve their fertility, there still possessed risks of recurrence and disease progression during follow-up. The purpose of this retrospective article is to investigate the treatment outcomes in early-stage BOTs/EOC patients who underwent FSS. In this cohort, we found that the rate of pregnancy was higher among the married BOTs patients who had no prior live birth experience than among those who had prior live birth experience. The fertility and pregnancy outcome presented in this article may provide an important reference during pre-operative counseling. This study examined treatment outcomes, including preserved fertility, menstrual regularity, and pregnancy outcomes, in patients with stage I epithelial ovarian cancer (EOC) or borderline ovarian tumors (BOTs) who underwent fertility-sparing surgery (FSS). Patients with stage I EOC and BOTs who were aged 18–45 years and underwent FSS between 2007 and 2022 were retrospectively reviewed. Significant differences between various subgroups in terms of disease recurrence, menstrual irregularity due to the disease, and pregnancy outcomes were analyzed. A total of 71 patients with BOTs and 33 patients with EOC were included. In the BOT group, the median age was 30 (range, 19–44) years. Recurrence occurred in eight patients, with one case exhibiting a malignant transformation into mucinous EOC. Among the 35 married patients with BOTs, 20 successfully conceived, resulting in 23 live births and 3 spontaneous abortions. A higher pregnancy rate was observed in those without prior childbirth (82.4%) than in those who had prior childbirth (33.3%). In the EOC group, the median age was 34 (range, 22–42) years. Recurrence occurred in one patient. Menstrual regularity was maintained in 69.7% of the patients. Among the 14 married patients in this group, 12 achieved a total of 15 pregnancies (including 2 twin pregnancies), 16 live births, and 1 spontaneous abortion. The results of the study confirmed that FSS is a favorable surgical option for young women with early-stage BOTs or EOC who wish to preserve their fertility. However, additional investigations are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Pay-for-performance (P4P) programs for diabetes care enable the provision of comprehensive and continuous health care to diabetic patients. However, patient outcomes may be affected by the patient's educational attainment. The present retrospective cohort study aimed to examine the effects of the educational attainment of diabetic patients on participation in a P4P program in Taiwan and the risk of dialysis. The data were obtained from the National Health Insurance Research Database of Taiwan. Patients newly diagnosed with type 2 diabetes mellitus (T2DM) aged 45 years from 2002 to 2015 were enrolled and observed until the end of 2017. The effects of their educational attainment on their participation in a P4P program were examined using the Cox proportional hazards model, while the impact on their risk for dialysis was investigated using the Cox proportional hazards model. The probability of participation in the P4P program was significantly higher in subjects with a junior high school education or above than in those who were illiterate or had only attained an elementary school education. Subjects with higher educational attainment exhibited a lower risk for dialysis. Different educational levels had similar effects on reducing dialysis risk among diabetic participants in the P4P program. [ABSTRACT FROM AUTHOR]

In this study, we reported the patterns, epidemiology, and clinical features of anterior uveitis (AU) in Taiwan, an area of Eastern Asia. This prospective, cross-sectional case series study was performed to identify patients with AU at two tertiary medical centers (Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital) located at the southern Taiwan between December 1, 2018, and March 31, 2020. The clinical diagnoses, ocular presentations, and laboratory data, including the results of the aqueous polymerase chain reaction tests, were investigated in these patients. A total of 112 patients, with a mean age of 48.9 years, were included. Most patients (87.5%) presented with unilateral eye disease, with 30 cases of ocular hypertension at the first presentation (27%). The most common clinical diagnoses were idiopathic AU (37.5%), human leukocyte antigen (HLA)-B27-associated acute AU (25.0%), and herpetic AU (18.8%). Among patients with herpetic AU, cytomegalovirus (CMV) was the most common pathogen (17/21, 81%). Compared to HLA-B27-associated acute AU, CMV-related AU was mostly observed in patients that were older in age, exhibited higher intraocular pressure, more keratic precipitates, greater iris atrophy, and more pseudophakia, but was least reported in those with posterior synechiae. This prospective study identified the pattern and clinical features of AU in southern Taiwan. [ABSTRACT FROM AUTHOR]

Introduction: This cohort study aimed to explore the potential association between ambient air pollution and dementia incidence in adults who have experienced a stroke. Additionally, the study aimed to determine dysphagia as a predictive factor for the subsequent development of dementia in patients with stroke. Materials and methods: This retrospective nested case--control study used data from the Kaohsiung Medical University Hospital Database in Taiwan. Data collected include average ambient air pollution concentrations within 3 months and 1 year after the index dysphagia date. The primary outcome includes incident dementia in patients with or without dysphagia. Logistic regression analysis was performed to examine the association between significant air pollution exposure and the risk of dementia while controlling for baseline demographic characteristics (age and sex), and comorbidities. Results: The univariable regression models revealed a higher likelihood of dementia diagnosis in patients with dysphagia (odds ratio = 1.493, 95% confidence interval = 1.000-2.228). The raw odds ratios indicated a potential link between air pollution exposure and elevated dementia risks in the overall study population and patients with stroke without dysphagia, except for O3. Particulate matter (PM)2.5 and nitrogen oxides (NOx) exhibited significant effects on the risk of dementia in the stepwise logistic regression models. Conclusion: The presence of dysphagia following a stroke may pose a risk of developing dementia. Additionally, PM2.5 and NOx exposure appears to elevate the risk of dementia in patients with stroke. [ABSTRACT FROM AUTHOR]

Teenage pregnancy is a major public health concern. However, few studies have investigated the relationship between pediatric bipolar disorder and early pregnancy, and whether bipolar disorder medications reduce the risk of early pregnancy remains unknown. In total, 3218 adolescent girls with bipolar disorder and 32,180 controls matched for age, family income, residence, and time of enrollment were enrolled in this study from 2001 to 2009. Early pregnancy, defined as pregnancy occurring in patients younger than 20 years old, was identified during the follow-up period from enrollment until the end of 2011. After adjustment for demographic data, psychiatric comorbidities, and bipolar disorder medications, adolescent girls with bipolar disorder had 20 times the risk of early pregnancy (hazard ratio [HR] = 20.63, 95% confidence interval [CI] [15.68, 27.16]) and about 25 times the risk of repeated early pregnancy (HR = 24.59, 95% CI [15.20, 39.78]) compared with those without bipolar disorder. Long-term use of both mood stabilizers (HR = 0.34, 95% CI [0.23, 0.52]) and atypical antipsychotics (HR = 0.32, 95% CI [0.20, 0.51]) was associated with a reduced risk of early pregnancy. Bipolar disorder was associated with an increased risk of early pregnancy in adolescent girls. Bipolar disorder medications reduced this risk. The results suggest that interventions targeting the vulnerable population of adolescent girls with bipolar disorder are warranted to prevent early pregnancies. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we used Taiwan's National Health Insurance Research Database to investigate the potential association between sleep disorder (SD) and colorectal cancer (CRC) after matching 177,707 patients with SD and without a history of CRC with 177,707 non-SD and non-CRC Taiwanese citizens without SD and without CRC based on age and gender. The results demonstrated a significantly higher likelihood of developing CRC in SD patients compared to the control group. Subgroup analysis revealed that among the four different types of SD, the insomnia group exhibited a significantly elevated risk of CRC. It should be noted that individuals simultaneously affected with sleep apnea and insomnia had a significantly higher risk of developing CRC than those with either condition alone. These research findings suggest a potentially higher risk of CRC in Taiwanese SD patients, underscoring the need to explore the relationship between SD and CRC risk. The impact of sleep disorders (SDs), particularly sleep apnea (SA), on the development of colorectal cancer (CRC) has been the subject of significant research. However, the potential contribution of other SDs to the incidence of CRC remains unexplored. The objective of this study was to examine the effects of SDs on the risk of developing CRC. This study assessed CRC risk among individuals diagnosed with SDs compared with age- and sex-matched unaffected individuals. A longitudinal, nationwide, population-based cohort study was conducted using data from the Taiwan National Health Insurance Research Database (NHIRD) encompassing 177,707 individuals diagnosed with SDs and 177,707 matched controls. Cox proportional hazard regression analysis was used to determine the relative increased risk of CRC in individuals with SDs and specific subgroups of SDs. The CRC incidences were 1.32-fold higher (95% CI 1.23–1.42) in the overall SD cohort, 1.17-fold higher (95% CI 0.82–1.68) in the SA cohort, 1.42-fold higher (95% CI 1.31–1.55) in the insomnia cohort, 1.27-fold higher (95% CI 1.17–1.38) in the sleep disturbance cohort, and 1.00-fold higher (95% CI 0.77–1.29) in the other SD cohort, after adjusting for age, sex, and comorbidities. [ABSTRACT FROM AUTHOR]

Background: Patients with serious mental illness (SMI) are more likely to have Type 2 diabetes mellitus (T2DM). However, studies that discuss the eating habits of patients with both T2DM and SMI are lacking. Purpose: This study was designed to explore the beliefs and experiences of Taiwanese patients with SMI who also have T2DM. Methods: Fieldwork for this study included 2 years of participant observation and individual interviews with 13 patients with SMI. Data from transcripts of observational field notes and interviews were transcribed verbatim and analyzed. Results: The participants described their experiences and concerns regarding dietary management during the period after receiving their T2DM diagnosis. The results of the data analysis were distinguished into three categories, including (a) increased difficulty in life, (b) positive view of dietary control, and (c) inability to abide by dietary restrictions. Conclusions: The findings suggest that healthcare professionals should work to better understand the challenges faced by patients with SMI and T2DM in implementing changes and resisting the temptation to eat unhealthy food and provide suggestions tailored to their cultural background, lifestyle, and eating characteristics. [ABSTRACT FROM AUTHOR]

The multifaceted nature and swift progression of Amyotrophic Lateral Sclerosis (ALS) pose considerable challenges to our understanding of its evolution and interplay with comorbid conditions. This study seeks to elucidate the temporal dynamics of ALS progression and its interaction with associated diseases. We employed a principal tree-based model to decipher patterns within clinical data derived from a population-based database in Taiwan. The disease progression was portrayed as branched trajectories, each path representing a series of distinct stages. Each stage embodied the cumulative occurrence of co-existing diseases, depicted as nodes on the tree, with edges symbolizing potential transitions between these linked nodes. Our model identified eight distinct ALS patient trajectories, unveiling unique patterns of disease associations at various stages of progression. These patterns may suggest underlying disease mechanisms or risk factors. This research re-conceptualizes ALS progression as a migration through diverse stages, instead of the perspective of a sequence of isolated events. This new approach illuminates patterns of disease association across different progression phases. The insights obtained from this study hold the potential to inform doctors regarding the development of personalized treatment strategies, ultimately enhancing patient prognosis and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To elucidate the relationship between various sleep-wake-related indicators and nutritional status. Design: Cross-sectional study. Setting: Community-based survey between 2017 and 2022 in Yilan City, Taiwan. Participants: 1,905 community-dwelling older adults aged ≥65 years. Measurements: Nutritional status was evaluated using the Mini Nutritional Assessment, and participants were classified into normal nutritional status and undernutrition groups. Regarding sleep-wake-related indicators, specific items or component scores of the Pittsburgh Sleep Quality Index were used to assess sleep-wake schedule, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, presence of sleep disturbances, hypnotic use, and dysfunction in maintaining enthusiasm. The 5-item Athens Insomnia Scale and the Epworth Sleepiness Scale were used to evaluate insomnia and excessive daytime sleepiness, respectively. Results: Of the 1,905 participants, the mean age was 75.6±7.1, with 52.2% being ≥75 years old, 58.9% were women, and 11.4% had undernutrition. After controlling for covariates, short sleepers were less likely to have undernutrition (OR: 0.63; 95% CI: 0.41–0.97); in contrast, long sleepers were more likely to exhibit undernutrition (OR: 1.52; 95% CI: 1.06–2.17). In addition, poor habitual sleep efficiency (OR:1.69; 95% CI:1.15–2.50), taking hypnotics in the past month (OR: 1.58; 95% CI: 1.12–2.24), and dysfunction in maintaining enthusiasm (OR: 1.93; 95% CI: 1.24–2.99) were associated with increased risk of undernutrition. Conclusions: Among older adults, various sleep-wake-related indicators differed in their relationships with nutritional status. Specific sleep-wake disturbances may indicate undernutrition in this population. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer with liver metastases (CRLM) has a poor prognosis. Systemic treatment alone, or worse, best supportive care, only affords patients limited survival. This study aims to provide evidence that aggressive local control through hepatic resection and/or radiofrequency ablation (RFA) can significantly prolong CRLM overall survival. Out of the 2612 patients enrolled in this study, 637 underwent hepatectomy, 93 had RFA, 92 were given combined hepatectomy and RFA, while 1790 received non-aggressive treatment. Based on the Kaplan–Meier curves and multivariate Cox's regression analysis as well as frequency matching analysis, we conclude that aggressive local control in CRLM patients has survival benefits, in addition to systemic therapy from a large multi-institutional database. Hepatectomy and/or local ablation therapy have been recommended for colorectal cancer liver metastases (CRLM). However, they still lack strong evidence for their survival benefits, in addition to systemic therapy. This study aims to evaluate the survival evidence of hepatectomy and/or radiofrequency ablation (RFA) therapy in CRLM patients from a large multi-institutional database. A total of 20,251 patients with colorectal cancer, 4521 of whom were with CRLM, were screened for eligibility. Finally, 2612 patients (637 hepatectomy, 93 RFA, 92 combined hepatectomy and RFA, and 1790 non-aggressive treatment) were enrolled. Frequency matching analysis was used to adjust for baseline differences. The 5-year overall survival (OS) was as follows: hepatectomy alone was 47.8%, combined hepatectomy plus RFA was 35.9%, RFA alone was 29.2%, and the non-aggressive treatment group was 7.4%. Kaplan–Meier curves showed that hepatectomy, RFA, and combination were significantly associated with a better OS compared to those without aggressive local therapy (p < 0.001). Multivariate Cox regression analysis showed that male gender (hazard ratio (HR) 0.89; 95% confidence interval (CI), 0.81–0.97; p = 0.011), old age (≥60 years) (HR 1.20; 95% CI, 1.09–1.32; p < 0.001), high CEA level (>5 ng/mL) (HR 2.14; 95% CI, 1.89–2.42; p < 0.001), primary right-sided cancer (HR 1.35; 95% CI, 1.22–1.51; p < 0.001), extrahepatic metastasis (HR 1.46; 95% CI, 1.33–1.60; p < 0.001), systemic therapy (HR 0.7; 95% CI, 0.62–0.79; p < 0.001), and aggressive local therapy (hepatectomy vs. non-local therapy HR 0.22; 95% CI, 0.20–0.26; p < 0.001; RFA vs. non-local therapy HR 0.29; 95% CI, 0.29–0.41; p < 0.001) were independent factors associated with OS. In the frequency matching analysis, patients receiving hepatectomy and/or RFA resulted in a better OS than those without (p < 0.001). In conclusion, aggressive local treatment provides survival advantages over systemic therapy alone among CRLM patients. [ABSTRACT FROM AUTHOR]

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are the primary cause of pediatric chronic kidney disease. Maternal body mass index (BMI) before pregnancy, pregestational diabetic mellitus (DM), and gestational diabetic mellitus (GDM) are potential modifiable risk factors for CAKUT in offspring. Methods: In this case control study, 4619 neonates were enrolled during 2012–2020 from Kaohsiung Veterans General Hospital in Taiwan. Maternal risk factors before and during pregnancy were compared in children with and without CAKUT. The yearly incidence of CAKUT in offspring and maternal overweight were recorded. Results: In total, 73 (1.6%) cases of CAKUT in offspring were identified. Maternal overweight before pregnancy (BMI ≥ 24 kg/m2) was an independent risk factor for CAKUT in offspring. No associations of pregestational DM and GDM with CAKUT in offspring were observed. The incidence rates of CAKUT and maternal obesity have increased in the past 10 years. Conclusions: Maternal obesity before pregnancy is associated with CAKUT in offspring and should be addressed to ensure better outcomes. [ABSTRACT FROM AUTHOR]

Cyberbullying has become an international concern among youth with autistic traits in the digital age. It draws the attention of professionals in mental health and education due to its potentially severe psychosocial and academic impacts. However, there is limited knowledge about the mediators for these associations. This study investigated whether school dysfunction and comorbid psychopathologies mediated the link between autistic traits and cyberbullying. We used a nationally representative sample of 9,483 students (9–14 years of age). The instruments included the Social Responsiveness Scale for autistic traits; the Cyberbullying Experiences Questionnaire for cyberbullying victimization and perpetration; the Swanson, Nolan, and Pelham, version IV for inattention, hyperactivity/impulsivity, and oppositional behaviors; the Child Behavior Checklist for anxiety/depression; and the Social Adjustment Inventory for Children and Adolescents for impaired school functions. Multiple mediation models were used for statistical analyses. The results showed that the 1-year prevalence rates of pure victims, pure perpetrators, and bully-victims of cyberbullying were 7.9 percent, 2.4 percent, and 5.7 percent, respectively. Cyberbullying victimization and perpetration were positively associated with autistic traits, school dysfunction, and comorbid psychopathologies. The associations between autistic traits and cyberbullying victims and bully-victims were significantly mediated by school dysfunction and hyperactivity/impulsivity (only for bully-victims), independent of sex and age. Our results suggest that early identification and intervention of these difficulties may mitigate the risks of cyberbullying. ClinicalTrials.gov ID: NCT02707848. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aims to examine the association between nasopharyngeal carcinoma and human papillomavirus infections by means of a nationwide population-based study. This study included 2747 individuals aged 20 years and older who were diagnosed with nasopharynx cancer as cases and 13,735 propensity-score-matching controls. The chi-squared test indicated a significant dissimilarity in previous human papillomavirus infection rates between nasopharynx cancer patients and controls (12.7% vs. 7.2%, p < 0.001). The adjusted odds ratio for prior human papillomavirus infections was found to be significantly higher for nasopharyngeal carcinoma cases compared to controls at a value of 1.869 with confidence interval ranging from 1.640 to 2.128 (p < 0.001). Our study indicates a noteworthy association between previous human papillomavirus infections and nasopharyngeal carcinoma. Healthcare providers should consider patients' history of human papillomavirus infection when evaluating their susceptibility to nasopharyngeal carcinoma. This population-based study aims to examine the association between nasopharyngeal carcinoma and human papillomavirus infections. This study included 2747 individuals aged 20 years and older who were diagnosed with nasopharynx cancer as cases and 13,735 propensity-score-matching controls. Multivariate logistic regression models were employed to quantitatively assess the association of nasopharynx cancer with human papillomavirus infections while considering age, sex, monthly income, geographic location, and urbanization level of the patient's residence as well as diabetes, hypertension, and hyperlipidemia. Our chi-squared test indicated a significant dissimilarity in previous human papillomavirus infection rates between nasopharynx cancer patients and controls (12.7% vs. 7.2%, p < 0.001). The adjusted odds ratio (OR) for prior human papillomavirus infections was found to be significantly higher for nasopharyngeal carcinoma cases compared to controls at a value of 1.869 with confidence interval ranging from 1.640 to 2.128. Among female participants, compared to controls, the adjusted OR of prior human papillomavirus infections was 2.150 (95% CI = 1.763–2.626) in patients with nasopharynx cancer. In male participants sampled in this study, we observed a statistically significant association between prior human papillomavirus infections and nasopharynx cancer (adjusted OR = 1.689; 95% CI = 1.421–2.008). Our study indicates a noteworthy association between previous human papillomavirus infections and nasopharyngeal carcinoma. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to explore farmers' self‐care behaviours including oral hygiene, remaining natural teeth, cardiometabolic risks, hepatitis, risk of stroke and their determinant factors. Methods: This cross‐sectional study was conducted between June 2020 and March 2021 in the south‐western remote areas of Taiwan. We recruited current farmers who participated in an annual community health screening conducted by a collaborated local hospital. Data were collected through face‐to‐face interviews using a semi‐structured questionnaire. Blood samples were drawn and stored in the central laboratory of the cooperating hospital. The study outcomes included cardiometabolic risks, the remaining natural teeth, and farmers' self‐care behaviours including oral hygiene, adopting a healthy diet and substance use. Results: Overall, 183 current farmers (55.2% women, aged 66.9 ± 11.7 years) were enrolled. Abnormal blood pressure, high risk of stroke, metabolic syndrome and hepatitis C virus infection were found among the participants. The average remaining teeth were 12.1, 73.2% of participants had <20 teeth; 90.2% and 71% did not undergo regular dental check‐ups and scaling or use dental floss, respectively. The determinant factors associated with the remaining teeth included a high risk of stroke, teeth scaling and dental floss use. Although only 3.8% felt mentally distressed, many farmers were unaware of having potential cardiometabolic diseases and curable viral hepatitis, and only two had received antiviral treatment. Conclusion: The farmers in this study had a high prevalence of cardiometabolic risks, a high probability of stroke, inadequate number of remaining teeth and poor oral hygiene behaviours. These findings can provide evidence to develop health promotion programmes for farmers. Impact: This study demonstrates the health needs of farmers. We strongly recommend that community nurses empower farmers to engage in self‐care behaviours through tailored health promotion programmes. For instance, by discussing cardiometabolic risk prevention from the farmers' perspectives to improve their health literacy. [ABSTRACT FROM AUTHOR]

Background: Individuals with Down syndrome are at a higher risk of cardiac, renal, and other health issues due to a complex disease physiology. However, few data exist on long-term disease risks to guide prevention and care. We aimed to determine the 10-year incidence of cardiac, renal, and urinary tract complications in Down syndrome versus matched controls. Methods: This retrospective cohort study utilized a large collaborative database. We identified 32,444 patients with Down syndrome and matched controls, excluding those with pre-follow-up target events. Covariates included demographics, lifestyle factors, and comorbidities. Outcomes were ischemic heart disease, hypertension, hypothyroidism, epilepsy, urinary tract infections and chronic kidney disease. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox regression and plotted Kaplan–Meier survival curves. Findings: Over 10 years, Down syndrome patients showed a 3.7-fold higher ischemic heart disease risk (95% CI: 3.0–4.6) and a 1.6-fold higher hypertension risk (95% CI: 1.4–1.8) versus controls. Hypothyroidism (HR = 2.0; 95% CI: 1.7–2.4), epilepsy (HR = 4.5; 95% CI: 3.5–5.8), and urinary tract infection (HR = 3.9; 95% CI: 3.4–4.6) risks were also higher. Chronic kidney disease risk was 2.7-fold greater (95% CI: 2.1–3.5). Survival analysis confirmed a significantly higher incidence of all outcomes in Down syndrome (p < 0.0001). Interpretation: This large study found major health challenges in Down syndrome, with risks 3- to 5-fold higher for chronic conditions versus matched controls over 10 years. Though survival remains high with proper care, focusing resources on the prevention and management of complications in this high-risk group can optimize well-being across the lifespan. Future research accounting for limitations here would provide definitive estimates of disease risk in Down syndrome to guide targeted health strategies. [ABSTRACT FROM AUTHOR]

Background: Previous observational studies have shown that people with dental scaling (DS) had decreased risk of stroke. However, limited information is available on the association between DS and poststroke outcomes. The present study aimed to evaluate the effects of regular DS on the complications and mortality after stroke. Methods: We conducted a retrospective cohort study of 49,547 hospitalized stroke patients who received regular DS using 2010–2017 claims data of Taiwan's National Health Insurance. Using a propensity-score matching procedure, we selected 49,547 women without DS for comparison. Multiple logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of poststroke complications and in-hospital mortality associated with regular DS. Results: Stroke patients with regular DS had significantly lower risks of poststroke pneumonia (OR 0.58, 95% CI 0.54–0.63), septicemia (OR 0.58, 95% CI 0.54–0.63), urinary tract infection (OR 0.68, 95% CI 0.66–0.71), intensive care (OR 0.81, 95% CI 0.78–0.84), and in-hospital mortality (OR 0.66, 95% CI 0.62–0.71) compared with non-DS stroke patients. Stroke patients with regular DS also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of poststroke adverse events in patients with regular DS were noted in both sexes, all age groups, and people with various types of stroke. Conclusion: Stroke patients with regular DS showed fewer complications and lower mortality compared with patients had no DS. These findings suggest the urgent need to promote regular DS for this susceptible population of stroke patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma (HCC) is a severe complication of chronic hepatitis B virus (HBV) infection. HCC can still develop in CHB patients undergoing antiviral therapy. Although several scoring systems for the prediction of HCC risk in CHB patients are available, very few of them are established for CHB patients receiving antiviral therapy. Our study developed a predictive scoring system for CHB patients on finite antiviral treatment, categorizing them into three risk groups based on a multivariate Cox proportional hazards model. Significant differences in HCC incidence were observed among these groups. PURPOSE: Hepatocellular carcinoma (HCC) is one of the most severe complications in chronic hepatitis B virus (HBV) infection. HCC can still develop in patients with chronic HBV (CHB) infection undergoing antiviral therapy. Several effective scoring systems for the prediction of HCC risk in CHB patients have been established. However, very few of them are designed for CHB patients receiving nucleos(t)ide analogues (NAs) therapy. Furthermore, none are available for HCC risk prediction in CHB patients receiving finite periods of antiviral therapy. METHODS: This study enrolled 790 consecutive treatment-naïve patients with CHB infection who had visited our liver clinics from 2008 to 2012 for pretreatment assessment before receiving antiviral therapies. The treatments were provided at finite periods according to the National Health Insurance Policy in Taiwan. The last follow-up date was 31 December 2021. We analyzed the virological and clinical factors in these 790 CHB patients receiving finite periods of NA treatments and identified the most significant risk factors for HCC to establish a novel predictive scoring system. By using stepwise selection in a multivariate Cox proportional hazards model, we divided the patients into three risk groups. RESULTS: Our predictive scoring system included five independent variables: genotype C (adjusted HR [aHR] = 2.23), NA-withdraw-related hepatitis relapse (aHR = 6.96), male (aHR = 4.19), liver cirrhosis (aHR = 11.14), and T1768A core promoter mutation (aHR = 3.21). This model revealed significant differences in HCC incidence among the three risk groups. The 5-year cumulative HCC risk significantly differed among the three risk groups (low risk: 1.33%, moderate risk: 4.99%, and high risk: 17.46%), with log-rank test p < 0.001. CONCLUSION: Our predictive scoring system is a promising tool for the prediction of HCC in CHB patients receiving finite NA treatments. Genotype C, NA-withdraw-related hepatitis relapse, male gender, liver cirrhosis, and the T1768A HBV core promoter mutation were significant independent risk factors. [ABSTRACT FROM AUTHOR]

This study investigated the association of de Quervain tenosynovitis (DQT) with subsequent adhesive capsulitis (AC) development. Patients with DQT between 2001 and 2017 from the Taiwan National Health Insurance Research Database were the DQT cohort. The 1:1 propensity score matching method was applied for creating control cohort. The primary outcome was defined as new-onset of AC at least 1 year after the date of confirmed diagnosis of DQT. In total, 32,048 patients with mean age 45.3 years were included. DQT was significantly positively associated with risk of new-onset AC after adjustment for baseline characteristics. Furthermore, severe DQT requiring rehabilitation was positively associated with risk of new-onset AC. In addition, male gender and age under 40 may be additional risk factors for new-onset AC, compared to female gender and age over 40. Cumulative incidence of AC after 17 years was 24.1% among patients with severe DQT requiring rehabilitation and was 20.8% among patients with DQT without rehabilitation. This is the first population-based study to demonstrate an association between DQT and new-onset AC. The findings recommend that preventive occupational therapy, including active modification for the shoulder joint and adjustments to daily activities, may be necessary for patients with DQT to reduce their risk of developing AC. [ABSTRACT FROM AUTHOR]

People with autism spectrum disorder (ASD) may have poor oral health status because they often experience challenges with daily oral hygiene and have inadequate access to oral health care services. This study explored periodontitis risk in adolescents with ASD compared with those who did not have a diagnosis of ASD. Data from 2001 through December 31, 2011 from the Taiwan National Health Insurance Research Database on 3,473 adolescents with ASD and 34,730 age- and sex-matched people who did not have a diagnosis of ASD were obtained, and subsequent periodontitis was identified from enrollment through December 31, 2011. Adolescents with ASD (hazard ratio, 2.01; 95% CI, 1.84 to 2.20) were more likely to develop periodontitis at follow-up than those who did not have a diagnosis of ASD. Findings remained consistent in subanalyses stratified by sex and intellectual disability. People with ASD had periodontitis onset at an earlier mean (SD) age than those who did not have a diagnosis of ASD (17.97 [3.12] vs 21.86 [2.28] years; P <.001). ASD is an independent risk factor for subsequent periodontitis development. Oral health should be closely monitored in adolescents with ASD. Future investigation of the common pathogenesis between periodontitis and ASD is warranted. [ABSTRACT FROM AUTHOR]

Background: Serum albumin level is a crucial nutritional indicator for patients on dialysis. Approximately one-third of patients on hemodialysis (HD) have protein malnutrition. Therefore, the serum albumin level of patients on HD is strongly correlated with mortality. Methods: In study, the data sets were obtained from the longitudinal electronic health records of the largest HD center in Taiwan from July 2011 to December 2015, included 1,567 new patients on HD who met the inclusion criteria. Multivariate logistic regression was performed to evaluate the association of clinical factors with low serum albumin, and the grasshopper optimization algorithm (GOA) was used for feature selection. The quantile g-computation method was used to calculate the weight ratio of each factor. Machine learning and deep learning (DL) methods were used to predict the low serum albumin. The area under the curve (AUC) and accuracy were calculated to determine the model performance. Results: Age, gender, hypertension, hemoglobin, iron, ferritin, sodium, potassium, calcium, creatinine, alkaline phosphatase, and triglyceride levels were significantly associated with low serum albumin. The AUC and accuracy of the GOA quantile g-computation weight model combined with the Bi-LSTM method were 98% and 95%, respectively. Conclusion: The GOA method was able to rapidly identify the optimal combination of factors associated with serum albumin in patients on HD, and the quantile g-computation with DL methods could determine the most effective GOA quantile g-computation weight prediction model. The serum albumin status of patients on HD can be predicted by the proposed model and accordingly provide patients with better a prognostic care and treatment. [ABSTRACT FROM AUTHOR]

Summary: Osteoporosis was suggested to be associated with higher odds of age-related macular degeneration. However, the temporal relationship between osteoporosis and age-related macular degeneration has not been explored. This population-based longitudinal follow-up study showed an increased risk of age-related macular degeneration in both men and women with osteoporosis. Purpose: To investigate the long-term risk of age-related macular degeneration (AMD) in patients with osteoporosis. Methods: This is a retrospective cohort study using the Longitudinal Health Insurance Database 2005, a subset of Taiwan's National Health Insurance research database. A total of 23,611 individuals aged 50 to 79 who were diagnosed with osteoporosis between January 1, 2002 and December 31, 2006, were enrolled in the osteoporosis group. An exactly equal number of propensity score-matched individuals without osteoporosis comprised the comparison group. The variables used in propensity score matching included age, sex, comorbidities, and socioeconomic status. Cox proportional hazard regression analysis was used to evaluate the association between osteoporosis and AMD. The main outcome measure is the occurrence of newly diagnosed AMD. Results: The hazard ratio (HR) of AMD in the osteoporosis group was 1.34 times higher than in the comparison group (95% confidence interval [CI] 1.22–1.47, p < 0.05). The AMD-free survival rate of the osteoporosis group was significantly lower than that of the comparison group (p < 0.0001). Sex-stratified analysis revealed a significantly increased risk of AMD in both osteoporotic men (HR 1.45; 95% CI 1.20–1.76, p = 0.0002) and women (HR 1.31; 95% CI 1.17–1.46, p < 0.0001) compared with their non-osteoporotic counterparts. Conclusion: This longitudinal follow-up study revealed an increased risk of developing AMD in both men and women with osteoporosis. [ABSTRACT FROM AUTHOR]

Aims: Diabetes can be an important cofactor in the development of penile inflammation. Here, we explored the association between penile inflammatory disorders and diabetes mellitus (DM), hypertension, and hyperlipidemia in the Taiwanese population, using a population-based data set. Methods: The research data in this study were obtained from Taiwan's National Health Insurance Research Database between January 1997 and December 2010. We identified 12,819 patients who had a diagnosis of DM, and randomly matched 38,457 subjects as controls. The data were analyzed with Poisson regression analysis and with Cox regression with a frailty model after propensity score matching. Results: DM (odd ratio (OR) = 1.43, p < 0.01), and age (OR = 0.71, p < 0.01), but not hyperlipidemia (OR = 0.96, p =0.36), or hypertension (OR = 1.09, p = 0.10) had an impact on the development of penile inflammatory disorders. DM was a risk factor associated with penile inflammatory disorder (HR = 1.42, 95% CI = 1.27~1.68, p < 0.01), whereas no statistical difference was noted between penile inflammation and hypertension (HR = 0.98, 95% CI = 0.89~1.09) and hyperlipidemia (HR = 1.03, 95% CI = 0.92~1.14). Conclusions: T2DM and younger age, but not hypertension or hyperlipidemia, were associated with an increased risk of penile inflammatory disorders in men between 30 and 49 years of age. Our findings suggest the need for preemptive circumcision for selective men with diabetes may prevent diabetes-associated penile inflammatory disorders. [ABSTRACT FROM AUTHOR]

Background: Periodontal disease may drive a systemic inflammatory response that triggers migraine; however, the association between periodontal disease and migraine has rarely been investigated in a community‐based setting. Methods: This cross‐sectional study included 66,109 participants aged 30 to 70 years from Taiwan Biobank (TWB). A structured questionnaire was administered to participants, who were also subjected to whole‐genome single nucleotide polymorphism genotyping using the customized Axiom–TWB array. To identify subjects with periodontal disease and migraine, the computerized linkage of data obtained from TWB and the National Health Insurance Research Database was performed. Participants were evaluated for their genetic predisposition to migraine using a polygenic risk score. We examined and estimated the magnitude of associations between periodontal disease and migraine. Results: In this study, 4618 (4618/66,109; 7%) participants with migraine and 61,491 (61,491/66,109; 83%) participants without migraine were included. Participants with migraine exhibited a higher prevalence of periodontal disease than participants without migraine (4324/4618; 94% vs. 56,036/61,491; 91%). A significant positive association was observed between periodontal disease and migraine, with an adjusted odds ratio (ORadj) of 1.40 (95% confidence interval [CI] = 1.24–1.59; p < 0.001). The association remained consistent even after excluding participants with other comorbidities (ORadj = 1.34; 95% CI = 1.16–1.55; p < 0.001). Moreover, the positive association between periodontal disease and migraine remained significant across the subgroups of age, sex, other comorbidities, and classified polygenic risk scores of migraine, with the ORadj ranging from 1.26 to 1.78. Conclusions: A significant positive association was observed between periodontal disease and migraine. Future studies need to explore the biological mechanisms of how periodontal disease might affect migraine. [ABSTRACT FROM AUTHOR]

Music therapy can help social workers deal with negative behaviors and symptoms of dementia in older adults without drugs or physical restraints, thereby improving the quality of care. This study tested the effectiveness of music therapy activities for improving agitated behavior in older adults with dementia living in long‐term care institutions. The study was quasi‐experimental. Eighty older adults were recruited from two nursing homes. A purposive sampling strategy was used to select subjects aged 65 years and above with dementia and agitated behavioral tendencies residing in nursing homes. The music therapy program comprised 90 minute sessions 3 times a week for two months. The program evaluation focused on one criterion: the agitated behavior of participants at the beginning and end of the music theory program, which was measured using a structured scale. Ultimately, the music therapy program showed promise for improving agitated behavior in older adults with dementia living in nursing homes. Incorporating music therapy activities into social work may help make long‐term care more diverse and innovative. [ABSTRACT FROM AUTHOR]