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

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

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

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

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

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

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

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

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

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

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

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

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

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