Search

Whether patients with Mycoplasma infection have an increased risk of ocular surface ulcers. Using a nation-wide database, we identified patients with a new diagnosis of Mycoplasma infection between 1997 and 2013, and compared them with age-, sex-, and index year-matched subjects without the infection. Cox proportional regression was performed to compare the risk of corneal diseases between the two cohorts. The incidence of corneal diseases was significantly higher in the 4223 patients with Mycoplasma infection than in the 16,892 patients without (7.28 vs. 5.94 per 1000 person-years, P Mycoplasma infection might be a predisposing factor for patients with keratitis.

Adding protein-bound polysaccharide K (PSK) to adjuvant chemotherapy with mitomycin and fluorouracil after gastrectomy for gastric cancer was demonstrated to improve survival in a previous study in Japan. However, the efficacy of PSK outside Japan and in combination with other adjuvant chemotherapeutic agents remains unclear. The aims of this study were to evaluate the efficacy of PSK. We conducted a population-based historical cohort study using the National Health Insurance Research Database of Taiwan. We performed sensitivity analysis with propensity score matching to control for possible confounders. Patients who used PSK (PSK group) were matched at a 1:4 ratio to those who had never used PSK (control group) after adjusting for covariates including sex, age, urbanization, income and comorbidities. The primary outcome was overall survival. Multivariate hazard ratios from competing risk analysis were calculated by adjusting for demographic data and all confounding factors. From 1999 to 2008, we identified 10,617 patients with gastric cancer received gastrectomy and adjuvant chemotherapy. 1295 patients used PSK (PSK group) and 5180 patients never used PSK (control group) were analyzed after propensity score matching. The median overall survival was 6.49 years (95% confidence interval [CI] 5.22-7.63) in the PSK group and 3.59 years (95% CI 3.38-3.80) in the control group. After adjusting for age, sex, urbanization, income, and comorbidities, adding PSK to adjuvant chemotherapy was the most significant prognostic factor for improved survival (hazard ratio 0.76, P.0001). Adjuvant chemotherapy combined with PSK significantly prolonged overall survival in gastric cancer patients after gastrectomy.

Background:Increased traumatic brain injury (TBI) risk was found in patients with bipolar disorder (BPD). Whether the medications for BPD and dosage moderate the risk of TBI is not clear.Aim:This study aimed to determine whether an association exists between BPD and TBI and whether the prescription of psychotropics moderates TBI risk.Methods:A total of 5606 individuals who had received diagnoses of BPD between January 1, 1997 and December 31, 2013 and 56,060 matched controls without BPD were identified from Taiwan’s National Health Insurance Research Database. Cases and controls were followed until the date of TBI diagnosis.Results:BPD was associated with a high risk of TBI (adjusted hazard ratio (aHR): 1.85; 95% CI: 1.62–2.11). Patients with BPD, with or without a history of psychiatric hospitalization, had increased risks of TBI (aHR: 1.94, 95% CI: 1.57–2.4 and aHR: 1.82, 95% CI: 1.55–2.1, respectively). The prescription of typical antipsychotics (0 Conclusion:Patients with BPD have a higher risk of TBI. The use of typical antipsychotics, TCAs, or high-dose BZDs increases the risk of TBI in BPD.

Objectives: Traditional Chinese medicine (TCM) has been shown to reduce insulin resistance and improve beta cell function in previous studies. The aim of this study was to assess whether the use of...

Purpose This study explored and compared the effects of depression and antidepressants on sexual dysfunction in men with diabetes mellitus (DM). Patients and methods Patients older than 18 years who had been newly diagnosed with DM (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) between 1999 and 2010 were identified from Taiwan's National Health Insurance Research Database and were followed up until 2013. Patients with preexisting depression or sexual dysfunction were excluded. A total of 636,210 patients with DM were enrolled. These patients were divided into two groups: DM with comorbid depression and a matched cohort without depression. The groups were followed up until the end of 2010 for the first diagnosis of sexual dysfunction (ICD-9-CM codes 302.70, 302.71, 302.72, 302.74, 302.75, 302.76, 302.79, 607.84, and V417). A Cox proportional hazard model and a Cox regression model with time-dependent covariates were applied. Results Patients with DM and depression had a higher risk of sexual dysfunction than those with DM without depression (hazard ratio [HR] = 1.44; 95% confidence interval [CI], 1.33-1.55). The risk of sexual dysfunction was lower in the subgroup who used antidepressants (per 28 cumulative defined daily doses [cDDDs]), HR = 0.96; 95% CI, 0.94-0.97). A significantly lower incidence of sexual dysfunction was also associated with the use of selective serotonin reuptake inhibitors (SSRIs, per 28 cDDD). The adjusted HR was 0.95 (95% CI, 0.93-0.97). Subgroup analysis indicated that SSRI use was significantly associated with an amelioration of erectile dysfunction (per 28 cDDD), with an HR of 0.95 (95% CI, 0.92-0.97). Conclusion Male patients with DM and depression are at increased risk of sexual dysfunction. Antidepressant use had a small inverse association with the risk of sexual dysfunction in men with DM and depression. Antidepressants, in particular SSRIs, did not increase the risk of sexual dysfunction in this population.

Context The effect of antidepressant (ATD) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied, although comorbid depression is common in this population. Objective To explore the impact of ATDs on mortality among DM patients. Design A retrospective cohort study in a national database. Setting This population-based study used the National Health Insurance Research Database in Taiwan. Since 2000, we identified 53,412 cases of newly diagnosed patients with DM and depression. Patient cases were followed for assessing mortality until 2013. Main Outcome Measure The association between mortality and ATD use was explored adjusting for cumulative dosing. Results Using the time-dependent Cox regression model, ATD use was associated with significantly reduced mortality among patients with DM [in the highest dose group: hazard ratio (HR), 0.65; 95% CI, 0.59 to 0.71]. Further analysis showed that differences in mortality existed across ATD categories: selective serotonin reuptake inhibitors (HR, 0.63; 95% CI, 0.56 to 0.71), serotonin-norepinephrine reuptake inhibitors (HR, 0.58; 95% CI, 0.44 to 0.78), norepinephrine-dopamine reuptake inhibitors (HR, 0.20; 95% CI, 0.07 to 0.63), mirtazapine (HR, 0.60; 95% CI, 0.45 to 0.82), tricyclic/tetracyclic antidepressants (HR, 0.73; 95% CI, 0.54 to 0.97), and trazodone (HR, 0.52; 95% CI, 0.29 to 0.91). However, reversible inhibitor of monoamine oxidase A (RIMA) was found to be associated with an increase, rather than a decrease, in total mortality (HR, 1.48; 95% CI, 1.09 to 1.99). Conclusion Most ATDs, but not RIMA, were associated with significantly reduced mortality among a population with comorbid DM and depression.

Supplemental material, sj-docx-1-jop-10.1177_02698811211013582 for Effect of medication on risk of traumatic brain injury in patients with bipolar disorder: A nationwide population-based cohort study by Yin-To Liao, Yu-Hui Ku, Hong-Ming Chen, Mong-Liang Lu, Ko-Jung Chen, Yao-Hsu Yang, Jun-Cheng Weng and Vincent Chin-Hung Chen in Journal of Psychopharmacology

Introduction Patients with hemoglobinopathies have been reported to have higher rates of pulmonary complications. Few studies have investigated the association between thalassemia and asthma in children. Methods We used the data of one million individuals randomly selected from the Registry for Beneficiaries of the National Health Insurance Research Database. One thalassemic child was matched with four control children without thalassemia according to sex, birth year, birth season, prematurity, and previous enteroviral infection. Results A total of 800 hundred thalassemic children and 3200 controls were included. Children with thalassemia had higher rates of developing asthma (41.81 vs 25.70 per 1000 person-years, P < 0.001) than the non-thalassemia controls with an adjusted hazard ratio of 1.37 (95% confidence interval [CI] = 1.19–1.58). Boys in the thalassemia cohort had a significantly higher adjusted incidence hazard ratio (IRR) of asthma than those in the non-thalassemia cohort (adjusted IRR = 1.45, 95% CI = 1.02–1.73). The risk of atopic and nonatopic asthma was higher in the thalassemia cohort than in the non-thalassemia cohort (IRR = 1.3, 1.61, respectively). Conclusions Children with thalassemia were more likely to develop asthma. More attention should be paid to the early diagnosis of asthma and prevention of asthma attacks.

Background:Antidepressants are frequently used to treat depression in patients with dementia. In addition, late-life depression is associated with the incidence of subsequent cognitive impairment or dementia. However, the association between exposure to antidepressants in late-life depression and the development of incident dementia remains understudied.Methods:Through a population-based retrospective cohort design, data were extracted from the Taiwan National Health Insurance Research Dataset of medical claims registered from 1998–2013. We collected data of individuals who had received a new diagnosis of depression between 2000 and 2007. We excluded those who received a diagnosis of depression and were given antidepressants before 2000 and those younger than 60 years. The primary outcome was the occurrence of incident dementia. The time from the prescription of antidepressants or the diagnosis of depression until the outcome or the end of 2013 was calculated as the time to event. A total of 563,918 cases were included and were divided into either antidepressant users or antidepressant nonusers. Cox proportional hazards models were used to calculate the hazard ratio and 95% confidence interval.Results:Exposure to antidepressants did not increase the risk of dementia in patients with late-life depression at either a low exposure dosage (hazard ratio: 1.06, 95% confidence interval: 0.91–1.23) or a high exposure dosage (hazard ratio: 1.07, 95% confidence interval: 0.95–1.20). To confirm the validity of our results, we performed a sensitivity analysis and subgroup analysis, and the post-hoc results were consistent with the main results.Conclusion:Antidepressants did not increase the risk of incident dementia in patients with late-life depression.

Background: Numerous studies have revealed that statins have antitumor effects in vivo and in vitro. However, few studies have explored the relationship between statin use and the mortality of gastric cancer (GC) patients after treatments. This study examines the relationship between statin use and the overall survival (OS) of GC patients after surgery and adjuvant chemotherapy, using data from the nationwide cohort database of Taiwan. Methods: All patients newly diagnosed with GC from 1999 to 2008 in Taiwan were identified from the Registry of Catastrophic Illness Patients Database. Through propensity score matching, statin users were matched to statin non-users at a 1:4 ratio. The relationship between statin use and the OS of patients with GC was estimated through Cox regression models. Results: The study cohort included 1835 patients with GC who had received therapies during the study period. The death numbers among statin users (defined as those who used more than 28 cumulative defined daily doses (cDDDs)) and statin non-users were 138 and 895, respectively. A dose&ndash, response association was noted between statin use and the OS of patients with GC after treatments. The adjusted hazard ratios were 0.62 (95% confidence intervals (CI), 0.50&ndash, 0.78) and 0.34 (95% CI, 0.26&ndash, 0.45) for statin users administered 28&ndash, 167 cDDDs and &gt, 168 cDDDs, respectively, compared with no statin use (&lt, 28 cDDDs). Conclusions: This study highlights that statin use may dose-dependently improve the OS of patients with GC after surgery and adjuvant chemotherapy in Taiwan. Additional studies are required to confirm the efficacy and safety of statin use.

Purpose This study explored and compared the effects of depression and antidepressants on sexual dysfunction in men with diabetes mellitus (DM). Patients and Methods Patients older than 18 years who had been newly diagnosed with DM (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) between 1999 and 2010 were identified from Taiwan’s National Health Insurance Research Database and were followed up until 2013. Patients with preexisting depression or sexual dysfunction were excluded. A total of 636,210 patients with DM were enrolled. These patients were divided into two groups: DM with comorbid depression and a matched cohort without depression. The groups were followed up until the end of 2010 for the first diagnosis of sexual dysfunction (ICD-9-CM codes 302.70, 302.71, 302.72, 302.74, 302.75, 302.76, 302.79, 607.84, and V417). A Cox proportional hazard model and a Cox regression model with time-dependent covariates were applied. Results Patients with DM and depression had a higher risk of sexual dysfunction than those with DM without depression (hazard ratio [HR] = 1.44; 95% confidence interval [CI], 1.33–1.55). The risk of sexual dysfunction was lower in the subgroup who used antidepressants (per 28 cumulative defined daily doses [cDDDs]), HR = 0.96; 95% CI, 0.94–0.97). A significantly lower incidence of sexual dysfunction was also associated with the use of selective serotonin reuptake inhibitors (SSRIs, per 28 cDDD). The adjusted HR was 0.95 (95% CI, 0.93–0.97). Subgroup analysis indicated that SSRI use was significantly associated with an amelioration of erectile dysfunction (per 28 cDDD), with an HR of 0.95 (95% CI, 0.92–0.97). Conclusion Male patients with DM and depression are at increased risk of sexual dysfunction. Antidepressant use had a small inverse association with the risk of sexual dysfunction in men with DM and depression. Antidepressants, in particular SSRIs, did not increase the risk of sexual dysfunction in this population.

To determine whether exposure to antidepressants (ATDs) results in improved overall survival (OS) of patients with gastric cancer (GC) after surgery, we conducted a large cohort study and considered confounding factors that might affect the research outcomes.Patients who received a new diagnosis of GC and received surgery and chemotherapy between 1999 and 2008 were recruited and were classified into different groups based on the ATD level used. The association between the OS of patients with GC after surgery with different levels of ATD use, and the hazard ratio with comorbidities at different ATD use levels were compared.According to Kaplan-Meier method, the more of an ATD was taken, the longer the OS and a dose-dependent relationship was discovered in the OS curve; the adjusted HRs were 0.76 (95% confidence interval [CI] = 0.68-0.84) and 0.48 (95% CI = 0.41-0.57) for ATD users taking a cumulative defined daily dose (cDDD) of 28-167 and ≧168, respectively. Sensitivity analyzes were performed to investigate the effect of various comorbidities on OS with different degrees of ATD use and the results remained consistent among the varying models. Additionally, the effect of ATD use still exhibited a dose-dependent relationship in distinct stratifications for sex and age.The OS for patients with GC after surgery and chemotherapy improved with ATD use, and a dose-dependent relationship was discovered in this study. Further studies on the association between OS of GC and ATD use are required.

Background Hepatitis C virus ( HCV ) infection not only links closely to systemic inflammation but also has numerous extrahepatic manifestations. Chronic inflammation also increases the risk of new‐onset atrial fibrillation (AF). However, little is known regarding the clinical association between HCV infection and new‐onset AF. Methods and Results We conducted a population‐based cohort study using Taiwan's National Health Insurance Research Database during 1997 to 2013. A total of 11 771 HCV ‐infected patients were included in this study, and each of them was matched in a ratio of 1:4. Because of higher mortality among HCV cohorts, we used both Cox proportional hazard regression and competing risk regression models to compute the hazard ratios accompanying 95% CI s after adjustment for relevant confounder. The results demonstrated that the patients with chronic HCV infection had significantly higher incidence rate (332.0 versus 265.8 in 100 000 person‐years, P HCV population. The adjusted hazard ratio of HCV for new‐onset AF was 1.32 (95% CI , 1.20–1.44; P CI, 1.10–1.31; P =0.0001) while calculated with Cox proportional hazard regression model and competing risk model, respectively. Intriguingly, we observed that the patients with HCV treated with antiviral agents had significantly lower incidental AF than those without anti‐ HCV treatment (1.2% versus 6.0%; P Conclusions Chronic HCV infection was associated with an increased risk of incidental AF probably through sharing common pathology of chronic inflammation. Furthermore, a well‐designed study is needed to clarify whether anti‐ HCV therapy can provide protection against the occurrence of AF .

Background Intracranial aneurysms after radiotherapy (RT) have previously been reported. However, the majority of studies were case reports. Therefore, we performed a nationwide study to explore the risk of radiation-induced intracranial aneurysms. Methods This study included patients diagnosed with head and neck cancer (ICD9: 140–149, 161). Intracranial aneurysms formation was identified using the following ICD9 codes: nonruptured cerebral aneurysm (ICD9:4373), aneurysm clipping (ICD9:3951). Patients who did not receive curative treatment and those with intracranial aneurysms before the diagnosis of head and neck cancer were excluded. Results In total, 70,691 patients were included in the final analysis; they were categorized into the following three groups: nasopharyngeal carcinoma (NPC) with RT, non-NPC with RT, and non-NPC without RT. Patients in the NPC with RT group had the highest risk of developing intracranial aneurysms (hazard ratio (HR) 2.57; P

BackgroundChronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.MethodsThis retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000-2013) between these two cohorts.ResultsThis study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36-1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04-2.06).ConclusionThe present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.

High comorbidity of obsessive-compulsive disorder (OCD) has been reported in patients with schizophrenia. The sequence of OCD and schizophrenia onset might clarify the underlying pathophysiological relationships between these two disorders, but available evidence is limited. In this study, we used a population-based cohort to investigate the risk of schizophrenia in people with newly diagnosed OCD. Patients who were first diagnosed with OCD from 2000 to 2013 were selected from the Longitudinal Health Insurance Research Database. The non-OCD group was randomly sampled, and matched with the OCD group by gender, age, urbanization level, and income. Cox regression analyses and competing risk model were used to estimate the risk of schizophrenia, adjusting for potential confounding factors. In total, 2009 patients with OCD and 8036 controls were identified. The crude incidences of schizophrenia in the OCD and non-OCD groups were 876.2 per 100,000 person-years and 28.7 per 100,000 person-years, respectively. After adjustment, a substantially higher risk of schizophrenia was observed in the OCD group (hazard ratio = 30.29, 95% confidence interval = 17.91–51.21). Male gender, age of OCD onset before 20 years, and antipsychotic prescription were associated with schizophrenia. Patients with comorbidity of autistic disorder have higher risk of schizophrenia (hazard ratio = 4.63, 95% confidence interval = 1.58–13.56). In conclusion, OCD diagnosis, male gender, age of OCD onset before 20 years, comorbidity of autistic disorder, and antipsychotic use were associated with higher risk of schizophrenia. It is essential for psychiatrists to note that OCD may be the initial presentation of schizophrenia.

The goal of this study was to investigate the gratifications Taiwanese students sought and obtained from Instant Messaging use (IM). This study also examined the relationship among gratifications Taiwanese students obtained, gender, and their frequency of IM use. A 13-motivation with 37 statements scale derived from previous uses and gratifications studies is presented along with the demographic information as an instrument to determine Taiwanese students’ gratifications from IM use. The participants were 406 undergraduate, graduate, and doctoral college students, who are the primary users of this new interactive communication technology. The results indicated there were 10 gratifications sought (Flexibility, Escape, Convenience, Companionship, Socialization, Control, Habit, Identity, Utility, and Surveillance) and nine gratifications obtained (Convenience, Escape, Companionship, Socialization, Mobility, Identity, Surveillance, Control, and Utility) from IM use. Gratifications obtained were positively associated with the frequency of IM use. Gender differences that lead to different gratifications obtained and frequency of IM use per week were also found.

Aims The aim of this study was to assess the fertility rate in Taiwanese women before and after a diagnosis of type 1 diabetes. The potential risk factors which may have influenced fertility were also investigated. Methods We conducted this retrospective, nationwide, population-based, matched cohort study using data from the Taiwan National Health Insurance Research Database. The diabetic group (n = 1191) included women with type 1 diabetes aged between 16 and 30 years in 2000. The non-diabetic group (n = 4764) was matched by sex, gender, income, and urbanization. The endpoints, including live births, abortions, and fertility, were tracked until the end of 2013. Poisson regression was used to assess incidence rate ratios (IRRs). We also analyzed the influence of autoimmune thyroid disease, diabetic ketoacidosis, diabetic complications, and daily insulin dose on the endpoints. Results The diabetic group had a lower rate of live births (IRR 0.67 [95% CI 0.62–0.73]) than the non-diabetic group, and it was even lower when combined with hyperthyroidism (IRR 0.54 [0.39–0.74]). There were also fewer live births before a diagnosis of diabetes than after a diagnosis of diabetes (IRR 0.58 [0.52–0.65] vs. 0.80 [0.71–0.90]). Diabetic ketoacidosis and a higher daily insulin dose were strongly associated with abortion. Diabetic complications significantly reduced the number of live births. Conclusions Type 1 diabetes compromises female fertility, even before it is diagnosed. Associated hyperthyroidism further reduces fertility. Blood glucose and thyroid function surveillance in infertile females may allow for an early diagnosis of type 1 diabetes and associated thyroid disease.

To determine the plasma levels of thymosin-α1 (TA1) and prothymosin-α (PTMA) proteins in renal cell carcinoma (RCC) or urothelial carcinoma (UC) patients, and explore the potential of these 2 molecules as biomarkers.Blood samples were taken from 50 consecutive patients with RCC, 97 with UC, and 55 with benign urologic diseases before surgery. Their clinical characteristics were obtained from medical record review. Plasma TA1 and PTMA levels were measured using enzyme-linked immunosorbent assay and their correlation with tumor grade, pathologic stage, and survival were explored.Plasma TA1 levels were significantly lower in RCC patients than in UC or benign patients, particularly in UC of the renal pelvis patients (P0.0001). Plasma PTMA levels were also significantly lower in UC patients compared with RCC patients and benign patients (P0.05). Plasma TA1 levels inversely correlated with pathologic stage both in bladder cancer and RCC patients (P = 0.03 and 0.02, respectively). Both plasma TA1 and PTMA did not correlate with tumor grade. Plasma TA1 was a prognostic indicator for progression-free and disease-specific overall survival in bladder cancer patients (P = 0.008 and 0.04, respectively).Plasma TA1 level may be a biomarker for differentiating between UC and RCC. It may also be a prognostic factor for disease progression and disease-specific survival in bladder cancer patients. These findings warrant more studies for validation.

Background While mortality from coronary heart disease (CHD) has declined substantially in most developed countries in recent decades, discordant rising trends have been observed in many developing and newly developed countries. In this study, we examined the trends of CHD mortality and its hospitalization rate, and correlated the trends with changes in major cardiovascular risk factors in Taiwan. Methods Mortality data during the period 1971–2001 were obtained from official vital statistics. Hospitalization rates were calculated using information extracted from the National Health Insurance Database, which was available from 1996 to 2001. Changes in major cardiovascular risk factors were obtained from official statistics and review of previous epidemiologic studies. Results In 2001, the age-standardized CHD mortality in Taiwan was 28.7 per 100,000 for men and 15.5 per 100,000 for women. For both men and women, age-adjusted CHD mortality increased slowly but steadily from 1971 to 1992, but after that, a downward trend was observed. Hospitalization rates for CHD, however, increased substantially from 1996 to 2001. Levels of per-capita cigarette consumption, dietary fat intake, body mass index, and prevalence of hypertension and diabetes had all increased over the past three decades. Conclusions The overall cardiovascular risk profile has worsened in the general population in Taiwan. The decline in CHD mortality observed in recent years was most likely attributable to the improvement in acute cardiac care and medical treatment among patients with CHD. We anticipated that CHD incidence and prevalence would continue to rise in Taiwan.