Joseph J. Keller

Obstructive sleep apnea and the risk of adverse pregnancy outcomes

OBJECTIVE We examined the risk of adverse pregnancy outcomes, including low birthweight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), low Apgar score (at 5 minutes after delivery), and preeclampsia in pregnant women with and without obstructive sleep apnea (OSA). STUDY DESIGN Our subjects included 791 women with OSA and 3955 randomly selected women without OSA. We performed conditional logistic regression analyses to examine the risks of adverse pregnancy outcomes between women with and without OSA. RESULTS Compared with women without OSA, adjusted odds ratios for LBW, preterm birth, SGA infants, CS, and preeclampsia in women with OSA were 1.76 (95% confidence interval [CI], 1.28-2.40), 2.31 (95% CI, 1.77-3.01), 1.34 (95% CI, 1.09-1.66), 1.74 (95% CI, 1.48-2.04), and 1.60 (95% CI, 2.16-11.26), respectively. CONCLUSION Pregnant women with OSA are at increased risk for having LBW, preterm, and SGA infants, CS, and preeclampsia, compared with pregnant women without OSA.

A nationwide population-based study on the association between chronic periodontitis and erectile dysfunction

AIM To explore the association between chronic periodontitis (CP) and erectile dysfunction (ED) by using a nationwide, population-based dataset with a retrospective case-control design in Taiwan. MATERIAL AND METHODS We identified 32,856 patients with ED as cases and randomly selected 162,480 patients as controls. Conditional logistic regression analyses were performed to investigate the association between ED and having been previously diagnosed with CP. RESULTS Of the sampled patients 24,294 (12.3%) had been diagnosed with CP prior to the index date; this included 8825 cases (26.9% of the patients with ED) and 15,469 controls (9.4% of the comparison cohort). After adjusting for patient monthly income, age, geographic location, hypertension, diabetes, hyperlipidaemia, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome, patients with ED were more likely to have been diagnosed with CP prior to the index date than controls (OR = 3.35, 95% CI = 3.25-3.45, p < 0.001). In addition, the association was much stronger among the population aged less than 30 years (OR = 4.54, 95% CI = 3.81-5.40) and the group aged over than 69 years (OR = 4.84, 95% CI = 4.35-5.39). CONCLUSIONS Our study demonstrated an association between ED and having been previously diagnosed with CP.

Asian Dust Storm Events are Associated With an Acute Increase in Pneumonia Hospitalization

PURPOSE This study aims to examine the association of Asian dust storm (ADS) events with the daily number of pneumonia admissions using 10-year population-based data in the Taipei metropolitan region. METHODS We identified 1,933,247 admissions with a principal discharge diagnosis of pneumonia between 2000 and 2009. The auto-regressive integrated moving average (ARIMA) method was used to examine the associations between ADS episodes and the logarithm of the daily number of pneumonia hospitalizations. RESULTS There was a significant difference in the mean number of daily pneumonia admissions between ADS event days, post-ADS event days, and non-ADS event days (P < .001); the mean number of daily admissions for ADS event days, post-ADS event days, and non-ADS event days were 292.5, 305.7, and 279.0, respectively. After adjusting for the time-trend effect, ambient temperature, and SO(2), CO, and O(3), the ARIMA showed that compared with non-ADS event days, ADS event days and post-ADS event days 1 through 4 had a significantly higher mean number of pneumonia admissions for the total group. CONCLUSIONS Our results suggest that ADS event days and post-ADS days 1 through 4 had significantly higher mean numbers of pneumonia admissions than non-ADS days.

Psoriasis and the Risk of Erectile Dysfunction: A Population‐Based Case‐Control Study

INTRODUCTION Psoriasis is associated with systemic metabolic and cardiovascular disorders, both of which share risk factors with erectile dysfunction (ED). However, few studies have investigated the association between ED and psoriasis. AIM This study set out to estimate the association between ED and having previously been diagnosed with psoriasis by using a population-based dataset with a case-control design. METHODS This study used administrative claim data from the Taiwan National Health Insurance program. We identified 4,606 patients with ED as the study group and randomly selected 13,818 patients as the comparison group. Conditional logistic regression was used to examine the association between ED and having previously received a diagnosis of psoriasis. MAIN OUTCOME MEASURE The prevalence and risk of psoriasis between cases and controls were calculated. RESULTS Of the sampled patients, 136 (0.7%) had been diagnosed with psoriasis before the index date: 77 (1.7% of the cases) were from the study group and 59 (0.4% of controls) were from the control group. Conditional logistic regression analysis revealed that after adjusting for the patients monthly income, geographic location, hypertension, diabetes, hyperlipidemia, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome status, patients with ED were more likely to have been diagnosed with psoriasis before the index date than controls (odds ratio = 3.85; 95% confidence interval = 2.72-5.44). CONCLUSIONS There was an association between ED and prior psoriasis. The results of this study highlight a need for clinicians dealing with psoriasis patients to be alert to the development of ED.

Population‐Based Estimates of Medical Comorbidities in Erectile Dysfunction in a Taiwanese Population

INTRODUCTION Erectile dysfunction (ED) is usually associated with systemic disorders. This population-based study supports and expands on previous research. It also presents data in a Taiwanese male population where existing data on this topic remain sparse. AIM The aim of this study is to analyze the prevalence and risk of 36 medical comorbidities in patients with ED compared with the general population. METHODS A total of 2,213 patients with ED and 11,065 matching controls were selected from the Taiwan National Health Insurance Research Dataset. We chose 22 comorbidities from the Elixhauser comorbidity index, 10 highly prevalent medical conditions in an Asian population, and four male gender-specific comorbidities for analysis. MAIN OUTCOME MEASUREMENT Conditional logistic regression analyses conditioned on age group and monthly income were performed to investigate the risk of various comorbidities for patients with and without ED, after adjusting for the geographic region and level of urbanization of the patients community. RESULTS Patients with ED were at an increased risk for multiple systemic comorbidities. Conditional regression analyses showed that patients with ED were at a higher risk for hypertrophy of the prostate (odds ratio [OR] = 12.87), chronic prostatitis (OR = 9.36), alcohol abuse (OR = 3.60), drug abuse (OR = 2.62), urinary incontinence (OR = 2.58), ankylosing spondylitis (OR = 2.19), peripheral vascular disorder (OR = 1.98), ischemic heart disease (OR = 1.94), psychoses (OR = 1.97), depression (OR = 1.88), uncomplicated diabetes (OR = 1.91), complicated diabetes (OR = 1.84), hepatitis B or C (OR = 1.71), hyperlipidemia (OR = 1.69), and chronic pulmonary disease (OR = 1.55) than patients without ED. CONCLUSION The results show that patients with ED have a higher prevalence of multiple noncardiovascular comorbidities than the general population in Taiwan.

Asian dust storm events are associated with an acute increase in stroke hospitalisation

Objective Asian dust storms (ADS) are long-ranged meteorological phenomena, which are suggested to be associated with several health problems. This study aimed to investigate the risk of stroke hospitalisation following ADS events by conducting a population-based study. Study design and setting The authors identified 810 947 hospitalisations with an admission diagnosis of stroke during the time period between 2000 and 2009 in Taiwan. The ARIMA method (Auto-Regressive Integrated Moving Average) was used to examine the associations between ADS episodes and the daily number of stroke hospitalisations. Results There were 46 separate ADS episodes which resulted in a total of 135 ADS days between 2000 and 2009. The Kruskal–Wallis test revealed that there was a significant difference in the mean number of daily stroke admissions among ADS days (239.6), post-ADS days (249.2) and non-ADS days (219.7) (p<0.001). After adjusting for the time-trend effect, ambient temperature, season, SO2 and CO, the authors found post-ADS days 1 and 2 to have a significantly higher number of stroke admission than non-ADS days. Post-ADS days 1 and 2 had significantly higher numbers of ischaemic but not haemorrhagic stroke admissions. Conclusion The authors conclude that ADS events are associated with an acute increase in stroke admission rates.

Monthly variation in acute appendicitis incidence: A 10-year nationwide population-based study

BACKGROUND The present study investigated the monthly variation of acute appendicitis and its association with climatic factors (ambient temperature, relative humidity, atmospheric pressure, rainfall, and hours of sunshine) using a nationwide population-based data set in Taiwan. METHODS We identified 237,760 first-time hospitalizations for acute appendicitis from 2000 to 2009. We used the auto-regressive integrated moving average method to examine the monthly variation in the acute appendicitis incidence rates after adjusting for the time-trend effect and seasonality. RESULTS Throughout the 10-year study period, we found that the monthly incidence rate of acute appendicitis demonstrated a fairly similar monthly pattern for each gender independently and for the pooled data. May through July had the greatest rates, decreasing in August to a trough in February. We used the autoregressive integrated moving average test for seasonality and found a significant difference in the monthly incidence rate for the pooled genders and for the male- and female-only groups (all P < 0.001). Furthermore, the auto-regressive integrated moving average regression models for the male, female, and combined groups all suggested that a significant positive association exists between the monthly incidence rates of acute appendicitis per 100,000 population and the ambient temperature after adjusting for time trends and month. CONCLUSIONS The results of our study have revealed a significant difference in the monthly incidence rate of acute appendicitis.

A case-control study on the association between chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction

Study Type – Symptom prevalence (case control)

Association of Erectile Dysfunction with Atopic Dermatitis: A Population-Based Case-Control Study

INTRODUCTION Some studies have highlighted the high prevalence of erectile dysfunction (ED) in patients with dermatological diseases such as psoriasis, chronic hand eczema, and systemic sclerosis. However, to date, there is still no study that has explored the relationship between ED and atopic dermatitis (AD). AIM Using a population-based data set, this case-control study aimed to examine the association of ED with prior AD by comparing the risk of prior AD between patients with ED and matched controls in Taiwan. METHODS This study used administrative claims data from the Taiwan National Health Insurance program. We identified 3,997 patients with newly diagnosed ED as cases and randomly selected 19,985 subjects without a history of ED as controls. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) for previously diagnosed AD between cases and controls. MAIN OUTCOME MEASURE The prevalence and risk of having been previously diagnosed with AD between cases and controls were calculated. RESULTS Of the 23,982 sampled subjects, 1,758 (7.3%) had been previously diagnosed with AD; it was found among 425 (10.6%) cases and among 1,333 (6.7%) controls (P<0.001). Conditional logistic regression analysis demonstrated that cases were more likely to have prior AD than controls (OR=1.60, 95% CI=1.42-1.80, P<0.001) after adjusting for monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome. CONCLUSIONS There was an association between ED and prior AD. We suggest that clinicians should be more attentive to sexual complaints from patients with AD.

Chronic rhinosinusitis increased the risk of stroke: A 5-year follow-up study

It has been recognized that chronic rhinosinusitis (CRS) involves intracranial vessels and may be associated with stroke occurrence. However, the detailed epidemiological profile of stroke risk among patients with CRS is still not well understood. Therefore, this study aimed to explore the frequency and risk for stroke among patients with CRS by conducting a large scale population‐based cohort study in Taiwan.