Nicole Huang

Pulmonary tuberculosis increases the risk of lung cancer: a population-based cohort study.

The possible effect of pulmonary tuberculosis (TB) on subsequent lung cancer development has been suspected, but the evidence remains inconsistent. The purpose of this study was to perform a nationwide population‐based cohort study to investigate the risk of lung cancer after pulmonary TB infection.

Association between a history of periodontitis and the risk of rheumatoid arthritis: a nationwide, population-based, case–control study

Objective To investigate the association between the risk of rheumatoid arthritis (RA) and a history of periodontitis. Methods This nationwide, population-based, case–control study used administrative data to identify 13 779 newly diagnosed patients with RA (age ≥16 years) as the study group and 137 790 non-patients with RA matched for age, sex, and initial diagnosis date (index date) as controls. Using conditional logistic regression analysis after adjustment for potential confounders, including geographical region and a history of diabetes and Sjögrens syndrome, ORs with 95% CI were calculated to quantify the association between RA and periodontitis. To evaluate the effects of periodontitis severity and the lag time since the last periodontitis visit on RA development, ORs were calculated for subgroups of patients with periodontitis according to the number of visits, cumulative cost, periodontal surgery and time interval between the last periodontitis-related visit and the index date. Results An association was found between a history of periodontitis and newly diagnosed RA (OR=1.16; 95% CI 1.13 to 1.21). The strength of this association remained statistically significant after adjustment for potential confounders (OR=1.16; 95% CI 1.12 to 1.20), and after variation of periodontitis definitions. The association was dose- and time-dependent and was strongest when the interval between the last periodontitis-related visit and the index date was <3 months (OR=1.64; 95% CI 1.49 to 1.79). Conclusions This study demonstrates an association between periodontitis and incident RA. This association is weak and limited to lack of individual smoking status.

Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003.

BackgroundIn 1995, Taiwan has launched a national health-care system (the National Health Insurance Program, NHI) covering the use of both Western medicine (WM) and Chinese medicine (CM). This population-based study was conducted to understand the role of CM in this dual medical system by determining the utilization patterns of CM and WM and to analyze the demographic characteristics and primary indications influencing the choice of the medical services for the development of strategies to enhance the appropriate use and reduce unnecessary use of CM.MethodsThis study used the NHI sample files from 1997 to 2003 consisting of comprehensive utilization and enrolment information for a random sample of 200,432 NHI beneficiaries of the total enrolees from 1995 to 2000. A total of 136,720 subjects with valid and complete enrolment and utilization data were included in this study. The logistic regression method was employed to estimate the odds ratios (ORs) for utilization of CM and WM. The usage, frequency of services, and primary indications for CM and WM were evaluated. A significance level of α = 0.05 was selected.ResultsCompared with WM, the odds of CM increased from 1997 to 2003. The odds of using CM (OR = 1.48; 95% CI: 1.45–1.50; p < 0.001) and WM (OR = 1.74; 95% CI: 1.72–1.77; p < 0.001) were higher in females and that of CM increased with age to a peak in the 45–54-year-group (OR = 1.75; 95% CI: 1.68–1.82; p < 0.001) and WM (OR = 1.09; 95% CI: 1.05–1.13; p < 0.001) in the elderly subjects (≥ 65 years). The odds of CM and WM were similar in all income groups. However, those of CM were higher in Central (OR = 1.65; 95% CI: 1.56–1.74; p < 0.001) and Southern Taiwan (OR = 1.18; 95% CI: 1.12–1.25; p < 0.001) and lower in the remote areas (OR = 0.57; 95% CI: 0.52–0.63; p < 0.001). Most of the patients had one ambulatory visit of both medical services annually. However, the utilization of WM predominated over CM. Over 90% of CM service was provided by clinics, whereas over 60% of WM service by hospitals. Diseases of the respiratory system was the most frequent primary indication in CM and WM. Herbal medication was the most commonly used form of CM (68.4–72.7%).ConclusionIn recent years, there is an increasing trend in the utilization of CM in Taiwan. This increasing trend may be due to the covering of CM in the national health insurance system.

The Impact of the SARS Epidemic on the Utilization of Medical Services: SARS and the Fear of SARS

Using interrupted time-series analysis and National Health Insurance data between January 2000 and August 2003, this study assessed the impacts of the severe acute respiratory syndrome (SARS) epidemic on medical service utilization in Taiwan. At the peak of the SARS epidemic, significant reductions in ambulatory care (23.9%), inpatient care (35.2%), and dental care (16.7%) were observed. Peoples fears of SARS appear to have had strong impacts on access to care. Adverse health outcomes resulting from accessibility barriers posed by the fear of SARS should not be overlooked.

Association of Body Mass Index with All-Cause and Cardiovascular Disease Mortality in the Elderly

Objectives To evaluate the associations of body mass index (BMI) with all-cause, cardiovascular disease (CVD), and expanded CVD mortality in the elderly. Design Observational cohort study. Setting Annual physical examination program for the elderly from 2006 to 2010. Participants We included 77,541 Taipei residents aged ≥65 years (39,365 men and 38,176 women). Measurements BMI was categorized as underweight (BMI<18.5), normal weight (18.5≤BMI<25), overweight (25≤BMI<30), grade 1 obesity (30≤BMI<35), or grade 2–3 obesity (BMI≥35). Mortality was ascertained by national death files. Results Underweight (hazard ratios [HRs] of all-cause, CVD, and expanded CVD mortality: 1.92, 1.74, and 1.77, respectively), grade 2–3 obesity (HRs: 1.59, 2.36, and 2.22, respectively), older age, male sex, smoking, and high fasting blood sugar were significant predictors of mortality. Meanwhile, being married/cohabitating, higher education, alcohol consumption, more regular exercise, and high total cholesterol were inversely associated with mortality. Multivariate stratified subgroup analyses verified smokers (HRs of all-cause, CVD, and expanded CVD mortality: 3.25, 10.71, and 7.86, respectively, for grade 2–3 obesity), the high triglyceride group (HRs: 5.82, 10.99, and 14.22, respectively for underweight), and patients with 3–4 factors related to metabolic syndrome (HRs: 4.86, 12.72, and 11.42, respectively, for underweight) were associated with mortality. Conclusion The associations of BMI with all-cause, CVD, expanded CVD mortality in the elderly are represented by U-shaped curves, suggesting unilateral promotions or interventions in weight reduction in the elderly may be inappropriate. Heterogeneous effects of grades 1 and 2–3 obesity on mortality were observed and should be treated as different levels of obesity.

Antibiotic prescribing for children with nasopharyngitis (common colds), upper respiratory infections, and bronchitis who have health-professional parents.

Objective. Antibiotic resistance might be reduced if patients could be better informed regarding the lack of benefits of antibiotics for children with viral infections and avoid antibiotic prescriptions in these circumstances. This study investigated whether children having health professionals as parents, a group whose parents are expected to have more medical knowledge and expertise, are less likely than other children to receive antibiotics for nasopharyngitis (common colds), upper respiratory tract infections (URIs), and acute bronchitis. Methods. Retrospective analyses were conducted by using National Health Insurance data for children of physicians, nurses, pharmacists, and non–health personnel, who had visited hospital outpatient departments or physician clinics for common colds, URIs, and acute bronchitis in Taiwan in 2000. A total of 53733 episodes of care for common colds, URIs, and acute bronchitis in a nationally representative sample of children (aged ≤18 years) living in nonremote areas were analyzed. Results. The study found that, after adjusting for characteristics of the children (demographic, socioeconomic, and health status) and the treating physicians (demographic, practice style, and setting), children with a physician (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.36–0.68) or a pharmacist (OR: 0.69; 95% CI: 0.52–0.91) as a parent were significantly less likely than other children to receive antibiotic prescriptions. The likelihood of receiving an antibiotic for the children of nurses (OR: 0.91; 95% CI: 0.77–1.09) was similar to that for children in the comparison group. Conclusions. This finding supports our hypothesis that better parental education does help to reduce the frequency of injudicious antibiotic prescribing. Medical knowledge alone, however, may not fully reduce the overuse of antibiotics. Physician-parents, the expected medically savvy parents, can serve as a benchmark for the improvement potentially achievable in Taiwan through a combination of educational, regulatory, communication, and policy efforts targeted at more appropriate antibiotic prescribing in ambulatory settings.

Dental Prophylaxis and Periodontal Treatment Are Protective Factors to Ischemic Stroke

Background and Purpose— A correlation has been found between periodontal disease (PD) and stroke. This study was conducted to investigate whether dental prophylaxis and periodontal treatment reduce the incidence rate (IR) of ischemic stroke. Methods— We identified 510 762 PD cases and 208 674 non-PD subjects from January 1, 2000, to December 31, 2010. The PD cases were divided into dental prophylaxis, intensive treatment, and no treatment groups. The stroke IRs were assessed among groups during follow-up. Cox regression analysis was used after adjustment for age, sex, and comorbidities to determine the relationship between periodontal treatment and incidence of ischemic stroke. Results— The stroke IR of the non-PD subjects was 0.32%/year. In the PD group, subjects who received dental prophylaxis had the lowest stroke IR (0.14%/year); subjects with intensive treatment or tooth extraction had a higher stroke IR (0.39%/year); and subjects without PD treatment had the highest stroke IR (0.48%/year; P<0.001). After adjustment for confounders, the dental prophylaxis and intensive treatment groups had a significant lower hazard ratios for stroke than the non-PD group (hazard ratio=0.78 and 0.95; 95% confidence interval=0.75–0.81 and 0.91–0.99, respectively), whereas the PD without treatment group had a significant higher hazard ratio for stroke (1.15; 95% confidence interval=1.07–1.24), especially among the youngest (20–44) age group (hazard ratio=2.17; 95% confidence interval=1.64–2.87) after stratifying for age. Conclusions— Maintaining periodontal health by receiving dental prophylaxis and PD treatment can help reduce the incidence of ischemic stroke.

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

Patients with colorectal cancer (CRC) who undergo cancer surgeries with higher‐volume providers may have better outcomes. The current debate focuses on whether it is hospital volume or surgeon volume that matters more.

Cognitive impairment assessed at annual geriatric health examinations predicts mortality among the elderly

OBJECTIVE To determine whether cognitive impairment assessed at annual geriatric health examinations is associated with increased mortality in the elderly. METHOD This cohort study was based on data obtained from the government-sponsored Annual Geriatric Health Examination Program for the elderly in Taipei City between 2006 and 2010. The study sample consisted of 77,541 community-dwelling Taipei citizens aged 65 years or older. The Short Portable Mental Status Questionnaire (SPMSQ) was selected to measure cognitive impairment. Mortality was ascertained by matching cohort IDs with national death files. RESULTS There was a dose-response relationship between cognitive impairment and mortality (increased one score of SPMSQ, Hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.10-1.14). Relative to no cognitive impairment, the HRs were 1.67 (95% CI: 1.43-1.94), 2.26 (95% CI: 1.90-2.70), and 2.68 (95% CI: 2.25-3.19) for mild, moderate, and severe cognitive impairments, respectively. The causes of death associated with cognitive impairment were circulatory, respiratory, and other causes, but not death from cancer. CONCLUSION Cognitive impairment as measured by the SPMSQ is associated with an increased risk for mortality. Even mild cognitive impairment was associated with greater risk of mortality at a relatively short follow-up time.

Health issues among nurses in Taiwanese hospitals: National survey

BACKGROUND Few, if any, studies have compared the health issues of nurses working in different hospital settings. The objective of this study was to compare the health status and work-related health hazards among nurses working in different hospital units in Taiwan. METHODS This study was a cross-sectional survey. The study participants were 21,095 full-time employees with a professional background in nursing, working at 100 hospitals across Taiwan. The study participants responded to a structured questionnaire from May to July, 2011. RESULTS After adjustment for age, sex, educational level, accredited hospital level, and certification as a health promoting hospital, nurses who worked in administration and in outpatient clinics reported better overall health than nurses who worked in operating rooms/delivery rooms, and these nurses reported better overall health than nurses who worked in emergency rooms/intensive care units and general wards. Depressed mood followed the same trend. Nurses who worked in the operating rooms/delivery rooms, wards, and emergency rooms/intensive care units were at higher risk for occupational incidents than nurses who worked in outpatient clinics and administration. The most prevalent health hazards among nurses were low back pain, sprained/strained muscles, cuts, and verbal or sexual harassment/violence. CONCLUSIONS Nurses who worked in emergency rooms/intensive care units and in wards had worse health and more depressed moods than nurses in other hospital units. Work-related health hazards were common and varied among nurses working in different hospital units. Worksite-based health promotion programs should take these differences into consideration to tailor wellness programs for nurses working in different hospital settings.