Shih Feng Weng

Increased risks of healthcare-seeking behaviors of anxiety, depression and insomnia among patients with bladder pain syndrome/interstitial cystitis: a nationwide population-based study

AbstractPurposenTo explore the association between bladder pain syndrome/interstitial cystitis (BPS/IC) and the risk of subsequent healthcare-seeking behavior for common mental disorders in Taiwan using a population-based administrative database.Materials and methodsBoth BPS/IC subjects and their age- and sex-matched non-BPS/IC control subjects who had no previous insomnia and mental diseases, including anxiety, depression, were subsequent serviced for these mental disorders by psychiatrists from the recruited date between 2002 and 2010. The risk of outcomes was assessed with Kaplan–Meier curves; and the impact of BPS/IC was estimated with Poisson regression analysis and Cox proportional hazards models.ResultsnWe included 16,185 BPS/IC subjects and 32,370 non-BPS/IC subjects, with a mean age of 46xa0years and 73.5xa0% of women. Difference of the prevalence of hypertension, diabetes, chronic kidney disease, and hyperlipidemia between groups was not significant difference. Subjects with BPS/IC had a significant higher incidence rate of anxiety, depression, and insomnia than the matched controls (92.9 vs 38.4, 101.0 vs 42.2, 47.5 vs 23.0; per 10,000 person-year). After adjusting for age, sex, and common comorbidities in multivariable analysis, BPS/IC remained a significant predictor with hazard ratio and 95xa0% confidence incidence, 2.4 (2.2–2.7), 2.4 (2.2–2.6), and 2.1 (1.8–2.4) for anxiety, depression, and insomnia, respectively.ConclusionPatients with BPS/IC are at risk of development of anxiety, depression, and insomnia. These findings can help guide urologists, urogynecologists, and psychiatrists toward early identification and treatment of psychological complications that may develop in BPS/IC patients.

Long-term Mortality Risk After Hyperglycemic Crisis Episodes in Geriatric Patients With Diabetes: A National Population-Based Cohort Study

OBJECTIVE Hyperglycemic crisis is one of the most serious diabetes-related complications. The increase in the prevalence of diabetes in the geriatric population leads to a large disease burden, but previous studies of geriatric hyperglycemic crisis were focused on acute hyperglycemic crisis episode (HCE). This study aimed to delineate the long-term mortality risk after HCE. RESEARCH DESIGN AND METHODS This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 13,551 geriatric patients with new-onset diabetes between 2000 and 2002, including 4,517 with HCE (case subjects) (ICD-9 code 250.1 or 250.2) and 9,034 without HCE (control subjects). The groups were compared and followed until 2011. RESULTS One thousand six hundred thirty-four (36.17%) case and 1,692 (18.73%) control subjects died (P < 0.0001) during follow-up. Incidence rate ratios (IRRs) of death were 2.82 times higher in case subjects (P < 0.0001). The mortality risk was highest in the first month (IRR 26.56; 95% CI 17.97–39.27) and remained higher until 4–6 years after the HCE (IRR 1.49; 95% CI 1.23–1.81). After adjustment for age, sex, selected comorbidities, and monthly income, the mortality hazard ratio was still 2.848 and 4.525 times higher in case subjects with one episode and two or more episodes of hyperglycemic crisis, respectively. Older age, male sex, renal disease, stroke, cancer, chronic obstructive pulmonary disease, and congestive heart failure were independent mortality predictors. CONCLUSIONS Patients with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up. Referral for proper education, better access to medical care, effective communication with a health care provider, and control of comorbidities should be done immediately after HCE.

Healthcare-seeking prevalence of lower urinary tract symptoms among national health insurance enrollees in Taiwan, 2000-2009

OBJECTIVEnTo investigate the healthcare-seeking prevalence of those with lower urinary tract symptoms (LUTS) among National Health Insurance enrollees in Taiwan.nnnMATERIALS AND METHODSnData from the National Health Insurance Research Database were obtained from a random population sample of about one million as a representative cohort from 2000 to 2009. Subjects aged≥18 years with ≥1 outpatient service claim and coding for a LUTS-related diagnosis were identified and analyzed annually.nnnRESULTSnThe healthcare-seeking prevalence for LUTS increased from 23.11‰ in 2000 to 38.37‰ in 2009. Similar trends were found for storage symptoms and voiding symptoms (P<.0001). In 2009, the age distribution of LUTS was 4.32%, 5.82%, 10.92%, 19.23%, 21.25%, and 38.47% in those aged 18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. The overall LUTS prevalence was more common in men (54.45‰) than in women (21.73‰). For LUTS subtypes, storage symptoms were more common in women (19.46‰) than in men (13.13‰); however, the trend was reversed in the population>60 years old. Voiding and mixed symptoms were more common in men (4.69‰, and 0.83‰, respectively) than in women (2.80‰ and 0.58‰, respectively).nnnCONCLUSIONnIn the present cohort study, patients with LUTS seeking medical help increased annually from 2000 to 2009 in Taiwan. The occurrence of LUTS subtypes varied according to age and sex. LUTS is becoming a substantial healthcare burden as the number of aged people who want to maintain a good quality of life increases.

Higher prevalence of autism in Taiwanese children born prematurely: A nationwide population-based study

The reported prevalence of autism in preterm and full-term children varies partially because of small sample sizes. Moreover, little is known about the specific factors that contribute to the risk of autism in preterm children. We aimed to compare the prevalence of autism in preterm and full-term children and to identify neonatal risk factors for autism in preterm children using a large national health system database. We analyzed data from 1078 early preterm (<28 weeks of gestation or birth weight<1000 g), 28,947 later preterm (28-36 weeks), and 1,104,071 full-term (≥ 37 weeks) children who were 8-11 years old in 2009. The descending order of prevalence was early preterm (2.2%), later preterm (1.3%), and full-term (0.6%). The prevalence of autism was approximately 2-4 times higher in preterm children than in children born at full-term. The male-female ratio (4:1) in preterm and full-term children was not significantly different. Most of the children were first diagnosed with autism between 3 and 6 years old. Preterm children with autism were not diagnosed earlier than were full-term children. Regression analysis showed that male gender, a very low birth weight, and neonatal cerebral dysfunction were risk factors for autism in the preterm group. We conclude that autism is more prevalent in preterm children. Preventing extremely preterm birth and significant early brain insults may be helpful in reducing the risk of autism in preterm children.

Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants.

Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.

Trends in reoperation for female stress urinary incontinence: A nationwide study

Using the National Health Insurance (NHI) database in Taiwan, the study aimed to evaluate the rates and associated factors for reoperation of female stress incontinence.

Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study

AbstractnHyperglycemic crisis episodes (HCEs)—diabetic ketoacidosis and the hyperosmolar hyperglycemic state—are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 23,079 non-elder patients (≤65xa0years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1xa0%) patients with HCE and 725 (4.71xa0%) patients without HCE died (Pxa0<xa00.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (Pxa0<xa00.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40–64xa0years) [IRR 3.29; 95xa0% confidence interval (CI) 2.98–3.64] and young adult (18–39xa0years) (IRR 3.91; 95xa0% CI 3.28–4.66), but not in the pediatric subgroup (<18xa0years) (IRR 1.28; 95xa0% CI 0.21–7.64). The mortality risk was highest in the first month (IRR 54.43; 95xa0% CI 27.98–105.89), and still high after 8xa0years (IRR 2.05; 95xa0% CI 1.55–2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.

Acute Anticholinesterase Pesticide Poisoning Caused a Long-term Mortality Increase: A Nationwide Population-based Cohort Study

Abstract Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwans National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (Pu200a<u200a0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (Pu200a<u200a0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0–191.0) and still high for ∼6 months (IRR: 3.8; 95% CI: 1.9–7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.

The surgical trends and time-frame comparison of primary surgery for stress urinary incontinence, 2006-2010 vs 1997-2005: a population-based nation-wide follow-up descriptive study

Introduction and hypothesisThe purpose of our study was to describe the surgical trends for female stress urinary incontinence (SUI) during 2006–2010, and a time-frame comparison with 1997–2005, based upon the National Health Insurance (NHI) claims data in Taiwan.MethodsWomen who underwent various primary surgeries for SUI during 2006–2010 were identified, with a total of 15,099 inpatients. The variables included surgical types, patient age, surgeon age and gender, specialty, and hospital accreditation levels. Chi-squared tests and SAS version 9.3.1 were used for statistical analysis.ResultsDuring the follow-up study, midurethral sling (MUS) application increased significantly from 53.09xa0% in 2006 to 78.74xa0% in 2010. It was associated concomitantly with a decrease in retropubic urethropexy (RPU) from 29.68xa0% to 12.99xa0%, and pubovaginal sling treatment (PVS) from 9.33xa0% to 3.46xa0%. MUS was most commonly used among all patients’ and surgeons’ age groups, and different accreditation hospital levels. MUS was more commonly used by gynecologists (71.38xa0%) than urologists (57.91xa0%); while PVS and periurethral injection were more commonly performed by urologists than gynecologists. Similar surgical trends were found during time-frame comparison, 2006–2010 vs 1997–2005. SUI surgeries increased in patients aged ≥60, surgeons agedu2009≥u200950, and in regional hospitals.ConclusionThis follow-up study depicts the increase in popularity of MUS and offers evidence of surgical trends and a paradigm shift for female SUI surgery. More older women were willing to seek healthcare and undergo surgery. The surgical skills and knowledge spread from medical centers into regional hospitals. The time-frame shift may have a profound impact on patients, as well as the healthcare providers.

Associations Between Topical Ophthalmic Corticosteroids and Central Serous Chorioretinopathy: A Taiwanese Population-Based Study.

PURPOSEnTo investigate the association between central serous chorioretinopathy (CSCR) and topical ophthalmic corticosteroid use.nnnMETHODSnData were collected from the Longitudinal Health Insurance Database 2000, containing randomly selected medical claim data from 23 million residents in Taiwan. The study cohort comprised all patients diagnosed with CSCR between January 2001 and December 2010 (n = 2921) with a control group of patients (n = 17,526) matched to study patients according to age, sex, geographic region, and date of index medical care. Demographic characteristics, comorbidities, and corticosteroid use (topical ophthalmic, oral, nasal spray, injected, and inhaled) within 1 year before CSCR diagnosis were examined using univariate logistic regression. Students t-test was used for continuous variables. Adjusted logistic regression was used to compare the odds ratio (OR) of the prognosis of CSCR patients with that of controls.nnnRESULTSnIn CSCR patients, we observed an increased prevalence of topical ophthalmic corticosteroid use (OR 6.328, 95% confidence interval [CI] 5.786-6.921, P < 0.0001). After adjusting for age, sex, geographic location of the patients residence, hypertension, diabetes mellitus, hyperlipidemia, chronic renal disease, peptic ulcer, psychiatric disease, allergic respiratory disease, coronary artery disease, and corticosteroid use, conditional logistic regression analysis showed that CSCR patients were more likely to have used topical ophthalmic corticosteroids recently than the controls (OR 6.036, 95% CI 5.512-6.610, P < 0.0001).nnnCONCLUSIONSnResults strongly support an association between recent topical ophthalmic corticosteroid use and CSCR. Thus, patients who require ophthalmic corticosteroids should be advised of the associated risk of developing CSCR.