RESUMO
Higher serum cholesterol levels have been associated with an increased risk of dry eye disease (DED). The relationship between statin (HMG-CoA reductase inhibitor) use and DED in patients with hyperlipidemia remains unclear. To investigate the association between statin use and the risk of DED in patients with hyperlipidemia, we conducted a population-based retrospective cohort study utilizing data from Taiwan's Longitudinal Generation Tracking Database. Patients were categorized into statin users and nonusers, with a 5-year follow-up period. The study identified patients with newly diagnosed hyperlipidemia, excluding those with prior DED diagnoses. Matching and adjustments for covariates resulted in 41,931 individuals in each group. Patients receiving statin therapy were compared with those unexposed. Cumulative exposure doses were also evaluated to assess dose-response relationships. The primary outcome was the incidence of DED diagnosed during the follow-up period. Cox proportional hazards regression models estimated the risk of DED, and conditional logistic regression analyzed the dose-response effect of statin exposure. Among 41,931 matched pairs, statin users exhibited a slightly increased risk of developing DED compared with nonusers (adjusted hazard ratio, 1.06; 95% CI, 1.02-1.11; p < 0.01). However, no dose-response relationship was observed between statin exposure and DED risk. Statin use among patients with hyperlipidemia is associated with a marginally higher risk of DED. These findings underscore the importance of regular eye examinations in this patient population to facilitate early detection and management of DED.
Assuntos
Síndromes do Olho Seco , Inibidores de Hidroximetilglutaril-CoA Redutases , Hiperlipidemias , Humanos , Síndromes do Olho Seco/epidemiologia , Síndromes do Olho Seco/induzido quimicamente , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/etiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/tratamento farmacológico , Hiperlipidemias/epidemiologia , Hiperlipidemias/sangue , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Taiwan/epidemiologia , Incidência , Fatores de Risco , Adulto , Relação Dose-Resposta a Droga , Modelos de Riscos Proporcionais , SeguimentosRESUMO
BACKGROUND: The challenge of preventing in-patient falls remains one of the most critical concerns in health care. OBJECTIVE: This study aims to investigate the effect of an integrated Internet of Things (IoT) smart patient care system on fall prevention. METHODS: A quasi-experimental study design is used. The smart patient care system is an integrated IoT system combining a motion-sensing mattress for bed-exit detection, specifying different types of patient calls, integrating a health care staff scheduling system, and allowing health care staff to receive and respond to alarms via mobile devices. Unadjusted and adjusted logistic regression models were used to investigate the relationship between the use of the IoT system and bedside falls compared with a traditional patient care system. RESULTS: In total, 1300 patients were recruited from a medical center in Taiwan. The IoT patient care system detected an average of 13.5 potential falls per day without any false alarms, whereas the traditional system issued about 11 bed-exit alarms daily, with approximately 4 being false, effectively identifying 7 potential falls. The bedside fall incidence during hospitalization was 1.2% (n=8) in the traditional patient care system ward and 0.1% (n=1) in the smart ward. We found that the likelihood of bedside falls in wards with the IoT system was reduced by 88% (odds ratio 0.12, 95% CI 0.01-0.97; P=.047). CONCLUSIONS: The integrated IoT smart patient care system might prevent falls by assisting health care staff with efficient and resilient responses to bed-exit detection. Future product development and research are recommended to introduce IoT into patient care systems combining bed-exit alerts to prevent inpatient falls and address challenges in patient safety.
Assuntos
Acidentes por Quedas , Internet das Coisas , Segurança do Paciente , Humanos , Acidentes por Quedas/prevenção & controle , Segurança do Paciente/estatística & dados numéricos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Taiwan , Idoso de 80 Anos ou mais , Assistência ao Paciente/métodos , AdultoRESUMO
BACKGROUND: After enactment of the Patient Right to Autonomy Act in Taiwan, most of the individuals participating in advance care planning (ACP) and signing advance decisions (AD) have been healthy adults. This demographic is inadequately covered in the literature, in which related studies focus primarily on individuals with major illnesses. PURPOSE: This study was implemented to understand the experiences of healthy adults participating in ACP. METHODS: A qualitative approach was taken and participants were recruited from ACP outpatient clinics in three hospitals in northern, central, and southern Taiwan. All of the participants were healthy adults who had completed the ACP process, did not have a major illness, had no psychiatric diagnoses, and could express themselves clearly. Data were collected via semi-structured interviews and analyzed using content analysis. RESULTS: A total of 15 participants were interviewed, generating three major themes: "Establishing the foundations of ACP", "Preserving dignity in end-of-life care", and "Key elements for successful ACP". Their motivation to engage in ACP and sign the AD form was influenced by past experiences and a desire to maintain dignity and physical autonomy through the aging process. Their decision-making processes were influenced by family opinions, sociocultural factors, and systemic dynamics. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: During the ACP and AD signing process, the consulting team not only helps healthy adults successfully provide informed consent but also, by fostering a supportive communication environment, ensures medical preferences and expectations are accurately reflected, thus promoting mutual care, support, and understanding among all parties.
Assuntos
Planejamento Antecipado de Cuidados , Adulto , Humanos , Taiwan , Assistência Terminal , Autonomia PessoalRESUMO
One nucleotide substitution in codon 136 of HLA-B*40:02:01:01 results in a novel allele, HLA-B*40:78.
Assuntos
Alelos , Sequência de Bases , Códon , Éxons , Antígeno HLA-B40 , Teste de Histocompatibilidade , Humanos , Taiwan , Teste de Histocompatibilidade/métodos , Antígeno HLA-B40/genética , Análise de Sequência de DNA/métodos , Povo Asiático/genética , Alinhamento de Sequência , Polimorfismo de Nucleotídeo ÚnicoRESUMO
BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease 2023 revision proposed that chronic obstructive pulmonary disease (COPD) has various etiologies including infections (COPD-I), such as tuberculosis and human immunodeficiency virus. While nontuberculous mycobacterial pulmonary disease (NTM-PD) and pulmonary tuberculosis share similar clinical manifestations, research on COPD development during longitudinal follow-up in patients with NTM-PD is limited. In this study, we aimed to evaluate the incidence and risk of COPD development in patients with NTM-PD. METHODS: We retrospectively enrolled patients with NTM-PD with normal lung function and 1:4 age-, sex-, body mass index-, and smoking status-matched controls between November 1994 and January 2022. We compared the risks of spirometry-defined COPD between the NTM-PD and control groups (study 1). A nationwide cohort study using the health insurance claims database was conducted to validate the findings (study 2). RESULTS: In study 1, during a mean follow-up of 3.3 years, COPD occurred in 14.0% (241/1,715) and 4.3% (293/6,860) of individuals in the NTM-PD and matched control cohorts, respectively. The NTM-PD cohort exhibited a higher risk of incident COPD (adjusted hazard ratio [aHR], 2.57; 95% CI, 2.15-3.09) compared to matched controls. In study 2, COPD occurred in 6.2% (24/386) and 2.5% (28/1,133) of individuals with and without NTM-PD, respectively. The NTM-PD cohort had a higher risk of incident COPD (aHR, 2.04; 95% CI, 1.21-3.42) compared to matched controls. CONCLUSION: These findings suggest that NTM-PD could be considered a new etiotype of COPD-I and emphasize the importance of monitoring lung function in individuals with NTM-PD.
Assuntos
Infecções por Mycobacterium não Tuberculosas , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Masculino , Feminino , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Pessoa de Meia-Idade , Incidência , Estudos Retrospectivos , Seguimentos , Estudos Longitudinais , Idoso , Fatores de Risco , Adulto , Taiwan/epidemiologiaRESUMO
Bongkrekic acid (BKA), a rarely happened foodborne toxin by Burkholderia gladioli pathovar cocovenenans (Burkholderia cocovenenans) might leads to devastating life-threatening condition after eating meal contaminated BKA. Unbelievable event from March 19, 2024, to March 24, 2024, there was an outbreak of BAP in a luxury shopping area of eastern Taipei, Taiwan. Most of the victims are young to middle-aged people who made a tour over there and ate the cooked wet rice noodles. Of them, 13 males and 20 females, aged 40.9 ± 14.7 years old visited or were sent by ambulances to the emergency department presenting with watery diarrhea, and vomiting. Some progressed to severe hepatic and renal failure, altered mental status, disseminated intravascular coagulation, and fatalities within several hours within 2 days. The primary health workers especially emergency physicians need to keep in mind of BKA poisoning is quite different in presentations from other infectious colitis commonly seen before. Knowing the toxic-kinetic and toxic-dynamic mechanisms is important to farseeing the presentation of these BAP patients. Throughout this outbreak, we gathered abundant experiences in mitigating and managing these debilitated patients. Aggressively supportive care and early liver transplantation if there is no concurrent inflammatory process and the patient's condition is tolerable to surgical intervention saves lives. For food safety education, it is crucial to enhance our understanding of inhibiting BKA production and promote proper food preservation methods and a suitable environment to ensure food safety.
Assuntos
Doenças Transmitidas por Alimentos , Humanos , Taiwan/epidemiologia , Feminino , Masculino , Adulto , Doenças Transmitidas por Alimentos/etiologia , Doenças Transmitidas por Alimentos/epidemiologia , Surtos de Doenças , Burkholderia gladioli , Pessoa de Meia-Idade , Diarreia/induzido quimicamenteRESUMO
OBJECTIVES: In Taiwan, many women receive postpartum care at postpartum nursing centers for one month. However, limited research has examined the postpartum depressive symptoms in women residing in postpartum nursing center. The objectives of this study were to investigate the prevalence of postpartum depressive symptoms and to identify the risk factors and protective factors for postpartum depressive symptoms in postpartum nursing center. MATERIALS AND METHODS: This was an observational study. Postpartum women who were over 20 years old and able to speak Mandarin Chinese or Taiwanese, and had delivered singleton, live infants at term were recruited between January 2020 and June 2020 from a postpartum nursing center in central Taiwan. A questionnaire including sociodemographic characteristics, the Edinburgh Postnatal Depression Scale, and a pain scale was administered at first week and last week in the postpartum nursing center. RESULTS: A total of 60 postpartum women participated in the study. The prevalence rates of postpartum depressive symptoms after admission and before discharge from a postpartum nursing center were 13% and 8%, respectively. The postpartum depressive symptoms and postpartum pain intensity (including perineum pain and postoperative pain after caesarean delivery) scores were significantly decreased after staying at the postpartum nursing center. The risk factors for postpartum depressive symptoms were previous abortion experience and postpartum pain, while the protective factors were having child care arrangements after return home and having 8-11 h of sleep per day. CONCLUSIONS: There is a need for the early detection and management of postpartum depressive symptoms in postpartum nursing center.
Assuntos
Depressão Pós-Parto , Fatores de Proteção , Humanos , Feminino , Depressão Pós-Parto/epidemiologia , Adulto , Fatores de Risco , Taiwan/epidemiologia , Prevalência , Gravidez , Cuidado Pós-Natal , Inquéritos e Questionários , Adulto Jovem , Escalas de Graduação PsiquiátricaRESUMO
OBJECTIVE: To determine the incidence and present our experience with prenatal diagnosis and postnatal outcome of dacryocystocele. MATERIAL AND METHODS: All cases of congenital dacryocystocele diagnosed in our center between 2020 and 2022 were identified in our database to establish the incidence of these defects. The medical records were then reviewed for gestational age, gender, size, and side of dacryocystocele and postnatal outcome. RESULTS: A total of 26 cases with dacryocystoceles were found at a mean gestation age of 30 weeks (range, 29-33 weeks). The overall incidence was 1.35%, there was an obvious female predominance (73%), 69% of cases were unilateral and 31% were bilateral. There were no serious associated anomalies. The postnatal outcome was obtained in 88% of cases (23/26), in 39% (9 out of 23) cases the dacryocystocele was confirmed postnatally, and in 7 (77%) of these it was complicated by dacryocystitis. The spontaneous resolution was more likely in the right-sided lesions, and this was statistically significant. The treatment in cases with dacryocystitis involved massage and local antibiotics and was successful in 71% of cases. 2 cases (29%) suffer from recurrent dacryocystitis and are followed up with recurrent probing and local antibiotics. No breathing difficulties were described postnatally in our study group. CONCLUSION: The overall prenatal incidence of dacryocystocele was 1.35%. The outcome is favorable, 61% of dacryocystoceles in our study resolved spontaneously and in no case postnatal breathing complications were reported. Dacryocystitis was common in persisting cases but was usually treated successfully by massage and antibiotics. The right-sided dacryocystoceles are more likely to resolve spontaneously than left-sided, and this was the only significant factor predicting persistence.
Assuntos
Idade Gestacional , Humanos , Feminino , Gravidez , Masculino , Recém-Nascido , Incidência , Ultrassonografia Pré-Natal , Estudos Retrospectivos , Dacriocistite/diagnóstico , Dacriocistite/epidemiologia , Dacriocistite/congênito , Adulto , Diagnóstico Pré-Natal/métodos , Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/diagnóstico , Taiwan/epidemiologiaRESUMO
OBJECTIVE: Endometrial cancer (EC) is the most common gynecological malignancy in high-income countries. In Taiwan, the incidence of EC increased from 1.69 in 1980 to 11.36 per 100,000 women/year in 2010. Therefore, we aimed to study the prognostic factors and survival of patients with EC in southern Taiwan. MATERIALS AND METHODS: This study included patients with EC who underwent hysterectomy-based surgery at our hospital between 2010 and 2020. The primary outcome was 5-year progression-free survival (PFS) and overall survival (OS) of patients diagnosed with EC. The secondary outcome was the prognostic factors associated with 5-year PFS and OS in patients with EC. We used the chi-square test to assess categorical variables and the independent t-test to assess continuous variables. The Kaplan-Meier method was used to estimate survival outcomes. Cox regression analysis was conducted to examine the factors associated with PFS and OS. RESULTS: A total of 133 patients were enrolled in this study. The mean age of the patients was 56.5 ± 10.71 years. The mean body mass index was 26.4 ± 5.21 kg/m2. The 5-year PFS and OS were 90.3% and 94.53%, respectively. In terms of PFS, endometrioid histology was linked to more favorable outcomes (hazard ratio [HR] = 0.02, 95% confidence interval [CI]:0.001-0.59), while lymph-vascular space invasion (LVSI) was associated with adverse results (HR = 9.11, 95% CI: 1.07-77.44). Initial analyses revealed no significant correlations between OS and various factors, including age, BMI, parity, DM, hypertension, age at last birth, and tumor grade. However, univariate analysis found grade 3 tumor differentiation, LVSI, and lymph node invasion associated with poorer OS. Laparoscopy was associated with better OS. Nevertheless, subsequent multivariate analysis did not reveal any factor significantly associated with OS. Most patients with EC (76.69%) underwent laparoscopic surgery. CONCLUSION: In conclusion, endometrioid histology was linked to more favorable PFS, while LVSI was related to adverse PFS. Our study did not identify any factors associated with OS. Two-thirds of the patients underwent minimally invasive surgery.
Assuntos
Neoplasias do Endométrio , Histerectomia , Humanos , Feminino , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Taiwan/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Prognóstico , Histerectomia/estatística & dados numéricos , Idoso , Carcinoma Endometrioide/mortalidade , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Estimativa de Kaplan-Meier , Intervalo Livre de Progressão , Taxa de Sobrevida , Estadiamento de Neoplasias , Adulto , Modelos de Riscos Proporcionais , Metástase LinfáticaRESUMO
Type 2 diabetes mellitus (T2DM) is a prevalent health challenge faced by countries worldwide. In this study, we propose a novel large language multimodal models (LLMMs) framework incorporating multimodal data from clinical notes and laboratory results for diabetes risk prediction. We collected five years of electronic health records (EHRs) dating from 2017 to 2021 from a Taiwan hospital database. This dataset included 1,420,596 clinical notes, 387,392 laboratory results, and more than 1505 laboratory test items. Our method combined a text embedding encoder and multi-head attention layer to learn laboratory values, and utilized a deep neural network (DNN) module to merge blood features with chronic disease semantics into a latent space. In our experiments, we observed that integrating clinical notes with predictions based on textual laboratory values significantly enhanced the predictive capability of the unimodal model in the early detection of T2DM. Moreover, we achieved an area greater than 0.70 under the receiver operating characteristic curve (AUC) for new-onset T2DM prediction, demonstrating the effectiveness of leveraging textual laboratory data for training and inference in LLMs and improving the accuracy of new-onset diabetes prediction.
Assuntos
Diabetes Mellitus Tipo 2 , Registros Eletrônicos de Saúde , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Taiwan/epidemiologia , Redes Neurais de Computação , Feminino , Masculino , Curva ROC , Pessoa de Meia-Idade , Estudos de Coortes , Aprendizado Profundo , Bases de Dados FactuaisRESUMO
A sex change phenomenon was reported in some free-living, non-sessile coral species of the Family Fungiidae. However, there are no reports describing sex change in sessile colonial species. Timing and cellular processes of sex change are also unclear in corals. Here, we report sex change of the colonial coral, Fimbriaphyllia ancora, and its cellular process. Of 26 colonies monitored at Nanwan Bay, southern Taiwan, about 70% changed their sex every year after annual spawning for least 3-4 consecutive years, i.e., colonies that were male two years ago became female last year, and male again this year. The remaining 30% were permanently male or female. Sex-change and non-sex-change colonies grew in close proximity or even side-by-side. No significant differences were found in colony size between sex-change and non-sex-change colonies. Histological analysis showed that, in female-to-male sex change, small oocytes were present up to 3 months in some gonads after spawning and disappeared by 5 months. This suggests that sex change occurred 4-5 months after spawning. In contrast, in male-to-female sex change, oocytes appeared weeks after sperm release and in most gonads by 3 months, suggesting that male-to-female sex change occurred 0-3 months after sperm release.
Assuntos
Antozoários , Reprodução , Animais , Antozoários/fisiologia , Antozoários/crescimento & desenvolvimento , Masculino , Feminino , Processos de Determinação Sexual , Taiwan , Gônadas/crescimento & desenvolvimento , OócitosRESUMO
BACKGROUND: Hepatitis B, a liver infection caused by the hepatitis B virus (HBV), can develop into a chronic infection that puts patients at high risk of death from cirrhosis and liver cancer. In this study, we aimed to investigate the difference of reactome pre-Notch expression and processing between males and females by using gene to function analysis in FUMA. METHODS: We analyzed Taiwan Biobank (TWB) data pertaining to 48,874 women and 23,178 men individuals which were collected from 2008 to 2019. According to hepatitis B surface antigen (HBsAg) status in hematology, positive and negative were classified into case and control in the genome-wide association study (GWAS) analysis. RESULTS: We found 4715 women and 2656 men HBV cases. The genomic risk loci were different between males and females. In male, three risk loci (rs3732421, rs1884575 and Affx-28516147) were detected while eight risk loci (Affx-4564106, rs932745, rs7574865, rs34050244, rs77041685, rs107822, rs2296651 and rs12599402) were found in female. In addition, sex also presented different results. In females, the most significant SNPs are gathered in chromosome 6. However, except for chromosome 6, significant HBV infection SNPs also could be found in chromosome 3 among males. We further investigated gene function in FUMA to identify the difference in reactome pre-Notch expression and processing between males and females. We found that POGLUT1 and HIST1H2BC only appeared in men but not in women. CONCLUSION: According to our study, the reactome pre-Notch expression including POGLUT1 and HIST1H2BC was associated with a risk of Hepatitis B in Taiwanese men when compared to women.
Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). It can lead to long-term liver damage and cancer. We looked at differences in how the virus affects men and women in Taiwan. We analyzed data from over 72,000 people in the Taiwan Biobank. The study individuals were divided into two groupsthose who had the hepatitis B virus (cases) and those who did not (controls). We looked for genetic differences between the two groups and found that the specific genetic risk factors for hepatitis B differed between men and women. We found three genetic risk factors in men and eight in women. This suggests that the way the hepatitis B virus interacts with our genes may differ between the sexes. We found that in women, the most significant genetic risk factors were all located on chromosome 6. However, in men, the significant risk factors were spread across different chromosomes, including chromosome 3. Finally, we looked at how these genetic differences might affect the way the body processes the hepatitis B virus. We found that two specific genes, called POGLUT1 and HIST1H2BC, were only linked to hepatitis B risk in men, not in women. This indicates that the biological pathways involved in hepatitis B infection may differ between males and females. Understanding these differences could lead to more effective, personalized treatment strategies for those affected by the virus.
Assuntos
Hepatite B Crônica , Receptores Notch , Caracteres Sexuais , Transdução de Sinais , Humanos , Masculino , Feminino , Taiwan , Hepatite B Crônica/genética , Hepatite B Crônica/metabolismo , Receptores Notch/metabolismo , Receptores Notch/genética , Pessoa de Meia-Idade , Adulto , Bancos de Espécimes Biológicos , Estudo de Associação Genômica Ampla , Polimorfismo de Nucleotídeo Único , Vírus da Hepatite BRESUMO
Background: Sodiumâglucose cotransporter-2 (SGLT2) inhibitors offer glycaemic and cardiorenal benefits in the early stage of chronic kidney disease (CKD). However, the use of SGLT2 inhibitors may increase the risk of genitourinary tract infection (GUTI). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may also cause deterioration of kidney function. The long-term follow-up of cardiorenal outcomes and GUTI incidence in patients with advanced CKD receiving SGLT2 inhibitors combined with ACEIs/ARBs should be further investigated. Methods: We analysed data from 5,503 patients in Taiwan's Taipei Medical University Research Database (2016-2020) who were part of a pre-end-stage renal disease (ESRD) program (CKD stages 3-5) and received ACEIs/ARBs. SGLT2 inhibitor users were matched 1:4 with nonusers on the basis of sex, CKD, and program entry duration. Results: The final cohort included 205 SGLT2 inhibitor users and 820 nonusers. SGLT2 inhibitor users experienced a significant reduction in ESRD/dialysis risk (aHR = 0.35, 95% CI = 0.190.67), and SGLT2 inhibitor use was not significantly associated with acute kidney injury or acute kidney disease risk. Among SGLT2 inhibitor users, those with a history of cardiovascular disease (CVD) had greater CVD rates. Conversely, those without a CVD history had lower rates of congestive heart failure, arrhythmia, acute pulmonary oedema, and acute myocardial infarction, although the differences were not statistically significant. Notably, SGLT2 inhibitor usage was associated with a greater GUTI incidence (aHR = 1.78, 95% CI = 1.122.84) shortly after initiation, irrespective of prior GUTI history status. Conclusion: Among patients with CKD stages 3-5, SGLT2 inhibitor use was linked to increased GUTI incidence, but it also significantly reduced the ESRD/dialysis risk without an episodic AKI or AKD risk. Clinical physicians should consider a personalized medicine approach by balancing GUTI episodes and cardiorenal outcomes for advanced CKD patients receiving SGLT2 inhibitors.
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Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Insuficiência Renal Crônica , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Taiwan/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Incidência , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/complicações , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologiaRESUMO
Background: Controlling saturated fat and cholesterol intake is important for the prevention of cardiovascular diseases. Although the use of mobile diet-tracking apps has been increasing, the reliability of nutrition apps in tracking saturated fats and cholesterol across different nations remains underexplored. Objective: This study aimed to examine the reliability and consistency of nutrition apps focusing on saturated fat and cholesterol intake across different national contexts. The study focused on 3 key concerns: data omission, inconsistency (variability) of saturated fat and cholesterol values within an app, and the reliability of commercial apps across different national contexts. Methods: Nutrient data from 4 consumer-grade apps (COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!) and an academic app (Formosa FoodApp) were compared against 2 national reference databases (US Department of Agriculture [USDA]-Food and Nutrient Database for Dietary Studies [FNDDS] and Taiwan Food Composition Database [FCD]). Percentages of missing nutrients were recorded, and coefficients of variation were used to compute data inconsistencies. One-way ANOVAs were used to examine differences among apps, and paired 2-tailed t tests were used to compare the apps to national reference data. The reliability across different national contexts was investigated by comparing the Chinese and English versions of MyFitnessPal with the USDA-FNDDS and Taiwan FCD. Results: Across the 5 apps, 836 food codes from 42 items were analyzed. Four apps, including COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, significantly underestimated saturated fats, with errors ranging from -13.8% to -40.3% (all P<.05). All apps underestimated cholesterol, with errors ranging from -26.3% to -60.3% (all P<.05). COFIT omitted 47% of saturated fat data, and MyFitnessPal-Chinese missed 62% of cholesterol data. The coefficients of variation of beef, chicken, and seafood ranged from 78% to 145%, from 74% to 112%, and from 97% to 124% across MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, respectively, indicating a high variability in saturated fats across different food groups. Similarly, cholesterol variability was consistently high in dairy (71%-118%) and prepackaged foods (84%-118%) across all selected apps. When examining the reliability of MyFitnessPal across different national contexts, errors in MyFitnessPal were consistent across different national FCDs (USDA-FNDSS and Taiwan FCD). Regardless of the FCDs used as a reference, these errors persisted to be statistically significant, indicating that the app's core database is the source of the problems rather than just mismatches or variances in external FCDs. Conclusions: The findings reveal substantial inaccuracies and inconsistencies in diet-tracking apps' reporting of saturated fats and cholesterol. These issues raise concerns for the effectiveness of using consumer-grade nutrition apps in cardiovascular disease prevention across different national contexts and within the apps themselves.
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Doenças Cardiovasculares , Aplicativos Móveis , Humanos , Aplicativos Móveis/normas , Aplicativos Móveis/estatística & dados numéricos , Reprodutibilidade dos Testes , Doenças Cardiovasculares/prevenção & controle , TaiwanRESUMO
Background: Young children are susceptible to enterovirus (EV) infections, which cause significant morbidity in this age group. Objective: This study investigated the characteristics of virus strains and the epidemiology of EVs circulating among young children in Taiwan from 2011 to 2020. Methods: Children diagnosed with EV infections from 2011 to 2020 were identified from the routine national health insurance data monitoring disease system, real-time outbreak and disease surveillance system, national laboratory surveillance system, and Statistics of Communicable Diseases and Surveillance Report, a data set (secondary data) of the Taiwan Centers for Disease and Control. Four primary outcomes were identified: epidemic features, characteristics of sporadic and cluster cases of EV infections, and main cluster institutions. Results: From 2011 to 2020, between 10 and 7600 person-times visited the hospitals for EV infections on an outpatient basis daily. Based on 2011 to 2020 emergency department EV infection surveillance data, the permillage of EV visits throughout the year ranged from 0.07 and 25.45. After typing by immunofluorescence assays, the dominant type was coxsackie A virus (CVA; 8844/12,829, 68.9%), with most constituting types CVA10 (n=2972), CVA2 (n=1404), CVA6 (n=1308), CVA4 (n=1243), CVA16 (n=875), and CVA5 (n=680); coxsackie B virus CVB (n=819); echovirus (n=508); EV-A71 (n=1694); and EV-D68 (n=10). There were statistically significant differences (P<.001) in case numbers of EV infections among EV strains from 2011 to 2020. Cases in 2012 had 15.088 times the odds of being EV-A71, cases in 2014 had 2.103 times the odds of being CVA, cases in 2015 had 1.569 times the odds of being echovirus, and cases in 2018 had 2.274 times the odds of being CVB as cases in other years. From 2011 to 2020, in an epidemic analysis of EV clusters, 57 EV clusters were reported. Clusters that tested positive included 53 (53/57, 93%) CVA cases (the major causes were CVA6, n=32, and CVA10, n=8). Populous institutions had the highest proportion (7 of 10) of EV clusters. Conclusions: This study is the first report of sporadic and cluster cases of EV infections from surveillance data (Taiwan Centers for Disease and Control, 2011-2020). This information will be useful for policy makers and clinical experts to direct prevention and control activities to EV infections that cause the most severe illness and greatest burden to the Taiwanese.
Assuntos
Infecções por Enterovirus , Humanos , Taiwan/epidemiologia , Infecções por Enterovirus/epidemiologia , Pré-Escolar , Lactente , Masculino , Estudos Retrospectivos , Feminino , Criança , Recém-Nascido , Enterovirus/isolamento & purificação , Enterovirus/classificação , Surtos de DoençasRESUMO
OBJECTIVES: Pharmacological and non-pharmacological interventions are mostly designed for patients with early Alzheimer's disease (AD) dementia. Long-term case management and planning for the remainder of life with disability require an estimation of the survival duration. METHODS: This cohort study utilized data from the National Health Insurance Research Database, Taiwan, to identify incident cases of mild-to-moderate AD dementia diagnosed from 2000 to 2002, followed through December 31, 2017. A multivariate Cox proportional hazards regression model was constructed to compare the independent effects of age, sex, and comorbidities on all-cause mortality risk. Cumulative survival rates and survival times were estimated. RESULTS: A total of 5258 incident cases were identified, all treated with cholinesterase inhibitors after diagnosis confirmation by an expert committee. During the 15-year follow-up period, 4331 deaths occurred. The 1-, 3-, 5-, 10-, and 15-year cumulative survival rates were 95, 92, 67, 37, and 18, respectively. The median (95% CI) survival time after diagnosis was 7.69 (7.46-7.90) years overall, 6.37 (6.06-6.65) years in men, and 8.81 (8.49-9.12) years in women. After stratification by age and number of comorbidities, the median survival time ranged from 13.72 (ages 40-64) to 5.29 (ages ≥ 80) years among those without comorbidities. For those with ≥ 3 comorbidities, the median survival times decreased to 6.43 for individuals diagnosed at ages 40-64 and to 2.98 years for those diagnosed at age 80 or older. CONCLUSIONS: This nationwide, large, long-term cohort study provided survival rates and durations from diagnosis to death, varying by sex, age group, and presence/number of comorbidities. This information can serve as a foundation for further cost-effectiveness studies on new treatments, and may aid clinicians, patients, and families in shared decision-making and advance personalized care planning for early dementia cases.
Assuntos
Doença de Alzheimer , Modelos de Riscos Proporcionais , Humanos , Masculino , Feminino , Doença de Alzheimer/mortalidade , Doença de Alzheimer/diagnóstico , Taiwan/epidemiologia , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Estudos de Coortes , Taxa de Sobrevida , Comorbidade , Inibidores da Colinesterase/uso terapêutico , Bases de Dados FactuaisRESUMO
Nucleotide substitution in codon 221 of HLA-B*51:01:01:01 results in a novel allele, HLA-B*51:01:44.
Assuntos
Alelos , Antígenos HLA-B , Humanos , Sequência de Bases , Códon , Teste de Histocompatibilidade , Antígenos HLA-B/genética , Polimorfismo de Nucleotídeo Único , Alinhamento de Sequência , Análise de Sequência de DNA/métodos , TaiwanRESUMO
AIMS: Research evidence has established an association of obsessive-compulsive disorder (OCD) with suicidal thoughts and suicide attempts. However, further investigation is required to determine whether individuals with OCD have higher risk of death by suicide compared with those without OCD. METHODS: Of the entire Taiwanese population, between 2003 and 2017, 56,977 individuals with OCD were identified; they were then matched at a 1:4 ratio with 227,908 non-OCD individuals on the basis of their birth year and sex. Suicide mortality was assessed between 2003 and 2017 for both groups. Time-dependent Cox regression models were used to investigate the difference in suicide risk between individuals with versus without OCD. RESULTS: After adjustment for major psychiatric comorbidities (i.e., schizophrenia, bipolar disorder and major depressive disorder), the OCD group had higher risk of suicide (hazard ratio: 1.97, 95% confidence interval: 1.57-2.48) during the follow-up compared with the comparison group. Furthermore, OCD severity, as indicated by psychiatric hospitalizations due to OCD, was positively correlated with suicide risk. CONCLUSIONS: Regardless of the existence of major psychiatric comorbidities, OCD was found to be an independent risk factor for death by suicide. A suicide prevention program specific to individuals with OCD may be developed in clinical practice in the future.
Assuntos
Comorbidade , Transtorno Obsessivo-Compulsivo , Suicídio , Humanos , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia , Taiwan/epidemiologia , Masculino , Feminino , Adulto , Suicídio/estatística & dados numéricos , Suicídio/psicologia , Estudos Longitudinais , Pessoa de Meia-Idade , Fatores de Risco , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Ideação SuicidaRESUMO
BACKGROUND: The upper tract urothelial carcinoma (UTUC) risk associated with statin therapy in hyperlipidemic patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) remains obscure. AIM: This retrospective cohort study investigated the UTUC risk for hyperlipidemic patients with CKD or ESKD associated with statin therapy. METHODS: From the national insurance claims data of Taiwan, we identified hyperlipidemic patients and established three pairs of statin users and non-users sub-cohorts matched by propensity scores: 401,490 pairs with normal kidney function, 37,734 pairs with CKD, and 6271 pairs with ESKD. Incidence rates and hazard ratio (HR) of UTUC were estimated, by the end of 2016, between statin and non-statin cohorts, and between hydrophilic statins users and lipophilic statins users. Time-dependent model estimated adjusted HR, and sub-distribution HR (sHR) accounting for the competing risk of deaths. RESULTS: The statin-users with ESKD were at increased UTUC risk (sHR 1.98; 95% confidence interval (CI), 1.28-3.06), significant for younger patients (40-64 years). The incidence was twofold greater in women than in men (31.8 versus 15.9 per 10,000 person-years). Receiving lipophilic statins was associated with increased UTUC risk in CKD and ESKD patients, while receiving hydrophilic statins was associated with increased UTUC risk in ESKD patients. CONCLUSIONS: Patients with ESKD receiving statin were at an increased UTUC risk, significant for younger group (<65 y/o). The positive associations between UTUC and statin persisted in both genders with ESKD, and in therapy with either lipophilic statins or hydrophilic statins. Statin users with ESKD deserve attention for UTUC prevention.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hiperlipidemias , Falência Renal Crônica , Insuficiência Renal Crônica , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Estudos Retrospectivos , Hiperlipidemias/tratamento farmacológico , Hiperlipidemias/complicações , Hiperlipidemias/epidemiologia , Taiwan/epidemiologia , Idoso , Adulto , Seguimentos , Incidência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Carcinoma de Células de Transição/epidemiologia , Carcinoma de Células de Transição/complicações , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/complicações , Modelos de Riscos Proporcionais , Pontuação de PropensãoRESUMO
BACKGROUND: Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care. OBJECTIVE: This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app. METHODS: Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience. RESULTS: Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app. CONCLUSIONS: Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan.