ㄧ、Zolpidem使用與車禍住院危險性增加:個案交叉研究 二、台灣更年期婦女中醫藥使用情況分析

Abstract

Part1 Background: Epidemiological and experimental studies indicated that prescriptions of benzodiazepines (BZDs) and zopiclone are associated with increased risk of motor vehicle crash (MVC). In contrast, there was limited evidence on the use of zolpidem one day before and the risk of MVC. Objectives: To determine whether the use of zolpidem one day before is associated with increased risk of MVC. Methods: We identified 12,929 subjects ever hospitalized due to MVC from the data of 1,000,000 people randomly sampled from the reimbursement database 1998-2004 of national health insurance of Taiwan. By case-crossover design, we selected the day before MVC as the case period and retrospectively 91st, 182nd, and 273rd days prior to the case period as the three control periods for each subject. The dosage of different medications were summed up based on per defined daily dose (DDD) .Conditional logistical regression model were constructed to calculate the odds ratio of having MVC and prescription of zolpidem, BZDs, and zopiclone one day before after control of potential confounding by other medications with suspected hypnotic effects. Results: After adjustment for related risk factors, the odds ratios (ORs) of having MVC for taking zolpidem per DDD one day before was 1.74 (95% CI 1.25-2.43) while that of zopiclone was 1.55 (95% CI 0.98-2.45). And those for per DDD of taking long half-life and short half-life of BZDs one day before were 1.74 (95% confidence interval (CI) 1.26-2.40) and 1.13 (95% CI 1.04-1.23), respectively. Conclusions: Use of zolpidem one day before might be associated with increased risk of MVC. Part2 Introduction: Complementary and alternative medicine (CAM) has become more popular as therapies for symptom relief among menopause-age women. Traditional Chinese medicine (TCM) is an important part of CAM which is also widely used by menopausal women. However, there is still lack information on TCM utilization for climacteric women. The aim of our study was to conduct an analysis of TCM utilization for climacteric women in Taiwan. Methods: This study used the 200,000 random sampling cohort from national health insurance (NHI) Database 1997-2004 and drug registration numbers to analyze TCM utilization, including disease categories of visiting OPD, using frequencies and percentage of herbal formula (HF) for each disease category. We also applied data mining techniques to explore co-prescription patterns for menopausal and postmenopausal disorders. Result: Diseases of the musculoskeletal system and connective tissue were the most frequent diagnosis of disease category for climacteric women, acupuncture and traumatology manipulative therapies were the most common TCM modality to treat diseases of the musculoskeletal system and connective tissue. Diagnoses of symptoms, signs, and ill-defined conditions are most common in TCM visits with prescription of Chinese herbal remedies and Jia-wei-xiao-yao-san was the most common HF prescribed in TCM visits. Conclusions: The pattern of TCM utilization of climacteric women is different from whole population in both TCM and WM. Diseases of the musculoskeletal system and connective tissue, Symptoms, signs, and ill-defined conditions were much more frequent. It might due to two reasons: First, climacteric women have more symptoms or signs which related to menopausal syndrome. Second, the concept of advantage and disadvantage of TCM and WM might influence patients’ choice of using TCM or WM. Safety issues should be a priority for future research and more clinical trial is needed to assess the effects of TCM for menopausal syndrome during climacteric period.