Nationwide Population-based Database Research Articles

Outcomes differ by first documented rhythm after witnessed out-of-hospital cardiac arrest in children: an observational study with prospective nationwide population-based cohort database in Japan.

To evaluate and compare outcomes and impacts of delay of time to cardiopulmonary resuscitation (CPR) by type of first documented rhythm in paediatric patients with out-of-hospital cardiac arrest (OHCA). We enrolled 3968 paediatric (aged <18 years) OHCA patients whose events were witnessed between 2005 and 2012 from a prospective nationwide population-based cohort database in Japan. We assessed and compared their neurologically favourable 1-month survival according to first documented rhythm: pulseless ventricular tachycardia/ventricular fibrillation (pVT/VF), pulseless electrical activity (PEA), or asystole. Out-of-hospital cardiac arrest patients with pVT/VF, PEA, and asystole totalled 556 (14.0%), 1249 (31.5%), and 2163 (54.5%), respectively. The proportion of overall neurologically favourable 1-month survival in patients with pVT/VF, PEA, and asystole was 36.5, 5.0, and 1.8%, respectively, in the entire study population, and 73.8, 27.7, and 13.8%, respectively, in patients who achieved pre-hospital return of spontaneous circulation (ROSC). As the time from collapse to CPR lengthened, the number of patients with asystole increased, whereas those of pVT/VF and PEA decreased (P < 0.001). After paediatric OHCA, earlier initiation of CPR resulted in higher rates of pre-hospital ROSC (adjusted odds ratio 0.97, 95% confidence interval 0.95-0.99, P = 0.018), which led to much better patient outcomes than in the total study population. We confirmed that pVT/VF and early ROSC in general were associated with better outcomes in patients with witnessed paediatric OHCA.

Gender ratios of administrative prevalence and incidence of attention-deficit/hyperactivity disorder (ADHD) across the lifespan: A nationwide population-based study in Taiwan.

To verify the hypothesis that there is different gender ratio of attention-deficit/hyperactivity disorder (ADHD) among adults compared to children and adolescents in the clinical setting among Asian population. The nationwide population-based database containing data on enrollees in the National Health Insurance program in Taiwan during 2000-2007 was used in this study, and we investigated the lifetime gender ratios of administrative prevalence and incidence in healthcare-seeking ADHD patients (n=228,029). The male-to-female ratios of diagnosed incidence and prevalence of child/adolescent ADHD (age <20 years) ranged from 3.39 to 4.07 and 3.87-4.31, respectively. The male-to-female ratios of diagnosed incidence and prevalence of ADHD in the adult group (age 20-65 years) ranged from 0.24 to 0.76 and 0.35-0.98, respectively. In conclusion, there was substantially increased female-to-male ratio in adults ADHD compared to children and adolescents in the clinical setting. Further researches on the management and mechanism are needed.

MP82-14 TEMPORAL TREND OF MEDICAL UTILIZATION AND COST FOR UPPER AND LOWER URINARY TRACT STONE DISEASES, 2000-2010: A POPULATION-BASED STUDY IN TAIWAN

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2016MP82-14 TEMPORAL TREND OF MEDICAL UTILIZATION AND COST FOR UPPER AND LOWER URINARY TRACT STONE DISEASES, 2000-2010: A POPULATION-BASED STUDY IN TAIWAN Han-Yu Weng, Che-Yuan Hu, Kuo-How Huang, and Hong-Chiang Chang Han-Yu WengHan-Yu Weng More articles by this author , Che-Yuan HuChe-Yuan Hu More articles by this author , Kuo-How HuangKuo-How Huang More articles by this author , and Hong-Chiang ChangHong-Chiang Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2155AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urolithiasis, a prevalent disease with high recurrence rate, is associated with a high cost to society. In this study, we aim to investigate the medical utilization and costs of urolithiasis in Taiwan using a nationwide population-based database. METHODS This study is based on Taiwan's National Health Insurance Research Database (NHIRD), which contains the data of all medical beneficiary claims from 22.72 million enrollees, accounting for nearly 99% of Taiwan’s population. We selected subjects whose claims records included the diagnosis of upper (UUT) and lower urinary tract (LUT) stone diseases to analyze the medical utilization and costs during the period, 2000-2010. RESULTS There were significantly rising trends in the annual medical visits and costs for stone disease over the 11-year period (r2=0.25; p=0.050 and r2=0.63; p=0.001, respectively). The rate of medical care visits for stone disease increased by 7.5% from 1,513 in 2000 to 1,627 in 2010 per 100,000 subjects. Similarly, the medical cost of stone disease increased by 31.7% from $113.7 million dollars in 2000 to $149.7 million dollars in 2010. UUT stones consists of 97.9% of medical costs for stone disease. There were rising trends in the medical utilization and costs for UUT stone disease during the period by increasing 9.9% in medical care visits/100,000 subjects and by 31.1% increase in medical costs. For LUT stone disease, the declining trend in the medical utilization is not significant; however, the medical costs disease significantly increased by 21.6% during the 11-year period. CONCLUSIONS The present study provides important information on the increasing trends in medical utilization and cost of stone disease in Taiwan. It helps to quantify the burden of urolithiasis and to establish the strategies to reduce the cost of urolithiasis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1078 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Han-Yu Weng More articles by this author Che-Yuan Hu More articles by this author Kuo-How Huang More articles by this author Hong-Chiang Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk of Cerebrovascular Events in Pneumoconiosis Patients: A Population-based Study, 1996-2011.

Pneumoconiosis is a parenchymal lung disease that develops through the inhalation of inorganic dust at work. Cerebrovascular and cardiovascular events are leading causes of mortality and adult disability worldwide. This retrospective cohort study investigated the association between pneumoconiosis, and cerebrovascular and cardiovascular events by using a nationwide population-based database in Taiwan.The data analyzed in this study was retrieved from the Taiwan National Health Insurance Research Database. We selected 6940 patients with pneumoconiosis from the database as our study cohort. Another 27,760 patients without pneumoconiosis were selected and matched with those with pneumoconiosis according to age and sex as the comparison cohort. We used univariate and multivariate Cox proportional-hazard regression analyses to determine the association between pneumoconiosis and the risk of cerebrovascular and cardiovascular events after adjusting for medical comorbidities.After adjustment for age, sex, and comorbidities, the patients with pneumoconiosis exhibited a significantly higher incidence of ischemic stroke (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.05–1.24) than did those without pneumoconiosis. The incidence of hemorrhagic stroke was higher, but not significant, in the pneumoconiosis patients (HR 1.20, 95% CI 0.99–1.46). No statistically significant differences were observed between the pneumoconiosis and nonpneumoconiosis groups in acute coronary syndrome (HR 1.10, 95% CI 0.95–1.26).The findings of this study reveal an association between pneumoconiosis and a higher risk of cerebrovascular events after adjustment for comorbidities. Healthcare providers should control the related risk factors for primary prevention of stroke in pneumoconiosis patients.

A Nationwide Population-Based Cohort Study of Migraine and Organic-Psychogenic Erectile Dysfunction.

As chronic illnesses and chronic pain are related to erectile dysfunction (ED), migraine as a prevalent chronic disorder affecting lots of people all over the world may negatively affect quality of life as well as sexual function. However, a large-scale population-based study of erectile dysfunction and other different comorbidities in patients with migraine is quite limited. This cohort longitudinal study aimed to estimate the association between migraine and ED using a nationwide population-based database in Taiwan.The data used for this cohort study were retrieved from the Longitudinal Health Insurance Database 2000 in Taiwan. We identified 5015 patients with migraine and frequency matched 20,060 controls without migraine from 2000 to 2011. The occurrence of ED was followed up until the end of 2011. We used Cox proportional hazard regression models to analyze the risks of ED.The overall incidence of ED was 1.78-fold greater in the migraine cohort than in the comparison cohort (23.3 vs 10.5 per 10,000 person-years; 95% confidence interval [CI] = 1.31–2.41). Furthermore, patients with migraine were 1.75-fold more likely to develop organic ED (95% CI = 1.27–2.41) than were the comparison cohort. The migraine patients with anxiety had a 3.6-fold higher HR of having been diagnosed with ED than the comparison cohort without anxiety (95% CI, 2.10–6.18).The results support that patients with migraine have a higher incidence of being diagnosed with ED, particularly in the patient with the comorbidity of anxiety.

The association between participation in a pay-for-performance program and macrovascular complications in patients with type 2 diabetes in Taiwan: A nationwide population-based cohort study

ObjectiveDiabetes and diabetes-related complications are major causes of morbidity and mortality worldwide and contribute substantially to health care costs. Proper care can prevent or delay vascular complications in people with type 2 diabetes. We sought to examine whether a diabetes pay-for-performance (P4P) program under Taiwan's National Health Insurance program decreased risk of macrovascular complications in type 2 diabetes patients, and associated risk factors. Research design and methodWe conducted a longitudinal observational case and control cohort study using two nationwide population-based databases in Taiwan, 2007–2012. Type 2 diabetes patients with a primary diabetes diagnosis in year 2007 and 2008 were included. We excluded patients with any diabetes complications within 2years before the index date. A propensity score matching approach was used to determine comparable P4P and non-P4P groups. We followed each P4P and non-P4P patient until December 31, 2012. Complication incidence rates per 1000 person-years for each complication were calculated. ResultsOverall, our results indicated that P4P patients had lower risk of macrovascular complications than non–P4P patients. Specifically, hazard ratios (95% confidence intervals) were 0.84 (0.80–0.88) for stroke, 0.83 (0.75–0.92) for myocardial infarction, 0.72 (0.60–0.85) for atrial fibrillation, 0.93 (0.87–0.98) for heart failure, 0.61 (0.50–0.73) for gangrene, and 0.83 (0.74–0.93) for ulcer of lower limbs. ConclusionsCompared with patients not enrolled in the P4P program, P4P patients had lower risk of developing serious vascular complications. Our empirical findings provide evidence for the potential long-term benefit of P4P programs in reducing risks of macrovascular complications.

Abstract 12348: Different Outcomes by First Documented Rhythm After Witnessed Out-of-Hospital Cardiac Arrest in Children

Background: Preventing the tragedy of pediatric out-of-hospital cardiac arrest (OHCA) is an important public health problem, and further accumulation of evidence is needed to improve the outcomes after pediatric OHCA. However, little evidence is available about the prognostic differences by first documented rhythm. Methods and Results: We enrolled 3968 young (&lt; 18 years old) witnessed OHCA patients between 2005 and 2012 from a prospective nationwide population-based cohort database in Japan. We assessed and compared the neurologically favorable one-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electrical activity [PEA], and asystole). The number of OHCA patients with pVT/VF, PEA, and asystole were 556, 1249, and 2163, respectively. The proportion of overall neurologically favorable one-month survival in patients with pVT/VF, PEA and asystole were 36.5%, 5.0%, and 1.8%, respectively in all study population and 73.8%, 27.7%, and 13.8%, respectively in patients who achieved prehospital ROSC. Figure shows the relationship between time from collapse to first cardiopulmonary resuscitation (CPR) and the endpoint in total population with estimated probabilities of the endpoint (line) and the respective 95% confidence intervals (bands). The proportion of asystole increased as the time from collapse to CPR delayed whereas those of pVT/VF and PEA decreased (Trend p&lt;0.001). Earlier initiation of CPR after pediatric OHCA resulted in higher achievement rate of prehospital ROSC (adjusted odds ratio 0.97, 95% confidence interval 0.95-1.00, p=0.025) which showed much better prognoses than those in total study population. Conclusions: The pediatric OHCA outcome differed by the type first documented rhythm. Shortening of time to first CPR is crucial for improving outcomes after pediatric OHCA.

Unfinished Root Canal Treatments and the Risk of Cardiovascular Disease

IntroductionRoot canal treatments (RCTs) aim to eradicate pulpal diseases and save the infected teeth by eliminating microorganisms from the root canal system. Starting but not finishing an RCT can perpetuate a dead space for bacterial growth, which can spread to other sites in the body and develop systemic symptoms. The objective of the present study was to investigate the association between unfinished RCTs and the risk of cardiovascular disease (CVD) using a nationwide population-based database. MethodsA total of 283,590 participants who received at least 1 RCT and with no cardiovascular history before 2005 were recruited and followed until the end of 2011. An unfinished RCT was defined as a tooth on which an RCT was started but with no completion code. Cox proportional hazards models were used to estimate the effect of unfinished RCTs on the risk of CVD. ResultsA total of 3626 participants underwent CVD hospitalization during an average observation period of 6.01 years, thus yielding an overall CVD hospitalization incidence rate of 0.21% per person year. Compared with the participants with no unfinished RCTs, the adjusted CVD hospitalization hazard ratio for the participants with 1 or 2 unfinished RCTs was 1.22 (95% confidence interval, 1.11–1.35) and for those with 3 or more unfinished RCTs, it was 3.61 (95% confidence interval, 2.36–5.51; test for trend, P < .0001). ConclusionsParticipants with unfinished RCTs were associated with a higher risk of CVD hospitalization.

Dental service use among patients with specific disabilities: A nationwide population-based study.

The Taiwan National Health Insurance program has allocated a specific fund for dental services to patients with specific disabilities (PSDs); however, the trends and the quality are unknown. In this study, we conducted quantity analyses and quality assessments of dental service use among PSDs using a nationwide population-based database. PSDs were identified according to the codes of diagnosis fee. Quantity analyses included the number of patients receiving dental services, the number of visits, and the percentages of categories of dental service use. Quality assessments included refilling rates for operative dental treatments and unfinished rates for endodontic therapies. For quantity analyses, dental services were accessible to 3-4% of patients with disabilities and were mostly provided to younger PSDs. The general population received more operative and endodontic therapies, and PSDs received more periodontal therapies. For quality assessments, the teeth of PSDs had a 9.74-15.07% refilling rate, which was higher than that of the general population (1.39-6.37%). Furthermore, the teeth of PSDs had a 32.03% unfinished endodontic rate, which was higher than that of the general population (21.42%). During 2010-2012, only 3-4% of patients with disabilities had access to dental services, mostly provided to younger PSDs. Teeth of PSDs had higher refilling rates and unfinished endodontic sessions than the general population. We suggest that a more comprehensive dental care system is necessary to improve the quantity and quality of dental services, especially in middle-aged and older PSDs.

The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan.

This study estimated the fracture-related mortality and direct medical costs among postmenopausal women in Taiwan by fracture types and age groups by utilizing a nationwide population-based database. Results demonstrated that hip fractures constituted the most severe and expensive complication of osteoporosis across fracture sites. The aims of the study were to evaluate the risk of death and direct medical costs associated with osteoporotic fractures by fracture types and age groups among postmenopausal women in Taiwan. This nationwide, population-based study was based on data from the National Health Insurance Research Database in Taiwan. Female patients aged 50years and older in the fracture case cohort were matched in 1:1 ratio with randomly selected subjects in the reference control cohort by age, income-related insurance amount, urbanization level, and the Charlson comorbidity index. There were two main outcome measures of the study: age-differentiated mortality and direct medical costs in the first and subsequent years after osteoporotic fracture events among postmenopausal women. The bootstrap method by resampling with replacement was conducted to generate descriptive statistics of mortality and direct medical costs of the case and control cohorts. Student's t tests were then performed to compare mortality and costs between the two cohorts. A total of 155,466 postmenopausal women in the database met the inclusion criteria for the fracture case cohort, including 22,791 hip fractures, 72,292 vertebral fractures, 15,621 upper end humerus (closed) fractures, 36,774 wrist fractures, and 7,988 multiple fractures. Analytical results demonstrated that patients experiencing osteoporotic fractures were at considerable excess risk of death and incurred substantially higher treatment costs, notably for hip fractures. Furthermore, results also revealed that the risk of mortality increased with advancing age across the spectrum of fracture sites. The present study confirmed an excess mortality and higher direct medical costs associated with osteoporotic fractures. Moreover, hip fractures constituted the most severe and expensive complication of osteoporosis among fracture types.

Unplanned Excision of Extremity Soft Tissue Sarcoma in Korea: A Nationwide Study Based on a Claims Registry.

Unplanned excision of extremity soft tissue sarcoma (STS) is common and has detrimental effects not only on patients’ oncologic outcomes but also on functional and economic issues. However, no study has analyzed a nationwide population-based database. To estimate the incidence and treatment pattern of unplanned excision in extremity STS in the Korean population, a nationwide epidemiologic study was performed using the Korean Health Insurance Review and Assessment Service database, a centralized nationwide healthcare claims registry of Korea that covers the entire Korean population. Among 1,517 patients with extremity STS in the 4-year study period, 553 (36.5%) underwent unplanned excision (unplanned group). About 80% of unplanned excisions were performed in tertiary or general hospitals. Of the unplanned group, 240 (43.4%) underwent re-excision with or without radiation therapy and/or chemotherapy, and 51 (9.2%) did not undergo re-excision but were treated with radiation therapy and/or chemotherapy; whereas, 262 (47.4%) did not undergo any further treatment following unplanned excision. This study is the first nationwide population-based study on the unplanned excision of extremity STS. The results may have implications in establishing preventive or therapeutic measures to reduce the burden of unplanned excision of extremity STS.

Cardiovascular comorbidities in patients with rosacea: A nationwide case-control study from Taiwan

Rosacea is a chronic inflammatory skin disease. Inflammation plays a prominent role in atherosclerosis and its complications. We sought to investigate the associations of rosacea with cardiovascular disease risk factors and cardiovascular diseases from a nationwide population-based database. A total of 33,553 patients with rosacea and 67,106 age- and gender-matched control subjects were identified from the National Health Insurance Research Database in Taiwan from 1997 to 2010. Multivariate logistic regressions were performed to compare the odds of comorbidities between the 2 groups. Dyslipidemia (odds ratio 1.41; 95% confidence interval 1.36-1.46), coronary artery disease (odds ratio 1.35, 95% confidence interval 1.29-1.41), and hypertension (odds ratio 1.17, 95% confidence interval 1.12-1.21) were significantly associated with rosacea. Coronary artery disease remained independently associated with rosacea after adjustment for hypertension, diabetes mellitus, and dyslipidemia. Male patients with rosacea had higher risks for all comorbidities than female patients with rosacea. The National Health Insurance Research Database does not contain information regarding rosacea subtypes or disease severity, or laboratory data. Patients with rosacea are more likely to have dyslipidemia and hypertension. They are also at increased risk of coronary artery disease after adjustment for cardiovascular disease risk factors.

Abstract 4: Different Impacts of Time From Collapse to First Cardiopulmonary Resuscitation on Outcomes After Out-of-Hospital Cardiac Arrest in Adults by First Documented Rhythm

Background: It is well-known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it has not been sufficiently investigated about the impact of time to CPR on OHCA outcome by first documented rhythm (pVT, pulseless ventricular tachycardia/VF, ventricular fibrillation; PEA, pulseless electrical activity; and asystole) in a same cohort. Methods: We enrolled 257354 adult (≥ 18 years old) witnessed OHCA patients (median age 77 years old and 60.2% were male sex) between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR by bystanders or emergency-medical-service personnel and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 both in whole population and patients who achieved return of spontaneous circulation (ROSC) by first documented rhythm. We employed logistic models for the estimation of prognoses. Results: During the study period, the number of OHCA patients with pVT/VF, PEA, and asystole were 38661 (15.0%), 96906 (37.7%), and 121787 (47.3%), respectively. Of them, 12551 (32.5%) patients with pVT/VF, 13137 (13.6%) PEA, and 7310 (6.0%) asystole achieved ROSC. Estimated curves with their 95% confidence intervals (bands) of neurologically favorable outcome after OHCA in adults calculated from measured values (dots) were shown in the Figure by time to first CPR and first documented rhythms. Prognoses became worse as first CPR delayed irrespective of type of first documented rhythm, but were totally different by the rhythm both in total population and in patients who achieved ROSC. Conclusions: We revealed that the OHCA outcome exceedingly differed by time to first CPR and first documented rhythm in the prospective nationwide population-based cohort database. Shortening of time to first CPR is crucial for improving the OHCA outcome.

Different Impacts of Time From Collapse to First Cardiopulmonary Resuscitation on Outcomes After Witnessed Out-of-Hospital Cardiac Arrest in Adults.

It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole). We enrolled 257,354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38,661, 96,906, and 121,787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively. The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome.

The association of healthcare seeking behavior for anxiety and depression among patients with lower urinary tract symptoms: A nationwide population-based study

Lower urinary tract symptoms (LUTS) have a negative impact on the quality of life, and may relate to anxiety and depression. The objective of this study was to test the hypothesis that LUTS are associated with anxiety and depression using a nationwide population-based database in Taiwan. Data were obtained from a random population sample of about one million enrollees in the National Health Insurance program from 2001 to 2009, and consisted of 22,980 LUTS patients and 45,960 matched controls. The records of healthcare seeking for anxiety and depression were collected 2 years before and after the diagnosis of LUTS. The results showed that patients with LUTS had a significantly higher prevalence of anxiety or depression than the matched controls (11.45% vs. 5.72%). After controlling for sociodemographic variables and other major systemic diseases, the odds ratios for anxiety, depression, either anxiety or depression, and both anxiety and depression, were 2.05, 2.19, 2.14, and 2.56, respectively. There was an association between LUTS and the stress-related common mental disorders, and there seemed to be an additive effect of anxiety and depression on the association with LUTS. These findings imply a psychological role in the pathogenesis or sequelae of LUTS.

Substance use patterns associated with adult ADHD in SUD treatment-seeking patients: Results from the aquitaine addiction cohort study

To verify the hypothesis that there is different gender ratio of attention-deficit/hyperactivity disorder (ADHD) among adults compared to children and adolescents in the clinical setting among Asian population. The nationwide population-based database containing data on enrollees in the National Health Insurance program in Taiwan during 2000–2007 was used in this study, and we investigated the lifetime gender ratios of administrative prevalence and incidence in healthcare-seeking ADHD patients (n=228,029). The male-to-female ratios of diagnosed incidence and prevalence of child/adolescent ADHD (age <20 years) ranged from 3.39 to 4.07 and 3.87–4.31, respectively. The male-to-female ratios of diagnosed incidence and prevalence of ADHD in the adult group (age 20–65 years) ranged from 0.24 to 0.76 and 0.35–0.98, respectively. In conclusion, there was substantially increased female-to-male ratio in adults ADHD compared to children and adolescents in the clinical setting. Further researches on the management and mechanism are needed.

The association between chronic obstructive pulmonary disease and dementia: a population-based retrospective cohort study.

Chronic obstructive pulmonary disease (COPD) is frequently associated with various comorbidities. However, the proportion of COPD patients with dementia has not been adequately examined. This retrospective cohort study investigated the association between COPD and dementia by using a nationwide population-based database in Taiwan. Data were retrieved from the Taiwanese National Health Insurance Research Database and analyzed using multivariate Cox proportional hazards regression models to assess the effects of COPD on the risk of dementia after adjusting for demographic characteristics and comorbidities. The COPD cohort exhibited a higher prevalence of diabetes, hypertension, coronary artery disease, head injury and depression at baseline than did the non-COPD cohort (P < 0.0001). After adjusting for covariates, the COPD patients exhibited a 1.27-fold higher risk of developing dementia (hazard ratio 1.27, 95% confidence interval 1.20-1.36). The incidence rate was higher in patients with frequent acute exacerbations than in the non-COPD patients regardless of whether a hospital admission or emergency room visit was required (hazard ratio 196.8 vs. 41.7, 95% confidence intervals 145.9-265.5 and 22.3-78.0). This study shows that COPD is associated with a subsequent higher risk of dementia after adjusting for comorbidities. Specifically, the association between COPD and dementia is greater in patients with more frequent acute exacerbation events of COPD.

The Effect of Rubber Dam Usage on the Survival Rate of Teeth Receiving Initial Root Canal Treatment: A Nationwide Population-based Study

IntroductionIt is well-known that the usage of rubber dams during root canal treatment (RCT) improves infection control and treatment efficacy and protects patients. However, the effect of rubber dam usage on endodontic outcomes remain uncertain. The aim of the present study was to investigate whether rubber dam usage affects the survival rate of initial RCT using a nationwide population-based database. MethodsA total of 517,234 teeth that received initial RCT between 2005 and 2011 met the inclusion criteria and were followed until the end of 2011. Univariate and multivariate Cox proportional hazards models were used to estimate the effects of rubber dam usage on the risk of tooth extraction after initial RCT. ResultsOf the 517,234 teeth, 29,219 were extracted, yielding a survival rate of 94.4%. The survival probability of initial RCT using rubber dams after 3.43 years (the mean observed time) was 90.3%, which was significantly greater than the 88.8% observed without the use of rubber dams (P < .0001). After adjusting for age, sex, tooth type, hospital level, tooth scaling frequency per year after RCT, and systemic diseases, including diabetes and hypertension, the tooth extraction hazard ratio for the RCT with rubber dams was significantly lower than that observed for RCT without rubber dams (hazard ratio = 0.81; 95% confidence interval, 0.79-0.84). ConclusionsThe use of a rubber dam during RCT could provide a significantly higher survival rate after initial RCT. This result supports that rubber dam usage improves the outcomes of endodontic treatments.

Association between migraine and irritable bowel syndrome: a population-based retrospective cohort study.

Migraine and irritable bowel syndrome (IBS) share many similarities characterized by their epidemiology, periodic pain, lack of definable organic causes, trigger factors, comorbidities and proposed pathophysiology. In this retrospective case-control study, the association between migraine and IBS was investigated using a nationwide population-based database in Taiwan. The data were retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. In all, 14 117 newly diagnosed migraine cases were identified in a subset of the NHIRD and 56 468 migraine-free individuals were randomly selected as the comparison cohort. The multivariate Cox proportional hazards regression model was used to explore the risk of IBS in migraine sufferers after adjusting for demographic characteristics and comorbidities. After adjusting for the covariates, the incidence of IBS was 1.95-fold higher in the migraine cohort than in the comparison cohort (73.87 vs. 30.14 per 10 000 person-years). The adjusted cumulative incidence of IBS was also higher in the migraine group than in the control group in the follow-up years (log-rank test, P < 0.0001). In addition, the risk was most prominent in the youngest group (<30 years old), exhibiting a 3.36-fold increased risk (95% confidence interval 2.44-4.63) of IBS compared with the migraine-free cohort. Moreover, the incidence of IBS in migraine sufferers tended to increase with the frequency of migraine diagnoses. The current population-based study demonstrated that migraine is associated with an increased risk of IBS after adjusting for comorbidities, particularly in the young population.

High Incidence of Ischemic Stroke Occurrence in Irradiated Lung Cancer Patients: A Population-Based Surgical Cohort Study

Background and PurposeA high risk of stroke occurrence has been reported in several types of irradiated cancer patients. However, clinical data are lacking in irradiated lung cancer patients. The present study intended to explore a risk level of ischemic stroke occurrence in irradiated lung cancer patients.MethodsA nationwide population-based database obtained from the Taiwan National Health Insurance was analyzed. Between 2003 and 2006, we recruited 560 resected lung cancer patients into two study groups: surgery-plus-irradiation (n = 112) and surgery-alone (n = 448). Patients treated with chemotherapy were excluded. Propensity score match was used for pairing cases with a ratio of 1∶4. Two-year ischemic-stroke-free survival was defined as the primary endpoint.ResultsThree observations supported a high risk of ischemic stroke occurrence in patients with postoperative irradiation when compared with those patients with surgery alone: first, a high incidence per 1,000 person-year (22.3 versus 11.2, 1.99 folds); second, a low two-year ischemic-stroke-free survival rate (92.2% versus 98.1%, P = 0.019); and third, a high adjusted hazard ratio (HR, 4.19; 95% CI, 1.44–12.22; P = 0.009). More notably, the highest risk of ischemic stroke occurrence was found in irradiated patients who had diabetes mellitus (HR, 34.74; 95% CI, 6.35->100; P<0.0001).ConclusionsA high incidence of ischemic stroke was observed in irradiated lung cancer patients, especially in those with diabetes mellitus. For these patients, close clinical surveillance and strict diabetes control should be considered. Further studies to define detail biological mechanisms are encouraged.