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Diagnosis and treatment for hyperuricemia and gout: a systematic review of clinical practice guidelines and consensus statements

Por: Li · Q. · Li · X. · Wang · J. · Liu · H. · Kwong · J. S.-W. · Chen · H. · Li · L. · Chung · S.-C. · Shah · A. · Chen · Y. · An · Z. · Sun · X. · Hemingway · H. · Tian · H. · Li · S.
Objectives

Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia.

Design

Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology.

Data sources

PubMed and EMBASE (27 October 2016), two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017).

Eligibility criteria

We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese.

Data extraction and synthesis

Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.

Results

Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4%, range 66.7%–100.0%) and clarity of presentation (median 79.2%, range 48.6%–98.6%), but unsatisfactory in applicability (median 10.9%, range 0.0%–66.7%) and editorial independence (median 28.1%, range 0.0%–83.3%). The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long-term control, on some indications for urate-lowering therapy (ULT), and on the first-line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia.

Conclusions

Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high-quality clinical evidence are potential approaches to reduce recommendation inconsistencies.

PROSPERO registration number

CRD42016046104.

Effectiveness of a musical training programme in promoting happiness and quality of life of underprivileged preschool children

Abstract

Aims and objectives

To test the effectiveness of a musical training programme in promoting happiness and quality of life of Hong Kong Chinese underprivileged preschool children.

Background

The impact of poverty and income disparity on the psychological well‐being of children remains a profound global public health concern. There is substantial evidence that poverty and income disparity have many negative impacts on children's psychological well‐being, adversely affecting their quality of life.

Methods

A nonequivalent, quasi‐experimental, two‐group, pretest and post‐test, between‐subjects design was conducted with 171 Hong Kong Chinese underprivileged preschool children (aged 3–6 years). Participants (n = 100) in the experimental group attended a weekly 1‐hr musical training lesson for 12 weeks conducted by the Music Children Foundation. Participants (n = 71) in the wait list control group received the same training after all data had been collected. Data collection for both groups was conducted at baseline and 12‐week follow‐up. The measured outcomes were happiness level and quality of life. A TREND checklist was completed.

Results

Participants in the experimental group reported significantly higher levels of happiness (p = .002) and quality of life (p = .44) than those in the wait list control group.

Conclusions

The present study indicates the effectiveness of a musical training programme in promoting happiness and quality of life of Hong Kong Chinese underprivileged preschool children. It also demonstrated the feasibility of implementing the programme in a community context.

Relevance to clinical practice

This study aids to inform nurses the beneficial effect of the musical training programme in improving underprivileged children's psychological well‐being and quality of life. Indeed, community nurses may act as facilitators to promote the musical training programme to underprivileged children. The involvement of community nurses may greatly enhance the sustainability of the programme, thus making it to be a routine health promotion activity.

The influence of welfare state factors on nursing professionalization and nursing human resources: A time‐series cross‐sectional analysis, 2000–2015

Abstract

Aim

The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators.

Design

We used a time‐series, cross‐sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian.

Methods

We used fixed‐effects linear regression models and conducted Prais‐Winsten regressions with panel‐corrected standard errors, including a first‐order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March–December 2017 and subsequently updated from August–September 2018.

Results

Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes.

Conclusion

Additional country‐level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization.

Impact

We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools.

Association of genetic polymorphisms of CYP2E1, NAT2, GST and SLCO1B1 with the risk of anti-tuberculosis drug-induced liver injury: a systematic review and meta-analysis

Por: Yang · S. · Hwang · S. J. · Park · J. Y. · Chung · E. K. · Lee · J. I.
Objectives

The objective of this study was to investigate the association between genetic polymorphisms of N-acetyltransferase 2 (NAT2), cytochrome P450 2E1 (CYP2E1), glutathione S-transferase (GST) and solute carrier organic anion transporter family member 1B1 (SLCO1B1) and the risk of anti-tuberculosis drug-induced liver injury (ATDILI).

Design

Systematic review and meta-analysis.

Data sources

PubMed, Embase, Web of Science and Cochrane Reviews databases were searched through April 2019.

Eligibility criteria

We included case-control or cohort studies investigating an association between NAT2, CYP2E1, GST or SLCO1B1 polymorphisms and the ATDILI risk in patients with tuberculosis.

Data extraction and synthesis

Three authors screened articles, extracted data and assessed study quality. The strength of association was evaluated for each gene using the pooled OR with a 95% CI based on the fixed-effects or random-effects model. Sensitivity analysis was performed to confirm the reliability and robustness of the results.

Results

Fifty-four studies were included in this analysis (n=26 for CYP2E1, n=35 for NAT2, n=19 for GST, n=4 for SLCO1B1). The risk of ATDILI was significantly increased with the following genotypes: CYP2E1 RsaI/PstI c1/c1 (OR=1.39, 95% CI 1.06 to 1.83), NAT2 slow acetylator (OR=3.30, 95% CI 2.65 to 4.11) and GSTM1 null (OR=1.30, 95% CI 1.12 to 1.52). No significant association with ATDILI was found for the genetic polymorphisms of CYP2E1 DraI, GSTT1, GSTM1/GSTT1, SLCO1B1 388A>G and SLCO1B1 521T>C (p>0.05).

Conclusions

ATDILI is more likely to occur in patients with NAT2 slow acetylator genotype, CYP2E1 RsaI/PstI c1/c1 genotype and GSTM1 null genotype. Close monitoring may be warranted for patients with these genotypes.

Screening Of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA): rationale and design of a multicentre, cross-sectional study

Por: Cheng · Y. · Tung · C.-K. · Chung · A. K. K. · Liu · W.-W. · Huang · D. · Chan · P. H. · Lam · M. · Chan · W.-C. · Siu · C.-W. · Hai · J. J.
Introduction

Methamphetamine misuse is classified as a ‘likely’ risk factor for pulmonary arterial hypertension (PAH). Nevertheless, the actual prevalence of and a screening strategy for PAH in methamphetamine users have not been established. We plan to study the prevalence of PAH and identify its independent risk factors among methamphetamine users.

Methods and analysis

The Screening Of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA) study will be a multicentre, cross-sectional screening study that will involve substance abuse clinics, hospitals and rehabilitation facilities in Hong Kong that cater to more than 20 methamphetamine users. A total of 400 patients who (1) are ≥18 years at enrolment; (2) report methamphetamine use in the last 2 years; (3) are diagnosed with methamphetamine use disorder; and (4) voluntarily agree to participate by providing written informed consent will be included. Patients will undergo standard echocardiography-based PAH screening procedures recommended for those with systemic sclerosis. Right heart catheterisation will be offered to participants with intermediate or high echocardiographic probability of PAH. For participants with a low echocardiographic probability of PAH, rescreening will be performed within 1 year. The primary measure will be the prevalence of PAH in methamphetamine users. The secondary measures will be the risk factors and a prediction model for PAH in methamphetamine users.

Ethics and dissemination

The SOPHMA study has been approved by the institutional review board. The findings of this study will provide the necessary evidence to establish universal guidelines for screening of PAH in methamphetamine users. Our results will be disseminated through immediate feedback to study participants, press release to the general public, as well as presentation in medical conferences and publications in peer-reviewed journals to healthcare providers and academia worldwide.

Determinants of nurses’ willingness to receive vaccines: Application of the health belief model

Abstract

Aims and objectives

To assess the willingness of nurses to receive vaccines as recommended by Taiwan's “Immunization Recommendations for Healthcare Personnel” (IRHCP), as well as the factors associated with their willingness.

Background

Immunisation for healthcare personnel (HCP) is a means of reducing pathogen transmission. Also, vaccinating HCP reduces personnel and labour costs during an epidemic.

Methods

A cross‐sectional study was conducted. A self‐administered questionnaire survey targeting nurses working in various service units at three hospitals was used. In total, 413 nurses completed the questionnaire. The main outcome measure was the willingness to receive vaccines recommended by the IRHCP, and the variables we assessed included knowledge regarding the IRHCP, individual perceptions (perceived risk of contracting the infection, perceived severity of the infection and perceived transmissibility after disease onset), perceived benefits and barriers to the vaccination, cues to the vaccination and demographics. This study followed the STROBE checklist for reporting this study.

Results

The willingness of nurses to receive vaccines recommended by the IRHCP was high; the highest level of willingness was for the hepatitis B vaccine. The nurses’ willingness to receive various vaccines recommended by the IRHCP was predicted by the knowledge regarding the IRHCP and perceived transmissibility after disease onset. Except the diphtheria–tetanus–acellular pertussis vaccine, perceived benefits and perceived barriers were also predictors of the willingness to receive vaccines.

Conclusions

Our results showed that interventions focusing on increasing the knowledge regarding the IRHCP and perceived transmissibility after disease onset, emphasising the benefits of the vaccination and reducing the perceived barriers to the vaccination are needed to increase nurses’ willingness to receive vaccines.

Relevance to clinical practice

It is suggested using health education courses and mass media broadcasts at the individual and societal levels to raise awareness regarding the benefits of vaccines and enhance nurse’ confidence in vaccination programs.

The symptoms, resourcefulness and quality of life in community‐based patients with schizophrenia

Abstract

Aims and objectives

To test Zauszniewski's resourcefulness and quality of life theory in community‐based patients with schizophrenia. The objectives were to: (a) examine the relationship among psychotic symptoms, resourcefulness and quality of life, and (b) explore the determinants of quality of life.

Background

According to Zauszniewski's resourcefulness and quality of life theory, for patients, the skills constituting resourcefulness should centre on helping oneself or the use of resources to achieve their health. While the significant associations between resourcefulness and quality of life have been consistently delineated in published research, little is known about resourcefulness in patients with schizophrenia.

Design

A cross‐sectional study design was used in this study.

Methods

A total of 120 patients were recruited with convenience sampling who received home care service and community rehabilitation programme. The participants were assessed with the Brief Psychiatric Rating Scale, the Resourcefulness Scale and the World Health Organization Quality of Life ScaleBREF. The psychotic symptoms were rated by the researchers with structured face‐to‐face interviews. Resourcefulness and quality of life were assessed through self‐reporting. STROBE checklist was followed.

Results

The data were analysed using one‐way analysis of variance, t test, Pearson's correlation coefficients and stepwise multiple regression analysis. Results showed that employment status and psychotic symptoms were correlated with resourcefulness, while employment status, psychotic symptoms and resourcefulness were correlated with quality of life. Resourcefulness and psychotic symptoms were the determinants of quality of life.

Conclusion

Patients with employment and less psychotic symptoms had greater resourcefulness. In addition, patients with employment, less psychotic symptoms and greater resourcefulness had better quality of life.

Relevance to clinical practice

Community rehabilitation programmes should include supported employment, symptom management and resourcefulness skills training to enhance patients' resourcefulness and quality of life.

Predicting cochlear dead regions in patients with hearing loss through a machine learning-based approach: A preliminary study

by Young-Soo Chang, Heesung Park, Sung Hwa Hong, Won-Ho Chung, Yang-Sun Cho, Il Joon Moon

We propose a machine learning (ML)-based model for predicting cochlear dead regions (DRs) in patients with hearing loss of various etiologies. Five hundred and fifty-five ears from 380 patients (3,770 test samples) diagnosed with sensorineural hearing loss (SNHL) were analyzed. A threshold-equalizing noise (TEN) test was applied to detect the presence of DRs. Data were collected on sex, age, side of the affected ear, hearing loss etiology, word recognition scores (WRS), and pure-tone thresholds at each frequency. According to the cause of hearing loss as diagnosed by the physician, we categorized the patients into six groups: 1) SNHL with unknown etiology; 2) sudden sensorineural hearing loss (SSNHL); 3) vestibular schwannoma (VS); 4) Meniere's disease (MD); 5) noise-induced hearing loss (NIHL); or 6) presbycusis or age-related hearing loss (ARHL). To develop a predictive model, we performed recursive partitioning and regression for classification, logistic regression, and random forest. The overall prevalence of one or more DRs in test ears was 20.36% (113 ears). Among the 3,770 test samples, the overall frequency-specific prevalence of DR was 6.7%. WRS, pure-tone thresholds at each frequency, disease type (VS or MD), and frequency information were useful for predicting DRs. Sex and age were not associated with detecting DRs. Based on these results, we suggest possible predictive factors for determining the presence of DRs. To improve the predictive power of the model, a more flexible model or more clinical features, such as the duration of hearing loss or risk factors for developing DRs, may be needed.

Lactate normalization within 6 hours of bundle therapy and 24 hours of delayed achievement were associated with 28-day mortality in septic shock patients

by Seung Mok Ryoo, Ryeok Ahn, Tae Gun Shin, You Hwan Jo, Sung Phil Chung, Jin Ho Beom, Sung-Hyuk Choi, Young -Hoon Yoon, Byuk Sung Ko, Hui Jai Lee, Gil Joon Suh, Won Young Kim, for the Korean Shock Society (KoSS) Investigators

This study evaluated the prognostic ability of lactate normalization achieved within 6 and 24 h from septic shock recognition. Data from a septic shock registry from October 2015 to February 2017 were reviewed. The study included 2,102 eligible septic shock patients to analyze the prognostic ability of lactate normalization, defined as a follow-up lactate level

Harambee!: A pilot mixed methods study of integrated residential HIV testing among African-born individuals in the Seattle area

by D Allen Roberts, Roxanne Kerani, Solomon Tsegaselassie, Seifu Abera, Ashley Lynes, Emily Scott, Karen Chung, Ermias Yohannes, Guiomar Basualdo, Joanne D. Stekler, Ruanne Barnabas, Jocelyn James, Shelley Cooper-Ashford, Rena Patel

Background

African-born individuals in the U.S. are disproportionately affected by HIV yet have low HIV testing rates. We conducted a mixed methods study to assess the uptake and feasibility of a novel strategy for integrating HIV testing into residential health fairs among African-born individuals in Seattle, WA.

Methods

From April to May 2018, we held six health fairs at three apartment complexes with high numbers of African-born residents. Fairs included free point-of-care screening for glucose, cholesterol, body mass index, blood pressure, and HIV, as well as social services and health education. The health fairs were hosted in apartment complex common areas with HIV testing conducted in private rooms. Health fair participants completed a series of questionnaires to evaluate demographics, access to health services, and HIV testing history. We conducted 18 key informant interviews (KIIs) with health fair participants and community leaders to identify barriers to HIV testing among African-born individuals.

Results

Of the 111 adults who accessed at least one service at a health fair, 92 completed questionnaires. Fifty-five (61%) were female, 48 (52%) were born in Africa, and 55 (63%) had health insurance. Half of African-born participants accepted HIV testing; all tested negative. The most common reasons for declining testing were lack of perceived risk for HIV and knowledge of HIV status. We identified a high prevalence of non-communicable diseases (NCDs) among health fair participants; among those tested, 77% (55/71) were overweight/obese, 39% (31/79) had blood pressure > 140/90 mmHg, and 30% (22/73) had total cholesterol > 200 mg/dL. KIIs identified community stigma and misinformation as major barriers to HIV testing among African-born individuals.

Conclusions

Residential health fairs are a feasible method to increase HIV testing among African-born individuals in Seattle. The high prevalence of NCDs highlights the importance of integrating general preventive services within HIV testing programs in this population.

Development and external validation of new nomograms by adding ECG changes (ST depression or tall T wave) and age to conventional scoring systems to improve the predictive capacity in patients with subarachnoid haemorrhage: a retrospective, observational

Por: Hong · J. y. · You · J. S. · Kim · M. J. · Lee · H. S. · Park · Y. S. · Chung · S. P. · Park · I.
Objectives

To develop new nomograms by adding ECG changes (ST depression or tall T wave) and age to three conventional scoring systems, namely, World Federation of Neurosurgical Societies (WFNS) scale, Hunt and Hess (HH) system and Fisher scale, that can predict prognosis in patients with subarachnoid haemorrhage (SAH) using our preliminary research results and to perform external validation of the three new nomograms.

Design

Retrospective, observational study

Setting

Emergency departments (ED) of two university-affiliated tertiary hospital between January 2009 and March 2015.

Participants

Adult patients with SAH were enrolled. Exclusion criteria were age

Primary outcome measures

The 6 month prognosis was assessed using the Glasgow Outcome Scale (GOS). We defined a poor outcome as a GOS score of 1, 2 or 3.

Results

A total of 202 patients were included for analysis. From the preliminary study, age, ECG changes (ST depression or tall T wave), and three conventional scoring systems were selected to predict prognosis in patients with SAH using multi-variable logistic regression. We developed simplified nomograms using these variables. Discrimination of the developed nomograms including WFNS scale, HH system and Fisher scale was superior to those of WFNS scale, HH system and Fisher scale (0.912 vs 0.813; p

Conclusions

We developed and externally validated new nomograms using only three independent variables. Our new nomograms were superior to the WFNS scale, HH systems, and Fisher scale in predicting prognosis and are readily available.

Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögrens syndrome: nationwide population-based cohort study

Por: Liao · M.-T. · Chien · W.-C. · Wang · J.-C. · Chung · C.-H. · Chu · S.-J. · Tsai · S.-H.
Objective

The aim of this study was to explore whether patients with Sjögren’s syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan.

Design

A nationwide population-based retrospective cohort study.

Setting

Data were extracted from Taiwan’s National Health Insurance Research Database (NHIRD).

Methodology

Medical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression.

Results

Overall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test

Conclusion

Patients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.

Effects of preferred music therapy on peer attachment, depression, and salivary cortisol among early adolescents in Taiwan 首选音乐疗法对台湾早期青少年同伴依恋、抑郁和唾液皮质醇的影响

Abstract

Aims

To explore the effects of preferred music therapy on peer attachment, depression, and salivary cortisol among early adolescents.

Background

As adolescents enter puberty, they start to seek partnering relationships among peers. Peer attachment is central for adolescents and greatly influences their physical and psychological development.

Design

A pre‐test‐posttest control group design.

Methods

The data were collected from July ‐ October 2016. A total of 65 individuals were included. The treatment group received 40 min of music therapy twice per week over the course of 10 weeks. The control group maintained its typical routine. The research data were collected using structured questionnaires, including basic information, the Inventory of Peer Attachment, the Beck Depression Inventory‐II questionnaires, and salivary cortisol concentrations. Statistical analysis methods included percentages, chi‐square tests, t tests, analyses of covariance, and the Johnson–Neyman technique.

Results

There were statistically significant differences in peer attachment, depression, and salivary cortisol levels in the music group compared to the control group (< 0.05). Additionally, the findings showed that early adolescents with more severe depression experienced greater improvement through preferred music therapy.

Conclusion

The results allude to the beneficial effects of receiving preferred music therapy in terms of the peer attachment, depression, and salivary cortisol levels of early adolescents. Adjustments should be made based on the characteristics of student groups to develop suitable and safe music therapy and to reduce the risks of poor mental health.

目的

探讨首选音乐疗法对早期青少年同伴依恋、抑郁和唾液皮质醇的影响。

背景

随着青少年进入青春期,他们开始寻求同伴之间的伙伴关系。同伴依恋是青少年的中心,对他们的身心发展影响很大。

设计

试验前‐试验后控制组设计。

方法

数据收集自2016年7月至10月。共有65人参加。治疗组在10周内每周接受两次40分钟的音乐治疗。对照组保持其典型的常规。研究数据采用结构化问卷收集,包括基本信息、同伴依恋量表、Beck抑郁量表II问卷和唾液皮质醇浓度。统计分析方法包括百分比、卡方检验、t检验、协方差分析和Johnson‐Neyman技术。

结果

音乐组的同伴依恋、抑郁和唾液皮质醇水平与对照组相比有统计学意义(P<0.05)。此外,研究结果表明,抑郁更严重的早期青少年通过首选的音乐治疗经历了更大的改善。

结论

研究结果表明,在早期青少年的同伴依恋、抑郁和唾液皮质醇水平方面,接受首选音乐治疗的会产生有益效果。应根据学生群体的特点进行调整,以发展合适、安全的音乐治疗,降低心理健康不良的风险。

Variants in FAT1 and COL9A1 genes in male population with or without substance use to assess the risk factors for oral malignancy

by Chia-Min Chung, Chung-Chieh Hung, Chien-Hung Lee, Chi-Pin Lee, Ka-Wo Lee, Mu-Kuan Chen, Kun-Tu Yeh, Ying-Chin Ko

A number of genetic variants were suggested to be associated with oral malignancy, few variants can be replicated. The aim of this study was to identify significant variants that enhanced personal risk prediction for oral malignancy. A total of 360 patients diagnosed with oral squamous cell carcinoma, 486 controls and 17 newly diagnosed patients with OPMD including leukoplakia or oral submucous fibrosis were recruited. Fifteen tagSNPs which were derived from somatic mutations were genotyped and examined in associations with the occurrence of oral malignancy. Environmental variables along with the SNPs data were used to developed risk predictive models for oral malignancy occurrence. The stepwise model analysis was conducted to fit the best model in an economically efficient way. Two tagSNPs, rs28647489 in FAT1 gene and rs550675 in COL9A1 gene, were significantly associated with the risk of oral malignancy. The sensitivity and specificity were 85.7% and 85.5%, respectively (area under the receiver operating characteristic curve (AUC) was 0.91) for predicting oral squamous cell carcinoma occurrence with the combined genetic variants, betel-quid, alcohol and age. The AUC for OPMD was only 0.69. The predictive probability of squamous cell carcinoma occurrence for genetic risk score without substance use increased from 10% up to 43%; with substance use increased from 73% up to 92%. Genetic variants with or without substance use may enhance risk prediction for oral malignancy occurrence in male population. The prediction model may be useful as a clinical index for oral malignancy occurrence and its risk assessments.

Association between spinal curvature disorders and injury: a nationwide population-based retrospective cohort study

Por: Kuo · Y.-L. · Chung · C.-H. · Huang · T.-W. · Tsao · C.-H. · Chang · S.-Y. · Peng · C.-K. · Cheng · W.-E. · Chien · W.-C. · Shen · C.-H.
Objectives

Injury is an important issue in public health. Spinal curvature disorders are deformities characterised by excessive curves of the spine. The prevalence of spinal curvature disorders is not low, but its relationship with injury has not been studied. The aim of this study is to investigate whether spinal curvature disorders increase the risk of injury.

Design

Population-based retrospective cohort study.

Setting

Using data from the Taiwan National Health Insurance Research Database from 2000 to 2010.

Participants and exposure

Patients with spinal curvature disorders were selected using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. A cohort without spinal curvature was randomly frequency-matched to the spinal curvature disorders cohort at a ratio of 2:1 according to age, sex and index year.

Primary outcome measures

The risk of injury was analysed using Cox’s proportional hazards regression models adjusting for age, sex, comorbidities, urbanisation level and socioeconomic status.

Results

A total of 20 566 patients with spinal curvature disorders and 41 132 controls were enrolled in this study. The risk of injury was 2.209 times higher (95% CI 2.118 to 2.303) in patients with spinal curvature disorders than in the control group. The spinal curvature disorders cohort exhibited higher risk of developing injury compared with the control group, regardless of age, sex, comorbidities, urbanisation level and subgroup of spinal curvature disorders. Based on the subgroup analysis, the spinal curvature disorders cohort had higher risks of unintentional injury and injury diagnoses such as fracture, dislocation, open wound, superficial injury/contusion, crushing and injury to nerves and spinal cord compared with the control cohort.

Conclusions

Patients with spinal curvature disorders have a significantly higher risk of developing injury than patients without spinal curvature disorders. Aggressive detection and management of spinal curvature disorders may be beneficial for injury prevention.

Increased risk of rheumatoid arthritis among patients with Mycoplasma pneumonia: A nationwide population-based cohort study in Taiwan

by Kuo-An Chu, Weishan Chen, Chung Y. Hsu, Yao-Min Hung, James Cheng-Chung Wei

Objective

An association between Mycoplasma pneumonia (MP) and rheumatoid arthritis (RA) had been reported in animal studies for decades. However, clinical evidence for this association is lacking. Therefore, this study aimed to provide epidemiologic evidence to clarify the relationship between MP and development of RA.

Methods

This 13-year nationwide, population-based, retrospective cohort study analyzed the risk of RA in a cohort of MP patients. We cross linked and compared the database of those with catastrophic illnesses to make sure the diagnoses of RA are correctly labeled. We selected 116,053 hospitalized patients diagnosed with MP between 2000 and 2012 from the Taiwan National Health Insurance Research Database and 464,212 matched controls at a 1:4 ratio by age, gender, and index year, in relation to the risk of developing RA. The follow-up period referred to the initial diagnosis of MP until the date of RA diagnosis, censoring of RA, or 31st December 2013. The Cox proportional hazard model was used to analyze the association between MP and incidence of RA among patients with different potential risks.

Results

The adjusted hazard ratio (HR) for incidental RA in the MP group was 1.37 (95% confidence interval CI = 0.87–2.16), compared to non-MP controls. Stratified analysis revealed that the adjusted HR was 3.05 (95% CI = 1.16–7.99, p = 0.02) in a subgroup of patients over the age of 65.The adjusted HR of RA for the MP group among aged ≦19 years and ≥ 65 years was 3.19 (95% CI = 1.04.9.76) and 4.14 (95% CI = 1.27,13.4) within the first 2 years of follow-up.

Conclusion

This cohort study demonstrated that patients with MP had a higher risk of developing RA, especially in the first 2 years, in those aged younger than 19 and over 65.

Psychiatric Disorders After Attention‐Deficit/Hyperactivity Disorder: A Nationwide Population‐Based Study in Taiwan

Abstract

Purpose

To investigate the risk for psychiatric disorders in patients newly diagnosed with attention deficit hyperactive disorder (ADHD) from two longitudinal groups of children with and without ADHD.

Study Design

In total, 1,745 children newly diagnosed with ADHD and 6,980 participants without ADHD were identified from Taiwan's National Health Insurance Research Database in 2005 and followed until 2010. Risks for psychiatric disorders in the ADHD and non‐ADHD groups were compared.

Results

The ADHD group was 3.82 times more likely to develop psychiatric disorders than their counterparts. The ADHD group showed the highest risk for oppositional defiant disorder, followed by adult ADHD and autism spectrum disorder. Moreover, the time effects of psychiatric disorders in the ADHD group were significant. Patients with ADHD subtypes had a significant risk for psychiatric disorders compared to their counterparts.

Conclusions

A high risk for psychiatric disorders was revealed in this study among children with ADHD. Childhood ADHD, the duration after the ADHD diagnosis, and the ADHD subtype were associated with psychiatric disorders.

Clinical Relevance

Various psychiatric disorders were observed in children after they had been newly diagnosed with ADHD, indicating a need for integrated care that includes medical practitioners, family members, social workers, and early intervention workers for patients newly diagnosed with ADHD to decrease the risk for comprehensive psychiatric disorders.

Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan

Por: Hsieh · C.-I. · Kuo · R. N.-C. · Liang · C.-C. · Tsai · H.-Y. · Chung · K.-P.
Objectives

One feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes.

Setting

Data from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009.

Participants and methods

Postoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts.

Results

We examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not.

Conclusions

The discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.

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