Publications by authors named "Tzeng-Ji Chen"

496 Publications

Does COVID-19 vaccination cause excess deaths?

J Chin Med Assoc 2021 Sep;84(9):811-812

Department of Family Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.

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http://dx.doi.org/10.1097/JCMA.0000000000000580DOI Listing
September 2021

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan.

Int J Environ Res Public Health 2021 Aug 28;18(17). Epub 2021 Aug 28.

Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments.
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http://dx.doi.org/10.3390/ijerph18179097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431456PMC
August 2021

Association between Dental Scaling and Reduced Risk of End-Stage Renal Disease: A Nationwide Matched Cohort Study.

Int J Environ Res Public Health 2021 Aug 24;18(17). Epub 2021 Aug 24.

Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.

Periodontitis is prevalent in patients with chronic kidney disease (CKD) and is also associated with kidney function decline. It is unclear whether dental scaling treatment prevents the progression of CKD. In a nationwide cohort study, Taiwan's National Health Insurance Research Database was used to select people with CKD. Propensity score-matching procedures were performed to compare the long-term risk of end-stage renal disease (ESRD) between CKD patients with and without the receipt of dental scaling. A total of 33,637 matched pairs with CKD were included, with 503,373 person-years of follow-up for analyses. Dental scaling was significantly associated with a lower risk of ESRD (adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.77-0.90). In addition, there was a dose-dependent relationship between the frequency of dental scaling and a reduced risk of ESRD. Dental scaling was also linked to reduced risks of major adverse cardiovascular events (aHR: 0.91, 95% CI: 0.87-0.95), sepsis (aHR: 0.81, 95% CI: 0.77-0.85), and all-cause mortality (aHR: 0.81, 95% CI: 0.76-0.87). Dental scaling was significantly associated with lower risks of progression to ESRD in patients with CKD. Regular dental scaling may serve as a prophylactic measure for kidney function decline.
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http://dx.doi.org/10.3390/ijerph18178910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430582PMC
August 2021

Is Obesity a Risk or Protective Factor for Open-Angle Glaucoma in Adults? A Two-Database, Asian, Matched-Cohort Study.

J Clin Med 2021 Sep 6;10(17). Epub 2021 Sep 6.

Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 33305, Taiwan.

Obesity contributes to multiple systemic disorders; however, extensive discussion regarding obesity and open-angle glaucoma (OAG) remains limited, and conclusions in the existing literature diverge. This study aims to analyze the risk of OAG among obese adults in Taiwan. In this study, adults (aged ≥18 years) with a diagnostic code of obesity or morbid obesity registered in the Longitudinal Health Insurance Database (LHID) 2000 and LHID2005 from 1 January 2001 to 31 December 2010 were included. All adults were traced until the diagnosis of OAG, the occurrence of death, or 31 December 2013. Risk of OAG was significantly higher in obese adults than in non-obese adults after multivariable adjustment (adjusted hazard ratio (aHR): 1.43 (95% confidence interval (CI) 1.11-1.84)/aHR: 1.54 (95% CI 1.23-1.94) in the LHID2000/LHID2005). Both databases demonstrated that young obese adults (aged ≤40 years) had a remarkably increased risk of OAG compared with young non-obese adults (aHR 3.08 (95% CI 1.82-5.21)/aHR 3.81 (95% CI 2.26-6.42) in the LHID2000/LHID2005). This two-database matched-cohort study suggests that obese adults have an increased risk of OAG. In young adults, in particular, obesity could be a potential risk factor of OAG.
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http://dx.doi.org/10.3390/jcm10174021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432455PMC
September 2021

Risks of Coaggregation of Major Psychiatric Disorders Among First-Degree Relatives of Patients With Bipolar I and Bipolar II Disorder: Evidence From a Nationwide Population-Based Study.

J Clin Psychiatry 2021 Sep 7;82(5). Epub 2021 Sep 7.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

Etiologic differences between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) have been challenged recently, and family epidemiologic studies may elucidate the matter. Nevertheless, it remains unclear whether BD-I and BD-II display different familial aggregation patterns within each bipolar disorder subtype and coaggregation with other psychiatric disorders.

Per the Taiwan National Health Insurance Research Database (N = 23,258,175), patients with bipolar disorder were classified as having BD-I or BD-II based on the history of psychiatric hospitalization for a manic episode. During the study period (2001-2011), 184,958 first-degree relatives (FDRs) of patients with BD-I and BD-II were identified. By comparing patients with 1:4 age-, sex-, and kinship-matched samples without BD-I/BD-II probands, the relative risks (RRs) of major psychiatric disorders were estimated.

FDRs of BD-I probands had a significantly higher risk of BD-I than those of BD-II probands (BD-I proband: RR = 15.80 vs BD-II proband: RR = 5.68,  < .001). The risk of BD-II was similar between FDRs of BD-I and BD-II probands (BD-I proband: RR = 6.48 vs BD-II proband: RR = 5.89,  = .1161). Familial aggregation was greater within each BD subtype than among cross-subtypes. Furthermore, FDRs of BD-I probands had an increased risk of schizophrenia (BD-I probands: RR = 5.83 vs BD-II probands: RR = 2.72,  < .001); FDRs of BD-II probands had a higher likelihood of attention-deficit/hyperactivity disorder (BD-II probands: 2.36 vs BD-I probands: 1.93,  = .0009).

The risk of psychiatric disorders is higher among the FDRs of patients with either BD-I or BD-II. Furthermore, the familial specificity of BD-I and BD-II assessed in this study may further the current understanding of etiologic boundaries between bipolar disorder subtypes.
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http://dx.doi.org/10.4088/JCP.20m13810DOI Listing
September 2021

Proton Pump Inhibitors Are Associated with Increased Risk of Psoriasis: A Nationwide Nested Case-Control Study.

Dermatology 2021 Sep 2:1-7. Epub 2021 Sep 2.

School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Background: Proton pump inhibitors (PPIs) are among the most widely used drugs. Little is known about the association between PPI use and risk of psoriasis.

Objective: To investigate the association between PPI use and subsequent psoriasis risk.

Methods: We included participants from the Taiwan National Health Insurance Research Database. Patients with PPI use and an incidence of psoriasis (n = 5,756) were assigned to the case cohort and 1:1 matched to controls. PPI use was defined as >30 cumulative defined daily doses (cDDDs); PPI nonuse was defined as ≤30 cDDDs. Logistic regression was used for the analyses.

Results: There was a significant association between PPI use and psoriasis risk. The confounder-adjusted odd ratios (95% confidence interval [CI]) were 1.52 (1.31-1.76) and 1.54 (1.22-1.93) for patients with 120-365 cDDDs and >365 cDDDs, respectively, compared with PPI nonusers. Stratified analyses based on PPI type showed that exposure to lansoprazole (OR, 1.25; 95% CI, 1.11-1.41) was associated with subsequent psoriasis risk.

Conclusions: PPI use might be associated with an increased risk of developing psoriasis or as an epiphenomenon. Further prospective studies are needed to elucidate the association and underlying mechanisms.
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http://dx.doi.org/10.1159/000517515DOI Listing
September 2021

Association between hepatitis C virus infection and subsequent chronic inflammatory skin disease.

J Dermatol 2021 Aug 30. Epub 2021 Aug 30.

School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Hepatitis C virus (HCV) infection is associated with several cutaneous manifestations, including lichen planus and psoriasis. However, its association with other chronic inflammatory skin diseases (CISD) remains largely unknown. The aim of this study was to investigate the association between HCV infection and CISD. Participants were recruited from the National Health Insurance Research Database in Taiwan. Altogether 23 509 patients with HCV infection and 94 036 matched controls were included to assess the risk of CISD. A Cox regression model was used for the analyses. Compared with controls, patients with HCV infection had an adjusted hazard ratio (aHR) of 6.34 (95% confidence interval [CI], 5.30-7.58) for CISD after adjustment for potential confounders. Regarding individual CISD, patients with HCV infection had a significantly increased risk of developing lichen planus, psoriasis, vitiligo, alopecia areata, and cutaneous lupus erythematosus. Interferon-based antiviral therapy (IFN-based AVT) was significantly associated with a decreased risk of CISD (aHR = 0.42; 95% CI, 0.28-0.64). Patients with HCV infection had a significantly increased risk of CISD, while IFN-based AVT was associated with a decreased risk. These findings suggest monitoring of CISD in patients with HCV infection.
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http://dx.doi.org/10.1111/1346-8138.16129DOI Listing
August 2021

Clinical Risk Score for the Prediction of Incident Atrial Fibrillation: Derivation in 7 220 654 Taiwan Patients With 438 930 Incident Atrial Fibrillations During a 16-Year Follow-Up.

J Am Heart Assoc 2021 Sep 28;10(17):e020194. Epub 2021 Aug 28.

Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.

Background Although several risk schemes have been proposed to predict new-onset atrial fibrillation (AF), clinical prediction models specific for Asian patients were limited. In the present study, we aimed to develop a clinical risk score (Taiwan AF score) for AF prediction using the whole Taiwan population database with a long-term follow-up. Methods and Results Among 7 220 654 individuals aged ≥40 years without a past history of cardiac arrhythmia identified from the Taiwan Health Insurance Research Database, 438 930 incident AFs occurred after a 16-year follow-up. Clinical risk factors of AF were identified using Cox regression analysis and then combined into a clinical risk score (Taiwan AF score). The Taiwan AF score included age, male sex, and important comorbidities (hypertension, heart failure, coronary artery disease, end-stage renal disease, and alcoholism) and ranged from -2 to 15. The area under the receiver operating characteristic curve of the Taiwan AF scores in the predictions of AF are 0.857 for the 1-year follow-up, 0.825 for the 5-year follow-up, 0.797 for the 10-year follow-up, and 0.756 for the 16-year follow-up. The annual risks of incident AF were 0.21%/year, 1.31%/year, and 3.37%/year for the low-risk (score -2 to 3), intermediate-risk (score 4 to 9), and high-risk (score ≥10) groups, respectively. Compared with low-risk patients, the hazard ratios of incident AF were 5.78 (95% CI, 3.76-7.75) for the intermediate-risk group and 8.94 (95% CI, 6.47-10.80) for the high-risk group. Conclusions We developed a clinical AF prediction model, the Taiwan AF score, among a large-scale Asian cohort. The new score could help physicians to identify Asian patients at high risk of AF in whom more aggressive and frequent detections and screenings may be considered.
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http://dx.doi.org/10.1161/JAHA.120.020194DOI Listing
September 2021

Dengue and dementia risk: A nationwide longitudinal study.

J Infect 2021 Aug 27. Epub 2021 Aug 27.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address:

Background: Accumulating evidence suggests neurological manifestations after dengue infection. However, the relationship between dengue and long-term neurocognitive sequel remains unclear.

Methods: We recruited 816 patients with dengue and 8,160 controls between 1997 and 2012 using data from Taiwan National Health Insurance Research Database and followed them up until the end of 2013. Individuals who exhibited any type of dementia were identified during the follow-up period. Cox regression analyses were performed with adjustments for demographic data and medical and mental comorbidities (cerebrovascular diseases, traumatic brain injury, hypertension, dyslipidemia, diabetes mellitus, depression, alcohol use disorder, and substance use disorder). The E-value for the causality of the evidence was calculated. Sensitivity analysis was conducted to exclude patients with prodromal dementia.

Results: Patients with dengue were more likely to develop dementia (hazard ratio [HR]: 2.23, 95% confidence interval [CI]: 1.51-3.28), Alzheimer's disease (HR: 3.03, 95% CI: 1.08-8.45), and unspecified dementia (HR: 2.25, 95% CI: 1.43-3.53), but not vascular dementia compared to controls during the follow-up period. Sensitivity analyses after exclusion of the observation period over the first three years or first five years and after exclusion of patients' enrollment before 2010 or 2008 showed consistent findings. The E-values for the HR (range 3.62-5.51) supported the association between dengue and subsequent dementia among the whole population, men, and women.

Conclusion: The risk of dementia was 2.23-fold higher in patients diagnosed with dengue during the follow-up period than in the controls. Further studies are necessary to investigate the underlying pathophysiology of dengue and dementia.
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http://dx.doi.org/10.1016/j.jinf.2021.08.037DOI Listing
August 2021

Risk of attention deficit hyperactivity and autism spectrum disorders among the children of parents with autoimmune diseases: a nationwide birth cohort study.

Eur Child Adolesc Psychiatry 2021 Aug 13. Epub 2021 Aug 13.

Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.

Studies have suggested that maternal autoimmune diseases are associated with an increased risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, research on the association of paternal autoimmune diseases with ADHD and ASD risk has remained inconclusive. Using the Taiwan National Health Insurance Research Database, we selected 708,517 family triads (father-mother-child) between 2001 and 2008 and followed them until the end of 2011. Parental autoimmune diseases as well as ADHD and ASD in children were identified during the study period. Increased ADHD risk in children in terms of hazard ratios (HRs) and 95% confidence intervals (CIs) was associated with prenatal exposure to paternal autoimmune diseases, including Sjögren's syndrome (HR: 8.41, 95% CI: 2.72-26.05), psoriasis (HR: 1.95, 95% CI: 1.05-3.63), and ankylosing spondylitis (HR: 2.02, 95% CI: 1.29-2.15), as well as maternal autoimmune diseases, such as systemic lupus erythematosus (HR: 1.53, 95% CI: 1.09-2.15), type 1 diabetes mellitus (HR: 1.55, 95% CI: 1.02-2.36), inflammatory bowel disease (HR: 2.37, 95% CI: 1.59-3.52), psoriasis (HR: 1.70, 95% CI: 1.00-2.87), and ankylosing spondylitis (HR: 2.07, 95% CI: 1.11-3.86). However, ASD was only associated with paternal inflammatory bowel disease (HR: 3.08, 95% CI: 1.15-8.28) and ankylosing spondylitis (HR: 2.65, 95% CI: 1.10-6.39). Both paternal and maternal autoimmune diseases were associated with increased likelihood of ADHD in children. However, only paternal autoimmune diseases were related to offspring ASD risk. The precise pathomechanism underlying the correlation between parental autoimmunity and child neurodevelopment requires further investigation.
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http://dx.doi.org/10.1007/s00787-021-01860-0DOI Listing
August 2021

COVID-19 Publications in Family Medicine Journals in 2020: A PubMed-Based Bibliometric Analysis.

Int J Environ Res Public Health 2021 07 21;18(15). Epub 2021 Jul 21.

Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.

Family medicine physicians have been on the front lines of the novel coronavirus disease 2019 (COVID-19) pandemic; however, research and publications in family medicine journals are rarely discussed. In this study, a bibliometric analysis was conducted on COVID-19-related articles published in PubMed-indexed English language family medicine journals in 2020, which recorded the publication date and author's country and collected citations from Google Scholar. Additionally, we used LitCovid (an open database of COVID-19 literature from PubMed) to determine the content categories of each article and total number of global publications. We found that 33 family medicine journals published 5107 articles in 2020, of which 409 (8.0%) were COVID-19-related articles. Among the article categories, 107 were original articles, accounting for only 26.2% of the articles. In terms of content, the main category was prevention, with 177 articles, accounting for 43.3% of the articles. At the beginning of the epidemic, 10 articles were published in family medicine journals in January 2020, accounting for 11% of all COVID-19-related articles worldwide; however, this accounted for <0.5% of all disciplinary studies in the entire year. Therefore, family medicine journals indeed play a sentinel role, and the intensities and timeliness of COVID-19 publications deserve further investigation.
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http://dx.doi.org/10.3390/ijerph18157748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345810PMC
July 2021

Pharmacist Workforce at Primary Care Clinics: A Nationwide Survey in Taiwan.

Healthcare (Basel) 2021 Jul 8;9(7). Epub 2021 Jul 8.

Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan.

Although dispensing is usually separated from prescribing in healthcare service delivery worldwide, primary care clinics in some countries can hire pharmacists to offer in-house dispensing or point-of-care dispensing for patients' convenience. This study aimed to provide a general overview of pharmacists working at primary care clinics in Taiwan. Special attention was paid to clarifying the relationship by location, scale, and specialty of clinics. The data source was the Government's open database in Taiwan. In our study, a total of 8688 pharmacists were hired in 6020 (52.1%) 11,546 clinics. The result revealed significant differences in the number of pharmacists at different specialty clinics among levels of urbanization. Group practices did not have a higher probability of hiring pharmacists than solo practices. There was a higher prevalence of pharmacists practicing in clinics of non surgery-related specialties than in surgery-related specialties. Although the strict separation policy of dispensing and prescribing has been implemented for 2 decades in Taiwan, most primary care clinics seem to circumvent the regulation by hiring pharmacists to maintain dominant roles in dispensing drugs and retaining the financial benefits from drugs. More in-depth analyses are required to study the impact on pharmacies and the quality of pharmaceutical care.
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http://dx.doi.org/10.3390/healthcare9070863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306307PMC
July 2021

Postpartum Depression and Psychosis and Subsequent Severe Mental Illnesses in Mothers and Neurodevelopmental Disorders in Children: A Nationwide Study.

J Clin Psychiatry 2021 Jul 27;82(4). Epub 2021 Jul 27.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

The association between postpartum depression and postpartum psychosis and subsequent maternal and offspring mental disorders in Western countries has been established; however, whether the relationship can be generalized to the Asian population is unknown.

Using the Taiwan National Health Insurance Research Database, this study enrolled 933,745 mother-infant pairs who delivered their first child and had no history of severe mental illness before childbirth from 2001 to 2010. Postpartum depression and postpartum psychosis were assessed in 3 periods between childbirth and 3, 6, or 12 months after childbirth. Subsequent maternal schizophrenia ( code: 295), bipolar disorder ( code: 296 except 296.2x, 296.3x, 296.9x, and 296.82), and depressive disorder ( codes: 296.2x, 296.3x, 300.4, and 311) and offspring autism spectrum disorder (ASD; code: 299) and attention-deficit/hyperactivity disorder (ADHD; code: 314) were identified during the follow-up period to the end of 2011.

Both postpartum depression and postpartum psychosis were found to be related to increased risks of schizophrenia, bipolar disorder, and depressive disorder in mothers, with hazard ratios (HRs) ranging between 8.80 (95% CI, 7.95-9.74) and 63.96 (95% CI, 50.39-81.18). Children exposed to maternal postpartum depression and psychosis were more likely to develop ADHD. Only postpartum depression was related to the likelihood of offspring ASD.

Per these findings, we clinicians and health care providers should closely monitor the mental health condition of postpartum women and their children.
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http://dx.doi.org/10.4088/JCP.20m13735DOI Listing
July 2021

Should oral anticoagulants still be prescribed to patients with atrial fibrillation with a single stroke risk factor but at high bleeding risk? a nationwide cohort study.

Eur Heart J Qual Care Clin Outcomes 2021 Jul 24. Epub 2021 Jul 24.

Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Objective: To investigate the co-distributions of stroke and bleeding risks in Asian patients with atrial fibrillation (AF) and the clinical benefits of oral anticoagulants (OACs) among AF patients with single stroke risk factor but at high bleeding risk.

Methods: From January 1, 2001 to December 31, 2016, a total of 404,949 AF patients were retrospectively identified from Taiwan National Health Insurance Research Database. Stroke risk was assessed using the CHA2DS2-VASc score and was categorized as low (score 0 for males, 1 for females), intermediate (ie. a single non-sex stroke risk factor; score = 1 for males and 2 for females) and high risk (score ≥2 for males and ≥3 for females). A high risk of bleeding was defined as a HAS-BLED score ≥3.

Results: Around 57.5% of AF patients were at high risk for both stroke and bleeding, and most patients (97.6%) with a low stroke risk were also low risk for bleeding. Around 18.3% of patients with a CHA2DS2-VASc of 1 (males) or 2 (females) were at high bleeding risk, and the use of OACs in such patients was associated with a lower risk of composite adverse events of ischemic stroke, intra-cranial hemorrhage or mortality (4.19/100 person-years versus 5.22/100 person-years, adjusted hazard ratio = 0.781, P = 0.04).

Conclusions: For AF patients with an intermediate risk of stroke (ie. a single non-sex stroke risk factor) but at high bleeding risk, the use of OACs was still significantly associated with a better overall clinical outcome.
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http://dx.doi.org/10.1093/ehjqcco/qcab050DOI Listing
July 2021

Family Medicine Academic Workforce of Medical Schools in Taiwan: A Nationwide Survey.

Int J Environ Res Public Health 2021 07 5;18(13). Epub 2021 Jul 5.

Taiwan Association of Family Medicine, Taipei 10046, Taiwan.

Little is known about family medicine academic workforce in Taiwan, and basic data on this may aid healthcare decision-makers and contribute to the limited literature. We analyzed data from 13 medical schools in Taiwan collected by the Taiwan Association of Family Medicine from June to September 2019, regarding characteristics of medical schools, and total staff, gender, age, degree, working title (adjunct/full-time), academic level, and subspecialty of each current family medicine faculty member. Total 13 medical schools in Taiwan with an undergraduate education program in family medicine, but only nine of the 13 medical schools had family medicine departments, while four still do not. A total of 116 family medicine faculty members ranging from 33-69 years. Of these, most were male ( = 85, 73.3%), with a mean age of 43.3 years. Most faculty members possessed a master's degree ( = 49, 42.2%), were academic lecturers ( = 49, 42.2%), were located in northern Taiwan ( = 79, 68.1%), and subspecialize in gerontology and geriatrics ( = 55, 47.4%) and hospice palliative care ( = 53, 45.7%). Additionally, most family medicine faculty in medical schools were adjunct faculty ( = 90, 77.6%), with only about one-fourth ( = 26, 22.4%) working full-time. Our study provides the most holistic census to date on academic family medicine faculty from all medical schools in Taiwan. The novel information can provide educational leaders, health policy managers, and decision-makers about the current developments of the family medicine departments in Taiwan's medical schools. The basic data will help formulate an effective medical school family medicine education plan and improve the establishment and development of the family medicine faculty workforce to help medical education and national health policy development in the future in Taiwan.
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http://dx.doi.org/10.3390/ijerph18137182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297066PMC
July 2021

Risk of retinal diseases in patients with psoriasis: A population-based cohort study in Taiwan.

J Dermatol 2021 Jul 15. Epub 2021 Jul 15.

School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Psoriasis has been associated with the risk of several ocular complications; however, its relationship with retinal diseases remains unknown. This study aimed to investigate the risk of developing retinal diseases in patients with psoriasis. Study participants were recruited from the National Health Insurance Research Database in Taiwan. A total of 11 729 psoriasis patients and 117 290 matched controls were included, showing an incidence rate of 121.15 and 28.34 cases of retinal diseases per 100 000 person-years, respectively. Compared with controls, patients with psoriasis had an adjusted hazard ratio (aHR) of 3.40 (95% confidence interval [CI], 2.63-4.39) for retinal diseases after adjustment for potential confounders. Regarding the individual retinal disease, psoriasis patients had a significantly higher risk of developing retinal detachment (aHR, 5.07; 95% CI, 2.92-8.79), retinal vascular occlusion (aHR, 3.75; 95% CI 2.42-5.82), and retinopathy (aHR, 2.84; 95% CI, 1.99-4.05) than controls. In conclusion, patients with psoriasis had a significantly higher risk of retinal diseases than controls. Further studies are necessary to investigate the pathophysiology underlying the relationship between psoriasis and retinal diseases.
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http://dx.doi.org/10.1111/1346-8138.16062DOI Listing
July 2021

The Risk of Alzheimer's Disease After Acute Appendicitis With or Without Appendectomy.

J Am Med Dir Assoc 2021 Jul 13. Epub 2021 Jul 13.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan. Electronic address:

Objective: Previous epidemiologic studies have suggested an association between appendectomy and Parkinson's disease. The aim of the current study was to examine the risk of Alzheimer's disease (AD) and other types of dementia following appendicitis or appendectomy for appendicitis.

Design: Population-based cohort study.

Setting And Participants: We used claims data from the Taiwan National Health Insurance Research Database. Participants aged ≥45 years with acute appendicitis or who received appendectomy for appendicitis were enrolled and followed up for more than 15 years. Cases and controls underwent 1:1 matching by age, sex, index date, and dementia-related comorbidities.

Methods: The primary outcome was AD, and secondary outcomes included other dementia types. Adjusted hazard ratios (aHRs) were calculated, and a competing risk regression model was created. The E value for causality of evidence was calculated.

Results: Patients developing appendicitis (0.6% vs 0.1%, P = .005) and those receiving appendectomy for appendicitis (0.4% vs 0.1%, P = .003) had higher incidences of AD than the controls during the follow-up period. A Cox regression analysis with adjustment for potential confounders showed that patients with appendicitis [aHR 6.68, 95% confidence interval (CI) 1.84-24.48] and those receiving appendectomy for appendicitis (aHR 5.01, 95% CI 1.33-18.85) were more likely to develop AD than the controls. These 2 groups also had higher risks for unspecified dementia and all types of dementia but not for vascular dementia than the controls. The age at dementia diagnosis was 88.51 years in the controls; however, among people who developed dementia following appendicitis, the mean age at diagnosis was 70.18 years, and dementia occurred 5.84 years after appendicitis. The competing risk regression models and the E values support the study findings.

Conclusions And Implications: After recovery from appendicitis, these patients should be followed up for signs of AD.
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http://dx.doi.org/10.1016/j.jamda.2021.06.013DOI Listing
July 2021

Endovascular aortic repair is a cost-effective option for in-hospital patients with abdominal aortic aneurysm.

J Chin Med Assoc 2021 Sep;84(9):890-899

Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: To investigate the cost-effectiveness of endovascular aortic repair (EVAR) versus open aortic repair (OAR) for abdominal aortic aneurysm (AAA) using incremental costs per decreased in-hospital mortality rate gained through our patients' cohort.

Methods: Medical records and healthcare costs of patients with AAA hospitalized between 2010 and 2015 were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Multiple regression analysis was applied to adjust for confounding factors and to compare the differences in postoperative clinical outcomes between patients who received EVAR and OAR. The incremental cost-effectiveness ratio (ICER) of EVAR was determined based on the healthcare cost obtained from the analyzed data.

Results: A total of 2803 AAA patients were identified (n = 559 with ruptured AAA and n = 2244 unruptured AAA). Patients with ruptured AAA who underwent EVAR compared with OAR patients had shorter hospital and intensive care unit (ICU) stays (all p < 0.05). For patients with unruptured AAA, those who received EVAR compared with OAR, the adjusted odds ratio (aOR) of postoperative complications and in-hospital mortality were 0.371 and 0.447 (all p < 0.05). The total direct surgical costs and medical expenses during hospitalization in all AAA patients were higher for the EVAR group; however, ICER was <1 per capita gross domestic product. Stratification by age groups further suggested that ICER for patients with unruptured AAA who received EVAR, compared with OAR, decreased with age.

Conclusion: Total direct medical costs were higher for AAA patients receiving EVAR regardless of rupture status; however, the cost is offset by lower odds of postoperative complications and in-hospital mortality. The observed decrease in ICER with age and EVAR use warrants further analysis. Our findings further validate the use of EVAR over OAR. These results provides supporting evidence for physicians and patients with AAA to inform shared decision making regarding endovascular or OAR options.
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http://dx.doi.org/10.1097/JCMA.0000000000000581DOI Listing
September 2021

Taipei Veterans General Hospital secure open-source telemedicine system-TeleCARE.

J Chin Med Assoc 2021 Aug;84(8):743-744

School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.

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http://dx.doi.org/10.1097/JCMA.0000000000000572DOI Listing
August 2021

Analysis of the Content and Comprehensiveness of Dermatology Residency Training Websites in Taiwan.

Healthcare (Basel) 2021 Jun 21;9(6). Epub 2021 Jun 21.

Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.

With a growing trend in the popularity of web-based resources, it is important to evaluate residency program websites for providing accurate information for dermatology residency applicants. Little is known about the quality of dermatology residency websites in Taiwan. The aim of the study is to assesses the quality of official websites of dermatology training programs in Taiwan. A literature search for all related studies from inception to 31 July 2020 was performed using PubMed without restriction on language. We used criteria that had 6 domains and 25 items to evaluate 23 official websites of the dermatology training programs in Taiwan from August to September 2020. Of the 23 training programs, only 6 (26%) of the websites met more than half of the criteria. Notably, the items "features of the department" and "comprehensive faculty listing" were included in all websites. The criteria for interview process, board pass rates, social activities and information on the surrounding area were not met by all websites. Evidently, there is much room for improvement for the dermatology training program websites in Taiwan.
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http://dx.doi.org/10.3390/healthcare9060773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235558PMC
June 2021

Varied impacts on outpatient services among departments and divisions in the early phase of the COVID-19 pandemic: Implications for personnel mobilization and preparatory training.

J Chin Med Assoc 2021 Jun 17. Epub 2021 Jun 17.

Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Department of Financial Engineering and Actuarial Mathematics, Soochow University, Taipei, Taiwan, ROC Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Department of Family Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Background: Coronavirus Disease 2019 (COVID-19) spread all over the world in 2020. In the face of the sudden pandemic, workforce mobilization has been of critical concern to medical institutions. During the pandemic, the public's behaviors of seeking medical assistance have also changed. Using the real-world data of a large medical center in Taiwan, this study aimed to analyze the fluctuations of outpatient visits among various departments and divisions in the early phase of the COVID-19 pandemic and to provide suggestions for staff allocation in similar future events.

Methods: Data of outpatient visits at Taipei Veterans General Hospital were obtained for analysis. The weekly fluctuations of outpatient visits among 36 departments or divisions were computed for the 8 weeks from February 3 to March 29, 2020, the early phase of the pandemic. The monthly data of outpatient visits by department and division in March 2020 were also extracted for comparison with those in March 2019. A simple regression equation was used to calculate the weekly trends.

Results: Average outpatient visits decreased by 26% in the 2 months following the outbreak. Among the 36 departments or divisions, ophthalmology, orthopedics, and cardiology underwent marked declines after the outbreak; the slopes of the simple regression equation were -110.8, -100.7, and -99.2, respectively. By contrast, transfusion medicine, toxicology, transplantation surgery, pediatric surgery, chest surgery, technical aid, and oncology were divisions less influenced. In the year-over-year comparison, infection was the only department or division with positive growth (20.5%), whereas all others exhibited negative growth.

Conclusion: In the future, we can fulfil the additional personnel needs during a pandemic by redeploying physicians from departments experiencing a reduced workload. Hospitals should also establish preparatory employee training programs to ensure that the reassigned personnel are adequately equipped to serve in their new positions.
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http://dx.doi.org/10.1097/JCMA.0000000000000569DOI Listing
June 2021

Experiences With Internet Triaging of 9498 Outpatients Daily at the Largest Public Hospital in Taiwan During the COVID-19 Pandemic: Observational Study.

JMIR Med Inform 2021 Jul 27;9(7):e20994. Epub 2021 Jul 27.

Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: During pandemics, acquiring outpatients' travel, occupation, contact, and cluster histories is one of the most important measures in assessing the disease risk among incoming patients. Previous means of acquiring this information in the examination room have been insufficient in preventing disease spread.

Objective: This study aimed to demonstrate the deployment of an automatic system to triage outpatients over the internet.

Methods: An automatic system was incorporated in the existing web-based appointment system of the hospital and deployed along with its on-site counterpart. Automatic queries to the virtual private network travel and contact history database with each patient's national ID number were made for each attempt to acquire the patient's travel and contact histories. Patients with relevant histories were denied registration or entry. Text messages were sent to patients without a relevant history for an expedited route of entry if applicable.

Results: A total of 127,857 visits were recorded. Among all visits, 91,195 were registered on the internet. In total, 71,816 of them generated text messages for an expedited route of entry. Furthermore, 65 patients had relevant histories, as revealed by the virtual private network database, and were denied registration or entry.

Conclusions: An automatic triage system to acquire outpatients' relevant travel and contact histories was deployed rapidly in one of the largest academic medical centers in Taiwan. The updated system successfully denied patients with relevant travel or contact histories entry to the hospital, thus preventing long lines outside the hospital. Further efforts could be made to integrate the system with the electronic medical record system.
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http://dx.doi.org/10.2196/20994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317989PMC
July 2021

Increased Risk of Stroke in Patients With Obsessive-Compulsive Disorder: A Nationwide Longitudinal Study.

Stroke 2021 Aug 27;52(8):2601-2608. Epub 2021 May 27.

Department of Psychiatry (M.-H.C., S.-J.T., T.-P.S., C.-T.L., W.-C.L., Y.-M.B.), Taipei Veterans General Hospital, Taiwan.

[Figure: see text].
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http://dx.doi.org/10.1161/STROKEAHA.120.032995DOI Listing
August 2021

The role of patient records in research: A bibliometric analysis of publications from an academic medical center in Taiwan.

J Chin Med Assoc 2021 07;84(7):718-721

Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Background: This study aimed to assess the use of medical record items in clinical research in one large academic medical center in Taiwan.

Methods: A descriptive survey design was adopted to collect the data. Articles published in 2018 by Taipei Veterans General Hospital (TVGH) staff as the first author were obtained. The types of specialties and types of research were analyzed. To understand the conditions for the use of medical records, the retrospective research using hospital's medical records were analyzed. Each article was read in entirety to realize the use and number of patients and the medical record items.

Results: Among the 362 articles first-authored by TVGH staff in 2018, 219 (60.4%) were classified as clinical studies, 60 (16.6%) as basic studies, 53 (14.6%) as database studies, and 30 (8.2%) as other categories. About 50% of the retrospective research using TVGH medical records had a case number <100 (67 cases, 49.6%) with an average number of 41 cases and 13 studies (9.6%) had a case number >1000. Analysis of the number of medical record items used in 135 retrospective research studies based on TVGH medical records showed that 118 (87.4%) used basic patient information. In addition to basic information, notes written by professionals were used most frequently (73 cases, 54.0%), whereas medication information was used in 50 cases (37.0%); laboratory test data were used in 49 cases (36.2%); and body measurements was used in 27 cases (20%).

Conclusion: More than one-third of publications utilized medical records, but the patient numbers and record items in use were relatively limited. In the era of digitalization and big data analytics, the potential of medical records in research deserves attention. Investment in establishing a more accessible database of medical records to access nonstructural, descriptive medical records could be considered.
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http://dx.doi.org/10.1097/JCMA.0000000000000554DOI Listing
July 2021

Anesthesia services in Taiwan: A nationwide population-based study.

J Chin Med Assoc 2021 07;84(7):713-717

School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: This study was conducted to provide an overview of anesthesia services in Taiwan from 2001 to 2010.

Methods: A retrospective population-based analysis was performed using data from Taiwan's National Health Insurance Research Database for the period 2001 to 2010. The results were stratified by patient sex, patient age, anesthesia type, and hospital setting. Categorical data are presented as totals and percentages. Linear regression was performed to analyze the anesthesia trends.

Results: The annual use of anesthesia increased continually from 964,440 instances in 2001 to 1,073,160 in 2010, totaling 10,076,600 cases with a total cost of 25.4 billion USD. The overwhelming majority (83.9%) of anesthesia cases was for anesthesia in an inpatient setting; general anesthesia accounted for 73.8% of anesthesia cases, and female patients outnumbered male patients (52.4% vs 47.6%). The average number of anesthesia cases was 44.2 per thousand of the population annually, but this percentage was much higher in elderly people (100.9 cases per thousand people annually). The annual number of anesthesia cases per thousand of the population increased from 104.4 in 2001 to 113.0 in 2010 in the oldest group (>80 years). By contrast, a considerable decline in use of anesthesia was discovered over the study period among those aged younger than 18 years.

Conclusion: The use of anesthesia services in Taiwan has increased over the years. The relationships of age with anesthesia volume and cost were found to follow an inverse U-shaped pattern. Elderly people used anesthesia services more frequently. The planning of geriatric anesthesia services deserves attention, especially in continually aging societies such as Taiwan.
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http://dx.doi.org/10.1097/JCMA.0000000000000553DOI Listing
July 2021

Obsessive-Compulsive Disorder and Dementia Risk: A Nationwide Longitudinal Study.

J Clin Psychiatry 2021 May 11;82(3). Epub 2021 May 11.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: Several case reports have suggested an association between obsessive-compulsive disorder (OCD) and dementia. However, the exact relationship remains unclear.

Methods: Using the Taiwan National Health Insurance Research Database, 1,347 patients with OCD (ICD-9-CM code 300.3) aged ≥ 45 years and 13,470 controls matched for age, sex, residence, income, and dementia-related comorbidities were included between 1996 and 2013 for investigation of subsequent dementia from enrollment to the end of 2013. Stratified Cox regression analysis on each matched pair was applied to assess the dementia risk between the OCD and control groups. The analysis for the current study was performed in 2018.

Results: Patients with OCD had increased risk of developing any dementia (hazard ratio [HR] = 4.28; 95% confidence interval [CI], 2.96-6.21), Alzheimer's disease (HR = 4.04; 95% CI, 1.55-10.54), and vascular dementia (HR = 3.95; 95% CI, 1.70-9.18) compared with controls.

Discussion: Future research on the pathogenic mechanisms and molecular underpinnings of the relationship between OCD and dementia may lead to the development of novel therapeutics.
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http://dx.doi.org/10.4088/JCP.20m13644DOI Listing
May 2021

In-kind donations to healthcare facilities during COVID-19: Experiences from a large medical center in northern Taiwan.

J Chin Med Assoc 2021 07;84(7):704-708

School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.

Background: In early 2020, a global outbreak of 2019 novel coronavirus disease (COVID-19) caused high mortality rates and public panic. Worldwide demand for personal protective equipment has risen, with diminishing supplies and shortages reported. During the pandemic, charitable donations have been made by the public, aimed at helping medical staff. Based on the open data, we investigate the charitable in-kind donations received by a large medical center in northern Taiwan (Taipei Veterans General Hospital [TPEVGH]) in Taiwan during the pandemic.

Methods: The period of investigation was the first half of the year 2020. TPEVGH has received various public donations. The list of donations published on the hospital's official website was analyzed. The variables in the analysis were donation category, donation percentage, number of donations, and total donation amount.

Results: Most in-kind donations were food and beverages (55.1%), with a monetary value of 3 124 510 New Taiwan Dollars (NTD) (24.3%). Medical equipment accounted for the second-highest number of items (34.8%) but was the highest monetary value (70.6%; 9 275 945 of 12 875 855 NTD). Daily necessities accounted for the lowest number of items (10.1%) and had a total monetary value of 475 400 NTD (3.7%). Over two-thirds were beverages (68.4%), all of which were bottles or cans for easy storage. Despite only five items (13.2%) being juice, the donation size was the largest, accounting for nearly half (47.1%) of the total monetary value. Only one item was fruit, which was high-class organic apples. The monetary value of this item was the highest (7.8%) among all donated food. Most donated snacks were biscuits.

Conclusion: During the COVID-19 pandemic, most public donations to TPEVGH were food and daily necessities. While every donation should be appreciated, accepting high volumes of donations might incur donation management problems. Further research could be focused on managerial aspects, for example, quality and safety checking, storage, and distribution.
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http://dx.doi.org/10.1097/JCMA.0000000000000550DOI Listing
July 2021

Effect of relative age on childhood mental health: A cohort of 9,548,393 children and adolescents.

Acta Psychiatr Scand 2021 08 1;144(2):168-177. Epub 2021 Jun 1.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: The effect of relative age on the diagnoses of attention deficit hyperactivity disorder (ADHD), disruptive behavior disorder (DD), anxiety disorder, and depressive disorder and the prescription for ADHD and antidepressant medications remains unclear.

Aim: To clarify the impact of relative age in a school year with the diagnoses of ADHD, DD, anxiety disorder, and depressive disorder and the prescription for ADHD and antidepressant medications.

Methods: The annual cutoff birthdate for entry to school in Taiwan is August 31. The Taiwan National Health Insurance Research Database was used to enroll 9,548,393 children and adolescents aged 3-17 years during the study period (September 1, 2001, to August 31, 2011). The Poisson regression model was performed to examine the likelihood of receiving diagnoses of ADHD, DD, anxiety disorder, and depressive disorder, as well as the prescription of ADHD and antidepressant medications among children born in August (the youngest) and September (the oldest).

Results: Both boys and girls born in August had a higher risk of being diagnosed as having ADHD (odds ratio [OR] = boys: 1.65, girls: 1.80), DD (1.29, 1.45), anxiety disorder (1.49, 1.33), and depressive disorder (1.10, 1.10). Furthermore, children born in August were more likely to be prescribed ADHD medication (1.71, 1.72) and antidepressants (1.18, 1.09) compared with those born in September.

Discussion: Relative age, as an indicator of neurocognitive maturity, is a critical factor for the likelihood of being diagnosed as having ADHD, DD, anxiety disorder, and depressive disorder among children and adolescents.
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http://dx.doi.org/10.1111/acps.13327DOI Listing
August 2021

Effect of relative age on diagnosis of autism spectrum disorder in children: a nationwide study in Taiwan.

Eur Child Adolesc Psychiatry 2021 May 8. Epub 2021 May 8.

Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Taipei, 11217, Taiwan.

Background: The annual cut-off birthdate for entry into school in Taiwan is August 31. Thus, children and adolescents born in August are typically the youngest in their grades. The potential effect of relative age on the diagnosis of autism spectrum disorder (ASD) remains uncertain.

Methods: A total of 9,548,393 individuals aged 3-17 years during the study period (from September 1, 2001, to August 31, 2011) identified from the Taiwan National Health Insurance Research Database were enrolled into our study. Logistic regression analysis was used to examine the likelihood of receiving ASD diagnosis for those who were born in August (the youngest) compared with those who were born in September (the oldest).

Results: Both boys and girls born in August had a higher likelihood of being diagnosed with ASD (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.16-1.32; OR: 1.23, 95% CI 1.06-1.42) than did those born in September. Sensitivity analysis conducted over different periods revealed consistent findings.

Discussion: Relative age, as an indicator of neurocognitive maturity, is a crucial contributor to the risk of being diagnosed with ASD among children and adolescents. Our findings highlight the importance of considering the age of a child within a grade when diagnosing ASD.
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http://dx.doi.org/10.1007/s00787-021-01791-wDOI Listing
May 2021

Risks of Major Mental Disorders and Irritable Bowel Syndrome among the Offspring of Parents with Irritable Bowel Syndrome: A Nationwide Study.

Int J Environ Res Public Health 2021 04 28;18(9). Epub 2021 Apr 28.

Department of Psychiatry, Taipei Veterans General Hospital, Taipei 112, Taiwan.

Irritable bowel syndrome (IBS) is a functional bowel disorder that is highly comorbid with mental disorders. However, few studies have examined the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), and schizophrenia in the offspring of parents with IBS. We used nationally representative cross-sectional survey data to analyze cross-generational transmission patterns of both IBS and major mental disorders. Odds ratio (OR) was calculated by using logistic regression models with adjustment for potential confounding factors. Offspring of parents with IBS were more likely to develop IBS themselves (OR = 2.41, 95% confidence interval (CI), 2.09-2.78), ADHD (OR = 1.33, 95% CI, 1.08-1.62), and MDD (OR = 1.32, 95% CI, 1.04-1.68) than the controls. Data stratification by parental sex revealed that paternal IBS increased risk of ADHD (OR = 1.34, 95% CI, 1.01-1.77) in the offspring, while maternal IBS increased the risk of MDD (OR = 1.51, 95% CI, 1.11-2.06). This is the first study to reveal parental IBS is associated with IBS, ADHD, and MDD among offspring, suggesting the necessity for early implementation of prevention strategies for at-risk children.
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http://dx.doi.org/10.3390/ijerph18094679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124475PMC
April 2021
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