A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan

ABSTRACT: BACKGROUND: Previous follow-up studies of repeated self-harm show that the cumulative risk of repeated self-harm within one year is 5.7%--15%, with females at greatest risk. However, relatively few studies have focused on the Far East. The objective of this study was to calculate the cumulative risk of repeated self-harm over different lengths of follow-up time (3 months, 6 months, and 1--8 years), to determine factors influencing repeated self-harm and to explore the interaction between gender and self-harm methods. METHODS: We used self-harm patient who hospitalized due to first-time self-harm between 2000 and 2007 from 1,230 hospitals in Taiwan. Hospitalization for repeated self-harm among members of this cohort was tracked after 3 months, 6 months, and 1--8 years. Tracking continued until December 31, 2008. We analyzed the cumulative risk and risk factors of repeated self-harm by using negative binomial regression. RESULTS: Of the 39,875 individual study samples, 3,388 individuals (8.50%) were found to have repeatedly self-harmed. The cumulative risk of repeated self-harm within three months was 7.19% and within one year was 8%. Within 8 years, it was 8.70%. Females were more likely to repeatedly self-harm than males (RR = 1.21, 95% CI = 1.15--1.76). The main method of self-harm was solid or liquid substances (RR = 1.88, 95% CI = 1.23--2.04) or cutting or piercing (RR = 1.36, 95% CI = 1.02--1.82), and in patients with psychiatric disorders were more likely to self-harm (RR = 1.61, 95% CI = 1.48--1.75). CONCLUSIONS: The key time for intervention for repeated self-harm is within three months. Appropriate prevention programs should be developed based on gender differences.     

Cause-specific mortality in a cohort of patients with diabetes mellitus: a population-based study in Sweden

A cohort of patients with diabetes mellitus hospitalised in Sweden from 1965 to 1983 was followed up until 1989, by linkages of population-based registers. Standardised mortality ratios (SMR), adjusted for confounding variables, and 95% confidence intervals (CIs) were calculated. After exclusion of the first year of follow-up (to reduce the effect of selection bias), the cohort consisted of 144,427 patients, of whom 92,248 patients died during follow-up. The SMR for all causes of death combined was 2.62 (95% CI 2.58-2.67) among men and 3.23 (95% CI 3.18-3.28) among women. The excess mortality was still evident 20 years after first hospitalisation, but became less marked with longer follow-up time. Patients with presumably insulin-dependent diabetes mellitus (IDDM) had the highest SMRs (10.2; CI 9.5-11.0); however, there was a significant (34%) improvement over time in their mortality risk. We conclude that excess mortality persisted throughout all calendar periods and at all ages, indicating the need for health care prevention measures.     

Asian dust storms and diabetes hospitalization: a nationwide population-based study

This study analyzed the association between Asian dust storms events and diabetes hospital admissions during 2000–2009 in Taiwan using time-series autoregressive model with explanatory variables. Data came from National Health Insurance Research Database, Taiwan Environmental Protection Agency, and Central Weather Bureau. There were 1,283,509 diabetes hospital admissions and 55 ADS events. Our study showed that Asian dust storms were positively associated with diabetes hospital admissions for women, but the connection was delayed rather than immediate. The females who were aged above 74 and who were active in the labor market were more vulnerable to Asian dust storms.     

砷暴露对脂代谢影响及其机制研究进展

目的 描述安徽省马鞍山市孕早、中期孕妇外周血和脐带血清砷水平,并探讨其与妊娠期高血压疾病的关系。 方法 选取2013年5月 — 2014年9月马鞍山优生优育队列（MABC）纳入的3 474名孕妇作为研究对象,在孕妇孕早期首次产检时收集其一般人口学信息,使用电感耦合等离子质谱仪（ICP-MS）测定孕妇孕早、中期和分娩时脐带血清砷含量,采用logistic回归模型分析孕妇孕早、中期及脐带血清砷水平与妊娠期高血压疾病（HDCP）的关联。 结果 随访的3 247名孕妇中HDCP发生率为5.9 %。孕妇孕早、中期及脐带血清砷水平[P₅₀（P₂₅～P₇₅）]分别为1.74（1.22～2.51）、1.77（1.28～2.54）、1.87（1.27～2.88）μg/L,脐带血中砷的含量显著高于孕早、中期孕妇体内砷的含量（P < 0.001）。logistic回归分析显示,孕早期血清砷高暴露组孕妇发生HDCP的风险是低暴露组的1.63倍（95 % CI = 1.08～2.48）,孕中期和脐带血清砷水平与HDCP发生无统计学关联（P > 0.05）。 结论 脐带血中砷水平高于孕妇孕早、中期;孕早期砷高暴露可增加HDCP的发生风险。     

Pre-pregnancy metabolic syndrome and insulin administration in gestational diabetes: A nationwide population-based cohort study

BackgroundThe present study aimed to evaluate whether mothers with obesity/central obesity and metabolic syndrome before gestation are at higher risk of insulin administration in gestational diabetes mellitus (GDM) to diminish the burden of insulin use during pregnancy.MethodsThis was a population-based retrospective cohort study conducted using data from the National Health Information Database of Korea. We identified all deliveries from January 1, 2011 to December 31, 2015 (N = 1,214,655). Among the deliveries, we identified mothers with pre-pregnancy health checkup records and without previous diabetes history (N = 325,208). Hazards of insulin use in GDM were calculated based on pre-pregnancy obesity/central obesity and metabolic syndrome.ResultsHazards of insulin use in GDM increased proportionately with an increase in the pre-pregnancy body mass index (BMI) and waist circumference (WC). After the adjustment for clinical factors, high BMI group (≥30 kg/m²) and high WC group (≥100 cm) were significantly associated with higher hazard ratios (HRs) (HR 4.161, 95% Confidence interval [CI] 3.381–5.121, P < 0.001 and HR 2.563, 95% CI 1.769–3.712, P < 0.001, respectively). The presence of pre-pregnancy metabolic syndrome significantly increased the hazard of insulin use in GDM (0.54% vs. 5.04%). In the presence of obesity (BMI ≥ 25 kg/m²) or central obesity (WC ≥ 85 cm), HRs of insulin use in GDM were 2.637 (95% CI 2.275–3.056) and 1.603 (95% CI 1.023–2.511), respectively, after adjustment for clinical factors.ConclusionsThe presence of pre-pregnancy obesity/central obesity and metabolic syndrome in Korean mothers is associated with increased risk of insulin use in GDM.     

上海市1993至2002年孕产妇死亡情况分析

目的 通过孕产妇死亡资料的分析，总结上海市孕产妇系统管理的经验和教训，为进一步降低孕产妇死亡率提供科学的依据。方法 采用回顾性研究的方法，对1993～2002年来上海市孕产妇死亡的个案及评审情况进行分析。结果 10年来上海市孕产妇死亡率平均为26／10万(223／858 467)，其中本市户籍者为15／10万(100／666 818)。外来户籍者为64．2／10万(123／191 649)；10年中孕产妇前6位死因顺位依次为产科出血、心脏病、妊娠高血压综合征(妊高征)、肝病、异位妊娠和羊水栓塞；通过加强技术培训及健康教育，异位妊娠死亡率从1993～1997年的2．0／10万(9／444 054)降到1998～2002年的1．2／10万(5／414 413)．但值得关注的是近年的异位妊娠死亡又有上升趋势；1993年成立了上海市产科心脏病和肝病诊治中心后，妊娠合并心脏病和肝病的死亡率有了明显下降，从专家评审结果看，本市户籍的孕产妇死亡主要与医疗保健因素尤其是医务人员的知识技能相关，而外来人口中的孕产妇死亡则主要与社会各部门的管理及个人家庭因素尤其是知识水平及经济状况有关。结论 上海本市户籍的孕产妇死亡率已接近一些发达国家的水平，要进一步降低全市孕产妇死亡率，必须加强对外来户籍孕产妇的保健管理。此外，对产科医务人员的队伍建设应提到议事日程。     

A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus

The effect of alcohol use on risk of non-insulin-dependent diabetes mellitus was assessed in a defined population. A 24-hour recall of alcohol intake and past-week alcohol intake were obtained by separate interviewers between 1973 and 1975, and responses were coded by the Nutrition Coordinating Center, University of Minnesota. Of the 524 adults aged 30-79 years without diabetes at baseline, 31 men and 44 women were identified as diabetic by means of a glucose tolerance test (World Health Organization criteria) between 1984 and 1987. Men, but not women, who developed diabetes reported significantly more alcohol intake in the past week and in the past 24 hours. The highest rate of diabetes among alcohol users was in heavy drinkers--statistically significant only in men. Alcohol use remained a significant predictor of diabetes in men after adjustment for baseline age, body mass index (weight (kg)/height (m)2), cigarette smoking, family history of diabetes, and systolic blood pressure with a logistic regression model. The relative risk associated with past-week alcohol intake was 1.5 per 137.8 g; for past-24-hour alcohol intake, it was 1.5 per 24.5 g. Adjustment for baseline fasting plasma glucose and triglycerides did not change the results. Alcohol intake appears to be associated with risk of non-insulin-dependent diabetes mellitus in men.     

Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study

The single and combined effects of three healthy lifestyle behaviors-nonsmoking, being physically active, and having a high-quality diet-on survival were investigated among older people in the SENECA Study. This European longitudinal study started with baseline measurements in 1988-1989 and lasted until April 30, 1999. The study population consisted of 631 men and 650 women aged 70-75 years from Belgium, Denmark, Italy, The Netherlands, Portugal, Spain, and Switzerland. A lifestyle score was calculated by adding the scores of the lifestyle factors physical activity, dietary quality, and smoking habits. The single lifestyle factors and the lifestyle score were related to mortality. Even at ages 70-75 years, the unhealthy lifestyle behaviors smoking, having a low-quality diet, and being physically inactive were singly related to an increased mortality risk (hazard ratios ranged from 1.2 to 2.1). The risk of death was further increased for all combinations of two unhealthy lifestyle behaviors. Finally, men and women with all three unhealthy lifestyle behaviors had a three- to fourfold increase in mortality risk. These results underscore the importance of a healthy lifestyle, including multiple lifestyle factors, and the maintenance of it with advancing age.     

Home healthcare services in Taiwan: a nationwide study among the older population

Background  

Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan.     

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 2 years 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.     

Perceived discrimination and mortality in a population-based study of older adults

Objectives. We examined the relation of individual-level perceived discrimination to mortality in a biracial, population-based sample.Methods. Participants were 4154 older adults from the Chicago Health and Aging Project who underwent up to 2 interviews over 4.5 years. Perceived discrimination was measured at baseline, and vital status was obtained at each follow-up and verified through the National Death Index.Results. During follow-up, 1166 deaths occurred. Participants reporting more perceived discrimination had a higher relative risk of death (hazard ratio [HR]= 1.05; 95% confidence interval [CI]=1.01, 1.09). This association was independent of differences in negative affect or chronic illness and appeared to be stronger among Whites than among Blacks (Whites: HR=1.12; 95% CI=1.04, 1.20; Blacks: HR=1.03; 95% CI=0.99, 1.07). Secondary analyses revealed that the relation to mortality was related to discriminatory experiences of a more demeaning nature and that racial differences were no longer significant when the sample was restricted to respondents interviewed by someone of the same race.Conclusions. Perceived discrimination was associated with increased mortality risk in a general population of older adults. The results suggest that subjective experience of interpersonal mistreatment is toxic in old age. This study adds to a growing literature documenting discrimination as an important social determinant of health.There is growing interest in the health effects of perceived discrimination.1^,2 Although evidence has been mixed, several studies have demonstrated that discrimination is related to poor physical and mental health, including blood pressure,3^,4 breast cancer,5 self-rated health,4^,6^–8 psychological distress,7^–10 well-being10^,11 and depressive symptoms.8^,12 Several studies have reported no or conditional associations as well.13^–18 Inconsistency in results may be because, at least in part, of the variation in the measurement of discrimination, differences in study methodologies and populations, and the variety of outcomes that have been considered.1^,2 Overall, however, it appears that the results have been stronger for mental health than for physical health outcomes. Although the mechanisms are not clear, hypotheses include restricted access to socioeconomic resources, poor health behaviors, and stress responses.6^,19^–22Few studies have focused on well-established clinical outcomes, such as hypertension. Although some studies have reported that discrimination increases the risk for hypertension,23^,24 others have not found an association.13^,14 Discrimination has also been linked with subclinical cardiovascular disease, including carotid intima-media thickness25 and coronary artery calcification.26We examined perceived discrimination in relation to all-cause mortality for 2 reasons. First, this end point has rarely been considered in relation to discrimination.27^,28 Second, mortality serves as the common end point of many disease processes that affect adult populations. Because the negative health effects of discrimination are thought to be nonspecific—that is, they are not restricted to a particular disease process—this end point may be particularly suitable to capture much of the spectrum of adverse outcomes associated with this risk factor.Racism, racial discrimination, and perceived discrimination have been used interchangeably in the research literature. We focused on perceived discrimination, defined as the subjective experience of common forms of unfair treatment,10 and its relation to mortality in a population-based study of older Blacks and Whites. Because the weight of the current evidence shows that discrimination is associated with poorer health among minorities, we hypothesize that perceived discrimination is related to an increased risk for mortality and that this risk is stronger among Blacks than among Whites.     

Cause-specific mortality in a population-based study of diabetes.

BACKGROUND. Mortality from vascular diseases has been reported to be high in diabetic persons. METHODS. To evaluate mortality from these and other specific causes, we examined cause-specific age-sex standardized mortality ratios in a geographically defined population of younger onset (diagnosed before age 30 and taking insulin, n = 1200) and older onset (diagnosed after age 30, n = 1772) diabetic persons followed for 8.5 years. Cause of death was determined from death certificates. RESULTS. In younger onset persons, age-sex standardized mortality ratios were significantly high (P less than .05) for all causes of death (7.5) as well as for diabetes (191), all heart disease (9.1), ischemic heart disease (10.1), other heart disease (6.3), nephritis and nephrosis (41.2), accidents (2.9), and all other causes (3.2). In older onset persons, age-sex standardized mortality ratios were significantly high for all causes of death (2.0) as well as for diabetes (16.8), all heart disease (2.3), ischemic heart disease (2.3), other heart disease (2.1), stroke (2.0), and pneumonia and influenza (1.7). CONCLUSIONS. Diabetic persons experience very high mortality, especially from vascular diseases, compared to the general population.     

Lower utilization of cervical cancer screening by nurses in Taiwan: a nationwide population-based study

ObjectiveUsing a nationwide population-based database in Taiwan, this study compares use of Pap smear testing by nurses and the general population.MethodWe compared 1093 practicing female nurses and 5465 randomly selected female patients from the 2006 National Health Insurance (NHI) database to evaluate the likelihood of receiving at least one Pap smear during a three-year period.ResultsWe found that 48.9% of the nurses and 56.2% of comparison subjects received a Pap test from 2004 to 2006 in Taiwan. Regression analysis showed that practicing female nurses were less likely to receive a Pap smear compared with the general population (OR = 0.42, 95% CI = 0.35–0.50, p < 0.001), after adjusting for monthly incomes, number of ob/gyn ambulatory care visits, urbanization level and the geographic location of the communities where subjects resided.ConclusionNurses were less likely to undergo cervical screening than the general population, despite ease of access and a national health insurance system providing universal coverage to residents of Taiwan. Efforts to raise the Pap screening rate among nurses may require addressing unique cultural and occupational concerns.     

Association between metabolic syndrome and mortality in patients with COVID-19: A nationwide cohort study

ObjectivesWe investigated the association between metabolic syndrome (MetS) and mortality among coronavirus disease 2019 (COVID-19) patients in Korea.MethodsWe analyzed 3876 individuals aged ≥ 20 years who were confirmed with COVID-19 from January 1 to June 4, 2020 based on the Korea National Health Insurance Service (NHIS)-COVID-19 database and had undergone health examination by NHIS between 2015 and 2017. Multivariable Cox proportional hazard regression analyses were performed.ResultsOf total participants, the prevalence of MetS was 21.0% (n = 815). During 58.6 days of mean follow-up, 3.1 % (n = 120) of the participants died. Compared to individuals without MetS, COVID-19 patients with MetS had a significantly increased mortality risk after adjusting for confounders in total participants (hazard ratio [HR]: 1.68, 95 % confidence interval [CI]: 1.14–2.47) and women (HR: 2.41, 95 % CI: 1.17–4.96). A low high-density lipoprotein cholesterol level in total participants (HR: 1.63, 95 % CI: 1.12–2.37) and hyperglycemia in women (HR: 1.97, 95 % CI: 1.01–3.84) was associated with higher mortality risk. The mortality risk increased as the number of MetS components increased among total participants and women (P for trend = 0.009 and 0.016, respectively). In addition, MetS groups had higher mortality risk in aged ≥ 60 years (HR: 1.60, 95 % CI: 1.07–2.39), and never-smokers (2.08, 1.21–3.59).ConclusionsThe presence of MetS and greater number of its components were associated with increased mortality risks particularly in female patients with COVID-19. Managing MetS may contribute to better outcomes of COVID-19.